WatchI was reading my wife's Rice U. alumni magazine ( http://www.rice.edu/ricemagazine/features/index2.shtml ), and there was a good article by a medical economist named Vivian Ho which said this:
"As the number of uninsured Americans and private health insurance premuiums rise simultaneously, many hospitals have argued that they have had to raise prices for the insured patients in order to cover the costs of treating uninsured patients," Ho said. "But our preliminary analysis suggests that this hypothesis is false."
Ho and her team have looked at hospitals in Texas and found that they receive reasonable government subsidies to care for the uninsured, so that cost doesn't appear to be shifted to a privately patient. Rather, the costs of treating privately insured patients seem to be rising on their own.
"Costs continue to rise because doctors and hospitals are rewarded for performing more services, not for improving patient health," Ho said. "Our system is set up to reward specialists performing costly surgeries, not general practitioners taking preventative measures." ...
"As much as a third of our health care costs could be waste," Ho said. "The thing is, we trust our doctors too much. ... We don't price shop or compare. If they tell us we should have a knee surgery, we have it, regardless of the literature and studies that tell us knee surgeries could be ineffective."
Heck, I bet it's more than one third waste. Compared to every other country, we seem to be wasting half of all health care dollars.
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Troy says
I'm saying that how much I'm willing to pay should be irrelevant. I should not have to choose between bankruptcy and death. Only America imposes such hellish dilemmas on its citizens. Whether a heart transplant happens and gets paid for should depend on how effective it's likely to be, compared to the cost. If it's a million dollars and will probably get me another 1 year of not-so-good life, that's probably too high, because that million dollars could get a lot of other people much more than 1 year each.
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Patrick says
Other countries solve this problem through cost controls, top-down government cost controls like what Medicare is doing. We, however, have a more complicated and divided picture, with plenty of people attached to the free market ideologies of the right.
The following numbers are just out of my ass, but AFAIK 50% of the country has decent insurance, either through work or Medicare.
Republicans/conservatives are deathly afraid of any more big-government liberalism in this area. They know it's a bread & butter Democratic issue and their historical opposition to anything in this area has really boxed them in.
Republicans have become the party of "got mine f--- you".
The problem is that they are 40-50% of the population and they vote, as demonstrated last November -- the Big Lie that "government is the problem" has worked its intended purpose.
It's going to take a lot more collapse before the overall crisis becomes clearer to people. Most of this country can't even find any other country on a map, let alone understand their differences in their approaches to "socialism".
This is a political fight and the left is highly outgunned here. I took 6 years of crisis for FDR to get his 80% majorities in the House and Senate in 1936. We're now entering year 4 and our decline has been greatly softened by THREE TRILLION of deficit spending 2009-2010 -- $10,000 per person per year! Not sure how much longer this game of kicking the can is going to continue.
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Patrick says
This is health care rationing and this is what I argued for on another thread. We as a society need to do a better job of rationing care - whether the health insurance carriers do this or whether the government ends up getting the controversial task. Health insurance carriers try to ration or "deny" benefits in examples exactly as you give (poor prognosis) but patients cry foul. Deny me? Yet judge others worthy of this expensive procedure? These decisions are made even when patients are insured and have paid premiums. A health insurer needs to decide whether they go bankrupt giving procedures (the latest and greatest interventions) to ALL members or do they try to ration care to get a more widespread, effective use of premiums paid.
Patrick says
Uninsured patients do receive heart transplants...and liver transplants, etc. See medicaid. Essentially, if we have universal health care, you will have the government making decisions for society on how to ration healthcare. We as a society will have to take a look at how we treat death and how far we will intervene. We will have to b/c we simply don't have the funds to do the latest and greatest for ALL.
Of course there is waste in the system that we can trim. But, this point about rationing healthcare is really the elephant in the room that no one wants to deal with. It is end of life care that will be CRUSHING us very shortly. Everyone starts screaming death panels, etc. No, on a practical basis, we cannot afford to do all these life extending treatments which keep the person alive but dependent on ongoing medical care to keep them alive. Troy's point about "how much is a functioning heart worth to you?" is a strong one. To many individuals it is worth EVERYTHING. Yet, the individual isn't being asked to give everything...they are demanding that health insurers use up all the premiums on their case...or they are demanding that Medicare (taxpayers) fork it over. We as individuals will keep making these demands (we individuals tend to be selfish that way).
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I agree. My own mother underwent brain tumor surgery in the last three months of her life that must have been very expensive, but which the surgeon told us in advance would probably not help much. In fact, it ended up making her worse off.
She liked to gamble though, and since it had some slight chance of prolonging her life, she went for it, at public expense. I suppose the surgeon came out of it richer though, so not everyone lost.
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a4adam's website
Patrick says
Or even like the old Chinese system. You pay when you are well, when you get sick you stop paying the doctor.
If you think about it, why do we even need insurance companies at all? We all need effective and affordable health care, not insurance providers. I know insurance providers will claim they help keep costs down, but that is just pure BS because we pay for the cost of all their salaries and expenses.
I also agree with Ellie, we pay for procedures instead of focusing on outcomes. It's just ridiculous. Perfect example of this is one of my coworkers who has had hundreds of procedures over the past 1.5 years. Probably spent close to $250,000.00 in procedures and they still can't figure out what's wrong with her. Has it improved her health in any way? Absolutely not.
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a4adam says
Wow, I have to think about that one. New idea for me. I guess people would then have a financial motive to get sick, to save money. But then they'd be sick. I would not make that trade, but some other people might.
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Patrick says
Isn't it Madicare?
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a4adam says
Ok, while more focus should be geared to outcomes, the fact is not all sick people will recover. Don't you deserve medical attention when you have a terminal illness? Further, let's say you enacted this. So, a surgeon would look at a patient and see that the patient had only a 50/50 chance of recovering. Well...if he had a 50% chance of not getting paid for doing the same amount of effort, requiring the same amount of training to even offer the procedure, he would just refuse to do it. He would only offer the treatment to patients that would almost certainly recover.
And..so that system would in fact have a way of automatically rationing healthcare because I guarantee that the doctor, nurses and hospital staff won't be working for free. Would you? So, they would only help those who would recover and pay.
But, you know, another problem would develop. Say doctors didn't receive pay for poor outcomes...well, in only dealing with issues that they could cure they would never learn a thing. Advances would cease. Because it is though studies treating and managing these borderline cases that technology advances. And we want the advances but haven't yet a way to pay for all this care.
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Isn't this how the school systems are trying to make things? Get more money for being better than other schools. Pay for performance. That should be easier to figure out than how well a person does, or feels.
Based on the complaints of the school system, I'm going to say that trying to pay for performance where teachers/doctors are only a minor factor in their clients well being, it seems like a doomed system.
Teachers can't teach every kid. They can't enforce things, they can't take things into their own hands and force parents to do what is necessary.
Likewise a patient will behave in the same way when seeing a doctor in many cases. Ignoring what they should be doing. It's a neat idea, that just wouldn't function well.
Doctors would simply start looking for patients which performed well when sick. I know if I was a doctor I would spend a bit of time looking over patients to see if they were likely to do what I've asked and/or see if they've got any issues that might effect the outcome of some service I might provide later. Stacking the deck in my favour, but not the patients.
That will then leave the crappy patients for the doctors who don't stack the deck and we're right back to where we are today, but doctors not willing to stack their decks or perhaps "cheat" the system will be hurt the most.
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a4adam's website
The responses to my offhand comment about the old Chinese way of handling health care is pretty much proof of just how broken our system really is in this country. I was not really suggesting we adopt this method, it was more to elaborate on Patrick's point.
Of course, as a patient you would always offer to pay. But good doctors would not accept payment while their patient was sick. It's somewhat like having insurance (without the insurance companies of course) or having a doctor on a retainer. And it was a good way to keep doctor's focused on outcomes instead of charging for procedures. It was more honest.
If a patient refused to follow a doctor's suggestions, that's fine but they can't complain to them that they aren't getting better and just refuse to pay. A doctor should be able to fire a patient and vice versa.
There's plenty of money in this country to pay for good health care for everyone, but there's isn't enough to line everybody's pockets, to charge for completely unnecessary procedures, all the while enriching the parasites we call insurance companies.
Right now what we have is a broken "sick care" system because there's not much in the way of health to speak about.
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Put some dollars in your cars ashtray and pull over to the Vacuums at the gas station then place the hose over the Ashtray. That's not where it goes but the sound is an exact representation.
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artistsoul says
What I mean is not that doctors should be paid for absolute outcomes, but for outcomes compared to the patient's starting condition.
So doctors would not reject anyone they could possibly help. If they help, they get paid. If the patient ends up worse off or the same, they don't get paid.
But yes, doctors would then be biased toward taking only patients who are willing to make an effort to improve their own health. Maybe that's the way it should be. If you're an overweight smoking alcoholic promiscous drug user, maybe they shouldn't waste their time with you.
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Patrick says
Agreed that we need to find a way here for the individual to take more personal responsibility for the state of their health. B/c while I want universal treatment, I don't think it's feasible to treat the general populous today given the state of health and the massive amount of ongoing treatment required to keep us alive until the end of time. We are victims of our own success in the medical field. Not sure solely paying docs for outcomes is fair or feasible but I can see why it's suggested as a way to ration med care.
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Patrick says
In theory in a perfect world this would be a nice solution.
As a practical matter how would this all be possible? Who would make the decisions on outcomes? What would be considered a good outcome? How would you calculate a good outcome based on hundreds of variables depending on what other illnesses were involved? What would be a good outcome for a heart attack in a 45 year old in good health vs a 85 year old with congestive heart failure, kidney failure, emphesema and cancer? The permutations are endless. Would there some gigantic new federal agency? Would it all be subject to political meddling? Who would do the research? How would you keep up to date in a constantly changing world like medicine. Would it be like the tax code where thousands or even ten's of thousands of changes occur every year and the regulations run to hundreds of thousands of pages that require huge staffs just to keep up? As it is no one in the American health care system can even begin to agree on the most cost effective treatment for most illnesses now. Trying to track all this might cost a lot more than the current system.
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bob2356 says
That's what I meant by the not feasible part. You just said it much better.
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This one I think is pretty accurate.
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I think these health care costs go hand in hand with our countries poor diet/nutrition/fitness habits. We (myself included) eat so much processed crap, and aren't as active as we need to be. Some people will complain about the health care system, but yet be 60 lbs overweight. I know from friends and acquaintances, that the people who eat well and work out regularly are less prone to getting sick and having other ailments....especially later in life. When the number one killer in this country is heart disease (a completely preventable "disease" in most cases), I think that kind of sums it up.
If people were constantly getting into car accidents, it would increase the cost of auto insurance. That doesn't mean the solution to lower car insurance would be to regulate the industry. You'd attack the root of the cause - why are people getting into more accidents? Maybe it's bad roads, unsafe vehicles, or poor driving instructions.
Everyone's points on the flaws in our current health care system are definitely valid, and they do need to be addressed... but I also think that if we all took better care of ourselves (better eating habits/working out more), that would significantly reduce our health care costs as well.
I am certainly no expert on the health care industry - just my opinion.
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elliemae's website
Oh, I agree with the better eating habits/working out issue. I believe that we've poisoned ourselves with air polution and poisons we put in our bodies (nutrasweet) plus all of the toxins we're exposed to daily.
So add to that how one can go to a drive in for breakfast, drive thru dry cleaners, drop off mail at the drive up, etc... If one truly tried, they could never get out of the car. Not much exercise is needed to get thru the day now.
We're killing ourselves. It appears to me that there are so many more auto immune diseases these days. I don't know if it's becaue we're living longer, or it's my theory of toxins around us taking our health away.
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ChrisLA says
Except for the part about the "Cost of Medical Liability and Defensive Medicine" at 10%.
QUOTE (original poster is user Kevin):
http://www.ncbi.nlm.nih.gov/pubmed/16136632
In 2001 the figure was 0.46% for the combined cost of defending, insuring, and settling
malpractice claims)
Less than a quarter of that was awarded to victims. At best, completely banning lawsuits is going to reduce medical care costs by less than 1%. Awesome.
ENDQUOTE
Now, the cost of defensive medicine is harder to estimate. I haven't seen any really good studies. How to know that doctors will not continue to order more tests than needed, based on profit motive, and that that all the talk about "defensive medicine" is just a cover story for doing what is profitable?
I think someone should look into what percentage and what total awards of malpractice suits hinged upon a doctor not ordering a specific test. That might tell us something about what is really going on.
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Thanks, that's really informative. OK, hospitals are the biggest portion of cost and probably the best target for savings.
RealisticOptimist says
But what about all the TV, car company, and fast food industry commercials and sales? Are you saying that their profits at the expense of our health are somehow not good? But private profit is always good and always creates what's best for everyone! Ayn Rand told me so.
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elliemae's website
Working in healthcare, I have people threaten to sue and/or call the media just about every day. I'd say about 10% of the time they actually have a case. I don't believe that there should be a limit on the amount of damages because I've seen people who were crippled for life, that required specialized services forever, which will cost in the millions during their lifetime.
I do get pissed when people get settlemetn and refuse to pay for the patient's care anyway. It ain't right - but family members get dollars in their eyes and figure that the state should pay. It's the provider that gets screwed in the process.
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I wish that most of the people bringing up the frivolous lawsuits could have a fine or countersuit slapped on them (but not only for healthcare)...
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Premium
Let's quit pretending that American health care isn't the best in the world.
Rick Scott made hundreds of millions in health care - and now owns Florida which he'll use to make billions!
Why is everyone pretending not to know what Rick Scott knows?
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Patrick says
As long as rich execs get their cut they don't care if poor have to die in the process. Medicine for profit is the same, why prevent problems which would cut into profit margin.... just ensure people are super sick and permanently taking meds... thats where the big bonuses come from.
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Patrick says
Haha. Nice! Yeah, I believe anything that commercials and corporations tell me to. Especially if they come from pharmaceutical companies. We know they always have our best interest at heart.
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Premium
Obamacare is a criminally insane plot to steal from impoverished pharma and hospital executives who are the backbone of Free Enterprise, people who innovate and rake in billions - like Rick Scott!
America is a place where anyone can own a hospital, like Rick Scott did, and create vast wealth for himself and his investors!
This is proof of its greatness!
America is a place where anyone can own a state, as Rick Scott does, and will create vast wealth for himself and his investors!
This is proof of the infallibility of Free enterprise!
Whatever you are told by the pharma companies and health insurers is the perfect truth - because markets are perfect!
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Hmmm, looks like Rick Scott did not create vast wealth, but simply stole it:
Rick Scott "was forced to resign as Chief Executive of Columbia/HCA in 1997 amid a scandal over the company's business and Medicare billing practices; the company ultimately admitted to fourteen felonies and agreed to pay the federal government over $600 million."
And now he's governor of Florida.
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Patrick says
That brings us to our next topic of discussion, "Stealing Florida." Wait, that's a great idea for a movie pitch! ;)
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Why does Florida elect for itself such inane governors?
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American in Japan says
Because all the media are corrupt and do not do their job of informing the citizenry?
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Reston, VA
I'm surprised nobody challenged this broad generalization: "Compared to every other country, we seem to be wasting half of all health care dollars."
Simply roll that line around in your head for a minute. "Every" other country? "Half" of "all" health care dollars?
One of the things I like to ask proponents of socialism who go on and on how the USA is awful compared to their socialist utopias is "Why don't you move there?" Then they huff and puff and proclaim: "How DARE you tell me I should have to move?!?! Are you saying "love it or leave it?"
To which I respond: Why is that so unreasonable? If you are living on the side of a volcano and yearn to live in the valley where things are more tranquil and prosperous, why not move there? America is a land of immigrants who came for a better opportunity. If they think that other countries offer a better deal, why not go there? (Wait, that's a rhetorical question!)
They don't leave because they don't want to go to Sweden because it's cold there. They worry they can't learn the language. Perhaps they worry that Sweden and other generous welfare states don't roll out the welcome mats for people such as themselves with great jobs and free stuff. And there's the biggest reason of all, but I'll save it for the end.
All that said, Patrick has a point even if he uses an unsupported generalization to make it: The American health care system is in need of reform but the socialists have an agenda that goes beyond improving health care: It's about getting votes from their special interest race, gender, and other entitlement groups. It's about keeping their ambulance chaser lawyer lobby happy. And it's about getting slush and kickback money for their relatives and high paying "speaker" gigs when they retire.
And here's the biggest reason of all for why worshippers of Western European Socialism don't pick up and go there: Because they like TALKING about how stupid people who disagree with them are. If they went to Sweden, they'd be a American putz with little to actually contribute to the country other than saying: "Wow! You do things great here! I agree with you!" and, and this may happen, if they didn't like something, they couldn't criticize the locals because they would be immediately asked: "Why don't you go back to the states?" and then what could they say to that? Here, they can feel superior about themselves because that's what leftism in the states is all about.
Bottom line: Jabber on and on but don't expect a socialist paradise here due to the political and sociological mess created by special interests including yours. If you wonder why someone else doesn't "take one for the team" and volunteer to get thrown in front of a bus for the utopia project, it's perhaps because they're waiting for you to take that turn. Actually, white male leftists largely are a suicide cult hiding in bunkers like suburban SF...
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Polish--
Welcome back. I see you haven't lost your flair for strawman arguments and inside knowledge of socialists' desires.
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LIke Patrick has said...
"I'm against Socialism for the rich."
Lol...
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Chula Vista, CA
Good article Patrick! Hospitals are incentivized to perform lots of costly procedures and tests that treat symptoms, but rarely, if ever address prevention. Of course healthy patients cured of "chronic' disorders don't generate income for the cashcare racket.
To quote a farmer from the documentary Food Inc. "If our goal was "Let's have less people in hospitals this year than last year" things would be alot different."
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PolishKnight says
WTF are you babbling about? The politicians taking all the money from the people who have a vested interest in the current system are the ones fighting tooth and nail against any kind of change.
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NuttBoxer says
The way that hospitals work is amazing. If you are admitted with a broken leg but have chronic diabetes and high blood pressue, you'll see an ortho, an internest, and a cardiac doc just about every day. If you have any other problems, more specialists. More tests.
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@Zlxr
>From what I saw of things - I would basically say the Doctors were underpaid (by the insurance companies) and good X-Rays and such are often underpaid, but pharmacy and supplies were often times paid in full or at a much higher rate.
Fascinating. You may be on to something here (really-no sarcasm).
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Zlxr says
Zlxr, your terminology is not clear to me. By "underpaid", do you mean actual price is less than "list price"? Calling this "underpaid" is misleading. Just as the all-to-common 3x inflated list prices are misleading as well.
Please clarify.
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PolishKnight says
This is piffle. Your silly partisan theory rests on the idea that wealthy leftists want to make fees for speaking engagements? I suppose there are not millions of people in America who have no insurance? And that triage is not overburdened and ER doctors are NOT overworked?
And that businesses don't pay too much to cover their employees? And that too many don't go to the ER and get an amputation rather than insulin?
Yep...you got us. It's all about trial lawyers.
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PolishKnight says
Hahahahah you'd like that wouldn't you. Too fucking bad.
I am an American. This is my country. My soil. My government. My roads. My water. My air. This is ALL MINE.