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View Diary: Why healthcare costs so much in the U.S. (181 comments)

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  •  that is one of the problems (2+ / 0-)
    Recommended by:
    hmi, samddobermann

    I think we overuse elective healthcare when we think someone else is paying.

    Newt Gingrich: Believes marriage is between one man and a series of ever younger women. Wife #1 born ~ 1936, divorced when in her mid-40s...Wife #2 born ~1947, divorced when in her mid-40s...Wife #3 born ~1966.

    by trillian on Fri May 13, 2011 at 06:29:07 PM PDT

    [ Parent ]

    •  my doctor had been pushing me to get (3+ / 0-)
      Recommended by:
      mamamedusa, samddobermann, BYw

      this baseline evaluation and others when I turned 50.  I should have pushed back harder against her, and would have, if I had known it wasn't fully covered.

      "Politics is like driving. To go backward put it in R. To go forward put it in D."
      I support Bob Massie for MA-Sen

      by TrueBlueMajority on Fri May 13, 2011 at 06:36:30 PM PDT

      [ Parent ]

      •  colonoscopies (3+ / 0-)
        Recommended by:
        denise b, RJDixon74135, mamamedusa

        If your doctor didn't push you to get that colonoscopy and in the end you turned out to have colon CA, you could sue him and probably win millions. Clinical guidelines essentially mandate it at age 50- any Dr. who DIDN'T push you to get it would be grossly negligent and expose himself to liability.  Further, even if you chose not to have it, and the Dr. documented your refusal, and did everything right, and you subsequently had a bad outcome, you could STILL win millions, because the outcome of that trial is up to the jury.  Even if you got the colonoscopy and it showed cancer, and the doctor tried to contact you in any way possible, up to and including sending certified letters and asking the police to check on your whereabouts, you could sue him and STILL win millions, because the outcome of the trial is up to the jury.  See the problem?

        That being said, I totally agree that all medically indicated screening should have ZERO out of pocket cost for patients.  It's a win-win-win for Drs-pts-insurance companies because a colonoscopy is way cheaper than a colon resection and all the possible complications thereof. Not to mention the effects on the patient.  

        •  Are you sure about this? (3+ / 0-)
          Recommended by:
          mamamedusa, samddobermann, BYw
          Further, even if you chose not to have it, and the Dr. documented your refusal, and did everything right, and you subsequently had a bad outcome, you could STILL win millions, because the outcome of that trial is up to the jury.  Even if you got the colonoscopy and it showed cancer, and the doctor tried to contact you in any way possible, up to and including sending certified letters and asking the police to check on your whereabouts, you could sue him and STILL win millions, because the outcome of the trial is up to the jury

          I thought medical malpractice requires a physician to be negligent. Judges do instruct juries. Can you cite cases in which physicians performed well and still lost big amounts?

          Men never do evil so completely and cheerfully as when they do it from a religious conviction. -- Blaise Pascal

          by RJDixon74135 on Fri May 13, 2011 at 09:32:54 PM PDT

          [ Parent ]

          •  Here's what I found (4+ / 0-)
            Recommended by:
            Matt Z, mamamedusa, elfling, BYw

            at "Debunking the Top 5 Myths about Medical Malpractice" by US Action

            MYTH: Debate over malpractice compensation is just about frivolous lawsuits.
            FACT: The proposed limits on damages would apply to ALL CASES, no matter how serious the injury or how egregious the malpractice by the doctor, hospital, nursing home or drug manufacturer.

            MYTH: Medical malpractice claims are driving up the cost of health care for everyone.
            FACT: The Congressional Budget Office (CBO) reports that all costs related to medical malpractice account for less than 2% of total health care costs. (1)

            (1)Malpractice costs amounted to "less than 2 percent of overall health care spending. Thus, even a reduction of 25 percent to 30 percent in malpractice costs would lower health care costs by only about 0.4 percent to 0.5 percent, and the likely effect on health insurance premiums would be comparably small." [Congressional Budget Office, "Limiting Tort Liability for Medical Malpractice," 1/08/04]

            Men never do evil so completely and cheerfully as when they do it from a religious conviction. -- Blaise Pascal

            by RJDixon74135 on Fri May 13, 2011 at 09:44:17 PM PDT

            [ Parent ]

            •  And the corollary is that (1+ / 0-)
              Recommended by:
              BYw

              medical malpractice suits as currently practiced are more about a bad outcome than about the severity of the error.

              Better to have a system where people's care is 100% paid regardless of fault and then mistakes can be dealt with by disciplinary commissions of doctors than our current system, where someone with a bad outcome has to hope that someone can be found at fault to pay for the care they need but can't afford.

              Fry, don't be a hero! It's not covered by our health plan!

              by elfling on Sat May 14, 2011 at 10:31:44 AM PDT

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              •  You have fallen for the medical (0+ / 0-)

                propaganda.

                Why should a doctor (or hospital's etc) sloppy care be encouraged? That leads to more sloppy care.

                What if someone's life is ruined because of the mistakes? What if a whole family suffers and has high expenses for things not designated medical or health care?

                The tale of woe described above is short of a lot of pertinent detail but it sounds like at least one thing that went wrong was a massive horrible hospital acquired infection. Most hospital acquired infections are preventable. It is sloppiness within the health care system that allows those infections to kill and torment patients.

                I'm asking you to believe. Not in my ability to bring about real change in Washington ... I'm asking you to believe in yours. Barack Obama

                by samddobermann on Sat May 14, 2011 at 03:13:52 PM PDT

                [ Parent ]

                •  Lawsuits don't solve those problems (0+ / 0-)

                  Lawsuits are expensive and thus they're only pursued when damages are high. Many horrible errors are made that are never corrected, not by torts and not administratively. Many families have expenses that are high because of mistakes but not high enough to get an attorney - and it happens regardless of cause. That is, a minor or barely mistake can cause high expenses just as a major one can.

                  When you're in the throes of a medical crisis, the last thing you want to do is take on a lawsuit, anyway.

                  Single payer eliminates medical damages: the person gets the care she needs to recover regardless of fault or cause. This is a good thing. The person will be made as medically whole as possible, no questions asked, no need to find anyone at fault. Sometimes no one is.

                  If there are high non-medical expenses, lawsuits could still be an option.

                  Then, separately, medical boards at the local level can investigate the incident and take corrective action if need be. It might be that a doctor needs a reprimand or some remedial training. It might be that a procedure needs to be changed. It might be that someone needs to lose a license.

                  Under the current scenario, if you sue, any winnings you get are first claimed by your lawyer and then by your health insurance company. Very few people have damages high enough to exceed these two takes, and then they obviously still end up with less cash than their actual total damages.

                  Fry, don't be a hero! It's not covered by our health plan!

                  by elfling on Sun May 15, 2011 at 09:05:56 AM PDT

                  [ Parent ]

        •  And that age is too high (1+ / 0-)
          Recommended by:
          TrueBlueMajority

          Darrel Strawberry had full blown colon CA at 34. I had a precancerous polyp at 37. And i had been screened just two year earlier and was clear...but I pushed for another. Had i waited til 50...

        •  This is total bullshit Dr DZ (1+ / 0-)
          Recommended by:
          BYw

          And it may be that other doctors lied to you.

          Find me one case that fits what you described and I will check it out.

          The problem is with most screening tests for rare problems are so poor you have more FALSE NEGATIVES than you have cases found. And way more FALSE POSITIVES that scare the hell out of patients and their families.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... I'm asking you to believe in yours. Barack Obama

          by samddobermann on Sat May 14, 2011 at 01:36:33 PM PDT

          [ Parent ]

          •  re false negative/positive (0+ / 0-)

            the key part of your comment is rare problems. Prior probability is key. You don't look routinely for heart disease in kids because it is rare. You do look in overweight, sedentary smokers in their 60s because it isn't rare. The National Preventative Care Task Force that makes these recommendations takes prior probability into account. Actually they tend to get criticized more for recommending against screening because it isn't cost effective, but plenty of people know someone who wouldn't have been treated in a timely fashion without going against the screening recommendations.

      •  It would have been a mistake (4+ / 0-)

        not to have it, and it is mistake to structure health care costs in such a way as to discourage people from having them.

        We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

        by denise b on Fri May 13, 2011 at 08:22:56 PM PDT

        [ Parent ]

      •  The colonoscopy isn't a waste. (7+ / 0-)

        50 is the flex point where colon cancer rates start to increase substantially. The cost of everyone having a colonoscopy is trivial compared to the futile care given to 85 yr olds in ICU's.

        FYI- PhD in Pharmacy/Health Care Economics.

        WTF!?!?!?! When did I move to the Republic of Gilead?!

        by IARXPHD on Fri May 13, 2011 at 08:25:15 PM PDT

        [ Parent ]

        •  50 is the age under which (1+ / 0-)
          Recommended by:
          TrueBlueMajority

          insurance companies figure the rates of occurence are low enough that they can afford to refuse coverage for the people in their 30's and 40's ( and I know of a few personally ) who will get colon cancer each year.

          •  Usually with family hx (1+ / 0-)
            Recommended by:
            TrueBlueMajority

            your insurance will cover before 40.

            The thing is that there are points where the cost to avoid 1 occurrence of a condition are overwhelming, and take resources away from things like immunizations and cheap meds to treat hypertension.

            WTF!?!?!?! When did I move to the Republic of Gilead?!

            by IARXPHD on Sat May 14, 2011 at 05:34:27 PM PDT

            [ Parent ]

            •  Understood (0+ / 0-)

              But colon cancer is not that rare before 50. You don't see rare things everyday (  I had something rare, so I'm keenly aware of this ) but a colon CA in the 40's w/o family history, while not common, is hardly rare. And I know of several cases in the 30's, w/o family history. To me, rare means 1 or 2 per million. BUT, one in ten people will get some sort of rare condition, so actually getting a rare condition is not that rare; your getting a particular rare condition is remote, but your chance of getting any rare condition is not. And one in eight cancers is a rare one. Bottom line; more people need colonoscopies under 50, esp. if they see any bleeding; chances are it's hemorrhoids, but even so you might find ( as I did ) a nasty polyp hanging out biding its time. Same for prostate. I know several guys under 50 who, had they waited for 50 for a PSA, would have been in trouble.  That is why the doctor/patient decision needs to take precedence over the insurance company's wishes.

      •  Colonoscopies find colon cancer (2+ / 0-)
        Recommended by:
        TrueBlueMajority, BYw

        My  doc pushed me to have one and at 58 I finally agreed. They found colon cancer. Luckily, it was still early stage and very easily treated by surgery.
        A friend of mine's mother DIED of colon cancer. It is a major cause of death.
        Spend the money. Get a colonoscopy.
        Currently 27 states and the District of Columbia require insurance coverage of colorectal cancer screening.

        Conservation is green energy

        by peggy on Sat May 14, 2011 at 02:50:22 PM PDT

        [ Parent ]

    •  Is there any evidence (1+ / 0-)
      Recommended by:
      elfling

      that we use more healthcare than people in countries whose total costs are half of ours? Those countries that I'm aware of tend not to have high co-pays and deductibles from what I've seen. People visit the doctor when they feel they need to and do not have to worry about the cost.

      I don't claim to know, but my impression is that what you are suggesting is another myth.

      We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

      by denise b on Fri May 13, 2011 at 07:05:50 PM PDT

      [ Parent ]

      •  it's not overuse really (0+ / 0-)

        in certain areas there is abuse, but in my case, I had a medical situation that needed this procedure (wasn't just preventative). If I hadn't had that situation, my doctor would never have recommended it. Most people don't get preventative endoscopies until they are much older.

      •  I realize the plural of anecdote is not data (0+ / 0-)

        but just look at what true blue just said.  It is a very human response.  

        Newt Gingrich: Believes marriage is between one man and a series of ever younger women. Wife #1 born ~ 1936, divorced when in her mid-40s...Wife #2 born ~1947, divorced when in her mid-40s...Wife #3 born ~1966.

        by trillian on Fri May 13, 2011 at 07:19:32 PM PDT

        [ Parent ]

        •  Perhaps I wasn't clear (1+ / 0-)
          Recommended by:
          mamamedusa

          I wasn't questioning that high co-payments are effective in reducing the amount of services used. I was questioning whether patient overuse of services is a real factor in our high costs and whether using high out-of-pocket costs to discourage patients from getting services is a good idea.

          Re the French system:

          There are no deductibles. French National Health Insurance typically pays 70 percent of an office visit. A G.P. typically charges the patient 30 percent of the $35 fee, and a specialist will charge 30 percent of the $45 fee. But co-insurance is waived for all patients with serious chronic medical conditions such as asthma, diabetes, cancer, heart disease or any other medical condition requiring more than $100 per month in payments.

          I don't believe patients in France or anywhere else in Europe have to pay $500 out-of-pocket for recommended tests.

          Yes, of course a $500 bill will discourage people from having baseline colonoscopies. I also think this is one of our particularly American approaches to health care that does not serve us well.

          We decided to move the center farther to the right by starting the whole debate from a far-right position to begin with. - Former House Majority Leader Tom DeLay

          by denise b on Fri May 13, 2011 at 08:16:16 PM PDT

          [ Parent ]

      •  Actually (2+ / 0-)
        Recommended by:
        RJDixon74135, mamamedusa

        There is quite a bit of data suggesting overuse.  CT and MRIs scans especially.  We have way more machines per capita and get way more scans per capita than, for example, France which has better outcomes.  But it is my understanding France has a copay for everything the percentage of which decreases with the severity so folks with something like terminal cancer may have a copay of zero.

        Newt Gingrich: Believes marriage is between one man and a series of ever younger women. Wife #1 born ~ 1936, divorced when in her mid-40s...Wife #2 born ~1947, divorced when in her mid-40s...Wife #3 born ~1966.

        by trillian on Fri May 13, 2011 at 07:30:29 PM PDT

        [ Parent ]

        •  One reason we have so many machines per capita (5+ / 0-)

          is that they're very aggressively marketed to physicians and groups of physicians by their manufacturers as a way to get rich. In 2009, the New Yorker magazine published an outstanding article titled, "The Cost Conundrum" on this very phenomenon using what's happened in the small town of McAllen, Texas as an example.  The per patient average billing to Medicare for McAllen residents is about twice the national average, and only Miami, Florida is higher. Why? Because of the profusion of physician-owned "imaging centers." Everybody gets an MRI for just about every ailment.  Mayo Clinic, BTW, has one of the lowest per patient average billing rates. How and why? Again, it's all in this article. It's a fascinating investigative piece that will really open your eyes. I can't recommend it highly enough.

          Men never do evil so completely and cheerfully as when they do it from a religious conviction. -- Blaise Pascal

          by RJDixon74135 on Fri May 13, 2011 at 10:18:45 PM PDT

          [ Parent ]

        •  It's my understanding that in Japan (0+ / 0-)

          they get far more MRIs and go to the doctor more often - but that MRIs are very cheap (~$100) and doctor visits are also less expensive.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Sat May 14, 2011 at 10:34:26 AM PDT

          [ Parent ]

          •  That is because the government (0+ / 0-)

            sets prices and has forced the costs down.

            Americans, especially the doctors will never stand for that. Look at the need for the "doctor fix" where they tried to force costs down a percent or so each year. It was stopped each year.

            I'm asking you to believe. Not in my ability to bring about real change in Washington ... I'm asking you to believe in yours. Barack Obama

            by samddobermann on Sun May 15, 2011 at 05:15:21 PM PDT

            [ Parent ]

            •  possibly true that (0+ / 0-)

              Americans won't stand for that.

              Even though it makes as much sense as saying you won't get a tetanus vaccine because it was developed with government funds.

              Fry, don't be a hero! It's not covered by our health plan!

              by elfling on Sun May 15, 2011 at 05:30:49 PM PDT

              [ Parent ]

      •  We get a hell of a lot more tx and tests (0+ / 0-)

        all of it ordered by a doctor and much of it not only worthless but potentially damaging.

        Our healthcare system kills 30,000 Americans each year by totally ineffective and unnecessary treatment.

        That doesn't match the over 200,000 deaths each year by preventable medical error.

        It is estimated that 3% of all cancer is due to the radiation people get from all the scans and x-rays people get, all ordered by doctors.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... I'm asking you to believe in yours. Barack Obama

        by samddobermann on Sun May 15, 2011 at 05:10:10 PM PDT

        [ Parent ]

    •  A colonoscopy at 50 y/o is not 'elective' (3+ / 0-)
      Recommended by:
      TerryDarc, gneissgirl, mamamedusa

      It is medically indicated and can save your life.

    •  overuse? To screen for (0+ / 0-)

      one of the top killers in the US? One that has no symptoms until it is fairly moved along? Is this snark or ignorance?

    •  You got it, trillian. And look (0+ / 0-)

      who is doing the pushing. The doctor.

      Doctors order all medical care. If a doctor doesn't authorize it it does not happen.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... I'm asking you to believe in yours. Barack Obama

      by samddobermann on Sat May 14, 2011 at 01:29:25 PM PDT

      [ Parent ]

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