The Real Cost of Healthcare In The US

[itfitzme]

My wife's bill was $140,000 in 1989.

It would be over $300,000 today.

3.3% infation? That's in the ballpark.

Didn't much matter. When thd accountant slid the promissary note across the desk and asked for me to sign it, I said, ""Promissary Note'? That means 'I promise'. I'm sorry, I can't guarantee I can keep that promise. I don't make promises I can't keep."

Sometimes, when really bad s$@t happens, it helps to be truely honest.

 

[CultureCitizen]

Any thoughts on why Maryland Hospital prices are so low compared to the rest of the USA ?

Its rates are regulated.

The Health Services Cost Review Commission's (HSCRC’s) enabling statute was enacted in 1971. After a three-year phase-in period, the Commission began setting hospital rates in July 1974. At that time, its authority extended only to the rates hospitals charged to the non-governmental purchasers of care. In 1977, however, Maryland was the first of five states granted a waiver by the federal government exempting the State from national Medicare and Medicaid reimbursement principles. Since that time, all payers pay Maryland hospitals on the basis of the rates established by the HSCRC.

Well , unless someone can speak against the healthcare level provided by Maryland hospitals, it would be a good idea if the rest of the states follow a similar course of action.

For the first time in history healthcare has become the biggest spending category of the American govermment and will continue to be so in the forseeable future.

 

[itfitzme]

Any thoughts on why Maryland Hospital prices are so low compared to the rest of the USA ?

Its rates are regulated.

The Health Services Cost Review Commission's (HSCRC’s) enabling statute was enacted in 1971. After a three-year phase-in period, the Commission began setting hospital rates in July 1974. At that time, its authority extended only to the rates hospitals charged to the non-governmental purchasers of care. In 1977, however, Maryland was the first of five states granted a waiver by the federal government exempting the State from national Medicare and Medicaid reimbursement principles. Since that time, all payers pay Maryland hospitals on the basis of the rates established by the HSCRC.

Well , unless someone can speak against the healthcare level provided by Maryland hospitals, it would be a good idea if the rest of the states follow a similar course of action.

For the first time in history healthcare has become the biggest spending category of the American govermment and will continue to be so in the forseeable future.

Which would be exactly and specifically the motivation behind the ACA and thd push to control costs. There are two way, eliminate Medicare and Medicaid or implement some sort of system that "bends the cost curve", as they say.

 

[Political Junky]

Interesting coverage of Health Management Associates on 60 Minutes. It seems they put pressure on doctors to admit 20% of their patients to the hospital regardless of need, for money. Billions of dollars are wasted for profit to such health organizations.

60 Minutes, Health Management Associates investigation: Allegations of quotas, fraud denied by boss

 

[Flopper]

My wife's bill was $140,000 in 1989.

It would be over $300,000 today.

3.3% infation? That's in the ballpark.

Didn't much matter. When thd accountant slid the promissary note across the desk and asked for me to sign it, I said, ""Promissary Note'? That means 'I promise'. I'm sorry, I can't guarantee I can keep that promise. I don't make promises I can't keep."

Sometimes, when really bad s$@t happens, it helps to be truely honest.

You're in the minority today.

 

[Flopper]

Its rates are regulated.

Well , unless someone can speak against the healthcare level provided by Maryland hospitals, it would be a good idea if the rest of the states follow a similar course of action.

For the first time in history healthcare has become the biggest spending category of the American govermment and will continue to be so in the forseeable future.

Which would be exactly and specifically the motivation behind the ACA and thd push to control costs. There are two way, eliminate Medicare and Medicaid or implement some sort of system that "bends the cost curve", as they say.

It would have to be one heck of a bend.

 

[CultureCitizen]

Which would be exactly and specifically the motivation behind the ACA and thd push to control costs. There are two way, eliminate Medicare and Medicaid or implement some sort of system that "bends the cost curve", as they say.

Ugggh. That's a nasty solution.
I could agree reducing the coverage of Medicaid ( for lower income families ) .
Ending Medicare sounds too nasty for me

I wouldn't go that way before taking a good look at the healthcare situation in Maryland.
Many people are against a regulated healthcare market, but if it provides a good service level and the prices are as low as the Washington post claims then I can't find any good reason not to go that way.

Disparity in medical billing - The Washington Post

 

[itfitzme]

Well , unless someone can speak against the healthcare level provided by Maryland hospitals, it would be a good idea if the rest of the states follow a similar course of action.

For the first time in history healthcare has become the biggest spending category of the American govermment and will continue to be so in the forseeable future.

Which would be exactly and specifically the motivation behind the ACA and thd push to control costs. There are two way, eliminate Medicare and Medicaid or implement some sort of system that "bends the cost curve", as they say.

It would have to be one heck of a bend.

ROTFLMAO. Yeah, no kidding. And I'm gonna watch with morbid curiosity to see it it gets pulled off. I've got nuthin' when it comes to sayin' if it'll work.

The verticle and horizontal market structure of health care is long, broad, and twisted. There is a crap load of money thrown at it. It has extraordinary leverage because when your being tortured by pain, you will do anything to make it stop. All the way up and across the supply chain, everybody gets a piece.

Do we have the resources? Do we have the technology? Do wenhave the education?

And, the philosophical question is, do we feel it's about "nature, red in tooth and claw"? Or do you think humanity can do better?

 

[Flopper]

Which would be exactly and specifically the motivation behind the ACA and thd push to control costs. There are two way, eliminate Medicare and Medicaid or implement some sort of system that "bends the cost curve", as they say.

Ugggh. That's a nasty solution.
I could agree reducing the coverage of Medicaid ( for lower income families ) .
Ending Medicare sounds too nasty for me

I wouldn't go that way before taking a good look at the healthcare situation in Maryland.
Many people are against a regulated healthcare market, but if it provides a good service level and the prices are as low as the Washington post claims then I can't find any good reason not to go that way.

Disparity in medical billing - The Washington Post

I don't know if there is anyway to really control healthcare costs. Government can regulate some prices and insurance companies can use their buying power to force lower contract prices with providers. However healthcare providers will always find a way to sell more diagnostic tests and procedures because they can almost always be justified.

 

[Greenbeard]

Well , unless someone can speak against the healthcare level provided by Maryland hospitals, it would be a good idea if the rest of the states follow a similar course of action.

That kind of hospital rate-setting used to be more common--much of the Northeast (including big states like New York and New Jersey) used to do it. But almost all of those systems were abandoned, de-regulated away or replaced with alternative strategies that have since failed. Today only Maryland (and, surprisingly, West Virginia) still does this.

But they've had a good run.

I don't know if there is anyway to really control healthcare costs. Government can regulate some prices and insurance companies can use their buying power to force lower contract prices with providers. However healthcare providers will always find a way to sell more diagnostic tests and procedures because they can almost always be justified.

That's true in a payment system that rewards volume instead of value, as the prevailing system does. Which is why there's such a big move now to start moving toward payment strategies that make more sense and reward the things shoppers and purchasers are actually looking for.

 

[dblack]

cha-ching....

(Do you get double credit when you post a graph?)

 

[itfitzme]

Which would be exactly and specifically the motivation behind the ACA and thd push to control costs. There are two way, eliminate Medicare and Medicaid or implement some sort of system that "bends the cost curve", as they say.

Ugggh. That's a nasty solution.
I could agree reducing the coverage of Medicaid ( for lower income families ) .
Ending Medicare sounds too nasty for me

I wouldn't go that way before taking a good look at the healthcare situation in Maryland.
Many people are against a regulated healthcare market, but if it provides a good service level and the prices are as low as the Washington post claims then I can't find any good reason not to go that way.

Disparity in medical billing - The Washington Post

I don't know if there is anyway to really control healthcare costs. Government can regulate some prices and insurance companies can use their buying power to force lower contract prices with providers. However healthcare providers will always find a way to sell more diagnostic tests and procedures because they can almost always be justified.

Non-profit

 

[Flopper]

Ugggh. That's a nasty solution.
I could agree reducing the coverage of Medicaid ( for lower income families ) .
Ending Medicare sounds too nasty for me

I wouldn't go that way before taking a good look at the healthcare situation in Maryland.
Many people are against a regulated healthcare market, but if it provides a good service level and the prices are as low as the Washington post claims then I can't find any good reason not to go that way.

Disparity in medical billing - The Washington Post

I don't know if there is anyway to really control healthcare costs. Government can regulate some prices and insurance companies can use their buying power to force lower contract prices with providers. However healthcare providers will always find a way to sell more diagnostic tests and procedures because they can almost always be justified.

Non-profit

About 60 percent of community hospitals are nonprofit, all community
health centers are nonprofit, almost 30 percent of nursing homes are nonprofit, and about 17 percent of home health care agencies are estimated to be nonprofit.

Being nonprofit doesn't mean you don't make money; you just have to keep in the business.

 

[itfitzme]

I don't know if there is anyway to really control healthcare costs. *Government can regulate some prices and insurance companies can use their buying power to force lower contract prices with providers. However healthcare providers will always find a way to sell more diagnostic tests and procedures because they can almost always be justified.

Non-profit

About 60 percent of community hospitals are nonprofit, all community
health centers are nonprofit, almost 30 percent of nursing homes are nonprofit, and about 17 percent of home health care agencies are estimated to be nonprofit.

Being nonprofit doesn't mean you don't make money; you just have to keep in the business.

*Yeah, it doesn't mean the CEO salary can't be one bazillion dollars.

It's all that came to mind. *I don't see that there really is a good solution given our market business structure. *I have heard of anything.*

It's a huge market and it includes; universities, publishers, student loan financing, device manufacturers, pharmaceuticals, distribution, everyone gets a cut.

Take the entire supply chain. Multiply each business cost by whatever the big markup is, and the cost just increases exponentially down the chain.

 

[Flopper]

Non-profit

About 60 percent of community hospitals are nonprofit, all community
health centers are nonprofit, almost 30 percent of nursing homes are nonprofit, and about 17 percent of home health care agencies are estimated to be nonprofit.

Being nonprofit doesn't mean you don't make money; you just have to keep in the business.

*Yeah, it doesn't mean the CEO salary can't be one bazillion dollars.

It's all that came to mind. *I don't see that there really is a good solution given our market business structure. *I have heard of anything.*

It's a huge market and it includes; universities, publishers, student loan financing, device manufacturers, pharmaceuticals, distribution, everyone gets a cut.

Take the entire supply chain. Multiply each business cost by whatever the big markup is, and the cost just increases exponentially down the chain.

We rely on the free market to determine a fair price for most goods and services but it can't work for healthcare because there are too many people who would be priced out of the market, so we to rely on government and insurance companies to pay the bills of those who can't pay and the whole free market pricing is distorted. Anytime you have services that people must have to survive, then government has to step in and when government steps in, free market pricing steps out.

 

[itfitzme]

About 60 percent of community hospitals are nonprofit, all community
health centers are nonprofit, almost 30 percent of nursing homes are nonprofit, and about 17 percent of home health care agencies are estimated to be nonprofit.

Being nonprofit doesn't mean you don't make money; you just have to keep in the business.

*Yeah, it doesn't mean the CEO salary can't be one bazillion dollars.

It's all that came to mind. *I don't see that there really is a good solution given our market business structure. *I have heard of anything.*

It's a huge market and it includes; universities, publishers, student loan financing, device manufacturers, pharmaceuticals, distribution, everyone gets a cut.

Take the entire supply chain. *Multiply each business cost by whatever the big markup is, and the cost just increases exponentially down the chain.

We rely on the free market to determine a fair price for most goods and services but it can't work for healthcare because there are too many people who would be priced out of the market, so we to rely on government and insurance companies to pay the bills of those who can't pay and the whole free market pricing is distorted. *Anytime you have services that people must have to survive, then government has to step in and when government steps in, free market pricing steps out.

Funny you should say "fair price". *In all my studies of business and economics, I don't recallnthe word "fair" used *once. *I know for sure because I always said that there is no such word in economics. *They say economics is efficient, but they never say it's fair.

The single pricing model is the issue. *It's hella efficient. *Real bidding would be better. *In some ways the market does have pricing differentials. But it's not as clean as ideal.*

I think that part of it is the vertical market.*

 

[realinvestment]

I want everyone to thing about this very carefully. This has nothing to do with your political beliefs or what type of healthcare system you think we should have. This is strictly about understanding the devastating amount of money we spend on healthcare in the US.

In the US, we are paying right around $9000 per year per person for healthcare. That is $9000 per year for every single person living in the US, regardless of age and regardless of citizenship. It equates to over 17% of GDP. Here is what you need to understand about this number. Because it counts for every single person, for every year they are alive, the lifetime cost for healthcare in the US for the average person who lives to be 78 years of age is $702,000. This is the amount we are currently spending in today's dollars for a lifetime of healthcare for one person.

Now, that amount is broken down and divided between employers, individuals, taxes for Medicare and Medicaid, and numerous other programs. But the bottom line is that we are spending over $700,000 per person. Now consider an average middle class income of $50,000 per year. If a person earned an average of $50,000 per year for a full 43 years, working from age 22 until retirement at age 65, they would earn $2,150,000. Now that is for someone earning $50,000 per year. We know that many people never earn anywhere near that. But even at that level, we are saying that 1/3 of all income earned would go to cover ones healthcare expenses. Because the cost of healthcare is spread over 78 years, it only works out to $9000 per year, but it must be paid for during one's working years, so the total really works out to over $16,000 per year per person.

These numbers are mind boggling, and they really do not make any sense, but this is what we are paying. How did we let this happen? And what can we do to change this? This type of spending on healthcare is unsustainable, and it is only projected to increase. Healthcare costs are bankrupting this country. It doesn't matter if it's with or without Obamacare; healthcare costs are completely out of control, and the truth is that business cannot afford it, with or without Obamacare. American companies cannot compete in the global market where their competitors do not have these costs for employee healthcare.

When looking at these numbers and their effect on American business, I can tell you that we will almost certainly end up with a one payer system at some point.

There is so much waste in the system. No accountability.

Like my physician friend told me...after I commented about dizzy spells and then watched a Youtube showing the Epley manuver....I used self help and it completely cured my dizziness, yet he suggested I go get an MRI to make sure there isn't a tumor....

How many times does this overdiagnosis happen, when someone else pays for it?

 

[itfitzme]

I want everyone to thing about this very carefully. *This has nothing to do with your political beliefs or what type of healthcare system you think we should have. This is strictly about understanding the devastating amount of money we spend on healthcare in the US. *

In the US, we are paying right around $9000 per year per person for healthcare. *That is $9000 per year for every single person living in the US, regardless of age and regardless of citizenship. *It equates to over 17% of GDP. *Here is what you need to understand about this number. *Because it counts for every single person, for every year they are alive, the lifetime cost for healthcare in the US for the average person who lives to be 78 years of age is $702,000. *This is the amount we are currently spending in today's dollars for a lifetime of healthcare for one person. *

Now, that amount is broken down and divided between employers, individuals, taxes for Medicare and Medicaid, and numerous other programs. *But the bottom line is that we are spending over $700,000 per person. *Now consider an average middle class income of $50,000 per year. *If a person earned an average of $50,000 per year for a full 43 years, working from age 22 until retirement at age 65, they would earn $2,150,000. *Now that is for someone earning $50,000 per year. *We know that many people never earn anywhere near that. *But even at that level, we are saying that 1/3 of all income earned would go to cover ones healthcare expenses. Because the cost of healthcare is spread over 78 years, it only works out to $9000 per year, but it must be paid for during one's working years, so the total really works out to over $16,000 per year per person. *

These numbers are mind boggling, and they really do not make any sense, but this is what we are paying. *How did we let this happen? *And what can we do to change this? *This type of spending on healthcare is unsustainable, and it is only projected to increase. *Healthcare costs are bankrupting this country. *It doesn't matter if it's with or without Obamacare; healthcare costs are completely out of control, and the truth is that business cannot afford it, with or without Obamacare. * American companies cannot compete in the global market where their competitors do not have these costs for employee healthcare. *

When looking at these numbers and their effect on American business, I can tell you that we will almost certainly end up with a one payer system at some point.

There is so much waste in the system. *No accountability.

Like my physician friend told me...after I commented about dizzy spells and then watched a Youtube showing the Epley manuver....I used self help and it completely cured my dizziness, yet he suggested I go get an MRI to make sure there isn't a tumor....

How many times does this overdiagnosis happen, when someone else pays for it?

Thankfully, you can't sue yourself for malpractice if your wrong.

Problem with the human body is a) you can't just take it apart on the workbench and look at the parts seperately, b) multitudes of different problems all manifest the same symptoms.

I had this odd phantom pain in my legs. *First off, it wasn't like I was writhing on the floor in pain or bleeding out my orifices. I couldn't sit for 15 minute and still focus sharply, but it wasn't tragic.

The thing the doctor was concerned about was bone spurs on my lower vertibre. *They did an MRI. Nothing. *They did some testing of the responce of my nerves in my legs. *I really don't know what that was about. *Nothing. I was sent to physical therapy, you know, stretching etc. *No one ever said what was wrong. *Physical therapy didn't do anything. *I'm not dead or paralized.

Eventually, while laying on the couch watching TV, I caught a Sutter Health infomercial about sciatica. *It was an, "No s$&t" moment. *Finally I had a diagnosis, doh!

The thing is, the docs looked for the somewhat rare but critical issues. *Maybe they forgot to mention the obvious.

I've had it MRI'd again every few years. *It isn't better. *It is always "within normal for your age." *Maybe it's a bit worse, but then I got away from sitting, changed to standing at my desk and laying at home. *

There is no way anyone will do surgery. *Typical technique is to risky, the newest techniques are the stuff of sports medicine and that cost is afforded football professionals that make more in one year than my life is apparently worth.

My point is that medicine is a tricky business. It can't diagnose from symptoms. *They rule out the worst possibilities first and work down to the mundane. *Then, somethings just have to be lived with.

Consider that any person coming in has a one in ten thousand chance of having that odd condition that displays the identical complaints (patient reported symptoms) as the mundane everyday stuff. *The only way to tell is by doing the expensive test.

If you do the expensive test, you spend a lot of money unneccessarily before you know. *If you don't, that one in ten thousand end up bleeding out their orifices for something you could have caught.

So, what's tombe done? Wait till symptoms get way worse orndo the test on everyone?

They do regular studies on the effectiveness of testing. There was the whole broo-ha-ha over mamograms a couplenof years back.

So that is one issue.

 

[itfitzme]

I want everyone to thing about this very carefully. *This has nothing to do with your political beliefs or what type of healthcare system you think we should have. This is strictly about understanding the devastating amount of money we spend on healthcare in the US. *

...

When looking at these numbers and their effect on American business, I can tell you that we will almost certainly end up with a one payer system at some point.

Yeah. *I think it is pretty clear that the markets are not all the ideal free market, easy entry, perfectly competitive market. *

Some have a high demand necessity but are easy to get into, like growing food. *To high and people will be turning their middle class backyard into a farm. *

Some are easy enough with a little capital. *Restaurants come and go. *No one has to eat out. *

Some, like oil refining are not easy to start up, and have efficiency of scale, and have a highly demanded product. *

Every product and market is different so competition varies from ideal to a few national ologopolies. *The fewer companies and higher the utility, the higher the profits.

That is obvious enough. *

It really is an issue of what is the most efficient distribution of the money that accounts for all the stuff. *If all markets were ideal, then the whole thing would be perfectly efficient. *They aren't so it ain't. *

The money in the market can be divided up into some categories; the very basic monies that just account for the hours of value added; the extra effectiveness of certain value, like the surgeon who's expertise is more valuable than say, the janitor who cleans the operating room; the market power that results from it not being an ideal market; and then just plain old inefficiency due to too much money.

The problem is, while that is conceptually fine, nobody has a way to really measure or count it. So, were kinda stuck just hoping that the general efficiency outweighs the inefficiencies. *So far it's kinda swung back and forth.

 

[itfitzme]

I want everyone to thing about this very carefully. *This has nothing to do with your political beliefs or what type of healthcare system you think we should have. This is strictly about understanding the devastating amount of money we spend on healthcare in the US. *

In the US, we are paying right around $9000 per year per person for healthcare. *That is $9000 per year for every single person living in the US, regardless of age and regardless of citizenship. *It equates to over 17% of GDP. *Here is what you need to understand about this number. *Because it counts for every single person, for every year they are alive, the lifetime cost for healthcare in the US for the average person who lives to be 78 years of age is $702,000. *This is the amount we are currently spending in today's dollars for a lifetime of healthcare for one person. *

...

When looking at these numbers and their effect on American business, I can tell you that we will almost certainly end up with a one payer system at some point.

It's way cheaper just to have robots do the work. *And, as consumers, they don't need much. *It leaves so much more for the few running the world. Just think, some day in the distant future, no huddled masses. A world where allmthe farming, production and service is provided by robots. The poor and huddled masses, a thing of the past. And all overseen by a few million people enjoying the benefits of nearly unlimited resources, including all the medicine that could ever be required.