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njlauren -> RE: Eye-Popping Health Care Costs (4/30/2013 8:11:10 PM)
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The problem is despite those who tell us we have the best medical care system in the world (we do if you have the money to pay for it), it is also very expensive, and there are a lot of reasons that are hard to address.
-Medicare is very popular, but the government plays a trick with it, they cut back what they will pay for medicare payments to doctors and hospitals, who in effect have to take it. So what do Hospitals do? Cost shift. So when someone comes in with insurance, the thousands of dollars Medicare or medicaid won't pay is shifted onto private insurance patients. That 400 tylenol, that 300 dollar bandaid, are signs of that. It is very well and good to talk about how efficient medicare is, but the reality is the government in effect forces hospitals and doctors to take medicare, and they shift the cost to others.
-Over use of expensive equipment. MRI's machines cost a lot of money, and to recoup the cost the hospital wants to keep them running all the time, so doctors are encouraged to use them even if not needed. Unneeded tests like that cost a lot of money but are big money generators.
-Fear based medicine, running a shitload of tests so if the doctor misses something, someone can't sue them for not, for example, running an MRI. While I think the reality of that is way, way overblown (more on that in a second), a lot of doctors are so afraid of lawsuits they are practicing CYA medicine.
-Using doctors where trained nurses and LPN's could do as good a job. Face it, a lot of the things we go to the doctor for are routine things, if you have strep throat, a bad cold, a respiratory infection, a sprained ankle, bad poison ivy, a trained nurse/nurse practitioner could take care of it at a lot less cost, instead you see someone, these days often a specialist, and it costs.
-The number of uninsured patients is large, and guess where they end up..the ER, the most cost inefficient place you can go. When morons like Rick Santorum say that the uninsured are guaranteed treatment, they can go to the ER, it again jacks the prices up for other people with insurance, to cost shift to make up for it. State funds for the uninisured are so small it is almost non existent, especially these days.
-There is no competition in health insurance. In most places, there are very few insurance companies, and the idea that all we need to do is introduce new companies fails, because the amount of capital needed to get into insurance is huge. You can't just hang out a shingle for 'xyz insurance", you need large reserves to start with to pay off claims that will come in. Take a look sometime at health insurance available in your area, and you will find a United Health care company, probably Blue Cross/Blue Shield, Maybe Aetna, Maybe humana and that is about it. Given that, there is no competition...
And the cross state plan the GOP tried promoting won't work. They talk about how someone in NJ could theoretically get a plan from let's say Arkansas that was a lot cheaper, but that leaves out one major point, health insurance in Arkansas is cheaper because the cost of medicine there is cheaper. If you get a plan from Arkansas, they will have to pay doctors in your area a lot more, which will increase the cost, and even over a pool of people, some in high cost states, some cheaper ones, it will still be expensive (not to mention the headach that you may live in NJ, and find out when the company denies your claim for cancer treatment, legal under arkansas law, you have no recourse).
-The health insurance companies themselves have raised premiums are ridiculous rates, and it is not because of malpractice claims or any of the other excuses. Health insurance companies once upon a time took premiums and invested them in the markets, they basically made their profit on investing the 'float' , money they didn't have to pay out. In the last 10 years, health insurance companies, primarily at the urging of consulting firms like McKimsey, have switched and they have raised rates to where they are collecting 20% above expected payouts (also known as profits), along with cutting back what they will pay for, raising deductables, and basically refusing to pay what their are supposed to, and telling patients to sue them. I have heard tales of woe with insurance companies, but someone explain to me how 'financially tough' firms can pay a CEO 100 million a year, as the head of United Healthcare was paid a couple of years ago.
-The excuse it is lawsuits is bogus, same with the cost of malpractice insurance. California capped pain and suffering in malpractice suits several years ago, and malpractice and insurance premiums continue to soar.
-Another biggie is the cost of medicine. When I was growing up, you never saw ads for medicines, the doctor decided what was good for what you had. These days, a lot of the time, patients are specifying expensive name brand drugs, in part because of advertising, in part because doctors make good money off the drug companies in perks like consulting fees, junkets and the like, so instead of a perfectly serviceable older drug, they choose the one that makes an older woman able to run after her dog and the like...
-One of the biggest costs? Dying. Estimates I saw recently were that 70% of the cost of healthcare were maintaining the last month of life, and we are all responsible for that. It sounds great to keep a loved on alive at all costs, but every time they revive someone it costs about 100k last I checked. It is an incredibly hard decision, but when they are using every kind of medical resource to keep someone with advanced cancer alive, especially older people, it is expensive as hell. I am not advocating euthenasia nor am I unsympathetic, but for example, when Terry Schiavo's parents wanted to keep her alive on machines, it is expensive as hell, and they wouldn't pay the full cost. These are hard decisions, ones that are heartbreaking, but it does raise questions about how far you can go or should go..and we have to be aware of it as caregivers and family members. My MIL has advanced dementia, she is not really cognizant at all, she is in her early 80's. We have a DNR on her and have left instructions that she be kept comfortable, but no extraordinary measures should be taken, either, because it doesn't make sense to us.
Also keep in mind we have extended lifetimes tremendously with modern medicine, but the quality of that life is often not that good, we may have a lot of people reaching their 80's, but many of them are dependant on expensive medical care to stay alive....the problem is we have extended the lifespan, but not necessarily the quality of life.
-We have a medical system that does a tremendous job at treating disease, but a lousy job of preventing it. A lot of the ills that run up costs are lifestyle, yet information of nutrition and on how the prevent disease is all over the place. One week they are telling you cholesterol is everything with heart disease, then they figure out it is homocystein, then they figure out that lowering the LDL/HDL ratio with certain drugs does nothing to help heart health, last one i heard, eggs hurt you, not because of cholesterol, but a backteria.......we spend very little time on prevention, unless it is in innoculations that make drug companies money.
Solutions? All of them have limitations, drawbacks, things that make them not help, plus there are too many stakeholders, Doctors are going to fight for their unique status, private health insurers have their stake, and we the people want the 5 course meal in some ways and want to pay McDonald's prices, and it isn't a good mix. I suspect any solution is going to come about the way it always does, when it gets so bad that to not do something is political suicide. At present, the cost of a family health care policy for a family of 3 (like mine) in terms of premiums is about 15k a year, and that is through a corporate group plan, I hear those saying people should get their own insurance, but who can afford that? Likewise, I hear about medical competition, but are you going to go to the doctor advertising bypass for 1999.99? I suspect it is going to end up being some single payer system, employers are getting fed up, and unless we want to end up like China which basically has no health care system for most people, we are going to need something. All I know is I debated this stuff more then 30 years ago in high school, and nothing has solved the problem, HMO's, PPO's, HSA's, you name it, none of them worked.
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