Why are American health care costs so high?

[Kshartle]

I'm sure there is something about being confronted by someone in a white lab coat when you are ill that puts you at a disadvantage as a consumer.

It seems like there would be an opportunity for a doctor to act more honestly or cater to very price-sensitive, discerning customers.

[notsheigetz]

Have you ever comunicated back to the doctor's office that you are now on the hook for what they perscribed? You can't be alone. Why are doctors getting away with this?

Do you end up paying then? Does the insurance company? Does the doctor/hospital just take it on the chin?

This sounds so weird. Unneccessary procedures means wasted money and that cost has to fall on someone. Who is taking the beating for all this?

Yes, I communicated back to the doctor (well, actually her administrative assistant).  It was supposed to be only a simple screening for glucose and cholesterol required for my wife by my company's insurance plan (and this had something to do with an Obamacare provision, BTW). Her attitude seemed to be that the doctor thought all those tests were necessary in her opinion and it was therefore a matter between me and the insurance company and none of her business. After many calls to the insurance company, the doctor, and the medical lab I ended up saying the hell with it and paying the bill myself.

And to add insult to injury I even had to pay for the glucose and cholesterol tests because of incorrect billing codes.

That doctor has been fired and now we don't have one.

[Kshartle]

That doctor has been fired and now we don't have one.

Well I guess he really paid for it! 

[Kshartle]

I'm sure there is something about being confronted by someone in a white lab coat when you are ill that puts you at a disadvantage as a consumer.

It seems like there would be an opportunity for a doctor to act more honestly or cater to very price-sensitive, discerning customers.

Just curious. How is that any different than a busto furnace and being without heat when the HVAC technician shows up? Or the mechanic when the car won't run? Do you have car repair insurance? Who pays the bill for the repairs? Are the costs reasonable?

Very good comparisons. I was thinking the the car repair one myself. If you could convince people you really were "Honest Auto Repair" you could have chains everywhere and would put many shady shops out of business. The question would be how do you properly motivate the employees to be honest? It wouldn't be based on sales but perhaps on customer reviews. I don't know I never go to the mechanic either.

[WiseOne]

To answer a few of the above comments/questions:

CMS = federal  agency overseeing Medicare/Medicaid.

In the case of the ICU patient with the hopeless medical situation:  That's on Medicare (all hospital costs for anyone > 65 years).  I would really enjoy a system whereby once two physicians confirm futility, the patient is welcome to continue getting "full court press" as long as the family is willing to pay for it.  Limits like this are not unreasonable - for example, home ventilators are not covered for ALS patients.

Unnecessary procedures:  Insurance companies deal with these by imposing one-size-fits-all rules, which work about as well you'd expect.  Medicare just reimburses everything.

Unfortunately, a lot of doctors in private practice particularly have "gone to the dark side" and decided to play the game of maximizing revenue by tacking on lots of procedures, some of which may be pure snake oil.  (Chiropractors too incidentally.)  I know of some practices that automatically tack a particular procedure onto every office visit, whether it's needed or not.  The patients love it because they think it means they're getting great care.  I guess one way to tell if your doctor is one of these is whether you're automatically scheduled for a procedure at the same time as an office visit.  A procedure should only be ordered DURING the visit, after a discussion about why it's being ordered, what is expected to be learned from it, and (most important) whether it might change clinical management.  Another red flag is the small practice that has its own (say) MRI scanner.  Not surprisingly, these sorts of practices order an awful lot of MRIs.  In my experience, the quality is so bad that the studies are often useless.

[hedgehog]

http://www.bloomberg.com/visual-data/be ... -countries

[Benko]

http://www.bloomberg.com/visual-data/be ... -countries

"Among advanced economies, the U.S. spends the most on health care on a relative cost basis with the worst outcome"

since the populations are VASTLY different any comparison is flawed.  Rates of obesity, diets, over-ordering of medical tests (which I assure you is real.)....

[Jan Van]

...Banning drug reps from physician offices would instantly solve the problem, not that it's likely to happen since the pharm companies have a pretty strong lobby going...

Didn't they do something like that after which pharma started advertising directly to consumers? ("Ask your doctor about .....")