What Drives High US Healthcare Costs? Price or Utilization?

[Midpack]

Quote:

Originally Posted by haha This is an interesting theory but quite obviously falsified by a quick look at the evidence. All European health systems have lower costs than the US system. All European countries separate the payer from the user of health services. No European countries have worse health than the US. Q.E.D. Ha

Except costs for every procedure, hospital costs, even Doctors pay in developed countries with universal care are set/regulated by their governments down to the greatest detail, Great Britain, Germany, Switzerland, Japan & Taiwan for example - not comparable to the US. And our administrative costs are 2 to 3 times greater than theirs (about 6% for Taiwan vs 15-16% for the US). See the Sick Around the World link above, it's compelling...

[kumquat]

As an outsider from the land of socialized medicine, looking in, I've always blamed your legal system:

• baby isn't perfect, sue the OBG
• grampa dies of heart attack, sue the hospital ER
• broken arm heals funny, sue the guy who set it

One reason I think this is that about 1980, an oncologist friend moved from here in the the unexplored hinterlands to Miami. He told me his US malpractice insurance premium would be higher than his gross (from a public clinic) here. His comment, "and my patients are expected to die".

Are there any stats on legal actions against doctors, US vs. other countries? They might be interesting.

[Gone4Good]

Quote:

Originally Posted by haha This is an interesting theory but quite obviously falsified by a quick look at the evidence. All European health systems have lower costs than the US system. All European countries separate the payer from the user of health services. No European countries have worse health than the US. Q.E.D. Ha

Yes, except all European health systems use some form of price controls and / or rationing that isn't present in our system. So you're kind of comparing apples and oranges.

BTW, I'm not arguing that one system is better or worse, just offering an observation as to why prices in the U.S. are higher than elsewhere. One way or another you have to equilibrate supply and demand. A free market with transparent pricing and adequate competition is one way. Price controls and rationing is another. But what we have in the U.S. is a free market without transparent pricing. I don't think a market can work that way.

[Gone4Good]

Quote:

Originally Posted by haha No European countries have worse health than the US.

Has anyone seen a study that tries to adjust for lifestyle differences in these health comparisons? I'm guessing American's carry around an extra 30 lbs of belly fat on average versus their European counterparts.

So how much of the health disparity is due to the fact that our health care system blows and how much is do to the fact that we are fat and lazy?

[haha]

Quote:

Originally Posted by . . . Yrs to Go Has anyone seen a study that tries to adjust for lifestyle differences in these health comparisons? I'm guessing American's carry around an extra 30 lbs of belly fat on average versus their European counterparts. So how much of the health disparity is due to the fact that our health care system blows and how much is do to the fact that we are fat and lazy?

Americans have more gym memberships than any other people. Americans smoke less than most other countries. I know we are not lazy; fat I don't know. Where I live I see darn few fat people but I read that there are a lot of them around.

Ha

[rjsciurus]

Here's a data point for you: I got a 6-month prescription last year, the first ever. My Doctor named a well-known, widely used drug. Mistakenly thinking I had no prescription coverage (I never use it!), I asked about cheaper alternatives. Visibly surprised, she immediately changed to a generic that was, from my limited research later, essentially equivalent. A quick check of online drug advertisements indicated I was paying per month what the name brand would have cost per day. Round down to 20x if you'd like.

[dex]

Quote:

Originally Posted by haha Americans have more gym memberships than any other people. Americans smoke less than most other countries. I know we are not lazy; fat I don't know. Where I live I see darn few fat people but I read that there are a lot of them around. Ha

World's Fattest Countries - Forbes.com
The U.S. weighs in at No. 9, with 74.1% of those over 15 years old considered overweight. But given that its population is nearly 20,000 times that of Nauru, clearly the U.S.’s size belies it rank.
++++
They are out there. I think a lot depends upon where you live if you see them

[rjsciurus]

Quote:

Originally Posted by Frugality_of_Apathy If the insurance company can get the cost of the hospital visit at $2,000 why does average joe off the street have to pay $10,000?

They charge that because they can, obviously. It's often impractical or impossible (if you're ill or disabled), difficult (ever tried to fully decipher a complex medical bill afterwards? Now imagine beforehand.), and socially unacceptable to bargain for health care as an individual. This is a good example of a reasonable and beneficial regulatory role of government in modern society. US society is way behind the times, although some people are obviously making a lot of money off it.

[Gone4Good]

Quote:

Originally Posted by haha Americans have more gym memberships than any other people. Americans smoke less than most other countries. I know we are not lazy; fat I don't know. Where I live I see darn few fat people but I read that there are a lot of them around. Ha

In any obesity study I can recall, the US always seems to rank near the top (most obese). And while we may have more gym memberships than any other people, how many actually use them regularly? On the other hand, whenever I travel overseas I tend to see a lot of people out walking and riding bicycles. Most U.S. cities and suburbs are set up in a way that actually discourages such activities. I think for some folks a long walk is defined as not being able to find a closer spot in the parking lot. Meanwhile, here is a picture I took of a parking lot in Amsterdam.

I'm making gross generalization, of course.

[Gone4Good]

Quote:

Originally Posted by rjsciurus It's often impractical or impossible (if you're ill or disabled), difficult (ever tried to fully decipher a complex medical bill afterwards? Now imagine beforehand.), and socially unacceptable to bargain for health care as an individual.

I've tried to ask the question "how much is this going to cost" before receiving care and rarely have I ever even been given an estimate. Even for things that are completely discretionary that I might choose not to do if they cost too much.

[Jay_Gatsby]

Quote:

Originally Posted by haha Americans have more gym memberships than any other people. Americans smoke less than most other countries. I know we are not lazy; fat I don't know. Where I live I see darn few fat people but I read that there are a lot of them around. Ha

I'm a firm believer in preventative medicine. The best preventative medicines on the planet are exercise and a healthy diet. If more Americans did both, our health care costs would plummet dramatically. Unfortunately, we're "married" to our cars and our fast food.

There are many times that I've considered relocating to parts of the U.S. where people are more prone to exercise and eat right (e.g., Boulder, Colorado). Unfortunately, I wouldn't be as highly-compensated in such places. Perhaps DW and I will relocate once we ER.

[Patsweb]

I believe that the hospitals and drs. pass on the costs incurred by the non-insured onto the ones who can pay or who have insurance. Also, from what I have read, administrative costs of insurance and billing (probably CEO's jets and salaries,too) make up a high percentage of what we pay. Not to mention what the industry is paying members of our Congress. See this link Consumer Watchdog - Health Insurers & Drug Companies Contributed $5.5 Million to Top 10 Senate and House Recipients Since 2005 and see if this doesn't anger you.
This seems like a good case for healthcare reform, particulary in favor of a single payer system where everyone will have affordable, health insurance; however, I can't help but wonder if it is at all possible when the members of Congress who are running the show are not only refusing to listen the Drs. and supporters of the single-payer option, but having them arrested. See this site:
Doctors, Single Payer Activists Arrested, Make History at Senate Finance Roundtable | Physicians for a National Health Program

I think that it is time that we let our members of Congress know that this is un-acceptable. They need to stand up for up and not just for who gives them the biggest contributions for re-election.

[Notmuchlonger]

Quote:

Originally Posted by Patsweb I believe that the hospitals and drs. pass on the costs incurred by the non-insured onto the ones who can pay or who have insurance. Also, from what I have read, administrative costs of insurance and billing (probably CEO's jets and salaries,too) make up a high percentage of what we pay. Not to mention what the industry is paying members of our Congress. See this link Consumer Watchdog - Health Insurers & Drug Companies Contributed $5.5 Million to Top 10 Senate and House Recipients Since 2005 and see if this doesn't anger you. This seems like a good case for healthcare reform, particulary in favor of a single payer system where everyone will have affordable, health insurance; however, I can't help but wonder if it is at all possible when the members of Congress who are running the show are not only refusing to listen the Drs. and supporters of the single-payer option, but having them arrested. See this site: Doctors, Single Payer Activists Arrested, Make History at Senate Finance Roundtable | Physicians for a National Health Program I think that it is time that we let our members of Congress know that this is un-acceptable. They need to stand up for up and not just for who gives them the biggest contributions for re-election.

So do you expect the hospital and doctors just absorb the costs of people who don't pay? They already have to do some of that. But yeah health care reform is certainly needed.

[jug]

High cost of US health care, hmm

Inefficiency in paperwork, a tangle of insurers and administrators to handle the mess. Lack of uniformity.

Defensive medicine, call for expensive tests to rule out stuff the Doc knows is not there, but if a small chance it is there, he is up creek.

Insurance to cover mistakes, leading into next comment.

Lawyers, ready to sue, not negotiate settlement. Adversary legal system.

Overabundance of diagnostic equiptment, ready to be used and encoraged to be used if underused. Again many tests given to rule out stuff doc knows is not likely to be there.

However, up side, great technology that will most likely reduce need for skilled physicians whereas techicians will be able to diagnose you just like they do a car and print out protocall for treatment. This is becoming the de-rigor and is firmly objected to by medical profession.

However, leave the well trained ones for the big tiime thinking and for 95% of the other cases, the techs will do just fne. Perhaps prices will go down.

Notice I didn't even touch on European system, just looked at ours.

jug

[bubba]

Not sure if this story is even of interest, but this is happening to a very close family friend. Lady, 70ish, diagnosed with a blood cancer which is destroying her bones (myeloma, I believe). She has no insurance, no money, no pension (social security only) but she told the doctor she wanted every measure taken to save her life. In the last month, she's had hospital stays, MRIs, PET scans, this scan, that scan, radiation treatments, ambulance transportation to/from the radiation center, hospital bed brought into the home, chemo, IV treatments of something to strengthen bones, and I could go on forever. She hasn't paid a dime, nor will she as she has no money and her Social Security check is used for daily expenses. And, I don't believe there is anything unique about this situation. Probaby goes on every day of the world in every hospital/clinic/doctor's office in the U.S.

I have mixed emotions. On the one hand, I think the world of this lady; she's been in my life since I was a very young child. On the other hand, how, without one red cent in your pocket, can you look a doctor straight in the face and say you want all measures employed to save your life. Maybe because you are aware that someone else is paying - who knows. And, while I hope and pray I'll never be in these shoes, who knows?

While I'm not privy to the exact way this treatment is being paid for, I believe, based on comments from the family members, "the government" is paying for everything.

Is this what we all want? Is this socialized medicine? It's a serious question; not trying to pick a fight. Sure, it sounds great to not worry about the cost and just order up whatever treatment you prefer based on the physician's diagnosis, but someone has to pay for the experts, technology, etc etc. Why would the best and brightest in the nation want to be involved in the medical field if they can't make a lot of money while making a signficant contribution to society?

[haha]

Quote:

Originally Posted by bubba Not sure if this story is even of interest, but this is happening to a very close family friend. Lady, 70ish, diagnosed with a blood cancer which is destroying her bones (myeloma, I believe). She has no insurance, no money, no pension (social security only)

Why does she not have Medicare? I beleive that if you are eligible for SS, you are eligible for Medicare.

Ha

[bubba]

Quote:

Originally Posted by haha Why does she not have Medicare? I beleive that if you are eligible for SS, you are eligible for Medicare. Ha

Well, I think she does have Medicare, but evidently you only have so many days you can stay in hospital under the Medicare plan, and I believe you are charged a % of all cost under Medicare (20%, maybe). My belief is that Medicaid pays for all the costs Medicare won't pay. I'm not old enough yet to participate in Medicare, so I don't know all the ins and outs.

But my mind struggles with contribute basically nothing (she has never had money/income to amount to anything) and take so much. Truly, I'm not being negative; just trying to wrap my mind around this situation and the health care debate going on in our nation.

[Meadbh]

Quote:

Originally Posted by bubba how, without one red cent in your pocket, can you look a doctor straight in the face and say you want all measures employed to save your life?

I'm a doctor. My patients are babies, and many of them come from poor families. I get requests like this all the time. The health care team and the families try to make life or death decisions together based on ethical principles such as beneficence (doing good), nonmaleficence (avoiding harm) and justice (including individual and societal equity in allocating resources). It's often a challenging process, but it's respectful.

Quote:

Originally Posted by bubba Is this what we all want?

If "we all" refers to US society, my observations would suggest no. The US is a highly individualist society, where "making it" is theoretically possible for everyone, but if you don't, it's sometimes assumed that it's because you didn't take advantage of opportunity. The reality is that some people will not be able to make the most of those opportunities due to a variety of personal and external challenges. On the other hand, in a highly collectivist society, most people would agree that there should be a "safety net" on the basis that access to health care is a societal good.

Quote:

Originally Posted by bubba Why would the best and brightest in the nation want to be involved in the medical field if they can't make a lot of money while making a signficant contribution to society?

I don't work in the US, but I have done in the past. Personally, I need to be fairly reimbursed for my work, but money is not the only, or even the major, motivating factor in what I do. In the case of this lady, the physician and the hospital will build in an allowance for lower Medicare reimbursement for care into their business model. Paying clients will end up subsidizing this lady's care.

[bubba]

Meadbh, thank you for your comments. I continue to struggle processing (1) this serious illness of someone who has been in my life forever, and (2) the financial implications (elasticity of the safety net). It is very beneficial to hear the opinions of a medical professional.

[jug]

Quote:

Originally Posted by Meadbh If "we all" refers to US society, my observations would suggest no. The US is a highly individualist society, where "making it" is theoretically possible for everyone, but if you don't, it's sometimes assumed that it's because you didn't take advantage of opportunity. The reality is that some people will not be able to make the most of those opportunities due to a variety of personal and external challenges. On the other hand, in a highly collectivist society, most people would agree that there should be a "safety net" on the basis that access to health care is a societal good. I don't work in the US, but I have done in the past. Personally, I need to be fairly reimbursed for my work

The concept of individualistic goes right down the drain when a highly individiualistic person needs expensive health care, due to injury, illness, but mostly old age. He may have been the marlboro man paying his insurance premiums, but the big hit is being taken by the rest in society, spread among us all.

Here society pools together the resources to pay for the care, whether medicare, medicaid, private insurance, or hitting the uninsured with the big bill.

The fact is when we take off our politically tinted glasses and look at the what reality is, is that the society, the US for example, is the risk pool. Each of us in most emergencies will receive medical care. When you are young and healthy, you feel why should you pay for the old and sick, but reality again strikes, chances are you will get old and sick.

I for one believe that we all need to kick in our bucks early into the system, whether private or national, when we first start working, since we all are at risk, and any insurance fool knows, the more in the risk pool, the cheaper per capita it is.

As for being paid for services, I agree, as a doc, you should be fairly paid, and the system can sustain that.

jug