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Merged "Bitter Pill": Major article on US expensive healthcare (Time)

Blue Mountain

Resident Skeptical Hobbit
Blue Mountain
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Waging war on woo-woo in Winnipeg
Bitter Pill: Why Medical Bills Are Killing Us (link is to the "printable" version)

It's not a light-weight article: at nearly 25,000 words, it gives a detailed reckoning of the endemic problems in the US health care system as it's currently constituted: large bills for routine care and catastrophic bills for catastrophic care, perverse economics that value profits and equipment over providing services at a reasonable cost, and hospitals that double and triple charge at grossly inflated rates for the most basic of supplies.

The article paints a picture of a hospital system that generates huge profits at the expense of the people who desperately need their services. Some of the stories are just heart-breaking. One couple with health insurance got a $475,000 bill from a 30 day hospital stay for pneumonia. Their insurance had a $100,000 annual cap on it and had already paid out earlier in the year, so it paid only $70,000 and left the couple with a $450,000 debt. They managed to get it down to $313,000. "We can’t apply for charity, because we're kind of well off in terms of assets. We thought we were set, but now we're pretty much on the edge."

Does this sort of insanity happen anywhere else in the world?
 
I just have to tell the tale of my Christmas visit to New York. Basically, I went to New York. I got sick - Swine Flu. I went to the hospital (being from Sweden, I was used to paying about 100 SEK - roughly 15 or so Dollars - for the privilige). I had forgotten to renew my insurance. Bill was $3000 for an eight hour stay with X-ray, blood cultivation, two bags of salt-solution and a couple of painkillers.

$300 just for the use of a hard-as-hell bunk in a 4 meter by 4 meter room shared with another person.

I was kind of taken aback.
 
Troponin I is a fairly expensive test, it is about £ 7 or $ 11 for the reagent costs alone the last time I checked, but charging $ 200?

Doodles.
 
I've been saying here for years that the expense of US health care comes not from the much-maligned insurance companies but from the health care providers themselves. But everyone wants to blame the insurance companies, mostly just for being the bearers of bad news.

This is part of the reason I'm disappointed in the ACA - it does virtually nothing to bring costs down. Should be the ECA. ;)
 
US Health Care Problems!

http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

I'm not going to get into an explanation in depth here becasue I would prefer that only people who are really interested in discussing the problems take part. To do that they will have to read this sad story. My only question is: Is this representative of the day to day situation in the US when people fall ill with serious problems?
 
"According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart."

All that to make sure poor people cannot access health care. Why not just shoot them for falling ill?
 
Nessie said:
"According to one of a series of exhaustive studies done by the McKinsey & Co. consulting firm, we spend more on health care than the next 10 biggest spenders combined: Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia. We may be shocked at the $60 billion price tag for cleaning up after Hurricane Sandy. We spent almost that much last week on health care. We spend more every year on artificial knees and hips than what Hollywood collects at the box office. We spend two or three times that much on durable medical devices like canes and wheelchairs, in part because a heavily lobbied Congress forces Medicare to pay 25% to 75% more for this equipment than it would cost at Walmart."

All that to make sure poor people cannot access health care. Why not just shoot them for falling ill?
Click to expand...

I would rather keep this on a more compassionate level as opposed to a inflammatory hatefest. So in that respect, killing people doesn't belong here.

If Canada can provide health care to all it's citizens for roughly half the cost per capita that the US does, and provide higher quality of health care, as stated by the W.H.O, then why won't the right let change happen?

It clearly becomes in theri best interest financially to let change happen so what's holding it back? Have they somehow been convinced by big money interests that they would be lowering the quality?
 
The article contained some amazing costings where the ill person was charged way over the odds with huge mark ups for basic items.

"Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500."

The money is needed, not for health care but for

"I noticed a group of glass skyscrapers about a mile away lighting up the evening sky. The scene looked like Dubai. I was looking at the Texas Medical Center, a nearly 1,300-acre, 280-building complex of hospitals and related medical facilities, of which MD Anderson is the lead brand name."

and for

"Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”

DePinho’s salary is nearly triple the $674,350 paid to William Powers Jr., the president of the entire University of Texas system, of which MD Anderson is a part."

Medicine as business, not care.
 
Canada has many fewer people than the USA.

Canada relies on the USA to defend its borders.

Several Canadian Provinces do not have single-payer healthcare systems, and require their citizens to pay monthly premiums for health insurance.
 
Look at my signature

The US system as of 2007 cost more in taxes than the UK system of the same time. I am not advocating an NHS for the US, but every other OECD country manages to achieve universal healthcare, some are densely populated, some are sparsely populated but large (Canada, Australia). In previous threads I have seen an odd form of American exceptionalism proclaimed, where the anti universal healthcare posters have claimed a unique level of incompetence for US bureaucrats as a reason why it wouldn't work in the US.

I'd suggest that when it comes to cockups, the UK can lead the world (look at the procurement history for HMS Queen Elizabeth and Prince of Wales for fairly current examples). Despite this, the UK system provides far more cost-effective care than the US system (although the UK government is trying to rectify this)...
 
If Canada had 313 million people they wouldn't have such an easy time paying for all of their health insurance through just income taxes.

Nevermind the fact that wealthier Canadians cross the border for higher quality healthcare in the USA.
 
WildCat said:
I've been saying here for years that the expense of US health care comes not from the much-maligned insurance companies but from the health care providers themselves. But everyone wants to blame the insurance companies, mostly just for being the bearers of bad news.

This is part of the reason I'm disappointed in the ACA - it does virtually nothing to bring costs down. Should be the ECA. ;)
Click to expand...

Rolfe (I think) posted links that suggested about 38% of US healthcare costs were in administration and middlemen.

I'll try to find them.
 
Yep. I remember being charged $10.00 for a "temperature control device". It was a latex glove filled with ice. :(
 
Courier said:
http://en.wikipedia.org/wiki/Healthcare_in_Canada#Criticisms

Indeed, our neighbors to the north have problems with their healthcare system.

One could say that I possess a form of universal healthcare as it benefits hundreds of thousands of people in the same area. My co-pays are mostly $15 and I can usually see the doctor of my choice within 7 days. Not so, in Canada.
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Whereas I can usually see a doctor on the same day, and guaranteed within 48 hours and pay a flat rate for any prescription drugs - albeit more than Welsh or Scottish people.
 
And from a different thread, comparing the US and Canada:

blutoski said:
CMAJ had an [editorial with citations] and in 2002 a peer-reviewed research [article] showing profit motive significantly deducts from quality of care in healthcare, rather than enhancing it.

Canada and the US had identical systems until the end of a transition over 1969-1972, and in the time since then, the US has fallen drastically behind in outcomes and is now more than double the cost. This value gap has grown especially fast since 2000.

IIRC, HMOs' costs outside actual care delivery - eg: accounting, marketing/advertising, lobbying, lawsuits, claim screening, collections - has inflated to about 30% of costs, compared to between 1 and 2% in Canada, depending on province.

The efficiency of US healthcare delivery is considered to be less than half of Canada's, even though Medicare is almost as efficient. This means that outside of Medicare (which has a 2% overhead) - so that means HMOs and private hospitals - is less than half as efficient. Maybe about 35% as efficient, based on my back-of-the-envelope estimate.
Click to expand...
 
jimbob said:
Whereas I can usually see a doctor on the same day, and guaranteed within 48 hours and pay a flat rate for any prescription drugs - albeit more than Welsh or Scottish people.
Click to expand...

I pay $5 for most generic prescriptions.

The fact is for many Americans, hundreds of millions of us infact or around 90% of our population, our healthcare system works just fine.
 
Blue Mountain said:
Bitter Pill: Why Medical Bills Are Killing Us (link is to the "printable" version)

It's not a light-weight article: at nearly 25,000 words, it gives a detailed reckoning of the endemic problems in the US health care system as it's currently constituted: large bills for routine care and catastrophic bills for catastrophic care, perverse economics that value profits and equipment over providing services at a reasonable cost, and hospitals that double and triple charge at grossly inflated rates for the most basic of supplies.

The article paints a picture of a hospital system that generates huge profits at the expense of the people who desperately need their services. Some of the stories are just heart-breaking. One couple with health insurance got a $475,000 bill from a 30 day hospital stay for pneumonia. Their insurance had a $100,000 annual cap on it and had already paid out earlier in the year, so it paid only $70,000 and left the couple with a $450,000 debt. They managed to get it down to $313,000. "We can’t apply for charity, because we're kind of well off in terms of assets. We thought we were set, but now we're pretty much on the edge."

Does this sort of insanity happen anywhere else in the world?
Click to expand...

This 2009 paper is relevant:
Medical Bankruptcy in the United States, 2007:
Results of a National Study (PDF)

ABSTRACT
BACKGROUND: Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened.
METHODS: We surveyed a random national sample of 2314 bankruptcy filers in 2007, abstracted their court records, and interviewed 1032 of them. We designated bankruptcies as “medical” based on debtors’ stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.
RESULTS: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.CONCLUSIONS: Illness and medical bills contribute to a large and increasing share of US bankruptcies.
Click to expand...
 
Until something goes wrong.


Which is when you need a healthcare system.

75% of Medical bankruptcies in 2007 happened to people who had medical insurance (PDF)



Also you seem to be suggesting that the US system is not working for about 30-million Americans.
 
jimbob said:
Until something goes wrong.


Which is when you need a healthcare system.

75% of Medical bankruptcies in 2007 happened to people who had medical insurance (PDF)



Also you seem to be suggesting that the US system is not working for about 30-million Americans.
Click to expand...

yup, those are the folks who don't have insurance.
 
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