U.S. HC Spending Compared to other countries

[Sunset]

HC in USA is a business, a VERY BIG business, so profit is a large motive.
Immediately the HC business should/has to make 20% profit just for the CEO and shareholders to be happy, so this means 20% of your costs are going to the pockets of someone and not paying for actual care. This 20% is in Excess of the costs (doctor salaries, nurses, drugs, buildings, etc).

Then there is all the expensive fancy equipment, that makes a patient think something good is happening when in reality an MRI is not needed on every corner of the street. Someone (the patient) has to pay for all those under-used machines. This overuse of expensive equipment/tests pushes up the base cost (the actual care part of the cost).

Finally, because it's so vast, and complex with 100's of private deals on cost between insurance companies (who want their 20% profit) and treatment facilities, even more people need to be employed to manage the paperwork, claims, etc. and everyone of these companies is a business and wants their 20% profit, which is buried in the costs.

With so many hands in the pot, taking profit (beyond actual costs), I'm surprised there is any money left for the patient's treatment.

 

[Silver]

Silver, my cousin is an administrative nurse (over several departments) at Johns Hopkins. Let's say the opinion I gather, there is much more treatment given than is needed.

That's a small part of it, but the much larger cost issues are not clearly seen or understood by the public. A well known example is that our government approved a bill that disallows Medicare from negotiating drugs costs with drug companies although they are the largest purchaser of pharmaceuticals in the country.

Another issue receiving some press within the past few years are physicians getting kickbacks from drug and medical device companies for ordering their higher-priced products when much less expensive items work just as well.

A much less known area of very high profits is the ownership of professional medical periodicals by drug and medical device companies. They control what is published, and if a research paper is submitted for publication that shows an adverse result to a product they are selling,(such as the drug researched really doesn't work all that well) that research may have a delay in publication sometimes by years. There are billions to be made before those results will be published. Your personal physician tries to stay up on the "latest" research, but is at the mercy of what's available, and it's controlled by a very greedy industry.

We are a country manipulated by our health care system in the name of profit.

 

[Popeye]

Interesting article in Forbes challenging the thinking on outcomes in the US. It looks at infant mortality, life expectancy, and Pharmaceuticals. Basically it says much of the data is not apples to apples comparison, poverty rates have an effect, and our obesity rate is unbelievable. The point being that if you don’t look at these factors you won’t be solving the actual problems.

https://www.forbes.com/sites/physic...-other-countries-are-misleading/#7274afdf1232

From the article...

Life expectancy has been another “knock” on the U.S. healthcare system. Unfortunately, our suicide rate is higher than the other countries mentioned in the Papanicolas et al study, with the exceptions of only France, Switzerland and the world leader, Japan. We have the worst rate of car crash deaths and the highest rate of gun homicides. Furthermore, we lead the world in another very dubious “distinction” – that of obese or overweight adults. The Center for Disease Control and Prevention reports that 36.5 percent of the U.S. population suffers from obesity, which sets the U.S. apart as the most obese nation when compared to the other listed countries.

 

[CRLLS]

Do I think that USA healthcare costs caused by unnecessary tests and referrals to specialists for the simplest of matters might be to CYA against litigious clients? Not to mention the cost of malpractice insurance? You Betcha. That contributes to USA costs being higher, at least some, IMO.

 

[candrew]

Having retired just over 2 years ago after w*rking for 35 years in a large, health care system mega-corp, I learned the following to be true.

Health care systems like my previous empl*yer have no interest in lowering the cost of *your* health care, but rather, are only interested in lowering *their* cost of providing it.

 

[ShokWaveRider]

Ha! I've seen that Monty Python sketch a few times. If you want to go in that direction, my argument is we should get more stars for reading than for posting. I would then have 10 stars. Not to distract from my original post.

"No you shouldn't"

"An Argument is an intellectual process. Contradiction is just the automatic gainsaying of anything the other person says"

"Your 5 Minutes is up"

 

[zinger1457]

Do I think that USA healthcare costs caused by unnecessary tests and referrals to specialists for the simplest of matters might be to CYA against litigious clients? Not to mention the cost of malpractice insurance? You Betcha. That contributes to USA costs being higher, at least some, IMO.

Malpractice claims and payments have been on the decline in the US for most of the last 15 years. I thought Midpack and Silver summed it up really well in the above post.

 

[CRLLS]

I wasn't primarily talking about the malpractice insurance or claims. The main point was that, perhaps, perhaps, the drs (or the groups that they work for) want to CYA more in the US compared to other countries. Or at least, order more testing, which has already been suggested here.

While I can find data that supports a slight reduction in malpractice claims paid out over the last 12 years, I cannot find similar charts on the Insurance rates charged over the same period.

 

[Sunset]

That's a small part of it, but the much larger cost issues are not clearly seen or understood by the public. A well known example is that our government approved a bill that disallows Medicare from negotiating drugs costs with drug companies although they are the largest purchaser of pharmaceuticals in the country.

Another issue receiving some press within the past few years are physicians getting kickbacks from drug and medical device companies for ordering their higher-priced products when much less expensive items work just as well.

A much less known area of very high profits is the ownership of professional medical periodicals by drug and medical device companies. They control what is published, and if a research paper is submitted for publication that shows an adverse result to a product they are selling,(such as the drug researched really doesn't work all that well) that research may have a delay in publication sometimes by years. There are billions to be made before those results will be published. Your personal physician tries to stay up on the "latest" research, but is at the mercy of what's available, and it's controlled by a very greedy industry.

We are a country manipulated by our health care system in the name of profit.

Another common practice that has only recently come to light. When you go to a pharmacist for a prescription, they were prevented by contract from telling you about a cheaper way to buy the drug.... Unless you Specifically asked.
So they would merrily sell you drug X, under your plan even when it was more expensive than paying cash without the plan.

I honestly could not believe this when first told, but turns out it is true. Lots of reports of this happening in VARIOUS news locations. Ask your pharmacist.

 

[Red Badger]

I feel compelled to initiate a thread of a lighthearted nature.

FWIW, I do think we are more sick than many other western nations. We (as a nation) succumb to advertising that shouts what a great deal the "all you can stuff in your pie hole (Ryan's)," to the 3000 calorie $10 pasta (unlimited) at Olive Graveyard. And don't overlook that .99 sausage biscuit on your way to 8-10 hours in your cube.

America's obesity level is one of the highest in the world. How's that low fat mantra working for Joe (and Joeleen) six pack?

 

[zinger1457]

I feel compelled to initiate a thread of a lighthearted nature.

FWIW, I do think we are more sick than many other western nations. We (as a nation) succumb to advertising that shouts what a great deal the "all you can stuff in your pie hole (Ryan's)," to the 3000 calorie $10 pasta (unlimited) at Olive Graveyard. And don't overlook that .99 sausage biscuit on your way to 8-10 hours in your cube.

America's obesity level is one of the highest in the world. How's that low fat mantra working for Joe (and Joeleen) six pack?

Overall your probably right but not sure it's a big difference. Unfortunately many of the western countries, especially in Europe, are slowly working their way up to the US in terms of obesity rates. Most of those European countries also have a higher smoking rate than the US.

 

[jimbee]

I feel compelled to initiate a thread of a lighthearted nature.

FWIW, I do think we are more sick than many other western nations. We (as a nation) succumb to advertising that shouts what a great deal the "all you can stuff in your pie hole (Ryan's)," to the 3000 calorie $10 pasta (unlimited) at Olive Graveyard. And don't overlook that .99 sausage biscuit on your way to 8-10 hours in your cube.

America's obesity level is one of the highest in the world. How's that low fat mantra working for Joe (and Joeleen) six pack?

That low fat mantra probably won't work if you're eating 3000 calories a day.

 

[oscar1]

In Texas Whataburger will advertise 15 times a night that the Monterey Melt sandwich is gooooood for your belly. But they do not tell you it’s 1,000 calories. Require calorie/fat content on all food advertisements!

Better yet, implement a fat tax! Every year when you do your taxes, you go to a body mass index table and depending on your weight, you get a fat tax. That would fix the obesity problem in the U.S.A. in a few years.

 

[NW-Bound]

Healthcare in the US is not always expensive.

My usage of healthcare this year: 2 visits to a GP for him to prescribe a drug, then monitor its effect, for "essential hypertension" (essential hypertension or primary hypertension is high blood pressure that doesn't have a known secondary cause). Each visit cost me $80.36.

I bought the medicine (Lisonopril) at Walmart, paying $10 for a 3-month supply.

The doctor said I was in good health, but should have a complete blood test as my last one was 2 years ago. It cost me $41.93 for the metabolic and CBC panels at Sonora Lab.

It was also time for a colonoscopy, due to previous problems. My GI was not covered by the only ACA insurer where I live, so I called the office to ask to pay the usual insurance-negotiated rate. It was $877, which I would have to pay anyway even if he were on the network because our deductible was $10,000 or something like that.

 

[MichaelB]

Healthcare in the US is not always expensive.

My usage of healthcare this year: 2 visits to a GP for him to prescribe a drug, then monitor its effect, for "essential hypertension" (essential hypertension or primary hypertension is high blood pressure that doesn't have a known secondary cause). Each visit cost me $80.36.

I bought the medicine (Lisonopril) at Walmart, paying $10 for a 3-month supply.

The doctor said I was in good health, but should have a complete blood test as my last one was 2 years ago. It cost me $41.93 for the metabolic and CBC panels at Sonora Lab.

It was also time for a colonoscopy, due to previous problems. My GI was not covered by the only ACA insurer where I live, so I called the office to ask to pay the usual insurance-negotiated rate. It was $877, which I would have to pay anyway even if he were on the network because our deductible was $10,000 or something like that.

These charges come after paying for insurance, correct? How does the total cost of insurance premiums plus these payments compare with other countries?

I think it is very difficult to compare healthcare systems of countries. Far too anecdotal, and individual experiences don’t necessarily reflect the performance of the system as a whole, here or there.

 

[ShokWaveRider]

When we lived in Canada, our total monthly expense for healthcare for our family (No Limits of persons and I cannot remember if there was an age limit) was $175pm. (Ontario) Not including Drugs.

 

[Rianne]

These charges come after paying for insurance, correct? How does the total cost of insurance premiums plus these payments compare with other countries?

I think it is very difficult to compare healthcare systems of countries. Far too anecdotal, and individual experiences don’t necessarily reflect the performance of the system as a whole, here or there.

Taxes are much higher in countries that provide "free" HC. You have to weigh the cost. I have no idea what a knee replacement costs in the U.S. The problem is it varies from surgeon to hospital to all the added extras one might receive and is based on the quality of your insurance and what it covers and if the HC people are in network. Long sentence. But we have to consider and research all the angles our HC system offers. We have to ask questions and find out if someone is out of network and on and on.


My DBI, Italian, got a knee replacement a few months ago. Had all the best care, rehab, 8 days in the hospital because they are more concerned about the total outcome. They don't send anyone home after a major surgery until they are sure you are good to go. He paid nothing. Does the extra 15% in taxes make up for the knowledge you're not getting screwed by a profit industry? I don't know.

 

[ShokWaveRider]

Taxes are much higher in countries that provide "free" HC.

I am getting little tired of saying this. IT IS NOT FREE. It is paid for by Taxes and Provincial monthly HC charges, at least in Canada.

People who think HC is free in other countries are completely misinformed and are misleading the folks that do not know. Again, it is not free, one just pays for it in a different way, without being controlled and decided on by for profit insurance companies.

 

[Rianne]

I am getting little tired of saying this. IT IS NOT FREE. It is paid for by Taxes and Provincial monthly HC charges, at least in Canada.

People who think HC is free in other countries are completely misinformed and are misleading the folks that do not know. Again, it is not free, one just pays for it in a different way, without being controlled and decided on by for profit insurance companies.

That's why I put "free" in quotes. I said in that post the taxes are higher. Yes, you pay for it in other ways. But our HC is for profit. You have to do homework before a big procedure and make sure you're not getting screwed by a for profit HC system. Sorry if you're getting tired of saying this, but that is not what I said. I added the example of my DBI from ITALY.

 

[ShokWaveRider]

That's why I put "free" in quotes. I said in that post the taxes are higher. Yes, you pay for it in other ways. But our HC is for profit. You have to do homework before a big procedure and make sure you're not getting screwed by a for profit HC system. Sorry if you're getting tired of saying this, but that is not what I said. I added the example of my DBI from ITALY.

My comment was not directed at you exctly. The problem we have is as long as we keep referring to it as free in other countries, people will keep believing that it is.

I was talking to my insurance agent the other day and even she thought it was really free in the EU and Canada, and as such MUST be inferior. People believe what they hear, regardless of the source.

 

[NW-Bound]

These charges come after paying for insurance, correct? How does the total cost of insurance premiums plus these payments compare with other countries?

I have to pay for everything, up to the deductible of $10K or something like that. And yes, the premium is absurdly high.

On the other hand, you have to include the tax burden in other countries.

I think it is very difficult to compare healthcare systems of countries. Far too anecdotal, and individual experiences don’t necessarily reflect the performance of the system as a whole, here or there.

Exactly my point.

I cited the above numbers, because that is what my healthcare providers get for the services that I described. Their fees are not at all unreasonable. They definitely were not gouging.

Then, I have to ask, where does my high premium go? It does not all go into the insurer's pocket, because he is required by law to pay out 80% in claims. So, it has to go to service providers, but somebody else's, not mine. And for what?

Here's another anecdote. I had a major surgery a few years ago. The total bill came to around $35K, if my memory serves. My surgeon's fee was around $1,200. The rest was for hospital various billings.

 

[neihn]

I recently spent two days in the hospital to treat an internal bleeding due to ulcer (which I did not notice until I lost so much blood). The hospital gave me two unit of bloods and the bunch of potassium.

Room and board was $5,000 per day
Hospital Care (monitoring, nurses etc...) $7,000 per day
Endoscopy from GI doctor - $1,500
Anesthesia for the procedure above $1,000
Misc follow up doctor visits, medication $3,500

Total bill ~= $30,000

My oop portion is $6,500 - my insurance paid $23,500. All this is on top of $700/month for my HDHP.

I can not say it is not expensive. Many charges are an eye opening for me (for example, while in bed in the hospital, doctors stopped by and looked at my chart and chatted with me, it was $300 for each incident. The doctor that handed me the discharge paper charged $200. They are in the itemized bill)

 

[Sojourner]

Where is the data supporting the cost and effectiveness of US healthcare? Sure the US leads HC technology is some areas, but where is the data showing the US HC "system" is more effective overall than all the developed countries with universal health care in various forms? I've yet to see it. When will someone start a solid fact based thread defending US HC, instead of another example of 'proof by exception' (so and so cured Uncle Bob's condition so it must be the best).

The U.S. spends around 17% of its GDP on healthcare. Every other developed country that spends 10% or more of its GDP on health care has a lower infant mortality rate and a higher life expectancy than the United States. (According to https://www.americashealthrankings.org/learn/reports/2016-annual-report/comparison-with-other-nations)

IMHO, the chart below is a pretty scathing indictment of the outrageously expensive health care system we have in the U.S. For the money we spend (over $9,000 per capita yearly), we should have the highest longevity by far of any other nation. Yet we rank 26th out of 35 OECD countries in longevity. People living in Slovenia and Chile, for example, have higher life expectancies than those of us here in the US.

 

[NW-Bound]

I recently spent two days in the hospital to treat an internal bleeding due to ulcer (which I did not notice until I lost so much blood). The hospital gave me two unit of bloods and the bunch of potassium.

Room and board was $5,000 per day
Hospital Care (monitoring, nurses etc...) $7,000 per day
Endoscopy from GI doctor - $1,500
Anesthesia for the procedure above $1,000
Misc follow up doctor visits, medication $3,500

Total bill ~= $30,000

My oop portion is $6,500 - my insurance paid $23,500. All this is on top of $700/month for my HDHP.

I can not say it is not expensive. Many charges are an eye opening for me (for example, while in bed in the hospital, doctors stopped by and looked at my chart and chatted with me, it was $300 for each incident. The doctor that handed me the discharge paper charged $200. They are in the itemized bill)

Yes, the medical cost in the US is not outrageous until you step foot in the hospital.

As my earlier example shows, the fees by GPs and other outpatient services are not outrageous at all. Somebody else is pocketing a lot of that money, and hospitals are in that group.

 

[Offgrid Organic Farmer]

... Are we a sicker nation?

Are we sicker?

No, I do not beleive we are. We live in a nation that has the highest costs for healthcare.

Drug companies are allowed to charge high prices, here.

Insurance companies in the USA make record profits.

Doctors want higher pay so most of them become specialists who are paid more.

Our waiting lines to see a specialist are much shorter than they are in other nations. I live in a border town, my nearest hospital gets a lot of medical tourists [foreigners who come here for medical treatment, that in their native countries would require very long waiting lists].