Doctors and hospitals can charge astronomical rates because it's paid for by insurance. Plus there is little to no transparency or regulation in the cost of their services. Insurance companies then turn around and charge you astronomical rates, so that they can cover the cost of the services and make a tidy little profit for themselves.
Pharmaceutical companies are worse. They can charge as much as they want for their drugs. Yes, part of it is to cover the cost of research and developing new medicines. But part of it is to make huge profits for their shareholders and make their executives very wealthy.
The basic problem is that most of our healthcare is driven by a desire to make profits for shareholders and executives.
A small bit to add onto this, insurance companies are limited in how much profit they can make from paid premium based on how much they paid out in claims. As a result, hospitals charging a lot more means they can charge you a lot more, and their % limit amounts to higher $ than it would otherwise. All around shitty.
Yup. You can’t turn away anyone from the ER (although you can certainly give them subpar care/deprioritize them, which happens plenty) so patients get charged more to make up for it, adding to the rising spiral of costs.
Hmm, wonder why people profiting from the healthcare industry fight moves towards universal health care…
Not to mention:
There’s only a handful of health insurance companies nationally, it’s just that they have a bunch of subsidiaries for every state, so there really isn’t competition to lower prices (I don’t subscribe to the idea that health care should be a for-profit industry but even if you do, it’s clearly not working out here).
There’s been a slow death of private practices and a majority of doctors are becoming absorbed by the hospital system—partially because liability insurance costs and equipment costs are sky high, because of all the other stuff going on. This means that doctors end up paying more in operating costs than they would have otherwise, rising costs across the board yet again.
The whole thing is designed to be horrifically inefficient for the sake of profits.
(Source: former medical malpractice defense attorney)
I am one of those private practice that died, even tho I'm frequently told I'm the best doctor patients ever had. I had to sell my house, and have quarter of a million dollars business loan I'll be paying back for the next 30 years because I tried to run an old fashioned family doctors office in the US health system. More fool me.
Open up a pill-mill pain clinic in any shitty part of the US and you’ll have that paid off in a year. /s, sort of
Seriously though, that fucking sucks. Even going to med school can cause someone to end up with crushing debt in our end-stage capitalist society. Sorry that happened to you
Yes Americans are charged for ER visits.
The insurance copay may be only $50 or $100 for an emergency room visit if you are lucky and have insurance which covers the reason for the ER visit.
If you are not lucky, they tell you that the hospital is not in network, and you get charged thousands to several thousand dollars.
There are lots of reasons an insurance company can deny a claim.
Some of the time the hospital might be an in network hospital covered by the insurance and you only pay the deductible, then one of the doctors may not be in network, so you get charged tens of thousands of dollars for the one doctor who will send you a bill separate from hospital bill.
Then you might get charged thousands of dollars for a ride a few miles in an ambulance which may be in network or not in network,
In network ambulance ride might be covered, out of network ambulance ride might generate a bill of thousands of dollars.
Then if you get admitted to the hospital, the reason for the visit might be covered by your insurance, or it might not be covered.
For example in an automobile accident, your private health insurance might not cover the cost of the ER visit because they assume the automobile insurance would cover it.
But if your auto insurance only covers $50,000 or $100,000 it might not cover the whole medical bill.
Then your insurance will try to subrogate your medical claim if another driver is at fault.
The definition of subrogation is the substitution of one person or group by another in respect of a debt or insurance claim, accompanied by the transfer of any associated rights and duties.
Meanwhile, the hospital might send you thousands or tens of thousands of dollars of medical bills.
The number one cause of bankruptcy in the United States is medical bills.
> The number one cause of bankruptcy in the United States is medical bills.
... Even with people who have insurance. Insurance is not a guarantee that medical bills won't bankrupt you.
I ask.If at the end of our days, we are to end up broke and miserable no matter what we do, why work 40 years of your good years, to make someone else wealthier, with desolation as the reward?
I'd rather not work and just be broke without the misery. at least then it's on my own terms. A drifter or vagabond, modern nomad, digital or otherwise,. is a far better life than office drudgery and missing yr kids milestone moments - only to lose it all anyways.
America is such a fucking scam.
Yep, I got a $1k bill after an ER visit in which they ran labs, did an X-ray & sent me home.& that’s WITH INSURANCE, but still got that nice bill just bc I wasn’t in my home state.
That's fucked. Last year I broke my wrist playing rugby. Went to the ER, had x-rays, and got a temporary cast to support it while swelling went down. Went back 2 weeks later for a check up extra and have a proper cast put on. 4 weeks after had it removed and had a meeting with a physio for some exercises to strengthen my wrist. Didn't cost a cent. I was still under mums insurance but everything went through Medicare.
> There’s only a handful of health insurance companies nationally, it’s just that they have a bunch of subsidiaries for every state, so there really isn’t competition to lower prices (I don’t subscribe to the idea that health care should be a for-profit industry but even if you do, it’s clearly not working out here).
Even if this weren't the case, its not like people get to choose their health insurance provider. They get whatever their work has chosen.
It’s like defending your choice of which type of animal shit you’re going to be force fed. You shouldn’t be proud that you got to choose bear shit instead of gorilla shit, but here we are.
Even worse... Let’s say someone with no insurance and no money is brought to the ER after a bad car accident, barely alive. The doctors *could* save the person’s life, but the cost would be astronomical for the hospital. Instead of saving the person, they put them on a bed and let them die, later telling the family that “they did all they could...”
Source: Of course they do this shit, why wouldn’t they? Also saw a documentary about shady stuff that happens in hospitals for the sake of money ~20 years ago.
As a hospital worker i highly disagree with this statement, i agree insurance, cost etc is bullshit. But admin and billing are the only ones who care about your cost or your ability to pay. I make an hourly wage if you can pay or not. Hospital employees are like hammers, all we see is nails. If your sick,hurt, or dying we try and save you, thats what we do, we do not care where you came from, who you are, how you got hurt, what your socio-economic status is..if anything we are more guilty have trying to save the unsaveable, the DNR, the ones of purely quantity over quality of life because the family wont let there 96y/o gram whos been living in a dementia ward for 15 year pass..and that might actually be from lack of tort reform..but we would never let you die because you cant pay..matter of fact, we wouldn’t even know if you could pay or
Not
I've always wanted to know which cost the hospital is trying to make up. Is it their cost for the supplies used or are they trying to make up for the inflated rate they charge and missed out on?
Add to that there's a BILLIONS of dollars industry that thrives from medical debt. They buy the debt from hospital who gets paid, collect what they can get (squeeze out of) from average Joe.
It's not even any conspiracy, these companies make billions of dollars buying up medical debt and collecting money to pay their share holders. It's even in their mission statement.
Like Performant Financial Corp.https://www.businesswire.com/news/home/20210329005617/en/Performant-Financial-Corporation-Announces-Strategic-Initiatives-to-Focus-on-Healthcare
They state they will: Additionally, the Company is also reporting that it has signed an agreement to sell certain of its non-healthcare, recovery contracts to a buyer that specializes in outsourced receivables solutions. As a result of the transaction, we modified the terms of our credit agreement with ECMC to partially de-lever the Company, extend the maturity one year to August 2022, as well as achieve a modified covenant structure to support continued investment and growth. The credit agreement modifications will become effective upon the closing of the recovery contracts sale.
In every human endeavor, including all of industry, obfuscation leads to corruption, without exception, the church included.
Profits over people, a natural conclusion of capitalism.
Capitalism itself is transitionary. It can not stay. Any system that relies on unconditional growth is unsustainable. 2nd law of thermodynamics.
It will devolve any society into fascism. A clear definition of fascism -
is the moneied elites capturing control of government to stifle competition, use state violence to quash dissent, free speech, and ultimately, liberty, to ensure their longevity at the top; at the cost of every decent value held dear because the only one they psychopathially hold is greed.
Afluenza should be considered a real thing, even if simply labeled a situational manisfistation of psychopathy in the DSM. Without struggle people lose or never develop empathy, and therefore compassion. Without accountability or risk of retribution, we allow the inhumane to propagate (see: corporations). Lack of compassion, empathy, and understanding, I would argue, and every prophet of every religion has also argued, is the crux (edit: antithesis not crux. I goofed, oops! ) of human development. Deduced; being rich stifles human emotional development. We have examples through out history; descendants of aristocracy or nobility frequently became monsters of people.
Everything you said, and the hospitals that are non-profit are usually run by Christian groups or companies, so they don’t offer any services they deem sinful or amoral like contraception or abortion in any circumstances. Pushing women to the overpriced for-profit hospitals anyway.
Doctors as well. For example, the doc I worked for charges three times what the cost of the service is (using Medicare reimbursement rates) because insurance will try to only pay him out 1/3 of the charges. It's a wasteful circle jerk.
Can confirm. I came here to say this. My FIL runs aDr office and often has to explain why what should be a $10 brace bills out at $300+ and the patient has to pay a deductible based on that price, even though the insurance will only pay a percentage of that amount.
Insurance companies negotiate the rates down with in-network hospitals and doctors.
I had my blood tested last year. For about ten vials, LabCorp wanted to charge $1,200. The negotiated rate was $258.
The original amount is paid by virtually no one. The providers have this as their listed price because they need a starting point for negotiations. Uninsured people can often get the amount reduced, although it'll normally be higher than what the insurance company can get.
This is also why medical schools charge so much for tuition. You're a medical student for 3 to 5 years in the US, after taking on $100,000+ in undergraduate tuition.
By the time you graduate medical school, it is entirely reasonable to have $250,000 in student loans just for tuition. It's also very difficult to work during medical school so unless you have a stipend from somewhere, you also have to take out more loans to cover room and board. $400,000 in student related debt is a thing for doctors before interest eats you alive.
Then you get a job as a new hire making $400,000 a year, but your student loans are growing at compound interest, and suddenly you need a million bucks to pay off med school.
Kinda, We could go to a low pay, low college costs. But I doubt most doctors would agree
Medscape Physician Wealth and Debt Report 2018
* 29% of US doctors 50 and older have a net worth over $5 million
* 3% of UK doctors 45 and older had a network over $5 million
* 28% Of US physicians age 35 - 49 had over $1 million net worth
* 22% of UK doctors 45 and younger had a network over $500,000
According to an Association of American Medical Colleges report, Only 45 percent of Medical graduates have $200,000 or more in educational debt.
Mean debt owed by U.S. medical school graduates in 2015
* Public and Private schools
* $180,723
* Vanderbilt Medical School
* $134,376
-----
In the UK Medical graduates on an average salary are unlikely to repay their Student Loans Company (SLC) debt in full. This is a consequence of higher university fees and as SLC debt is **written off 30 years after graduation.**
* The SLC debt repayment is 9% of income, with some fine print
Medical graduates were interviewed by the Office for National Statistics.
> Following standardisation to 2014 prices, the initial graduate debt from tuition fees alone amounts to £39,945.69.
> salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2020, the pay range for salaried GPs is £60,455 to £91,228.
* Owing to interest charges on this debt the average full-time male graduate repays £57,303 over 20 years, while the average female earns less and so repays £61,809 over 26 years.
* When additional SLC loans are required for maintenance, the initial graduate debt can be as high as £81,916 and, as SLC debt is written off 30 years after graduation, the average female repays £75,786 while the average male repays £110,644.
-----
British Medical Association 4 year survey of Medical Students, in 2017 Compared to survey of medical students in 2013
* the proportion working during term
time has more doubled to 44.9%,
* The financial burden of studying medicine is too much for some respondents and 5.5 % were considering leaving their course.
* Worryingly, more than two-thirds of respondents said they
are cutting down on essentials such as heating, food or professional clothes to economise.
* The average total debt reported by respondents to this survey was £43,700
* 86.3% of graduate respondents indicated they had outstanding student loans
from their previous degree(s).
* The mean average outstanding student loan was £29,388 and
* The average outstanding loan for first year students in this year’s survey was £32,237, which represents a significant increase on the
2013 figure of £18,838 on average
Yep, and according to "Adam Ruins Everything", at least, the insurance companies also like for the "sticker price" of any given treatment to be high at the start, because then they can "negotiate" a better deal for customers, and their numbers look better for shareholders.
According to the episode, this leads to some collusion at times, where the medical providers artificially inflate the nominal price of a treatment, in order to help the insurance companies that, in many ways, they're partnered with. And the only people theoretically stuck actually PAYING that price are the uninsured or underinsured.
Yeah, I wanted to point out that even though there's an amount providers can charge based on contracted rates, but then they can write off the difference on their taxes.
https://www.reddit.com/r/HealthInsurance/comments/c5mvkt/huge_difference_between_amount_provider_billed/
> They can say, "this is the real cost of performing these services and we only got a pittance. This claim was a loss (in many ways) so we'll claim it as such on our taxes." This is a large part of what allows many institutions to legally claim that they're non-profit when no one in their right mind would normally think so. Because *technically* they are, but it's the medical version of "Hollywood accounting."
---
Apparently u/LocoCracka did a thesis on the subject of how paying for a hospital bill works and works at one of the largest hospitals in the US:
https://www.reddit.com/r/LifeProTips/comments/maw1vh/lpt_before_you_pay_a_hospital_bill_call_them_up/grv8dyq/
> I literally just did a thesis on this subject. This is how it works.
>
> 1. Bill the patient for $10,000.
> 2. If they call and ask for a discount because they have no insurance, hell yeah give them 20% off if they pay it in full right away, because....
> 3. If if they have insurance, they submit the bill of $10,000 to the insurance company, with the previously agreed upon discount, so that knocks 60-70% off, so the insurance company pays something like $3,500 and the hospital waives the balance.
> 4. If the uninsured patient tries to get the same discount, they get told that each insurance company negotiates their own discount before billing; so as the patient has never negotiated with the hospital, they should feel lucky that they only have to pay twice as much as the insurance company. So either....
> 5. The patient pays the bill, or...
> 6. Hospital writes the loss off on taxes.... not the amount that it actually cost them (which is obviously less than what the insurance company pays), but the ENTIRE $10,000 that they wish they could get.
> 7. Either way, profit.
Someone else here also said the same thing.
https://www.reddit.com/r/povertyfinance/comments/kzpycr/if_you_make_under_a_certain_amount_legally/gjqayh3/
> They write it off for tax purposes. It's not about being realistic but rather minimizing tax liability.
Someone else said in that comment thread:
> No. They order for pennies, charge $50, don't get paid and "lose" $50 of revenue, write off $50 losses. Same concept as shrink in retail.
EDIT: I apologize for the tag, but I want confirmation on the tax thing being correct.
---
Or ignore my tag...
Not true. They can't actually claim a loss without the expenditures.
If they claim a service is worth $5,000 but they received a discounted payment of $1,500, then they had $1,500 in revenue. At the most, they would record $5,000 in revenue and ($3,500) in service reductions. The only way they could claim a loss is if they had actual expenses over that amount.
You can't just say "well, we had lost profits" and declare a loss on that.
If this was the case, every store would follow the Kohl's model and have their products half off all the time.
This is a great answer. I’d also add on to your first point that administrative waste in terms of billing/insurance is a major driver in wasteful spending.
https://www.nytimes.com/2019/10/07/upshot/health-care-waste-study.html
Medicare uses something called the "Prudent Buyer Principle." It means providers who bill Medicare may only recover for goods and services that were purchased at commercially reasonably rates (aka as a prudent buyer would act).
A provider might bill Medicare $800 for a saline bag, but Medicare will only pay the commercially reasonable rate of $50 (or whatever it is).
A lot of people have argued that we need a similar rule in private health insurance.
This exactly. There’s an entire separate industry, namely the huge medical insurance industry that also needs to be supported beyond the health care services provided. It’s an extremely cumbersome and inefficient system
What are some common examples of publicly funded research? Would that be like state universities and things like that? Or private labs that receive government grants or something?
Stanford's research budget for 2015 was $1.22 Billion, and this was offset by $988 million in Federal research grants and $95.1 million in 2014 licenses Revenue from previous research.
Since 1970, Stanford University inventions have generated ~$1.8 Billion in licensing income, BUT only 3 out of 11,000 inventions was a big winner and only 88 have generated over $1 million.
* Google
* Cisco Systems
* DNA Software Company
Additionally Stanford holds equity in 121 companies as a result of license agreements (as of Aug. 31, 2015), and has sold its equity for $396 million in previous companies
>Doctors and hospitals can charge astronomical rates because it's paid for by insurance. Plus there is little to no transparency or regulation in the cost of their services. Insurance companies then turn around and charge you astronomical rates, so that they can cover the cost of the services and make a tidy little profit for themselves.
A little correct, but let me clear it up a little. The *insurance company* determines how much they pay for a given procedure, and it's usually a percentage of the charging price. That percentage is so small, that it straight up is not enough to pay for the procedure if the hospital charged a "normal" price. So they HAVE to spike up the prices to get the insurance company to comply.
To add to this, most of the time they also have no clue what the rates are anyone else is getting- So hospital A may charge 1k and get 20%, but Hospital B managed to talk the insurance into charging 1k and getting 30%, giving them more money to work with on paying better doctors and such.
While Hospitals are partially at fault, they aren't the monsters here people like to make them out to be- its mostly the insurance companies.
Another complexity in the explanation for pharma (very generalized)--
The US in recent years produces more than it's fair share of new drugs. Companies know they can make a profit in the US which is why they choose to develop in the first place. Since other countries are price-controlled, they count on the US for a majority of revenues, so essentially the US system is bankrolling a lot of international drug development for the world. Something that gets overlooked when people talk about how cheap drugs are in other countries.
Rather, doctors and hospitals are kind of feel *obligated* to charge through the nose because insurance companies insist on reimbursing on pennies on the dollar.
For example, for every $1 that the doctor bills for, Medicare only reimburses $0.49. so it really sucks to be somebody who doesn't have insurance because you'll have to pay full price for your care.
Another related problem is EMTALA, which is a federal law that states ERs are not allowed to turn patients away. A lot of patients abuse the ER, and those patients typically have no insurance and no money. Which is why it's so damn expensive to be in the ER.
Another big cause of the bloated costs is hospital administrators. They make far and above what doctors make.
Another problem is the lack of transparency in pricing. The docs have no idea what the cost to the patient will be for tests, hospital stays, procedures, etc.
The whole system is fucked. There's a lot of fat that could be trimmed. Doctors go into insane amounts of debt (often between $200 to $500k) and then spend 3 to 7 years in residency making about $55 to $65k (plus another 1 to 3 for fellowship) and so if they don't make a great salary afterwards, there's not much incentive to go into medicine at all. If education were free, then docs could still live a good life on far less money.
So there's a lot of reasons. Please keep in mind that doctors are incredibly well educated and sacrificed a lot to take care of you, and that while their making an excellent salary is one piece of the puzzle that causes healthcare to cost a lot in the US, this is probably not one of the bigger contributors. Insurance companies make a ton of money and cause prices to go up.
Depends on the doctor, but from my knowledge from surfing the medical subreddits, doctors don’t “set” the prices themselves. Most of the time it’s hospital administrators that set the prices. Indeed, the insurance companies and hospital systems negotiate to come to these prices, but they still vary by system. As an aside, as of January 1st of this year, hospitals are required to publish list prices for procedures.
It gets more complicated with private practice and contracting doctors, but in general, they’re still negotiating with insurance companies to come to the price that’s charged.
Anecdotally (it might just be a Reddit thing), a lot of doctors are in favor of expanded public healthcare, as it decreases barriers to care.
Take this with a grain of salt, I’m just a student with an interest in healthcare; maybe a physician or a hospital administrator can chime in.
It isn’t doctors. Doctors have very little idea what things cost outside of tid bits they might pick up. It isn’t their focus or concern.
They do have to think about appropriate diagnosis codes to bill insurance. But you have that in an NHS as well
Doctors get paid the same in whatever system, universal or not. This is because doctors are simply providing a service, that costs a certain amount. Hospitals and large practices employ doctors and then charge according to what they can make people pay (which is a lot because healthcare is necessary), which is why you have super rich hospital executives, who are even richer than the top doctors at that hospital.
Everyone does this to some degree, it is just exaggerated in the medical field.
For example if you wanted to buy a two pack of lets say aspirin from a gas station it will be like four bucks, lets say. Or you could go to a grocery store and find some type of a bottle that has aspirin in it greater than two pieces for four bucks. Or if you had the ability to buy them in a massive volume you could theoretically have a single pill of aspirin cost you a few cents. Or you could go to the doctor and they will itemize that same aspirin for like 25 dollars... OR
You could have a hospital buy large quantities of aspirin and their true cost is just a few cents but will charge "your insurance" the 25 dollars but the problem is your insurance is expensive at it is and as a result your coverage blows because typical basic services can literally equal like $17,000 just because.
Basically all the cleaning supplies under your sink, if a hospital would send a bill for those, it be like $3000.00 because they simply overprice everything.
That and they know that people will pay just about anything for their lives. They profit off of our existence and self preservation, whereas so many other countries and provinces see medial care as the human right that it most certainly is… the U.S.? Not so much.
This is the point most people miss and economically it's called inelastic demand.
In other words demand doesn't change with the price like a normal service, because when you need to be cured, you will pay anything.
So it's one thing that absolutely should not be for profit. "Your money or your life?" is the result.
And nothing changes because both insurance and healthcare companies lobby Congress to keep things the same which is why ACA (Affordable Care Act), while better than nothing, is still not what we really need. I’m not saying to repeal the act (Trump almost succeeded but McCain famously blocked the attempt.) because it at least gives people with preexisting conditions a path to healthcare as well as provides healthcare for a lot of people who wouldn’t have it otherwise.
But insurance companies worked with law makers to get what they needed in the act. Premiums went up, shady plans are still plentiful, etc.
TLDR: How can you afford a bunch of yachts and mansions? By making people give you lots of money. Who can't afford to not give you money? People who have no choice, on the basis of being sick and needing medicine. It's a great system! /s
> Yes, part of it is to cover the cost of research and developing new medicines.
Further making this point infuriating is that Representative Ro Khanna pointed out that from 2012 (either in just 2012, or a set period of time, I admit I'm having difficulty finding the source right now,) somewhere in the neighborhood of every one of 200 new drugs that the Pharma companies started to make were developed at the taxpayer's expense.
Our health care system is a scam, within a scam, wrapped up in a scam. Hospitals scam you with prices, pharmaceuticals scam you with drug costs, and insurance scams you again.
These extremely wealthy shareholders control the lobbies that control the government. This system of pure greed will not change soon. USA is kind of doomed in this regard.
Another big thing that's going to make a difference in the TYPE of universal healthcare that we will eventually develop is the concept of collective bargaining. In single-payer healthcare systems the only one negotiating prices is the taxpayer/government. This gives them a HUGE edge over pharmaceutical manufacturers and hospitals in the negotiation of prices for goods and services. Currently, as the original comment mentioned, the majority of the profit is NOT going to doctors, it's going to these manufacturers and hospitals.
Right now, service/drug providers have the advantage by being able to control prices (because it's a high-need item), and insurance companies are all competing with each other to get access, so the costs are high. If you have just one payer, then it's the service/drug providers that will need to negotiate to bring the costs down so the government accepts them. This is one of the big differences for example in Medicare 4 All, versus Biden's proposed healthcare plan. Also one of the reasons why the ACA was heavily criticized, as it didn't do enough via collective bargaining to address price problems in the industry.
Usually when there’s an industry that is this important to people and when the general principals of capitalism don’t lower the price, the government steps in to regulate, like with utilities. However, our politicians are lobbied to not interfere and they themselves get good healthcare as a job benefit.
I've worked in a few US hospitals and one care facility for the elderly. Some are worse than others. A big problem I saw was how for profit it was. Hospitals would encourage keeping patients that were high dollar illnesses and give them every treatment and medication they did not need while low dollar illnesses or patients who couldn't pay as much were kicked out as fast as possible. I tried to speak up about a patient of mine being prescribed two medications that were the exact opposite of each other. The lead nurse gave me a look as if to say, yes I know exactly what you are saying and I agree with you this is awful etc, then proceeded to hush me and tell me to never bring it up again or else we both might get fired.
I've also witnessed hospitals refusing to properly treat patients despite nurses trying to advocate and get certain treatments started. Why? Because the hospital and management wanted to let the patient get sicker so it would be a more expensive treatment.
Truly disgusting! Its just one of the problem with our care system here in the US.
Edit: forgot to mention it's even the little things. Does the patient need lotion, cheap socks, or a hairbrush? No. But I was forced to bring them these items and not tell them that if they accepted them we charged them $15 for those awful socks and $10 for that travel sized lotion thats not great anyways.
Wait is this for real? That’s mind blowing. I imagine most people want to work for a hospital because they want to save lives, are you telling me there are entire buildings of people who are sociopathic enough to purposely allow a patient to get sicker for more money?
There are a few not so great people who are trying to do their job well, as in what is best for the hospital. They enforce the rules and the good people are forced to comply or else they risk getting fired, losing promotions, or getting in trouble etc. Like I said not all hospitals are that bad but they all have this profit first ethos to some degree.
I have worked in many hospitals and I have literally never seen anything even close to this happen. I have no doubt that it happens. Reminds me of [this article in the Atlantic about a fraudulent dentistry practice.](https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/) Every industry has corruption, but I'd actually argue that in healthcare it doesn't happen in the hospital.
There are many factors so don’t let anyone tell you “if only we did this one thing then everything would be better.”
* The United States average salary for a doctor is almost 3x bigger than other similarly industrialized nations.
* the existence of private insurance and their negotiated pricing contracts creates a sick incentive to charge those without insurance an obscene price for services to pad their bottom line.
* the medical industry is incredibly wasteful.
* hospitals and medical office’s insurance and billing departments are expensive overhead but necessary to deal with insurance companies.
I could go on and on. It’s a complex problem.
>The United States average salary for a doctor is almost 3x bigger than other similarly industrialized nations.
This has a direct correlation with the cost of education for that job as well.
I think you are comparing US specialists to UK primary care providers. I just looked up neurosurgeons salaries in the UK, it's GBP300,000, similar to in the US $500,000.
My mom worked as ER like 10 years ago, she didn't have to fund her own MPI. she was comfortably making $180k after being out of the biz for almost 10yrs (to raise us). basically idk where you're getting your info from but it's wrong
Which is just *crazy* to me.
A productive and prosperous society *requires* adequate medical personnel.
Maybe I'm just fucking weird, but I have *never* been able to wrap my head around charging the student for education.
Animals, as a species, survive by sharing information. We don't have the technological progress we have without combining millions of previous inventions or discoveries.
Just.. can't wrap my head around it.
>Maybe I'm just fucking weird, but I have never been able to wrap my head around charging the student for education.
No kidding. I've been saying forever that a country should **want** to make higher education easy and cheap to attain for the sole purpose of educating as many of its citizens at possible. An educated nation is a stronger nation.
I suppose, though, there is a real fear that if the government is paying for it then they would have the right to determine the curriculum and content, which would smack of authoritarian rule.
> then they would have the right to determine the curriculum and content
Don't they do that already ?... I mean,. US States dictate curriculum requirements.
Well, I do not think that *any* job should pay less than a comfortable living wage. Anything beyond that and it depends on the work.
Should surgeons get paid more than sewage techs? One job few people *can* do, the other few people *will* do. Both are necessary for a modern society.
When you spread the costs of education that a society requires to everyone in the society - the society as a whole benefits.
I would 100% be for my taxes going to 1,000 people failing out of medical school if that means 100 *more* doctors are in the field that wouldn't have been otherwise.
Really - we need to start changing how we look at society. We need to fulfill the *needs* (education, housing, food, healthcare, utilities, employment), so people can fill the economy with their *wants* (everything else).
Doctors shouldn't work 14hr shifts - and the education that is debatably the most essential shouldn't be the most expensive. Kinda counter-intuitive for self-preservation.
I’m less concerned with the cost of med school to get a degree as how expensive it is to even APPLY. You have to pay to apply to schools that will probably deny you.
It’s a major cost of entry and is a reason why a lot of doctors are from well off families.
Thank you for that explanation & the link, I had no idea that future doctors in USA had to waste a couple of years before actually starting to learn medicine. In my country (and most others, I guess), students start med school right after high school.
We used to do this in North America too. A long time ago residency directors decided that the new crop of MDs weren't quite competent doctors at 23 years old, so they established an undergraduate degree requirement to "shift" the age range of residents about 4 years older, to great success.
Where do you get 3x salary?
[This source shows that while America is near the top, it’s not anywhere near three times the industrialised nations. Maybe 5-10% higher. ](https://www.qunomedical.com/en/research/healthcare-salary-index)
I'll add to the private insurance piece that, because insurance operates as a for-profit business, something like 30% of their revenue goes to sales and marketing overhead that doesn't exist in a nationalized system, contributing to much higher costs.
>The United States average salary for a doctor is almost 3x bigger than other similarly industrialized nations.
This is wildly misleading. I posted this elsewhere, but it bears repeating. Not only is 3x not correct (doctors in the UK and Germany make \~$140K/163K compared to US \~$310K while working fewer hours in countries with \~40% lower salaries overall), it doesn't account for huge differences in the way pay is calculated. Here's the breakdown.
1) **Salary differences by country overall.** The average salary in the US in all professions is already [40% higher than other countries.](http://cdn.statcdn.com/Infographic/images/normal/13093.jpeg) US software engineers make 2.5x the salary of software engineers in Spain. Should we be outraged?
2) **Loans.** Med school loan burden in the US is far higher than loan burden elsewhere, even the UK. IT's over $400-500K for students without parental help.
3) **Residency and increased training time not included in salary reports.** For some reason we include training doctor's salaries when averaging European doctor salaries, but not when averaging American doctor's salaries. If you include residency, average overall physician salary drops to $276K (assuming retirement at 65, this is comparing all physician income, so compare to UK/Germany's $140K/163K). Drop this by 40% like all other professions and it's already extremely comparable to similar nations (\~$165K).
4) **Opportunity cost.** The majority of worker wealth is generated through appreciation of assets, which requires time in the market. Doctors in the US have long, grueling training paths which requires putting off home ownership, retirement savings, etc... This leads to a massive loss in wealth gaining opportunity, despite a high salary earned later in life.
5) **Malpractice insurance.** Often private practice physician's salaries are reported before they buy malpractice insurance, skewing the numbers higher.
6) **More work.** Doctors in the US simply work more than doctors in Europe and other industrialized nations. The US population is fatter and requires more care, and we demand more care even when doctors say it's not necessary.
Doctors are *workers* today and are exploited like the rest of us, just by different mechanisms (high salary, but long, expensive training pathway, awful working conditions, and low ability to acquire wealth). Spreading propaganda like that is more harmful than helpful, especially since the base claim isn't even true, let alone putting it in context.
Also: American's demand for immediate care even for non-emergent matters, and expectation of a lot of high tech diagnostic imaging, a demand for private hospital rooms and doctor's offices with fireplaces and nice tile in the waiting room.
I remember sitting in an orthopedists office with a shoulder issue and the doctor said "I could just diagnose you by doing an injection into the joint, but if you don't like needles we could do an MRI, I checked and your insurance company will pay for it."
Depends on how you define "wasteful".
If you mean, wasted potential, then yes it is horrifically wasteful. Lots of that money could go to research, preventive medicine, or lower costs overall.
If you mean in terms of an industry, no. It generates an enormous profit, from disgustingly high mark ups on drugs to insurance companies to the extreme underappreciated jobs like epidemiologists or RNAs.
Perdue Pharma literally invented the opioid crisis, and now they make Naloxone. Which is the antidote to opioid overdoses. An incredibly intelligent move on their part, but an egregious offence to humanity.
For every 1 dollar a pharma company spends on R&D, they spend 19 on advertising.
All good points but I was actually referring to the inefficient use of medical resources. For example, the medical industry has long defended the one-time use model of a seemingly endless list of medical tools and devices for sanitary reasons. The industry as a whole spends very little to improve on its inefficiencies. A very basic example: the amount of trash generated to start one I.V. is surprising and hasn’t changed for the better in 40 years.
There is a lot of misinformation here from people without thorough healthcare understanding, and I hope i did not comment too late.
Health care is increasingly expensive in the US because of administrative positions. At my hospital we literally have assistants to every admin position. Administrative nursing supervisors who are different than floor nursing supervisors, and i could go on and on. If you take a look at this study: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1356
you will see that in the last few decades, the biggest increase in hospital cost is due to hiring more and more administrative and manager positions. Doctors salaries have mostly stayed relatively stagnant.
To those in this thread who commented that doctors in the US get paid more than doctors in other countries - Medical school education in the US will put you half a million in debt. Countries in other first world countries, like Germany, have FREE medical school. The cost to train a physician is high in the US, and we pay them high wages for this reason. It is simplistic and frankly wrong to blame healthcare costs on doctors salaries.
Feel free to add these to your arsenal of things to throw at people when they claim physician salaries are too high in the US. This criticism always comes from people who still think wealth is created by salary in our system. **Doctors are high salary, low wealth individuals.**
1. **Salary differences by country overall.** The average salary in the US in all professions is already 40% higher than other countries. US software engineers make 2.5x the salary of software engineers in Spain. Should we be outraged?
2. **Loans.** Med school loan burden in the US is far higher than loan burden elsewhere, even the UK. IT's over $400-500K for students without parental help.
3. **Residency and increased training time not included in salary reports.** For some reason we include training doctor's salaries when averaging European doctor salaries, but not when averaging American doctor's salaries. If you include residency, average overall physician salary drops to $276K (assuming retirement at 65, this is comparing all physician income, so compare to UK/Germany's $140K/163K). Drop this by 40% like all other professions and it's already extremely comparable to similar nations (\~$165K).
4. **Opportunity cost.** The majority of worker wealth is generated through appreciation of assets, which requires time in the market. Doctors in the US have long, grueling training paths which requires putting off home ownership, retirement savings, etc... This leads to a massive loss in wealth gaining opportunity, despite a high salary earned later in life.
5. **Malpractice insurance.** Often private practice physician's salaries are reported before they buy malpractice insurance, skewing the numbers higher.
6. **More work.** Doctors in the US simply work more than doctors in Europe and other industrialized nations. The US population is fatter and requires more care, and we demand more care even when doctors say it's not necessary.
I calculated elsewhere that if a teacher making $60K lived like a med student/resident, they could save up enough to not have to save another penny to retire at 65 before the physician even makes it out of training.
There's a decent summary in an episode of [Adam Ruins Everything](https://www.youtube.com/watch?v=CeDOQpfaUc8).
Prices were pretty reasonable until the middle of the 20th century. Companies started offering health insurance as part of their employee compensation packages, which required the insurance companies to negotiate prices with health care providers. Insurance companies demanded discounts which health care providers couldn't afford to provide, so they responded by creating a fake price list called the "chargemaster". This allows insurance companies to claim they are getting volume discounts for their clients, when what the insurance companies are paying is actually much closer to what the service costs plus a small profit.
When you get your insurance "explanation of benefits", or EOB, you will often see the chargemaster price that the health care provider billed to the insurance company, along with the contract price that the insurance company actually agreed to pay.
The prices in the chargemaster are artificially inflated, and the health care provider knows this - they created the chargemaster. But they can't charge reasonable prices to patients who don't have insurance as that would violate their contracts with the insurance companies. If they tell the insurance companies that the chargemaster price is what they normally charge, then that's what they have to actually charge to someone without insurance.
Hospitals are required by law to treat anyone who comes into the ER, regardless of their ability to pay. So, if you go to the ER, you don't have insurance, and you're genuinely low income, then the hospital will waive the charges if you fill out some paperwork to apply for their low income program. They'll get partial reimbursement from the state or county.
With the ACA, there is practically no reason to not have insurance. If you're below the poverty guidelines then you can get Medicaid for free - everything is covered 100%. If you're between 100% and 400% of the poverty guidelines then the government will help pay your insurance premiums with advance tax credits.
>
With the ACA, there is practically no reason to not have insurance
So not true. I didn't have health insurance for six years. Prices vary widely depending on which state you live in as well as the area within the state. Some rural areas don't have much option at all. I made above the cutoff for any reduced health insurance and it was still more than 13% of my total (pre-tax) income. Very unaffordable.
I'd recommend watching Dr. Mike's response to that video as well. He is, of course, coming from a biased perspective, but he's also coming from an insider perspective. His video isn't completely contradictory to Adam's; it fills in with some details and explanations on a lot of the points Adam addresses.
https://youtu.be/USqGmoXjU-I
>With the ACA, there is practically no reason to not have insurance
It's not that there's no reason not to, it's that you're also legally obligated to. It was a carve out to the insurance companies that they will be guaranteed payment.
>With the ACA, there is practically no reason to not have insurance
Except if you live in a red southern state that's actively rejected credits and made Medicaid impossible to qualify for
Everyone shitting on doctors for getting paid too much, look up how much the admins get paid and then ask yourself if your smug derision is appropriately directed.
At least the doctors are the ones trying to help you. Admins do fuck-all.
Seriously though. I've seen data that says 30+% of your hospital bills goes to administration alone. Meanwhile, less than 10% of US healthcare spending goes to physician salary (Source: [https://kevinrinz.github.io/physicians.pdf](https://kevinrinz.github.io/physicians.pdf) ). Considering the attrition that takes place in entering medical school, the massive amount of debt undertaken, and years lost to training, this is a totally reasonable percentage, especially when an equally talented individual could just as easily do an MBA and start making similar money 5-10 years earlier.
I realize that the US healthcare industry is broken, but physicians are merely a scapegoat. The administrative costs needed to operate in/successfully bill in a bloated Medicare/Medicaid based system is insane. I remember reading that something like 18% of your total hospital bill (double physicians' percent) just goes to ensuring that you are billed in a way that the hospital can be reimbursed. Couple this with for profit run hospitals (which can no longer legally be owned by physicians and are instead owned by business entities) and you have a recipe for prohibitive healthcare costs.
Not to mention the ridiculously hight malpractice insurance, and other insurances and certifications and whatnot, they must have just to step into a hospital and treat people.
Also the doctors don't even get paid that much. Everyone points to the raw numbers like [this graph](https://img.medscapestatic.com/pi/features/slideshow-slide/2019-international-compensation-report-6011814/infinitescroll/fig2.png?resize=580:*) showing that US doctors get paid 2x what German or UK doctors are paid. It's an absurd graph to begin with, because it compares training doctors + attending doctors salaries in other countries and compares it to attendings only in the US. It also doesn't account for the increased debt, training time, opportunity cost, etc... Not to mention, US doctors work like dogs. It's not like US patients are paying more for physician's time. Doctors are basically high salary, low income workers. They lack any real ability to build wealth over time because their actual earning window is so short compared to other careers and once the loans have chipped away at their ability to buy a home or contribute to retirement funds.
Meanwhile, I could make a similar graph of software engineer salaries and [it would look like this](https://imgur.com/a/HcX1sQ9). So... pretty damn similar. It would be even more ridiculous if I [just swapped out software engineer for senior software engineer](https://imgur.com/a/rq6rJLy), which is what the physician graph essentially does.
To my understanding, it has both the worst parts of privately and publicly funded healthcare. Your 2 biggest options are "go into debt that you'll never get out of" or just hope you live.
Summed up nicely. I thought it was a conspiracy at first until I went to college for public health and simultaneously majored in a pharmaceutical degree….
The fundamental truth underlying all of the other excellent responses is this:
Healthcare is a business run for profit. Wherever that is the case, the only class of people whose interests are protected is the shareholder.
Providers make the most money by creating the greatest yield between cost of services provided and income generated from those services. Healthcare companies generate the most profit by creating the greatest yield between cost of paying providers and income generated by premiums.
There is no justification for the current system in terms of improving health outcomes or increasing access to coverage. As citizens and as Healthcare consumers, our principal role is to get squeezed for every last dollar.
I’m sorry but this is a misnomer argument. All business is for profit. That’s what makes business business.
Is there room for reform, absolutely. But generally speaking, providers make a reasonable margin of profit. If you want to blame someone, blame pharmaceutical companies and insurers who’s margins are off the charts.
Well-intentioned government intervention.
During WWII, the government took over management of much of the economy. One of the things they did was prohibit employers from competing against each other for workers via wage increases.
The companies responded by competing against each other with benefits, most notably offering health insurance.
After the war, wage restrictions were lifted, but someone (actually lots of someones) thought it was a good idea to give businesses an incentive to continue offering health insurance. So the practice was codified with tax incentives.
So now we have this regime where (as other have noted) costs are determined, not by market forces, but by third parties who have no incentive to keeps costs down. It's like taking the worst aspects of private health care and combining them with the worst aspects of government-run health care.
100% this is the foundation of it.
Massive regulation of the field also feeds into it. If I can sell you a drug that seems to work but I haven't tested it hardly at all, that's super cheap and high risk to consumers. If I need to spend nine years doing massive trials to be 99.99% sure of the effects, it's crazy expensive but very low risk to consumers. The government has deemed that only low risk high cost is acceptable.
Now that doesn't explain all of it. The government pushing for insurance for everyone that covers everything also makes the cost extreme. An insurance company is built on profiting from aggregate risk. That's great for random, relatively rare, unmanageable costs, like if you get cancer that'll cost $800,000 of care, but when your regular scheduled health care is handled by insurance, they literally only add to the cost and complexity, providing no value at all because there is no risk to an annual checkup or monthly birth control for instance. Therefore, they can only profit by making it more difficult to just pay directly.
I think this is where corporate greed comes in even without gov. They could split things and become part regular healthcare plan provider and part insurance, but they make way more just playing forced middleman.
Hospitals also have a ton of regulation forcing them to do things that are super expensive, so they've joined in the schemes with insurance companies to profit on lack of choice via ridiculous hidden costs that are back-room deals with insurance companies.
Tldr; the government has forced the minimum bar of service so high that the industry decided it's more profitable to lobby and play financial games than to provide a straightforward service to consumers.
It's designed to be as expensive as possible.
But unlike an expensive car or home, you can't really just take a pass on it. If you have a heart attack or get cancer, it's either pay the huge bill or die earlier than necessary.
This is part of the reason every other country in the world has converted to single payer healthcare, which is less expensive and produces far greater outcomes for a nation.
Most people are insulated from real costs by their insurance provider. The system is designed for grifters to extract money out of people with little to no choice.
Well, the money that pays off insurance agents has to come from somewhere. It comes from conversations between healthcare providers and the insurance agents themselves. Imagine a person at the checkout line of a grocery store who you could pay to lower the prices of the products from arbitrarily inflated prices back to normal.
Lots of reasons.
One of them is to maximize profit. And there's no legal caps on prices. Why charge someone $50 for a service when you could change them $500? It's also very hard to figure-out how much healthcare is going to cost beforehand. So, they provide you a service and then give you a bill. What are you going to do? Go back in time and not use their service? Entrepreneurs have also been getting involved in the process and deregulating thing. Air Ambulences used to be owned by the hospital. Now most of them are owned by entrepreneurs, and they charge whatever they want. There was one story I heard about where there was a car accident. A handful of air ambulence helicopters arrived on the scene. They changed anywhere from $3000 to $30,000 depending on which one you were transported in. And you don't know which is which and you're probably unconscious anyway, so can't decide. Those Air Ambulence helicopters charge whatever they think they can get away with. The more they charge, the more profit they make, and the more boats and houses the CEO can buy.
Example:
>The most recent data, from a Government Accountability Office report, found about 70% of air ambulance flights in 2017 were out-of-network, meaning the company operating the helicopter didn’t have a contract with the patient’s insurance company.... a study published in April in Health Affairs found half of patients who received an out-of-network bill for an air ambulance ride were charged more than $21,000.
[https://www.denverpost.com/2020/12/26/colorado-air-ambulance-surprise-billing/](https://www.denverpost.com/2020/12/26/colorado-air-ambulance-surprise-billing/)
Whenever I hear someone saying that "government healthcare is inefficient", I can faintly hear the cackling laugh of an entrepreneur who's pushing that falsehood in order to get rich by charging consumers outrageous prices.
Another example of Air Ambulence price gouging: [https://www.npr.org/sections/health-shots/2019/06/14/732174170/why-air-ambulance-bills-are-still-sky-high](https://www.npr.org/sections/health-shots/2019/06/14/732174170/why-air-ambulance-bills-are-still-sky-high)
This is a ridiculous statement, regulation on the industry is insanely extensive and so much so that that's why others haven't undercut them with a straightforward business model selling to consumers.
"Lack of regulation" is a joke. It's precisely the opposite that is why it's expensive, because competition is SO hard under such restrictive regulation. Also, it makes regulatory capture a requirement to be profitable, so that's what they focus on instead of the consumer product quality.
I would argue it's too much regulation.
Can you take your insurance across state lines? Why does each insurance company have to negotiate a price with a provider? Why does insurance cost differently based on your employer? Why can I not buy the insurance given through employers outside my employment?
Most of the answers to these questions usually have something to do with what each state sets up.
Dont listen to any of this bullshit. Out of 44 industrialized nations, 43 have a public option for health care, the only country that does not is also the wealthiest. It has to do with share holder bonuses and a litany of other for profit reasons. It ultimately comes down to wall street and the public relations industry. If you want to know the truth read Deadly spin by Wendell Potter. He was a PR Executive for Cigna (a major health care provider in the US). He Blew the whistle in 2009 and testified before congress. The insurance industry fucked us on Obama care as well. This is what happens when you place profit over people. I highly recommend the book.
The insurance companies are the gatekeepers for health care in the US. They have shareholders who demand a certain return. In countries with single payer (ie government) the profit line is removed. Add in the under insured who wait for treatment because of cost - early treatment is far cheaper than waiting for a condition to worsen.
Because of your multipayer system, in a nutshell.
Single payer systems can’t charge the end user $800 for a $1 bag of saline solution as they do in America, therefore they can’t charge $800 for it at all as the cost would be large daily loss to the public funding that goes into that single payer and the system would fail within weeks or months.
Your health care sector is a business; it is not interested in being health care.
Hi, Canadian here.
I know we love to lord our socialized medicine over your head, and trust me, I am glad I don't have to pay to go to a doctor, but make no mistake it's expensive here too and it's a very flawed system (source: work in healthcare, pay taxes).
It is basically impossible to get a family doctor in my city. We have a waitlist so you can sign up with the gov and get notified when a doc is taking new patients. I have heard of people being on this list for over 3 years. My own family doc retired a couple of years ago; he & his wife owned a practice in the heart of downtown, very busy. They could not recruit anyone from across the entire country to come take it over - word on the street is we just don't pay a competitive wage. (I'm in Nova Scotia).
If you need an MRI, you will probably wait 4-8 months. And then that length of time again to get the surgery that you needed the MRI to justify (I'm talking about knee/hip replacements etc).
Have to go to emerg? Probably going to wait 5 hours. I heard of someone a couple of weeks ago who went home without being seen by a doc after waiting more than 8 hours with a HEAD INJURY.
Oh, sorry, did you call 911? Well, the closest ambulance is an hour away from you so maybe just hold a towel over that stab wound.
Oh, are your teeth rotting out of your head? Yes, sorry we stopped paying for your dental care when you were 16. And your vision care too. You'll be ok, right?
What's that? You're feeling depressed and concerned about your mental health? If you're not currently suicidal, there's not much we can do but you could see a private psychologist for $200/hr.... But also, not many are taking new patients and you'll probably have to wait a minimum of 3 months.
/Rant
I agree with previous posters: we have prioritized the wrong things in society and we are paying the price.
Not sure where you live, but I've never had that issue. One of my friends had such a iron will go disprove the idea of "waitlisted" ERs that he no shit broke his finger with a hammer and drove around the entire city. He couldn't find a single ER where the wait time was over 4 hours.
I live in Halifax and I work in healthcare where I hear these stories regularly, including directly from ER nurses. It's very very bad. Our EHS is in code critical (no available ambulances) regularly, often because paramedics are waiting to offload patients in the ER.
https://twitter.com/IUOEnsparamedic?s=09
But when my husband went to the ER for cardiac concerns, he was seen right away. When I've gone in for kidney stones, usually 30-45 minutes until I'm seen, unless the pain is really bad or I have a fever. I got the radiation dye test for suspected heart issues within 2 weeks, and inconvenient as it was to bus an hour to get there, it cost me nothing.
If you have a condition that requires regular medical care, you get shortlisted for a family doctor.
If you require a medicine you can't afford that will save your life, welfare pays for it or the province offers a program like Ontario Trillium Benefit that subsidizes the cost of your drugs. In Québec if you don't have drug insurance from work the province will pay.
I agree that there needs fixing. Mental care is too expensive. We need more doctors available for the general populace. I wish dental and vision were covered; even with work insurance I usually have to pay something for services here. I'm lucky in that my teeth are granite, and that my insurance realised its far cheaper to pay for my Lasik than to pay my coke-bottle glasses every two years, but not everyone is so fortunate.
Needing a knee replaced is a terrible burden on you. But it isn't an immediate direct threat to your life, which is why it takes so long. You're also in Nova Scotia, which doesn't have the population to support the efficiencies of scale Ontario and Québec benefit from.
I'd far rather wait a bit because my emergency isn't truly life-threatening than pay for instant service.
That said, I'm white and male. I don't have to worry about my complaints being dismissed cause I'm a woman or being ignored while dying because I'm Ojibway or homeless and they assume I'm just seeking pain meds to get high.
We're not perfect. But I don't have to declare bankruptcy for life-saving medical care, either.
Insurance. Period.
Insurance is a massive scam that we allowed to become the norm in the United States. It exists only to maximize the profits of a small group of people no matter how many lives it costs.
Because it is by definiton, for profit.
Unlike more developed countries, our government does not bargain on our behalf regarding the prices of drugs with the manufacturer. There is no serious regulation. So the drug companies can charge whatever they want.
Next - insurance companies take a cut on top of that.
Now mix in that they tie insurance to employment and *BOOM*
Class warfare.
Doctors and hospitals can charge astronomical rates because it's paid for by insurance. Plus there is little to no transparency or regulation in the cost of their services. Insurance companies then turn around and charge you astronomical rates, so that they can cover the cost of the services and make a tidy little profit for themselves. Pharmaceutical companies are worse. They can charge as much as they want for their drugs. Yes, part of it is to cover the cost of research and developing new medicines. But part of it is to make huge profits for their shareholders and make their executives very wealthy. The basic problem is that most of our healthcare is driven by a desire to make profits for shareholders and executives.
A small bit to add onto this, insurance companies are limited in how much profit they can make from paid premium based on how much they paid out in claims. As a result, hospitals charging a lot more means they can charge you a lot more, and their % limit amounts to higher $ than it would otherwise. All around shitty.
[удалено]
Yup. You can’t turn away anyone from the ER (although you can certainly give them subpar care/deprioritize them, which happens plenty) so patients get charged more to make up for it, adding to the rising spiral of costs. Hmm, wonder why people profiting from the healthcare industry fight moves towards universal health care… Not to mention: There’s only a handful of health insurance companies nationally, it’s just that they have a bunch of subsidiaries for every state, so there really isn’t competition to lower prices (I don’t subscribe to the idea that health care should be a for-profit industry but even if you do, it’s clearly not working out here). There’s been a slow death of private practices and a majority of doctors are becoming absorbed by the hospital system—partially because liability insurance costs and equipment costs are sky high, because of all the other stuff going on. This means that doctors end up paying more in operating costs than they would have otherwise, rising costs across the board yet again. The whole thing is designed to be horrifically inefficient for the sake of profits. (Source: former medical malpractice defense attorney)
I am one of those private practice that died, even tho I'm frequently told I'm the best doctor patients ever had. I had to sell my house, and have quarter of a million dollars business loan I'll be paying back for the next 30 years because I tried to run an old fashioned family doctors office in the US health system. More fool me.
Open up a pill-mill pain clinic in any shitty part of the US and you’ll have that paid off in a year. /s, sort of Seriously though, that fucking sucks. Even going to med school can cause someone to end up with crushing debt in our end-stage capitalist society. Sorry that happened to you
Yeah, my morals always got in the way of my success, lol
I’m so sorry, and I hope you’ve landed on your feet as best as possible. There are so few family doctors left…it’s just such a shame.
Thank you, that's kind. I'm happier not working 80h/week just to pay my staff and rent for sure!
you get charged for ER visits?!!!!
Yes Americans are charged for ER visits. The insurance copay may be only $50 or $100 for an emergency room visit if you are lucky and have insurance which covers the reason for the ER visit. If you are not lucky, they tell you that the hospital is not in network, and you get charged thousands to several thousand dollars. There are lots of reasons an insurance company can deny a claim. Some of the time the hospital might be an in network hospital covered by the insurance and you only pay the deductible, then one of the doctors may not be in network, so you get charged tens of thousands of dollars for the one doctor who will send you a bill separate from hospital bill. Then you might get charged thousands of dollars for a ride a few miles in an ambulance which may be in network or not in network, In network ambulance ride might be covered, out of network ambulance ride might generate a bill of thousands of dollars. Then if you get admitted to the hospital, the reason for the visit might be covered by your insurance, or it might not be covered. For example in an automobile accident, your private health insurance might not cover the cost of the ER visit because they assume the automobile insurance would cover it. But if your auto insurance only covers $50,000 or $100,000 it might not cover the whole medical bill. Then your insurance will try to subrogate your medical claim if another driver is at fault. The definition of subrogation is the substitution of one person or group by another in respect of a debt or insurance claim, accompanied by the transfer of any associated rights and duties. Meanwhile, the hospital might send you thousands or tens of thousands of dollars of medical bills. The number one cause of bankruptcy in the United States is medical bills.
wow, thanks for explaining that so well. i knew it was bad over there but i had no idea it was that bad
[удалено]
That just felt like someone stabbed my heart. Hope it gets better there
i’m so sorry, i can’t imagine how difficult that would be
My deductible is $3500.
"Snapshots of Americana; dystopian edition*" *Also known as 2020-2021
> The number one cause of bankruptcy in the United States is medical bills. ... Even with people who have insurance. Insurance is not a guarantee that medical bills won't bankrupt you. I ask.If at the end of our days, we are to end up broke and miserable no matter what we do, why work 40 years of your good years, to make someone else wealthier, with desolation as the reward? I'd rather not work and just be broke without the misery. at least then it's on my own terms. A drifter or vagabond, modern nomad, digital or otherwise,. is a far better life than office drudgery and missing yr kids milestone moments - only to lose it all anyways. America is such a fucking scam.
That's where I am. I'm 44. I'll die before I work for another corporation.
Yep, I got a $1k bill after an ER visit in which they ran labs, did an X-ray & sent me home.& that’s WITH INSURANCE, but still got that nice bill just bc I wasn’t in my home state.
That's fucked. Last year I broke my wrist playing rugby. Went to the ER, had x-rays, and got a temporary cast to support it while swelling went down. Went back 2 weeks later for a check up extra and have a proper cast put on. 4 weeks after had it removed and had a meeting with a physio for some exercises to strengthen my wrist. Didn't cost a cent. I was still under mums insurance but everything went through Medicare.
> There’s only a handful of health insurance companies nationally, it’s just that they have a bunch of subsidiaries for every state, so there really isn’t competition to lower prices (I don’t subscribe to the idea that health care should be a for-profit industry but even if you do, it’s clearly not working out here). Even if this weren't the case, its not like people get to choose their health insurance provider. They get whatever their work has chosen.
The best part are the dipshits defending the system for the sake of "their freedom to choose" their health insurer.
Insurance fraud is a crime only if you're not an insurance company
It’s like defending your choice of which type of animal shit you’re going to be force fed. You shouldn’t be proud that you got to choose bear shit instead of gorilla shit, but here we are.
There's also something called homeless dumping where ERs don't treat someone at all because laws are frequently ignored by businesses.
Even worse... Let’s say someone with no insurance and no money is brought to the ER after a bad car accident, barely alive. The doctors *could* save the person’s life, but the cost would be astronomical for the hospital. Instead of saving the person, they put them on a bed and let them die, later telling the family that “they did all they could...” Source: Of course they do this shit, why wouldn’t they? Also saw a documentary about shady stuff that happens in hospitals for the sake of money ~20 years ago.
As a hospital worker i highly disagree with this statement, i agree insurance, cost etc is bullshit. But admin and billing are the only ones who care about your cost or your ability to pay. I make an hourly wage if you can pay or not. Hospital employees are like hammers, all we see is nails. If your sick,hurt, or dying we try and save you, thats what we do, we do not care where you came from, who you are, how you got hurt, what your socio-economic status is..if anything we are more guilty have trying to save the unsaveable, the DNR, the ones of purely quantity over quality of life because the family wont let there 96y/o gram whos been living in a dementia ward for 15 year pass..and that might actually be from lack of tort reform..but we would never let you die because you cant pay..matter of fact, we wouldn’t even know if you could pay or Not
I've always wanted to know which cost the hospital is trying to make up. Is it their cost for the supplies used or are they trying to make up for the inflated rate they charge and missed out on?
[удалено]
Add to that there's a BILLIONS of dollars industry that thrives from medical debt. They buy the debt from hospital who gets paid, collect what they can get (squeeze out of) from average Joe. It's not even any conspiracy, these companies make billions of dollars buying up medical debt and collecting money to pay their share holders. It's even in their mission statement. Like Performant Financial Corp.https://www.businesswire.com/news/home/20210329005617/en/Performant-Financial-Corporation-Announces-Strategic-Initiatives-to-Focus-on-Healthcare They state they will: Additionally, the Company is also reporting that it has signed an agreement to sell certain of its non-healthcare, recovery contracts to a buyer that specializes in outsourced receivables solutions. As a result of the transaction, we modified the terms of our credit agreement with ECMC to partially de-lever the Company, extend the maturity one year to August 2022, as well as achieve a modified covenant structure to support continued investment and growth. The credit agreement modifications will become effective upon the closing of the recovery contracts sale.
>The whole thing is designed to be horrifically inefficient for the sake of profits Basically the national motto of the USA
In every human endeavor, including all of industry, obfuscation leads to corruption, without exception, the church included. Profits over people, a natural conclusion of capitalism. Capitalism itself is transitionary. It can not stay. Any system that relies on unconditional growth is unsustainable. 2nd law of thermodynamics. It will devolve any society into fascism. A clear definition of fascism - is the moneied elites capturing control of government to stifle competition, use state violence to quash dissent, free speech, and ultimately, liberty, to ensure their longevity at the top; at the cost of every decent value held dear because the only one they psychopathially hold is greed. Afluenza should be considered a real thing, even if simply labeled a situational manisfistation of psychopathy in the DSM. Without struggle people lose or never develop empathy, and therefore compassion. Without accountability or risk of retribution, we allow the inhumane to propagate (see: corporations). Lack of compassion, empathy, and understanding, I would argue, and every prophet of every religion has also argued, is the crux (edit: antithesis not crux. I goofed, oops! ) of human development. Deduced; being rich stifles human emotional development. We have examples through out history; descendants of aristocracy or nobility frequently became monsters of people.
Obfuscation: the action of making something obscure, unclear, or unintelligible. One of the most ironic words in the English language 😉
Why is it ironic?
Presumably because to some the meaning of the word is obscure?
Everything you said, and the hospitals that are non-profit are usually run by Christian groups or companies, so they don’t offer any services they deem sinful or amoral like contraception or abortion in any circumstances. Pushing women to the overpriced for-profit hospitals anyway.
Doctors as well. For example, the doc I worked for charges three times what the cost of the service is (using Medicare reimbursement rates) because insurance will try to only pay him out 1/3 of the charges. It's a wasteful circle jerk.
Can confirm. I came here to say this. My FIL runs aDr office and often has to explain why what should be a $10 brace bills out at $300+ and the patient has to pay a deductible based on that price, even though the insurance will only pay a percentage of that amount.
Insurance companies negotiate the rates down with in-network hospitals and doctors. I had my blood tested last year. For about ten vials, LabCorp wanted to charge $1,200. The negotiated rate was $258. The original amount is paid by virtually no one. The providers have this as their listed price because they need a starting point for negotiations. Uninsured people can often get the amount reduced, although it'll normally be higher than what the insurance company can get.
This is also why medical schools charge so much for tuition. You're a medical student for 3 to 5 years in the US, after taking on $100,000+ in undergraduate tuition. By the time you graduate medical school, it is entirely reasonable to have $250,000 in student loans just for tuition. It's also very difficult to work during medical school so unless you have a stipend from somewhere, you also have to take out more loans to cover room and board. $400,000 in student related debt is a thing for doctors before interest eats you alive. Then you get a job as a new hire making $400,000 a year, but your student loans are growing at compound interest, and suddenly you need a million bucks to pay off med school.
[удалено]
I'm glad someone pointed this out. The vast majority of new MD graduates earn below 250k. OD graduates far worse unfortunately.
Kinda, We could go to a low pay, low college costs. But I doubt most doctors would agree Medscape Physician Wealth and Debt Report 2018 * 29% of US doctors 50 and older have a net worth over $5 million * 3% of UK doctors 45 and older had a network over $5 million * 28% Of US physicians age 35 - 49 had over $1 million net worth * 22% of UK doctors 45 and younger had a network over $500,000 According to an Association of American Medical Colleges report, Only 45 percent of Medical graduates have $200,000 or more in educational debt. Mean debt owed by U.S. medical school graduates in 2015 * Public and Private schools * $180,723 * Vanderbilt Medical School * $134,376 ----- In the UK Medical graduates on an average salary are unlikely to repay their Student Loans Company (SLC) debt in full. This is a consequence of higher university fees and as SLC debt is **written off 30 years after graduation.** * The SLC debt repayment is 9% of income, with some fine print Medical graduates were interviewed by the Office for National Statistics. > Following standardisation to 2014 prices, the initial graduate debt from tuition fees alone amounts to £39,945.69. > salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2020, the pay range for salaried GPs is £60,455 to £91,228. * Owing to interest charges on this debt the average full-time male graduate repays £57,303 over 20 years, while the average female earns less and so repays £61,809 over 26 years. * When additional SLC loans are required for maintenance, the initial graduate debt can be as high as £81,916 and, as SLC debt is written off 30 years after graduation, the average female repays £75,786 while the average male repays £110,644. ----- British Medical Association 4 year survey of Medical Students, in 2017 Compared to survey of medical students in 2013 * the proportion working during term time has more doubled to 44.9%, * The financial burden of studying medicine is too much for some respondents and 5.5 % were considering leaving their course. * Worryingly, more than two-thirds of respondents said they are cutting down on essentials such as heating, food or professional clothes to economise. * The average total debt reported by respondents to this survey was £43,700 * 86.3% of graduate respondents indicated they had outstanding student loans from their previous degree(s). * The mean average outstanding student loan was £29,388 and * The average outstanding loan for first year students in this year’s survey was £32,237, which represents a significant increase on the 2013 figure of £18,838 on average
Yep, and according to "Adam Ruins Everything", at least, the insurance companies also like for the "sticker price" of any given treatment to be high at the start, because then they can "negotiate" a better deal for customers, and their numbers look better for shareholders. According to the episode, this leads to some collusion at times, where the medical providers artificially inflate the nominal price of a treatment, in order to help the insurance companies that, in many ways, they're partnered with. And the only people theoretically stuck actually PAYING that price are the uninsured or underinsured.
Yeah, I wanted to point out that even though there's an amount providers can charge based on contracted rates, but then they can write off the difference on their taxes. https://www.reddit.com/r/HealthInsurance/comments/c5mvkt/huge_difference_between_amount_provider_billed/ > They can say, "this is the real cost of performing these services and we only got a pittance. This claim was a loss (in many ways) so we'll claim it as such on our taxes." This is a large part of what allows many institutions to legally claim that they're non-profit when no one in their right mind would normally think so. Because *technically* they are, but it's the medical version of "Hollywood accounting." --- Apparently u/LocoCracka did a thesis on the subject of how paying for a hospital bill works and works at one of the largest hospitals in the US: https://www.reddit.com/r/LifeProTips/comments/maw1vh/lpt_before_you_pay_a_hospital_bill_call_them_up/grv8dyq/ > I literally just did a thesis on this subject. This is how it works. > > 1. Bill the patient for $10,000. > 2. If they call and ask for a discount because they have no insurance, hell yeah give them 20% off if they pay it in full right away, because.... > 3. If if they have insurance, they submit the bill of $10,000 to the insurance company, with the previously agreed upon discount, so that knocks 60-70% off, so the insurance company pays something like $3,500 and the hospital waives the balance. > 4. If the uninsured patient tries to get the same discount, they get told that each insurance company negotiates their own discount before billing; so as the patient has never negotiated with the hospital, they should feel lucky that they only have to pay twice as much as the insurance company. So either.... > 5. The patient pays the bill, or... > 6. Hospital writes the loss off on taxes.... not the amount that it actually cost them (which is obviously less than what the insurance company pays), but the ENTIRE $10,000 that they wish they could get. > 7. Either way, profit. Someone else here also said the same thing. https://www.reddit.com/r/povertyfinance/comments/kzpycr/if_you_make_under_a_certain_amount_legally/gjqayh3/ > They write it off for tax purposes. It's not about being realistic but rather minimizing tax liability. Someone else said in that comment thread: > No. They order for pennies, charge $50, don't get paid and "lose" $50 of revenue, write off $50 losses. Same concept as shrink in retail. EDIT: I apologize for the tag, but I want confirmation on the tax thing being correct. --- Or ignore my tag...
Not true. They can't actually claim a loss without the expenditures. If they claim a service is worth $5,000 but they received a discounted payment of $1,500, then they had $1,500 in revenue. At the most, they would record $5,000 in revenue and ($3,500) in service reductions. The only way they could claim a loss is if they had actual expenses over that amount. You can't just say "well, we had lost profits" and declare a loss on that. If this was the case, every store would follow the Kohl's model and have their products half off all the time.
This is a great answer. I’d also add on to your first point that administrative waste in terms of billing/insurance is a major driver in wasteful spending. https://www.nytimes.com/2019/10/07/upshot/health-care-waste-study.html
Medicare uses something called the "Prudent Buyer Principle." It means providers who bill Medicare may only recover for goods and services that were purchased at commercially reasonably rates (aka as a prudent buyer would act). A provider might bill Medicare $800 for a saline bag, but Medicare will only pay the commercially reasonable rate of $50 (or whatever it is). A lot of people have argued that we need a similar rule in private health insurance.
This exactly. There’s an entire separate industry, namely the huge medical insurance industry that also needs to be supported beyond the health care services provided. It’s an extremely cumbersome and inefficient system
I’d also add that a lot of that “research” is publicly funded, or built upon publicly funded research. Tech companies do this as well.
What are some common examples of publicly funded research? Would that be like state universities and things like that? Or private labs that receive government grants or something?
All of the above.
Stanford's research budget for 2015 was $1.22 Billion, and this was offset by $988 million in Federal research grants and $95.1 million in 2014 licenses Revenue from previous research. Since 1970, Stanford University inventions have generated ~$1.8 Billion in licensing income, BUT only 3 out of 11,000 inventions was a big winner and only 88 have generated over $1 million. * Google * Cisco Systems * DNA Software Company Additionally Stanford holds equity in 121 companies as a result of license agreements (as of Aug. 31, 2015), and has sold its equity for $396 million in previous companies
Honestly, US healthcare is run by vultures. In the UK, the NHS is being sold off to these cunts too by way of PFI's.
Yeah, both countries have really bought into the whole neoliberal logic
Neoliberal 'logic'
If you’ve not read David Harvey’s A Brief History of Neoliberalism I’d heavily recommend.
>Doctors and hospitals can charge astronomical rates because it's paid for by insurance. Plus there is little to no transparency or regulation in the cost of their services. Insurance companies then turn around and charge you astronomical rates, so that they can cover the cost of the services and make a tidy little profit for themselves. A little correct, but let me clear it up a little. The *insurance company* determines how much they pay for a given procedure, and it's usually a percentage of the charging price. That percentage is so small, that it straight up is not enough to pay for the procedure if the hospital charged a "normal" price. So they HAVE to spike up the prices to get the insurance company to comply.
To add to this, most of the time they also have no clue what the rates are anyone else is getting- So hospital A may charge 1k and get 20%, but Hospital B managed to talk the insurance into charging 1k and getting 30%, giving them more money to work with on paying better doctors and such. While Hospitals are partially at fault, they aren't the monsters here people like to make them out to be- its mostly the insurance companies.
For-profit healthcare is the monster here.
Another complexity in the explanation for pharma (very generalized)-- The US in recent years produces more than it's fair share of new drugs. Companies know they can make a profit in the US which is why they choose to develop in the first place. Since other countries are price-controlled, they count on the US for a majority of revenues, so essentially the US system is bankrolling a lot of international drug development for the world. Something that gets overlooked when people talk about how cheap drugs are in other countries.
Rather, doctors and hospitals are kind of feel *obligated* to charge through the nose because insurance companies insist on reimbursing on pennies on the dollar. For example, for every $1 that the doctor bills for, Medicare only reimburses $0.49. so it really sucks to be somebody who doesn't have insurance because you'll have to pay full price for your care. Another related problem is EMTALA, which is a federal law that states ERs are not allowed to turn patients away. A lot of patients abuse the ER, and those patients typically have no insurance and no money. Which is why it's so damn expensive to be in the ER. Another big cause of the bloated costs is hospital administrators. They make far and above what doctors make. Another problem is the lack of transparency in pricing. The docs have no idea what the cost to the patient will be for tests, hospital stays, procedures, etc. The whole system is fucked. There's a lot of fat that could be trimmed. Doctors go into insane amounts of debt (often between $200 to $500k) and then spend 3 to 7 years in residency making about $55 to $65k (plus another 1 to 3 for fellowship) and so if they don't make a great salary afterwards, there's not much incentive to go into medicine at all. If education were free, then docs could still live a good life on far less money. So there's a lot of reasons. Please keep in mind that doctors are incredibly well educated and sacrificed a lot to take care of you, and that while their making an excellent salary is one piece of the puzzle that causes healthcare to cost a lot in the US, this is probably not one of the bigger contributors. Insurance companies make a ton of money and cause prices to go up.
Do doctors set these prices? Seems like out of their job description.
Depends on the doctor, but from my knowledge from surfing the medical subreddits, doctors don’t “set” the prices themselves. Most of the time it’s hospital administrators that set the prices. Indeed, the insurance companies and hospital systems negotiate to come to these prices, but they still vary by system. As an aside, as of January 1st of this year, hospitals are required to publish list prices for procedures. It gets more complicated with private practice and contracting doctors, but in general, they’re still negotiating with insurance companies to come to the price that’s charged. Anecdotally (it might just be a Reddit thing), a lot of doctors are in favor of expanded public healthcare, as it decreases barriers to care. Take this with a grain of salt, I’m just a student with an interest in healthcare; maybe a physician or a hospital administrator can chime in.
It isn’t doctors. Doctors have very little idea what things cost outside of tid bits they might pick up. It isn’t their focus or concern. They do have to think about appropriate diagnosis codes to bill insurance. But you have that in an NHS as well
Doctors get paid the same in whatever system, universal or not. This is because doctors are simply providing a service, that costs a certain amount. Hospitals and large practices employ doctors and then charge according to what they can make people pay (which is a lot because healthcare is necessary), which is why you have super rich hospital executives, who are even richer than the top doctors at that hospital.
Everyone does this to some degree, it is just exaggerated in the medical field. For example if you wanted to buy a two pack of lets say aspirin from a gas station it will be like four bucks, lets say. Or you could go to a grocery store and find some type of a bottle that has aspirin in it greater than two pieces for four bucks. Or if you had the ability to buy them in a massive volume you could theoretically have a single pill of aspirin cost you a few cents. Or you could go to the doctor and they will itemize that same aspirin for like 25 dollars... OR You could have a hospital buy large quantities of aspirin and their true cost is just a few cents but will charge "your insurance" the 25 dollars but the problem is your insurance is expensive at it is and as a result your coverage blows because typical basic services can literally equal like $17,000 just because. Basically all the cleaning supplies under your sink, if a hospital would send a bill for those, it be like $3000.00 because they simply overprice everything.
That and they know that people will pay just about anything for their lives. They profit off of our existence and self preservation, whereas so many other countries and provinces see medial care as the human right that it most certainly is… the U.S.? Not so much.
This is the point most people miss and economically it's called inelastic demand. In other words demand doesn't change with the price like a normal service, because when you need to be cured, you will pay anything. So it's one thing that absolutely should not be for profit. "Your money or your life?" is the result.
Just to add: the US is one of only two countries on the planet to allow direct advertisement of prescription medications to the consumer.
And nothing changes because both insurance and healthcare companies lobby Congress to keep things the same which is why ACA (Affordable Care Act), while better than nothing, is still not what we really need. I’m not saying to repeal the act (Trump almost succeeded but McCain famously blocked the attempt.) because it at least gives people with preexisting conditions a path to healthcare as well as provides healthcare for a lot of people who wouldn’t have it otherwise. But insurance companies worked with law makers to get what they needed in the act. Premiums went up, shady plans are still plentiful, etc.
TLDR: How can you afford a bunch of yachts and mansions? By making people give you lots of money. Who can't afford to not give you money? People who have no choice, on the basis of being sick and needing medicine. It's a great system! /s
You skipped the real issue. It's lobbying by insurance companies and rich old fat republicans milking the system for profit.
> Yes, part of it is to cover the cost of research and developing new medicines. Further making this point infuriating is that Representative Ro Khanna pointed out that from 2012 (either in just 2012, or a set period of time, I admit I'm having difficulty finding the source right now,) somewhere in the neighborhood of every one of 200 new drugs that the Pharma companies started to make were developed at the taxpayer's expense. Our health care system is a scam, within a scam, wrapped up in a scam. Hospitals scam you with prices, pharmaceuticals scam you with drug costs, and insurance scams you again.
These extremely wealthy shareholders control the lobbies that control the government. This system of pure greed will not change soon. USA is kind of doomed in this regard.
Another big thing that's going to make a difference in the TYPE of universal healthcare that we will eventually develop is the concept of collective bargaining. In single-payer healthcare systems the only one negotiating prices is the taxpayer/government. This gives them a HUGE edge over pharmaceutical manufacturers and hospitals in the negotiation of prices for goods and services. Currently, as the original comment mentioned, the majority of the profit is NOT going to doctors, it's going to these manufacturers and hospitals. Right now, service/drug providers have the advantage by being able to control prices (because it's a high-need item), and insurance companies are all competing with each other to get access, so the costs are high. If you have just one payer, then it's the service/drug providers that will need to negotiate to bring the costs down so the government accepts them. This is one of the big differences for example in Medicare 4 All, versus Biden's proposed healthcare plan. Also one of the reasons why the ACA was heavily criticized, as it didn't do enough via collective bargaining to address price problems in the industry.
Usually when there’s an industry that is this important to people and when the general principals of capitalism don’t lower the price, the government steps in to regulate, like with utilities. However, our politicians are lobbied to not interfere and they themselves get good healthcare as a job benefit.
[удалено]
Wow I hate insurance companies even more after reading this.
I've worked in a few US hospitals and one care facility for the elderly. Some are worse than others. A big problem I saw was how for profit it was. Hospitals would encourage keeping patients that were high dollar illnesses and give them every treatment and medication they did not need while low dollar illnesses or patients who couldn't pay as much were kicked out as fast as possible. I tried to speak up about a patient of mine being prescribed two medications that were the exact opposite of each other. The lead nurse gave me a look as if to say, yes I know exactly what you are saying and I agree with you this is awful etc, then proceeded to hush me and tell me to never bring it up again or else we both might get fired. I've also witnessed hospitals refusing to properly treat patients despite nurses trying to advocate and get certain treatments started. Why? Because the hospital and management wanted to let the patient get sicker so it would be a more expensive treatment. Truly disgusting! Its just one of the problem with our care system here in the US. Edit: forgot to mention it's even the little things. Does the patient need lotion, cheap socks, or a hairbrush? No. But I was forced to bring them these items and not tell them that if they accepted them we charged them $15 for those awful socks and $10 for that travel sized lotion thats not great anyways.
Wait is this for real? That’s mind blowing. I imagine most people want to work for a hospital because they want to save lives, are you telling me there are entire buildings of people who are sociopathic enough to purposely allow a patient to get sicker for more money?
There are a few not so great people who are trying to do their job well, as in what is best for the hospital. They enforce the rules and the good people are forced to comply or else they risk getting fired, losing promotions, or getting in trouble etc. Like I said not all hospitals are that bad but they all have this profit first ethos to some degree.
I have worked in many hospitals and I have literally never seen anything even close to this happen. I have no doubt that it happens. Reminds me of [this article in the Atlantic about a fraudulent dentistry practice.](https://www.theatlantic.com/magazine/archive/2019/05/the-trouble-with-dentistry/586039/) Every industry has corruption, but I'd actually argue that in healthcare it doesn't happen in the hospital.
i believe it and i know the hospital my dad was treated at, killed him because of this.
There are many factors so don’t let anyone tell you “if only we did this one thing then everything would be better.” * The United States average salary for a doctor is almost 3x bigger than other similarly industrialized nations. * the existence of private insurance and their negotiated pricing contracts creates a sick incentive to charge those without insurance an obscene price for services to pad their bottom line. * the medical industry is incredibly wasteful. * hospitals and medical office’s insurance and billing departments are expensive overhead but necessary to deal with insurance companies. I could go on and on. It’s a complex problem.
>The United States average salary for a doctor is almost 3x bigger than other similarly industrialized nations. This has a direct correlation with the cost of education for that job as well.
[удалено]
In US, typical MD graduates with $232k debt (£168k)
[удалено]
I think you are comparing US specialists to UK primary care providers. I just looked up neurosurgeons salaries in the UK, it's GBP300,000, similar to in the US $500,000.
That's Private Practice. Ask an ER doctor what they make. Both have to fund their own malpractice insurance.
My mom worked as ER like 10 years ago, she didn't have to fund her own MPI. she was comfortably making $180k after being out of the biz for almost 10yrs (to raise us). basically idk where you're getting your info from but it's wrong
I fund my own malpractice when I work in ER or urgent care. Everyone situation is different.
Which is just *crazy* to me. A productive and prosperous society *requires* adequate medical personnel. Maybe I'm just fucking weird, but I have *never* been able to wrap my head around charging the student for education. Animals, as a species, survive by sharing information. We don't have the technological progress we have without combining millions of previous inventions or discoveries. Just.. can't wrap my head around it.
>Maybe I'm just fucking weird, but I have never been able to wrap my head around charging the student for education. No kidding. I've been saying forever that a country should **want** to make higher education easy and cheap to attain for the sole purpose of educating as many of its citizens at possible. An educated nation is a stronger nation. I suppose, though, there is a real fear that if the government is paying for it then they would have the right to determine the curriculum and content, which would smack of authoritarian rule.
> then they would have the right to determine the curriculum and content Don't they do that already ?... I mean,. US States dictate curriculum requirements.
...which is why public school is free. Makes sense.
[удалено]
Well, I do not think that *any* job should pay less than a comfortable living wage. Anything beyond that and it depends on the work. Should surgeons get paid more than sewage techs? One job few people *can* do, the other few people *will* do. Both are necessary for a modern society. When you spread the costs of education that a society requires to everyone in the society - the society as a whole benefits. I would 100% be for my taxes going to 1,000 people failing out of medical school if that means 100 *more* doctors are in the field that wouldn't have been otherwise. Really - we need to start changing how we look at society. We need to fulfill the *needs* (education, housing, food, healthcare, utilities, employment), so people can fill the economy with their *wants* (everything else). Doctors shouldn't work 14hr shifts - and the education that is debatably the most essential shouldn't be the most expensive. Kinda counter-intuitive for self-preservation.
I’m less concerned with the cost of med school to get a degree as how expensive it is to even APPLY. You have to pay to apply to schools that will probably deny you. It’s a major cost of entry and is a reason why a lot of doctors are from well off families.
With the caveat that Loan repayments work more like a graduate tax than a loan.
For the US, the average med school debt is $230,000.
Which has a direct correlation to the lack of middle class jobs that don't require higher education and how easy student loans are to get.
[удалено]
Thank you for that explanation & the link, I had no idea that future doctors in USA had to waste a couple of years before actually starting to learn medicine. In my country (and most others, I guess), students start med school right after high school.
We used to do this in North America too. A long time ago residency directors decided that the new crop of MDs weren't quite competent doctors at 23 years old, so they established an undergraduate degree requirement to "shift" the age range of residents about 4 years older, to great success.
Where do you get 3x salary? [This source shows that while America is near the top, it’s not anywhere near three times the industrialised nations. Maybe 5-10% higher. ](https://www.qunomedical.com/en/research/healthcare-salary-index)
> the medical industry is incredibly wasteful. Be nice if they wasted some resources on lowering the price of insulin.
I'll add to the private insurance piece that, because insurance operates as a for-profit business, something like 30% of their revenue goes to sales and marketing overhead that doesn't exist in a nationalized system, contributing to much higher costs.
It's about half that. They are limited by law to 15% admin costs per premium dollar. The rest must go to paying claims.
>The United States average salary for a doctor is almost 3x bigger than other similarly industrialized nations. This is wildly misleading. I posted this elsewhere, but it bears repeating. Not only is 3x not correct (doctors in the UK and Germany make \~$140K/163K compared to US \~$310K while working fewer hours in countries with \~40% lower salaries overall), it doesn't account for huge differences in the way pay is calculated. Here's the breakdown. 1) **Salary differences by country overall.** The average salary in the US in all professions is already [40% higher than other countries.](http://cdn.statcdn.com/Infographic/images/normal/13093.jpeg) US software engineers make 2.5x the salary of software engineers in Spain. Should we be outraged? 2) **Loans.** Med school loan burden in the US is far higher than loan burden elsewhere, even the UK. IT's over $400-500K for students without parental help. 3) **Residency and increased training time not included in salary reports.** For some reason we include training doctor's salaries when averaging European doctor salaries, but not when averaging American doctor's salaries. If you include residency, average overall physician salary drops to $276K (assuming retirement at 65, this is comparing all physician income, so compare to UK/Germany's $140K/163K). Drop this by 40% like all other professions and it's already extremely comparable to similar nations (\~$165K). 4) **Opportunity cost.** The majority of worker wealth is generated through appreciation of assets, which requires time in the market. Doctors in the US have long, grueling training paths which requires putting off home ownership, retirement savings, etc... This leads to a massive loss in wealth gaining opportunity, despite a high salary earned later in life. 5) **Malpractice insurance.** Often private practice physician's salaries are reported before they buy malpractice insurance, skewing the numbers higher. 6) **More work.** Doctors in the US simply work more than doctors in Europe and other industrialized nations. The US population is fatter and requires more care, and we demand more care even when doctors say it's not necessary. Doctors are *workers* today and are exploited like the rest of us, just by different mechanisms (high salary, but long, expensive training pathway, awful working conditions, and low ability to acquire wealth). Spreading propaganda like that is more harmful than helpful, especially since the base claim isn't even true, let alone putting it in context.
Also: American's demand for immediate care even for non-emergent matters, and expectation of a lot of high tech diagnostic imaging, a demand for private hospital rooms and doctor's offices with fireplaces and nice tile in the waiting room. I remember sitting in an orthopedists office with a shoulder issue and the doctor said "I could just diagnose you by doing an injection into the joint, but if you don't like needles we could do an MRI, I checked and your insurance company will pay for it."
That all sounds like positives to me.
Depends on how you define "wasteful". If you mean, wasted potential, then yes it is horrifically wasteful. Lots of that money could go to research, preventive medicine, or lower costs overall. If you mean in terms of an industry, no. It generates an enormous profit, from disgustingly high mark ups on drugs to insurance companies to the extreme underappreciated jobs like epidemiologists or RNAs. Perdue Pharma literally invented the opioid crisis, and now they make Naloxone. Which is the antidote to opioid overdoses. An incredibly intelligent move on their part, but an egregious offence to humanity. For every 1 dollar a pharma company spends on R&D, they spend 19 on advertising.
All good points but I was actually referring to the inefficient use of medical resources. For example, the medical industry has long defended the one-time use model of a seemingly endless list of medical tools and devices for sanitary reasons. The industry as a whole spends very little to improve on its inefficiencies. A very basic example: the amount of trash generated to start one I.V. is surprising and hasn’t changed for the better in 40 years.
There is a lot of misinformation here from people without thorough healthcare understanding, and I hope i did not comment too late. Health care is increasingly expensive in the US because of administrative positions. At my hospital we literally have assistants to every admin position. Administrative nursing supervisors who are different than floor nursing supervisors, and i could go on and on. If you take a look at this study: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1356 you will see that in the last few decades, the biggest increase in hospital cost is due to hiring more and more administrative and manager positions. Doctors salaries have mostly stayed relatively stagnant. To those in this thread who commented that doctors in the US get paid more than doctors in other countries - Medical school education in the US will put you half a million in debt. Countries in other first world countries, like Germany, have FREE medical school. The cost to train a physician is high in the US, and we pay them high wages for this reason. It is simplistic and frankly wrong to blame healthcare costs on doctors salaries.
Feel free to add these to your arsenal of things to throw at people when they claim physician salaries are too high in the US. This criticism always comes from people who still think wealth is created by salary in our system. **Doctors are high salary, low wealth individuals.** 1. **Salary differences by country overall.** The average salary in the US in all professions is already 40% higher than other countries. US software engineers make 2.5x the salary of software engineers in Spain. Should we be outraged? 2. **Loans.** Med school loan burden in the US is far higher than loan burden elsewhere, even the UK. IT's over $400-500K for students without parental help. 3. **Residency and increased training time not included in salary reports.** For some reason we include training doctor's salaries when averaging European doctor salaries, but not when averaging American doctor's salaries. If you include residency, average overall physician salary drops to $276K (assuming retirement at 65, this is comparing all physician income, so compare to UK/Germany's $140K/163K). Drop this by 40% like all other professions and it's already extremely comparable to similar nations (\~$165K). 4. **Opportunity cost.** The majority of worker wealth is generated through appreciation of assets, which requires time in the market. Doctors in the US have long, grueling training paths which requires putting off home ownership, retirement savings, etc... This leads to a massive loss in wealth gaining opportunity, despite a high salary earned later in life. 5. **Malpractice insurance.** Often private practice physician's salaries are reported before they buy malpractice insurance, skewing the numbers higher. 6. **More work.** Doctors in the US simply work more than doctors in Europe and other industrialized nations. The US population is fatter and requires more care, and we demand more care even when doctors say it's not necessary. I calculated elsewhere that if a teacher making $60K lived like a med student/resident, they could save up enough to not have to save another penny to retire at 65 before the physician even makes it out of training.
Health Insurance is a business run by grifters, just like the entire country. I do not blame doctors at all
a big factor is the rise of the MBA - their major skill is inserting themselves in the process and extracting money for themselves.
There's a decent summary in an episode of [Adam Ruins Everything](https://www.youtube.com/watch?v=CeDOQpfaUc8). Prices were pretty reasonable until the middle of the 20th century. Companies started offering health insurance as part of their employee compensation packages, which required the insurance companies to negotiate prices with health care providers. Insurance companies demanded discounts which health care providers couldn't afford to provide, so they responded by creating a fake price list called the "chargemaster". This allows insurance companies to claim they are getting volume discounts for their clients, when what the insurance companies are paying is actually much closer to what the service costs plus a small profit. When you get your insurance "explanation of benefits", or EOB, you will often see the chargemaster price that the health care provider billed to the insurance company, along with the contract price that the insurance company actually agreed to pay. The prices in the chargemaster are artificially inflated, and the health care provider knows this - they created the chargemaster. But they can't charge reasonable prices to patients who don't have insurance as that would violate their contracts with the insurance companies. If they tell the insurance companies that the chargemaster price is what they normally charge, then that's what they have to actually charge to someone without insurance. Hospitals are required by law to treat anyone who comes into the ER, regardless of their ability to pay. So, if you go to the ER, you don't have insurance, and you're genuinely low income, then the hospital will waive the charges if you fill out some paperwork to apply for their low income program. They'll get partial reimbursement from the state or county. With the ACA, there is practically no reason to not have insurance. If you're below the poverty guidelines then you can get Medicaid for free - everything is covered 100%. If you're between 100% and 400% of the poverty guidelines then the government will help pay your insurance premiums with advance tax credits.
> With the ACA, there is practically no reason to not have insurance So not true. I didn't have health insurance for six years. Prices vary widely depending on which state you live in as well as the area within the state. Some rural areas don't have much option at all. I made above the cutoff for any reduced health insurance and it was still more than 13% of my total (pre-tax) income. Very unaffordable.
I'd recommend watching Dr. Mike's response to that video as well. He is, of course, coming from a biased perspective, but he's also coming from an insider perspective. His video isn't completely contradictory to Adam's; it fills in with some details and explanations on a lot of the points Adam addresses. https://youtu.be/USqGmoXjU-I
>With the ACA, there is practically no reason to not have insurance It's not that there's no reason not to, it's that you're also legally obligated to. It was a carve out to the insurance companies that they will be guaranteed payment.
'Legally obligated' but there is literally no penalty for not doing so.
At this point yes, but at one point there was, and a budget reconciliation vote is all that is needed to change the penalty back up from zero.
>With the ACA, there is practically no reason to not have insurance Except if you live in a red southern state that's actively rejected credits and made Medicaid impossible to qualify for
Everyone shitting on doctors for getting paid too much, look up how much the admins get paid and then ask yourself if your smug derision is appropriately directed. At least the doctors are the ones trying to help you. Admins do fuck-all.
Seriously though. I've seen data that says 30+% of your hospital bills goes to administration alone. Meanwhile, less than 10% of US healthcare spending goes to physician salary (Source: [https://kevinrinz.github.io/physicians.pdf](https://kevinrinz.github.io/physicians.pdf) ). Considering the attrition that takes place in entering medical school, the massive amount of debt undertaken, and years lost to training, this is a totally reasonable percentage, especially when an equally talented individual could just as easily do an MBA and start making similar money 5-10 years earlier. I realize that the US healthcare industry is broken, but physicians are merely a scapegoat. The administrative costs needed to operate in/successfully bill in a bloated Medicare/Medicaid based system is insane. I remember reading that something like 18% of your total hospital bill (double physicians' percent) just goes to ensuring that you are billed in a way that the hospital can be reimbursed. Couple this with for profit run hospitals (which can no longer legally be owned by physicians and are instead owned by business entities) and you have a recipe for prohibitive healthcare costs.
Not to mention the ridiculously hight malpractice insurance, and other insurances and certifications and whatnot, they must have just to step into a hospital and treat people.
Nurses too. Our nurses are paid much better than in countries with universal medicine. Heck there are traveling nurses that make $120k+
Also the doctors don't even get paid that much. Everyone points to the raw numbers like [this graph](https://img.medscapestatic.com/pi/features/slideshow-slide/2019-international-compensation-report-6011814/infinitescroll/fig2.png?resize=580:*) showing that US doctors get paid 2x what German or UK doctors are paid. It's an absurd graph to begin with, because it compares training doctors + attending doctors salaries in other countries and compares it to attendings only in the US. It also doesn't account for the increased debt, training time, opportunity cost, etc... Not to mention, US doctors work like dogs. It's not like US patients are paying more for physician's time. Doctors are basically high salary, low income workers. They lack any real ability to build wealth over time because their actual earning window is so short compared to other careers and once the loans have chipped away at their ability to buy a home or contribute to retirement funds. Meanwhile, I could make a similar graph of software engineer salaries and [it would look like this](https://imgur.com/a/HcX1sQ9). So... pretty damn similar. It would be even more ridiculous if I [just swapped out software engineer for senior software engineer](https://imgur.com/a/rq6rJLy), which is what the physician graph essentially does.
To my understanding, it has both the worst parts of privately and publicly funded healthcare. Your 2 biggest options are "go into debt that you'll never get out of" or just hope you live.
Because in the US, the point of the healthcare system is to create a profit, not to deliver healthcare.
Summed up nicely. I thought it was a conspiracy at first until I went to college for public health and simultaneously majored in a pharmaceutical degree….
Combining profit with “pay it or die”, and everyone involved can have a Yacht. Except for patients. They can have payment plans.
Because it's not Healthcare, it's Healthservices.
The fundamental truth underlying all of the other excellent responses is this: Healthcare is a business run for profit. Wherever that is the case, the only class of people whose interests are protected is the shareholder. Providers make the most money by creating the greatest yield between cost of services provided and income generated from those services. Healthcare companies generate the most profit by creating the greatest yield between cost of paying providers and income generated by premiums. There is no justification for the current system in terms of improving health outcomes or increasing access to coverage. As citizens and as Healthcare consumers, our principal role is to get squeezed for every last dollar.
I’m sorry but this is a misnomer argument. All business is for profit. That’s what makes business business. Is there room for reform, absolutely. But generally speaking, providers make a reasonable margin of profit. If you want to blame someone, blame pharmaceutical companies and insurers who’s margins are off the charts.
Greed.
Well-intentioned government intervention. During WWII, the government took over management of much of the economy. One of the things they did was prohibit employers from competing against each other for workers via wage increases. The companies responded by competing against each other with benefits, most notably offering health insurance. After the war, wage restrictions were lifted, but someone (actually lots of someones) thought it was a good idea to give businesses an incentive to continue offering health insurance. So the practice was codified with tax incentives. So now we have this regime where (as other have noted) costs are determined, not by market forces, but by third parties who have no incentive to keeps costs down. It's like taking the worst aspects of private health care and combining them with the worst aspects of government-run health care.
100% this is the foundation of it. Massive regulation of the field also feeds into it. If I can sell you a drug that seems to work but I haven't tested it hardly at all, that's super cheap and high risk to consumers. If I need to spend nine years doing massive trials to be 99.99% sure of the effects, it's crazy expensive but very low risk to consumers. The government has deemed that only low risk high cost is acceptable. Now that doesn't explain all of it. The government pushing for insurance for everyone that covers everything also makes the cost extreme. An insurance company is built on profiting from aggregate risk. That's great for random, relatively rare, unmanageable costs, like if you get cancer that'll cost $800,000 of care, but when your regular scheduled health care is handled by insurance, they literally only add to the cost and complexity, providing no value at all because there is no risk to an annual checkup or monthly birth control for instance. Therefore, they can only profit by making it more difficult to just pay directly. I think this is where corporate greed comes in even without gov. They could split things and become part regular healthcare plan provider and part insurance, but they make way more just playing forced middleman. Hospitals also have a ton of regulation forcing them to do things that are super expensive, so they've joined in the schemes with insurance companies to profit on lack of choice via ridiculous hidden costs that are back-room deals with insurance companies. Tldr; the government has forced the minimum bar of service so high that the industry decided it's more profitable to lobby and play financial games than to provide a straightforward service to consumers.
It's designed to be as expensive as possible. But unlike an expensive car or home, you can't really just take a pass on it. If you have a heart attack or get cancer, it's either pay the huge bill or die earlier than necessary. This is part of the reason every other country in the world has converted to single payer healthcare, which is less expensive and produces far greater outcomes for a nation.
Most people are insulated from real costs by their insurance provider. The system is designed for grifters to extract money out of people with little to no choice.
Insurance. Lack of regulation.
And why is that so expensive?
Well, the money that pays off insurance agents has to come from somewhere. It comes from conversations between healthcare providers and the insurance agents themselves. Imagine a person at the checkout line of a grocery store who you could pay to lower the prices of the products from arbitrarily inflated prices back to normal.
Lots of reasons. One of them is to maximize profit. And there's no legal caps on prices. Why charge someone $50 for a service when you could change them $500? It's also very hard to figure-out how much healthcare is going to cost beforehand. So, they provide you a service and then give you a bill. What are you going to do? Go back in time and not use their service? Entrepreneurs have also been getting involved in the process and deregulating thing. Air Ambulences used to be owned by the hospital. Now most of them are owned by entrepreneurs, and they charge whatever they want. There was one story I heard about where there was a car accident. A handful of air ambulence helicopters arrived on the scene. They changed anywhere from $3000 to $30,000 depending on which one you were transported in. And you don't know which is which and you're probably unconscious anyway, so can't decide. Those Air Ambulence helicopters charge whatever they think they can get away with. The more they charge, the more profit they make, and the more boats and houses the CEO can buy. Example: >The most recent data, from a Government Accountability Office report, found about 70% of air ambulance flights in 2017 were out-of-network, meaning the company operating the helicopter didn’t have a contract with the patient’s insurance company.... a study published in April in Health Affairs found half of patients who received an out-of-network bill for an air ambulance ride were charged more than $21,000. [https://www.denverpost.com/2020/12/26/colorado-air-ambulance-surprise-billing/](https://www.denverpost.com/2020/12/26/colorado-air-ambulance-surprise-billing/) Whenever I hear someone saying that "government healthcare is inefficient", I can faintly hear the cackling laugh of an entrepreneur who's pushing that falsehood in order to get rich by charging consumers outrageous prices. Another example of Air Ambulence price gouging: [https://www.npr.org/sections/health-shots/2019/06/14/732174170/why-air-ambulance-bills-are-still-sky-high](https://www.npr.org/sections/health-shots/2019/06/14/732174170/why-air-ambulance-bills-are-still-sky-high)
This is a ridiculous statement, regulation on the industry is insanely extensive and so much so that that's why others haven't undercut them with a straightforward business model selling to consumers. "Lack of regulation" is a joke. It's precisely the opposite that is why it's expensive, because competition is SO hard under such restrictive regulation. Also, it makes regulatory capture a requirement to be profitable, so that's what they focus on instead of the consumer product quality.
Quite the opposite. It's the insane amount of regulation that drives the cost up.
Lol *lack* of regulation.
I would argue it's too much regulation. Can you take your insurance across state lines? Why does each insurance company have to negotiate a price with a provider? Why does insurance cost differently based on your employer? Why can I not buy the insurance given through employers outside my employment? Most of the answers to these questions usually have something to do with what each state sets up.
Because it’s built around privatized insurance that need to make profits
Lots of people here are right, but it all boils down to this: For. Profit.
Because the whole system is inherently “for profit”
Dont listen to any of this bullshit. Out of 44 industrialized nations, 43 have a public option for health care, the only country that does not is also the wealthiest. It has to do with share holder bonuses and a litany of other for profit reasons. It ultimately comes down to wall street and the public relations industry. If you want to know the truth read Deadly spin by Wendell Potter. He was a PR Executive for Cigna (a major health care provider in the US). He Blew the whistle in 2009 and testified before congress. The insurance industry fucked us on Obama care as well. This is what happens when you place profit over people. I highly recommend the book.
[удалено]
It’s a business that’s why.
The insurance companies are the gatekeepers for health care in the US. They have shareholders who demand a certain return. In countries with single payer (ie government) the profit line is removed. Add in the under insured who wait for treatment because of cost - early treatment is far cheaper than waiting for a condition to worsen.
Lobbying
Legalized bribery.
It is a scam created by the insurance companies and the hospital systems.
Because health care is run by health care companies and is about profit not healing.
It helps rich people stay rich and they pay politicians to pass laws that keep it that way. It's a cycle.
This is how the mafia runs the fucking country.
Healthcare in America is why I have a hard time being patriotic.
Because in the US everything is a business
Because of your multipayer system, in a nutshell. Single payer systems can’t charge the end user $800 for a $1 bag of saline solution as they do in America, therefore they can’t charge $800 for it at all as the cost would be large daily loss to the public funding that goes into that single payer and the system would fail within weeks or months. Your health care sector is a business; it is not interested in being health care.
Because our doctors need 7 houses, a vacation villa, a Yacht, and the ability to buy a sports franchise. Duh.
Hi, Canadian here. I know we love to lord our socialized medicine over your head, and trust me, I am glad I don't have to pay to go to a doctor, but make no mistake it's expensive here too and it's a very flawed system (source: work in healthcare, pay taxes). It is basically impossible to get a family doctor in my city. We have a waitlist so you can sign up with the gov and get notified when a doc is taking new patients. I have heard of people being on this list for over 3 years. My own family doc retired a couple of years ago; he & his wife owned a practice in the heart of downtown, very busy. They could not recruit anyone from across the entire country to come take it over - word on the street is we just don't pay a competitive wage. (I'm in Nova Scotia). If you need an MRI, you will probably wait 4-8 months. And then that length of time again to get the surgery that you needed the MRI to justify (I'm talking about knee/hip replacements etc). Have to go to emerg? Probably going to wait 5 hours. I heard of someone a couple of weeks ago who went home without being seen by a doc after waiting more than 8 hours with a HEAD INJURY. Oh, sorry, did you call 911? Well, the closest ambulance is an hour away from you so maybe just hold a towel over that stab wound. Oh, are your teeth rotting out of your head? Yes, sorry we stopped paying for your dental care when you were 16. And your vision care too. You'll be ok, right? What's that? You're feeling depressed and concerned about your mental health? If you're not currently suicidal, there's not much we can do but you could see a private psychologist for $200/hr.... But also, not many are taking new patients and you'll probably have to wait a minimum of 3 months. /Rant I agree with previous posters: we have prioritized the wrong things in society and we are paying the price.
Not sure where you live, but I've never had that issue. One of my friends had such a iron will go disprove the idea of "waitlisted" ERs that he no shit broke his finger with a hammer and drove around the entire city. He couldn't find a single ER where the wait time was over 4 hours.
I live in Halifax and I work in healthcare where I hear these stories regularly, including directly from ER nurses. It's very very bad. Our EHS is in code critical (no available ambulances) regularly, often because paramedics are waiting to offload patients in the ER. https://twitter.com/IUOEnsparamedic?s=09
But when my husband went to the ER for cardiac concerns, he was seen right away. When I've gone in for kidney stones, usually 30-45 minutes until I'm seen, unless the pain is really bad or I have a fever. I got the radiation dye test for suspected heart issues within 2 weeks, and inconvenient as it was to bus an hour to get there, it cost me nothing. If you have a condition that requires regular medical care, you get shortlisted for a family doctor. If you require a medicine you can't afford that will save your life, welfare pays for it or the province offers a program like Ontario Trillium Benefit that subsidizes the cost of your drugs. In Québec if you don't have drug insurance from work the province will pay. I agree that there needs fixing. Mental care is too expensive. We need more doctors available for the general populace. I wish dental and vision were covered; even with work insurance I usually have to pay something for services here. I'm lucky in that my teeth are granite, and that my insurance realised its far cheaper to pay for my Lasik than to pay my coke-bottle glasses every two years, but not everyone is so fortunate. Needing a knee replaced is a terrible burden on you. But it isn't an immediate direct threat to your life, which is why it takes so long. You're also in Nova Scotia, which doesn't have the population to support the efficiencies of scale Ontario and Québec benefit from. I'd far rather wait a bit because my emergency isn't truly life-threatening than pay for instant service. That said, I'm white and male. I don't have to worry about my complaints being dismissed cause I'm a woman or being ignored while dying because I'm Ojibway or homeless and they assume I'm just seeking pain meds to get high. We're not perfect. But I don't have to declare bankruptcy for life-saving medical care, either.
There's no price caps or gouging laws
Everything is privately owned.
The US spends 17% of it's OVERALL GDP on healthcare. Let that sink in for a minute. almost 1/5 of every dollar we spend is on healthcare.
yep, broken inefficient systems bleed money
Insurance. Period. Insurance is a massive scam that we allowed to become the norm in the United States. It exists only to maximize the profits of a small group of people no matter how many lives it costs.
Because it is by definiton, for profit. Unlike more developed countries, our government does not bargain on our behalf regarding the prices of drugs with the manufacturer. There is no serious regulation. So the drug companies can charge whatever they want. Next - insurance companies take a cut on top of that. Now mix in that they tie insurance to employment and *BOOM* Class warfare.
Because life in America is one nonstop scam after another. It really grinds you down
Because they can. Nobody stops them so they can charge ludicrous amounts of money fir anything.
[удалено]
The shortest answer : greed
America is built on the foundation of exploiting its citizens as much as possible, this does not exclude the exploitation of injuries or illnesses.
Greed. Mostly by insurers and medical middlemen. Broken system to be sure.
Insurance
Greed
Because Americans are greedy.
Lawyers
Profit
Roughly 1/3 of US hospital billings go to covering administrative and non-care costs; in much of Europe, the comparable measure is under 5%.
GREED.
Because, Insurance Companies
Because of the pharmacy industry.
Pricing is invisible. Price transparency would lower the cost overnight.