# Why isn't anyone actually looking to cut healthcare costs? **URL:** \ **Category:** Great Debates\ **Created:** [February 10, 2016, 2:44pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711 "2016-02-10T14:44:17Z")\ **Posts on this page:** 16\ **Page:** 5
**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:** [February 13, 2016, 7:29am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/81 "2016-02-13T07:29:42Z")
> [@even\_sven](#): > > It took me about five hours of my time to sort out what happened between the insurance, the provider, and the provider’s billing company. I bill about $30 an hour, and the people on the phone get paid as well. Eventually, I sorted out the story (no easy feat when the insurance company refuses to actually tell me what is and is not covered), wrote an appeal letter, and was promptly awarded the appeal. This took hours of my time, and hours of their time. To what end? _Pour décourager les autres._ 😛 ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [February 13, 2016, 8:11am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/82 "2016-02-13T08:11:28Z")
> [@Broomstick](#): > > Want to cut costs? > > _Eliminate the insurance companies._ For the win! Not only would you eliminate all the bureaucrats in the insurance companies – whose main duty is _denying_ care – and funding diverted to insurance company profits, but doctors’ offices (and patients’ time) would be far more productive: today’s doctors spend very much effort interacting with payers. But it can’t happen in America. In other more charitable countries, unfortunate people are provided with health care for the same cost as the U.S. spends denying them care. But in the U.S. these pople _need_ to be denied care, so that we don’t reward laziness, poverty, or disease. Trying to “Love thy neighbor as thyself” just won’t work here – some of these so-called “neighbors” even have different skin color than we do! ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [February 13, 2016, 8:28am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/83 "2016-02-13T08:28:39Z")
One reason the U.S. has less contentment than some other countries despite its higher GDP, is that some GDP is spent “breaking windows.” In another recent thread a Doper wrote “Yadda yadda, you Dopers don’t understand economics. How can we afford free schools?” But it’s easy to understand that spending on education comes back in the form of higher productivity by the schooled. A better question would be “How can we afford useless military boondoggles … or breaking windows?” But even if we agree that health insurance companies are as useless as broken windows, it might seem unfair to their stockholders and employees to eliminate them in one fell swoop. But very few propose that. We wanted a public option, which would have competed with private insurance. It might impose a long-term down-trend on the health insurance industry, but some industries (tobacco, asbestos, etc.) deserve a down-trend. Go to Google Finance and look at the stock prices of America’s health insurance companies. Obamacare was the best thing that ever happened for them. ---
**Author:** ![T.M](https://avatars.discourse-cdn.com/v4/letter/t/ad7895/32.png) [@T.M](https://boards.straightdope.com/u/T.M)\ **Post date:** [February 13, 2016, 1:50pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/84 "2016-02-13T13:50:47Z")
I do not know about your American health care but my question is how much does the cost of litigation ramp up the cost of health insurance it has to be a deciding factor. In the U.K. we have a National Health Service ( N.H.S ) that we pay into through our wage packet, the rate of contribution is calculated according to salary and is provided free at the point of service. The only use for private health insurance in the U.K. is that it gives the flexibility of having treatment when it is convenient. One of the major costs to the N.H.S is health tourism where staff refuse to ask none residents how they intend to pay which is a perfectly reasonable question and could be covered by travel insurance or ask for their card details, while the N.H.S would never refuse emergency treatment why should we provide free treatment for people who travel to the U.K. with established illnesses so that they can receive free treatment. ---
**Author:** ![Pearl\_Clutching\_Provocateur](https://avatars.discourse-cdn.com/v4/letter/p/c68b51/32.png) [@Pearl\_Clutching\_Provocateur](https://boards.straightdope.com/u/Pearl_Clutching_Provocateur)\ **Post date:** [February 13, 2016, 2:34pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/85 "2016-02-13T14:34:33Z")
> [@septimus](#): > > For the win! Not only would you eliminate all the bureaucrats in the insurance companies – whose main duty is _denying_ care – and funding diverted to insurance company profits I disagree. If health insurance companies are so profitable, then why aren’t there more of them? Why don’t big companies self insure? Why don’t people simply pool their money together in a big jar and when someone needs a doctor, an abortion, or sex change, they take that jar to the hospital and pay cash for the procedure? Health insurance companies are also consumer advocates. They act as representatives for consumers. Most of us don’t know what reasonable costs are or what would be a reasonable course of medical action would be. Think about your automobile repairs. A lot of us never know if we’re getting ripped off or not. With medical care, the stakes are far higher. Without a middle man, even relatively wealthy people could end up broke with needless procedures and treatments without someone knowledgable on their side. There’s a difference between “denying care” and the prudent use of resources. I’m not saying there aren’t cases where the insurance company is being unreasonable or cheap. Being too generous with one patient may mean another in equal or even more dire need may go without. ---
**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:** [February 13, 2016, 3:56pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/86 "2016-02-13T15:56:20Z")
[quote=“Pearl\_Clutching\_Provocateur, post:85, topic:745711”] > [@](#): > > Without a middle man, even relatively wealthy people could end up broke… Which is already happening in the US: “Medical Bills Are the Biggest Cause of US Bankruptcies: Study” > **[Medical Bills Are the Biggest Cause of US Bankruptcies: Study](https://www.cnbc.com/2013/06/25/medical-bills-are-the-biggest-cause-of-us-bankruptcies-study.html)** > > Rising medical bills are likely to force many people to file for bankruptcy—making it the single biggest cause of such filings, according to new data from NerdWallet. Even those with health insurance are buckling under mounting bills. > [@](#): > > …with needless procedures and treatments without someone knowledgable on their side. “On their side”. \ ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [February 13, 2016, 4:19pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/87 "2016-02-13T16:19:18Z")
> [@septimus](#): > > For the win! Not only would you eliminate all the bureaucrats in the insurance companies – whose main duty is _denying_ care – and funding diverted to insurance company profits, but doctors’ offices (and patients’ time) would be far more productive: today’s doctors spend very much effort interacting with payers. > > But it can’t happen in America. In other more charitable countries, unfortunate people are provided with health care for the same cost as the U.S. spends denying them care. But in the U.S. these pople _need_ to be denied care, so that we don’t reward laziness, poverty, or disease. Trying to “Love thy neighbor as thyself” just won’t work here – some of these so-called “neighbors” even have different skin color than we do! If we had medicare for all I think we’d spend about 16% of GDP on health care (instead of the 18% we spend now). Nations with private insurance companies like the netherlands or Israel spend 8-11% of GDP on health care. ---
**Author:** ![HoneyBadgerDC](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/honeybadgerdc/32/1033_2.png) [@HoneyBadgerDC](https://boards.straightdope.com/u/HoneyBadgerDC)\ **Post date:** [February 13, 2016, 6:01pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/88 "2016-02-13T18:01:32Z")
I think the op is correct in saying we need to lower health cares basic costs. How we do it may be complicated. My personnal feelings are that it is approaching or has already surpassed the point where healthcare is no longer available to everyone. As mentioned above years of work and hundreds of thousands of dollars go into getting an education. What if this aspect were slighty changed where qualified students could actually be reimbursed as they attended college so no real sacrifice was made. Maybe the payoffs would not need to be as great to attract doctors. Maybe we could make the medical field a more attractive field for those who don’t want to work 16 hours a day and would like some opportunity to pursue research. ``` Maybe all aspects of health care need to be reevaluated to decide what level of skill is needed to perform the various tasks. We could possible not loose any staffing but get more bang for our bucks. Changes have to be made, it is allready an emergency for many people. ``` ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [February 14, 2016, 12:18am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/89 "2016-02-14T00:18:42Z")
> [@Pearl\_Clutching\_Provocateur](#): > > \Why don’t big companies self insure? Many do. Almost a third of those covered on employer plans according to this [site](http://www.siia.org/i4a/pages/Index.cfm?pageID=4546). I spent twenty years at such a firm. Everything was administered by the local BCBS but the company paid the BCBS negotiated prices directly and paid no premiums, just an administrative fee. ---
**Author:** ![boffking](https://avatars.discourse-cdn.com/v4/letter/b/858c86/32.png) [@boffking](https://boards.straightdope.com/u/boffking)\ **Post date:** [February 19, 2016, 5:24pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/90 "2016-02-19T17:24:43Z")
I would like to mention that I just found out about this [group](http://highvaluehealthcare.org/). They are a partnership between Dartmouth College and many hospital systems across the county. Their goal is to allow hospitals to coordinate efforts on healthcare to provide better care while cutting costs. One of their larger goals is reducing sepsis and hospital-acquired infections. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [February 20, 2016, 10:32am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/91 "2016-02-20T10:32:35Z")
> [@GrumpyBunny](#): > > Why do you think that anyone isn’t trying to cut health care costs? Because we have literally dozens of examples of how to provide health care at a fraction of what we currently spend, and nobody is trying to replicate those examples. All the efforts are trying to save money while maintaining the current system, when the system IS the problem. ---
**Author:** ![Ramira](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ramira/32/344_2.png) [@Ramira](https://boards.straightdope.com/u/Ramira)\ **Post date:** [February 20, 2016, 12:11pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/92 "2016-02-20T12:11:07Z")
> [@Northern\_Piper](#): > > France, coverage is provided by insurance companies, but under strict government regulation. > > Those countries don’t have a government system of single-payer, unlike Canada and the UK. (I’m open to correction on this, but that’s my understanding from previous threads on this issue.) Yes in the France there are the Mutual insurance companies. This is a [good description on wikipedia](https://en.wikipedia.org/wiki/Health_care_in_France#Health_insurance) and I found in the links this comparison for the american systems For the large companies with international needs we do buy some extra insurance, but this is not usual. It is unfortunate that there is so much ideological blindness in the American discussions of the health care. For the economic efficiency it would clearly be helpful and an improvement for the competitiveness of companies to have a system less balkanized and more efficient, and the model of the France, the Netherlands etc. shows a rational path that remains private. > [@T.M](#): > > …One of the major costs to the N.H.S is health tourism where staff refuse to ask none residents how they intend to pay which is a perfectly reasonable question… I like it how TM can turn any subject into the complaint about the foreigners stealing from the little English island with the pub anecdotes. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [February 20, 2016, 3:41pm UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/93 "2016-02-20T15:41:36Z")
> [@jasg](#): > > 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! Some corrections wrt France : -Healthcare in France doesn’t depend on insurance companies. It depends primarily on the single payer system. Insurances kick in for medical expenses it covers poorly or not at all (for instance : dental expenses, extra payment for a single room at the hospital, seeing a specific doctor/surgeon who charges more than the standard rates…) -Insurance companies aren’t all non-profit, even though a large number of them are (they generally appeared before there was an UHC system to cover members belonging to a specific group, created by the mining industry or a teachers’ union, or the association of Paris shop owners, etc…later on, they became simply a complement to the UHC system and typically began to offer coverage to everybody). Note that this is also true for other insurances : car insurers, homeowner insurers, etc…are also often non-profit. These “mutual insurances” are administered by elected representatives of the insured people. -There are indeed standardized fees. However, physicians aren’t obligated to adhere to them (even though they have some incentives to do so). IME the majority of generalists follow them, the wide majority of specialists overcharge, sometimes heavily. The UHC system only reimburse the standard rates, that’s when a complementary insurance proves useful. Major hospitals are almost always public (private hospitals tend to be small and to either be very specialized in some procedures or at the contrary to simply offer better amenities/more pampering for usual procedures), and they charge by the day, regardless of whether you’re treated for an ingrown nail or on life support. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [February 21, 2016, 3:15am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/94 "2016-02-21T03:15:02Z")
> [@clairobscur](#): > > Some corrections wrt France : > > -Healthcare in France doesn’t depend on insurance companies. It depends primarily on the single payer system. Insurances kick in for medical expenses it covers poorly or not at all (for instance : dental expenses, extra payment for a single room at the hospital, seeing a specific doctor/surgeon who charges more than the standard rates…) > > -Insurance companies aren’t all non-profit, even though a large number of them are (they generally appeared before there was an UHC system to cover members belonging to a specific group, created by the mining industry or a teachers’ union, or the association of Paris shop owners, etc…later on, they became simply a complement to the UHC system and typically began to offer coverage to everybody). Note that this is also true for other insurances : car insurers, homeowner insurers, etc…are also often non-profit. These “mutual insurances” are administered by elected representatives of the insured people. > > -There are indeed standardized fees. However, physicians aren’t obligated to adhere to them (even though they have some incentives to do so). IME the majority of generalists follow them, the wide majority of specialists overcharge, sometimes heavily. The UHC system only reimburse the standard rates, that’s when a complementary insurance proves useful. Major hospitals are almost always public (private hospitals tend to be small and to either be very specialized in some procedures or at the contrary to simply offer better amenities/more pampering for usual procedures), and they charge by the day, regardless of whether you’re treated for an ingrown nail or on life support. Thanks for the update. However I am still confused. Is this Wiki [entry](https://en.m.wikipedia.org/wiki/Health_care_in_France#Health_insurance) in need of revision? It states : > [@](#): > > The entire population must pay compulsory health insurance. The insurers are non-profit agencies that annually participate in negotiations with the state regarding the overall funding of health care in France. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [February 21, 2016, 8:20am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/95 "2016-02-21T08:20:09Z")
> [@jasg](#): > > Thanks for the update. > > However I am still confused. Is this Wiki [entry](https://en.m.wikipedia.org/wiki/Health_care_in_France#Health_insurance) in need of revision? It states : I had read that article and was myself a bit confused by it. I think it would probably need revision, not because it’s technically inaccurate but because the way it’s written and the words used make very likely that it will be misunderstood by people not familiar with the French system. For historical reasons, the UHC system in France isn’t directly handled by the state or a state agency, but by organizations technically independant from the government. These are mentioned elsewhere in the article : [QUOTE=wikipedia] Today, 95% of the population are covered by 3 main schemes. One for commerce and industry workers and their families, another for agricultural workers and lastly the national insurance fund for self-employed non-agricultural workers [/QUOTE] It’s these organizations (an other minor similar ones like for instance the special scheme of railway workers or the special scheme of Paris Opera) the wikipedia article confusingly calls : “insurers” in this sentence : [QUOTE=wikipedia] The insurers are non-profit agencies that annually participate in negotiations with the state regarding the overall funding of health care in France [/QUOTE] They are technically “insurers” indeed. But mostly in the same way the British NHS is the “insurer” in the UK (except more complicated). In practice, they’re the French UHC system provider. Joining them is compulsory, money is taken out of your pay/benefits to fund them, they decide what will be covered and for what amount, etc…and obviously they’re extremely dependant on the state (for instance, they can’t just decide that an extra 1% tax will be levied on your salary, or that public hospitals will have to reduce their expenses by 5%). There are negociations within them (typically between representative employer unions and worker unions) when for instance a reform is deemed necessary, but when all is said and done, the state has the last word because it’s the only one that can decide to enforce anything. But when people (be them Americans unfamiliar with the French system or French people) say or read “insurer”, what they have in mind aren’t the “régime general de la sécurite sociale” or “régime agricole de la sécurité sociale” but independant entities providing healthcare benefits and that you freely join after having compared the cost and the coverage offered. In the case of France, for instance the “mutual insurances” (what I was talking about) offering coverage complementary to the “sécurité sociale” general scheme (what the wikipedia quote you posted was refering to). Hence the confusion. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [February 22, 2016, 4:11am UTC](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711/96 "2016-02-22T04:11:20Z")
Thanks. [Previous page](https://boards.straightdope.com/t/why-isnt-anyone-actually-looking-to-cut-healthcare-costs/745711.md?page=4)