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As usual this "thread' has relapsed into party line bickering instead of the basic topic of the biggest problem in our health care system: the fact that our prices for health care and drugs are the highest in the world with poorer results than most!
Posted by krlklar
Karl, the reason why health care in the United States is so high and we do not get value for our health care dollars is that there are far too many cooks in the kitchen. The United States is the only developed country on earth that does not have some form of a goevrnment administered system of universal health care. Unlike every other nation on earth, the United States views health care as some commodity that can be bought and sold like a television set while those other countries view health care as a basic right of citizenship.
What we have here in the United States is a mish mosh of government and private health insurance plans as well as a myriad of employer sponsored plans that seldom coordinate with each other on anything. As a result medical facilities, hospitals and medical practices have to employ so many people just to handle patient accounts. Back in 1993, when the Clinton health care reform plan was being discussed, it was reported that one hospital here in Cleveland Ohio employed more people handling patient acocunts and billing than the entire Canadian province of Ontario just across Lake Erie. Those paper pushers don't work for free and I am sure than since 1993, that situation has gotten worse in stead of better.
Then there is the cost of providing medical care to the uninsured and those who lack the ability to pay their bills. When a hospital has as much as 25% of their billings being written off as uncollectable (very common in some hospitals); those costs have to be made up somewhere if that facility is to stay open. So the cost of uncompensated medical care is shifted to those who can pay their bills.
A physician I know who has practiced both in Canada with its single payer system and here in the United States has told me that her overhead in the United States was about 50% higher than it was in Canada. A large part of that was the extra staff to handle patient accounts and billing. Plus there was the amount of uncompensated medical care. Her practice is anestesiology which often meant being in on surgery for patients who were uninsured or unable to pay their medical expenses. She said that uncompensated medical care in Canada was almost non existent but about 30% of their billings were written off as uncollectable.
Many surgical procedures where her services were needed are done on an emergency basis where the hospital is mandated to provide the services regardless of a patient's ability to pay. The surgeon is on staff at the hospital and often paid by the hospital, but the anesthesiologist is often an independent practitioner, yet is still needed on the sugery. That is why she had so much uncompensated care.
This doctor is strongly in favor of a single payer system for the United States, but is skeptical of expanding Medicare to cover everyone. She said that a large part of the uncompensated medical care they give is from Medicare patients who just do not pay their 20% share. There are a lot of Medicare beneficiaries out there who have too much money to qualify for Medicaid, yet don't have enough to afford a Medicare supplement. I have talked to many and despite the fact that they can enroll in a zero premium Medicare Advantage plan, they resist because of the co-payments in the plan. So they just go on like they have always done by ignoring their responsibility and not paying their 20% share under Medicare. When one doctor refuses to see them because of the unpaid bill, they just find another doctor.
The reasons why health care in the United States is so high are well known and the solutions are readily available. What we lack is the political courage and will to actually do what needs to get done. Just look at all the lies, distortions and half truths being spread about the ACA. Although the ACA is far from perfect, it is a good beginning to tackle the problem of too high health care costs and too many uninsured people in the United States who lack access to basic health care.
In 2006, the Citizens Health Care Working Group (authorized by congress in 2003 and required to report in 2006) and the Robert Wood Johnson Foundation (which has studied the problem of the uninsured in the United States extensively) both concluded that the cost of providing medical care to the uninsured exceeded the cost of actually covering the uninsured. That was seven years ago and the estimated number of uninsured has grown by more than fifteen million despite the passage of the ACA in 2010.