One important reason why health care is so much more expensive here:
Americans seem to be less willing to take no for an answer and more willing to try almost anything, no matter how expensive or how slim the odds, to prolong life. (The United States is also a fatter, more diverse country with wider income disparity, which gives our medical system a harder task.) . . .. . . But much of it is simply wasteful. Expensive procedures – like some Alzheimer’s treatments, some knee surgeries and many body scans -— are often no more effective than basic ones, according to research. Yet doctors can keep on getting reimbursed for the expensive ones. “Basically, anything that doesn’t kill patients is paid for by Medicare and insurance companies,” said Jonathan Skinner, a health care researcher at Dartmouth College.
Backed by lawyers, families often corner doctors in doing “everything they can” during hopeless cases. A “more is more”, fee-for-service reimbursement system also spurs doctors on.
Related posts:
- Pre-authorizations
- Pharmacists are beginning to feel the reimbursement pain
- Some continue to think that health care is "free"
- When you switch to Medicare
- Mandates and health insurance premiums
- Arbitration is an answer
- Death by polypharmacy
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{ 28 comments }
Why are costs higher domestically?
Provider compensation rates.
QED.
Yo, Crim,
Do you actually read what is written in these posts? Provider reimbursement is DOWN, I repeat DOWN. Try Reading Comprehension 101.
Living in a glass house? A course in logic would help you.
Provider compensation being reduced from astronomic levels to nearly stratospheric levels (especially when compared to providers in other first world countries)is in line with my post. Please try again.
QED.
Crim,
The true criminal is you, as you need to take your head out of the sand. Why don’t you really look at what docs are reimbursed instead of making ignorant statements like “Provider compensation being reduced from astronomic levels to nearly stratospheric levels”. You have absolutely no friggin clue as to what you are talking about. So, please, get yourself a reality check, take your head out of your butt, and take your own advice about a course in logic. You are totally clueless about physician compensation. And, Crim, I don’t give a damn what our compensation is compared to other countries. If you want their healthcare, why don’t you move there?
“One important reason why health care is so much more expensive here”
This is the first sentence of the original post. Your response was, “I don’t give a damn what our compensation is compared to other countries.” You are commenting on this post because…? Unlike the sniveling left wing celebritard types that threatened to run off to Canada unless GWB was defeated, I will be staying in this country and doing what I can to make it a better place. Per procedure reimbursement for scutt procedures may be low but it is not sufficiently low enough in that “fee-for-service reimbursement system also spurs doctors on.” Overpaid for similar work as your first world colleagues. One can hardly imagine the cacaphony of indignation that would come from the current practitioner lot if they had to compete on a global basis as most every other profession.
criminallopath,
Everybody is entitled to their opinion, however, adamantly supporting something you wish were true doesnt make it true.
The facts: Threee unrelated studies by economists over the past 20 years found that physician compensation rates and the cost of healthcare are INVERSELY related. What does that mean you ask? They found that the correlation coefficient is negative (around -.3). This means that the empiricle evidence shows that when doctors are paid less, healthcare costs simultaneously increase. (See Cooper et al. J of Economics, 1998)
You can argue this doesn’t make sense, but you would be arguing against factual evidence. This happens because when all the other people in the chain of healthcare jack up prices dr compensation is simultaneously reduced to compensate, however usually not enough to cancel out the initial increases.
You sign your posts “QED” which in Latin represents something which was definitively proven, yet it is ironic your posts offer not one shred of evidence. Give us some numbers, some studies, anything besides your gut feeling.
Perhaps you should stick to meteorology.
Crim,
Good God almighty, do you not even remember what you wrote? In my anon post of 4:44 PM, I was responding to your following asinine comment about American physician reimbursement – “(especially when compared to providers in other first world countries)”. So, as I said, I really don’t give a damn what foreign docs make in their own countries. And what does that have to do with any of this anyway? As far as foreign competition goes, if that’s what your vaunted sheeple want, then thats fine by me. If you want to make this country a better place, as you say you do, then consider moving out of the USA!!! If you don’t want to do that, then at least try to contribute something constructive to the healthcare debate other than your tiresome ignorant rants about whoring doctors and lawyers. The rants do nothing but contribute to the increasing incivility of public discourse. Enough already! And, Crim, I really tried my best to be as civil as possible.
“Backed by lawyers, families often corner doctors in doing “everything they can” during hopeless cases.”
Kevin, of all the hopeless cases out there, what percentage hire lawyers to force doctors to treat them? It must be pretty high, since you claim it is “often”, right?
It’s the entitlement mentality. I had a patient who complained of musculoskeletal pain. I assured this otherwise healthy 35 y/o female that her diagnosis was musculoskeletal pain. However, she wasn’t satisfied and demanded a CT scan. So I obtained a CT scan and it was negative. Then she wanted more tests and read about upper and lower endoscopies thinking that she had a gastrointestinal cancer. So I ordered the upper and lower endoscopies – both also negative. Then the patient had a notion that it was her gallbladder and an ultrasound was ordered and it, too, was negative. She was convinced it was her gallbladder and I referred her to a surgeon who, obligingly, removed it. She still continued to have the same complaints. Oh, by the way, all you taxpayers out there paid for this, because she was a Medicaid patient.
The point is that if patients have to pay for their own care they will consume less, even if this goes against medical advice. A busy doctor has no reason to unnecessarily sell procedures/tests.
Grand Wazoo:
Who gives a shit if you order all these tests? What is our downside to ordering all these tests? I think I ordered $100,000 worth of unnecessary tests in my Busy ER today, do you think I care? It’s if I don’t order the tests I get screwed. Today I ordered 3 CT pulmonary angiograms on patients who probably had mechanical back or shoulder pain (for months). But if I miss one thing in the 5000 patients who’s charts I sign a year I get raped. So I order away. And I sleep better at night.
“What is our downside to ordering all these tests?”
For starters radiation exposure, possible renal damage, and possible anaphylaxis, not to mention driving up our health insurance premiums.
“……do you think I care?”
And you get to sleep at night?
“And you get to sleep at night?”
Obviously you haven’t had to sit through bullshit depositions, where you did nothing wrong or didn’t even see the patient. Has any doctor been sued yet, successfully or unsuccessfully, for irradiating these patients? Not that I know of. I’m not the one causing cancer by ordering all these defensive tests, it’s society and the lawyer politicians that says it’s OK to sue a doctor at the drop of a hat or with any bad outcome. When the frivolous lawsuits go away, the frivolous testing will go away.
Another downside is that there really is no stopping with those patients. Every test, every operation and every procedure performed on her only serves to bolster and reinforce her belief that something really is wrong (”I must be terminal, otherwise the doc wouldn’t order all these tests”)
We’ve had our share of these patients in the Gyn departement, and I distinctly remember my old boss saying “Let’s take her remaining ovary now. That way, she won’t have any gynecological organs left, and can’t bother us anymore”.
Surely this is not the way to practice medicine. And the society that has made it so, deserves what it gets.
hmm, lets take a real world example, on march first 2000, in an hmo hospital in florida, just a day or so before an elderly patient who was recovering nicely and would have been off of a respirator,he was removed early due to the discovery of a DNR order signed due to the constant build up of fluid around the heart causing acute pain and misery this caused,naturally this patient died in rather short order,this particular patient was one of doctor Gelch’s patients whom he pioneered the proceedure of cleaning out of the veins and arteries of the neck to increase blood flow and prevent many strokes due to build up in these vessels, this patient had a new lease on life and lived another 20 yrs with the decline only in the last couple before his demise(which i call euthanasia),now 2 or 3 weeks after this patient died a procedure for the insertion of a shunt to relieve the pressure of this condition (ergo the misery of it)was normalized,which would have restored quality of life so that this patient would be alive and well today most probrably, but the physician who should have known this was of a caliber that his hands were full beyond measure just maintaining his day to day activities that this physician was not up on the current procedures that were being pioneered due to the contraints on his limited abilities, this physician to this day i would wager can seldom stay up on the current journals, because while barely adequate to perform his duties there was no where withall left for such things;now this man is lost to our society,war veteran,local statesman,head of his local lodge,a man who turned down vice presidencies and other top management positions in his company in order to do good work for the other employees of his company and like companies by staying as a worker and union official because he felt he had enough for he and his,and would be of more value to his society remaining in his current position,thats true altruism,which he found to be not enough once eastern air lines was seized by texas air and their fully funded pension fund destroyed by texas air and frank lorenzo,and since he chose an innocuous retirement with his wife in florida out of the limelight he had lived in he wasnt considered worth saving now all he was, lives only in those who knew him, to the rest what he was is lost like tears in the rain
“I’m not the one causing cancer by ordering all these defensive tests, it’s society and the lawyer politicians that says it’s OK to sue a doctor at the drop of a hat or with any bad outcome. “
True, you have no responsibility whatsoever for your own actions. Just like any other professional.
True, you have no responsibility whatsoever for your own actions. Just like any other professional.
# posted by CJD : 9:27 AM
Just like in the legal profession, eh, CJD?
“just a day or so before an elderly patient who was recovering nicely and would have been off of a respirator,he was removed early due to the discovery of a DNR order signed due to the constant build up of fluid around the heart causing acute pain and misery this caused,naturally this patient died in rather short order”…my point was that another day or so and the patient would have been breathing quite adequately on his own and lived the interum time period until it was approved(about 2 weeks), it was already slated for approval at the time and if the MD hadnt been so overwhelmed by his everyday duties and had the wherewithal to keep up on the journals, this entire post would be moot, but with further investigation it was found he was a poor student who squeaked by to his diploma with a “C” average, a “D” in the first 2 years of academics with sufficient curved grading to maintain his financing until further curved grading allowed him a grade suffucient in the second 2 years of clinical to make his final grade a “C”, he took 3 shots at the licencing, so in a nutshell he was graduated and licenced with heavy support from the goals 2000 program and should never been an MD…credentialing is destroying the medical profession in the name of social engineering and is the main reason your premiums are through the roof, well other than insurers sucking up the majority of each medical $, there is a positive correlation between gaffs and credentialing, research the data, and look at some of the posts by your peers and if you wonder how they could be so thick then you should wonder how they became MDs but i digress, this post is about the elderly and their medical plight,they do have value and their lives should be maintained as long as it is feasable,with consideration taken as to what is about to come down the pipe that could help them
I know, it’s Soooo easy to get geriatric patients off of ventilators, if I’m 95 please intubate me because I know in 1-2 days I’ll just come off the vent, no problem.
TAPayne, you do more than “digress.” What exactly is your point? How does that relate to the post? And what do the grades some un-named physician allegedly earned (your story makes no logical sense in that regard) have to do with patient’s wanting or not wanting treatment despite there being marginal or no benefit to that treatment?
Sounds to me like he/she is alluding to affirmative action.
Its amusing to contrast the accusations that, on the one hand, too many unqualified doctors are being pushed through the credentialing system hence causing life-ending mistakes and jacking up malpractice rates and yet, on the other, there is a choking supply-side restriction in the production of new physicians causing a crippling decline in physician quality (attributable to decreased competition).
TAPayne and Crim should go find their own corner and hash this out…
By the way- the idea that C-level undergraduates are being admitted to U.S. med schools left and right is downright laughable. These days (actually for awhile now) you need a mininum 3.2 or so (B+) to have any decent chance. If you’re sub-3.0, better start looking Carribean. A “C” GPA in the 2.0 neighborhood wouldn’t get through the inital automated screening process at even the lowliest of schools here.
TAPayne- Please, for the love of God learn how to use a period at the end of sentences. I’m sure you have something to say, I just keep having to reread so much of your posts that I finally gave up. Your entire 50 zillion line post was one long sentence with 400 commas and a semicolon or two throuwn in for good measure.
rally round the ivory tower?as you like ,it is of no consequence to me. i personally have seen 4.0 students passed over in favor of 2.0 students for admission, believe me or dont, im sure the blinders will serve you well,unfortunately it wont serve the public in the least.find out what standard deviation is and correlate the data yourself
TAPayne, I don’t believe you. Exactly where have you seen applicants to a U.S. medical school turned away with 4.0 GPAs where applicants with 2.0 GPAs have been accepted. And please also tell how you would even be privileged to have that information. If you can’t give specifics, then I call you not credible.
I don’t see where anyone has to be blindered or beholden to anything to question your rambling and over-the-top claims. They are so outrageous as to demand proof. Have you got any?
I’d love to see you name just one out of the over one hundred med schools in this country that accepted students with 2.0 UGPAs this past year. You’re completely full of shit.
TAP has not shown one shred of evidence to support his statements. He has his head so far up his ass he could do a colonoscopy on himself. Please support your statements TAPPY or shut up.
TAPayne:
Can you just directly answer this one question? In talking about admitting poorly qualified students over 4.0 students in the name of social engineering, are you in fact referring to affirmative action? Because it sure sounds like it. If you are trying to positively correlate an increase in the number of black and Hispanic doctors in this country to malpractice, I think you’re way off the mark. Beyond that, though, I really have no idea what else you could be referring to.
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