I’m not so sure that the curent system is that bad. Yes, it is bad for those without insurance. In most cases, people choose not to get insurance in some way: they refuse to give up something else to pay for it. Ultimately, whether you do it through taxes or other methods, you’re paying. The U.S. system probably does cost too much.
Yet as costly as it is and as bad as service can get, there are serious advantages. Treatments are often faster, more varied, and closer to the cutting-edge of scientific knowledge than in Europe or Canada. And despite the real advantages of the Canadian system, it is also seriously slow in some areas.
As with most things in life, it’s a trade off. I also get a bit irritated with this issue, because I think people tend to see flaws close to home more easily than flaws far away. People want perfect health care with all the trimmings for free for everyone, everywhere. And that’s not going to happen.
(Not sure what you mean by “private” in this context–usually that split is private/public (meaning government owned hospitals.)
While for-profit hospitals may have advantages in access to private capital and more of an entrepeneurial/innovative spirit (and while many hospitals were traditionally owned by doctors), there are tax benefits to being nfp too–tax-exempt bonds, ability to accept tax-deductible donations, property tax exemptions. The hospital world will continue to be heavily nfp for many years to come (remember also that almost all academic medical centers are organized nfp).
Everyone does not get charged the same, I wish people would stop saying that. Here is an article from 2 weeks ago in the Sun about an Illinois, Democrat Attorney General Lisa Madigan has introduced legislation to address the abusive collection policies and hold these hospitals accountable to the non-profit regulations. Injustice to patients without insurance is still happening.
I don’t think you actually read lorinada’s post. At least, not the relevant parts. Or even the relevant parts of the column you cited.
It is not required for the provider to contract with insurers, and if there is no contract, the provider can then bill the patient whatever remaining balance is outstanding after the insurer pays. The whole reason people pay for medical insurance is so they can defray a large percentage of the cost to them.
Allow me to explain what happens when hospitals already losing money are required to cut costs even further. They close. Trauma centers, urgent care centers, birthing centers that take medicaid, doesn’t matter. Other hospitals take the overflow and become even more overcrowded, then start to lose money themselves and start cutting costs by cutting staff… vicious circle.
Refuse it, buy your own. Like damn near every other business most people have zero idea how markup works, usually its a pretty consistent percentage of the price the business pays the vendor.
How much does it cost in materials to make a pepperoni pizza. About $2. How much do you pay the pizza place including delivery $10-$15.
Do we hear screaming about the unfairness of coupons and the horrific prices of pizza…what about coupons…not every one gets charged the same…
Materials cost in most common business usually run somewhere in the 10%-30% range for all consumable products. There are exceptions, but most standard business models depend on that markup to remain solvent.
Nevertheless, why are US hospitals so damned expensive compared to other countries? Just an anecdote but my wife had major thoracic surgery, two weeks in a private room that would have been acceptable as a hotel room, eight weeks of radiation therapy, CT scans, and all the other medical parephanalia.
As far as I could tell from a laymen’s POV, the hospital was fine. Sparkling clean, attentive nursing staff, good docs, shiny new equipment, everything you could want. Hell, they even had a roof garden for the patients to roll around in.
I expected financial ruin but when we got the bill it was US $8K. Total.
As I said, I’m a complete laymen on these matters but if I got sick I’d go back there in a heartbeat.
Our medical system is set up such that those who can afford it the least are the only ones actually expected to pay full retail. Which of course they fail to do in large numbers. It is a perversity but it is a function of the system and not one of any individual player in the system.
Why is full retail and even the insurance discounted rate so expensive in American hospitals, above and beyond hospitals elsewhere in the world for the same service? Because the costs of providing care to the uninsured is buried in those costs. The uninsured do not get preventitive or early care. Instead they show up more severely ill on the hospitals doorsteps and the hospital takes care of them first and worries about payment later (not like they have a choice). When the uninsured cannot pay even a fraction of that full retail price then the hospital gets stiffed and those unrecompensed expenses are part of the costs that they need to recover in other ways to stay afloat. All bills go up.
Perhaps the biggest factor in controlling healthcare costs is solving the problem of the uninsured.
That’s one hospital system in a very populous state, and it’s a problem the Attorney General is trying to solve. It’s true there are bad apples in every industry, and health care is no exception. (See also Max Torque’s recent threads on the fertility clinic he and his wife had to deal with.) However, most providers try to deal with patients as fairly as they can, because without patients, the provider has no practice.
That said, I agree with DSeid. When or if we get the problem of the uninsured solved, we will have solved much that is wrong with health care.
I’ll give you an example. I have no dental insurance. I have to make an appointment to see my dentist because I’ve got a cavity and it needs to be fixed. I could have taken care of this sooner but I didn’t have the money at the time, and now I do when it’s a bigger cavity and more expensive to fix. Had I had dental insurance, it would’ve cost a lot less to get the cavity fixed at first – or to be able to get regular checkups.
It’s hard to know if the uninsured are a symptom of the problem, or the problem itself. I do think it’s the case that you could solve the problem of the uninsured (say by a new government program), but still leave unaddressed many of the inefficiencies of the current system. The fact is that healthcare is way, way behind the curve on using information technology to streamline its processes. It’s a bit of a Catch-22: healthcare is insanely complex because of the multiplicity of payors and plans and interests, but because it’s so complex, it’s generally too expensive to come up with a comprehensive IT solution that would fix the problems.
http://www.hospitalpricegouging.org/update2_030905.html
The states will have to pass new, or enforce existing consumer protection laws. If all of the uninsured pay their hospital bills at the discounted or wholesale price, then it shouldn’t have that big of an impact on the hospital’s operating margin. As the article suggests, only about 10% of the uninsured will do so. Guess who is going to make up the difference?
I hope those who hate the idea of a single payer system don’t mind paying higher premiums to subsidize more charity care.
Along with those costs are often some of the most massive and well equipped medical infrastructure in the world.
Expensive equipment like MRI systems are easily available in just about every decent sized city.
Masters degree and PhD level nurses are not horribly uncommon.
24 hour trauma surgery teams.
Specialized burn units.
Mobile neonatal intensive care teams putting highly trained people into remote hospitals to transport extrememly sick babies to specialized neonatal intensive care units by ground ambulance or helicopters.
Many of these things are taken for granted and or hospitals are seen as second rate for not providing such expensive to operate high level specialties. Nobody questions their value when their 2 hour old baby needs to be flown 400 miles for open heart surgery to survive, but they sure seem to question the bill.
You are not just paying for a specific service, you are paying for what these people know. Anyone can give tylenol sure we all take it now and then, but do you know wat it does to you if your in renal failure…have hepatitis…a low platelet count?
Do you know what your platelet count is right now?
No one could tell me the price when they were handed to me with orders on how to take them. Two of the nurses (wrongly) told me that they were included with the per-day price. One nurse opened the bottles and instructed me to begin self-administering from them while still in the hospital. Only later did they appear on my bill as “take home medications”.
In the end, it was moot, since my insurance didn’t pay for them, and the hospital, per its agreement with the insurance agency, did not therefore charge me personally for them. This is one example of what the OP and I are talking about: had I not had insurance, they would have cost me $76. Because I have insurance, the hospital accepted $0. How is this charging us the same with insurance? Perhaps “charging” is a clumsy word, since it was technically charged. But the fact that is was never attempted to be collected means that, essentaily, I/my insurance company legally paid less than the woman who gave birth in the next room without insurance.
All of those drugs are donated free to the hospital by the manufacturers. Ditto infant formula, Soothers pacifiers and Pampers diapers. The only logical percentage of $0 is $0.
We live ‘better’ than the rest of the world… we trash our bodies and our medical system keeps us around… our life expenancy is comperable to any in the world… and many of those who can afford to come to THIS country for medical treatment…
As has been mentioned above, there are a lot of services that even in other ‘long living’ countries you simply would not have access to…
Medicine is EXPENSIVE (not drugs… the entire system)… someone has to pay for ALL of it… some of it is covered by the government… some by charities and donations… some by insurance companies… and some by individuals…
As far as marking up the ‘donoted’ items… someone must store, order, catergorize, ship, administor… etc… none of which is free… even if the item itself is…
Interesting factoid I heard the other day, namely that government already pays half the healthcare costs in this country. So by my back-of-the-envelope reckoning, your taxes already pay, on a per-person basis, nearly as much as European countries pay to cover everybody. So what are we getting for the other trillion dollars we’re spending, besides non-coverage for about 45 million people?
Besides the fact that we are larger (population wise) than they are… have better/more equipment… and many more locations for healthcare?
For example… Greece has a wonderful healthcare program… as long as you live on one of the larger 10 islands (out of about a 100) and/or near Athens or other large mainland cities… else you get to wait for a ferry and/or helicopter (if weather is ok) to come get you…
I’ve lived in some VERY rural areas… and as never more than 1 1/2 hours for a major hospital… not bad for a country our size
Greece with its bajillion islands is a little bit of an atypical example. But even at that, their life expectancy is higher than ours, so their health system can’t be too shabby.
It is atypical… but i dont know of a country that has our system… (number of hosptials… number of specialists… speed of care… etc)… so an apples to apples wont work
In Greece MOST people (esp in rural areas) don’t go to the hosptial… and their life spans are more about lifestyle than healthcare
We pay more per capita than other countries. And let’s compare some statistics that are easy to find. How about infant mortality, 2005 estimates (the higher the number on the left, the better. The best rate is Singapore, coming in at 226, with 1/3 the infant mortality of the US. The worst is Angola, at 1):
181
Guam 6.94
182
Lithuania 6.89
183
Croatia 6.84
184
United States 6.50
185
Taiwan 6.40
186
Cuba 6.33
187
Korea, South 6.28
188
Faroe Islands 6.24
You know I read somewhere (and I’ll have to look for it, but it was either Wall Street Journal, CNN, or the like) that our infant mortality rate is so ‘high’ because we are able to keep more at risk pregancies from being still born (or miscarried)…