Whether directly from their wallets or through insurance policies, Americans pay more for almost every interaction with the medical system. They are typically prescribed more expensive procedures and tests than people in other countries, no matter if those nations operate a private or national health system. A list of drug, scan and procedure prices compiled by the International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all 21 categories-- and often by a huge margin.The National Memo reviewed Gar Alperovitz’s recently released book, What Then Must We Do? Straight Talk About The Next American Revolution this morning:
Americans pay, on average, about four times as much for a hip replacement as patients in Switzerland or France and more than three times as much for a Caesarean section as those in New Zealand or Britain. The average price for Nasonex, a common nasal spray for allergies, is $108 in the United States compared with $21 in Spain. The costs of hospital stays here are about triple those in other developed countries, even though they last no longer, according to a recent report by the Commonwealth Fund, a foundation that studies health policy.
While the United States medical system is famous for drugs costing hundreds of thousands of dollars and heroic care at the end of life, it turns out that a more significant factor in the nation’s $2.7 trillion annual health care bill may not be the use of extraordinary services, but the high price tag of ordinary ones. “The U.S. just pays providers of health care much more for everything,” said Tom Sackville, chief executive of the health plans federation and a former British health minister.
Colonoscopies offer a compelling case study. They are the most expensive screening test that healthy Americans routinely undergo-- and often cost more than childbirth or an appendectomy in most other developed countries. Their numbers have increased manyfold over the last 15 years, with data from the Centers for Disease Control and Prevention suggesting that more than 10 million people get them each year, adding up to more than $10 billion in annual costs.
Largely an office procedure when widespread screening was first recommended, colonoscopies have moved into surgery centers-- which were created as a step down from costly hospital care but are now often a lucrative step up from doctors’ examining rooms-- where they are billed like a quasi operation. They are often prescribed and performed more frequently than medical guidelines recommend.
The high price paid for colonoscopies mostly results not from top-notch patient care, according to interviews with health care experts and economists, but from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees.
While several cheaper and less invasive tests to screen for colon cancer are recommended as equally effective by the federal government’s expert panel on preventive care-- and are commonly used in other countries-- colonoscopy has become the go-to procedure in the United States. “We’ve defaulted to by far the most expensive option, without much if any data to support it,” said Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.
...Hospitals, drug companies, device makers, physicians and other providers can benefit by charging inflated prices, favoring the most costly treatment options and curbing competition that could give patients more, and cheaper, choices. And almost every interaction can be an opportunity to send multiple, often opaque bills with long lists of charges: $100 for the ice pack applied for 10 minutes after a physical therapy session, or $30,000 for the artificial joint implanted in surgery.
The United States spends about 18 percent of its gross domestic product on health care, nearly twice as much as most other developed countries. The Congressional Budget Office has said that if medical costs continue to grow unabated, “total spending on health care would eventually account for all of the country’s economic output.” And it identified federal spending on government health programs as a primary cause of long-term budget deficits.
While the rise in health care spending in the United States has slowed in the past four years-- to about 4 percent annually from about 8 percent-- it is still expected to rise faster than the gross domestic product. Aging baby boomers and tens of millions of patients newly insured under the Affordable Care Act are likely to add to the burden.
...A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor. Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide, for example.
“In the U.S., we like to consider health care a free market,” said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ”But it is a very weird market, riddled with market failures.”
Consider this:
Consumers, the patients, do not see prices until after a service is provided, if they see them at all. And there is little quality data on hospitals and doctors to help determine good value, aside from surveys conducted by popular Web sites and magazines. Patients with insurance pay a tiny fraction of the bill, providing scant disincentive for spending.
Even doctors often do not know the costs of the tests and procedures they prescribe. When Dr. Michael Collins, an internist in East Hartford, Conn., called the hospital that he is affiliated with to price lab tests and a colonoscopy, he could not get an answer. “It’s impossible for me to think about cost,” he said. “If you go to the supermarket and there are no prices, how can you make intelligent decisions?”
Instead, payments are often determined in countless negotiations between a doctor, hospital or pharmacy, and an insurer, with the result often depending on their relative negotiating power. Insurers have limited incentive to bargain forcefully, since they can raise premiums to cover costs.
“It all comes down to market share, and very rarely is anyone looking out for the patient,” said Dr. Jeffrey Rice, the chief executive of Healthcare Blue Book, which tracks commercial insurance payments. “People think it’s like other purchases: that if you pay more you get a better car. But in medicine, it’s not like that.”
Everyone knows we have problems in the United States: unemployment, poverty, environmental decay, global warming-- to say nothing of whole cities like Detroit, Cleveland, St. Louis, and many others that have essentially been thrown away. If you are black or brown, your prospects are far worse. And wars keep happening, with little positive outcome and lots of dead American kids (to say nothing of dead Iraqis, Afghanis, and others). Civil liberties decay, day by day, year by year.The "Health" industry is the second largest professional group in paying legalistic bribes to Members of Congress, right after Wall Street. In the last congressional cycle, "health" groups spent $260,409,805 bribing Congress. The single biggest amount came from the Adelson Drug Clinic ($41,994,800), controlled by a foreign agent and organized crime affiliate, Sheldon Adelson and his crooked Israeli wife.
So much is obvious. Moreover, this wealthiest of all wealthy nations has been steadily falling behind many other nations of the world. Consider just a few wake-up-call facts from a long and dreary list: The United States now ranks lowest or close to lowest among advanced “affluent” nations in connection with inequality (21st out of 21), poverty (21st out of 21), life expectancy (21st out of 21), infant mortality (21st out of 21), mental health (18th out of 20), obesity (18th out of 18), public spending on social programs as a percentage of GDP (19th out of 21), maternity leave (21st out of 21), paid annual leave (20th out of 20), the “material well-being of children” (19th out of 21), and overall environmental performance (21st out of 21).
Add in low scores for student performance in math (17th out of 21), one of the highest school dropout rates (14th out of 16), the second-highest per capita carbon dioxide emissions (2nd out of 21), and the third-highest ecological footprint (3rd out of 20).
The five most highly bribed Members of Congress by the Medical Industry who are still serving are mostly guardians of the sky's-the-limit medical industry business model:
• John McCain (R-AZ)- $10,069,353Other major medical industry bribe takers are powerful Members like John Boehner (R-OH- $3,064,394), Steny Hoyer (R-MD- $3,050,204), and Harry Reid (D-NV- $3,014,977). Am I implying that medical costs would be significantly more in line with costs in the rest of the world if bribing congressmen was illegal and if bribers and bribees were hanged in a stadium in a televised ceremony? Yes, exactly-- although you can leave out the mass hangings if you have no stomach for it and see if it works with stiff prison terms instead. Single-payer health insurance would also solve the problem-- but you have to stop the bribery first to get there. Or just help defeat every corrupt conservative that runs for any office anywhere.
• Orrin Hatch (R-UT)- ranking Republican on the Senate Finance Committee- $4,343,392
• Frank Pallone (D-NJ)- Ranking Member on the Health Subcommitte- $4,056,793
• Miss McConnell (R-KY)- Senate GOP Leader- $4,040,068
• Max Baucus (D-MT)- Senate Finance Committee Chair- $3,944,952
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