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

[jimbob]

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

You also need to add in the 75% of medical bankruptcies in 2007 who did have medical insurance at the start of their medical problems.

 

[Blue Mountain]

Also being discussed here: US Health Care Problems! in the USA Politics forum. I'll ask the mods if a merge is required.

 

[Blue Mountain]

I pay $5 for most generic prescriptions.

The fact is for many Americans, hundreds of millions of us infact or around 90% of our population, our healthcare system works just fine.

Correction: your opinion is that is works well. You've just given an excellent example of the "I'm alright Jack!" argument.

The facts are otherwise. It works well for you, for today. What if you suddenly lost your job? What if you got sick and then lost your job? What if your employer decided to switch to a discount health insurance provider who puts an annual cap on your coverage? (Fortunately that can't happen after this year.)

The other fact is over 40% of Americans have no health insurance or inadequate insurance, or fall into that crack between being able to afford insurance but making too much for Medicaid. The system is not working for them.

A quote from the article:

Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot. People fare differently according to circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or they’re protected only partly by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow know the prices before they get billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.

 

[maxpower1227]

As a person whose significant other has significant medical problems requiring a large number of expensive prescription medications as well as other medical tests with some regularity, and who was recently forced by her employer (a university) onto an inferior health insurance plan than the one she had over the last few years, I would just like to say that the views expressed by Courier et al about the adequacy of our health care system are quite naive. I'll leave my comments at that so as not to run afoul of any terms of the membership agreement.

 

[Myriad]

The article was quite informative. I've been aware (by reading the details of the deliberately cryptic notices I receive from my health insurance company, and from medicare on behalf of my developmentally disabled brother) that the main purpose of health insurance in the U.S. is not to cover the actual costs of treatment, but to protect the subscriber from being charged over ten times more based on fictitiously high rates (that can suddenly become not fictitious if anything goes wrong with your coverage). I now understand where those high figures come from.

A simple example: last year I had my dog tested for Lyme disease. My vet is great but the group charges top dollar for everything; for instance if I bought my routine pet treatments like Frontline flea and tick treatment there I'd pay double what the pet stores charge for them. Their charge for the Lyme test (which also tests for five other diseases) was $60, which means it couldn't cost them more than $20 for the test. Probably more like $5 or $10, because they're also charging for a few minutes' labor to put the blood sample onto the test strip and read the result.

During the same year, my wife had a suspicious tick bite, so she also had her blood tested for the exact same organism by her doctor's office lab. The base charge was over $600. The amount her insurance plan allows them to charge was $139, of which the insurance covered $79, leaving us out of pocket for... $60.

So we end up paying a more or less fair market price for the test, after having already paid insurance premiums. But without the insurance we'd have to pay tenfold more for the same test.

It's as though your food warehouse club cost $5000 a year for membership, and you could buy food there at normal prices (say, $3 for a loaf of bread), and if you didn't have the membership, you'd have to buy your food at stores that charge $50 for a loaf of bread instead.

Respectfully,
Myriad

 

[Courier]

...The other fact is over 40% of Americans have no health insurance or inadequate insurance, or fall into that crack between being able to afford insurance but making too much for Medicaid. The system is not working for them.

A quote from the article:

Around 30 million Americans have no health insurance.

That's less than 10% of our population.

 

[DavidJames]

The fact is for many Americans, hundreds of millions of us infact or around 90% of our population, our healthcare system works just fine.

You seriously have no freaking clue. Stop smoking xenophobic weed and take an honest look at the rest of the 1st world countries.

Once you stop listening to right wing talk radio and take an honest and fact based view (you can't do the latter without doing the former), you'll realize that the health care in the U.S. sucks.

The "fact" you state is simply not supported by real facts and real studies.

 

[WildCat]

You also need to add in the 75% of medical bankruptcies in 2007 who did have medical insurance at the start of their medical problems.

But a lot of medical bankruptcies are because people are unable to work due to the illness, not just because of medical bills. Even if 100% of the medical costs are paid there's still the rent/mortgage, utility bills, car payments/insurance, etc etc.

 

[Travis]

If Canada had 313 million people they wouldn't have such an easy time paying for all of their health insurance through just income taxes.

Nevermind the fact that wealthier Canadians cross the border for higher quality healthcare in the USA.

I pay $5 for most generic prescriptions.

The fact is for many Americans, hundreds of millions of us infact or around 90% of our population, our healthcare system works just fine.

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

Yeah, just screw them.

Oh wait I'm part of that percent.

I wasn't poor and homeless (or female because that matters for this) but I couldn't get private health insurance on account of pre-existing conditions.

What do you think should be done for people like me?

Around 30 million Americans have no health insurance.

That's less than 10% of our population.

Yeah, who cares if I die from a treatable condition? We have millions more!

 

[Cain]

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

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

I was kind of taken aback.

So you have a point of comparison. The U.S. vs. Sweden. Would you say the U.S. is better or a lot better?

 

[Blue Mountain]

Around 30 million Americans have no health insurance.

That's less than 10% of our population.

Your number's too low, but even at 30 million that's almost the same as the entire population of Canada! (Currently 36 million.)

My statement was as follows:

The other fact is over 40% of Americans have no health insurance or inadequate insurance, or fall into that crack between being able to afford insurance but making too much for Medicaid. The system is not working for them.

(A correction: the second half of the first sentence should have read "or fall into that crack between not being able to afford insurance but making too much for Medicaid.")

For example, This commentary from the Community Health Network:

TUESDAY, Aug. 7 (HealthDay News) -- About 29 percent of Americans have health insurance that is inadequate and leaves them struggling to pay medical bills, according to a survey in the September issue of Consumer Reports. When added to the 16 percent of Americans who lack health insurance, this implies that 45 percent of Americans have inadequate access to health care.

So, your 10% number of completely uninsured was too low (the above article says 16%), and you ignored the part about inadequate insurance. You know, the type that pays out only $100,000 on a $450,000 bill.

I notice you did not address my question about what would happen if you suddenly lost your job.

 

[TragicMonkey]

But a lot of medical bankruptcies are because people are unable to work due to the illness, not just because of medical bills. Even if 100% of the medical costs are paid there's still the rent/mortgage, utility bills, car payments/insurance, etc etc.

And if you get insurance through your employer, and you become too sick to work, you lose the insurance. You can extend it with COBRA...for a lot more money than you were paying. And of course now you're not working you can't really afford what you were paying before, much less more...

As long as health insurance comes through employers, people are not secure because both your insurance and income eggs are in the same basket.

 

[kellyb]

Yeah, just screw them.

Oh wait I'm part of that percent.

I wasn't poor and homeless (or female because that matters for this) but I couldn't get private health insurance on account of pre-existing conditions.

What do you think should be done for people like me?


Yeah, who cares if I die from a treatable condition? We have millions more!

Die or go to debtor's prison.
I'm pretty sure that's the idea.

 

[uke2se]

So you have a point of comparison. The U.S. vs. Sweden. Would you say the U.S. is better or a lot better?

 

[jimbob]

But a lot of medical bankruptcies are because people are unable to work due to the illness, not just because of medical bills. Even if 100% of the medical costs are paid there's still the rent/mortgage, utility bills, car payments/insurance, etc etc.

True, and a lot are not:


From the OP

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

Because I don't need to worry about insurance for medical bills, I can my employer can afford more insurance against the second (part of my employment conditions) and the social safety net helps.

 

[Nessie]

......

Does this sort of insanity happen anywhere else in the world?

Certainly not in Europe and I don't think so anywhere else. Though for many countries health care is totally dependent on international efforts such as Medicine without Frontiers and local "healers".

 

[Molinaro]

If Canada had 313 million people they wouldn't have such an easy time paying for all of their health insurance through just income taxes.

Nevermind the fact that wealthier Canadians cross the border for higher quality healthcare in the USA.

Are you saying that economy of scale works in reverse with healthcare services?

Things generally cost less when you manufacture/buy in bulk.

Why should the per capita costs be doubled for a larger group of people instead of being lower?

 

[Molinaro]

http://en.wikipedia.org/wiki/Healthcare_in_Canada#Criticisms

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

One could say that I possess a form of universal healthcare as it benefits hundreds of thousands of people in the same area. My co-pays are mostly $15 and I can usually see the doctor of my choice within 7 days. Not so, in Canada.

When I call my GP to make an appointment the longest I ever had to wait was, tomorrow. Most of the time I get a same day appointment.

The wait times listed are actually considered reasonable by many Canadians. If you are seriously ill, you don't wait. If you are not, you wait. Why should we throw money away to hurry things up that don't need to be hurried?

 

[jimbob]

If Canada had 313 million people they wouldn't have such an easy time paying for all of their health insurance through just income taxes.

Nevermind the fact that wealthier Canadians cross the border for higher quality healthcare in the USA.

Are you saying that economy of scale works in reverse with healthcare services?

Things generally cost less when you manufacture/buy in bulk.

Why should the per capita costs be doubled for a larger group of people instead of being lower?

I hope you don't mind me reposting from earlier in the thread...

Canada is a good example because its system used to be like the US system and then changed - and now has a better efficiency.

And from a different thread, comparing the US and Canada:

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

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

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

The efficiency of US healthcare delivery is considered to be less than half of Canada's, even though Medicare is almost as efficient. This means that outside of Medicare (which has a 2% overhead) - so that means HMOs and private hospitals - is less than half as efficient. Maybe about 35% as efficient, based on my back-of-the-envelope estimate.

 

[Tatyana]

http://en.wikipedia.org/wiki/Healthcare_in_Canada#Criticisms

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

One could say that I possess a form of universal healthcare as it benefits hundreds of thousands of people in the same area. My co-pays are mostly $15 and I can usually see the doctor of my choice within 7 days. Not so, in Canada.

If I stop by my surgery at 8 am, I can typically see a doctor by 8:45-9:15 the same day.

I can also phone for an appointment at the end of the day, so it fits with work schedules, or make an appointment for the following week.

I do not have a co-pay, and I don't pay for prescriptions as I have a medical exemption as I am hypothyroid and take daily thyroxine.

I am in the UK.