Why does the U.S. spend so much on health care?

[jasg]

According to this article, paying physicians less would not make much of a dent in health care costs.

[groman]

@code_grey

if a visit to the doctor or dentist in their private office where there are no “tests” of any kind done costs $100 or $200, is that because the of for-profit hospitals? Or because of accounting? The only thing that is apparently being spent is the time of the doctor/dentist or nurse. So if they charge that much, where does the money go?

I wouldn’t say that $100 is a lot for a doctors visit either. That’s probably along the lines of what a lawyer, a psychologist, a veterinarian or any other professional would charge for the same amount of time.

Now, on the other hand, an overnight stay at the hospital can run you several thousand dollars even if you never actually get checked on by a doctor.

[Apex_Rogers]

@code_grey

if a visit to the doctor or dentist in their private office where there are no “tests” of any kind done costs $100 or $200, is that because the of for-profit hospitals? Or because of accounting? The only thing that is apparently being spent is the time of the doctor/dentist or nurse. So if they charge that much, where does the money go?

I can think of any number of other costs the doctor might have as a course of business:

1. Normal operational costs: building rental, janitorial services, electricity/water/trash, etc.
2. Specialized non-medical staff: These are the receptionists and other folks involved in dealing with the insurance companies. With the US system being as complex as it is with little to no standardization amongst plans, the submittal/approval/reimbursement process is often unique to that plan or company. Learning to do these for the hundreds or thousands of plans out there requires a little more than just entry-level grunt workers.
3. Malpractice Insurance: Doctors need to carry this to protect themselves in case of a malpractice suit. The plans are often expensive and are an additional overhead for the doctor to carry.
4. Cost of specialized medical equipment. This can be a sunk cost but it does get passed to the consumer in some fashion.

I’m sure I’m missing some other areas, but that is a start. You seem to be under the impression that doctors and nurses go home to their pool of extra fees and swim around like Scrooge McDuck laughing at the [strike]suckers[/strike] patients they’ve swindled. Such a doctor would be swiftly undercut by someone who charges reasonable prices. The more likely option is that running a doctor’s office is pretty expensive.

[Markxxx]

Wow I’m lucky I only pay $50.00 for my doctor visit and I’m uninsured, so I guess I’m lucky

[Snnipe_70E]

@Rigamarole

Because American doctors like to drive Porsches, and Porsches ain’t cheap.

and it does not matter if they are a good Dr. or ha ve lost alot of malpratice cases.

[wolfman]

Malpractice insurance, and legal costs adds an overhead as well.

[Tom_Tildrum]

@elfkin477

And to add to that request: how about statistics that show how much US doctors and nurses are paid in comparison to countries with lower health care costs?

Here are some quick sources showing that American physicians make sharply more than those in other developed countries. It looks like maybe 1/3 to 1/2 again as much as in the UK and maybe twice as much as in France.

[The_Great_Philosopher]

@wolfman

Malpractice insurance, and legal costs adds an overhead as well.

Medical malpractice insurance is not the primary reason. It’s probably not even one of the major reasons. In 2005 the CBO estimated that tort liabilities probably account for a lot less than 0.5% of medical spending. Last year the CBO predicted that tort reform would save an average of $5.4 billion a year over the next 10 years, which is a pretty insignificant figure in a country which spends $2.4 trillion a year on health care and which has more than a $1.3 trillion a year budget deficit. I don’t think we’d even notice the difference.

Nor does it seem tort reform would make much difference to premium levels: in this state, this state and this state studies showed that tort liabilities had no correlation with premium levels. McArdle in Texas has become infamous for its high levels of medical spending, despite the fact it has implemented some of the toughest tort reform in the country.

[Really_Not_All_That_Bright]

@Colibri

This is GQ. Let’s keep the responses to this thread factual. I also note that professional jabs are against forum rules. If you are going to allege that US health costs are purely due to the high pay of medical personnel, be prepared to back it up with facts.

Part of the reason physicians make so much money in the US is that we don’t have enough. The American Medical Association has been deliberately depressing the number of US MD graduates for some time (by limiting the number of medical schools it accredits).

The AMA defended this policy by contending that the US would face a surplus of physicians, which would drive many practices out of business and essentially make a mess of the US health system. In the last decade it has reversed course and admitted to (or predicted) physician shortages.

Now, the upside to this policy has been that the standard of US-trained physicians is if not the best in the world than certainly among them. The downside has been that the number of US-trained physicians is not enough to provide adequate care for the number of US patients. As a result, one quarter of the practicing physicians in the US (200,000 out of 800,000 last time I checked) are foreign born, and 91% of those graduated from foreign medical schools. 150,000 of those 200,000 are from the Indian subcontinent, though often they’re graduates of medical schools elsewhere (especially the UK).

An interesting trend is the growth of female physicians as a percentage of the US workforce - they now make up just under half of medical school graduates. This is a problem in that female physicians work fewer hours than their male counterparts , reducing the number of physician-hours available.

[Airman_Doors_USAF]

I would say that a big part of the cost is that younger, healthy people opt out because they think they’ll never get hurt.

Of course, that means that there are fewer people in the pool, which causes premiums to go up, which forces people out, which causes premiums to go up… I think you get the picture. And since cost limitations require a big pool that is only diminishing due to cost of entry, they continue to escalate.

[Balthisar]

@Airman_Doors_USAF

I would say that a big part of the cost is that younger, healthy people opt out because they think they’ll never get hurt.

Of course, that means that there are fewer people in the pool, which causes premiums to go up, which forces people out, which causes premiums to go up… I think you get the picture. And since cost limitations require a big pool that is only diminishing due to cost of entry, they continue to escalate.

You’re not describing the cost of medical care, but the cost of insurance (as correct as you are).

[Airman_Doors_USAF]

To the average person the cost of insurance IS the cost of medical care, which is why I though it was noteworthy.

[Indistinguishable]

@Really_Not_All_That_Bright

This is a problem in that female physicians work fewer hours than their male counterparts , reducing the number of physician-hours available.

Why is this? Apart from, I suppose, very occasional maternity leave, I can’t fathom.

[Rigamarole]

@Thudlow_Boink

If you’re seriously suggesting (in a GQ thread) that high salaries for doctors, due to their expensive tastes, is a significant reason for the high U.S. health care costs, I’d like to see a cite or two to back the assertion up.

@Colibri

[Moderating]

This is GQ. Let’s keep the responses to this thread factual. I also note that professional jabs are against forum rules. If you are going to allege that US health costs are purely due to the high pay of medical personnel, be prepared to back it up with facts.

Colibri
General Questions Moderator

There’s no question that doctors in the U.S. make a lot more than in other countries. Here’s a comparison chart.

[AboutAsWeirdAsYouCanGet]

but it wouldnt take a very high percentage of “try to save em / fix em at any cost, regardless of the likelyhood of success” to increase the overall cost dramatically.

nods Or people who feel like they HAVE to have the latest cutting edge technology.
I have a lot of exposure to the severe/profoundly disabled population. And a lot of the parents are …just really in denial about the quality of their kid’s life. Yes, you love them dearly, and losing a child hurts like HELL, but your child doesn’t have much of a life. And of course the old grandparent types who have lived a pretty long life and may even have very significent Alizheimers.
Don’t kill them, but at the same time just give them pallatative care. Don’t go all agressive.
That might lower health care costs quite a bit (especially since the profound and severe kids tend to have tons and tons of disabilties.

think there are a lot of reasons.

Yes, there’s no real ONE reason as to why health care costs are so high.
I think too it’s agressive marketing. For example, there is a device called the coahlear implant. It has been very agressively marketed. It is covered by health insurances. However, hearing aids (a much cheaper alternative) are not covered. Yes, there are some people who get little to no benifit from HA and so right off the bat qualify. But there’s been a lot of waffling and playing around with numbers so that people who get benifit from HA, can get implanted.
It’s also the advertising for Presciption Fukital…and the fact that a lot of people feel entitled to Teh latest cutting edge technology/medicene.

[Magiver]

Americans spend more because they want the same health care that Canadian Prime Ministers get. The difference is measured in secondary level (not directly life threatening) care where something like a hip replacement, kidney stones, or heart by-pass surgery is done on-demand.

[DanBlather]

@Magiver

Americans spend more because they want the same health care that Canadian Prime Ministers get. The difference is measured in secondary level (not directly life threatening) care where something like a hip replacement, kidney stones, or heart by-pass surgery is done on-demand.

And yet we are less healthy than other industrialized countries.

[casdave]

One effect of relatively high practitioner incomes is that he US medical system is effectively subsidised by those of other nations, some of which have pleny of their own problems.

The 200k practitioners that are mentioned by Really not all that bright cost a huge amount of money to train, and to gain the right experience.

As a result, one quarter of the practicing physicians in the US (200,000 out of 800,000 last time I checked) are foreign born, and 91% of those graduated from foreign medical schools. 150,000 of those 200,000 are from the Indian subcontinent, though often they’re graduates of medical schools elsewhere (especially the UK).

Add to this the other staff, radiologists, nurses etc that are foreign trained, and that many come from places such as India, Phillipines etc and you start to see how the US healthcare system actually costs everyone else.

I suppose it keeps our own medical schools full up, and it does enable a lot of research, since interns often carry out the more mundane tasks that are necessary for it, such as testing, sampling, collating.

All I am saying is that the US does not actually pay the full cost of its very expensive medical system, instead it burdens other nations who could better use the resources

[Indistinguishable]

Burdens them? What, is someone forcing foreign doctors to emigrate here? That’s up to them.

[cplif]

For some reason, at least here in France, the social security system is endlessly trying to pinpoint what is costing so much, the deficit is constant. No probing result ever seems to surface, although I’ve been following it for the last 30 years or so. Every so long somebody comes up with an austerity plan aiming at

• doctors
• drug prices
• hospital practice
• elderly care
• demographics
• etc
  but no clear path has ever been stated, medical costs just seem to be an inevital burden whether state or private. Bits and pennies are certainly saved by better management/control, but the overall cost seems to rise whatever the “plan”