From a country that soared through era after era of technical proficiency, economic support of new entrepreneurial explosions and analytically-driven cost efficiencies, we have grown into a nation of Keystone Cops, bumbling and struggling at every turn. We wage “short term” wars that last more than a decade, sapping our economic strength, while cutting educational funding and student aid so that those developing nations go zooming past our kids in test results. Our national legislature (commonly known as Congress) can’t legislate. Our most important new technological event, implementing the much-touted Affordable Care Act, remains a website mired in glitches, a level of failed interactivity that I suspect even our most malevolent hackers could fix.
With crumbling roads and bridges, educational standards falling like a rock tossed off the highest mountain, it seems pretty clear that Americans, on average, will simply continue to watch their quality of life and their buying power erode, a fact of life that has followed, year after year, for well over a decade. Yet with all the best intentions, plots and schemes, we have one of the least accessible and absolutely the most expensive healthcare system in the developed world. Comparable medical procedures at parallel levels in other major developed countries can cost as much as five times the average cost in the United States. About 17% of our GDP is consumed by healthcare costs, and the disparities of costs even within the U.S. vary often by multiples depending on which hospital in which city or state.
“In a medical system notorious for opaque finances and inflated bills, nothing is more convoluted than hospital pricing, economists say. Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.
“A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.” New York Times, December 3rd. Is it doctors raping the system, nurses driving their high-end BMWs to the valet that are driving the costs through the roof? I don’t know a lot of rich nurses, and most of the doctors I know complain that their take home pay has fallen steadily over the years.
Byzantine-complex software systems track the tiniest charges for elements you would think are simply “included” in the most basic hospital care, accumulating costs and building some of the most massive medical bills in recorded human history… all the while watching as competition, particularly in smaller communities, just disappears. “The main reason for high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a health care system that has little or no price regulation in the private market.
“Rising costs of drugs, medical equipment and other services, and fees from layers of middlemen, play a significant role in escalating hospital bills, of course. But just as important is that mergers and consolidation have resulted in a couple of hospital chains — like Partners in Boston, or Banner in Phoenix — dominating many parts of the country, allowing them to command high prices from insurers and employers…
“In other countries, the price of a day in the hospital often includes many basic services. Not here. The ‘chargemaster,’ the price list created by each hospital, typically has more than ten thousand entries, and almost nothing — even an aspirin, a bag of IV fluid, or a visit from a physical therapist to help a patient get out of bed — is free. Those lists are usually secret, but [here in] California requires them to be filed with health regulators and disclosed.” NY Times.
I’m sorry, but the powerful drug lobby has made sure you cannot buy prescriptions from Canada (gee, we can’t insure quality, they say with a wink) and hospitals simply have pushed any semblance of true regulation out the window where they can, with many doctors rejecting Medicare and Medicaid patients where reasonable cost limits are imposed by the government. It’s time to create some homogeneity among pricing, perhaps factoring local cost-of-living differentials. This system is a bust. It doesn’t work. We cannot afford it. The medical industry lobby cannot continue to buy Congress, particularly the House, under the false rubric of “regulation is un-American.”
“‘Chargemaster prices are basically arbitrary, not connected to underlying costs or market prices,’ said [Glenn Melnick, a professor of health economics at the University of Southern California]. Hospitals ‘can set them at any level they want. There are no market constraints.’… Prices for any item or service are set by each hospital and move up and down yearly, and show extraordinary variability, health economists say. The codeine that costs $20 and the bag of IV fluid that costs $137 at California Pacific are charged at $1 and $16 at the University of California San Francisco Medical Center, across town. But U.C.S.F. Medical Center charges $1,600 for an amniocentesis, which costs $687 at California Pacific…
“California Pacific Medical Center’s 400-page chargemaster for this year contains some eye-popping figures: from $32,901 for an X-ray study of the heart’s arteries to $25,646.88 for gall bladder removal (doctor’s fees not included) to $5,510 for a simple vaginal delivery (not including $731 for each hour of labor, or $137 for each bag of IV fluid). Even basic supplies or services carry huge markups: $20 for a codeine pill (50 cents at Rite-Aid or Walgreens), $543 for a breast-pump kit ($25 online), $4,495 for a CT scan of the abdomen (about $400 at an outpatient facility nearby). Plenty of other hospitals set similar prices.” NY Times.
What exactly would you do if you needed some life-saving care that your carrier won’t pay for because it just plain costs too much. And even if your shiny new Obama-Policy covers the cost, if there is government subsidy involved, why exactly should taxpayers support a system that only makes the shareholders of those mega-for profit institutions – from insurance and pharmaceutical companies to mega-conglomerate hospitals – richer? Can you think of a better use for that money? Is anything other than reasonable cost containment remotely sustainable?
I’m Peter Dekom, and I harken back to one definition of insanity, one that seems to define American healthcare, of repeating the same behavior and expecting a different result.
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