TouristTrap

U.S. gets bad grade on health care scorecard
Americans pay most, but only get mediocre care, report says

http://www.msnbc.msn.com/id/14928778/

Dan725

Serious question, why is it that healthcare in the US costs twice what it does everywhere else? I'm not talking about individual cost, even if the insurance picks up the tab, why is it so bloody expensive?

Having seen the scamming and debacles that call themselves "Medical Insurance" and "Medical Billing" companies, my take is that these paper pushing middle men with their outrageous fees for doing nothing apart from shuffling bills around are the culprit. Its regularly reoccuring major economic crime on a grand scale, yet they rarely get prosecuted for it.

Angry White Pyjamas

Insurance premiums for doctors.
Billing companies fees
The expectation that doctors earn 6 and 7 figure salaries
Profiteering by companies that run facilities...

For instance heres an article about TENET a major operator of medical facilities about their price gouging practices:

http://www.uow.edu.au/arts/sts/bmart...t_gouging.html

Note that TENET (who run hundreds of facilities) used to be called "National Medical Enterprises (NME)" and were raided by the FBI in conjunction with cases of insurance defauding in the 90's:

" during the 1980s and 1990s the company was called National Medical Enterprises (NME). It was involved in a massive scandal defrauding Medicare by buying patients for up to US $2000 each from anyone who could persuade them to come to hospital. The company had contracts with bounty hunters and even pleaded guilty to kidnapping a patients. It bought patients from Canada....

...Vast numbers, many of them children did not need hospital admission. The company lied to them and kept them in hospital for the full duration of their insurance all the time providing them with vast amounts of unneeded treatment. All of this was signed for by doctors. The company eventually pleaded guilty to criminal practices in 1994, was forced to sell its specialty hospitals where the fraud occurred, entered into a variety of integrity and compliance agreements and paid in the region of US $1 billion in settlements and compensation to patients...

...in 1999 It immediately resumed its former business policies and practices. It used its market dominance to rapidly increase its prices while at the same time targeting sicker patients and complex procedures. This allowed it to circumvent the restrictions on profits imposed by Diagnosis Related Groups (DRGs) funding....

The second scandal broke in October 2002....once again gamed Medicare to generate vast profits, and that large numbers of patients were subjected to profitable invasive cardiac procedures and surgery when there was no need for this."

Manc

that's only fair though seen as they have 6 and 7 figure student loans to pay back.

in order to lower doctor wages, we need to scrap the loans.

Angry White Pyjamas

I agree. Its all part of the vicious cycle of the almighty dollar.

Hiro11

I think there are several reasons (based on my limited understanding):

1. There's absolutely no competitive price pressure or pricing transparency in healthcare from the consumer's perspective. I honestly don't actually know what a doctor is charging me as I have good insurance. I don't cross-shop ever because I have no idea how to compare pricing. Compeition would force in industry to get more efficient.

2. We're all are generally compelled to get more, better and fancier healthcare, regardless of price. People don't care how much an optional test is going to cost as long as they feel they're getting the best service. Because of the insane malpractice liabilities, doctors are compelled to push to expend every possible resource in the pursuit of any possible solution to even the most minor problem and insuance companies rarely say no. It's even worse with end of life care where every possible expense is taken to save unsavable lives. Even state-mandated coverage has gotten ridiculous: accupuncture coverage is required in 11 states, chiropractors in over 40 etc...

All of this is exacerbated by the lack of transparency into costs, increasing life spans, a rapidly fattening population and ever increasing technological capabilities. Lastly, there's no increase in efficiency that goes along with this technological advancement. Unlike, say, manufacturing, increasing tecxhnological sophisitcation leads to simply more work required by high skilled labor rather than less.

3. Huge costs for talent and physical space. It costs hundreds of thousands of dollars to train a doctor and they spend hundreds of thousands each year on insurance. Malpractice suit damages are completely out-of-hand these days. Healthcare facilities are forced to adhere to unbelievably high and unbelievably expensive regulatory standards. the technology your average doctor needs to acquire to provide "standard" care (MRI, CAT scans etc) gets more expensive each year. Forty years ago, a doctors office could fit in a bag, now they look like Space Shuttle assembly plants.

others:
4. Binding inter and intra state insurance regulation
5. Increasing rates of chronic, expensive-to-treat deseases like diabetes, asthma. Better detection of nuisance conditions like allergies etc.
6. Ridiculously drawn-out, expensive drug validation procedures. The unbelievable R+D costs of developing new drugs and the rapid adoption of these new drugs as they are created.

etc, etc, etc.

It's not as if Americans don't realize this is a problem. This topic has been hammered in the press, on the Congressional floor and in corporate board rooms over the past few decades. Healthcare systems worldwide (notable examples: the Canadian and UK systems) are well on the road to seeing similar issues.

ironporer

Not an altogather bad idea- if you couple it with a period of public service work-where they would work with programs for the uninsured, medicare etc sor a minimum wage of...say $85,000 (nice salary for most...a pittance to a recent medical student grad) a year for 3-4 years.

One other thing that might help would be to immediately do away with the AMA's limits on new medicos thru licensing or restricting medical school graduates. Free visas to any doctor who can pass the same test as an American doctor too!! Add another 200,000 doctors, and you'ld see them making a nice $100-150K living- and reasonable prices for most services.

Chorlton

They needed a survey for that?

Manc

and you can't blame someone either for raking in $250,000 a year...........after spending 4 years in college, further 2 years in rotation, and finally then, earning money as a resident.........$50,000 or so.

but even as a resident $50,000 only works out to be $5 per hour when you take into account the hours they are at the hospital.

cindyabs

The cost of malpractice insurance isn't cheap either...........

Duncan Roberts

I have to stick up for medical billing companies a little. With all the HIPAA regualtions it's almost imposible for hospitals/doctors/etc to keep within the regulations without some kind of outside company doing it or providing software to do it. Also, more and more insurance companies, including medicare and medicaid, are now requiring that almost all claims have to be submitted electronically which can't really be done without an extra cost for the providers.

paddingtongreen

In the early days of the NHS, people were upset to find that there were more admin people than doctors and nurses. Some how, the free enterprise system seems worse. I don't mind doctors and nurses making good money, is the others who seem to make better money that I don't like. There are too many people feeding from that trough. I would love to know how much of the cost of healthcare goes into buying the fancy cars for lawyers and the financing of political campaigns.

Angry White Pyjamas

A (resident) doctor friend of ours was on call a straight 120 hours over the labor day week.

Longy

I can't see the full list anywhere, but judging by the last paragraph it doesn't look like the UK does too well in the report either....

But the United States scores 15th out of 19 developed nations on deaths from causes that are easily prevented if timely medical care is provided, such as heart attacks. France scores the best, with 75 deaths per 100,000, while the United States weighs in with 115 per 100,000. Only Ireland, Britain and Portugal score worse.

Angry White Pyjamas

"U.S. infant mortality is far higher than in any of the other 23 countries measured, with a rate of 7 deaths per 1,000 births."

Which is not good for the self proclaimed leaders of the western world.