The only time I feel health care is working for me is when I’m healthy and don’t need it…and we have great private insurance. The moment I need to do anything beyond a yearly physical, there always seems to be a problem.
I also agree that our reimbursement system if overly complicated. I had to do medical billing as part of a previous job and it was the single worst part of the job. From the patient or family perspective, even worse.
I’m in the camp that health care should be not for profit.
Of course, many age 65+ people have multiple health issues that require a fair amount of attention.
But then doesn’t Medicare have low reimbursement while paying easily without dispute? Seems like an incentive to run up a lot of procedures, tests, etc. to make up volume…
This is essentially the way it works, with a few caveats.
First, “cost” is a squishy term. Some practices run more efficiently than others. Medicaid is one thing, but if an entity can’t make it on Medicare reimbursement, they need to look at their business practices.
Second, book rates can be all over the map. It’s not uncommon to see 5X Medicare or more. If you haven’t met your deductible, you pay the book rate. If you’re out of network, you pay the book rate. Hospitals typically extend 50% discounts to cash pay patients, which may still be multiple times higher than Medicare.
Lastly, none of this precludes an entity from freely disclosing their book rates, but almost no one does.
I have witnessed the exact opposite. For a variety of reasons, providers often try to avoid doing any interventions on a Medicare (geriatric) patient unless they are a medical necessity.
What about the people that work there?
In 2022, the United States performed 4,111 heart transplants and set the all-time record for liver, heart, and lung transplants with over 42,800 total transplants (including kidney) performed. The United States accounts for more than 1/2 of the heart transplant surgeries worldwide and has by far the most heart transplants per capita in the world.
Assuming the cost of a heart transplant is $1.6 million, those 4,111 patients paid more than $6.5 billion. My guess is that very few beneficiaries of these life-saving surgeries are paying out of pocket. It’s more likely everyone on this forum helped pay for these surgeries when they paid their federal taxes and ballooning insurance premiums.
That’s the point…SOMEBODY paid.
And just maybe that 6.5 billion dollar expenditure on a relatively small group of people was not a wise use of health care funds?
But that’s the problem, everyone complains about how unfair it is that they have pay $$$ for health insurance when they barely use it. However, when the sick person is you or your family, the complaint shifts to how it is unfair why you can’t get the $1.6 million surgery or $2 million medication for your spinal muscular atrophy. You can’t have it both ways.
It’s easy to argue from a distance. But from what I’ve personally observed, more than 9 out 10 times, the family wants everything done to keep their family member alive even when it’s going to be the last year of his/her life.
Of course. But it is other people’s money they are spending in doing so, thus the rest of us should have a vote as well.
Ok. Tell that to the family members as well as patients who are currently residing in the ICUs all over the country. I don’t think that will go over very well.
And that is why the system is broken. Doctors in Western Europe and Canada do not push expensive and fruitless treatments on those whom it would little benefit. We can not, as a society, provide limitless resources, whether in healthcare or any other field, to all. I had hoped the covid surge would make that obvious, but it seems we have to wait a while longer for the system to totally breakdown before we recognize that.
My family member had a heart transplant. He lived 20 years after the transplant. His insurance, which he paid dearly for, only paid 80% of the costs of the surgery. It was a huge amount of money for the family out of pocket, not to mention the years of transplant medications, and tons and tons of hoops to jump.
Health insurance is just like taxes, we all pay but don’t have a say in how it’s spent (other than with our votes). I’m totally OK with the medical professionals making the decisions.
And for the record, people who get transplants are those who have a meaningful chance of decent life expectancy and quality of life. And, the early transplants paved the way for all kinds of life saving research for other issues.
It’s not the medical system itself. It’s the priorities that our society has set for itself and our government has followed suit. The medical system has adapted to those priorities.
If our #1 priority was to provide the greatest good for the greatest number of people, the medical system would behave differently. Like any other industry, it goes to where the money is headed. But I suspect there would still be a lot of unhappy consumers, just different ones.
I’m not going to comment on docs ‘pushing’ treatments, or whether said treatments are fruitless.
Expenses in the last year of life are high in many countries, including the US and Canada. Luckily there is quite a bit of data on this, here are two representative studies (there are many more):
Here is one study from Canada (published last year, analyzing data over a 3 year period from 2010-13) showing that treating patients in their last year of life represented 10% of all Canada’s government funded healthcare costs.
Using population-based health administrative databases, we examined health care use and cost in the last year of life. Results: Among 264,755 decedents, the average health care cost in the last year of life was $53,661 (Quartile 1-Quartile 3: $19,568-$66,875). The total captured annual cost of $4.7 billion represents approximately 10% of all government-funded health care.
This study shows high end of life spending in US (of course), Denmark, Germany, and the Netherlands.
But we do have a say in how taxes are spent-that is why we have elections where we vote for representatives who authorize budgets in accordance with our priorities, at least theoretically. US Doctors have no incentive to limit medical costs, and often make no effort to do so. I am happy for your family member, but not sure all transplants resulted in an additional 20 life years.
The rest of the developed world does.
Can you explain who and how they do it?
At the risk of this thread being sent to the politics subforum, I will redirect towards the original post. Doctors are complaining? I will believe it when the AMA steps up to advocating for changes. Until then, they can live with a system they were instrumental in creating. They could be powerful lobbyists for change if they wished.