What is causing healthcare prices to go up?

vesper said:

Firstly, *snip because I type a lot*

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I'd argue that the employer is not picking up the tab - it's part of their compensation package, they wouldn't get that if they didn't work.
What getting healthcare via an employer DOES provide is a form of socialism - the more employees a company has, the bigger their risk pool, which probably means a better deal from a healthcare provider.
Essentially, the employees are collectively buying healthcare, via their employer, negotiated by those in management who were empowered to do so.

The idea of single-payer is just employer provided healthcare on a national scale (or state scale).

vesper said:

Second,*snip because I type a lot*

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It's nowhere near as expensive as what the corporations who own the patents charge.
That's so they can make profits, sometimes very large profits.

vesper said:

Third, *snip because I type a lot*

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Yet we still have medical tech and medicines which are not sufficiently tested, in some cases.
At least, judging by what we discover down the road - side effects that should have disqualified that device or pill from sale, hidden by unscientific practices in a supposedly scientific test.
Certainly not in all cases, but enough for me to question the validity of this point.

vesper said:

Fourth,*snip because I type a lot*

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Oddly enough, the solution to this problem, at least, is universal healthcare - if everyone is the risk pool, the individual risk can be spread out so no one is destroyed by something they cannot control.

vesper said:

Fifth, *snip because I type a lot*

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Competition is in some ways impossible.

Hospitals and doctors cannot be a fully competitive market, because they are limited in number and have a local monopoly (doctors less so, but certainly hospitals, in current form)
There's little point in having multiple full-scale hospitals in the same area, the capital costs to build them both outweigh the benefits of competition.
It might work in large cities, where there is enough concentrated demand to provide business for all of them.

Insurance competition might help, I am unsure.

Drug competition is almost literally impossible, unless you take all the patents away from drug companies, which is the entire reason they do research - so they can have a monopoly on one product, at least.
On drugs whose patents have expired, there is potential.
But the massive spending by drug companies to lobby congress has prevented much of that competition.

The last line of your post brings up a fundamental issue I have with competitive and incorporated medicine.

It pushes people with limited means away from preventative care, or seeking care until the issue has progressed.
It prevents those without the means from access to care.
It doesn't care for some who need care.

I thus consider it insufficient.

The ACA was an attempt to patch that gap, provide care for those who could not afford it otherwise.
Personally, I think that idea MIGHT work, if implemented better - but, again, the lobbyists came in and spent a bunch of money from medical corporations, and cut out the things which would have maybe made it work.
Like allowing the government to negotiate with drug companies what they should pay.

ttwtt78640 said:

With an aging and more obese population demanding that insurance (using a for profit middle man often selected by the employer) cover ever more costs it is no wonder that medical care prices go up far faster than general inflation. Insurance should be used only for the rare, unexpected and expensive medical care costs - not to guarantee that all out of pocket medical care costs are reduced to a flat (monthly) rate based on one's age and tobacco use alone.

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High Deductible / HSA plans have done nothing to reduce overall health spending. Its not routine care that is driving up over all health spending, it's the big stuff: chronic health conditions, cancer, heart disease, orthopedic surgery, long term care and so on.

biglawnmower said:

10% of overall spending?

sure.

but they still control health care.

whats a hospital without medicine?

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Its various physicians groups, medical devices, labs, and so on, all of which bill more than big pharma.

ttwtt78640 said:

With an aging and more obese population demanding that insurance (using a for profit middle man often selected by the employer) cover ever more costs it is no wonder that medical care prices go up far faster than general inflation. Insurance should be used only for the rare, unexpected and expensive medical care costs - not to guarantee that all out of pocket medical care costs are reduced to a flat (monthly) rate based on one's age and tobacco use alone.

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As someone with the experience of primary nonmedical care giver of someone impaired by a sudden, massive stroke later followed by an aggressively treated, five year battle with cancer,
I think you do not know what you are talking about. If you did know, the weight of the reality that the U.S. is the only ODC attempting to meet the challenge of distributing medical care
by ignoring the success of the single payer model under its nose, Medicare, in favor of a for profit, care rationing roadblock euphemistically presented as "insurance" might influence you
to stop proposing when "insurance should be used," as if it is useful and not actually, in its current form, THE PROBLEM. You ignore the recent wise observations of Jimmy Kimmel.

A society fielding ten incomparable aircraft carriers that cannot or will not avoid putting lifetime caps on medical care spending limits on week old infants
needs desperately to apply some of the innovation and spending priorities applied to those aircraft carriers to provision of health care instead of rationing it according to ability to pay
driven risk modeling.

Remove the money devoted to lobbying backed by insurer profits spent on political donations and just maybe we can explore practical workable options like the one funding and controlling French
healthcare.

https://www.theatlantic.com/busines...ee-market-american-health-care-system/254210/
The Myth of the Free-Market American Health Care System

MEGAN MCARDLE MAR 8, 2012

Yesterday, Pascal-Emmanuel Gobry posted a stimulating comparison between the American and French health-care systems. "From my outlook," he writes, "there's something that I haven't seen discussed and yet seems striking to me: how similar the French and U.S. healthcare systems are. On its face, this seems like a preposterous notion: whenever the two are mentioned together, it's to say that they're polar opposites."

Indeed, there are a lot of misconceptions about how America's health-care system compares to those of the other developed countries, including France. Both liberals and conservatives believe that the American system is a "free-market" or "capitalistic" one, and that European systems providing universal coverage are "socialized." In this article, I'll explain where both of these conceptions go wrong.

THE FREE-MARKET MYTH....

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itsforthekids said:

new technology.

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greed!

I voted "Not sure", because to be quite honest, I'm not sure. Some of the posts in here were interesting to read and there is a lot of truth and merit to them.

My big disappointment with the ACA was that it never really was intended to provide cost containment measures in the healthcare industry. It really didn't get to the root causes of the spiking costs through the decades. It absolutely had its merits, especially for people who couldn't otherwise get insurance, but for those of us who purchase insurance through our jobs, and contribute along with our employers to our costs, it didn't do much other than slow the speed of increases (and offer good preventive care).

tres borrachos said:

I voted "Not sure", because to be quite honest, I'm not sure. Some of the posts in here were interesting to read and there is a lot of truth and merit to them.

My big disappointment with the ACA was that it never really was intended to provide cost containment measures in the healthcare industry. It really didn't get to the root causes of the spiking costs through the decades. It absolutely had its merits, especially for people who couldn't otherwise get insurance, but for those of us who purchase insurance through our jobs, and contribute along with our employers to our costs, it didn't do much other than slow the speed of increases (and offer good preventive care).

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If you read my post on the immediately preceding page you might appreciate I have spent enough time over the last decade in medical provider offices, hospitals, rehab clinics, cancer treatment providers, to make some informed observations.
Hospital rooms are the only place I have noticed where every item in the room has a made in USA label. The billing is 6 times higher than the price private insurance has contracted with the provider to actually pay.
In many instances the patient responsibility amount billed is an amount equal to or higher than the insurer portion and the insurer frequently acts as price limiter, claims processor and approver, and guarantor the insured receives
the insurer negotiated rate and is not overbilled. The flip side is that the insurer may deny payment of the claim and on vital, expensive procedures, the provider protects its financial exposure by refusing to perform when the insurer
refuses to approve a prescribed and scheduled procedure.

So, the billing is mandated by insurer created and policed billing codes requiring providers hire medical billing specialists to work around the codes to defeat the limits the codes are designed to impose,
and street pricing of medical billing is influenced by drastically overbilling anyone not protected by insurer negotiated pricing agreements, ostensibly to compensate providers for the expenses of those deep discounts
to insurers, the cost of medical billing specialist to get providers paid those deeply discounted fees paid by insurers, and uncollected payments determined to be the share owed by patients, and the losses from
caring for the uninsured who cannot or won't pay the absurd, fictitious street price billing, or even anything at all.

Fifteen years ago, as one example, there were no PET scans performed because that newer, more sensitive cancer detection and monitoring technology had not impressed insurers as a medically necessary and cost effective
alternative to CAT scans and then more frequently performed CAT Scan guided needle biopsies.

Local PET scan street price in our market is $9,000. Insurer negotiated price is under $1200 and insurer pays $900, patient pays $270.

Cancer patients with certain active cancers under treatment are prescribed this test every three months. The PET scan measures rate of glucose uptake in even tiny areas of the body and cancer cells more quickly uptake glucose
than normal cells. There is a risk of false positives caused by recent unrelated infections or ongoing cancer treatment by radiation.

The PET scan has reduced frequency of needle biopsies and detects what even needle biopsies do not detect and reduces the incidence of excessive chemotherapy or radiation formerly killing patients or
seriously impairing outcomes because the PET scan is the oncologist's most sensitive and reliable eye evaluating the state of the cancer and confirms remission or positive treatment results sooner and with unrivaled reliability.

The PET scan literally pays for itself but requires investment and facility expansion and may actually drive reduced revenue for the facility, offset by better outcomes effecting facility reputation.

Usual and customer pricing determines street price billing and providers make it their business to learn and attempt to influence higher usual and customary regional prices.
Larger insurers negotiate deeper provider discounts than smaller insurers have leverage to negotiate.

If all of that was removed and providers were paid by single payer and could assume, as they do with medicare patients, they would in fact be paid at least the portion of billing the patient is not responsible for paying,
the providers could set prices determined by knowable variables....no need to price for anticipated provision of services to the uninsured....no need for patients to be protected by insurer, from balance (artificially high street price) billing.

Hospitals and other providers should not restrict purchasing to sources represented by sales reps who call on them and offer them incentives amounting to bribes. Hospital beds made in USA and priced
accordingly may not be needed in every room.

The AMA should not be restricting the number of future physicians, post graduate university admissions and government should incentivize medical students to serve where the need is acute, after completion of residency and training,
by offering more tuition reimbursement and maximizing instruction and training effectiveness, thus lowering the number of new doctors beginning licensed or certified careers at the advanced age of 31 and deeply in debt, in too many instances. We have an extreme need for more evenly geographically distributed, 28 year old well trained doctors with lower tuition debt and Physicians assistants and Nurse Practitioners practicing semiautonomously
to compensate for the lack of physician availability.

https://en.wikipedia.org/wiki/Medical_school_in_the_United_States#Accreditation
.....Accreditation
All medical schools within the United States must be accredited by one of two organizations. The Liaison Committee on Medical Education (LCME), jointly administered by the Association of American Medical Colleges and the American Medical Association, accredits M.D. schools,[36] while the Commission on Osteopathic College Accreditation of the American Osteopathic Association accredits osteopathic (D.O.) medical schools. There are presently 141 M.D. programs[37] and 30 D.O. programs[38] in the United States.

Accreditation is required for a school's students to receive federal loans. Additionally, schools must be accredited to receive federal funding for medical education.[39] The M.D. and D.O. are the only medical degrees offered in the United States which are listed in the WHO/IMED list of medical schools....

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SouthernDemocrat said:

High Deductible / HSA plans have done nothing to reduce overall health spending. Its not routine care that is driving up over all health spending, it's the big stuff: chronic health conditions, cancer, heart disease, orthopedic surgery, long term care and so on.

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Much of the "big stuff" is a direct result of obesity and ignoring the "little stuff" like proper diet and exercise. Long term (nursing home or assisted living) care costs are interesting because they count towards legitimate medical care costs only sometimes - try writing those nursing home or assisted living faciality (room and board) costs off on your federal income tax.

For some (political?) reason long term care costs that are deemed legitimate care expenses to be paid by Medicaid (which inlcude room and baord expensies in a nursing home) are not considered as deductible medical care expense for federal income tax purposes. It makes no sense that an incapacitaed senior citizen may not deduct their own nursing home (room and board) care costs yet must pay income taxes to subsidize those same (nursing home room and board) costs for others under Medicaid.

Something else. Over litigation.

post said:

As someone with the experience of primary nonmedical care giver of someone impaired by a sudden, massive stroke later followed by an aggressively treated, five year battle with cancer,
I think you do not know what you are talking about. If you did know, the weight of the reality that the U.S. is the only ODC attempting to meet the challenge of distributing medical care
by ignoring the success of the single payer model under its nose, Medicare, in favor of a for profit, care rationing roadblock euphemistically presented as "insurance" might influence you
to stop proposing when "insurance should be used," as if it is useful and not actually, in its current form, THE PROBLEM. You ignore the recent wise observations of Jimmy Kimmel.

A society fielding ten incomparable aircraft carriers that cannot or will not avoid putting lifetime caps on medical care spending limits on week old infants
needs desperately to apply some of the innovation and spending priorities applied to those aircraft carriers to provision of health care instead of rationing it according to ability to pay
driven risk modeling.

Remove the money devoted to lobbying backed by insurer profits spent on political donations and just maybe we can explore practical workable options like the one funding and controlling French
healthcare.

Click to expand...

As the permanent legal guardian for a 95 year old totally incapacitated person (my father) now residing in a state veterans home Alzheimer's unit I think that I do know what I am talking about.

cabse5 said:

Something else. Over litigation.

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That is a partisan argument actually a component of a broader republican strategy to defund two identified predictable contributors to democrats....labor unions and trial lawyers.
The fact remains it is a politically motivated target more than it is a noticeable cost reducing solution and malpractice premiums are influenced more by rate of return of insurer investment at any given time, than on malpractice
claim payout expense.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/
National Costs Of The Medical Liability System
Michelle M. Mello, Amitabh Chandra, Atul A. Gawande, and David M. Studdert

.....Conclusion
The medical liability system costs the nation more than $55 billion annually. (2.4 percent, in 2008) This is less than some imaginative estimates put forward in the health reform debate, and it represents a small fraction of total health care spending. Yet in absolute dollars, the amount is not trivial.

Moreover, to the extent that some of these costs stem from meritless malpractice litigation, 21 they are particularly objectionable to health care providers. The psychological and political value of addressing this grievance could be considerable.

Reforms that offer the prospect of reducing these costs have modest potential to exert downward pressure on overall health spending. Reforms to the health care delivery system, such as alterations to the fee-for-service reimbursement system and the incentives it provides for overuse, probably provide greater opportunities for savings.

Some aspects of federal health reform may reduce medical liability costs. Extending health insurance coverage to the uninsured may reduce their need to file malpractice claims to recoup medical expenses occasioned by injuries caused by malpractice.

Additionally, in states that have adopted “collateral-source offsets”—meaning that costs covered by health insurance cannot be recovered by malpractice plaintiffs—greater prevalence of health insurance will mean more frequent offsets, lower total indemnity payments, and less “double payment” of medical expenses. A farther-reaching reform that merits discussion would be to impose a federal collateral-source offset in connection with the move to universal coverage. In these respects, health reform and liability reform may have unexpected synergies in bending our cost curve down......

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ttwtt78640 said:

As the permanent legal guardian for a 95 year old totally incapacitated person (my father) now residing in a state veterans home Alzheimer's unit I think that I do know what I am talking about.

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What timely, relevant experience does that give you related to private insurance or insurers? The rules governing billing, rates, and mandated and denied services pertaining to patients covered under medicare or veterans benefits
are highly regulated and negotiated by the government, the single payer. Private insurers were given the claims handling responsibility of nonprofit medicare to discourage them from lobbying heavily against the 1966 passage of medicare legislation.
Are you proposing making the retired pay more of the cost of their care, out of pocket? That is absurd, considering the already limited wealth of many seniors.

I do think it is a shame we have no way to practically and fairly limit the costs of caring for the infirm aged, such as my nursing home maintained, 90 yr. old father who so far shoulders payment of all bills from that facility, out of pocket.
No debate seems even possible without "death panels" objections raised as a debate ender.

SouthernDemocrat said:

Its various physicians groups, medical devices, labs, and so on, all of which bill more than big pharma.

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big pharma's billing isnt the issue. liberals these days...

its being able to control the cure

biglawnmower said:

big pharma's billing isnt the issue. liberals these days...

its being able to control the cure

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"..its being able to control (monetize) the cure.."

over the last 18 years i had insurance ,,,and i pay all of my insurance (self Employed ) it went from 350 per month to 1000 per month it did not raise this year. it went up every year and obama care had nothing to do with it . but i am 62 so i think it raised faster than others because of age . by the way i have full insurance not junk insurance that trump will allow.

biglawnmower said:

big pharma's billing isnt the issue. liberals these days...

its being able to control the cure

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My wife has worked in insurance defense for over 15 years. She pulls medical records and billing all the time. This notion that big pharma is the biggest driver of health spending is a convenient myth for politicians. As I pointed out earlier, prescription drugs are 10% of healthcare spending. https://www.cms.gov/Research-Statis...onalHealthExpendData/downloads/highlights.pdf

Despite all the press coverage that expensive drugs get, most prescribed drugs are inexpensive generics. Now, lets say you are in a car wreck and suffer severe trauma. You are taken by ambulance to the hospital, you spend 2 days in critical care and another 3 days in the hospital before you are released. You basically will be looking at something like the following in terms of bills:

$2000 for the ambulance ride
$35,000 for the time in critical care.
$22,000 for the time in general care.
$4,000 for imaging
$1,200 for lab work
$3000 for a neurologist
$5000 for a orthopedic surgeon eval (assuming you don't need surgery)
$10000 for a plastic surgeon (to stitch you up)
$1500 for a PT
$1000 for an OT
$7000 in misc
$2500 for drugs

SouthernDemocrat said:

My wife has worked in insurance defense for over 15 years. She pulls medical records and billing all the time. This notion that big pharma is the biggest driver of health spending is a convenient myth for politicians. As I pointed out earlier, prescription drugs are 10% of healthcare spending. https://www.cms.gov/Research-Statis...onalHealthExpendData/downloads/highlights.pdf

Despite all the press coverage that expensive drugs get, most prescribed drugs are inexpensive generics. Now, lets say you are in a car wreck and suffer severe trauma. You are taken by ambulance to the hospital, you spend 2 days in critical care and another 3 days in the hospital before you are released. You basically will be looking at something like the following in terms of bills:

$2000 for the ambulance ride
$35,000 for the time in critical care.
$22,000 for the time in general care.
$4,000 for imaging
$1,200 for lab work
$3000 for a neurologist
$5000 for a orthopedic surgeon eval (assuming you don't need surgery)
$10000 for a plastic surgeon (to stitch you up)
$1500 for a PT
$1000 for an OT
$7000 in misc
$2500 for drugs

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sorry. didnt realize i was chatting with a wall street and big corporation supporter.

biglawnmower said:

sorry. didnt realize i was chatting with a wall street and big corporation supporter.

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Sorry, I would not have bothered to explain the actual drivers of healthcare costs had I known you didn't care about the actual causes.

Masterhawk said:

Healthcare is very expensive. Costs have been rising over the decades. In 1960, healthcare expenditures per capita were only $147 but in 2010, they were $8,402.
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Some people say that it is being caused by certain providers gaining monopolies while others say that they are caused by overregulation. And then some think that it is caused by something completely different entirely.

What do you think?

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There is basically no system in place to get to the root causes of rising health care costs. We always seem to use the top down approach instead of getting at the roots. Until we address the root causes, we will never control health care costs.

Moderate Right said:

There is basically no system in place to get to the root causes of rising health care costs. We always seem to use the top down approach instead of getting at the roots. Until we address the root causes, we will never control health care costs.

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Single payer addresses the root causes

Moderate Right said:

There is basically no system in place to get to the root causes of rising health care costs. We always seem to use the top down approach instead of getting at the roots. Until we address the root causes, we will never control health care costs.

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At the risk of oversimplifying, the primary root cause is that when it comes to virtually any concrete example of health spending people will be for it. They want a convenient facility in their community, they want every new treatment, drug, or technology you can come up with if it offers a chance. And for those with a job in or nation's largest employment sector, they want a paycheck. And as a rich country with a rather lenient permission structure for such things, we've historically been pretty content to emphatically say "yes!" to such things.

But in the abstract folks are aghast at what we spend on health care. Which is to say that when "the problem" is directly placed before people no one sees a problem. Only when faced with the abstraction of The Problem and feeling the financial pinch from this philosophy do people come to feel there's something amiss.

vegas giants said:

Single payer addresses the root causes

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Not unless it mandates a healthy lifestyle. Americans are fat, fat, fat. And getting fatter, especially the kids. And so many are drug addicted; to prescription drugs as well. All that's always going to be expensive.

vegas giants said:

Single payer addresses the root causes

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Medicare is the piece of the American health care landscape that for the most part functionally approximates single-payer. And the prices that it sets for itself are still 50% higher than the OECD average. And that's because the costs those payments are meant to cover are higher here than in many places. And even then Medicare only covers the direct cost of providing a service at best, it generally doesn't do much to help keep the lights on or the needed health care infrastructure in places, which is why most hospitals run negative margins on Medicare business.

Single-payer has to grapple with the same thing our current multi-payer landscape does: costs here are higher than anywhere else.

Waddy said:

Not unless it mandates a healthy lifestyle. Americans are fat, fat, fat. And getting fatter, especially the kids. And so many are drug addicted; to prescription drugs as well. All that's always going to be expensive.

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No one is going to stop that. But single payer is the best way to deal with it