<p>"There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”</p>
<p>This is a very good point. Hardly anyone shops around and prices different health care options. The system is not set up for it and a big blame goes to the employer-based system. If everyone had their “own” plan, I bet there would be much more shopping of costs resulting in lower prices.</p>
<p>I would buy those things without knowing the exact price. There are often additional expenses associated with taking a plane or buying a car and sometimes those are substantial. Then there’s buying or selling 100 shares of AAPL at market. Most of my trades are at market and I don’t know what the buying or selling price will be - hopefully somewhere around where I last saw the price. Sometimes I really don’t care.</p>
<p>^^ True, medical care is rationed by price. But usually, it’s not rationed by the price of the services themselves, but by the price of insurance. Those who can afford insurance (or lucky enough to have employers who can) get the services. Those who can’t afford insurance generally can’t afford the services either.</p>
<p>dstark – my point was that pre-HDHP I neither knew nor cared what a procedure cost, since my out-of-pocket cost was indifferent. With the HDHP, it behooves me to know the difference, and to follow that. In my case, one hospital was substantially less expensive than another. And, in the case of an emergency hospitalization, I’d blow through the $4k deductible so quickly that it wouldn’t matter either, and the $4K would be my annual OOP except for some drug copays. But in the years without the emergencies, I’m certainly being a lot more observant of prices, and I don’t think that is a bad thing.</p>
<p>I’m also hoping that the changes in healthcare in the US are going to lead to a lot more advanced practice nurses and physician’s assistants providing primary care. I’ve had very good experience with them, and would be delighted to see more of my routine healthcare handled that way. I’m not sure why doctors in the US generally go to 4 years of undergrad, 4 years of medical school, and then extensive residency periods when doctors in the UK can start medical school right after secondary school (which goes one year more than ours, but still…)</p>
<p>Unfortunately I think you will see education to continue to increase rather than decrease in healthcare. “Doctorate of Nursing,” “Doctorate of Physical Therapy,” “Doctorate of Pharmacy” and on and on and on.</p>
<p>Consumer-driven high deductible health plans are the new big thing … for exactly the reason arabrab cites … people tend to pay attention to costs with these plans. Sure, you aren’t going to care in certain situations … but when you CAN, you will. Every little bit helps.</p>
<p>I hate to say it, but another big part of our increasing health care costs is tied to obesity. Obesity in the U.S. is increasing at alarming rates, and the associated health issues are increasing along with it. All of us are affected because the underwriting process is affected by the experience of the group. I know it’s not P.C. to point it out, but folks have got to stop eating so much c**p and start getting off their rears. I have a brother who battles weight (was 500 lbs until his recent successful downward trend on the scale), so I am extremely sympathetic to those who struggle with obesity. But truly, it does affect our overall costs … and some of us could make some changes without too much pain or effort.</p>
<p>I’ve always wondered why doctors don’t stress the obesity problem more with their patients. Both my mom and my MIL are obese. Neither one has ever had a doctor that encourages them to lose weight! I have asked them what the doc says about that, and the answer is, nothing!!
They are 83 and 92 respectively, and both have mobilty issues that are directly related to carrying too much weight on their bones and ligaments. The docs just give my 83 year old tests and talk about future surgeries if things get worse. !! Um. How about losing 50 pounds.
It’s frustrating, but then why should they listen to me? I may be trim and look fit as a fiddle and walk my dog 3- 5 miles a day, but then I’m the one with cancer. So I have no influence whatsoever. Being the “health nut” in the family certainly didn’t exempt me.
(I won’t say it didn’t help, because I believe it did, and does.)</p>
<p>Thanks for the links to those articles, dstark. Very illuminating.</p>
<p>Have you ever tried to find out before hand, what a medical procedure is going to cost you? Nobody knows, and they behave like you’re being unreasonable to ask.</p>
<p>My H’s cardiologist was concerned about a finding from some test (echocardiogram, probably) a few years ago, and said he needed a cardiac MRI for more definitive information. We asked what it would cost. The cardiologist’s staff didn’t know. Our insurer (think it was UHC at the time) couldn’t say until they were billed. The hospital (where the MRI was actually to be performed) said $40. We were very relieved and happy with the $40 figure; H went and had the test. The billing went through and we had to pay $700. That was a lot of money to us.</p>
<p>But I keep hearing about how great the US private insurance system is, because the patient, as consumer, is cost conscious, as opposed to a system like Canada’s (where I used to live), where the patient has no incentive to keep the costs down. I keep wondering where are these mythical patients who can shop on price? I’ve tried it, and it doesn’t seem to be possible.</p>
<p>Finally, if we had been able to learn the $700 price tag in advance, what then? H’s cardiac condition is a serious one. When a cardiologist says you need a diagnostic test for a condition that could be life threatening, is a patient actually supposed to say “No, it’s too expensive?”</p>
<p>I buy it…slightly… I think there are times when if people paid more out of their pockets…they would be more careful about price. </p>
<p>Moonchild…you are welcome…</p>
<p>My mom is over 100 pounds overweight and her doctor said, “Don’t worry about it. Losing the weight won’t matter”. </p>
<p>My mom now lives in an independent living center where all her meals are prepared for her. She dislikes the food…and…she dislikes the desserts. The food served is healthy. Lol.</p>
<p>And after 4 months at the center…she has lost 16 pounds. And she is getting a lot more mobile. She doesn’t need a walker as much as she used to need one.</p>
<p>I don’t really understand the doctor’s comments unless…the doctor just doesn’t think my mom could lose weight…which is understandable. S
My mom does not have a good track record.</p>
<p>Moonchild…you threw a comment out there… cancer.
How are you doing?</p>
<p>It’s because most are conditioned not to ask. It’s our health, we just should pay outrageous prices to be healthy…right?..That’s how they want us to behave. Low cost HDHP are the way to go…then everyone would ask the costs involved before anything is done.</p>
<p>If more people demanded to know the costs and shopped around, the prices would decline.</p>
<p>A distinction without a difference, in my opinion. But cash still counts in some communities.</p>
<p>In a former life, I used to consult with a hospital that had TWO armored truck pickups a day so they would’t keep too much cash hand. I happened to be in the finance office one day when a family member came in and unfurled ~$38,000 in C-Notes to pay a bill for his mother. And in this LA hospital, such a payment system was common.</p>
<p>edited to add: And this was 15 years ago when $38k was some real money. :D</p>
<p>dstark, it turns out we did get our open enrollment notice yesterday. I’m downright excited to call my broker tomorrow. We are no longer trapped!! :D</p>
<p>“I’ve always wondered why doctors don’t stress the obesity problem more with their patients. Both my mom and my MIL are obese. Neither one has ever had a doctor that encourages them to lose weight! I have asked them what the doc says about that, and the answer is, nothing!!”</p>
<p>I guess the doctors in ct are different than in the rest of the country. Everybody that I know who is overweight including me get constant lecturing about this from their doctors to the point that a lot of people don’t even bother listening anymore. As far as your mother and mil, just because they say that the doctor says nothing about obesity doesn’t mean than he actually didn’t say anything. My father claimed that he didn’t have a lot of health issues that he has. It wasn’t until my daughter picked up on them and we contacted his doctors that we found out what was really going on. It wasn’t necessarily because my father was hiding them but more because doctors tend to talk in a lot of technical terms that I frequently can’t keep straight, so imagine somebody who is older, doesn’t hear as well etc.</p>