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A poll of Massachusetts residents by Harvard’s School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation found that regular people in Massachusetts are remarkably well informed about the primary reasons their health care is so extremely expensive compared to health care in other industrialized countries.
According to the poll regular people correctly identified overcharging by the different industry providers as being the top reason why health care is so expensive. Drug companies charging too much was first with 77 percent calling it a major reason for high health care costs today. Insurance companies charging too much was second with 72 percent calling it a major reason, and hospitals charging too much was a fourth, with 63 percent calling it a major reason costs are high.
In addition regular people simply don’t buy the frankly silly idea that the problem is a lack of shopping around for bargains. Only 20 percent said people not shopping around for a lower price was a major reason for high costs. The idea that very ill patients or even healthy ones with relatively little power and a huge knowledge gap can reduce costs by being smart shoppers is absurd.
Unfortunately the Kaiser Health News, NPR, WMUR and the Harvard School of Public Health all worked to promote the myth that regular people are somehow mistaken. From the Kaiser Health News:
Q [WBUR's Martha Bebinger]: Respondents say the high cost of health care is either a crisis (25 percent) or a major problem (53 percent). Why does the public say health care costs are too high?
A [Pollster Robert Blendon, with Harvard's Kennedy School and the Harvard School of Public Health]: The main reasons were excessive charges by pharmaceutical firms, hospitals and insurers. There was less concern about the things experts always talk about: using too much high cost technology, going to expensive teaching hospitals or not shopping for care. The big takeaway here is that 74 percent of respondents want the state to take action.
*emphasis mine
These so called “experts” who think the real problem is people not shopping around and using more expensive teaching hospitals too often are either idiots, hacks or a combination of both.
The regular people are basically right, and that should be clear to anyone who does a simple international comparison. Americans pay way more for the exact same drugs or procedures compared to other first world countries like Japan, Canada, Germany, France, etc. The biggest problem is not that Americans are using dramatically more health care or not shopping enough; the big problem is simply that Americans are paying dramatically more than those in other nations with equal or better care for the health care they use.
It is good to see that despite a widespread campaign by industry paid-for “experts,” many media outlets and politicians in both parties, the people of Massachusetts haven’t been tricked into thinking the problem is they don’t have enough “skin in the game.”
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Oh snap! That’s why it costs so much to get care! Technology is too expensive! We should go back to just leeching and bleeding for everything.
Prices are too high because entities charge too much. That must be one of the most remarkable displays of command of the obvious. Call Tom Friedman.
Last month I had to go to the ER with what felt like a heart attack. It was actually pneumonia with a pleurissy. So I was admitted, received IV antibiotics and blood tests and they pushed a CT scan on me. Discharged at 48 hours and the bill comes to 39,600.00. Just how I am expected to shop around on a Sunday evening while I can’t breath and my chest feels like I took a bullet is beyond me. And the costs are obscene. Each bag of antibiotics was 800.00, CT can 4000.00, hospital bed 6000.00 per night, blood tests 800.00 each. I even have a charge for a proximal pulse test. 27 bucks to feel my pulse. But the hospital said I have 2 weeks to pay. How nice.
I know right.
Instead of x rays, doctors should have one of those magic eight balls in their office. “Do I have pnuemonia? Try Again Later.” Who needs labwork? The doctors can have a “cootie catcher” and you can pick a number and a color to determine whether or not your white count, cholesterol levels, or your red blood cells are off.
It’s be sooooo much cheaper.
Consumers should ask their doctors if a particular test or medication is necessary before they agree to subject themselves to it. (I realize that this isn’t always feasible in an emergency situation.)
In primary care alone, researchers at Mount Sinai School of Medicine have found that $6.7 billion was spent in one year performing unnecessary tests or prescribing unnecessary medications in primary care.
…and there are so many unnecessary surgeries in this country.
Let’s see, the company who gave 6.7 million at a non profit for their CEO salary is going to tell us we should all tighten our belts and use less health care.
The doctors are slaves to the system, except those increasing numbers who own the system. To blame too many tests is to blame the gnat bite for the crocodile feasting on the limbs.
Just had a talk with my drug insurer. They are cutting premiums in the amount they have decided to increase the deductible. Jeez! these geniuses of human nature figure we only buy meds for fun and if we are discouraged by the large deductible we will buy less. I am so sick of this whole country and its commercialism I really want to leave.
Had a surgery many years ago and a safety pin and a rubber band were used – no, don’t ask. Both appeared on the bill. I’ve never laughed so hard. The hospital bill – not the surgeon.
So why again do we send doctors to school for years if we are supposed to question whether or not their belief that a person needs a test or medication is warranted?
I think this idea that surgeries, medication, or tests were “unwarranted” are likely overestimated.
I have fibroids. Technically I could live with them and the pain. Does that mean a hysterectomy is “unwarranted?” Or does it mean the insurance companies would prefer to not have to pay for the costs associated with a surgery? If the results of my surgery are less than optimal does that make the surgery “unwarranted?” Or does it mean that medical interventions are never 100% guaranteed?
Too much testing is a large part of the problem, especially since physicians often own or lease the testing equipment and they have to amortize the cost of that “investment.”
So, don’t tell me it’s not part of the problem.
Ditto, $1200 to get a $5 inhaler.
P.S. I know of a relative who had surgery and after going over the final bill noticed a $500 charge for a sterile needle. When she called about it the billing dept just said ” Oh no one ever calls about that, we will take it off the bill” and this was at UCLA.
Seems a little odd to cite an Opinion Poll as proof that industry experts are wrong about Health Care Cost Problems.
It was the opinion of half the population that Bush was going to be a good Prez, and then the other half that had the opinion that Obama was.
Opinions aren’t facts.
Great point! It’s the consumer’s fault! God forbid the doctors not order unnecessary tests or prescribe unnecessary medication.
Many medical professionals and medical researchers believe there is overuse of hysterectomies in the United States. About 85% of hysterectomies could possibly be avoided through less invasive methods, such as removing painful fibroid tumors from the uterine wall or through medication.
U.S. hysterectomy rates are triple those of other industrialized nations. Why take out a healthy uterus when it’s normal otherwise?
Yes, medical consumers should QUESTION their doctors. Just because they’re doctors, it doesn’t mean they have all the answers.
I ended up in the ER for abdomen pain. Because of where pain was located they thought it might be my appendix. The cost without insurance was $7900 dollars(They sent me the bill since the original charge was declined by our insurance because we were going through our annual verification to ensure I wasn’t covered by another policy.) The bill for the insurance company was half that.
If you want to know why prices are inflated, there’s your answer. The insurance companies are only willing to pay a portion so what the hospitals have done is inflated the cost.
So Jane Doe who has no insurance pays TWICE what John, who does, pays for the same darn procedures and outcome. That way the insurance companies can feel like they are “getting a bargain” for their members.
Doesn’t sound like insurance companies are charging too much money in this case.
Where did I say it’s the consumers fault?
But, now that you mention it, the consumer does have a responsibility to intelligently participate in his/her healthcare — and if asking if a test/medication is necessary, that makes sense — and it saves money and often LIVES, to decline a test or a medication.
I sit on my organization’s benefits committee and am located in a rural community.
We have outside consultants helping control health care costs. These controls
are on the patients (consumers is a charged word). I have asked many times
for price lists to be posted. E.G. what is the cost of a room? How much can I
save by bringing (and administering) my own pills/drops?. How much does a CT
scan cost? A colonoscopy? What is the price of pills? Why do we have 2 hospitals
in an area that can support one? [e.g.it makes CT scans more expensive as there
are not enough patients to cover much more than base costs].We even have an ex-med
billing person on our committee who tells us how difficult it is to determine
these costs-as they change so rapidly to maximize hospital’s profits.We’ve
had a member’s blood pressure go “sky-high” on generics. As he is a chemist,
he analyzed the brand and generic pills and discovered a significant difference
in the active ingredient (he’s now back on the brand name). Using the health
system is like shopping in a supermarket with no prices,and then being
punished for spending too much. Actually worse,since some of the “food”
can do you quite a bit of damage.
You have been drinking the Kool Aid. It’s a part of the problem. A gnat’s worth. Don’t tell me otherwise.
Yep Steve Jobs did a good job shopping for a treatment he liked better than the proven best.
I’d love to know what “unnecessary” is by this places definition?
Does it mean someone in pain should forgo surgery?
Does it mean someone with a abnormal test result should just try to wait it out?
It’s a pretty bald statement without actual examples to back up this idea that there are hundreds of doctors just saying “I’m bored today. How about we go ahead and see if we can convince Mrs. Smith she should undergo surgery for her hip.” or ” I know Mr Potter came to my office for absolutely no reason whatsoever, so I’m going to order a full workup. What the heck, chem panels for everyone today!”
Is there probably some abuse? Sure. I remember reading that some clinics were ordering testing from their own clinics to make a couple of bucks more but from my anecdotal experience doctors aren’t randomly x raying and testing everyone for everything. As a matter of fact, the doctors my family has seen tend to be very conservative with their testing and medication orders.
In your position you are getting quite a sense of just how badly broken the system is and how people are suffering and dying as a result. And our average life spans decline into the 30s below Cuba.
I need to not post on this it is so personal and I understand too well how awful it has become my anger and impatience gets out of hand.
Billions of dollars is a gnat’s worth?
You have been drinking the Kool-aid.
Okay I’ll bite.
Scenario A:I go to a doctor’s office and complain of x.
He says well I think it might be y. We’ll run a test.
i then say “Is this medically necessary?”
Scenario B: I go to the doctor’s office and complain of e.
He says well Medication F has been fairly effective at dealing with complaints of e. I’ll write you a prescription for it.
i then say “Are you sure that’s medically necessary?”
That’s just plain dumb. People go to the doctor’s office for TREATMENT. So the idea that doctors are randomly prescribing TREATMENT or TESTING to determine what kind of TREATMENT a patient should receive arbitrarily is absurd on its face. It’s even more absurd that someone who is seeking professional medical help is then going to play 20 questions in order to save MONEY.
Ever since the advent of direct-to-consumer drug advertising, 2/3 of doctor visits result in a drug prescription.
Drug company ad campaigns are one of the main reasons why spending for prescription drugs is today the fastest growing category of health care spending.
…another good reason to ask your doctor if that prescription is really necessary.
Too bad this country looks for quick fixes, instead of individuals being willing to make life-style changes. Also, too bad, the medical profession prefers it that way — they can rake in more dough treating disease, than dispensing real “health care.”
So what am I supposed to do?
Go to med school to become an informed consumer?
Maybe I should consult an expert, maybe my doctor…
Of course he ordered the test, so he thinks they are necessary.
A couple of years ago my husband was in the hospital for a week… three separate times in three consecutive weeks. That’s three weeks total. He almost died. We got a real education on the healthcare system.
If you haven’t already, I suggest that you be sure to search the web for advice on negotiating your bills after the fact. There seems to be lots of it out there. This is not at all to defend the notion that shopping around for health care is the way to go, but with the system we have – advice abounds on how to not just roll over and take it. I think the rules are constantly changing, so I doubt I can be helpful beyond this. I wish you well.
“Oooooooooooo Hey doc my chest hurts.”
(Doctor listens to chest with stethoscope.)
“Well I think I’d like an X ray to see if there’s any fluid in there.”
“Wait, doc, are you sure that’s medically necessary?”
I love how they set this up as lose-lose for the doctors too.
If they don’t test and treat with medication, then they are recklessly prescribing medication. If they do test in order to get a more accurate diagnosis then they are recklessly testing.
What a swell game!
First off, the ADVERTISING portion you’re talking about is aimed at consumers or patients. That’s why it always ends with “Ask your doctor about blah, blah blah.”
Second off, if you are going to the office to specifically ask your doctor about blah,blah,blah then after he prescribes it to you the idea that you’ll then look it him and ask if it’s medically necessary is laughable.
I get that drup companies spend an absurd amount of money to get their medications into a doctor’s office. I’d agree with that. However, it seems if you want to attack this problem you do so by directly addressing drug company revenue spent on ad campaigns not by appealing to the consumer or bad mouthing the physicians as being too quick to prescribe.
And one wonders if he was rushed out of the hospital in order to “save money” and then ended up back in the hospital as a result of it.
I’ve seen that happen quite a few times too.
My neighbor became a full blown diabetic. They sent her home with a medication pen that because of rhematoid arthritis was impossible for her to use(and at that I had to beg the pharmacy for the needles that they forgot to prescribe so she could use it.). Needless to say, she ended up right back in the hospital(after a lovely ambulance ride after I found her unresponsive). Plenty of blame to go around there. I went down to the hospital and had a chat with patient contact after that little fiasco.
There are plenty of doctors that encourage lifestyle changes first and foremost.
However, if lifestyle changes don’t happen or aren’t effective then they do prescribe medication.
what would you have them do? Go home with the patient and FORCE THEM to eat oatmeal or skip the drive thru? Ignore testing that suggests their patients are going to die without intervention?
That is the uninsured rate. The insured rate would be about 1/5th that amount. Hospitals charge 3-5 times more to the uninsured as they do to the insurance companies because insurers drive hard bargains and work out binding contracts.
You’re supposed to “shop around” so then they(these wonderful health insurance organizations) can accuse you(the consumer) of needlessly visiting doctors offices. We all know you have nothing better to do then visit another doctor to verify that he’d do the exact same thing as Doctor 1(and if he doesn’t then visit a 3rd)
It’s a fun game.
Blame the patient, blame the doctor, blame everyone for costs except for the middlemen. They, of course, are blameless.
Uh, pretty sure he was rushed out twice with a fever of unknown origin. I could go on and on with enlightening details, but I have to scaddadle. Later, pups.
Do you know the side effects of medication?
I do. I think I’ll skip severe depression thank you. My father and brother already took their own lives.
But thanks for playing the I know more than the medical professional and the patient game for me and proving my point.
Without ALL THE INFORMATION it’s impossible to know what is or isn’t “warranted.”
Every time the insurance companies or the Medicare adm wants to increase charges or decrease benefits they roll out figures that are highly suspect to justify putting the blame on the doctors and the “uninformed” patients.
Sorry to be so short with you. It is that I have heard this for years while first as a provider then as a patient having tons of correspondence over almost everything I ordered or had ordered questioned and often turned down on some technicality. They can do a better job always but this is one area where there is a fair amount of oversight, especially as pertains to Medicare.
I don’t have the will to get into a battle of links. Have a good day.
Uh because it isn’t a “healthy uterus”!
It’s got two large hopefully benign tumors growing on it with a plethora more waiting to grow if I get rid of those two.
Additionally, they now believe it may be responsible for the hydronephrosis that up until now has been unexplained.
Sounds like a good deal for the consumer if they only have to pay 1/5.
You aren’t just paying for the “antibiotics” when you are in a hospital. You are paying for the staff that provides the antibiotics too(a bag of IV fluid requires a technician to make it up and a pharmacist to check it, it then gets dispensed to a nurse that will have to hang and monitor it).
One of the biggest problems with our system is that it doesn’t do enough to encourage care before it gets to the point where you need to be hospitalized.
That isn’t saying that I don’t agree that pricing needs to be looked at.
As I stated above. The same visit was TWICE the cost when the hospital thought I was uninsured. That should be an unacceptable amount of “savings” marked up. It also makes me wonder why in the world we are charging people who can’t afford insurance or don’t have access to affordable insurance to begin with TWICE what those who have it. It seems arbitrary. Obviously a test is a test is a test. It can’t be worth $100 and $200 simultaneously and yet that is exactly what the hospital is saying by charging two different rates.
That’s going to depend.
You may need to spend hours on the phone in order to achieve that discount since it’s a pretty widely accepted fact that insurers make a goodly sum declining care.
Oh and you also are paying a premium monthly so it isn’t like that 1/5 discount is free.
My husband and his company spend over $20,000 a year on insurance. If I get my hysterectomy then we’ll likely have gotten our money’s worth. However, there are years where the cost for the insurance company definitely exceeds our usage. In those cases, THEY got the good deal.
Another excellent, “news that people can use”, post, Jon, thank you.
Doubtless, as people come to understand more of how the “sytem”, shall we say “works”(?), the more often “experts will be trotted out to tell the people that they are stupid and uninformed, generic “effin’ retards” …
Soon enough, “the people” are going to understand, as did much of Obama’s “base”, that the “experts” and those who hire them have no interest in the truth, merely in continuing to “make” money and maintain their status quo … regardless of the cost to civil society and real human beings.
Consequence IS coming …
DW
Are you sure it’s a $5 inhaler. The aerosol inhalers were just reformulated. It definitely increased the cost(although $1200 is excessive) and I know that even outpatient you are looking at $30 for an inhaler now.
This post is quite odd. It supposes that the cost of medical services has basically stayed the same while only the insurance has gone up.
I don’t buy too many prescription drugs, but none of the 3 or 4 I do get has gone up at all.
As we all know, the public in polls, thought gay marriage was bad until very recently, so what the public thinks in polls doesn’t mean it is right.
The big question for me, and one which no one hear, or anywhere that I know, has given the EXACT reason why the cost of medical services continues to skyrocket up.
THAT is the main reason insurance rates go up.
If you don’t find the reason WHY for that and solve it, it does not matter WHAT you do regarding insurance.
You have the government take over all insurance, save some paperwork cost, etc. for the first year, and then, after a few years of medical service cost increases, be right back where you started.
Is there someone here in the medical service business; nurse, doctor, etc. who knows the answer?
And, it isn’t filling out paperwork. That would not even begin to explain the huge increases in the cost to get medical care–not pay for insurance, the cost of the service itself.
People are “short” with commenters all the time at FDL. Couldn’t care less. For a site with mostly very intelligent participants (commenters), it amazes me how many reduce everything to INDIVIDUAL anecdotal “evidence” rather than look at the bigger picture.
Whoever that is with the fibroids, seems to think that I said that her uterus was healthy — no, I didn’t say that, nor did I imply that. The fact is that women in the United States are subjected to hysterectomies, for instance, 4X the rate in Sweden (I could find links that show similar numbers for other countries). When a women undergoes hysterectomy, often her ovaries (which COULD BE healthy) are removed also, “since we’re in there.” Well, when that happens that woman increases her chances for osteoporosis, heart disease and a plethora of other conditions. The fact is, that a large percentage of hysterectomies are not medically necessary — there are options.
Also, gallbladder surgery is often unnecessary; same for C-sections, and many other surgical procedures.
To give an anecdotal example as to why it’s a good idea to ask if a test is necessary: A friend with extensive arterial obstruction who was already identified as NOT a surgical candidate, was scheduled for a chemical stress test.
He asked his doctor “why?” if they already knew about his arterial obstructions, “what is the purpose?” The doctor had no good answer and cancelled the test. The patient’s daughter talked her dad into having the test.
He had the test; during the test, complications developed. He was admitted to the hospital (he was having the test at the hospital on an out-patient basis). Before the night was over, he died. Yes, I know — anecdotal.
But, for all you people here who think tests are benign and without their own risks, I suggest you do a little research.
Its not the technology its that for some reasons Hospital Corps. when they build a new hospital have to build it to look like a 5 star Hotel on some Caribbean Island. Its because drug companies have to make huge margins on drugs that cost them pennies to produce. Its because Ins. companies charge Drs. huge amounts for liability Ins. Its because their is nobody saying no to all of this, except health Ins. companies and they only say no to the people with their policies.
The whole system is one huge rip off from top to bottom anymore. Its scary and soon its going to collapse as only the Drs. and a few others will be able to afford any of it.
Actually you did say and I’ll quote,
U.S. hysterectomy rates are triple those of other industrialized nations. Why take out a healthy uterus when it’s normal otherwise?
If you are getting a hysterectomy for fibroids than your uterus is not healthy(and I reject the idea that they are giving you a hysterectomy for a “normal” uterus.) It has tumors. Most likely benign tumors(that are caused by the hormone estrogen) but tumors nonetheless.
Would those tumors go away over time? Most likely. However, if you are seeing a doctor for them then it is likely that it is a) causing you pain and discomfort or b)it is causing problems with other areas of your body or c) both.
(oh and by the way you’ll be happy to know that unless your ovaries are in bad shape they no longer remove them. They just remove the fallopian tubes. If they remove the ovaries you’re still stuck taking medication.)
You miss my point. My point is that “unwarranted” is going to be largely subjective. Who gets to determine how much pain a person should be required to live with or how long an abnormality should be “watched?” I feel a doctor and a patient are best qualified to make that determination TOGETHER.
Oh and in Sweden I wouldn’t have procedures unavailable to me due to the fact that they are still “investigative” like UAE. So that could contribute to why it is less frequent there than here.
As to anecdotal, I spent 12 years in health care. I was a nationally registered EMT and a corpsman for 3 years(worked with doctors in sick call and physical exams) and then specialized in pharmacy in the military(non profit) As a pharamacy technician while on ships I was responsible for ordering medical supplies and had access to expenditures for products like Xrays and medication. After I left the military I spent a year working for HCA(a for profit hospital) as a technician. My positions are far from mere anecdotes. I’ve seen both non profit and for profit health care up close and personal.
Any medical procedure has risks, heck WALKING INTO THE OFFICE OF A DOCTOR has risks since you are being exposed to germs. However, if you are going to the office to begin with it’s generally because you have a complaint(I know I know it was just a year or two ago during the health care debate we were hearing it was because Americans are bored and just love visiting doctors). In order to fix that complaint a doctor has a limited bag of tools. He can a) test and hope in addition to a subjective complaint that he can find the reason for the complaint in order to ensure his plan is the most effective(and then listen to the community whine and complain about the cost of said tests) or b) treat(and then listen to the community whine and complain about blindly medicating). Both of those options are complicated by the fact that each and every individual is UNIQUE. While we all have the same systems, there is still alot about the body that is a mystery and what works well for one person may not be effective in another. (Questions like why does one medication work well on one person but not work on another? Why does one person create kidney stones while another with a similar diet does not? ) In many cases the doctor and patient are left to trial and error. It appears to me that the people who are calling things “unwarranted” want to exploit the fact that medicine isn’t always an exact science and pin the blame everywhere except on middlemen who have driven up costs and added no value whatsoever to the end process.
Sorry, but if it’s Kool-Aid that’s being drunk, it sure ain’t the kind Kesey recommends. It has been very well documented that “high tech” medical facilities (eg MRI, labs, etc) that are owned by, or whose investor are, doctors are major sources of profits for these very same doctors: https://secure.wikimedia.org/wikipedia/en/wiki/Physician_self-referral
The problem with our health system is that is not a health care system in that it’s primary function is not to ensure peoples’ health but rather to return maximum profits to those that own it.
Here’s one more example: My meds — doctor prescribed and critical for me to function — cost $16 per pill (I need at least one per day.) Of course my insurance won’t (Regence) will not cover it. I am forced to engage in a criminal act to buy my medication from Canada where I pay $1.47 per pill. The pills come from India where, on the package, the Maximum suggested price is (converted to US) $0.27 per pill. That is a difference of $15.73 between the buying the same medicine in US as India.
The drug I get is generic and the patent has expired in the US though no generic is available in the US — the drug company paid off the generic manufacturers to the tune of hundreds of millions of dollars to not sell here. The drug is modafini (provigil) and this easily verifiable.
That is because the fees for their services are now so low. They have to buy into businesses that are still permitted some profit. However they are owned or how profitable has nothing to do with over or under utilization. I don’t deny some misuse or duplication of services that are not caught by oversight but I promise you there is a great deal of oversight — which by the way, makes it necessary to hire staff just to keep up with the guidelines and correspondence regarding certification and and justification. This of course increases the overhead which has to go into cost of services. There is much to do that could improve things in those areas; but the rip off artists in Pharma, insurance and the GOP do just fine getting people to blame and mistrust their doctors and hospital services.
The real problem is as you say in #48 :
I think this article sums up the term “unnecessary testing” pretty well for me.
http://www.epmonthly.com/whitecoat/2009/10/unnecessary-medical-testing/
Our insurance company was able to deal with the problem quite easily. In order to perform a high end test like a CT scan a doctor that isn’t in an ER is now required to get preauthorization from the insurance company.
That is how high end testing such as CT scans, MRI, even bone density are handled as far as I know by all insurance companies and Medicare. If richwa is not a troll for the industry I don’t see how he/she can hold on to the claims. I promise you those stories are rolled out every time someone starts complaining about the real problems.
This thread is dead and I am tired so I am not going to take the effort to find the links to the real information that refutes this as a major cause of the cost of medical care.
This thread is validation that we’re fucked in the drive-thru. The woman with the fibroids and the retired physician can’t see beyond their noses. I hope they have good vision care insurance.