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8 comments

1 aagcobb  Sat, Aug 24, 2013 6:19:11am

One reason is that US Doctors are the highest paid in the world. In most of the developed world, government pays for healthcare and dictates what healthcare providers are paid. If we had simply enrolled everyone in Medicare, which has the power to dictate payments far lower than what individuals and even insurance companies pay, costs could be greatly reduced. More savings could also be achieved if additional states allowed nurse practitioners, who deliver high quality care at lower cost, were allowed to practice without having to affiliate with a doctor.

2 Eclectic Cyborg  Sat, Aug 24, 2013 9:37:50am

I think the hospitals share some of the blame for charging exorbitantly high rates for things that seem to have no connection to the actual cost of those things whatsoever. The classic example is of course the $200 aspirin pill you get in the ER, but I also read awhile back that even companies that supply hospitals with vital medical equipment are known for grossly overcharging for it.

Pharma takes some of the blame too. Why are brand name prescriptions so bloody expensive? Well, someone has to cover that big marketing budget each year. I really wish advertising prescription drugs was illegal in this country as it is in most other developed nations.

I would also level some of the blame at the health care culture in general. Thanks to the efforts of big pharma and other large healthcare companies, American medicine is less about “what’s the best way to treat the patient?” and more about “I think you have condition Y, I’m going to order a bunch of unnecessary tests and put you on medication X.” This applies even when there are known non-medicinal ways of dealing with condition Y.

Yet another issue is the “cross pollination” of the industry shall we say. Hospitals, Big pharma and doctors all have their hands in each others business, commonly working together to extract as much money from patients and health insurers as possible.

3 sagehen  Sat, Aug 24, 2013 1:39:22pm

The doctors’ salaries aren’t the main driver (and once you knock off what they’re paying for their student loans, and malpractice insurance, and a full-time insurance billing clerk, etc., they don’t make as much as you might think).

here’s where America’s ridiculously high medical expenditures go:

Let’s start with the 20% off the top that goes to massive salaries for insurance company management, plus shareholder profits for the stockholders. There’s stockholders and management raking in another 20% of hospital revenue. 10% of insurance company budgets is for the department that dicks doctors and policyholders around denying claims.

Another 25% goes to futile care — procedures, hospital beds, drugs, etc. — for the terminally ill elderly. That’s not just a waste of money, it also puts patients through agony. But when middle-aged people are faced with losing their mommy, they become totally irrational. They don’t think to balance (3 months at home with her grandchildren, sleeping in her own bed, visiting hours are whenever she’s awake, maybe a visiting nurse for hygiene and pain management) vs (4 months in hospital being poked and prodded and drugged to the gills). That futile care is hideously expensive — and the way we can know for sure it’s horrible is that doctors never choose it for themselves when they get to that age.

But if you try to suggest to a 50-year-old that his parents forego surgeries that could possibly extend their life by a couple of weeks (and those weeks will be spent battling a painful infection, because surgery on old people is pretty dangerous in itself), he starts screaming “sarah palin death panel!! you’re killing my momma to save money!!”

4 calochortus  Sat, Aug 24, 2013 2:23:16pm

Some of the blame also has to go to the average patient. We want hospitals with beautiful gardens, meditation rooms, and fancy food. We want every test possible and the very latest drugs (never mind that side effects include the condition known as “hot dog fingers” and children born with the heads of golden retrievers-we’ll sue if we have those problems.) And heck, the majority of us aren’t paying directly, so we don’t care what the extra cost might be.

I’m also happy to assign blame to drug companies, insurance companies, large healthcare corporations, and pretty much everyone involved in any way in delivering healthcare.

5 Amory Blaine  Sat, Aug 24, 2013 4:22:05pm

re: #3 sagehen

I think some of that attitude is borne in the system itself. Health care is a very expensive “product” (in our sick society) we are compelled to buy that most people don’t really use in any intensity until the end of life. Then there’s a “I/he/she/we paid into it all our lives and now that it’s needed god damn it I’m gonna use it!!” type of thought process.

6 Renaissance_Man  Sat, Aug 24, 2013 4:43:46pm

re: #1 aagcobb

One reason is that US Doctors are the highest paid in the world. In most of the developed world, government pays for healthcare and dictates what healthcare providers are paid. If we had simply enrolled everyone in Medicare, which has the power to dictate payments far lower than what individuals and even insurance companies pay, costs could be greatly reduced. More savings could also be achieved if additional states allowed nurse practitioners, who deliver high quality care at lower cost, were allowed to practice without having to affiliate with a doctor.

US doctor salaries are on par with many other places in the First World. Furthermore, doctor pay makes up 8% of healthcare costs. 8%. That’s it. Squeezing savings by skimping on the people who actually provide the care is one of the biggest red herrings in the healthcare debate. And it exists specifically to distract people from the huge waste - 40% and up - of healthcare dollars that goes to complete bullshit like management, advertising, hospital administration, and all the corporate trappings that for some reason are considered essential and sacrosanct, despite the fact that they provide no health care or patient benefit whatsoever.

It is also not true that nurse practitioners save money. NPs have lower salaries, this is true. But salaries are a tiny part of the healthcare cost of treating a patient. The vast majority of the cost is in things like administration, which continues to go up and up without anyone talking about it, and in the tests and drugs that the NPs prescribe, which are in fact generally more than a doctor because the NP is not usually as comfortable with their clinical judgement over a possibly unnecessary scan or test.

The real culprit in the completely ridiculous cost of healthcare in the US is in the fact that hospitals, pharmaceutical companies, and the other big businesses of health care charge whatever the hell they want. There are no pressures, free market or otherwise, that prevent them making up prices out of thin air. The hospital chargemasters are frankly fraudulent documents that have no basis in reality, and generate mind-blowing price lists that have no relationship to costs or anything else. Pharmaceutical and device companies price similarly, without any consideration of the actual cost of developing their product (which, by the way, is nothing near what they would have us believe it is).

In the rest of the First World, the existence of universal single payer and a national pharmacy allows for price control - that is, the government sets a price that allows a profit, and that’s what they will pay. Private insurers then pay generally a small amount more than the single payer reimbursement. Prices are then totally transparent - patients, providers, and everyone else knows what the cost is and what’s going to be paid. Furthermore, costs are kept down. And the pharmaceutical and device companies accept it, because they’re still making a profit. In the US, however, your government is specifically forbidden by law from negotiating a lower price. They have to pay whatever the company decides they will. And they have to pay it with your dollars. That’s why they want you to argue over who should pay the cost, rather than the really important argument of why the hell things cost so much.

So don’t fall for the ridiculous idea of squeezing more savings out of the doctors and nurses who actually provide the health care, and whose pay makes up only a small fraction of the total cost. Instead, ask why it is that your government exists to transfer public wealth into the hands of a few big corporations, so that you can get less of the same thing that people in other countries get for a fraction of the price.

7 Amory Blaine  Sat, Aug 24, 2013 4:51:13pm

Not to mention our doctors spend at least 30% of their time on paperwork while in Canada it’s closer to 0%.

8 Romantic Heretic  Sat, Aug 24, 2013 5:22:31pm

A couple of good articles on American vs. Canadian health care.

10 Myths About Canadian Health Care, Busted

Mythbusting Canadian Healthcare, Part II: Debunking the Free Marketeers


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