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Old 03-09-2013, 06:26 AM  
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Bitter Pill: Why Medical Bills are killing us

Read this article recently and did not see it discussed here. This appears to me to be an entire facet of health care problem that is not being discussed at all nationally. I found the pricing practices to be extremely disturbing.


Also saw this guy on the Daily Show. It's a long article, but worth the read IMO.



Bitter Pill: Why Medical Bills Are Killing Us

By Steven Brill
Feb. 20, 2013



1. Routine Care, Unforgettable Bills
When Sean Recchi, a 42-year-old from Lancaster, Ohio, was told last March that he had non-Hodgkin’s lymphoma, his wife Stephanie knew she had to get him to MD Anderson Cancer Center in Houston. Stephanie’s father had been treated there 10 years earlier, and she and her family credited the doctors and nurses at MD Anderson with extending his life by at least eight years.

Because Stephanie and her husband had recently started their own small technology business, they were unable to buy comprehensive health insurance. For $469 a month, or about 20% of their income, they had been able to get only a policy that covered just $2,000 per day of any hospital costs. “We don’t take that kind of discount insurance,” said the woman at MD Anderson when Stephanie called to make an appointment for Sean.

Stephanie was then told by a billing clerk that the estimated cost of Sean’s visit — just to be examined for six days so a treatment plan could be devised — would be $48,900, due in advance. Stephanie got her mother to write her a check. “You do anything you can in a situation like that,” she says. The Recchis flew to Houston, leaving Stephanie’s mother to care for their two teenage children.

About a week later, Stephanie had to ask her mother for $35,000 more so Sean could begin the treatment the doctors had decided was urgent. His condition had worsened rapidly since he had arrived in Houston. He was “sweating and shaking with chills and pains,” Stephanie recalls. “He had a large mass in his chest that was … growing. He was panicked.”

Nonetheless, Sean was held for about 90 minutes in a reception area, she says, because the hospital could not confirm that the check had cleared. Sean was allowed to see the doctor only after he advanced MD Anderson $7,500 from his credit card. The hospital says there was nothing unusual about how Sean was kept waiting. According to MD Anderson communications manager Julie Penne, “Asking for advance payment for services is a common, if unfortunate, situation that confronts hospitals all over the United States.”




Diagnosed with non-Hodgkin’s lymphoma at age 42. Total cost, in advance, for Sean’s treatment plan and initial doses of chemotherapy: $83,900. Charges for blood and lab tests amounted to more than $15,000; with Medicare, they would have cost a few hundred dollars

The total cost, in advance, for Sean to get his treatment plan and initial doses of chemotherapy was $83,900.

Why?

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.

Dozens of midpriced items were embedded with similarly aggressive markups, like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.

Every time a nurse drew blood, a “ROUTINE VENIPUNCTURE” charge of $36.00 appeared, accompanied by charges of $23 to $78 for each of a dozen or more lab analyses performed on the blood sample. In all, the charges for blood and other lab tests done on Recchi amounted to more than $15,000. Had Recchi been old enough for Medicare, MD Anderson would have been paid a few hundred dollars for all those tests. By law, Medicare’s payments approximate a hospital’s cost of providing a service, including overhead, equipment and salaries.

On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.

When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”

The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1

The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”

DePinho’s salary is nearly two and a half times the $750,000 paid to Francisco Cigarroa, the chancellor of entire University of Texas system, of which MD Anderson is a part. This pay structure is emblematic of American medical economics and is reflected on campuses across the U.S., where the president of a hospital or hospital system associated with a university — whether it’s Texas, Stanford, Duke or Yale — is invariably paid much more than the person in charge of the university.

I got the idea for this article when I was visiting Rice University last year. As I was leaving the campus, which is just outside the central business district of Houston, I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name. Medicine had obviously become a huge business. In fact, of Houston’s top 10 employers, five are hospitals, including MD Anderson with 19,000 employees; three, led by ExxonMobil with 14,000 employees, are energy companies. How did that happen, I wondered. Where’s all that money coming from? And where is it going? I have spent the past seven months trying to find out by analyzing a variety of bills from hospitals like MD Anderson, doctors, drug companies and every other player in the American health care ecosystem.

When you look behind the bills that Sean Recchi and other patients receive, you see nothing rational — no rhyme or reason — about the costs they faced in a marketplace they enter through no choice of their own. The only constant is the sticker shock for the patients who are asked to pay.



Gauze Pads: $77
Charge for each of four boxes of sterile gauze pads, as itemized in a $348,000 bill following a patient’s diagnosis of lung cancer


Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

What are the reasons, good or bad, that cancer means a half-million- or million-dollar tab? Why should a trip to the emergency room for chest pains that turn out to be indigestion bring a bill that can exceed the cost of a semester of college? What makes a single dose of even the most wonderful wonder drug cost thousands of dollars? Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?

Recchi’s bill and six others examined line by line for this article offer a closeup window into what happens when powerless buyers — whether they are people like Recchi or big health-insurance companies — meet sellers in what is the ultimate seller’s market.

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives. And in our largest cities, the system offers lavish paychecks even to midlevel hospital managers, like the 14 administrators at New York City’s Memorial Sloan-Kettering Cancer Center who are paid over $500,000 a year, including six who make over $1 million.

Taken as a whole, these powerful institutions and the bills they churn out dominate the nation’s economy and put demands on taxpayers to a degree unequaled anywhere else on earth. In the U.S., people spend almost 20% of the gross domestic product on health care, compared with about half that in most developed countries. Yet in every measurable way, the results our health care system produces are no better and often worse than the outcomes in those countries.

According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart.

The Bureau of Labor Statistics projects that 10 of the 20 occupations that will grow the fastest in the U.S. by 2020 are related to health care. America’s largest city may be commonly thought of as the world’s financial-services capital, but of New York’s 18 largest private employers, eight are hospitals and four are banks. Employing all those people in the cause of curing the sick is, of course, not anything to be ashamed of. But the drag on our overall economy that comes with taxpayers, employers and consumers spending so much more than is spent in any other country for the same product is unsustainable. Health care is eating away at our economy and our treasury.

The health care industry seems to have the will and the means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

When you crunch data compiled by McKinsey and other researchers, the big picture looks like this: We’re likely to spend $2.8 trillion this year on health care. That $2.8 trillion is likely to be $750 billion, or 27%, more than we would spend if we spent the same per capita as other developed countries, even after adjusting for the relatively high per capita income in the U.S. vs. those other countries. Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit. The other $2 trillion will be paid mostly by private health-insurance companies and individuals who have no insurance or who will pay some portion of the bills covered by their insurance. This is what’s increasingly burdening businesses that pay for their employees’ health insurance and forcing individuals to pay so much in out-of-pocket expenses.

Rest of article (LONG)

http://healthland.time.com/2013/02/2...re-killing-us/
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Old 04-05-2013, 08:28 PM   #61
'Hamas' Jenkins 'Hamas' Jenkins is offline
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Originally Posted by BigRedChief View Post
Thats BS. Where there are limits on medical judgements have no cheaper insurance than those who don't have limits.

$13 aspirin's are a by product of the free health care of the uninsured walking in through the ER and getting unlimited free health care. If everyone has health insurance, those billable costs will go down.
That's a gross oversimplification of the issue. That plays a very real part in the equation, but by no means is it all of it.

  • Administrative costs are comparatively ridiculous between large employer plans and small plans or individuals. Furthermore, administrative overhead is far greater in this country than in countries with a single payer system.
  • Medical bills are the largest cause of bankruptcy in this country. Of those who file for bankruptcy due to such bills, two-thirds have insurance.
  • Those who use the ER or hospital as a free clinic pass on inflated charges to those with means to pay, but even then insurance companies negotiate set costs for procedures and medications w/ hospitals. Those prices are always just written off unless a cash patient comes in. They'll almost always negotiate a cash discount, however.
The fact of the matter is that our median quality of health care is the worst value of any industrialized nation. The upper echelon of care is the best due to the facilities and physicians here, but that level of care is inaccessible to the vast majority of the populace.


However, like everything, people want to reduce a complex issue down to a three second soundbyte. It's far easier to blame malpractice judgments, illegal immigrants, or the doctor themselves than the entirety of the system which is arcane and inefficient.
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Old 04-06-2013, 06:18 AM   #62
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Originally Posted by 'Hamas' Jenkins View Post
That's a gross oversimplification of the issue. That plays a very real part in the equation, but by no means is it all of it.

  • Administrative costs are comparatively ridiculous between large employer plans and small plans or individuals. Furthermore, administrative overhead is far greater in this country than in countries with a single payer system.
  • Medical bills are the largest cause of bankruptcy in this country. Of those who file for bankruptcy due to such bills, two-thirds have insurance.
  • Those who use the ER or hospital as a free clinic pass on inflated charges to those with means to pay, but even then insurance companies negotiate set costs for procedures and medications w/ hospitals. Those prices are always just written off unless a cash patient comes in. They'll almost always negotiate a cash discount, however.
The fact of the matter is that our median quality of health care is the worst value of any industrialized nation. The upper echelon of care is the best due to the facilities and physicians here, but that level of care is inaccessible to the vast majority of the populace.


However, like everything, people want to reduce a complex issue down to a three second soundbyte. It's far easier to blame malpractice judgments, illegal immigrants, or the doctor themselves than the entirety of the system which is arcane and inefficient.
I was not trying to say only "this" reason is why health care costs way too much. I was just pointing out that lawsuits and the increase in malpractice insurance premiums is not a major contributing factor when compared to what the uninsured cost the system.

There is not one cause or one solution, no magic solution.

Obamacare fixes #1. I got a $300+ check from my insurance company because they spent too much money on administrative expenses.

Obamacare fixes #2. It will be illegal to limit the amount of care you can recieve in a year. You get colon cancer or have a kid that needs a hole in its heart repaired.......... no problem, you will get the care that you need.
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Old 04-06-2013, 08:14 AM   #63
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http://epianalysis.wordpress.com/201...sversuseurope/


U.S. versus European healthcare costs: the data




"do we pay higher prices for the same care? Among prescription drug costs, we pay far more than any other country, at least 20% more than Canada and over 60% more than New Zealand. For the same MRI’s and CT scans, we also pay more: $1,080 is the commercial average cost for an MRI in the U.S. as compared to $599 in Germany; at CT of the head costs $510 on average in the U.S. versus $272 in Germany. For a hip replacement, we again pay the most: $1,634 among public payers and $3,996 among private payers, versus $1,046 and $1,943 respectively in Australia. And physicians’ incomes are the highest: $187,000 on average among primary care doctors in the U.S. versus $93,000 in Australia; and $442,000 among orthopedic surgeons in the U.S. versus $154,000 in France."

Do we get more in return?

The results of this hefty spending on the same drugs and (perhaps better) doctors doesn’t seem to clearly correlate into better outcomes. Mortality rates in U.S. hospitals after admission for a heart attack, for example, are just average—at 4.3% as compared to just 2.3% in Denmark. Similarly depressing results are available for respiratory diseases, cancers, and surgical or medical mistakes. And overall we have the highest rate of death that would be amenable to healthcare intervention (deaths among people less than 75 years old that are from heart attacks, strokes, diabetes and bacterial infections); the U.S. has 96 such deaths per 100,000 people as compared to France’s 55 deaths."

---

Even Mitt Romney knew our free market Healthcare was a sham:

"When our health care costs are completely out of control. Do you realize what health care spending is as a percentage of the GDP in Israel? 8 percent. You spend 8 percent of GDP on health care. And you’re a pretty healthy nation. We spend 18 percent of our GDP on health care. 10 percentage points more. That gap, that 10 percent cost, let me compare that with the size of our military. Our military budget is 4 percent. Our gap with Israel is 10 points of GDP. We have to find ways, not just to provide health care to more people, but to find ways to finally manage our health care costs.

Romney’s point about Israel’s success in controlling health care costs is spot on: Its health care system has seen health care costs grow much slower than other industrialized nations.
How it has gotten there, however, may not be to the Republican candidate’s liking: Israel regulates its health care system aggressively, requiring all residents to carry insurance and capping revenue for various parts of the country’s health care system.

Israel created a national health care system in 1995, largely funded through payroll and general tax revenue. The government provides all citizens with health insurance: They get to pick from one of four competing, nonprofit plans. Those insurance plans have to accept all customers—including people with pre-existing conditions—and provide residents with a broad set of government-mandated benefits."

http://www.washingtonpost.com/blogs/...en-down-costs/
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Old 04-06-2013, 08:19 AM   #64
chiefzilla1501 chiefzilla1501 is offline
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Originally Posted by 'Hamas' Jenkins View Post
That's a gross oversimplification of the issue. That plays a very real part in the equation, but by no means is it all of it.

  • Administrative costs are comparatively ridiculous between large employer plans and small plans or individuals. Furthermore, administrative overhead is far greater in this country than in countries with a single payer system.
  • Medical bills are the largest cause of bankruptcy in this country. Of those who file for bankruptcy due to such bills, two-thirds have insurance.
  • Those who use the ER or hospital as a free clinic pass on inflated charges to those with means to pay, but even then insurance companies negotiate set costs for procedures and medications w/ hospitals. Those prices are always just written off unless a cash patient comes in. They'll almost always negotiate a cash discount, however.
The fact of the matter is that our median quality of health care is the worst value of any industrialized nation. The upper echelon of care is the best due to the facilities and physicians here, but that level of care is inaccessible to the vast majority of the populace.


However, like everything, people want to reduce a complex issue down to a three second soundbyte. It's far easier to blame malpractice judgments, illegal immigrants, or the doctor themselves than the entirety of the system which is arcane and inefficient.
Well yeah, from the standpoint that anyone who thinks malpractice reform, insuring everybody, and creating some system for providing care to illegal immigrants isn't going to solve everything, much as people think it would.

Malpractice judgments matter moreso because that, plus an encyclopedia of administrative rules, in addition to hospital incentives that are often not outcome-based, doctors often resort to overly cautious care or care they know is wrong but is advised because it "follows the rules." While you have to have safeguards in place to punish doctors who abuse the system, I am willing to bet that if you let doctors be doctors, that right there trims out a ton of unnecessary patient visits, unnecessary cautious procedures, and pricing of services would be a whole lot easier because there isn't a confusing payback system on the back-end.

I've also said before, while the system needs fixing, so do the people within the system. As long as we shrug our shoulders at diabetes and obesity, of course our health care costs will go up and the quality of care we receive will go up as well. Imagine how much our homeowners insurance premium would go up if your area was repeatedly wrecked by a tornado. Same applies here. Pretty simple concept --when insurance companies pay out less, they have more flexibility to cover more for everyone or pass on premium discounts.
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Old 04-06-2013, 08:20 AM   #65
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If you want to change your situation, you may try something other than getting stoned and bitching on the internet.

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Old 04-06-2013, 08:23 AM   #66
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Originally Posted by Loneiguana View Post
?

http://epianalysis.wordpress.com/201...sversuseurope/


U.S. versus European healthcare costs: the data




"do we pay higher prices for the same care? Among prescription drug costs, we pay far more than any other country, at least 20% more than Canada and over 60% more than New Zealand. For the same MRI’s and CT scans, we also pay more: $1,080 is the commercial average cost for an MRI in the U.S. as compared to $599 in Germany; at CT of the head costs $510 on average in the U.S. versus $272 in Germany. For a hip replacement, we again pay the most: $1,634 among public payers and $3,996 among private payers, versus $1,046 and $1,943 respectively in Australia. And physicians’ incomes are the highest: $187,000 on average among primary care doctors in the U.S. versus $93,000 in Australia; and $442,000 among orthopedic surgeons in the U.S. versus $154,000 in France."

Do we get more in return?

The results of this hefty spending on the same drugs and (perhaps better) doctors doesn’t seem to clearly correlate into better outcomes. Mortality rates in U.S. hospitals after admission for a heart attack, for example, are just average—at 4.3% as compared to just 2.3% in Denmark. Similarly depressing results are available for respiratory diseases, cancers, and surgical or medical mistakes. And overall we have the highest rate of death that would be amenable to healthcare intervention (deaths among people less than 75 years old that are from heart attacks, strokes, diabetes and bacterial infections); the U.S. has 96 such deaths per 100,000 people as compared to France’s 55 deaths."

---

Even Mitt Romney knew our free market Healthcare was a sham:

"When our health care costs are completely out of control. Do you realize what health care spending is as a percentage of the GDP in Israel? 8 percent. You spend 8 percent of GDP on health care. And you’re a pretty healthy nation. We spend 18 percent of our GDP on health care. 10 percentage points more. That gap, that 10 percent cost, let me compare that with the size of our military. Our military budget is 4 percent. Our gap with Israel is 10 points of GDP. We have to find ways, not just to provide health care to more people, but to find ways to finally manage our health care costs.

Romney’s point about Israel’s success in controlling health care costs is spot on: Its health care system has seen health care costs grow much slower than other industrialized nations.
How it has gotten there, however, may not be to the Republican candidate’s liking: Israel regulates its health care system aggressively, requiring all residents to carry insurance and capping revenue for various parts of the country’s health care system.

Israel created a national health care system in 1995, largely funded through payroll and general tax revenue. The government provides all citizens with health insurance: They get to pick from one of four competing, nonprofit plans. Those insurance plans have to accept all customers—including people with pre-existing conditions—and provide residents with a broad set of government-mandated benefits."

http://www.washingtonpost.com/blogs/...en-down-costs/
We all know our health care costs are out of control. I completely reject the idea that this is because it isn't regulated enough or because doctors are getting paid too much. Holy hell.
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Old 04-06-2013, 08:56 AM   #67
Loneiguana Loneiguana is offline
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Originally Posted by chiefzilla1501 View Post
We all know our health care costs are out of control. I completely reject the idea that this is because it isn't regulated enough or because doctors are getting paid too much. Holy hell.
From the article:


"Where is all this money going?

As David Squires of the Commonwealth Fund has explained, there have been at least five dominant theories: (1) that the U.S. is wealthier so we just pay more in our economy; (2) that we have an older and sicker population; (3) that we utilize more healthcare (e.g., go to doctors, hospitals and emergency rooms more); (4) that the costs comes from our use of more technology; or (5) that we charge higher prices for the same goods and services.

Let’s test each of these theories against the data.

Does higher income necessarily result in greater healthcare spending? Actually, the U.S. seems to be an outlier from the overall curve between GDP and healthcare spending per capita. While most countries do spend more when they have more money, the U.S. disproportionately spends more, by about $3,000 per head.



Do we simply have an older and sicker population? Actually, the proportion of the population older than age 65 is 13% in America (see graph below), which is lower than the OECD median of 16% and much lower than Japan’s 23%. Also, our population does not necessarily seem to be more ill. Among key healthcare risk factors such as smoking, Americans actually do better in most cases. Only 16% of Americans smoke, as compared to the OECD median of 22% and the 28% rate in The Netherlands. Similar trends exist for alcohol use and related healthcare risk factors. The one exception to this rule is our obesity rate, which is at a whopping 34% among adults, though this does not seem to sufficiently explain the overall heavier health expenditures (sorry for the pun).



Do we simply use a lot more healthcare? The average number of physician visits per person in the U.S. is 4, below the OECD median of 6.4, and far below Japan’s 13 visits per person. Similarly, we have fewer hospital discharges at 131 per 1,000 people versus the OECD median of 160 and France’s 263 per 1,000. The average hospital stay per person is also lower in the U.S., at 5.4 days versus the OECD median of 5.9 days and Canada’s average of over one week.



So do we simply use more expensive technologies? Are doctors murdering our pocketbooks with their tests? In fact, Americans get less MRI scans per person than Japan, and have fewer hip and knee replacements and cardiac catheterizations than many European countries. The distribution of our spending among various sectors—basic medical care, diagnostics, hospitals, pharmaceuticals, and nursing homes—is not actually very different from European countries (we actually spend far less of our healthcare expenditures on nursing homes, at only 6.2% as compared to 20% in Switzerland, and slightly more than European countries on basic care). The highest cost technologies don’t seem to be disproportionately used by us.

This leaves the last theory: do we pay higher prices for the same care? Among prescription drug costs, we pay far more than any other country, at least 20% more than Canada and over 60% more than New Zealand. For the same MRI’s and CT scans, we also pay more: $1,080 is the commercial average cost for an MRI in the U.S. as compared to $599 in Germany; at CT of the head costs $510 on average in the U.S. versus $272 in Germany. For a hip replacement, we again pay the most: $1,634 among public payers and $3,996 among private payers, versus $1,046 and $1,943 respectively in Australia. And physicians’ incomes are the highest: $187,000 on average among primary care doctors in the U.S. versus $93,000 in Australia; and $442,000 among orthopedic surgeons in the U.S. versus $154,000 in France.



So overall, our spending is out of proportion to our income, our population is younger than most of Europe, and we have fewer hospital stays with only typical technology use. This leaves us with the theory that higher drug and imaging prices, along with higher physicians’ fees and income are driving our healthcare costs."

Feel free to dispute any of those findings with your own.

And:
"The most obvious conclusion from this analysis is that a single-payer health system can contain costs and streamline clinical management protocols to avoid the unnecessary testing and procedures of private fee-for-service systems like the U.S. system, as well as incentivizing prevention. Nearly every other country in the analysis had a 100% government-based health insurance system, except for Germany at 89.5% (the U.S. has just 27.4% of the population covered through public-sector programs). As the single payer, the government needs to prevent disease to maintain a budget, rather than having the incentive of making money from managing a disease (doing procedures, ordering tests) but not preventing it, as in the fee-for-service private U.S. model. It can also bulk-purchase goods and supplies and help equalize salaries between current public sector rates and private sector networks that feed off of mutual referral systems and inflated pricing."
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Old 04-06-2013, 09:57 AM   #68
chiefzilla1501 chiefzilla1501 is offline
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Originally Posted by Loneiguana View Post
From the article:


"Where is all this money going?

As David Squires of the Commonwealth Fund has explained, there have been at least five dominant theories: (1) that the U.S. is wealthier so we just pay more in our economy; (2) that we have an older and sicker population; (3) that we utilize more healthcare (e.g., go to doctors, hospitals and emergency rooms more); (4) that the costs comes from our use of more technology; or (5) that we charge higher prices for the same goods and services.
Those are good theories, but the important thing is what those things mean.

Quote:
Let’s test each of these theories against the data.

Does higher income necessarily result in greater healthcare spending? Actually, the U.S. seems to be an outlier from the overall curve between GDP and healthcare spending per capita. While most countries do spend more when they have more money, the U.S. disproportionately spends more, by about $3,000 per head.
Which we all know. We know our health care system is cost-inefficient.

Quote:
Do we simply have an older and sicker population? Actually, the proportion of the population older than age 65 is 13% in America (see graph below), which is lower than the OECD median of 16% and much lower than Japan’s 23%. Also, our population does not necessarily seem to be more ill. Among key healthcare risk factors such as smoking, Americans actually do better in most cases. Only 16% of Americans smoke, as compared to the OECD median of 22% and the 28% rate in The Netherlands. Similar trends exist for alcohol use and related healthcare risk factors. The one exception to this rule is our obesity rate, which is at a whopping 34% among adults, though this does not seem to sufficiently explain the overall heavier health expenditures (sorry for the pun).
This is a poor argument that you claim we are not ill because we don't smoke and drink, but by the way, we are disgustingly obese. Obesity translates into over $700B in direct and indirect costs. It increases rate of heart disease, diabetes, and a whole host of other medical conditions.


Quote:
Do we simply use a lot more healthcare? The average number of physician visits per person in the U.S. is 4, below the OECD median of 6.4, and far below Japan’s 13 visits per person. Similarly, we have fewer hospital discharges at 131 per 1,000 people versus the OECD median of 160 and France’s 263 per 1,000. The average hospital stay per person is also lower in the U.S., at 5.4 days versus the OECD median of 5.9 days and Canada’s average of over one week.
You are talking about a system where we are encouraging a flood of new doctor/patient visits and procedures, while supply of doctors to provide the service is becoming alarmingly thin. Who will take care of these people?

Doctors go through 10 years of hell to train to become a doctor. They incur a shitload of debt. What's the point if their salaries are going to get reduced and their authority is getting slashed? The trends show that doctors are working significantly less hours, and I can bet you that as government becomes more involved in health care, you'll see a dramatic increase in doctor retirements.

Quote:
So do we simply use more expensive technologies? Are doctors murdering our pocketbooks with their tests? In fact, Americans get less MRI scans per person than Japan, and have fewer hip and knee replacements and cardiac catheterizations than many European countries. The distribution of our spending among various sectors—basic medical care, diagnostics, hospitals, pharmaceuticals, and nursing homes—is not actually very different from European countries (we actually spend far less of our healthcare expenditures on nursing homes, at only 6.2% as compared to 20% in Switzerland, and slightly more than European countries on basic care). The highest cost technologies don’t seem to be disproportionately used by us.
Actually, the US has been a marvel and runaway leader in terms of medical technology and devices. That tide is shifting as government/private insurers dictate technology needs based on what they will cover, instead of talking with doctors who provide the care. That trend will continue to shift as long as you have government trying to dictate how doctors should do their own jobs. And as long as this continues to happen, good technology becomes more expensive because of basic supply & demand. We have the best medical technology in the world and we are absolutely neutering the shit out of it.

Quote:
This leaves the last theory: do we pay higher prices for the same care? Among prescription drug costs, we pay far more than any other country, at least 20% more than Canada and over 60% more than New Zealand. For the same MRI’s and CT scans, we also pay more: $1,080 is the commercial average cost for an MRI in the U.S. as compared to $599 in Germany; at CT of the head costs $510 on average in the U.S. versus $272 in Germany. For a hip replacement, we again pay the most: $1,634 among public payers and $3,996 among private payers, versus $1,046 and $1,943 respectively in Australia. And physicians’ incomes are the highest: $187,000 on average among primary care doctors in the U.S. versus $93,000 in Australia; and $442,000 among orthopedic surgeons in the U.S. versus $154,000 in France.
Again, we know that there are cost problems. That's not rocket science. But the idea that this is all because we don't have single-payer health care is phooey. It's like looking at a Yugo and claiming that the only reason the car sucks is because it needs better brakes.

Quote:
So overall, our spending is out of proportion to our income, our population is younger than most of Europe, and we have fewer hospital stays with only typical technology use. This leaves us with the theory that higher drug and imaging prices, along with higher physicians’ fees and income are driving our healthcare costs."Feel free to dispute any of those findings with your own.

And:
"The most obvious conclusion from this analysis is that a single-payer health system can contain costs and streamline clinical management protocols to avoid the unnecessary testing and procedures of private fee-for-service systems like the U.S. system, as well as incentivizing prevention. Nearly every other country in the analysis had a 100% government-based health insurance system, except for Germany at 89.5% (the U.S. has just 27.4% of the population covered through public-sector programs). As the single payer, the government needs to prevent disease to maintain a budget, rather than having the incentive of making money from managing a disease (doing procedures, ordering tests) but not preventing it, as in the fee-for-service private U.S. model. It can also bulk-purchase goods and supplies and help equalize salaries between current public sector rates and private sector networks that feed off of mutual referral systems and inflated pricing."
That's the conclusion? That not having a single-payer system is the only problem with health care in America? And that a government-run program should somehow be the model of effectiveness and efficiency? That's a pretty pie-in-the-sky scenario. What I see is a government with a history of massive inefficiencies running our programs and taking on an enormous amount of responsibility (and with size, always comes massively more inefficiencies), more control being taken away from doctors and innovators and more power to the administrators, health care decisions often becoming politically charged vs. the right thing to do.

Meanwhile... if we don't go into the ridiculous "one size fits all" solution, we'd recognize that quality of care improves when doctors and innovators have authority to do what's best for the patient vs. being forced to provide cautionary care or conducting procedures they do not agree with in order to comply with administrators or to avoid lawsuit. We'd realize that the government CAN play an active role in health care, but in the form of encouraging prevention and health education, NOT in dictating actual medical care. That you can streamline medical administration through universal processes and procedures and pricing, and more importantly, massive improvements in the technology to enable those things.

I'd rather we try to do those things, which matter regardless of it's single payer or not, see if that fixes the problem before we go and suggest that single payer is some kind of cure-all. It's not. Your view of that system is based on a Candyland world where there aren't enormous costs and quality deficiencies that come with government running a massive health care program.
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Old 04-06-2013, 10:47 AM   #69
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Originally Posted by Loneiguana View Post
?

http://epianalysis.wordpress.com/201...sversuseurope/


U.S. versus European healthcare costs: the data
What point are you making here? That the US health care system is broken? I'm pretty sure everyone on both sides of the aisle already agree with that.
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Old 04-06-2013, 10:57 AM   #70
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What point are you making here? That the US health care system is broken? I'm pretty sure everyone on both sides of the aisle already agree with that.
I think he's claiming that the US health care system is broken and that single-payer system is some kind of cure-all that fixes everything.
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Old 04-06-2013, 03:24 PM   #71
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This guy does as good a job as anyone explaining why Obamacare doesn't work (it does nothing to control increasing costs).

"Healthcare is not a marketplace" on the Charlie Rose vid
Obamacare was written in large part by the healthcare and insurance industries. How much change can be expected from that?
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Old 04-06-2013, 05:04 PM   #72
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How I lost my fear of Universal Health Care

http://www.patheos.com/blogs/permiss...alth-care.html

What price does one place on treating a loved one? At what price does one say, no that is too high, I will not seek a Heart Attack treatment? Can the market set the price on a commodity where cost may make little difference? are you free do this in our current system under insurance companies, now, because of cost, are almost mandatory?

Taking Healthcare out of the hands of insurance companies (a socialized system of healthcare, only in the hands of corporations) would reduce risk in new business, free up capital for investment, remove a huge financial burden from the backs of employers and employees, therefore stimulating the economy.

Last edited by Loneiguana; 04-07-2013 at 06:13 AM..
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Old 04-06-2013, 06:43 PM   #73
Bump Bump is offline
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For ****s sake would you please shut the **** up about how everything is about rich vs. poor. Every ****ing thread it's the same ****ing bullshit whining. Either accept the state your life is in or work hard to change it.
Put me on ignore if it butthurts you so much. Everything is rich vs poor in this country. The rich have a separate healthcare, education and legal system and yes, I'm gonna bitch about it. We live in a Plutocracy and it's not really the lifestyle for me. I'm not a good american because I think for myself and just don't really buy into this Plutocracy that's disguised as democracy with this bullshit 2 party system that's all an illusion of free choice. It's not even about my life, it's about 90% of the population in this country that are deemed as replaceable, worthless, money generating idiots.

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Old 04-07-2013, 06:21 AM   #74
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Originally Posted by chiefzilla1501 View Post


That's the conclusion? That not having a single-payer system is the only problem with health care in America? And that a government-run program should somehow be the model of effectiveness and efficiency? That's a pretty pie-in-the-sky scenario. What I see is a government with a history of massive inefficiencies running our programs and taking on an enormous amount of responsibility (and with size, always comes massively more inefficiencies), more control being taken away from doctors and innovators and more power to the administrators, health care decisions often becoming politically charged vs. the right thing to do.

Meanwhile... if we don't go into the ridiculous "one size fits all" solution, we'd recognize that quality of care improves when doctors and innovators have authority to do what's best for the patient vs. being forced to provide cautionary care or conducting procedures they do not agree with in order to comply with administrators or to avoid lawsuit. We'd realize that the government CAN play an active role in health care, but in the form of encouraging prevention and health education, NOT in dictating actual medical care. That you can streamline medical administration through universal processes and procedures and pricing, and more importantly, massive improvements in the technology to enable those things.

I'd rather we try to do those things, which matter regardless of it's single payer or not, see if that fixes the problem before we go and suggest that single payer is some kind of cure-all. It's not. Your view of that system is based on a Candyland world where there aren't enormous costs and quality deficiencies that come with government running a massive health care program.

Are you aware that all these things are currently done under our American model, only they are done by Executives of Insurance companies? That administrators of Insurances companies of dictating medical care. And those decisions are based off of profit, without at all regard for the patient.

What you are scared of, is already happening now.

Republican Congressman Tim Murphy (PA) — agreed:
MURPHY: Yeah and that brings up the point here that with regard to one of our big frustrations with insurance companies is they control the market place, they control what’s done, a lot of times doctors not making the decisions here. And you recognize the frustration.

http://thinkprogress.org/politics/20...lth-insurance/

/God forbid we copy the working results of every other developed Country in the world who systems are providing better care at lower cost
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Old 04-07-2013, 06:34 AM   #75
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Originally Posted by Loneiguana View Post
Are you aware that all these things are currently done under our American model, only they are done by Executives of Insurance companies? That administrators of Insurances companies of dictating medical care. And those decisions are based off of profit, without at all regard for the patient.

What you are scared of, is already happening now.

Republican Congressman Tim Murphy (PA) — agreed:
MURPHY: Yeah and that brings up the point here that with regard to one of our big frustrations with insurance companies is they control the market place, they control what’s done, a lot of times doctors not making the decisions here. And you recognize the frustration.

http://thinkprogress.org/politics/20...lth-insurance/

/God forbid we copy the working results of every other developed Country in the world who systems are providing better care at lower cost
Yes, I am aware. which is why I again ask why you think this system needs to be overhauled versus trying to reform the system to get insurance companies to play by better rules. Or why you think it would become more efficient for a government notorious for inefficiency even within a smaller slice that is Medicare to suddenly become a monopsony. Or that with that much of a gargantuan program, that a massive government program won't be subject to similar abuses by crooked politicians who use special interests or political gamesmanship to fuel health care decisions vs. doing what's right.
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