# Why is healthcare in the USA such a clusterfuck? **URL:** \ **Category:** Great Debates\ **Created:** [June 6, 2015, 6:20pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805 "2015-06-06T18:20:43Z")\ **Posts on this page:** 20\ **Page:** 6
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [June 10, 2015, 8:27pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/101 "2015-06-10T20:27:22Z")
Just a quick point, when these graphs and charts talk about ‘administration’, is that mostly code for treatment and/or physician fees, and not some low paid lady filing triplicate forms? ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [June 10, 2015, 8:38pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/102 "2015-06-10T20:38:28Z")
> [@up\_the\_junction](#): > > Just a quick point, when these graphs and charts talk about ‘administration’, is that mostly code for treatment and/or physician fees, and not some low paid lady filing triplicate forms? Why would you think that? There’s a hell of a lot of administration besides filing. Payroll, staffing, contracting with suppliers, collections, etc. You think a Hospital Administrator is a glorified low paid filing clerk? ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 10, 2015, 8:41pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/103 "2015-06-10T20:41:29Z")
> [@filmstar-en](#): > > The affects of the WW1 and WW2 were very relevant to the development of a Universal Heath Care in the UK. In WW1 the country had a population of 45million, mobilised 5 million men and it lost about a million men and several million suffered war injuries. > > In WW2 about half a million men were lost and a million or more injured. There were also many thousands of civilian casualties from nightly bombing raids. > > I think it was fairly obvious to everyone that in the face of such national emergency it takes the concerted effort of a centralised government to organise healthcare on that scale. > > \ > > The political conditions in the US seem to have been completely different after these world wars. Certainly after WW2, the US was on the crest of an economic wave. > > How did the insurance business in the US get such a hold on healthcare? I am also guessing that Big Pharma had something to do with it. > > I would have thought that employers would have been pleased pass on the responsibility for financing healthcare to the state, it must be a significant overhead. Actually, the current US system is also a hangover from WWII, but in reverse. Prior to 1940, there was essentially no medical insurance plan. Nearly everything was done on a fee-for-service basis, just like buying any other consumer good or service. Beginning in the 1930s, hospitals began offering a limited form of insurance: prepaid care. You paid $10 or whatever and your hospital care would be provided free by participating regional hospitals. That system later developed into the first health insurance plans. During WWII, the government imposed price and wage controls to stabilize the war economy. That stifled wage competition, so employers looked for other ways to attract employees (it goes without saying that it was an excellent market for job-seekers other than the price controls, since a million men had been removed from the labor pool.) Thanks to a quirk of the tax code, it turned out that employer-sponsored health insurance plans were among the simplest and cheapest ways to compete on a non-wage basis. So by 1950 the dominant model was employer-sponsored health insurance. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [June 10, 2015, 8:47pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/104 "2015-06-10T20:47:42Z")
> [@CarnalK](#): > > Why would you think that? There’s a hell of a lot of administration besides filing. Payroll, staffing, contracting with suppliers, collections, etc. You think a Hospital Administrator is a glorified low paid filing clerk? Not literally. I should have used some smiley thing. Sorry. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [June 10, 2015, 8:51pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/105 "2015-06-10T20:51:35Z")
Well regardless, I’m sure "administration " means administration on those charts. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [June 11, 2015, 1:34am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/106 "2015-06-11T01:34:57Z")
My 2¢ When you go to the doctor, what is their cost of the healthcare they provide? Let’s say it is the checking of your vitals, 30 min with the doctor, a shot of an antibiotic and writing a prescription? Or you need an MRI. What is the cost for using the MRI (e.g. the MRI has a life span of 5 years, cost $100,000 and needs approx $30,000 in repair/maintainence over the life span) per use? How much is the technician paid to run the machine and the radiologist paid for their 30 minutes to interpret the results? Yes I pulled these number out of my ass but the point is who knows the costs because hospitals are on record saying they don’t know. ---
**Author:** ![JackieLikesVariety](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackielikesvariety/32/296_2.png) [@JackieLikesVariety](https://boards.straightdope.com/u/JackieLikesVariety)\ **Post date:** [June 11, 2015, 1:37am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/107 "2015-06-11T01:37:24Z")
whatever else is happening, people should be able to get preventative care (because it is less cost in the long run, DUH!) and nobody should have to go into bankruptcy because of medical bills. NOBODY!!! ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [June 11, 2015, 1:48am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/108 "2015-06-11T01:48:14Z")
> [@up\_the\_junction](#): > > Maybe it’s the cost of ‘going private’ in the UK. It has to relatively cheap or people will just go on the NHS. Cost is not the same as price. The cost within a prepaid system can be calculated, but it doesn’t get passed on to the individual user. ---
**Author:** ![Shagnasty](https://avatars.discourse-cdn.com/v4/letter/s/9dc877/32.png) [@Shagnasty](https://boards.straightdope.com/u/Shagnasty)\ **Post date:** [June 11, 2015, 2:12am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/109 "2015-06-11T02:12:25Z")
> [@Saint\_Cad](#): > > My 2¢ > When you go to the doctor, what is their cost of the healthcare they provide? Let’s say it is the checking of your vitals, 30 min with the doctor, a shot of an antibiotic and writing a prescription? Or you need an MRI. What is the cost for using the MRI (e.g. the MRI has a life span of 5 years, cost $100,000 and needs approx $30,000 in repair/maintainence over the life span) per use? How much is the technician paid to run the machine and the radiologist paid for their 30 minutes to interpret the results? > > Yes I pulled these number out of my ass but the point is who knows the costs because hospitals are on record saying they don’t know. Just to nitpick, it is extremely rare for doctors to spend 30 minutes straight with anyone unless it is a surgery or a true emergency. The average now for new doctors is 8 minutes per patient. They aren’t slacking off the rest of the time. Most of the rest of the time is spent on paperwork which is one of the biggest problems in an extremely bureaucratic healthcare system like the U.S. I consider my own primary care doctor very good and personable in his role in a very small practice but I have never seen him (or any other general care doctor) for more than 15 minutes straight even when I was very much life-threateningly ill. To be fair, doctors don’t need to be there every second of your appointment or while you are in the hospital. The nurses do most of the hands on work and a non-surgeon doctor’s main job is to do a brief cross-check and then come up with a treatment plan behind the scenes. You are also way off on your cost estimate of MRI machines. New ones generally cost $1 - 3 million dollars and service contracts on a single machine are typically $100,000+ a year. That is for one single piece of equipment only. It does not include the trained technician(s), the testing facility infrastructure as whole or the doctor’s fees. The only reason that I point that out isn’t to criticize you. I work in the medical devices industry and most people are completely oblivious to how much every single piece of equipment costs. I admit that our billing system is completely screwed up but there is a reasonable explanation for much of it even if end consumers can’t see it. The hospitals charge $20 for Tylenol and Band-Aids because they also have to support their infrastructure as whole and all of the extremely expensive equipment within it. Whenever they can’t itemize bills well enough to support equipment that they are virtually required to have, they mark up whatever other common services they can to get the money back. It also puts pressure on the system to use very high cost equipment even when it is of dubious benefit. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 11, 2015, 2:14am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/110 "2015-06-11T02:14:31Z")
> [@Chief\_Pedant](#): > > Is it your sense that Canadians prefer their system? Yes. I would support that comment in two ways. First, the _Canada Health Act_ was passed by Parliament in 1984. That was the last major legislative development in our Medicare system, 31 years ago. Ever since then the federal government has alternated between Liberals and Conservatives, with all sorts of major policy disagreements. There have also been several different Opposition parties. And yet, as far as I can remember, no party has suggested that the Act be repealed, even at the height of financial retrenchments in the mid-90s. Cut-backs in funding, yes, but those have been made up as the financial positions of governments have improved. Lots of suggestions for reforms to make the system work better, yes, but always on the assumption that single-payer would continue. So if in 31 years no political party, even the most conservative ones, have thought it worth their while to suggest abolition, that suggests that their polling shows general support for the status quo. My second reason is that in every province where Ive followed the politics, when the opposition raises health care as an issue to beat the government with, it’s never coupled with calls to abolish, but to improve our single-payer system. Left-wing opposition parties, right-wing opposition parties are similar: they point to inefficiencies in the system as deep moral and managerial failings by the party in power, and suggest that if they get elected, they will run the system more efficiently, so people get better health care, less waste, etc. Again, I conclude from that approach, regardless of ideology, that the parties have concluded it would be political suicide to challenge Medicare. > [@](#): > > I have nothing but anecdotal experience, but it’s common in my practice for Canadians to find various ways to consume US Healthcare instead–for example, to purchase vacation health insurance and then get something taken care of here in the US such as an MRI. But you’ve got a skewed sample of Canadians: you’re getting the ones who are selected for dissatisfaction with the Canadian system, and the money to travel south for medical care. That’s not an accurate sample of Canadian attitudes as a whole. Also, I’m puzzled by the idea of Canadians getting health-care like an MRI on their travel insurance. Any travel insurance I’ve bought when I go to the States always excludes treatment for pre-existing conditions, unless a chronic situation suddenly flares up to acute. I don’t think any travel insurance I’ve bought would pay for an MRI for a pre-existing condition. ---
**Author:** ![filmstar-en](https://avatars.discourse-cdn.com/v4/letter/f/50afbb/32.png) [@filmstar-en](https://boards.straightdope.com/u/filmstar-en)\ **Post date:** [June 11, 2015, 11:25am UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/111 "2015-06-11T11:25:54Z")
> [@JackieLikesVariety](#): > > whatever else is happening, people should be able to get preventative care (because it is less cost in the long run, DUH!) and nobody should have to go into bankruptcy because of medical bills. > > NOBODY!!! I just did a search and discovered that medical bills in the US are the major cause of personal bankruptcy. Maybe bankruptcy is regarded is a less serious condition in the US. In the UK, it is very serious, you really have to screw up. You end up a distrusted, financial pariah. It is astonishing that, through no fault of your own, an accident or sickness can render you and your family destitute. It must make people quite anxious about losing their jobs and worry that their insurance cover has gaps that they cannot afford to fill. How much do you end up paying for medical insurance each month? How good are these employer provided policies? It must give employers huge leverage over employees. A huge carrot and big stick. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [June 11, 2015, 12:26pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/112 "2015-06-11T12:26:24Z")
> [@up\_the\_junction](#): > > Maybe it’s the cost of ‘going private’ in the UK. It has to relatively cheap or people will just go on the NHS. If that is the case then the article is muddled at best and worthless at worst. It talks elsewhere of healthcare spending in total and breaks it down as private and public and as a percentage of GDP. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 11, 2015, 1:40pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/113 "2015-06-11T13:40:24Z")
> [@Northern\_Piper](#): > > …I’m puzzled by the idea of Canadians getting health-care like an MRI on their travel insurance. Any travel insurance I’ve bought when I go to the States always excludes treatment for pre-existing conditions, unless a chronic situation suddenly flares up to acute. I don’t think any travel insurance I’ve bought would pay for an MRI for a pre-existing condition. I don’t think it would be particularly difficult to assert that your knee pain just started yesterday and to ask the doctor to write an MRI script. I doubt that’s a common practice, though. > [@filmstar-en](#): > > Maybe bankruptcy is regarded is a less serious condition in the US. In the UK, it is very serious, you really have to screw up. You end up a distrusted, financial pariah. > > \ > > How much do you end up paying for medical insurance each month? How good are these employer provided policies? It must give employers huge leverage over employees. A huge carrot and big stick. Bankruptcy isn’t that big a deal in the US. I imagine it’s because of our entrepreneurial spirit and what not - you can’t make an omelette without breaking a few eggs, etc. It does make it hard to get credit, and it can affect your job prospects, but we have about a million new bankruptcy filings per year for a population of 300 million. That number is a bit inflated given the current economic climate, though. [The average American pays $4800 per year for employee-benefit health insurance. Employers kick in an average of $12,000 on top](http://kff.org/report-section/ehbs-2014-summary-of-findings/). Employer health plans are the vast majority of the ones that exist, because they get favorable tax treatment over individual market plans. They’re no different quality-wise, generally. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 11, 2015, 2:04pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/114 "2015-06-11T14:04:13Z")
> [@Really\_Not\_All\_That\_Bright](#): > > I don’t think it would be particularly difficult to assert that your knee pain just started yesterday and to ask the doctor to write an MRI script. I doubt that’s a common practice, though. It may be easy to get it done in the US, but that doesn’t mean your travel insurance company will pay out without question. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 11, 2015, 2:08pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/115 "2015-06-11T14:08:17Z")
No, but I doubt they are going to spend $1000 to investigate your prior medical history over a claim for a $400 MRI. Now, if you end up having surgery… ---
**Author:** ![emacknight](https://avatars.discourse-cdn.com/v4/letter/e/3ec8ea/32.png) [@emacknight](https://boards.straightdope.com/u/emacknight)\ **Post date:** [June 11, 2015, 4:49pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/116 "2015-06-11T16:49:36Z")
Sorry guys, but you can’t use Canadian style health care, it requires getting a government issued photo id. ---
**Author:** ![Cyros](https://avatars.discourse-cdn.com/v4/letter/c/a698b9/32.png) [@Cyros](https://boards.straightdope.com/u/Cyros)\ **Post date:** [June 11, 2015, 5:19pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/117 "2015-06-11T17:19:08Z")
> [@emacknight](#): > > Sorry guys, but you can’t use Canadian style health care, it requires getting a government issued photo id. You can still come to New Brunswick and not need a photo ID for medicare. Of course, then you have to live in New Brunswick. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [June 11, 2015, 5:20pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/118 "2015-06-11T17:20:07Z")
Not in my province. Health card doesn’t have a photo. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [June 11, 2015, 5:28pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/119 "2015-06-11T17:28:31Z")
And I am violently guarding my old OHIP card that has no photo or renewal requirement. They warned they’d take them all away but gave up. My dad still has his too. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [June 12, 2015, 6:33pm UTC](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805/120 "2015-06-12T18:33:29Z")
> [@Chief\_Pedant](#): > > Is it your sense that Canadians prefer their system? The health insurance system in Canada is the single most popularly supported thing the government has ever done. Support for it is hard core political correctness in its truest form; any politician suggesting its elimination would be voted out of office at the soonest opportunity, and just suggesting changes is risky. > [@](#): > > There are some obviously unfair comparisons as well. If a drug developed in the US has its development costs recouped here, and then is cheaper in Canada b/c the incremental cost of making the next dose is trivial, that’s not a fair comparison unless you figure out who is developing the majority of drugs. Prescription drugs aren’t part of the Canadian health insurance system. [Previous page](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805.md?page=5) [Next page](https://boards.straightdope.com/t/why-is-healthcare-in-the-usa-such-a-clusterfuck/721805.md?page=7)