Can someone please disect why health care costs are so high and still rising?

Is it pharmica
Cost of medical education
Cost of renting office space
Liability coverage
Salaries of medical professon
Simple gouging of the public
Insurace company greed
Stock holder greed and ignorance
High energy costs
Greedy physicians
Fraud by insurance comapnies and/or doctors?
What the hell is it?

How come America denies far more care than countries with single-payer healthcare, who have universal coverage, better outcomes, and they pay half or one-third what we do?

Gawd, Reaganesque frames of entitled citizens and their "Cadillac" health demands are pervasive!

(2) Healthcare insurers, for profit, incentives for denying healthcare (3)Total control of life/death services = 'whatever the cost, I'll pay response'.

#1 Issue: INCREASE # of physicians by doubling, tripling, med school options
#2 Open/operate federal healthcare facilities with salaried caregivers/nurses/physicians
#3 Be serious about providing healthcare services and focus on reducing costs/duh! Increase avail. of services = reduced costs
#4 Phase out health insurance cos. & replicate medicaid/'care for all.

and say it all comes down to two things: competition and regulation.

IMO private sector healthcare, with a public option, can work in this country. But antitrust has been so neglected over the last 50 years there's no way for the best to succeed. We need twice as many insurance companies, twice as many doctors. We need checks on fraud, we need public evaluation of doctors (it's starting).

And a single insurer ran by the state would be inherently regulated to operate for the welfare of the people anyway.

Competition is not necessarily the answer. Insurance is an industry without innovation. The product cannot really be enhanced

Airline on-time performance improved dramatically after the introduction of the Bureau of Transportation's on-time tracking. There's a lot of room for innovation: healthy lifestyle discounts, fast-track claims, etc etc. The key is making performance public, and that takes a regulatory infrastructure that's responsive to public pressure.

Its a simple model that has been around for centuries. You don't need the private market to make it any fancier or more innovative, nor do you need to pay the exorbiant fees the private market demands to do so

It's all about the details.

all hell broke loose. Their innovations were unnecessary, dangerous, aimed at helping the rich get richer, and ultimately a disaster.

I'm also am an advocate of direct government-to-consumer lending, or at least using credit unions as fair brokers for this process. We don't need huge, private, for-profit banks to make massive profits off of loaning money they are borrowing in the first place, in order for credit to be available in a country. We don't need to devote a huge sector of our economy to making fake money on paper. We don't need to give a single sector sole power to completely and utterly tank an economy.

Private competition in banking has brought more harm than good throughout its lifespan. Its time to find a new paradigm (government owned and/or co-op banking)



I'm not sure why Americans still insist it is worth paying rich people to provide services that the government could provide itself (better & cheaper). Perhaps its remnants of some Ayn Randian suggestion that without all these exceptional people (IOW, those who inherit their wealth), us peasants would walk blindly into the night in despair.

and the reason derivatives tanked the economy was that the SEC is so overloaded with casework they couldn't have kept up with the situation even if they'd seen it coming.

You would prefer to have everyone's money controlled by the government? Sounds like a recipe for disaster to me. You might recall Jefferson also feared Hamilton's idea for a public bank, The Bank of the United States:

"...in a masterpiece of legal obfuscation, well calculated to confuse the president, he asserted the bank bill violated the laws of mortmain, alienage, forfeiture and escheat, distribution and monopoly. Washington, overwhelmed by the arguments...send Hamilton copies of Randolf's and Jefferson's opinion...inviting Hamilton in effect to defend the bank if he could..."

<>

"Secretary of State Thomas Jefferson argued that the Bank violated traditional property laws and that its relevance to constitutionally authorized powers was weak."

http://en.wikipedia.org/wiki/First_Bank_of_the_United_States

I'm not sure why you would pay extra to have private industry do something in a worse fashion than the government could do it, and then spend more on a whole new bureaucracy to reign them in. That is truly "uniquely American"


"You would prefer to have everyone's money controlled by the government?"

Well, I did mention co-op banking (credit unions), did I not? So your strawman is a bit outlandish. But yes, as far as credit, it wouldn't be the end of the world to have direct to consumer lending. Hell, the main thing banks are doing is just re-lending money they borrow from the government (with large margins tacked on).

I'm not entirely sure why the speculative lending and ponzi-scheme financial instruments that the private financial sector brought to the world are beneficial in anyway.

and that in the Soviet Union was among the worst. So I don't buy your contention that private industry automatically does something in a worse fashion than the government could do it. And what specifically are you referring to regarding "large margins"? I can go to my bank today and get a loan for about 4% more than they are paying for it.

All these wacky "speculative lending and ponzi-scheme financial instruments" are what start new businesses. Try starting a company sometime and you'll quickly learn the value of venture capital. The car you drive, the computer you're sitting at, etc etc are the result of investment and the innovation that results. It's responsible for a big part of the quality of your life, whether you know it or not.

That wasn't my contention, that is your straw-man argument.

My contention is that the government does SOME things, under SOME conditions better than private industry (health insurance being one of them). It varies drastically upon the activity, the current state of the market, the abilities of the government, and the actual structure of the industry.

But your comparison of two very separate entities with entirely different conditions (US vs Soviet Union) could not be more intellectually dishonest. Perhaps Canada would be a far better country to look at, being that they retain a private industry delivering the care and merely socialized their insurance industry. Many of the economic, political, and social conditions in Canada make it a far better comparison (a comparison that shows the strength of public health insurance, mind you).

Yes, many businesses started on unsound credit. At this point in time, we cannot fully understand if that, over a long period of time, has a beneficial effect on the country. We clearly are not in the position right now to tout the wisdom of the last decade as any universal truth in economics. There is a lot of pain that has been caused by a bubble blown up by cheap credit and risky ventures.

And I have started a business--thank you very much.

I'm not entirely sure why you are not arguing for the regulation and privatization of banking insurance, or of social security for that matter. Imagine the innovation we could have if we allowed private industry to handle social security (though, there is no guarantee it would actually be secure at the end of the day). Imagine the wonderment that the nation would see if these banks were allowed to purchase their own fancy financial insurance instead of forced to buy it from the government. Oh, it would be wonderful, right? Im sure all your money would be there in case the bank failed...right there in your privately insured account.

"I'm not entirely sure why you are not arguing for the regulation and privatization of banking insurance, or of social security for that matter."

Why, you wouldn't be "ignoring a person's actual position and substituting a distorted, exaggerated or misrepresented version of that position", would you? :P

So, why aren't you arguing for that? Do you not believe that the regulated private industry could enhance social security and banking insurance for the betterment of the population? Why or why not?

I am about as capitalistic as they come but health insurance serves no purpose.

They are more like a tax.
They collect $100. Waste $20. Keep $10 in profit and then provide $70 in actual health care.
They are like drag or friction in system.

NOT EVERYTHING HAS TO BE DONE BY THE PRIVATE SECTOR.

Private Sector tends to be good at some things (Sony vs Vizio on HDTV for example).
The Public Sector tends to be good at other things (regulation, war, courts).

I think health care falls into the later. Congress is mandated to "promote the general welfare" and you can't get do much better than ensuring your citizens are happy, healthy, and safe.

When an industry produces no tangible product (insurance/banks), or the product is vital for the safety and function of the country (energy, for example), its always possible that the capitalistic paradigm will need not apply. Capitalism isn't a universal truth.

I have both government health insurance and energy (which is for-profit and outstanding), and I couldn't be happier. I buy my beer at a for-profit government liquor store (which competes with the private sector), and I ride government operated ferries. My world has not come to an end and all those services are far superior than what I would receive in the US from private companies.


"Private Sector tends to be good at some things (Sony vs Vizio on HDTV for example)."

Yes, but the private sector doesn't have to be a "capitalistic" sector in order to excel at these things. In capitalism, the workers work for a set fee, which is part of the cost of production. They have no more incentive beyond this because they have no right to profit from their labor, but the incentivized people are the shareholders who are not even materially involved with production.

The private sector can also be a co-op company, whereas the workers are paid in both wages and allocated shares so that they directly profit from their very own labor. This produces companies that incentivize workers to be more productive and innovative.

Even in the private sector, capitalism isn't the end-all, be-all of the world. People are starting to understand that are see its shortcomings

insurance companies.

The more companies, the more ways there are of cooking the books. Insurance companies do not exist to give people healthcare. They exist to give stockholders profits.

health care can NOT fit the typical American 'competition' model, because nobody CHOOSES to get sick, and when they do get sick the ONLY thing they care about is getting well. Nobody with a hot appendix shops around for the best ambulance service, the best hospital plan, the best surgical team.

Competition does NOT work with healthcare.

Would it be more cost effective to have

multiple private competing roads (all going same place)
multiple private competing fire depts
multiple private competing police depts
multiple private competing waterlines and sewer systems.
multiple private competing powerlines going into every single home.

Of course not.

Competition works in some instances but not all.

There is NO competition. I get healthcare from my job. I have no choice. There is no "shopping around". There is no innovation. No improving the system.

Health Insurance = $100 coming in - $10 profit - $30 waste/admin costs (denying claims is expensive) = $60 going out for actual healthcare.

In some instances it makes sense for the govt to provide a service for the common good (DMV, courts, military, police, regulation, inspections, and HEALTHCARE).

It is something that benefits the entire society from the richest to the poorest.

82% of food workers have no healthcare, 50% have no sickdays. Think that might have a hidden cost. One guy flipping burgers with the strep throat or some other ailment. How many people do you think he can infect?

The private sector is good at something and bad at others. The public sector is good at something and bad at others.

Not sure how the two relate. Utilities provide the same services to everyone, health care requires a wide scope of services.

If you noticed my caveat there would be a public option. We need it.

Re: your job, in many jobs you can choose from a variety of plans. In others, you're not shopping - your employer is, but you can bet she's looking for the best value.

Public health insurance can pay for private health care (mine does).

Again, insurance is a rather straightforward product. We don't need the Ayn Randian heros of the world to hold our hands and step us through it, for but a small fee.

One is simple a middle man. That middle man should be as lean and efficient as possible.

Medicare for all paid for by taxes. Done.
Same Dr, same hospitals, same specialists.

It really can be that simple. The only REASON for private health insurance is to skim some off the top. That is it. They serve no other purpose.

Basically medical providers can charge whatever they want to--and get away with it.

You're not going to walk away from the hospital because the price is too high. And so as modern medicine comes up with more and more treatments to save the patients life, nobody is willing to say no (nor should they), and as a result overall costs go through the roof.

the field and yet their is no competition at the buyer level. Because the majority of the people who have insurance get that insurance as a work place benefit. There really is no way a person can say they don't like the coverage except by changing jobs.

There is absolutely no market pressure operating in the so-called free market system.

Now that isn't the only way but I firmly believe that with something as important as a persons health at stake, their should be some kind of market pressure at work. And that is why i support the public option and why the Insurance companies are so vehemently against the PO.

Good health, whatever the cost. Do they buy vitimin pills even though there is no proven benefit? Yes. Just the promise of good health will get people to turn their wallets inside out. Will they take a crappy job that pays very little just to get good health care coverage? You betcha. When the Doctor says you need this, that and these, will you cough up the dough? For sure. The whole industry is a scam. On the otherhand, its nice to have it when you need it.

You can't address everything at once. Single-payer is a method to address at least a lot of it (profits, outsourced billing, lack of preventative care, high billable rates).

explains a lot of it to me (even it that description is overly simplistic).

Take the "insurers" for example: insurance costs go up each year because, among other things, the business's executives are obligated as fiduciaries of their company, to make descisions in the entity's best interests, which inevitably means decisions made with "the bottom line" in mind.

edited for grammar

We are literally killing ourselves so these parasites can live in obscene excess.
:thumbsup:

The health insurance companies spend MORE on administrative costs then they collect in profit.

They aren't even that good at making a profit.

For every $1 in profit they make, they waste $4 in additional costs. Basically to make a buck they waste $4.

So rather than $100 revenue = $10 in profits + $90 in actual healthcare
It is more like $100 in revenue = $10 in profits + $30 in costs trying to avoid healthcare + $60 in actually healthcare.

Their health care costs aren't nearly as high as ours and yet they are able to cover many more people. Our costs are also increasing at an astronomical rate.

Hmmm...I wonder what it is. Could it be that we have a for profit health care system? :think:

Insurance companies are taking billions in profit and people are literally dying because of it.

for things like preventative medicine, alternative treatments and the like. Case in point. I was having a discomfort after eating. Call it indigestion. I went to a naturopath (that's an N.D. as opposed to an M.D.). She put me on a regimen of various vitamins and homeopathic remedies. After a couple of months on her protocol, the issue disappeared. Of course, none of this was covered by my insurance company, so the $300 or so cost came out of my pocket.

I asked her what would have happened if I had gone to an M.D. and just gotten a prescription for Nexium or Prilosec or something. She said, "you would eventually have had to have your gall bladder taken out."

Guess what. My insurance company would have had no problem ponying up thousands of dollars for a gall bladder operation, but the $300 was on me. What do you think most people would do?

No incentive to get cheaper care if you have insurance. And those costs are borne by the marketplace in higher premiums for everybody.

unsustainable.

Get while the getting is good, and then get the hell out.

And of course, that happens in two ways: jack up rates astronomically, and deny more and more services. It's really very simple.

And in my opinion, sales of medical "insurance" should be a capital offense.

SINGLE PAYER NOW.

medicines and 'specialization'. Back in the olden days, there was no direct marketing to 'patients/consumers'. Your doctor determined what was wrong with you and what you needed. Now you can't get a GP to do anything except refer you for tests or to a specialist. I would rather have my dog's vet take care of me. He does the blood tests, the x-rays, the diagnosis, and hands out the prescription drugs.

I know at Kaiser you have to have something fairly serious/unusual to get referred to a specialist. But it makes it much easier to get treated (I have not been a patient so this is hearsay).

It should also be illegal for physicians to profit from prescribing any drugs or outside procedures.

have been laid waste as easy prey for big money leaches and exploitative d-bags.

"Protectionism" in the broad since: on trade policy, workers' protections, consumer protections, regulation as a form of community protection, etc.

Our country has sold itself off under the illusion that trade is free in a world filled with imbalances (in labor cost, access to resources, etc.). We failed to protect our communities, our people by favoring a mythical creature that exists in the same realm as the flying spaghetti monster.

It takes crisis to get people to get people to wake up from the deep hypnotism of the market-god. ...and we have done so only to learn that it may be too late. Our communities are dying and our homes are financial shells. The equity we thought we had was dangled in front of our faces like a carrot and then snatched away before we could cash in.

In this context, insurance companies and pharmaceuticals can charge whatever they want. They captured the "market" (ahem... the consumer, the worker, the small business owner) and turned it upside down and are currently ringing all the loose change from its pocket.

One thing we have learned through the bailouts and stimulus is that laid-in costs (hence supply v demand issues) are only a partial determinant of pricing. The rest is speculative gamesmanship being conducted by real people out to steal your money.

It works like this: "We want to push our profit margin up to 5% growth each quarter this year. Mr. Actuary, what do we need to do with pricing to get there? Boost rates 39%? Drop heavy users? Can we get away with it? What we have up until this point? All right, let's give it a whirl!"

Aurora Health Care will open its long-anticipated hospital in Summit on March 1. It will bring more options for patients, and competition to a market previously dominated by ProHealth Care and its nearby hospital, Oconomowoc Memorial.

Aurora spent $200 million to build the hospital and clinic. And ProHealth hasn't stood still while the hospital was being built. It spent $58 million on a new wing that opened in December at Oconomowoc Memorial as well as adding an array of new services at the hospital.

But what happened after Aurora opened a hospital in Oshkosh in late 2003 isn't encouraging. From 2003 through 2008, the combined revenue of the two hospitals in Oshkosh increased 41% faster than national expenditures on hospital care.

Mercy Medical Center and Aurora Medical Center in Oshkosh had combined revenue of $183.6 million in 2008, the most recent year for which information is available. That was 51% more than Mercy Medical Center's revenue of $121.6 million in 2003, when it was the city's only hospital.

If the increased spending had been in line with the national average, health insurers, employers and government health programs would have spent roughly $18 million less on hospital care in Oshkosh in 2008 than they did.

Nearly 50 years ago, Milton Roemer, a physician and health policy researcher, noted that a hospital bed, once built, will be filled. The axiom is known as Roemer's Law, and many health care economists contend that it still holds true today - only now it also applies to imaging centers, outpatient surgical centers and other services.

The phenomenon is known as "supply-induced demand."

"There is pretty good evidence that it exists," said Robert Town, a health economist and professor at the University of Minnesota.


http://www.jsonline.com/business/84874112.html

Does lowering the costs of healthcare benefit the Rich White Penis?

This question can also be posed to any current political issue.

Have fun with that :)

which is why I don't support mandated insurance.

If our entire health care system exists for the sole purpose of making a profit, it stands to reason that companies will strive to maximize the cost.

Drug companies can make a drug for pennies and sell it for thousands of dollars a dose, but only if they hold a patent on it. That's why they continually request patent extensions and market new drug brands, even though the new brands may be little or no more effective than existing drugs. And they keep prices artificially high by lobbying to prevent governments from using bulk purchasing power to buy them.

Insurance companies make their money by
1) selecting only the healthiest customers
2) charging as much as they possibly can
3) paying as little as they possibly can.
Their goal is not to make insurance affordable. It's to make as much money as they possibly can.

Hospitals, even not-for-profits, have to at least break even. If 15% of their customers have no insurance, they likely won't ever pay their bills. To make up for it, they charge everyone who has insurance 15% more. And since more and more people lose their insurance every day, that cost keeps going up.

Doctors are paid by insurance companies based on the services they perform, so they have an incentive to do more than may be needed.

Having dozens or hundreds of different insurance programs creates large administrative costs for hospitals and doctors offices. It's a lot of work trying to collect money from dozens of different companies when each company sets it's own rules for the forms you have to submit, their reimbursement rates, etc.

If you want to make health care better and cheaper, you need to start with that as a goal and eliminate any other considerations. You could start by eliminating unnecessary overhead costs like having 3000 different claim forms. You would centralize and standardize claim processing. You would spend money to research the most effective drugs and let drug companies compete to make that drug at the lowest cost. You would encourage people to seek treatment early by covering everyone and not forcing them to make decisions on their health on the basis of their bank balance.

simple as that...they can do it and get away with it...

Insurance=extortion+racketeering

Single payer would be the best start in this mess.

health care.

(the elderly too, stand outside the profit driven system along with the poor, because as elderly peoplee who're certain to require expensive medical interventions in increasing frequency before their inevitable end, they also cannot be profited on) Middlemen in any business make their money a percentage of the total sale of some good produced by someone else.

Now then, do middlemen want prices to remain steady - or do they want prices to rise? That's right, they want and indeed they require prices to RISE. Always. Or else, as publicly traded share issuing firms they will soon be at an evolutionary dead-end.

Back in the old days when I went to the doctor I visited him in his office which was the front room of his house. His wife was his receptionist and nurse. Me, as a one single individual person paid my doctor as one single individual person and that was that.

Today, I visit my doctor in a huge medical complex with hundreds of employees which is owned by a huge corporation 600 miles away in San Fransisco which has huge office buildings and hundreds of employees.

And the whole reason for all that corporate overhead is so that these huge corporations can siphon off a large chunk of every dollar spent on medical bills and turn it over to the investor class who expect to sit on their fat asses getting money for nothing just because they bought stock in the company.

So instead of medical bill helping to support one member of my own community I'm helping to support hundreds of employees scattered all over the country, and thousands of lazy bastards who expect money for nothing year after year just because they bought a piece of paper with the name of the corporation on it.

It's not the cost of medical care that's gone up. It's the cost of the heavy burden of freeloaders expecting their free lunch at my expense.

http://www.news-medical.net/news/20100220/Study-Physicians-attribute-2625-of-overall-healthcare-costs-to-the-practice-of-defensive-medicine.aspx


Study: Physicians attribute 26% of overall healthcare costs to the practice of defensive medicine
20. February 2010 03:00

Physicians attribute 26 percent of overall healthcare costs to the practice of defensive medicine according to a study released today by Gallup and Jackson Healthcare.

Physicians generally estimate that defensive medicine costs are higher overall when compared to their own personal practice. While physicians attribute an average of 26 percent of overall costs to defensive medicine, 13 percent believe the practice constitutes 50 percent or more of the cost.

Of the physicians surveyed, 73 percent agreed that they had practiced some form of defensive medicine in the past 12 months. Twenty-three percent of practicing physicians estimate that defensive medicine constitutes less than 10 percent of their practice while 29 percent estimate the percentage to be between 10 percent and less than 25 percent.

Physicians indicating they had practiced a form of defensive medicine in the last twelve months attribute 21 percent of their practice to be defensive in nature.

In the study, defensive medicine was defined in this manner: "Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. This may include tests, prescriptions, hospitalizations and referrals that may not be medically necessary, but are viewed as providing protection from a potential lawsuit."

Jackson Healthcare retained Gallup for the study in an effort to quantify the scope and impact of defensive medicine practices in the U.S.

Results are based on telephone interviews with 462 randomly selected US physicians. Interviews were conducted in December and January.

stir up shit much?

Abusive suits like the one filed recently by that twit in IL (and her twat lawyer/husband) suing the hospital where her child was born because she breast fed someone else's baby for 15 seconds. Shit like that is not helping to reduce anyone's cost. When every mistake is seen as $$$PAYDAY$$$ by scumsuckers and their lawyers, costs go up.

Most of all, it's because a large number never pay their bills because they can't afford a $15 asprin. It's a catch 22. That Is The Reason We Need Universal Health Care Now!!! Hospitals and health care insurance providers build in the cost of those who Can't Pay NOT Won't, those are the charges transfered to you !

Physician costs: Salaries, insurance, continuing ed.

Technology I. It's been documented that demand for a piece of equipment rises when the equipment becomes more common. If you have a CT scanner you'll use it. Why? Because the information you get is better than what you'd have otherwise. Do you need the information? Not in most cases.

Insecurity I. You'll want the CT scan because you're insecure. Might you miss something with low-budget tests? Sure. Can't make a mistake. Your very-much-imperfect patients expect you to be perfect. Then there are stupid referrals. My endocrinologist insists that I see a cardiologist every time I go into a-fib--even when it's obvious that my thyroid hormone levels are too high and it's not a cardiologist-related problem. The endocrinologist doesn't want the blame. The cardiologist scowls because the thyroid test results aren't back yet. Stupid referral.

Insecurity II: You treat things that are subclinical or potential because they might just be there and you may have missed them.

Risk aversion. This piggy-backs on Insecurity II: You treat things even if they have really, really low risk. There's no price too great for others to bear to keep you from having that one-in-a-million problem.

Drugs and research. While the government puts a lot of money into drug development, drug companies do, too. You can't make money in most countries, so you engineer your price structure to produce the needed revenue from countries that don't control drug prices. You can fund drug innovation via drug prices and have it count as "medical costs" or you can move it into the science budget as some other countries do. Of course, if it's in the science budget then you've reduced medical costs without saving a dime and your medical costs accounting is skewed.

Drugs and prescriptions: People don't want old drugs. They want new ones. Doctors and people fall for sales pitches. In some cases they actually prefer brand-name and not generics. Sometimes new drugs work marginally better. Sometimes they work a lot better.

Overuse and unnecessary use. People see doctors when they don't need to. It's cheap, why not? It provides peace of mind, not necessarily greater health. Then there's the "doctor as bureaucratic adjunct": My kid's school requires a doctor's note if he's out for 3 days or more--and then says that if the kid has a fever over 100 F he can't return to school for 24 hours after the fever drops below 100 F. So if he has a mild flu and has a fever for 2 days, he has to stay home on the 3rd. That means that we have to get him to the doctor to document that he has a fever on day 2; as parents we can't be trusted. My kid's pediatrician hates this. There's also nothing that she can do about it.

Increased need I: With an ageing population you need more services, on average. Average age is 30: You need ob/gyns and some GPs for kids. Average age is 70: You need geriatric specialties, and lots of them. Guess which is more expensive, which is a chronic condition, and which will just cost more and more in terms of medical costs as time goes on.

Technology II: As more things become treatable, more things will be treated. And new treatments tend to be expensive. Think of it: All of the expense for Viagra simply didn't exist 50 years ago.

Increased need II: As more specialists became available they described more things to treat and convinced us that these things need to be treated. Many of them don't need to be, but we're convinced that we can't live without treatment.

Technology III: Even though a piece of equipment may not be all that useful, the health organization wants it. Nay, it needs it. Then they have to pay for it, house it, maintain it, and have trained folk around to be able to use it when necessary.

Increased need III: We save lives that we couldn't 20 years ago, but once we save them it's expensive to keep them alive. This is a strictly utilitarian problem: How much should society pay to warehouse a person--whether infant or senior--whose contribution will be simply living and producing jobs for medical staff? Take my father-in-law: 20 years ago he'd have died at least a year before he did and his case would have made a medical journal. During that year or more he did nothing but get treatment: He was usually not in his right mind, he was abusive, all he did was go to and from appointments with his neurologist, nephrologist, internist, endocrinologist, surgeons, going from ICU to hospital room to special care facility and then back to the ICU, sometimes dropping in at home for a few weeks with special equipment and a nurse that visited him daily. Each month he was alive under those conditions his *hospital* bills topped $200k each month, and those don't include the 15 or 20 drugs he was taking--mostly newer drugs--or his care facility or equipment. They finally diagnosed him 6 months before he died: Nobody diagnosed with that in the US or Europe lived for more than 3 years, and over 70% of them died in the first year--after lots of care, amputations, drugs, etc., etc. (People would usually die before diagnosis in most other countries; it's a rare condition.)

There was one report that surveyed hospitals; those with low costs were cited as models to emulate for health reform. Those with high costs were condemned as wasteful. A second study noted that there was no discussion of patient outcomes. It re-examined that report and pointed out that the first, low-cost hospitals tended to have either very high risk or low risk patients. They were quick and cheap to treat because they checked out fairly quickly--well or dead, they still checked out. The high-cost hospitals, condemned as wasteful and a model to be avoided, had a greater number of people leave alive, but costs were higher because their treatments were more prolonged. That is, often enough, the choice.

Decor: The doctors I see are in fairly nice digs. In nice buildings. They don't need to be. Yet people expect them to be.

Dividends/stock prices, for for-profit corporations: Of course, we hate the idea of profits. That the largest holders of such corporations are pension funds, private and public, so that a lot of pensions would be hurt in the absence of such dividends or should stock prices fall is apparently beside the point.

Different demographics: It's often pointed out that countries with far lower expenses are healthier. Leave aside everything above, populations differ crucially in a lot of respects, both in what diseases afflict them and the way they maintain their own health. Even controlling for SES, there are still questions as to why some subgroups show the illness trends that they do.

do it??

C'mon, DU, get wise.

of a fee they'll pay. The provider then raises their price so they will get the amount they want. Next year, same thing. Big insurance says we'll pay X%, the provider raises the rates. Over and over and over again like greedy hamsters on wheels.

Since 1945, the health and medical malpractice insurance companies have had anti-trust exemption! WHY? This boggles the rational mind. I don't know how they managed this. Add minimal regulatory oversight and you get "fuck the public." The House was to take up an anti-trust bill this month, but I'm not aware of its fate. Anybody know?
Also, malpractice awards might have large dollar amounts publicized, but the actual settlement figures are almost always FAR less, reduced by judges or other processes. Only the few huge award$ get the headlines and these foment the reich-wing outrage about tort reform. It's all a kabuki performance. My $0.02...

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