Why Is Health Care In America So Fucked Up?

Rambo

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I read this bullshit in the NYT today:

www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html

And had to wonder just why the fuck we put up with this shit in the good ole US of A. This line especially stuck me as poignant:

In many other countries, such as Australia — where, as in the United States, people often rely on private insurance — it is seen as a patient’s right to be informed of out-of-pocket costs before hospitalization, said Mark Hall, a law professor at Wake Forest University.
The comments are also worth a read. Here's a good one:

I received a bill from my secondary insurer ( NYSHIP - Empire Plan ) that included over $6, 000 for "surgery" I never had. A MRI showed a compressed vertebra. Empire stated they will cover none of the " surgery". They said that CODE D on the bill means a fracture of any kind- even if I did not have surgery." He was with me for a total of 5 minutes.
And another:

I had several biopsies performed and knew I would be receiving a pathology bill from the screening laboratory, but was surprised when I received a second bill from a laboratory I'd never heard of for twice the amount of the first lab's bill. The second laboratory had apparently been asked to "consult" by the first, without the knowledge or consent of my physician or myself. At the time, I was a self-pay patient and had no recourse through an insurer to dispute the charges.
 

Journeyman

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I don't know that much about the US system, although I do remember reading that a lot of health care is provided through employer plans and that if you don't have an employer-paid health care plan then you're in trouble or you have to pay a crap-load to set up a healthcare plan for yourself.

Australia has a "two-tier" system.

There is a public system that is funded by Medicare, and taxpayers pay a contribution to Medicare as a levy on their tax. If you earn less than $20 000 per year, you don't pay any levy and so your healthcare is largely free. Public hospitals provide free healthcare but if you need an operation you could have to wait, particularly if it's not urgent. If you go to a GP (general practitioner, your local doctor), your doctor may choose to only take the rebate that he or she receives from Medicare for seeing you and charge you nothing, or he or she may choose to ask you to pay a surcharge on top of the Medicare rebate. The rebate is about $37, from memory, and places that only charge the rebate (ie don't ask patients to pay anything out of pocket) tend to try to get patients through as quickly as possible so you don't get to spend very long with the doctor (probably ten minutes tops). I prefer to go to a doctor where I pay an extra $40 and I get more personalised care.

I also pay private health insurance. My private health insurance doesn't cover visits to the GP, but it covers things like hospitalisation and some tests and scans, as well as some "extras" like glasses, dental care, physio and so on. Obviously, hospitalisation is the main cost there. My mother was hospitalised for three weeks last year and she spent that time in a private room in a private hospital with top-notch health care. Everything was covered and she did not have to pay anything, anything at all, when she left the hospital. For that level of cover, she pays $35 per week or $1820 per year. If you're a young person, you pay less than that but if you have kids, you pay more.

I tend to think that the "mix" of the Australian system works very well, so it's disappointing that our current government is seeking to privatise more of the healthcare system and to also impose a $7 fee on all GP visits, including ones where the doctor currently only charges the Medicare rebate.
 

Thruth

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Not surprising then that American health care spending and costs are world leaders both in terms of per capita ($8000+) spending and percent of GDP (almost 18%). Private health care can work; Australia's two tiered system has often been cited as a solid model. Their GDP spending is less than 9 percent. America's problem is that the relative cost of health care is expensive and the system is inefficient. The country's litigious nature is part of the problem; the number of insurance companies providing care leads to high administrative costs and a disjointed system that favours high cost specialist/specialized delivery instead of primary health care. Nor is patient-centred care effective as evidenced by these examples of patients being blind-sided by unexpected costs. Where else do you find this "out-of-network" bullshit? Nowhere I submit.

If you need the best treatment by the best providers and you need it now, American s second to none. But you pay for this privilege.

The Commonwealth Fund compared health care systems in Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom in 2010. It paints an interesting picture.


http://www.commonwealthfund.org/pub.../2010/jun/us-ranks-last-among-seven-countries


This year, they compared the administrative costs of health care in Canada, England, Scotland, Wales, France, Germany, US and the Netherlands, again confirming that America's multi-payor system is administratively expensive without a commensurate impact on quality of care.

http://www.commonwealthfund.org/pub...rature/2014/sep/hospital-administrative-costs

The difficulty is comparing one system to another. Each country's system has developed out of their own history, governance and culture and this means that you cannot necessarily replicate it elsewhere.
 

Russell Street

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Mandatory. or perceptually mandatory insurance, raises prices because the opt-out option is eliminated. Price elasticity increases. Thus, prices increase. Attempts to cut prices lead to fraud. Since insurance is a fraud, it is hard to contest.
 

Rambo

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Mandatory. or perceptually mandatory insurance, raises prices because the opt-out option is eliminated. Price elasticity increases. Thus, prices increase. Attempts to cut prices lead to fraud. Since insurance is a fraud, it is hard to contest.
What is this jumble of bullshit?
 

Journeyman

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Mandatory. or perceptually mandatory insurance, raises prices because the opt-out option is eliminated. Price elasticity increases. Thus, prices increase. Attempts to cut prices lead to fraud. Since insurance is a fraud, it is hard to contest.
Well, I think that there are a variety of reasons in the US, as far as my limited knowledge goes:

- In other countries, public systems are larger and thus act to keep prices on procedures down;
- The US has a large number of different insurers and each insurer negotiates prices with health care providers. I suspect that there is little knowledge by each insurer as to what price other insurers have negotiated so the market is opaque. The lack of perfect information and the large number of insurers make it difficult to negotiate lower prices with providers (in other words, the providers tend to have the upper hand and thus work to push prices up);
- The large number of different insurers and the large number of different health pricing plans means that things are very confusing and so hospitals (health providers) need more and more administrative staff to deal with the various insurers in regard to pricing and payments;
- In other countries, the government negotiates with pharmaceutical companies to set prices for drugs. The US govt doesn't seem to do this, or at least, not do it very aggressively and thus the US has (I think) the highest drug prices in the world;
- Doctors and health-care providers get paid per procedure and so there's strong temptation to do lots of tests/procedures even though they might not be strictly necessary. A fear of litigation no doubt helps to spur medical practitioners on, too, as they're concerned that if they don't test for absolutely everything they might be sued for negligence; and
- Because most health insurance in the US is provided through employers, and because employers receive big tax breaks for providing healthcare for employees, neither the employers nor the employees (who are the subject of the insurance) are particularly price sensitive. There's less incentive to shop around to try to get lower pricing and so (I assume) healthcare insurance providers aren't being pressured to reduce prices.

There's probably more reasons than that, but essentially there's a whole jumble of reasons as to why the US is so expensive compared to other countries. It's very complex and not at all easy to resolve.
 

Thruth

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there is an over-reliance on technology partly because of the high-tech nature of US healthcare in general driven by the private sector in competing for an ever-increasing share of insurance company networks and patients plus playing it safe because of the fear of litigation. It is a vicious circle. Physician compensation is higher than anywhere else, plus there is a skewed specialist to GP ratio driving up costs. without a history of significant public funding of health care (although public sector funding in America is still comparatively huge) it has always been driven by purely market forces. other countries have cost containment mechanisms.

Canada is often erroneously singled out in America as a potential model although less so these days. While we do provide a national health insurance plan for all Canadians it can be likened to a kettle or a pot of water on a stove threatening to boil over. The system has been boiling over for more than 20 years and is always in the top 5 countries for per capita and GDP spending. It is an expensive system that insures everyone but is unsustainable without government intervention. Patients abuse the system by running to a doctor every time they have a sniffle and physicians do nothing to deter that behaviour. The system compensates by rationalizing technology, de-insuring procedures, having long queues for surgery because there are not enough docs (especially specialists). Hips and knee surgeries have historically waiting lists measured in years. Hospitals are decaying. Americans would not stand for this type of care unless they were uninsured.
 

Russell Street

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What is this jumble of bullshit?
I read my own words in a sober awake state and it makes sense.
If you have to have insurance, there is much less effort toward price competition. They don't need to attract customers or maintain them, as everybody has to buy from somewhere.
Instead of having open, honest prices, insurance sets artificially low ones and the billers retaliate by setting artificially high ones to reach a "compromise" after gobs of inefficient negotiating. Almost every woman I know that is not a teacher works in insurance or medical billing. Bloated bureaucracy!
 

Rambo

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I read my own words in a sober awake state and it makes sense.
If you have to have insurance, there is much less effort toward price competition. They don't need to attract customers or maintain them, as everybody has to buy from somewhere.
Instead of having open, honest prices, insurance sets artificially low ones and the billers retaliate by setting artificially high ones to reach a "compromise" after gobs of inefficient negotiating. Almost every woman I know that is not a teacher works in insurance or medical billing. Bloated bureaucracy!
Ah, Mr. Free Market. I should have gotten what you were after. So, if no one has insurance, yet there's no elasticity in pricing, how is one to get health care? You're putting the cart before the horse, aren't you? Because this was the situation we were in before.
 

Russell Street

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Well, we have that Ponzi scheme of young healthy (poorer) people that really barely need or want health insurance paying for the old unhealthy (richer) people that rely on it. This is a major social injustice and hampers economic advancement.

I get groceries, housing, vehicles by writing a check directly to the seller. There is no flotilla of complexity and opacity behind it. If I can't afford these items, I either do without or rely on some barebones welfare program. Medical doctors barely existed a century ago, people lived for millennia without health insurance. It is by no means a necessity.

I have no dental insurance. It is expensive, but I write checks. Same with optical. I value eyes and teeth. I assure you there are people that don't. They can lose their eyes and teeth and maintain their meth habits instead. I'm fine with their decisions.
 

Thruth

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the Netherland's, since the reconfiguration of their health care, which includes everyone having to buy private insurance is now the the winner in the eyes of health policy people. ConchitaWurst ConchitaWurst any comments on how your health care system has changed?
 

Thruth

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Do you have a source for that?
I will dig it up. The 2010 Commonwealth Report ranks them highly. I was talking with a colleague yesterday who is a comparative health care system researcher and policy expert and asked him outright about Current "rankings" and after savaging Canada as we have fallen once again - I think 10th best, down from 7th in 2010, he gave me a snapshot of the Netherlands and what occurred since they redid their system. He referred to a 2014 Commonwealth Fund report and I am not sure if it was the administration cost comparison I've previously posted or another overall ranking one.
 

Thruth

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This is not to say that Oz or NZ have become worse. I think it has to do with the Dutch getting a bigger bang out of higher GDP & per capita spending. They outspend Oz & NZ but in a good way if that makes sense.
 

Thruth

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Ok, thanks. CR are a good source, but fairly partisan, politically. They usually rank Thr UK as best and US as worst.
True that. Just skimmed the 2014 Mirror Mirror report which uses 2013 rankings and Oz and NZ are 4 and 7 respectively. Holland is 5. UK #1 and US last
 

ConchitaWurst

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the Netherland's, since the reconfiguration of their health care, which includes everyone having to buy private insurance is now the the winner in the eyes of health policy people. ConchitaWurst ConchitaWurst any comments on how your health care system has changed?
It's not really something I know a great deal about. But, I think it's fair to say that the system became more efficient by giving more power to the health insurance companies. They were successful in driving down the cost of drugs, making hospitals work more efficiently and detecting and combating fraud. The greater power of the insurance companies does, however, to some extent limit the free choice of patients (e.g. which hospital to go to). The health insurance companies here in Holland are not for profit entities, at least that's what in their articles of association. Profits they make should be returned to the insured by way of a reduction of next year's the insurance premium. I recently picked up a discussion where some experts were saying that in fact the insurance companies were building up too large reserves and should reduce their insurance premiums significantly. I don't have any information to verify whether this is true, but in general I have some distrust of banks and insurance companies so there may be some truth this.
 

Rambo

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http://www.vox.com/2014/9/25/6840391/facts-american-health-care-dysfunction

9 mind-blowing facts about the dysfunction of the American health-care system

Updated by Joe Posner on September 25, 2014, 10:00 a.m. ET @joeposner joe@vox.com

It might not be a surprise that the American health-care system is broken, but some of the reasons why certainly are. The 90 second video above is a tour through the dysfunction, but let's break out some of the important points here, too.

America spends a lot. A whole lot.



The United States of Health Care would be a huge country.

Only the US itself, China, Japan, and Germany are larger in terms of raw GDP.



Really meditate on this: of every six dollars spent in the US economy, one goes to health care.



That health care doesn't always help. Medical errors kill huge numbers of patients. It's like 10 jumbo jets crashing every week.



The US just pays a lot more for everything.

Even when it's the exact same thing.



A lot of the money the US spends goes to stuff that doesn't seem to help anyone.



That's a lot of waste. Where does it all go?


The US spends so, so, so much on medical paperwork.



Even after Obamacare is implemented, millions of Americans still won't have health insurance.
 

Russell Street

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I will live much longer without medical care than without restaurants and grocery stores. I'm not even on food stamps!
The Hunger Care System is magic!!!!
 

Allen Smithee

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Russell Street

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If this doesn't aggravate you to the point of wanting to punch something, you've got some issues:

Fighting to Honor a Father’s Last Wish: To Die at Home

http://www.nytimes.com/2014/09/26/n...e-request-to-die-at-home.html?smid=tw-nytimes
I skimmed this, but it seems that this is a case of a non-confrontational woman not knowing her rights to ignore medical advice, and of course insurance bilkers suckling on the teat.
In America, you get all the medical care you can afford, whether you want it or not.
 
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