Why medical bills are killing us.

[eridanus]

Bread is too expensive. Clearly we should cut the pay of bakers.

Meaningless.

 

[Gatordoc50]

Let's not also discount wait times for elective surgeries. The United States is among the lowest and I don't think it's a stretch to say that those with private insurance will wait less and pay more. By increasing wait times to that of Canada's, we could significantly reduce costs due to staffing and facility expense.

 

[youbet]

As a Canadian i'll never understand why America tolerates such an outrageous health care system..

Fortunately you don't need to be concerned. I do understand why you would find it amusing to watch at arms length as we work all this out.

 

[samclem]

Meaningless.

What's meaningless is holding out doctors as being paid too much. They are getting paid exactly what the market will bear, just like everyone else. Next you decide some other "Big Fish" need to be skewered. Look to treat the cause, not the symptom, grasshopper.

 

[eridanus]

Let's not also discount wait times for elective surgeries. The United States is among the lowest and I don't think it's a stretch to say that those with private insurance will wait less and pay more. By increasing wait times to that of Canada's, we could significantly reduce costs due to staffing and facility expense.

Nah, the US is in the middle. Canada is worst but socialist France and Germany have shorter wait times.

Edit: study here http://content.healthaffairs.org/content/29/12/2323.abstract

 

[eridanus]

What's meaningless is holding out doctors as being paid too much. They are getting paid exactly what the market will bear, just like everyone else. Look for the cause not the symptom, grasshopper.

The free market doesn't apply to health care. You've written that yourself, right? So how can doctors be "getting paid exactly what the market will bear"?!?

Look for the real problem through the fog, the student teaches the master.

 

[samclem]

The free market doesn't apply to health care. You've written that yourself, right?

Uh, no.

What I believe is that we don't presently have an efficient free market in health care services in the US.

The free market could apply just fine to health care--modified as we see fit to accomodate social goals.

 

[eridanus]

Uh, no.

Sorry, maybe I'm misunderstanding your position.

Do you believe that the free market is working as intended for health care in the US at the current time? In which case, the article and the health care "crisis" and this thread are much ado about nothing because, well, that's how the market works?

I realize that you want free market solutions tried.

Edit: We're cross-posting. I don't necessarily disagree with an efficient free market approach but I wonder if more transparency, etc., will accomplish those goals.

 

[samclem]

Do you believe that the free market is working as intended for health care in the US at the current time?

No, surely not. But I do think doctors are getting paid according to the distorted market principles now in effect. Addressing those distortions is (IMO) a more productive approach than calling doctors out as overpaid.

Payments to doctors, hospital adminstrators, the phalanx of code-enterers and bill-sorters, etc are all reflections of the "system" we've set up.

 

[bUU]

Could you please spell out how you see that working out? What specific changes to which specific programs and policies are you suggesting?

 

[eridanus]

No, surely not. But I do think doctors are getting paid according to the distorted market principles now in effect. Addressing those distortions is (IMO) a more productive approach than calling doctors out as overpaid.

Fair enough. Most people would support more efficient market approaches. The devil is in the details, of course.

 

[Gatordoc50]

http://benbrownmd.wordpress.com/

This pretty much explains salaries by profession. It doesn't explain additional costs like leasehold improvements, Impact fees ( 50 to 100 thousand in my county), or the need to sock away a million dollars just in case one of your kids is dumb enough to want to go to med school. It also shows why dentistry is better financially.

 

[Midpack]

Let's not also discount wait times for elective surgeries. The United States is among the lowest and I don't think it's a stretch to say that those with private insurance will wait less and pay more. By increasing wait times to that of Canada's, we could significantly reduce costs due to staffing and facility expense.

Really? It's pretty easy to find evidence to the contrary online, though you chose the worst case Canada instead of looking at all 30 OECD countries with lower cost and better outcomes.

This shows otherwise (wait times are often misused by opponents of universal health care in the US, mostly an out of date argument). For example the UK used to have long wait times from what I've read, but they've improved dramatically it seems...

 

[Gatordoc50]

Total healthcare expenditures are 4.6 trillion. Total physician salaries are about 300 billion. So that means somebody else is raking in 4.3 trillion or 94% of the pie.

 

[youbet]

Gatordoc50 was talking about wait times for elective surgery as opposed to the percentage of people waiting 6 days or longer to see the doc when sick. Although it's an interesting graph. That data is different. Tlhis graph shows weeks wait for elective surgery in varous countries at different points in time.

 

[eridanus]

Gatordoc50 was talking about wait times for elective surgery as opposed to the percentage of people waiting 6 days or longer to see the doc when sick. Although it's an interesting graph. That data might be different.

It's similar. Some universal health care countries still beat out the US in price and have similar (short) waiting times for elective surgeries. It's more a factor of hospital beds rather than costs (though, obviously, one dictates the other). Pages 106-7 have some graphs.

Explaining Waiting-time Variations for Elective Surgery Across OECD Countries

 

[Gatordoc50]

Really? It's pretty easy to find evidence to the contrary online, though you chose the worst case Canada instead of looking at all 30 OECD countries with lower cost and better outcomes.

This shows otherwise (wait times are often misused by opponents of universal health care in the US, mostly an out of date argument). For example the UK used to have long wait times from what I've read, but they've improved dramatically it seems...

Let's be fair. Those who would like to convince themselves that their docs are ripping them off have been cherry picking data thru out this thread. Pick a country. We are fatter than them all.

 

[youbet]

It's similar.

Doesn't look similar to me. That's not to say that if we move to a single payer or total gov't managed system we can't emphasize the service levels we wish to emphasize. But, at the moment, our elective surgery waiting times look pretty good. Improving elective surgery wait times would NOT be a reason for us to change. I'm not saying there aren't other reasons, just that wait time for elective surgery isn't one of them.

And these times are very different than the "percentage of people waiting 6 days or more to see a doc" times that midpack showed.

 

[eridanus]

Improving elective surgery wait times would NOT be a reason for change. I'm not saying there aren't other reasons, just that wait time for elective surgery isn't one of them.

Right but no one claimed that going to universal care would shorten waiting periods. It's obvious from your graph, though, that doing so doesn't have to mean longer waiting times.

 

[youbet]

Right but no one claimed that going to universal care would shorten waiting periods. It's obvious from your graph, though, that doing so doesn't have to mean longer waiting times.

No, it wouldn't have to mean longer waiting times. They could stay the same or improve. Actually, there's no medical system metric that could not be improved if we went to universal care. Likewise there is no medical metric that could not be improved if we stayed with our current system. It's all trade-offs and allocation of resources. You have to decide what you want and apply the will and resources to make it happen.

Look again at the graph Midpack posted. "Percentages of people waiting six days or more to see their doc" is not the same as "weeks of time wating for elective surgery."

That's all I'm sayin'

 

[Midpack]

Improving elective surgery wait times would NOT be a reason for us to change. I'm not saying there aren't other reasons, just that wait time for elective surgery isn't one of them.

+1. Seems to me wait times for elective procedures would be more flexible, and our wait times for sick people are already longer than many/most countries...that was my point.

I don't understand those who defend the status quo without offering anything to address US access, cost (and rate of increase) and middling outcomes...instead of throwing out Canadian elective procedure wait times.

 

[Mulligan]

I don't doubt it but read the Bloomberg article above.

"Last year, a routine visit to a U.S. doctor cost commercial insurers $89 on average, compared with $64 in Switzerland, $40 in Germany and $23 in France."

That's per visit. American doctors simply make more. Period.

"No other developed country pays doctors this much. In 2004, general practitioners in the U.S. were estimated to earn double -- measured by purchasing power -- the median for 21 nations in the Organization for Economic Cooperation and Development; for specialists, the difference was almost threefold."

“It’s the Prices Stupid”--Why Americans Pay More for Health Care - 2005 - Stories - News - Johns Hopkins Bloomberg School of Public Health

"OC&PA: What would it take to fix the problem?

GA: In the United States, every individual physician or hospital is negotiating the prices for health care services with insurance companies. In other countries, one agency, not necessarily a government agency, negotiates and sets the cost for all of the public and private health insurers. That gives them a much stronger negotiating entity to make deals with physicians and hospitals."

But maybe we should go after the Big Fish first.

Do American doctors get paid too much? - Slate Magazine

"But none of this really matters, because doctors' salaries aren't a large enough chunk of health care spending in the United States to make a difference. According to Reinhardt, doctors' net take-home pay (that is, income minus expenses) amounts to only about 10 percent of overall health care spending. * So if you cut that by 10 percent in the name of cost savings, you'd only save about $26 billion. That's a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors' offices, and advertising for drug companies. The real savings in health care will come from these expenses."

A article I read reinforces your last paragraph. In fact, they have it at 8.6% lowest only to Sweden as percentage of cost, though in actual dollar terms of actual salary they compare favorably.

Total U.S. physicians’ salaries comprised 8.6 percent of the nation’s total healthcare costs. Of the western nations with modern healthcare systems, only Sweden devoted less money to physician salaries than the U.S, at a portion of 8.5 percent.

In contrast, Jackson researchers found physician compensation to represent about 15 percent of total healthcare expenditure in Germany, 11 percent in France and 11.6 percent in Australia. In the United Kingdom, physician payment constituted 9.7 percent of the total healthcare costs.

http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations

I personally would be very leery of wage controls on our medical providers. Providers sacrifice many years of their lives to pursue their careers and incur significant debt doing this. I would hate to put in a measure that is a disincentive for bright people to pursue this career.

 

[obgyn65]

I have not read the entire thread nor seen that Harvard study but the 25% figure does not surprise me. In fact I think the number could be even higher.

Harvard study estimated at least 1/4 of total spending on health care was for administration overhead, specifically dealing with insurance claims.

The coding system wasn't standardized so there had to be specialists and doctors had to employ people just to deal with the insurance. Or spend a lot of their own time handling it.

 

[scrinch]

When we apply market principles in this way to buy health care in advance (not, as I said earlier, comparison shopping for an MRI when you are bleeding), then the emphasis will be where it needs to be and costs will be bounded by supply and demand. No need for top down cost controls (which always result in artificial scarcity). No need for the very wasteful single-payer fee-for-service model (Medicare, etc).

I think one of the main points of the Brill article is that the free market is currently at work in the drug, medical device, and to a certain extent hospital/medical group sectors. Relatively unregulated, it has led to near-monopoly conditions and price fixing (okay, very uncompetitive pricing) so far. I agree with you that in principle that free market forces should theoretically make an economic system efficient. But free market forces also led to the Standard Oil monopoly, thalidimide babies, and Love Canal. Like eridanus says, the devil is in the details!

 

[explanade]

You can't really get the same kind of market in health care that you can in other products and services.

It's difficult enough to evaluate other professional services like law or accounting. But you have the time to do it, whereas if you got a major condition for which you need to start receiving care right away, you're not going to shop around.

Certainly if you're taken to the hospital in an ambulance, you're not going to look up reviews and tell the ambulance driver to take you to so and so hospital and call a certain doctor.

Or for that matter, shop for a provider based on price if your life or health is at stake. So the demand for health care is not driven by the same set of concerns that demand for say cars is driven.

And without medical training, most people are not in a position to evaluate how good a given provider is. What are you going to do, Google for reviews of a doctor? There are some sites that have reviews but they're nothing like restaurant reviews.