Which sucks, from about 2008-2014 it was rising by modest amounts of 2-4% a year.
How in gods name is this sustainable, especially when you factor in stagnating wage growth and the lack of jobs?
I don’t see this country doing anything intelligent to fix this problem anytime soon either. Despite this costing the government endless trillions since they pay for about half of medical bills, and despite about 70%+ of the country being driven to poverty or locked out of health care, too many powerful industries like our system overpriced and the public are scared of change. We aren’t the nation we were in the 1960s when we could solve big problems. We are an empire in decline, and in many ways the rise of China is better for the world because at least they seem competent rather than mired in plutocracy and ideology like we are.
Meanwhile nations like Israel have managed to keep health care at a steady 8% of GDP for decades, dropping to 7.3% in 2012. By comparison the US spent 9% in 1980 and about 17% in 2012. Israel kept their spending steady, most other wealthy nations only saw health care grow by 2-3% of GDP, while the US grew by 9% and is going to grow by another 2% in the next decade. Israel also has a life expectancy 3 years longer than the US, 81 vs 78.
I worry about what the kids my generation are having are going to do. They will have public health, generic pharmaceuticals and some medical procedures, but they are pretty much SOL beyond that. Medicare will become too unaffordable. I don’t know what all the kids the people I went to high school with are supposed to do when they grow up.
I’m honestly shocked medical tourism hasn’t EXPLODED already, I mean get a mini vacation and your surgery done in a modern professional hospital at a tenth of the cost as in the USA?
English language nation should jump on this and make it a money maker.
I don’t get it either. I’m assuming it is part of our oligarchical economic system, many wealthy interests like a captive market.
Technically it is illegal to buy Rx medications from a foreign country, but luckily the government doesn’t prosecute. So maybe (as a guess) something similar is going on, the government works to protect the economic interests of domestic health providers despite it costing trillions more by working to prevent consumers from engaging in international competition. That is just speculation though.
But yeah, I don’t get it either. You can get a great vacation in Europe, Asia, Latin America, etc. and get a surgery for less than the surgery itself in the US.
It isn’t. And we should all be afraid when the Baby Boomers all retire and go on Medicare, because that’s a hell of a lot of new people, and the generations that came after are smaller.
Sigh. That doesn’t mean that attempts aren’t being made. I work for a company that produces software to help identify higher-value, lower-cost care, easy ways to reduce costs, and identify gaps in care that will cost money if not handled by the physician.
As in any industry, more goes on than you see on the TV news. Dr. Atul Gawande is a thought leader in changing the US from fee-for-service to a value-based healthcare economy. Google him and read up on the Texas town that spent the most, and then turned around and became the most medically efficient. They were *shamed *into reducing costs by getting rid of unnecessary and expensive procedures.
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Medicare is actually one of the learner-run programs in the US.
Honestly, the country needs to stop believing that by accepting universal coverage, we’ve all signed up to work on a dacha in Siberia every weekend. Most places you’d want to live have “socialized” medicine and spend considerably less than the US.
The country also needs to stop thinking that we have to DO SOMETHING just because we can. Several tests touted by wellness companies and even doctors are not really very useful or beneficial, and they lead to overdiagnosis and overtreatment because OMG DO SOMETHING!
In another example, a study has found that knee arthroscopy for general arthritic changes doesn’t do more than sham arthroscopy to reduce pain. So should we be doing that procedure at all?
A LOT is going on behind the scenes, but data analysis is not sexy so it never makes the news.
I"ve read several of Atul Gawande’s articles, but that doesn’t change the fact that I don’t see any major implementations of his ideas for streamlining medical care. One city in Texas spends 2x as much as another, mostly on over-utilization. But I don’t see any national efforts at streamlining, comparative effectiveness, public regulations, stronger private market forces, etc to drive down costs. The ACA had to get rid of most cost control measures because industry didn’t like them.
Israel will probably spend 8% of GDP on health care in 2024 while the US will be approaching 20%.
Can change occur w/o political will? Can it all come from consumers, insurance companies, etc?
I’ve read the medicare tax rate may need to be hiked to 6-10% to keep the program sustainable.
And new drugs are more than just “expensive,” and getting wildly more so.
There would be one way to get a handle on medical costs that I think would work quite effectively. Completely ban MRIs, joint replacements, heart surgery, brain surgery, new drugs – any and all medicines, equipment, and procedures developed in the past 50 years.
I don’t understand – Who do you think will do this? Do you think that we’ll have a Health Insurance Czar who will come out and force companies to change in a public way?
What’s actually going to happen is quiet, behind-the-scenes work, that will help bring costs down and work toward accountable care.
I’ll let someone else rain on Flyer’s “but, but, but…we make lots of new drugs! and use lots of MRIs!” parade.
Don’t worry. Obamacare is going to fix all this. Under Obamacare we will all save $2400 a year on medical expenses. Obama said so and as a politician he would never lie.
I work as a post acute care hospitalist. And I see the patients described in the article every day. I think the answer is an increased utilization of hospice and palliative care. I don’t see my fellow physicians as an obstacle to this. If anything, it was all the talk about “death panels” that has hindered a national conversation on the topic of palliative care. It’s just a fact of life that we all have to die, and I personally see little value in using heroic measures to extend the life of a terminally ill person. I still do so when directed by the patient or their designated representative, but in all these situations that I’ve been involved in, I’ve never seen the outcome change or the patient having any outcome that I would consider a better outcome. It makes no sense. I think an increased utilization of palliative care is a big part of the answer.
Obamacare was the greatest boon to the Insurance Industry in history. Why? Because nobody blames them for anything anymore. Costs go up, Obamacare. Coverage denied, Obamacare. Lose your doctor, Obamacare.
On the plus side, if you ‘fix’ Obamacare, you might fix a few of these problems.
On the minus side, we have plenty of fools who think these problems, which existed for decades pre-Obamacare, will magically vanish if you get rid of Obamacare.
Are they needed, though? My thankfully-limited experience with the American system was that there was a lot of overtesting and overprocedures (this refers both to firsthand and to coworkers and friends). Normal pregnancy treated as high risk, the doctor insisting in scheduling a cesarean the mother did not want; a visit for a lipoma getting a referral to a surgeon (?) who wanted to schedule a biopsy for cysts that had been in place as long as the rest of the breasts; vaccinations that WHO actually did not recommend for the location I was going to visit; a broken leg that got cast and recast because they took multiple Xrays.
And how many MRI machines are needed? How are they distributed? Are there locations where the nearest one is 3 or 4 hours away (and I don’t mean through rush hour in a metro area), whereas in others you have several machines in different hospitals of the same medical complex?
Some of the problem with overtesting has to do with fear of lawsuits if you miss something. Another part of the problem is patients demanding unnecessary testing. Does the patient with a headache have classic stress induced or tension headaches,or maybe migraines or cluster headaches? Most likely they do. But some people want to “make sure it’s not something serious.” If you tell them they don’t need an MRI, they just go looking for another doctor until they find one who will order it.
First off, being concerned about endless trillions in liabilities, people not being able to afford health care, endless unnecessary suffering and how kids today are going to afford health care when they grow up is not ‘whining’ unless you don’t have a fairly firm grasp of priorities. This is a serious issue. In 1980 the US spent about 9% of GDP on health (compared to 6-8% for other wealthy nations). now the US has grown by 9% and spends 18%, but other wealthy nations have seen theirs grow by 0-3%. We are doing something seriously wrong in this nation and we aren’t fixing it.
As far as having more MRIs, there are two factors that are important.
How necessary are those MRIs? The US also performs more surgeries, but I don’t believe our outcomes are necessarily better. Because we have a fee for service system there is an incentive to push for as many diagnostics and treatments as possible. In the US, doctors are more likely to push for surgery because that is how they make money, but that doesn’t mean outcomes are better.
MRIs are $99 in Japan vs $1000+ here (if done in a hospital, outpatient prices are lower). In Japan you can get 10 MRIs for the price of one in the US. Because of how poorly run our system is the same level of care can cost several times more here.
Medical R&D in the US is something like $130 billion a year. Of that, maybe 40%+ is public funded, leaving about $70 billion a year in private R&D. Our health system, if it were as cheap as Israel, would cost about 1.6 trillion a year less. IN what world is spending an extra 1.6 trillion to get a few billion in private R&D a good deal? We would still have private R&D with lower cost health care. Maybe a bit lower, but with the endless trillions we’d save on health spending we could easily offer grants and loans to medical companies to engage in R&D. And only a fraction of that $130 billion is pharma R&D.
That is like saying it is a good investment to spend a million dollars on a house because you get a few thousand a year in tax credits. It is actually a better idea to not do that, and instead just give yourself a few thousand in tax credits directly. We could easily recoup whatever loss in private R&D out of savings from having a more efficient health system via incentives and tax credits.
Also every other wealthy nation has functioning health care. Their life expediencies tend to be longer than ours. It isn’t like people are falling apart in the UK, Germany, New Zealand, Canada, etc. from shit health care. If anything that is what happens here since people can’t afford care.
I wish apologists had better arguments, your were shit.
Yeah but pallative care is mostly a medicare issue (and medicaid I assume since that covers a lot of long term care for the elderly). I think about 85% of deaths occur in people age 65+, so most are on one or both of those programs.
But those programs only make up about 1/3ish of our health spending. And end of life care is a fraction of that 1/3.
This article is from 2001, I’m not sure if it is out of date.
It says that the medicare outlays for the last year of life are about 1/4 of total outlays per patient. Fine and good, but medicare is also only a fraction of the health system and 1/4 of medicare is probably about $150 billion a year, less than 5% of total health spending per year.
So I agree what you are saying is part of the problem, but I think the US health system has dozens of small problems and they all add up, and that end of life care is just one.
Have you read the most recent one, the one GrumpyBunny referenced? (It gave me more hope than any article in years.) The 2X more expensive hospital cut their costs, not by fiat from some government czar, but out of shame. You think that the board of an expensive hospital is not going to put pressure on the administration to cut costs when they become visible? The insurance companies will stop sending people there, and the hospital will get screwed.
The medical industry is like we were in pre-web days, when shopping around was time consuming and if you didn’t luck out and find a product that was cheap, you wound up paying too much because you didn’t want to drive to yet another store.
Transparency is going to cut costs, that and the resulting competition.
I haven’t read it yet, I didn’t know he wrote that one until this thread. I read a few of his in the past but I thought GrunpyBunny was talking about this articles.
I do hope something changes, because our system is not sustainable.
The one you mentioned was the first famous one. And he says that in his experience he never stayed up fretting about giving a patient too many tests, but did fret about missing something because of not enough testing. So fear of lawsuits is not the major cause of over-testing, according to him.
Look at the breast exam controversy. It is obviously easy for people to see the harm in missing something, but not the harm in false alarms and spending too much on ineffective testing.
I can’t think of anyone I know that would be able to afford such a “vacation” in cash (or on their credit card). Or be away from home long enough to travel, heal, and travel back.
Even if it’s half the price, people who don’t have the $20,000 for a procedure probably don’t have the $10,000 either. Easier to stay home and have it done, get in and out of there with doctors you know and trust (presumably your PCP is involved somehow), and deal with the “devil you know” health insurance and hospital industry in the US when they start calling.
