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My brother is a doctor. I work in a university hospital in medical informatics and I'm friends with literally dozens of doctors across a spectrum of specialties. Every single one of them will put obesity at the top of the "what's wrong with healthcare/the population/people" list.

Just stop being fat.

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Successful "healthcare service providers", not obesity is what is making healthcare expensive. Ask a Porsche salesman who his clients are.

Obesity doesn't explain a $800 knee MRI or $4K ambulance ride. A californian hospital billed us at $3.7 per second for a broken wrist.

Your brother, not fat people, is making healthcare expensive. This is so freaking obvious I'm starting to veer into conspiracy theories territory failing to explain this craziness: they'll start suspecting "mongolians and puerto-ricans" as factors before they'll notice this enormous elephant in the room. Every US city has a neighborhood where "doctors live". It's sickening.

Also, ask your brother what he thinks. I have a few friends in healthcare and they're very open about it (it's hard to deny if you know their lifestyles)

Obesity (or, possibly better put, the behaviors that lead to obesity) is what makes (many) people sick.

Cost is explained by a great variety of factors, some of which you have identified, but many of which are much more subtle.

Doctors should cost a lot. They undergo almost a decade of (debt-incurring) training to provide extremely valuable services, often at absurd hours. You ever hear of being "on-call?" Anybody that works ER shifts doesn't have a job -- they have a life in medicine. So you're going to have to work hard to convince me doctors should be paid less. We're already facing a downturn in the number of people entering the medical career (to the extent that nurses are now being trained to handle more of the job -- good in some ways, but difficult in others).

Regarding other facets of healthcare costs, some kinds of medicine and equipment are just flat-out expensive. Figuring out what costs are largesse and what costs are justified is tough, and made somewhat more difficult by distortions to the market by insurance and medicare. I'm not saying insurance or medicare are not the best solution (I don't really know) but I do know it affects the market pricing mechanisms.

Cost-controlling is a huge topic in the healthcare industry right now. Nobody disagrees that the costs are too high, but some things are worth paying for more than others. I think there are other places to look before the docs.

That's because the supply of doctors is kept artificially low and the cost of training is not borne out by society. There are other countries in the world, you know. You can just look at what they do.

Your entire answer is basically what TV tells you to think of doctors after watching numerous sitcoms about them. Doctors exist in other countries, they manage to learn the same amount and some are apparently better than their US counterparts [1]

Moreover, I said "heathcare providers", not "doctors". Every piece of medical equipment, from an artificial joint to a scalpel, goes through a lengthy list of middlemen each making a healthy margin.

Walk into the oncology clinic (the same ones who accept donations from various "X to cure cancer!" events) and take a look at price of the hardwood they put in. That's your "cure cancer" money and it has nothing to do with "doctors should cost a lot".

Healthcare lobbyists is the problem, but I'm just pointing out the easiest signs everyone can see. It's not rocket science: if you think obesity is the problem, look at the cost of giving birth. If you think insurance companies are the problem, try to get an MRI independently. If you think cost of education is the problem, look at the degree a jet-owning medical equipment salesman holds.

[1] http://en.wikipedia.org/wiki/World_Health_Organization_ranki...

I assumed you meant doctors because you singled out sicular's brother (a doctor) for making healthcare expensive. You also called the overall wealth of doctors (not equipment middlemen) sickening. To your overall point, I agreed that costs are a problem and that there are some parties that extract more than they contribute ("largesse"). My point is just that we need to be very precise in evaluating which costs can be cut.

Also, don't assume anything about my experience with healthcare-- because you're wrong. I'm not sure why you'd swing wild with that remark anyway.

Dean Baker has been making an argument similar to yours for years. He usually presents it as a free trade vs. protectionism issue, which is an interesting way to think about health care costs:

http://www.theguardian.com/commentisfree/2013/nov/11/support...

This is the same as blaming obese people for the rising costs of healthcare. The reason why hospitals and doctors can charge what they do is because they are not directly dealing with the consumers of health care services, but with third parties (insurance companies &/or government agencies.)

Furthermore, health insurance is used as payment system as opposed to insurance. Adding layers of bureaucracy to a system serves to only inflate the cost of that system.

There is a confluence of factors involved in why the system is the way it is. It is not simply obese people or doctors who are at fault here.

The system is expensive for a lot of reasons, but placing the blame on doctors or obese people seems absurd to me.

It's extremely expensive to go through the medical education process in the united states (both in terms of time and money). Columbia medical school is over 70k/year and they offer no financial aid. For some specialties that's 4 years undergrad, 4 years med school, 4 years residency and 3 years fellowship with some extreme hours and lower pay before you actually begin work.

The higher incomes some specialties have are in response to the cost of education and the cost of time (basically your entire twenties). Without this only the obscenely wealthy would be able to even consider medical school since the up front cost would make it prohibitively expensive (it's already bad currently).

The American health care system is complex - as is the reason for its extreme listed prices (insurance companies don't actually pay what's billed). I don't think it's valuable to draw strong conclusions/blame based on a dramatic oversimplification of it.

$3.70 per second is 222 per hour. In a world where a freelance Javascript developer can bill 125 or more per hour, that doesn't seem too unreasonable for doctor plus nurse plus office overhead plus materials. In fact it seems cheap. My daughter just broke her wrist and I paid the bill. 3.70 per second is ballpark what I paid as well. I feel the pain, but yes it was worth it.

EDIT: oops, bad math. But 3.70 per minute is closer to the actual cost I paid. I can't say exactly because I didn't have a stopwatch going.

>$3.70 per second is 222 per hour.

$3.70 per minute is $222 per hour. $3.70 per second is $13320 per hour.

$3.70 per second is $13320 per hour.

I'll borrow from a separate reply. When you dedicate 14 years of your life and are hundreds of thousands in the hole when you're finally able to earn feel free to talk about how you get paid too much.

What I know is that when I'm sick and/or injured I want a well paid doctor who has spent 14 years in training taking care of me.

The reason your ambulance ride was 4k is because anybody who is even remotely able to pay subsidizes everyone who doesn't. Healthcare is systematically broken in this regard, here in the US because there is no universal coverage. Not because there are neighborhoods where doctors live.

Your gripe is with the ever increasing administrative burden on doctors and the burgeoning bureaucracy. Doctors and other healthcare professionals are worth every penny.

Actually, what's sickening is ingrates like you who begrudge experts their due.

> The reason your ambulance ride was 4k is because

Also, ambulances are expensive vehicles crammed full of expensive technology and two expensive well trained staff.

When you're lying on the asphalt in a pool of blood you don't want any old flatbed with a couple of burly blokes turning up. Sure, they can heave you onto the back of the van and get you to ER quickly, but will you still be alive when you get there?

(Having said that, $4k seems expensive. Average UK ambulance cost is a couple of hundred pounds)

Agreed the main issue is with the system being broken, but the professionals are a part and driving factor of that issue and also deserve at least some of the blame.

Many careers cost a great deal of time and money to get into (the cost of schooling is a huge issue, but a totally different discussion). Most of those careers make no where near the same sorts of salaries as MDs expect to make. The sciences in general have all of the same issues you mention. Doctors make obscene salaries in our current society (though not necessarily historically). It is disingenuous to say that doctors "deserve" these sorts of salaries. Doctors in other countries do not make the same sort of inflated salaries as US Docs. [0]

Again, while I agree that the system in general is broken, it is not sickening to point out that doctor's make obscene salaries.

[0] http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-...

Nobody cares how hard doctors think they work.

Goods are priced based on their value to the consumer, not based on their cost to the manufacturer.

I don't know how health care is priced, but the idea I should internalize sympathy for the education burden on a doctor into the cost of my bill is asinine.

MRI radiographer here. Obese people take longer to scan, require bigger and stronger equipment and more (and better trained) staff. Fat saturated sequences - the workhorses of knee imaging but also a key part of all MRI work less well, require repeats etc. All this is long hand for saying, obesity makes things harder and take longer. Do we bill fat people more? No, we make all booking a bit longer, so that when we run late, we can catch up or even get ahead. The $ billed per hour falls - so presumably the charge per scan rises to cover this. I don't set the charges, I do make the invoice.

It's things like this that really make you think; I am no sort of medical professional, but you have to wonder how many hidden costs are due to obesity, and not just for procedures. Sure, losing weight won't cure someone's allergies or cancer, but I'd be curious to see the correlated incidence rates, and I know I stay healthier in "completely unrelated" ways when I weigh less and get regular exercise.

I don't know what the literature says, but someone who is very big gets a lower quality scan, which surely correlates with greater miss rates with imaging reports (slices have larger voxel due to thicker slices, larger slice gap, lower image matrix etc). We resort to more robust imaging types which tend to have problems of their own (lower resolution usually). Then further down the track, operations are more complex and recovery slower. It's all bad.

> Just stop being fat.

Unfortunately, as we learn more about obesity, it's becoming increasingly clear that once you are fat, it is very difficult to ever lose the weight and keep it off for a significant amount of time[1].

I don't know what the solution is, but being overweight, especially "on the way up" is something that should be taken much more seriously.

1. http://www.nytimes.com/2011/10/27/health/biological-changes-...

It may seem distasteful in some ways, but stomach-stapling is a fairly effective solution to consider for the morbidly obese. If you've not heard of this (a gastric bypass) I recommend googling. It's not the end solution, but boy does it work.

It's a solution that does work, but it seems to me like a last resort and also a solution that doesn't scale very well. 35.9% of the US population over age 20 is obese[1].

1. http://www.cdc.gov/nchs/fastats/overwt.htm

I know a few obese people and they require almost an ongoing medical attention. Starting from diabetes and on to various complications with deteriorating prospects. They can't participate in many activities feeling alienated or wear trendy clothes their like - which adds to emotional stress and psychological issues on top of it.

But really, it's quite easy to stay fit, if you want it. First thing you do is eat less (can't emphasize it enough). Second, eat home food and cut all the junk. And lastly, stay active: bike, swim, hike, whatever. No need for fancy diet programs.

Any of them work in ER? What about alcohol or mental health?

EDIT (after question was answered) I do agree that obesity is the leading problem with healthcare! I'm just curious about the problems of alcohol or MH in emergency care settings. They're significant in the UK.

ER, Neuro, OB, Radiology, Psych, GI, Cardio, Optho, Family, Peds, Nursing. I'm sure I'm skipping a few.

Honestly, obesity is a root cause for so many preventable illnesses. All it takes is moderate diet and exercise and you'll be set.

Every single one of them will put obesity at the top of the "what's wrong with healthcare

(1) Have you actually asked them? (2) So you're saying that they'll blame someone else, rather than blame their own bureaucracy and inflated salaries.

1. Yes. Obesity as a problem comes up often when talking candidly with doctors.

2. I can agree with you on the bureaucracy thing but when you get sick you're gonna want the best doctors working on you. I don't begrudge doctors a single penny they honorably and legitimately earn. 14 years of school and hundreds of thousands in debt? Ya, you do that and get back to me.

I don't begrudge doctors a single penny they honorably and legitimately earn.

Your answer begs the question. Also, US doctors earn a higher multiple of the average salary than doctors in other Western countries do, while not providing measurably better patient outcomes.

Have you seen the profiles of Congresspeople lately?

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