Why I think Obamacare will drive down healthcare costs.

[fuzzybabybunny]

The more I read about the ACA the more I think it has a good chance of driving down the cost of our healthcare.

Let me start off with some foundation so we are all on the same page.

Foundation:

The root of the problem is that healthcare prices are too high in the US.

I refer you to the Time Magazine article "Why Medical Bills are Killing Us":

http://content.time.com/time/magazine/article/0,9171,2136864,00.html

If you google search you can find places to read it - it is a long but enlightening read that absolutely holds true to my own experiences getting healthcare from Stanford Hospitals, a non-profit.

Healthcare prices do not operating in a free market. Anyone who says we should just let the free market decide completely misunderstand the very foundation of the problem.

- Prices are not public knowledge and are not advertised. Results of work done are also not easily found. There is no chance of comparison shopping, and therefore no chance of creating real competition between hospitals.

- Healthcare Supply and Demand is inelastic, meaning when prices go up, even way up, the demand for general healthcare and especially life-saving treatments remains the same. This is critical because it means hospitals can charge whatever they want.

- You don't know what you're paying for. The charges on your bill are usually indecipherable medical shorthand codes that a normal layman won't understand and can never understand.

- Due to the above point, hospitals routinely make charges for things that give them a 400% or more profit market. Drugs. durable medical devices like canes, scans, excessive doctor's visits, errors in billing. And most of the time, mundane things like pills of aspirin. Refer to the Time Article. There are hospitals that make Operating Profits of 25%. Operating Profits are those profits AFTER salaries, overhead, equipment expenses, administrative expenses, etc.

When you take the above points into account, you will see that the individual consumer has ZERO bargaining power over the prices set by the hospitals. It is not a free market. And due to many innate reasons, IMO it can never be a free market between the consumer and hospital. The products and services are simply too complex.

The Actual Market

Hospitals have customers, and their customers are insurance companies. Insurance companies are the demand. Hospitals are the supply.

Negotiating Prices

In any negotiation you have to start with the relative bargaining power of the two parties.

We've already determined that the individual consumer has zero bargaining power.

Insurance companies have more negotiating power than the individual, but it is dwindling. Because hospitals have been so profitable and have been swamped in cash, they get bigger and bigger. They buy out individual practices and absorb those doctors into the conglomerate. They build more campuses, create more additions to their buildings, create more lobbies and lobbyists, and do more marketing that paints a picture of a "charitable" organization for the general population, even though their financial documents show charity operations as an abysmally-low percentage of overall operations.

Thus, insurance companies are losing their bargaining power, meaning they will continue to pay higher and higher prices to hospitals because hospitals have the power to demand more and more. This translates into a spiral of hospitals getting more and more profits, insurance companies paying more and more, and the consumer paying more and more in premiums (or getting kicked off insurance).

Insurance Companies will have Less Money to Pay Out

Remember that everything operates in concert with everything else. Supply and Demand. Limited Resources. Cause and Effect.

The ACA limits the amount of money that the insurance companies have to work with.

(A) Now insurance companies have to accept EVERYONE. They cannot pick and choose their customers at will. They can only "pick and choose" which customers use them by (1) setting different prices and (2) changing their product mix to match the customers they would want to have, BUT...

- (1) Insurance companies now compete even more directly with each other because they are now visually side by side and open to comparison shopping in our Health Insurance Marketplaces. So their pricing and services have to be competitive, which limits how high they can make their premiums.

- (2) Insurance companies now have to meet minimum requirements for services that are provided. So their product mix is now limited.

When you take (1) and (2) into account, insurance companies are now very much limited in what customers they get to choose. But at the end of the day, they have to *get* customers, or else they will cease to exist. Basically, they've gotta work with what they've now got. You would think that even though EVERYONE must now buy insurance, that insurance companies should now be flooded with money, but these two restrains put a limit on how much they can advertise their service for (aka money they can collect for themselves) before people move to another competing insurance company, leaving them with a lost sale.

(B) At least 80% of this money collected from the insured person must be used to pay for healthcare services and the other remaining percentage can be used for running the insurance business. As a result, insurance companies must get leaner and more efficient since their costs are now strictly defined.

When you take (A) and (B) together, you see that insurance companies will now feasibly only have so much money to give out to healthcare providers. What they can collect from the insured is limited by competition in the Marketplaces. They have a set of services they are mandated to provide. They can't really choose their customers by kicking off the costly ones. Their costs are strictly defined. And they need to survive and continue competing with other hungry insurance companies on what's remaining.

The money that they have to give out to healthcare providers is a scarce resource.

The Beauty of the ACA - Bargaining Power Through Scarcity

Again we have two parties at the bargaining table. The all-powerful hospitals with insane profit margins (ie. LOTS of room to market DOWN services) and the insurance companies. Only now, ALL of the hospital's customers, the insurance companies, have LESS money to pay out.

As a hospital, you can't squeeze more money out of something that simply doesn't have that money to give out, no matter how hard you bargain.

The insurance companies can now ALL go and bargain and say "look, this is the max amount of money we can give you for this procedure due to our government-mandated situation. Take it or leave it. If you can't take it, we'll simply go to the hospitals that *can* take it."

Bargaining Power Through Scarcity

Initial Refusal

Initially, insurance companies will terminate relationships with many of their previous healthcare providers because many providers will refuse the lower payouts that the insurance companies can give. This predictably makes many end consumers angry because now their previously-covered doctor is no longer covered.

BUT what this really means is that these healthcare providers are now NOT getting PAID by their previous customers, the insurance company.

Remember that since all insurance companies are in the same scarcity situation - if the hospital refuses to do business with Insurance Company A due to their lower payout, they will most likely have to refuse the other Insurance Companies like dominoes.

If the hospital loses enough insurance companies due to their refusal to take the lower payouts, their overall income will dramatically decrease.

Scarcity will now force the hospitals to change.

Future Acceptance, and close to Checkmate for the hospitals

Hospitals will now need to gain back their insurance company customers.

And this means DECREASING their prices to a level that the insurance companies can afford.

This, everyone, is how healthcare costs will be brought under reasonable control in this country.

The result:

- Everyone has access to affordable healthcare (with future tweaks of course, we're not there yet).

- Everyone has access to a minimum of care - the original moral goal of government has been attained.

- Prices for health insurance are now public knowledge and comparisons can resume as a free market. This has the beautiful flow-though effect of placing limits on what hospitals can charge. After all, insurance companies can only pay out what they can take in through the free market.

- Costs are brought down.

- The government now has a regulatory "in" on the healthcare market that could be used for the common good. Imagine the power that the government could have in further bringing down healthcare costs if they actually placed a cap on what people could pay for their premiums. Insurance companies would still have to insure everyone, only now they have a cap on the income they can bring in with each customer. Their overhead costs remain the same. So they would *have* to put more pressure on the hospitals to lower their prices even further, and compete more fiercely with other insurance companies to get more customers. A similar result can happen if the government mandates an even higher minimum standard for services covered by insurance.

Topics not touched on in this thread:

Tracking and only paying for effective treatments.
Tort Reform
Possible issues of decreased Research and Development.
People off the IRS radar.
Some people won't be able to afford this in its current configuration.
Employer costs.
Bigger government control in our lives.
Guns.

 

[AViking]

I have to go to bed but one thing that is interesting in the US system is how the actual costs that insurance companies pay is determined. There's a panel of like 20 doctors who get together each year and look at every new procedure and any old ones in question and itemize the entire procedure from top to bottom. They then assign a cost for these things. The problem is that old procedures might not be reevaluated for years and doctors routinely come up with ways to save costs like reusing a part that they are charging the customer 7 times for even though they use the same one for the whole procedure.

I heard a podcast about this a while ago and it might be worth looking up. I can't figure out what keywords to find it with.

 

[fuzzybabybunny]

I have to go to bed but one thing that is interesting in the US system is how the actual costs that insurance companies pay is determined. There's a panel of like 20 doctors who get together each year and look at every new procedure and any old ones in question and itemize the entire procedure from top to bottom. They then assign a cost for these things. The problem is that old procedures might not be reevaluated for years and doctors routinely come up with ways to save costs like reusing a part that they are charging the customer 7 times for even though they use the same one for the whole procedure.

I heard a podcast about this a while ago and it might be worth looking up. I can't figure out what keywords to find it with.

Are you sure you are thinking of insurance companies? Medicare (the US's government-sponsored insurance for the elderly) would do this and currently only Medicare has the power to dictate what it will pay for certain procedures.

Insurance companies could do this, but the result would only be what they would "like" to pay for such a procedure. They would then go to the bargaining table with what they would "like" to pay and then hospitals would of course negotiate on this.

 

[DaveSimmons]

I wouldn't be surprised to see a shift towards employers no longer offering insurance, but instead offering a fixed payment for employees to go buy it themselves.

This would be good, IMHO, since employees see the real costs and (as FBB says) start to shop for the best coverage and start exerting more pressure on prices.

There may also be more more political pressure to improve oversight and reduce waste.

Finally, as employees change jobs their coverage will continue with the same provider, network, etc. since it is their own insurance just like their car and house insurance/

 

[piasabird]

Right now under Obamacare every state still has its own insurance law. There is no portable insurance.

 

[Hayabusa Rider]

You'll wind up with less providers and less services. We're at the point where reimbursements don't cover costs so quality is going down with an increased likelihood of error and subsequent harm. This isn't a hypothetical. I'm dealing with it right now.

 

[piasabird]

If your insurance uses a high deductable to lower costs you just end up paying for insurance twice. What good is a $6k deductable medical insurance if you have to use $6k out of your pocket before the insurance pays for anything?

 

[fuzzybabybunny]

You'll wind up with less providers and less services. We're at the point where reimbursements don't cover costs so quality is going down with an increased likelihood of error and subsequent harm. This isn't a hypothetical. I'm dealing with it right now.

Read my section on Initial Refusal.

We spend much much much more than other countries on the same procedures and on our healthcare, yet our results are still worse, and we do things like bill ER stays at $6,000 an HOUR (that was my ER bill - $36,000 for 6 hours, a year's worth of college tuition), yet our hospitals are still getting reimbursements that don't cover costs?

Also, keep in mind that an actual practitioner of medicine in a hospital doesn't have the whole cost picture. Only those in at least a high level accounting position might know true cost.

 

[LagunaX]

If your insurance uses a high deductable to lower costs you just end up paying for insurance twice. What good is a $6k deductable medical insurance if you have to use $6k out of your pocket before the insurance pays for anything?

That is the premise of "catastrophic" health insurance.

You are happy to pay out of pocket to a certain amount as say for BC in California with a $40 copay and $500 deductible per person PPO you would end up paying $15k a year in premiums for a family of 4.

You are picking up the smaller bills you can afford and planning on or gambling on general good health. You don't use your policy short of an auto accident, cancer, surgery, etc.

Sadly, though, BC premiums are projected to increase up to 30% if not already due to Obamacare.

 

[Mr. Pedantic]

I don't understand why you don't extend Medicare coverage to the whole US population. Why is it only an over-65 service?

 

[Hayabusa Rider]

Read my section on Initial Refusal.

We spend much much much more than other countries on the same procedures and on our healthcare, yet our results are still worse, and we do things like bill ER stays at $6,000 an HOUR (that was my ER bill - $36,000 for 6 hours, a year's worth of college tuition), yet our hospitals are still getting reimbursements that don't cover costs?

Also, keep in mind that an actual practitioner of medicine in a hospital doesn't have the whole cost picture. Only those in at least a high level accounting position might know true cost.

Our results are pretty good. What you've failed to take into account is the demographics of the US, which sucks. McHeartattacks aren't the fault of the health care system. There are a lot of things which can be done but "we're not going to pay you." has already torpedoed research on brain trauma that I'm aware of. Besides you select hospitals. What about the rest of the system? Do you have any suggestions besides "lets not pay people"?

Out of curiosity, what were you in the ER for?

 

[Zodiark1593]

Healthcare and economics make for an ugly mix, no matter which way we swing it, we're looking for the "lesser evil" instead of "no evil", particularly where multiple private companies are involved.

If one wants to go the way of socialist healthcare, why not go the full hog and have all hospitals run by the government (or by their respective states), funded by tax dollars through a reasonable priced (for example, 1%-5% for family, capped off for higher incomes) tax, and from there, every taxpaying citizen from birth gets their healthcare without hassle or question.

 

[Pray To Jesus]

No cap on what people could pay for their premiums = increase premiums to cover costs.

 

[AViking]

You guys can rant on and on about how we can't reduce costs since it's already hurting the healthcare system but the results are in. The World Health Organization ranks the USA as 38th for healthcare but first on expenditures. I don't know how to make this any clearer but the USA is doing it wrong. Way wrong.

If you cover the whole USA then the next argument would be that there are too many people not working and not paying their fair share. My rebuttal to that would be to lower the ridiculous costs, generate more jobs and control immigration so that it is in balance with the job market. Need more cherry pickers? Bring them in. Need more doctors? Bring them in. Don't just have open borders with no controls though. At some point the US has to understand that in order to maintain their quality of life and increase it (as in the American Dream of everyone doing better than their parents) you need to have good basic necessities for everyone. This includes Education and healthcare. If you have too many people and can't afford to pay for it because too many people make shit salaries and aren't working then you need to address that.

As it is right now though the income and wealth disparity is so large that less than 20% of Americans would even be "hurt" by simply raising taxes and going single payer. Financially they will pay more. However that's the choice you're ultimately going to have to make. Do you want to live in a country where you have a bunch of poor people with no access to healthcare or do you want a country with a basic level of quality of life like the rest of the first world?

I urge every single one of you to go live in a foreign country that provides healthcare to its citizens for a few years. It's quite a different society to live in and I have a feeling you'd like it. I can pretty much guarantee it. Then go home and fix what we are doing wrong since our leaders aren't about to do it without first making us default and look like a bunch of 12 year olds on the world stage.

 

[AViking]

Healthcare and economics make for an ugly mix, no matter which way we swing it, we're looking for the "lesser evil" instead of "no evil", particularly where multiple private companies are involved.

If one wants to go the way of socialist healthcare, why not go the full hog and have all hospitals run by the government (or by their respective states), funded by tax dollars through a reasonable priced (for example, 1%-5% for family, capped off for higher incomes) tax, and from there, every taxpaying citizen from birth gets their healthcare without hassle or question.

The better way is hospitals paid for by the government (and taxes) but run as a corporation by actual doctors and not bureaucrats. Right by my place in Stockholm we have a hospital that runs that way and it's very impressive how well it operates.

 

[Hayabusa Rider]

The better way is hospitals paid for by the government (and taxes) but run as a corporation by actual doctors and not bureaucrats. Right by my place in Stockholm we have a hospital that runs that way and it's very impressive how well it operates.

That's a far better way to do things than what many seem to want. The problem with the US is that the idea of bureaucrats not running things is anathema. Even having experts coordinate efforts with the goal of systematically remaking our system has been despised by some in favor of Obamacare. The apparent working theory is that politicians who cannot know what they are legislating about need to run things. Nothing that those people in DC is done without political gain being a primary goal. That's at least as bad as financial gain, because you cannot fire the bureaucracy. A considered, well thought out and forward looking plan is simply not wanted. Shouting "UHC UHC" is not a solution. We're looking at 1.2 trillion dollars for Alzheimers alone and people will blame, but not do a constructive thing about it. That's my frustration, the blind leading the clueless.

 

[Goothry]

Regarding fuzzybabybunny's argument, there is the assumption that all hospitals operate for and obtain profit. This is simply not true. I would not go as far as to say that this debunks everything else mentioned, but that I only mention it as a point for consideration.

I can say that through knowing people whom have served on hospital boards that the picture people paint isn't always 100% correct. It would be nice to be able to say, "Yes, these are the bad people, and we're going to take action," but this isn't one of those cases. I would say that it is possible for a given hospital to charge as if for a profit, but in the end, due to various factors, not actually retain any of it.

 

[EagleKeeper]

Realize the hospitals also have costs for manpower, equipment and supplies.
MRI scanners and lab equipment (not just vials/slides) are not cheap.
Blood analysis tools can run multi-millions each due to development costs for units from by GE/Phillips, etc

Figure a team of 30 (H/W & S/W + management) for 3 years at a salary cost of $100/hr as well as physical equipment needed for prototypes adds up.

 

[dud]

Hey ... OP, before you arrive at a conclusion on the ACA I believe you should take a more holistic approach to prove your argument. Case in point:

Yesterday I visited a large pet care store with a truly national presence. This company is huge in their niche market. I proceeded to shop but required assistance from their staff. I have shopped at this store before and found their staff to be highly (overly) educated, underpaid yet highly motivated (go figure). During a question/answer session with one of the staff I learned that the average employee was having their hours cut while the store was hiring more staff. The bottom line was that the corporation was trying to avoid having to deal with the ACA. This person was intelligent, highly motivated and very helpful ... but bemoaned the fact that she would not be able to pay her bills because her hours were being cut.



Only time will tell if the ACA will be a "good" thing or a "bad" thing. Unfortunately, corporations are already positioning themselves to avoid it. In the case of the employee above she will NOT have health insurance and NOT have enough money to pay her bills ... because of the ACA. Explain how that is a good thing?

Or we could just blame the corporations who only care about the bottom line ... right?

 

[smackababy]

Hey ... OP, before you arrive at a conclusion on the ACA I believe you should take a more holistic approach to prove your argument. Case in point:

Yesterday I visited a large pet care store with a truly national presence. This company is huge in their niche market. I proceeded to shop but required assistance from their staff. I have shopped at this store before and found their staff to be highly (overly) educated, underpaid yet highly motivated (go figure). During a question/answer session with one of the staff I learned that the average employee was having their hours cut while the store was hiring more staff. The bottom line was that the corporation was trying to avoid having to deal with the ACA. This person was intelligent, highly motivated and very helpful ... but bemoaned the fact that she would not be able to pay her bills because her hours were being cut.



Only time will tell if the ACA will be a "good" thing or a "bad" thing. Unfortunately, corporations are already positioning themselves to avoid it. In the case of the employee above she will NOT have health insurance and NOT have enough money to pay her bills ... because of the ACA. Explain how that is a good thing?

Or we could just blame the corporations who only care about the bottom line ... right?

The problem with your story is that an intelligent, highly motivated person would try and better themselves beyond working at PetSmart. They either are a) not intelligent, b) not highly motivated, or c) both. I don't have much sympathy for the lowly retail worker, because they just aren't trying very hard.

I grew up poor (I had ketchup and water for dinner at one point because it was all we could afford). I barely finished high school and did not complete more than a year at college. But, I worked my ass off, I dedicated myself to learning a skill, and I make damn good money now. True, I am above average intelligence, which is why I wasn't going to spend my life as a construction worker or a retail manager at best.

 

[AViking]

First off which pet store? I worked for Petsmart when I was 16. Everyone there was in high school or college working part time except for 3 people. It's not exactly a great example. No offense to that woman but working for a petstore is not going to pay anyone's bills unless they are the manager running the store and in that case they have healthcare.

 

[AViking]

That's a far better way to do things than what many seem to want. The problem with the US is that the idea of bureaucrats not running things is anathema. Even having experts coordinate efforts with the goal of systematically remaking our system has been despised by some in favor of Obamacare. The apparent working theory is that politicians who cannot know what they are legislating about need to run things. Nothing that those people in DC is done without political gain being a primary goal. That's at least as bad as financial gain, because you cannot fire the bureaucracy. A considered, well thought out and forward looking plan is simply not wanted. Shouting "UHC UHC" is not a solution. We're looking at 1.2 trillion dollars for Alzheimers alone and people will blame, but not do a constructive thing about it. That's my frustration, the blind leading the clueless.

Keep in mind that a lot of what you're saying is probably just fear and misunderstanding. In our culture anything run by the government is terrible but we have plenty of things that work pretty well under the governments control.

Funny story. I mailed a couple postcards from a 3rd world country recently. They took 6 weeks to arrive to the USA and I'm still waiting for one to Europe. Our postal system is a miracle compared to most of the world. It's way cheaper than anything I have ever seen and it gets there when it should.

Now I definitely do not want the DMV running our Hospitals. So don't get me wrong it needs to be done correctly. However it can be PAID for by the government and taxes and be far more effective.

 

[Hayabusa Rider]

Keep in mind that a lot of what you're saying is probably just fear and misunderstanding. In our culture anything run by the government is terrible but we have plenty of things that work pretty well under the governments control.

Funny story. I mailed a couple postcards from a 3rd world country recently. They took 6 weeks to arrive to the USA and I'm still waiting for one to Europe. Our postal system is a miracle compared to most of the world. It's way cheaper than anything I have ever seen and it gets there when it should.

Now I definitely do not want the DMV running our Hospitals. So don't get me wrong it needs to be done correctly. However it can be PAID for by the government and taxes and be far more effective.

I have worked for a few decades in health care in the US and have watched the system mutate in terms of both private and government influence. I saw the bureaucracy kill an AIDS patient because the regs forbade giving out information on his new medicaid numbers. I attended a conference where gerontologists kept complaining because the government kept sending paperwork out, multiple times, which threatened to withhold payment because the physicians weren't giving a treatment which not only didn't work but was harming the patient, as if one size fits all. I don't misunderstand, and any fear I have is based on harm done. Funding? Sure. Control by political partisans? No.

 

[fuzzybabybunny]

Realize the hospitals also have costs for manpower, equipment and supplies.
MRI scanners and lab equipment (not just vials/slides) are not cheap.
Blood analysis tools can run multi-millions each due to development costs for units from by GE/Phillips, etc

Figure a team of 30 (H/W & S/W + management) for 3 years at a salary cost of $100/hr as well as physical equipment needed for prototypes adds up.

You have to delve into actual numbers, not just conjecture.

Profit margins for the majority of hospitals is indeed close to break-even. But note that profit margin / income from operations is calculated AFTER salary pay. For the sake of simplicity, if a hospital's revenue is $100 mil, but it has $50 mil in salaries and $48 mil in other expenses, the profit is "only" $2 mil, or 2%. All this could mean is that it pays obscene amounts to certain people. If you want to decrease the profit margin of your company, just pay yourself more!

If you look at the financials for Stanford Hospitals (a non-profit, numbers are in thousands): http://stanfordhospital.org/aboutUs...-Statements/SHC-consol-FY-2012-audited-FS.PDF

You'll see that (in thousands):

$2,430,488.00 - Operating Income (money it brought in)
$988,008.00 - 41% - Salaries
$559,778.00 - 23% - Purchased Services (includes non-salaried doctors)
$33,344.00 - 1% - Professional Services
$325,073.00 - 13% - Supplies
$94,299.00 - 4% - Depreciation
$236,730.00 - 10% - Income from Operations


Only 13% was used for supplies. Yet I was billed $200 for a disposable cervical neck collar that I can find on Amazon for $12: http://www.amazon.com/Ambu-Perfit-Ad...rds=neck+brace

The same thing went for things like blankets, bandages, CT scans, etc that were on my bill. Everything was completely inflated.

The 4% depreciation is used for purchased equipment from medical equipment companies with the huge profit margins we all talk about, so as you can see it's not a big contributor to cost.

So:

There is a HUGE mark-up on supplies to the patient, yet supplies only account for 13% of actual costs.

The 41% of salaries is significant and probably due in large part to admin costs to bill all the different insurance companies. The CEO of Stanford Hospitals makes about $2 mil a year.

64% of the costs are in salaries and purchased services.

Examples of Purchased Services:

Services provided by the SoM include physician services that benefit SHC, such as emergency
room coverage, physicians providing medical direction to SHC, and physicians providing service
to the clinical practice, which are covered by the Professional Services Agreement (―PSA&#8214. Such
expenses are reflected as purchased services in the consolidated statements of operations and
changes in net assets, and total $314,959 and $291,936 for the years ended August 31, 2012
and 2011, respectively.

SHC provides various services to LPCH. These services include
operating room, cardiac catheterization, interventional radiology, radiation oncology and
laboratory. The cost of these services is charged back to LPCH based on a percentage of
charges intended to approximate cost or a cost per procedure. Costs of these purchased
services are reflected in the appropriate category in the consolidated statements of operations
and changes in net assets. Reimbursement of purchased services from LPCH totaled $43,405
and $42,341 for the years ended August 31, 2012 and 2011, respectively, and is reflected in the
consolidated statements of operations and changes in net assets as net patient service revenue.

It would be like saying on average that my 6-hour ER stay that was billed at $36,000 cost $23,400 in labor and services to provide. For *6 hours*? One dude with a concussion and road rash cost $3,900 per hour in just labor and purchased services alone. Let's say that a nurse makes $80/hour. That's 48 nurses.

Also, for those people who believe that non-paying people in the ER contributes a lot to driving up costs, for Stanford, the "Provision for Doubtful Accounts" ie. people who don't pay, is $99,110,000. The overall revenue is $2,398,832,000. Doubtful Accounts is thus only 4% of the overall revenue figure. By comparison, 2.7% is what I pay my credit card processing company to accept credit cards payments from my clients...

 

[fuzzybabybunny]

Our results are pretty good. What you've failed to take into account is the demographics of the US, which sucks. McHeartattacks aren't the fault of the health care system. There are a lot of things which can be done but "we're not going to pay you." has already torpedoed research on brain trauma that I'm aware of. Besides you select hospitals. What about the rest of the system? Do you have any suggestions besides "lets not pay people"?

Out of curiosity, what were you in the ER for?

ER for a motorcycle accident. Basically a concussion and road rash.

Look at the financials that I posted for Stanford Hospital - that's the one that I went to. Also note that Stanford gets a lot of influx from nearby poor neighborhoods and my ER nurse who works there complains about all the people who walk into the ER but never pay. But as you'll see from their financials, the cost of that is actually quite small (4%). The numbers don't lie.

Salaries and purchased services (including contractor work) are huge. Some of that is going to be from ordering unnecessary tests and the army of people needed to get the billing straight. So we need to have simpler billing (closer to single payer ala Medicare) and tort reform. But I suspect that a lot of it really is just people being paid large sums of money.