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Klein writes: "Two of the five most profitable industries in the United States - the pharmaceuticals industry and the medical device industry - sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability."

A number of medical procedures like MRIs are far less expensive in single-payer healthcare systems. (photo: Alamy)
A number of medical procedures like MRIs are far less expensive in single-payer healthcare systems. (photo: Alamy)



Why an MRI Costs $1,080 in America and $280 in France

By Ezra Klein, The Washington Post

06 March 12

 

here is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.

That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America's deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.

There are many possible explanations for why Americans pay so much more. It could be that we're sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, "it's the prices, stupid."

As it's difficult to get good data on prices, that paper blamed prices largely by eliminating the other possible culprits. They authors considered, for instance, the idea that Americans were simply using more health-care services, but on close inspection, found that Americans don't see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians.

"The United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do," they concluded. "This suggests that the difference in spending is mostly attributable to higher prices of goods and services."

On Friday, the International Federation of Health Plans - a global insurance trade association that includes more than 100 insurers in 25 countries - released more direct evidence. It surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor's visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we're paying quite a bit more. The exception is cataract surgery, which appears to be costlier in Switzerland, though cheaper everywhere else.

Prices don't explain all of the difference between America and other countries. But they do explain a big chunk of it. The question, of course, is why Americans pay such high prices - and why we haven't done anything about it.

"Other countries negotiate very aggressively with the providers and set rates that are much lower than we do," Anderson says. They do this in one of two ways. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they're set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.

In America, Medicare and Medicaid negotiate prices on behalf of their tens of millions of members and, not coincidentally, purchase care at a substantial markdown from the commercial average. But outside that, it's a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured.

Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say "no." In certain cases, the customer is passed out, or otherwise incapable of making decisions about her care, and the decisions are made by providers whose mandate is, correctly, to save lives rather than money.

In other cases, there is more time for loved ones to consider costs, but little emotional space to do so - no one wants to think there was something more they could have done to save their parent or child. It is not like buying a television, where you can easily comparison shop and walk out of the store, and even forgo the purchase if it's too expensive. And imagine what you would pay for a television if the salesmen at Best Buy knew that you couldn't leave without making a purchase.

"In my view, health is a business in the United States in quite a different way than it is elsewhere," says Tom Sackville, who served in Margaret Thatcher's government and now directs the IFHP. "It's very much something people make money out of. There isn't too much embarrassment about that compared to Europe and elsewhere."

The result is that, unlike in other countries, sellers of health-care services in America have considerable power to set prices, and so they set them quite high. Two of the five most profitable industries in the United States - the pharmaceuticals industry and the medical device industry - sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability.

The players sitting across the table from them - the health insurers - are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That's a signal that the sellers have the upper hand over the buyers.

This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. "We end up with the benefits of your investment," Sackville says. "You're subsidizing the rest of the world by doing the front-end research."

But many researchers are skeptical that this is an effective way to fund medical innovation. "We pay twice as much for brand-name drugs as most other industrialized countries," Anderson says. "But the drug companies spend only 12 percent of their revenues on innovation. So yes, some of that money goes to innovation, but only 12 percent of it."

And others point out that you also need to account for the innovations and investments that our spending on health care is squeezing out. "There are opportunity costs," says Reinhardt, an economist at Princeton. "The money we spend on health care is money we don't spend educating our children, or investing in infrastructure, scientific research and defense spending. So if what this means is we ultimately have overmedicalized, poorly educated Americans competing with China, that's not a very good investment."

But as simple an explanation as "the prices are higher" is, it is a devilishly difficult problem to fix. Those prices, for one thing, mean profits for a large number of powerful - and popular - industries. For another, centralized bargaining cuts across the grain of America's skepticism of government solutions. In the Medicare Prescription Drug Benefit, for instance, Congress expressly barred Medicare from negotiating the prices of drugs that it was paying for.

The 2010 health-reform law does little to directly address prices. It includes provisions forcing hospitals to publish their prices, which would bring more transparency to this issue, and it gives lawmakers more tools and more information they could use to address prices at some future date. The hope is that by gathering more data to find out which treatments truly work, the federal government will eventually be able to set prices based on the value of treatments, which would be easier than simply setting lower prices across-the-board. But this is, for the most part, a fight the bill ducked, which is part of the reason that even its most committed defenders don't think we'll be paying anything like what they're paying in other countries anytime soon.

"There is so much inefficiency in our system, that there's a lot of low-hanging fruit we can deal with before we get into regulating people's prices." says Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University. "Maybe, after we've cut waste for 10 years, we'll be ready to have a discussion over prices."

And some economists warn that though high prices help explain why America spends so much more on health care than other countries, cutting prices is no cure-all if it doesn't also cut the rate of growth. After all, if you drop prices by 20 percent, but health-care spending still grows by seven percent a year, you've wiped out the savings in three years.

Even so, Anderson says, "if I could change one thing in the United States to bring down total health expenditures, it would definitely be the prices."


View an interactive graphic: The High Cost of Medical Procedures in the US.


Related:

Klein: What the Business Roundtable knows about U.S. health care

On health care, Ore. picks up where Obama left off. But will it work?

The downside of digital medicine

 

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+131 # AndreM5 2012-03-06 17:15
The short answer is single-payer insurance.

Where did they get the idea that the health insurance industry has a "profit margin of 2.2%?" These companies have an administrative margin of 20-30%++ and pay dividends to shareholders. Compare that to Medicare's admin margin of 2% and you have a clear contrast in healthcare costs. The VA operates a genuinely socialized medical system and their costs are a fraction of even the "non-profit" HMO's such as Kaiser with a higher quality rating.
 
 
+57 # CandH 2012-03-06 18:26
"Coming Soon: The End of Health Insurers As We Know Them -- By Self-Inflicted Wounds," By Wendell Potter

"Aetna CEO Mark Bertolini caused quite a stir when he said at a Las Vegas conference a few days ago that the insurance industry as we know it is, for all practical purposes, a dinosaur on the verge of extinction." (http://michaelmoore.com/words/mike-friends-blog/coming-soon-end-health-insurers-we-know-them-self-inflicted-wounds)
 
 
+66 # CandH 2012-03-06 17:15
"Why an MRI Costs $1,080 in America and $280 in France"

Where can you get such a cheap MRI like that in the US? For uninsured patients, a T-2 weighted head MRI (with gadolinium contrast) cost in 2008 USD 4,200 in Silicon Valley. A veinous T-2 weighted head MRI (without contrast) cost in '08 USD 2,800. All payable immediately upon arrival, or no test. And prices have NOT gone down since then, only up.
 
 
+22 # jackson47 2012-03-06 23:50
I think this is the contract price for a health provider. A cash customer would pay the amounts you have posted.
 
 
+24 # NanFan 2012-03-07 04:06
Quoting jackson47:
I think this is the contract price for a health provider. A cash customer would pay the amounts you have posted.


Nope, jackson47, CandH is right. Insured heavily, I paid more than 2,500 USD for each MRI I have had in America, and I have had many.
 
 
0 # AndreM5 2012-03-07 10:32
We get reimbursed ~$600 total for a head MRI with contrast from third party payers including Medicare. Pharma gets about $180 for the Gadolinium DTPA alone. Cash customers will pay as much as the provider can extract from them, but even that is negotiable. There really is no single price for a healthcare service in the USA. "It depends." BTW, we run our MRI and CT scanners 24/7. The point about lower costs in France is disingenuous given the subsidies. So the obvious problem for our broken healthcare system is that many payers are subsidizing the costs of others. And all of us are subsidizing the profits of the few.
 
 
+6 # hasapiko 2012-03-07 20:05
I just had an MRI on my knee in Cincinnati. It cost just over $300 at Proscan. The same MRI would cost three times as much at Jewish Hospital. The hospital can get away with it becuse they have a captive market.
 
 
+26 # Activista 2012-03-06 19:24
" Two of the five most profitable industries in the United States - the pharmaceuticals industry and the medical device industry - sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability."
greedy doctors/dentist s MAXIMIZING $profits$ ...
 
 
+36 # Lolanne 2012-03-07 09:29
Quoting Activista:
" . . .
greedy doctors/dentists MAXIMIZING $profits$ ...


Generally speaking, it is NOT the doctors and dentists who are the greedy ones; it is, as the article says, the pharmaceutical and medical device industries. My son is a doctor. After all the years of medical school, internship, residency, and 7 yrs of practice, he FINALLY makes a decent income -- but he will be paying back student loans for many years yet to come.

Not that there are no greedy docs -- of course there are -- but it's pretty easy to pick them out and avoid them. They're the ones with the plush offices in the upscale neighborhoods who drive BMWs, etc. (my son drives a pick-up). But the docs I know are caring, thoughtful people struggling to make it in private practice, given its extremely high costs: malpractice insurance, extra salaries for employees required to deal with insurance, etc.

We definitely need single-payer NOW! But there are some simple things that could be done in the meantime to bring costs down. One very simple one would be to standardize the hundreds of forms insurance companies use and require them to all use the same one. But it will never happen as long as we have a government run by and for the corporations rather than the people.
 
 
+4 # Activista 2012-03-07 15:04
Your son could be exception to the rule. My last two experiences with doctor and dentist was to use insurance on MOST expensive procedure (root canal) that I did NOT need. Than I had to pay from my pocket what I really needed.
40 years in Chicago/Evansto n I had a toothache - went to the dentist to pull the tooth. He pulled the 3 teeth - on opposite side of mouth before pulling obvious bad tooth - $100/tooth - it was 4 x higher profit. It took me 40 years to realize that "Dr" would destroy person teeth for extra couple of hundred dollars. It was NOT in our culture.
Hart bypass surgeon in New York is making over half million per year on $50K surgery that in MOST cases is not necessary.
 
 
+13 # Lolanne 2012-03-07 15:55
Activista, likely we all can cite some horror stories of receiving unnecessary treatment from price-gouging medical "professionals" -- and I use the term loosely! I had one with a dental practice last summer after moving to a new state. Went to a nearby practice for my free preventive care apptmt (cleaning, xrays, exam) and they REFUSED to clean my teeth, saying I had gum disease and needed "deep cleaning and scaling" instead -- to the tune of about $400! I knew better, so I said NO and left -- with a "treatment plan" totaling $6000!!! I knew a lot of that was bogus, too. Saw another dentist (after wising up and reading reviews online, which I should have done to start with). Result: clean teeth, good solid exam, NO gum disease, NO "deep cleaning/scalin g" required, and a treatment plan amounting to less than $2000 (for crowns, which I already knew I needed). Quite a difference. I wrote a complaint/griev ance to my insurance plan suggesting they drop the first, obviously crooked, practice from their provider list.

It is definitely "buyer beware" with dental/medical care, just as it is with everything else these days.

I've had my share of unpleasant experiences with MDs too, but I still don't agree that honest, caring physicians are the exception to the rule. In my 74 yrs, it's the other way around -- there are SOME bad apples, but MOST have the highest integrity and ethics.
 
 
+11 # CandH 2012-03-07 17:31
I've had 15 surgeries in my lifetime (midlife now.) I've experienced dozens and dozens of medical professionals of all specialties from the time I was an infant. Like Wall Street, all aspects of for-profit medicine in this country, as a general rule, is tainted and corrupted by the for-profit model. US Medicine is predatory profiteering off illness, like WS predatorily profiteers off of misinformation/ignorance.

And BTW: "the SOME bad apples" meme is what has been repeated about WS, even today, when all signs are decidedly pointing to the complete reverse (ie SOME good apples.) Your son may be a very good doctor, but all that means is HE is the exception, not the rule.
 
 
+8 # KittatinyHawk 2012-03-07 18:56
These new pratcies who have a doctor and then hire the Nurses to do their work still charges price to see a doctor, I filed petition on that. I also file petition on the fact that my insurance pays $130 ti $160 and they only have to see us for 6 minutes I said that the two of them together weren't worth $19 no less their price. I fired them since they didnpt know what procedures I had, were going to do pap smear again and I had one a month before. Then ordered Mammogram, I just had one, I asked them and my Insurance Provider if they could read.
Too many people are going to Medical School to rip off People, not just Americans. Medical Practice is a very lucrative business. Sad thing is they love writing prescriptions for meds we do not need. Do little research into the meds, side affects but love the kick backs.

I hope your son is a good doctor, as they are becoming few and far between.
 
 
+6 # Activista 2012-03-07 20:49
Lolanne - my value system is be good at my work - it is criminal to pull extra teeth on immigrant for extra hundred bucks.
It seems that "new" generation of dentist/doctors see cash before the patient.
And cost of US medical schools - again profit - why is tuition free in Finland - was example here.
I have a son - professional here - and all his values are money, money money.
Congratulation if you were able to raise a sane young man in this system.
 
 
+11 # AndreM5 2012-03-08 10:24
All education is free in Finland, from kindergarten to post-graduate school. A student just has to perform.
 
 
+2 # Activista 2012-03-08 21:58
And the system is getting value/investmen t back -
How much is getting USA back (people) on military spending ($1.3 trillion/year).
The esteem of teacher and professor is about the same as for doctor on Finland.
 
 
-1 # Lolanne 2012-03-09 09:51
Quoting Activista:
Lolanne - my value system is be good at my work - it is criminal to pull extra teeth on immigrant for extra hundred bucks.
It seems that "new" generation of dentist/doctors see cash before the patient. . . .


I completely agree with you -- it definitely is criminal AND unethical to perform any kind of medical procedure that is not needed. I think my disagreement here is with broad generalizations -- you and some others seem to be painting everybody in the medical system with the same brush. I think it is necessary to look more closely and carefully.

Do some people go to medical school so they can make as much $$ as possible? Hell yes! Same reason some go into any profession that promises the big bucks. Nothing wrong with wanting to make as much $$ as possible, as long as they keep their priorities straight, put the PEOPLE they're supposed to be serving FIRST. Some do not, I agree. In some professions (like politics!), perhaps MOST do not.

But in my rather long experience, most of the doctors DO. I've moved a lot, across state borders 6 or 8 times and a few times within the state, in my lifetime. That means I’ve had to see a lot of docs & most of them have been fine people. I hope you have seen some of the good ones in addition to your bad experiences.

And I hope your son someday rediscovers the good, solid value system I'm sure you tried to teach him.
 
 
0 # KittatinyHawk 2012-03-07 18:50
My doctors drive nice vehicles, they travel miles so what?
My Doctors go to Haiti and work for free, and other third world countries. My Doctors have marched against the State, gone to meetings with petitions State and Federal.
They had to pay back student loans, that is the price to pay for a Career They both have 10 people working for them so that is lot of insurance. It is also write offs.
 
 
+19 # Cambridgemac 2012-03-07 13:52
You are mistaken. It's not the docs and dentists. Docs and dentists in other countries make almost as much as ours do, after discounting for malpractice insurance premiums.

The money goes to the pharma and medical device shareholders (named above), and also to the HUGE staff of hacks in the health insurance companies (about 1 million people), whose time is spent denying you care, and the equally huge staff in the hospitals that spend their time fighting the insurance companies.

Fifteen years ago, BlueCross of Massachusetts, which then covered about 25% of our 5 million insured residents (as I recall), had MORE staff than the Canadian single payer health insurance system, which serves close to 30 million people. Nobody but nobody does waste, fraud and abuse like private insurance companies.
 
 
+7 # Activista 2012-03-07 15:13
Two of the five most profitable industries in the United States - the pharmaceuticals industry and the medical device industry - sell health care. With margins of almost 20 percent, they beat out even the financial sector for sheer profitability. ..
The players sitting across the table from them - the health insurers - are not so profitable. In 2009, their profit margins were a mere 2.2 percent. That's a signal that the sellers have the upper hand over the buyers"
2.2 percent profit - "and also to the HUGE staff of hacks in the health insurance companies (about 1 million people)?"
I believe that one reason USA is boycotting travel to Cuba (basic human right to travel) is to block Americans from great vacation and affordable medical/dental care.
 
 
+2 # KittatinyHawk 2012-03-07 19:02
Many other countries have more updated medicines, use of than our Country.
Many Researchers in past 15 years have left the USA to do research elsewhere...rea sons given, they could find cures in other Countries. USA Pharmaceuticals do not want people Cured what profit would they Hospitals and Pharms have if we got well.
Instead the create disease, go oops a strain of has suddenly gone missing and we do not know how that could happen.
They have antidotes but refuse to use them.
Does anyone realize how long we have been researching Cancer, MS, MD, Parkinson Heart Disease? Hepatitis ? There are cures but we are Guinea Pigs and the FDA is happy. They also get paid off.
 
 
+1 # Activista 2012-03-07 20:57
Americans doctors are "modern" technologist - cutting and cutting (the factory is set up - let amortize it).
And yes - any interest/resear ch in (example) alternative medicine that can not MAKE quick profit does not fly.
Preventive medicine - zero.
 
 
+62 # Granny Weatherwax 2012-03-06 23:55
This is not new - Alexis de Tocqueville wrote it at the beginning of the XIXth Century in his "Of Democracy in America": there was a very special relationship between people and wealth generally and more specifically to cash.

The US is the country where health care is for profit (and nearly for profit only), but also education, public transportation, some police and soon the army.

All posts where most of the other OECD countries have a significant intervention of the state.

Why?
Because they have that notion of public service, i.e. the governement is not just of, for and by the /wealthy/ people but all of the people, and the aim of the game is population happiness, not wealth and especially not money.
You do need some money and wealth for happiness, but it is not enough.

Oh and before someone pulls of "social darwinism" on me, you can't make the populatin more happy by killing off the unhappy, or richer by eliminating the poor. Anyone claiming this is not what social Darwinism is about better reread Lord Galton.

Ayn Rand did a great disservice to the US by pushing her punishable "objectivism".

Greed is still one of the seven deadly sins.
"The virtue of selfishness"? Yeah, right.
 
 
+2 # Activista 2012-03-07 15:18
Thanks - sad think is that money/power culture is now "civilized western society".
 
 
+35 # liz4peace 2012-03-07 00:44
I'm vacationing at Mammoth Mountain in California. There happens to be an Emergency Medical Services conference going on here. While having an Irish coffee this afternoon, I spoke with a salesman for Boehringer, a big pharmaceutical company. He rhapsodized about his annual conference, which enabled him and his fellow employees to ski all day, dine and drink all evening - all either on the company's dime or as tax deductible business expenses. And we wonder why our health care costs are higher??
 
 
+70 # Kiwikid 2012-03-07 01:11
Where I live (New Zealand), health care is considered a right. It is universal, provided by the state, and paid for out of taxes. The last figures I read said that the US spends 9% of GDP for a system which fails millions, while we spend 5% for a system that works. Ahhh, the joys of socialism :-)
 
 
+18 # AndreM5 2012-03-07 14:28
This is the crux of the entire issue! ANYWHERE in the world but the USA, it would be abhorent, immoral and illegal to make a profit on healthcare.
 
 
+24 # brenda 2012-03-07 02:25
I was in a hospital emergency treatment room, waiting there for 2 hours for a doctor to do an initial evaluation my medical problem and request various diagnostic testing, then another hour for that testing to be done, and then 2 more hours for the doctor to advise and treat my medical problem. This came out to a total of 5 hours of emergency room of which I was billed for a one day rate for the use of the emergency room. The price for the room was over $1000 bucks. While I was in that room looking at all the medical stuff hooked up and ready to go, plus the various sterilized medical packages of instruments, catheters, IV's, sutures, bandages, etc., I came to the conclusion that I was being billed for all that surrounding stuff, whether I needed them or not, by being included in the price of the treatment room. Also, I wouldn't be surprised that the entire nursing staff's daily payroll is also folded into every treatment room and included in the ER bill as well.
Now here's where the money pours into the hospital. That same unused stuff and unused nursing staff will again be charged to the next emergency room patient whether they needed them or not. Now keep in mind that any medical testing along with the technicion is an aditional charge, as well as the ER doctor's fee. I can see how the hospital makes a bundle of money on it's ER patients.
 
 
+13 # AndreM5 2012-03-07 10:36
$1000 per day charge for a trauma center ER is fairly low compared to other places. It is ridiculous to use the ER as the point of entry to the healthcare system, but for too many that is the case.
 
 
+1 # James38 2012-03-07 12:57
While I am a defender of single payer health systems, your gripe seems overblown. Why you were in an ER you don't say, but if you had a choice, you should have gone to your GP and saved some money.

Part of the cost of a well equipped ER is that all the stuff you didn't need had to be there because an ER never knows what is going to come in. The ER has to be ready for ALL Emergencies.

It is expensive to set up a hospital, especially for ER service.

Until we get a decent single payer system, you are paying for the service you got, which in the case of an ER, includes them being ready for everything you didn't have.

Would you prefer that the ER was bare of supplies, and therefore cheap? Move to Iraq. That is how it is there.

Otherwise, calm your misplaced bitching and get to work pushing for a Single Payer system.
 
 
+3 # brenda 2012-03-07 16:31
Quoting James38:
While I am a defender of single payer health systems, your gripe seems overblown. Why you were in an ER you don't say, but if you had a choice, you should have gone to your GP and saved some money.

Part of the cost of a well equipped ER is that all the stuff you didn't need had to be there because an ER never knows what is going to come in. The ER has to be ready for ALL Emergencies.

It is expensive to set up a hospital, especially for ER service.

Until we get a decent single payer system, you are paying for the service you got, which in the case of an ER, includes them being ready for everything you didn't have.

Would you prefer that the ER was bare of supplies, and therefore cheap? Move to Iraq. That is how it is there.

Otherwise, calm your misplaced bitching and get to work pushing for a Single Payer system.

I was in the ER because (1) It was late at night. (2) I knew I'd need testing done before I could get the medical problem cure ASAP. (3) What if I was bleeding like hell, or needed to be catheterized pronto, or I was doubling over in pain, or my breathing was in distress and perhaps I had pneumonia. (4) I needed a fractured bone set. (5) What if I had food poisoning.
....(continued in my next post)
 
 
+5 # brenda 2012-03-07 16:38
[quote name="James38"] While I am a defender of single payer health systems, your gripe seems overblown...... .

The fact is that GP's aren't available around the clock unless they are affiliated with the Emergency Room. And let's say that I did have a local GP, and I do, and if I called them, the receptionist would tell me that "Doctor can see me at 4:00 PM tomorrow or the day after".
I also agree. It would be awful stupid if I showed up at an ER with a boil to be removed, or a bad caugh, or a sore knee joint.
Before you go around saying that I'm misplaced bitching, think about what you are saying. Right now it's you that are misplaced bitching. Not me.
 
 
+6 # hasapiko 2012-03-07 20:17
Years ago I slid off a motorcycle and needed some stitches on my chin. I made it to the ER, got treated and was sent on my way. No bill. Oh, forgot to mention, this was in Israel, at the time a fairly poor developing nation. Four years ago my son needed almost exactly the same treatment - in Columbus, OH. The ER treated him - and we got a bill for $1900 dollars!
 
 
+3 # James38 2012-03-07 23:34
Brenda, you seem to be saying the same thing I said, but saying I didn't say it.

You say, "I was in the ER because (1) It was late at night. (2) I knew I'd need testing done before I could get the medical problem cure ASAP. (3) What if I was bleeding like hell, or needed to be catheterized pronto, or I was doubling over in pain, or my breathing was in distress and perhaps I had pneumonia. (4) I needed a fractured bone set. (5) What if I had food poisoning."

That is what I was talking about. The ER has to be ready for all of that and more, and since we do not have a single payer system, the price is high. With a single payer system, everybody would have equal access to the care they need, and costs would be much lower.

Sorry you didn't understand, but we appear to agree.
 
 
+1 # KittatinyHawk 2012-03-07 19:11
I hate to tell you but your PCP is going to tell you to go to the Emergency room because they have equipment, blood, meds, that he doesnot. So unless it it a cold, flu, or annual, ER was set up to take in patients that have excessive bleeding, breathing problems, stitches needed. PCP is the nic Doc you go to to get the appts at all the other Specialists. ER has phone number for them all there an then, many do extra service

Get your facts straight. People do not have access to doctors after 4 or 5 pm certainly not on Saturday/Sunday . Then Doctors do actually take Vacations. Mine is a Doc with out Borders so his is spent in his native land giving meds he stocked up, got donated to people in need. He is not off on a Yacht or Golfing on my dime.

If everyone on RSN actually worked together to sign petitions, go to States, or DC you might actually get some attention.
 
 
+2 # AndreM5 2012-03-08 10:29
Your points are fine, but the ERs are much busier and more heavily staffed during daylight hours than at night.
 
 
+3 # Activista 2012-03-07 15:24
This is modem operandum of "new" medical/dental industry.
Before doctor sees you - one spends hours and thousands with machines - even that there is something as obvious as rusty nail in your foot.
Hey we are technological society!
 
 
+21 # hobbesian 2012-03-07 04:37
It doesn't cost that much; they just charge you that much. Because doctors own the machines - they took the hypocritical oath.

We wuz screwed, America. Atul Gawande has written very good New Yorker articles on this subject. The rest of the rich world looks after their citizens' health - Not US.
 
 
+23 # Charles3000 2012-03-07 06:05
The health insurance industry benefits from increasing health care costs. It means more sales dollars and more profits. Nor do they "add value" as normal businesses do. They are not really a legitimate business.
 
 
+1 # Activista 2012-03-07 15:30
Small business owners are not able to pay insurance - there is a market mechanism.
money.cnn.com/2011/09/13/news/economy/census_bureau_health_insurance/index.htm
number of people without insurance is climbing.
 
 
+57 # 666 2012-03-07 06:33
It's not "a devilishly difficult problem to solve", the solution is single-payer, stupid!

Before this post is reviewed, I hope our resident conservatives will jump in with "but-THEY-pay-m ore-in-taxes-th an-we-do" bullshit.

I can't find exact data, but the effective tax rates for those "socialist" single-payer countries are often said to be around 50%. OMG!

So I calculated real costs for a family of 4 for taxes (fed, ss, medicare, etc for both worker & employer) + family health insurance (both employer contribution, worker premiums, deductible, "co-insurance", & uncovered stuff like OTC meds-but not health-cost portion of auto ins). Numbers from my employer's offerings: family insurance premiums =$30k/year, I pay $10k, employer pays $20k.

A family grossing $75k/year PLUS employer-paid taxes & premiums has $96k/year effective income. Their taxes+health care costs = $66k/year!! Or 68.75% of effective income!!!

You don't have to be a Marxist to realize something is seriously wrong. The conservative argument has absolutely NO traction.

How do we get out of our economic toilet?
1) tax reform (make corps & the rich pay their share)
2) single-payer health care: even if I paid 10% more in taxes (medicare is 2.9% split by worker & employer), I'd still save ~$20k/year
3) cut defense spending - the real reason the US can't afford single-payer.
 
 
+16 # ericlipps 2012-03-07 09:19
Quoting 666:
It's not "a devilishly difficult problem to solve", the solution is single-payer, stupid!

Before this post is reviewed, I hope our resident conservatives will jump in with "but-THEY-pay-more-in-taxes-than-we-do" bullshit.

I can't find exact data, but the effective tax rates for those "socialist" single-payer countries are often said to be around 50%. OMG!


Personally, I wouldn't mind paying a bit more in taxes (burn, heretic, BURN!) if I knew I was getting value for my money.

In this country, health care is presented as a profession, but operates as a business, even a racket. It has a captive market, especially for specialized care, and takes full advantage of that fact to jack up prices.

I recently read of an interesting proposal, though: pay for results. Since some people respond to certain treatments while others don't, let only those who are actually helped pay for that treatment. This, the article suggested, would spur the medical industry to avoid prescribing ineffective treatments and do serious research into why some medicines work on some people and not others and what to do about it.
 
 
0 # KittatinyHawk 2012-03-07 19:15
We pay more in taxes all the time then everyone gets raises but us
 
 
+20 # JePa 2012-03-07 11:52
We lived in the U.S. as my husband is from there but moved to my home country, Finland, when Bush got re-elected. People gladly pay taxes here because it covers not only healthcare but there are continuous improvements in infrastructure, good schools in every neighbourhood (we often score as 1st and 2nd in Pisa tests), free school meals, cheap subsidized daycare with 3 meals a day (top payment 254 euros first child, less for subsequent kids. Depends on family size and income, many even go for free), good public transport (I don't have a driver's licence), good libraries, free college, the finnish irs sends pre-filled tax form so you just check it to correct it etc. We end up having more money to spend here...and time! We have been on so many trips here and abroad with our 3 kids and we are not especially wealthy.
 
 
-6 # Activista 2012-03-07 15:35
And Finland is tundra behind the Arctic Circle. Society is much more important than natural resources.
 
 
+3 # James38 2012-03-07 23:37
Good point Activista, I think your calling Finland "tundra" threw people off.
 
 
+4 # Activista 2012-03-08 00:08
I admire Finland - did my masters thesis on their small debarking machine. Source of Linux, NOKIA cell phone - and most of all Helsinki Human Watch
Helsinki Accords: Declaration on Human Rights | Making the History ...
chnm.gmu.edu/1989/items/show/245
The Helsinki Declaration of August 1, 1975 was a turning point in Cold War relations inside European borders. The Soviet Union and the Warsaw Pact countries .. communists let me visit my parents thank to Helsinki.
People - strong society can make great society without natural resources. Invest in people (education) NOT BOMBS and DRONES. 2% GDP (USA 5% GDP). Medical education is free etc.
Wish we got some advisers from Finland .. in US government.
 
 
+4 # KittatinyHawk 2012-03-07 19:18
Canada also seems to be able to care of their own. Foreclosures... my friends were helped to save their homes/farm
Not here.
Islands off Atlantic said they could afford their way of life because the taxes were aasessed on your assets. That would not wash here, been fought since I can remember. GOP pretend they would go for it but they run to lawyers to make sure it never happens
 
 
+13 # James38 2012-03-07 13:16
Good statement, 666, except for point #3. We could afford Single-payer right now by shifting the system around. What is being spent for health care now includes profits for the Private Health Insurance for Profit scam with its various sets of overpaid CEO's and other Execs and lots of duplication of buildings and computers and sets of bureaucrats and bureaucracy with a zillion different forms that all do the same thing, and the billions they spend on lobbying to keep their scam in place, and excess profits from ultra high priced drugs and tests, etc.

In other words, single payer would cost less. Taxes would not have to go up much, especially if defense were cut, and that needs to be done anyway, but it is a separate issue.

In order to make the change, the bold move might include nationalizing the insurance companies. Just imagine all those fat-cat CEO's and greedy useless lobbyists having to get real jobs. LOL.

I understand that the Private Health Insurance for Profit Scam is illegal in Switzerland. Can anybody confirm that?
 
 
+13 # 666 2012-03-07 14:05
I agree we could shuffle things a bit and get single-payer -- and that it would cost less. And I definitely agree about nationalizing insurance. Point #3 was suggesting (without much space) that our defense budget consumes such an enormous share of the US budget that it effectively prevents such shuffling. I often wonder if we spend so much on "defense" in order to prevent such "socialized" programs from coming into existence. Moreover, a growing chunk of what we spend on defense goes to pay contractors two or more times what GIs make -- that is we spend far more than we really need to on defense. Sounds like the health care problem, we spend more than we need to...
Sometimes you CAN have guns, butter, and penicillin
 
 
+6 # hasapiko 2012-03-07 20:20
We don't only spend 2X per capita on health care. Also on defense, energy, education. The entire system is set up to suck wealth from the working class to the 1%.
 
 
+6 # James38 2012-03-07 23:42
Defense is way overfunded, but Education is underfunded. The US has far too many lousy schools. Our society is suffering greatly because of poorly educated young people from poor areas. They are crippled economically because they are not equipped to get better jobs. This is a horrible waste of our people, and causes much of our crime and social problems.

Energy programs need to be funded since we must quit burning oil and coal and natural gas. We must convert to Fourth Generation Nuclear power and renewables, and that requires investment. The alternative to that is ever worsening Climate Change disasters.
 
 
+5 # Activista 2012-03-08 11:06
What the United States could learn from Finland about education reform -
www.tnr.com/article/politics/82329/education-reform-Finland-US
"In 1971, a government commission concluded that, poor as the nation was in natural resources, it had to modernize its economy and could only do so by first improving its schools. To that end, the government agreed to reduce class size, boost teacher pay, and require that, by 1979, all teachers complete a rigorous master’s program.
Today, teaching is such a desirable profession that only one in ten applicants to the country’s eight master’s programs in education is accepted. In the United States, on the other hand, college graduates may become teachers without earning a master’s"
 
 
+34 # sj-ias 2012-03-07 07:49
Here's the dirty word - cartel. The medical industry - clinics, pharmaceuticals , hospitals, technology companies, labs, attorneys, insurance - is unique. Price competition is virtually non-existent. Third party payments are pervasive. It has the profitability to keep politicians on its side. And as a consequence, it functions as though it were a price-fixing cartel. Except it doesn't have to fix prices, it just has to rig the political system in its favor and doing that achieves the same result. Other countries acknowledge the need to suppress cartel-like over-charging, we don't, and therein lies the difference.
 
 
+10 # peterjkraus 2012-03-07 08:14
It IS a cartel, one that assures its customer base by manipulating lawmakers/laws.
Why does a medication made in the US and exported to Canada cost LESS there than here? Why does the VA system (and parts of Medicare) which are not beholden to for-profit medical care cost a ton less than whatever the market will bear?
Americans distrusting "government" makes as much sense as toadying up to the hangman when you´re on death row. It´s the stupid majority that is doing us in.
 
 
+6 # Nell H 2012-03-07 08:38
As prices go up and salaries do not, fewer and fewer people will be paying insurance. People who do not or can not pay for insurance will still receive medical care, but those with insurance will be covering their costs. Fewer and fewer people paying more and more for insurance will cause a collapse of the whole system.

Is it possible that the Affordable Health Care bill is the only thing that can save the insurance companies from collapse?
 
 
+7 # reiverpacific 2012-03-07 12:07
Quoting Nell H:
As prices go up and salaries do not, fewer and fewer people will be paying insurance. People who do not or can not pay for insurance will still receive medical care, but those with insurance will be covering their costs. Fewer and fewer people paying more and more for insurance will cause a collapse of the whole system.

Is it possible that the Affordable Health Care bill is the only thing that can save the insurance companies from collapse?

With all due respect, your first sentence is right on but you appear to have the remainder of your post it upside-down. I don't give a baboon's bum for the insurance company's fortunes -they can still pay for flashy TV ads, build huge spec-investment headquarters buildings and sponsor PGA Golf tournaments off YOUR premiums and own shills like Mr "Handout from Hartford" Leiberman. This country has a long history of denying care for the uninsured, resulting in over- crowded E.R.'s where people end up after they had initially been afraid to go for primary care and their illness is now critical or incurable!
The whole insurance ploy is sick. I don't care if you are Superman, you WILL get ill sometime and the vultures are just hovering, waiting to deny you treatment and subsequent coverage. This is the only country I've ever been to in which "Pre-existing" conditions are the subject for denial of treatment rather than research.
Single payer universal coverage is it!
 
 
+21 # MainStreetMentor 2012-03-07 08:54
One things for sure ... These excessive costs don't have a single thing to do with organized labor.
 
 
+8 # AndreM5 2012-03-07 15:54
The single greatest personel growth area in healthcare is "administration ." Mainly administration for compliance with insurance reimbursement, fighting for insurance reimbursement, justifying reimbursement, requesting approval for treatment, etc. That silly layer of wasted resources can be eliminated entirely with one stroke: a move to single payer.
 
 
-21 # Wallace 2012-03-07 09:16
I am not 100% sure of the truth of this, but I have heard that Canada has only 3 full-service MRI facilities through the entire nation. This could explain the prices in the US as well, since every small-medium-la rge radiology group in the country is pressured to provide as many services as possible to their own market. In ways, we get great care here. Mostly, I agree with this article.
 
 
+19 # goodsensecynic 2012-03-07 12:14
You heard wrong. According to the Canadian Institute for Health Information, as of January 1, 2009, there were 266 MRIs and 465 CTscans. I am sure the number has only increased.
 
 
+15 # MJnevetS 2012-03-07 12:54
Quoting Wallace:
I have heard that Canada has only 3 full-service MRI facilities through the entire nation.
According to The Canadian Institute for Health Information, as of January 1, 2009, there were 266 MRI scanners and 465 CT scanners operational in Canada. (one or two more than '6'). Further, the reason the cost is higher in the U.S. is, at least partially, caused by over-utilizatio n of such devices when the doctor owns the equipment. Studies have shown that Dr.s who own their own radiology equipment (and can, through self-referral get multiple billings for the same patient, will increase the number of tests requested), will over-treat the patient with unnecessary tests. It is pure profit motive, not reasonable health care. In fact, excessive use of radiology/MRI/C T scans is more harmful to the patient than any benefits received. (Google 'doctor radiology self-referral') In fact a study reported in the New England Journal of Medicine confirmed this in the 90's and since that time, doctors' practices purchasing their own diagnostic imaging devices has become a boom industry. Articles for doctors in the trade journals hyping the financial benefits of same surely hasn't helped the problem. Please educate yourself on this issue. While a test appropriately prescribed can be life-saving, when it is prescribed to pay for the Rolls-Royce and the country club membership it results in actual harm to the patients! US needs a single payer system!
 
 
-3 # AndreM5 2012-03-07 15:55
In most states, self-referral is illegal.
 
 
+4 # Cambridgemac 2012-03-07 13:58
Stop reading NewsMax.
It's all garbage, all the time.
 
 
+19 # walt 2012-03-07 09:34
This discussion is long over-due but needs to be addressed. Why do our hospitals and doctors charge so much? We have the most expensive health care in the world and rate about 37th in quality.

The answer may be simply BECAUSE THEY CAN. And never rule out the fact that our health care and pharmaceutical companies are profit-making corporations.

Where are the controls as other countries maintain? And why are doctors almost always among the richest Americans?

It needs to change! We cannot allow families to re-mortgage homes or go bankrupt just to pay for medical bills!
 
 
+6 # jerryball 2012-03-07 17:35
The true answer is that our politicians who can place regulatory laws are bribed by these avaricious companies who bribe for a "free" market. LOL. There's nothing "free" about it. The politicians and the medical industry are scratching each other's backs with OUR dime.
 
 
+19 # reiverpacific 2012-03-07 10:06
Not a word in the article about the "System of delivery" and the politicians who are in the pockets of big pharam and insurance -same thing really. Best example, that Connecticut darling of both and AIPAC as well, Joe "Super-Blue" Leiberman.
And the only solution I've ever heard from the Repugs is that totally out of touch with reality proposal for "Medical Savings Accounts", like anybody but the wealthy can afford this kind of stuff -and they don't need it.
The criminal medical non-system here is the main reason I've never become a citizen; and it has finally bankrupted me -with decent insurance- destroyed my business and made me one of the "New Poor".
When I first came here from Scotland, I developed a hernia working as a cook and on making enquiries discovered that it was several times cheaper to fly back to Scotland and get it done by the NHS (I'd been paying a small tax out of my wages for this all my working life) + they keep you in there until they are sure you are ready to leave.
I have had experience with different health care systems around the world like Singapore, Australia, all European countries, Bahrain, Northern India, and the US is by far the worst. I have a friend who just moved back to S. Korea for just this reason and I also intend to go back to Europe before I am too much older.
One more example of how national well-being is being sacrificed to spending on the Military and other destructive forces.
 
 
+11 # Peter Fassett 2012-03-07 10:10
I had an issue with my shoulder and was sent to a local Orthopedic clinic for an MRI, I was there a total of 15 minutes, my out of pocket expense was $700.00 and the total bill was $2400.00 - Criminal!
 
 
+2 # Activista 2012-03-07 15:43
Did they (Orthopedic clinic)find anything? Good experienced doctor can find the issue by observing and touch without sending to specialist.
 
 
+11 # John Gill 2012-03-07 10:14
Very good article. Wonderful, thoughtful reader comments. RSN at its best! Thankyou RSN!
 
 
+13 # Dick Huopana 2012-03-07 11:22
The Republican presidential candidates have held 20 TV debates moderated by members of our national news media. I quit wasting my time watching them after the third debate. Does anyone know if the candidates were asked their positions regarding this health care cost problem during the next 17 debates? If not, has anyone heard of the news media anywhere asking the candidates to acknowledge the problem and say what they intend to do about it if elected? If not, have any candidates, during their campaign appearances and in their political ads acknowledged the problem and said what they intend to do to solve it? If not, why aren't Republicans - and our news media - concerned about health care?
 
 
+5 # bugbuster 2012-03-07 11:39
I wish they were all this easy. They don't care because they and their families all have gold plated coverage. We pay for it.
 
 
+11 # bugbuster 2012-03-07 11:36
These charges are rigged so that your portion of the payment under your "insurance" policy will in fact cover the whole cost.

Our daughter had an appendectomy. The charge for **just 24 hours in the hospital room**, not the surgery, medicine, doctor visit, or anesthesiologis t was $12,000. That's right, twelve thousand dollars for the room. A reasonable fee would be $1200. Our deductible was, amazingly enough, $1200.
 
 
+3 # 1984 2012-03-07 12:33
Don't forget about the drug store corporations. I had no drug coverage but I thought it was ok since all my drugs came in generic form. I was stunned to see charges of $100 and even $200 and above for some of my drugs!!! Generics are supposed to be low price and ease the burden of ridiculously high drug prices. I think the middle man, i.e. the drugstore is making a big profit out of the generics. Does anyone have statistics on the price generics are sold to a drug store?
 
 
+7 # Billy Bob 2012-03-07 12:39
Yeah, but the French and the Germans don't have to subsidize the insurance industry's insatiable NEED for profit.

The difference in costs is what's known in medical terms as the "PROFIT MARGIN" (not to be confused with such less important terms as "health care" and "hypocratic oath").
 
 
+4 # Charles3000 2012-03-07 13:41
Anyone commenting on the "health care system in the USA" is missing the mark. It is health care systems and there are about five; 1. people who pay directly for care with no insurance, 2. insurance provided by an employer, 3. people who buy insurance directly, 4. Medicare/Medica id, 5. veterans (VA) health care. Whit this many samples on "how to do it" it should be very simple to gather the statistics to determine the best care/lest cost option. Would you like to wage which one would win?
 
 
+4 # James38 2012-03-07 23:22
VA wins hands down. Higher quality care at a lower cost. A Single Payer system is the way to go.
 
 
+5 # AndreM5 2012-03-08 09:37
Except the VA is NOT single-payer but rather socialized medicine. VA hospitals are owned and operated by the govt, docs and all professionals are employees who make about 1/2 to 3/5 of the private market. It can work very well if reasonably funded.
 
 
+3 # JohnnyK 2012-03-07 15:39
I recently had a CT scan and it was $4,295.
 
 
+1 # goodsensecynic 2012-03-10 16:22
In 2001, I had a CT-scan, followed by brain surgery. The cost was $10 (for TV rental). Thank you Canadian single-payer system.

In 2010, I had robotic prostate surgery. The identical procedure in the US (Cleveland Clinic & Loma Linda) would have cost between $100,000 and $150,000. The cost for me was $16.00 (also for TV rental).
 
 
+4 # Interested Observer 2012-03-07 15:51
But John Stossel and Antonin Scalia will assure you that ours is better and worth every cent, all for the glory of trickle-down America and the Free Market.
 
 
+17 # SOF 2012-03-07 16:10
Great article and comments! Thanks.
Can I point out that we don't have healthcare at all. We have sick 'care'. Consider that a government with single payer healthcare is invested in the people's health. Part of the reason GMOs are rejected in Europe is because their health system will be responsible for the unknown effects, for instance. Add to that the pervasive harm done to health by under regulated poisons -in food additives, in fertilizer, mega farm practices, air pollution, cosmetics, pesticides, oil and discarded pharmaceuticals and mercury in our water, aluminum and barium raining from the sky, and radiation from past and present nuclear disasters and wars. -DDT anyone? Add our diet of sugar, denatured grains, GMOs in everything, antibiotics in dairy -The whole system seems bent on making people sick and then profiting on ill health. Now they're attacking supplements, "organic" and 'natural' credentials, and as always, traditional herbs until they can be chemically synthesized and profitable. We're sick in so many ways..
 
 
+3 # Billy Bob 2012-03-07 21:55
Very insightful comment.
 
 
+6 # jerryball 2012-03-07 17:30
I took my little epileptic Chihuahua to UC Davis Vetinarian School and they wanted to give her a $1,400 MRI. I declined. I also gave walking papers to my Medicare Prescription provider who was ripping me off. The bulk of my prescriptions were generic which I had to pay out of my pocket, the thing they helped out with was my insulin which was a $40 copay for a $112.00 vial, plus $70 a month fee to the provider. I went on the web and found the exact same Lilly Humulin insulin in bulk from Canada which came out to $20 a vial complete. These creeps are ripping off America in a grand scale. Shop around and find the cheapest and help out our country.
 
 
0 # Activista 2012-03-07 21:12
Yes - this is a way - take a trip - learn - take care of your body and $SAVE. Especially on dental.
I can see dental and doctor offices empty most of the time - dentists doubled in last 10 years.
Would doubling patients for half the cost make sense? Who is in control - market or AMA?
 
 
+7 # AndreM5 2012-03-08 09:39
Recall your Repub friends passed legislation that STOPS Medicare from negotiating reasonable presciption costs like the VA does. You are paying for that twice in massive tax giveaways to PhARMA and in co-pays.
 
 
+4 # kitster 2012-03-07 17:35
...yet the pachys continue to pander to the heath care poobahs. when will the public realize they're getting raped by their representatives in congress...and without even a kiss?

universal health care...with the power of the federal government negotiating for the best prices...is the only equitable way to solve the problem. and it's time to remember who the federal government is: US!!!

prove the proffer of any other policy makes any sense.
 
 
+5 # Kowal 2012-03-07 19:26
Ahem, Mr Reinhardt, I don't think you should be endorsing the shift of funds to the military - they do just fine.

"There are opportunity costs," says Reinhardt, an economist at Princeton. "The money we spend on health care is money we don't spend educating our children, or investing in infrastructure, scientific research and defense spending. "
 
 
+9 # RMDC 2012-03-08 05:53
This is typical of the way the Wash Post and other mainstream media which rely on advertising from health care providers and drug companies treats important issues like the cost of health care in the US. They confuse the issue with lots of stupid and irrelevant information so that at the end no one really knows anything. The point of mainstream news is to de-politicize people -- in effect, to say that this issue is too complicated for you so leave it to the experts (who by the way all work for the healthcare industry).

THis is not a complex issue. A for-profit system costs more because it requires profits. Its aim is not healthcare but profits for its executives and stock holders.

A competitive healthcare system as opposed to a universal single payer system is more expensive because it has non-healthcare costs such as advertising and marketing.

A single payer universal system has the advantage of an economy of scale -- the more you buy the less you pay per unit.

the US has the least efficient healthcare system because it is not aimed at efficency of healthcare delivery. It is aimed at profit.

Case closed.
 
 
+2 # Activista 2012-03-08 11:14
Running country via MAXIMIZING (short) PROFIT model is a gamble - and USA model - empire is bankrupt by endless for profit wars.
What is worse is our money/greed culture - from the baby to the baby boomers. Earth could not survive "American Century".
 
 
+10 # RMDC 2012-03-08 13:11
In the 1980s, US Steel shut down its steel businesses and changed its name to USX. The CEO of USX said in a speech that we are not in the steel business and were never in the steel business. We are in business to make money. The X stands for money.

Healthcare insurance companies and providers are also in the business to make money. They are not in the healthcare business. They sell healthcare now because there's lots of money to be made there. But if Obamacare radically cut back on healthcare profits, you'd just see the capital in these companies move somewhere else. Then it would be clear what they are in business for.

Most doctors and nurses and technicians are in the healthcare business. They want to treat people and are less concerned about the wages they make. Some would practice medicine if there were no wages.

The US needs a healthcare system, not a profit system. The two are not compatible. The profit system will always drain the healthcare system until it is totally dysfunctional. That's what capitalism does.
 
 
+1 # MEBrowning 2012-03-08 16:04
Where did the author get $1,080 for an MRI? I was charged $5,128 by a teaching hospital in Los Angeles. And that was in 2003.
 
 
0 # goodsensecynic 2012-03-10 16:27
As long as health care is regarded as a commodity and not a right, the profit-seekers will change what the traffic will bear. Until your compatriots and their elected representatives move decisively for public insrance, I suppose the best advice is to go "comparative shoping." Not that it will make you feel any better about your experience in LA.
 
 
+5 # ozken 2012-03-08 16:15
A shame you all can't just hop on a plane to Cuba for decent and inexpensive medical treatment.
 
 
+2 # Activista 2012-03-08 22:08
Quoting ozken:
A shame you all can't just hop on a plane to Cuba for decent and inexpensive medical treatment.

When the politicians will start screaming "freedom" we should remind them:
"Everyone has the right to freedom of movement and residence within the borders of each state. Everyone has the right to leave any country, including his own, and to return to his country." -- Universal Declaration of Human Rights, Article 13
 
 
+1 # futhark 2012-03-08 19:06
I have to get 2 MRIs annually to monitor my intercranial lymphoma. For $1080 a pop (or whatever Anthem Blue Cross is paying) someone could at least invent one that played a Bach concerto or Pachelbel's Canon in D Major instead of sounding like having one's head inside a steel drum being pounded on by baseball bat wielding thugs.

Single Payer medical insurance seems like the most humane way to treat those who have been removed from active life by serious illness. The current system is inefficient and victimizes everyone, even if they don't have have their nerves jangled by noisy MRIs.
 
 
+2 # futhark 2012-03-08 19:11
"Competitive Healthcare" as currently practiced in the United States is not really competitive, because no one but professional lawyers could really figure out what is covered and what is not covered by a given plan, not to mention the hospitals recruiting "out-of-network " physicians to treat patients at great expense. Just because you think you have a good plan, when you are hospitalized for weeks on end you will find out how many holes there really are in the fabric of your plan's coverage.
 
 
0 # cybersleuth58 2012-03-09 13:30
Why can't consumers obtain estimates for the cost of treatments? A recent study comparing the costs of the same operative procedures in several major cities in one area showed the price difference from one physician to the next to be substantial & independent of experience, education or skill, Price is not the only factor by which a patient should choose a provider, but why is that information unavailable? There are pricing guides for other countries, why not for the US?

A few years ago I was referred to a surgeon by an ER doctor. I could not schedule my first appointment unless/until I put down a $25,000 deposit, even though I had health coverage through my employer. Needless to say, I don't have that kind of cash so I found my surgeon through the yellow pages. :( Even the healthiest among us will eventually need to see a doctor. A 'for profit' health care delivery system encourages greed and 'delivers" one thing: high cost.

One day, after a check up, I read the inspection notice in the elevator of my physician's clinic. He not only owns the clinic but a real estate company as well. (He owns something like a dozen clinics in this state alone). Yes, these guys do have educational loans to repay. Can't they still discharge their obligations by agreeing to provide low cost care in areas where health care is not readily available? (eg reservations?) I wonder how many of them are millionaires by the age of 40?
 
 
+1 # medusa 2012-03-09 23:55
I am always puzzled by the way patients are described as consumers, and getting sick and needing to see a doctor is described as if it were like deciding to buy a new car. Shop around, check the deals, then go ahead if it looks good! The reality is that you sit in the only clinic that's open, reading last month's consumer magazine, and taking the treatment ordered by the doctor you see. At least, in my experience, the doctors and health care staff themselves have been good.
 
 
0 # DoctorDemocracy 2012-03-10 02:06
@EZRA. Great piece. One of the most important financial we face as a nation.

However, you did not notice some very important price constraining elements of PPACA. There are Trojan Horses in PPACA that may well have more impact on health care costs than is readily apparent. These account for CBO's estimate that insuring all those extra people will lower system-wide health care costs substantially.

One is the requirement that insurers return either 80% or 85% of their premium dollars in the form of health care services. Now, health insurers in the US take 25% to 40% off the top of premium dollars, spending only 60% to 75% on services. A huge portion of our higher prices is driven by insurance profits. PPACA starts wringing some of the excess out of that.

PPACA also accelerates a shift toward quality-related payments (QRPs). Now, health care providers' revenue is volume-based. This leads to three strategies: Don't do things that don't pay well. Do more of the things that pay well. For everything, optimize volume at the lowest cost (not price).

However, under QRPs (svalue-based payments, penalties for excess readmissions, etc), providers' planning will begin to shift from volume only. They will focus more on producing the best outputs at optimized costs. This will tend to squeeze out costs that do not contribute to good outcomes. Research shows there is a lot to squeeze in this way.
 
 
0 # lilpat126 2012-03-10 11:03
We got dumped into a company to handle our health care by my husbands former employer. He had turned down a raise at one point to have the money set aside for medical insurance after retirement. A Medicare supplement type thing. He ended up with 23 years of coverage. We still have 10 years left. They still pay but we have to jump through hoops to get it. We pay for the insurance and we get reimbursed. I opened a special checking account to do this since they prefer automatic withdrawal and deposit. So after an initial cost of about $600. we should be set. Wrong one of the insurers forgot about us for 3 months. No coverage and $1,200 in lab fees for annual check up. Then the company covering our drugs called and wanted us to by drugs from them. I told them no we support our local economy. We would not throw the druggist we have had for over 30years under the bus.
It took 2 urgent care visits and an appointment with my Doctor for them to decide that I had a staph infection. I was close to death. But, one Doctor have given me Valium for a "tension" headache. It put me out for 19 hours. So I really didn't care.
 
 
+2 # Colleen C 2012-03-10 20:16
It is absolutely appalling what the uninsured are charged for procedures. Complete blood work for thyroid disease is $1100 for the uninsured and $110 for the insured -- even when the insured person is paying the full amount due to a deductible. Ultrasound = $850 uninsured; $318 insured. I could go on & on. I know insurance companies negotiate a discount but it is ridiculous. What other industry pays 1/10th the going price just because they negotiate? It should be possible to have one set price for each procedure. Most hospitals are non-profits. Instead of charging outrageous prices to the uninsured and then writing the full amount off as a charitable expense why not have the uninsured charged the medicare rate? I can pay $110; I can't pay $1100 on a regular basis. I don't know how this could be legislated in America but it would go a long way toward making things more equitable.
 

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