Originally posted by: eskimospy
Originally posted by: mattpegher
Let do a step by step.
You go to see your doctor. You have been vomiting and your back hurts.
First you see the nurse.
Is she paid to much?
Then you see the doctor. His visit is $120. He spends 30 minutes with you. He therefore is billing $240 /hour. He gets about 150 from you and the insurance company. After he pays his nurse and office staff, rent and utilities, he has about $100/hour.
First he pays his malpractice which is about $30/hour that he works. or about $60000/year. Is that too much?
His take home before taxes is $70/hour. But he must spend about $10K/year (5/hour) to keep his job. Is he paid to much?
He has to pay back his loans. Should we pay for medical school in our taxes?
Now we can debate that medicines are too expensive, but are we going to take over all medicine production and R&D in this country, and if so how much money are we going to put in.
Currently the price of crutches, hospital services, lab and xray are bloated to cover the uninsured. But I have not heard of any hospitals making money hand over fist as most are operating in the red, many actually going under. And the average salary of a major hospital CEO is about 500K, certainly a heafty sum but not outragious by any means, certainly no multimillion dollar bonuses or stock options here. So is too much money going to hospitals, I don't think so.
Who is paying million dollar salaries to CEO's, who is making big money? Just lookup the annual reports of the insurance companies. Is BC/BS, or Aetna, or Cigna going out of business. They are reporting (thats reporting) huge profits.
Sure one can argue that the top speciallist are making >1mil/year but those guys are few, and their numbers do not affect the cost that much.
Yes preventive medicine can decrease cost, yes supporting healthy choices can decrease costs, but these alone are only a small porportion.
We as a society are not ready, and in my opinion should not be, to ration health care and condemn some of our number to suffering and death by limiting access.
We already do condemn people to suffering and death by limiting access to treatment of the uninsured until an emergency occurs. Drug costs here are astronomical, and it's hard to say significant savings couldn't be had when the companies spend more on marketing than they do on R+D. Furthermore, malpractice costs both in insurance and in awards amounts to less than 2% of US expenditures.
If you are interested in how savings could be realized, here is an
OECD analysis of our health care system, with the hopes of understanding why it works so incredibly poorly. This is just within our current system.
I think it is exceedingly difficult to argue with the evidence from an array of countries with similar demographics and socioeconomic backgrounds that have made socialized medicine work. They achieve superior health outcomes at a fraction of the cost. Those who oppose UHC don't seem to realize that nearly every one of their complaints already occurs in our system as it is. (rationing care, paying for deadbeats)
Of interest in the OECD analysis was a lack of any clear data on the cost of the insurance industry on american health care.
several quotes:
The relatively high physician incomes in the United States are likely mainly to reflect the relatively high compensation for professionals
in general compared with that in other countries.
A factor that may help to explain the apparent relative underperformance of the US health-care
system is the much higher prevalence of chronic health conditions in the United States than in other
countries, at least insofar as this reflects the underlying population health status as opposed to screening
rates.
Another factor that contributes to higher US
health expenditure levels, but which may improve outcomes, is that the US medical system tends to screen
for disease more aggressively than in many other countries and to treat less severe cases of disease
(Thorpe, Howard, and Galactionova, 2007). For example, these authors conclude that more intensive
screening in the United States contributes to the higher prevalence of (diagnosed) cancer there, but also
that mortality rates from cancer tend to be lower.
For instance, Skinner, Staiger and Fisher (2006) examine
variation in the costs and survival gains across regions in the United States and find that increased
spending on the treatment of heart attacks is not associated with comparable increased benefits. This factor
may be more important in the United States than in other countries owing to the greater utilisation of new
technologies and weaker controls on their use than in systems with single payers.
This is interesting because failure to diagnose a myocardial infarction is the number one complaint in lawsuits, and about one in 10 patients admitted to the hospital with chest pain are having a heart attack, many are found to have no coronary disease at all
In the United States, malpractice awards can be enormous, and certainly much greater than in
most other countries. This risk encourages physicians to practice defensive medicine, prescribing tests to
rule out potential health problems with a low probability of occurring. It also drives up the cost of buying
professional liability insurance,14 and hence providers? cost of doing business. Based on data for elderly
Medicare beneficiaries treated for serious heart conditions in 1984, 1987, and 1990, Kessler and McClellan
(1996) found that malpractice reforms that directly reduced provider liability pressure led to reductions of
5-9% in medical expenditure, potentially reflecting both the practice of less defensive medicine and lower
professional liability insurance costs, without substantial effects on mortality or medical complications.
They concluded that professional liability reforms do indeed reduce the practice of defensive medicine.
Actually some good reading if you actually pay attention to all the data.
The article actually suggests that UHC is not an easy answer for the USA.
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