Why our health care system is so expensive...

[RetMD21]

You can just call the fraud phone number in your Medicare Summary Notice. I think an injection and an incision are meaningfully different. Let us know what happens.

 

[keppelbay]

in a word: litigation

 

[Qs Laptop]

There's much more R&D than in other countries. Less expensive systems did not come up with a COVID vax, for example.

AstraZeneca COVID-19 vaccine, for example.

 

[Midpack]

Interesting article but it never goes very deep on reasons for the "truths" that it describes.

I was giving a source for an outline of the reasons healthcare is expensive. If you have a better source, by all means share it with all of us.

 

[YellowSubmarine]

Do you have the details on how the US gummint paid for "development" of that drug? I ask because a lot of drugs are created by gummint money - often at universities with gummint funding. I'm guessing most drugs are "found" that way. Most "Big Pharma" drug companies farm that part of the business out to universities and smaller drug companies.

And yes, drug companies "license" those drugs which are now a "chance" at treating/curing something.

But generally speaking, drug companies "develop" them and get them through the lengthy and expensive approval process. The drug companies are the ones who get sued when the one person has an adverse event that was not discovered among the 10,000 people in clinical trials.

Ordinary looking pills? Likely cost the drug company what? A dollar to make, right? Right. Maybe only 10 cents. But the clinical trials to get approval to treat a few thousand cases per year with that dollar (or 10 cent) pill cost a billion dollars (with a B).

How many treatments will a drug company create if they are not allowed to recoup costs and make a profit for their large investments?

Plenty of issues and lots of folks to blame for high health care costs. Drug companies are greedy and totally profit motivated. Not much altruism there, that's for sure. But we all want safe and effective health care. I can't think of too many things more valuable to spend my money on than that. I'm okay with making a drug company rich if they cure me or provide me quality of life. (Heh, heh and I buy their stock too). YMMV

Okay, but meanwhile I will source this med overseas and pay <$130.00 perhaps. It's a rip
Got to love our trial lawyers.

 

[ivinsfan]

I was giving a source for an outline of the reasons healthcare is expensive. If you have a better source, by all means share it with all of us.

I scrolled thru that article but I can't stop laughing at the term health economists...if healthcare needs its own economists we are doomed.

 

[sengsational]

The thread title doesn't really align with the first post, does it?

At to the first post, do what MD21 said. Report fraud. If the guy spent 5 minutes, the associated CPT code would have to be reimbursed at a level of a hundred or a couple hundred at the most.

As to the thread title, I know we pay more, and the outcomes aren't as good on average, but there's nowhere in the world better for over 65 year olds, according to Peter Attia. And Medicare is reasonably priced, IMO. Sure, it's far from perfect, but it works for most retired people.

 

[martyp]

One of the best things about living in Thailand is how good and inexpensive the health care is here. The quality in the private hospitals is as good as the US for most things and the accessibility is much better. I have a $1,500 deductible on my insurance and I have never had a medical bill over $700-800. Overnight hospital stays, emergency room care, MRI’s, specialist doctors - all under $800.

Anything involving labor is cheap but it can’t be that cheap here to account for the lower costs abroad.

 

[jesaco]

this is unusual, are you saying that your Medicare EOB, did not reduce the original billing by even one dollar. My DH had an open heart surgery on Medicare and they reduced literally every single item on the multi-page EOB. Sometimes the charge was reduced by a few bucks and other times they literally zeroed out the charges saying this item is already covered under another charge in the billing summary. So in our experience they CAN charge whatever they want but Medicare actually decides what and how much they are going to pay out. Something doesn't sound right in your case

All I see is that the EOB states (My issue really is why an injection was coded as an incision or minor surgery)

Billed $5,655.00
Insurance covered $5,488.94
payments and adjustments- Medicare ($5,488.94)
- Humana ( $0 ) - due to deductible

reviewed the EOB again, its for the supposed "incision" , x-ray and office visit in total and I am still being billed by doctor for the balance. maybe I'm reading it wrong?

 

[jesaco]

I have a couple questions, I have/had a trigger finger, I would describe it different though. When I closed my hand the finger would get stuck, when you tried to open it, it would trigger open. "TV commercials analysis would suggest you are describing Dupuytren contracture.'
I have been in twice in the last two years to have a trigger finger injection. The most recent in March 2025, For the outpatient visit, the provider charged $210, Medicare Approved Amount $74,66, Medicare Paid $58,55. For the Tendon Injection, the provider charged $172, Medicare Approved Amount $47.91, Medicare Paid $37.56. The cost for the triamcinolone acetonide 10mg, the provider charged $24, Medicare Approved Amount $1.80, Medicare Paid $1.41.
Have you received your Medicare statement? I have seen Medicare Approved amounts that are less than 10% of what the provider charged. The provider must eat it.

Your trigger finger were exactly the same as mine. rates you mentioned are reasonable.

 

[Alan]

AstraZeneca COVID-19 vaccine, for example.

Exactly. First patient in the world to have a COVID-19 vaccination was in England. Vaccine was developed by Oxford University who then partnered with Astra-Zeneca on the condition that it would be produced and sold at cost to 3rd world countries.

 

[RetMD21]

All I see is that the EOB states (My issue really is why an injection was coded as an incision or minor surgery)

Billed $5,655.00
Insurance covered $5,488.94
payments and adjustments- Medicare ($5,488.94)
- Humana ( $0 ) - due to deductible

reviewed the EOB again, its for the supposed "incision" , x-ray and office visit in total and I am still being billed by doctor for the balance. maybe I'm reading it wrong?

I think it matters how much was payment and how much was adjustment. If you really want to resolve a problem or get a better understanding you can call the fraud number. EOBs from insurers are sometimes hard to understand. I would advise you again to look at the MSN.

 

[sengsational]

Your trigger finger were exactly the same as mine. rates you mentioned are reasonable.

Something is seriously amiss if a finger joint injection under ultrasound guidance netted the provider more than a couple hundred bucks. Maybe they put someone else's codes on your account. They could claim "clerical error" to skirt the fraud charge.

 

[Gumby]

in a word: litigation

This article from the NYT (and the associated study it links to) is almost 7 years old, but I have no reason to believe that things have changed substantially in the intervening years. It makes the point that it is not the direct malpractice claims that drive up the costs, but the resulting "defensive medicine" practiced by physicians to preemptively head off any malpractice claims, because that results in excessive and often unnecessary testing that does not improve outcomes.

A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests (Published 2018)

Doctors are known for complaining about how the malpractice system adds costs. But it has been hard to prove, until now.

www.nytimes.com

https://www.nber.org/system/files/working_papers/w24846/w24846.pdf

 

[Midpack]

As to the thread title, I know we pay more, and the outcomes aren't as good on average, but there's nowhere in the world better for over 65 year olds, according to Peter Attia. And Medicare is reasonably priced, IMO. Sure, it's far from perfect, but it works for most retired people.

I don’t disagree but Medicare is headed toward insolvency, so it’s not sustainable as is? I assume seniors will have to make sacrifices along with other generations, though I know some here will strongly disagree.

Every other developed country in the world provides health care more cost and outcome effectively - but the US can’t. Obviously where the primary problem is.

 

[sengsational]

All government programs have been on the brink of collapse for as long as I've been able read, LOL! I'm figuring they'll continue to find a way.

We pay a lot more for worse outcomes, on average, I granted that point. But it tips to better outcomes for fogies.

I appreciate "access." My sister and BIL in Canada have had significant hoops to jump through, long delays, and more. And this was on pretty much every they had to do. Multiple encounters each. And these were for something that I could have done in a week in the US. I can book with an internationally recognized expert, jump on a plane and get a consultation, whereas in Canada, if your GP retires, you can't even find a replacement GP that will take new patients. And one of our fellow e-r buddies that I've kept in touch with has dealt with these kinds of issues too. I certainly don't want what Canadians have!

 

[COcheesehead]

I have a friend who is a doctor. He has sort of has an interesting take on all this. He said the days of practicing medicine are behind him. Now he has to fit your cure into what the insurance will pay for and he spends an inordinate amount of time documenting all of it. He said he feels more like a bureaucrat than a doctor.

 

[VanWinkle]

Medicare is Insurance supplied by the government, not government healthcare. Government healthcare might look more like Medicaid, but no one knows for sure. I'll take my chances with what we have vs some unknown that could be far worse.

 

[pacergal]

I have a friend who is a doctor. He has sort of has an interesting take on all this. He said the days of practicing medicine are behind him. Now he has to fit your cure into what the insurance will pay for and he spends an inordinate amount of time documenting all of it. He said he feels more like a bureaucrat than a doctor.

Unfortunately true, in my experience. so many hoops I had to go through to help my patients get their medical care covered. Even in a low cost government health clinic, patients were still charged some part of their care( as appropriate on sliding scale) and would forgo said care if they could not afford the co payment. So making sure everything done was "covered by insurance" as best as I could required doing what the insurance company required, not necessarily what the Dr wanted or desired. So many denied claims for needed care, then calling the insurance company to find out what hoops to go through. Frustrating! And formularies changed all the time! Just when I thought I had the right ones so I could relay to Drs what RX would be covered and what needed PA, they would change.
Ahh, off my soapbox now.
So glad I am retired, but I do feel for the medical profession. Insurance companies do not make it any easier.

 

[Rianne]

I think our healthcare system is expensive because it's based on treatment rather than prevention. And sadly, profit.

 

[Closet_Gamer]

I’ve been in the American system and I’ve been in the British system.

I will take the American system.

 

[Irishgirlyc58]

in Canada, if your GP retires, you can't even find a replacement GP that will take new patients. And one of our fellow e-r buddies that I've kept in touch with has dealt with these kinds of issues too.

Not being able to find a PCP replacement for months happens where I live in California. If you live in the rural north in California your health care availability can be dicey. I assume that happens in other areas of the country.
I live close to Sacramento and can easily drive there for healthcare if needed but for those further north it can be a day long drive just to get there.

 

[CalBird]

American high cost healthcare system plus the for-profit health insurance is such a disaster. Normally you don’t know the cost before having the medical service. Then you get the bill that largely difficult to understand what’s the justification of the charge. It’s completely up to the medical service organization and insurance companies to decide what you owe.

 

[Gallaher]

During WWII. There were wage freezes, and offering healthcare insurance was a legal way to offer incentives to workers.

This why Keizer went from being ship manufacturer to being a healthcare provider……obviously more money

 

[Gallaher]

I had trigger finger surgery in the office last year. All in total cost was about $1,000. Commercial insurance