Why American health care is so expensive

One reason is the attitude of the American consumer. Maggie Mahar is right on the money:

Part of the problem may be that American consumers want and expect more health care. We just won’t accept our own mortality: we expect medicine to save us. Indeed some, like medical ethicist Daniel Callahan, have suggested that our high-tech, high-profit health care industry is “in the business of selling dreams.”

I like the following statistic:

If your personal doctor told you that you had an incurable and fatal disease, would you accept that diagnosis or seek a second opinion?
In the U.S., 91 percent of patients said they would seek a second opinion.
In the U.K., [it's] 28 percent.

Comments

Anonymous
Oh for goodness sake, be fair about it. How many times do doctor’s encourage this by telling us over and over, that there is still hope. Pushing us to have this treatment or that surgery, knowing full well there is no hope.
People in this country who are diagnosed with a terminal cancer many times are not even given the option to do nothing. It is “We are going to try radiation and also I think there is a new checmo drug that might just work for you”. Even though they know that in reality nothing is going to help that patient.
Put the blame where it belongs, Doc.
Anonymous
It may be that we Americans seek far too many second opinions, but I’d rather be distrustful of someone’s professional opinion and alive because I had the freedom to choose not to believe that person than dead because I went on blind faith.
Anonymous
Yes, and that is why we will always spend more on healthcare in America. Why should I trust what this stat or doctor says, he/she might be wrong and I’ll end up dead. Better to get a second opinion, try that surgery, do that experimental treatment, etc.
This is exactly what the article is saying!!!
Anonymous
So it’s the patients’ fault for believing in the healthcare industry’s marketing?
Do you guys ever take responsibility for ANYTHING?
Anonymous
Should we simply resort to shipping terminal patients off to the glue factory? Have you ever seen Soylent Green? Maybe we could cure hunger to boot….
Anonymous
Do you guys ever watch out for your health. Do you guys ever eat right, exercise, etc. Do you guys ever do anything right! Don’t we just love blanket statements that include “you guys”.
Anonymous
The survey only tells me about the attitude of people from different countries. It is not necessarily what people do. Whether patients actually make the effort to get a second opinion is not known in these different countries. What I see in practice is that doctors from different specialties manage the patient’s problem. As Margaret Mead once said,”What people say, what people do, and what they say they do are entirely different things”.
Mike
There is nothing wrong with a second opinion. As long as one is willing to pay for it. Doctors don’t (and shouldn’t have to) work for free.
Anonymous
Having strong opinions is fine, but at least be consistent. Under the thread about defensive medicine I asked what would happen if a patient declined a test. An alleged doctor quickly replied that s/he’d drop the patient. So if we try to economize, we’re screwed out of care…if we accept every overpriced test and treatment, we’re blamed for the high cost of health care. What exactly do you want — other than to point fingers?
Zagreus Ammon
Hey Kevin,
Do you think these multiple anonymous posters are proving the point? Kind of sad.
I wonder if the point that the health care industry began marketing its technology and selling hope in a tidy billable package, is the same point the personal relationship with a primary physician went to heck in a handbasket!
So why did we decide to go into primary care again? To face this brutal stupidity, the consequence of our higher paid colleagues’ technological advances?
Anonymous
Off-topic, but here’s an interesting article about a creative solution to the problem of compensating physicians for being on-call.
http://www.healthleadersmedia.com/magazine/view_magazine_feature.cfm?content_id=92880
The authors contemplate various deferred compensation plans. One problem I could imagine is setting up unreasonably long vesting schedules. Physicians no longer stay in the same place for a lifetime.
Anonymous
“How many times do doctor’s encourage this by telling us over and over, that there is still hope. Pushing us to have this treatment or that surgery, knowing full well there is no hope. “
Anon 11:22,
The point here is that, if the physician honestly tells the patient, that, to the best of their knowledge, there is no further hope for their condition, the patient is frequently unwilling to accept that statement. You can, if you wish, blame marketing campaigns for your perceptions of a promise of eternal hope. However, if you wish to be factual, unless you have personal knowledge of a doctor pushing some-one to seek treatment when they believed there was no hope, you should refrain from the accusation.
I personally can think of no physician, and for that matter, no human being, who would push some-one through surgeries or treatments, when they believe, in their heart of hearts, there truly is no hope. Your accusation is despicable, and seeks to make doctors into monsters.
You, of course, have the right to your beliefs, but reality is far different from that expressed by you.
Anonymous
Zagreus,
Hate to disagree, but you list yourself as a “physician executive”. To doctors, that is the opposite of a primary care doctor. I’m not sure you can commisserate with us at the same time you are screwing us.
anon
Anonymous
“I personally can think of no physician, and for that matter, no human being, who would push some-one through surgeries or treatments, when they believe, in their heart of hearts, there truly is no hope. Your accusation is despicable, and seeks to make doctors into monsters. “
However, there are physicians who would have someone undergo surgery for the money.
http://www.kait8.com/Global/story.asp?S=5539574&nav=0jsh
The evidence didn’t go as St. Edwards thought it would.
Happyman
certain specialties are not immune to giving futile care for money:
“why do they put nails in coffins? to prevent the oncologist from giving another round of chemo!” ha ha.
Payne Hertz
Don’t you just love how players in our medical system always complain about the high cost of medical care as if it’s coming out of their pockets, rather than going into them? And of course, they always find some way to blame someone or something else for all this: patients, the government, EMTALA, whatever.
The reality is end-of-life care is a major revenue generator for doctors and hospitals; I read somewhere that the majority of medical expenses most people accrue in their lives occur at the end-of-life, an average of like $200,000 per person. Somehow, I don’t think a second opinion costs anywhere near that much, nor do I see why you’d begrudge a person who’s been told he’s going to die a second opinion, unless of course you think doctors are infallible and are never wrong about these things, and patients should juts shut up and accept their fate.
Doctors and hospitals certainly have a cash incentive for persuading people who are probably going to die anyway to pursue useless therapies, and I can say that when my friend recently died of lung cancer, they were telling us she was not going to make it three weeks before she died, but still doing chemo and radiation until 3 days before she died.
In my mother’s case, we were told by her doctor she was “brain dead” after suffering a stroke, and her doctor was adamant about letting her go. But the doctors at the hospital got my father in a room and convinced him there was still a chance, and convinced him to let them put her on life support. What they didn’t tell him was that once you do that in Texas, she can’t be legally taken off. She died 3 weeks later, after causing us the most horrendous emotional pain and stress I have ever known, and then we got the bill: $240,000 for three weeks of care. My father contacted his lawyer, who told him that this hospital had a history of doing this kind of thing, and suddenly the bill was reduced to $21,123 or thereabouts but no zeros, still a hefty amount. Their explanation? “Typographical error.” If the bill was for $24,000 and they added an extra zero by accident, I might see it, but how do you get 4 zeros out of a number that has none?
Let’s not mention the unnecessary surgeries, or medical fraud that costs upward of $170 billion a year by one estimate. No, it could only be the astronomical costs of getting second opinions that is making health care so expensive.
Like someone else here said, do you guys ever take responsibility for anything?
Medicienne
Although I am very impressed with the quality of health-care in the United States, I must say the cost that comes with that is ridiculous.
I could not believe that even a simple office visit to a dermatologist costs more than a hundred dollars.
Coming from a country where we had to pay out of pocket and office visits were just a mere 5-10 dollars, I found this ridiculous!
Also there is great disparity between specialties in the US, all due to the insurance system.
I hope we can see some improvement in a few years.
Anonymous
People need to separate doctors from hospitals in their mind. For some reason people think that the money going to the hospital is going to their doctors when in fact this is usually a separate bill that is a pittance compared to the hospital bill. I had kidney stones and had to the ER. My physicians (ER doc and radiology) bills were around 310 bucks (2 separate bills combined), while my use of hospital fee was like 4000. Where is this money going?
Anonymous
“I could not believe that even a simple office visit to a dermatologist costs more than a hundred dollars.”
What are malpractice premiums in the country you come from? Hopw much does the doctor pay to medical school?
Finally, if 100 is too much, you are free to return to your country, or ask the local witch doctor for advice.
Clearly, the doctor’s advice was not wotrh the price, so you should look elsewhere.
Anonymous
Of course, the medical office visit was not ten dollars. Unless we’re talking about some Third World country, the physician is not making a living with ten-dollar office visits. There is other payment behind the scenes. Taxes, or mandatory insurance asessments.
ME
Umm that’s crap, you’re saying that American Medical care is so expensive because we get second opinions and won’t accept mortality. What does that have to do with the initial cost? Yes getting a “second Opinion” is going to cost you double, but the initial diagnoses is still more expensive here than anywhere else in the world. So even if you didn’t get two one would still be expensive. Also we have a very high infant mortality rate compared with the rest of the world, and also live shorter lives. So maybe us not accepting our mortaility, is just our way of showing that it’s crap that our American health care system costs more and yet doesn’t keep us healthier than other countries.
Anonymous
Prehaps Americans just don’t have a reason to trust their physicians.

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