I got a bill in the mail today for a doctor’s visit. Nothing wrong with the bill, and the cost is low; in line with nice lunch out. Except… that doctor visit was last September. It took 10 months for a routine urgent care visit to work its way from the provider to me.
I couldn’t help but think of all the potential issues and arguments between the provider and insurance that may have caused a 10 month hold up in sending me a bill. And with those, the added costs of dealing with my particular case. Then for visits that aren’t so clear cut, and have orders of magnitude more back and forth. Then for the added accounting costs of tracking and holding on to liabilities for an extended period of time. I thought about how much we’re spending in wasted man hours for what could be a much simpler process.
This is why I hate when people try to argue that if we have single payer the government will waste so much money. They always argue that “government programs are wasteful”. Compared to our current medical system, it’s not even close. There is no way that our existing shitty system is any better than a single payer one.
Changed their minds. I’d like to say this is because the administration realized how disruptive this would be for a whole lot of people, but that’s never stopped them before. More likely, they got a lot of angry calls from deep-pocketed insurance company executives about upcoming campaign donations.
Just like the explosion in costs in the higher education sector, a large part of the explosion in healthcare costs come from a huge increase over the last 30 years in the administration costs faced by providers. Over half the cost of your average doctor or hospital visit is administrative in nature, and for all that money being spent, they still suck at it. You are 100% correct, the system is broken and only a ground-up restructuring will fix it.
Personal anecdote about ridiculous healthcare costs/waste: My daughter recent hurt her foot playing volleyball. We took her to the orthopaedic doctor near us, very well regarded practice in town and highly recommended. They were fantastic, the doctor spoke directly to my daughter, asked her questions not just about how and where it hurt, but how she moves when she plays volleyball and other inquires designed to figure out how the injury happened and prevent it from reoccurring. They took an x-ray, and diagnosed a “stress reaction”, which is the beginning of a stress fracture only without an actual crack on the bone. Treatment was to put her foot into a boot for 4 weeks, rest and light physical therapy, with a follow up appointment after the 4 weeks to make sure all was well.
It was, and she finished out the season with no pain. When the bills came, I thought the office visits and x-ray were reasonable. Then I saw the cost for the boot (which is a simple plastic and Velcro strap contraption with an air bladder and pump to get it to fit snugly). The doctor’s office charged me $400 for the boot…essentially doubling the cost of the entire rest of the bill. My insurance company knocked that down to $175 as what they would allow. Since I have an HDHC that $175 was also my cost. Out of curiosity I took the manufacturer and model number off the bottom of the boot and Googled it.
$120, retail, shipped free to my house, from multiple healthcare supply companies. If I can buy that boot for $120 retail, you can be damn sure the ortho place gets them for under $100 a pop. Then they mark them up to $400, and wait to see what insurance (assuming you have it) will actually pay or tell the patient to pay. When I called them to confront them on the price disparity, they told me that they cannot adjust the cost because my insurance company had already done so and applied the $175 to my deductible. In the end I paid the full bill despite being pissed about the price of the boot and justified it as the price paid for the excellent service and care given to my daughter…but it still illustrates what’s fundamentally wrong with American healthcare. If they’re marking up stupid plastic boots by 300%, imagine that multiplied out by all the medical costs across the country every single day…
Check a hospital bill for what they charge for aspirin or other disposable items required for your stay. The costs of “overhead” are added to everything.
As for the cost of the boot, I would imagine your doctor probably had no idea of the cost he charged or how much it cost online.
Would medicare for all actually be removing all of the premiums, deductibles, and co-pays?
I mean, under the current medicare system, you still have to pay that stuff.
It references “Bernie Sanders most recent Medicare-for-All proposal” but I’m not sure of the details of that one.
Also, co-pays etc. are part of the total cost so that $2 trillion savings is probably the reduced costs after applying the Medicare Fee Schedule to all medical treatment. So there would be a loser in this proposal: medical providers, but I think the upsides of the proposal outweigh the negatives by a big margin.
We tend to get lost focusing on universal health care, but health price reform is a necessary part of any sustainable long term health solution in the US. One advantage of all almost all of the many “Medicare-for-all” proposals (and there are lots of variations) is that they almost all extend the Medicare Fee Schedule to all or most treatment.
There is a caveat to that, which is that the Medicare Fee Schedule is basically only as good as the Congress that writes the laws. For example, for many years, Congress kept writing a yearly “doc fix” into Medicare to allow doctors to get paid more than the schedule, to serve their slave-masters in the medical provider lobby. Also, when the drug benefit was added to Medicare, Congress restricted Medicare’s ability to negotiate the lowest possible price such that Medicare does not get as good a deal on drugs as it does on other forms of treatment.
In the long run, to make any Medicare for All or any Medicare-adjacent proposal work, you need a Congress that is not going to slavishly give money away to the provider lobby.
In our current political economy, that is the Achilles Heel of all single payer or single-payer adjacent proposals. But it’s still better than the current system, which is of course still subject to lobbying and exploitation.
Back of napkin calculations say that a $2 trillion savings over 10 years comes out to about $600 a year for every man, woman and child in the United States. For people already using the system it’s probably more than that in savings, because these numbers represent a healthcare cost spread out among the entire population, including millions of currently uninsured people. I know it’s not really that simple, but imagine our economic growth if we injected $2400 back into the budget of a family of 4 every year for 10 years through reduced healthcare costs.
@Sharpe is also correct in that for Medicare for All to be workable, we would need to have a dramatic overhaul of healthcare costs and pricing, bringing everything back in line with realistic costs (no more $25 hospital Tylenols) and uniform pricing and payment for services. This will never happen in our current U.S. political climate because the lobbyists for the various aspects of the healthcare industry own Washington. We’ve let it fester to the point where healthcare is such an enormous part of our national economy that fucking with it would cause reverberations across the entire economy in general. Taking apart the private insurance and healthcare industries and putting them back together as some sort of state regulated entity is not going to happen easily, quickly or quietly.
I could spend hours spinning out the horseshit my wife and I have had to deal with in health care. Incorrect billings, “gotcha” charges foisted on us after literally hours spent researching in advance whether a particular treatment is covered or not, phone calls with clueless insurance company reps, phone calls with clueless doctor’s office employees, endless interoffice miscommunication, a years-long bureaucratic kerfuffle over whether and to what extent we are covered by MediCal (which we adamantly have not wanted).
And, needless to say, through all of this we have payed a significant portion of our income, anywhere from 12-20% depending on circumstances, on premiums for high quality policies.
Our system’s a fucking mess. And it won’t get fixed because our politics is broken.
I’m 57 and healthy. So is my spouse. If I could buy Medicare, the premium would be about $270 per month(assuming coverage for me and spouse). If I buy private health insurance instead, the premium for the 2 of us is $800 per month, and that leaves me with $26,000 in deductible I have to pay every year before any coverage kicks in.
So, I’d happily buy Medicare tomorrow. I imagine there are millions of people who would.
Where is that $270/month figure coming from? The total cost of Medicare per person is much higher than that (around $800/month/person) but that’s for over 65 folks. At age 57 you would probably be a bit less than $800/month/person - probably $600-ish per person. But your $270/month figure for two people is $135/month/person and although I do support Medicare for All proposals, that $135 figure sounds way too low to me, by about a factor of 4.
The Medicare Part B premium for 2018 is $134 per person. Drug coverage would add another $15 per person, more or less. I’m not telling you what I think I’d pay under Medicare-for-all proposals, because I have no fucking idea. I’m telling you what I’d pay if I were elegible for Medicare now. Of course it would be more. But if Medicare for all costs people $800 per month per person, it’s going nowhere as a policy proposal.
Yes, including the cost paid by the government. The personal share is much less than that, depending on the donut hole and co-pays and so on but the total cost is a bit over $10K/yr.
