What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways.<p>For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the government, then I could understand the US rejecting that as being too much government intrusion. (Note I didn't say I'd necessarily agree with such rejection--good health care arguably is more important than limited government power--I'm just saying I could understand such rejection).<p>But looking around, what stands out is how diverse the approaches of other countries are. There are some that do have the government finance and provide health care, much the way the police or military are provided by the government.<p>There are some that use private insurers paying, with care provided by private hospitals and doctors, but the insurance companies are non-profit and regulated.<p>There are some that provide care via private hospitals and doctors, but have a government run insurance program to pay for it.<p>There was a good look at how it is done in 5 capitalist democracies here: <a href="http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/" rel="nofollow">http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/c...</a><p>See also the link on that page to the explanation of the four basic models used around the world. That page includes a striking way to explain the other systems to Americans:<p><pre><code> These four models should be fairly easy for Americans to
understand because we have elements of all of them in our
fragmented national health care apparatus. When it comes
to treating veterans, we're Britain or Cuba. For Americans
over the age of 65 on Medicare, we're Canada. For working
Americans who get insurance on the job, we're Germany.
For the 15 percent of the population who have no health
insurance, the United States is Cambodia or Burkina Faso
or rural India, with access to a doctor available if you
can pay the bill out-of-pocket at the time of treatment
or if you're sick enough to be admitted to the emergency
ward at the public hospital.</code></pre>
The US has inexpensive MRIs as well.<p>This nationwide chain provides MRIs as low as $335 depending on the state.<p><a href="http://a2zimaging.com/" rel="nofollow">http://a2zimaging.com/</a><p>No insurance accepted, no payment plans. Those cost money. Just charges the cost.
Can't believe they didn't even mention the Monopoly Protection Certificate racket run by the government in many states:<p><a href="http://en.wikipedia.org/wiki/Certificate_of_need" rel="nofollow">http://en.wikipedia.org/wiki/Certificate_of_need</a><p>And never mind the huge monopoly granted to AMA certified physicians, in terms of providing medical care. Of course those guys have a huge incentive to keep as many people out of the physician pool as possible. We certainly couldn't allow competition, which might drive down costs. :~(
Not only do Americans spend more per-capita on health care than Canadians, the <i>American government</i> spends more per-capita on health care than the Canadian government. And yet Americans <i>still</i> need private medical insurance. And depending on how you count, more than 60% of American bankruptcies are for unpaid medical bills and about 78% of those people <i>had</i> medical insurance.<p><a href="https://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States" rel="nofollow">https://en.wikipedia.org/wiki/Comparison_of_the_health_care_...</a>
I once had to have a CAT scan done. I was really scared. I asked how much it would cost. No one was able to tell me! I was told the price would be negotiated with my health-care provider, if they opted to cover the procedure.<p>How can there be competition when no-one can give you the price of the procedure? Seriously WTF.
High health care spending is yet another way the US subsidizes other countries. From the article:<p>"This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.”<p>In the past 30 years have you heard of any medical innovation or drugs coming from anywhere other than the US?<p>Of course the MRI machine was itself invented in the US:
<a href="http://web.mit.edu/invent/a-winners/a-damadian.html" rel="nofollow">http://web.mit.edu/invent/a-winners/a-damadian.html</a>
The article completely ignores structural problems that lead to high prices. Since the US health care market effectively has government price controls (due to Medicare, which is a huge percentage of revenue for most facilities), this causes some perturbations in the market.<p>Pretend you're an optometrist. Historically you got paid well for your time, so you organized your business around seeing as many patients as possible and referring out things like labwork, glasses-making, etc, since you couldn't compete on price with shops that kept their capital equipment busy nearly 24/7. Life is good; you get paid well for your time and your customers get reasonable prices on things like labwork, glasses, etc.<p>Over time, your medicare rates keep dropping. Eventually you actually start losing money when you see medicare patients. You then realize that the labwork/glasses part of the business is pretty high margin, and even if you buy a machine and keep it barely busy, you can still eek out some profit from keeping that work in-house. So you buy some equipment, and instead of referring out labwork and glasses, you start doing it in-house. Again you can finally make money on medicare patients.<p>The medical device companies LOVE this. What better way to expand your market than "invest" (ahem lobby) so that your customers can make money with machines that are only busy 30-50% of the time. That's 2-3x as many devices as if they had 95% utilization, WIN! The doctors won't complain, b/c the system is so messed up that they know it's the only way for them to actually make money. And the insurers can't really do much about it b/c they can't force their patients to go to a different facility as that's too intrusive.<p>So it's kind of a combination of market failure, lobbying, and price-fixing that causes procedures to be way too expensive in the US since the normal market mechanisms that cause prices to approach a small margin over the cost at high capital utilizations to fail.<p>There's a lot more to it than that, but whenever I talk to my many relatives in the medical industry, this is always happening, and it's a major factor in prices. MRI machines aren't cheap (think $1M).
For what it's worth, it's ~$160 in Japan. (<a href="http://www.npr.org/templates/story/story.php?storyId=120545569" rel="nofollow">http://www.npr.org/templates/story/story.php?storyId=1205455...</a>)<p>Interesting seeing this here on HN after my wife and I just finished watching "Frontline: Sick in America" on Netflix tonight, in which an American reporter travels to 5 countries that provide some form of universal healthcare to discuss (with doctors, administrators, and patients) the different mechanics, what percentage of GDP they spend on healthcare, what wait times and gate keeper policies are like, what financial issues exist, etc. The fixed, negotiated price for MRIs was one of the things he discusses. (<a href="http://movies.netflix.com/WiMovie/Frontline_Sick_Around_the_World/70098734?trkid=2361637" rel="nofollow">http://movies.netflix.com/WiMovie/Frontline_Sick_Around_the_...</a>) I grew up with nationalized healthcare, but found the documentary quite informative.
The problem with studies like this is that they pick a single issue within healthcare and try to make a broad assessment from it. There have been other studies that break down the overall costs of health car in the US that are more informative. It's four years old, but this McKinsey study is a good example:
<a href="http://www.mckinsey.com/Insights/MGI/Research/Americas/Accounting_for_the_cost_of_US_health_care" rel="nofollow">http://www.mckinsey.com/Insights/MGI/Research/Americas/Accou...</a><p>The Interactive Flash slide show is interesting as well (where "interactive" is defined as clicking forward and back buttons, I guess).
Without yet reading any of the other comments, I have an anecdote that may be interesting to others: One of my father's business partners has a mother that lives in France. She is ~88 years old, and the family's net-worth is on the order of 100s of millions ($USD). She had a medical condition which required surgery, but due to her age, she was not eligible in France, so she had to come to the US for her surgery. So, it seems like the phrase, "The US has the best healthcare money can buy" still stands.<p>[I will now read the other 80 comments...]
Just a plug for Paul Starr's The Social Transformation of American Medicine. It's the definitive text on healthcare in America. After that, all the other writing is quaint.<p>On a separate note, you should have seen the fear on the faces of the retired English couple I saw today when I sent the poor man to the ER. They're here on vacation, he had an MI 15 years ago, ran out of his aspirin a month ago on vacation, now he has had vertigo for a week (stumbling like a drink) and new onset high blood pressure. Never paid a dime for healthcare and I just sent them to the lion's den. I reimbursed them the cost of my office visit, but that will be a drop in the bucket.
Because if it was $280 in America the insurance ceos, investors, doctors and administrators would not be able to buy their second vacation homes.<p>As long as healthcare is a profit center, you will only have the right to die quietly if you cannot afford it in America.
I just got my shoulder redone by arguably one of the best sports orthos in the country. This guy handles a substantial percentage of high profile professional athlete cases per year. He charged me $3200 for a rotator repair and bicep reattach. I think that's a bargain for his skill level.<p>My guess is the total bill will be another story though. I suspect my insurance will be dinged for about $11k. O.R. rental, nurse anesthetists who make $150/hr, etc are the source of expensive healthcare in the US, at least for surgery.
" If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive."<p>Also world peace would break out and poverty would be eliminated.<p>I liked the article, and I think this is most certainly a pressing problem for this country. But the facts are strong enough to independently make a strong case. No need for the hyperbole
With an increasing elderly population there's a need for a lot more care, especially for people with dementias.<p>Here's one fascinating article about US prisons which face a serious problem. (Caution: contains descriptions of violent crimes.)<p>(<a href="http://www.nytimes.com/2012/02/26/health/dealing-with-dementia-among-aging-criminals.html?hp=&pagewanted=all" rel="nofollow">http://www.nytimes.com/2012/02/26/health/dealing-with-dement...</a>)<p>This shows that big improvements in quality of life can be achieved with small changes. Give health care assistants better training about dementia and give them more time to talk to patients. This small cheap change has several benefits: nurses can do more nursing; meals get eaten; falls are reduced; people feel like they're getting better care; etc.
"The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it."<p>This is probably the same reason we've taken close to 40 years to finally try and get off our dependence on foreign oil after Jimmy Carter said we needed to in 1978. Yet, we still pay more than we really should and haven't done anything about it.<p>Why? Lobbyists, too many layers of bureaucracy, special interest groups. Take your pick, but at the end of day, it takes a lot of people wanting to do the right thing to make things change. In this country, that's a lot harder to do than most people think.
I always had the idea that American health care is more expensive because there's not much competition - there are just a few major companies that control the pharma industry and the hospitals, and it's pretty much impossible for someone to just barge in and start offering their services at a lower price - they'd have to pass by the government first (with their impossibly high fees and heavy regulations), then if successful, they'd be harrased to bankruptcy by the established monopoly.<p>It's much easier to open a private practice or hospital in the EU, for example...
Rates in India's best hospital <a href="http://www.aiims.edu/aiims/hosp-serv/hosp-rates/revised-rate-list.htm" rel="nofollow">http://www.aiims.edu/aiims/hosp-serv/hosp-rates/revised-rate...</a>
FWIW, its roughly $100 or even less in India.<p>Granted, the quality of medical care varies by a lot in India, but there are places and doctors in India who are so good, that if I am sick, all I want to do is take a flight back home...<p>The lack of health insurance in general in India ( now, it is being sold to a growing section of the population ) has meant that prices are comparitively lower ( though, they are really rising these days ).
Reminds me that according this NYT infographic :<p><a href="http://www.nytimes.com/packages/html/newsgraphics/2012/0115-one-percent-occupations/index.html" rel="nofollow">http://www.nytimes.com/packages/html/newsgraphics/2012/0115-...</a><p>about 20% of physicians are in the top one percent. This is the highest percentage of all occupations.
If there was medical procedure that would cost a lot in a hospital an MRI would not surprise me, it such a large powerful, power hungry, complex device I can't see how it couldn't.<p>I wish each person could get access to an MRI each year it would be nice to track your health visually.
On a related note, medical toursim is a great business/startup opportunity for other countries. Let them spend a weekend in a new city and get that dental filling done for far less cost. It's $4 in some medical colleges in India.
Anyone who has insurance doesn't care about the price. They only care about the deductible. When people shop around, they look for the insurance companies that provide the lowest deductibles and stick with them. After that, there's no pressure on the providers to lower prices. The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles. The providers can increase the price without fearing that patients will go to a different clinic or buy a different generic version of their drug. Medical care in the US is one of the only industries where raising the price can get your more customers, since it makes the government push for universal health insurance to keep deductibles low.<p>There are a few solutions, two of which were mentioned in the article. The insurance companies can negotiate prices with providers, or the government can set the price. A third option is to let the patients themselves set the price by having them shop around. The patients would put pressures on the providers by going where they can get the cheapest MRI or the cheapest Lipitor. Then insurance would be reserved for emergency procedures, instead of being used as a medical credit card.
Want to get our costs down to competitive levels?<p>85% of all healthcare costs in America are for those over the age of 65. America has the leading health care system for the elderly. We pay for 80 year olds to have surgeries that they can't get in Canada or France.<p>Nobody wants to talk about it though, because it's not a nice thing to say, that grandma is buying six extra months at a price of a million in treatment.<p>Socialized medicine will slice the most money out of treatment for people in that demographic. It's by far the largest savings spot. Good or bad, you can debate that endlessly; but that's exactly what will happen.
You want to hear David Sedaris on this. He was amazed that his visits to the dentist and to hospitals in France where so cheap they didn't even bother to charge him. He had to force them to bill him and it would be for tens not hundreds or thousands of dollars.<p>Social medicine works in Europe and in Cuba, where I've also seen it first hand. This is why it is so important to preserve the NHS here in the UK.