The high cost of healthcare in the United States; the truth behind why we pay so much as compared to other countries.
The cost of care in the USA continues to increase, yet other countries pay half or less than we do for care that is better value. The problem, as per Forbes’s is a systemic one, with the incentives created by the system, led by insurance companies and less so by the center for Medicare services.
In the 1960’s, as many baby boomers remember, doctors had real relationships with their patients, and primary care was where you began and often ended your healthcare journey when something went wrong. Now, your primary care visit, courtesy of big insurance is about 10 minutes of a doctor looking at a screen and then quickly assessing, either giving you a drug for your symptom or sending you out to specialists who look at one part of you, as if your body is a disjointed mechanism.
The truth is, even though we have moved forward with better technologies, better imaging, and better surgeries, the truth is that the lack of a true primary care experience is the root of what drives costs. When I speak with people who visit from foreign countries, their experiences are more like a number of year ago, where the doctor looks at you, not just your symptoms and will refer you when necessary. The other problem is that in the USA, primary care looks at diseases which are classifications that allow for the medical prescription of drugs, instead of the problems which are often interconnected with the musculoskeletal system, an area that most primary care providers are less comfortable with, but most complementary providers such as chiropractors excel at.
Part of the problem is also the model we work in, which is often confusing, causes providers to jump through hoops and then reimbursing them in ways that incentivizes behaviors that are more about profitability and income instead of quality of care that is cost effective.
In our experience, every year, insurance companies change the rules of the game and we have to either play by their rules and prosper, or deviate and be punished. The most recent idea of meaningful use is both wasteful, has little to do with quality of care and outcomes, but further pushes the idea that the electronic health record is mandatory or else, reducing health care efficiency. Also, having insurance companies play games requiring a number of people whose sole purpose on our staff is to code, or call them to find out why something was paid or confuse us with insurance details that are often quoted wrong. The higher deductible model is the latest snafu, causing patients to put off needed care, which will cost them more later as their problem worsens; hardly a cost saving idea for the system, but great for insurers since they are pushing those costs on to the consumer. The other fact is that healthcare providers have not gotten a raise in years from most insurers, especially at the primary care level; resulting in the often inadequate 10 minute office visit. Considering all this, the only way they can maintain their practices among rising costs is to get into bigger groups, sell their groups or go outside the system, something all too frequent in our healthcare system.
There is also the perversion of costs such as an MRI which in the network may cost $800, but if you have cash, it is $400. This makes little sense because an MRI is an MRI, but not all physicians are the same. Colonoscopies are mostly the same as are many other common commoditized healthcare procedures. Then there is the ever changing idea of what is medically needed, which tests really help, and as we have recently read, are doctors really helping patients with the yearly physical or are they scaring patients and themselves into digging deeper into their diagnostic acumen, only to bring harm to a patient unintentionally with a biopsy or other test which leaves emotional and sometimes physical scars, while the test itself comes back negative, as most of them do.
Clearly, we need a reboot. Of course, politicians blame the doctors, yet the doctors are merely cogs in the wheel of a highly inefficient system, trying to pay off their school loans (many doctors in practice for years still are paying off their loans) and trying to live their lives like you and I do, and some specialists who have read the tea leaves figured out how to keep their incomes very high, by investing in over priced surgi-centers whose prices are made legitimate by insurance companies fee schedules. Yup, those darn incentives are a huge part of the problem.
Drug companies, fat from years of unquestionably overpriced drugs, charge what the market bears, buffered again from insurance interests willing to pay outrageous prices, while reducing consumer exposure to the real costs of what they charge. That game continues and we all are paying dearly for it. Even medical device prices are way beyond what a true market would ever pay for them. Imagine an 8,000 dollar insulin pump with less than 100 dollars in actual parts costing the patient only $400. Would the patient, the consumer actually pay 8,000 or would a lack of sales bring prices and efficiencies in line. If they were told that the insurance could only pay $2000 toward the cost, would the consumer pay the balance or would the market price for such a device drop. What do other countries do in the same circumstances and what is the effect on cost?
One more thought; Medicare can better negotiate the cost of care than any of the insurers and can do it across state lines. Is Bernie Sanders entirely wrong about moving towards a single payer. Other than the noise created by lobbyists in Washington for the Drug companies or insurance companies, do we really need to require us to keep companies in business that spend healthcare dollars on image advertising, commercials on television and force doctors to hire more people to properly administrate their arcane system of reimbursements that may need collection calls due to their complexity?
As you see, the patient, our healthcare system is terminally ill, and unless it received a heart transplant, it will lead to a single payer system eventually. Is there any politician out there courageous enough to allow people 50 and older to buy into Medicare? After a couple of years, more people will likely sign up and the cost will be lower, as the group gets larger. If we paid premiums out of our payroll, or a VAT since we all consume, would that really be a bad thing instead of, as many of us found out, getting a special tax form from our health care company to show that we were insured so we do not have to pay a penalty. Doesn’t simplicity just cost less?
Check out this thoughtful article in Forbes
Should Presidential Candidates Be Vilifying Physicians For The High Cost Of Medical Care?
When asked what enemies she was proud to have made during her political career, Hillary Clinton mentioned, in order, “œthe NRA, the health insurance companies, the drug companies [and] the Iranians.” Pretty villainous company to place healthcare industries into. But Clinton is not alone among presidential candidates in vilifying pharmaceutical and insurance industries for, as Bernie Sanders puts it, “œripping off the people.” Donald Trump called pharmaceutical profiteering “œdisgusting” and claimed that “œinsurance companies are making a fortune because they have control of the politicians.” Marco Rubio blamed high drug prices as “œpure profiteering” by pharmaceutical companies. It is a strange world when Republicans join Democrats in vilifying people and companies who pursue profits through the marketplace.
Even stranger, neither party is taking aim at a group of people in the healthcare industry who have been making a fortune by exerting enormous influence over healthcare spending. No one seems to be vilifying physicians.
Yet if candidates are looking to blame someone for high healthcare costs in the United States, they should include physicians, whose decisions”“to order tests or treatments”“are responsible for the bulk of healthcare spending. Yes, pharmaceutical companies are charging exorbitant prices for many of their products. But patients do not receive expensive medications unless physicians prescribe them. True, insurance premiums are very expensive and rising rapidly. But those premiums reflect the cost of paying for all those services that physicians order for their patients. And some of those services reflect physician fees, which for some subspecialists are quite high. Many American physicians are extremely well paid for their work, with the median allergy doctor making almost $300,000 a year, and the median gastroenterologist making almost $400,000. Indeed, American physicians often take home 50 to 100% higher annual incomes than their peers in Europe or Canada.