Insatiable Health Care Appetite Trumps Cost Cap Efforts
Here's yet another hint about why reforming America's health system is so daunting-- the overall consumer price index jumped by 4.1% in 2007 while prescription drug prices rose by 1.4%, hospital prices went up 3.5% and fees charged by doctors rose by 3.9%.
So what's the problem? It seems that the health prices are rising more slowly than others. Obviously, this apparent good news isn't the whole story. In fact, health spending gobbles up a growing percentage of our GDP (16.2% in 2007) because total spending on care rose by 6.1% as increases in volume far outpaced price hikes. We took more pills and had more tests.
This is the latest bit of evidence confirming that any effort to cap costs will have to focus on limiting volume, which keeps creeping up. Politicians understandably prefer to adjust prices because that has little direct impact on patients. If Medicare cuts reimbursement for a physician visit by $5, that doesn't make it more difficult to see a doctor.
To the contrary, doctors will probably schedule more visits in an effort to maintain their income at a constant level. Or, as a therapist remarked to me recently, that's why poor people in government programs typically require more visits to deal with any given problem.
But if you try to limit the number of visits, tests or pills, that's quickly obvious to the patient population that generally believes more is better.
Hospitals offer an example of the difficulty. Between 1990 and 2006, the number of days Americans are hospitalized dropped by better than 28% (from 784 to 558 per thousand of us), continuing a trend that began earlier. But our national hospital bill continues to rise much faster than the price of any individual hospital service.
Part of that merely reflects the fact that people in hospitals are sicker than they once were (those with minor problems who used to be hospitalized are now treated as outpatients), but part reflects a growing intensity of services delivered to those who are hospitalized. Medicare has tried to combat that problem by paying a flat fee per diagnosis regardless of the services delivered, but private insurance continues to pay for individual services.
These trends also raise a quiet but potentially explosive question about whether America has enough physicians. Already there are complaints about local shortages. If behavior by American patients, who already tend to visit doctors more often than residents in other rich countries, is going to move in this direction, then there's a need to spent more money to educate more doctors -- a strategy that will drive costs up even further because, in medicine, supply creates demand.
If, on the other hand, we can create a system where people are comfortable visiting their doctor less often, the current system may be adequate for decades ahead. That decision, which has yet to inspire any public discussion, will have a big impact on medical costs during the second half of this century.
Originally posted to Centeredpolitics.com
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Look'it here - we don't feed ourselves, we don't clothe ourselves, etc.... We outsource darn near everything. How about outsourcing the management of the health care system. Let the French, Germans, Swiss, ... bid on the job. they obviously have it figured out a lot better than we do.
Either that or start gradually allowing folks to buy into Medicare - start with the lowest risk groups first to inject money. The first year add everybody who's birth date is within 1 calendar year. The next year add the next group who's birth date spans two calendar years, ...
As self employed people give my wife & I the opportunity to transfer o Medicare and we'll leave our current pseudo-health insurance company in a heartbeat.
From a medical technologist viewpoint: Universal Health Care is the ONLY way to go. NOW.
It seems that the author is blaming the patients at the end of this article. Where does the assumption that all of these costs are accrued because Americans want to visit the doctor too often come from?
We have to pay every time, we have to miss work, pay for parking, do paperwork, wait hours and be treated like cattle, and the problem is that we like it so much we have become greedy?
Tomorrow I have to go to a yearly appointment to renew the prescription that I will need for the rest of my life. The test that is recommended yearly for people with my condition will probably be put off another year as not necessary yet. I get to pay real money in copays and premiums for what will probably be a yearly "nothing".
How is this my fault as a consumer because "we" use more doctor's appointments than some theoretical people in Europe? I can just die, as many Americans ultimately end up doing.
How about a consumption tax SPECIFICALLY mandated for health care and education? We could send people to school to be physicians, and then they could spend 2 years or so working in the system before setting up their own practices. Repeal the Bush tax cuts, raise the gas tax, raise the limit on the FICA tax. Sure, it`s a lot of taxes, but obviously the free market approach to health care is a miserable failure! The leader of the world, $8000 per person for care, and our infant mortality rates are the highest of the industrialized nations. We need more pro-active
What you describe as a consumption tax is why our sales tax in BC Canada is high 11% except on food, and yes much of it goes to healthcare. Because of this my monthly health insurance payment is about $39.00 per month. Booze & Cigs are highly taxed as is gasoline etc., etc.. To me this is worth it as I can decide to control or not control my consumption. America better move into the 21st century if you want to survive let alone maintain your standard of living. Having lived most of my life in the States , I can honestly say paying higher taxes is not the problem, it is what you get for your tax dollars. How are they used or misused. No question, things are more expensive here in Canada, yet my wife & I find our quality of life exceeds what we had in the States and we had a very good life there. A Canadian once said their impression was, " that in the States it was more about "ME" whereas in Canada it more about "WE". Though some Canadians I am sure would not agree, I find it to be true. We're getting hit by the fallout from the States, but it will not be as bad. Banks and financials are regulated more and though the Conservatives continue to attack the social safety net , there is still a greater social conscience, which is lackingin the US.
Unfortunatly I think we can't jump into the socialized medicine pool yet...
Don't get me wrong, I think the Canadian/E
The best option is the phase-out, which will be more tolerable to the medical complex and eventually get us where we want to go. Of course it is even better if they don't realize they are being phased out, then they won't fight at all.
Offer "Catastrophic Medicaid," to patients who have pre-existing conditions, are turned down for insurance, or are quoted prices above, say, $500 per month for insurance. I realize someone can just go bankrupt paying for medical care and qualify for medicaid that way, but that doesn't serve the public interest. Instead, catastrophic medicaid will allow people to enter the medicaid program in exchange for a percentage of their income, probably around 8% (look at the Canadian, British, and French costs and base it on that). The trick is that you don't raise the price cap on insurance costs, so every year more people qualify. Once the system is in place and working, it is easy to find more "exceptions," to allow more people into the catastrophic system.
Universal health care would not hurt the GDP as much as you think. Health Care is 17% of the GDP now and that is too much. It is hurting families and other businesses. Many have no money left after insurance. Many wages are too low for high health insurance and co pays.
Taking the insurance companies and their multimillion dollar salaried CEOs would help bring down the costs. So would bidding, which is out lawed now.
Basically though, it won't cost a lot of jobs because they will still need accountants and the health field.
That should read:
Taking the insurance companies' profits and their multimillion dollar salaried CEOs out of the picture would help bring down the costs
Most people want universal insurance. They are not going to fall for the Harry and Louise ads this time.
I had to cancel a medical procedure today--one that in the past cost me a $100 co-pay for an out-patient procedure--because, due to the fact that the doctor intends to do a biopsy, the procedure was coded as a surgery. So now my co-pay is $578. Whether or not this will stand remains to be seen, but in the meantime the procedure is cancelled.
You see comments by the terminally stupid making unfounded claims that a UHC system would result in horrendous waiting periods for procedures and surgeries; if you've dealt with our so-called heathcare professionals here in the US, you know for a fact that such waits are common due to the extreme inefficiencies of healthcare personnel and insurance companies.
The US healthcare system sucks on every imaginable level, and the only non-medical profession people who think otherwise are the blissfully ignorant folks who are fortunate enough to have avoided extended interaction with the medical community.
"blissfully ignorant folks" -
I agree with everything you say. I have similar experience. It is just that the elites in media and corporate America blue states are living in a bubble and just won't accept that the present system is steadily worsening. In all the talk about the financial troubles this country is facing in the immediate prospective future, there is no talk about doing something in the 2 trillion dollar medical industry, an industry where there is more that can be done than in any other sector with the exception, perhaps, of defence (1 trillion dollar industry) or white collar bureaucracies like the IRS which can be automated. The elites are caught in the headlights and they are going to be run over before they realize how incredibly inefficient the whole system has become.
Rolo - Sorry to hear about your situation. You are absolutely correct in your assesment of the US system. Having experienced it for 50 years and having moved to Canada 3 years ago, I can talk from experience. Though there are problems in Canada and we have have our "terminally stupid" who like to complain. My wife and I have found the system to be excellent. The other thing I never understood is why businesses never pushed for Univeral Health Insurance. What a monkey off their back, if they pushed for it, rather than oppose it. I figure AARP and the Chamber of Commerce have been and are being paid off by insurance and Big Pharma. It just doesn't make health or economic sense. I just had an ER experience (2 hrs in and out) and am scheduled for a CT scan day after tomorrow. It didn't cost anythiong out of pocket. Just the $48.00 CND ($39.00US) I pay a month for medical insurance. For those who will scream we pay high sales taxes, true, but it is well worth it in our humble opinion. We control what we buy.
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