If you want some real information, read the article in The Guardian: https://www.theguardian.com/us-news/2018/mar/13/us-healthcare-costs-caus.... It provides the detail that this article leaves out.
74
Just give us the numbers please. The article contains too many vague phrases like "was in the middle of the pack."
43
NOPE
Maternal Mortality Rising...
https://www.nytimes.com/2016/09/22/health/maternal-mortality.html
Worst Rate of Maternal Deaths in Developed World
https://www.npr.org/2017/05/12/528098789/u-s-has-the-worst-rate-of-mater...
35
These days, it's a miracle if you get top-notch medical care anywhere. It's really a crap shoot. It almost doesn't matter who your doctor is, or what hospital you go to, the system is skewed against the patient. The layers and layers of money seeking middlemen, i.e. insurance companies, drug companies, medical suppliers, etc. force the patient/consumer to pay an exorbitant amount for their care, while receiving, often, less than adequate care.
The healthcare system is broken. All the data shows us this and almost all of our experience proves this point. Yet, all we seem to do is complain and put stopgap measures in place, instead of demanding a better, single-payer system.
I will never say we're getting exactly what we deserve at this point, but if we don't demand these changes, we have no one to blame but ourselves. Both political parties are guilty of creating this healthcare mess and all of us are complicit in this if we don't demand change, or vote.
67
Oh yeah, I had to declare bankruptcy from the 77K bill that I would never be able to afford on a teacher's salary from a 1 month stay in a hospital (which if I didn't go I would have died). But sure, nothing to see here folks. Give me a break. Disgusting.
122
“It’s not that we’re buying more pizzas, we’re just paying more for each pie,” Dr. Jha said. “But that doesn’t mean that you can’t still buy fewer pizzas.”
But isn't that the unsolvable dilemma of capitalism... you can have anything -- if you can pay for it (a big if).
39
So healthcare in the rest of the developed world
a) costs half as much
b) is just as good
c) covers everyone.
Why isn't the story presented accordingly?
178
There are many reasons for the rapidly rising and high costs of healthcare in this country. Fraud, waste, defensive medicine, high malpractice rates, etc., all contribute in part to the costs increases. But, the single biggest contributor (that is rarely discussed) is the sheer growth in the number of advanced treatments that simply didn’t exist decades ago. Think about it: If you had a bum knee 50 years ago, it was just too bad. You took some aspirin and toughed it out. Today, you get a new one . . . probably in an outpatient surgery center . . . oh, and you will probably sue the doctor if the outcome isn’t perfect and “good as new”.
Similar advances have been made in all medical, surgical and behavioral health fields (Schizophrenia can be successfully managed with medications today!).
We fully expect Medicare/Medicaid and private health insurance companies to cover these “new” procedures and advances. As long as this is the case, barring some magical breakthrough, healthcare costs will continue to soar.
One final thought. The majority (but, not all) of contemporary major medical advances have either originated or been perfected here in the U.S. We have the best healthcare system in the world. It’s too expensive, but we are a rich country and have been able to afford it, so far.
24
Sure, whatever.
Who shows up at the top of this list when sorted by average annual wage?
https://www.bls.gov/oes/current/oes_nat.htm#29-0000
7
Does this mean that our doctors earn considerably more?
19
So, it's the prices! The system is corrupt driven by greed. Everyone is charging much more than other countries. An MRI is $3000, not $150. Doctor visit is $500, not $50. Medications are 10 or 100 times as expensive in the US.
61
American healthcare is so expensive because we allow for-profit healthcare. It’s really simple. For-profit companies exist to sell as much as they can, for the highest prices they can charge. In healthcare, “consumers” are weak and vulnerable, and providers often have monopolies. No one shops for deals when one is sick. It’s no surprise that our healthcare is ridiculously expensve, the only surprise is that we seem ignorant as to why.
85
Too bad physician greed is taking down our medical system. Isn't $300,000 to $500,000 enough?
Why do many gouge for even more?
Incredible when you recognize that malpractice premiums average around $10,000/year. Incredible greed by physicians.
Docs, heal thyself...
17
Myths??? First, the report is by the AMA...they have a lot to loose if the USA ever gets to single payer. But then you confirm why care is so expensive with worse outcomes:
"There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. And our complex payment system causes us to spend far more on administrative costs. The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems."
Costs with show a massive curve up once millions find themselves priced out of the private insurance market and booted off Medicaid...they'll be back at your ERs.
35
No mention by Dr. Jha about the fact that costs are keeping people away from healthcare in the US.
29
No mention of the billions that go towards covering outrageous malpractice settlements, which other countries have restrained.
11
I'm a cynic. I always assumed that all of those other explanations (too many specialists, people visiting their doctors at the drop of a hat, etc.) were just excuses designed to deflect attention away from the reality. And, sure enough, there were two areas where the data showed the real difference between them and us: prices are too high and administrative costs are ridiculous.
Sometimes, often really, the most obvious answer is the correct one.
52
Simple...
Lack of oversight is the main reason for high costs.
5
"The quality of health care looks pretty good, [the study] finds...."
Okay, then why does the referenced study also say: "The United States consistently had the poorest population health outcomes (Figure 4)." I advise everyone to read the study for themselves.
This article is very careful to talk about "health system function" rather than than health outcomes. That's a tad tricky. Ms. Sanger-Katz makes it sound like Americans just pay more, probably because our administrative costs are too high and we order too many scans, otherwise, everything is the same everywhere. But, the truth is, we pay more...for less.
Another source of info for those wishing to read further:
http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/
28
The most convincing evidence suggests to me that the American healthcare is expensive because healthcare induced deaths are the fastest growing cause of death. The only other thing that is close is drug overdoses, which is a subset of healthcare.
2
When actors and sports figures are paid what they are worth—about 50,000/yr—-then I will believe doctors make too much money.
If you can afford to pay an actor or an athlete then you can afford to pay the doctor.
16
We have several unique factors that lower our life expectancy beyond those mentioned in the article: shootings and auto accidents.
6
Surprised by the lack of meaningful data points in this article — feels more like social commentary than reporting on Healthcare, a sector representing 18% of our GDP. And definitely some totally unnecessarily painful data points, such as: 60% of all bankruptcies are Medical bankruptcies; in more instances than you’d imagine, there are more hospital billing and insurance associates than there are hospital beds; in the average family of 4, at least one member will forego medical treatment so that the electric bills are paid and food is on the table. And this: all health metrics improve for Americans when they turn 65 — and enrolled in Medicare. All points argur for stopping this immoral madness and bring The New York Health Act to fruition.
35
Working class and poor people just need to die from their illnesses and diseases and stay out of the way of those with more financial resources.
That is how it comes across to me after watching
the price of medicine and drugs continue to rise and rise and rise.
I will swap my constitutional rights for firearms for protection to have medical benefits and drugs at a cost that will not send me into bankruptcy.
Every working man should profit from their labors but medicine has gone beyond reason.
I may not be able to afford a headache over the situation.
24
"There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. And our complex payment system causes us to spend far more on administrative costs. " For heaven's sake, what else is new? This get the award for most misleading headline of the day (or at least the afternoon).
26
This is a misleading article. The author alleges that the US healthcare system is no worse than that of other nations. Yet, the article admits that our healthcare system has "substantially higher prices" and "lower life expectancy". The only benefit identified in the US system is the questionable benefit of better technology.
Our healthcare system is twice as expensive on a per capita basis as other advanced countries. When you combine much higher costs with the Us poverty rate, gaps in insurance coverage and high insurance deductibles you arrive at our health care system whose structure undermines the best intentions of the medical community.
I recently became eligible for Medicare and marvel at its extensive benefits compared to my previous employer sponsored plan. I also marvel at the reduced financial stress when I contemplate healthcare.
We have a viable alternative to our hodge podge health care system. Medicare for all.
38
Most important paragraph:
"There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. And our complex payment system causes us to spend far more on administrative costs. "
That is why we need a single payer system. Price ontrols on doctors, hospitals,drug makers and medical device makers. Boy they are to hate that.
"The United States also has a higher rate of poverty and more obesity than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems."
No "possible" about it. You can't get medical treatment without money in the good-old USA. You don't have money you get sick and die. Nobody really wants to change this. I would call that greed.
18
In the USA, people don't go to doctor or hospital because of the outrageous costs. As a US citizen living in London now, I know I would be dead right now if I had continued living in the USA. After 5 years of treatment for prostate cancer here, I am in remission with good prospects. My out-of-pocket costs: ZERO.
20
Care is not bizarre but the payment system definitely is.
10
"[O]ur complex payment system causes us to spend far more on administrative costs." That statement may well be the crux of the issue. Complex and cumbersome systems always cost more. We have the providers with a Charge-Master that sets the prices for the smallest details of any contact with the provider. On the other side we have the insurers Reasonable-and-Customary payments with all of the same diagnostic codes as the Charge-Master. We also have providers that simply do not accept any insurance or negotiate their Charge-Master rates. Then we have uninsured who get mandated care but wind up having tax payers cover their bills or have them sold to debt collection services.
This drives those without insurance to avoid care until it the condition becomes a crisis and medical care costs the most because there is no history or preventative care. Did someone design this or, did it just happen?
3
Removing my appendix should not have cost $100,000. Our system rips off its citizens at every level and yet it benefits the people that do not work and do not contribute to the funding the most. We do not need to research this anymore. We need to fix it.
21
OK, here's something that's not a myth: Nobody can tell you what a procedure is going to cost until long after it's completed. Try having cancer in America. I asked both my insurance company and the clinic for an estimate of what my wife's planned, six-week radiation treatment would cost, just so I could budget for it. No one could even give me an estimate. Our system is ludicrous. I wouldn't let a mechanic start work on my car before getting an estimate, but for procedures that could bankrupt the average American, we're just supposed to accept a mutual shrug from both the insurance company and the hospital. The question isn't "Why is it so expensive?" It's "Why can't you -- clinic or insurer -- give me an estimate on a common procedure?" It's not like I can wait and shop around for cancer treatment. I'm not a sociopath. But our system? It's inhuman.
35
US healthcare spends more on administration? That means things like ACO mandated by ACA - which helped increase administration costs and hasn't made a single impact on any metric regarding health of Americans.
4
The U.S. health care system is a scam, plain and simple. Everything about it is designed to extract as much money from people as possible. Even the most minute contact with medical professionals in the U.S. is coded and processed to extract the highest level of billing possible. Third party doctors are allowed to charge hospital patients outside network coverage. Everything is overpriced in the system. And, it cannot be emphasized enough: the outcomes from the U.S. system aren't better than those in the socialized systems here in Europe in spite of the fact that you spend 18% of GDP on healthcare and European nations spend about 10%.
You Americans just love to torture yourselves. You could have created more European system years ago, but you'd rather line the pockets of the health care industry and pretend that you have the best system in the world. Well, you don't.
22
Consider these facts; US healthcare costs are the highest in the WORLD ($9,500 + / capita), US infant mortality is 27th in World in industrialized countries, US rates 37th in overall health care in the World, US rates 31st in life expectancy. It is estimated by the World's leading medical economists that insurance companies, HMO's, and PPO's take more than 60% of our health care dollars, leaving slightly more than 30% for the actual providers of health care. SEE the real problem here? ... GREED.
15
Because they become doctors to be get rich whereas other countries doctors are being doctors to heal. I'm willing to bet America has the largest number for mistakes, deaths, mal-practice complaints..
5
I've read that people can be bankrupted by medical expenses in the US. Can that actually be true? If so, was it measured in this study?
16
Hunt (Costco President in Canada) scoffed at claims made by some American free-market health care advocates that Canadians don’t like their single-payer system. He noted that the Canadian system has survived many decades of conservative government at the national and provincial level, and has never been seriously threatened. He explained this broader support across party lines compared to the situation in the U.S., where even the relatively modest ACA reforms pushed through by President Obama are now under threat by Republicans: “In Canada we have the attitude, liberals and conservatives alike, that everyone should have the right to affordable medical care.”
The total cost of Health care spending at this time is a total of 3.3 Trillion, so the increase with total government coverage would add 1.65 trillion. We pay more then any other Nation for care and have poor results. Payments to US physicians by private insurers 70-120 % more then single payer systems. Private Insurance companies cost 730 Billion dollars a year. Recently Canadian docs say they are paid too much.
One of the biggest objections to Single payer is the projected costs. Actually thats not a valid reason, the real reason is that some do not want government paying the bills.
28
This article, and its headline, seem like a justification for our wasteful, whatever-we-want-to charge healthcare "system". Not even mentioned in the column is the constant floating anxiety of people who fear becoming ill for the worst of reasons - going bankrupt or being denied care. Also not mentioned are such disease-mongering schemes as direct-to-consumer prescription drug ads, found only here in the U.S. and one other country - New Zealand. Other countries have health care; we have corporate health "care".
61
A few years ago someone I knew took a ski trip to the U.S. While there he started to feel chest pains. To be safe, he went to the ski hill clinic. As he had travel insurance he was seen to quickly. After an initial exam, they decided to run a test on him.
It came back negative. So they said, "Let's run it again just to be safe." So they ran it a second time.
When he got back to Toronto, he was talking to a nurse and told her this story. She replied, "If it had happened here in Toronto, they probably would have given you the same test. However, you'd likely have waited six weeks for it."
So was it a good thing or a bad thing that in the U.S. he was given the test immediately and the again for a second time?
12
This doesn’t seem that heartening to know outcomes are about the same for disproportionately more expensive care. I would hazard a guess that this may come from the fact that people wait longer before seeking care in the United States. If many pregnant women's first interaction with a doctor for her pregnancy takes place on the due date, the doctor and the mom to be are flying blind. If a patient comes in after a major heart attack, but walks off many smaller ones, the patient will likely be in need of more urgent care. Prevention can be expensive, but it is often a lot cheaper than the all-hands-on-deck solution proposed.
7
Interesting article. One of the main reasons doctors in the United States order more imaging studies and perform more C-sections has to do with our broken legal system. As a doctor practicing medicine in the Bronx, I am often thinking about defensive medicine. My primary goal is always to optimize patient outcome but at the same time I am also thinking about the best way to protect myself in the event of a lawsuit. In addition to spending a lot of extra time documenting the encounter in the electronic medical record I also order a lot of imaging studies, often a CT or MRI, which are relatively expensive.
When my wife had our first child we went with a Midwife over an OB doctor. I was alarmed by the high C section rate and when I researched why it was so high I found that the lawsuit rate was much lower if a C section was done.
If our government wants to bring down health care costs then medial malpractice reform is a must. It is not just the cost of the medical malpractice insurance but the "hidden cost" of practicing defensive medicine.
Unfortunately, the recent passage of Lavern's Law will just make this worse.
37
I read a study on the US medical system more than 10 years ago and it concluded that salaries in the US were higher and we spend more on administration. Seems to still be the case.
15
Here in Germany representatives of health care providers, insurance companies and patients negotiate a schedule of prices for all medical and dental products and services. These are binding for those insured by the public non-profit part of the system; there is more flexibility with those of us who are privately insured, which is why doctors love to see us walk into their practice. We are privately insured because the premiums are lower than in the public system, where what you pay depends on what you earn. Overall, the system works: costs are reasonable, doctors still drive Mercedes and BMWs, everybody is insured, outcomes are as good as or better than the US. But it all starts with price controls.
37
The study clearly points out that the major difference between the U.S. and other countries is simply cost. Doctors charge more, hospitals charge more, and pharmaceutical companies charge more. This shouldn't surprise anyone and it's exactly what one would expect in a heavily regulated industry that does not have price controls. The regulations both limit competition and drive up costs. The lack of price controls guarantees that those costs will be passed on to the consumer. If healthcare were viewed liked utilities then we might see a decrease in prices.
35
Yes ealth care costs are related to the providers charging whatever they want. I was a Radiologist for 40 years and my hospital would add a 6a% increase in charges on all exams each year automatically. When I pointed out that many imaging machines were years old and paid for and shouldn't we charge less they ignored the idea. When asked they always blamed it on the "expensive "equipment costs.
Drug prices, for the same drugs, are 6X cheaper in Europe.
12
It is estimated that one third of us spending is wasted. I would emphasize patient demands and expectation. Some pass out expensive tests on request like candy. Pas and nps unsure of themselves.
But go bac k to how medical schools are built like cathedrals and paid for. High tuition and debt can make new graduates seek and feel deserving of high income.
Then there is the cost and anxiety of lurking lawyers.
7
I would love to see a study that tracked the correlation between increase in health care costs and the deregulation of direct-to-consumer pharmaceutical advertising in the late 1990s. Airtime costs money, and certainly those costs are being passed on to consumers.
35
Somehow this NY Times article does not get it right.
The USA spends as much money on health care as the REST of the world combined and something like twice as much as ten of the wealthiest countries in the world.
All countries have problems with health care costs. The problem with medical advances is that they work and that they are expensive. That is true for all countries.
This article fails to address that gap.
Drug costs, physician fees, and hospital costs in the USA are part of the problem by they represent only about half of American medical expenses.
21
Hmmm no, that's for the military. US health care costs are double the OECD average - definitely not ten times that. But it is interesting that you would confuse the two...
3
Do people in other countries feel anxiety when receiving an envelope with the return address of their insurance company? Or do they have more of a sense of a safety net in terms of costs and coverage?
50
I think Margot has the backwards take on this report. What it is saying is, we're paying a lot more than other countries even though the actual care we receive is about the same. That's the problem. The lede is, we're paying too much because prices are higher here. Drug companies charge US patients 2, 3, 10 times what they charge other countries. Hospitals bill insured patients outrageously high fees, in part to cover the costs of treating poor people but in part so they can build gold-plated executive suites and jewel-encrusted lobbies to satisfy their institutional egos.
Whatever the lede should definitely NOT be "U.S. healthcare surprisingly similar to the rest of the world" -- it's "U.S. economy is being sucked dry by expensive health care system even though care is no better here than other countries."
127
Absolutely correct. Compare a specific cancer treatment in the US and France, Germany, Canada, Great Britain, or a few other countries and the financial differences are staggering. Outcomes are not especially different, except that one is likely to end up bankrupt in the US even with insurance in some cases and almost certainly when without insurance. This is the real world experience for too many of us. It is not a singular, once in a while, event in the US. Bankruptcy is not the experience in most of the rest of the industrialized world due to medical costs. I found the article almost insulting in its naivete'.
49
Did the study analyze bad debt and charity care expenses in the other countries? Uncompensated care for people with no insurance or inadequate coverage is a cost driver that should be considered. We know that the US is a leader in uncompensated care.
9
Bobby, in the other "civilized" countries with universal coverage, either by single-payer or other arrangement, there ISN'T any "uncompensated" care -- unless you include "foreigners" like you and me who might skip out after receiving care while visiting country "x" and have no "foreign-coverage" rider on our insurance policy! Moreover, waiting times for elective consultations and procedures would constitute the only "inadequate coverage," depending on one's point of view.
Our far higher costs do not buy you or me better care ("quality" outcomes), but line the pockets of over-priced insurance and hospital network executives, physicians (especially procedure-oriented "specialists" and "sub-specialists"), Big Pharma and manufacturers of our high-tech equipment (which other countries purchase at far lower prices).
19
I met 2 people from Australia and 2 from Canada when I was just in Texas. They both mentioned that in their respective countries that everyone has access to healthcare. They also said that no one in Australia or Canada goes broke over receiving medical care.
I wish we could say the same in the US.
97
"Substantially higher prices" is explanation #1. HELLO. Why didn't the journalist and the AMA article lead with that fact, which is hardly a new finding?
Did the study: 1) compare physician incomes by speciality (typically, US physician incomes are 2-3X those in other developed countries and hospital executive comp differentials are even greater; 2) note that we have little competiton in most smaller metro markets due to massive consolidation, creating monopolistic pricing power by dominant, integrated health systems; 3) note that according to most insurers' price transparency tools, the total cost or "price" for any diagnostic test, procedure, surgery or visit typically is 200-400% higher in a health system setting than in independent site (i.e, not owned by locally dominant, health system cartels); 4) that there has been little anti-trust enforcement as providers have consolidated massively (both vertically-- more than 50% of physicians now are employed by health systems-- and horizontally); 5) that large health system ("cartel") executives receive multimillion dollar annual compensation, largely based on revenues and bottom line (surplus), which grow exponentially due to consolidation. These systems then dictate prices to private (non-government) payers (e.g., Sutter Health System, one of these "not for profit" cartels has more than 30 execs who earn more than $1M annually).
Let's get real folks.
60
This article and related headline are infuriating. The most obvious reason why health care in the US is more expensive is near the end of the article, and this study backs that reason up: "There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. And our complex payment system causes us to spend far more on administrative costs." EXACTLY! And you know what is the best way to simplify that payment system and lower admin costs? SINGLE PAYER! Get rid of the middle man (insurance companies). This ain't rocket science.
220
I’m a bit flabbergasted. How is it that reporting on Healthcare, a business sector that comprises about 18% of our GDP, reads more like casual conversation between reasonably uninformed young adults. Healthcare produces more data than is humanly imaginable, yet some very informative data points are overlooked. These include, for example, that 60% of all bankruptcies are medical bankruptcies. Another is that for the average family of four, one or two members will forego medical treatment in a calendar year because the choice is food on the table and lights on, rather than the insurmountable co-pays, minimums, medicines and supplies— plus payroll deductions — all which can cause a broken arm to be a $14,000 incident. And then we have the startling fact that most all healthcare metrics improve for American seniors — including life span — when they turn 65 and begin to receive the excellent care provided by Medicare. All of this immoral insanity argurs well for passage and implementation of The New York Health Act, bringing Medicare-plus to every New Yorker.
103
While the author looks for reasons to justify her assessment, she neglected to mention that because of the unknowns of what is happening to the current status of American healthcare, by the end the first year of the Trump Presidency there was over 3 MILLION "LESS" Americans that had coverage than in 2016. It is estimated that in 2018 that unless significant changes occur in the U.S. Healthcare set-up, because of increased rising costs, the number of uninsured Americans will increase by another 9 MILLION and that is not even taking into account the massive increase in cuts in medicare and medicaid that could happen in their current budget bill if Republicans maintain the house in the 2018 mid-term elections.
There is no point in discussing comparisons to other countries systems when unlike those, fewer and fewer Americans will ultimately have access to healthcare, whatever it turns out to be.
35
Why do so many NY Times reader focus on paper/plastic insurance cards in pockets? ACA provided more "insurance" cards to people than the system before it. Yet ACA hasn't improved the health of Americans by any metric whatsoever! ACA was insurance reform - It replaced bloc grants to poor communities with expanded medicaid enrollment - it changed how charges are paid it did nothing whatsoever to improve the health of Americans. It mandated more administrative positions - more hospital reports, new administrative agencies (like ACOs- which do not deliver healthcare). ACA was insurance reform when what we needed and still need is healthcare reform. The obsession on "insurance" cards impedes true change.
1
In the US we pay more for labor. Nurses, allied health staff are good jobs in the US and paid well. If we adjusted for compensation the systems would be even more alike.
7
Exactly, how many orthopedic surgeons in the Netherlands or Germany earn $500K per year? This is a major contributor to our higher costs, our medical practitioners earn substantially more than other countries' do. We'll never have comparable prices to Italy, for example, if our medical staff earn 4-10 times what Italian medical staff do.
14
Actually, No. It is not the same in every country with universal care. That is a red herring. Surgeons in specialties in Canada earn very comparable incomes to their U.S. counterparts and in many cases, nurses earn even more. The question one has to ask, even with higher earnings, after one takes out the significant increase in expenses an American doctor has over other countries physicians that have a universal system, what are they left with?
My doctor whom at one point was considering a position in the U.S. indicated to me that in private practice, his malpractice insurance premiums would be SIX TIMES higher than what they are in Canada and his expenses overall would be at least FIVE TIMES as much.
11
Deus, can you point me to a study that shows Canadian doctors and nurses earn comparable salaries to their US counterparts. This article http://nationalpost.com/news/canada/canadian-doctors-still-make-dramatic... states that "Orthopedic surgeons in Canada make less than half the $440,000 average net income of colleagues in the States while doing more procedures". I'd be interested to see your references
Our employer has just added another layer of well-meaning administration to our United Healthcare coverage. Employees spending too much time "negotiating" with UHC now have an advocacy group to work through. If US healthcare is so complex that advocates are needed, much is very wrong. BTW, the company workforce is mostly technical PhDs meaning even mathematicians cannot navigate US healthcare.
51
We have executive directors of "non-profit" health insurance corporations making upwards of $5,000,000 per year. Health insurance "non-profits" spend lots of money on marketing and operate like big businesses. That's not the recipe for lower administrative costs. Bottom line: Until the United States reduces the role of health insurance companies/non-profits in administering care, we will continue to see high prices due to high administrative costs. There's no reason why civil servants cannot administer a healthcare program on more reasonable salaries at a lower overall cost.
56
Absolutely! If low costs are what you're after, just make all medical staff government employees like those that work for the VA. In Italy, doctors and nurses are government employees, and their salaries are a fraction of ours.
13
What about 'not for profit" health system execs who earn more than $1m annually---- largely based on top line and bottom line ("surplus"). Sutter Health has more than 30 execs that earn more than $1M annually. Insurance premiums vary by market due to underlying PROVIDER costs volume (utilization) and unit cost (price). The ACA caps insurer administrative costs and profit @ 15% for large health plans and 20% for individuals and small health plans. How about price controls on hospitals, which have consolidated massively and now employ more than 50% of physicians/health professionals (who are the only persons authorized to "order" or purchase services from the health system cartel)... In other words, the integrated health system "owns" (employs) its "customers" (physicians/health professionals), who are the only purchasers allowed to "order" health system services. Now that's what I call a racket!
6
It seems like based on this study, we need to discover why Americans are spending so much money on health care in which case the study didn't really answer this question. It did possible rule out some of the changes that have been suggested such as health care utilization and reducing medical specialization. Then there is the issue of the growing inequality and obesity in the United States. Some of these problems appear to be the focus on Republican desire to helping the wealthy and the commercial food business promoting cheap, unhealthy foods for profit using lot of salt and sugar to addict the public like tobacco companies. Looks like a change in our President and Congress remains in order.
7
" The United States also has a higher rate of poverty ... than any of the other countries, possible contributors to lower life expectancy that may not be explained by differences in health care delivery systems."
Why does the US have such a high level of poverty? I thought the Trump tax cuts was suppose to lift people out of poverty?
3
You make reference to underlying issues in America that many of them wish to pretend does not exist. There was a column yesterday discussing tips in restaurants and the overall income of servers in those establishments. When many states, especially in the South and Mid-West maintain a mandated minimum wage level in those industries of $2.13/hr., at that ridiculously low hourly rate of pay, unless one is working about 3 jobs, how does one ever expect to get out of poverty?
19
Well, paying higher prices for the same services is exactly what I thought the main problem was.
Yet still, not being addressed by policymakers.
19
The system is expensive because of administrative costs - which means that every time you go to the doctor of get a procedure, there are possibly as many as a dozen non-clinicians involved in processing that visit. Schedulers, coders, practice managers, and billers at the hospital, and agents at the insurance company. Not to mention the CEO’s, their assistants, and other middlemen who run the hospital and clinics.
This costs money, and for physicians like me, immense amounts of time, spent clicking and filling out redundant forms to maximize billing income (and minimize legal risk) for my hospital.
Combined with high deductibles, this same administrative nightmare also discourages patients from coming to the office early in the course of the disease for preventive care, which contributes to poor outcomes (and more expensive care that is required late in the disease).
Bottom line is: there are too many people making too much money in healthcare for the system to change easily.
67
Dr. Tim, I'm not sure what you include in the term "administrative costs", but yes everything I read today says that there are no incentives in US healthcare to reduce costs. The two biggest examples are that insurance has little or no incentive to reduce drug costs, so they just pay the costs and pass it on to their subscribers. Similarly, the costs of things like MRIs vary by hundreds or even thousands of percent from provider to provider. The answer is just as you say. The CEOs, the middle-men and others who are all bilking every American out of their livelihoods.
21
You've some good points.
One thing that never comes up is variable pricing. My hospital charges upwards of $30K for a hip replacement if you are paying cash. It charges about $10K total if insurance pays.
It's time we required all medical providers to charge standard costs for specific services irrespective of who pays. This one change would solve a whole lot of problems...
But then it would cut into a lot of cartel styled profits.
And one other thing. It's absurd to tell hospitals to pick up the tab for the indigent. If we the people agree that the indigent need medical care, then we the people should agree to pay for them out of our taxes.
37
Stu A - you are correct. I understand Maryland has an All-payer law. Which as I understand means providers must charge the same rate to everyone - instead of charging different rates depending on what deal an insurance company negotiated all parties must be billed at the same rate. I would like to learn more about this and I wonder why more states are not passing similar legislation.
3
Thanks for a fact based article on healthcare. Kudos to Drs. Irene Papanicolas et al, the authors of the referred article for collecting, analyzing and presenting data. In addition to the factors mentioned in the study, key take away are:
1. Rent seeking salary of healthcare workers, especially doctors
“Although the ratio of primary care physicians to specialists was similar between the United States and other high-income countries, the salaries paid to both generalist and specialist physicians were markedly higher in the United States, where specialists were paid TWICE as much as those in the United Kingdom or Germany and primary care physicians and nurses also had substantially higher salaries”, P. 1035 in a new study.
2. Bulk of the healthcare spending in the US is borne by private spending. OECD average is ~ 3.25% of GDP whereas US private spending is of the order of ~ 9.5% of its GDP (Table 2 in the cited study).
3. With the ruling by the majority of the Republican appointed US Supreme Court favoring the corporations to have the same rights as individuals, and thanks to Citizens United, the price gouging the drug companies is endemic. Per capita spending in the US is $1443 compared with our neighbor, Canada at $613 (Fig. 9, cited study)
4. Very high outpatient spending at 42% of the total national healthcare spending in the US is a major contributor.
9
Whoa. What about the overall statistic that reports that U.S. health system costs are 15%+ of GDP vs. only about a 10% of GDP average in all other developed countries?
6
Reasons our health care is so expensive not mentioned in this article:
- The high cost of medical education -- someone has to pay for those student loans
- The high cost of medical malpractice insurance, particularly in some specialties and the failure of the medical establishment to weed out the 1% of doctors who account for the bulk of awards
- Our litigious society, that feels that someone needs to pay -- literally -- when there are bad outcomes. Sometimes, bad things happen no matter how good the care is
- Proliferation of for-profit services, such as labs, radiology clinics, etc.
- For-profit hospitals
- For-profit insurance companies
- For-profit pharmaceutical and medical device companies
- Administrative costs for providers of dealing with numerous health plans
I could go on, but you get the picture. It's not the quantity of the care that is generally the issue. It's the unnecessary costs that result in the high price that we need to get our arms around.
29
If for profit hospitals drive up costs - how come the non-profit hospitals charge the same high rates? The two largest insurers in Oregon - Kaiser and Providence are both non-profits - how come they are as expensive as for profit health insurers? Seems to me profit/non-profit isn't a factor. The other items you list may be.
7
Everything you list falls into prices being too high and administrative costs of trying not to pay the high prices only increase the costs.
ie, the price for having a PreX is very high so you must sue to get someone to pay for the PreX high price/cost that was forced on the family by someone else, or God. If everyone is treated exactly the same regardless of the past, no one will fight with lawsuits to get exactly the same long term price as everyone else.
1
"Analysts are fond of describing the system as wasteful, with too many patients getting too many services, driven by too many specialist doctors and too few social supports."
You mean politicians are. These ideas have been uran myths for a long time, repeatedly debunked by the evidence. Our health care system is expensive because the people in it get make a lot more money for the same services compared to other countries.
8
In an aside about the recent AMA study that American healthcare compares favorably with other countries, Dr. Ashish Jah admits: “we pay substantially higher prices for medical services and prescription drugs, we pay far more for administrative costs, we’re fatter and poorer (which may contribute to the lower life expectancy).
This study was commissioned before Paul Ryan threatened to cut “entitlements” to help pay for the deficits in the tax bill and before Seema Verma director of the CMA, said it was fine for states to issue work requirements for Medicaid users (even though most are elderly and too ill to get out of bed, let alone into the work force) and before the Wall Street Journal reported how insurance companies are “gaming the system” to pull more payments from the federal government into their Medicare Advantage Plans to enlarge their already huge profits.
I ask: what’s rosy about a system that leaves millions of working Americans without insurance, fosters insurance denials to those who pay exorbitant prices for it, scares people away from getting medical attention because the deductibles on the cheap plans now sanctioned by the Trump administration compel them to choose which of their multiple ailments they can medicate in a given month?
20
In the health care industrial complex, one man's costs are another's income, broadly speaking. I am writing this from Sydney, where an ongoing dental emergency forced me to see a dentist at the highest walk-in/insurance not accepted cost of USD65 for a consult + medications; earlier in Wellington, New Zealand I paid USD80 for the same + an X-ray. The professional encounters were as good as any that I have experienced with my regular DC dentists, for a fraction of the total cost charged in the US to my insurance company and me, let alone the "rack rate".
21
Sanger-Katz presents aggregate data suggesting that American medical care:--number of hospital visits, proportion of physicians who are specialists, etc.--is not an outlier among prosperous, "advanced" countries. Yet for an advanced, prosperous society, our mortality rates et al. do not stack up well; we are comparatively sick. Can it be that the less egalitarian distribution of medical care in the USA compared to that of Western Europe and other "peer" countries explains some of our low ranking?
11
In this case, I wonder if the average obscures the distribution. On average, we do a typical number of a procedure. But is that equally spent? Or are some people (with good insurance & access) getting too many, while others don't get enough, meaning we get worse outcomes for the same number of tests?
I remember reading about the C section rate in Brazil. Private hospitals had extremely high rates, above 90%. But the overall rate wasn't significantly higher than is typical--because public hospitals have a much lower rate. Rich women get C sections more often than is necessary; poor women get them less often.
10
This is anecdotal of course because I do not have access to the data. But the whole layer of costs (who actually has to pick up the tab for this procedure, deductibles, network vs. non-network, etc.) which does not exist in a single payer system jacks up the $$$. I once asked my pharmacist how much time he spends being a pharmacist (drug interactions, don't eat grapefruit with that) and how much time he spends fighting with someone in a cubicle at the insurance company - he said 50:50. I believe it.
32
Just like the article reported the study said.
Somehow none of these studies about higher prices ask the logical next question, which is where those prices go. The answer is that the lions share accrues to doctors salaries, which even adjusted for the costs of insurance and education are off the charts compared to every other occupation in the economy. Next time you shop for a mortgage, ask your broker out of curiosity what kind of rates are available to doctors; they're in a different underwriting category! Just one sign of many that something is deeply wrong.
7
I really do not begrudge any of the money doctors earn. I would have been dead at age 28 if it weren't for my surgeon.
2
Why this article suggests there is anything new or surprising in this study is not clear. Expert analysis and data have demonstrated for years that much higher prices for almost everything and high administrative costs are responsible for our indefensibly expensive health care system. The real tragedy is that Americans pay so much for a system that also excludes tens of millions from basic coverage and falls short of other wealthy nations in most measures of quality and safety.
83
A good example of the difference is colonoscopies. American docs extensively use colonoscopies as the primary diagnostic tool for colon cancer. A colonoscopy costs $1500 on average; a clinic can scope 20 patients a day which is a lot of money.
Compare that to France, which uses fecal blood testing as the primary colon cancer screen. If blood is found, a colonoscopy is done, but that is a low percentage. The blood screen costs $20. It is not a big money maker for French doctors.
Here is the kicker - France comes out better in its ability to screen for colon cancer, and it does it cheaper. So why does the US favor colonoscopies? Because medicine in the US is now big business and colonoscopies are a big money earner. That in a nut shell is what is wrong in the US - medicine is now big business.
134
The fecal occult blood test is in every PCP office that I’ve been to (4 and counting this year). It’s a great test, but not appropriate for all patients. A major drawback is that it’s done yearly versus every ten years. High risk patients may be better off with the colonoscopy as well.
All the PCPs I’ve seen offer both FOBT and colonoscopies to their patients. For whatever reason, maybe 30-40% choose the colonoscopy. Sometimes they want it over with or they don’t trust the new test. I expect more and more people to choose the FOBT over time, though. There’s another one coming out soon that’s just a blood test, which is even easier.
7
The anesthesiologist was not happy when I had my colonoscopy sans anesthetic.. There was discomfort/even pain initially but after that I held my tum and closed my eyes and almost went to sleep a couple of times. The MD was initially nervous but she survived and I walked out without having to bother someone to pick me up. PS you don't feel a thing when they snip the polyps.. No nerves in the colon walls. It's muscle stuff.. and you do get to watch on HD TV in living color... sort of fun.
?How much did my choice save the system?? Why not encourage this? Maybe just give a relaxing pill??
4
Healthcare in the US is not subject to market forces. Services, drugs and products are not priced competitively. Insurance companies and Medicare pay low fixed rates on behalf of patients who, without insurance, would pay crushingly high rates for the same services. Pricing is intentionally opaque. The medical system isn't based on capitalism, but a weirdly structured monopolistic model that defies analysis or understanding.
A bicycle accident in Greece resulted in an emergency hip replacement at a small provincial hospital for a family member of mine, a woman in her 70's. This operation would have cost $30,000-$40,000 in the US. Conditions in Greece in 2015, at the bottom of the Economic Crisis, made the hospital stay less than comfortable, but the surgeon, trained in hip replacement at New York's Hospital for Special Surgery, was superb. The bill, walking out the door, was $1600.
43
Actually with Medicare one pays out of pocket about 1K for knee replacement.
1
It's immensely hard to tease out all the vectors of international comparison, given different age distributions, eating habits, guns, social expectations of care, liability cultures, etc., but it's always useful to try.
It would behoove this country if our political class were more capable of talking about cost-benefit trade-offs and how to prevent catastrophic costs from bankrupting any single family or individual rather than constantly overpromising a panacea for every healthcare wish, cradle to grave.
There is a constant infantilization of the public that refuses to acknowledge the obvious truth that healthcare is a potentially infinite spectrum against which we all have more lifetime needs/demands than realistic expectations of total treatment.
Just look at the last six months of care.
Until the cost per unit of care, bureaucracy, and the number of doctors we graduate (and NPs we license) become more central to the conversation we will never make our system more optimal.
Promise everyone the moon and pretend like the government can be your Partner in Life, (i.e. the Left's way), walking with you every step of the way for every minor copay, and you both balloon our debt and create a populace of adult-children.
At some point the fairy tales must stop and adult politicians need to talk about the real world, in which nobody on earth gets free Mayo-level healthcare for every little thing.
1
You just want the market is your friend and will be for life. Market statism is not the answer.
1
When over 50% of all healthcare spending comes from the government (local, state, and federal), inflation is inevitable. Why should anyone receiving government subsidies care about costs? Patients just want their service and providers just want their money. Neither cares about cost, because it doesn’t affect them. Gut all this spending and suddenly, providers will be forced to minimize costs and patients will search for the best deal. Medicare runs out of money in less than 15 years and by that time, entitlement spending, along with interest payments, will represent over 100% of current government spending. I guess as long as all the current providers make their millions, it will all be OK.
2
You're conflating spending with efficiency/value per $. Medicare is provably more efficient than other available private insurance in delivering similar health solution and outcomes. Most of our elderly and poor use government programs – how should that otherwise be administered? Private insurance has been attempting to do what you're advocating for multiple decades without success.
If we as a society want to spend less, getting everyone on Medicare would accomplish that. The idea of a "health marketplace" is a canard that conservatives have been selling for some time. Yes, as a patient, I do want my service and I also face a staggering amount of information asymmetry. We can't expect sick patients to comparison shop or try to amalgamate some notion of value based on a complex treatment plan a doctor has chosen. Patients simply don't have the information to do this (outside of some small number of commoditizable services, like MRIs, and in those cases, have the provider recommend the lowest cost option as long as quality of care has been established and verified).
On Medicare running out of funding, there a number of different policy options to head that off including improved efficiency (part of ACA), moderate increases in Medicare contributions and/or increases in premiums (or constraints in benefits, which is less likely).
9
The insurance companies hire an army of paper pushers who's primary job is to find ways to not pay for care. On the other side each doctor needs to hire staff to fight with each insurance company. And each company has different requirements. That is rumored to be 40% of medical cost, right off of the top.
161
What many people abroad wonder about is how the system that produces so many lawsuits is a major contributing factor to the high cost. Sky-high insurance costs along with the many extra tests and procedures to cover the derrières of all involved must surely be taken into account to determine what solutions can be found.
7
In comparing doctor's incomes, more data should be taken into account. Cost of education in US versus the other countries. Is medical education paid by the state vs the individual? Where does the US rank in productivity, how many patients do US medical providers see, per capita, vs the other countries .
Another point to be made is that the entire world benefits from the high US drug and device prices and the incentive it creates to develop new therapies. Any data on that?
7
Red herrings.
Doctors' incomes do not adjust downward once they have finished paying their educational loans.
On your second point, several questions: what are the cost/benefit data for the people who actually do the paying? And how is it that new therapies are developed in countries that do not allow their peoples to pony up to the exorbitant extent that the US does?
9
Why should they adjust downward? Do lawyers salaries adjust after they are finished paying off their loans? Do public employee pensions adjust downward so as not to bankrupt entire cities and states?
1
I am baffled how nobody mentions - or if they do they immediately gloss over it - about the cost of THINGS used in a healthcare. The things. Not the salaries or the American lifestyle or anything, but the things themselves. Why is a piece of gauze that costs 0.01 cents to produce & marketed for public consumption at 1 cent is sold to a hospital for 10 dollars?? I worked in research and used the same, identical brand, quality, type, sterility, surgery-rated gauze and still we purchased it at 1 cent a piece. Why do hospitals get them for 10 dollars?! This anecdote serves only to illustrate that the overwhelming majority of things sold to health care facilities in USA are so overpriced that 'ridiculous' is not an enough descriptive word. Anybody who had received a detailed health care bill must have seen exorbitant prices (the internet is abundant with examples, try a Google search for hospital bills, see glass of water). A (one) sleeping pill can cost $500-800 when the manufacturing cost is again in the cents realm. So, obviously, we are coming back to GREED. If all companies are selling gauze starting at 10 bucks a piece and up, of course the hospitals purchase it, they have NO CHOICE (hint hint). And then they pass the cost to the patient either directly or via the insurer. Conclusion: Instead of asking 'Why is the US health care so expensive?" maybe we should ask 'How can we stop companies from being so greedy?" And the controversial word of 'regulations' springs to mind...
112
In the hospital you don't just get "things" and that's no different from going to a steak restaurant you don't just get a hunk of meat. There is "service" involved and service provided in a hospital is no doubt much more complicated than that in a restaurant. I do not know what counts as a fair price but the problems is that it is difficult to apply market competition principles to healthcare delivery.
As far as "greed" is concerned, greed is the driving force and the, perhaps only, common denominator among Americans. While many are complaining about healthcare costs, are there any complaining about cellphones that cost $500 and up or $5 or higher for a cup of souped-up coffee?
And concerning the pricing and cost issue, for high end and exclusive "things" they are not priced according to the cost of their production. They are priced according to the benefit their customers are going to gain from those product. The manufacturers are not selling materials, they are selling possible experience in customers' life.
4
Cellphones are a choice. Coffee is a choice. I chose the former and rarely buy the latter. Health care often is not a choice. If one wants to live, s/he's gotta get treated, which costs $. Market principles cannot be applied to health care, that's the fact of the matter.
1
It's not GREED per say.
it's a CAPTIVE MARKET where the price is as high as the buyer can tolerate.
Healthcare is not a competitive market and hence must be regulated like any natural monopoly.
13
What about the dollars spent in the last year of life? What percentage of total health care dollars are we spending on that and how does it compare to other countries and systems?
20
I wonder if this study's authors (or some other diligent researcher failing that) would score each country for the number of times they appear in a low-cost "sweet spot" for each of the 98 indicators they chose to follow. Similarly, how often they ranked in the most expensive position. This might help illuminate whether the issue is really one of the US having too few instances of cost-saving or efficiency built into their system.
3
Profits, shareholders, and drug prices. All unnecessary evils that we've "voluntarily" injected into our health systems. It's so simple and obvious that removing those from the equation would radically change our cost outcomes.
33
Let's connect more dots. How much of the $3T in healthcare spend per year is related to guns?
See related article https://www.nytimes.com/2018/03/12/health/gun-violence-research-cdc.html
According to an NIH study, it's $154,000 per gunshot survivor on average, or $40 billion a year. Seems like we don't include those costs in our equation.
Many more dots to address if we want to get serious about unraveling the spiraling costs.
51
How much more is related to cars? First of directly from accidents, secondly from pollution. there's no special amendment giving the right to have a car. Maybe you could start there for maximum benefit.
1
once again health care reform has been derailed by a failure of both parties to understand the true nature of the health care market. both parties have conducted their debate based on the premise that the markets for health care are characterized by free market capitalist principles. this is absolutely not the case. instead the markets are based on 4 interlocking govt sanctioned monopolies. Doctors enjoy a govt protected monopoly to practice medicine, and a govt protected monopoly to decide who can obtain a medical license.Doctors also enjoy a govt protected monopoly on access to prescription medicine, and pharmacists a govt protected monopoly to dispense it. Insurance companies enjoy a government protected monopoly to sell insurance. US Pharmaceutical companies enjoy a govt protected monopoly to sell drugs in the US. to say that these govt granted monopolies exist is not advocating that they be removed. however it is essential to recognize them for what they are if the two main purposes of health care reform, cost containment and guaranteed access, are to be achieved. usually when govt provides an industry a protected monopoly as in the case of utilities it creates a commission to control prices and ensure quality of service.going to a single payer system would not solve these problems. doctor salaries, medical school fees, pharmaceutical costs, shared pharmaceutical development costs, supplemental insurance costs will all have to be taken into consideration.
6
Lovely how quickly the researchers glossed the greed factor. Doctors want to make enough money to be rich. Pharmaceutical and medical device execs want to get rich. We've all seen the vanity plate Porches in the lot, the salary and bonus data. Insurance company executives? They can afford a high standard of living--big houses, big cars and trucks, big vacations, all of which the planet can ill afford.
Meanwhile, ah, the patients. Raised to adore such aspirations and standards, they are poor but try to live rich and get unhealthy and indebted. They are ill and can ill afford their expensive health care. Cannot afford it.
Silly aside--I wonder if Elon Musk thinks this will change on Mars colonies, once we've used this place up? They'll need lots of good drugs up there.
18
I saw outside one of the local doctor's offices here a NEW BMW M4 GTS. This car costs $134,200.
Let's see some hands: how many people reading this post even makes that much BEFORE taxes?
2
So, we're pretty much the same but we "pay substantially higher prices." And not the slightest mention in this article about why that is! If you want a story, that's were to start...
244
In contrast to other nations, profiteering, high administrative costs and excessive prices under the current U.S. system are caused by increased commercialization and dominance of self-serving private firms in health care delivery, Big Insurance, BigPharma.
Solutions to exorbitant U.S.health and insurance expense:
1). Cut administrative costs and mandate reasonable pricing (which would result in very large one-time savings and allow an affordable transition to comprehensive coverage of the un- and under-insured).
2). Over the longer term, the keys to savings lie in improved health planning implemented by control of capital spending and limits on market incentives and on huge for-profit involvement in health care delivery.
3). Health planning is needed to assure that investments in expensive new technology meet needs, but do not exceed them.
4). Limits on for-profit ownership and on the excessive compensation of health care executives are needed to stop the immense incentives for institutional gain at the expense of system-wide performance.
24
Thank you for such clarity in arguments used to support a single-payer approach, such as the NY Health Act (see NYHCampaign.org). Add just 2 more points: negotiating bulk-pricing of drugs and cut another 6% of our entire HC costs — to the 17% reduction that comes from eliminating admin costs that don't benefit health. Savings of 23% right there. AND all Americans could then enjoy comprehensive, affordable, cost-effective care.
2
There are a multitude of reasons, of course.... but from a physician's perspective a few stick out.
1. Lawyers. Malpractice insurance in some states, like NY, is astronomical with respect to reimbursement for individual services. Other states are far cheaper. Are we worse doctors here? Doubt it... we just have a legislature controlled by plaintiff lawyers and a climate in which people view litigation as a lottery.
2. We DO give too much care.... to people who do not need it. 90+ year olds with dementia getting life extending and fruitless treatments. I do not believe doctors push this. Patients and their families push it. "Do everything" we hear from people who have no skin in the game.
3. In NY, anyone from another country, here legally or illegally, gets expensive care for free. Fly from anywhere with a chronic problem or acute problem (like a new cancer diagnosis) and show up at an ER at a major hospital and you get admitted and get 'everything' because people in the hospital are either too liberal or too scared of the legal ramifications of saying 'no.' But the hospital is not the place to solve this entirely.... the government must stop entrance into the country without demonstrable means to pay for services that may be needed.
21
There isn't much evidence that litigation is a big part of the problem. From the limited research out there, it is a problem on the order of maybe 4% of total costs in the sector. So yes, it is a problem, but not a very big one compared to, for example, how much you and your peers earn vs. doctors in other countries (PCP's aside).
35
Tom- I do not know of any study that has looked state by state and I imagine it does make a huge difference here in NY. 130k premium vs 40k premium elsewhere. I cannot be insignificant. And 4% of a huge number is huge.
Regarding salaries- we are different than other countries. When my neighbor with half the education makes millions on wall street, and manufacturers get huge tax breaks, am I not entitled to be one of the higher earners? But I'm actually not, compared to the incomes of my finance colleagues.
Universal healthcare reduces malpractice premiums by as much as 90%. Why? Because most suits go forward because plaintiffs need to pay really expensive medical costs for the rest of their lives. Universal healthcare means that if you harm me, my medical needs won't bankrupt me. No one sues for fun. Few sue for revenge. Most sue because medical costs can be as catastrophic to the family as the injury to the patient.
62
Well if the organ of the AMA says it...
Who are these "analysts" that got it so wrong?...
12
Indeed, Ben C. I agree. Perhaps Ms. Sanger-Katz buried the issue of AMA credibility: "Some experts who reviewed the results wondered about the accuracy of all the paper’s data points, which were numerous and drawn from an array of international sources. Dr. Jha acknowledged that the numbers may not be perfect ..."
1
People whose salary depends on them getting it wrong
1
The American medical establishment, as represented by the AMA, would be the last place to expect any fruitful information on what's wrong with our broken system, but even they couldn't deny the sad state of US health care. Here's the opening sentence of the study that Sanger-Katz highlights in her report:
"In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes".
Basically, Sanger-Katz has no answers to the question posed in the headline, and most of the report is the usual anti-single payer propaganda that we've all come to expect from the corporate-media.
Polls continue to show majority support for Medicare for all, so the question remains, how long will our politicians continue to favor the profits of the private insurers over the needs of the American people?
Despite all the ranting about Russian meddling in our elections, clearly, the biggest usurper of US democracy is corporate America
264
"There were two areas where the United States really was quite different: We pay substantially higher prices for medical services, including hospitalization, doctors’ visits and prescription drugs. And our complex payment system causes us to spend far more on administrative costs."
Good point ... now if the AMA would support required reduction of the costs of medical services (unlikely as its constituency is the very doctors who benefit from those higher fees; reducing physician income is unlikely to play well with AMA members) and support re-engineering of the administrative side of medical practice. It seems to me that the study needs replication by researchers unaffiliated with the AMA.
35
Who shows up at the top of this list when sorted by average annual wage?
https://www.bls.gov/oes/current/oes_nat.htm#29-0000
6
A true non article here. What is the point? To normalize the ridiculous costs of US health care by claiming that, Yes, we are pricey, but not an outlier if we consider how many people actually go for care? Duh! People avoid going for care because it is so costly for even the most basic services. THAT makes us an outlier too--not a member of the pack.
191
I took the point of the article to be that it's not patients' fault. If overutilization was the problem, trying to push us into using less care by pushing high deductibles and co-pays would make sense. If the problem is that the prices are too high, then the problem is on the providers' side.
5
So doctors, hospitals , pharmaceuticals, and administrative costs are all far too high ? And here I thought it was medical malpractice that was causing the spike, or so they told us. Its funny how the blame hot potato got passed around the last 25 years.
Its obvious that a national health plan where prices and fees are negotiated and set in stone is the way to go, but that would mean no more 6 figure salaries, and no more 40 million dollar wings at hospitals who claim they are broke, but have no problem with 3 story atriums with cascading waterfalls, or media marketing budgets that would make you vomit.
I guess it will again come down to whose pockets are deepest to keep the con job alive ?
136
Re paragraph 2: Don't forget no more doctors, who begin their careers in their 30s, with mountains of debt.
3
CEO salaries, "cover your rear end" strategies to keep the trial lawyers at bay, end of life "no holds barred" expenses to pay for us in our last weeks of life - these are huge cost drivers in the US.
15
All things equal but cost? Could it be profit motive?
64
"Profit?" Like a "people's president" who charges $400,000/speech? Lot of "profit" there, right?
Leaders need to lead. That hasn't happened in the USA for decades.
3