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William Lazonick

William Lazonick

Posted: September 23, 2010 08:41 AM

At one of the town hall meetings that preceded the passage of the Affordable Care Act (ACA), President Barack Obama read an exhortation from a woman enrolled in Medicare: "I don't want government-run health care. I don't want socialized medicine. And don't touch my Medicare.'" This woman should perhaps now count herself fortunate that the ACA is law. She will be eligible for preventive health care with no out-of-pocket expenses as part of an ACA program that will save tens of thousands of lives per year and generate huge health care savings.

Long before the passage of the law, the government was highly involved in the US health care system. In 2008 public expenditure on health care was $3,507 for every man, woman and child in the U.S., and private expenditure was $4,031. The United States spends far more on health care than any other country, but the main discrepancy is in private spending, not public spending. Compared with France for example, in 2008 US public expenditures per capita were 22 percent higher, but private expenditures per capita were 391 percent higher. Yet, in contrast to France and other European nations which provide universal medical coverage, about 47 million Americans - some 16 percent of the US population - were uninsured in 2008.

The United States clearly has a problem of out-of-control health care costs. The problem resides, however, in the business component of costs, not in the government component. What Americans should be worrying about is how to regulate the businesses that get rich when we get sick.

The ACA takes steps to limit the boundless profiteering that has become customary in the U.S. health care system. By tackling key sources of waste, fraud and abuse, the law starts us on a road to cost containment. Here are some examples:

Overcharging for health insurance. The leading health insurers in the United States deliver low-quality, high-cost coverage. The biggest among them use virtually all of their enormous profits to do enormous stock repurchases. That means that a significant percentage of an insurance premium goes simply to boost the insurer's stock price, which in turn jacks up executive pay. During the past decade four of the biggest insurers -- UnitedHealth Group, WellPoint, Aetna, and Cigna -- did combined stock buybacks of $62.9 billion, more than their combined net income.

States have two new tools to prevent health plans from gouging consumers. First, 46 states have received grants from the US Department of Health and Human Services to investigate premium rate increases. This funding will give states the resources to review the complicated actuarial explanations filed by insurance companies and to judge whether premium increases are justified. In addition, plans will now be required to devote a minimum percentage of their premium revenue to medical care instead of administration, executive salaries, profits, lobbying and administrative waste. Plans will owe their customers rebates if they fail to spend at least 80 percent (individual and small group) or 85 percent (large group) of premium dollars on medical expenses.

Over-investment in expensive equipment.
The U.S. has about 26 magnetic resonance imaging (MRI) units per million population, more than double the average of 11 units in all economically advanced nations. Japan has 43 units per million population, but under the country's single-payer insurance system, the cost of a scanning session in Japan is about one-tenth the typical charge in the United States. The ACA addresses this problem by adding a new sales tax on the purchase of expensive equipment and changing the formula that Medicare uses to pay for imaging services in order to avoid overpayment. In addition, there are new disclosure requirements so patients will know if their doctor is rewarded financially for prescribing a particular imaging test.

Overcharging for prescription drugs. The prices that Americans pay for drugs are about double the prices in other advanced countries. Since the 1980s, major pharmaceutical companies have successfully argued in Congress against the regulation of drug prices, claiming that high profits are needed to fund research and development. Yet a large portion of the profits of these companies is devoted to repurchasing their stock. For the decade 2000-2009, Pfizer bought back $50.6 billion, equivalent to 65 percent of its profits and 66 percent of its research spending, and Amgen repurchased $25.8 billion, about equal to its net income and R&D.

While we await regulation to confront this troubling inconsistency, the ACA takes steps to reduce the cost of drugs. Already this year more than one million Medicare beneficiaries have received $250 checks to help offset drug costs after falling into the prescription drug donut hole, and starting next year, seniors will get a 50 percent discount on brand name drugs when they enter the donut hole. The ACA also expands access to a prescription drug discount program for children's hospitals and other community providers.

At the root of the high cost of health care in the United States is a highly financialized business system. The ACA is an important step toward significant health reform. Until we control the behavior of business corporations in the health care sector, as parts of the law begin to do, Americans will continue to grapple with extraordinarily high health care costs.

 
 
 
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Damiano Iocovozzi MSN NP
Director, CEO, the Thomas Edwin Walls Foundation
02:37 PM on 09/26/2010
A wonderfully written and insightful article! The US is highly corporatized and still profits highly from the waste, fraud and abuse of people with less than six months of life. In fact, this accounts for 1.2 trillion USD wasted on medical futility for those past all cures, all remissions and reprieves from dementia or advanced age. The ICU settings are largely warehouses of the dying at $10,000 per day for room and nursing care. The myriad of consultants visiting the dying patient order all sorts of useless consults, wasteful treatments and medicines, diagnostics, disposibles and surgeries, making insane profits on natural human decline with no medical goal in mind. The best alternative is in-home hospice care at $100-450 per day until natural death where the quality of one's life is maximized: control, time to enjoy friends and family with the energy to do just that. The ICU scenario is a fool's errand that robs patients of control, dignity and even their good days and enriches just the great American Medical Business Machine which brings dishonor to the professions of medicine and nursing for no honest medical goals may be achieved, making billion off the dying is not a noble goal. Visit my web page at soonerorlaterbook.com for lots of free information and podcasts. Damiano de Sano Iocovozzi MSN FNP CNS at the Thomas Edwin Walls Foundation
03:31 PM on 09/24/2010
The cost of medical care in the US is high because of government intervention in the marketplace. Period. As a physician who actually works in the system; this is undeniable.

Examples: Government sponsored monopolies which include licensing of professionals, certificates of need to build facilities, preventing insurance from being sold across state lines, allowing lawyers to sue for any frivolous idea which pops in their head, etc. (I was once sued by an elderly gentleman with a post-op numb finger and part of his complaint was his sex life had been disrupted. Never mind the two hip replacements and two knee replacements. Sex just cannot be accomplished now that I have a numb finger.)

To summarize, those who feel that medical care is too expensive believe that Obamacare will make it cheaper despite insuring 47 million new americans and creating 157 new regulatory bureaucracies on top of the medical care previously provided.

People want lower costs and better quality. Obamacare accomplishes neither which is why the more people learn about the obama plan, the more they will hate it. Obama keeps complaining he is a poor communicator on health care. It is obvious he is a great communicator, and people understand his medical care takeover exactly, and this is why people are opposed.
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Jean Clelland-Morin
religion / the Golden Rule
07:03 AM on 09/25/2010
"Obamacare" (a dirty word like "liberal") is not what I want either. It was watered down by the Great-Obstructionist-Party and lack of Campaign Reform. I'm just a lowly, retired Medical Technologist who worked on the California's Proposition 186 in my relative youth. We can't go back. We need to build on what we got and quit listening to Special Interest propaganda and expert-doctors.// Jean Clelland-Morin
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tlcpro
Work is not work when you love what you do.
08:18 AM on 09/24/2010
We pay high prices on drugs so that the drug companies can pay to advertise them on television. I remember a day when medications were not advertised on TV, and no one was ever told what to tell their doctor. Don't doctors go to medical school to learn to treat illness? Why then should we march off to the clinic and tell our doctor that we need to try XYZ drug because we saw it on television? Crazy. I pay the doctor to tell me what's wrong, I don't pay the doctor so that I can go in and tell him what I need. Ban drug advertising on television. Decrease the national hypochondria.
05:54 AM on 09/24/2010
Government should involve itself in as little as possible, that way, what it is involved in, can operate as effectively as possible. I feel that keeping it's citizens healthy and productive one of the few. We think not a bit about our government guarding each and every one of us against a common enemy, why is it so hard to imagine it defending us all against disease?
We hear all the time how our businesses need tax relief and deregulation to help them be competitive on a global scale. Wouldn't relieving them of the burden of providing/administrating health care coverage make them more competitive w/companies from countries w/national health insurance?
Why can't we afford 10 trillion over a decade for health care, but we can spend damn near a trillion a year on the Pentagon, and that doesn't include the added expense of the war we wage to put all that defense spending to use, then, add to that subsidies for foods that end up making us sicker than we might be otherwise. Medicare for all begins to pale in comparison.
Insurance companies are just big financial institutions like our OH HOLY investment banks. Sometimes they are one and the same. Now do you see why we can't do anything that might affect their business? Check out where the people who represent you get their campaign cash and what stocks they hold, then ask yourself why this 1/5th of the US economy is defended so vigorously.
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BBackSoon
Hello, I must be going.
12:53 PM on 09/24/2010
That is the beauty of the argument, we need to be more competitive with the rest of the world, but we don't want Socialized medicine, that the rest of the world enjoys.
05:15 AM on 09/24/2010
From my experience, let me add a couple more reasons for higher costs, first and formost, the percieved bottomless pockets of an insurance company. Many a time have I been charged at a higher rate w/insurance than w/out. In 1982 the first of my two children was born. Friends of mine had their second, in the same year, the same hospital, w/the same physician. Ours bill, w/BCBS, a little over $2000. (82 mind you) Theirs $1200. I know, the story is freeloaders w/o insurance are the reason for the higher charges. Is it? Or is the rate w/o insurance more reflective of what a free market for medical care might look like. Of course, the punch line for this tale, is he the way this company set up it's policy periods at this time. They were 6 months long. Every new policy period started a new $500 deductable. Timing being everything, this 9mo term spanned 3 policy periods, and the newborn was immediately deemed a new entity, subject to another new deductable. So even though I had insurance, I ended up paying nearly 80% of the costs.
Another is the thought process of "using up the deductable", so some go to a provider more often that might be necessary.
Now we have mandated insurance - THAT otta drive down costs. :0
12:07 PM on 09/24/2010
Well, when you look at a simple, relatively inexpensive operation like child birth, or a doctor checkup, etc, you can tout the advantages of paying all of it out of pocket and not paying insurance. However, when you look at $100,000 treatments for cancer, or thousand dollar MRI scans, or any type of serious health problem that you couldn't feasibly pay out of pocket, and in fact which drives a huge percentage of bankruptcies in America, you see the advantages of health insurance.
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BBackSoon
Hello, I must be going.
01:00 PM on 09/24/2010
But nowdays the Insurance Companies tell the Hospital/Doctors Office how much they will pay for each procedure. And they do not get paid for just Talking. This is why we do all the tests nowdays, This is why you leave with a script or two. Doctors are paid for doing something that generates income.

Check out this great report on Bill Moyers Journal. It is a documentary that I believe he played almost in it's entirety called Money Driven Medicine.

http://www.pbs.org/moyers/journal/08282009/watch.html

The most damning thing that was said was that if there was an Official Bird of the Health Care industry it would be the Crane because every Hospital is expanding so they can service more patients, More Patients + More Procedures = More Profits!
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Jean Clelland-Morin
religion / the Golden Rule
03:43 AM on 09/24/2010
In a country infected with the Brainwashing of the better-dead-than-red era, BigBiz (insurance companies, for example) have been successful in tapping into the "socialized medicine" fear. We are pitted against one another and exploited by Business propaganda. // Jean Clelland-Morin
12:08 AM on 09/24/2010
One large expense in the health care system is the "Fee for Service" billing by MDs, DDS and othe professionals. A $10,000 fee for a 75 minute procedure is a huge incentive for the MD to do the operation because of the fee earned. Many procedures are done solely for the fee, because in too many cases the insurance companies will pay it, not the patient. The insurance companies in turn will just increase premiums to cover the fees charged. A detailed examination of any hospital bill also suggests that a large number of the charges are outlandish. Another example is the ambulance services: I found that instead of wheeling a gurney 75 steps to an MRI building, and ambulance was used for the round trip at a total cost of $3450. It was considered a justified normal charge. - There is little question that the desire of a large fraction of the specialists is that they retire early as multi-millionaires.
Any wonder that health care costs havebeen rising at a faster [pace than inflation for decades?!
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bosse
09:00 AM on 09/24/2010
SO TRUE gunther. And the govt and Reps. see the poor getting rich and welfare mothers the cause for increased cost, and national Insurance a communist plot. We have so many just employed to find fraud and so many rules for doctors to charge and not get caught, they have to employ five clerks to fill out the forms correctly or send them again.
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jstrate
11:30 PM on 09/23/2010
There's a lot of things driving costs higher. The author has identified some of them. I'm not an expert in this area but it would seem that it's mainly medical facilities and doctors who drive the demand for health care services. I'm told by a radio ad that if I don't see a Beaumont doctor I might die. Doctors often do not know or do not care what the procedures they order for their patients cost. It's not their job to know. It's fee for service, and somebody is going to pay the tab. There's some defensive medicine. There are a lot of medicine that would not pass the benefit/cost test, such as a lot of heart surgery. Surgeons will cut. Medicine also can do a lot more. Watching TV, you would think that erectile disfunction is the worst health care problem in the country. Does the military spend more on Viagra and Levitra than tanks? Then we spend a lot of money to keep older persons who are dying alive longer than even they would like, despite the growth in Hospice. Long ago, they stopped taking fluids and died peacefully, probably at home. Too much high technology was another factor the author discussed. Yes, there's more. Psychiatric hospitals discharge patients too early, and without follow up care many stop their meds and wind up back in the hospital again. No one theory and no one cause is going to explain rising costs.
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bosse
09:06 AM on 09/24/2010
So true again.jssrtae: Malpractice costs and lawyers are often blamed by some as the biggest culprits. How untrue.Like we would like to check the cost for a toilet seat at the pentagon and the cost of safaris for the Congress,can we look into the necessities of most MRI s and operations and scare tactics of some surgeons? Advertisement was prohibited and still is in most civil societies. But along with the Hippocratic Oath,went those items from the Medical scholools and AMA
11:18 PM on 09/23/2010
Points two and three are utterly bogus given the fact that they both rest on gov't intervention not business. To claim that we are over invested compared to other countries is ridiculous. Greater investment leads to greater access which is what we have over these other "advanced" nations. Prescription drugs cost more largely due to gov't intervention as well thanks to the FDA and limits on generics which are imposed by gov't not business.
08:15 PM on 09/23/2010
High health care costs come from people who are not healthy. Those people are prey and profit for Pharma, whose goal is have people on multiple pills as early as possible. Those physicians who prescribe those pills are convinced that people need pills, not safe food or vitamins, or exercise. We are producing generations of children born with toxic chemicals, injected with mercury, forced to drink fluoridated water, fed with petrochemical food. This country is breaking itself and our poor health is the symptom of that problem. Industries just make money on our illnesses.
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09:43 PM on 09/23/2010
An interesting statement from Michael Pollan on your same thread, we can spend our money on decent food or on medical treatment for eating cheap food.
There are still some great doctors but yes, the pharmas are feeding most that the answer to every ill is pills. It's actually strange to bump into the salesmen in the waiting rooms.
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bosse
09:13 AM on 09/24/2010
mikies: I buy my expensive medicines from other countries( not Mexico) at costs 10 to 20 of that I pay her. Example a bottle of Xalatan for which I was charged 106 here 20, where I bought. Note if you have to pay doctors charge less, but Pharmacies charge more. They know most expensive medicine( like bifocal eye glasses) are not covered by most insurance and Medicare
Some doctors are honest and talk about good food etc and provide pamphlets, and info from American Medical and Cancer societies! Not many follow. But many also take millions of dollars worth supplements and vitamins, that are indiscriminately sold and advertised. This should stop! Women in those shops pretend to be pharmacists and give advice! It is illegal to practice medicine even for well educated nurses and pharmacists.
07:47 PM on 09/23/2010
I used to manage a large multi-specialty clinic where we sincerely tried to find ways to provide quality affordable care. We realized that the single largest change we need to make to reduce health care costs for the patient and the practice is to rearrange the financial relationships that drive the costs and reimbursements for care. Instead of a closed market between insurance companies and physicians, where all costs are actually determined, we need to return to an open market where the financial relationship is between the patient and the physician. We were able to offer substantial discounts to cash pay patients and still cover our costs because we were able to finally determine what the market could bear.
09:07 PM on 09/23/2010
juster3d. Yours is the best I read regarding this article. The reason for high costs is not evil business. As a businessman I was anxious to give my employees the best care I could afford. If you would like to see a validation of your comments go to the North Dakota web page and see the comments on the two health care insurance companies covering that state. Much of the state still operates pay as you go. The other great problem with health care is that everyone believes because it exists, it should be used.
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bosse
09:20 AM on 09/24/2010
Mark I wrote about abuse of company provided health care, for eg: mosquito bite, stubbed toe
and mild head aches, spending hours in the ER, where they have to make $$ and order X rays and lab. Two services the hospital make most money in. Some one said," I pay for my insurance and I will use it" This kind of ignorance is pervasive. This great nation was built by hard working men and women who often lived to be ninety without doctors and medicines!
They did exercise and ate home made items.
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biggerjake
Religion poisons everything...
07:38 AM on 09/24/2010
The system of managed capitalism works well enough in many areas but (as Paul Krugman says) health care is not one of them, and a big reason is the one you have mentioned here. There is no good way to truly institute competition. Without competition there is no incentive to reduce prices so there is no effective downward pressure on prices.

In addition, as several people have mentioned, pharmaceutical companies, health insurance companies, etc. are all businesses trying to maximize profits. They must please their Wall Street handlers so every quarter must be better than the last.

The ultimate (and only real) solution is to get rid of private insurance and institute a single payer, non-political system. That we could have real experts making decisions and a system with enormous clout over purchasing and pricing.
07:44 PM on 09/23/2010
industries, government included have had hamster like management from as early as we have been able to record by learning how to write. Sumeria, (today's Iraq) about 4 K before time. Laws of Hammurabi included the first type of insurance provided by law. A great king had his second in command executed for theft from the people. The chain of command in all industries is riddled with people who suggest rules to management to increase profits to gain advance in their position with increase of pay. This usually is only reduced by competition. Monopolies are the death, and the watchdogs against this are often bribed by the outfits offering jobs to relatives or after they retire. Now with Wikipedia much of the history gets to be seen by those who know how to look for it.
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rdrioane
07:39 PM on 09/23/2010
Government regulation has caused the out of control price increase of Americas health care. No one shops for health care anymore becuse government has decided to make insurance companies cover everything. The great excepion to that is lasic surgery. Almost no insurer covers it so people shop for it. The result is the cost of the surgery is going down. Oh, and on the wonderful new healt bill and medicare. The bill takes $500 billion from Medicare. That should help it a lot.
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johnminehan
06:22 PM on 09/23/2010
Let's be honest; people who are on Medicare are stuck with it. Destabilizaing it for PPACA does them a disservice while helping no one else.
05:14 PM on 09/23/2010
The key question (unanswered by the author, but I am sure we can all figure out what he wants), is how do we "control the behavior of business corporations in the health care sector"? We can have the government put more and more rules and regulations on how and what they can and cannot do, we can have the government take over all the health care institutions, we can change the way government subsidizes current behavior.

Remove the tax deductibility of health benefits from corporations, separate insurance (protection against accidents and disease) from basic care and allow cross state competition of insurance companies and the consumer would "control the behavior" very well, thank you.
05:43 PM on 09/23/2010
The free market has failed to solve the problems of lack of access to care and increasing costs of care. The free market will not solve all the problems we face. Corporations care only for profits even if people suffer and die. The profit motive is the sole goal of corporate america- even though each and every person has different goals. Society has different goals. More free market profit driven goals will likely result in- more suffering and death while corporations amass profits.
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johnminehan
07:26 PM on 09/23/2010
As medicine is perhaps the most regulated of industries, saying the free market has failed is w/o any credibility.
06:27 PM on 09/23/2010
The Government could build an alternative health care system that would compete with corporate health care. It would be the reverse of what happened to the Post Office. Years ago, the mail service was in the toilet. UPS and Fedex went into competition. Now we have excellent delivery from both, because neither wants to go out of business.

A public option could create a "no frills" health care system that rich people wouldn't go near. We tried this, but the insurance industry didn't want any competition. So they managed to kill it not onlly with lobby money but with PR ads falsifying the reality, and calling it "socialized" medecine... what insurance is in the first place - a society where everyone chips into a pot to cover the medical expenses of anyone who gets sick. However, the health care brokers, who call themselves "providers" but don't actually provide anything, take so much out of the pot that the system cannot work (multimillion dollar salaries, skyscrapers, private jets, executive golden parachutes, offshore resort properties disguised as investiments, conventions... you name it). But sadly enough, most Americans respond to meaningless buzz words and catch phrases rather than reality. Until Americans wake up to the BS, we will continue to be bled dry.
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johnminehan
07:29 PM on 09/23/2010
You would almost certainly be better served by allowing no-frills, high deductable plans to be sold in all 50 states than to do what you suggest.
08:23 AM on 09/24/2010
The reality is that US post office is still financially in the toilet, Washington subsidizes them to keep them in biz. artificially creating what you call competition. Wake up and smell the coffee--The Gov. has not efficiently run anything better than the private sector.

Insurance is not "everyone chipping in" for the good of everyone,that is what is called communism - Insurance is a paid for transfer of Risk by a company to a person -for a profit.

Two things that are left out when speaking to the "left" on Healthcare.
1. Tort reform- getting rid of the "Business" of suing medical providers for frivolous issues. ( This is why every test is run and the cost goes up i.e CYA expense ) Out of court settlements which are under the radar- are HUGH.
2. Eliminate the cross state policy barriers