Why is health care so expensive in America?

[ColbertWatcher]

[flvegan]

1. E&F is the only correct answer.

Insurance being both health and liability.

[ayeshahaqqiqa]

2. Insurance companies have no incentive to keep health care down

As I understand it, insurance companies are allowed to keep only a certain percentage of their premiums each year. When health care costs go up, however, they can raise their rates. So there is no incentive for them to keep costs down--after all, 10% of $1 billion is a lot more than 10% of $1 million.

[Jackpine Radical]

9. Then why the hell does my small clinic have to employ somebody full-time

to fight them over claims? Why are they continually trying to force us to sign contracts that cut our hourly pay rates in half?

A service denied, or a provider screwed, is a profit made.

[ayeshahaqqiqa]

35. That's part of it too

Doncha love it when the insurance companies come in and tell you NO you can't give the patient prescription X--it has to be prescription Z, even though it is documented that Z doesn't work for that patient and actually causes bad side effects?

I know what it is like to fight over claims. That is part of my job at the clinic where I work.

[anonymous171]

20. That is why Health Insurance should be provided by the state.

"Market forces" make it worse, not better.

[Jackpine Radical]

38. Yes. Exactly.

[eridani]

39. The real problem is their diversion of health care dollars away from health care n/t

[Earth_First]

3. E&F is the only correct answer. n/t

[rucky]

4. Because of E & F...also C.

[RC]

13. And your basis for C?

[L0oniX]

5. Sociopath HMO CEOs

[Jackpine Radical]

7. Yes, that's a huge factor.

[Jackpine Radical]

6. More E & F than the other choices. but really because the whole system

has gotten very out of balance and screwed up. A great deal of money is spent as providers & insurers battle each other over payments. Competition among hospitals has caused insane duplication of unneeded resources such as too many MRI machines, which they then struggle to find business for. Maybe docs get too much; some do, but some don't; this is not a major driving factor in prices. Neither is malpractice insurance, nor malpractice lawsuits. The malpractice insurance is somewhat out of line, but again is not a major driving problem. Overall, a for-profit system doesn't work well as the overall model for health care delivery.

[wolfgangmo]

66. Also consider that malpractice is not an issue...

... in countries where there is universal care because the largest part of any settlement or lawsuit is the cost of ongoing care, which, in countries with universal care, is covered. Thus any malpractice awards are much lower on average and not filed in the majority of cases.

[The Gunslinger]

8. A, E, F

[hunter]

18. Front line primary care doctors are paid less than they ever were.

Once you work out the student loans, the insurance, and everything else, an ordinary pediatrician of today enjoys about the same standard of living as an ordinary union high school teacher of the 1970's.

The only people who become doctors these days suffer abnormal levels of altruism or seek specialties that are still highly paid.

Britney Spears needs bigger boobs, and there's always some drug addict celebrity who needs saving. Or maybe you can keep watch over Dick Cheney's heart...

:woohoo:

[Jackpine Radical]

40. Maybe that's why the majority of students in med school today are women.

The numbers are even higher for grad students in PhD and PsyD clinical psych programs.

[johnlal]

46. Many of us pay "student loans, insurance and everything else"

Doctors are not the only people who have to pay student loans, insurance, and overhead. Why do you lump that in?
Additionally, why do you compare doctors to '70's era teachers? Are you implying that teachers today are better off than doctors? The comparison seems arbitrary.

[wolfgangmo]

68. He lumps it in for primary care doctors

The average of which makes about 96K a year. While this seems like a lot, keep in mind that this is based on a 70 hour work week, and that half of the primary care docs earn less than 96K.

Also the average student loans for a doc is 250,000 dollars. My wife is a doc at our clinic. She makes about 48K a year and we take half of that to pay student loan minimums, about another 10% on insurance and about another 20% of that for overhead.

This means that she keeps about 20% of 48K a year in take home.

And I am just waiting for some idiot to say that she should get another job. She loves what she does and she gives away a lot of free care. But yes, she is looking at making a change by moving to Canada where she will work half the hours at at least twice the pay. America's loss.

[johnlal]

84. I don't think she should get another job...

If she likes what she's doing she should keep doing it. But keep in mind, there's a lot of people who are paying student loans who don't make $96,000 a year. There's a lot of people who work several hours a week, and pay high overhead because they love what they're doing.

It's a trend in America that people are doing a lot more work for a lot less pay and benefits. Nowhere is it written that doctors have a right to be rich just because they are doctors.

[Runcible Spoon]

56. well I think a lot of specialists have found a nice comfortable niche....

I agree that primary care docs are not responsible to nearly the same extent...

[Greyhound]

30. E&F are the largest factors by far. A is not really true as doctors have been getting squeezed

more and more by E, F, and their predecessors. Doctors on the whole don't make that much any more and the more recently they graduated the less they have to look forward to.

[johnlal]

47. I don't know about that...

My doctor drives a pretty nice car...

[Greyhound]

77. I didn't mean to imply that they're impoverished or anything, but there

is a great deal of downward pressure on them now. Imported Dr.s, and employment limited to working for the care denial companies, and the continued increases in patient load have taken a toll.

One of my old neighbors had just finished his residency (this is about 8 years ago)and was employed by Kaiser-Permanante as a GP. He was working 70 - 90 hours a week and his take home was under $70K (that's < $20 p/hr). The working conditions were really terrible too, they actually calculated the number of minutes he was allowed to spend with a patient and were constantly riding him to keep it under 4 per, and every time he referred someone to a specialist he was called into admin to explain why.

[OhioChick]

10. Insurance Companies and Big Pharma. n/t

[4 t 4]

11. I agree with all of the above but

I think one of the biggest reasons is because so many people don't have insurance so all hospital and doctors charge such high costs to make up for those that will not and cannot ever afford to pay. I know that is the case with hospitals that's why a tylenol costs like 9$ to compensate for those that will never pay. Plus they're all greedy bastards. It is now such a business it use to be more of a actual service. Health care in the United States use to be more non for profit.

[Jackpine Radical]

45. Nonprofits got run out of business because

the for-profit outfits would treat only insured, paying patients, dumping the poor and uninsured on the nonprofit hospitals. And medical assistance pays so little in most states that it isn't even worht messing with. Most dentists won't take it at all. I droped my MA number years ago because the hassle of dealing with authorizations, collections and denials of payment was not worth the pittance they were paying me. Instead, I either work out a sliding fee arrangement or do pro bono work when necessary.

[Donnachaidh]

55. I worked in a medical parts factory years ago

We made those plastic tips used in corneal replacement. As a worker, I was required to crank out 1800 of those little parts per HOUR. The actual cost for the part in silicon might have been one cent. Out of curiosity I start enquiring about what the hospitals were charging patients for those little tips.

Remember, the cost of actual materials was about one cent. Each worker was required to produce EIGHTEEN HUNDRED of those per hour.

The hospitals were charging patients $75 per PAIR. SEVENTY FIVE DOLLARS for a part that cost ONE PENNY. So the lowly workers making minimum wage were cranking out $67,500 worth of PROFIT PER HOUR for someone somewhere.

And this was over a decade ago. How many people have had corneal surgery in that time? How much have the prices gone UP in that time?

I find it very hard to pity a system that rakes in OBSCENE amounts of profit, and then whines when people ask for change. And we are going to have to take the PROFIT out of healthcare, in order to come up with a system that works for ALL Americans.

[wolfgangmo]

71. You are partly right.

Yes there is some greed and overcharging happening with hospitals, however the majority of extra costs are because the hospitals regularly settle for pennies on the dollar with insurance companies. They charge that much in order to get enough to cover operating expenses. The insurance companies have rigged the system. In order to play the game, hospitals and doctors must charge more, knowing that they will get paid only a percentage of the total bill. If they billed reasonably they would be out of business within months.

This is not to say that there are not numerous examples of hospitals screwing patients. In that you are 100% on target.

[OhioChick]

12. UnitedHealth posts $1.2 Billion quarterly profit

UnitedHealth posts $1.2 Billion quarterly profit

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=132&topic_id=3062484

[RC]

14. Why is For Profit health care allowed in this country?

[mike_c]

49. because in America EVERYTHING is for sale....

Human suffering is a resource to be mined for potential profit. You wouldn't want that income source to go to WASTE, would you? Or to be sub-optimally developed? Of course not.

:puke:

[ColbertWatcher]

21. This is shocking. It's almost two years old, but still shocking. n/t

[OhioChick]

24. Since it's two years old....

I'd venture to guess that they make much more quarterly now.

[Statistical]

15. Lawyers.

It has been documented in multiple medical journals that doctors order unecessary tests.

They do it to cover their ass.
Malpractice insurance has gotten so expensive and medical suits so massive that many malpractice insurance companies WON'T cover the doctor unless they order dozens of useless tests to insure they have a fighting chance in a malpractice claim.

Worst hit are OB/GYN.
Some towns have no OB/GYN simply because no doctor can afford the malpractice insurance premiums (which can run as much as $32,000 per month for an OB/GYN that performs deliveries).

[JDPriestly]

26. They also order the tests to save life.

[Maru Kitteh]

29. They also do it because of real humans of genius like this:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=4772236&mesg_id=4773130

[wolfgangmo]

73. Let's light that straw man on fire.

OK, let's ignore for a moment that most malpractice lawsuits that get a court date are chucked out for lack of evidence and that the vast majority are only settled because the malpractice insurance companies tend to settle rather than fight. The highest estimates I have seen on malpractice suits is that they cost the system about 2%. If you compare that to the average 27% administrative costs , malpractice is small indeed.

You should know that in a single payer system both the number of lawsuits and the rewards would go down precipitously. Why? Because the largest monetary part of any award is the cost of continued care. As this would be covered automatically in single payer systems, this part of the award would be moot. There would be less incentive for frivolous lawsuits as well as smaller awards. How do I know this? By comparing my malpractice rates with quotes for Canada, Australia, France, and Italy where single payer systems are in place. They are orders of magnitude less expensive.

I don't like insurance companies generally, but their actuaries do not set any rates that will lose the companies money. The malpractice insurance companies own statistics prove my point.


Now go forth an spread this mistruth no more.

Cheers.

[MazeRat7]

16. Other - we do not have "health care" we have "illness management" here in the west...

We treat disease, not health. There is no money in helping well people keep well... but there is tons of money to help (promise) sick people wellness.

Peace,
MZr7

[eridani]

42. 5% of the population accounts for 50% of costs

20% of the population accounts for 80% of the costs. OF COURSE that money is used to treat disease! Jeebus! Most people are not going to get expensively sick. Any good behavior on the part of the healthy majority is irrelevant to costs. As someone famous said a long time ago "It is not the healthy who need a physician, but they who are sick."

[Selatius]

17. Insurance companies fight tooth and nail to deny care and spend money on secondary operations.

The result is hospitals have to employ dedicated staff just to handle the insurance issues. Further, by denying insurance based on pre-existing conditions, forcing patients to see doctors that they find "affordable," and providing incentives to make patients accept higher deductibles, they can increase their profit margins and executive compensation, most likely at the expense of providing easy, affordable, effective care to all. What's worse, some of the money spent on health insurance goes to non-related functions, like lobbying Congress to continue such a system.

[norepubsin08]

19. Greed and liability

[stuntcat]

22. my birth control pill was gonna cost $40 or $50 a month :p

Luckily someone told me how to order it, $6 a month, from England YAY!
It's a hassle, but a hassle I'll have to put up with for another decade at least! :p


Just my little addition to this stuff. One of the things I hate the world for daily :)

[leftofthedial]

23. A, E and F

(some doctors)

[hunter]

25. See above.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=4773246&mesg_id=4773603

[warren pease]

27. Because for-profit medicine is an extortion racket that has nothing to do with health care...

This isn't a health care system. It's just another corporate shake down. Premiums are protection money paid to professional extortionists to keep medical providers from stealing your house, cars, bank accounts and anything else that isn't fused to the earth's core in case something serious (i.e., expensive and maybe requiring hospitalization) happens to you.

Medical insurance has nothing whatsoever to do with health care except in the twisted minds of Chicago School libertarian fanatics and free market pitchmen. Break that nonsensical, artificial link, dump the idea of for-profit medicine entirely, replace it with a single-payer, universal-access system and spread the risk over the entire population in the form of a modest, progressive tax.

In other words, take a hint from the rest of the modern world where people pay far less per capita for their health care, never see a doctor invoice or hospital bill and enjoy far better outcomes than in the US -- lower infant mortality rates, longer average disease-free life spans, a focus on preventative rather than reactive care, fewer stress-related illnesses and deaths per capita, and on and on and on.

And here's the final insult: We suck at keeping people healthy although we spend far more money pretending to try than any other country in the world. Here's some stats I got from a sort on the World Health Organization database and, lookie there, the US spends more money as a percentage of GDP than any other country in Europe or the Americas.

Which is bad enough, since most of these other countries spend far less and still provide universal access to health care for all. But then you look at this chart and see that the US ranks 37th in the world in overall effectiveness of its health care system -- right ahead of that medical nirvana, Slovenia.

There's no possible way to put a happy face on a system that allows bottom-line-driven public corporations to net obscene sums by selling access to health care providers, reserved solely for those who can afford the premiums, deductibles, copays and the rest of their bullshit fees and phony charges -- while keeping the riffraff out by denying access to those who just can't afford to get sick.

The practice of triaging by bank account balance literally imposes death sentences on at least 22,000 Americans every year, according to this study, released in January 2008, and entitled Uninsured and Dying Because of it. The summary includes this particularly shameful sentence: "According to Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006."

The US does so many things so poorly compared with civilized countries. And it's all about money and profits. There's no other reason for such a dysfunctional system to even exist, much less become the model for a medical scam that never tires of thumping its collective chest and declaring its superiority to anything those damn furriners do.

And why would that be? Because it's American, goddammit, and that's all that's required to grab the top spot in anything. Or so I'm told by fools and idiots.

USA! USA! USA! Perfecting the art of systemic suckage, just for the children.


wp

[Maru Kitteh]

28. E & F in differing amounts for different reasons.

Between the two, the insurance companies are the at the absolute bottom of hell.

[StreetKnowledge]

31. E and F.

E more than Fr, but both are guilty. The idea of for-profit healthcare has become ridiculous. People are dying as a result. We need HR 676 passed, right now. That shoulda happened 30 years ago.

[JCMach1]

32. Doctors, Hospitals, Pharmaceutical Companies, Insurance Companies are all guilty of greed

Oh yeah, and then there is the consumer who often has unreasonable expectations.

All of this = the disaster of a system we have...

[quidam56]

72. Profit Care comes way ahead of Patient Care

The politicians and profit machines see to themselves first. http://www.wisecountyissues.com see what is on record as the acceptable standards of health care in Tennessee. Hospitals are infecting our communities with MRSA but as long as there's a buck to be made, so what.

[JCMach1]

82. We have been applying 'free market' principles to a system where there

is little or NO choice for most people.

The free market does not work when it comes to health care. The rest of the world knows this, why can't Americans figure that out!

[Quantess]

33. Don't forget, malpractice lawsuits and malpractice insurance.

Not the biggest reason of course, but it is a factor.

[eridani]

43. About 1% of costs

The reason that people in sane developed countries don't sue as often is that they automatically have a right to treatment for any medical mistakes. With universal health care as a right, that motive disappears.

[Donnachaidh]

58. if the AMA would actually police itself and force out the bad apples

This wouldn't be such a factor.

[Lucian]

34. It all comes down to big corporations wanting to make money.

They couldn't care less about helping people.

To sum it up in one word: greed.

[johnlal]

52. A sense of entitlement...

Doctors are accustomed to a certain level of wealth +
Insurance Executives feel entitled to a certain level of wealth +
Pharmaceutical Executives feel entitled to a certain level of wealth+
medical services and affiliated industries feel entitled to wealth

and they all rely on poor and less wealthy people to keep them at their desired level of wealth.

[Lucian]

62. Greed.

[Deja Q]

36. E, F, and others

The cost to get educated in the field.

The rumor that these industries (medical, legal) only allow x number of people into the field to help keep prices jacked up. A rumor I cannot substantiate, so take that with a grain or bucket full of salt.

[Soylent Brice]

37. 2 things:

1. 5th rec


2. the answer is Richard Nixon.

thank you magnetic tapes.

[Cleita]

41. I just finished reading Tom Daschle's book on health care,

"Critical, What We Can Do About The Health-Care Crisis". I'm really bummed, he knows the problem in detail and admits single payer is a good solution for other countries, but not for us. Instead, he's pushing for a plan like Massachusetts, which is already proving not to work. I hate these DLC types. I intend to write him a letter telling him where he is wrong, giving him examples of why it's wrong and unworkable and I hope he reads it.

[mike_c]

50. that's the main reason I oppose Daschle for HHS....

Anyone who acknowledges that there is a best solution for a pressing problem but then advocates against the best solution is, in effect, advocating FOR the problem, i.e. Tom Daschle seeks to perpetuate the health care problem, not to solve it.

[Cleita]

51. Well, he's already it, so I guess it's up to us health care activists to try to

change his mind. Honestly, I'm so fed up with fighting but fight I must.

[newtothegame]

44. What exactly is the proposal on the pharmaceutical companies though?

Are we gonna punish them? Do we really foresee innovation in drug research if there's no profit?

[mike_c]

54. absolutely-- in academic research settings with public support....

The pharmaceutical industry has effectively hijacked drug R&D. A far better model might be to provide adequate support for academic science and medical research. That takes the profit motive out of the equation all together-- but I can assure you, the folks actually doing the research- most of us, anyway-- want to do THAT work regardless. I'm not a medical researcher but I nonetheless do most of my science on minimal support, often working for free just because it's what I love to do. That model makes much more sense to me. Support public research adequately.

That will also lead to more research into curing maladies that don't offer huge profit incentives. The pharmaceutical industry spends billions researching cures for hair loss and the like, or for diseases that are common and widespread, but little or nothing for terrible diseases that don't have major profit capability. Many of those diseases interest academic scientists for a variety of reasons, however.

That model could be enhanced and supported by the national lab system, with medical and pharmaceutical research being conducted by government scientists. Not everyone likes academia, but many very smart and capable people love working in the focused environment of the national or agency labs.

[wolfgangmo]

74. Another straw man dances into the discussion.

Let me ask you a question.

The US is the ONLY country that has private insurance and companies running the show, right? So by your logic, the only country where there would ever be any drug research happening is the USA.

And yet there is a flood of medical and drug research happening in other countries. So either your logic is faulty here, or all those innovations happening in other countries are happening by magic, because their medical and research systems are obviously non existent.

Thanks for the question. To answer it, yes, I think that drug research and medical innovations will continue. They will just have to settle for less than quasi criminal profits just like every other big company does in single payer countries [google drug companies and check out how many of them are headquartered in Canada or the EU. Hint; the reason is their publicly funded research facilities.

[newtothegame]

76. What logic? I wasn't making a point, I was asking a question.

A little less time "troll-hunting" and a little more time making discussion, and we'll make a legitimate poster out of you yet!

Hugs and kisses :)

[undeterred]

48. I think we can get the answer by comparing it to veterinary care.

Veterinarians have comparable professional training and good but not exorbitant salaries. They have overhead, but generally they do not get sued. Often they use the same pharmaceutical companies (which manufacture for both animals and humans) and have the same kinds of supplies. The meds specifically manufactured for animals are usually for things that many animals have, like arthritis.

And while there is pet insurance now, it is not exorbitant and it does not determine whether animals will get care. Animals can have major operations like hip replacement, be treated for cancer, and get good emergency care.

If you compare the bills you can get an idea where we would be without the insurance industry. Insurance adds nothing positive to medical care, and makes it impossible for many people to afford care at all. After paying the bill for insurance and the copay, many people still can't afford what they really need.

[wolfgangmo]

75. Great post

And very good comparison.

[BabbaTam]

53. one reason

The medical equipment companies in the United States have a monopoly on selling hospital equipment and so they jack the prices up. (just one of the reasons)

[slackmaster]

57. E&F plus out-of-control litigation

Which raises the cost of malpractice insurance, and in turn results in doctors getting paid more to compensate.

[Donnachaidh]

59. litigation is required when the medical community protects bad doctors

As it stands now, the medical community does virtually nothing to see that the doctors that kill and maim are forced out.

[slackmaster]

61. I don't disagree with you

The problem is excessive settlement amounts.

[johnlal]

67. I see. That's brilliant!

So the patient pays the doctor's bill as if everything went perfectly, and if the doctor harms the patient, the patient has to bear the cost of the doctor's mistake.

I would estimate that for every doctor who gets sued for malpractice, 100 of them get away with harmful malpractice because either the patient doesn't want to be litigious, or because costs of litigation are too high, or because the doctors cover up the negligence.

[slackmaster]

70. That's a classic Straw Man - I never said doctors shouldn't be held accountable for malpractice

I would estimate that for every doctor who gets sued for malpractice, 100 of them get away with harmful malpractice because either the patient doesn't want to be litigious, or because costs of litigation are too high, or because the doctors cover up the negligence.

What else can you pull out of your ass?

[johnlal]

83. Just off the top of my head...

I can name at least 5 close relatives who should have sued a doctor or hospital for actual damage done to their persons who declined to do so. If I did more digging, I'm sure that I could find a lot more. Your average person really isn't litigious.

[harun]

60. Insurance companies are MUCH more of a problem than the pharmaceuticals

[Cleita]

63. I think big PhRMA is more insidious than the insurance companies.

They are inventing diseases to sell drugs. I mean no one, including doctors, ever knew of restless leg syndrome, until a prescription drug was advertised for it.

[meow2u3]

64. Both insurance and pharaceutical companies are trying to steal from the American public

by gouging their customers. They are charging sky-high premiums while simultaneously slashing benefits, if not on paper, in practice. The companies twist the rules to deny coverage as much as possible, despite what the contract reads, by perverting the meaning of "medically necessary."

Pharmceutical companies jack up the prices by having legalized direct-to-consumer prescription drug advertising, as well as other marketing and PR ploys, which they justify the hyperinflation of prices as "research and development." As in "research and develop new, devious ways to compete with street drug dealers to kill as many unsuspecting sick people as possible at the highest price the market can bear."

Many of those heavily advertised drugs have been put on the market because of the windfall profits of the companies--not so much for the alleviation of diseases. Reports have circulated that the drug companies push for lowering standards for normal levels of blood pressure, blood sugar, cholesterol levels, etc., and even went as far as to invent diseases that previously didn't exist, e.g., peripheral artery disease, all to push their products on the public via their physicians. They've changed the names of disorders and conditions to make them sound better, e.g., impotence has become erectile dysfunction. They've extended the length of the patent indefinitely, with the blessing of Republican lawmakers and policymakers who've taken millions, if not billions, of dollars from Big Pharma's lobbies. Even the Medicare prescription drug plans have the pharmaceutical lobby's tentacles on it; Congress are not allowed to negotiate to bring down the prices to reasonable levels; in other words, the companies have been given a license to steal from the elderly and disabled.

Roche, a Swiss company, have even admitted that they don't give a rat's ass about helping people get better; all they care about is the betterment of their bottom line. Unfortunately, you get more honesty from illegal street drug dealers then the legal drug dealers in the corporate suites. At least the drug dealers on the streets are forthright about their motive of making money, the consequences of people becoming sickened, addicted, or even six feet under be damned.

[Juche]

65. Administration and bulk purchases play a role

Under HR 676 if we had single payer and bulk purchases we'd save about $400 billion a year, which is about 1/6 of all healthcare spending.

Plus there is no real incentive to provide low cost care in the US. An insurance company tries to deny all care, not just expensive care. They may deny $50 medications that result in a disease progressing until it costs $20,000 to treat.

http://www.pnhp.org/publications/nejmadmin.pdf

[ColbertWatcher]

80. "no real incentive to provide low cost care in the US."

Your post and link are shocking.

Thank you for sharing this information.

You really should make it a separate thread; the information is important.

[Mz Pip]

69. Health care costs

are out of control partially do to price gouging.

Perhaps someone can explain to me why an out-patient cortisone shot to the hip is billed at $10,000. A friend of mine got a copy of the bill that was sent to the insurance company. She went in for a cortisone shot for inflammation in her hip joint. 10 grand. Wow. I doubt these kind of costs are unusual.

[Fire1]

78. And physician's mal practice insurance

[KamaAina]

79. Go rent "Sicko"

Q.E.D.

[lumberjack_jeff]

81. 80% of the problem is E&F. n/t