The Real Cost of Healthcare In The US

[koshergrl]

I'm especially interested in verification of the assertion that poor people can't get medical care in this country.

 

[Underhill]

Actually, there's no evidence that it does save money.

http://www.medscape.com/viewarticle/735245

 

[Underhill]

I'm especially interested in verification of the assertion that poor people can't get medical care in this country.

Now you're reverting back to just making stuff up...?

Why bother coming here if your only goal is to muck up the works with bullshit?

He was saying if you make people pay out of pocket poor people won't get care.

 

[Underhill]

Actually, there's no evidence that it does save money.

This is how pseudo facts get out there.

A politician or pundit comes out asking the question, "is their evidence"?

They find some "expert" willing to come out and say he isn't sure, or the evidence isn't conclusive. Usually some phd completely out of his field or past his prime.

Then politicians, industry experts and pundits start spreading it all over the web and certain networks claiming, as though it were fact, "there's no evidence"!

Meanwhile the vast majority of the scientific community, who has very little voice in this country, is left trying to argue with politicians and industry people who spend their lives putting this garbage out there.

It's happened with climate change, alternative energy, healthcare and the finance industry. Complete horseshit is converted to gold right before your eyes.

 

[Flopper]

I'm especially interested in verification of the assertion that poor people can't get medical care in this country.

I'm not saying the poor can not get medical care. I said, "Do you really believe access to these new technologies should be based on the ability of a patient to pay? Those with adequate financial resources live and those without die." It was a hypothetical statement.

 

[Flopper]

Actually, there's no evidence that it does save money.

This is how pseudo facts get out there.

A politician or pundit comes out asking the question, "is their evidence"?

They find some "expert" willing to come out and say he isn't sure, or the evidence isn't conclusive. Usually some phd completely out of his field or past his prime.

Then politicians, industry experts and pundits start spreading it all over the web and certain networks claiming, as though it were fact, "there's no evidence"!

Meanwhile the vast majority of the scientific community, who has very little voice in this country, is left trying to argue with politicians and industry people who spend their lives putting this garbage out there.

It's happened with climate change, alternative energy, healthcare and the finance industry. Complete horseshit is converted to gold right before your eyes.

Good Point, however I do believe some prevent medicine is a waste of money. Routine physicals for people in good health probably increases costs where routine physicals for people in poorer health saves money but that's just my opinion. Some preventive care such as colonoscopies can certainly reduce medical costs and save lives, however like most preventive care and screenings it really depends on the assessment of the doctor.

 

[koshergrl]

You said they died if they didn't have money.

So go ahead and provide your verification.

 

[Flopper]

You said they died if they didn't have money.

So go ahead and provide your verification.

In case you're having problem understanding, I will repeat.

I'm not saying the poor can not get medical care. I said, "Do you really believe access to these new technologies should be based on the ability of a patient to pay? Those with adequate financial resources live and those without die." It was a hypothetical statement.

 

[lynn63]

The people that need an organ transplant would be the best source to ask that question.

 

[FireFly]

It should be easy to save $700 Billion a year on Medicare.

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

 

[BillyV]

It should be easy to save $700 Billion a year on Medicare.

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

Well, yes, the article does say that, but its overall view isn't nearly so one-sided as your post would indicate:

Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.
That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive….. That is why critics say Dartmouth’s approach takes an overly pessimistic view of medicine: if you consider only the patients who die, there is really no way to know whether it makes sense to spend more on one case than another…… unless the distinction can be clearly drawn between excellence and excess in medical care, efforts to cut wasteful spending could be little more than blunt rationing.

They went on to do further testing:

The Dartmouth analysis prompted Dr. Rosenthal to seek further data. He collaborated with colleagues at U.C.L.A. and four other medical centers affiliated with the University of California system, as well as Cedars-Sinai Medical Center in Los Angeles, to design a study of why some hospitals spent so much more on dying patients than others and what they got from their efforts.

To focus their analysis, the researchers chose to look only at a single category of patients: elderly people with heart failure. The dead would be counted, as Dartmouth does, but so would the living.

What they found seemed to contradict the Dartmouth thesis. The hospital that spent the most on heart failure patients had one-third fewer deaths after six months of an initial hospital stay.

End of life treatment is a difficult subject with few black and white answers. It may really not be worth it, but at least the article provided balanced reporting, unlike your post.

 

[Flopper]

It should be easy to save $700 Billion a year on Medicare.

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

Well, yes, the article does say that, but its overall view isn't nearly so one-sided as your post would indicate:

Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.
That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive….. That is why critics say Dartmouth’s approach takes an overly pessimistic view of medicine: if you consider only the patients who die, there is really no way to know whether it makes sense to spend more on one case than another…… unless the distinction can be clearly drawn between excellence and excess in medical care, efforts to cut wasteful spending could be little more than blunt rationing.

They went on to do further testing:

The Dartmouth analysis prompted Dr. Rosenthal to seek further data. He collaborated with colleagues at U.C.L.A. and four other medical centers affiliated with the University of California system, as well as Cedars-Sinai Medical Center in Los Angeles, to design a study of why some hospitals spent so much more on dying patients than others and what they got from their efforts.

To focus their analysis, the researchers chose to look only at a single category of patients: elderly people with heart failure. The dead would be counted, as Dartmouth does, but so would the living.

What they found seemed to contradict the Dartmouth thesis. The hospital that spent the most on heart failure patients had one-third fewer deaths after six months of an initial hospital stay.

End of life treatment is a difficult subject with few black and white answers. It may really not be worth it, but at least the article provided balanced reporting, unlike your post.

You're absolutely correct. End of life treatment is a difficult subject, for the patient, the doctor, and the family. My experience with family members in the end of life phase have been quite different than this article. The doctors for most part did not recommend expensive treatments. Of the 5 elderly family members who have passed, doctors recommend Hospice for all but one. In my opinion, Hospice is a very good alternative for end of life care. Hospice saves money for the family and Medicare but most important it focuses on improving the individual’s quality of life by managing symptoms, providing emotional support, spiritual support and addressing issues most important to the patient’s needs and wants.

 

[BillyV]

It should be easy to save $700 Billion a year on Medicare.

Well, yes, the article does say that, but its overall view isn't nearly so one-sided as your post would indicate:



They went on to do further testing:

The Dartmouth analysis prompted Dr. Rosenthal to seek further data. He collaborated with colleagues at U.C.L.A. and four other medical centers affiliated with the University of California system, as well as Cedars-Sinai Medical Center in Los Angeles, to design a study of why some hospitals spent so much more on dying patients than others and what they got from their efforts.

To focus their analysis, the researchers chose to look only at a single category of patients: elderly people with heart failure. The dead would be counted, as Dartmouth does, but so would the living.

What they found seemed to contradict the Dartmouth thesis. The hospital that spent the most on heart failure patients had one-third fewer deaths after six months of an initial hospital stay.

End of life treatment is a difficult subject with few black and white answers. It may really not be worth it, but at least the article provided balanced reporting, unlike your post.

You're absolutely correct. End of life treatment is a difficult subject, for the patient, the doctor, and the family. My experience with family members in the end of life phase have been quite different than this article. The doctors for most part did not recommend expensive treatments. Of the 5 elderly family members who have passed, doctors recommend Hospice for all but one. In my opinion, Hospice is a very good alternative for end of life care. Hospice saves money for the family and Medicare but most important it focuses on improving the individual’s quality of life by managing symptoms, providing emotional support, spiritual support and addressing issues most important to the patient’s needs and wants.

Agreed, Hospice is a wonderful program for terminally ill patients, but that isn't what this article is about. Hospice is not really medical care, it is simply maintenance care in anticipation of death (by the rules, the patient must be certified terminal with less than 6 months to live). These are older patients who are critically ill but not necessarily terminal, who die within that six month time frame set by the Dartmouth study. The indication from the UCLA data was that patients with more aggressive care live beyond the scope of the Dartmouth study and are therefore not counted in their results. The question here is, at what point do you "throw in the towel" and stop looking for medical answers to prolong someone's life? Is age the relevant factor? There are many who feel that certain procedures should be withheld from those where the "quality adjusted life years" to be added don't justify the cost, thereby effectively rationing care to the elderly who will always score lower on that basis than a younger person. These are the difficult questions. Once you have reached the stage where Hospice is involved, it is no longer a question of whether you will die, but whether it will be three months or six, and the determination has already been made that further medical care is not warranted.

 

[Flopper]

Well, yes, the article does say that, but its overall view isn't nearly so one-sided as your post would indicate:



They went on to do further testing:



End of life treatment is a difficult subject with few black and white answers. It may really not be worth it, but at least the article provided balanced reporting, unlike your post.

You're absolutely correct. End of life treatment is a difficult subject, for the patient, the doctor, and the family. My experience with family members in the end of life phase have been quite different than this article. The doctors for most part did not recommend expensive treatments. Of the 5 elderly family members who have passed, doctors recommend Hospice for all but one. In my opinion, Hospice is a very good alternative for end of life care. Hospice saves money for the family and Medicare but most important it focuses on improving the individual’s quality of life by managing symptoms, providing emotional support, spiritual support and addressing issues most important to the patient’s needs and wants.

Agreed, Hospice is a wonderful program for terminally ill patients, but that isn't what this article is about. Hospice is not really medical care, it is simply maintenance care in anticipation of death (by the rules, the patient must be certified terminal with less than 6 months to live). These are older patients who are critically ill but not necessarily terminal, who die within that six month time frame set by the Dartmouth study. The indication from the UCLA data was that patients with more aggressive care live beyond the scope of the Dartmouth study and are therefore not counted in their results. The question here is, at what point do you "throw in the towel" and stop looking for medical answers to prolong someone's life? Is age the relevant factor? There are many who feel that certain procedures should be withheld from those where the "quality adjusted life years" to be added don't justify the cost, thereby effectively rationing care to the elderly who will always score lower on that basis than a younger person. These are the difficult questions. Once you have reached the stage where Hospice is involved, it is no longer a question of whether you will die, but whether it will be three months or six, and the determination has already been made that further medical care is not warranted.

If we accept the definition of end of life care to mean care not only of patients in the final hours or days of their lives, but more broadly care of all those with a terminal illness or terminal condition that has become advanced, progressive and incurable, then you're right. It's a very difficult situation. With many diseases, the doctor can give the patient an estimate of survival for some period along with survival rates for specific treatments. However, in other cases it's not possible. Some people cut years off their life by just giving up the fight too soon. Other fight for life much too long putting themselves and their family through needless suffering not to mention the financial impact.

I think the best we can do is push more end of life counseling for patients and their families so they make the right decision. I think the huge uproar over death panels means that end of life decisions will continue to be made by the patient with the help of doctors, family and spiritual advisers, not government or insurance companies.

 

[CultureCitizen]

To think that that the patient will question and evaluate cost is ridiculous.

If they're spending their own money, it's ridiculous to assume otherwise. That's the problem with the situation we have now: when it comes to health care, most people aren't spending their own money.

If all healthcare providers were paid by the patient, not by insurance, not by Medicare, not by Medicaid, or any other method that takes the responsibility off the patient, then yes healthcare cost would fall dramatically and deaths would rise dramatically.

We want to encourage people to use low cost healthcare available from their family doctor, to make sure small problems don't become big problems. Putting the responsibility on the patient does just the opposite.

I've been doing some research regarding medical inflation.

Part of the medical inflation is caused by an increase in demand as medicaid and medicare programs have given access to more people to health care.

But that is only half of the story, competition between hospitals is not perfect, because hospital treatment costs are not easily available and comparable. Evenmore, when someone gets seriously ill he will probably not be in the best condition to do any "healthcare shopping".

Finally, there is another component : insurance companies. When a person is insured the insurance company becomes the customer.
I don't think insurance companies do any serious price / quality comparision between hospitals. It is easier for them to simply rise the premium , this in turn allows the hospitals to rise their prices which creates an inflationary spiral.

That I think is how medical inflation is working. I'll be happy to hear any other viewpoints.

 

[Flopper]

If they're spending their own money, it's ridiculous to assume otherwise. That's the problem with the situation we have now: when it comes to health care, most people aren't spending their own money.

If all healthcare providers were paid by the patient, not by insurance, not by Medicare, not by Medicaid, or any other method that takes the responsibility off the patient, then yes healthcare cost would fall dramatically and deaths would rise dramatically.

We want to encourage people to use low cost healthcare available from their family doctor, to make sure small problems don't become big problems. Putting the responsibility on the patient does just the opposite.

I've been doing some research regarding medical inflation.

Part of the medical inflation is caused by an increase in demand as medicaid and medicare programs have given access to more people to health care.

But that is only half of the story, competition between hospitals is not perfect, because hospital treatment costs are not easily available and comparable. Evenmore, when someone gets seriously ill he will probably not be in the best condition to do any "healthcare shopping".

Finally, there is another component : insurance companies. When a person is insured the insurance company becomes the customer.
I don't think insurance companies do any serious price / quality comparision between hospitals. It is easier for them to simply rise the premium , this in turn allows the hospitals to rise their prices which creates an inflationary spiral.

That I think is how medical inflation is working. I'll be happy to hear any other viewpoints.

I partially agree with your assessment. There is no doubt that American's healthcare bill is rising but the primary factor is not price inflation. The healthcare price index showed only a 1.7% increase for 2012, and a 2.3% for 2011 and about 2.4%/yr over the last 10 years. However, America's total healthcare cost has been rising at nearly twice those rates. Also insurance companies have been passing more costs to the consumer which explains why personal spending on healthcare is rising so much faster than prices. I think your conclusion that we are delivering more healthcare services is correct and in my opinion is a good thing for the country.

Insurance companies do a good job of reducing prices by contracting with network providers at deep discounts. I'm really not sure what insurance companies do in reguard to quality. I think some insurance companies are more sensitive to quality of service than others. Obviously, providers that keep their patients healthy and deliver effective treatments will reduce claims over the long term. However, some companies have little interest in the long term, because of the rapid turnover in customers.

The bottom line is the cost of healthcare has been rising significantly while healthcare prices have barely kept up with overall inflation. The major reason has been the increase in the volume of services delivered, not price increases. With Obamacare, the number of people covered will increase that volume even more which may or may not significantly increase prices. However, one thing is for sure, we will be spending a larger portion of our GDP on healthcare which is the price we will pay for longer life spans and a healthier nation.


http://www.altarum.org/files/imce/CSHS-Price-Brief_March 2013.pdf

 

[boedicca]

Health Insurance is not the equivalent of Health Care. After stripping out all of the rent seeking, it's a far lower amount. Total "health care spending" was 7% of GDP in 1970. The growth to 18% has been fueled by four things:

- Increases in Medicare/Medicaid
- Overhead for regulatory costs
- The increased disconnect of the consumer and the payer leading to price insensitivity and overuse of services (going to the emergency room for a common cold)
- The increase in obesity due to the promotion of garbage food subsidized by the Agriculture Department

The only way to fix this is to decouple health care/health insurance from employment and government gate keeping, and return the patient to the "payer" position.

 

[Flopper]

The only way to fix this is to decouple health care/health insurance from employment and government gate keeping, and return the patient to the "payer" position.

I think we all know that's not going to happen. Insurance companies, drug companies, Medicare and Medicaid recipients, medical service providers. and state governments which would be faced with funding healthcare for the poor would be oppose any such proposal.

 

[dblack]

The only way to fix this is to decouple health care/health insurance from employment and government gate keeping, and return the patient to the "payer" position.

I think we all know that's not going to happen. Insurance companies, drug companies, Medicare and Medicaid recipients, medical service providers. and state governments which would be faced with funding healthcare for the poor would be oppose any such proposal.

Yep. Our government has granted to these interests what amounts to under-the-table deals. ie corporatism

 

[lynn63]

I agree that health insurance should be decoupled from employment. In my opinion, it is the only way to make a stand to lower cost across the board. The government is allowing businesses with under 50 employees to opt out of providing health coverage. There are approximately 30 million people that are employed with under 50 employee limit.

78% of them have coverage right now so it definitely would make an impact if all those employers stopped providing benefits all at the same time. If this could become a reality, the over 50 employee limit would definitely join forces with them.

It is the only way the citizens of this country can demand real change in the healthcare industry and reduce cost that is aligned with our wages. If we don't do anything, eventually healthcare will be stripped down to bare bone coverage with higher premiums and higher out of pocket costs.

Most of the big top ten insurance companies have already begun expanding their market to Brazil and other areas that are not under a government system. They are also beginning to outsource their administration depts which further adds to unemployment rates. They do get tax deductions for overseas market so our government is supporting their efforts. Our premiums are paying for all of it.

The ACA has put requirements on them that they must spend 80% on healthcare expenses but there is no penalties or big fines if they don't. I don't see how it is possible for them to pay 80% when 76% of the workforce population has coverage through their employer group plans with high deductibles annually before the insurance company is obligated to pay on our healthcare expenses.

Insurance companies are worthless to us now that they switched the population from HMO plans where we only had to pay a co-pay to PPO plans that have higher premiums and higher out of pocket cost. The fee schedule allowables always manage to stay under our deductible so we are paying for all of our healthcare at a reduced rate.

There is too much fraud and abuse on all levels in the healthcare industry and we are footing the entire bill.