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Why Are Medical Costs So High In The U.S.A.?

Updated on August 9, 2013
Source

Medical costs are soaring every year, but the focus of the discussion seems to be on covering these medical costs rather than bringing them down. In the meantime, Americans spend more on healthcare than any other advanced county. The Washington Post reported that in 2009 Americans spent $7,960 per person next to Canada at $4,808, Germany at $4,218 and France at $3,978. The U.S. spends 20% of the gross domestic product on health care while other countries only spend half that amount. Despite these higher medical costs, we do not have better outcomes than these peer countries. Studies show that we don't go to the doctor more often, and we don't get sick more often - so why are we paying so much more for our healthcare? Put simply, the major cause of high medical costs is that we pay doctors, hospitals and pharmaceutical companies significantly more than most other countries do.

Higher Hospital Costs

Steve Brill's expose in Time Magazine examined eight hospital bills line by line. What he found was shocking. The prices that hospitals charge for services and products are inconsistent and exorbitant. These prices are set by an internal price list called a "chargemaster". The chargemaster prices are completely arbitrary and don't have any relationship to what the article really costs. For example, at one hospital the charge for a single accu-check diabetes test strip was $18.00. You can buy a box of these same test strips on Amazon for $27 (55 cents a piece). If you don't have any health insurance, then you have to pay the hugely inflated price. If you have insurance, then you'll pay less. Insurance companies negotiate the price with hospitals, and the rate that the chargemaster has set will be reduced by varying rates, perhaps reducing the cost by as much as 75%. However, even at a 75% reduction, the rate will still be much higher than it should be. (The test strip would cost $4.50, still a huge mark-up). The chargemaster rates affect what the hospital charges for medical equipment, drugs, diagnostic tests - anything that the hospital uses for your health care, and there is a huge mark up on all of these items. You would think that there would be legislation to prevent this gouging of the public, but our congress is heavily influenced by lobbyists. The American Hospital Association spent a whopping $1,859,041 on lobbyists in 2012.

See Steve Brill's video on Why Health Care Costs So Much

Source

Higher Physician Fees

A study by Miriam J. Laugensen and Sherry A. Glied reported that among primary care doctors, those in the United States had the highest annual pretax earnings after expenses — an average of $186,582 in 2008 — while those in Australia and France had the lowest earnings, $92,844 and $95,585. Specialty doctors had an even larger gap, with an average of $442,450 next to Britain at $324,138, with all other countries coming in at less than $210,000. They concluded that these high costs were strictly due to higher fees, not to higher practice costs, higher volume of services or tuition expenses.

Source

Higher Pharmaceutical Pricing

The Organization for Economic Cooperation and Development (OECD) reported that in 2007 U.S. pharmaceutical prices were at least 60% higher than those in five large European Countries. Pharmaceutical manufacturers state that costs are so high because of the high cost of developing new drugs. That argument may not really hold up. since data shows that pharmaceuticals spend as much on advertising as they do on development. Keep in mind also that many of these new drugs may not be especially innovative. A good percentage are “me-too” drugs, where a new drug simply imitates an already existing lucrative drug. The pharmaceutical industry is the most profitable in the world, and has thousands of lobbyists in Washington to protect their interests. They certainly seem to be doing a great job in making the United States consumer pay exorbitantly high drug costs.

Source

Higher Administrative Costs

In “The Paper Work of Medicine: Understanding International Medical Costs”, it's reported that for every office-based physician in the United States, there are 2.2 administrative personnel, more than the number of nurses, clinical assistants, and technical staff put together. Duke University Hospital has 900 hospital beds and 1,300 billing clerks.

The United States has 25 percent more healthcare administrators than the United Kingdom, 165 percent more than the Netherlands, and 215 percent more than Germany . What are they doing? There is much time spent on credentialing (receiving permission to practice in a particular hospital, or participate in a particular health care plan). Verifying insurance information, billing and payment collection take up a large percentage of time.

Overuse Of Diagnostic Tests

The overuse of diagnostic tests has been estimated to cost as much as $250 billion a year – about 10% of the total cost of health care in the country. Many feel that this could be an effect of physicians practicing defensive medicine because of the threat of malpractice suits. The New England Journal of Medicine reported that “among physicians in low-risk specialties, 36% were projected to face their first claim by the age of 45 years, as compared with 88% of - physicians in high-risk specialties. By the age of 65 years, 75% of physicians in low-risk specialties and 99% of those in high-risk specialties were projected to face a claim”. Although there's been no proven correlation between malpractice suits and defensive medicine, it's logical to assume that there is one.

Solutions?

We need to find solutions to these problems, and quickly. It is projected by CMS that national healthcare costs will grow to $13,708 a year per person by 2020. Some possible solutions that I've seen offered include restricting the mark-up that hospitals can tack onto products and services, encouraging the use of primary physicians over specialists, allowing drugs to be imported from other countries, adopting uniform billing and payment procedures, and reforming the tort system to prevent frivolous law suits. The Affordable Care Act has provisions in it to encourage wellness, such as the annual Wellness Visit, smoking cessation programs, and discounted premiums for participants in wellness programs. It has provisions for streamlining administrative costs through the use of electronic record keeping. The ACA also introduces a new 15 member Independent Medicare Payment Advisory Board. Their task is to study ways to contain Medicare costs and offer solutions that reduce the growth rate of medicare costs while maintaining or enhancing beneficiary access to quality care. Contrary to many critics of this board, they are not allowed to offer solutions that ration health care, restrict benefits, raise beneficiary cost sharing or raise premiums. Hopefully they will come up with solutions that will not only contain Medicare costs, but will also serve as a model for the entire health care industry to bring costs down to a reasonable rate.

© 2012 Margaret Perrottet

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    • profile image

      Larry Wall 5 years ago

      Good explanation:

      Now explain to me why athletes who did not finish college are making millions of year for playing a game, not counting the money they make from endorsements.

      You said the average doctor make $186,000. That is a lot of money. Lawyers in Washington D.C. charge $650 per hour. Many lobbyists make between $250,000 and $400,000.

      You said the annual income was after expenses--did that include the cost of paying off their student loans?

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      @Larry Wall - I believe that was after all expenses, including student loans.

    • pagesvoice profile image

      Dennis L. Page 5 years ago from New York/Pennsylvania border

      Voted up and interesting. You have prepared a disturbing look into the skyrocketing costs of healthcare. My wife and I pay over $7,000.00 per year for our health insurance and that is with a 20% copay. Personally, I do not blame the doctors for healthcare increases. Physicians in the U.S. must graduate from a 4 year college, then 4 years of medical school and finally they must complete a 3 to 6 year residency program and all of this before they get to actually ply their trade. Then they need malpractice insurance, overhead operating expenses, etc. "No" I don't point the finger of blame on the physicians...rather I look to the pharmaceuticals, insurance companies and the extremely high price of medical testing equipment. I honestly do not know what the answer is in how to rein in the astronomical costs of medical care.

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      Thanks for reading and commenting, pagesvoice. I personally think that the pharmaceuticals would be the first place to start since they are making such huge profits and have way too much pull through their lobbyists in Washington.

    • profile image

      Larry Wall 5 years ago

      I will not disagree about pharmaceuticals completely. I wish they were not allowed to advertise on television, as it use to be. Too many people go to doctors demanding a drug that they do not need. Doctors give it to them because insurance pays it.

      Name brand drugs are more expensive because the patent on the drug is basically unused for several years while all the clinical and FDA-mandated testing in underway. The drug is not marketed during this time thus there is no income from it. Therefore, the drug company has to reclaim its investment and make a profit, in a shorter amount of time.

      If you are lucky enough to belong to a group program that uses a PPO, you probably only pay $10 or $20 for a prescription and get a bigger discount if you order a three month supply. The insurance company negotiates a lower price with the pharmacy and the drug makers to make this possible. Thus, those without insurance pay a higher price.

      Pagevoice mentioned that his combined premium for he and his wife is $7,000. I was paying $7,200 a year for a second rate medical indemnity program with limited drug coverage. I now only pay $3,600 for a second rate medical indemnity program, with better drug coverage, but not great. The prescription strength of one med I take was going to cost $80 with insurance. I can buy the generic strength (half of the prescription strength) and get a month's supply by taking two pills a day instead of one for $35.

      There is definitely some problems that need to be resolve.

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      My husband and I are on Medicare, and have a part D prescription plan My husband is diabetic, and also has some heart issues. Our out of pocket costs for his drugs so far this year has exceeded the donut hole and our insurance won't pay any more for the rest of the year. We've paid $1,187 put our pocket so far for his drugs this year, and will pay at least a$400.00 a month for the next six months. This plus our medigap and part D premiums ($406 a month) take a huge part of our retirement income. Something is just not right here.

    • profile image

      Larry Wall 5 years ago

      Please tell me where I am wrong. I thought once you got past the donut hole Medicare or the Supplement picked up 100 percent of the prescription cost. I am not on Medicare yet. My son is and three or four prescriptions that were pretty expensive--two are now generic. I just want to know if I am missing some. I have a Plan J medicgap policy for him and he as a separate prescription plan to supplement Medicare. He has parts AB and D

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      Once you reach the donut hole you are on your own until you reach the catastrophic level, which is over $4,700 in out of pocket costs. In the catastrophic phase, you get get greatly reduced rates - in our plan the copay is only about $6.50 for non-generics, or 5% - which ever is less . Since we have only paid $1,187 so far this year, we will probably not make it to the catastrophic level, and so will be in the donut hole and on our own for the rest of the year.

    • profile image

      Larry Wall 5 years ago

      I am sure you have checked this out, but when I was looking at plans for my son, I found a couple that claimed, they paid for all prescription drugs, including the donut hole. That was a couple of years ago when I checked and I have not started shopping for myself and my wife, since we are four years away, and who knows what we will have then. There are some groups out there that offer help with prescriptions. You might check with your insurance agent. I checked out one, but then I changed insurance carriers and most of my drug problems were resolved to a point of reasonableness. Your doctor may know of some. You can have a decent income and still qualify. If I remember the names I will send them too you.

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      Thanks for the heads up. I'll be sure to check it out. I know that my plan has options where they will pay for generics throughout the donut hole, but not brand names. Of course, it is the brand names that cost so much. However, under the Affordable Care Act you now pay only 50% of brand names once you are in the donut hole, so that eases the pain somewhat. Insulin, unfortunately, is still over $200 a month for my husband, even at half price.

    • profile image

      Larry Wall 5 years ago

      I am a Type II Diabetic. I do not take insulin, but I know a little about it. Contact the American Diabetes Association. They would know if there are any plans available that would help pay for your husband's insulin, or at least pay a portion of it.

      Keep me posted. You can contact me through my e-mail on my profile page if you rather.

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      That's a great idea - thanks so much for the input.

    • Johnkadu123 profile image

      Johnkadu123 5 years ago from Toronto, Canada

      I am about to do an article on the so called Obamacare. This is a great hub and an eye opener. It is a wonder why politicians have not thought about these solutions up to this point. I am afraid I fall within the European model of Socialized healthare. Essentially I am of the view that healthcare should always be free at the point of delivery especially in a developed country where people have enough money to put in tax havens like the Cayman Islands. The reasons why the costs are high in the USA are primarily to do with the involvement of private sector speculators. Get them out of there and the costs might reduce a bit. Now ready for the red arrows! LOL

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      The more research I do on this topic, the more I become convinced that a single payer system would reduce costs and would have been a better way to go. I agree with you that in a privatized system speculation as well as lobbyists drive costs up.

    • billybuc profile image

      Bill Holland 5 years ago from Olympia, WA

      Excellent job of detailing a rising problem in this country. I don't know how the average family is supposed to handle these costs and although recent legislation is encouraging it is only one small step in the right direction. Enjoyed your hub greatly!

    • mperrottet profile image
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      Margaret Perrottet 5 years ago from Pennsauken, NJ

      Thanks for reading and commenting, billybuc. You're right - the burden is too high on the average person, and the matter needs to be seriously studied in depth.

    • kj force profile image

      kjforce 4 years ago from Florida

      mperrottet...Veru well researched and written hub..you covered pretty much everything..Most Physicians are not aware of the cost factors and have no control over them..Pharmaceutical and Insurance companies have bottom line it's $$$...now on the flip side, are you aware there are meds that you can get for " free" ? (metformin ) for type 2 diabetes is one..and antibiotics are another..check with your state..you must have Rx from a doctor.. I know this because I am retired from Medicine and now do Medical research...thanks for sharing this informative hub...

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      kj force - thanks so much for reading and commenting. Thanks for the tip about the Metformin - my husband is on that, but I don't know if we would qualify for any help with that drug. I really wish that we could get help with insulin, but I don't think we qualify financially for it.

    • kj force profile image

      kjforce 4 years ago from Florida

      mperrottet..Publix Grocery/Phar. in Florida has a Diabetic Management System..and they are the ones that offer FREE..bp.meds/type 2 diab./and antibiotics.you DO NOT have to qualify....I will research and forward any info I can find for you in your area...via e-mail..do you have one listed on your profile page ? if not e-mail me from my page...

    • chip1775 profile image

      Brett Wood 4 years ago from Atlanta

      Our insurance systems do not encourage consumers to make decisions based on cost, especially government programs like medicaid and medicare. Insurance, as a middle man, is incapable of controlling demand and cost.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      chip1775 - I see that you've written an article on this subject. I'm going to take my time to read it. My own feeling is that we need to concentrate more on wellness. Thanks so much for stopping by and commenting.

    • vinayak1000 profile image

      vinayak1000 4 years ago from Minneapolis

      This is such an awesome Hub. I've always wondered about this and it's great that I could get to spend some time reading up on it. Thanks a lot Margaret!

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      vinayak1000 - Time magazine did an article on this subject, so hopefully it will get much more attention. Thanks for taking the time to read this!

    • rajan jolly profile image

      Rajan Singh Jolly 4 years ago from From Mumbai, presently in Jalandhar,INDIA.

      This hub explains it all, Margaret. I feel by going in for generic medicines rather than the branded ones can cut the medicine cost and hopefully the insurance cost.

      Useful and informative. Sharing.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      rajan - Yes, the generic medicines do really help out in bringing costs down. I think articles such as the ones that you write about eating healthy also help people greatly in maintaining their health. Thanks so much for reading and sharing!

    • tillsontitan profile image

      Mary Craig 4 years ago from New York

      You've nailed this one mperrottet...we are all paying through the nose when it is not necessary. Rising expenses in the medical field are understandable but price gouging has to stop. Hospitals are out of control...I've seen the prices you talk about where an aspirin is $5.00, where a test is $5,000 and is negotiated down to $750 by an insurance company...certainly something wrong with that picture!

      Good luck with your medications...I hope you can find something more reasonably priced, or somewhere you can get it at a discount.

      Voted up, useful, and interesting.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      tillsontitan - I really hope that the committee designated to bring down costs (under Affordable Health Care Act) comes up with some real solutions to this problem. Seems to me we have to stop letting lobbyists control things. Thanks so much for reading and voting - I really appreciate it.

    • mr-veg profile image

      mr-veg 4 years ago from Colorado United States

      Well Yeah totally agree upon this one.. I paid $600 after insurance deductions for a root canal and porc crown out here.. back in my country India, same costs just $200 in total without a insurance :) .. Nice information Margarett, hope no one ever falls sick :D

    • Written Up profile image

      Written Up 4 years ago from Oklahoma City, OK

      Citizens also need to start taking personal responsibly for the their health and lifestyle choices. It needs to be more about prevention rather than treatment.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      mr-veg - I really wish that dental care was covered under medicare. Since retirement, I've had huge dental bills that I am responsible for paying myself - thousands of dollars a year. This is an area that nobody talks about, but that I think should be changed. Thanks so much for reading and commenting.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      Written Up - I strongly agree with you - the system should promote wellness, not sickness. However, there also needs to be a focus on cost cutting and not allowing people to be gouged by the health care industry. Thanks so much for taking the time to read and comment.

    • torrilynn profile image

      torrilynn 4 years ago

      Hi mperrottet,

      thanks for the great information that you give about health

      care costs and the reasons why they are so high

      I appreciate the time and effort you took to make this hub

      voted up

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      torrilynn - Thanks so much for the kind feedback, and for voting - I appreciate it so much.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      Healthexplorer - I'm sure that all countries are facing problems in this area, and that health care fraud plays a big part in that. Thanks so much for reading and commenting.

    • Peggy W profile image

      Peggy Woods 4 years ago from Houston, Texas

      You have certainly hit on a lot of the problem areas regarding our health care system in America. The lobbyists...the insurance companies...the hospital costs, malpractice lawsuits, etc. are all a part of this problem. There are some shining examples like the Mayo Clinic where doctors are on a set salary and all departments within the hospital work together for the benefit of the patient sharing results. Thus, no over ordered tests for example.

      Per your dental situation: My husband and I are both past 65 and instead of Medicare we chose United Healthcare for our insurance coverage. We have added the dental insurance which pays for 2 teeth cleanings a year and substantially discounts any needed dental work. There are probably many other dental plans. If you need a lot of dental work, some type of insurance would probably greatly benefit you.

      UUI votes and will share.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      Peggy - I have a medicare supplemental plan, not an advantage plan, and the supplemental plans don't offer dental coverage. I've looked into different dental plans, and they're really quite expensive. Thanks for the feedback, though, and maybe I'll re-investigate dental plans. Glad you stopped by - thanks for the good input!

    • Dolores Monet profile image

      Dolores Monet 4 years ago from East Coast, United States

      Great hub, shared and tweeted. My bnb who is an insurance man claims that medical care went sky high after everything was privatized, that in the past, hospitals and insurance were all nonprofit. Face it, in the US medical care is big business with the strongest lobby support. A young friend of mine who was switching jobs tried to get health insurance to fill in for her family of 4 (mom, dad, 2 kids) and the best she could do was $1500.00 for one month!

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      Dolores - Yes, things are just out of hand as far as the medical care industry making huge profits. I believe the $1500.00 monthly fee, because when I first retired I wasn't covered by Medicare, and had to pay $600.00 a month for coverage. Thanks so very much for taking the time to read this and I really appreciate you sharing and tweeting!

    • ib radmasters profile image

      ib radmasters 4 years ago from Southern California

      MPerrottet

      This was a great hub and a lot of good information.

      I do want to comment on the solutions section.

      Solutions?

      " Some possible solutions that I've seen offered include restricting the mark-up that hospitals can tack onto products and services,

      ib--------------

      This is like the mini bar at hotels, but unlike the hotels you don't have any discretion whether to use it or not

      -----------------

      encouraging the use of primary physicians over specialists,

      ib------------------

      Over the last several decades we have not seen medical cures, but we have added thousands of newly labeled diseases. These of course require going to specialists. People are looked at by the doctors the same way as consumers shop for meat at a butcher. These doctors are usually myopic. The referral system also increases the cost of medical for the patient.

      -------------------

      allowing drugs to be imported from other countries,

      ib----------------

      This is the problem of the FDA monitoring the Pharmaceutical companies. This drives up the drug develop costs by about one billion dollars. The problem is that the FDA doesn't do any drug testing, they just use whatever they get from the drug company.

      Unfortunately, many of the FDA approved drugs find themselves in lawsuits, as hungry and greedy law firms wait for their kill.

      Since the FDA was given congressional authority from congress to monitor the drug companies in the last 1950s, there hasn't been any major diseases that have been cured.

      ----------------------------------

      adopting uniform billing and payment procedures, and reforming the tort system to prevent frivolous law suits.

      ib-------

      Usual Reasonable and Customary is applied on the low side compared to what is actually being charged for people that don't have insurance.

      --------------

      The Affordable Care Act has provisions in it to encourage wellness, such as the annual Wellness Visit, smoking cessation programs, and discounted premiums for participants in wellness programs. It has provisions for streamlining administrative costs through the use of electronic record keeping. The ACA also introduces a new 15 member Independent Medicare Payment Advisory Board. Their task is to study ways to contain Medicare costs and offer solutions that reduce the growth rate of medicare costs while maintaining or enhancing beneficiary access to quality care. Contrary to many critics of this board, they are not allowed to offer solutions that ration health care, restrict benefits, raise beneficiary cost sharing or raise premiums. Hopefully they will come up with solutions that will not only contain Medicare costs, but will also serve as a model for the entire health care industry to bring costs down to a reasonable rate."

      iv------------------

      Electronic Record Keeping is a good idea, but the rest of Obamacare is more overhead than help.

      --------------

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      ib radmasters - I really agree with most of your comments. The services that hospitals are like the minibar - hugely marked up, but as you said you have no choice, and are forced to pay the inflated prices. One of my biggest gripes is the inflated mark-up on drugs in this country. If you can get it cheaper in another country, you should be able to. I'm more optimistic than you on Obamacare, however, and really think it will ultimately bring costs down. If the advisory board does their job, it may help. Certainly something needs to be done - the situation is way out of hand. Thanks you so very much for your thoughtful and insightful comments - I really appreciate you taking the time to give me such useful feedback.

    • Que Scout profile image

      Stephen Hodgkinson 4 years ago from Sydney Australia

      Hi All

      It appears to me that medical costs in the USA are through the roof because the people need to pay for all those law suits. A long as the courts allow compensation be paid to disgruntled patients who have little to complain about (you know the cases I mean) then the insurance the doctors need to pay will always be high.

      Americans can't wait to sue, many are proud to sue just for the fun of it. Fix the courts and you fix the medical cost problem. Possibly introduce what I call "a bit of bad luck" clause.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      Que Scout - I'm sure that frivolous law suits are indeed a part of the problem, but I think that all of the other factors that I mentioned are a huge factor as well. Thanks so much for taking the time to read comment.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      Que Scout - I'm sure that frivolous law suits are indeed a part of the problem, but I think that all of the other factors that I mentioned are a huge factor as well. Thanks so much for taking the time to read comment.

    • mperrottet profile image
      Author

      Margaret Perrottet 4 years ago from Pennsauken, NJ

      Que Scout - I'm sure that frivolous law suits are indeed a part of the problem, but I think that all of the other factors that I mentioned are a huge factor as well. Thanks so much for taking the time to read comment.

    • ib radmasters profile image

      ib radmasters 4 years ago from Southern California

      mparrottet

      " I'm more optimistic than you on Obamacare, however, and really think it will ultimately bring costs down. If the advisory board does their job, it may help.

      ib----------------

      Take a look a Medicare and that is the way that government runs healthcare. The advisory board will do more to make the system worse, than it will do for making it better. When did you ever see the government doing something better. Obama, already stole $750 billion from Medicare for his Obamacare.

      -----------------------

    • mperrottet profile image
      Author

      Margaret Perrottet 4 years ago from Pennsauken, NJ

      ib radmasters - guess time will tell. Thanks for commenting!

    • ib radmasters profile image

      ib radmasters 4 years ago from Southern California

      mperrottet

      When you find out, it will be too late.

    • Que Scout profile image

      Stephen Hodgkinson 4 years ago from Sydney Australia

      Hi mperrottet

      I think you are very correct with your reply. The other factors in this hub have a strong influence in the price for medical care.

      Thank you for this hub. I think it effectively brings relevant matter to the forefront and perhaps the hub will help make a change.

    • MikeNV profile image

      MikeNV 4 years ago from Henderson, NV

      Obamacare is a complete Disaster that is Driving the Cost of Sick Care up. We do not have healthcare in this country we have managed Sick Care. It's highly profitable to treat symptoms. I have little interest in discussing Obamacare here though.

      The reason I am commenting is this: Doctors are the SOLUTION not the problem.

      A Doctor goes to College, then Medical College, then does a Residency, then Specialized Training on top of that.

      Typically a Doctor will be 32 years old before they have their first "Job". Many specialists will be in excess of 35. Along the way they can accumulate hundreds of thousands of debt.

      They may get an offer after completing Residency of $180,000 a year perhaps much higher for specialists. But they will also be placed in an Immediate Tax Bracket that will take half of that money away from them.

      Most Doctors do not even Break Even with other College Graduates until they hit age 40 or higher.

      It's not uncommon for a small Independent Doctors office to incur expenses of $150 an hour. They have a hellish litigious environment to consider. Specialists (OBGYN's, Surgeons) can pay as much as $50,000 a year or more for malpractice insurance.

      Commercial Real Estate in Medical Facilities is very expensive. Nurses and Staff don't come cheap.

      Medicare Reimbursement is a nightmare of regulations and rules. The Doctors and/staff must keep up with the constant changes of what is covered and what is not. Make a mistake and they eat the cost.

      Many Doctors are fleeing Medicare because the Reimbursement doesn't cover their actual practice costs.

      Doctors are NOT the problem they are the SOLUTION. Their costs are a symptom of a system that is layered with Administrative Costs. And those Administrative costs are necessary to comply with Government Regulation and the potential for Law Suits. Doctors deserve the compensation they EARN because they have made major life Sacrifices to get where they are. Without them we have no system.

    • mperrottet profile image
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      Margaret Perrottet 4 years ago from Pennsauken, NJ

      MikeNV - thanks for taking the time to read this and for commenting. The fact still remains that doctors in the U.S. are more highly paid than doctors in other countries, and that this is one of a number of factors that drive costs up in the United States. However, I'm sure many people would agree with you that they deserve the compensation that they get.

    • JayeWisdom profile image

      Jaye Denman 3 years ago from Deep South, USA

      This is an excellent article. Thanks for shining a bright light on the problems in the American healthcare system and the reasons for its high costs.

      Dental care was mentioned in the comments, and I also wish Medicare had broad dental coverage. Poor dental care can cause severe physical problems from bacteria in the bloodstream (including heart disease), yet even Medicare Advantage plans (I have Humana's regional PPO) only provide minimal benefits, nothing major. I researched dental insurance, including that offered through AARP. The premiums are exorbitant and not justified by the scanty coverage. If you can't afford the unreasonably high dental costs, you can't afford dental insurance and co-insurance either.

      It pays to check line items in hospital and other medical bills. Sometimes a patient is billed for supplies or services that weren't even received. Those should be appealed.

      A recent Bloomberg ranking of the most efficient healthcare in the world by country spotlights the huge gap between cost per capita ($8,608 in the U.S.) versus effectiveness. The U.S. ranks 46 among 48 countries, with only Serbia and Brazil having lower efficiency scores. In other words, the world's richest country (if the politicians don't ruin our economy) spends MORE for WORSE healthcare outcomes than nearly any other country. I don't think anyone can justify a healthcare system with this ranking. I encourage your readers to check out the full results of this study and the variables used at the bloomberg.com website. It's a real eye-opener!

      Voted Up+++

      Jaye

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      Jaye Denman 3 years ago from Deep South, USA

      Just for the record, I would support a single-payor universal healthcare system 100%. Those who don't are uniformed. France, which (according to the World Health Organization) has superb healthcare, has a universal healthcare system largely financed by the government, which only spends 11% of the GDP on healthcare compared to 16% in the U.S. Yet the French live two years longer on average than Americans, have half the infant mortality, everyone gets free treatment for chronic diseases, and their citizens get free cancer treatment (which often bankrupts American families).

      When Genentech developed Avastin (for treatment of metastatic colorectal cancer), Business Week calculated a year’s supply at $48,000 in America. It cost patients NOTHING in France. Yet even poor Americans won't support an equitable system in the U.S. I think the generally poor educational system in this country is to blame for the lack of knowledge among the general citizenry. I am sure my comments will draw ire to your hub, and for this I apologize, but not for my opinions.

      Jaye

    • mperrottet profile image
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      Margaret Perrottet 3 years ago from Pennsauken, NJ

      Jane - thanks so much for both of your extremely thoughtful and informed comments. I'm with you on a single payer system - as you state so well, facts support that this system has worked well in other countries, and there's no reason to believe that it wouldn't work here in the United States. I'm not sure if the lack of knowledge in this country is due to a poor educational system. It may be due to the fact that misinformation and propaganda are promoted by political and business factions in this country. I do find that most people are not well informed on the subject of health care. It's nice to hear from someone who has their facts straight!

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      Johnkadu123 3 years ago from Toronto, Canada

      The Democrats have been very clever about this. Single Payer is coming whether the Republicans like it or not. The discussion is now about how to make the system work and not going back to the old ways of individual burdens. Watch this space. The so called battle over Obamacare has already been won by the Progressives in my view.

    • mperrottet profile image
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      Margaret Perrottet 3 years ago from Pennsauken, NJ

      Johnkadu123 - I hope that you're right, and that eventually we will see a single payer system. Thanks for stopping by and commenting!

    • Brian Prickril profile image

      Brian Prickril 3 years ago from Savannah, GA

      Hi, mperrottet. Don't even get me started on this! I don't want to hear a lot of excuses, I want to know why when I had a skin problem it cost me $100 for THIRTY seconds under nothing more than a tanning lamp? Ridiculous! Whew...sorry...I guess you hit a little too close to home on that one. Thanks for shining a little light on the "why" part. Good hub.

    • mperrottet profile image
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      Margaret Perrottet 3 years ago from Pennsauken, NJ

      Brian, that doesn't surprise me. Everything is way too expensive, and it's a sore point with me too. Thanks for stopping by and commenting - I really appreciate it!

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