(Sarcasm)Whats wrong with America's healthcare system?

[richi1173]

I went to the Emergency Room yesterday at my local hospital. After about 30 minutes of waiting in line, I was given a physical and then I was given a room to stay in. The ER staff promptly administered x-rays, bodily fluid analyzes, and an EKG. They also started an IV.

My aunt, who is a nurse at the hospital's ICU, visited me whenever she could on the 4 hours I spent in the ER. On one of the visits, we got into a talk on the costs that I would accrue if I did not have health insurance. We joked and laughed until I asked her how much did it cost to put an IV in. Just a simple IV, no medication, no blood analyzes. Her answer was $150 US.

I do not dare think what my total for the visit was but most likely it ranged on the thousands of dollars. Never-mind the availability of health insurance, its the damn costs.

My question is: Why is healthcare so damn expensive, speaking from a healthcare providers point of view? It cannot be the materials, because they are mass produced; so what is it?

 

[shanedk]

There are a number of factors that have contributed to the high costs.

One is basically a shortage of physicians. Obviously, it's tough to get a medical degree, but to make matters worse, more and more doctors are getting out of the business. Here's an article on the reasons why:

http://www.physiciansfoundations.org/news/news_show.htm?doc_id=728872

From the article:

An overwhelming majority, 78 percent, of physicians believe that there is an existing shortage of primary care doctors in the United States today. Additionally, nearly half of them, 49 percent, or more than 150,000 practicing doctors- say that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.

And the reasons why:

The reported reasons for the widespread frustration among physicians include increased time dealing with non-clinical paperwork, difficulty receiving reimbursement and burdensome government regulations. Physicians say these issues keep them from the most satisfying aspect of their job: patient relationships.

"Tens of thousands of primary care doctors face the same problems as millions of ordinary citizens: frustrations in dealing with HMOs and government red tape," said Sandra Johnson, Board Member, The Physicians' Foundation. "The thing we heard over and over again from the physicians was that they're unhappy they can't spend more time with their patients, which is why they went into primary care in the first place."

So there's a shortage of doctors, and anyone with a basic knowledge of economics will tell you that a shortage increases price.

Another reason is the shortage of technology. For example, when the MRI was first introduced, it was very expensive, as all new technology is. Ordinarily there's an "early adopter" effect: a few people buy the first expensive units, and over time the price drops and more people buy. This is why you can get a Garmin GPS for your car for under $100 that would have cost you $1000 just a few years ago.

But in the case of the MRI (and most medical technology) gets regulated by government, because it "wouldn't be fair" if only the rich could get it. So they essentially put a price cap on it. This stops the "early adopter" effect in its tracks, and the result is it never really gets down to where it would have been otherwise.

Then there's the costs of the regulations themselves. Every year, PricewaterhouseCoopers releases a report for the reasons of the increasing costs, and government regulation is consistenly at 20-25% of the rise. Add to it the unintended consequences like the above cases and you have a real problem.

Not only that, but it's a complete myth that hospitals don't treat people who can't pay, as I'm sure your aunt can confirm. Hospitals routinely settle for payments at pennies on the dollar. Also, Medicare and Medicaid only pays a fraction of the costs the hospital incurs treating their patients. They HAVE to make this back somehow. The result is a $5 charge whenever they give you two aspirin.

PWC has mentioned that changes in patient behavior brought on by greater transparency in costs has caused these increases to lessen since 2003, but now they're predicting much greater increases in 2009:

http://www.pwc.com/extweb/pwcpublications.nsf/docid/A49D5B8DD5727D5685257467006BDBEB

Healthcare costs continue to outpace the rate of inflation but the silver lining is that since 2003 the percentage rate of increases has diminished each year. According to employers and health plans, that trend is predicted to level off in 2009 and premium increases should be expected in the future.

Changes in patient behavior and new technology have helped to limit recent medical cost increases in the recent past but these are being offset by multiple factors which are expected to reverse past trends and help drive medical cost increases in 2009. Some of these factors include:

• The healthcare industry is in an era of booming construction to replace plants and adjust to consumer demands, such as a preference for private hospital rooms and a move to outpatient venues.
  
• Cost-shifting from the uninsured, Medicare and Medicaid continues to increase and will account for nearly one in every four dollars spent by private payers in 2009. This trend is expected to continue because the federal government is underfunding public medical insurance programs while the number of uninsured is increasing.
  
• Wellness programs and initiatives to personalize the experiences of health plan members are on the rise.
  
• Employers will rely on prevention and disease management programs to temper costs in 2009 rather than shifting higher levels of cost-sharing onto workers.
  
• The number of privately insured continues to slowly decrease, which increases cost shifting, makes it more difficult to control costs and increases competition among health plans as they try to keep cost growth in check without sacrificing member satisfaction.

I could probably go on with a lot of other reasons, but these probably account for the vast majority of the expenses.

 

[ImprobableJoe]

Because the "free market" drives up costs, and drives down quality. That's why in countries with a nationalized healthcare system, there is higher efficiency, lower costs, and better overall outcomes.

 

[shanedk]

Because the "free market" drives up costs, and drives down quality. That's why in countries with a nationalized healthcare system, there is higher efficiency, lower costs, and better overall outcomes.

What is it with you? You're like a creationist, and the free market is your evolution! The free market drives DOWN costs and quality UP! Again, that's why you can get a $100 Garmin GPS that does more than a $1000 would five years ago!

If the evidence supplied in my post makes one thing clear, it's that HEALTH CARE IS NOT A FREE MARKET! And I'm sick and tired of pseudo-skeptic dogmatists taking problems caused by government interference, and blaming the free market and proposing MORE government interference as the solution!

It's your religion, your dogma, and you are NOT swayed by the evidence.

 

[ImprobableJoe]

What is it with you? You're like a creationist, and the free market is your evolution! The free market drives DOWN costs and quality UP! Again, that's why you can get a $100 Garmin GPS that does more than a $1000 would five years ago!

If the evidence supplied in my post makes one thing clear, it's that HEALTH CARE IS NOT A FREE MARKET! And I'm sick and tired of pseudo-skeptic dogmatists taking problems caused by government interference, and blaming the free market and proposing MORE government interference as the solution!

It's your religion, your dogma, and you are NOT swayed by the evidence.

I'm right, and accusing me of being a "creationist" to support the free market cult that has ruined the economy just makes you look silly. Profit-based systems seek to charge the maximum while cutting costs as much as possible. In some cases, market forces drive priced sown and quality up... but it is your blindness and religious belief in "free markets" that make you claim that it ALWAYS happens that way. In the case of healthcare, it has not worked that way at all. It is doubly stupid of you to claim that government regulations are ALWAYS the problem... that's more religious thinking on your part.

Look at reality, instead of relying on your retarded "free market" cult and ignoring the simple truth. Nationalized health care does a better overall job, for much less money. Them's facts, my friend.

 

[irmerk]

What is it with you? You're like a creationist, and the free market is your evolution! The free market drives DOWN costs and quality UP! Again, that's why you can get a $100 Garmin GPS that does more than a $1000 would five years ago!

If the evidence supplied in my post makes one thing clear, it's that HEALTH CARE IS NOT A FREE MARKET! And I'm sick and tired of pseudo-skeptic dogmatists taking problems caused by government interference, and blaming the free market and proposing MORE government interference as the solution!

It's your religion, your dogma, and you are NOT swayed by the evidence.

America's health care system is privatized, save for medicare or medicaid (or both, I always get them mixed up). To be fair, I was too lazy to read all of your post - actually, any of it. He's really not like a creationist because what he says is pretty evident in cross continental consideration: America spends more GDP than any other nation on health care yet Canada and the UK pay for 100% of the population. More people are covered and more are happy about it. Less people are covered in the U.S. and those who are are not as satisfied as other countries.

What was it you were saying? The free market drives down price and up quality? Not in health care, it seems. Privatized insurance and health care companies would like nothing more than to not help citizens and still try to get money out of it. This is actually the foundation of the insurance companies business plan.

 

[ebbixx]

If the evidence supplied in my post makes one thing clear, it's that HEALTH CARE IS NOT A FREE MARKET!

In practical terms, in the US, it is becoming more and more a free market. Those without premium health insurance increasingly seek out treatment from people who are not accredited through the mainstream allopathic medical establishment.

A lot of the the issues are the result of a mixed price system, though, since, without health insurance, the bills are much higher comparing same procedure to same procedure, looking at what Medicare vs. Aetna vs. unisured are billed. For something that insurance might pay $1,000- $2,000 for, an uninsured person can expect a flood of bills that range more like $8,000 - 16,000. Given such bills, only a small number of the uninsured will actually ever pay those amounts... most will enter bankruptcy first.

Do you have a serious proposal for how to make heath care actually operate in a truly free market? One that actually does not allow everyone from faith healers to magnetic bracelet salesmen to call themselves health care providers? (Though I suppose that's a contradiction of free market principles... in a free market, everyone should be allowed to compete to provide goods and services, regardless of efficacy... caveat emptor, baby!)

 

[ImprobableJoe]

Do you have a serious proposal for how to make heath care actually operate in a truly free market? One that actually does not allow everyone from faith healers to magnetic bracelet salesmen to call themselves health care providers? (Though I suppose that's a contradiction of free market principles... in a free market, everyone should be allowed to compete to provide goods and services, regardless of efficacy... caveat emptor, baby!)

It isn't a strategy at all, it is an justification for sociopathic selfishness and outright fraud.

 

[Ozymandyus]

Actually a big reason that costs are so high that is not accounted for in the above posts, though ebixx and shane touched on it, is that we give away so much health care for free. The number of times a hospital ACTUALLY gets paid $150 by someone for administering an IV bag is essentially 0. Insurance companies and medicare only reimburse a set amount of what is charged. For a $150 bag of IV they charged $150 but only get approximately $40-50 (or less).

In addition, an emergency room HAS to treat everyone, regardless of payment ability. As such, as much as 30-50% of people don't pay anything at all. So in the end the hospital is only getting 20-25 per bag. Because it costs more than this to adminster a bag (when taking into account the nursing staff pay, doctor pay, lawsuits etc.) there is a constant upwards pressure on the cost of medicine, because a very small group of people (Auto insurance, HSA, people that pay their health care bills) actually pay something close to the amount that is charged, and it makes up some of the difference.

Edit: BTW the reason a Garmin costs so much less now has more to do with technological advances and economies of scale than free market competition.

 

[ImprobableJoe]

Actually a big reason that costs are so high that is not accounted for in the above posts, though ebixx touched on it, is that we give away so much health care for free. The number of times a hospital ACTUALLY gets paid $150 by someone for administering an IV bag is essentially 0. Insurance companies and medicare only reimburse a set amount of what is charged. For a $150 bag of IV they charged $150 but only get approximately $40-50 (or less).

In addition, an emergency room HAS to treat everyone, regardless of payment ability. As such, as much as 30-50% of people don't pay anything at all. So in the end the hospital is only getting 20-25 per bag. Because it costs more than this to adminster a bag (when taking into account the nursing staff pay, doctor pay, lawsuits etc.) there is a constant upwards pressure on the cost of medicine, because a very small group of people (Auto insurance, HSA, people that pay their health care bills) actually pay something close to the amount that is charged, and it makes up some of the difference.

That's another place where creating a national healthcare system would really make a difference. If everyone had access to medical care, everything would be paid for which means that the hospitals wouldn't get stiffed. It all plays into the "economy of scale' idea you mentioned. If everyone is in the system, and hospitals and doctors don't get stiffed, everything begins to cost less. Plus, of course, people don't go to the emergency room for things that can more cheaply be handled by a primary care physician.

 

[irmerk]

That's another place where creating a national healthcare system would really make a difference. If everyone had access to medical care, everything would be paid for which means that the hospitals wouldn't get stiffed. It all plays into the "economy of scale' idea you mentioned. If everyone is in the system, and hospitals and doctors don't get stiffed, everything begins to cost less. Plus, of course, people don't go to the emergency room for things that can more cheaply be handled by a primary care physician.

Citizens would be the taxpayers (even though I am for the FairTax) and thus would be paying for everything they get. A mix of universal health care and privatized health care really makes the least amount of sense. It would be like education. Why would we leave it up to the individual schools to decide the prices and thus allow millions of children to be without schooling? It is a social imperative.

Edit: I think I am on board with Joe on this kind of issue. Meaning... I am just fed up with people getting a boner over free market capitalism and it's supreme being ability to turn coal to diamond with no defects. Get a fucking history book or turn on the T.V. and figure out it's an indoctrinated and propagated delusion.

 

[richi1173]

Ozymandyus: It wasn't even a bag, it was just the IV line.

 

[Master_Ghost_Knight]

There are a number of factors that have contributed to the high costs.

One is basically a shortage of physicians. Obviously, it's tough to get a medical degree, but to make matters worse, more and more doctors are getting out of the business. Here's an article on the reasons why:
("¦)
So there's a shortage of doctors, and anyone with a basic knowledge of economics will tell you that a shortage increases price.

Your forgetting most importantly is lack of regulations, sense there is allot of competition for different hospitals, doctors exploit this to increase their salary to the highest biter. And sense there is no government investment in the education of new professionals, that makes doctors even lower still.
And the notion that shortage = increase of price is ridiculous and only someone without knowledge of the market mechanics could apply such a statement independent of the situation.
First of all a doctor is not a product in a assembly line whit an initial cost of production, it's a person whit just cost of living, and profit talks only to his own. Only competition can increase its price.
If the hospitals where state owned, there wouldn't be competition and doctors wouldn't be half as expensive. And that wouldn't in any way prevent big and differentiated salaries dependent of the merit of the professional.

And until this point and all the way to the rest of your comments you have failed to address the costs of healthcare production products, such has drugs and other medical equipment.
The only reason that they are so expensive is that they are completely unregulated, because when it comes to healthcare if you increase the price of the product, not in any way will that decrease the market absorption capability. Because independent of what some political idiots try to convince you *caugh*shanedk*caugh* or either people buy the products or they can just go"¦ well fuck themselves and lose a leg or something (so you really don't have too much of an option).
If we where to set a fair price in function of production cost and leave a margin for a good profit for the company (and perhaps adding competition), those products wouldn't cost a 1/10 of what they cost.

Not only that, but it's a complete myth that hospitals don't treat people who can't pay, as I'm sure your aunt can confirm. Hospitals routinely settle for payments at pennies on the dollar. Also, Medicare and Medicaid only pays a fraction of the costs the hospital incurs treating their patients.

Oh really?
What is this then? Or this?
And this is just the first thing it showed up when "Google'd", and there were several pages of hits whit similar cases. Now imagine the thousands of cases that doesn't hit the web.
Add the fact that most people don't even pass triage without cash front and you can start have a better idea of what is going on.
The felling I have is that you don't really live in this world.

What is it with you? You're like a creationist, and the free market is your evolution!

Everyone that disagrees whit you must be necessarily stupid isn't it? You're a bigot, a hypocrite and a negative quality projectionist.

The free market drives DOWN costs and quality UP! Again, that's why you can get a $100 Garmin GPS that does more than a $1000 would five years ago!
If the evidence supplied in my post makes one thing clear, it's that HEALTH CARE IS NOT A FREE MARKET! And I'm sick and tired of pseudo-skeptic dogmatists taking problems caused by government interference, and blaming the free market and proposing MORE government interference as the solution!

I just proved you wrong whit knowledge of cost. I live in a country whit free health care.
I can take any exam, anytime, anywhere, without costing me one damn thing. Quality of service is by far much higher than the US and the statistics speaks for itself.

Free market capitalism is "your religion, your dogma, and you are NOT swayed by the evidence".

 

[shanedk]

I'm right, and accusing me of being a "creationist" to support the free market cult that has ruined the economy

It's government corporatism that ruined the economy, NOT the free market, WHICH WAS NOT ALLOWED TO ACT.

Profit-based systems seek to charge the maximum while cutting costs as much as possible.

WRONG. You don't even understand the BASICS of economics. Prices seek EQUILIBRIUM. If they charge too much, they'll end up making way too many items that they can't sell.

Look at reality,

I DID. I posted EVIDENCE. You posted nothing but your blind, unsupported dogma.

 

[shanedk]

America's health care system is privatized,

Health care is CORPORATIZED. It is NOT a free market!

He's really not like a creationist because what he says is pretty evident

What he says is WRONG to anyone who understands even the basics. In that way, he's VERY much like a creationist.

More people are covered and more are happy about it.

Then why are so many coming to America for life-saving medical procedures?

What was it you were saying? The free market drives down price and up quality? Not in health care, it seems.

BECAUSE HEALTH CARE ISN'T A FREE MARKET!!!

But, by your own admission, you didn't even READ my post, so apparently you don't want your dogma challenged.

 

[shanedk]

In practical terms, in the US, it is becoming more and more a free market.

In NO sense is it doing so! It's becoming more and more regulated! More and more corporatized!

Do you have a serious proposal for how to make heath care actually operate in a truly free market?

Yes, in fact, I have a video on that very subject explaining how we could have universal coverage without costing the taxpayers a dime:

 

[shanedk]

Edit: BTW the reason a Garmin costs so much less now has more to do with technological advances and economies of scale than free market competition.

Technological advances and economies of scale are PART of the free market. Notice how it's not allowed to work in health care.

 

[shanedk]

That's another place where creating a national healthcare system would really make a difference. If everyone had access to medical care, everything would be paid for which means that the hospitals wouldn't get stiffed.

Where would the money come from?

 

[Master_Ghost_Knight]

Then why are so many coming to America for life-saving medical procedures?

Do you mind provinding any statistics, and let say compare it to, I don't know Cuba? Venezuela?

Where would the money come from?

Socail Security? Oh whait, you think that is a ponzy scheme.

Ps. The text box holds more then 2 words, start using it more wisely.
PPs. If you think that by avoinding my point would make you look something else besides stupid, you can think again.

 

[shanedk]

Socail Security? Oh whait, you think that is a ponzy scheme.

It IS a Ponzi scheme. And Social Security doesn't pay medical costs anyway.

We are talking about ADDITIONAL money being spent. Where's it going to come from?