So why do you think health insurance in America costs so much?

[Skwmom]

Don't you think insurance companies needing to recoup investment losses has something to do with it?

[spindrifter]

1. Well, a lot of the cost is b.s.--have you ever received a

bill from the dentist that has a discounted price because you don't have dental insurance or because the dental insurance you do have doesn't cover as much as the "preferred" dental insurances? That has always bugged me. I don't think it has a thing to do w/ recouping investment losses.

[Skwmom]

8. So how do you think they recoup those investment losses?

Hmmm... maybe by raising insurance premiums? Oh no, they'd never do that. :sarcasm:

[dflprincess]

2. It could be that

it could also be that they're greedy and will never have enough.

But don't worry, we can trust them to be part of the solution. :sarcasm:

[cutlassmama]

4. You're right. It's greed. Pure and simple.

They hire lobbyists for Congress and they pay people to "deny" claims all day. Then they pocket millions or billions. It's greed at the expense of people's lives.

[FormerDittoHead]

39. Exactly. They will charge us what we're willing to pay and just under what we'd reject.

They charge us just as much as they can to prevent a core number of people from taking the risk onto themselves and march on DC and demand single payer.

They PAY (to hospitals, doctors, etc) just enough for them not to reject the insurance coverage.

It's just that simple. That's how they will CONTINUE to operate that way.

The only freedom of "choice" that exists in the "market" is "take it or leave it".

[NYC_SKP]

3. I'll give it a shot, in no particular order, and not an exhaustive list.

Greed and profit.

More technology at higher costs, and greed, and profit.

More people without any coverage accessing emergency rooms and driving up costs for those who pay, and greed.

More people aging and accessing more procedures and meds, and greed, and profit.

Lots more meds being prescribed to us all, and associated greed and profit.

Much unregulated malpractice, overpractice, underpractice, and greed, and profit.

And greed.

And profit.

:patriot:

[Andy823]

5. I agree.

Two words that say it all "GREED AND PROFIT"!

[JenniferJuniper]

9. Good points all. And just to flesh out one...

I review medical records as a part of my work. The level of over-treatment, over-diagnosis, over-medicating, and unnecessary diagnostic and surgical procedures is truly astounding. The entire medical community plays a role here. I believe it's partly driven by a fear of malpractice lawsuits, but mostly driven by greed.

An anecdote. When my late grandmother was 94, her doctor ordered a bone density test. I was concerned about the need for the test (and just getting on and off the table would have posed a risk for her) so I asked the doctor why it was needed when he and I both already knew at 94 her bones were not dense and she was very frail. His response was a curt "Medicare will pay for it!"

Needless to say, she never had that test. But unfortunately, her doctor's mindset and motivations are not all that unusual.

[NYC_SKP]

11. Oh, yeah....I've heard that one...medicare will pay for it.

Sigh.

I was just reading somewhere about how often pap smears are given to women with hysterectomies. wtf.

Thanks for elaborating.

:thumbsup:

[JenniferJuniper]

14. Oh, don't get me started!

I have a sister who has been getting annual mammograms since she was 29. Not because she has any risk factors, (in fact, she's in the lowest risk group based upon her history) but because her doctor once had a patient who was diagnosed with breast cancer in her early 30's.

Oh, sure, Doc. Radiate someone unnecessarily for years with a test that doesn't even work for pre-menopausal women just because you suffer from professional paranoia! Screw that old "first do no harm" crap.

But that's just another anecdote. I could tell horror stories all night about trends I am seeing in medical records.

[Raineyb]

38. Odd. I've been doing them since I turned 30 because my mother was

diagnosed at 32. However, my aunt wanted to start earlier than 40 (needless to say this was a few years back as the age difference between me and my aunt is nearly 2 decades) they absolutely refused to do so even though there was a family history.

Either they do too little or too much. :shrug:

I guess depending on the situation I would prefer too much. Too little got my mother killed.

Regards

[JenniferJuniper]

50. Just please understand

that the test is of very limited value for women under 50 due to the nature of young tissue. Indeed, many doctors and statisticians say they are of no value for the young. The American College of Physicians has revised it's guidelines in recent years and recommends only women over 50 have them routinely. At 32, it's not likely mammograms would have helped your mother.

As you would likely be in a higher risk group due to family history, I would suggest genetic counseling and perhaps insist on MRIs for screening. The multi-billion dollar mammography industry has been actively trying for decades to brainwash women into believing they can rely on mammograms to keep them save from breast cancer and that early detection is the "best prevention". Neither of these assertions are supported by current independent and objective statistical analysis.

[patrice]

15. Elder Care is FULL of stories like that. I work with 3 nurses with a combined total of

almost 60 years in Geriatric nursing. They are regular people socially, politically, and all other wise, but absolutely far out radicals against over-medicating the elderly.

My family has several stories about this too.

And I can tell you about battling the home my MIL was in about candy, candy, candy, and more candy, BAGS OF CANDY. Every simple-minded Christian in the universe thought it was their moral duty to visit the Old People and, apparently, couldn't think of one simple decent way to express their concern for the Infrim other than to give my MIL CANDY. I lost several battles against this, but I guess you'd say my MIL lost the war when the home decided that she needed

ALL of her teeth pulled!!!

She passed on before I could get them to get some dentures for her and I don't think they ever intended to do so.

:grr:

[Jackpine Radical]

19. I want to add two things to your list:

1) Greed and gluttony
2) Insatiable gluttony and greed.

[avaistheone1]

32. How about CEO pay?

William McQuire when he was head of United Health had a compensation package worth more than $1.5 Billion dollars. That is alot of our health care dollars down the drain on one person.

[ejpoeta]

43. i think you forgot something.......

greed and profit. :P

[NC_Nurse]

6. Have you ever seen a published list of prices at a hospital or doc's office?

They charge differently based on your insurance or lack thereof, plus you don't get to comparison shop either, do you?

I've often thought that if prices for medical procedures had to be published that things might go VERY differently. At this point, the consumer
has NO IDEA what they're getting into and what exactly they will get for their money. How many other services are sold this way? They've GOT YOU
because you're sick or injured and desperate for their "help".

I know that sounds pretty weird coming from a medical professional, but that's my theory.

[ejpoeta]

44. they should also have a rating posted. a rating given by their 'customers'.

It is so infuriating to have to deal with a hospital that is somewhat lacking in their excellence overall. Just sit in a waiting room or pay attention and see how the patients are treated. My sister told me that she saw a guy who peed himself in the hall and the nurse just changed his socks. didn't wash his feet or leg off or anything. uggh. there's a guy basically tied to a chair in the hall because he keeps 'escaping' and walking around the halls. LOL!! my dad for his part keeps trying to escape. gee i wonder why.

[subterranean]

53. The problem is that a single procedure can result in several different bills.

If you get a diagnostic test, for example, you might get a bill from the doctor who performed the test, a bill from the hospital and another bill from the lab that analyzed the results. So it's hard to get a single price quote for anything. I heard that even doctors in hospitals often don't know the real cost of the services they perform.

[empyreanisles]

7. The increasing costs of malpractice insurance burdens doctors and drives costs up

It's not a popular thing to say around here, but it should be considered. A reduction in law suits would allow doctors to offer more alternatives to patients instead of just ordering procedures "just to be safe". It shouldn't be about covering their asses, it should be a case-by-case basis about what is best for the patient.

[The Velveteen Ocelot]

12. Bullcrap. The medical profession already has more protection than any other.

In my state, Minnesota, the statute of limitations for medical malpractice is only two years; for every other tort claim for professional malpractice it's six years. In order to commence a medical malpractice lawsuit you have to present an affidavit from an expert that supports your claim -- but no other types of lawsuits require expert opinions before you can even sue. And about 80% of all medical malpractice cases that actually go to trial result in defense verdicts (the doctor wins), in part because the insurance company can afford to bury the plaintiff in onerous, miserable discovery demands and delay the case for years until the injured person, who probably is broke and can't work, has to take whatever measly settlement they offer.

The real reason malpractice insurance is expensive is that the insurers invested heavily in the stock market and they raised their premiums to make up for their losses -- but they gave the doctors a line of bull about frivolous malpractice claims. Some years ago they were actually required to refund premiums when a state investigation uncovered what they were really doing.

And if a negligent doctor caused you or your family member to be permanently injured -- which does happen, more often than we'd like to imagine -- how would you feel about a cap on recoverable damages? Say, $250,000, which was one number that was being kicked around. That would take care of a paraplegic for maybe a year.

Medical professionals should be treated like everyone else; to avoid negligence claims they should use risk management methods like other businesses and professions. And keep in mind that the real culprits here are the insurance companies.

[Hieronymus]

17. That's been used by those who are pro-insurance for ages. France spends

half of what we do per patient and they have the best care in the world. The US is #37.

[elifino]

34. While working in France, my wife go food poisoning

Trust me you do not want to got to a hospital in France. Yes the cost was low, but the care was substandard. She was placed in a ward containing 15 other patients.

[Hieronymus]

56. Sorry, but I don't believe that. Maybe during WWII.

[JenniferJuniper]

23. The just-to-be-safe testing is an issue, yes, but

it's only a part of a much bigger picture.

There's a great deal more of let's test because we've got the machine and it needs to be paid for. Let's test and treat because it generates revenue and insurance, private or otherwise, will pay for it and for my services, even if it isn't really necessary. And then if we find a little something we can make an issue of - yippee! More tests, more treatment. Or as most posters have been saying over and over here - Greed.

There's a wonderful book out there called "The Last Well Person: How to Stay Well Despite the Health-Care System" written by a physician who addressed this issue of what he termed the "medicalization" of our culture. Can't recommend it enough to anyone who is seriously interested in this topic.

[susanna]

24. Self-delete, but I'll answer soon...

[Laelth]

35. Insurance industry propaganda.

A number of states have passed "tort reform" that made it much harder to sue medical professionals. Georgia is one of them. Medical malpractice insurance premiums did not go down after the law was passed. Insurance industry profits, however, went way up.

:dem:

-Laelth

[Lex]

41. WRONG. Ever consider the CEO bonuses and obscenely inflated salaries of the executives?

Hmmmm?

[Bluestar]

10. Good question--I have a friend who used to work for a major health insurer

He said that they have two divisions--medicare and the commercial products division. He said that the Medicare division makes money hand over fist and the commercial products division was always struggling and lost money a lot. The difference? The Medicare division didn't require a marketing staff or budget in order to compete in the commercial market--they always had to come up with new products or cut prices in order to sell to corporate insurers.

So, I figure just by the fact that we have universal health coverage might eliminate these marketing costs and drive prices down, even if we can't get single-payer. Call me a Pollyanna.

[Speck Tater]

13. There used to be TWO people involved in each transaction...

One doctor and one patient. Or maybe the doctor, the patient, and the doctor's wife who was an RN, both working from an office in their house.

Now there is the doctor, his receptionist, his nursing staff, his finance person, his bookkeeper, the appointments clerk, the medical transcriptionist, the medical group they're employed by, the group's front office staff at that location, their ten-story corporate headquarters building in San Fransisco and the shareholders, PLUS the insurance company, and all their office personnel at their fifty-story home office, AND their shareholders.

Now now, instead of paying one person for his services, you end up having to pay about 37 people, plus you have to put up a portion of the dividend paid out to shareholders in both the medical group AND the insurance company who expect to be paid year after year after year for doing absolutely nothing at all except holding shares in companies that really don't even need to exist if doctors and patients could just deal with each other directly like they used to.

[acmavm]

16. Recoup losses? I pay 300+ per month for me and one child. I hardly

use the shit because it pays NOTHING. And every two years, my premiums go up, and the policy pays less.

Who's the loser here?

[Jackpine Radical]

20. My wife and I, in order to cover just the 2 of us, as members of the

State of Wisconsin employees plan (I'm retired from the state but--thanks in no small measure to health care needs--not from work), pay $1726 a month. Last year my pension covered my premium, which was a little smaller. But the premium went up and my pension went down. I now have to pay quite a bit extra out-of-pocket for my insurance.

[acmavm]

22. That's a lot of money. But for me, that 300+ is a LOT of money. Especially

for something I have to keep in the event of a major accident or illness. Don't use it now because it's not worth it. It pays next to nothing, especially after the last switch in January.

[Jackpine Radical]

37. I certainly wasn't trying to play "My case is worse than your case."

It was more a matter of "I hear you and sympathize." I spent a number of years marginally employed, sometimes unemployed, and without any kind of coverage. I know what it feels like.

[acmavm]

49. No no no no no. I took it the way you meant it. I was just trying (obviously

poorly) that for you it's one amount (holy smokes, how can you afford that?), and for me it's a lesser amount but still a burden.

[Skwmom]

52. Hmm.. maybe your premium goes up b/c they need to recoup

the money they lost on bad investments.

Yet, for some reason this just doesn't seem to be part of the public debate. Nothing like ignoring the obvious.

[jody]

18. Because the umbrella companies derive profits as a percentage of gross revenue. Higher the basic

cost, higher the profits with little incentive to reduce direct costs without pressure from the customer which is impossible since customers aka patients are detached from the entire process.

[Christian30]

21. It went off the rails when

groups like Blue Cross/Blue Shield went from being non-profits to for-profit HMOs. Prior to that, non-profit insurers kept the market in line and forced for-profits to offer a decent product. IMO, no insurance company should be a for-profit.

[silverojo]

25. Incompetent doctors

They treat patients like dog crap, so patients have to go from one doctor to the next, desperately looking for help...or even a proper diagnosis.

Meanwhile, expensive tests are done over and over, because doctors want "more recent" tests (wink-wink), even if you had them done two weeks ago. Trust me, this happens--it's happened to me, a lot.

Your insurance is billed, your premiums go up, and doctors stuff their greedy wallets with your misery.

Yes, there are many other factors making insurance rates go up, too. But if doctors would worry as much about their patients as they do about their portfolios, medical care costs would be much lower.

[MadLabrador]

26. in a word: Republicans

[harun]

46. I have to agree.

[OwnedByFerrets]

27. Folks like Dr. William McGuire

who get benefits packages of up to 1.6 billion are one huge reason. How in the hell could we commoners expect them to live on less than 500 million. Oh, the horrors.

[Hieronymus]

30. I've heard about this guy too. Check out this article on the French system....

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/11/frances_model_healthcare_system/

[OwnedByFerrets]

48. This is one of the most frustrating things....

Its when the naysayers say it wont work. We don't have to create a model. We don't have to TRY to build a system. We already have working models out there. The America I grew up in would take those models and improve upon them. The America I live in now, including our leaders or maybe ESPECIALLY our leaders, throws up its hands and says "We cant do this!! Its too hard or its too expensive or It wont work"
We have turned into a bunch of quiters, for the most part.

[Hieronymus]

55. Well said ...

[subterranean]

54. Ironically, McGuire's retirement package included free health care.

http://www.alternet.org/story/50360/more_uninsured_means_more_healthcare_corporate_profits/?page=2

But CEO William McGuire, of UnitedHealth Group, a health insurance company, stands alone. His annual salary in 2005 was $124 million, and he has been provided stock options worth more than $1.7 billion, according to Forbes.com. As part of his retirement package, he and his spouse will receive free healthcare for as long as they live, according to AFL-CIO Corpwatch.

[TechBear_Seattle]

28. Because insurance is treated as a commodity rather than as a necessity n/t

[doc03]

29. Here is an example:

This was the billing for the laboratory service on a one tube blood sample.
Total---------- $468.00 for 10 separate providers laboratory charges.
minus---------- $248.61 that is non-billable to member because it's in network.
covered charges $214.41
insurance pays--$192.97
I pay------------$21.44

This was to analyze one tube of blood, they had a printout of the results ready about 20 minutes later when I saw the Doctor. These were the totals of ten separate charges covering two sheets of paper. You see my insurance allowed a charge of $214.41 and paid 90% of the bill that was $192.97 and I paid the other 10% or $21.44. I asked someone that does billing for a hospital who actually pays the full $468 charge and was told virtually nobody. The example I was given is say my insurance paid $214.41, another insurance company may pay $225 and another may pay $240, it depends on their contract with the hospital. The difference between what insurance companies contract to pay and the total is written off then the remainder is billed to Uncle Sam to cover uninsured patients. I don't know how true this is but it sounds about the way our crazy system would work.

[doc03]

31. Here is another example

from when my father was in the hospital several years ago. He had Medicare and a supplemental policy from his employer, he would be billed say $2000 and medicare would allow a payment of $1000. Medicare would pay 80% of the allowable charges ($800) then my father's insurance would pick up the other 20% ($200) then they would bill my father $1000. Finally after several months in the hospital he was billed a total of $189,000 and he didn't have the money to pay, who paid the difference Uncle Sam. One time his doctor went on vacation for a month. I look at the bill for that month and they are billing over $100 every day for the doctor who filled in for him and another equal amount billed from the doctor on vacation for (medical management). I called a friend of mine that works for SS and told him about it thinking it was some kind of double billing violation, he said it is done all the time and was standard practice.

[Vinca]

33. One word: greed.

For starters, insurance companies only make money by denying care and if the cost of the care can justify high premiums, they're happy campers. Secondly - and this is probably the major reason for the high cost - after an insurance company tells a provider they will only cover a certain percentage of the cost of a procedure, the provider raises the price of the procedure so their profit will remain the same. Next year the insurance company evaluates the new, higher price and tells the provider what percentage they will cover and, once again, the provider raises the price so they continue to rake in the number on the price tag. And so it goes. Year after year after year after year. That's why the government must get involved beyond Medicare, Medicaid, the VA, SCHIP . . . OMG, IT'S SOCIALIZED MEDICINE!!!!:scared:

[CANDO]

36. Because it's based on a for profit basis.

eom

[baldguy]

40. b/c Insurance co.s aren't in business to provide health care.

All their incentives are geared to NOT providing health care.

It's the only service industry whose profit is generated by NOT providing the service. That's the definition of a scam.

[ejpoeta]

42. you have a number of insurance companies each having their own

overhead costs and administrative costs. plus you have uninsured people who wait and end up in the ER. then when they can't pay the bill then it gets factored into the cost of services at the hospital. PLUS you have pharma charging an arm and a leg for their drugs that they also market in commercials on tv. so then the insurance companies have tiers and we get to pay more towards our meds. It's like a cycle, really. And it has progressively intensified over the recent years as more and more people end up without insurance and underinsured. because the insurance may be fine until you get sick and find out you aren't covered. then you end up with medical bills. those costs end up added to the overall cost of health insurance. that's why i find it amusing when people like relatives of mine say they don't want to have to pay for insurance for poor welfare recipients or 'those people'. we already are. but we are paying MORE because of the backend nature of it. It's like fixing the leak in the pipe with duct tape and then wondering why it costs a crap load of money when you have to fix the pipe AND the floor... and the walls.... and everything around the leak. Would have been cheaper just to replace the pipe in the first place.

[Lex]

45. We know insurance companies pay huge CEO bonuses & obscenely inflated salaries to executives.

AIG, for example.

It is done industry-wide.

[LiberalFighter]

47. It's all about how much profit they can demand. They are a private entitity unlike the government.

[CurtEastPoint]

51. Just watched Sicko. It's because the med/insur/pharma co's own Congress. It's shameful.

and we just let it happen.