The PTB always blame the masses for our problems. Lazy, indolent, uneducated, unsophisticated masses that can’t pull themselves up by their own bootstraps like the “jobcreators” and “old money” civilized elites that always know best. They sure are doing a shitty job by any sound person’s metric.

I wonder if we are subsidizing the rest of the world’s health care costs. They pay less, so the designers, patent holders, and drug companies charge us more to compensate?

The differences between the 95 percentile and the average is incredible. Who pays that high rate?

Insurance corporations add no value to care. They take 30% off the top of premiums. It’s time to get them out of the equation.

So you’re saying that the profit margins, executive compensation, administrative costs, and investor dividends are what drives the rise in health-care costs? The same with the drug industry?

Who’d a-thunk it?

Don’t you know the whole point of having this country is to provide for immense profits from every aspect of life? — and death? — even after death? The there is the pre-born segment also. Our rights to life etc. are now defined on the basis of how profitable it is to permit us to live.

The bulk of the additional costs of healthcare in the US come from the fact that the healthcare system is run like a business. Or at least has changed to be that way in the last 50 years. Individual practitioners or a two-physician partnership are a vanishing institution, along with the nurse-receptionists that worked for them. In its place are huge religious, university, or private health care systems with multi-million-dollar CEOs or administrators and an hierarchy of highly paid non-providers and support staff, marketing budgets, huge billing and collections staffs, and lobbyist fees. That is huge growth in non-essential overhead.

And since the 1960s, too many physicians (especially specialists) went to medical school not to practice medicine but to get a license to print money. The ones who succeeded are those who are senior partners of a specialist practice. The financial failures are the primary care physicians who work for huge health care systems.

Finally there is upcoding of services presented to insurers and DHHS. Consider a simple blood test for warfarin maintenance. Have a lab tech do it and charge $70; have an RN do it (badly) and charge $170. Insurance balks at the $170; patient winds up with out-of-pocket $130 instead of $30.

The “Grand Human Experiment” embodied by Jefferson’s all men created equal with inalienable rights to life, liberty, and pursuit of happiness is officially over. Never really had a good foothold either IMO.

I agree with most of what you say, especially that the problem is it is run like a business with business values now. As to what has happened to the doctors; mostly bad and not just the lust for money which many took up but the death of the whole philosophy of Osler and thousands of years of tradition. Now it’s just knowing how to read “guidelines” and write prescriptions suggested by your local pharma and insurance friends. It is not surprising that just recently a serious article appeared in JAMA suggesting cutting medical education by 2 and more years.

Speaking of guidelines here are the latest developed by some of the specialties under pressure from the board ACA sets up are awful and could be described as slow euthanasia in many cases, especially once you hit 80.

Well, what do you expect in a country where health care is provided on a for profit basis?

lol.

That might be worth looking into……

Then again, greedy doctors, greedy insurance companies, greedy drug companies…….that could be a contributing factor too.

Sometimes, SOMETIMES, the answer is right under your nose.

there is the pre-born segment also. Our rights to life etc. are now defined on the basis of how profitable it is to permit us to live.

Is this supposed to sound pro-lifey?

OK,OK, OK…I’ve got a solution…….a constitutional amendment prohibiting anybody from reaping huge profits off living, soon to be living, dying, or dead people. Aren’;t we granted “life, liberty and the pursuit of happiness” IN the Constitution. Nobody should be able to exploit that for their own ill-gotten gain.

Damn, if only our forefather and foremothers had anticipated that problem.

I’m more alluding to that we live in a global economy, with a global product system. It’s hard to imagine there are more than a handful of companies that make an MRI system. How can an MD in Japan afford to provide an MRI at 1/10th the cost if they pay the same price for the machine and the maintenance and servicing? I posit that they can buy the machine for 1/10th what the manufacturers expects in profit, and in the US consumers pay 9/10th of the expected profit. Same with drugs and all the other hardware. I’m not saying greed isn’t a factor. I am sure there are people who love money enough to compromise their moral standards. We get into deeper waters though when we start asking what is a ‘fair’ profit.

We need to take the profit out of the system.

Doctors, nurses, hospital CEO’s, everyone in insurance and everyone else associated with the healthcare industry should be paid the national average of $48,000 per year. If it’s good enough for the house painter, it should be good enough for health care professionals. After all, healthcare is a right.

I say “pay for performance”. If they make you better, they get paid more. If they make you worse, less.

We get into deeper waters though when we start asking what is a ‘fair’ profit.

Only because of a person’s self-interest.

A fair profit is the amount required to allow the business to do business in the future. To many business owners confuse profit with entrepreneurial rent of owning the business; most take that out of the business as part of their tax deductible CEO salary.

For corporations, the bonuses that executives take out of the corporation are essentially theft from their own company because it drives the need to have a greater percent of profit in order to ensure that the firm can keep functioning.

And every bit of money the Bain Capital takes out of stripping companies of their assets is “unfair profit”. It’s not even rent. It is also theft from the workers whose pensions got stolen, workplaces dismantled, and livelihood sold off.

And none of this involves Marxian analysis at all.

We need to stop pretending that the provision of healthcare is a market relationship. Markets allocate scarce goods and services based on ability to pay. That rule ensures that people are denied healthcare and thereby die.

Even the US healthcare system doesn’t work that way. ER’s cost-shift from patients who cannot afford to pay to patients who can and have no other choice. That’s because hospitals don’t like to see people die in the ER waiting room because they can’t afford a walletectomy.

The lack of preventive and primary care that operates on the same basis means that dealing with health problems are often delayed until they are expensive enough for the ER to treat.

Single-payer coverage would do the cost shifting through the tax system and not through price inflation by hospitals and insurance companies. And would permit preventive and primary care services that could reduce loads on ERs.

I’ve never been an executive, so I don’t know how it works exactly, but aren’t the bonuses that executives take out of the corporation approved by someone higher up, or a board of directors or someone?

Don’t corporations usually start with sales projections or some baseline that executives are expected to meet, and if they exceed, that is when bonuses kick in? If that’s the case, then they’re not taking unfair profit, but a portion of the “extra” profit that they are responsible for.

I don’t think it is really that complicated. Profit today is determined on the basis of who has the most power. Sick people have no power because of their need. Also there is no such thing as optional levels of care. It is either good enough or not good enough.

We so far do restrict profits of certain necessary services and “natural monopolies.” called utilities. I think it is more than possible to separate ares of service into those where the need is universal and those in need are powerless to choose from competing programs.

I am all for entertainment and gambling and frivolous gadgetry being provided by an un regulated free for all. It just doesn’t work for the necessities in a civil society.

I understand there can be some savings, but Medicare hasn’t fixed the problem, especially if you have to refactor the “doc fix” every year.

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

Also there is no such thing as optional levels of care. It is either good enough or not good enough.

Heh, reminds me of the weatherman. “Fifty percent chance of rain again today, either it’ll rain or it won’t.”

Do you want treatment for your illness to be determined on the basis of “will it relieve the suffering?” or “will it be cost effective to the society to treat this illness in this person?”

Today we are rapidly falling into the mindset that human need and suffering are secondary to their value as profit producers for the some.

Medicare has not fixed the problem precisely because of the Doc-Fix every year. And Medicare has gotten to the point where deductibles and co-pays discourage seniors from preventive (not covered extensively) and primary care. And no one has demonstrated that system works any better than it did when there were no deductibles and co-pays and Medicare picked up the entire bill. The result is that cost-effective preventive and primary care does not occur, meaning that even under Medicare conditions are delayed until they are both serious and expensive. And too many Medicare patients wind up with out-of-pocket cost far above what Medicare allows because Medicare has ceased to be the advocates for seniors in cost disputes.

I agree wholeheartedly! There is another factor involved in so-called health insurance — the staff that doctors must hire to take care of the paperwork for the insurance companies, coordinate approvals, etc. It is absurd!

Thirty years ago, I paid $30 for a doctor’s office visit. Today, that same visit costs as much as $200, except I still pay $30.

What would happen if we began calling “health insurance” something else, such as prepaid healthcare, and passed a law stating that prepaid healthcare could be sold and administered only as a non-profit product?

Love you last sentence. Very true.

We SOOOO have the fixes that this healthcare/health insurance crisis require. But our “bought and paid for legislaturds”, whose benefactors have a big stake in the status quo, will not enact them.

Of course, I guess we must wait and see what the SCOTUS rules. For the meantime, to quote the republicans, “If you’re poor, please die quickly.”

Thanks, Jon, for an excellent article.

I’d like to recommend the following article, which fills in all of the details behind your claim: It’s The Prices, Stupid: Why The United States Is So Different From Other Countries in the journal Health Affairs by Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey and Varduhi Petrosyan. It was first published in 2004 but has been updated since.

Secondly, I’d like to note that we spending 17% of our GDP on healthcare, while other developed countries (OECD) spend 10% of theirs and cover all of their people. Also in quality of health care we rank near the bottom of OECD countries.

Finally, let’s note that we have a GDP of $15 trillion. 10% of that would be $1.5 trillion, which is what we’d pay if were were as efficient as those other OECD nations. But we are spending $2.5 trillion per year and for inferior care. In other words, the waste is a trillion dollars per year.

So, where does all of that money go?
* We pay about $300 billion per year for drugs, which is about three times what other nations would pay for the same pills, etc.
* We pay a couple hundred billion more than we should for insurance.
* Hospitals load up their charges a great deal.
* We spend way more on paper work. For example, primary care in the U.S. is essentially a cottage industry. Each practice keeps its own records and is reluctant to share them because they constitute that practice’s competitive advantage.

The list goes on. But the basic problem is that American capitalism and the unseen hand have failed us.

Another issue is “useless” services and procedures designed to either CYA or line the pockets of doctors groups.

For example, my elderly mom hurt her knee. Its been a month and she has had several doctors visits but has yet to recieve ANY MEDICAL CARE!

Here is how it goes. She makes an appointment to see her doctor and waits a week to get in. He spents a few minutes with her before “refering” her to an orthopedic that she cant just see on her own. She then makes an appointment and waits days to see him. She sees him and he spends a few minutes with her before sending her to another location to get X-Rays at a facility owned by a doctors group.. (now back in the day you could xrayed and go over them in one visit). Then she has to make an appointment for the following week to go over the xrays. The xrays didnt show anything so now they want to do an MRI.

So my mom is out co pays and they want her to cough up more for an MRI… they havent even given her a tylonal or an ace bandage. They wont do anything for her unless she gets the MRI which she literally can not afford.

So she and the government have dropped some cash on the medical industrial complex for nothing but making her drive all over town

The list goes on. But the basic problem is that American capitalism and the unseen hand have failed us.

Bingo!

Another point. It’s been clear for a long time that the US has been paying for 50% more of its GDP than other OECD nations for inferior health care. As Gerard Anderson and Uwe Reinhardt put it in the title of the article I referenced above, “It’s the prices, Stupid.”

So, when Obama decided to fix healthcare, what was the first thing he took off the table? The prices. He cut deals with PhRMA, AHIP, the insurers cartel, etc. Everyone was guaranteed that they’d not lose money, which guaranteed that the “real problem” would not be fixed. An opportunity tragically wasted by the cowardly Obama and the ever so clever Rahm Emanuel.

Every element of the health care sector is sucking as much money out of all of us it can get. We are fools for fighting to keep the system we have. We are manipulted by political slogans and wining theives. We need to throw it all up in the air and start over. And single payer also needs to be in the toss up. A friend called what we are doing “rearranging the chairs on the Titanic.” So true.

Take a look at some of the executive compensation revealed over on the Healthcare Renewal site. The boards of most of these healthcare corporations are cronies; they insist they must pay ‘market prices’ to attract the best talent. Then, when best (or mediocre) talent loses money–like the banksters on Wall Street–they get raises, bonuses, etc. You (like most of us) have instilled in our DNA a belief in fairness. FAIRNESS don’t exist at the elite level.

AMEN!

Nobody understands why things cost so much in our so called healthcare system, not even the people who supposedly run it. It’s just another bubble waiting to destroy the economy and then the elites will profit even more when we have to bail them out.

After 2 -3- maybe near 4 decades of the Maryland price procedure approval board (for what 3rd part payers can pay for a procedure in Maryland), why do we pretend cost/procedure controls are so unAmerican?

Add a bit more teeth to the Maryland model and we have a solution.

But that solution will not be fair to Doctors as long as we kiss the butt of the student loan industry and insist our medical professions not get a free education – but instead they must graduate with $250,000 of debt that require high fees to service if they are to survive economically.

None of this is rocket science – the only conflict is kissing off some contributors/contributions to ones campaign money collectors.

So it is nor going to happen under Obama.

That 30% counts only what the insurance companies take. To accurately assess their total cost, it is necessary to add the additional burdens they bring – complex rules require significant resources to file claims, track those claims, appeal those claims, etc. Additionally, some value should be assigned all the damage insurance companies do. Estimates of some 40,000 excess deaths are commonly assigned to lack of insurance; there is surely a significant additional population whose lives are substantially damaged or ended by denial of coverage for those who thought they were insured. I do not know what that amounts to, but when I talk about all this with my siblings who are doctors, their estimate of the actual cost of using insurance companies as gatekeepers is in the neighborhood 50% more or less of total health care expenditures.

Keep saying it. Our current health care system is ripping us off and siphoning of the dollars we need for everything else.

Repeat. Repeat. We DON’T need to zap Social Security. We DON’T need to turn Medicare into a voucher system. We just need the US government to do some of the things every other developed country in this world has stepped up to do.