Who is to blame for the high cost of US healthcare, and why medical tourism may be a necessary option.

Who is to blame for the high cost of US healthcare, and why medical tourism may be a necessary option.

Much has been written lately about the high cost of care in the US, with a recent poll of practicing physicians expressing that the insurance companies and the attorneys were to blame, yet in a post written by Chris Kaiser, the cardiology editor on Medpage, he debunks some of these same tired talking points showing that by neutering attorneys as they did in Texas, health care costs continued to rise. He also uses examples of the ridiculous markups that occur from the drug company, through the physician or hospital to the patient and even after the insurance company discounts the cost, the end fee is outrageous. Read his post below.

Rising Health Costs? Don’t Blame Docs


Published: Aug 3, 2013 By Chris Kaiser, Cardiology Editor, MedPage Today

Physician readers of MedPage Today concur with physicians at large: We are not to blame for runaway healthcare costs. Everyone else is.

That’s what the MedPage Today survey indicated when more than three-quarters of voters agreed that doctors are disproportionately blamed for rising healthcare costs.

The percentage of “yes” votes remained constant all week at around 75% and the final tally of votes hit nearly 3,800 with 60 comments.

This is a hot-button topic for sure.

The question was conceived when the results of another survey published in JAMA revealed that docs wanted other healthcare stakeholders — such as lawyers, insurers, hospitals, drug companies, and patients — to bear more cost-cutting responsibility.

MedPage Today readers who responded to the survey also heaped blame on everyone but physicians and in this order: Lawyers, insurers, drug companies, lawyers, hospitals, the government, lawyers, insurers, physicians, lawyers, drug companies, insurers, patients, and lawyers. Sense a theme here?

Let’s have the readers speak.

“As a practicing RN finishing my second series of chemotherapy infusions and injections, I am most interested in the costs of medications. One of the meds in question is Neulasta [pegfilgrastim]. It is a fine drug, accomplishing its task with all deliberate speed. I found it listed, perhaps by a manufacturer, at $1,200. Curiously, my insurance statement lists the Neulasta charge at $5,000 and the payment at $3,000. I don’t know at whose feet to lay the usurious price.”

One doctor said that patients must pay for their care if cost is to be managed and quality improved, which had a reader screaming “No!”

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Of course, since the medical economy in the US is propped up by insurance carriers, and a monopoly which does not exist in many other countries, there really is competition for medical procedures when we consider other countries. An interesting article in the NY Times talks about someone who needed a new hip, but the cost of having it done in the US was several times the cost of having it done in another country. Even with the cost of flying to the other country, the quality of care was high, the cost of care was within reason and he followed up with his local doctor who approved of the quality of the work as he removed the stitches.

Some might be afraid to take the leap of faith having a procedure done outside the US, but as many people are finding, many countries have more affordable and terrific healthcare systems that can do a great job there for much less than the cost here. To put the cost in perspective, many of those same countries have a cost of living that is not too different than living here. The difference is the culture of gouging and the multiple layers of profit (think multi level marketing) which pushes the price up and having no real economy to put checks and balances on the prices. Since the US healthcare economy is way out of whack pricewise, why not go somewhere else where the care is good, the quality is high and you will not be bankrupted because of egregious fees.

Read about this mans story here

In Need of a New Hip, but Priced Out of the U.S.

By | Published: August 3, 2013

WARSAW, Ind. — Michael Shopenn’s artificial hip was made by a company based in this remote town, a global center of joint manufacturing. But he had to fly to Europe to have it installed.

Mr. Shopenn, 67, an architectural photographer and avid snowboarder, had been in such pain from arthritis that he could not stand long enough to make coffee, let alone work. He had health insurance, but it would not cover a joint replacement because his degenerative disease was related to an old sports injury, thus considered a pre-existing condition


Desperate to find an affordable solution, he reached out to a sailing buddy with friends at a medical device manufacturer, which arranged to provide his local hospital with an implant at what was described as the “list price” of $13,000, with no markup. But when the hospital’s finance office estimated that the hospital charges would run another $65,000, not including the surgeon’s fee, he knew he had to think outside the box, and outside the country.

“That was a third of my savings at the time,” Mr. Shopenn said recently from the living room of his condo in Boulder, Colo. “It wasn’t happening.”

“Very leery” of going to a developing country like India or Thailand, which both draw so-called medical tourists, he ultimately chose to have his hip replaced in 2007 at a private hospital outside Brussels for $13,660. That price included not only a hip joint, made by Warsaw-based Zimmer Holdings, but also all doctors’ fees, operating room charges, crutches, medicine, a hospital room for five days, a week in rehab and a round-trip ticket from America.

“We have the most expensive health care in the world, but it doesn’t necessarily mean it’s the best,” Mr. Shopenn said. “I’m kind of the poster child for that.”

As the United States struggles to rein in its growing $2.7 trillion health care bill, the cost of medical devices like joint implants, pacemakers and artificial urinary valves offers a cautionary tale. Like many medical products or procedures, they cost far more in the United States than in many other developed countries.

Makers of artificial implants — the biggest single cost of most joint replacement surgeries — have proved particularly adept at commanding inflated prices, according to health economists. Multiple intermediaries then mark up the charges. While Mr. Shopenn was offered an implant in the United States for $13,000, many privately insured patients are billed two to nearly three times that amount.

An artificial hip, however, costs only about $350 to manufacture in the United States, according to Dr. Blair Rhode, an orthopedist and entrepreneur whose company is developing generic implants. In Asia, it costs about $150, though some quality control issues could arise there, he said.

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Most people would never think of having a procedure done outside the US, and most primary doctors are not the problem; it is the procedures and the specialty care. Until we get these costs under control and add some reasonableness to our system of healthcare, health insurance costs will remain high and people will be bankrupted by a system whose pricing is ridiculous.

While many doctors a the front lines (primary care, chiropractors) work hard, the problem in containing costs are many, including insurance companies who do not negotiate well enough to keep costs in check. Perhaps, this is why all along, a single payer Medicare style system is what we needed in the first place. Perhaps, Obamacare was designed to put this in place by allowing the current system to fail by costliness and then have another alternative that sounds like Medicare for all.

The future will tell but for now, it going abroad is an option, as a consumer, it is worth considering. As more of us have higher and higher deductibles, perhaps insurers themselves should arrange to make it easy for people to have certain procedures out of the country, and reward the patient by perhaps waiving the deductible if they do it.

What do you think? As always, I value your opinion