Warning: long post with actual facts.
Here's what we know:
1)
Americans spend 50% more per capita than the next highest country.2)
The US lead's "developed nations" in medical error rate.3)
The US is 50th in the World in life expectancy.4)
The US is 46th in the world for infant mortality.
We have THE MOST expensive system in the world with the highest error rate rendering among the worst results in the developed world. How is that an acceptable system? Will the government do better as a single payer? Probably not, but at least admit the above is NOT acceptable.
Now lets bust some myths:
1) Malpractice suits are responsible driving up the cost of health care.
The United States spends about $2,500,000,000,000.00 ($2.5 TRILLION dollars) a year on health care. In a given year about 14,000 payments are made on judgments or to settle malpractice claims, totaling approximately
$3.7 Billion. Or about 0.1% of the United States health care expenditures. (Kaiser Family Foundation numbers)
0.1%? Really? We are supposed to believe that the .1% is the driving force behind out health care cost crisis. I don't care if you argue twice, three times, or ten times that amount is spent to defend the suits - it still doesn't equal a meaningful portion of medical expenses in this country. Yet listening to the debate you'd think this is among the driving forces.
To say that again, insurance payouts for medical malpractice total 0.1% of total medical expenses in the United States.2) Pharmaceutical costs are driving our expenses.
The cost of drugs represented
8.5% of our total expenses in 2006. That is a lot and much of it was on "penis pills" and other non-essential medication. But certainly essential medications like HIV drugs, cancer drugs, and other required pharmaceuticals are very expenses.
However, at 8.5% of total expenditures it seems unlikely that such costs are the primary driver of medical costs.
3) Physicians are impoverished.
Medical doctors are represent
22% of all medical expenses, or about $550,000,000,000.00 ($550 Billion) per year.
The average MD makes $170,000.
For medical malpractice insurance the average MD pays just over 10% of wages for malpractice insurance (as low as 6% for family practice as high as 20% for anesthesiologists, also 5% of MDs are responsible for 54% of claims). That's a ton of money, but that leaves the average MD taking home $151,300 a year after insurance premiums, or 4.5 times the wage of the average patient.
Extrapolating those numbers out it leads to $55,000,000,000 a year in malpractice insurance, of which $3.7 Billion ends up in the hands of victims of medical malpractice (and their attorneys). Incidentally, Med Mal insurance is usually the most profitable division of an insurance company and Med Mal defense is among the most profitable practices of law. The insurance companies and defense firms are getting a TON more money (about 1200% more) than victims or Plaintiff's counsel. I'm not demonizing this division of wealth, but questioning why Med Mal plaintiffs are seen as the cost drivers when they end up with less than 10% of the pot.
Doctors have worked very hard to get into a good college. They compete strongly to get into medical school. Then they work for a decent wage for a few more years before they make "the big bucks." At which point they can pay off their school debts. They earn their money, but to pretend that they are somehow suffering financial difficulties when they make more than 4 fold the average wage earner is misleading.
Note: this is NOT an argument that MDs should earn less. But MDs salary constitutes 22% of the expense and malpractice payouts constitute 0.1% of the cost. Listening to the debate passively one would get the opposite impression.
As a side note, the AMA lobbied the government to pay medical colleges NOT to accept students in order to reduce the number of medical doctors in the 1990's. The feds agreed and dolled out tens of millions of dollars to medical colleges to reduce the supply of doctors. Predictably, the number of doctors dropped, competition among doctors was eliminated, prices went up, and quality (as measure by errors) went down.
Why are medical doctors the only field in which "qualified" doesn't mean qualified? A combination of politics, economics, and traditions determines how many medical doctors this country will produce and how many we will import - always insuring a shortage of Medical Doctors. Demand isn't a primary factor in the equation and competition is capped at the front end.
We have a system in which you need to have a man who makes $160,000 a year sign off on a piece of paper that your penis can't get hard in order for you to get a pill. Now, the nurse (if anyone) will be the one to look at your penis. To take down all your information and to do any other checks. Many MDs will come in for 40 seconds and chat, sign off and leave (not blaming them, in many instances their time is wasted on such things and they act more as a medical supervisor). It's a waste of resources when that MD could be doing something that utilizes and challenges his medical knowledge.
Then we have a system that highlights a division of labor. A patient typically has many doctors if something is actually wrong. It is amazingly difficult for a person, even a doctor, to keep track of that much information and do their job well. There are times when a specialist is needed for damn sure - but often a good GP will have more complete knowledge of the patient. But when a specialist can earn an extra $100,000 a year, GPs are fewer and fewer.
Add to that an insurance system that has, for some reason, become synonymous with "I don't have to pay my medical bills." It usually doesn't reward healthy lifestyles or annual checkups. It doesn't punish frivolous use most of the time. And with the employer pay system the cost is a sunk cost that Americans never see (hence: it doesn't exist). Unless you don't have insurance, then your screwed. Why not have a system with a 25% or even 50% copay for items less than $200 and major medical coverage with a 10% copay up to $10,000 and a 1% copay over that? Add an incentive for an annual (or every other year, or whatever is appropriate at your age/health). Add incentives for reaching certain health guidelines (weight, BP, cholesterol) by giving discounts just like car insurance (no tickets = good risk. Not obese = good risk). You know - encourage people financially to be healthier or pay the price.
Which brings us to the root cause: Americans are lazy. We are too lazy to be healthy. We are too lazy to pay attention to our health insurance cost (as long as the cost is/was hidden, we're fine). And our leaders are too lazy to actually address real problems.
Bah!
/frustration
