Not just anesthesiologists, and sometimes more than 50% of their income. Most OB/Gyn pay huge amounts of malpractice insurance. They can pretty much be sued for anything that goes wrong with a kid even years later. “Tommy is not very smart, he must not have gotten enough oxygen during delivery.” etc. For this reason it was very difficult for years to even find an OB/Gyn practicing in the state of Florida.
I have no answers, but I’ll add my anecdote to the list:
A few months ago, I went to the ER with a friend due to a dog bite. It was a new family pet and it wasn’t that bad – but better safe than sorry, so we went. We first went to the doctor she sees about once a year, since she plays team sports. He didn’t see us. The receptionist said he wouldn’t, and to go to the ER since it was a dog bite.
Off we went. We waited about four hours to get seen by a nurse. It was two small puncture wounds – the nurse said she wouldn’t get stitches. She got a tetanus shot and had an x-ray done. The nurse showed us how to clean the wound, said we shouldn’t close it up, and gave us a tube of anti-bacterial soap goop. I don’t know the technical term for any of this stuff.
Before the nurse ever saw us, and about 3 and a half hours into our wait, a very pleasant lady from bill collection showed up. We were required to pay $100 up front, and then she asked my friend some questions about qualifying for certain programs. Both of us are students, and she works a minimum-wage job part time. No insurance. The lady told her that she could pay the total bill, whatever it is, over a period of 12 months.
After the x-ray, the cleaning, and the tetanus shot, all done by the nurse, the doctor showed up. He spoke with the nurse briefly and signed something, and left. He never actually spoke or looked at my friend.
The final bill: $2500. Half of that is the doctor’s fee. The rest was the x-ray and tetanus shot. The thing he signed was a prescription for antibiotics, which were free courtesy of a local grocery chain.
Why was the ER turning people away? They’re required by law to treat anyone regardless of their insurance status, which is why ERs are referred to as the “safety net of the safety net” (and why they’re generally unprofitable in poor areas).
Life threatening conditions only. They are not obligated to treat people’s cough and colds I believe.
To supplement the good comments here so far, I want to add that another reason health care without health insurance is so expensive is that insurance tends to make the cost of things go thru the roof, by shielding you from the true cost of care. Consumers not bearing the cost of health procedures, doctors, hospitals and drug companies are free to set the market prices. As stated, when you purchase insurance the product you are buying is essentially access to that insurer’s network of doctors, hospitals and pharmacies at negotiated (volume discounted) rates. If you try to buy your way into a doctor office, hospital, or at the pharmacy on your own, you will be paying the going rate for that service from that establishment.
As stated, there are a lot of reasons the cost has risen: better and more complete care, more options, better safety, more complexity, lawsuits, R&D, profit, etc. I, for one, prefer today to the good ol’ days of paying the doctor with chickens, given the better outcomes and longer lifespans we see today. The system is expensive and complex, and can be done a whole lot better (in the US).
We’re accustomed to having the latest and greatest of everything. So we want 21st century medicine at 1960s prices. That can’t be done for all.
Part of the reason is that doctors and hospitals know that most people do not pay their own bills so they can charge higher prices to third-party payers. It’s like if your car is in the shop and your auto insurance company gets you a rental car from Hertz. You don’t care how much Hertz charges your insurance company.
I can’t get health insurance in the USA (pre-existimg) so I try not to use US health services. I am in a situation right now where I need an MRI scan for a US government agency and they will not accept a non-US scan. The “retail” price at the cheapest local place in Nevada is $4600… but they were willing to give me 50% off, bringing it down to $2300. But they also have a “cash price” list which lists it as $425. So the $4600 price is what insurance companies are told it costs, but nobody really pays that.
In my experience, ERs are fairly generous with treating indigent uninsured people. It probably does vary state to state and hospital to hospital. I figure, if for example, you go in with a minor sore throat and it turns out to be strep and you die because they refuse to provide you with antibiotics, your survivors could sue the pants off them.
Not unreasonable, when health insurance premiums are 30% of your monthly income.
Except, of course, in the 45 or so countries where it is. Pretty much all universal coverage countries pay a fraction of US costs per capita for better outcomes.
I was born in 1951, and my parents were in a very early HMO, HIP in New York, which the UN used. We had a nearby family doctor as part of the plan, and everything else was in their center in Jamaica, I think. Never heard my father complain about it. And he complained about a lot.
This is absolutely true.
You need to separate what you pay from what is charged for the event.
For example, in the above case, you may pay $41.50 for the blood test if you are insured and use a facility that is “in the plan”, but you will pay $95 for the same test without insurance. The insurance company pays the difference if you are insured. So you feel that you are being charged 200%+ more if you are not insured–but the truth is that the test is 400%+ more if you are insured, but you do not see that–and probably don’t care.
I have had an MRI/A and had to pay $190 out of pocket while insured and the insurance company paid the remaining $1100. The same test, same facility, same techs, same radiologist reading and reporting results without insurance: $395.
The reason prices (ie, not costs) are so high is that most people have no idea what is being charged, just what they themselves have to pay.
Many OECD nations provide first world healthcare for less than half of what we spend. So yeah, it it totally possible if you have a well run system. But since America is a plutocracy with very strong anti-statist sentiment, I don’t see any of that kind of reform happening here.
Although medical costs have risen in other first world countries with comparable and sometimes superior standards of care to those of the United States, they have not risen by anything like the same amount. This of course, is because these countries organize their health care systems much better, as single payer UHC systems, or reasonably close approximations to that.
Yes part of the rising cost has to do with improved but expensive medical technologies, and rising expectations, but those factors affect other countries too. They are not what make US medical costs so absurd. The fact is that the US private medical insurance system is a hugely overcomplex, financially inefficient nightmare, full of multiple perverse incentives, that bleeds money at every point. Of course, that money bleeds into the pockets of certain people (relatively small amounts for some, very large amounts for others) who thus have a very strong incentive to make sure that the situation remains as financially inefficient as it is, or even gets worse (and have the money to spend to make sure this happens). Many of the reasons that are given for the high costs of US medicine, such as malpractice insurance, are red herrings, minor factors at best, but useful as dust to throw in the face of the public to confuse them about where their money is really going.
According to ex-OMB director Peter Orszag about 1/3 of medical spending ($800 billion) doesn’t do anything to improve our health and is pretty much wasted (sometimes it makes things worse. Unneeded health care has side effects).
But how can you realistically cut that? That $800 billion is income for various powerful lobbying groups and cutting that amount would require government intervention in the market. Like I was saying earlier, we are a plutocracy with anti-statist sentiments. Government intervention to cut the income of powerful lobbying groups isn’t realistic on the national level, and is only realistic on the state level in a handful of states on the west coast or the northeast.
I have no idea what’ll happen in the US. Back when unaffordable health insurance and health care was something that only affected the poor most Americans didn’t really care. Now that people with Masters degrees and good jobs can’t afford to get medical care, maybe something will change. But who knows. Like you said and like I’ve seen, many people seem to be falling back on the ‘mexican immigrants and tort reform’ red herrings for why our system is so screwed up from what I can tell.
Several important points from the above discussion:
-When the person getting the service is not th one paying the bill, when the bill payer (insurance company) doesn’t care much either because they just charge higher premiums, often paid by the employer - then there is no reason for people on either side of th transaction to worry about the price. By rolling individual expensive treatments into one premium spread over months and a large group of insured, there is a big disconnect between price and willingness to pay that much. If the patient had to pay out of pocket, the price would drop bcause nobody would pay that.
-As in the case of the Emergency dog bite - you have no idea what they are doing and what it will cost until sometimes days or weeks later. If it was like a restaurant menu - “Do you want an Xray for $700?”, “Do you wnat me to use a $20 tongue depressor?” - then people would be more willing to say no and challenge some things. (Why the heck is an Xray needed for a dog-bite on soft flesh???) If you knew it would cost $2500, heck, break out the polysporin and don;t see the doctor unless the arm turns green and black. If the sign said “Doctor - $800 for 5 minutes” would you go there? In the real world, we have a good idea of costs. You know it will cost about $100 or less to rotate your tires. An oil change should not exceed $50. New carpet for the bedroom? Probably $200 to $500. Etc. We have no such “Price is right” training for medical procedures. (The only similar profession that comes to mind is lawyers. Quick, how much for a divorce? For a will probate?)
Tests are overdone for a myriad of reasons - many to do with covering all bases in anticipation of malpractice. There’s another issue. Lawsuits are much less common in Canada because (a) lawyers are discouraged from taking contingency fees, and (b) since most medical bills are paid by the government, there’s not a lot of “loss” left over to sue about.
The medical insurance system is incredibly ineffcient. First, they have to figure out your coverage, and whether what they are going to do is insured or not. There may be different approval processes for each procedure, for each insurer. As mentioned above, the hospital will have staff to do nothing but interview patients about how they intend to pay, and verify their insurance. Then the individual items, down to supplies like aspirin, have to be tracked. In a single government UHC like Canadian provinces, much much simpler. One provider, one form to fill out, one set of guidelines as to what’s covered, no finance department to chase down people who pay cash, any admissions nurse can just read your provincial health card and check it against the system…
One cynic once also mentioned to me why health costs soared in Canada when the government moved in. He said, St, Michaels and St. Josephs hospitals used to be run by nuns paid $2 a day and room and board; the government replaced them with civil service administrators making cushy salaries. Then the lowly-paid cleaning staff, for example, became unionized government employees and got $15/hour to mop the floors.
That might be an extreme situation or exagerration, but both north and south of the border, the expectations for salaries has also gone up; especially as modern medicine became more effective. If you can actually make a big difference in saving lives, you job is worth so much more.
The writing is on the wall for health care. It has allready far exceeded a sustainable level of purchaseability. As much as I hate the thought I believe the government will need to set up fully staffed and equipped hosptitals in all metro areas. Possibly including housing for outpatients with long term care such as cancer treatments who live in rural areas. It would have to be cheaper. Set limits on Mal practice and only in cases of gross negligence. I bet we could get healthcare down to about $2,000 per year per person. 10% of family incomes in not unreasonable. I think it could easily be brought into that range. Plenty of Dr’s from other countries would come over here and work for $200,000 a year.
This is a bit of apples and oranges statement because it’s difficult to measure what is payed for and what is received.
I have a wider range of medical services available with little or no waiting time. In my area that is amplified by the ability to shop competing services. There would never be a waiting period for something like an MRI. If my doctor can’t see me when I want to be seen then I would go to what is called an Urgent Care facility which specializes in walk-ins and extended office hours. It is leveraged in Metro areas by the use of public and private air transportation to extend services to surrounding areas rural areas. This comes at a price and it’s not universal but we’ve come to expect this kind of service.
This is not meant to start the usual arguments over universal health care versus private care. I’m only pointing out that the price difference also includes service differences.
I don’t see the government doing anything cheaper by decree. If anything they manage to raise the cost of doing business within industries by way of regulations. They raise the cost of doing things from within by shear bureaucratic weight.
I agree that you could lower the wages of doctors by reducing the insurance costs associated with malpractice law suits. That also has to include medical equipment. There is still the cost of medical degrees and it should not be based on siphoning off those skills from other countries. That presents an immoral redistribution of intellectual wealth.
Obviously, yes. If things can’t keep going on like this - they won’t.
You can’t have flat wage growth and medical costs that climb at 10% a year. Sooner or later something will give.
Xrays don’t cost $700 and tongue depressors or aspirin don’t cost $20 each. There is just such a massive overhead in health care costs, that an arbitrary cost far in excess of real cost is attached to each item to justify the final bill.
Even 15 years ago or more, there was the joke that it was cheaper to check out of the hospital, and into the 5-star hotel across the street, and hire full time nurse care.