5 bullshit things about health care and the reasons behind them

health careDo you find the health care system in America baffling? Me too. But industries work the way they do for a reason.

With help from independent health care analyst Skip Snow, I did my best to reveal the perverse logic of American health care.

It all comes down to one thing: when the people who use a service aren’t the ones who pay for it, the whole system functions chaotically. Here are #5BullshitThings:

Nothing has a fixed price tag.

How are we supposed to make smart health care choices when you can’t tell what things actually cost? This leads to absurdities like this $153,000 bill for a snakebite treatment. Go ahead, ask that hospital what it’s going to cost you to get that dailysis treatment or hip replacement. Just don’t expect a straight answer.

What’s really going on. You’re under a misconception. You think that you, the patient, are the customer for health care. You’re not. Your insurance company is the customer, because they’re the ones paying most of the bill.

Your insurance company has negotiated rates with suppliers like hospitals and doctor’s offices. Those rates are a lot less than the “rack rates,” which very few people ever end up paying. Since the negotiated rates aren’t public, you don’t see them. If you did, you’d see that the rate varies according to the agreement, which is why there is no fixed cost.

You need to fill out the same paperwork in every doctor’s office.

You go to a doctor. You go to a specialist. You go to a hospital. Everybody gives you a form on a clipboard. Every form asks for your medical history. This is bullshit. Why can’t you just fill this out once and make it available to everybody?

What’s really going on. There are two kinds of medical information. There is self-reported information, which are you are free to share with anyone, but which providers don’t necessarily trust. And there is your health record (things like test results and doctors’ notes), which is protected by HIPAA. HIPAA allows health care providers to share information when needed, but there’s no easy way to do it.

There are plenty of people trying to fix this, like Medicare’s “Blue Button” initiative, the electronic health records company EPIC, and initiatives from Microsoft and Google. But so far they’ve failed to make sharing and privacy easy. So we have to fill out the same paperwork over and over again.

The Affordable Care Act (Obamacare) isn’t actually about insurance.

The backers of Obamacare would like you to focus on the number of people who are insured now. The ranks of the uninsured have decreased from 15% of the population to 11%. But that’s just the opening salvo in the transformation that Obamacare is trying to create.

What’s really going on. Right now, your insurance pays for things medical providers do, like tests, exams, and procedures. But what we as patients really want is to be well. The Deloitte Center for Health Solutions says we’re at the beginning of a transformation where insurers will pay for value provided, not just for tasks. According to Skip Snow, “The ACA moves the system to deliver care based on value. Providers will get paid when they do good job managing a person and a population’s health state.” That would be a complete transformation in the payment models for health care.

As you might expect, those measures of value are controversial. For example, Dr. Wayne Altman** is part of a group called Care That Matters, studying quality measures designed to incent physicians to provide better care, not just save costs. Don’t expect this fight to settle down any time soon.

Our healthcare system is the most expensive, but not the best.

The Commonwealth Fund ranked America’s healthcare system last of 11 developed nations, even though, at $8,500 per person per year, it is by far the most expensive.

universal health careWhy it happens. As shown on this map, most western countries provide health insurance for all citizens. This is the “single-payer” system. The system is overall more efficient. On the other hand, it means that, at least in theory, everyone gets the same basic level of care; it’s hard to turn being rich into better treatment.

Skip Snow points out that although the US system based on insurance companies is more expensive, it has a benefit: it makes it easier for medical entrepreneurs and pharmaceutical companies to create breakthrough treatments and profit from the results. Much of the medical innovation happens right here in the U.S. And if it succeeds, we end up paying quite a bit for it. That’s capitalism in health care.

You can’t get help by email.

Or apps. Or videoconference. It’s 2015 — we’ve got any number of ways to communicate. I can get a notification when my flight is late and an email when my car repair is done. Why can’t I ask my doctor a question that way?

Why it happens: Nobody can figure out how to reimburse doctors appropriately for electronic communication. There’s the liability issue, as well: who’s responsible if you read the doctor’s email and interpret it incorrectly? We’re all suffering because the incentives in the system don’t allow for technology. Yet.

** Disclosure: Dr. Wayne Altman is my partner in the non-profit WellnessCampaign.org.

Photo: 401kcalculator.org via Flickr.

Universal health care” map by NuclearVacuum, Obi-wan Kenobi, Apatens – This file was derived from: BlankMap-World6.svg. Licensed under CC BY-SA 3.0 via Wikimedia Commons

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  1. If prices are not published and known, then there can be no price competition in the healthcare market. This is the key to competition lowering market prices. This healthcare system will never lower costs without pricing becoming transparent.

    1. Monopolies generally become byzantine and ubiquitous. The ‘medical establishment’ is rather monolithic and sort of sets the tone of what medicine even is, don’t you think? I’m not saying that, for brevity, I’ll call ‘western medicine’ doesn’t often do wondrous things at whatever price. But for instance… Im no longer sure if I can trust the food at the grocery store as to what’s been sprayed on the produce or the effects of ingredients in the food. The same folks own big pharma also make pesticides and vaccines and cereal and nearly all the seeds. I guess what I’m wondering is if we should look into the bullshit that causes the need for health care and whether or not some of the medicine they’re selling us for what ever price is bullshit. After that one might look into the bullshit the governmental medical agricultural folks have suppressed or outright lied about (pot is being worked on so maybe see what else or was cannabis the only fib). Then we might be able to lower the cost of health care in many ways. Regardless of who pays.

  2. Many doctors now use email. Some use secure systems, some just use plain old insecure email. This may be geographically driven, like many healthcare decisions.

  3. “Much of the medical innovation happens right here in the U.S. ”

    Yet, according to the OECD the average life expectancy in the US is 79 years; in the UK it is 81 years, Japan – 83 years, Canada – 82 years, Germany – 81 years, France – 82 years and so on.

    Co-incidentally, a lower and falling life expectancy works in favor of health insurance companies as there is less expense to pay out for.

  4. We’re playing a shell game. I am forced to switch insurance @12/1. The new company, Aetna, can’t tell me if an ultra sound is covered without my new insurance being effective. I know the policy “name”, “level”, & premium but there’s no way to get an answer.

    It’s like buying auto insurance & then finding out you don’t have collision. WTF!?!? Plus it took 4 phone calls to actually speak to a human being.


    Thanks Obamacare, another feather in the cap.

  5. The cost of healthcare is outrageous! I have to pay $1,675 a MONTH for bloody healthcare! My wife and I both work so we make more than 100k but less than 125k, so we don’t receive any help/tax credit on healthcare. Our employers do not subsidize healthcare so the full weight is on us. I really hate obama for forcing us to have insurance. If I could just insure my kids I would do that instead. The problem is that only certain people are helped while others are royally screwed over. It makes me mad that some burger flipper gets free healthcare and I have to pay extra so that bum can have free healthcare. Go to hell obama.

  6. i’m so friggin pissed off. have spent all night looking for new insurance and it is more than 3 times what i have been HAPPILY paying. so, in order to afford insurance, i have to stop contributing as much into my retirement. my husband and i are both self employed, so we don’t receive any match from an employer. f off obama!

  7. The biggest piece of bullshit is that America has a healthcare system at all. In a place where health care is provided by thousands of competing businesses, we don’t have a healthcare system any more than we have a restaurant system.

    As soon as we stop pretending we have a system at all, we can begin to have the conversation about whether we need one and what the design should be.

  8. So my toddler woke up with a fever of 103f and no other symptoms. Of course my wife and I were concerned when nothing we did would lower his temperature. So we did what any scared parents would do. Yup, a quick trip to the ER. Our visit was surprisingly short, about 30 minutes total. During that time a nurse gave him a dose of Motrin, the doctor came in and announced that he did not know what was wrong, and another nurse screened him for strep and flu. Fortunately the tests were negative. A few weeks later I received a charge from the hospitals lab requesting $78.00 for the two screenings. Not bad. Then one from the hospital ER requesting $2,000.00. Then one from the doctor requesting an additional $1,400.00. Why should I pay the ER or the doctor all that money if they didn’t do anything for my son? It’s like paying a mechanic to fix your car but he couldn’t find the problem. They didn’t charge me for the Motrin, the most beneficial part of the visit. I’m confused and supremely irritated. I thought highway robbery was a crime?

    1. That is almost nothing. “Kidney Stones” did you get that.
      Well, of course, ER …. 3 kidney stones of the size of smaller than grain of sand
      2 hours in the Hospital ER
      Torso scan, some painkillers, Dr checkout, and nurse injected the painkiller.

      The solution,… diuretics and painkillers.

      The hospital sent me a Bill for $9’000. I did have to fight that and anyway pay around $3’000 for the deductible. The insurance paid the rest.

  9. Other options to get a trade group that offers a more affordable replacement for an individual health care insurance policy.
    The more hours you spend focusing on the above three points, the more it might be so that you can feel you have the space,
    time and energy to pamper, care and nurture your mind, body and soul.
    Generally, the greater a deductible you ultimately choose,
    the reduced a premium you’ll pay each month.

  10. I have saved over $56,000 in the last 7 years. I no longer have health insurance. I don’t smoke,drink, or eat crap. I pay to go to the dentist twice a ear, ($350 total) the “penalty” for not having insurance is much cheaper than the insurance, but its still bullshit. thank you Obama.

    1. Yeah they no good you can’t see a list of providers and rates per income or choices weirdos you don’t know call house and lie and only care about the sale and don’t even know the laws or what MCC is? U believable

  11. I have saved over $56,000 in the last 7 years. I no longer have health insurance. I don’t smoke,drink, or eat crap. I pay to go to the dentist twice a year, ($350 total) the “penalty” for not having insurance is much cheaper than the insurance, but its still bullshit. thank you Obama.

  12. I am not sure that the problem of the Medical Health in America are the plans or the medical system.
    For me, the problem is on the Private Insurance.
    Health Insurance: The Health Private insurance in America eat all the money that should be dedicated to Heath. Those private insurance Markets control all related with medical without knowing in many cases basics about medicine.
    Just an example:
    I am not sure why one broken arm is priced less than a mental disability. We know that many people with cancer will die in a year or five years later or finally survive,…. but a mentally disabled will kill himself or do harm to many others in those 4 to 5 years. But instead of treatment, they are put in jail. Jail is more expensive than a mental medical treatment

    The Government should create a Public Health Ministry “to manage” and “regulate prices and cost” of the Medical Services. The insurance and government shouldn’t decide the type of treatment.
    The MD should decide what kind of medical treatment a person should receive

  13. Thank you for any other informative website. Where else could I am getting that kind of info written in such an ideal means?

    I have a mission that I’m simply now operating on, and I’ve been at the glance out for such information.

  14. As an outsider, I find the American lack of universal healthcare saddening. I guess you can pay for a fleet of aircraft carriers (and all the other trappings of global power projection) or have universal healthcare – but not both.
    For another interesting perspective on your lack of meaningful healthcare, read Joe Bageant’s excellent “Deer Hunting with Jesus”.
    It’s not communist to think my taxes should go to ensuring every citizen should be able to walk into a doctor’s office or hospital and receive essential care for free – it’s basic human decency.
    “…that’s capitalism in healthcare” – that’s an oxymoron if ever there was.

  15. Just spent an hour trying to find an Ear Nose doc. Was told by insurance that I did not need a referral for the doctor they approved as “in network.” Called the doctor, was told I needed a referral. I asked who gives referrals. They said my PCP. I said I don’t have a PCP. They said it’s important that I have a doctor. I was polite, but could have told her telling me to have a doctor is important is like telling a poor person it’s important to have a mansion. I said, thanks and we both kept our dignity. It took over one hour to be told I cannot receive service unless a stranger I’ve never met agrees to write me a note, after I go see and pay him, to go see someone who will almost certainly try to sell me hearing aids rather than fix my problem.
    I give up. I served my country and worked for communities my whole adult life. (No, the VA is not an option. Think of the DMV for health care. That’s almost as bad as going to a VA hospital. Overworked, understaffed). In this “great” nation of ours, single wides now cost what I bought my first all brick home for (only 20 years ago) and this country has become a giant wal mart with a trailer park next to it.
    If I never paid for insurance I would have over $100,000 in savings. So all I’ve done is pay for unhealthy people b/c I do a check up like once every five years and it comes back a okay. It’s a scam. It’s insulting and degrading. It’s unAmerican. I am not free. I don’t have a say. I only pay and wait to need it. And of course, when there does come a day I need insurance, they’ll get a team of lawyers on retainer to deny my coverage because on page 9, paragraph 4, I used a comma instead of a semicolon, thereby releasing the Insurance for profit pirate ship scam team to keep my money and go buy another yacht or dinner with a cute drug rep chick with big knockers and a bag full of opiods. Done with this scam system. I’d rather go curl up and die in a corner in charge of myself than to put my care in the hands of people who see me as a mark, as a chump, as an idiot, which is what I feel like trying to even use my healthcare.

    1. I hear you on the “no real choice” point. As an economist I can tell you that health insurance is a bad deal. Most people pay significantly more in premiums and copays than they would for the services actually provided. Add to that the fact that prices are also inflated and unpredictable and you get a real shitshow. I think it’s obvious that the system is broken. Question is: will we survive while we wait for someone to get around to fixing it?