7 massive problems with our health care system

A $21,000 bill for heartburn? Health care is bankrupting the country, and there's little we can do about it. Here's what caused this crisis.

By Kim Peterson Feb 22, 2013 3:27PM
The new American gold rush is at hospitals, where everything from X-rays to drug injections get marked up far beyond their actual value, Steven Brill of Time magazine reports in an amazing cover story out this week.

The prices we pay for health care are outrageous, and for those without health insurance, the costs are out of control. Consider the Connecticut woman who went to the hospital last year for chest pains only to find out it was a bad case of heartburn. She didn't have insurance, and Time reports that she got a bill for $21,000 -- $1,000 for the ambulance ride, $3,000 for doctors and $17,000 for a three-hour -- yes, three-hour -- hospital stay.
Her bill included charges for three protein-related blood tests at $199.50 each. Medicare would have paid $13.94 for each test at the same hospital, Time reports.

America spends 20% of its gross domestic product on health care. That's by far the most of any other country in the world.

How did things get this way? Why does medical help cost so much? Here are seven ways the system went off the rails:

1. No consistent pricing. Every hospital has an internal price list called a chargemaster, and none of those are consistent with each other, Brill reports. The prices keep going up almost automatically, a hospital executive tells the magazine.

2. Hospitals are consolidating.
They're also buying doctors' offices, which means they can have more leverage over pricing.Image: Surgeon with paperwork (Creatas Images/JupiterImages Corporation)

3. They use the expensive technology first. That heartburn patient received an $8,000 CT scan first instead of a regular stress test that the hospital bills at $1,200. Did the doctors need to go straight for the pricey stress test? By the way, the cardiologist reading that test charged $600 just to do that.

4. They test too much. Doctors in the U.S. run far more tests on patients than in other countries. One doctor describes it as "giving out CT scans like candy" in the emergency room.

5. They're scared of lawsuits. No one complains when a test ends up solving a mystery illness or improving medical care. But boy, doctors will hear about it if they pass on a test that could have helped. So doctors overtest to guard against potential lawsuits. "We can't be sued for doing too much," one doctor told the magazine.

6. We let it happen. As Brill noted when he went on The Daily Show this week, patients generally green-light the tests without knowing the costs and accept all of this because they have little choice. "You're an involuntary entrant into the marketplace," he told host Jon Stewart. "There is no marketplace in the most important sense of the definition, which is, does the buyer have any power at all?"

7. Congress is weak. The pharmaceutical and health care industries have spent $5.36 billion since 1998 on lobbying Congress, Brill reports. There's no better way to force the government to buckle under your will.

The 36-page Time magazine piece is one of the most important articles to come out in years. It's well worth a read.

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220Comments
Feb 22, 2013 4:09PM
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This is the one place where ObamaCare absolutely failed. I would have supported that legislation if it had done anything - anything at all - to address the cost of the services, rather than simply focusing on who's going to pay.
Feb 22, 2013 4:22PM
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How much has the trial lawyers spent lobbying? The Dems are always pushing us toward Western European Socialism, however they never point us towards their legal system where the loser of a lawsuit pays attorney fees for both sides (which ends many frivilent lawsuits).
Feb 22, 2013 5:00PM
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Hospital bill for wife's knee replacement - 45,873 (that's just the hospital charges). That's the price an uninsured person would pay.

 

Blue Cross Blue Shield plan allowance - 2,700.

Blue Cross paid - 2,450

Patient copay - 250

Total cost 2,700 with insurance.

 

In what world does that make sense ?

Feb 22, 2013 4:38PM
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The American health care system is the greatest scam in the history of man and our national shame. Of course Obamacare will be a failure but what else would one expect when only the stakeholders under the current system are invited to reform it? It's like gathering a bunch of foxes to reform henhouse security.
Feb 22, 2013 4:15PM
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Inflated prices on a sliding scale are just the start.
Even with Medicare, hospitals are finding and using "loopholes" to bill patients unreasonable amounts of money.

Feb 22, 2013 4:32PM
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It's amazing and obscene that a lifetime of savings can be consumed by a week in a hospital.  The medical system is not fixable - there are no forces that can keep the prices from endlessly spiraling upward.  It has to be rebuilt from the ground-floor up.  There was a time in my recent past where there was no health insurance, and everything was paid out of pocket.  The virtue was, of course, that I could check on the pricing beforehand and I determined whether I really needed to see the doctor.  Because lawyers and CEO's and the administrative network weren't involved, prices were enormously less than today.  I realized then that I would be responsible for paying out of pocket any catastrophic illness or accident and I was willing to exist in that environment.  Perhaps healthcare itself should be eliminated and replaced only with insurance to cover the rare catastrophic event.   

Feb 22, 2013 4:12PM
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Over 30 other nations learned a long time ago the only solution to skyrocketing costs was a Universal Health Care system. France today has the #1 rated health care system in the world for quality and affordable costs of care. They pay much less because they cut out the middle man, just $3,696 per year, while we pay on average $7,538, more than double for the same treatments. A Harvard university study estimates that 48,000 Americans die each year from treatable diseases, but without insurance they can't afford the care, this is the true American Death Panel, 48,000 per year.
Feb 22, 2013 4:18PM
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And all of you think its Obama? This S*** has been going on for way to long.
Feb 22, 2013 4:27PM
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A major reason health costs in America are so high, is the high cost of malpractice insurance.  To safeguard themselves and keep their premiums as low as possible, doctors and hospitals have been forced to run all the tests and procedures on patients to avoid being sued.  When Congress or the courts or whoever is in charge puts a reasonable cap on damage awards, then you may start to see the costs go down, but it is doubtful.  Of course they will charge everyone else $200 for a test medicare pays only 14.  The real cost/value is probably somewhere in the middle, but they have to makeup for the underpayments they receive from the 900 gorilla...government.

 

This is also a major reason you skiers have to pay so much for your lift tickets these days.

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Right!  The COST of medical care - it's OUT OF CONTROL.  And this is the by-far greatest failing of "Obamacare".  Obamacare mandates that we all BUY insurance.  So that we ALL get to be part of the insurance-pool.  So that there are MORE premium - payers and many more who are healthy and thus of little or NO COST to INSURANCE COMPANIES.  This means bigger revenue and BIGGER PROFIT for insurance companies.

 

Notice that I keep mentioning INSURANCE.  Insurance is NOT medical CARE.  Obamacare does not provide or in any way ensure that more or all Americans get medical CARE.  It DOES attempt to ensure that health INSURANCE COMPANIES collect more paying clients and get more income.

 

Insurance companies in turn pay doctors and hospitals.  So the CUSTOMER of those medical care services - YOU - are hereby sidelined and disconnected from almost all of the usual market mechanisms seen in other goods and services.  YOU have no say = no choice in what care you get in most cases (article describes a case of this...) and NO SAY what-so-ever in what is CHARGED for these services.  So there is little "market control" over costs of medical care. Medical Care is a money-mill for providers.  Doctors and hospitals simply tell insurance companies they want more, and the companies are free to raise their premiums. YOU are of course NOT FREE and MUST pay the more.

 

And, under Obamacare, YOU, the BUYER (and consumer of med care services) have zero control or influence on any of this.

 

Obamacare is failing us - The biggest way is that it simply has ZERO COST CONTROL.  All it does is ensure that YOU get to pay insurance companies.  It does NOT put any limit on how much hospitals, doctors charge or get paid.  So.  Is anyone surprised to see that medical CARE cost is going UP and will continue to do so?  It will go UP until someone forces this growth to STOP.

 

Maybe YOU, the electorate, can do something to save your wallet...  elect folks to Congress with a STRICT COMMAND - an assigned JOB DUTY - to act NOW to put a stop to this.   And back this up - IF they don't do what YOU tell THEM TO DO, FIRE THEM.  No.  I don't mean say "we'll not vote for you again".  I mean - treat these politicians like they really are YOUR EMPLOYEES - IF YOU don't do what your boss told you to do, does he/she say let YOU get away with not doing your job and assigned duties?  I doubt it.   I'll wager YOU will get FIRED.  You know. The old PINK SLIP.  No pension, no cushy benefits, no watch, no plaque, no take-home prizes.  Just a YOU ARE FIRED slip.  Don't let the door hit you on your way OUT.

 

I know.  I dream of this!  Too bad YOU folks all don't actually CARE whether you get the chance to PAY for medical INSURANCE or GET reasonably-priced medical CARE.  If YOU DID, we wouldn't be having THIS thread!

Feb 22, 2013 4:55PM
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Obama and his band of academians failed to address the cost drivers in the Health Care System.  Without doing that first, how the hell do you lower the cost?  You don't!  That's what you get when you have a community organizer run anything more than the night shift at a 7-11.
Feb 22, 2013 5:11PM
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I think it should be renamed "Obama don't care"
Feb 22, 2013 4:33PM
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Regardless of how often people try to compare how great european socialized medicine is, they wont concede that exemptions already granted in the U. S. and 11 million illegals sucking  from the sytem renders any comparision invalid.

Imaging centers from NY to Houston, Detriot, Chicago etc are full of Europeans and Canadians paying out of their own pockets seeking tests and treatments they cant get at home. Thats all i need to know about government run health care. When all this started, I knew there woud be NO reform without the first step being tort reform.

Feb 22, 2013 6:58PM
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it blows my mind how ignorant the vast majority of americans are about health care.  i bet that its safe to say that about half of people that go to ERs do not have any insurance OR any intention of paying their bill when they get it.  it is a law that everyone who presents themselves at an ER be seen and treated, many many people know this and use the ER for their primary care while literally not paying a dime.  it is not uncommon for a woman to go to the ER for a pregnancy test! this cost of all of the people that do not pay anything is shared by all of the people that do pay. 
also, a hospital literally could not run if operating only on the reimbursements from medicare.  like someone else pointed out, medicare might pay $20 for something the hospital bills $150 for.  the true value is somewhere in the middle. 
blaming unnecessary tests on physicians is also completely ignorant.  i am a physician.  i can't tell you guys how many times, on a daily basis, we say to ourselves (or out loud) "i better order this test so i don't get sued."  we don't have the luxury of working up the most likely diagnosis anymore, we have to also rule out anything else no matter how rare or unlikely it is.  CT scans are the easiest (and likely most often) abused and unnecessary tests.  the term for this is CYA medicine.  Cover Your A** Medicine.
lastly, people tend to greatly overestimate the amount of money that physicians make.  it is relatively lower now than ever.  it kills me when people suggest that the answer is to pay physicians less, the total of all physician's salaries in the US last year was less than 10% of the total cost of healthcare in our country.  few physicians went into their career with the sole desire to make money, there are easier ways to make what physicians do and nearly all are driven by at least some sense of altruism, but you are very naive if you believe that altruism alone will get someone through college, 4 yrs of med school and 3-5 yrs of residency to come out on the other side with a mountain of debt and a job that constantly deals with death, sickness and often the worst aspects of people. 


Feb 22, 2013 4:44PM
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You are missing the point... hospitals HAVE to charge insurance (and you) large sums to pay for the deadbeats of society ie... the woman with HEARTBURN for and ambulance, ER, cat scan, bloodwork, Physician time, etc... NO health ins. Multiply this by literally millions and you get the point. Who the hell do you think is going to pay for all this "free" Obamacare??? You people drank the Kool-Aid, now deal with the diarrhea!!!  Dumbazzes!!!
Feb 22, 2013 4:17PM
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Even the most ignorant and freeloaders are starting to understand the implications of Obamacare. Higher costs, reduced access, less treatment and the ones who thouht it would all be free are realizing illegals ar crowding them out of the emergency room.

The uneducated are also starting to wise up on how the current admin does math- most of them can add and subract at that level.

Feb 22, 2013 4:01PM
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Democrats, Socialist, Illegals, Lawyers, Medicaid, Medicare, HMO's
Feb 22, 2013 4:39PM
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GOVERNMENT IS THE LARGEST ISSUE  IN ALL ASPECTS OF THE HEALTHCARE DEBATE.TORT REFORM HAS TO BE DONE --THE DEMS LARGEST CONTRIBUTOR THE ABA [AMER BAR ASSC]  IS WHY IT WON'T HAPPEN.THERE ARE MANY WAYS THAT OUR SYSTEM CAN BE BETTER EASILY  DONE WITH MARKET DRIVEN FORCES RATHER THAN THE BCRATES IN WASH THAT HAVE LITTLE KNOWLEDGE OF THE ISSUE .
Feb 22, 2013 4:28PM
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Rising Health Care Costs were the reason many people could not afford healthcare.  Insurance companies try to negotiate with medical providers on reasonable and customary charges but the provider doesn't have to accept the amount they're offered.  Showing up at an ER because you're bleeding to death etc is not health coverage and the hospital will sue you for the treatments provided so whomever says the poor and illegals can get "Free" care are ignorant.  The only way to corral the overcharging of medical services is to mandate the amounts that can be charged, make sure everyone has coverage so the provider doesn't take a hit for providing care and legal expenses going after the patient, and finally providing affordable coverage so insurance companies have a guideline to base their rates on.  It's not that Obama care has failed.  It hasn't really had a chance to do what it's designed to do.  Greedy corporations and right wing politicians and businessman want it to fail so they can get their guy in office next election.   Rising health care costs are not caused by Obamacare.  Whether Obamacare works or not has yet to be seen.  To say it's the cause of rising health care is rediculous since it hasn't even gotten out of the gate yet. 

 

Feb 22, 2013 4:46PM
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My advice.....buy into a good Heath Care Mutual Fund with your IRA money....Vanguard Health Care comes to mind.

 

 

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