It is folly to think the insurance companies would not still make the decisions in a government run (single payer) system. Current Medicare and Medicaid are government run and these are both administered through large insurance companies such as United Healthcare etc. These insurance companies do an incredible amount of government lobbying as do the huge pharmaceutical companies in order to be included on these plans - this would not change in a single payer system.
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They serve the public if you or your health insurance can pay for your healthcare there and its associated other costs.
Mass General saved my husbandâs life when he had an extremely rare stage 4 cancer 20 years ago.
He had multiple failed rounds surgery and chemotherapy at a large regional cancer center. Evaluated at MD Anderson for a Hail Mary bone marrow transplant. Consulted a top doc specializing in this particular cancer at Indiana. But Mass General offered a specialized surgery not available elsewhere. After he was accepted for treatment at MG, he had to wait for 3 months while the hospital system and his insurer negotiable paying for his treatment. Three months of waiting with a late stage 4 cancer diagnosisâŠnot fun. He was also told he had to have a round-the -clock caretaker with him for the duration of the treatmentâwhich took 8 weeks for the pre-surgical chemo-radiation therapy and a round-the-clock caretaker for his post surgery recovery in Boston. which was another 6 weeks. Not many people can afford to pay that type of caretaker out-of-pocket or can afford for family member to leave a job and/or leave families behind with others for the 4 months the treatment took.
His treatment cost his insurer $800K in year 2000 dollars. (And that was after insurer discounts. We saw the internal company documents.)
Our out of pocket was well over $40K (transportation, 3 months lodging in downtown Boston near hospital, meals, caretakers for our children who were left back homeânone of these expenses are tax deductible, btw-- plus co-pays for hospitalizations, tests, medications, etc) That carefully saved college fund we had put away for our childrenâs educationâentirely gone to pay healthcare expenses.
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My older D did some back of envelope calculations about her reimbursements from her patients. She took the amount medicare paid for every RVU she generated over a monthânot for tests, not for supplies or consultations with other physicians, just for what actions she herself performed-- and compared that to what she saw in her paycheck. She ends up with less than 5-8% of the total income she generated for the hospitals she works for. Her physician staffing company managers? They got more than twice (15%) what she got on her RVUs. The rest went to the hospital system administration.
Something is very, very wrong with healthcare in the US.
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First of all @WayOutWestMom, I really appreciate all your posts and your willingness to help students out on any medical school question. Second, if it was my family member, I too would want no expense spared and want to be seen immediately by the best there is. Third, I believe in universal health care with very low out-of-pocket costs.
But having said all that, letâs look back at the scenario you described and try to evaluate it objectively. The reality is that with technology improvements it is now possible to create medications or procedures that help a small number of people. And because there is no economy of scale with those small number of people, the medications or procedures will be expensive.
You explained that Mass General hospital was innovating, and innovation costs money. Because money for health care is finite, an insurer must properly vet if spending $800K on an unproven treatment actually makes sense. Because otherwise there will be less scrupulous hospitals trying to cash in on that type of gravy train, driving up costs for everyone.
Actually there was nothing especially innovative about the treatment. It combined standard chemotherapy with standard radiation therapy prior to surgery instead of after. The only difference is that there was a surgeon at Mass General who was willing to perform surgery on the irradiated (thus scarred) tissues. His fee for the 10 hour surgery? $1400.
DH called the insurer to make sure that charge on the hospital bill was correct because he couldnât believe he was paid so little, but was told that was the standard negotiated rate for thoracic surgery regardless of how long or complicated it was.
I am a MA resident and proud of the facilities available to people who live here - I had several surgeries at Mass Eye & Ear as a teen and my kids both were treated at Childrenâs (not for anything serious, thankfully). That being said, access to MGH and the like is the exception, not the norm. There are vast swaths of our country where health care of any kind (let alone what is available at top notch hospitals) is in extremely short supply. Many people donât go to the doctor at all - resorting to the ER when things get dire because they canât turn you away.
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Care for pregnant women is especially in short supply with huge swaths of the country without any OB/GYNs or labor and delivery units in hospitals. In many parts of the West, Midwest and South, pregnant individuals need to travel 2 hours or more to get care. Itâs one of the reasons the USâs maternal mortality rates are 10x higher than other developed countries
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âMeanwhile, there is medical tourism from the US by somewhat more ordinary (probably merely upper middle class) patients who may find procedures in other countries to be much less expensive than in the US.â
Had to comment on this one-- the medical tourism from the US appears to be confined to plastic surgery (sometimes with fatal results) and other elective procedures. Yes- you can get a butt lift overseas for much less than in the US but I donât think thatâs what weâre talking about. For the typical cancer patient, they stay in the US.
I donât think hospitals like St. Jude fall under the category of âhardship cases for PRâ. I know kids who have been treated there-- talking about people with no assets and a child with a life-threatening disease- who were taken care of for nothing. Thatâs their mission. There are providers now who are stepping into the breach for the enormous number of refugees (yes, they are illegal, but some of these physicians-- with zero publicity-- believe that they were put on earth to heal the sick).
It is easy to criticize our health care system but donât throw out the baby with the bath water. And someone who wants a cosmetic procedure but whose insurance wonât cover it- do you really think that incentivizing them by having insurance cover these non-medically required procedures is a GOOD thing?
No, not just cosmetic surgery. Also ortho, fertility, substance use treatment, dental, physician assisted suicide, bone marrow and other transplant, even cancer treatment. These are all common enough that the CDC maintains a web page for US citizens giving advice.
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The anecdotes I know of medical tourism from the US to some other country that I know about were both cancer, not cosmetic procedures.
Medical tourism for bypass surgery is also enough of a thing that papers have been written about it: https://mds.marshall.edu/cgi/viewcontent.cgi?article=1131&context=mgmt_faculty