And it is not as though we are getting much more for our money. Despite significantly higher healthcare spending, America’s health outcomes are not any better than those in other developed countries. The United States actually performs worse in some common health metrics like life expectancy, infant mortality, and unmanaged diabetes. We are overtested, overdiagnosed, overtreated and overcharged but no healthier.
The fundamentals of the US healthcare system are broken. The culprits include insurance companies, government, hospitals, pharmaceutical companies, the occasional rogue doctor and us, the healthcare consumer. The result is out of control costs with no improvement in health outcomes.
As just one example, a heart bypass operation costs about $15,000 in France. In the US, with no measurable difference in quality of care or outcomes, the same procedure ranges from $40,000 to $500,000. That's right. The same procedure, with the same outcome, costs at least 160% more in the US than in France and may cost as much as 3,200% more.
Then there is the way hospitals bill for their services. Generally they have a "sticker price" that is grossly inflated. Why? Because hospitals negotiate prices with insurance companies that provide them with steep discounts and they have to make it up somewhere. Good luck finding out anything about this. The hospital and insurer generally agree to keep their discount rates secret. Your own insurer will not disclose it to you, let alone the hospital. Meanwhile, if you don't have insurance or are forced to go "out of network" for care, you pay the full sticker price, which may be marked up as much as 500%.
Even if you do have insurance, you may still be blindsided by a large "surprise bill". This happens to about 60% of insured American who receive hospital care. A surprise bill includes sticker price charges for lab work, "facility charges", and fees for doctors you never see but who consult on your case and who may be "out of network" to you.
And then there are pharmaceutical companies. If you remember back just a few months to when Bernie Sanders was running for the Democratic Presidential nomination, he made a big issue over the cost of insulin - a vital drug for many diabetics. Many people do not know that when insulin was developed the researchers sold the patent for just $1 because they felt it would be unethical to profit from a lifesaving drug. Pharmaceutical companies had no such reservations. A 10ml vial of insulin in the US costs roughly $300. The cost in Canada for the exact same amount of the exact same drug? $30. That's right, 1/10th of the US price. One out of 4 patients in the US reports that they ration their insulin, taking less than they really need, because of the cost. Why? Just because.
Do we really need all the "care" that we get? Johns Hopkins University School of Medicine has estimated that as much as 20% of all medical services provided in the US are medically unnecessary. This includes unneeded diagnostic tests, surgeries and medication. Why? Three reasons.
First, doctors often order extra tests or procedures "just in case", to protect themselves from malpractice lawsuits.
Second, some less than ethical doctors order tests or perform procedures that insurers will pay for to make up for artificially low reimbursement rates on the services that are actually needed.
And finally, there is us, the patients. We often demand medication based on that most reliable of all sources of medical information - drug company television ads. Or demand procedures that we do not need.
The key to changing the status quo in our healthcare system is transparency.
Imagine this if you will. You are booking a flight on an airline but they will not tell you exactly where you are going or when you will get there, and you will find out what it costs at the end of your trip, when you can be charged whatever the airline feels like charging you. Sounds crazy right? And yet that is exactly how our healthcare system works today.
As we continue to debate how to provide affordable healthcare services to all Americans, it is important that we not lose track of the fact that the system itself is broken. It is not just a matter of providing insurance to more people. That just pours more money down the bottomless hole. Prices need to be transparent. We need to know what things are going to cost before we accept services, and we need to be able to compare prices among providers. We need to become educated consumers.
Here are some things you can do right now.
1. Demand upfront pricing for your medical care. And get it in writing.
2. Know what things cost. Here are some resources you can use to research costs:
3. Don't be hesitant to negotiate. In our healthcare system everything is negotiable. Check out RestoringMedicine.org for guidance.
4. Read before you sign. Hospital admission paperwork is mindnumbingly complex small print. Consent forms often include language obligating you to pay them 100% of whatever they charge. Cross it out.
No one is going to protect you from a predatory healthcare system. Fixing what is really broken is not even part of the discussion. So until it is, you are on your own.
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