Pgh Public Schools to lay off a lot of people. Wow (Liberty: 2014, purchase)

[BrianTH]

No, the studies say it isn't obesity and smoking (as an aside, our higher obesity rate is offset by a lower smoking rate as compared to other developed countries). It is mostly because we pay more per procedure and drug, not because we are getting more of certain procedures and drugs. Note also that obesity and smoking, or any factor cutting across the entire U.S. risk pool, can't explain why Medicaid and Medicare have had lower cost growth than private insurance. Another chart:



The problem really is that private insurers do a terrible job controlling costs.

As for lawsuits:

[Enough_Already]

Originally Posted by BrianTH

No, the studies say it isn't obesity and smoking (as an aside, our higher obesity rate is offset by a lower smoking rate as compared to other developed countries). It is mostly because we pay more per procedure and drug, not because we are getting more of certain procedures and drugs. Note also that obesity and smoking, or any factor cutting across the entire U.S. risk pool, can't explain why Medicaid and Medicare have had lower cost growth than private insurance. Another chart:



The problem really is that private insurers do a terrible job controlling costs.

As for lawsuits:

As you know a chart can be made to say anything. The point I was making was relating life expectancy with healthcare costs. That does not take into account the genetic mix factor nor does it take into account that the average American is fat, eats a bad diet, and gets very little exercise. Numerous studies have shown how the American lifestyle choices make us sick and kills us. Any chart that does not show the effect of smoking and other bad lifestyle choices is obviously a chart that was prepared with an agenda other than showing the facts.

What is the source of you "defensive medicine" chart? It looks like something prepared by a child in elementary school. We are lawsuit happy in this country and that cost is built into the cost of drugs, medical devices, and professional fees.

What is amazing to me is after the drug companies agreed to reduce prices during the healthcare debate, they raised prices before the effective date of the agreement so they gave back nothing.

Better habits can help trim bloated health care system | McClatchy

Drug Makers Raising Prices Before Reform - NYTimes.com

[BrianTH]

Originally Posted by Enough_Already

The point I was making was relating life expectancy with healthcare costs. That does not take into account the genetic mix factor nor does it take into account that the average American is fat, eats a bad diet, and gets very little exercise.

As I noted previously, you are apparently overlooking the fact that the average person in other developed countries smokes more than the average American--and in fact now is closing the gap on obesity as well. There is no doubt that both smoking and obesity have impacts on health outcomes and health costs, but those factors are not unique to the United States.

More generally, if health problems related to obesity was the reason for higher costs of health care in the United States, it would show up as more use of related procedures and drugs. And there may be some of that, but given the massive gap in spending that really can't be the primary explanation, and in fact we know the cost difference is primarily because procedures and drugs in general cost more in the United States. In other words, if procedures and drugs unrelated to obesity on average cost a lot more in the United States, and they do, how can you blame obesity for that fact?

What is the source of you "defensive medicine" chart?

Here you go:

Meme-busting: Tort reform = cost control | The Incidental Economist

That is a blog post and chart by Aaron Caroll, an MD and Director of the Center for Health Policy and Professionalism Research. The ultimate source for the data and analysis presented in the chart are articles published in Health Affairs, a peer-reviewed health policy journal.

To sum up: it is not untrue that Americans have higher obesity rates than other developed countries (although we have lower smoking rates) which contributes to our health care costs. Nor is it untrue that defensive medicine contributes to our health care costs, and that tort reform would slightly lower those costs. But it is important to keep the scale, aka relative importance, of these various factors in mind. And those two particular factors cannot explain the vast majority of the difference in health care costs between the United States and other developed countries (and again, smoking goes the other way).

[gg]

Originally Posted by BrianTH

As I noted previously, you are apparently overlooking the fact that the average person in other developed countries smokes more than the average American--and in fact now is closing the gap on obesity as well. There is no doubt that both smoking and obesity have impacts on health outcomes and health costs, but those factors are not unique to the United States.

I have not looked into why we have such wild costs if you go to the hospital and have to pay our of your own pocket. There seems to be a stabbing/shooting or some major violence everyday in the city of Pittsburgh let alone the other cities like Camden, NJ, NYC and tons of others and we all know these people don't have insurance. We are probably the most violent countries in the developed world and those costs have to be pretty large with all these bloody bodies walking into emergency rooms everyday. Then you have huge bills going to Insurance companies that have some clout and they agree to pay a part of the bill. An individual is just that, someone with no clout.

Like I said, I have not looked into this and probably won't. My goal is not to get sick and hope for the best. I, like countless other Americans have no health insurance. I looked into it and it IS very expensive even with huge deductibles.

Bottom line is, if I go to the hospital and need an aspirin, the price for the aspirin will be about $30. Something is wrong with that.

[BrianTH]

Yep, people without insurance are totally screwed if they need major medical procedures, which is why so many bankruptcies are triggered by medical bills.

Fortunately, one of the things the new health care law will do is make health insurance at group rates available to individuals who don't get such rates through an employer, Medicare, or Medicaid.

[gg]

One has to wonder if there was no such thing as health insurance, medical costs would be 1/4 or maybe even less than current costs. People just pay their own way. If they don't have the money, they make payments. Of course that is never going to happen, but costs would plummet overnight. The insurance industry has messed so many things up. I do think it is time for some government option for the millions and millions of people that have no insurance. Oh well, maybe in my next life.

[BrianTH]

So there is a federal law that mandates that any provider that takes Medicare has to provide ER services to anyone who shows up, regardless of ability to pay. That law is a large part of why we don't have uninsured people dying in the streets, but that is part of why uninsured prices are so high. And providing a legal guarantee of care through ER services is really a horribly expensive and inefficient way of doing things.

[gg]

Originally Posted by BrianTH

So there is a federal law that mandates that any provider that takes Medicare has to provide ER services to anyone who shows up, regardless of ability to pay. That law is a large part of why we don't have uninsured people dying in the streets, but that is part of why uninsured prices are so high. And providing a legal guarantee of care through ER services is really a horribly expensive and inefficient way of doing things.

Correct.

My point was more about the battle of the insurance companies vs. hospitals. That battle of payments costs everyone money too. I was told that hospitals will bill the insurance companies way more than in years past because they know they will be battling or payment and it gets renegotiated. If true, the bills I get will be the same as what the insurance companies get, but I have no leg to stand on. In real life, I am getting 20% off my bill. That is in the adjustment category that I have on all my medical bills from the past 10 years, so I do get a little off the insurance bill. I suspect they get less from the insurance companies though. What a mess the whole thing is.

[BrianTH]

I think you are right that another reason the base price is so high these days is that it is just a starting point for negotiations. And in fact different insurance companies get different discounts (in addition to uninsured patients getting different rates). It is indeed an administrative nightmare.

[gg]

Originally Posted by BrianTH

I think you are right that another reason the base price is so high these days is that it is just a starting point for negotiations. And in fact different insurance companies get different discounts (in addition to uninsured patients getting different rates). It is indeed an administrative nightmare.

In these cases it is very bad to be an individual because one person has NO pull at all. They just give out a bill and if I don't pay the full amount my credit rating drops like a rock.

I will continue hoping no one in my home gets really sick. If my wife or child do, they have other options. If they didn't, I would have to carry something for them. I am out of luck.