US Health Care Costs
http://thedianerehmshow.org/shows/2013-02-27/us-health-care-costs
According to journalist Steven Brill, the Affordable Care Act changes some of the rules about who pays for what in health care, but a basic problem remains: the cost. In a lengthy cover story for Time Magazine, he explains why labs, drug companies, hospital administrators and the purveyors of medical equipment make so much money. He also explores why doctors who don’t game the system are getting squeezed and why patients, especially those under 65, are left holding the bag. Join us to talk with Steven Brill about why we pay so much for health care in the U.S. and what we can do about it.
Guests
Steven Brill
journalist and author of "Bitter Pill: How outrageous pricing and egregious profits are destroying our health care," a special report for Time Magazine's March 4, 2013, edition.
Bitter Pill: The Exorbitant Prices Of Health Care
Steven Brill talks to TIME about his cover story on the outrageous pricing and egregious profits that are destroying our health care.
Comments
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The VA negotiates significant discounts with the drug companies. So does the Canadian government. Prices are no secret. The difference is the amount of money our elected leaders need from big Pharma to continue wing employed.
I was being treated at the dentist yesterday. I think we all are observing how bad teeth are an indicator of increasing poverty under USA austerity. I started that ball rolling and was treated to a Libertarian lecture by my 30 year old dental surgeon as he replaced a failed filling. He says dentistry is where the rest of medicine was in the 80s as far as the costs and price structure. He dreads the very idea of "Obamadent." The thing he detests most is captive competitors on corporate payroll working in dental sweatshops. He insists they drive up costs and diminish the quality of care. If he could he'd regulate dentistry (except for clinical surgery) to sole practitioners and partnerships. Dr. Jim explained how he maintains his and his staff's integrity and keeps prices (and interest rates on financed work) down by assuming ethical responsibilities most people wouldn't want. As he was polishing my restoration his wife (also a dentist) peeked in to solicit my contribution for their next sojourn to provide free care in Haiti. Today I'm mailing their church relief group a check. Let me thank them here for a better mouth, and for firsthand information to put in it.
I live between Paris and Bethesda and was recently prescribed by a DC doctor (who charged me $620 for x-raying my knee and a 10 minute discussion on art) an anti-inflammatory drug, Voltarine. The local pharmacy wanted $140 for a single packet of tablets. I declined to pay as I was going to Paris the next day. My local pharmacy in the 7th arrondissement sold me the same packet for 6 euros (about $8). A few months ago my daughter had an ear ache, we visited our local paediatrician and was charged $120 for a short examination and given a prescription for a small tube of swimmer's ear liquid. Tge CVS pharmacy asked $180 and with our health insurance card got $50 off. The same medication in my Paris pharmacy cost 7 euros ($9.30). Why are Americans charged more than 20 times as much as someone buying the same drug n France?
Kyra Wolfe:
"Why is it so hard for the U. S. to adopt a national health insurance program without insurance companies when the facts (yes, facts) show that is the only way to keep health care affordable - even if not all are insured? Because of the disinformation campaigns by the health insurance companies who will lose billions each year designed to scare people into voting against their interests. I work in health care. The insurance companies are unnecessary middlemen who actually interfere with us getting quality care. It's long past time for them to go."
You say, "yes facts", as though nationalized healthcare is the only solution. It isn't. What is sorely missing in the health insurance industry is competition. Brill talked about that with his Connecticult example. When you're the only game in town you can charge what you want and people have to pay. Republicans fought for health insurance being sold across state lines in the ACA to create the competition we need. It has worked extraordinarily well for auto insurance. Democrats wouldn't hear of it and it didn't get included. Failing that, I would not be opposed to health insurance companies becoming "mutuals" (non-profit) again. I would much prefer seeing competition to reduce insurance costs or removing the profit motive all together before we nationalize 1/6 of our economy.
Drug costs: My dog came down with a life threatening systemic fungal infection. She needed two tablets of itraconazole each day for one year. In the U.S. each tablet of itraconazole was $14.00 - or $28.00 per day. We found the same tablet through a Canadian pharmacy for $2.00 per tablet - or $4.00 per day. That difference in price made it possible for us to treat her instead of euthanize her. Certainly at least we should let Medicare negotiate for the price of drugs. The Veterans Administration can and saves almost 50% on drugs each year. After all, the taxpayers fund most of the basic research on these drugs yet we can't access them at affordable prices.
It is difficult to separate the cost of drug production from the cost of research to produce the drugs. The reason that drug companies charge more in this country is because they need to generate income somewhere to fund the immense research efforts that are required to combat new drugs. Most drugs never make it to market, for a variety of reasons, but it is impossible to predict which will be successful until the research is done. This is very costly.
In October 2010 I underwent a cardioverision (an kind of electroshock) to take me out of atrial fibrillation. The total cost of this procedure was about $6,200, all of which was covered by Medicare and BC/BS. In July of 2012 I had exactly this same procedure performed by staff doctors at a hospital in Bochum, Germany; the total cost, which included about 8 hours in a hospital room with lunch, was 650 eurors, about $800 at that time. Explain?
In October 2010 I underwent a cardioverision (an kind of electroshock) to take me out of atrial fibrillation. The total cost of this procedure was about $6,200, all of which was covered by Medicare and BC/BS. In July of 2012 I had exactly this same procedure performed by staff doctors at a hospital in Bochum, Germany; the total cost, which included about 8 hours in a hospital room with lunch, was 650 eurors, about $800 at that time. Explain?
I'm sure the lefties will laugh at this, but have you seen what Glen Beck is up to on the Blaze, and the high quality shows he's putting out. I never thought much about him before because he seemed to be literally crying about something every time I tuned in so I tuned out. I completely underestimated his intelligence and his honest approach on the issues. The man is nothing short of a genius in my view.
My dentist's description of dentistry being at the cost and price structure where the rest of medicine was in the 80s, if it is accurate provides a terrific opportunity to experiment. I think Dr. Jim is correct, as other commentators insist, that medicine has too many middlemen and too much of the corporate dynamic. If we could keep dentists independent that would provide a comparative test against medicine as it exists. I'd like to see it tried.
Now I don't mean dental insurance doesn't have a place.
And I don't mean that wages should not go up for most people compared to corporate profits and executive compensation. I'm just excessively tired of looking at poor people's rotten teeth, knowing they are dying from lack of care, and seeing the malaise spread upward through the income ranks. Dr. Jim thinks some of his patients need to disconnect cable TV so they can buy his care. He's mostly right.
isn't this all just viscious cycle? what about the tv commercials that are malpractice attorneys for procedures or medications? isn't this all just 'cya'? aren't costs high because they feel they must cover their own butts with unscupulus lawyers or greedy clients?
What does Mr. Brill recommend that we, as citizens, do to correct this egregious problem???? Please help us understand how to change the system.
Pancake Rankin wrote: "I started that ball rolling and was treated to a Libertarian lecture"
I hope you learned something.
It's an ongoing removal of wealth from the middle class by corporations.
Politicians have been working in collusion with wealthy corporations thru lobbyist to steal from the working middle class. The people working in this criminal health caresystem go along to guard there paychecks.
There is no one doing investigative reporting to keep a check on anything, but this is such a low, people dying for profits.
Thanks you for such interesting shows.
I write as a reflexologist for many years and as a vegetarian/vegan
for 25 years. There are endless discussions about this topic that continually go around in circles but they NEVER get to the real issue. We do not have a
"health care" system, we instead have a DISEASE CARE SYSTEM which
is completely dysfunctional. It relies on drugs, operations and expensive tests
to figure out what is wrong.
Hippocrates stated "do no harm", and, "let food be thy medicine and thy medicine be thy food", yet the medical establishement continually dicounts
and ignores how their methods DO harm, and how diet helps heal diseases.
There is an M.D. in California, Dr. Dean Ornish who "cures" people with
"irreversible" heart disease by putting them on a vegan diet/lifestyle, Dr. McDougal is another doctor who changes people's health by dietary changes. Dr. Fuhrman another Dr. with the same focus has been on
PBS stations with his vegan dietary suggestions for health.All of these
vegan doctors "get it"---change your diet, your health problems disappear
and your health improves.
The way to deal with illnesses is to see them as a result of poor lifestyle,
malnutrition and a lack of prevention. As long as the dysfuctional and existing system focuses on tests, medical drugs/operations the system will continue to fail people and those people will look outside the box for answers. Health "insurance" gives people a false sense of
security because they need to PREVENT the problem from happening instead of inefficiently "treating" it after it happens.....namaste', rachel
I saw Steven Brill on Jon Stewart and rushed out to buy TIME. I was up until 2AM reading it last night.
What can we do? The article made me angry...but none of the solutions were seen as realistic. What can we do to change this system to be reasonable?
This timing of this piece couldn't be better. There was a segment the other day on the news showcasing little-known hidden tricks to lower the cost of prescription drugs. This only goes to show that there is a great deal of flexibility within the health care market in terms of creating policies effecting affordability and pricing that could considered when addressing costs!
Saving Money on Prescription Drugs - Little Known Tricks
patti from penn... wrote:
"isn't this all just viscious cycle? what about the tv commercials that are malpractice attorneys for procedures or medications? isn't this all just 'cya'? aren't costs high because they feel they must cover their own butts with unscupulus lawyers or greedy clients?"
This is my other pet peeve about ACA, and you are right. I already brought up the idea of creating competition by allowing HI companies to sell across state lines which was left out of the act. Also left out was tort reform because of the ABA lobby. It would also help to reduce costs.
The reason there are high prices and there is no incentive for insurance companies and others are profits as a percentage of business. An insurance company makes a profit by charging 100% to rate payers (the insured) and paying out 95% (or some other level, your guest will know) to health care providers (the hospital, doctors, etc.). If there is $1 billion dollars of business, then the insurance company gets to keep 5% or $50 million. If the insurance companies work to reduce the $1 billion to $800 million (20% reduction) and reduce rates to the insured, and still keep 5%, then they only get to keep $40 million. This cost them $10 million. Why would they do that? Would an insurance company CEO get to keep his job? That is why other countries put reasonable price controls on profits. Then the CEO can say “It’s not my fault” and can try to squeeze more profits by efficiency rather than keeping up the gross sales.
Americans have been trained to blindly believe in The Market as the only way to effectively allocate goods and services. But it's simply a fact that the health care sector does not follow the laws of the market. Think about a couple of basic questions: when was the last time any of us comparison shopped for a medical procedure? when was the last time a prospective seller offered us a guaranteed health result (as opposed to simply a fee for service provided)? do we as prospective buyers have good information about the procedures being offered? The health industry simply does not follow the laws of the market. And, like other sectors of the economy that do not follow the laws of the market, the health sector should be run by the government.
See Kenneth Arrow's (one of the grandfathers of modern economics) 1963 paper exploring this question: http://www.aeaweb.org/aer/top20/53.5.941-973.pdf
The medical-industrial complex has conspired with some of our politicians to fool us into thinking the market is the solution when in the case of the health sector, the market leads to the very behavior that Brill chronicles in his article. No accountability, high prices, low quality, etc.
We need to get over our blind trust in markets when it comes to the health industry.
I haven't read the article in its entirety, but wonder if Mr. Brill used or considered approaches outlined by Drs Marty Makary and Ben Carson in his research. It seems like both doctors' approaches focus on the patient as a consumer who should be driving (demanding) the medical marketplace...the Yelp Review/personal budget industry model.
Max from the Burgh wrote:
"And, like other sectors of the economy that do not follow the laws of the market, the health sector should be run by the government. "
Which burgh is that, Max? St Petersburgh, Russia?
When ever anyone starts an argument with "it's simply a fact", it's a red flag. I know that something other than a "fact" is about to follow.
"the health care sector does not follow the laws of the market"
Of course it does. The only problem is, a free and open market in healthcare/health insurance has NEVER BEEN TRIED in this country. Since the introduction of Medicare the FG has had its finger on the scale.
"Think about a couple of basic questions: when was the last time any of us comparison shopped for a medical procedure?"
Well, when I am paying next to nothing for treatment, (read: I have no skin in the game), why would I?
"when was the last time a prospective seller offered us a guaranteed health result (as opposed to simply a fee for service provided)?"
Excellent idea - that is a way to CHANGE the marketplace and force providers into outcome-based payment. If my plumber gets ready to leave and my pipe is still leaking, do you think he's going to get paid?
"do we as prospective buyers have good information about the procedures being offered?"
Again, when I have no skin in the game, why would I care?
Some of your premises are good, Max, but your conclusion is faulty. Let's actually try a market-based healthcare system first before we turn 1/6th of the economy over to the FG.
Have you ever heard of Angie's List, Yelp, Healthgrades or any of the other countless (medical) service provider review sites? I always check those when going to a specialist or if I need a new PCM. So, yes, the health industry can and is starting to follow a sort of marketplace model - at least many of us patients do.
auntbea had a golden nugget of a post today about how the biggest plague is corporate extraction. I could see that big parasite on the back of our medical system. It agreed with everything my dentist said (see other posts).
Some of you, like Frederick, need to outlaw those long clips and quit shooting off repetitive submissions. Have some patience, your ISP and DRShowpage ain't lightning fast, no matter what the commercials say.
It's clear to anyone who thinks about this for even a minute, our entire for profit fee for service health care system is dysfunctional and failing.
Nothing is going to change, nothing. The special interest are so intrenched and the idea that we have this so called “free market” is how America works. But people should look around, stop and take a real hard look. From flat wages and to huge increases in income disparity to health care 90% of us are getting shafted and ripped off. And we all take it like good Americans.
Most Americans agree and understand we need federally sponsored not for profit medical care and that the corporate model is killing us. I wish my doctor and I could decide what I need and estimate the price just like my dentist and I do, but that can never happen anymore. We missed that opportunity in the 1970s and 80s.The best way to discouraged deranged and pro-corporate posters is never reply to their stupidity. Leave it out there as an embarrassment. They always claim to be Libertarians while licking corporate boots. Anyone can see it. Mr. Brill is as bad as these shills. He don't want to fix nuthin', just tune us up. Diane hosted another lobbyist.
The guest had some common “straw man” arguments such as the comparison of the cost of a Tylenol in and out of the hospital. This would be similar to saying that the writer is grossly over paid because I can obtain the same amount of ink at the store for a fraction of the cost of Time. The thing to remember is you get what you pay for. I remember when the change to item pricing occurred. This was driven by the insurance (government and private) drive to cut costs and by changing the rules changed the billing practice.
I hear nothing about the loss factor. As a required provider we only collect 60 cents on every dollar billed. This is not accounted for by discounts but by non-payment and Medicaid (which pays only 1/10 what Medicare pays). This is the program that forces the greatest cost shifting and the push is only to increase the number of people who qualify
My sister is a nurse and she has a cancer that usually strikes older people. Her insurance, Healthcare Corporation of America would not cover a workup at MD Anderson, as in the author's example. MD Anderson wanted $60,000 up front, so she had to opt for covered care. 6 months since her diagnosis, chemo and transplant behind her, she has medical bills of $30,000 not covered by HCA and has not been able to work for 3 months. She is the main breadwinner for a family of 5.
We are solo medical oncologist locate in Houston area. The article from Steven Brill is exactly right. We have patients coming from MD Anderson and saying why we are charging $700 and MD Anderson will need $20,000 for down payment and wonder if we are using the same treatment. We mentioned to her that you are paying for brand name and hotel like environment. We always wonder why MD Anderson has become so commercial, provide just exactly same treatment as community oncologist with high cost and not staying concentration on research as a REAL research hospital.
US Healthcare is going to collapse with too many interest groups. Compare to other country so called corruption, US is the same with legal corruption instead calling illegal. All these lobbyist such as Hospital, Pharmaceutical companies, insurances companies, GPO such as Mckesson have legally so called support and actually bribe the Washington for their own interest.
Regarding to the drug cost, it is ridicules high with so many restriction to buy drug and so many interest groups. Also profit are eaten by Pharmaceutical companies due to patents and also by middlemen such as those GPO ...Mckesson.. Oncology supply...Cardinal ..etc.
Why would physician office cost are so high? Every time when patient come, we need to do verification, referral and authorization to see the patient and insurance companies have thousands product. After the physician see the patient by complying all the rules for medicare in order to charge the code, he also need to dictate and we need to send those dictation to outside company and wait for their transcription. Then we need a billing person to enter the code and submit through clearing house and then get to insurance companies. Then we need to wait at least 2 weeks to get the check if so called it is 'Clean Claim'.
Well, how can we encourage next generation to study medicine!
Pancake Rankin wrote:
"Some of you, like Frederick, need to ... quit shooting off repetitive submissions. Have some patience, your ISP and DRShowpage ain't lightning fast, no matter what the commercials say."
Agree - but it's not the size that matters. Here's a tip to the multiple posters; if you hit the submit and it takes a long time for a response to come back, open another browser window, navigate to the DR Show discussion page on which you are posting and see if your post is already there. Most times, it will be. Then just hit the "back" button on the page that is in limbo.