Straight up exploitation of people during their most vulnerable moments.
When people are totally removed from the cost, people aren't being exploited. Removing people from the cost increases the cost.
> which happened from union demands
Explain????
And with all that we have a shortage of doctors in the US.
So, supply, demand, cost, working lifetime to make up those costs, hours, volume of paperwork to deal with insurance, even more for Medicaid, malpractice insurance and now the shift to EMR.
Doctors pay is the most justified thing in the medical industry. Until we have an excess supply of doctors that isn't going to change.
The other costs in medical are where the story really is.
> Explain????
Company provided health care became a standard thing from union demands years ago. Never allowing individuals to tax deduct insurance costs removed insurance from the consumer market, purchased for millions of people without any choice from the employees about who provides it and this became the primary mechanism for paying for health care.
Individuals are 2 steps removed from the costs of care, so what do they care if a hospital stay cost $30,000 if $29,000 is covered?
That's how your costs rise. Medical costs haven't been even remotely participating in the free market for decades.
> The Birth of Employer-Provided Health Insurance
During World War II, the federal government was wary of post-war inflation. The administration saw the terrible devastation hyperinflation wreaked on post-World War I Germany and they were determined to hold it at bay through wage and price controls which they instituted during the war. In reaction to the wage controls, many labor groups planned to go on strike en masse. In order to avert the strike, in a concession to the labor groups, the War Labor Board exempted employer-paid health benefits from wage controls and income tax. https://www.zanebenefits.com/blog/part-1-the-history-of-u.s....
> Company provided health care became a standard thing from union demands years ago.
I have heard that for years and I can't see anything that wasn't really the Federal Government's plan to stop all wage increases. Yes the Unions got mad and were going to strike but that was because the federal government was going to freeze all wages. Hardly a Union fault.
How is this interpreted?
The "number of years" argument doesn't explain it. For most doctors, it is comparable to someone doing a PhD - maybe a year or two longer on average. PhD's don't get paid anywhere near the amount doctors do.
Granted there are specialities like dermatology that derive their compensation more from severely limiting the size of the specialty training programs, and the work itself is not as stressful as I'm claiming doctors in general have to bear.
All this said, yes of course they're all overpaid. But the way we got here makes perfect sense, and if we're going to change it there must be a new way to aid them that is just as impactful.
Knowing several doctors, it is not that hard to explain.
And frankly, most of your answer is merely a reflection of the status quo, but not why that status quo exists.
Look at most developed countries and I wager you'll see less stress in becoming a doctor. Are they providing lower quality of service than US doctors?
And not all doctors work highly stressful jobs. All the PCP's I've had had a comparatively relaxed lifestyle compared to people like surgeons. Sure, they get paid less, but still get paid a lot. In my company I know plenty of engineers who work longer hours with greater stress (roughly 10-12 hour days and then being on call on top of that - PCP's are usually not on call). Their pay is a lot lower than that of a PCP.
I'm not saying they don't deserve to get paid a lot. Just that the "number of years of training" is not a good justification for it.
Having a shortage of doctors is most consistent with insufficient reward to attract more entrants.
Similarly that that the mechanics of surgery aren't considered a manual skill practicable in a largely assembly line fashion.
Apparently, everyone gets artisanal health care, regardless of the level of complication (or not) of their condition.
Nothing wrong with doctors at all, but curious that this field above all others is so resistant to the methods of industry which have worked so well to reduce costs in every other field.
If a school opened up with the goal of training people to diagnose and treat cold and flu symptoms, so that the graduates could diagnose those symptoms and their severity, then recommend a course of care or call in a prescription...here are the potential barriers.
1. Insurance companies wouldn't pay for it at all because those graduates would lack any type of professional credentials.
2. Those graduates wouldn't actually be allowed to call in prescriptions, also due to lack of credentials.
3. Getting credentials approval would require a lot of money to push things through the process, if at all. Then the school would have to be setup in an effort to recoup those costs. The school would be setup with the goal of making money most likely and everything else in the process would have to happen before the school even became feasible.
Assuming all of those things happen, then insurance companies would largely decide whether or not to even pay for those services and people who had companies that wouldn't...would not likely go to those providers. If they did pay for them and the pay was too low to justify the time commitment of dealing with the insurance companies, additional costs would be involved in terms of staff to deal with billing and followup. (Insurance companies often deny on first request, requiring rebilling).
When it comes to cash flow, insurance changes at the beginning of every year can cause payments to be delayed for up to 3 months which becomes a huge problem for office leases and payroll. Between all that if the compensation isn't high enough, it disincentives people to go into the field at all.
The alternative is pure private pay and allowing individuals to decide, this care is good enough for me. Which would require signing something indemnifying the practitioner from legal recourse since they wouldn't be able to get malpractice insurance. If that care costs more than the co-pay at their regular doctor...they will have no reason to choose it. And even with private pay, those same practitioners still wouldn't be able to call in prescriptions.
That is the industry that has been created by removing health care from the free market.
More movement in that direction could lower health care costs, or at least improve utilization.
Also, improved outcomes (due to fewer errors) also improve costs, as patients won't have to come back due to complications as often.
Because biology is complicated.
And increasingly, first contact will not be with an MD or DO (there's several paths, nurse practitioners, physicians assistants, etc).
However, your statement about the doctor shortage. For some cases, like PCPs it is due precisely because they dot get paid nearly as Wells's you intimate. OTOH in general the supply of doctors across the board is carefully metered my the medical community. We could easily turn that dial up if we wished. They don't like that for various reasons, including watering down their pay.
If patients are looking for open heart surgery, brain surgery, or something else that's life-and-death? It's amazing how quickly people start looking for "one of the best surgeons in our state." And I don't blame them! If somebody is going to saw open your skull and stick a scalpel in your brain, you want the medical equivalent of a respected senior Google engineer, and not a fly-by-night outsourced IT subcontractor.
Similar issues apply with rare or weird medical conditions. In these cases, front-line doctors might see a condition once in their career. But there's a specialist somewhere that deals with those conditions all day long. If you ask your regular physician to try to diagnose something weird, you may wind up getting expensive tests like an MRI, whereas a specialist might instantly recognize that an MRI is useless.
Law, politics, and economics are hard, and they sometimes involve considering multiple factors. We shouldn't allow ourselves to be goaded into an unprincipled anti-intellectual stance by people trying to expedite their own solution.
Everyone agrees that the economics of health care in the US are bad. I don't know anyone who is happy with this state of affairs. Everyone feels like the other parties are out to screw them. Docs feel that they get fleeced by facilities and insurers, insurers feel that they get fleeced by beneficiaries and providers, etc. I had a medical device manufacturer as a client for a while and they too felt that the industry was unfair to them and that they had to set high prices to try to survive.
With so many people in the U.S. receiving their care on differing bases, it's hard to really get a single, strongly-motivated group to coalesce and push some real change through. Every employer negotiates their own contracts; some are good and some are bad, depending on how much your employer cares about benefits and such. Some people have state-provided care through Medicare or Medicaid. Others have to pay private (which is where things get really bad).
With everyone's experiences on such a deeply personal issue differing so widely, unification is difficult. Mix in a little political brou-ha-ha and it becomes nearly impossible. I'm sure that fracturing is part of the game by the insidious elements that lie underneath the covers, but it is a reality we must recognize and address legitimately.
On top of that, medicine is one of the largest industries in the U.S., and changes to that structure threaten to disrupt the employment of many people. There is no surer way to get a political position dismantled (and its elected purveyors destroyed in the next election cycle) than to threaten the livelihoods of a meaningful portion of the constituency.
Changes to the regulatory structures impacting all of this should be carefully considered, and I would hope that we at least run them through the "intellectual paces", as it were. Let's not jump on each other's backs with silly accusations for not acquiescing quickly enough.
In healthcare, though, how much people are willing to pay for a product is anything, if it's the one thing they need to stay alive, or to reduce chronic pain, etc.
The problem with healthcare is the opposite: there is no free market and it's impossible to compete without huge investment and even then it's sometimes still impossible (patents, long approval periods etc.).
The problem is for sure not simple but a lot of basic healthcare services could be a lot cheaper if it was easier to get in.
2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage can count here.)
To the extent that (1) is a small number, this question is a non sequitor. To the extent that (2) is large, even that small number is further mitigated.
There are lots of arguments about why it might be better to structure health care as a centrally-planned activity instead of a market-based activity. This isn't one of the good ones.
If just you're counting all issues it's obviously quite few. If you're weighting by potential costs then it's very high. Basically the more expensive and necessary a procedure is the less chance you have to shop around.
If I was to break down the costs of all medical procedures I've had over the past 30 years I'd say that almost all of it would be taken up by a single series of emergency surgeries.
Doctors don't know prices. Typically, front-office staff won't know prices until they've talked to your insurance company. It's probably not possible to get prices from your insurance company except in the context of a very specific claim, which can only come from the doctor's office or hospital's office staff. A small difference in coding for the same issue/procedure can result in huge cost differences.
It might be possible to shop around for prices on particular surgical procedures (eg), but only after you've paid an unpredictable amount for diagnosis. And you may have to pay twice for diagnosis to make this possible.
Maybe the thing to do is to start treating insurance-hospital networks that do not disclose pricing as collusion. It certainly makes no sense to me that our system has individual patients having adversarial dealings with 2 huge institutions every time they need care.
100%, in theory at least.
See I'm vaguely poor--18421 before taxes last year, currently about 5000 before taxes this year--which means I can't afford to go see a doctor because "I'm not sure but I think this is more than a sprain", "that's weird this lymph node has just swollen to thrice it's normal size over night" or "hmm this is definitely infected"[1]. In fact anything that isn't 0-copay, which isn't much because I can't afford swanky insurance, is basically out of reach. ALSO because I'm 31 and spent my adult life insurance-less I have almost literally no idea how to even get myself care if I could afford it (I mean what do you just throw a dart at a phone book? walk into a hospital and keep asking nurses questions?)
As a result any[2] health care I receive is going to be a result of some one else calling an ambulance for me. Which will leave me in exactly no state to be comparison shopping.
[1]true stories
[2]well I did manage to get on some anti depressents and counseling last year by crying at the good people at my student health center for an hour or so, only after some one pointed out that generics for chronic conditions are covered by my insurance (a fact which does not actually appear in the policy packet but is only mentioned in small print on a PDF comparing the different plans) and the first month of counseling being covered by my student activity fees.
Healthcare costs across the board - except in unregulated, uninsured spheres like plastic surgery, lasik, etc. - are extraordinarily high.
Therefore a free market system is feasible for everything else. Not that it's what we currently have as you point out.
Do you think (or the average person) knows enough to shop around? This stuff is complicated! I'm not sure I could make a rational decision between treatments that have different prices, but also different likelihoods of success, side effect profiles, and all that. This is even more complicated when you're paying for a diagnosis too, rather than just a treatment.
Lasik and plastic surgery are interesting because they're essentially commodities and the patient can easily evaluate the results themselves.
Do I think that education surrounding general health has diminished. I feel very strongly about this. There should not be as large of a chasm between my knowledge or ability to diagnose (i.e. is something serious enough to go to the doctor for) and the knowledge of a doctor/PA etc.
But yes, the average person deals with market economics every day and they're certainly smart enough to make decisions there.
> Lasik and plastic surgery
So are office visits, annuals, screenings, minor procedures (think stitches to Tonsillectomy). I.e. the bulk of medical service.
Every other developed nation has less of a free market in health care than the United States, and every other developed nation seems to do better on this front than the United States does.
It could well be that you're right, but the examples of other nations make this an extraordinary claim requiring extraordinary evidence.
Or we could just stop experimenting on our vulnerable populace and just choose a system that works better and adopt that. It may not be perfect, but perfect is the enemy of the good.
Generally what you're referring to is government run healthcare. This isn't "less" free market, it is no free market, (at least for the non-rich). So it's in a different realm.
I can agree that this like infant mortality is much better in a lot of countries. But this doesn't change the the U.S. pretends to have a "market" for medical services when the prices aren't set by government but only by providers and insurance companies. The people who are required to make free markets work, the consumers, have very little power in negotiation. Hence, it's not a free market.
Apples, oranges.
But the free market that we should have will likely never exist given political pressure. Single payer it is.
Nope. It's not government run in a number of those countries. Although I do not mean to include them in my comment, but even Canada's health care industry is not government run.
And Canada does on a large scale what Medicare does in the U.S. it is a single point of negotiation. This may be good or bad depending on how well medicare is run.
Many are saying that medicare should just be expanded to cover all people, prices should go down.
No, it's not; this is evident from all the other countries without free markets in healthcare that provide universal access and equal or better overall outcomes and far less cost (per capita, and even as a share of GDP) than the US, without anything more of a “free market”.
We're just kind of stuck in a local maximum in a poor area of the search space. In order to see a much better maximum, we'd have to move to an entirely different area of the search space.
Being intended for use on or inside a human body, we have higher expectations in quality and consistency. Unfortunately, these certifications can make the barrier to entry too high for good competition. Or they're locked into a supplier for whatever reason.
No; a free market has been _proved_ to be good at providing healthcare in the US. What you folks have now is an utterly corrupt cartel.
Any elective procedure. If I want to get laser eye surgery done, the price has dropped to 1/10th of what it was when the procedure first debuted. Likewise for common plastic surgeries.
Dental care is also interesting, there is actual competition for many cosmetic procedures, although there is of course a price floor, Dentists compete based on reputation and presentations of previous quality work to justify higher prices.
Same thing for eye glasses. Eye glasses range from $50 to $500, insurance distorts this a little bit, but the market is generally quite competitive. If you want hand made frames from a local artists, they are as available as $50 mass produced frames. Likewise many lens materials exist, from $20 plastic lens all the way up to $300+ fancy coated materials with some really cool properties (oleophobic lens coatings!).
There is also an interesting market for customer requested lab work. If I want to get basic blood work done, I can walk into clinics that specialize in it and request blood work for a fraction of the price my doctor can order it at!
Finally DNA testing is another example where an incredibly complex technological process can now be, quite literally, ordered off of Amazon, and mailed off to a processing center.
Meanwhile if I break a toe, I get a giant rubber flat sandal from the doctor that is billed at $200, that same boot can be ordered online for under $30!
Naturally, it's sold to the public as 'safety' or other BS.
Negotiation is easier when you have some time to negotiate. Most do.