Health Care: Can Anyone Pay if the Costs are so High?

[GoodEnoughForMe]

Often brushed aside in the health care debate in the US, as the following article aptly points out, are the reasons behind why everything is so expensive in the US. It's easy to look at someone who is paying tens of thousands of dollars for cancer, and realize that some form of public health care would help them pay for that; it's more difficult to fix the fact that all of our procedures and surgeries - from the routine to the extraordinary - are extremely high priced.

The first of the 344 lines printed out across eight pages of his hospital bill — filled with indecipherable numerical codes and acronyms — seemed innocuous. But it set the tone for all that followed. It read, “1 ACETAMINOPHE TABS 325 MG.” The charge was only $1.50, but it was for a generic version of a Tylenol pill. You can buy 100 of them on Amazon for $1.49 even without a hospital’s purchasing power.

When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?

The result is a uniquely American gold rush for those who provide everything from wonder drugs to canes to high-tech implants to CT scans to hospital bill-coding and collection services. In hundreds of small and midsize cities across the country — from Stamford, Conn., to Marlton, N.J., to Oklahoma City — the American health care market has transformed tax-exempt “nonprofit” hospitals into the towns’ most profitable businesses and largest employers, often presided over by the regions’ most richly compensated executives.

According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period.

Of the total $2.8 trillion that will be spent on health care, about $800 billion will be paid by the federal government through the Medicare insurance program for the disabled and those 65 and older and the Medicaid program, which provides care for the poor. That $800 billion, which keeps rising far faster than inflation and the gross domestic product, is what’s driving the federal deficit.

Full article here, I highly suggest reading the whole thing: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

So, we all have ideas on what to do to help people pay for health care. But how do we help reign in out-of-control costs with an industry that is both heavily embedded in our communities and our own government?

 

[AlpsStranger]

Shoot, if I knew the answer to that I'd be out convincing everyone who would listen instead of arguing abut video game censorship on the internet.

It is a good question. Lower costs would probably work better than most of what we're trying, but most "lower costs" solutions I hear are of the "let them eat cake" variety.

 

[Cutlass]

Universal Health Care. It's the only thing that works.

 

[Core Imposter]

In a country as rich as America....

If we can't figure out a way to put market forces to work in the health care system then we probably will end up with a single payer system with a boutique system for the wealthy.

 

[Kozmos]

The wealthy will always have options.

 

[emzie]

Universal Health Care. It's the only thing that works.

Basically.

 

[peter grimes]

Republican lawmakers have written rules that preclude federal and state health care entities from negotiating for lower prices.

That's one place to start, certainly.

 

[Kaitzilla]

Often brushed aside in the health care debate in the US, as the following article aptly points out, are the reasons behind why everything is so expensive in the US. It's easy to look at someone who is paying tens of thousands of dollars for cancer, and realize that some form of public health care would help them pay for that; it's more difficult to fix the fact that all of our procedures and surgeries - from the routine to the extraordinary - are extremely high priced.


Full article here, I highly suggest reading the whole thing: http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

So, we all have ideas on what to do to help people pay for health care. But how do we help reign in out-of-control costs with an industry that is both heavily embedded in our communities and our own government?

Requiring up front pricing would be a good way to start. That would help people who want to shop around.

http://archinte.jamanetwork.com/article.aspx?articleid=1569848

...Each hospital was contacted up to 5 times in efforts to obtain pricing information.

Setting/Participants All top-ranked and a sample of non–top-ranked US hospitals performing THA.

Main Outcome Measures Percentage of hospitals able to provide a complete price estimate for THA (physician and hospital fee) for top-ranked and non–top-ranked hospitals and range of prices quoted by each group.

Results Nine top-ranked hospitals (45%) and 10 non&#8211;top-ranked hospitals (10%) were able to provide a complete bundled price (P < .001). We were able to obtain a complete price estimate from an additional 3 top-ranked hospitals (15%) and 54 non&#8211;top-ranked hospitals (53%) (P = .002) by contacting the hospital and physician separately. The range of complete prices was wide for both top-ranked ($12 500-$105 000) and non&#8211;top-ranked hospitals ($11 100-$125 798).

So 5 tries to get a price for a common procedure for each hospital. Not very successful in getting one. Order of magnitude cost differences regardless of quality.

 

[RobAnybody]

I'm not really trying to defend hospitals' pricing, but it's difficult to tell what a procedure might cost ahead of time. For example, define "broken arm". Compund fracture? Upper arm? Lower arm? And if so, both ulna & radius, or just one? Any allergies? How old is the person?

There's lots of reasons why something as simple as "broken arm" may have a wildly varying cost to treat.

Plus, as far as shopping around, try shopping around when you're having a heart attack. Or if, like in many rural areas, there's one hospital with 10 miles & the next closest one is half an hour away.

 

[Kaitzilla]

I'm not really trying to defend hospitals' pricing, but it's difficult to tell what a procedure might cost ahead of time. For example, define "broken arm". Compund fracture? Upper arm? Lower arm? And if so, both ulna & radius, or just one? Any allergies? How old is the person?

There's lots of reasons why something as simple as "broken arm" may have a wildly varying cost to treat.

Plus, as far as shopping around, try shopping around when you're having a heart attack. Or if, like in many rural areas, there's one hospital with 10 miles & the next closest one is half an hour away.

Well, in an emergency I can see how a person would have no choice.


But for elective procedures, it would sure be nice to have some pricing info for people without good health insurance.

Every other business manages to do it. Like a plumber faced with an unknown clog. Or a cleaning service at a rock star's house.

 

[Leifmk]

Universal Health Care. It's the only thing that works.

Well; can be made to work. It can also, of course, be screwed up horribly. Most often in most countries it's made to work well enough but not as well as it should be working. Like most other things.

 

[MobBoss]

Universal Health Care. It's the only thing that works.

Universal studios is dropping their health care for part time employees because of Obamacare. So, no, it doesnt work so much.

 

[Leifmk]

Universal studios is dropping their health care for part time employees because of Obamacare. So, no, it doesnt work so much.

Half-assed compromises often don't work too well, no. (You need to hold out for whole-assed compromises.)

 

[Terxpahseyton]

There seem to be two separate issues here. The dysfunctionality of the private market which drives up costs. And the social-moral issue of some people not being able to afford healthcare. The two issues are related, but not entirely.
Obamacare doesn't appear to tackle the former much at all and latter half-assed.
But could he have achieved more?

 

[MobBoss]

Half-assed compromises often don't work too well, no. (You need to hold out for whole-assed compromises.)

Even limited health care for part time workers is better than no health care at all.

There seem to be two separate issues here. The dysfunctionality of the private market which drives up costs. And the social-moral issue of some people not being able to afford healthcare. The two issues are related, but not entirely.
Obamacare doesn't appear to tackle the former much at all and latter half-assed.
But could he have achieved more?

You forgot to mention those that dont desire to pay for it, even if they can afford it.

 

[FriendlyFire]

You forgot to mention those that dont desire to pay for it, even if they can afford it.

Like botched military adventures ?

 

[Ziggy Stardust]

You forgot to mention those that dont desire to pay for it, even if they can afford it.

Would you rather have it that those who can't afford it get healthcare while those who can afford it also have to pay for it, or those who can afford it don't have to pay for it, but those who can't afford it don't get healthcare?

 

[Cutlass]

Well; can be made to work. It can also, of course, be screwed up horribly. Most often in most countries it's made to work well enough but not as well as it should be working. Like most other things.

It must still be easier than our system, based on how many countries do better than we do.

 

[Terxpahseyton]

You forgot to mention those that dont desire to pay for it, even if they can afford it.

No I didn't. That is a group I am happy to ignore for now, because they are mostly a symptom of present conditions.

 

[Bamspeedy]

I'm switching sides on this.

Everbody loves Medicare. The right loves it because it shows how great our health care is. The left loves it because it is government healthcare. Canadians would love it if they knew what it covered because it's better than what they have.

Problem is you don't get it unless you're 65+, so if one is under 65, the Canadians would rather keep what they have. Good news is if you get to the age of 65 you tend to live longer here in the USA than you would in other countries. Problem is, not as many of us Americans will live to the age 65 to get Medicare and the extension on life.

Despite what you hear on Fox News, Canadians do not 'Hate' their healthcare as a reason for why they come here for treatment. There are things they don't like about it, but that doesn't mean they want our system.

The few, rich Canadians that do come here are NOT here to see a completely random doctor in a small town for a simple procedure. They come to see the world's best specialists, whether they are in America or elsewhere. You, as an American will likely never use those specific specialists those Canadians are paying to see. Your neighbors will be denied getting to see a specialist because they don't have insurance so that the specialist can make a few bucks off some elites from north of the border.

People come from all over the world for our health care. What does that say about our system?
We have Americans going to India and Mexico for transplants. What does that say about our system?

Need an expensive procedure done? A rich American (or senior citizen) will have it done in a month. A rich Canadian will have it done in a month as well (coming to the USA if needed). A poor Canadian will get it done in 3 months. A poor American will not get it done until he's 65.

Healthcare keeps getting more and more expensive for several reasons. As it gets more expensive, more people can't pay, thus driving up the cost for those of us who do pay.

Sure, it would be nice to see the 'world's best doctors' if I need brain surgery. As crappy as my insurance is, they will pay 100% of the costs for brain surgery (including travel expenses)....but only if I see their recommended expert. The brain surgeon may very well be the very best, but why do I need to pay 'world best' type fees to see a doctor about a broken bone, a simple checkup, or a worrisome rash on a baby?

A 15 minute visit with a family doctor shouldn't cost $250 (plus $300 for every blood test). My wife had latent (non-active) TB. A year of treatment got rid of the TB so that it never does become active and give our family a very serious health problem. The medicine was cheap enough (less than $5/month), but required many visits to the doctor, tests, and shots. Insurance doesn't think this is 'preventative' treatment, which they then would have paid for.

I glanced at the Time article and it seems to focus on the extreme cases, like MSNBC would, just like the right will focus on the extreme cases in other countries of long wait times as examples of other systems being broken. A patient ignored and dying on the emergency room floor does not represent our system, even if it did happened in America (at a county-government run hospital, BTW, so neither side can use that as an example to vilify the other).

Whatever side your on you will belittle or deminish the possible fixes from the other side. "Obesity isn't a problem, it is insignificant. Your trillion dollar healhcare is expensive because you pay a few CEOs of health insurance companies a few million more than they should be". or "We could be #1 in every health stat if people would get off the couch and take a walk".

We have our problems taking care of ourselves, so universal health care won't solve everything. We aren't #1 in many health statistics and we won't be #1 in many health stats even if we had universal health care. The left says our system is broken unless we are #1 in every health stat, the right won't believe our system is broken until we are dead last in every health stat.

We have more gun violence and we are fatter than other countries (Ok, Australia may have recently become fatter than us but let's compare after they've been fatter than us for 20 years rather than only 2 or 3 years.) We have more teenage pregnancies and our cigarette's are more toxic, so how much does this all affect our health stats?

As of 2012, The US is 40th in life expectancy. Surely we can increase our life expectancy if we eliminated the infant mortality rate, right? THINK OF THE CHILDREN! Kind of doing some rough math and if I take the CDC death reports and change everyone who died at 0, and instead said they died at age 80, it would increase our country's life expectancy by 1.2 years.

If I change the average age of victims from gun violence (suicide and homicide) from age 35 to age 80 we increase the country's life expectancy by 0.5 years.

How much does obesity shorten your life (not everyone that is obese is 'morbidly obese' which can shorten your life by 20 years or more)? If all 30% of our country's 'obese' people lost weight and lengthened their lives by 2 years, that raises the nation average 0.6 years. If the obese save themselves on average 7 years, then that raises the national average by 2 years.

So if I take the best possible estimates (eliminated infant mortality, obesity, and gun violence) we could improve our life expectancy by 3.7 years. That would move us to #2 behind Japan....

HOWEVER! We will never eliminate these things completely, and even if we do eliminate (or reduce them), why wouldn't other first world countries make the same kind of progress (other countries have fat people too), which would push them right past us on the list again, and send us back to #40.

Taking better care of ourselves will help, but we can't do it alone. We need those under 65 to have access to healthcare.

Universal healthcare won't solve our poverty problems (a very big problem for health issues, and why I don't ever seeing us be #1 in life expectancy regardless of how our health care system operates), but it very well may help some of it.

How do we pay for it?
---------------------
You're rich or have some extra money to spend? You can still buy private insurance and pay private doctors to get around any wait list.

Instead of taking $2300 out of my paycheck a year for insurance, charge me $2300 more in taxes. You can keep my earned income tax credit, because for the last three years it's all been going straight to the hospital to pay hospital bills that weren't covered by insurance (hadn't yet exceeded the yearly deductible). And my family didn't have any major accidents or illnesses during this time. Obamacare is a check to the insurance companies? EITC is a check to the hospitals in my case.

But now my wife is working, so if that continues we will no longer get the EITC and become net tax contributers. So I just wanted to say I loved you military guys when you took out Saddam and Osama, but I'd rather spend my tax money on healthcare. And it's not just military spending either, let's take care of ourselves before we worry about what other countries are doing by cutting off foreign aid whether it's to Israel or a country in Africa.

But if you are single and healthy or already have insurance paid for by the government then I guess you see no problem with the current system because your health insurance is great. My mom, sister and now my wife work or have worked for the government and have far better insurance than me working at the largest retailer or my dad working for a major oil company ever had. My wife's insurance (when she qualifies for it) will have almost as high of a deductible as I have, but her insurance has far more copays (for example $30 office visit rather than paying $250 through my current insurance), and the insurance pays 100% after meeting the deductible rather than the 80% through my insurance. It's more expensive now thanks to Walker, but I thank Walker for exposing more people to how expensive health care really is.