Why our Healthcare is so Expensive

[Lord Mord]

The difficulty is that as long as we're using government to keep prices of health care down, Big Brother will be weighing you anyway. One way or another, Big Brother is going to tell you if you are worth the bother; the criteria may not be a literal measurement of one's susceptibility to gravity, but it is a scaling of some kind.

[DanteGabriel]

The difficulty is that as long as we're using government to keep prices of health care down, Big Brother will be weighing you anyway. One way or another, Big Brother is going to tell you if you are worth the bother; the criteria may not be a literal measurement of one's susceptibility to gravity, but it is a scaling of some kind.

The unspoken part of all of these "OMG BIG GOVERNMENT IN CHARGE OF YOUR TREATMENT" sentiments is that, currently, a profit-driven health insurance company gets to determine if you are worth the bother.

[Mlle. Zabzie]

The unspoken part of all of these "OMG BIG GOVERNMENT IN CHARGE OF YOUR TREATMENT" sentiments is that, currently, a profit-driven health insurance company gets to determine if you are worth the bother.

Oh yes. I had a 3 month fight with the insurance company whether care was "medically necessary" - no matter that when I went in, I was in a lot of pain and the test FOUND SOMETHING WRONG. I don't see that exchanging the government for an insurance company will be an improvement, but I don't know that it will be materially WORSE (I say that now, of course).

Most of my doctors already won't take insurance. I can afford it (thank goodness). If we go to a nationalized system, I'm sure I will continue to pay out of pocket. However, my taxes will go up. :dunno:

On the subject of whether people should go in for a cold - yes, perhaps they should (maybe the cold is more serious than they think). HOWEVER, an antibiotic prescription is going to do jack (except create more drug resistent staph :tantrum:) , and that's what a lot of people will walk out of the GP's office with for that same cold.

[Caliban]

The unspoken part of all of these "OMG BIG GOVERNMENT IN CHARGE OF YOUR TREATMENT" sentiments is that, currently, a profit-driven health insurance company gets to determine if you are worth the bother.

THe government's idea of reforn in today's political environment is to subsidize the current system enought to extrapolate current insurance based health care system to include more people in it.

This doesnt need to just be a evil big government vs evil profit driven health insurance company thing. Just because you arent a republican, evangelical, or compassionate conservative rigth winger doesnt mean that you have to believe in what federal democrats are proposing.

[Lady Greywolf]

Sounds like another fabulous way to make people avoid the doctor.

My earlier proposal can be modified to a rewards only plan... you pay $xxxx in taxes toward health care in one form or another. You go to the Dr. and get monetarily rewarded by paying $xxxx - $xxx if you are dropping body fat also applies if you are maintaining a healthy body fat year in and year out. If you don't care about the reward you choose what you want to do go to the doc and pay the regular amount to the system. If you continue to get more obese, you still pay the max. If you never go you pay the max. Rewards are for those who care about themselves and/or their impact on the health care costs of this country enough to do something about it.

Not looking to have people avoid the doctor, (my father was a physician and I trained as an RN) really looking toward a achieving a healthier US population. Most health care professionals would like the same thing. In most cases people will only seriously look at changing if there is a monetary reason to do so.

(little factoid: Operating rooms are routinely upgrading from tables that were rated to hold 300 lbs to new tables that hold 500 lbs)

[Lady Greywolf]

This sounds like a bad idea.

Ive had my job for 2 years almost exactly, and I looked into my W2's ive paid out $3,157.5 on insurance for the two years and I made one claim on a 5 minute doctors visit, chest X-Ray (negative, took them about 90 seconds with the machine and 90 seconds of actually looking at it) and the bill was $750 or so and I paid $350 after the claim.

That is absurd.

Congrats on being employed in today's economy. :)

Not really sure of the exact meaning of your comment, so please correct me if this is not what you intended. Insurance insures the group. What you pay in you will never get back unless you are one of the people who have large to huge health care costs. That's how insurance was designed. I pay auto insurance and home owners insurance hoping I never have to use it. If I am unlucky enough to get into a really bad car accident or have a house fire the coverage will probably exceed all my premiums paid in combined over many years. That is what insurance it and it used to be voluntary. Not anymore in this state.

Your health insurance (remember to add in what you and your employer pay in for medicare/medicaid to obtain your true cost) was originally designed to cover only catastrophic care medical care and has morphed into the nasty morass of red tape it is today. Thus the $350.00 co-pay on the x-rays.

By rewarding people for getting healthier you may see a decrease in your overall expenses from (insurance and government taxation for health care coverage). Rates are based on the group as a whole.

[Lady Greywolf]

You're right, I shouldn't acquiesce so easily.

Lady Greywolf,

I just don't see how that would fly from a government intrusion perspective. If you tie it to taxes in that manner, you would have to mandate that people go in for a physical. Big Brother is weighing you and so on.

Not really, if you don't go for the physical or don't want your results reported, no problem. You just pay the regular rate. The choice is completely yours.

Example here: You are looking for financial aid for college, your parents will not fill out the income verification sheet, you don't qualify for certain programs. That is your choice (or your parents) and you pay.

[Annelise]

Not really, if you don't go for the physical or don't want your results reported, no problem. You just pay the regular rate. The choice is completely yours.

Oh I see, it's not that your taxes stand to go up, they would just never go down. Okay.

[Stalker]

The Atlantic had an absolutely scathing excoriation of all the ways our Healthcare system fails us. It's a nuanced step by step explanation of the opaqueness built into the supposedly "Free Market" system we have now. It's absurd to prop this system up (as it seems the Republicans want to do), but just papering over it, patching it up as the Democratic led congress seems likely to do (and Obama likely to agree with) is no true fix at all. [...]

I don't think there's much new here (the opaqueness of our system, the perverse incentives for doctors, the overflowing medical administration complex, the broken economics of healthcare which are only exacerbated by government), but he lays out it all out in such, clear and logical fashion. The article is long, but think it's a must-read for anyone trying to understand why costs are increasing exponentially and why it'll never be fixed until we understand that in the end, we're all paying for this....and we need to start asking what we're paying for. Fuck I think this is must-read for Congress and Obama...though God knows they won't.

An interesting read (tho' the man needs to look up the word 'Succinct'). It is pretty clear on many of the reasons the US system is such a mess. It doesn't mention others (yes, there are yet more) but just fixing the ones listed does seem outside what is politically realistic. He seems ambivalent on the current reforms, possible because they fix some of those unmentioned things. But he is right the these reforms are a patch on a fundamentally unsound system

On the other hand, the system he proposes is just as bad in many ways, and does not even do the things he himself says a good system must.

It's like we've fallen for our own ponzi scheme.

In an unrelated aside, the current fad for calling anything economical one dislikes for a Ponzi scheme disturbs me. The term used to have a meaning.

[Tormund Ukrainesbane]

Since this is the health care thread of the day I got a question for ya'll (having thoughts on the article, but don't want to write them up right now).

In order to get an single-payer system here in the US. Would you be willing to have a cut-off age?

We all know that end-of-life care is far and away the most expensive part of all health care, medicare, medicaid and most insurance payments are mostly made to dying people who are spending MASSIVE amounts to live as long as they can.

Would people be willing to have a system that provides universal coverage up to, say....75 years old (the male life expectancy)? Basically say, that we will cover your entire life's medical expenses to that point, but we aren't going to drop hundreds of thousands of dollars so that you can squeak 5 or 6 extra months out on the backs of the rest of the citizenry? Or is that so heartless and evil it doesn't bear thinking about?

[Jaime L]

In an unrelated aside, the current fad for calling anything economical one dislikes for a Ponzi scheme disturbs me. The term used to have a meaning.

Still does. So long as you know to what it refers. Ponzi schemes require a new generation of investors to pay off the returns promised to the previous generation. In this case, the returns promised were unlimited healthcare after a certain age. As healthcare costs increase exponentially, retirees are getting more in benefits than they paid into the system when they were working. They invested in their future medical care through payroll deductions throughout their working lives...but as they now demand ever greater returns, it requires those of us still working (and those still in strollers and not even born yet) to foot the difference. The only thing keeping it from collapsing is an ever widening national debt. Medicare (and Social Security) is functioning like a textbook Ponzi scheme. The only difference is intent.

The way this wouldn't be a Ponzi scheme were the government to limit medicare benefits to the amount actually received as tax revenue. As that will never happen...."rationing" is the new third rail of American politics (even though it's part of every insurance company's modus operandi)...we must pretend the Ponzi scheme doesn't exist. And express a similar optimism that our bills will never come due.

[Lord Mord]

DG,

The unspoken part of all of these "OMG BIG GOVERNMENT IN CHARGE OF YOUR TREATMENT" sentiments is that, currently, a profit-driven health insurance company gets to determine if you are worth the bother.

This I do not deny. I'm just saying, if you're already sold on gov't getting enough control to drive down costs, then to be against one particular idea because "Big Brother's going to weigh you," is silly, because he's going to weigh you anyway.

[Lord Mord]

Jaime L,

And express a similar optimism that our bills will never come due.

This is the heart of all American thinking, Democrat and Republican and Independents, all. For some, it is literally a financial statement that we will never have to account. For others, it is political meddling in distant lands who have no reason to love us as it is, whose suffering should never be visited on us in retribution, like planes flying into buildings, because that check we wrote was never actually supposed to be cashed.

[sologdin]

many doctors will prescribe it whether it is indicated or not; if one doctor doesn't, another will. And then they'll go get the insurance to pay for the majority of the drug.

wow. that's a false claims act quit tam suit waiting to happen.

[Lady Greywolf]

Oh I see, it's not that your taxes stand to go up, they would just never go down. Okay.

Taxes never really go down in this country.

If you think any information about any person is truly private, think again. If a person is unwilling to be weighed because they are afraid of increased costs, due to obesity or any other medical condition, they should realize the cost will be much greater when the problem gets too large to ignore and the cost is more than just money. Your good health is irreplaceable. Once it is lost, the true value of good health becomes known.

If a person does not see a doctor once a year for any reason and is pretty healthy, they may want to consider a yearly physical. One reason is to develop a patient history with a physician. When something does go wrong you need to know who to call. Another reason is that physician now has a record of your stats as a healthy person to compare against when you may have a complaint.

Lastly Annelise, I think you have been focusing too much on one part of an opinion that really expressed the responsibility of the individual to be a caretaker to his or her own body. If that person doesn't care enough to take care of it through lifestyle choices, why should anyone else?

[Jaime L]

Going back to an earlier post:

Finished it. He seems to be proposing something closer to the Swiss system (which is a pretty good one) but the whole thing suffers due to his major, unyielding hard-on for "The Free Market" and it's many godly powers. Government regulation, on the other hand, is the boogeyman.

What you're missing is that our system, right now, is attempting to be free market and failing utterly because the consumer doesn't care how much it costs him, because he's not the one paying for it. No-one is minding the store. A fully functioning, competitive, market keeps prices low...this is true in every industry on earth. Healthcare doesn't have to be the completely different animal it is. The whole thing about the consumer not understanding what he's buying? So overblown, I don't even know what to say. I own a car though I don't know shit about engines. I count on professionals I trust to help me with that. And let's be clear, my insurance company isn't helping me understand my options at all. There's nothing about insurance that somehow allows me to find the care I need better than I would if I were paying for it entirely myself.

But don't get me wrong, I'm not agreeing necessarily with his conclusion (though I think his idea is still markedly better than the system we have now), just that I completely agree with his diagnosis of the problem. I still very much believe we need a public option in Health Insurance, at the very least to cover the potential of a catastrophic illness. It's near barbaric that that has not been instituted yet. But let's not con ourselves into believing a public option is the panacea to cure all our health-care woes. Short of a total overhaul of the way healthcare in this country works, doctors and hospitals are still going to have perverse incentives and even more so, individuals will not exercise self-responsibility so long as they believe they don't have to pay for it. We need to unwind the way we look at the care we receive. We're far too accepting of paying any price for a 5 minute visit with the doctor, or an MRI which uses 20 year old technology and a little bit of electricity because someone else picks up the tab. It's making everything about healthcare more expensive. We need the price we pay for our healthcare to return to some kind of economic reality. It should be getting bid down to its cost inputs...but never does, because no-one's minding the store. Maybe I can accept the system will never be perfectly efficient in exchange for the security a public health option would provide. But we're foolish if we stop there. Because this problem won't go away on its own. It's like throwing a sheet over the 800 LB Gorilla in the room so you don't have to look at it anymore. But it's still there.

BTW, what I'm saying, doesn't just apply to America. It's happening around the world. From the article:

Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.

Whether healthcare is provided publicly or privately, it's becoming absurdly more expensive for all of us, far outstripping inflation. It's making every one of us poorer as it eats up GDP and crowds out money that could be spent elsewhere. Again, this is not to say single-payer isn't better than our system. It clearly is....much, much so. But it's not the end all, be all. It's simply not going to solve all our problems...and that's why this debate is important. There are two, somewhat conflicting, issues at hand that's making healthcare so expensive: 1) Public versus private coverage...and 2) Personal Ownership of our Healthcare...and until we get both right, we're still going to pay far more for healthcare than we should and we'll all be, literally, poorer for it.

And we're only going to do ourselves a disservice by oversimplifying the issue in either direction.

Brick,

because that check we wrote was never actually supposed to be cashed.

I like this description.

[The Space Pope]

What you're missing is that our system, right now, is attempting to be free market and failing utterly because the consumer doesn't care how much it costs him, because he's not the one paying for it.

I'm not missing it at all. What the author of the article is missing is that trying to make health care function like a free market is a combination of impossible, stupid and morally repugnant.

A fully functioning, competitive, market keeps prices low...this is true in every industry on earth.

:lol:

Yeah, in the like ... 4 industries that actually work like an Econ 101 textbook I'm sure it does.

The whole thing about the consumer not understanding what he's buying? So overblown, I don't even know what to say. I own a car though I don't know shit about engines. I count on professionals I trust to help me with that.

Your saying that people like and trust their mechanics so much, they want their doctors to be the same? When the hell did that happen?

[Jaime L]

Yeah, in the like ... 4 industries that actually work like an Econ 101 textbook I'm sure it does.

I'm not sure you look at things with enough nuance to really participate in this discussion. At least, meaningfully.

But please, continue missing the point for that one line you can respond to with a pithy one-liner.

[Caliban]

I'm not missing it at all. What the author of the article is missing is that trying to make health care function like a free market is a combination of impossible, stupid and morally repugnant.

:lol:

Yeah, in the like ... 4 industries that actually work like an Econ 101 textbook I'm sure it does.

What are you talking about? How are you say market forces dont drive down cost? That sort of ignorance is curious in somebody with internet access.

[Caliban]

To the person, i forget whom, who asked why i posted how much my W2 showed my medical insurance has been since i started at my current job (since i got out of college), its to prove part of the article's authors point. That was 3,100 bucks, double that because of my employer's contribution on my behalf, which is 100% reflected in a depressed base salary that i recieve. So its almost $6,500. Now, I have not bought anything for 6,500, but even when I spend 5% of that i put in a little legwork into what im buying. I completely ignorantly allow that money to leave with absoluetly no thought.

The same as how i went to ge that X ray. I didnt price compare, i wouldnt know how to began to consider quality concerns. It ended up costing $1,000, $350 of it was mine and $650 was shouldered by a number of people who had no input on the responsibility of my choices, no knowledge of the actions of the supplier, and no assurance of the fiduciary responsibilty of the insurance company that in essence represents us. Its pretty fucked up.

At least when you belong to a condo association you have access to the income and expense reports and have a say in where your assessments go.