Monday, February 25, 2013

Why Do We Pay So Much For Health Care in America: A mix of my thoughts and a recap from Time Magazine article


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

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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