patrick.net

More interesting stuff... 0.1% increases in health expenses despite an aging demographic that's far worse than the US.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html

Why? Gov't covers 25% of health care and sets the prices. Price Controls!

Remember when State Tuition was cheap? That's because State generally paid most of the College Expenses, and made sure it wasn't being spent on 6 figure Vice Assistant Associate Deans and a Health Spa at the brand new 10,000 sq foot Fitness Facility, but on tenured English-speaking professors required to teach so many classes a semester.

WaPoIsHitler Lipsovitch says

0% the cost of an MRI in Florida at the negotiated price with Aetna-US Healthcare.

Florida is messed up. In Vegas you can get an MRI for under $250.

I am all for making healthcare cheaper and better. At this point it will be difficult without a recession.

tr6 says

Why is US outperforming the rest of the developing and emerging markets in growth. It's not all Apple, Amazon, and Facebook. Forced spending on healthcare increases growth. I did not say it was productive.

That's a lazy way of explaining it. Kind of like keeping wage growth low and unemployment high is a good way of limiting inflation. Yet, it's been the primary method of doing that for the last twenty years. Both have been achieved by implementing policies of 1)globalism/off-shoring, 2)massively increasing immigration, 3) automation. The last one is inevitable, the first two are policy choice designed by the 1% to benefit the 1%. Everyone else gets screwed by falling wages and (contradictory to weak economy) rising rents/house prices which are also pumped by Fed attempts to "spur growth" by setting interest rates as low as they go.
The Fed has never been very effective at controlling inflation. It's meant for a far different purpose.

Quigley says

That's a lazy way of explaining it.

I agree with you fully. Was just trying to make a point for Patrick because he's been super excited about stock market gains. Those gains would not be there without Obamacare.

Ironman says

How do you attribute the gains in the market to Obamacare?

already explained this earlier. Healthcare 1/5 of GDP. Obamacare = forced way to raise healthcare inflation. Money in healthcare (a lot of it government subsidies) helps people who work in it buy cars and iphones.

Ironman says

Do you think medical related companies make up the bulk of the stock market?

They make up proportional part of the market.

Ironman says

So, then 82% of the GDP and stock market consists of NON-healthcare related companies, right?

Should we thank Obama for that too?

In 2007-2008 was housing more than 1/5 of the economy? Did it bring entire economy down with it?

WaPoIsHitler Lipsovitch says

$160 in Japan for an MRI, one of the highest Cost of Living Countries in the World. 10% the cost of an MRI in Florida at the negotiated price with Aetna-US Healthcare.

http://www.npr.org/templates/story/story.php?storyId=120545569

Thanks WaPols! That's the kind of thing I was looking for.

USA:

http://comparemricost.com

Why can the Japanese pay only $160 for the exact same procedure on the exact same equipment?

Somewhere in here is the Medicare list of medical codes and what the government will pay for each:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html

Gold star to anyone who can figure out where it is.

Another good point I heard:

Fire departments exist solely for emergencies and are paid by tax dollars.

Why couldn't we do the same thing with emergency rooms?

Ironman says

It's OK, you can admit Obamacare is a piece of crap

You forgot that i was always against ObamaCare. Curious2 and I have arguing with homeboy for years about it. https://patrick.net/1224190/2013-04-25-how-s-that-obamacare-working-out?c=956291#comment-956291

This is from 2013:

Homeboy,

You are blindly defending ObamaCare. Yes, it has some good parts, but it barely addresses the cost issue (there is 10B in it to study per patient instead of per procedure procedure payments). People like myself are bearing the cost increases. For example, my family could be making another house payment with our premium for a high deductible plan.

Again, if it was the reform that many expected in 2008, we would see premiums going down at this point.

Ironman says

When did the topic in this thread change to housing?

I was giving an example on how something that was less than 1/5 of the economy brought it all down because of interconnections. Healthcare is the housing now.

rando says

Fire departments exist solely for emergencies and are paid by tax dollars.

Why couldn't we do the same thing with emergency rooms?

Interesting idea. And it could still be attached to a hospital that it was independent of, in terms of patient billing, but I see a lot of potential red tape and regulations at that interface between the two, to prevent the hospital from exploiting it in some way or another.

Ironman says

tr6 says

Those gains would not be there without Obamacare.

How do you attribute the gains in the market to Obamacare?

Both Obamacare and Trumpcare are stupid. They are playing with insurance which is not healthcare. No one wants to work hard to fix the real issues.

Can "you" handle the truth.
This is a free market capitalist economy.
How dare anyone criticize private business.
Next "you" will want government interference & regulation.
So let's regulate whatever business "you" work in. If anyone complains
about the price,the price must be reduced.Sorry if you lose your income.
To summarize, IF YOU CAN"T PAY CASH,YOU ARE A FAILURE!
This is America,fuck other countries.
Hypocrisy is strong in all of us.

FortWayne says

No one wants to work hard to fix the real issues.

This is America! Democrats & Republicans solve any problem IMMEDIATELY,after months of committee hearings
& millions of dollars wasted.

FortWayne says

Both Obamacare and Trumpcare are stupid. They are playing with insurance which is not healthcare. No one wants to work hard to fix the real issues.

Does not fix the ridiculous cost of health care, which is the real problem.

rando says

Why couldn't we do the same thing with emergency rooms?

It's like splitting investment and commercial banks.

If you split the emergency from the elective, then people could shop best Price and Quality for the Elective Care while the price for Emergency would be subject to cost controls.

If you split the commercial from the investment, you cut easily cut off the CDs and checking accounts and lines of credit from the IPOs and Bundled Securities, saving Main Street while making Wall Street eat their own shit if they fuck up.

The reason the insurance/hospital industry doesn't want emergency care and elective care split apart is because they can use emergencies as leverage to support the cost of elective; just like Wall Street holds main street hostage by entwining commercial and investment banking. "Bail out our MBS derivatives or Grandma's Savings Account and Bill's Auto Care Line of Credit gets it!"

tr6 says

ObamaCare with its high costs has been responsible for a large portion of GDP growth. That's why everyone is afraid to take it away. Make medical procedure prices reasonable and see economy go into recession.

Broken window fallacy.

rando says

USA:

http://comparemricost.com

Why can the Japanese pay only $160 for the exact same procedure on the exact same equipment?

Those are the charges, that's not what insurance companies pay. You will pay full list price, but the insurance companies won't.

Why do you believe it's the exact same equipment? Most MRI's in japan are done with locally produced. low field models. The high field models are used in public hospitals and are subsidized by the government. http://www.diagnosticimaging.com/articles/japanese-study-touts-low-cost-mri https://medicalskeptic.wordpress.com/2010/06/10/mri-japan-and-the-u-s/

I once asked Professor Ikegami why doctors put up with this; why don’t they just refuse to take MRI scans if the fee is so low? “The answer to that is the Fee Schedule,” the economist replied, “There is only one payment scale in Japan. If a doctor won’t accept the price in the schedule, he won’t get any business. And he won’t have the scans he needs to diagnose his patients. So the doctors accept the price.”

As it turns out, the heavy-handed price control from above has had a salutary effect on the cost of medical care. Because the permitted fee for an MRI scan is so low, for example, Japanese doctors went to the MRI manufacturers–Hitachi, Toshiba, etc.– and demanded a new line of compact, inexpensive MRI machines. The industry responded. Today, Japanese doctors and clinics can buy MRI scanners for around $150,000– about one-tenth the price of the bigger machines used in the United States.

Notice how neatly the 1/10th of the price of machines translates into 1/10th the price of scans. Ass, gas, or grass no one rides free.

Can you say price controls and subsidies? Public health care? Funny how same people bitching about the price of health care scream they will never accept public health care. You can't have it both ways. When do you think the medical equipment industry will stop lobbying to keep these cheap and low profit MRI machines out of the US? Like never I would think. Nothing like good old fashioned bought and paid for crony capitalism. Oh my, most of that lobbying money goes to republicans. Draining the swamp I see.

Surgery Center of Oklahoma is an interesting example of removing the corrupt iinsurance rackets from the pricing of medical service. By refusing all insurance, and being strictly cash-and-carry, are able to post flat rate pricing:
https://surgerycenterok.com/pricing/

Wow, that is amazing! I have never seen any medical center price list before. Excellent. I hope others follow suit.

Ironman says

That's the big reason. They won't even take credit cards. By being cash and carry, that eliminates a HUGE chunk of their overhead, a billing staff. Not having to pay wages to a whole department of paper pushers, then waiting months to get paid, they're passing on the savings to the people.

The question is, how many people have CASH to pay for their medical procedures, when over half of the country doesn't have $400 saved up for an emergency?

Very good, you are actually making a valid point about where some of the big costs of health care come from instead of just regurgitating the libertarian mantra we need more insurance company competition to reduce costs. Health insurance is a huge part of increasing the cost of health care, not reducing the cost. Are you sick?

Many people actually could save money by paying cash. If you shop around there are many instances where the cash price is less than the insurance copay . The bad news is it doesn't count toward deductible. https://www.wsj.com/articles/how-to-cut-your-health-care-bill-pay-cash-1455592277

rando says

Wow, that is amazing! I have never seen any medical center price list before. Excellent. I hope others follow suit.

You are better off looking at websites that publish prices for all the providers in your area than looking at a single provider. Here are some https://disputebills.com/the-5-best-websites-for-comparing-medical-costs/

Anything that insurance refuses to cover, the price has gone down over the past 10 years. These things are dealt with in cash most of the time. No one is willing to acknowledge this.

What comes to mind:
1. Laser eye surgery
2. Botox treatments
3. Laser hair removal
4. Plastic surgery

Doctors in New York years back tried to band together and provide a network of coverage for a family for $600 per person for the year. You pay up front for the year and could see anyone within their network. They were shut down by the state because the state claimed they were running an unlicensed insurance program. The real reason the state shut them down is because if that were allowed to happen, it would put every insurance company out of business.

Ironman says

The problem is, very few actually have that cash, and the majority of the country lives paycheck to paycheck.

How do you fix that, oh great Wizard??

Ironman says

Here it is, "If my insurance isn't paying for it, I'm not getting it". This even came from people who had zero problems paying cash for it.

Reading comprehension problems again? Read the article, not that you have ever read anyone's link before but there is always a first time. The out of pocket cost using insurance is higher than just paying cash and not using the insurance at all.

Fix it? There is no fix for the US health care system where I believe it should be true is the only criteria people use for making choices. When people don't have the vaguest clue the difference between the cost of health care and the cost of health care insurance then you end up with an abortion like ACA rather than solutions that actually reduce health care costs. There is so much profit in the system that any attempt to fix it, as in actually reduce costs and profits, will be overwhelmed by lobbying money very quickly.

rando says

Wow, that is amazing! I have never seen any medical center price list before. Excellent. I hope others follow suit.

If you follow links from the Oklahoma site they are a member of an organization that does this:
http://fmma.org/
You can use that website to find a place near you, if one exists. There is one in York, PA, but it seems to only be an orthopaedic care specialty.

Ironman says

You really have issues, you didn't answer either of my questions, you just went off on another straw man and re-direction, as usual. Why do you always do that?

What straw man it that? If it costs more OUT OF POCKET using insurance than paying cash then what relevance is your question? Are you having trouble with this concept somehow?

bob2356 says

You are better off looking at websites that publish prices for all the providers in your area than looking at a single provider. Here are some https://disputebills.com/the-5-best-websites-for-comparing-medical-costs/

Good link, thanks!

When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront.

When she needed an MRI to investigate further, she was offered a similar choice—she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.

Rather than feel good about the savings, Ms. Surdoval got angry at her carrier, Blue Cross Blue Shield of Arizona. “I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?”

...

Finding the negotiated rates for those same services is tougher, since many insurance contracts bar payers and providers from disclosing them. But individual plan members can see that information on their Explanation of Benefit statements, so ClearHealthCosts has joined with public radio stations in New York, California and Pennsylvania, asking listeners to anonymously post what their health provider charged, what their insurance paid and what they paid out of pocket. Thousands have responded, showing that in many cases, while insurers had negotiated a big discount off the provider’s original charge, the negotiated rates were still higher than the service would have cost in cash at the same place or nearby.

http://clearhealthcosts.com

Clear Health Costs - Bringing transparency to the health care marketplace.Clear Health Costs | Bringing transparency to the health care marketplace.

When we compare prices, there are lot of factors. We should also compare average pay for doctors, and average income with cost of surgery for those countries.
Doctors can live happily with 30K in india but in US that is poverty rate.
e.g. in Japan MRI costs 160 but it is done by technician and doctor is not involved vs US where tech takes MRI but doctor will diagnose based on images.
How big is the rental cost differential for facility? Can client who gets MRI, sue and destroy the MRI facility for an error? so high insurance cost. Are they using same equipment newer and better equipment cost more. US has lots of regulations, each extra step cost more money. Does Japan charge cost thru taxes, hence actual cost is subsidized. indirectly it costs same money to citizen since govt takes and redistributes money.

Malpractice Insurance blamed for Health Costs is the biggest BS there is.

http://truecostofhealthcare.net/malpractice/

KgK one says

Does Japan charge cost thru taxes, hence actual cost is subsidized. indirectly it costs same money to citizen since govt takes and redistributes money.

Japanese government institutes price controls on every medical procedure, down to $/sq. in. Stitch.

Ironman says

bob2356 says

Health insurance is a huge part of increasing the cost of health care, not reducing the cost.

I worked in the medical industry my entire career. Want to hear the most popular comment in the insurance arena??

Here it is, "If my insurance isn't paying for it, I'm not getting it". This even came from people who had zero problems paying cash for it.

How do you fix that, oh great Wizard?

Singapore diverts around 5% of income into a health savings account controlled by the individual. Seems to work very well there.

theoakman says

Singapore diverts around 5% of income into a health savings account controlled by the individual. Seems to work very well there.

Not true. The Singapore system is far from a health savings account. There are multiple levels of health care accounts based on income. There is tight government control of spending of hospitals and providers. The government controls what medical procedures the individual can spend on. The contribution rate is 20% employer and 16% employer. The system certainly works well, but it is complex and very tightly managed by the government at all levels. Read Affordable Excellence by William A. Haseltine of the Brookings Institute. It documents the system very well, but is a very dense 170 or so pages that I found to be a bit of a slog.

Singapore scheme works like this (I live here and participate in this scheme):

37% of salary up to a max of 51,000 USD goes into a special account called CPF (essentially a retirement savings account).
Employees contribute 20% and Employers contribute 17%. 21% of 37% goes in to medical account. That means about 7.77% of the first 51,000 USD of salary.
Money goes in pre-tax and it earns approx 4% interest compounded monthly. Money in the fund gets divided into: savings and medical. You can take money out of the medical account and pay for large procedures and medical check ups.

Singaporeans does not receive much additional government support. The government is also fiscally very tight. In the past ten years, the government budget had surplus each year except for 2009 and 2015. In 2016, surplus was 1.3% of GDP. http://www.tradingeconomics.com/singapore/government-budget

The money going into CPF is managed by an entity called GIC. They have bought a lot of commercial real estate around the world, including USA. They are a big player for hard assets around the world. There's another government entity called Temasek. They invest in higher-risk situation and their investments goes toward generating the government budget surplus. Temasek got it's money from listing government owned assets, like telecom, port, subway systems and etc. Then they invested abroad and pioneered the concept of sovereign wealth fund.

It's a fascinating government design. Very corporate: efficient and profit focused.

Republicans will love it here. There's no capital gains tax and very very minimal social welfare, almost none. Corporate tax is low. However, there is a huge tax on car ownership. This is done in the name of reducing traffic jams. But the public transport is so good that you don't need a car. I have gone 11 years without having a car.

The CPF system is not important to this discussion.

The important thing to report from Singapore is the excellent medical services that can be purchased at reasonable prices (relative to USA, Singaporeans bitch and moan about the high cost of living in Singapore). Btw: Singaporeans also mostly hate the CPF. They don't like having so much money being restricted by the government.

Back on track:
For example: Cost of a non-ceasarian delivery: approx 6000 dollars for high end stuff: private rooms, etc...
Cost of GP visit - 40 dollars
Knee Surgery: 15,000 USD (how much in USA?)

My daughter broke her arm and got x-rays and series of consultations. Total cost was about 750 USD.

All of this has to be paid out of pocket, so "the market" found ways to adjust. Part of the problem in USA must be because of:

1. Medicare and Medicaid. patients don't pay.
2. Cost of drugs are ridiculous
3. Lawsuits

bob2356 says

Read Affordable Excellence by William A. Haseltine of the Brookings Institute. It documents the system very well, but is a very dense 170 or so pages that I found to be a bit of a slog.

Interesting!!

xyliang says

It's a fascinating government design. Very corporate: efficient and profit focused.

Republicans will love it here.

Republicans would love a 37% tax rate for a medical system totally controlled by the government? Really? As in the koch brothers republicans? I don't think so.

xyliang says

Back on track:

For example: Cost of a non-ceasarian delivery: approx 6000 dollars for high end stuff: private rooms, etc...

Cost of GP visit - 40 dollars

Knee Surgery: 15,000 USD (how much in USA?)

My daughter broke her arm and got x-rays and series of consultations. Total cost was about 750 USD.

All of this has to be paid out of pocket, so "the market" found ways to adjust.

There are very successful public health care systems out there. There are also some continually underfunded disasters like NIH in Britain.

Of the 5 health systems I've had experience with I like NZ best. You get good care for the money with the least hassle. All are far from perfect. In NZ the top income tax rate is 33% and I paid about 24-26% nominal. That was total income tax for all government services. Health care, low cost college, roads, police, military, legal system, retirement, etc.,etc.. That's vs 23-24% nominal income tax I pay in the US plus 7.65% fica, plus 5-6% state (which through the miracle of AMT I can't write off) with no health care at all.

NZ cost of gp 25-30 USD.
Everything else cost is 0.
No there aren't endless waits or death panels. Drugs are evaluated for cost vs effectiveness then bought in bulk by the government at a low negotiated rate. Expensive procedures are done on a regional basis so there isn't tons of expensive equipment sitting around underutilized. You might have to travel for a complex procedure. When I had a heart mapping and ablation the health system paid for my airfare (sitting in the copilots seat of a cessna 172, I was in a very rural area), hotel, taxi's, and even airport parking.

What is missing is:
the cost insurance companies selling and billing for policies (since taxes are collected anyway there is no additional cost for collecting health care taxes)
the cost of and inherent conflict of interest in pay by procedure (gp's get capitation, specialists are employees of the health system)
the huge cost of doctors negotiating with, billing, and getting paid by the insurance companies (doctors offices don't have any billing staff at all, just a receptionist and nurse(s))
the cascading profit markup on every single procedure or item
profits to insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.,
lawsuits (there are no lawsuits in NZ, lawyers have to actually practice law)
the amount of money spent lobbying politicians by insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.
the list goes on and on.

All of this adds directly to the cost of health care. The vast majority of Americans have no idea were the money is going because they don't know the difference between the cost of health care and the cost of health care insurance. They only know the political talking points of whatever party they follow.

The US health system and political system are both a disaster that can't be fixed. For the same reason. The ever increasing ability of wealthy people and corporations to spend large amounts of money to influence the process to their advantage. Parliamentary systems are messy, but it's difficult to have a large political influence financially since you don't know what the majority coalition will be.

bob2356 says

Republicans would love a 37% tax rate for a medical system totally controlled by the government?

Did you actually read what xyliang wrote? The part that goes into the medical fund is only 7.7% (of the first 50K salary).