Why isn't anyone actually looking to cut healthcare costs?

Healthcare debates usually revolve around things like insurance and medicare. Nobody seems interested in saving energy, cutting staff, more efficient practices, better inventory management, or anything else that would actually lower the price. We need to find ways to actually lower the price, not just get someone else to pay it.
There is a lot that can be improved on that front. I did an IT project for a company that manages nursing homes. They lost laptops worth $2000 each on a regular basis. I spent more time looking for these missing computers than I did on the project. My father used to work in the sterilization room of a hospital, and was always bringing home piles of perfectly good supplies that were going to be thrown away.
Why should insurance companies and taxpayers be forced to pay for waste?

Lots of work is being done to cut health care costs. What makes you think that there isn’t a significant effort going on?

Insurance companies don’t pay for waste, we do. They are just the middle men, raising our rates to cover that waste and taking a percentage off the top so they have no incentive to cut waste, that would cut into their profits. Likewise the medical institutions don’t care about waste because they are primarily run on a profitless basis and want to increase the amount of insurance payments, donations, and public money they receive.

You could probably eliminate all waste AND run the healthcare industry so that nobody was making a killing and or laughing all the way to the bank and you still wouldn’t fix IMO the fundamental problem.

When people get really sick, and at some point a good fraction of them will, it doesn’t take long at all before you can rack up an enormous bill. The basic math just won’t work. Like that other thread we had recently about “why can’t everybody be rich?”.

IMO you really do need some variation of the dreaded “death panels”.

While I’m on board with the energy thing, and the “more efficient practices” (though you have to let me know how you define “efficient”), what in the hell makes you think cutting staff is going to automatically improve health care? There are staffing shortages in many medical facilities, and even where there aren’t arguably some stuff, such as RN’s, are overburdened.

Likewise, there are issues with inventory management that other industries do not face, such as the need to control access to controlled substances, strict sterility requirements, and so forth.

How were they “perfectly good” yet unacceptable? Was sterility broken? Expiration dates? Outmoded by new models.

I’ll give your dad the benefit of the doubt, but diversion of “perfectly good supplies”, i.e. “theft”, is a significant cost to businesses.

Want to cut costs?

Eliminate the insurance companies.

Go to single-payer universal coverage like every other civilized nation on the planet. There is no real need for the current US private health insurance industry, they’re just middlemen driving costs up and providing no actual medical benefit. LACK of such a crop of parasites is why so many other countries provide universal health care at lower cost and better results than the US.

So what if you have truly socialised medicine? No insurance.

Total cost of healthcare (say, last year’s) is added directly to the nationwide tax for the present year.
That way every tax paying citizen pays their fair share of the nation’s healthcare costs.

One of the easiest ways to spot a bad premise is a single example that is presumed to be representative of an industry as a whole.

It’s like saying Japanese industry is shit because your Mazda had an oil leak one time.

[typical moron voter] How can it be fair? I didn’t get sick this year![/tmv]

A significant portion of the “total cost of healthcare” is administrative costs which exist only because of the woefully inefficient funding scheme we have now. In a single-payer system we could cut back healthcare spending by at least a third without affecting the amounts we paid physicians, hospitals and so forth.

No developed nation has ever been successful at reducing healthcare costs. For a period of time in the '70s and '80s, most other nations did a better job of restraining cost growth than the US did, which accounts for most of the higher cost in our system. As of now, though, we are doing just about as well as anyone in restraining cost growth.

You have two politicians, one promises more spending on medical care and one promises less. Which one gets the most votes? Santa Claus is always going to be more popular than Scrooge.
The current system in the US is set up so that the customer is as insulated from the price as possible. Thus it is hard for insurance companies to compete on price and nobody has an incentive to keep prices low.

When I was young I worked in a hospital. That was 40 years ago, and I can tell you that since that time. . .

Procedures once done by doctors are now done by nurses and physician assistants.

Routine patient care done by nurses now done by nurse assistants.

Administrative tasks done by nurses now done by non-medical staff.

In other words, wherever possible, mundane tasks are being pushed down to lower-paid staff leaving the skilled professionals to concentrate on the stuff they’re trained to do.

And you have a third politician who promises the same healthcare at the same or reduced spending. Now who wins?
Insurance companies do compete on price. Not for the end customer, but for the Benefits departments of big corporations who give them lots of business, and who take bids. That’s why they negotiate with providers.

In the last few years the government has started publishing prices for certain medical procedures at hospitals. They found great differences, even in the same towns. In some cases that led to the cutting of prices at the higher priced facilities. Good old capitalism and good old data can do a lot.

In my clinic, which is based in Silicon Valley, I can ask for refills on line and a doctor approves them on-line. That has got to be cheaper. My test results are on-line - my doctor comments on them in an email message, and I get to look at them at my leisure. And all my records are on-line and easily available to him in the exam room PC. That has to be saving costs.

This is true, of course.

The flip side of this is that all Presidents in the modern era, Obama included, are going to cut “waste, fraud and abuse” from Medicare as well as for the rest of government. It’s a great promise to make, because it looks like free money - no need to raise taxes, no impact on health outcomes (because, by definition, the spending is wasteful) with the added bonus of punishing those who abuse the system. Win!

As ever, the devil is in the details. Is that really wasteful spending? The OP mentions all the supplies hospitals throw away. It’s true. Sometimes they throw it away because of hospital policy or laws about re-using medical supplies. So we change the laws or the policies so that hospitals re-use stuff instead of throwing it away. And maybe we save money. We also get a certain number of patients who get infections when the hospital re-uses something instead of throw it away. Is it worth it?

A few years back there was a controversy because hospitals were discharging new mothers in 24 hours instead of 48 hours after giving birth. The medical consensus was that a healthy mother could go home after 24 hours - statistically the outcomes were not significantly different. But it was wildly unpopular, and there were even laws passed to prevent hospitals from doing this. Of course there were a few doctors who insisted that the extended stay was medically necessary, and their views were publicized. Another reason given was that the 48 hour stay allowed the mother to rest up before going home. Is that wasteful, to keep the mother in the hospital when she could probably recover just as well and much more cheaply either at home, or in the most expensive hotel in town?

Is it wasteful to prescribe statin drugs for otherwise healthy patients who merely have high cholesterol, or are over 70? There is very little evidence that it reduces mortality for those patients.

One of the major problems with health care costs is that cost-benefit questions make people very uncomfortable. Because the basic question is ‘how many people are we willing to let die, in order to save money?’

Health care costs in the US are not rising that much faster than in the EU (cite). Health care costs more in the US because we are starting from a higher level. But the factors driving health care increases are much the same in the US as in Europe.

Yes, we do.


I know someone who worked in the medical industry.

They once told me an “interesting” observation. Their job often involved being part of the ole “lets keep em alive as long as we can but we know they ain’t walking outa here” death watch scenario.

People with GOOD insurance. They stayed a lot longer until they ended up dying or plug got pulled. People with crappy insurance and or the family was getting the bill? Not so much.

Of course this statistically speaking.

Problem is that we as society like to think as the former, but when push comes to shove it’s more like the later.

Please tell us why you think no one is working to reduce medical costs, boffking?

I can tell you why you don’t hear about it in debates and on the news – it is not an exciting and sexy field that gets people riled up. It’s a bunch of nerdy data wonks who are thrilled to find out that by keeping one doctor’s radiology referrals in-network, we can save 3%.

The process is also complex and tedious to explain. Definitely not first-date material; it would bore any listener to tears who wasn’t also a data wonk.

Source: work in an IT company that makes a project that in part helps to identify ways to reduce healthcare costs, both immediately and down the road a few years.

Insurance companies are actually quite common in many civilized nations. For example, health care in Germany, France, the Netherlands and Switzerland all depends on insurance companies.

The difference with the US is that insurance companies and hospitals are non-profit (for basic levels of care if not all). In addition, in some countries there are standardized fee schedules for health care services. If you go to a physician in France, fees for common procedures are posted - and are the same for all providers. If the doctor treats you during a house call rather than in the office, they can charge an extra $13!

This is barely true. Insurance companies are regulated using a minimum medical loss ratio of 80% or 85%. This means that for every dollar they collect. 80 or 85% is required to pay for medial expenses. And of that 15-20 % not all of it goes away if you move to single payer, since the next 10% goes for taxes.

1] My question is does the cost of health care reflect the value of health care? Further, how do we determine the value of health care? Are we even prepared to look at health care in terms of “return on investment”? There’s no real way to economize providing world-class state-of-the-art health care services to every man, woman and child within 30 minutes.

2] We need to be mindful of the other side of the profits equation. More than just One-Percenters are on the take here, pension plans and orphanage trusts invest in the health care sector as well. A fair part of these “evil” profits do good things for us.

3] The single payer here in the USA would be Congress, perhaps this notion should be thought out a little more.

Each one of us will experience a medical emergency in our life for which no amount of money, doctors or procedures will have any effect … as such, each one of us will die. Do you want to live longer; then eat right, live clean and exercise.