The cost of the US healthcare system

[MillCreek]

http://seattletimes.com/html/health/2021534364_healthcarejointsxml.html

The latest in a series of articles by the NYT on how the cost of the US healthcare system does not always correspond to results, compared to other countries.

[Tallpine]

The terms "healthcare system" and "justice system" are both oxymorons.

[Perd Hapley]

Does the US actually have a "healthcare system," now? We used to have this thing called "freedom," under which people were able to take advantage of various means of health care. We didn't have a centralized system of health care.

[Tallpine]

Does the US actually have a "healthcare system," now? We used to have this thing called "freedom," under which people were able to take advantage of various means of health care. We didn't have a centralized system of health care.

Based on observation, I'm thinking that we have a "medical malpractice" system. 

Or maybe Billings MT is not a good place to get sick or have surgery 

Our neigbor had to go to ER several times including I think two ambulance rides before they finally figured out that she had a post-op blood clot in her lung. 

Her surgeon had no idea why she missed a follow-up because even after her asking for them to call him while she was in ICU - they never did.

The best way to save money on "healthcare" IMO is to stay far away from hospitals and doctors.

[Ryan in Maine]

That article caught my eye earlier since I think my Nan will be needing one within a few years if she wants to keep an active lifestyle.

His cost in the US
Hip implant (list price) $13k
Hospital fees $65k
Surgeon fees unknown

His cost in Belgium
Hip implant + hospital fees + surgeon fees + round trip ticket $13,660 total

Savings $64k+

The kicker: The hip implant, whether in the US or in Belgium, comes from the same place (Warsaw, IN.)

We'd have to get creative paying for something like that in my family.

[lupinus]

They also pay anywhere from 25-50% in income tax, a 21% VAT, and other various regional and property taxes.

Not hard to heavily socialize the cost of care when you are taxing the snot out of your population, price fixing, and all the other lovely things we see in heavily socialized European healthcare systems (as I understand it, don't forget to bring your own towel while you are at it...)

[Fly320s]

Does the US actually have a "healthcare system," now? We used to have this thing called "freedom," under which people were able to take advantage of various means of health care. We didn't have a centralized system of health care.

Bears repeating.

[MillCreek]

Does the US actually have a "healthcare system," now? We used to have this thing called "freedom," under which people were able to take advantage of various means of health care. We didn't have a centralized system of health care.

Absolutely.  As long as you could pay for it.

[Fly320s]

Absolutely.  As long as you could pay for it.

Paying a person for a service performed?  Sounds legit to me.

[Levant]

Based on observation, I'm thinking that we have a "medical malpractice" system. 

Or maybe Billings MT is not a good place to get sick or have surgery 

Our neigbor had to go to ER several times including I think two ambulance rides before they finally figured out that she had a post-op blood clot in her lung. 

Her surgeon had no idea why she missed a follow-up because even after her asking for them to call him while she was in ICU - they never did.

The best way to save money on "healthcare" IMO is to stay far away from hospitals and doctors.

My wife had a brain aneurysm rupture and lived to tell about it - barely.  After the initial brain surgery, by a brilliant neurosurgery team, things were going so well we thought she'd be home inside of two weeks - perhaps sooner.  Then a nurse made a mistake which was totally against what the doctors had said should be done.  After it was done, the doctors swore it was exactly what should have been done, backing the nurse 110 per cent.  My wife spent 6 weeks  in a coma, months in inpatient rehab, and will likely live with a tracheotomy for the rest of her life, or sacrifice her vocal chords to the knife, as a result of the mistake and the failure to respond to the mistake because response would have been an admission that a mistake was made.  Oh, and the bills were over a million dollars.

In the care following that million dollars there were more mistakes made resulting in weeks in intensive care and the hospital not related to her aneurysm.  It has been more than year since the initial aneurysm and she is still having surgeries to repair damage done in the hospital that had nothing to do with the aneurysm itself.  Her next operation is next week.  Maybe, if they don't screw anything up this time, it will be the last.  But we've been holding on to that hope through several operations and situations that have all gone badly.

Your best hope in our for-profit medical industry is to get in and get out quickly.  Once one mistake is made, then you end up in the "system" longer and the longer you are in, the more mistakes are made.  

I work for a great company with great insurance.  But we do not have a medical care system.  We have for-profit medicine industry.  I won't say that there's no care at all in the industry but they are very rare exceptions.  As rare in the medical industry as are folks like Snowden in the spying-on-Americans industry.

[AZRedhawk44]

Paying a person for a service performed?  Sounds legit to me.

Anything else is slavery.

[Levant]

Anything else is slavery.

What would you call it if you fell over a cliff and were hanging by a root that was breaking and I was sitting on a nearby rock, dangling my feet over the very cliff and had a strong rope in my hands - and I knew how to use it.  And I say to you, I have this rope.  It can save your life.  If you promise to pay me $100,000 and obligate your estate for the full amount in case my effort isn't enough and you die anyway. 

Would that obligation be just another case of services rendered?

[AZRedhawk44]

What would you call it if you fell over a cliff and were hanging by a root that was breaking and I was sitting on a nearby rock, dangling my feet over the very cliff and had a strong rope in my hands - and I knew how to use it.  And I say to you, I have this rope.  It can save your life.  If you promise to pay me $100,000 and obligate your estate for the full amount in case my effort isn't enough and you die anyway. 

Would that obligation be just another case of services rendered?

If that's how your conscience is served, sure.

But that's not a parallel argument.

You're not in the profession of cliff-hanger-saving.  If you were, you would have competition and there would be an established comparable fee schedule for services rendered.  I could choose to use a different cliff-hanger-saver, and you would be aware of that.  If I were climbing a dangerous cliff known to be tricky, there might be several cliff-hanger-savers loitering nearby and you each have competed for several years to establish a base price and then have relative prices that differ slightly based on prior success rate or inventiveness of technique.

If you weren't a professional cliff-hanger-saver, then you're a peer climber and would expect similar salvation from other climbers if the roles were reversed.

In the case of medicine, it's the Free $hit Army again.

Single payer, medicine becomes a practice where compensation is dictated.  Then it's just a matter of the government deciding that:
1. All doctors are worth the same for procedures rendered, regardless of inventiveness or skill.
2. All procedures can be compensated less and less until the income of doctors is dictated by government fiat.

It may be a nice looking plantation, but it's still slavery.  And the plantation will get less and less money as other money is wanted elsewhere.

Eventually your doctor is on par with your postman or county court clerk.

[Levant]

If that's how your conscience is served, sure.

But that's not a parallel argument.

You're not in the profession of cliff-hanger-saving.  If you were, you would have competition and there would be an established comparable fee schedule for services rendered.  I could choose to use a different cliff-hanger-saver, and you would be aware of that.  If I were climbing a dangerous cliff known to be tricky, there might be several cliff-hanger-savers loitering nearby and you each have competed for several years to establish a base price and then have relative prices that differ slightly based on prior success rate or inventiveness of technique.

If you weren't a professional cliff-hanger-saver, then you're a peer climber and would expect similar salvation from other climbers if the roles were reversed.

In the case of medicine, it's the Free $hit Army again.

Single payer, medicine becomes a practice where compensation is dictated.  Then it's just a matter of the government deciding that:
1. All doctors are worth the same for procedures rendered, regardless of inventiveness or skill.
2. All procedures can be compensated less and less until the income of doctors is dictated by government fiat.

It may be a nice looking plantation, but it's still slavery.  And the plantation will get less and less money as other money is wanted elsewhere.

Eventually your doctor is on par with your postman or county court clerk.

It is exactly a parallel argument.  When my wife's aneurysm ruptured, we didn't have an opportunity to interview neurosurgical teams, nursing teams, respiratory therapy teams, hospital administrators, or even the janitorial services whose job it was to keep the place sanitary so she didn't get MRSA - which she got, by the way - another probably lifelong ticking bomb she will carry.

We didn't get to find the best at each job and then take services from the best for each step of the journey.  We went to a local ER.  They drove her to Tulsa with lights and sirens because there were severe storms going on and the lifeflight helicopter couldn't fly.  The local ER chose the hospital to take her to based on their partnership agreements and availability.  No price lists, no resumes, no customer testimonials. 

That's the nature of medical care.  It is a large team that you don't get to choose.  When you get to make a superficial choice because you have a couple non-emergency visits to a doctor ahead of any surgery or critical care, you only barely touch the surface.  While my wife waits for surgery in a week, her condition gets worse.  If she makes it the week, we have full confidence in the doctor who is going to do it.  Since we're in a capitalistic society, we can choose to wait for the week or, if her condition worsens to a critical point - and it might - we can choose to wait and risk death or go to the ER and have whatever surgeon is on duty or call.  But you're right, the system is so wonderful to give us that choice.  Liberty,freedom, and unbridled capitalism at its finest.  If we don't like it we can choose to go ER hopping.  If we can't afford it or insurance won't pay for ER hopping, well, then we just can't afford it.  Capitalism.

Medical mistakes are the 6th biggest killer in the US.  http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm

If you take the GAO's numbers for hospital deaths, disregarding deaths from medical mistakes outside the hospital, you get 44,000 per year, still #8 if you insert their number into justice.org's list.  http://www.gao.gov/cghome/healthcare/img44.html

Eventually your doctor is on par with your postman or county court clerk.

Well, we agree on one thing: doctors should not be slaves.  If they don't want to be doctors they can always choose to be postmen or county clerks.  Or computer programmers or car mechanics.  If at any time they feel like the rewards for being a doctor don't meet their needs, they should quit being doctors.  Thank goodness we live in a free society where they get to choose their career by weighing the reward, both financial and personal, that they would receive.

We have a broken for-profit medical industry.  We do not have a medical care system.

[TommyGunn]

It is exactly a parallel argument.  When my wife's aneurysm ruptured, we didn't have an opportunity to interview neurosurgical teams, nursing teams, respiratory therapy teams, hospital administrators, or even the janitorial services whose job it was to keep the place sanitary so she didn't get MRSA - which she got, by the way - another probably lifelong ticking bomb she will carry.

We didn't get to find the best at each job and then take services from the best for each step of the journey.  We went to a local ER.  .....................

In a catastrophic event such as what happened to your wife you will not have the time to find a "doctor of your choice" no matter what the system is.  A ruptured aneurysm will kill someone very quickly if not repaired -- I'm sure you know that.
Over two decades ago my father was diagnosed with liver cancer.  The condition was fatal if untreated but it gave him time to search out a doctor who was best able to deal with the matter.  He even considered going to Japan as he'd read that a lot of research into treatments for his particular cancer was being done there.   He wound up finding a doctor in a Pittsburgh, PA hospital (interestingly he was of Japanese descent though an American citizen) who he thought best able to help.
The surgery went OK and I think he lived longer for it than without, though eventually he did succumb.

It is nice to think that doctors aren't "slaves" because they can quit and find employment elsewhere .... perhaps as ditch diggers or whatever.  But many doctors have expressed a desire to leave medicine due to the implementation of Obamacare and like it or not, they are not all bluffing.  Not all, but many will resign -- and some who have said nothing will also resign.  Furthermore the intense regulation will cause many students who might be interested in medicine to turn elsewhere, and eventually we will have a doctor shortage and that will do considerable damage to our health care.
My parents spent three years in Scotland in the 1980s and had opportunity to deal with their socialized medicine, as well as learn what other peoples' experiences were.  Long waits to see specialists -- months.  A chronic shortage of even highly used medications.  And the paperwork.......
I could go on with some horror stories. And to be fair I could point out that my then 95 year old grandmother died there but did receive some good treatment with regard to her drug regiment while she lived there.
In short that's not a system I want here.
If you're going to fall off a cliff you will never have a chance to take a calm and informed decision on who to rescue you -- you'd better hope that one guy sitting there is a miracle-worker.  
Other people will have other experiences .... no less life threatening. And neither is fair....life just ain't that way.

[Perd Hapley]

Absolutely.  As long as you could pay for it.

The lack of one overarching "system" doesn't preclude health insurance, charity, or even a certain amount of government-subsidized health care.

[MillCreek]

If you think you can shop for healthcare by price, I suggest you call your local hospital and physician and try to get an accurate estimate for various services. Good luck.

[RoadKingLarry]

Levant, did your wife's ordeal happen to begin at Hellcrest Hillcrest?

[lupinus]

If you think you can shop for healthcare by price, I suggest you call your local hospital and physician and try to get an accurate estimate for various services. Good luck.

Bwahahahaha

Do you have enough popcorn for two?

[makattak]

If you think you can shop for healthcare by price, I suggest you call your local hospital and physician and try to get an accurate estimate for various services. Good luck.

So what you're saying is that we don't have a market based healthcare "system"? Gee, what a shocker given government meddling since the 40's...

[Tallpine]

If you think you can shop for healthcare by price, I suggest you call your local hospital and physician and try to get an accurate estimate for various services. Good luck.

It seems to be some sort of great travesty in their opinion to even dare to ask. 


Back when our twins were born, we actually arranged to build some fence for our doctor to pay for the pre-natal and delivery fees   

[MillCreek]

It seems to be some sort of great travesty in their opinion to even dare to ask. 


Back when our twins were born, we actually arranged to build some fence for our doctor to pay for the pre-natal and delivery fees   

We will recall the article from Time magazine that I posted here a while back on healthcare costs: http://www.time.com/time/magazine/article/0,9171,2136867,00.html.

In many respects, it can be almost impossible to give you an accurate estimate for most areas of healthcare.  It is because until a bill is submitted to insurance, no one knows exactly what they will pay, and no one knows exactly what care you will require.  It is as if you take your truck in for an alignment for a quoted price of $ 300, and once the mechanics get in there, they discover you need a new set of struts for a few thousand more.

One area of healthcare that can give you a more reasonable estimate are the outpatient procedure types of care, like dentistry and elective plastic surgery.  A dentist can usually give a reasonably accurate estimate of how much that crown will cost and how much your insurance will cover.  A plastic surgeon can quote you $ 10,000 for those breast implants done in her office surgery suite.  Since this is not paid by insurance, they can tell you accurately how much you will owe.

But asking your hospital how much it will cost, all told, for an appendectomy, or your internist how much it will cost for your diabetes followup visit, and how much you will owe after insurance, they cannot give you an accurate estimate.

I think this is one of the great areas of improvement in healthcare.  For example, at my healthcare employer, we had our healthcare insurance moved to a HSA plan so we will all be more savvy consumers.  We work in the business, and we can't find out the cost of things.  All I know is that the first $ 1500 of all healthcare comes out of my pocket, and the rest is covered by insurance to some unknown degree.  I can call my internists office, and they can tell me that an annual physical is around $ 220, but they cannot tell me how much the labs will cost, since they don't know which ones the internist will order.  Labs and imaging are the great profit centers of outpatient care, and I usually pay more for the labs than the office visit.

Some of the retail clinics that don't take insurance have a menu of services on the wall, which I think is a great idea.  You go in and you see: 15 minute office visit: $ 125, urinalysis: $ 35 and so on.  I wish all healthcare facilities would do this. There could be more price transparency without insurance if everything was paid for with cash at the time of service.

[Tallpine]

I can get a mechanic or contractor to estimate cost within a reasonable variation.

[MillCreek]

I can get a mechanic or contractor to estimate cost within a reasonable variation.

Exactly.  Based on what they knew when they made the estimate.  But when they tear off the sheetrock and discover extensive mold that was not part of the job bid, that estimate goes out the window.

[Tallpine]

Exactly.  Based on what they knew when they made the estimate.  But when they tear off the sheetrock and discover extensive mold that was not part of the job bid, that estimate goes out the window.

Yeah but the medical industry generally refuses to even quote the rate for a non-complication procedure.

And if a contractor busts a window, or a mechanic drops a screw down the intake, he has to pay for the extra repair costs, not me