Why
Do We Pay So Much For Health Care in America: A mix of my thoughts and a recap
from Time Magazine article
Notes
and thoughts from : Bitter Pill: Why Medical
Bills Are Killing Us
Feb. 20, 2013
Charge-master
itemized rate-structures sit like maniacal-deranged Christmas wish-lists for
hospital administrations, health-insurance companies, medical-device
manufacturers, pharmaceutical companies, and medical testing laboratories. The manipulation and guise of profit hidden
in the terms non-profit organization and research and development beguile the
American people into the most costly health care system in the history of planet
with health results falling behind a laundry list of countries which spend
less.
This
article begs the question why does American health care cost so much while
holding the more often asked question who should pay at bay. What of the $77 gauze pads, $21,000 heart burn, $18
test strips, and $90,000 days in the hospital?
Why
with the unprecedented advances in digital technologies have health care costs
skyrocketed rather than declined? Has
the human body changed? Has the American
body developed a fifth more complicated appendage burrowing to the right of our
hip like a bottomless black hole to which doctors must spend unending resources
to explore and spelunk for jeweled cancerous growths and precious opportunities
for pharmaceutical chug-downs?
Why
is Medicare restricted from negotiating drug prices? Why do we use average sales price plus six
percent? Why is a medically equivalency
determination outlawed for taxpayers? Why
is comparative-effectiveness banned? Why
is Research and Development generally fifteen to twenty percent of gross revenue,
yet the pedestal of defense to such charges?
Why do taxpayers through the NIH fund much of that research through our public
universities and grants anyway? When
does a $25 payment for a woman’s plasma sold back to taxpayers and possibly her
for $250?
Why
do we legislate to lobbyists? Why are
true costs of production for pharmaceuticals, medical devices, surgeries, laboratory
tests, facility charges all hidden from the American people for any facility
doing business with taxpayers? Why are
MRI and CT machines treated like amusement park rides run by carnies with this
one takes 2,500 tickets, but today tickets costs $90 a piece for her and $5 for
him?
Why do we believe healthcare is a free market good? Why do we believe healthcare is a free market good? Why do we believe healthcare is a free market good? Why do we believe healthcare is a free market good? Why do we believe healthcare is a free market good? Why do we believe healthcare is a free market good? Why do we believe healthcare is a free market good? Why do we believe healthcare is a free market good?
Why
do hospital administrations, insurance companies, medical device manufacturers,
medical laboratories, and pharmaceutical companies hijack a pirated economy at
the expense of taxpayers, patients and even doctors and nurses?
Why
is a day in the hospital more than four years of college? How many women have been told their uterus is
broken due to impatient Pitocin in manipulative C-sections to shorten labor
delivery times at the expense of their family’s health and the profit margins
of a hospital?
Why
is total cost incurred by patient choice so de-linked from patient choice? How do we implement price sensitivity? How do we create a digital infrastructure to
demand upfront pricing for all based on national and regional standards of costs
in a true non-profit paradigm?
How
many professional debt collectors haunt the phone lines of the
unfortunate? How many lawyers,
lobbyists, CEO’s hide bank accounts? How
many $25 pills could be had at five cents apiece in any drug store?
How
many captive customers assume their care facility knows best and actually cares
about the charge that trickles through their health insurance company which
shows a paid benefit on a charge-master rate to pay seventy percent on an
$8,000 test leaving the patient with $2,400 to their deductible for a service
that cost the hospital $1,000? How many
people then think their employer did not give them a raise last year because of
a $1,400 per month health insurance premium?
Why
should the health insurance companies keep all the younger less-ill patients
when Medicare has lower administrative costs and despite laws handicapping the taxpayer’s
ability to negotiate many items, still has lower administrative-costs per claim
than any private insurer?
Why
does America’s fear of death and religious doctrine push us further from
reasonable birth control and family planning and away from death with dignity, humane
action and more cost effective end of life care? Why is comparative effectiveness painted as a
death panel? Who profits?
Why
do drugs only have to outperform a sugar pill rather than other drugs on the
market to get FDA approval? Why do we focus
more on patent life than medical effectiveness?
Why
do we have HIPA hiding our medical identities?
To protect us from our neighbors or from the private health insurance industry’s
tyranny?
If
Medicare costs less than comparable private health insurance in total, why
would we be raising Medicare eligibility rather than lowering it? Extrapolate that concept then do math and
think of your paycheck and what you and your employer pay for health insurance
or health care and dollars that are missing from your take home pay to buy
groceries, put gas in your car or dare be it take a vacation.
Quote
from the article
“Unless you are protected by Medicare, the health care market is
not a market at all. It’s a crapshoot. People fare differently according to
circumstances they can neither control nor predict. They may have no insurance.
They may have insurance, but their employer chooses their insurance plan and it
may have a payout limit or not cover a drug or treatment they need. They may or
may not be old enough to be on Medicare or, given the different standards of
the 50 states, be poor enough to be on Medicaid. If they’re not protected by
Medicare or they’re protected only partly by private insurance with high
co-pays, they have little visibility into pricing, let alone control of it.
They have little choice of hospitals or the services they are billed for, even
if they somehow know the prices before they get billed for the services. They
have no idea what their bills mean, and those who maintain the chargemasters
couldn’t explain them if they wanted to. How much of the bills they end up
paying may depend on the generosity of the hospital or on whether they happen
to get the help of a billing advocate. They have no choice of the drugs that
they have to buy or the lab tests or CT scans that they have to get, and they
would not know what to do if they did have a choice. They are powerless buyers
in a seller’s market where the only sure thing is the profit of the sellers.
Indeed, the only player in the system that seems to have to
balance countervailing interests the way market players in a real market
usually do is Medicare. It has to answer to Congress and the taxpayers for
wasting money, and it has to answer to portions of the same groups for trying
to hold on to money it shouldn’t. Hospitals, drug companies and other
suppliers, even the insurance companies, don’t have those worries.”
Solutions
suggested in the article
·
Tighten
antitrust laws related to hospitals
·
Tax
hospital profits at 75 percent and have a surcharge on all non-doctor hospital
salaries that exceed say $750,000.
·
Outlaw
the charge-master, reflect transparent costs. (Hospitals are government
sanctioned institutions.)
·
Amend
drug patent laws and set profit-margin caps on drugs exploiting monopolies
·
Tighten
what insurance companies can pay for MRI and CT scans
·
Tort
Reform: Embarrass Democrats into stop fighting medical-malpractice reform and
provide safe-harbor defenses for doctors
·
Require
drug companies to include a prominent plain-English gross profit margin on the
packaging of drugs
My
thoughts:
·
See
above, and read this American
Manifesto Part Three: Health Care
·
Overall
I concur with the direction of the article’s solutions. Almost all of these fit better in a
Single-Payer health care system (i.e. one national insurance company with untold
negotiating power, done with advanced digital systems informing patients on
where to get care, from whom and what charges to their copays and deductibles
based on facility choice and actual cost to the health care system.)
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