Why our Healthcare is so Expensive

[The Space Pope]

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.

"Market Forces" rely on many other things. Like "informed rational consumers" and said consumers having the ability and time to make meaningful choices about where they buy their products/services from.

And that's not even touching on collective action problems. Or the need for regulation to stop behavior that, while profitable, is not what society wants or in societies best interest.

The need for Anti-Trust and Fair Competition Laws is proof that "market forces" don't always do what some people wish they would.

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.

I'm sorry your article was a thinly-veiled overlong 6 page masturbation over the free market. Don't get all huffy about it.

[TerraPrime]

Re: healthcare reform

As far as I can tell, you cannot have a meaningful health care plan for all citizens without some form of price control. You can control it at the cost of physician visits, or the cost of medication, or the use of expensive procedures, or a combination of all of them. But price control, being the boogey-man herald of SOCIALISM, is not going to sell to the American public, imo.

And no, it's not free market if you want to install rules on things like pre-existing conditions being covered or some form of guaranteed continual coverage. So, really, very few people want free market to take over health care, if you ask me.

Re: Rhom

These two things:

In my own experience, I have found that patients who pay for their own care take much greater "ownership" of their condition.

Lastly, the pharmaceutical industry has taken prescription drug marketing to the masses. Explain to me why Nexium is advertised during football games? Can Joe Schmo get off the couch and go to the corner pharmacy and buy it? No, that's just as illegal as if he were to try and buy cocaine. So why are we advertising something to a population that cannot purchase it legally? Answer: It creates a demand.

Aren't these two in conflict? If you want to give people more control, then they're going to start demanding drugs that they may not need, thus creating a demand. Or are you saying that we need to limit or ban drug ads?

Already mentioned are the people who pay cash for cosmetic procedures. I have often pointed out in public talks that people find money to pay for what is important to them. I generally follow this up by mentioning that if the health is on the inside of the body, we are less likely to pay for it than if it is on the outside. People pay thousands of dollars for braces to straighten their teeth, but the effort to care for the internal workings of their body continues to be beyond them.

I don't know what you're advocating here. Most people don't have the right kind of medical knowledge to judge what's needed and what's not, as you seem to indicate when you give the example of people paying a lot for elective cosmetic surgeries and not paying near as much attention to other aspects. Is this the direction we want to drive our national health care plan towards?

My stance is that our country has become "entitled" to health care. We see it as something that we have a "right" to and not a "responsibility" for. In my opinion, health insurance should be there for emergencies or catastrophes and routine stuff should be up to us.

We most certainly are entitled to it by virtue of taking jobs where part of the compensation is paid in the form of health insurance. We're not "entitled" to it in the sense that we deserve it as a free compliment from our neighbors. We have paid for it. We should then receive the quality of care commensurate, including the number of people being covered.

[Angalin]

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?

I read about this recently in Salon. Part of the problem is that even if you're terminally ill and end up in a hospital, the job of the doctors and nurses there is to make you better, at vast cost. It was a very pro-hospice, pro-palliative care article. Palliative care takes incredible people to do it, but it is so worthwhile, cost-wise and especially for the patient's family.

Was also chatting about US healthcare lately with a friend just up from Minnesota. Apparently if US healthcare was run Mayo-Clinic-style, it wouldn't be taking the country into debt. I have no firm financials on this, but managed to find two pieces about it.

eta: found a mention of the possible savings if the entire country adopted the Mayo approach in Time:

One Dartmouth study found that if nationwide spending had mirrored the modest rate of that in Rochester, Minn. — where care is dominated by the renowned Mayo Clinic — Medicare would have reduced its costs for chronically ill patients by $50 billion from 2001 to 2005.

[Lyanna Stark]

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.

I don't understand this at all, as this is not how a UHC works. If you go in and have a problem, you get treated.

The ONLY time doctors may reason that treatment is not someting they'd recommend is when you have a clear terminal illness or want specific drugs that aren't covered for some reason. Make no mistake, these are very rare cases.

And if you end up with a specific kind of very rare kidney cancer and want to try that new, very expensive drug that is not yet covered, you have two options:

1) Take it to court, which may very well end up with you getting the drug under UHC

2) Pay for it out of pocket.

For "normal" stuff, like treatable cancer, a broken leg, child birth, bypass operations etc. you will be covered.

Also, GPs don't give antibiotics for colds. They just...don't. If I come in and demand antibiotics for what I think is sinusitis, and the GP examining me can clearly see there is nothing there, I won't get a prescription. Why would they incur extra costs to the system by giving out faulty medication, just because it is UHC? That makes no sense.

As for people running to the doctor all the time, that also doesn't happen, for two reasons:

1) If you aren't ill, the GP will send you on your way without any medication

2) Your employer will probably not be very impressed

[Werthead]

I don't understand this at all, as this is not how a UHC works. If you go in and have a problem, you get treated.

The ONLY time doctors may reason that treatment is not someting they'd recommend is when you have a clear terminal illness or want specific drugs that aren't covered for some reason. Make no mistake, these are very rare cases.

And if you end up with a specific kind of very rare kidney cancer and want to try that new, very expensive drug that is not yet covered, you have two options:

1) Take it to court, which may very well end up with you getting the drug under UHC

2) Pay for it out of pocket.

For "normal" stuff, like treatable cancer, a broken leg, child birth, bypass operations etc. you will be covered.

Also, GPs don't give antibiotics for colds. They just...don't. If I come in and demand antibiotics for what I think is sinusitis, and the GP examining me can clearly see there is nothing there, I won't get a prescription. Why would they incur extra costs to the system by giving out faulty medication, just because it is UHC? That makes no sense.

As for people running to the doctor all the time, that also doesn't happen, for two reasons:

1) If you aren't ill, the GP will send you on your way without any medication

2) Your employer will probably not be very impressed

Looking at all the vehement anti-UHC propaganda doing the rounds in the USA at the moment, I can only conclude that those arguing against it don't actually understand how it works or what it means and when people point out how successfully it works in other countries, they stick their fingers in their ears and start rabbiting about how some timewaster in Canada didn't get her free treatment for some spurious, non-fatal condition in twenty seconds so she had to drive to America and pay out tons of cash to do it instead (which frankly is an own goal if I've ever heard one).

The bit I don't understand is that those arguing against UHC are under no obligation to use it. They can keep paying their insurers and are completely free to keep dropping dead at an earlier age than most of the rest of the West to their heart's content. And since it seems to be the rich who seem to be arguing the most vehemently against it, I'm not sure their complaints about paying more in taxes (which wouldn't necessarily be true if the USA chose to spend less on, say, the latest weapon systems) are really that sympathetic.

[Stalker]

As far as I can tell, you cannot have a meaningful health care plan for all citizens without some form of price control. You can control it at the cost of physician visits, or the cost of medication, or the use of expensive procedures, or a combination of all of them. But price control, being the boogey-man herald of SOCIALISM, is not going to sell to the American public, imo.

But then, would price controls by insurance companies sell?

And no, it's not free market if you want to install rules on things like pre-existing conditions being covered or some form of guaranteed continual coverage. So, really, very few people want free market to take over health care, if you ask me.

I'd agree ,and very few actual proposals are free market. But to many it sounds good, and to those it don't, it's a red flag that makes them focus their attacks on something that doesn't exist.

[Nymeria Sand]

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.

And it wasn't so long ago. It was called "hospitalization" or "major medical". It didn't cover office visits, it didn't cover prescriptions. Those things were cheap enough that the majority of us could afford it on our own. Until fairly recently, insurance was for people who couldn't afford to pay cash for their procedures.

Remember the days when a doctor could make you stick your tongue out, say "ahh", diagnose you with strep throat, and give you a prescription, all for the bargain basement price of about $20? Now, they send you to a lab, swab your throat with a Q tip--the Q tip costs $10, the tongue depressor $10, $100 just for the technician to do it, and another who knows how much to send it to the lab--and then they might decide to treat you.

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.

Hmm. My insurance company has tried something like that this year. What they're doing is giving you a $400 rebate for completing Lifestyle Returns. But your contribution stays the same--the premium went up $400 a year. Now, if you choose not to do it or don't complete it, they're charging you $400 to be taken out of the first two paychecks of next year. So in other words, they're charging you the $400 and "waiving" the increase in fees if you do it. Bottom line: You're not saving anything. That's not a reward. That's maintaining the status quo.

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?

That sounds too much like Soylent Green. Many diseases of old age are just that--diseases of old age. There's not much you can do about it other than...don't live that long. We're seeing these diseases and will see a huge increase in them in the coming years as the boomers age...because not all that long ago, people didn't live that long. Even now with our advances in medicine, 25% still kick off before age 62. However the ones who make it to 70 have a much greater chance than ever before of living to 100.

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.

Since you mentioned it, the "death panels" and mandating end of life counseling propaganda are totally wrong. If you think your insurance company doesn't have a "death panel" of its own, guess again. And end of life counseling won't be mandated. All that's being proposed at this point is that if a person chooses to have that counseling, your insurance provider, whover it is, must cover it. That's all.

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.

Absolutely they do. And those results get reported to your state health department, who report it to CDC.

Re: healthcare reform

As far as I can tell, you cannot have a meaningful health care plan for all citizens without some form of price control. You can control it at the cost of physician visits, or the cost of medication, or the use of expensive procedures, or a combination of all of them. But price control, being the boogey-man herald of SOCIALISM, is not going to sell to the American public, imo.

The Bush Administration wouldn't allow Medicare to negotiate for the best drug prices. And what happened? The price of drugs has gone up 50% since then. That's what happens when you let the free market take over and there is no regulation over what the drug companies can charge. The bigger the potential pool, the more they'll raise prices. Supply and demand has nothing to do with it. It's just plain greed.

Aren't these two in conflict? If you want to give people more control, then they're going to start demanding drugs that they may not need, thus creating a demand. Or are you saying that we need to limit or ban drug ads?

This has been happening since drug ads were allowed on TV. People know NOTHING about these drugs (and doctors don't, either) and yet they still demand them. Yes, drug ads should be banned. If you want to know something about a drug, don't ask a doctor. They don't have time to sit down and read every pertinent fact on what they're prescribing. Some drug rep comes in, gives the doctor a few samples and some perks, and the next thing you know the doctor is prescribing that drug. If you want to know about a drug, ask a pharmacist.

If you listen to those ads and note the side effects, why in the world would you ever want to take those drugs? The cure is just as bad as the ailment.

We most certainly are entitled to it by virtue of taking jobs where part of the compensation is paid in the form of health insurance. We're not "entitled" to it in the sense that we deserve it as a free compliment from our neighbors. We have paid for it. We should then receive the quality of care commensurate, including the number of people being covered.

The more we pay, the less we get.

Also, GPs don't give antibiotics for colds. They just...don't. If I come in and demand antibiotics for what I think is sinusitis, and the GP examining me can clearly see there is nothing there, I won't get a prescription. Why would they incur extra costs to the system by giving out faulty medication, just because it is UHC? That makes no sense.

Some doctors here will give a prescription for any little thing just to shut you up and get you out the door. Especially parents with small children. He got his insurance reimbursement already (called double-billing) and it's on to the next one. Your child has an earache? Give them an antiobiotic. Sinus infection? Antibiotic. Have the sniffles? Antibiotic, even though antibiotics don't work on viruses. Think your kid has ADHD? Why, here's some Ritalin or Adderall. No problem.

We've become a nation of hypochondriacs, seriously. Fueled by TV ads, magazine ads, and overactive minds with underactive bodies.

[Mlle. Zabzie]

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.

Trying to influence human behaviour indirectly through the tax code is a TERRIBLE idea. Doing so presupposes that you know ab initio how the incentive structure you set up will play out in the real world. Can you imagine a BMI chart in the Code? The actuarial charts are bad enough.

Your plan also, in effect, would turn doctors and nurses into tax collectors. They have enough to do without that extra reporting burden IMO.

[Lady Greywolf]

Eh? Do you mean like in real terms or something about costs are just shifted around? Cause if you just literally mean that they never go down there are some very obvious recent examples to point to.

Costs get shifted around. Specific taxes may get changed (reduced or increased), but the government bills must get paid (eventually).

[Tormund Ukrainesbane]

Since you mentioned it, the "death panels" and mandating end of life counseling propaganda are totally wrong. If you think your insurance company doesn't have a "death panel" of its own, guess again. And end of life counseling won't be mandated. All that's being proposed at this point is that if a person chooses to have that counseling, your insurance provider, whover it is, must cover it. That's all.

I didn't mention it. I didn't bring it up at all. I was asking an unrelated question.

[Jaime L]

Does anyone have a good idea why we even use the fee-for-service model? Is it just all about profit (that's what I assume). This would be so annoying as a physician though. Your main motivation is to get through patient visits quickly. That is not to say that doctors don't try to give good care in the time that they do use but they are under pressure to move people through the queue.

My guess is because most doctor's run their own practice. They're basically equivalent to entrepreneurs. They pay the salaries of all their employees, the rent for their office etc. Those are fixed costs. So the more they can bring in through billing, the more it affects their personal bottom line.

[Greg]

But then, would price controls by insurance companies sell?

I'd agree ,and very few actual proposals are free market. But to many it sounds good, and to those it don't, it's a red flag that makes them focus their attacks on something that doesn't exist.

For most kinds of insurance. a well regulated "free" market works well enough. In cases where the insurance industry deems that it cannot meet a need profitably, the Federal or state governments can step in and and force the industry to take up the slack or take up the slack themselves . The US government already has the National Flood Insurance Plan and the VA healthcare systems as examples of programs that work---- well enough. In states where risk of loss by hurricane and earthquake are greater than insurance companies can bear alone, the state governments set up mandatory participation loss pools for companies that want to do business in those states. Same goes for high risk auto. The pool/high risk insurance is usually sold through a certified agent and administered by private insurance companies. These mixed market solutions are far from perfect, but they work well enough. They provide options for those who may not otherwise have them and preserve the efficiencies/incentives that market driven solutions can provide.

I am not proposing a health care variation on this as THE solution but has anyone seen a proposal like this anywhere?

Surely there is a rational compromise somewhere between the "free market" health insurance clusterfuck we have now and a single payer system?

[Nymeria Sand]

Part of what the Mayo Clinic does is salaried doctors as oppose to the fee-for-service model that so many organizations use. So the system isn't as bent of providing more care as oppose to better care.

Does anyone have a good idea why we even use the fee-for-service model? Is it just all about profit (that's what I assume). This would be so annoying as a physician though. Your main motivation is to get through patient visits quickly. That is not to say that doctors don't try to give good care in the time that they do use but they are under pressure to move people through the queue.

According to this article, more than 2/3 of us hate the fee-for-service thing:

http://www.medicalnewstoday.com/articles/128031.php

Fee for service has been around for a long time. In 1950, most states banned group practices with prepaid monthly fees in favor of fee-for-service providers, due to 2 decades of AMA pressure. It's the doctors who don't want to give that up. Fee for service allows doctors to drive the level of health care "consumption" (can't think of a better word right now), which means more health care is delivered in a clinical setting rather than focusing on prevention and maintenance. In 1974, the AMA wanted government funded fee-for-service plan without cost controls. Like that would have worked out well. In 1983, President Reagan seriously curtailed Medicare and private plan providers ability to charge patients varying fees per service because of complaints from the insurance companies that doctors were taking advantage of fee for service billing (duh, why wouldn't they?). He instituted "capitation", or a prepaid fee per person or diagnosis rather than a fee per treatment. By 1988, most HMO's were back to fee for service. (HMO's were supposed to replace the fee for service, but somehow or other they ended up doing the same thing. I think that has to do with the medical coding and billing. I'll have to check on that.) And 41% of HMO's were non profit compared with 88% in 1981. We have the AMA and Reagan to thank for that.

Changes are never going to happen until the pressures of supply side growth are eliminated. Look at how hard it is to get doctors to practice in rural areas. There aren't enough patients for their fee for service model to work. So they don't make money.

[Greg]

My guess is because most doctor's run their own practice. They're basically equivalent to entrepreneurs. They pay the salaries of all their employees, the rent for their office etc. Those are fixed costs. So the more they can bring in through billing, the more it affects their personal bottom line.

Totally anecdotal, but true:

A friend of mine who has two brothers that are dentists asked them how they arrive at their schedule of fees. They looked at each other, hemmed and hawed, then eventually admitted that they figured at such and such fixed costs, with so many patients a day, over so many years, at such a such personal savings rate, they would be able to live the same lifestyle retired at 65 as they live while working.

Trisk-

Doctors schedule so many appointments a day knowing that so many will cancel, etc. etc. It is designed to maximize the number of patients that can be seen in a day. My primary care physician(actually a PA), who is pretty cool, told me he could continue growing his business only by taking on a partner or by taking more patients a day. He doesn't want to schedule more patients because he thinks the quality of care would suffer and doesn't want to take on a partner, because most docs want to schedule more patients to maximize profit. Anecdotal FWIW

[Lady Greywolf]

Trying to influence human behaviour indirectly through the tax code is a TERRIBLE idea. Doing so presupposes that you know ab initio how the incentive structure you set up will play out in the real world. Can you imagine a BMI chart in the Code? The actuarial charts are bad enough.

Your plan also, in effect, would turn doctors and nurses into tax collectors. They have enough to do without that extra reporting burden IMO.

BMI charts are inaccurate in measuring a individuals body composition. I specifically used body fat % for a reason. It would take a nurse approximately an extra 20-30 second to assess and record BF% when she/he weighs you and takes your blood pressure.

Doctors and Nurses are already reporting the information to your State's Health Dept. In a perfect world doctors and health care professionals would concentrate 100% on the wellness of their patients. They can't in the current system. Legal & monetary needs forces documentation of everything they see, say, do which takes away from the time they can spend assessing, treating and/or educating the patient.

In MA, there was a proposal to make doctors responsible for reporting older people who in their medical opinion were no longer safe to drive. Thank goodness doctor's aren't burdened by that yet. Can you imagine the lawsuits?

It is not my desire to see doctors doing more paperwork. Keep the eye on the ball though. What does every person want? Increased wellness for themselves and their loved ones. Access to quality, results producing health care when it is needed. Affordability. Reasonable accountability from the health care professionals and every individual. What are Americans willing to do to participate in this "reform"? Most people will whine, complain, point out how one thing won't work or how they wish things were. The same people will not make changes that will increase their wellness and decrease their health care footprint and help the system heal/change so many may benefit. This is true even when those changes will not cost them a dime. The system is broken and does not work for all people, some people will have better results than others, some people will even die because of the system. Imo this will be true regardless of what health care system is in place.

Remember doctors/nurses become patients and have loved ones who become patients too. Listen to their experiences. They live this system every day. Most want the best for the patient they are caring for.

[The Space Pope]

According to this article, more than 2/3 of us hate the fee-for-service thing:

http://www.medicalnewstoday.com/articles/128031.php

Fee for service has been around for a long time. In 1950, most states banned group practices with prepaid monthly fees in favor of fee-for-service providers, due to 2 decades of AMA pressure. It's the doctors who don't want to give that up. Fee for service allows doctors to drive the level of health care "consumption" (can't think of a better word right now), which means more health care is delivered in a clinical setting rather than focusing on prevention and maintenance. In 1974, the AMA wanted government funded fee-for-service plan without cost controls. Like that would have worked out well. In 1983, President Reagan seriously curtailed Medicare and private plan providers ability to charge patients varying fees per service because of complaints from the insurance companies that doctors were taking advantage of fee for service billing (duh, why wouldn't they?). He instituted "capitation", or a prepaid fee per person or diagnosis rather than a fee per treatment. By 1988, most HMO's were back to fee for service. (HMO's were supposed to replace the fee for service, but somehow or other they ended up doing the same thing. I think that has to do with the medical coding and billing. I'll have to check on that.) And 41% of HMO's were non profit compared with 88% in 1981. We have the AMA and Reagan to thank for that.

Changes are never going to happen until the pressures of supply side growth are eliminated. Look at how hard it is to get doctors to practice in rural areas. There aren't enough patients for their fee for service model to work. So they don't make money.

Yes, fee for service is one of the primary reasons for the way US medical care sucks. It encourages "more treatment" and not "better health". Good for the doctors pocketbooks though, hence the AMA slobbering all over it.

I'll see if I can dig up the article I was reading a few months back on this. It was interesting how many doctors were performing the most complicated tests they could, because it made them more money then the cheaper but just as effective alternative.

[TrackerNeil]

Interesting article, Jaime. Thanks. I'm not persuaded that more consumer choice and free-market principle will be quite as helpful as the author thinks, but he's certainly given me something to think about.

[The Space Pope]

It was probably Atul Gawande's article from The New Yorker.

Ah, thank you. I'd started looking through The New Yorker for it just now. :)

[The Iceman of the North]

Legal & monetary needs forces documentation of everything they see, say, do which takes away from the time they can spend assessing, treating and/or educating the patient.

How so? Surely proper documentation is an important element of proper patient treatment. If doctors choose to treat more patients rather than treat the patients they do have properly, you should blame the doctors.

[Nymeria Sand]

BMI charts are inaccurate in measuring a individuals body composition. I specifically used body fat % for a reason. It would take a nurse approximately an extra 20-30 second to assess and record BF% when she/he weighs you and takes your blood pressure.

I agree. I like the old Metropolitan charts better. BMI doesn't take into account age, sex, or muscle mass/fat %. And CDC manipulated the BMI charts back in 1998. Under the old guidelines, a BMI of 27.5 or higher was considered overweight. Then they arbitrarily decided that 25 was a better number and viola!. Overnight 30 million Americans went from "healthy weight" to overweight.

In MA, there was a proposal to make doctors responsible for reporting older people who in their medical opinion were no longer safe to drive. Thank goodness doctor's aren't burdened by that yet. Can you imagine the lawsuits?

In PA I'm pretty sure they can do this. My mom had a heart attack about a month ago and her doctor threatened to report her to the state and have her license suspended if she tried to drive before he said it was okay.

It is not my desire to see doctors doing more paperwork. Keep the eye on the ball though. What does every person want? Increased wellness for themselves and their loved ones. Access to quality, results producing health care when it is needed. Affordability. Reasonable accountability from the health care professionals and every individual. What are Americans willing to do to participate in this "reform"? Most people will whine, complain, point out how one thing won't work or how they wish things were. The same people will not make changes that will increase their wellness and decrease their health care footprint and help the system heal/change so many may benefit. This is true even when those changes will not cost them a dime. The system is broken and does not work for all people, some people will have better results than others, some people will even die because of the system. Imo this will be true regardless of what health care system is in place.

Yes, but some people have this idealistic view of how great our health care system is--mistakes never happen, according to them. Mistakes are for inferior systems like Canada, France, and Great Britain.

Remember doctors/nurses become patients and have loved ones who become patients too. Listen to their experiences. They live this system every day. Most want the best for the patient they are caring for.

I'm sure that's true, but you can't say that they don't want their money just as much.

Yes, fee for service is one of the primary reasons for the way US medical care sucks. It encourages "more treatment" and not "better health". Good for the doctors pocketbooks though, hence the AMA slobbering all over it.

I'll see if I can dig up the article I was reading a few months back on this. It was interesting how many doctors were performing the most complicated tests they could, because it made them more money then the cheaper but just as effective alternative.

I'd love to see that article. I read something a few weeks ago that estimated that 1/3 of all medical procedures done have no medical benefit, which means they're done just to make someone money.

I think I might have an answer for the rise in fee for service even though HMO's were supposed to take care of that. The rise in PPO's (Managed Care Plans). They are just fee for service. It's the way they're set up. And the demand for PPO's is increasing while the demand for HMO's is decreasing. I think that's because less people get insurance from their employers, and the ones that do are automatically enrolled in PPO's.