Why our Healthcare is so Expensive

[ljkeane]

Not just pharmas, but the same goes for tests like MRIs, X-rays and whatnot. No relation between actual cost and what they bill people.

Yeah I was only uncertain because I've recently had an MRI on my knee and I remember reading in an article that they were something like $1,200 in the US. I looked it up and even if you get one privately in the UK they're only £200 and presumably it's cheaper for the NHS, so it would seem that prices are somewhat inflated in the US.

[Annelise]

I think that Big Insurance knew that this year and/or next year was when reform was going to happen if ever. They knew that the nation was down for it, they knew that their popularity had waned. They wanted to make sure that they had a seat at the table. This didn't mean that they were going to love said reform. It meant that they wanted to make sure that whatever did go through was tolerable. Being forced to cover people with pre-existing conditions was something that they could live with at the end of the day. The public option was not something that they could have lived with.

Speaking of..

The pharmaceutical industry's trade group has bowed to bullying by Democrats and sold out its members and the public, House Minority Leader John Boehner (R-Ohio) charges in a strongly worded letter to a former GOP congressman who helms the organization.

“Appeasement rarely works as a conflict resolution strategy,†Boehner wrote Monday to Billy Tauzin, the former Republican House member from Louisiana who has been president and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA) since 2005.

The House GOP leader takes Tauzin and PhRMA to task for striking a deal with Senate Democrats and the White House under which the group agreed to take an $80 billion hit on behalf of President Barack Obama’s campaign for healthcare reform.

“We’re at a pivotal moment in the debate and everyone’s jockeying for position,†PhRMA Senior Vice President Ken Johnson said in response to the letter. “Everyone has an opinion and everyone has the right to an opinion.

“We remained convinced that we’re doing the right thing for patients and for our country,†Johnson said. “We have been working for more than a year to advance comprehensive healthcare reform.â€

Boehner’s frustration with Tauzin and PhRMA seeps out of practically every word of his letter. Outrage has been swelling in Republican ranks for months, meanwhile, as PhRMA and other erstwhile GOP allies in the healthcare and business community continue to support Obama’s push for healthcare reform — or at least refuse to aid Republican efforts to scuttle it.

“When a bully asks for your lunch money, you may have no choice but to fork it over. But cutting a deal with the bully is a different story, particularly if the ‘deal’ means helping him steal others’ money as the price of protecting your own,†says the letter, which Boehner forwarded to the chief executives of PhRMA’s member companies.

“The ‘bully’ in this case is Big Government. At your behest, PhRMA has chosen to accommodate a Washington takeover of healthcare at the expense of the American people in hopes of securing favorable treatment and future profits. It’s a short-sighted bargain that leaves your own customers and employees behind,†Boehner wrote.

PhRMA has not endorsed any of the healthcare bills pending in Congress, but it remains a powerful, if unexpected, industry ally for the White House. At a minimum, Obama has neutralized an enemy. Were PhRMA to endorse a healthcare bill, the group’s stated willingness to spend up to $150 million on a pro-healthcare-reform advertising campaign would be a boon to Obama.

Other than a vow from the pharmaceutical group to offer discounted medicines to seniors during a gap in their Medicare drug coverage, the full terms of the arrangement have not been revealed. Senate Finance Committee Chairman Max Baucus (D-Mont.) opened the talks with PhRMA before the White House joined in.

Tauzin told The New York Times this month that the White House promised to help PhRMA fight against Democratic efforts to seek deeper cuts in spending on prescription drugs, such as allowing Medicare to directly negotiate their prices.

For me, that last is where a practical alliance becomes destructive. Suffice it to say, I hope it doesn't pan out that way. Anyhow, I would like to be a fly on the wall:

The White House denied the quid pro quo, but that has not quelled the frustration of Democratic lawmakers and liberal activists who believe Obama made a deal with the devil. Democratic lawmakers in the House and Senate uniformly said they are not bound by the agreement between the White House, PhRMA and Baucus.

The Democratic posturing against the deal is a clear sign that Tauzin erred, Boehner wrote. “Big Government is changing the terms … because it can.â€

To be sure, PhRMA has not offered its unqualified support for Democratic healthcare reform bills. The legislation approved by three House committees would make much deeper cuts into the drug industry’s Medicare and Medicaid funding, for example, leading PhRMA to denounce the bill.

PhRMA’s not the only group to forge a deal with the White House and Baucus. The American Hospital Association (AHA) and two other major hospital groups struck a deal in July to give up $155 billion in payments.

PhRMA, the AHA, America’s Health Insurance Plans (AHIP), the American Medical Association, the Advanced Medical Technology Association and the Service Employees International Union have vowed to trim $2 trillion over 10 years in national healthcare spending.

Even the health insurance industry, led by AHIP, has stayed in the game with Democrats, despite its intense opposition to the creation of a public option that would compete with its members.

http://thehill.com/leading-the-news/boehne...2009-08-17.html

I personally don't think Boehner yelling at Big Pharma, calling them nancies, appeasers and accusing them of selling out for coming to the table and participating reflects well on him. *shrugs* I admit that I am biased on that point however.

[awesome possum]

"Frightening future if healthcare reform fails"

Editor's note: Uwe Reinhardt is James Madison professor of political economy at Princeton University's Woodrow Wilson School. From 1986 to 1995 he served as a commissioner on the Physician Payment Review Committee, established in 1986 by Congress to advise it on issues related to the payment of physicians.

Milliman Inc., an employee benefits consulting firm, publishes annually its Milliman Medical Index on the total health spending by or for a typical American family of four with private health insurance. The index totals the family's out-of-pocket spending for health care plus the contribution employers and employees make to that family's job-related health insurance coverage.

The Milliman Medical Index stood at $8,414 in 2001. It had risen to $16,700 by 2009. It is likely to rise to $18,000 by next year. That is more than a doubling of costs in the span of a decade!

Since 2005, the index has grown at an average annual compound rate of 8.4 percent. Suppose we make it 8 percent for the coming decade. Then today's $16,700 will have grown to slightly over $36,000 by 2019.

And yet, it's the government option that is corrupt.

[Swordfish]

This is why I love Canada in Canada Healthcare is a right as it is in most European countries and the rest of the civilizied world.

A right that is going to need to be reformed soon, since it's fraught with problems as well.

[Guest Raidne]

They just have to remember that health care is a responsibility, not a right. It's what bothers me about Annelise seemingly moaning about paying for this and that. The insurance company isn't Daddy who pays for everything.

I've paid $7,000 so far this year on unreimbursed health expenses. However, I am perfectly happy with my insurance coverage, and have no problems paying what I just paid. Because I incurred those costs, I'm responsible for paying them. Not my neighbor, not you, not Donald Trump. Me.

Well, no. They have a contract. They are entitled to the coverage provided for under their contract. You might even call them "contractual rights." Isn't this pretty basic business stuff that every self-respecting Republican should know?

When I expect Verizon to actually provide me with internet service in return for my monthly payment, I'm not whining to Daddy, and nor am I if I expect my insurance to cover costs that my contract with them provides that they, in fact, will cover. The only difference is, Comcast, Verizon, and the like have not employed an army of attorneys to do nothing else but find slippery ways to interpret the contract so that they can, in bad faith, avoid their contractual obligation. And, before you can say it, that's not liberal alarmism, that's common knowledge. Go read the job postings for these positions. Go to an interview.

Annelise is getting completely fucked over by her insurance company's failure to adhere to the duty of good faith and fair dealing, a basic contractual obligation.

I hope you aren't referring to facials and elective plastic surgery when you're talking about your own $7,000 worth of health care costs and comparing to Ann's, but I supsect otherwise.

But more generally, it's impossible for people to determine what costs they are going to incur, as I already mentioned. My friend with seizures cannot just call up a doctor's office and ask what his treatment will cost, out of pocket. Nobody can - the system is not set up that way. That's - one of many reasons - why it's not capitalist.

I think it should be more of a capitalist system, and I'm beyond perplexed that you, seemingly, don't want a more capitalist system. I can't tell if it's because, like many conservatives, you're really just pro-business and not pro-capitalist...but wait, employer-sponsored healthcare, under the current system is also bad for business.

Color me confused.

Healthcare costs have no relation to 'real' costs in my experience. There is no way you can tell me that the base market price for a generic diabetes medication is $100 (I presume market price is what the uninsured pay). I think health insurance companies are running some kind of parallel economy where they are free to set whatever price they can without any meaningful competition.

Not just pharmas, but the same goes for tests like MRIs, X-rays and whatnot. No relation between actual cost and what they bill people.

I agree 100%. That really has to end. And it's a clear indication that capitalism is not in play.

What, do people just defend the status quo for the fucking sake of it? I'm just perplexed.

[Guest Raidne]

It's my SIL who is the problem, not my sister :)

Look, students just out of school, people who have lost their jobs - yeah, they fall through the cracks. Temporarily. I've been there a couple times (and bought COBRA before, too, when it was offered - the first time it wasn't, as it wasn't required to be). But most decent, hardworking people can generally get affordable, available health care, eventually even if "not at the current time".

Also, what kind of bullshit is this? In that case, you don't have healthcare. You temporarily have health care until you get laid off and run through your unemployment and severance. Or when you retire. You may have healthcare now, but you won't eventually, even if you have it at the current time. Enjoy it while it lasts.

[IheartTesla]

The other way you can tell it isnt capitalist is by the fact that some insurance plans (my current one for instance) the cost of brand/generic medication is fixed. Now this is the other ridiculous side of the coin - how can all drugs cost the same irrespective of the way they are manufactured or the amount of research that went into its production? Of course the answer is that one drug is subsidized by the other and the remainder by the uninsured coughing up the exorbitant fees the blood suckers charge. All with a substantial markup, of course.

There is no transparency anywhere, so we'll never be able to tell what the true production costs of these pharmas are. I'd be all for a truly capitalist system, with the government providing a public option so health insurance companies would be forced to compete at lower rates. Thats when we would see some truth in numbers.

[Shryke]

A right that is going to need to be reformed soon, since it's fraught with problems as well.

"fraught with problems"? :lol: Not like yours son.

There's a few issues. But don't confuse people complaining with people not thinking it's still WAY WAY WAY WAY better then the alternative (ie - anything like your system).

[Shryke]

My brother has type 1 diabetes, and a few years ago he had some sort of diabetic episode (I guess he actually died and was resuscitated) and had to go to the ICU for 3 days. The bill ended up being over $100,000. Luckily he had medical insurance at the time through his employer, but the insurance afterwards became so expensive that his employer had to drop the insurance. My brother now has no insurance, and gets his insulin from a friend of my dad who's a doctor.

The problem is, with diabetics it's not a matter of if you have a diabetic attack, it's when. Private insurance for people with diabetes is way too expensive, so the next time my brother has to go to the hospital he can pretty much kiss his future goodbye. What do you do when you have several hundred grand in hospital bills? Go on welfare?

There was an article I linked a few months back on this kind of thing.

Basically, a women worked for a smallish company and developed a major condition that, while easily treatable, required very expensive, ongoing treatment. The insurance company, after finding this out, added hundreds of thousands of dollars to the companies insurance payments, along with a "You know it's this 1 employee costing you all this money, right?" nudge.

The company was forced to let her go to remain solvent, no insurance would take her because of pre-existing conditions and she went bankrupt.

But, you know, she should have prepared better I'm sure.

[Swordfish]

"fraught with problems"? :lol: Not like yours son.

There's a few issues. But don't confuse people complaining with people not thinking it's still WAY WAY WAY WAY better then the alternative (ie - anything like your system).

Interesting that the intellectually lazy habit of assuming an criticism of 'A' is an endorsement of 'B' is so common these days on message boards.

Is it just general laziness, or is there something more insidious going on?

One wonders, doesn't one?

;)

[awesome possum]

My girlfriend is going through a similar experience. She's a type-1 diabetic who discovered she had the disease when she almost died last summer. She was horribly, horribly sick for five days but since she had no insurance she waited until she was knocking on death's door to go to the emergency room. She was eligible for insurance from her employer but it was something like $400 per month and only paid 20 to 50% of her medical bills depending on what it was and so she was going without because it was completely worthless.

After five days in the hospital because she didn't get treatment immediately (a stay that was written off due and will be paid by taxpayers), she has since been living off of insulin samples from her doctor's office. She works for a non-profit and doesn't make that much a year but was ineligible for the state's insurance program her employer offers insurance. However, her employer-based insurance slapped her with a pre-condition clause when she applied and refuses to pay for anything diabetes-related for 16 months (I call it the "We hope you die before then so we don't have to pay for you at all" clause), so she can't afford the hundreds of dollars that a vial of insulin costs since...

She has to pay out of pocket for lancets, test strips and syringes, which costs several hundred dollars per month that could be spent on healthier, more expensive food to help fight the disease or other necessities that she goes without. All the while paying $400 a month for insurance that only pays $75 a month for her monthly doctor's visit to make sure her A1C is under control and makes her pay the rest out of pocket.

In other words, FUCK our current system. Anything has to be better than this.

[14th Dragon]

There is no transparency anywhere, so we'll never be able to tell what the true production costs of these pharmas are. I'd be all for a truly capitalist system, with the government providing a public option so health insurance companies would be forced to compete at lower rates. Thats when we would see some truth in numbers.

If I may ask, why is it the universal thought that the public option will force insurance companies to compete at lower rates? I keep hearing this argument, but I really do not buy it. I really think that the insurance comapanies are not dumb on this one. The best way to compete with the public option in place is to make sure that those worst off are pushed to the public option and then under cut the prices on those that are healthy. In one move they burden the public plan to death and raise thier profit margins.

[Nymeria Sand]

What, do people just defend the status quo for the fucking sake of it? I'm just perplexed.

Yeah, it makes me sick and depressed when people say health care isn't a right but an individual responsibility as though real people don't count. They lump entire demographics together without ever stopping to consider that these are real people they're trashing. I guess that because they themselves are healthy now they're some sort of Chosen People and will never get sick. And when something bad happens, they're the first ones whining and crying about how they've lost everything and how it's not their fault.

That's the biggest thing that needs to change--the mindset that only a chosen few are worthy to have decent health care and access to it. That lesser human beings can just fuck off and die and that the status quo is fine. It's just mindboggling to me that people actually think that way. Worse, they really believe it.

[Swordfish]

That's the biggest thing that needs to change--the mindset that only a chosen few are worthy to have decent health care and access to it. That lesser human beings can just fuck off and die and that the status quo is fine. It's just mindboggling to me that people actually think that way. Worse, they really believe it.

I would love for you to point us all to the posts that indicate that anyone believes anything even resembling what you are describing in this little tirade.

[Shryke]

I would love for you to point us all to the posts that indicate that anyone believes anything even resembling what you are describing in this little tirade.

Ok, right here:

They just have to remember that health care is a responsibility, not a right.

If your not "responsible" enough to be able to afford your own health care, you don't deserve it.

[IheartTesla]

If I may ask, why is it the universal thought that the public option will force insurance companies to compete at lower rates? I keep hearing this argument, but I really do not buy it. I really think that the insurance comapanies are not dumb on this one. The best way to compete with the public option in place is to make sure that those worst off are pushed to the public option and then under cut the prices on those that are healthy. In one move they burden the public plan to death and raise thier profit margins.

Well, the theory is that competition would drive price down....that's all I am basing it on. I will also admit I have no idea why the prices arent lower than they are now, because there seems to be a fair bit of competition between various private insurance providers. It's all a bit confusing.

How likely is your hypothesis though? If the "worse off" are people with existing conditions whose treatments are being subsidized by the rest of the payees, then the gain the insurers obtain by jettisoning them to the public option has to be offset by lower costs for the "healthy", and with a smaller pool. Do the numbers actually work out that way?

[Shryke]

But more generally, it's impossible for people to determine what costs they are going to incur, as I already mentioned. My friend with seizures cannot just call up a doctor's office and ask what his treatment will cost, out of pocket. Nobody can - the system is not set up that way. That's - one of many reasons - why it's not capitalist.

I think it should be more of a capitalist system, and I'm beyond perplexed that you, seemingly, don't want a more capitalist system. I can't tell if it's because, like many conservatives, you're really just pro-business and not pro-capitalist...but wait, employer-sponsored healthcare, under the current system is also bad for business.

Color me confused.

It extends beyond that. Even with transparency, it's not a capitalist system. It's why the original article so completely misses the whole point.

Because, simply, your paying for the uninsured anyway. Those people are heading to the ER when shit goes bad and getting treated on the tax payer and insurance premium payers dime.

Unless you wanna eliminate the mandate to treat people, your health care is "socialised". It's just socialised really, really, really inefficiently and stupidly. Your paying for these people. One way or the other.

[Nymeria Sand]

I would love for you to point us all to the posts that indicate that anyone believes anything even resembling what you are describing in this little tirade.

Well, here's another tirade for you.

How about when someone said (I forget who it was) that the people who are unemployed and without health insurance can just fall through the cracks? That's just one example. At least they were honest about it.

If you don't believe health care is a right, then I don't know how you (not you personally, but generally speaking) can claim to care about what happens to those who don't have it, through no fault of their own. You can make all the excuses you want, but there have been plenty of personal stories written here. How can you read those and not think that maybe it's your thinking that needs to change, that there are real people who need a safety net and they need it now? The implication is that if someone dies from not having health insurance, they deserve what they get because they weren't responsible enough to get it. And make no mistake--people die. I don't know how you can claim otherwise.

Or if you do care, you don't care enough to want to do anything about it. You like things the way they are. And based on what? An ideological view that quite frankly doesn't stand up to scrutiny. Since most conservatives claim to be Christian, I'd ask where are your Christian values of compassion and helping those in need? Nowhere to be found when money is at stake, apparently.

We can argue till the cows come home about how much it's going to cost and the national debt yadayadayada, but that's not solving the problem. All it does it confuse and blind people to the real issues. And that's exactly what it's intended to do. And yet, there are no real solutions coming from the other side--nothing that won't benefit the insurance companies.

At least admit it. You don't really give a damn about what happens to anyone other than yourself. If they don't have health care, it's their own fault, and it's not your problem. You don't even grasp the simple fact that you're already paying for those who don't have health care in the form of higher premiums.

And this is a waste of time, really. You're never going to change your thinking.

/rant

[Eurytus]

Or if you do care, you don't care enough to want to do anything about it. You like things the way they are. And based on what? An ideological view that quite frankly doesn't stand up to scrutiny. Since most conservatives claim to be Christian, I'd ask where are your Christian values of compassion and helping those in need? Nowhere to be found when money is at stake, apparently./rant

The parable of the Good Samaritan had an epilogue in which the Samaritan repossesed the guys house because he couldn't pay for the care he had received.

[Andriy Czarchenko]

$5,600 - orthodontia for my son

$1,500 - root canal for me

:eek: :stunned: :o :ack: