Just out of morbid curiosity...what stops the free market in the USA from having normal healthcare?

The US doesn't have a healthcare problem. In fact the healthcare is quite good anytime I have needed it, even as a foreigner visiting the US. However, what the US does have is a problem with lobbyists (Big Pharma, for example), tort law (in serious need of reform), and the insurance companies with their hands in the pie.

Just my $0.02

and there's also lots of uninsured people going to the emergency room, and the costs get passed on to the insured people. That's why Democrats actually took a stab at reforming healthcare, instead of the Republicans way of doing things, which is to stick their head in the sand and keep the status quo. What do they care as long as they have insurance?

Our healthcare as a service is great. The problem is the cost and in some cases access related to cost.

The reason that we don't have real reform is that we don't have a real free market in the healthcare world.

Here are just a couple of things that hold it back:

1.Many insurance companies are only allowed to sell in specific areas. This often reduces competition and can raise the cost.

2. Big pharm has figured out ways to take advantage of the patent system (via lobbyists and other tools) so they can change outrageous prices for their medication. I use an inhaler that was first prescribed to me in 1978. Somehow that inhaler is still protected under the patent and there are no generics available for it.

3. Big pharm makes sure to put the squeeze on any kind of attempts to go around them. A few years ago there was a story in my local news about a guy who started business that helped people buy their medication online. He used a few different reputable online pharmacies and people would come in, he would help them create an account and order their meds and for this he would get a fee. He wasn't opened very long before he was forced out of business for violating various pharmacy laws.

4. Insurance companies stand to gain by having the cost of healthcare be very high. This allows them to scare people into making certain they have health insurance just in case something happens. If prices were low and reasonable, many people would just pay out of pocket and have no need for insurance.

5. General corruption among our elected officials. Healthcare companies spend a ton of money on lobbyists to get laws that benefit them passed. Many of those politicians who help those laws get passed end up with nice, high paying jobs in those big companies when they leave office.

These are just a few off the top of my head.

Also insurance companies work together with hospitals to jack up the price so that you actually get much less "coverage" than you pay for. For example, go to the doctor for a straightforward procedure, i.e. sutures. If you have insurance that covers 80% and your bill is, say, $1,000 then you pay $200 and insurance "pays" the rest. Go in with no insurance and pay cash up front and you'll often find your bill is closer to the $200. I am pretty sure on the back end the insurance company is getting a huge volume discount and is not paying the full remainder of the balance, in many cases I believe they pay much, much less.

kane hit a lot of the reasons there. In short there are some very vested powerful interests working together to ensure it remains massively profitable for them, against the public good.

I often wonder also - if non-Americans really understand how polarized US society and government is at this point. It's terrible. Basically two different cultures at odds within the same country, the result being that any notable reform in healthcare or other areas is near-impossible. When you have multiple smaller factions, cooperation becomes a necessity because you need to form coalitions and compromise to gain and hold power. In the dual system of the USA it's just two immovable forces pushing against each other.

25 Shocking Facts That Prove That The Entire U.S. Health Care Industry Has Become One Giant Money Making Scam

http://endoftheamericandream.com/arc...ey-making-scam

#1 The chairman of Aetna, the third largest health insurance company in the United States, brought in a staggering $68.7 million during 2010. Ron Williams exercised stock options that were worth approximately $50.3 million and he raked in an additional $18.4 million in wages and other forms of compensation. The funny thing is that he left the company and didn?t even work the whole year.

#2 The top executives at the five largest for-profit health insurance companies in the United States combined to receive nearly $200 million in total compensation in 2009.

#3 One study found that approximately 41 percent of working age Americans either have medical bill problems or are currently paying off medical debt.

#4 Over the last decade, the number of Americans without health insurance has risen from about 38 million to about 52 million.

#5 According to one survey, approximately 1 out of every 4 Californians under the age of 65 has absolutely no health insurance.

#6 According to a report published in The American Journal of Medicine, medical bills are a major factor in more than 60 percent of the personal bankruptcies in the United States. Of those bankruptcies that were caused by medical bills, approximately 75 percent of them involved individuals that actually did have health insurance.

#7 Profits at U.S. health insurance companies increased by 56 percent during 2009.

#8 According to a report by Health Care for America Now, America?s five biggest for-profit health insurance companies ended 2009 with a combined profit of $12.2 billion.

#9 Health insurance rate increases are getting out of control. According to the Los Angeles Times, Blue Shield of California plans to raise rates an average of 30% to 35%, and some individual policy holders could see their health insurance premiums rise by a whopping 59 percent this year alone.

#10 According to an article on the Mother Jones website, health insurance premiums for small employers in the U.S. increased 180% between 1999 and 2009.

#11 Why are c-sections on the rise? It is because a vaginal delivery costs approximately $5,992 on average, while a c-section costs approximately $8,558 on average.

#12 Since 2003, health insurance companies have shelled out more than $42 million in state-level campaign contributions.

#13 Between 2000 and 2006, wages in the United States increased by 3.8%, but health care premiums increased by 87%.

#14 There were more than two dozen pharmaceutical companies that made over a billion dollars in profits in 2008.

#15 Each year, tens of billions of dollars is spent on pharmaceutical marketing in the United States alone.

#16 Nearly half of all Americans now use prescription drugs on a regular basis according to a CDC report that was just released. According to the report, approximately one-third of all Americans use two or more pharmaceutical drugs, and more than ten percent of all Americans use five or more prescription drugs on a regular basis.

#17 According to the CDC, approximately three quarters of a million people a year are rushed to emergency rooms in the United States because of adverse reactions to pharmaceutical drugs.

#18 The Food and Drug Administration reported 1,742 prescription drug recalls in 2009, which was a gigantic increase from 426 drug recalls in 2008.

#19 Lawyers are certainly doing their part to contribute to soaring health care costs. According to one recent study, the medical liability system in the United States added approximately $55.6 billion to the cost of health care in 2008.

#20 According to one doctor interviewed by Fox News, ?a gunshot wound to the head, chest or abdomen? will cost $13,000 at his hospital the moment the victim comes in the door, and then there will be significant additional charges depending on how bad the wound is.

#21 In America today, if you have an illness that requires intensive care for an extended period of time, it is ridiculously really easy to rack up medical bills that total over 1 million dollars.

#22 It is estimated that hospitals overcharge Americans by about 10 billion dollars every single year.

#23 One trained medical billing advocate says that over 90 percent of the medical bills that she has audited contain ?gross overcharges?.

#24 It is not uncommon for insurance companies to get hospitals to knock their bills down by up to 95 percent, but if you are uninsured or you don?t know how the system works then you are out of luck.

#25 According to one recent report, Americans spend approximately twice as much as residents of other developed countries on health care.

http://endoftheamericandream.com/arc...ey-making-scam

What stops it? Umm could be America doesn't have a free market.. America has a govt subsidized and regulated in favor of big business market that is called "free" with the regulations written by the corporate lobbyists in their favor and not for the actual people's.

Simply put the hospitals don't have to give you a price chart as to what they charge ahead of time. They get away with calling their prices a trade secret so they have no ability to shop around as in a true free market. Due to this the hospitals are able to charge insane costs but then work deals with each insurance company separately but not with individuals whom don't have insurance. This creates a fake need for insurance because the prices are greatly inflated if you have none.

It's a giant scam..

The pharma companies are able to charge anything they can get away with because there is no regulation on their pricing. Once again they work deals with the insurance companies but royally ass rape the un insured, meaning there isn't a set price that anyone can pay you need insurance or you pay 3 times as much or more.

Essentially because there is a lack of govt regulation on prices for the consumers, it's created a fake market place where insurance is required.

Here is one example that shows what the problem is.

This drug is commonly given out in the U.S to treat toenail fungus.
http://en.wikipedia.org/wiki/Ketoconazole

and from that article

It's not only ER visits, but regular visits.

We usually have healthcare through my wife's work, and for some reason there was a lapse and my daughter broke her leg. I expected doctor's visits to be in the thousands of dollars. I was working for Lightspeed Cash at the time, very well paid, and just expected to bend over and take it. When they discovered I didn't have healthcare, they only charged me $500 - this covered three visits, multiple x-rays each visit, putting on and removing the cast. After that, physical therapy was $35 each visit.

My point is there is the price they bill the insurance companies, but then there is the price they charge people without insurance. And it's a huge difference.

"Dr. John Rengen Virapen, former Eli Lilly & Co executive who after 35 years of service decided to quit and speak out about Big Pharma's method for profit and the benefit of symptomatic diseases that people live with for the duration of their lives. "

A lot of time they won't just offer you that lower price.

Before getting regular insurance I had just a catastrophic policy so I had pay for doctor visits out of cash. I called several doctors and found out they don't have reduced rate for cash customers. In other cases when I told them I was self pay they told me the price and I had to talk to someone in accounting/bookkeeping in order to get a reduced price.

I understand the insurance part but what about offering medical services with no insurance deals, just for cash, with reasonable non-rapist bills for medical services? A doctors "shop" if you will.

Another thing would be what is stopping somebody from offering honest health insurance and cooperating with honest establishments? Would such a health plan/combo not be the easiest sell ever?

3rd world shit hole torn to shit by half a century of sanctions cuba has a lower infant mortality than the USA so quality healthcare is obviously in no correlation with huge expenses.

I understand that the system is corrupt but how could they stop a normal doctor charging normal rates and a normal health insurance program charging normal rates? *obviously the honest health insurance could only be applied in honest doctors offices , the corrupt hospitals would not be covered but would, in time, have to adapt to normal rates or die...

Greed678

Because of tort law, malpractice and insurance.

I don't think one can talk about prices of medical services without discussing tort law reform.

Even if a doctor doesn't think it's necessary to do extra testing he will just in case he gets sued later. Cost goes up this way.

They have these - walk-in or local clinics that attempt to be market-driven and offer basic medical services at somewhat reasonable rates. There's one right down the street from me. And they're fine costwise for basic check-ups, or if you're just moderately sick & need some meds, or for a basic in-office procedure. That's not the problem and it never really has been.

It's when you start getting into stuff that needs other layers of infrastructure - advanced diagnostics, real labwork, nongeneric meds still controlled under patent by pharm companies, inpatient surgeries & whatnot, hospital stays, chronic conditions that require some or all of the above over a long period of time.... that's when the prices skyrocket. There are so many moving pieces and stakeholders and conflicting interests it's very difficult to pinpoint what the problems are and how to lower costs.

So yeah, basic services can be made affordable but anyone saying you can apply the same market forces to in-depth healthcare just doesn't have an appreciation of the scale & complexity involved. Which unfortunately includes many of our politicians.

I hate to be a "boot em all out of office!!111" type, but IMO unless the political structures change dramatically in the USA (not gonna happen, if anything corporate interests are becoming more entrenched by the month) this problem will not be solved.

This does exist for many areas. Here is the price list for the Hollywood Urgent Care near me:

http://hollywoodurgentcare.snappages.com/services.htm

Note that even fixing a knife wound there tops out at $350.

Under ACA in California, my copay for an urgent care clinic would be $120, per Covered California. A regular visit only costs $69 though, so insurance would cover nothing, unless it was approximately knife wound level.

Real healthcare reform would have included Financial Aid help for doctors and more urgent care clinics.

i dont think any country has a perfect system but in the US it's beyond ridiculous

at least when you compare civilized western nations (and a few 3rd world countries)

Interesting thread, was curious about that too

Because we subsidize the rest of the world. Or because medical field isn't really a free market. Or because we live longer then ever and put a premium on staying alive at all costs. Or... there are a ton of reasons.

Well some europe countries have it pretty well,some they even managed to have non-waiting lists.

do any of those countries have comparable population sizes to the US though?

and a public option

i believe they compare on a percentage basis?

They could do this, but one problem that would hold it back is the corporatization of those doctors. Many independent doctor's offices are being bought up by larger companies. I live in a pretty small town. When I moved here about 10 years ago there were 3 independent pharmacies and 1 pharmacy that was part of a big chain store. There were also 3 or 5 independent doctor's offices. Now there is 1 independent pharmacy (the others closed down because both Walgreens and CVS opened up and put them out of business) and we are down to 1 independent doctor, the rest are still here, but they are now part of bigger corporate healthcare companies.

The Right has made it clear they would kill that baby in the cradle. Maybe in 20 years when the GOP is totally irrelevant.

I think he just means it's exponentially more difficult to administer healthcare to over 300 million people. For example, California alone has a higher population than Canada. And I honestly have wondered if things might be smoother on a purely state-by-state level, though you then lose a lot of the leverage that the national structure provides.

i am not sure what that has something to do with it

you need x doctors per 1000 people, x hospitals, x nurses and so on

1 person causes on average y dollars, euros whatever healthcare expenses per year

so it is basic math to calculate the average cost for a healthcare insurance - depending on how many people pay into it

it has zero to do with the size of the country or population

it becomes more complicated when - like in the US - you let "insurance" companies, big pharma and lobbyists run wild

despite of all problems they still have with it: Germany has a pretty good system with a mix of government regulated (and mandatory) healthcare insurance (which are not allowed to make profits - gasp!) plus private insurance companies for those that qualify for them

and no one will say that you get bad healthcare in Germany (just watch Dr. House, they use Siemens Medical MRTs ).

And when you can do it for 80 million people, you can do it for 300 million too - once again: basic math

It does though. Any organization and/or endeavor becomes more cumbersome, less nimble and able to adapt, and less efficient the larger it gets. Not that lobbyists & insurance/pharm industries aren't the primary culprits, and it's true that Germany manages alright with about 1/4 the population of USA. But that aside IMO it's just too big and too polarized politically & socially to resolve this shit anytime soon.

I think the polarization has more to do with it than the size.

There are states that are refusing to expand their medicaid enrollment even though the feds will pay for it because they are against Obamacare. In many cases it doesn't matter what one party does, the other will oppose it simply for political reasons. Add in the ever expanding ability of big businesses and wealthy individuals to give unlimited amounts of money to campaigns and companies can effectively buy opposition to something the don't like.

A major overhaul of our system to include something that actually reduced costs would take a herculean effort. I don't think anything like that can happen unless one part or the other clearly runs the countries (not just with a majority, but by making the other party irrelevant) or the system finally reaches critical mass and the people, no matter what their political ideals, demand a real change.

i am not saying that you can solve it right now - i am saying that in theory it could work

but the situation you are in right now is fubar

I'll add mine as well

$0.04

it has everything to do with it..

well, in that case... can't argue with that

what if the patient was told up front to sign a "I will not sue you" agreement in return for reasonable health care pricing? for people who just want to get better without being able to sue for millions and millions and accept that shit happens ect...

Doesn't work - unconstitutional. You can't sign away your day in court. Anyone can sue anyone for anything (vast majority never win). In some instances, you can agree to binding mandatory arbitration (which can hold costs down) but even those can often be appealed or taken to court.

I think you hit the nail on the head here. It is a failure of the US public school system that so few Americans can do basic math that the American insurance industry makes out like bandits exploited that inability to do basic math.

Capitalism fails on

Housing

Education

Food

Computer Operating Systems

Culture


Succeeds on

Poverty

War

Electronic Gadgets

Land of the FREE... not!

Not even CLOSE to a free market. In the 50s and 60s it was. At that time people only carried insurance for catastrophic issues, and paid cash for everything else. It kept costs down and quality climbing. Then a few things started happening. State governments started mandating certain care levels for every insurance carrier, pharma used lobbyests to get the regulations passed in order to control markets, lawyers started suing everyone that they could lay their hands on, etc, etc,

Now the government is SO involved with every aspect, the price is out of control. Having said that, the quality of care is truly amazing for the vast majority of people in the US. (I have dealt with health care systems personally in many places on the planet, including the EU). However, I believe that with the now massive increase in government intervention, you will see the pace of inovation slowing, the care levels going down, and wait times increasing, number of doctors going down, etc... Shit is about to go downhill big time IMHO.






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Luckily, there are still a few of those centrally planned workers paradises that you can take your deluded mind to and live in your fabulous utopia.....





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which capitalist free market economies have good housing for all, full employment and good health care?

USA the richest country on the planet and fails its people so badly.

Who are the deluded?

Whatever you say buddy.... I'm sure you are ABSOLUTELY RIGHT!


Like I said, go ahead and move to one of the centrally planned economies. There is nothing to stop you. You can escape this capitalist hell anytime.



Enjoy!




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So you argument is;

Don't look what happening here, its much worse over there.

That should work for people in power all over the World.

name one example where that worked out in history

Where what worked out?

its not free market. hospitals and doctors can't turn away people who won't pay them, insurance can't be sold across state lines, etc. etc.

all an American has to do to realize how good he has it is to travel outside of the US.

do i have to spell it out?

name one socialist/communist country that had/has good housing, full employment and good healthcare for everyone

AND: an economy that can compete with the rest of the world