Why medical bills are killing us.

[Mulligan]

I have read at various places that lifetime health costs for the obese and those for smokers are less than those for the non-obese and the non-smokers. This is because the obese and smokers tend to die sooner and therefore have lower lifetime health costs even after accounting for treating for illnesses associated with smoking and obesity. I see more support for this as to smoking (since they die earlier than the obese). However, how credible that research is I don't know:

The Burden of Healthy Living - Hit & Run : Reason.com

PLOS Medicine: Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure [Dutch article -lowest lifetime health costs for smokers, obese higher but not as high as non-obese non-smokers - This is the article most everyone cites to]

Alcohol, Obesity and Smoking Do Not Cost Health Care Systems Money - Forbes

Lifetime Medical Costs Of Obese People Actually Lower Than Costs For Healthy And Fit, Mathematical Model Shows

Center for Business & Public Policy

But not everyone agrees - Death, Taxes, Soda and Fat - NYTimes.com [talking about obesity not smoking]

As America's waistline expands, costs soar | Reuters [Again, about obesity not smoking]

Isn't it funny that dispite some of the examples like this mentioned here, you never really here it debated though. Well one thing is for sure, whether it is true or not, the insurance companies want you healthy until Medicare age. Whatever happens after 65 isn't really much of a problem to them, financially.

 

[Midpack]

Thanks Katsmeow and Mulligan, counterintuitive to say the least. Knowing that smokers, alcoholics and the obese have higher health care costs on average to age 56 or thereabouts - the conclusions of the links you point to (they look credible enough) says something substantial and potentially disturbing about end of life health care costs and spending on same. But I'm not asking to debate end of life costs...

And I haven't wrapped my head around the above with the other slice shown below. I wonder what the causes are for the top 10% of health care costs, end of life largely and not cancer, heart disease, etc.?

 

[palomalou]

Lots to say on this topic!

First, doctors in other countries don't leave med school with an Everest of debt, as do many American physicians. (And yes, I'm a "doctor" but not an MD or related!)

And have had cancer three times (picked the wrong mother). I've received state-of-the-art care, and wretched care. The price seems to be only a bit higher for the wretched care.

The insurance company and employer recently went to a "partnership" plan. Good, thought I, before they came after me with nagging phone calls to do "something"--what, I've been unable to determine, as they have no info about me. I have been a long-time Lifetime member of Weight Watchers, exercise 10 hours weekly, kept 50 pounds off for 9 years, take my meds daily, have never once smoked (having to leave one's aunts houses to vomit in the back yard as a young child can prevent that habit easily), don't drink. Okay, so they want me to go to my checkup. Fine --did that, attempted three times to input it into their system and it never appeared. Of course each time I had to pull up my medical records and 30 minutes or so. Let's not even get into why I have to tell THE INSURANCE COMPANY that I had had my checkup.
Finally I decided to deal with my anger over this as my contribution to the unemployment crisis as they had of course to hire a whole raft of people to call people up and nag them.

So I have no solutions. Yet I agree people should take some responsibility, and the system, if we can call it that, is indeed FUBAR.

 

[Midpack]

Interesting, I would have guessed wrong on many of these. I also found lists of the most expensive medical procedures, but that's not what's relevant here. And end of life costs are indeed the most expensive by a wider margin than I hoped...

The ten events or conditions that are most commonly expensive are as follows. These are average costs, so many patients even with these conditions will not reach the $100,000 per year mark:

1. HIV $25,000
2. Cancer $49,000
3. Transplant $51,000
4. Stroke $61,000
5 Hemophilia $62,000
6. Heart Attack including Cardiac Revascularization (Angioplasty with or without Stent) $72,000
7. Coronary Artery Disease $75,000
8. Neonate (premature baby) with extreme problems $101,000
9. End-Stage Renal Disease $173,000
10. Respiratory Failure on Ventilator $314,000

The 10 Most Expensive Common Medical Conditions - Forbes

 

[ERD50]

Interesting, I would have guessed wrong on many of these. I also found lists of the most expensive medical procedures, but that's not what's relevant here. And end of life costs are indeed the most expensive by a wider margin than I hoped...

The 10 Most Expensive Common Medical Conditions - Forbes

Thanks for posting, very interesting. It is important to keep in mind that these are averages. They point out that 40% of cancer patients receive treatment that is less than $14,000, so that really brings down the averages from some that incur very high expenses.

His last few paragraphs keep me thinking that high-deductible policies are a reasonable way to go, just as with most other insurance. Not a solution, but a piece of the puzzle. I wish my employer-retiree plan included a high deductible option.

-ERD50

 

[explanade]

wow, why is a ventilator that expensive? Probably because of the length of hospital stay?

 

[audreyh1]

Interesting, I would have guessed wrong on many of these. I also found lists of the most expensive medical procedures, but that's not what's relevant here. And end of life costs are indeed the most expensive by a wider margin than I hoped...

The 10 Most Expensive Common Medical Conditions - Forbes

My MIL's cancer treatment cost $300K over less than two years, so beware the averages.......

Medicare paid for most of it, and the high-dollar co-pays for the uber-expensive chemotherapy drugs were paid for by a "foundation".

 

[Midpack]

My MIL's cancer treatment cost $300K over less than two years, so beware the averages.......

Medicare paid for most of it, and the high-dollar co-pays for the uber-expensive chemotherapy drugs were paid for by a "foundation".

Understood. I was trying to get at what the most costly treatments collectively were/are, not what each case/event cost, averages or otherwise.

I thought that's what the link I posted was addressing (and that's why as I mentioned I did not post top 10 most expensive procedures, some of them averaged 7 figures!). FWIW

 

[Mulligan]

Thanks Katsmeow and Mulligan, counterintuitive to say the least. Knowing that smokers, alcoholics and the obese have higher health care costs on average to age 56 or thereabouts - the conclusions of the links you point to (they look credible enough) says something substantial and potentially disturbing about end of life health care costs and spending on same. But I'm not asking to debate end of life costs...

And I haven't wrapped my head around the above with the other slice shown below. I wonder what the causes are for the top 10% of health care costs, end of life largely and not cancer, heart disease, etc.?

I like that chart you provided, and it is basically what I try to "hang my financial hat on". I will be honest. If it wasn't for this forum and the Healthcare Act, I would never have given health costs a worry. I never used/paid for it while working as it was a non used benefit at my job. Retired got on a cheap $75 month plan with high deductible and still don't use it. Unfortunate health issues do strike many people, but clearly as your chart shows, many people do not have much in medical costs as 25% of population consumes the vast majority. That leaves 3/4 to 1/2 of us that don't. I am optimistic that I remain one of them. Although we all do and should worry about it, many will not have to spend much outside of their basic premiums. That is why, and yes this is self serving, I am disappointed that truly High Deductible plans are being scraped, as it can have a positive reward for people who maintain healthy lifestyles.

 

[meierlde]

If we want to hammer docs on over prescribing, I'm first in line. Especially in instances like yours. They overprescribe pain meds because they don't want to get postoperative phone calls. I almost never prescribed narcotics for tooth extractions. I instructed the patient in post op care, gave instructions for ibuprofen if they could take it, and gave them my personal phone number if they had a problem. Rarely did anyone need something more for a simple extraction. That protocol also reduced the number of drug seeking patients to my office because, believe me, they know which docs write for the "good stuff."

More specifically be sure that if a branded and a generic version of the same medication exists that the physician prescribe the generic only. Further ask if there is a generic that would work the same as a branded medication, (for example before the patent for lipitor expired would Simvastin work as well). Physicans do not know the cost of meds, and a lot don't even have the list of 4/10 medications from the major chain stores handy to check on it. The do not have any incentive to prescribe the lowest cost choice.

 

[Gatordoc50]

A lot of interesting views here. If we cut our costs in nearly half to match other countries cost per capita, what do you think that will do to our GDP? One might think that there would be no difference or maybe even an increase as those dollars can be spent elsewhere. But, we have to consider that much of our healthcare is subsidized by debt.

 

[Texas Proud]

A lot of interesting views here. If we cut our costs in nearly half to match other countries cost per capita, what do you think that will do to our GDP? One might think that there would be no difference or maybe even an increase as those dollars can be spent elsewhere. But, we have to consider that much of our healthcare is subsidized by debt.

This does not make sense to me (the last sentence)... for most people, you have to pay your insurance premiums from your paycheck... you also pay most bills when they occur or they are paid by insurance...

Also, you have to take the stance that all the taxes that are collected specifically for Medicare are not being paid for Medicare (not sure about Medicaid).... they might be running a deficiet, but is it big


Or are you thinking that cash is fungible and as long as there is debt you were borrowing to pay for whatever (and you say it is healthcare)


Edit to add: To answer your question... I do not think it would affect GDP as more than likely those dollars would be spent on something else... we might be living 'larger', but most people spend their dollars one way or another...

 

[unclemick]

One small act of defiance at a time. American passport and knowledge of medical tourism. Here in KCK I know 2 or three retiree's that use Mexico for meds and dental work. Elements of lowering costs via things like urgent care centers and legislation changes to allow Medicaid to operate more effficiently 'may' I say 'may' be on the horizion.

Competition for the medical tourist dollar is rising.

heh heh heh - meanwhile try to have an attitude of too bad to get sick.

 

[Gatordoc50]

This does not make sense to me (the last sentence)... for most people, you have to pay your insurance premiums from your paycheck... you also pay most bills when they occur or they are paid by insurance...

Also, you have to take the stance that all the taxes that are collected specifically for Medicare are not being paid for Medicare (not sure about Medicaid).... they might be running a deficiet, but is it big

Or are you thinking that cash is fungible and as long as there is debt you were borrowing to pay for whatever (and you say it is healthcare)

Edit to add: To answer your question... I do not think it would affect GDP as more than likely those dollars would be spent on something else... we might be living 'larger', but most people spend their dollars one way or another...

I am referring to federal dollars spent. Healthcare is driving the deficit, along with defense spending. Being paid for with debt. So, that 800 billion dollars of deficit spending on healthcare is providing a lot of jobs and contributing mightily to GDP? Since we are spend considerably more than other countries, it follows that we would have to cut considerably to get in par with them. If cutting 80B with the sequester is damaging to growth, then cutting 800B has gotta be worse.

 

[unclemick]

I am referring to federal dollars spent. Healthcare is driving the deficit, along with defense spending. Being paid for with debt. So, that 800 billion dollars of deficit spending on healthcare is providing a lot of jobs and contributing mightily to GDP? Since we are spend considerably more than other countries, it follows that we would have to cut considerably to get in par with them. If cutting 80B with the sequester is damaging to growth, then cutting 800B has gotta be worse.

Maybe. Maybe not. Look at what dereg changes did to the airlines. Good? Bad?

Heh heh heh - Given the size of this gorilla - this issue will be with us for a while.

 

[Gatordoc50]

Maybe. Maybe not. Look at what dereg changes did to the airlines. Good? Bad?

Heh heh heh - Given the size of this gorilla - this issue will be with us for a while.

http://www.usfederalbudget.us/federal_budget_detail_fy13bs12013n

Holy smokes. I never realized the amount of money dedicated to pensions in the federal budget. It's the same as healthcare spending! Time for a new thread? lol

 

[Mulligan]

http://www.usfederalbudget.us/federal_budget_detail_fy13bs12013n

Holy smokes. I never realized the amount of money dedicated to pensions in the federal budget. It's the same as healthcare spending! Time for a new thread? lol

The pension reference in the chart is mostly Social Security checks, I assume, correct?

 

[Gatordoc50]

The pension reference in the chart is mostly Social Security checks, I assume, correct?

Oh, my bad!

 

[Mulligan]

Oh, my bad!

I'm not 100% sure, it just would seem that way, since it wasn't mentioned by name. I thought the federal government was getting out of the pension game long term, but maybe I am wrong.

 

[Gatordoc50]

I'm not 100% sure, it just would seem that way, since it wasn't mentioned by name. I thought the federal government was getting out of the pension game long term, but maybe I am wrong.

No, you're right. Me stupid.

 

[Midpack]

So, that 800 billion dollars of deficit spending on healthcare is providing a lot of jobs and contributing mightily to GDP? Since we are spend considerably more than other countries, it follows that we would have to cut considerably to get in par with them. If cutting 80B with the sequester is damaging to growth, then cutting 800B has gotta be worse.

Were you also concerned about the loss of more than 5.6M US manufacturing jobs (and many more since 2007) 'damaging growth' at any time since 1978, all while health care costs were increasing much faster than inflation or GDP?

Many of the manufacturing losses were due to increased productivity/efficiency as we all demanded lower costs. Maybe we could all benefit if healthcare $ productivity/efficiency had similar gains? Seems possible if we're paying about double the OECD average per capita without comparable outcomes.

Job Losses in US Manufacturing by Industry, 1978-2007

		Computers/			Primary	Trans.	Paper/	Fabricated
Year	All	Electronics	Garments	Textiles	Metals	Equip.	Printing	Metals
% Chge.	-29%	-35%	-78%	-67%	-59%	-26%	-30%	-21%
Abs. Chge.	-5,657	-947	-797	-695	-648	-596	-479	-406

Source: US Bureau of Labor Statistics

 

[Gatordoc50]

Back to my original point, though. I don't think this administration wants to reduce healthcare spending but rather control it's growth going forward under the ACA. Cutting it drastically would hurt growth. The ACA along with tax increases passed and proposed should lower net incomes for high earning docs. It's a reasonable approach to the budget, but I'm afraid will do little for our spending per capita relative to others.

 

[Texas Proud]

Interesting link...

You can drill down and see that the retirement is $779B SS and $128B federal employee...

 

[Gatordoc50]

Were you also concerned about the loss of more than 5.6M US manufacturing jobs (and many more since 2007) 'damaging growth' at any time since 1978, all while health care costs were increasing much faster than inflation or GDP?

Many of the manufacturing losses were due to increased productivity/efficiency - maybe we could all benefit if healthcare $ productivity/efficiency had similar gains?

Job Losses in US Manufacturing by Industry, 1978-2007

		Computers/			Primary	Trans.	Paper/	Fabricated
Year	All	Electronics	Garments	Textiles	Metals	Equip.	Printing	Metals
% Chge.	-29%	-35%	-78%	-67%	-59%	-26%	-30%	-21%
Abs. Chge.	-5,657	-947	-797	-695	-648	-596	-479	-406

Source: US Bureau of Labor Statistics

Good point. Healthcare at present is service dominated which is expensive. Technology has increased costs thus far but there will probably be a shift where it leads to efficiency and cost reduction.

 

[Texas Proud]

I am referring to federal dollars spent. Healthcare is driving the deficit, along with defense spending. Being paid for with debt. So, that 800 billion dollars of deficit spending on healthcare is providing a lot of jobs and contributing mightily to GDP? Since we are spend considerably more than other countries, it follows that we would have to cut considerably to get in par with them. If cutting 80B with the sequester is damaging to growth, then cutting 800B has gotta be worse.

I get your point...

Not sure of the number, but isn't healthcare spending over $2Trillion

Now, if you could provided the same level of service and save $1Trillion.... isn't that a good thing

I don't think we should be paying twice as much for something just to keep jobs... (and I wished I knew where that savings would be coming from so we could attack it)...