FREE NEWSLETTER
Go to main Forum page »
This morning I found this very good summary of this issue on USA Today.
Check out this article from USA TODAY:
Seven reasons why Americans pay more for health care than any other nation
https://www.usatoday.com/story/news/health/2024/12/15/why-americans-pay-more-for-health-care/76900978007/
One problem is that the people who can improve the health care system in America (like Congress) have no skin in the game. Example: Nancy Pelosi takes a fall, breaks her hip, and gets a hip replacement in 24 hours paid by the US taxpayer. They don’t care about us, most are shareholders in Big Pharma and insurance companies.
Members of Congress must use ACA like others. They do receive an employer contribution just like millions of Americans. Her fall on government business may be handled like any on the job accident.
Except for the evacuation on a US government jet. Probably one of the huge Airforce transports you constantly see pictures of government official stepping off of in foreign lands.
Are you saying she didn’t get special treatment?
Special treatment, special circumstances. What’s the problem?
“The US military had medevaced the former House speaker from Luxembourg to Landstuhl Regional Medical Center in Germany, according to a defense official. The medical center is a major military hospital that for years has treated US troops injured in combat.” (CNN)
So she got the same treatment someone in the military would receive. If she had been a normal tourist in Luxembourg she would have been treated in a Luxembourg hospital, and I will bet you that the treatment would have been as good as that available in the US at a lower cost.
When I broke my wrist in Switzerland the cost for surgery to insert pins and a night in the hospital was the same as the cost of the ten minute out patient surgery to remove the pins in the US.
From the stories I have read about wait times for healthcare in Canada and The UK, I’ll take higher costs in exchange for having care sooner.
IIRC from my college economics course of half a century ago that is called ‘time utility’.
People wait in the US too.
Try making your comparisons to large hybrid public/private health care systems like Germany and France. Time has proven that a public system supported by optional private insurance delivers the most timely care with the best outcomes at costs sharply lower than the US model.
Under the most common measurements for the quality of a health care system — life expectancy, maternal mortality and infant mortality — the US is ghastly. We have the best hospitals, best doctors and nurses, best medical education and most fruitful research, and yet our infant mortality rate is by far the worst of any developed nation — and it’s actually rising.
What we’re doing isn’t working.
Mike wrote that:
”What we’re doing isn’t working.”
I can … uh … buy that 🙂
My experience probably isn’t typical as I have always been covered by excellent healthcare AND insurance.
What if we flipped this on its head and ran this like any other business? Consumers choose who they want buy services from, based on cost (which they would know up front) and perceived value. Insurance would serve its rightful purpose of covering low probability, high consequence costs that consumers choose to buy protection against. Insurance should not be involved in “normal” medical services.
Can you name any country in the world where this actually works? I’ve asked the same question about libertarianism and never gotten an answer.
Healthcare should not be a business or a consumer service. It should be a right that every American has full access to.
Patients are not consumers, they should not buy health care on cost or value.
Is that how you would seek care if you or a loved one were seriously ill?
Oh wait, I’m checking for the lowest cost cardiologist to save money?
The only value you really want is the best quality care possible.
Put every American in the same risk pool, in one payment system, set fair reimbursements to sustain the care we want and are willing to pay for and there is nothing more needed.
If a patient needs a hip replacement they can search for the best surgeon in the area. They don’t have to settle for an inferior surgeon. They can search for value. In this sense a patient can be a consumer and advocate for their own healthcare.
We can’t even objectively define “best.”
And then if you find what you want you likely have no choice of hospital.
I hope you have not faced a serious medical issue, but I can assure you looking for the best value is not the priority seeking care. Most of the time you referred from other physicians who know their peers.
Connie needed pain management for her back. We went to the best for us based on recommendations from my cousin an operating room nurse working every day with these doctors. Value or price was not part of the equation and given the same circumstances would not be for anyone- I hope.
To me, that’s exactly what insurance should be there for. To provide financial protection for the best care possible for those low probability, high consequence illnesses / injuries. And there needs to be more trust in allowing the patient and provider to determine what the best treatment plan is.
But for “normal” medical services, it would be better if consumers made value judgments based on transparency of cost, quality, timeliness, etc. If I need to get an MRI, it would be better if I could easily understand my options / cost and pay for the service when I receive it (just like any other service I purchase). Having insurance involved doesn’t add value, especially since I am paying for it out of my pocket anyways because of my deductible. Today, it is VERY difficult to shop around for the best MRI provider (based on cost, quality, timeliness, etc.).
I understand that my MRI example may be related to a broader medical diagnosis (e.g., what if the MRI shows cancer or some other issue). Again, this is where insurance provides value to provide financial protection against the costs of treating whatever bigger issue may be identified.
Just how do you propose to judge the quality of a medical provider? Or the quality of their advice? Times I’ve gotten a second opinion, the advice has been quite different.
This may not be the best analogy, but when there is something wrong with my car, I seek out information to find the best place to take it. If I am not comfortable with their opinion and advice, I take it somewhere else for a second opinion. Those who establish a good track record of high-quality service and reasonable cost become well known to the public. I sometimes decide to pay more because I am betting I will get a better outcome.
In no way am I equating health decisions to car decisions. But today, I don’t feel like I have information or transparency to make a good, educated decision when it comes to healthcare. With insurance, I have no idea what the cost is going to be until the insurance company processes the claim and the provider bills me for my share (typically 100% because of the deductible). This has gotten slightly better recently, but still very difficult to make informed decisions.
Those are the popular reasons, but not the real reasons which are that Americans have a spoiled view of health care. They want the most, the best (perceived) care, they want it immediately all paid 100% by a third party. Being the most obese nation in the world doesn’t help.
Our view is if a service is not paid in full, insurance is a scam. We ask why insurance didn’t pay more, but rarely why doesn’t the provider charge less.
I started being involved in health care coverage as a claim examiner in 1962. Then there were fee schedules for services, no coverage for out patient services including RX. As we gradually went from fee schedules to reasonable and customary fees, and expanded coverage costs escalated each year.
New technology created higher expectations and greater demand for more equipment and services. The US has too much of everything that must be used.
Americans demand convenience. They don’t want anyone interfering between their doctor and them assuming all the care they receive is appropriate and necessary – many time that is not the case, some estimates say 25% and yet we tend to think more care is better care.
Our way of paying for care is too complicated, too many choices.
Other countries pay for medical education, we don’t.
Patients knowingly participate in what boils down to fraud by seeking ways to cover ineligible services.
Some experts think we can become consumers by being prudent shoppers for care seeking the best deal. We can’t, health care is not a commodity like any other.
Try and make changes like extending Medicare with full coverage, uniform fees, reasonable universal income-based cost sharing and what do you get? Loud and false cries of rationing, and socialized medicine.
Why is health care expensive in the US? It’s what Americans demand, but don’t want to pay for.
Very simplistically, if you have fifty dollars, buying a new sweater is affordable, but paying a $50 co-pay for a prescription is not.
That’s how Americans view health care.
This is how some Americans view healthcare. Don’t assume we are all in this category you have created.
What is the other category? I’ve been seeking it for fifty years.
How can we become prudent consumers of healthcare if prices vary widely and we do not know what the actual cost will be?
You can’t and never will be. Providers set prices knowing they will be reimbursed differently by Medicaid, Medicare and by each insurance in which they participate which can be five or six.
Medicaid doesn’t even cover expenses so costs are shifted to others.
why should patients care about the price, there is no real price and if there was we aren’t paying it anyway.
there is a fair price, we don’t know, but if parts of our system doesn’t pay it, it is irrelevant anyway.
say a surgeon charges $1500 for an appendectomy, if that is a fair price allowing a reasonable profit above expenses all systems pay that. The surgeon who does not run the practice efficiently has a lower profit, the one who charges way more still receives $1500- no variables, no in and out of network pricing.
prices would vary by location. Of course, the fair price is somewhere between Medicare, Medicaid and fee-for-service insurance.
that’s why one system makes sense
Thanks for posting the article. All very factual points but it doesn’t try to address what the solutions could/should be to correct this inequity (value billing and compensation ?).
It’s a good article. In addition to the opaqueness of the billing I also think that by having insurance we have become terrible shoppers. I don’t have to worry about the cost of my care; insurance is paying the bill…. It’s free!
If a loved one is seriously ill, are you really going to shop for the best deal or seek the best care? You may take a generic drug to save money, but you want the best doctor and facility possible.
It’s also hard to shop when you are unconscious or in severe pain….
Not to mention the lack of information and expertise.
Very true. The idea that patients can, will or should be consumers of health care and shop for the best price is ludicrous.
That’s the idea behind high deductible plans, HSAs and HRAs and it hasn’t worked but it has shifted a financial burden on many Americans who can’t afford it.