cost of health care in the US

[Eric]

List of countries by total health expenditure (PPP) per capita - Wikipedia, the free encyclopedia
has the US 2009 health expenditure at 17.4% of gdp. The Netherlands is the next highest a 12%.

The 2011 10-k report from Bristol-Myers (ticker symbol bmy) explains that different countries pay different prices to pharmaceutical companies:
###
In many markets outside the U.S., we operate in environments of government-mandated, cost-containment programs, or under other regulatory bodies or groups that can exert downward pressure on pricing. Pricing freedom is limited in the UK, for instance, by the operation of a profit control plan and in Germany by the operation of a reference price system. Many European countries have continuing fiscal challenges as healthcare payers, including government agencies, have reduced and are expected to continue to reduce the cost of healthcare through actions that directly or indirectly impose additional price restrictions.
###
[pg 36]

I'm curious as to what people think we should do to lower the cost of health care in the US.

[JKDS]

IMO the problem is law suits.
1) High cost of malpractice insurance translates to higher doctor bills
2) Fear of a potential suit results in over protection by doctors. Ordering several expensive tests when one cheap one would suffice.

To reduce these, we need two long term goals.
1) Hold doctors to higher standards. College, in general, is far too easy and laid back atm. We need to be training better and more talented doctors.
----This will result in less causes for suits

2) Reinforce responsibility and ethics in the minds of young people, so Americans dont just get sue happy.
----This will result in less frivolous suits that somehow dont get immediately shot down.

[Eric]

2) Reinforce responsibility and ethics in the minds of young people, so Americans dont just get sue happy.
----This will result in less frivolous suits that somehow dont get immediately shot down.

I agree with this, we're way too litigious.

[wufwugy]

The PPACA fixes most of the problems, truth be told. However, US is way too litigious as well. Education costs being so high also requires healthcare compensation to be too high so doctors can pay back the loans.

We are on the right track. Fixing the litigation-happy problem in the US will be much harder though.

[Poopadoop]

The fact that judges award lawsuits for cases that would be laughed out of court in most other countries is definitely a problem. But are you still paying ridiculous prices for prescription drugs? That probably doesn't help either.

In the UK the National Health Service sucks, but health insurance is federalized, paid for through taxation, and universal. Prescription drug prices are state-controlled using profit limits, and the consumer pays only a set amount with the rest of the costs covered by gov't. All of which means (shock-horror!) that the quality of health care doesn't depend on income, unless, by some ironic circumstance, you are too poor to afford a bus ride to the doctor's.

In Canada, which is more on par with the US in terms of GDP, the same type of system exists, but without the prescriptions being subsidized. The costs of pills is still gov't controlled however, meaning that (shock-horror!) poor people can still get quality health care.

Basically the US needs to start considering health care as a fundamental right the way so-called socialist countries do, instead of having the current head up the ass attitude that any government intervention in people's lives is by definition negative EV. The War of Independence ended over 200 years ago. Get over it.

[MadMojoMonkey]

Basically the US needs to start considering health care as a fundamental right the way so-called socialist countries do...

Totally agree.

It's time we recognized that each of the major economic structures (capitalism, socialism, communism, etc.) has certain areas in which it excels over the others. There is nothing dangerous about embracing former enemies' strengths and using those methods to our own advantage. In fact, this is clever.

America has quite successful and beloved programs that are fundamentally socialist ideas: Medicare and Social Security to name a couple.

[!Luck]

Good luck getting tort reform in a country run by lawyers.

[Jack Sawyer]

Why does education cost so damn much?

[rong]

Why does education cost so damn much?

To keep the poor out.

[CoccoBill]

IMO the problem is law suits.
1) High cost of malpractice insurance translates to higher doctor bills
2) Fear of a potential suit results in over protection by doctors. Ordering several expensive tests when one cheap one would suffice.

I've read about a fair number of ridiculous and outlandish cases, but I'd be interested to know how big of a problem this actually is, and how much of it is exaggerated and used as an excuse for higher fees.

Re: tort reform, I'd recommend watching Hot Coffee (2011) - IMDb

[NightGizmo]

1) Hold doctors to higher standards. College, in general, is far too easy and laid back atm. We need to be training better and more talented doctors.

Doctors have significantly more schooling than just college. 4 years of post-graduate med school, then 3-5 years of training in their chosen field (residency), and 2-5 more years of training if they choose to specialize.

However, if you're talking about lowering healthcare costs, part of the problem is that doctors aren't well-trained to prevent disease, just treat it. Of course, the American people don't want to hear about preventative care, either (eat healthy? exercise? can't you give me a pill instead?).

[NightGizmo]

I've read about a fair number of ridiculous and outlandish cases, but I'd be interested to know how big of a problem this actually is, and how much of it is exaggerated and used as an excuse for higher fees.

I don't have specific cases, but I know for a fact that in my state (Illinois) that the cost of malpractice insurance is driving OBs out (specifically, doctors that deliver babies). If you're a family practice doctor, for instance, you can choose whether you want to deliver babies, too (they are trained for it, but it doesn't have to be part of their practice). If they decide they want to deliver babies, their malpractice premiums multiply severalfold.

Example: Illinois Medical Malpractice Insurance - FREE quotes - FREE Practice Tools. Notice that OB malpractice is over 3 times as expensive as internal medicine. It actually costs more to insure an OB than a surgeon.

I'm pretty sure that the average salary for an OB is about $180K, too. So that makes it impossible for an OB doctor to run a private practice. If you want to deliver babies, you have no choice except to work for a hospital or a large practice that can afford to pay you a decent salary and then another $100K+ in malpractice premiums.

[Eric]

However, if you're talking about lowering healthcare costs, part of the problem is that doctors aren't well-trained to prevent disease, just treat it. Of course, the American people don't want to hear about preventative care, either (eat healthy? exercise? can't you give me a pill instead?).

Yeah, this is part of the problem. In California (apart from San Francisco) people don't get out and walk the way they do in Europe. Some people do exercise at the gym but even then they'll drive there even if it is only 5 or 6 blocks from their house.

[JKDS]

I've read about a fair number of ridiculous and outlandish cases, but I'd be interested to know how big of a problem this actually is, and how much of it is exaggerated and used as an excuse for higher fees.

So theres a few things.

1) Unfounded cases get shut down immediately and fail before they even get out of the pleading stage. You cant just file a completely frivolous suit and hope a jury finds for you, because the court will shut it down way before the case even sees the light of day.

2) Lawyers are actually hesistant to pursue a frivolous claim as well. If the opposing side, or the court on their own, determines it to be unfounded and made only to harrass or extort or whatever...then the lawyer can be sanctioned and maybe disbarred.

3) HOWEVER, what constitutes a frivolous claim is what is at issue here imo. Theres certainly justifiable cases, such as when a doctor leaves a pair of forceps in someone's stomach or removes the wrong leg. These things happen, but obviously the patient has a right to compensation.

Then there are other cases where its not so clear. The patient may be injured...but in what way and how bad matter.

If a surgeon promises to give someone a "better nose", and fails, can the patient sue? Certainly. But that is something that is silly to me.

4) The other problem rests with punitive damages. Believe it or not, the courts do not normally give you vaults of cash for getting injured. If you win, they give you the costs of things like medical bills and attorney fees. They will attempt to reimburse you for lost wages and such, but you'd have to prove "pain and suffering" if you want that and you still wont get much in that case.

Punitive damages, however, are where these vaults come from. The lady that spilled 130 degree mcdonalds coffee on herself and sued got punitive damages iirc. These are designed to 'punish' corporations/doctors/whoever for their negligence and to push them towards better practices. However...the fear of punitive damages also gives rise to costs.



TLDR: Completely unfounded cases dont happen, but there are many cases of unclear injuries as well as rewards of punitive damages that would contribute to a rise in medical expenses.

[a500lbgorilla]

I believe that Americans should be free to choose to pay more for their healthcare; to choose to risk bankruptcy from unforeseen medical expenses, to choose to save money by neglecting preventative care which reduces their health and standard of living while shortening their lives.

That's the America I believe in.

[Jack Sawyer]

I believe that Americans should be free to choose to pay more for their healthcare; to choose to risk bankruptcy from unforeseen medical expenses, to choose to save money by neglecting preventative care which reduces their health and standard of living while shortening their lives.

That's the America I believe in.

[a500lbgorilla]

[MadMojoMonkey]

1) Unfounded cases get shut down immediately and fail before they even get out of the pleading stage.

The lady that spilled 130 degree mcdonalds coffee on herself and sued got punitive damages iirc.

This dubious misinformation is used as one of your examples?
Credibility in serious question.

That coffee was served at no less than 180 degrees (as was McDonald's policy at that time). The 79-year-old woman suffered from 3rd degree burns on 6% of her body, was hospitalized for days while she underwent skin graft surgery, and ultimately had ~$18,000 in medical bills. She asked the company to pay her medical bills, and they offered her $800. Then, she called the lawyers.

1st degree burn: redness (a sunburn)
2nd degree burn: blisters
3rd degree burn: blackened, burned flesh

[Poopadoop]

This dubious misinformation is used as one of your examples?
Credibility in serious question.

That coffee was served at no less than 180 degrees (as was McDonald's policy at that time). The 79-year-old woman suffered from 3rd degree burns on 6% of her body, was hospitalized for days while she underwent skin graft surgery, and ultimately had ~$18,000 in medical bills. She asked the company to pay her medical bills, and they offered her $800. Then, she called the lawyers.

1st degree burn: redness (a sunburn)
2nd degree burn: blisters
3rd degree burn: blackened, burned flesh

Didn't she order the coffee and spill it on herself?

One might reasonably argue that she took a risk by ordering a hot drink, then she realised that risk when she spilled it on herself. How the f**k is MacD's at fault for that?

[JKDS]

This dubious misinformation is used as one of your examples?
Credibility in serious question.

That coffee was served at no less than 180 degrees (as was McDonald's policy at that time). The 79-year-old woman suffered from 3rd degree burns on 6% of her body, was hospitalized for days while she underwent skin graft surgery, and ultimately had ~$18,000 in medical bills. She asked the company to pay her medical bills, and they offered her $800. Then, she called the lawyers.

1st degree burn: redness (a sunburn)
2nd degree burn: blisters
3rd degree burn: blackened, burned flesh

Uh, i didnt use that for a frivolous lawsuit...i used it to explain punitive damages. Sorry my iirc was inaccurate and i did not, in fact, recall correctly.

I mean, i used bullets...how was it at all unclear that i was talking about a different aspect?

[supa]

I audibly chuckled.

[supa]

I don't know if it's been mentioned yet but I think Doctors are allowed to charge something like 3 times as much to insurance as they could to a cash customer. Has to have something to do with it.

[Fnord]

Basically the US needs to start considering health care as a fundamental right the way so-called socialist countries do, instead of having the current head up the ass attitude that any government intervention in people's lives is by definition negative EV. The War of Independence ended over 200 years ago. Get over it.

Where do you draw the line between health care as a fundamental right and health care as a luxury good?

Do you dump $$$$$$ to try to add a couple years to Granny's life or do you focus effort instead on making those last days peaceful?

Do you roll the dice for $$$$$$ on a long-shot chance for someone who's critically sick/injured?


The big ones not mentioned in this thread are:
o Big bucks being spent at end-of-life because we are a very wealthy nation who believe in fighting death every inch.
o US is a big cash cow for medical research and manufacturing to recoup R&D costs. Many other countries then get the benefits of that R&D and infrastructure at a lower cost.

I think the fundamental problem is that too often capitalism leaves Children and Mothers at the mercy of Government and Charity.

[NightGizmo]

I don't know if it's been mentioned yet but I think Doctors are allowed to charge something like 3 times as much to insurance as they could to a cash customer. Has to have something to do with it.

It's a broken, fucked up system, but I can explain a little about this.

With a cash patient, obviously the patient has to pay you the full amount. It's the same as any other service rendered -- pay or deal with a collections agency (or, at the very least, you won't be able to go back to that practice).

But when you add insurance to the mix, the doctors first have to have a contract with the insurance company (I'm mainly talking about in-network PPOs -- don't know much about any other situation). That contract includes specified maximum allowed payments for specific services. But it doesn't specify a minimum. Everyone has figured out that the insurance company decides how much to pay based on how much the charge is, up to the maximum in the contract.

So if you're a doctor that wants to get paid $100 for a visit (and your contract allows you to get paid $100 for that visit), you need to charge $300 and see how much you get back. If you charge $100 to insurance, you'll get a check for significantly less instead.

The only good news for the patient is that the difference disappears -- the doctors just write it off (per their contract -- they have to abide by the charges dictated by the insurance company).

Anytime you get an "Explanation of Benefits" (EOB) from your insurance company, you'll see what I'm talking about. It has the amount the doctor charged to insurance, how much the insurance company decided the service was actually worth, how much they paid to the doctor, and how much left you owe to the doctor.

[Poopadoop]

Where do you draw the line between health care as a fundamental right and health care as a luxury good?

Good point. I don't mind paying taxes for some random poor person to get cancer treatment, but if it's a 300 pound chain-smoker I do feel they are getting a bit of a 'luxury'.

Not sure what else you are counting as a luxury here - care to elaborate?

Do you dump $$$$$$ to try to add a couple years to Granny's life or do you focus effort instead on making those last days peaceful?

Do you roll the dice for $$$$$$ on a long-shot chance for someone who's critically sick/injured?

These are ethical questions for which there is no easy answer of course, though certain countries like the Netherlands now have legalized euthanasia.

The big ones not mentioned in this thread are:
o Big bucks being spent at end-of-life because we are a very wealthy nation who believe in fighting death every inch.

Well I don't mean to be glib, but I think that countries with socialized health care might be showing that they value life more than you guys are. And as far as wealth goes there are many countries in Europe on a par with or above the US in terms of PCI.

But I think cases where a 99 year old person with terminal cancer gets an expensive treatment are exceedingly rare. It's not like we just throw money away to give granny another year of suffering.

o US is a big cash cow for medical research and manufacturing to recoup R&D costs. Many other countries then get the benefits of that R&D and infrastructure at a lower cost.

The pharmaceutical companies spend much more on marketing than on research. The US is paying mostly for that, and for their huge profits. You are not doing the world or yourselves any favours by not regulating the industry. They would still make money without you, just not as much.

I think the fundamental problem is that too often capitalism leaves Children and Mothers at the mercy of Government and Charity.

There is a lot to be said for having a meritocracy that rewards talent and hard work, but there is also a lot to be said for a society that cares for its own. Too often I think the US culture identifies the second part of that equation with ideas that go against what made America great, rather than with ideas that could make America better.

[MadMojoMonkey]

Sorry my iirc was inaccurate and i did not, in fact, recall correctly.

It took me 20 seconds to Google that case and find correct information. If you are trying to convince me of your opinions by citing information as fact, then iirc is no good. Take the time to find out if you remember correctly... this un-timed format is perfect for that.

(I'm still trying to find a simple way of explaining virtual particles without getting into complex math. The thread is waiting for me when I have my answer figured out.)

The weight of anecdotal evidence is minimal, at best, to me, anyway. It's the ultimate of small samples.

...

Yes, the woman bought and spilled the coffee on herself.
This case would have held more weight to me if it was a class-action.

[Poopadoop]

Yes, the woman bought and spilled the coffee on herself.
This case would have held more weight to me if it was a class-action.

So if you buy a kitchen knife and cut your finger off with it while chopping onions, that is the company's fault for selling you a sharp knife? And if you find a bunch of other people who have injured themselves with this product, a class action suit is appropriate?

There are cases where the person working at MacD's has spilled scalding coffee on a customer. I think these are much more justifiable cases than someone spilling it on themselves. What if someone orders a Big Mac and chokes to death on it? MacD is to blame for making a big burger?

Really, people need to take some responsibility for their own fuck-ups.

[MadMojoMonkey]

I'm not making any statements about what is appropriate in a legal sense. I'm only saying that incorrect information and anecdotal instances are not swaying me.

[JKDS]

I'm not making any statements about what is appropriate in a legal sense. I'm only saying that incorrect information and anecdotal instances are not swaying me.

You attacked my credibility and called my information dubious because you misinterpreted a very clear argument based on me misremembering the temp of the coffee....in a case everyone knows about. The temp wasn't relevant to my argument in any way, I said I wasn't sure about that specific fact, and yet I'm uncredible now. As someone in the scientific community, I'm genuinely surprised at how carelessly you did this.

edited to remove insult

[MadMojoMonkey]

I do misunderstand your point. I was only trying to say that I see a disconnect, which I thought was clear with the quotes, but apparently we're on different pages.

Given: All unfounded cases are thrown out of the judicial process before reaching a hearing.
Given: The case in discussion was not thrown out.
Conclusion: The case was not unfounded.

Given: A case happened in which punitive damages were the result of adjudication.
Given: Awarding punitive damages in this type of case has legal precedent.
Conclusion: The result did not change legal precedent. I.e. this is the standard.

Is your point: There should never be a case in which punitive damages are awarded?

Is your point: The fact that punitive damages exist has some impact on health care costs?

P.S. Thank you for removing insults. I have never intended to insult anyone on this site; I did not intend to insult you. I'm sorry if I did. Even scientists make mistakes.
We cool?

[MadMojoMonkey]

Something Jon Stewart said in the debate with Bill O'Reilly last weekend has got me thinking on this topic, though.

Jon said something to the gist of the problem with healthcare in America is that it needs to be decoupled from the workplace.

My initial thoughts:
The insurance companies sell their policies for cheaper in bulk. Employers are in a position to offer their employees a plan that is cheaper than what they could get outside the company. Most people have their health insurance through their job. Most people benefit from this system.

Further thoughts:
This puts the negotiating power in the employer's department. Which means that different companies are getting different rates for the same coverage. Which means that an individual who wants or needs to find an insurance plan for themselves is being charged significantly more, since they lack the negotiating resources of a company with many employees.

The cost of health insurance was paid for entirely by the employer in my father's day. Today, an employer tends to match a portion of the cost (if at all).
The cost of health insurance is being quietly passed on to the employees.

The lowest income of these employees are not able to afford the cost. They are forced to resort to reactive treatment in the ER, instead of preventative treatment through regular check-ups with their personal physician. Clearly, this is a problem.

But is "leveling the playing field" in terms of making the same options available to everyone going to fix it?

[Eric]

Where do you draw the line between health care as a fundamental right and health care as a luxury good?

Do you dump $$$$$$ to try to add a couple years to Granny's life or do you focus effort instead on making those last days peaceful?

Do you roll the dice for $$$$$$ on a long-shot chance for someone who's critically sick/injured?

How do countries in Europe answer these and other questions?

Suppose Walter, the main character in Breaking Bad, lives in Europe? Does the government pay for a second opinion on his lung cancer diagnosis? He wasn't a cigarette smoker but would the government have paid for his treatment if he got lung cancer because of smoking 3 packs of cigarettes a day?

If a coke addict keeps going to the ER from overdoses does the government keep paying for it?

[swiggidy]

Good luck getting tort reform in a country run by lawyers.

This. (have not seen coco bill's movie link)

Combined with the fact that nobody spends less then they earn, thus don't expect the government spend less than they earn means nothing will change.

Please stop using the McDonald's case as an example of excessive lawsuits. Read the first post here: snopes.com: The McDonald's Coffee Lawsuit

[CoccoBill]

Again, I'd recommend watching Hot Coffee (2011) - IMDb

It's a documentary about how certain legal cases (the main example being the mcdonalds hot coffee issue) are painted as frivolous to justify tort reform, aka limiting the liability of companies to pay compensation when their products or services eat babies. The hot coffee issue and several similar cases, as explained in great detail in the docu (including photos of the actual coffee burns), had nothing frivolous about them but a public smear campaign was launched to push for tort reform.

[Poopadoop]

How do countries in Europe answer these and other questions?

Suppose Walter, the main character in Breaking Bad, lives in Europe? Does the government pay for a second opinion on his lung cancer diagnosis? He wasn't a cigarette smoker but would the government have paid for his treatment if he got lung cancer because of smoking 3 packs of cigarettes a day?

If a coke addict keeps going to the ER from overdoses does the government keep paying for it?

They are covered, at least in the UK.

[Poopadoop]

The hot coffee issue and several similar cases, as explained in great detail in the docu (including photos of the actual coffee burns), had nothing frivolous about them but a public smear campaign was launched to push for tort reform.

I guess that's a matter of opinion. A British court threw out a hot coffee lawsuit against McD's filed by someone who also spilled it on themselves, and I agree with them.

[CoccoBill]

I guess that's a matter of opinion. A British court threw out a hot coffee lawsuit against McD's filed by someone who also spilled it on themselves, and I agree with them.

Entirely possible. I only meant the famous case covered in the docu and other completely different law suits that had nothing to do with hot coffee, also portrayed in it. I didn't mean that every legal case in the world involving hot coffee has been legit.

[JKDS]

@Mojo: We buds. Those conclusions are accurate, and my intent was only to say that the case was an example where punitive damages were applied. Its fairly famous, so i figured it would be a good way to show it.

I believe, though im unsure, that the fear of such punitive damages....or maybe the risk that such damages could be applied in case of a suit, have an effect on the price of healthcare.

To be sure, id have to have a better understanding of how punitive damages are applied to medical cases...specifically those that apply to things like doctor related injuries.

What I do know, is that companies that are held strictly liable for defects in their products...account for the possibility of punitive and other damages with increases in price. I assume that this translates to healthcare costs as well.

@Coco: Cool link, ima check it out.