Author Topic: I wonder why healthcare is so expensive in the US?  (Read 3905 times)

BTDretire

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Re: I wonder why healthcare is so expensive in the US?
« Reply #50 on: July 01, 2018, 12:59:10 PM »
Itís not just the drug companies. I had a diagnostic colonoscopy in February (all clear!) and as I have a high-deductible health plan, I received bills from 1) the gastroenterologist who actually performed the procedure ($800), 2) the outpatient surgical center where it was performed ($650), 3) the anesthesiologist ($150), and 4) the nurse anesthetist ($150). The bills came from four different business entities, one of which was out of state.

To me, that is insane. And none of this info was made available before the test.

 It's been my experience that your insurance company would negotiate those prices down, ie. here's what we allow you to charge. I have a$10k deductible and have mostly been very pleased with the difference between what is chargeed and what I owe.

These were my out of pocket costs AFTER the insurance negotiations. I don't have the statements in front of me, but I remember that the actual costs pre-negotiation were about $300 higher each for the anesthesiologist and nurse anesthetist.
I just open some mail from BCBS, it is the billing for some blood tests for my yearly checkup.
Three tests, Lipid Panel, PSA and Comprehensive E metabolic, Amount billed $360.90, Amount allowed $29.56.
I don't know what it all means, but I suspect there is some profit for the blood test provider even at $29.56.
That's kinda sick if someone actually had to pay $360.90.

RetiredAt63

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Re: I wonder why healthcare is so expensive in the US?
« Reply #51 on: July 01, 2018, 01:42:33 PM »
Americans need a Tommy Douglas.

Not if it leads to a Canadian style system.  The US is usually ranked about #37 in regards to healthcare compared to other countries.  Canada comes in at #30.  No thanks, please give me a system like France or Switzerland that comes in the top five on a consistent basis.

Is that the WHO ranking? That is pretty weighted to efficiency, rather than outcomes. Commonwealth fund puts the US at 11, with France at 10 overall. https://www.commonwealthfund.org/chart/2017/health-care-system-performance-rankings Canada doesn't come out much better at 9.

In any case it's clear that the US spends a higher percentage of GDP on health care at 16.6%, and in many cases gets worse outcomes. (E.g. infant mortality) Really it depends on what you are looking for. I would never argue that Canada has the best system, but there are no worries about the cost of catastrophic care, or of losing health care access with job loss or poverty.

 In Canada the provinces run the health care system, with some financial transfers and coordination from the feds.  Not everything is covered.  My podiatry treatment and surgery a few years ago was out of pocket, OHIP did not cover it and neither did my private health insurance.  I think (could be wrong) that in France and the UK it is federal?  Not sure how much difference it would make. And yes, we know our system is not perfect, and we bitch about wait times, but reading stories about  American health care costs does have us appreciate our system.  I was recently in a discussion with 4 people who have had their gall bladders out, and it was all about healing times, nothing about cost - because they were all covered under OHIP, and their care was paid for with our taxes.  And we know it, we do not think it is "free", but it is universal.
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pecunia

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Re: I wonder why healthcare is so expensive in the US?
« Reply #52 on: July 01, 2018, 01:45:23 PM »
BDTretire:
Quote
That's kinda sick if someone actually had to pay $360.90.

Someone did - The insurance company.  You did and your employer via premiums.

Apples

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Re: I wonder why healthcare is so expensive in the US?
« Reply #53 on: July 02, 2018, 07:59:35 AM »
I'm just here to complain.  I had blood work done, the regular first routine screen, due to some wacky possible amenorrhea.  Like, this is the very first thing to do before taking any further steps.  The blood draw was for 5 different tests, one of which was to confirm I wasn't pregnant.  Spoiler alert:  I'm not, I already knew that.

This cost $500 with fair but not great insurance coverage!  Not a HDHP!  I was shocked at how expensive such a routine procedure was.

rantk81

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Re: I wonder why healthcare is so expensive in the US?
« Reply #54 on: July 02, 2018, 08:19:23 AM »
Why is healthcare so expensive?

Here's a non-exhaustive list, in no particular order:

- unnecessary diagnostics ordered by doctors who are paranoid about being sued
- no price transparency for the customer
- prices/payments are tied to amount of services performed, not outcomes
- excessive amount of (potentially unnecessary) time and expense of schooling required for healthcare providers
- lots of middle-men in the process (insurance companies, PBAs, hospital groups "facility fees")
- government laws/regulation that is mostly written as the result of lobbying from insurance and pharma companies
- convoluted tax structures for employer based group coverage vs individual coverage
- profit motive
« Last Edit: July 02, 2018, 08:20:57 AM by rantk81 »

TheWifeHalf

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Re: I wonder why healthcare is so expensive in the US?
« Reply #55 on: July 02, 2018, 08:53:52 AM »
This is just pennies in the healthcare mess, but I have 3 examples of Ďmistakesí (Iím a nobody, and if this happened to us 3 times, that we know of, I would think this happens to many, especially if they do not check their bills)

1. I was going to sit on the couch and read a book to my three kids, all under 4. I sat on my daughterís elbow, it sort of just hung there, hurting. Took her to the ER, they took an xray, and I was told she dislocated it but on the ride there, it popped back in.
I received a bill for several medical procedures, that included paying for the doctorís putting the elbow back in place.  It was $800. Easy enough to rectify, I made a call, explained what happened, the charges for that procedure were removed.

2. I received a bill in the mail, from a hospital, for brain surgery (this was 20 years before my car accident/traumatic brain injury) It was a little over $10,000. Again, easy to rectify with a phone call because I hadnít used that hospital in 10 years.

3. I canít remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray.  Since the Dr had ordered an MRI, thatís what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they donít even have to call, itís right there on the computer using THHís name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.

Those are minor examples of mistakes, and pennies compared to the problem, but what about the mistakes that are not caught?

BTDretire

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Re: I wonder why healthcare is so expensive in the US?
« Reply #56 on: July 02, 2018, 09:05:08 AM »
BDTretire:
Quote
That's kinda sick if someone actually had to pay $360.90.

Someone did - The insurance company.  You did and your employer via premiums.

  Nope! I have $10,000 deductible, the insurance company pays nothing until I spend $10,000.
BCBS negotiates the allowed price with the testing company and I pay that price.
 I'm self employed with a private policy I pay for.
I need to check and see what is actually covered, Obamacare, forced some changes on my policy like covering part of a wellness checkup, a colonoscopy every 5 years and birth control.
 That was great, since Obamacare my premium went from $4300 to $11,200. /s/

BTDretire

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Re: I wonder why healthcare is so expensive in the US?
« Reply #57 on: July 02, 2018, 09:31:21 AM »
This is just pennies in the healthcare mess, but I have 3 examples of Ďmistakesí (Iím a nobody, and if this happened to us 3 times, that we know of, I would think this happens to many, especially if they do not check their bills)

1. I was going to sit on the couch and read a book to my three kids, all under 4. I sat on my daughterís elbow, it sort of just hung there, hurting. Took her to the ER, they took an xray, and I was told she dislocated it but on the ride there, it popped back in.
I received a bill for several medical procedures, that included paying for the doctorís putting the elbow back in place.  It was $800. Easy enough to rectify, I made a call, explained what happened, the charges for that procedure were removed.

2. I received a bill in the mail, from a hospital, for brain surgery (this was 20 years before my car accident/traumatic brain injury) It was a little over $10,000. Again, easy to rectify with a phone call because I hadnít used that hospital in 10 years.

3. I canít remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray.  Since the Dr had ordered an MRI, thatís what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they donít even have to call, itís right there on the computer using THHís name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.

Those are minor examples of mistakes, and pennies compared to the problem, but what about the mistakes that are not caught?

  My son was hit by a hit and run bicyclist, knocked unconscious for a short time, someone found him, called an ambulance that took him to the emergency room. When the bill came I started looking over billing codes. The just over 1" laceration that was sutured, was coded as a 3" laceration.
 I didn't fight the issue, just glad he was OK. But my daughter stopped to see him the next day, she report to me that he was in worse condition than he was letting on. He had small cuts, scratches and bruises on several areas
of his body. She had to clean him up, because the hospital left him with blood mated hair, took also cleaned up the minor wounds.

Schaefer Light

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Re: I wonder why healthcare is so expensive in the US?
« Reply #58 on: July 02, 2018, 01:11:47 PM »
I had an MRI a few months ago.  The bill was for $1500, but my insurance (TRICARE) only paid them $250.  I pay nothing out of pocket.  Was the cost of the MRI actually $1500, was the imaging center trying to high-ball the price, or was my government-funded insurance being stingy?

Healthcare facilities take a hit on insufficient payments such as from Medicare and Medicaid.  I've heard of hospitals having increased volume while losing money due to the increase in Medicare and Medicaid patients.  Someone else paying has to make up the difference.  Not everyone could get a Medicare rate if the facility is to survive.  They've already been known to start cutting different services.  Healthcare facilities should be compensated fairly.
 
   A few years ago I had an MRI of my back, I told them I didn't have insurance and wanted the best price.
They said it would be $380, I said, OK let's set a date. They ask can you come back at 9pm.
 I had to wait a whole 8 hours for an MRI!!
 When I mentioned this to my doc, he said, ya, we have a glut of MRI machines in the area.
 I'll never know if the insurance company would have negotiated a better price.
You all got better deals than I did.  I had two MRIs recently and my bill was $2000.  The total bill from the hospital was something like $11,000, so my insurance paid about $9,000. 

I had no idea what they were going to cost going in.  That only seems to happen in the medical industry, and it drives me nuts.  A doctor tells you to have a procedure, but he has no idea what it will cost.  You call the hospital and they tell you to call your insurance company.  You call them, and they say it depends on how it's coded.  No one can give you a straight answer.

inline five

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Re: I wonder why healthcare is so expensive in the US?
« Reply #59 on: July 02, 2018, 01:17:56 PM »
FWIW just talked to a co-worker that went to Germany for back surgery for three new discs. In the states it would've cost insurance roughly $450,000. It came with a second gen medical implant that severely restricted movement. 50% probability of slight recovery and 50% chance of "you won't improve". The newest generation is not FDA approved because the maker of the 2nd gen one keeps suing the maker of the 3rd gen (made in CA) and the FDA will not approve with pending lawsuits.

Went to Germany, got a lifetime warranty on the procedure if he were to ever have issues, implants last >25 years, and the surgeon gave him a 97% chance of "full recovery like he was young again". He's good and has full range of movement. No limitations on lifestyle. Third gen implant from the US. $50k.

bacchi

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Re: I wonder why healthcare is so expensive in the US?
« Reply #60 on: July 02, 2018, 01:23:04 PM »
This is just pennies in the healthcare mess, but I have 3 examples of Ďmistakesí (Iím a nobody, and if this happened to us 3 times, that we know of, I would think this happens to many, especially if they do not check their bills)

1. I was going to sit on the couch and read a book to my three kids, all under 4. I sat on my daughterís elbow, it sort of just hung there, hurting. Took her to the ER, they took an xray, and I was told she dislocated it but on the ride there, it popped back in.
I received a bill for several medical procedures, that included paying for the doctorís putting the elbow back in place.  It was $800. Easy enough to rectify, I made a call, explained what happened, the charges for that procedure were removed.

2. I received a bill in the mail, from a hospital, for brain surgery (this was 20 years before my car accident/traumatic brain injury) It was a little over $10,000. Again, easy to rectify with a phone call because I hadnít used that hospital in 10 years.

3. I canít remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray.  Since the Dr had ordered an MRI, thatís what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they donít even have to call, itís right there on the computer using THHís name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.

Those are minor examples of mistakes, and pennies compared to the problem, but what about the mistakes that are not caught?

  My son was hit by a hit and run bicyclist, knocked unconscious for a short time, someone found him, called an ambulance that took him to the emergency room. When the bill came I started looking over billing codes. The just over 1" laceration that was sutured, was coded as a 3" laceration.

This is probably pretty common. Something similar happened to me and I contacted the insurance company about it. They didn't care. After many faxes (!) and emails and letters, the provider finally backed down.

It's almost as if the insurance company makes as much money whether they pay a provider $5000 or $7500.*


* Yes, I realize that this is indeed what occurs. Insurance takes their 20% cut and everyone but the patient is happy.
« Last Edit: July 02, 2018, 01:29:13 PM by bacchi »

Travis

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Re: I wonder why healthcare is so expensive in the US?
« Reply #61 on: July 02, 2018, 04:10:44 PM »

3. I canít remember the condition, but our doctor had TheHusbandHalf go to the hospital and have an MRI (body trunk). Whatever it was, we and our Dr knew it was a soft tissue problem and would not show up on an xray.  Since the Dr had ordered an MRI, thatís what they did. It showed whatever the problem was.
Within a week we got a call from the hospital that our insurance would not pay for the MRI because they require an xray to be done first which is cheaper, to rule out something the xray reveals.
I would have said no because having unnecessary x rays taken is not good, but THH went and had it done. They already told us we would not have to pay for the x ray because it was their mistake to not call the insurance co (they donít even have to call, itís right there on the computer using THHís name) they just could not get reimbursed for the MRI if an x ray had not been taken. It was about $800.

I see this all the time.  My career has rewarded me with a list of injuries that have required MRIs, CT scans, and physical therapy.  Before I was authorized to do any of that I had to get an x-ray. Out of two shoulder injuries, a neck injury, a hip injury, and two knee injuries, only one of those showed up or even would have shown up on an x-ray.  The x-ray was the prerequisite to the MRI or the therapy sessions every single time.  On the flip side, my very first knee injury was misdiagnosed for 6 months because the clinic (doctor or insurance I can't say) would not authorize an MRI until I had gone through a specific number of therapy sessions.  At the end when it wasn't doing any good I got the exam and they discovered the damage was so severe that surgery was always going to be the solution.

Since I have to move every two years, I have to restart treatment with different clinics a lot - most of the time from scratch, and always beginning with medications and x-rays.
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pecunia

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Re: I wonder why healthcare is so expensive in the US?
« Reply #62 on: July 02, 2018, 06:42:45 PM »
BTDretire:
Quote
That was great, since Obamacare my premium went from $4300 to $11,200. /s/

Premiums were going up fast prior to Obamacare.  Is there a definite cause and effect between the passing of the ACA and the raising of your premium.  I have read that thee is nothing in the ACA that will control prices.

After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.

inline five

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Re: I wonder why healthcare is so expensive in the US?
« Reply #63 on: July 02, 2018, 08:42:36 PM »
Thanks to a helpful relative, i just bought an annual supply of medications from Israel for $180 that was costing me $3,000 here. This is basic and widely used medication, nothing fancy. So ridiculous. We are getting royally **&&%% and can't seem to do anything about it. I hope this is THE issue of the midterm elections.
Wow. Insane.

DreamFIRE

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Re: I wonder why healthcare is so expensive in the US?
« Reply #64 on: July 02, 2018, 08:51:28 PM »
BTDretire:
Quote
That was great, since Obamacare my premium went from $4300 to $11,200. /s/

Premiums were going up fast prior to Obamacare.  Is there a definite cause and effect between the passing of the ACA and the raising of your premium.  I have read that thee is nothing in the ACA that will control prices.

After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.

The ACA does include cost controls.  I assume BTDretire's premiums have gone up significantly because he's not getting the PCT, or he's just excluding it from his figure, and unsubsidized premiums have gone up significantly in some markets, in part due to sabotage from the republicans.

HiddenSp0t

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Re: I wonder why healthcare is so expensive in the US?
« Reply #65 on: July 03, 2018, 03:49:12 AM »
well because it's a quality one

Kris

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MasterStache

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Re: I wonder why healthcare is so expensive in the US?
« Reply #67 on: July 03, 2018, 09:15:30 AM »
BTDretire:
Quote
That was great, since Obamacare my premium went from $4300 to $11,200. /s/

Premiums were going up fast prior to Obamacare.  Is there a definite cause and effect between the passing of the ACA and the raising of your premium.  I have read that thee is nothing in the ACA that will control prices.

After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.

Yep. I think folks have short memories and/or don't understand healthcare premiums were rising rapidly before the ACA was passed. And there are mixed outcomes. For instance, many low income folks who were having to pay outrageous prices for premiums, saw a significant drop in their premiums. I have a family member who just stopped paying because they really couldn't afford the premiums and still afford even the most basic necessities to live. After the ACA they could finally afford health insurance. I myself, saw literally no change in my employer sponsored healthcare premiums even after the ACA was passed. And some folks saw some major increases. 

I will say for the flaws that still existed in the ACA, it was a step in the right direction to get everyone covered.

BTDretire

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Re: I wonder why healthcare is so expensive in the US?
« Reply #68 on: July 03, 2018, 10:26:37 AM »
Quote from: pecunia link=topic=94034.msg2 and 57865#msg2057865 date=1530578565
BTDretire:
Quote
That was great, since Obamacare my premium went from $4300 to $11,200. /s/

Premiums were going up fast prior to Obamacare.  Is there a definite cause and effect between the passing of the ACA and the raising of your premium.  I have read that thee is nothing in the ACA that will control prices.

  I know there was, they can't give away a physical, colonoscopy, birth control, more mental healthcare and drug treatment and not charge more for it. ( I think all of those things were forced on my private policy by Obamacare)
  I had been getting 7% and 8%increases per year until Obamacare started, then I got an 18.4% increase, the next year it was 19.2% and then a 24.2% increase, after that it dropped down to a 9% increase.

Quote
After hearing of drug companies buying out a small drug company so that they can greatly raise the price of a specific drug that will keep a few people alive, it doesn't seem out of bounds that premiums may be going up due to pure old fashioned greed.

 Yes, there are some problems in that area.




pecunia

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Re: I wonder why healthcare is so expensive in the US?
« Reply #69 on: July 03, 2018, 10:38:13 AM »
BTDretire:
Quote
Yes, there are some problems in that area.

Great wording - Reminds me of "collateral damage" or "right to work state" or even I dare say, "free market." 

Then there is "death tax" for inheritance tax and the "death panel."

Well, as long as we have "free market" insurance, you can shop around for a better price,...........right.

hoping2retire35

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Re: I wonder why healthcare is so expensive in the US?
« Reply #70 on: July 03, 2018, 01:22:53 PM »
US doctors start off making about 4X their UK counterparts; and it goes up from there.

Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...

PKFFW

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Re: I wonder why healthcare is so expensive in the US?
« Reply #71 on: July 06, 2018, 01:49:59 AM »
Probably because the USA as a society has accepted the idea that healthcare is a for profit commodity and the for profit corporations know that most people are likely to pay any asking price for the promise of fixing whatever ails them.

Abe

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Re: I wonder why healthcare is so expensive in the US?
« Reply #72 on: July 07, 2018, 11:16:18 PM »
US doctors start off making about 4X their UK counterparts; and it goes up from there.

Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...

Medscape UK salary report:

GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds

Family Medicine in US
Mean $220k = 166 UK pounds

US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.

Exflyboy

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Re: I wonder why healthcare is so expensive in the US?
« Reply #73 on: July 08, 2018, 12:18:37 PM »
US doctors start off making about 4X their UK counterparts; and it goes up from there.

Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...

Medscape UK salary report:

GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds

Family Medicine in US
Mean $220k = 166 UK pounds

US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.

Yes and in the UK the education is mostly state funded. Medical education also starts right out of high school (after A levels at 18.. Normal kids "graduate" high school at 16). So you do't have to go get the bachelors degree as a pre-requisite.

I know this because my Niece is in medical school in the UK. I also have physician friends here in the US with school loans in the +$300k range. My Niece will have to spend about $15k on her entire education.

Side note.. I would have LOVED to ave had the opportunity to be a Doctor  but that opportunity simply didn't present itself to me in the 1980's Britain. So I became an engineer instead.. I still wonder "what if" even today..:)
« Last Edit: July 08, 2018, 03:20:37 PM by Exflyboy »

pecunia

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Re: I wonder why healthcare is so expensive in the US?
« Reply #74 on: July 08, 2018, 08:17:28 PM »
Exflyboy:

Quote
I also have physician friends here in the US with school loans in the +$300k range

It looks like the way they do the doctor training may be better as well.  I wonder if the cost of medical training is inflated like the medical treatment and the drugs.  If the system was overhauled, could more doctors be trained at less cost?  This could mean that they could actually spend time with the patient.  When I go to the doctor for a checkup, all of the actual work seems to be done by others.

Abe

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Re: I wonder why healthcare is so expensive in the US?
« Reply #75 on: July 08, 2018, 08:20:02 PM »
US doctors start off making about 4X their UK counterparts; and it goes up from there.

Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...

Medscape UK salary report:

GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds

Family Medicine in US
Mean $220k = 166 UK pounds

US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.

Yes and in the UK the education is mostly state funded. Medical education also starts right out of high school (after A levels at 18.. Normal kids "graduate" high school at 16). So you do't have to go get the bachelors degree as a pre-requisite.

I know this because my Niece is in medical school in the UK. I also have physician friends here in the US with school loans in the +$300k range. My Niece will have to spend about $15k on her entire education.

Side note.. I would have LOVED to ave had the opportunity to be a Doctor  but that opportunity simply didn't present itself to me in the 1980's Britain. So I became an engineer instead.. I still wonder "what if" even today..:)

Ha, I had come home from an overnight call and completely forgot to include the opportunity cost part of it in the equation. My loans are paid off, but many of my friends who graduated at the same time are still paying them. Thanks for noting that.

Exflyboy

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Re: I wonder why healthcare is so expensive in the US?
« Reply #76 on: July 08, 2018, 09:00:50 PM »
US doctors start off making about 4X their UK counterparts; and it goes up from there.

Then again, given the level of stress and work, I don't think I want the med student who now only makes $80k to be cutting me open...

Medscape UK salary report:

GP (general practitioner, equivalent to Family or Internal Medicine in US):
Mean 104k pounds

Family Medicine in US
Mean $220k = 166 UK pounds

US physicians make 1.6x the UK physicians' salaries. However, physicians in the US have to deal with significantly more insurance-related paperwork and work longer non-patient care hours per week as a result. It's not 60% more, so we are a bit more highly compensated. However, it's not 400%.

Yes and in the UK the education is mostly state funded. Medical education also starts right out of high school (after A levels at 18.. Normal kids "graduate" high school at 16). So you do't have to go get the bachelors degree as a pre-requisite.

I know this because my Niece is in medical school in the UK. I also have physician friends here in the US with school loans in the +$300k range. My Niece will have to spend about $15k on her entire education.

Side note.. I would have LOVED to ave had the opportunity to be a Doctor  but that opportunity simply didn't present itself to me in the 1980's Britain. So I became an engineer instead.. I still wonder "what if" even today..:)

Ha, I had come home from an overnight call and completely forgot to include the opportunity cost part of it in the equation. My loans are paid off, but many of my friends who graduated at the same time are still paying them. Thanks for noting that.

I still think you have the best job in the World so even at $300k I would have done it. Of course being FIRED thats easy for me to say now. As a starving med student watching the bills rack up at 7.5% I might have a slightly different view..:)

Note my UK engineering education was also state funded, a number of young engineers working for me in my last grown up job (US) had school loans pushing $100k.
« Last Edit: July 08, 2018, 09:08:03 PM by Exflyboy »

maizeman

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Re: I wonder why healthcare is so expensive in the US?
« Reply #77 on: July 08, 2018, 09:14:25 PM »
The short answer to your question @pecunia is yes, we could be more efficient in training MDs. The US takes eight years from high school graduation to the awarding of a MD/DO, while most other first world countries (the german system is the one I am most familiar with) manage the same training in six years.

The biggest difference is that medicine in most countries is something you go straight into out of high school (like a trade school), while in the USA we ask potential med students to first get a regular 4 year college degree, and only then divert them to specialized and dedicated medical training.

pecunia

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Re: I wonder why healthcare is so expensive in the US?
« Reply #78 on: July 09, 2018, 10:38:54 AM »
Quote
The biggest difference is that medicine in most countries is something you go straight into out of high school (like a trade school), while in the USA we ask potential med students to first get a regular 4 year college degree, and only then divert them to specialized and dedicated medical training.

It would be somewhat interesting as to whether the doctors think the extra two years was a good use of time.  I assume the added training is in things like music appreciation, Sociology, US history, etc. that are not needed for one's career as a physician but valuable as a human being.

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Re: I wonder why healthcare is so expensive in the US?
« Reply #79 on: July 09, 2018, 11:26:52 AM »
Quote
The biggest difference is that medicine in most countries is something you go straight into out of high school (like a trade school), while in the USA we ask potential med students to first get a regular 4 year college degree, and only then divert them to specialized and dedicated medical training.

It would be somewhat interesting as to whether the doctors think the extra two years was a good use of time.  I assume the added training is in things like music appreciation, Sociology, US history, etc. that are not needed for one's career as a physician but valuable as a human being.

You have to be kidding me right?.. Extra 4 years (not 2) of school loans and also not earning any money.. Complete waste of time and $$.

Then again this is coming from a Brit where we consider the ONLY reason to go to University in the first place is to study for the career we are training for. The concept of the "college experience" is not in our vocabulary. At least it wasn't in my generation.. I suspect it might be a little different now.

maizeman

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Re: I wonder why healthcare is so expensive in the US?
« Reply #80 on: July 09, 2018, 11:38:17 AM »
I think it is 2 years. Dedicated med school only takes four years in the USA after a 4 year college degree, 6 years for med school out of high school in Germany.

Or is the British system 4 years total? (I've no exposure to medical training in the UK.) If so, that suggests the american approach to turning out MDs is even more over designed than I realized.

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Re: I wonder why healthcare is so expensive in the US?
« Reply #82 on: July 09, 2018, 11:52:16 AM »
Oh I see.. No you're right.. The British system is 6 years.

But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?

I assume the feeder degree is required to be in a STEM field??

maizeman

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Re: I wonder why healthcare is so expensive in the US?
« Reply #83 on: July 09, 2018, 12:28:20 PM »
Oh I see.. No you're right.. The British system is 6 years.

But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?

I assume the feeder degree is required to be in a STEM field??

Not required, but it tends to work out that way. You take a test with lots of questions on physics, chemistry, and biology (the MCAT) and the scores on that are a big part of your application to med schools. So technically you could major in anything you want and you might still get into med school, but most pre-meds major in biology or something similar.

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Re: I wonder why healthcare is so expensive in the US?
« Reply #84 on: July 09, 2018, 02:20:26 PM »
Oh I see.. No you're right.. The British system is 6 years.

But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?

I assume the feeder degree is required to be in a STEM field??
Yes, they take a lot of biology, anatomy, and some chemistry as a pre-med undergraduate student. Not all of that the year degree is BS.

OtherJen

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Re: I wonder why healthcare is so expensive in the US?
« Reply #85 on: July 09, 2018, 02:38:47 PM »
Oh I see.. No you're right.. The British system is 6 years.

But then thats 6 years of dedicated medical training.. How then does the US system turn out a Dr in only 4 years after a bachelors in basket weaving?

I assume the feeder degree is required to be in a STEM field??
Yes, they take a lot of biology, anatomy, and some chemistry as a pre-med undergraduate student. Not all of that the year degree is BS.

My undergrad degree is in biochem, and many of my classmates were pre-med. Our coursework included vertebrate anatomy, physiology, microbiology, molecular bio, genetics, organic chemistry, biochemistry, analytical chemistry, and physical chemistry, plus labs. Some of the possible electives included classes like immunology and human anatomy. That time wasn't wasted for the pre-med majors.

I do see the value in protracted professional programs. One of my cousins went through a 5-year physician assistant program (undergrad + masters) at my undergrad alma mater, which also offered a 6-year dental program (undergrad + DDS). I suspect MD could also be compressed into 6 years without a loss of essential coursework.

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Re: I wonder why healthcare is so expensive in the US?
« Reply #86 on: July 09, 2018, 06:58:52 PM »
Thanks to a helpful relative, i just bought an annual supply of medications from Israel for $180 that was costing me $3,000 here. This is basic and widely used medication, nothing fancy. So ridiculous. We are getting royally **&&%% and can't seem to do anything about it. I hope this is THE issue of the midterm elections.

Agree. "According to a column in the Los Angeles Times, Lilly began selling Humalog in the mid-1990s at $21 per vial. But since then, the company has substantially raised the price of Humalog, its insulin product. According to The Nation, the price of a vial of this insulin went up to nearly $270 from $74 over the 10 years that Azar worked at Eli Lilly."  from Newsweek, http://www.newsweek.com/man-turning-diabetes-unaffordable-put-charge-americas-health-719824

In London a few weeks ago, I thought I would research the price of insulin.  The price of a box of Tresiba insulin in London is about $100 in U.S. dollars. In the U.S., that same box of insulin is more than $500 at a DISCOUNT pharmacy.  Without insulin, Type 1 diabetics die. Type 1 diabetics can eat right, exercise, and will never be able to live without insulin, because their pancreas cannot produce insulin.  Without good health care and expensive medications, diabetics become disabled. They lose their eyesight and lose limbs to amputation. It is VERY short sighted to put people like that on high-deductible insurance plans. How many middle-class people have $10,000 a year available to them for premiums and then another $10,000 a year for the deductible?  And, it seems that the Republicans are continually trying to remove the protection for people with pre-existing health conditions to be able to buy insurance at all, at any price.  Bankruptcy is a very real fear for some of us. (And, many people in the 50 to 65 age-range have tried desperately to get employment with good health insurance, to no avail.)

pecunia

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Re: I wonder why healthcare is so expensive in the US?
« Reply #87 on: July 11, 2018, 05:14:42 PM »
From Doug Ules article:
Quote
And when economists like me look at medicine in America Ė whether we lean left or right politically Ė we see something that looks an awful lot like a cartel.

I wonder how many doctors are anti union.

Quote
n the United States, the supply of doctors is tightly controlled by the number of medical school slots, and more importantly, the number of medical residencies.

Quote
In recent years, the number of medical residents has become so restricted that even the American Medical Association is pushing to have the number of slots increased. The major obstacle at this point is funding. It costs a teaching hospital roughly $150,000 a year for a residency slot. Most of the money comes from Medicare, with a lesser amount from Medicaid and other government sources.

Huh!  The government is subsidizing medical education. 

Will the supply of doctors follow "market rules" for other commodities?  If there were more doctors would it help decrease medical costs?

Seems like a good use of government money educating people who save the lives of others.  If there were lots of doctors and they were sent overseas to help people, it could even generate more good will than those wars in the Middle East.

RetiredAt63

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Re: I wonder why healthcare is so expensive in the US?
« Reply #88 on: July 11, 2018, 05:47:03 PM »
If there were lots of doctors and they were sent overseas to help people, it could even generate more good will than those wars in the Middle East.

Doctors Without Borders/Mťdecins Sans Frontiers already exists.  Also Hydro-geologists Without Borders.
The measure of civilization is how people treat one another.

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kei te pai

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Re: I wonder why healthcare is so expensive in the US?
« Reply #89 on: July 11, 2018, 09:08:58 PM »


Seems like a good use of government money educating people who save the lives of others.  If there were lots of doctors and they were sent overseas to help people, it could even generate more good will than those wars in the Middle East.
[/quote]

Cuba has long sent teams of Drs to assist in other countries all around the world, despite being far from rich as a nation.

Exflyboy

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Re: I wonder why healthcare is so expensive in the US?
« Reply #90 on: July 11, 2018, 09:54:41 PM »
What you mean the Yemenies picking up parts of cluster bombs with "proudly made in the USA" after they leveled their neighbourhood.. You mean that DOESN'T win hearts and minds?

Gosh!

Abe

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Re: I wonder why healthcare is so expensive in the US?
« Reply #91 on: July 14, 2018, 03:36:12 AM »
PHysician salaries made up 10% of total healthcare costs in the US in 2008. Since then wages have stagnated to slightly decreased while spending has increased substantially. Like everyone else, physician income have gone down when adjusted for inflation. Thus decreasing wages further would have a small effect on total healthcare spending. You will have a decrease in good candidates once physician salaries drop below or equal to other fields requiring advanced training, due to the added stressors associated with being a physician. However, there are much larger fish to fry. I would start with unnecessary drug spending and hospitalization for futile ICU care, which approaches 30% of all spending by Medicare and a slightly lower  amount for private insurers. Thatís much less popular, despite likely being more effective, because of the optics. Remember death panels killing grandma? However, that is a major component of all other developed countries semi-socialized healthcare systems.
Regarding ďcartelsĒ - physicians are a cartel only as much as any field that self-accredidates is. Thus most professional fields are cartels by the economic definition. The AMA has tried to expand residencies to increase the supply and is very worried about the decrease in physicians as older ones retire.  However, unlike most cartels, physicians do not ďfixĒ their prices, they are very aggressively negotiated by insurance companies.

TLDR: physician salaries are a small and decreasing fraction of healthcare cost in the US. If physicians are a cartel, they are a very ineffective one. This trend will likely continue due to competitive pressures from other sectors of the healthcare industry. Cost savings will be higher with other, less popular, means.
« Last Edit: July 14, 2018, 03:48:12 AM by Abe »

RetiredAt63

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Re: I wonder why healthcare is so expensive in the US?
« Reply #92 on: July 14, 2018, 06:23:15 AM »
Remember death panels killing grandma? However, that is a major component of all other developed countries semi-socialized healthcare systems.

Huh?  The elderly are not hung out in the wind, end of life care is a good chunk of our costs too.  I've seen our health care system do everything it could for both of my elderly parents in the last years of their lives.  I've seen the health care system support my aging friends.  And we do get old, Canadians on average live longer than Americans.  At the other end of life, having a baby costs nothing, no hospital fees.  I was shocked the first time someone on the forums posted how much her delivery cost.

Can't find the source at the moment, but I remember reading that a lot of our savings is less paperwork, plus people get health care sooner so the treatment cost is less because they are not as sick when they start treatment, plus drug costs are much less because of one purchaser negotiating.   OHIP doesn't cover everything, the rest is out of pocket or private insurance.

You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans.  Think of the peace of mind public health care would bring to your fellow Americans.  And it is not "free", we all know we are paying for it through our taxes.  There is no reason your individual states couldn't run it just like our individual provinces do.
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pecunia

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Re: I wonder why healthcare is so expensive in the US?
« Reply #93 on: July 14, 2018, 11:32:23 AM »
Retiredat63:
Quote
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans.  Think of the peace of mind public health care would bring to your fellow Americans.  And it is not "free", we all know we are paying for it through our taxes.  There is no reason your individual states couldn't run it just like our individual provinces do.

High taxes up there.  Gas costs a lot.  However, facts and figures show that health care is less expensive per capita and more complete.  Given the fact that some people have NO health care, it certainly does seem like it would be an improvement for the common welfare. 

Abe:
Quote
However, unlike most cartels, physicians do not ďfixĒ their prices, they are very aggressively negotiated by insurance companies.

I guess because the prices are not "fixed" is one reason you can never get a clean answer as to what something will cost when you visit a clinic.  They tell me, "Why do you ask?  You have insurance."  Right.  I have premiums too.

RetiredAt63

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Re: I wonder why healthcare is so expensive in the US?
« Reply #94 on: July 14, 2018, 12:10:11 PM »
Retiredat63:
Quote
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans.  Think of the peace of mind public health care would bring to your fellow Americans.  And it is not "free", we all know we are paying for it through our taxes.  There is no reason your individual states couldn't run it just like our individual provinces do.

High taxes up there.  Gas costs a lot.  However, facts and figures show that health care is less expensive per capita and more complete.  Given the fact that some people have NO health care, it certainly does seem like it would be an improvement for the common welfare. 

Taxes - someone somewhere on the forums did an analysis of their taxes and health care premiums after moving from Canada to the US.  Ended up a wash.  Lower taxes, higher health care costs after the move.  Six of one, half a dozen of the other.  But I like the idea that everyone has access to health care, just like everyone has access to education.  I pay lots of taxes, and I am happy that I am supporting those things.

Gas - should cost a lot.  Higher prices lower consumption, so less driving and at slower speeds in smaller vehicles, which is good.   Those trucks that give off huge smoke (what is it, rolling coal or something?) I have never seen here, too much waste.  Not to mention less CO2 in the air.  Most European countries pay a lot more than we do.
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CindyBS

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Re: I wonder why healthcare is so expensive in the US?
« Reply #95 on: July 14, 2018, 12:50:18 PM »
Healthcare in the US is so expensive because of our culture's hyper obsession with the "free market" and profit over people. 

Healthcare and insurance companies buy politicians so there are no sensible laws about price caps passed ever.  This allows companies to price gouge people at their most vulnerable and charge sky high prices because there often is no real choice.   

If I came into an area hit by a natural disaster and started charging sky high prices for necessary items like water and food, that would be price gouging and illegal.  But if I am big Pharma and do the same thing by charging a cancer patient sky high prices for chemotherapy, that is ok.  If you suggest otherwise in our culture, people from the right immediately accuse you of being a socialist that wants to destroy this country.

Case in point:

My teenage son has cancer.  We have had more than $2 Million in medical expenses for the past 2 years.  One of the drugs he takes at home (a pill that requires no medical staff or equipment to administer) costs $11,000 per month.  There is no generic.  Our free market choice is to give it to him or let his cancer grow out of control and most likely kill him.

The research for this drug was largely funded by the taxpayers.  The CEO of the company that makes it received $18 Million in compensation for just 2017. 

Now we don't actually pay $11K per month for it - it is covered by insurance, so we all pay for this.   

But to many people, especially those from the supposedly "pro-life" (as long as you are still an embryo, unfortunately my son is past that stage) "all lives matter" (as long as you aren't disabled) and "family values" party, they think it will be the downfall of the nation if we pass a law that prohibits healthcare companies from taking advantage of sick kids to financially rape the system. 


kei te pai

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Re: I wonder why healthcare is so expensive in the US?
« Reply #96 on: July 14, 2018, 01:11:06 PM »
@CindyBS , I agree completely. I worked for over 40 years in healthcare in countries with competent public health systems. It is fundamentally an ideological decision about supporting your whole population to access a reasonable level of care.
As far as I am aware no country that has so called "socialised medicine" has any popular movement to dismantle it.

maizeman

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Re: I wonder why healthcare is so expensive in the US?
« Reply #97 on: July 14, 2018, 01:16:44 PM »
One of the drugs he takes at home (a pill that requires no medical staff or equipment to administer) costs $11,000 per month.  There is no generic.  ... The research for this drug was largely funded by the taxpayers. 

Completely agree healthcare for life threatening conditions is inherently not a "free" market.

However I'm curious which drug this is. Is the name something you'd be comfortable sharing?

CindyBS

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Re: I wonder why healthcare is so expensive in the US?
« Reply #98 on: July 14, 2018, 07:54:51 PM »
One of the drugs he takes at home (a pill that requires no medical staff or equipment to administer) costs $11,000 per month.  There is no generic.  ... The research for this drug was largely funded by the taxpayers. 

Completely agree healthcare for life threatening conditions is inherently not a "free" market.

However I'm curious which drug this is. Is the name something you'd be comfortable sharing?

Drug is called Dasatinib, sold under the brand name Sprycel.  It is for a rare, aggressive type of leukemia.

Here is the wikipedia on it and an excerpt (bolded parts my emphasis):

https://en.wikipedia.org/wiki/Dasatinib


"The Union for Affordable Cancer Treatment objected to the price of dasatinib, in a letter to the U.S. trade representative. The average wholesale price in the U.S. is $367 per day, twice the price in other high income countries. The price in India, where the average annual per capita income is $1,570, and where most people pay out of pocket, is Rs6627 ($108) a day. Indian manufacturers offered to supply generic versions for $4 a day, but, under pressure from the U.S., the Indian Department of Industrial Policy and Promotion refused to issue a compulsory license.[4]

Bristol-Myers Squibb justified the high prices of cancer drugs with the high R&D costs, but the Union of Affordable Cancer Treatment said that most of the R&D costs came from the U.S. government, including National Institutes of Health funded research and clinical trials, and a 50% tax credit. In England and Wales, the National Institute for Health and Care Excellence recommended against dasatinib because of the high cost-benefit ratio.[4]

The Union for Affordable Cancer Treatment said that "the dasatinib dispute illustrates the shortcomings of US trade policy and its impact on cancer patients"[4"

Abe

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Re: I wonder why healthcare is so expensive in the US?
« Reply #99 on: July 14, 2018, 09:08:11 PM »
Retiredat63:
Quote
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans.  Think of the peace of mind public health care would bring to your fellow Americans.  And it is not "free", we all know we are paying for it through our taxes.  There is no reason your individual states couldn't run it just like our individual provinces do.

High taxes up there.  Gas costs a lot.  However, facts and figures show that health care is less expensive per capita and more complete.  Given the fact that some people have NO health care, it certainly does seem like it would be an improvement for the common welfare. 

Abe:
Quote
However, unlike most cartels, physicians do not ďfixĒ their prices, they are very aggressively negotiated by insurance companies.

I guess because the prices are not "fixed" is one reason you can never get a clean answer as to what something will cost when you visit a clinic.  They tell me, "Why do you ask?  You have insurance."  Right.  I have premiums too.

They usually can give a list price if you pay out of pocket, which tells you at least the high end of the cost (since insurance companies always negotiate lower prices) but that doesn't really answer what an insured person is going to be billed.

The main reason a lot of places don't give clear prices on routine things is usually due to a non-disclosure agreement with insurance companies. For example, if my hospital has a contract with Insurance A, they will agree that X lab costs $Y for those patients with Z diagnosis, and the patients will owe W% of the cost. Generally patients will know what the W% is, but not the other numbers.

The contract almost always says you cannot disclose the cost because then:
1) people from Insurance B will find out and say "hey, why is Anthem paying $Y+5 ?!" and potentially switch to Insurance A
2) people from Insurance A through Z will realize they are paying significantly more in premiums than they are getting back
3) people at that hospital may go to a different one with a cheaper negotiated payment if they care how much the insurance company is paying (above their out of pocket expenses)

It's nuts, but the only other option is for the hospital to not take those patients' insurance, because, in general, the hospital system is usually a much smaller corporate entity than the insurance company. Generally what happens if the hospital balks and wants to be paid more is the insurance company no longer will pay for anything at that hospital (make them out-of-network). There are usually more hospitals than insurance companies in a given area.

Now, this generally matters to you if the insurance company refuses to pay because they didn't think that the test was necessary for a given disease / diagnosis. This happens a lot, and then there's much arguing back and forth. A good example I have is with patients who have high-risk cancers. Sometimes I will want to get a CT. If national guidelines indicate a CT is necessary, almost all the companies will pay without question and the patient only has the co-pay. They may specify it has to be done with a contracted imaging company, the cancer diagnosis confirmed by their physicians, etc. However, if these steps aren't followed exactly, they may refuse to pay any portion and the patient gets the whole bill (often without the physician even knowing). Even worse, if the guidelines say "consider a CT" or don't mention it at all, almost no insurance company will pay without an argument (called a "face-to-face" in the jargon - apparently people talked in person before computers). They may then agree to pay with certain stipulations like above, or just refuse entirely. Then the patient either pays all of it or forgoes the test. Either way only the insurance company wins.

Now, there are fraudulent practices by physicians and hospitals that the insurance companies are doing all of the above to prevent, so it goes both ways with the paperwork. This would be fixed in large part of physicians were salaried and hospitals were nationalized (like in a lot of other countries).