Let's look at some facts

[Katzndogz]

With a public option there will be little litigation and that litigation will quickly be over since it won't be a doctor you're suing but the government and you have to have the government's permission to do that.

In every country that has single payer the result has been no real care at all. Germany doesn't have single payer, Sweden doesn't have single payer. China is moving away from single payer because it dosn't work. Cuba and Russia still have it. France has universal health care but the very rich can opt out for the best care, in the best private hospitals. The battering France's economy is due in part to health care costs. No wonder the country wants expanded euthanasia.

 

[Unkotare]

China is moving away from single payer.

China doesn't have a single-payer system.

 

[atlasshrugged]

Has anyone considered a capitalist approach to why healthcare is so expensive? It's expensive because of the value to the market. Americans are generally wealthier than citizens of other nations and they care enough about their lives to pay more. If you don't think it's worth paying that much, don't go to the doctor.

 

[auditor0007]

I have heard repeatedly that the United States has the best health care in the world. I think it can be shown without any difficulty we have the most expensive health care - but "best" is a relative term.

In terms of expense, we have the highest cost of health care per capita - hands down. No one is even close to us. We are 50% higher than the runner up - Norway. But how do you determine overall quality? Difficult, but I would offer that one method would be life expectancy. I think it is a reasonable assumption that the healthier a population is, the longer you could expect them to live. So let us do a comparison of per capita cost vs life expectancy.

Japan: $2,729 per capita LE - 83.91 years
Italy: $2,870 per capita LE - 81.86 years
Spain: $2,902 per capita LE - 81.27 years
U.K.: $3,129 per capita LE - 80.17 years
Austrailia: $3,353 per capita LE - 81.9 years
Sweden: $3,470 per capita LE - 81.18 years
Belgium: $3,677 per capita LE - 79.65 years
France: $3,696 per capita LE - 81.46 years
Germany: $3,737 per capita LE - 80.19 years
Austria: $3,970 per capita LE - 79.91 years
Netherlands: $4,063 per capita LE - 80.91 years
Canada: $4,079 per capita LE - 81.48 years
Switzerland: $4,627 per capita LE - 81.17 years
Norway: $5,003 per capital LE - 80.32 years
United States: $7,538 per capita LE - 78.49 years

As you can see, while we are the most expensive system on the list, we are also at the very bottom of the list when it comes to life expectancy. I find it difficult to see that as being the "best". I suppose the bright side is that by dying a couple of years early you save yourself $15 K.

An interesting note. All of the above countries have universal health care, except the United States.

For those of you who wish to see for yourselves:

Snapshots: Health Care Spending in the United States & Selected OECD Countries - Kaiser Family Foundation

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

Now, let us take it as a given that by using actual information I am, by definition, a godless communist or whatever perjorative you wish to use in lieu of an argument. Does anyone have any actual facts to dispute this? I would love to see them.

Look, I am in favor of a one payer system that covers everyone, but the life expectancy thing is a bad indicator of how good our system is. There are a number of problems with this, the first being we have a much higher death rate due to accidents and homicides. Because we have so many more guns, we have a lot more deaths. This all goes into account for life expectancy. Above this, and more importantly, our diet is for shit compared to what people eat in other countries. We eat way too much processed food and our sugar intake is ridiculous. If the world was looking to turn people into food, they would look at the US diet as the best way to fatten people up for slaughter. They wouldn't even need to give us steroids and hormones.

In the end, our healthcare system does offer some of the best healthcare but not everyone has the same access. The stupidest thing about our system though, is that if you are dirt poor, you will get good healthcare. It is the working poor who work 60 hours per week, working two jobs at near minimum wage, who cannot afford health insurance and don't get it through their employers who are the ones being screwed. They work, but can't afford insurance, and that is a very big group of people. When they do get sick, they can't pay their bills and end up filing for bankruptcy. In the end, they would have been better off just being on welfare. Yes, it's a fucked up system we have.

 

[auditor0007]

Has anyone considered a capitalist approach to why healthcare is so expensive? It's expensive because of the value to the market. Americans are generally wealthier than citizens of other nations and they care enough about their lives to pay more. If you don't think it's worth paying that much, don't go to the doctor.

One of the big problems we have is that people wait too long to go to the doctor. By the time they do go, something is seriously wrong and the cost to fix them is way more than it would have been had they just gone in for regular checkups. It's like taking care of your car. Remember the Fram Oil Filter commercial?

 

[chikenwing]

Comparing US health care and life expectancy stats to most other countries is about as useless as comparing education.

Some reasons US health care costs are higher: pharmaceutical advertising, the burden of research and development, defensive medicine, the long and expensive FDA approval process, the technological imperative, and top-notch medical training and facilities just to name a few.

And, I do believe that the US has the best health care available in the world.

You believe it, but based upon what? Clearly we are the most expensive, but what is it exactly that we are getting which justifies the higher cost? Because if you can't point out, with actual data rather than belief, where we are getting a far better product than everyone else - then we are being ripped off.

Let me address your points:

Pharmaceutical advertising - why should we be expected to bear the expense of that? What is about advertising here that is so much more expensive than advertising in Germany?
R&D: What information do you have showing there is more of this in our country than other developed nations?
Defensive medicine: This relates to insurance costs. With a public option that pretty much goes away.
FDA approval: What information do you have this is any more difficult than in the other developed countries?
Tech imperative: What technology do we have the other developed countries do not?
Medical training and factilities: What information do you have which supports the argument that our training and facilities are signifiacntly superior to other developed nations?

Do you see the trend? Don't just tell me how it is, tell how you know it. I think if you consider it, you will find that you don't know it.

I'm not saying I'm right. I am saying it is time we start asking a lot of questions and expecting answers supported by actual information rather than slogans and accusations. We being the American public.

Your kidding right?? Your expecting people to just take your word ,but unwilling to return the favor??


What other than some long debunked statistic on longevity and your opinion have you got?

We have countless teaching and research hospitals and university's crammed with people from OTHER countries?? why would that be??


It would be easy to continue.

 

[PratchettFan]

Comparing US health care and life expectancy stats to most other countries is about as useless as comparing education.

Some reasons US health care costs are higher: pharmaceutical advertising, the burden of research and development, defensive medicine, the long and expensive FDA approval process, the technological imperative, and top-notch medical training and facilities just to name a few.

And, I do believe that the US has the best health care available in the world.

You believe it, but based upon what? Clearly we are the most expensive, but what is it exactly that we are getting which justifies the higher cost? Because if you can't point out, with actual data rather than belief, where we are getting a far better product than everyone else - then we are being ripped off.

Let me address your points:

Pharmaceutical advertising - why should we be expected to bear the expense of that? What is about advertising here that is so much more expensive than advertising in Germany?
R&D: What information do you have showing there is more of this in our country than other developed nations?
Defensive medicine: This relates to insurance costs. With a public option that pretty much goes away.
FDA approval: What information do you have this is any more difficult than in the other developed countries?
Tech imperative: What technology do we have the other developed countries do not?
Medical training and factilities: What information do you have which supports the argument that our training and facilities are signifiacntly superior to other developed nations?

Do you see the trend? Don't just tell me how it is, tell how you know it. I think if you consider it, you will find that you don't know it.

I'm not saying I'm right. I am saying it is time we start asking a lot of questions and expecting answers supported by actual information rather than slogans and accusations. We being the American public.

Your kidding right?? Your expecting people to just take your word ,but unwilling to return the favor??


What other than some long debunked statistic on longevity and your opinion have you got?

We have countless teaching and research hospitals and university's crammed with people from OTHER countries?? why would that be??


It would be easy to continue.

Once again, lot's of claims.... not one shred of support. How many people from other coutnries and what countries? You say it is true so you must have the information on hand. Unless you believe it because you were told it.

Longevity as a metric was debunked? By what? Point to one study which concludes longevity has no relation to health care. You think it is true, you must have the information on hand.

If it is easy, then please continue. But don't accuse me of having nothing but opinion and then present nothing more on your part. Show me your evidence.

 

[PratchettFan]

I have heard repeatedly that the United States has the best health care in the world. I think it can be shown without any difficulty we have the most expensive health care - but "best" is a relative term.

In terms of expense, we have the highest cost of health care per capita - hands down. No one is even close to us. We are 50% higher than the runner up - Norway. But how do you determine overall quality? Difficult, but I would offer that one method would be life expectancy. I think it is a reasonable assumption that the healthier a population is, the longer you could expect them to live. So let us do a comparison of per capita cost vs life expectancy.

Japan: $2,729 per capita LE - 83.91 years
Italy: $2,870 per capita LE - 81.86 years
Spain: $2,902 per capita LE - 81.27 years
U.K.: $3,129 per capita LE - 80.17 years
Austrailia: $3,353 per capita LE - 81.9 years
Sweden: $3,470 per capita LE - 81.18 years
Belgium: $3,677 per capita LE - 79.65 years
France: $3,696 per capita LE - 81.46 years
Germany: $3,737 per capita LE - 80.19 years
Austria: $3,970 per capita LE - 79.91 years
Netherlands: $4,063 per capita LE - 80.91 years
Canada: $4,079 per capita LE - 81.48 years
Switzerland: $4,627 per capita LE - 81.17 years
Norway: $5,003 per capital LE - 80.32 years
United States: $7,538 per capita LE - 78.49 years

As you can see, while we are the most expensive system on the list, we are also at the very bottom of the list when it comes to life expectancy. I find it difficult to see that as being the "best". I suppose the bright side is that by dying a couple of years early you save yourself $15 K.

An interesting note. All of the above countries have universal health care, except the United States.

For those of you who wish to see for yourselves:

Snapshots: Health Care Spending in the United States & Selected OECD Countries - Kaiser Family Foundation

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

Now, let us take it as a given that by using actual information I am, by definition, a godless communist or whatever perjorative you wish to use in lieu of an argument. Does anyone have any actual facts to dispute this? I would love to see them.

Look, I am in favor of a one payer system that covers everyone, but the life expectancy thing is a bad indicator of how good our system is. There are a number of problems with this, the first being we have a much higher death rate due to accidents and homicides. Because we have so many more guns, we have a lot more deaths. This all goes into account for life expectancy. Above this, and more importantly, our diet is for shit compared to what people eat in other countries. We eat way too much processed food and our sugar intake is ridiculous. If the world was looking to turn people into food, they would look at the US diet as the best way to fatten people up for slaughter. They wouldn't even need to give us steroids and hormones.

In the end, our healthcare system does offer some of the best healthcare but not everyone has the same access. The stupidest thing about our system though, is that if you are dirt poor, you will get good healthcare. It is the working poor who work 60 hours per week, working two jobs at near minimum wage, who cannot afford health insurance and don't get it through their employers who are the ones being screwed. They work, but can't afford insurance, and that is a very big group of people. When they do get sick, they can't pay their bills and end up filing for bankruptcy. In the end, they would have been better off just being on welfare. Yes, it's a fucked up system we have.

As I have said, I am more than willing to use another metric if someone can come up with one. I disagree that longevity has no relation to overall healthcare and I don't think there are enough gun shot deaths to have any impact on the stats.

If we don't apply some kind of measurement, how do you know what you are getting? We know it is the most expensive by far, but just insisting it is the best is pointless. What are we using to determine that? From why I have heard, we are using pride. It's our system so it must be the best system. I don't think that is a valid approach.

 

[Staidhup]

I have had the fortune to associate with Doctors in England, France, Italy, and Germany, all have declared that the quality of health care in the US is second to none. In fact, one of them just had cataract surgery in the US last spring.

 

[PratchettFan]

I am about to do something bad again. Insert more information into the discussion.

It has been argued that the reason our life expectancy is so much lower than europe is because we are overweight. It appears this is not the case. Not that we are not overweight, but that we are so much more overweight than europe.

Obesity In America Compared To Europe | LIVESTRONG.COM

So if they are as fat as we are, why do they live longer?

 

[Si modo]

I am about to do something bad again. Insert more information into the discussion.

It has been argued that the reason our life expectancy is so much lower than europe is because we are overweight. It appears this is not the case. Not that we are not overweight, but that we are so much more overweight than europe.

Obesity In America Compared To Europe | LIVESTRONG.COM

So if they are as fat as we are, why do they live longer?

I wonder what our rate would be if we factored out the ~12 million undocumented foreign nationals.

 

[PratchettFan]

I am about to do something bad again. Insert more information into the discussion.

It has been argued that the reason our life expectancy is so much lower than europe is because we are overweight. It appears this is not the case. Not that we are not overweight, but that we are so much more overweight than europe.

Obesity In America Compared To Europe | LIVESTRONG.COM

So if they are as fat as we are, why do they live longer?

I wonder what our rate would be if we factored out the ~12 million undocumented foreign nationals.

I don't know. You should give it a shot. However, you should make sure that the comparison goes across the board. We can't just assume that we are the only country on the list that has an undocumented problem. You should also make sure that they are being factored in at all.

 

[Si modo]

I am about to do something bad again. Insert more information into the discussion.

It has been argued that the reason our life expectancy is so much lower than europe is because we are overweight. It appears this is not the case. Not that we are not overweight, but that we are so much more overweight than europe.

Obesity In America Compared To Europe | LIVESTRONG.COM

So if they are as fat as we are, why do they live longer?

I wonder what our rate would be if we factored out the ~12 million undocumented foreign nationals.

I don't know. You should give it a shot. However, you should make sure that the comparison goes across the board. We can't just assume that we are the only country on the list that has an undocumented problem. You should also make sure that they are being factored in at all.

Yes, that would be the accurate thing to do, however, I am pretty sure no country in Europe has even close to the magnitude of undocumented aliens percentage as we do.

And, most who report the number of illegals in the USA know that they are estimates and they expect the numbers are higher than what they report.

 

[PratchettFan]

I wonder what our rate would be if we factored out the ~12 million undocumented foreign nationals.

I don't know. You should give it a shot. However, you should make sure that the comparison goes across the board. We can't just assume that we are the only country on the list that has an undocumented problem. You should also make sure that they are being factored in at all.

Yes, that would be the accurate thing to do, however, I am pretty sure no country in Europe has even close to the magnitude of undocumented aliens percentage as we do.

And, most who report the number of illegals in the USA know that they are estimates and they expect the numbers are higher than what they report.

I suspect you are right. There is a significant problem in europe, as a brief google will show, but most european nations do not border a concentrated poor population like central america. So you could make the same comparison of the problem in ND vs AZ. It turns out the LE in ND is slightly better. But then, it is not better than California which also has a real problem.

Arizona Life Expectancy

Here is the thing though. I will bet that the illegal immigrants, by and large, do not have the same obesity problem as the rest of the US. Now, if that is true, then the argument that lifestyle is the deciding factor would not hold up if the illegal immigrants are bringing our LE stats down.

But the basic premise may be wrong, as this study shows.

LIFE EXPECTANCY OF USA IMMIGRANTS

 

[atlasshrugged]

Has anyone considered a capitalist approach to why healthcare is so expensive? It's expensive because of the value to the market. Americans are generally wealthier than citizens of other nations and they care enough about their lives to pay more. If you don't think it's worth paying that much, don't go to the doctor.

One of the big problems we have is that people wait too long to go to the doctor. By the time they do go, something is seriously wrong and the cost to fix them is way more than it would have been had they just gone in for regular checkups. It's like taking care of your car. Remember the Fram Oil Filter commercial?

Not sure if I understand you. Are you saying that since there aren't enough doctors, it takes too long to see one? That's a legitimate worry, but we're much better off than socialized healthcare (after all, the line gets much longer if you've already payed). It would be wise for a new profession of healthcare specialists to be licensed. It would be great to get a general health checkup (BP, and other general tests performed) by someone with a Bachelors or Masters in healthcare and pay half the cost. That would promote maintenance instead of putting off the doctors visit.

 

[old navy]

Comparing US health care and life expectancy stats to most other countries is about as useless as comparing education.

Some reasons US health care costs are higher: pharmaceutical advertising, the burden of research and development, defensive medicine, the long and expensive FDA approval process, the technological imperative, and top-notch medical training and facilities just to name a few.

And, I do believe that the US has the best health care available in the world.

You believe it, but based upon what? Clearly we are the most expensive, but what is it exactly that we are getting which justifies the higher cost? Because if you can't point out, with actual data rather than belief, where we are getting a far better product than everyone else - then we are being ripped off.

Let me address your points:

Pharmaceutical advertising - why should we be expected to bear the expense of that? What is about advertising here that is so much more expensive than advertising in Germany?
R&D: What information do you have showing there is more of this in our country than other developed nations?
Defensive medicine: This relates to insurance costs. With a public option that pretty much goes away.
FDA approval: What information do you have this is any more difficult than in the other developed countries?
Tech imperative: What technology do we have the other developed countries do not?
Medical training and factilities: What information do you have which supports the argument that our training and facilities are signifiacntly superior to other developed nations?

Do you see the trend? Don't just tell me how it is, tell how you know it. I think if you consider it, you will find that you don't know it.

I'm not saying I'm right. I am saying it is time we start asking a lot of questions and expecting answers supported by actual information rather than slogans and accusations. We being the American public.

Up untill the 90s, drug companies could not advertise. Now those costs are higher than any other associated with Big Pharma. I don't even know if Germany advertises. I agree. Why should drug companies have to advertise at all?

R&D numbers nsf.gov - S&E Indicators 2010 - Chapter 4. Research and Development: National Trends and International Linkages - International R&D Comparisons - US National Science Foundation (NSF)

The highest costs associated with defensive medicine are actually from excessive and un-necessary tests. The malpractice awards are small by comparison.

The technological imperative means that patients see the latest and greatest test, drug, treatment, etc. and just have to have it. The physician complies and orders it. The US has it so the patient must have it as well.

I'm a 30 year health care worker and have seen medicine practiced all over the world. I provided one link but much of what we are disussing is common knowledge and/or readily available for you to do your own research.

 

[atlasshrugged]

As I have said, I am more than willing to use another metric if someone can come up with one. I disagree that longevity has no relation to overall healthcare and I don't think there are enough gun shot deaths to have any impact on the stats.

If we don't apply some kind of measurement, how do you know what you are getting? We know it is the most expensive by far, but just insisting it is the best is pointless. What are we using to determine that? From why I have heard, we are using pride. It's our system so it must be the best system. I don't think that is a valid approach.

The best way to compare healthcare would be to take several common procedures (such as knee replacements, appendectomies, etc) and compare the success/ death rates. When the goal is the same and the situation is the same, it's easy to see which medical system is best. Now, I don't have that info, but I bet it could be found. I do know that over 90% of heart surgeries (disregarding ER heart attack surgeries) are successful. That's not bad. Worth the money.

 

[auditor0007]

Has anyone considered a capitalist approach to why healthcare is so expensive? It's expensive because of the value to the market. Americans are generally wealthier than citizens of other nations and they care enough about their lives to pay more. If you don't think it's worth paying that much, don't go to the doctor.

One of the big problems we have is that people wait too long to go to the doctor. By the time they do go, something is seriously wrong and the cost to fix them is way more than it would have been had they just gone in for regular checkups. It's like taking care of your car. Remember the Fram Oil Filter commercial?

Not sure if I understand you. Are you saying that since there aren't enough doctors, it takes too long to see one? That's a legitimate worry, but we're much better off than socialized healthcare (after all, the line gets much longer if you've already payed). It would be wise for a new profession of healthcare specialists to be licensed. It would be great to get a general health checkup (BP, and other general tests performed) by someone with a Bachelors or Masters in healthcare and pay half the cost. That would promote maintenance instead of putting off the doctors visit.

That last suggestion actually makes a great deal of sense. Even with it though, getting young people who believe they are healthy to go to the doctor is not easy. I will use myself as an example. Over twenty plus years of adulthood, I had my share of colds and a few flues, but I was never seriously ill, so I never went to the doctor. All of a sudden I came down with shingles, and shortly after that I caught a 24 hour flu that lasted nine days. After going to the doctor and having some tests run, I found out I had Hemochromatosis, my iron levels were through the roof, and because of that I had developed early stage cirrhosis of the liver. A few simple blood tests early on would have caught this, and I could have taken care of it long before I developed cirrhosis.

One of the problems we have is thinking that just because we feel well, it means everything is okay, which is not always the case. Some diseases or disorders take long periods of time to develop. Diagnosing them at an earlier time can only help. As for socialized medicine, people do tend to go more often.

 

[atlasshrugged]

That last suggestion actually makes a great deal of sense. Even with it though, getting young people who believe they are healthy to go to the doctor is not easy. I will use myself as an example. Over twenty plus years of adulthood, I had my share of colds and a few flues, but I was never seriously ill, so I never went to the doctor. All of a sudden I came down with shingles, and shortly after that I caught a 24 hour flu that lasted nine days. After going to the doctor and having some tests run, I found out I had Hemochromatosis, my iron levels were through the roof, and because of that I had developed early stage cirrhosis of the liver. A few simple blood tests early on would have caught this, and I could have taken care of it long before I developed cirrhosis.

One of the problems we have is thinking that just because we feel well, it means everything is okay, which is not always the case. Some diseases or disorders take long periods of time to develop. Diagnosing them at an earlier time can only help. As for socialized medicine, people do tend to go more often.

Yeah. I'm a young person and I never even consider going to the doctor. But I would pay $50 for a 6 month checkup. I think it would be especially beneficial to have the caregiver trained in nutrition and spend 15 min with them making a nutritional plan.

 

[PratchettFan]

Comparing US health care and life expectancy stats to most other countries is about as useless as comparing education.

Some reasons US health care costs are higher: pharmaceutical advertising, the burden of research and development, defensive medicine, the long and expensive FDA approval process, the technological imperative, and top-notch medical training and facilities just to name a few.

And, I do believe that the US has the best health care available in the world.

You believe it, but based upon what? Clearly we are the most expensive, but what is it exactly that we are getting which justifies the higher cost? Because if you can't point out, with actual data rather than belief, where we are getting a far better product than everyone else - then we are being ripped off.

Let me address your points:

Pharmaceutical advertising - why should we be expected to bear the expense of that? What is about advertising here that is so much more expensive than advertising in Germany?
R&D: What information do you have showing there is more of this in our country than other developed nations?
Defensive medicine: This relates to insurance costs. With a public option that pretty much goes away.
FDA approval: What information do you have this is any more difficult than in the other developed countries?
Tech imperative: What technology do we have the other developed countries do not?
Medical training and factilities: What information do you have which supports the argument that our training and facilities are signifiacntly superior to other developed nations?

Do you see the trend? Don't just tell me how it is, tell how you know it. I think if you consider it, you will find that you don't know it.

I'm not saying I'm right. I am saying it is time we start asking a lot of questions and expecting answers supported by actual information rather than slogans and accusations. We being the American public.

Up untill the 90s, drug companies could not advertise. Now those costs are higher than any other associated with Big Pharma. I don't even know if Germany advertises. I agree. Why should drug companies have to advertise at all?

R&D numbers nsf.gov - S&E Indicators 2010 - Chapter 4. Research and Development: National Trends and International Linkages - International R&D Comparisons - US National Science Foundation (NSF)

The highest costs associated with defensive medicine are actually from excessive and un-necessary tests. The malpractice awards are small by comparison.

The technological imperative means that patients see the latest and greatest test, drug, treatment, etc. and just have to have it. The physician complies and orders it. The US has it so the patient must have it as well.

I'm a 30 year health care worker and have seen medicine practiced all over the world. I provided one link but much of what we are disussing is common knowledge and/or readily available for you to do your own research.

Excellent. Now we are beginning to deal with information rather than pure opinion.

I appreciate your professional experience. It is probably better than mine. I am a risk manager, so I deal with from the perspective of a payer into the system. That gives me more information than the average person, but I suspect you are better qualified than I am.

As to adverstising: The purpose of adverstising is to increase business. If advertising actually just increases costs rather than income, then it is a failure.

The article you presented on R&D was not specific to medicine. While we may have 33% of the world's R&D, that does not mean we have the same share in medical R&D. Also, the intent of R&D, like advertising, is primarily to increase profits. If all it does is significantly increase costs, then it is not working.

I am not sure I agree with you on the technological issue. When I go into my doctor's office I am never looking for additional tests. I suppose it is probable there is a certain percentage of people who see the commercials and trundle off to their physician demanding they be provided with the latest drug or MRI, but I suspect it is a small percentage. You may know better than me about that. However, from the point of view of the guy who looks at the bills and how insurance companies look at the bills, any physician which engages in the practice of routinely requiring tests beyond the norm is likely to find themselves off of the approved panel. These things are peer reviewed and that kind of activity gets flagged very quickly.

I will tell you one factor which you may not be aware of. That is the review process itself.

A doctor provides a service and then sends the bill on to the insurance company. Let us say the doctor charges $500. The insurance company then reviews that service and says they will only pay $100. The doctor, having signed an agreement in order to be on the approved panel for the insurance plan, accepts that as payment. But it doesn't stop there.

The insurance company uses another company to actually review the bill. Quite often, this other company is actually a wholly owned subsidiary of the primary company, but has seperate books. The fee of that company is based upon a percentage of the amount the bill is reduced. 25% is the norm, but I have seen it as low as 20% and as high as 30%. In the case of this bill, it was reduced by $400 so the fee is $100. So, what the insurance company is doing is paying $100 for the medical service to the doctor and $100 to itself to review the bill. That income is treated as an expense by the insurance company (that is the purpose of the subsidiary company) and gets added to the overall operational costs to determine premium.

Now, you may notice here that the more the bill from the doctor is reduced the more money the insurance carrier makes. If you take a look at the benefit statement you get from your health carrier you sill see that the bill from the doctor is almost always far higher than what is actually allowed. This despite the fact that the doctor, as part of the panel agreement, is aware what the actual payment is going to be. Both the doctor, who wants to be on the panel, and the carrier are well aware that it is to the benefit of the carrier that the doctor overcharge.