I know this isn't quite what this topic was originally about, but here's a good article on one reason why healthcare is so expensive.from healthbeatblog.org
The Disease: The Exorbitant Cost of U.S. Healthcare; The Symptom: The Uninsured and UnderinsuredOver at
Healthhcare Policy and Market Place Review, Bob Laszewski suggests that the elephant in the center of the room is the cost of health care—and I would add, healthcare inflation. The nation’s healthcare bill is rising 6 percent to 7 percent a year—far faster than either GDP or wages. This means that in roughly ten years, your health care bill will double. Even if you have insurance now, do you believe your salary will double over the next ten years? Do you think your employer will be able or willing to pay twice as much for your premiums?As I have written
in the past, U.S. healthcare is so impossibly expensive because we pay more for virtually everything—drugs, devices, hospitals, physicians’ services. Physicians complain that their incomes are not rising as quickly as their costs—and it is very true that the doctors at the low end of the income scale (the family docs, pediatricians, internists, general surgeons, primary care physicians, geriatricians and palliative care specialists) need to earn more.Yet overall, better-paid physicians continue to command higher incomes each year. Even though fees for many of their services remain flat, they have more than made up for the difference “on volume”—i.e. by “doing more”—more tests, more treatments. Medicare bills confirm that they are taking in more each year.The bottom line is that many specialists now take home four to six times as much as primary care physicians who typically earn $125,000 to $160,000 a year —yet it is difficult to argue that the services these specialists provide are four to six times more valuable. Meantime, hospitals pay for much of a specialists’ overhead—the operating room, the nurses, the receptionists, the testing equipment—while a primary care provider must cover most of his own overhead.Granted, specialists who perform the most aggressive and expensive procedures usually spend more years in training. But does it make sense to pay them four to six times more, every year, for thirty or thirty-five years? It would make much more sense to subsidize medical education in specialties where we need more doctors .How do we justify asking taxpayers to pay some doctors $500,000 or $600,000 or $800,000 a year (and taxpayers now pick up slightly more than half of the nation’s healthcare bill) when we cannot afford to provide basic healthcare for all of our citizens? People who cannot afford health care insurance for their own families are subsidizing those $500,000 incomes.
Other nations put patients first, and outcomes are better, even though specialists in other developed countries earn roughly 40 percent less, as a share of per capita GDP.I’m not arguing for slashing specialists salaries, but clearly, health care dollars need to be redistributed, up and down the physician income ladder. We need to adjust fees, with an eye to the benefit to the patient.Finally, research shows that when a service becomes particularly lucrative, volume increases: over-payment drives over-treatment.I’m focusing on payment to physicians here only because
I have talked so often in other posts about how health care dollars are squandered on over-priced, often unproven, drugs and devices—not to mention seven-figure salaries for hospital CEOs who don’t seem to understand the difference between a hospital and a hotel. Too often, they would rather invest in the hotel-like amenities that will bring in “the customers” than the systems that would make patients safer.Why focus on the cost of care rather than keeping our eyes fixed on the need for care? Because, as Bob Laszewski argues below, if we don’t face up to costs, we won’t be able to fill the need.Finally, yes, I know how much we have spent bailing out Wall Street banks. And, in my view, the money was not spent wisely. (I’ve said most of what I have to say about Wall Street in my first book, Bull! A History of the Boom and Bust, 1982-2003. )But the difference between the bail-out and healthcare legislation is this: when we promise universal coverage we are not talking about a one-time expenditure, this year or next. We are talking about a recurring contribution to a industry riddled with corruption and conflicts of interest where costs are climbing by 6 percent to 7 percent a year.Anyone who thinks that making that industry larger will somehow make it easier to make the tough decisions about where to cut costs hasn’t been paying attention to how American capitalism works.When an industry grows, it power increases; its lobbyist are better –funded; and the chances of persuading it to settle for a smaller piece of the pie diminishes. (See: the oil industry; the investment banking industry . . . ) ----------------------
To Break the Bank or Not to Break the Bank With Health Care Reform?--The Wrong QuestionBy Bob Laszewski, Healthcare Policy and Marketplace Review, January 30, 2009 The new debate in Washington these days seems to be over whether we can or cannot afford to do health care reform given the financial crisis and the huge budget deficits.Some argue that with the rising unemployment rate, certain increases in the number of those uninsured to follow, and the need to inject money into the system, this is the right time.Others say that in the face of daunting national debt it is not the time to dramatically increase our entitlement obligations even further.In my mind this is a false debate.Both sides seem to presume that solving the access problem, and not the cost of care in America, is the real problem.I come from the perspective that the onerous cost of health care in America is the problem that needs to be solved. Solving it is exactly the right thing to do in the face of an already dramatic increase in the national debt.The number of those uninsured--or on the edge of becoming uninsured--is a symptom just as the looming insolvency of Medicare is a symptom of the health care cost problem.If you want to really reform America's health care system and pay for more people to be a part of it you have to solve its long-term cost problems.What better time to do that then when we are faced with enormous budget deficits that, even before the financial meltdown, were always being driven to a great extent by health care costs?But here's the rub. Dealing with costs is the problematic part of health care reform. In a way, agreeing that we should pay to cover everyone is the easy part. Kind of like buying that new Porsche is the easy part--who wouldn't want one? The hard part is paying for it.The CBO's December report on the cost of health care broken down by 115 options tells the story of real health care reform. *MM-- I have written about the CBO report here