Why an MRI costs $1,080 in America and $280 in France

[Samael]

There is a simple reason health care in the United States costs more than it does anywhere else: The prices are higher.

That may sound obvious. But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. 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.

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.”

As it’s difficult to get good data on prices, that paper blamed prices largely by eliminating the other possible culprits. They authors considered, for instance, the idea that Americans were simply using more health-care services, but on close inspection, found that Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians.

“The United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do,” they concluded. “This suggests that the difference in spending is mostly attributable to higher prices of goods and services.”

On Friday, the International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — released more direct evidence. It surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more. The exception is cataract surgery, which appears to be costlier in Switzerland, though cheaper everywhere else.

Prices don’t explain all of the difference between America and other countries. But they do explain a big chunk of it. The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it.

“Other countries negotiate very aggressively with the providers and set rates that are much lower than we do,” Anderson says. They do this in one of two ways. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they’re set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.

More after the link:
http://www.washingtonpost.com/blogs/ezra-klein/post/why-an-mri-costs-1080-in-america-and-280-in-france/2011/08/25/gIQAVHztoR_blog.html

I've always listened to friends who live in the US with something like shock about the costs of their health care.
For example, I've had X-ray done a few weeks back, and I had to pay nothing. It all went out of my insurance, yet, someone in the US, getting the same done, and even having an insurance, would still have to pay a ton of money, it seems.

The problem, as I see it, is that Health care is treat like business in the US, and a business aims to make profits, no matter the results for the people who need to make use of it's services. Until the Government steps in and starts to regulate prices downwards some, I can only see this increasing. Free market is a nice idea, but keeping it so completely unregulated it a recipe for disaster.

[Jeramiahh]

I'll tell you, the biggest thing about the prices in healthcare? They're not really as bad as most people make them out to be... unless you're uninsured. Then they take you to the cleaners.

I used to work for a private doctor's office, and was intimately familiar with how the billing system works, and, honestly? It's insanity. Let's say you come in for a standard office visit. Regardless of your insurance coverage, we send a bill for $100. Why $100? Because it's more than any insurance company will pay; if you set your price too low, the companies will just write off the difference as free money for them. Too high, which is what everyone does, and they write off the difference between what you charge, and what they think the price is, and that's part of your contract. You don't get that money.

For example, I send the bill to Medicare, which is pretty much the average for all insurance companies. Some pay more, some pay less, but they all pay within about 10-20% of Medicare. I send Medicare the bill for $100. They consider it to be worth $75. They pay 80% of that, or $60, unless you have a deductible to be met; this amount goes towards your deductible, instead. The remaining $15 is your part of the bill, unless you have a secondary insurance. That $25 difference between what we billed, and what Medicare declared payable? Gone, written off in smoke.

Now, you don't have insurance? Here's your bill for $100. This isn't much of an issue, for office visits... but when you consider that, for a hospital stay, just having a doctor walk in the room (and you'll often see 2-5 doctors a day!) adds $200 to your bill. Plus any tests, which run in the thousands, treatments, and the stay in the hospital itself. Easy to rack up $10,000 in bills, in just a few days. You have insurance? Great! They'll shave 25% right off the top, or more, often writing off entire procedures. Then, once your deductible is met, and you'll meet it fast with a bill like this, they'll pay the majority of the rest. With a decent insurance policy? You might end up paying $1000 or less.

Or, you don't have insurance, and you're driven to bankruptcy by this sudden bill that probably cost more than your car. Which means you can't pay. So the prices have to raise everywhere, to pay for it all, because a lot of uninsured people who go into the hospital (and hospitals can't turn away people for inability to pay), just simply... never pay. Could you run a business where one in ten of your customers, and often the most expensive ones... didn't pay? Sure you could... you just have to charge those who DO pay a lot.

[Pumpkin Seeds]

Part of the problem is honestly that people in North America do not use the medical services available with greater frequency or involve themselves in their own healthcare.  As pointed out by the original poster, people in the United States utilize the healthcare system the least.  While people may think that would decrease the cost, in truth that means the cost is increased since healthcare problems which could be altered cheaply to start are handled at later stages where treatment is more expensive.  People in the United States are also more likely to use the Emergency Room as a clinic where costs increase greatly due to the level of care the Emergency Room can provide and the staffing restrictions.  Those costs are even greater at level one trauma centers which are also government subsidized.  A lot of the cost issue is culture related, especially later in life when things such as obesity and diabetes contribute to a great many comorbidities that must be treated.  All of these issues could have been handled with frequent visits to a doctor earlier in life and more focus on personal healthcare.  Preventative versus reactionary medicine is much more cost-effective.

A story that one of my Community Health instructors enjoyed telling was that of a program in Italy.  Women would come in to get pre-natal checkups and screenings.  Now there are a great many pre-natal appointments available but the women that came to a certain number received a car seat.  A lot of women came to only the ones that would contribute to the free car seat and then stopped coming.  Many of the students in my class said this was not fair and showed bad parenting.  My teacher responded with the fact that those necessary appointments reduced the risk of complications and birth defects tremendously and so also reduced the cost of medicine as the hospitals were less likely to care for a problem birth.  Before the program started, Italy had a tremendous problem with babies having to be placed in the NICU.  This cost the government millions of dollars because the level of care in a NICU is expensive.  After the program, the cost went down significantly.  All of this for the cost of a car seat, which also helped ensure that mothers were safely buckling their babies into the car.

In the United States, there is a problem with seeing such measures as cost effective and beneficial to everyone involved.  Something offered free to certain people is seen as unfair, even though the offered care would decrease overall costs and help free up additional money to be distributed elsewhere.  People are quick to blame the uninsured, not realizing that the insured are also adding to the problem.  Insurance companies do not pay nearly as much as people imagine and hospitals, many times, eat those costs.  For instance when my mother worked as a case manager, which is someone charged with negotiating hospital costs with insurance companies in regard to a patient, she would often see vast short falls.  A liver transplant can cost upward of 500 thousand dollars if all goes as planned.  Medicare/Medicaid will only cover up to 250 thousand of that surgery.  The hospital eats the rest or, as pointed out, passes the cost onto someone else. 

Few people realize that someone else’s crappy insurance means that their wonderful insurance pays more for the same procedure.  Insurance companies will often appropriate a set amount of money for a procedure.  So for instance if two people are going for knee replacement, one has amazing insurance that will cover the entire stay and the other person’s insurance will only cover three days.  Say both people stay five days in the hospital.  The hospital will then try to tack on those uncovered two days by one person onto the person whose entire stay is covered.  This is how people get bills for 500 dollar cups of jello.  The hospital knows the person, whose insurance company wouldn’t pay, is not going to be able to afford the cost of the hospital stay and so need to cover their costs somehow.

People may gripe, but the alternative is the hospital closes.  People still have to be paid regardless. 

[Serephino]

Pumpkin pretty much summed it up.  Uninsured people don't go to a doctor unless something is seriously wrong.  When I had my first kidney stone I went to the ER because I was in a lot of pain.  Now, I can know it's a kidney stone, and I'll still go to the ER.  They have to do the expensive tests right then and there to find out what's wrong.  If I were to go to the doctor and have him order the tests they can refuse to do them.  I went to my family doctor when I had the gallstone, and the hospital made me put $100 down for the ultrasound.  With the kidney stones I go to the ER and get the x-ray to find them, then they call the Urologist and ask what he wants to do.  I don't have to make an appointment and wait for an office visit.

It may sound bad, but when you don't have insurance you learn to work around the system because obviously if you need medical treatment you can't just sit and do nothing.  Now I do have Medicare, and I see see what you guys are talking about.  They send me itemized bills, and they always have this part that says Medicare Allowance, which is usually a lot less than the charge.  Of course, at least they get something, because it isn't like I have any money.     

[RubySlippers]

Pretty much the case my medical care choices are: the free clinic or the emergency room.

The first case its fine I drop $5 and they can do most basic tests in the clinic even an ultrasound and get prescriptions such as from the $4 drug list at most big chains or they give the meds there.

The ER I will go to the fact is with pretty much making nothing on paper I'm under the charity care law so they can't bill me for the hospital, the doctors and other parties billing departments usually don't try and if they did move to collect I have nothing to go after. This means the costs get passed on to those that can pay.

[TheyDontKnowIBurn]

The whole healthcare system sucks. True facts. And it doesn't help that some people choose to fraud the state provided services.

Point in case, girl A applies for medical at age 18 whilst living away from home, then as soon as she gets it, moves back home, and simply lies about her living situation to keep said medical, all whilst doing absolutely nothing to move her life forward. Girl B, however, has been living at home whilst going to college, and working when she could. She can't even get a little help, never mind the fact that she's paying her own books. Instead she gets screwed because her father makes too much, though she never sees any of the money.

What needs to happen is the states need to work on better appropriating their funds. I can guarantee that if some effort was put into pruning out the frauds, there's be a heck of a lot more help for those who really do need it. Then there could be preventative care, like Pumpkin spoke of.

People are less likely to get preventative care when they are going to be charged 150 bucks per office visit, not counting whatever prescriptions or tests may be needed.

[Callie Del Noire]

There is a LOT of bloat in the US medical care system. It's been going crazy since the HMOs came into the market. It went from providing a service to the public to 'making a wild profit at our client's expense' (at least to some providers). I know folks who have been stalled, lied to, and fleeced by their service, which is why I'm grateful for access to the VA and Tricare coverage. It's not perfect but its' good.

[The Irishman]

I'll tell you, the biggest thing about the prices in healthcare? They're not really as bad as most people make them out to be... unless you're uninsured. Then they take you to the cleaners.

I used to work for a private doctor's office, and was intimately familiar with how the billing system works, and, honestly? It's insanity. Let's say you come in for a standard office visit. Regardless of your insurance coverage, we send a bill for $100. Why $100? Because it's more than any insurance company will pay; if you set your price too low, the companies will just write off the difference as free money for them. Too high, which is what everyone does, and they write off the difference between what you charge, and what they think the price is, and that's part of your contract. You don't get that money.

For example, I send the bill to Medicare, which is pretty much the average for all insurance companies. Some pay more, some pay less, but they all pay within about 10-20% of Medicare. I send Medicare the bill for $100. They consider it to be worth $75. They pay 80% of that, or $60, unless you have a deductible to be met; this amount goes towards your deductible, instead. The remaining $15 is your part of the bill, unless you have a secondary insurance. That $25 difference between what we billed, and what Medicare declared payable? Gone, written off in smoke.

Now, you don't have insurance? Here's your bill for $100. This isn't much of an issue, for office visits... but when you consider that, for a hospital stay, just having a doctor walk in the room (and you'll often see 2-5 doctors a day!) adds $200 to your bill. Plus any tests, which run in the thousands, treatments, and the stay in the hospital itself. Easy to rack up $10,000 in bills, in just a few days. You have insurance? Great! They'll shave 25% right off the top, or more, often writing off entire procedures. Then, once your deductible is met, and you'll meet it fast with a bill like this, they'll pay the majority of the rest. With a decent insurance policy? You might end up paying $1000 or less.

Or, you don't have insurance, and you're driven to bankruptcy by this sudden bill that probably cost more than your car. Which means you can't pay. So the prices have to raise everywhere, to pay for it all, because a lot of uninsured people who go into the hospital (and hospitals can't turn away people for inability to pay), just simply... never pay. Could you run a business where one in ten of your customers, and often the most expensive ones... didn't pay? Sure you could... you just have to charge those who DO pay a lot.

Note: I've worked in healthcare.


Hospitals will rarely go after people with outstanding bills.  Most are written off and sold to collections agencies.  You'll hardly ever find a Hospital suing someone over a paid bill.  Chances are if it goes to collections, you can work something out with them -- if they bought the debt at 10% of the actual bill, they're usually delighted if you wind up paying them 20% of the bill.  None of this benefits the hospital.


What happens is much like what you describe in the rest of your post.  Emergency Room stays are expensive because there is a large influx of people that use the Emergency Room as the doctor's office -- because they're uninsured.  Due to this behavior, they're not worried about  bills coming back in their face -- they have nothing to take and the hospital is forced to treat them.  It's a lose/lose situation for the hospital.  You can't turn people away, but there is no way to force the government to recoup your losses.


Basically put: Healthcare in the United States is expensive because the system is broke.  There is no regulation and there is a non-functioning government safety net for those that need it.  Most Medicaid funds usually wind up being blown by people who do not deserve it. 

[elone]

The problems with the health care industry are just too many to list. Most of it from my point of view is just greed and inefficiency. Look at the MRI example. I had one recently, the bill was $1600. The insurance company paid $380. God help the uninsured. Look at prescription drug costs. They cost more here in the US than just about anywhere. The US is basically subsidizing the rest of the world. Pills that cost pennies to make sell for up to a thousand times that. Drug companies say it is research money that is needed, but in reality their advertising budgets exceed their research costs.

I am contemplating some major knee surgery, one of my incentives is to have the insurance company cough up some of the exorbitant fees I have been paying over the years. They are so in the black in my case.

Oh, by the way, why does a surgeon think he/she can charge $5,000  for an hours work or less. Is that their minimum wage?

The only answer is for some sort of universal healthcare that takes the insurance companies out of the mix, standardizes care, and negotiates fees and costs. Socialism??? If that is what it takes, I am all for it.

People in the US travel to India for major surgery because the cost is so much cheaper and the care just as good.

[Serephino]

It would help if Medicaid and Medicare would become more efficient, and not so cheap.  My one friend lives with her dad and boyfriend, but as far as the state of PA is concerned, since she's an adult and not married, she's a single person with no income.  She gets Medicaid, and was in the ER 9 times in 2 weeks for anxiety.  My boyfriend is a little ticked that his tax dollars pay for her hypochondria. 

Now, since I do not live with my mommy, they processed me as a single person, but counted my boyfriend's income.  I don't get that...  I actually need the help because I have bills to pay.  She was paying $150/month for a Verizon smartphone and I'm scraping together $25 a month for a prepaid phone.  She goes to her grandparents' house every night for dinner, and I'm not gonna get to eat until after midnight tomorrow when my boyfriend gets paid because we're out of money, food stamps, and out of food.  This is insane.

[Trieste]

I honestly don't understand why people are so focused on other people. Paying for someone else's "hypochondria" - who cares? Would you rather that money go to health care or a smartbomb? The tax code has nothing to do with who actually uses the money, it's based on your income. You're going to have to pay the same taxes whether she goes to the doctor or not.

Instead of focusing on people who abuse the system - because people who abuse the system tend to be much fewer and further between than those who are helped by the system, it's just that 90-year-old Aunt Ethel getting her insulin covered by Medicare doesn't enrage you like the chick who moved in with her parents, so you don't remember it as well - why don't we focus on the fact that it's barbaric that we have companies that profit off of insurance? Why is the rage aimed at people who are scraping by, instead of at the companies that essentially hold you hostage by your health?

Health care is not a luxury. If you have a kidney stone, it's not like you can say "Oh, okay, I eventually need painkillers so I can pass this stone, I better save up for that". If you have severe appendicitis, you can't tell the doc to hang on while you find financing for the surgery to remove it. If you do, you'll die. Or you'll be in agony. Or you'll damage your organs. Health care is not a privilege, it's a necessity. And it's not something that you have a choice about - when you gotta go, you gotta go. Even buying food has more flexibility to it than health crises that require professional intervention.

My uncle, who is pretty staunchly conservative, made the comment to me once that "your grandchildren will be paying for Obamacare". I couldn't help thinking, yes. Why, yes, they will. And at least the money they will be paying will go toward actually covering them without, in theory, dicking them around. We all already pay for health care, and we pay a whole freaking lot, but the system is so twisted right now that we are paying too much money into the wrong spots and not enough money into the right spots. That has to change, and I really think the health care reform bill was a step in the right direction.

FFS, it's time we caught the hell up with the rest of the civilized world on this.

[Serephino]

For now, it seems like it's a band-aid on a slit throat, but we'll see.  The reason the woman with anxiety pisses him off is because he has a heart problem that will kill him if left untreated too long, and he can't afford treatment.  Instead, he pays taxes that pay for her to get thousands of dollars worth of tests every time her tongue goes numb, even though we all know damn well it's her anxiety.  She'll start taking her medication and it will go away in a week.

The anger, at least in my case, is at the broken system.  90 year old Aunt Ethel doesn't bother me because she does need help, though, chances are, she'll have to jump through flaming hoops to get it.  W is living with her father, has no bills to pay, and won't get a job because she wants to try and get Disability for her hair pulling compulsion.  It's the people who don't sit on their asses and do try to scrape by that get screwed.  My boyfriend works, and now he has a job where he'll get health insurance in a few months.  McDonalds offered it, but it was way overpriced, and we needed the money for bills and food. 

[vtboy]

I honestly don't understand why people are so focused on other people. Paying for someone else's "hypochondria" - who cares? Would you rather that money go to health care or a smartbomb? The tax code has nothing to do with who actually uses the money, it's based on your income. You're going to have to pay the same taxes whether she goes to the doctor or not.

I don't think so.

Under a system in which taxes pay for health care, the amount of money which must be raised through taxation will necessarily bear a direct relation to the amount of health care demanded. And, I imagine we will want both health care and smartbombs, rather than a choice between them. Even under a system in which the government pays for everyone's health care -- in effect, a Medicare for all system -- there will need be constraints on the nature and amount of service provided, just as there are now, under both "socialized" medicine systems and under our own current private health insurance system.   

My point here is not that government-provided health care is a bad thing, only  that there is no such thing as a free lunch. Medicare works tolerably well. It's expansion into a universal single payer system might even conceivably yield cost savings and other efficiencies which would permit a greater level of service than  provided by a private system at similar cost. But, I think, there will be continual tension between those who favor more service and those who oppose the taxes that will be required to pay for it.

[Trieste]

It clearly was not obvious, but I was making reference to the specific case pointed out by another poster. That would be why I quoted him. :)

[Tamhansen]

Coming back to the original posts content. Why does an MRI cost 1080,- in the US and 280,- in France.

having worked for a health insurer in Europe for five years, the answer in part is differences in salaries, costs of materials and frequency of usage per machine. The biggest part of the difference however is something that seems to cause an allergic reaction to many US legislators. Government funding and Tax income. Let's give an example from my own country, the Netherlands.

We have a system very similar to what the Obamacare program seeks to accomplish.

Everyone in the Netherlands is forced to have at least a basic insurance. Now based on your insurer this basic insurance costs you between 1000 and 1300 euro's a year approximately (at current rate that's 1300 to 1700 USD) Now this insurance covers every basic medical need. Like visits to the GP's office, EMT treatment and operations and procedures deemed neccesary to ensure good health. It also covers most medications and medical aides (wheelchairs hearing aides, medical devices such as Cpap's) although it only covers the most basic of these, and the insured gets an excess for more luxureous forms.

Next to this amount each insured above the age of eighteen gets a one time per year excess regulated by government each year (270 euro's this year) This is a one time excess and once paid no further excess is charged that year, unless it is care not covered by the insurance (elective surgery, dental, alternative medicine) or the standardised excesses for meds and medical aides.

Now care not covered in this basic package can be insured by additional coverage packages ranging from 100 euros (130 dollars) to 1200 euros per year, based on what you want covered.

So an average adult in my country pays about 1500 euros (or 2000 dollars) per year on Health insurance, and about 400 euros (525 dollars)  in excesses.

People with low incomes can get government aid of up to 600 euros for a single person or up to 1600 euros for a family.

And that's it. Need open heart surgery? covered. Radiation or chemo therapy? covered. Dialysis? covered. Tried to mudwrestle your chainsaw and need a limb reattached, or a prosthetic placed? covered.

Now I think people might be wondering. "But kata, at that prices your doctors must be living in squalor, shacked in soviet era concrete cubicles, and your nursing staff must be selling their own organs to feed their children."

Nope. Surely they make less money than their US counterparts, but an average GP makes about 180.000 euros and a specialist makes around 250.000 to 500.000 depending on specialisation. A nurse makes between 16.000 and 30.000 based on tenure position and education level (not a lot in US terms I reckon, but C.o.L. expenses are lower here too)

"But then" you might wonder "Where are you getting all that money? Are you cheating the game somewhere?"

Nope, our residents are actually paying taxes, that helps.

We pay 7.1% of our gross income up to 51,000 euros (income that is) to cover the cost of insurance. Of course since we also don't pay taxes over that part of our income, our net contribution is about 4%. On a modal income, that's about 3300 euros per family per year, and then our normal taxes also play a big role. Dutch residents above eighteen pay between 34% and 52% of their gross income in taxes. about 9% of that is used to pay for the cost of healthcare.

This kind of system is used in most European countries. The Scandinavian countries pay even more taxes, but have no or very low insurance costs. Basically, in most of Europe, people don't need to die, because they can't afford medical treatment. But unfortunately it does mean very few of our rich can afford a diamond studded swimming pool, or ride a solid gold Humvee.

But to recap, a MRI in France would cost almost as much as one in the US (I'd wager about 70% but i'll do the math on tuesday after the easter holiday, and put it here) But most of it is covered simply because of our socialist tax systems. And that's why it's free over here. And hell, if you're an American visiting here, and you get injured or sick, we'll even treat you charging you less than 20 % of what you'd pay in a decent hospital back home, courtesy of our taxpayers.

[Tiberius]

It is sad what is going on in the US with their third world healthcare system. Our health care system pays for everything in the general spectrum. Our health insurance if you have it will pay for 90% of the cost of an operation. Our hospitals might be shit and sstarting to fall apart but people dont end up with massive bills because our government has regulated the health care industry to match a certain standard

[TheGlyphstone]

But unfortunately it does mean very few of our rich can afford a diamond studded swimming pool, or ride a solid gold Humvee.

Not to detract from the topic, but I approve of your taste in music (assuming this is the reference I think it is). ;D

[OldSchoolGamer]

We Americans pay more than the rest of the world for healthcare because we believe Fox News when it tells us that our purpose for existence is to toil to enrich Fortune 500 health insurance companies, and that without fat cats skimming the system left and right we will collapse and become poor starving commies like everyone in Europe.

[Serephino]

Yep, Socialist is a dirty, dirty word.  It's code for Communism, and as we all know, Communists are the enemy!  Capitalism is the American way.  If a few poor people have to die in order to protect American superiority, wealthy Conservatives are okay with that.  It's just so heartwarming.   

[Tamhansen]

Not to detract from the topic, but I approve of your taste in music (assuming this is the reference I think it is). ;D

"Weird Al" Yankovic - Don't Download This Song

[Sophronius]

I don't really have any information to add, but when I was in Paris last year, a friend and I were hanging out with some Belgian guys we met.  We were talking about life in America and how things are different from European living - generally sharing tales about both of our lands.  When my friend started talking about the large number of Americans who go bankrupt due to high medical costs, the Belgians were shocked and somewhat horrified at that.  They found it somewhat disgusting that so many people are allowed to suffer due to the failings of insurance companies and the high costs of healthcare.  It would have been funny to see them so surprised by the American healthcare system... you know, if it wasn't so tragic.

[PhantomPistoleer]

I might be late to the party, but you can actually pay $300 for an MRI if you sign a waver saying that you're poor as crap.

Call around.  Be up front about being uninsured and super poor.

[Tiberius]

I don't really have any information to add, but when I was in Paris last year, a friend and I were hanging out with some Belgian guys we met.  We were talking about life in America and how things are different from European living - generally sharing tales about both of our lands.  When my friend started talking about the large number of Americans who go bankrupt due to high medical costs, the Belgians were shocked and somewhat horrified at that.  They found it somewhat disgusting that so many people are allowed to suffer due to the failings of insurance companies and the high costs of healthcare.  It would have been funny to see them so surprised by the American healthcare system... you know, if it wasn't so tragic.

It is sad, especially when one of the world's poorest countries, while its not Belgium i'm talking about but one quite close, Bulgaria have a much more effective healthcare system and they're mostly broke but they can afford efficient health care and have a world class transport system that has been compared to New York or London's mass transit system.

America is just a fucked up backwards country, its more like a third world country then anything these days. The perception is that America is rich and powerful when the opposite is the truth. More then half of the country is poor as dirt and the society is very weak in many areas of the country.

[Torch]

It is sad, especially when one of the world's poorest countries, while its not Belgium i'm talking about but one quite close, Bulgaria have a much more effective healthcare system and they're mostly broke but they can afford efficient health care and have a world class transport system that has been compared to New York or London's mass transit system.

America is just a fucked up backwards country, its more like a third world country then anything these days. The perception is that America is rich and powerful when the opposite is the truth. More then half of the country is poor as dirt and the society is very weak in many areas of the country.

Let's not exaggerate, please.

In my 40-something years on this earth, I have never heard of any American jetting off to Bulgaria to take advantage of that country's health care system.

However, I can provide numerous examples of Europeans, Brits and Canadians (including the PM of Canada) who have come to the US to receive treatment in places like the Mayo Clinic in Minnesota and the Cleveland Clinic in Ohio. I'm sure I could find an Aussie or two, as well.

Is health care in the US perfect? Hardly. Could it be improved? Of course, without a doubt. But describing the US as a "third world country" is simply incorrect. And no, more the half the country is certainly not "poor as dirt", whatever that means. Let's stick to facts, shall we?

[RubySlippers]

But Amercians are jetting off to top private tourist hospitals in India and Thailand for example to save money and get usually extraordinary care for that money.

[Torch]

But Amercians are jetting off to top private tourist hospitals in India and Thailand for example to save money and get usually extraordinary care for that money.

Neither of those destinations are Bulgaria.

And no offense to the health care systems in those two countries, but if I get a cancer diagnosis, I'm calling MD Anderson in Houston or Sloan-Kettering in NYC.

Now, if I wanted a sex change operation, I might consider Thailand. But since I'm not in the market for one of those.... ::)

[Oniya]

Neither of those destinations are Bulgaria.

And no offense to the health care systems in those two countries, but if I get a cancer diagnosis, I'm calling MD Anderson in Houston or Sloan-Kettering in NYC.

Bulgaria might be off the table, but medical tourism is a growing industry.  I know I've seen people on this forum talking about significant operations that they can't possibly afford in the States without winning the lottery, but which would be almost feasible - including airfare and lodging - if they went to another country for the operation. 

[Torch]

Bulgaria might be off the table, but medical tourism is a growing industry.  I know I've seen people on this forum talking about significant operations that they can't possibly afford in the States without winning the lottery, but which would be almost feasible - including airfare and lodging - if they went to another country for the operation.

Oh, I don't disagree. But medical tourism caters to anyone with the cash to spend, not just Americans with the cash to spend.

It would be my guess that well off citizens of countries with socialized medicine are the most frequent customers of private tourist hospitals, rather than wait months for a needed operation.

Most well off citizens of the US are covered by private (i.e. employer sponsored) insurance, and therefore would really have no need to "jet" anywhere for treatment, unless it's something experimental or the like.

[Oniya]

Most well off citizens of the US are covered by private (i.e. employer sponsored) insurance, and therefore would really have no need to "jet" anywhere for treatment, unless it's something experimental or the like.

But there's the sticking point - 'well-off'.  The number of US citizens without health insurance is rising.  Also, the percentage that receive insurance through their employer is falling, either through the benefit not being offered at all, or through employers keeping employees to 'just-below-full-time' hours to avoid having to pay that benefit. 

[Torch]

But there's the sticking point - 'well-off'.  The number of US citizens without health insurance is rising.  Also, the percentage that receive insurance through their employer is falling, either through the benefit not being offered at all, or through employers keeping employees to 'just-below-full-time' hours to avoid having to pay that benefit.

Believe me, if I had a solution for insuring those 50 million tomorrow, I'd offer it up.

Would I be willing to give up my private insurance in order to have every citizen in the US covered by a national health plan? I have to be honest, I'm not sure I'd want to make that choice, especially if it meant risking my children's health and welfare. I'd rather my taxes be raised as long as I can keep the option of private insurance for my family.

And I freely admit that if I were uninsured, I'd feel differently.

[Oniya]

Believe me, if I had a solution for insuring those 50 million tomorrow, I'd offer it up.

Would I be willing to give up my private insurance in order to have every citizen in the US covered by a national health plan? I have to be honest, I'm not sure I'd want to make that choice, especially if it meant risking my children's health and welfare. I'd rather my taxes be raised as long as I can keep the option of private insurance for my family.

And I freely admit that if I were uninsured, I'd feel differently.

I never said that you (or anyone else) should have to give up their insurance.  Frankly, I don't see a problem with leaving in the option for someone to purchase more insurance if they want, but there should be a certain minimum standard of care that is provided in an affordable manner.  The point of the thread is that other countries are providing as good (and sometimes better) care for all of their citizens at a much lower cost.  As was pointed out in the initial post, it's at least partially because there's no regulation about how high a price can be submitted to the insurance companies.

[Torch]

I never said that you (or anyone else) should have to give up their insurance.  Frankly, I don't see a problem with leaving in the option for someone to purchase more insurance if they want, but there should be a certain minimum standard of care that is provided in an affordable manner.  The point of the thread is that other countries are providing as good (and sometimes better) care for all of their citizens at a much lower cost.  As was pointed out in the initial post, it's at least partially because there's no regulation about how high a price can be submitted to the insurance companies.

It was just a rhetorical question I threw out there, I know you didn't suggest it.  :-\

And I agree with you, there should be a minimum standard of care for everyone. As I said, I wish I had a solution, a workable solution that provides basic care to anyone who needs it, and allows for additional options if you can afford it.

[Oniya]

Ah, same page reached. :-)  The rhetorical question just confused me completely.  ^_^>

[TheGlyphstone]

Doctors are the highest-paying profession in the world, Dentists the 3rd, and Lawyers the 4th. The conspiracy theories practically write themselves.

[Torch]

Ah, same page reached. :-)  The rhetorical question just confused me completely.  ^_^>

My fault, I should have clarified. But when I'm typing and I think "rhetorical" in my head, I just assume everyone else can read it that way, too.  :P

[RubySlippers]

Oh, I don't disagree. But medical tourism caters to anyone with the cash to spend, not just Americans with the cash to spend.

It would be my guess that well off citizens of countries with socialized medicine are the most frequent customers of private tourist hospitals, rather than wait months for a needed operation.

Most well off citizens of the US are covered by private (i.e. employer sponsored) insurance, and therefore would really have no need to "jet" anywhere for treatment, unless it's something experimental or the like.

I wish they used this option as elective for all insurance why nitpick even with co-pays the costs could be very high, if they used the same percentages going to India to a first rate tourist hospital it would still save them money most likely and the company in question. And for Medicaid patiants needing expensive life saving care there should be no choice you go to the best and cheapest option on the list that could be being sent abroad for care.

[Callie Del Noire]

But there's the sticking point - 'well-off'.  The number of US citizens without health insurance is rising.  Also, the percentage that receive insurance through their employer is falling, either through the benefit not being offered at all, or through employers keeping employees to 'just-below-full-time' hours to avoid having to pay that benefit.

In the last six months I have offered no less then 9 30 hour a week jobs that should be full time tech positions

[DarklingAlice]

In the last six months I have offered no less then 9 30 hour a week jobs that should be full time tech positions

Which is a, I think, a huge part of the problem. If employers are starting to welch on providing health in insurance due to financial concerns, the government needs to step up. I have had an MRIs and several CT scans over the years and didn't even pay a portion of them because they were covered 100% by the insurance I had through my basic, 40 hour a week, retail job. Ditto the $900 outpatient surgery I had last year, all I paid was a $20 copay. I frankly don't understand the ability of employers to welch on benefits for <40 hr a week employees. Even if they pro-rated benefits with regard to time worked, their workers should still get something. The only time a company should be able to get away with not providing anything is if you work for them as an independent contractor.

The other part of the problem is a bit harder to fix. Americans (and to a lesser extent humanity in general) hate preventative medicine. As someone working in public health and drug discovery this has to be one of the single most frustrating things I have encountered. It seems that the majority of Americans would rather show up with a huge problem at an ER with a crisis than to make use of preventative care and behavior correction to ensure the crisis doesn't happen in the first place. And preventative care is not a luxury affordable only to the rich; every single city I have lived in has a range of underutilized free clinics overflowing with volunteers. Not to mention the horrible rates of patient compliance. But it would probably be easier to fix the insurance situation than to change the nature of people.

[Tiberius]

Darkling, one thing i've come to accept is that, people in general are STUPID you can sit around and scratch your head wondering why people are so dumb all day, or just accept it.

The government just doesn't do enough to help in ways of getting around the general stupidity of people who don't do what is actually sensible for them. I guess its just human nature to be an idiot and make things worse before going to seek treatment.

[DarklingAlice]

@Tiberius:
Despite your attempt to provide yourself as an example of your thesis, I still find such attitudes less than helpful when it comes to either saving lives or writing policy. Simplistic, puerile responses to complex issues tend to be a way to make ourselves feel better about sitting on our ass rather than a way to work towards an actual solution. Thanks though.

[RubySlippers]

Which is a, I think, a huge part of the problem. If employers are starting to welch on providing health in insurance due to financial concerns, the government needs to step up. I have had an MRIs and several CT scans over the years and didn't even pay a portion of them because they were covered 100% by the insurance I had through my basic, 40 hour a week, retail job. Ditto the $900 outpatient surgery I had last year, all I paid was a $20 copay. I frankly don't understand the ability of employers to welch on benefits for <40 hr a week employees. Even if they pro-rated benefits with regard to time worked, their workers should still get something. The only time a company should be able to get away with not providing anything is if you work for them as an independent contractor.

The other part of the problem is a bit harder to fix. Americans (and to a lesser extent humanity in general) hate preventative medicine. As someone working in public health and drug discovery this has to be one of the single most frustrating things I have encountered. It seems that the majority of Americans would rather show up with a huge problem at an ER with a crisis than to make use of preventative care and behavior correction to ensure the crisis doesn't happen in the first place. And preventative care is not a luxury affordable only to the rich; every single city I have lived in has a range of underutilized free clinics overflowing with volunteers. Not to mention the horrible rates of patient compliance. But it would probably be easier to fix the insurance situation than to change the nature of people.

Now that is kind of unfair I'm a diabetic and should be on insulin therapy but just can't afford it, testing supplies and insulin costs to much it would eat up 60% of my inome a month just for those and seeing a doctor is on top of that. The free clinic is at least an option. Same with compliance if the treatment costs more than I can afford if followed through say being released from the hospital what can I do? But for me it comes down to money plain and simple not lack of desire.

As for companies unless there is a contract backed by a good union that cares ,rare, you get what benefits the employers offer or you can quit at least in Florida in fact save for some salaried positions Walmart is offering no one more than 20 hours a week and using temps from agencies for those times they need more work done. You can't order employers to hire people for full time work can you and I fear Obamacare if it kicks in would force them to cut back more hours to get under the window where they must provide care or pay a fine. With the economy they could go to ten hours and get people in to do the work sadly. They don't otherwise have to offer any health care they could drop all programs, raise salaries a bit and say your health is not our problem if you can't work under that then leave, we have lots of people that want the job.

[DarklingAlice]

Now that is kind of unfair I'm a diabetic and should be on insulin therapy but just can't afford it, testing supplies and insulin costs to much it would eat up 60% of my inome a month just for those and seeing a doctor is on top of that. The free clinic is at least an option. Same with compliance if the treatment costs more than I can afford if followed through say being released from the hospital what can I do? But for me it comes down to money plain and simple not lack of desire.

Okay, maybe I have just had the luck to work in the few particular places that do have this, but every single free clinic I have worked in has been able to dispense a month's worth of Metformin, Novalin, and test strips (with a doctor visit) for a suggested donation of $10-15. I think part of the problem is that it is hard for the free clinic system to promote itself. There isn't spare money around to buy billboards when you are trying to keep your patients alive.

[Serephino]

I think it also depends on where you live.  There isn't much access where I live.  There is one free clinic here in town that operates at night one day a week.  Thing is, you have to make an appointment, and they only see 18 patients a night.  The way they do things is really unfair.  You have to call during that day for the appointment.  And if they fill up their appointments that day, will they start booking for the next week?  Nope.  You have to wait until the next day and try your luck again.  My boyfriend tried to get in, but after the third week he gave up.

There is another one about 25 mi away that doesn't require an appointment.  However, you have to pay $75 at the time of the visit.  If you don't have $75 that can be a problem, and that doesn't include medication.  Hell, that's about what my family doctor charges for an appointment, so how does that help anyone?  In this area, if you don't have insurance, preventive care isn't really an option.  It's either get up at the crack of dawn and try your luck at the clinic, or wait until you have a real problem and go to the ER.       

[DarklingAlice]

And you are sure that is the only aid available in your area? Cause we don't exactly live in the most opulent of areas (Dallas, Texas if you are curious) and have multiple general purpose free clinics along with devoted diabetes and HIV clinics. And the free clinics I have worked at average 60-100 patients an evening (though most are only open two to three nights a week). Still, unless you live in the middle of nowhere I would be surprised if there was only one free clinic.

[Serephino]

I live in the middle of nowhere... sort of.  It's a small town, and I'm sure that one clinic is the only one in the area.  There might be others in Johnstown, but none that I could find.  It's a long drive and I don't know the area.

[RubySlippers]

There are only two free clinics covering a part of our county, the county offers a program but they insist on proof of income and medical need earning under $680 a month and I can't prove my income and even if I did I make usually $800 a month so don't qualify for care. Medicaid I meet income levels but am a single adult, but if I get pregnant they would put me into that program but that is not exactly a wise move is it? Or if I purposefully gave myself HIV it would be easy to get help but I will not go there.

Frankly I would move back to Milwaukee if I could they have a huge community health complex that does everything based on ability to pay, but my work base is here and I don't have that kind of money.

But I was just commenting to the comment that patiants don't follow directions and all but in some cases it could be money if your poor eating right and paying for care is often out of the question. And if drugs prescribed cost the people won't buy them and smart ones will demand alternatives.

[Serephino]

I wish I could've gotten my prescription allergy pills.  Maybe then I wouldn't have this stupid sinus infection because the stupid dog is shedding her winter coat. 

[Callie Del Noire]

You know.. my mom told me for a clinic/hospital/facility to put in an MRI..they (the group in question) has to get a 'permission' licenses (or was it usage license) to ensure that it's NEEDED in the area they want to install it.

[Etah dna Evol]

The reason an MRI costs $1,080 in America and $280 in France is because in France they have already paid the other 800 in taxes and furthermore, in America you get the MRI is a few days. In France you might get that MRI next month, or maybe the month after that, depending on how emergent your condition is and what some suit decides. I would rather have my healthcare, expensive as it may be, in the hands of Medical professionals, rather than government bureaucrats.

[Trieste]

If so, then the US is not the way to go, either. Ask any number of Americans who cannot get procedures including cancer treatments and so-called cosmetic surgery because they aren't 'medically necessary'. Funnily enough, their doctors think the procedures are medically necessary. It's the insurance company that defines it otherwise - and insurance companies aren't exactly run by doctors.

You run through the same bureaucracy bullshit in the US as you do in other countries, but in the US you pay more for the privilege.

[OldSchoolGamer]

The reason an MRI costs $1,080 in America and $280 in France is because in France they have already paid the other 800 in taxes and furthermore, in America you get the MRI is a few days. In France you might get that MRI next month, or maybe the month after that, depending on how emergent your condition is and what some suit decides. I would rather have my healthcare, expensive as it may be, in the hands of Medical professionals, rather than government bureaucrats.

If you are insured through an HMO here in America, your healthcare is in the hands of corporate bureaucrats.  I'm not seeing where that's an improvement over government bureaucrats.

[Callie Del Noire]

If you are insured through an HMO here in America, your healthcare is in the hands of corporate bureaucrats.  I'm not seeing where that's an improvement over government bureaucrats.

Actually it worries me more.. they exist to make a profit for their company. I know of two friends who had to take their HMOs to court or call in powerful people (like senators) to fix personal issues with their heath care companies.

[Oniya]

More on the 'WTF-ness' that is the American health care system.  Apparently, Canada does an annual review of patented medicine prices.  Guess who pays the most for scrips?  Yeah, you got it.  The average US prescription is 85% higher than the same drug in Canada, and 150% higher than the same drug in France, Switzerland, Italy, and Sweden.  That's not even getting into 'cash cows' like HIV medication: 

one drug - Atripla - costs over $25,000 per person, per year, for a course of treatment, but that a generic, FDA-approved version of the very same drug is being purchased from a competitive supplier by a US government program, the President's Emergency Plan for AIDS Relief (PEPFAR), for under $200 per patient, per year, for distribution in developing countries.

http://www.sanders.senate.gov/newsroom/news/?id=C8D9B29A-723F-4F29-B4E1-78C61C99A35F

[Marconi Drake]

The reason an MRI costs $1,080 in America and $280 in France is because in France they have already paid the other 800 in taxes and furthermore, in America you get the MRI is a few days. In France you might get that MRI next month, or maybe the month after that, depending on how emergent your condition is and what some suit decides. I would rather have my healthcare, expensive as it may be, in the hands of Medical professionals, rather than government bureaucrats.

That's a misconception. I live in a country with socialized medicine. And it's not perfect (it's actually a long, long way from perfect.) And you're right that there are times that people have to wait a long time for non-emergency procedures. But the decision isn't in the hands of any "suit."

I had the misfortune of needing an emergency MRI not too long ago because of an injury. I was in there within an hour. Because it was my doctor's decision. She didn't have to worry about an administrator or an insurance company trying to decide if it is was medically necessary. She, the person with the training, said "this person needs in that machine now" and it was done. Bureaucrats aren't making individual medical decisions in this country. They do at insurance companies.

And while you're right that tax dollars are picking up some of the difference in cost, it's not the full $800. Medical treatment is cheaper in these countries because of 1) economies of scale and 2) governments don't need to cut themselves a healthy profit.

[RubySlippers]

I think I came up with a way around the health care mess if someones assets are to low to demonstrate a reasonable ability to repay a medical debt and are over the charity care law limit do this:

As long as the person pays at least ten dollars on the debt the debt cannot go to collections or otherwise be acted upon until that person has the reasonable ability to repay the debt. They could take a hit to their credit and that could be notified to the appropriate parties.

This could be done at the state level and be based on income verses the debt with a two year repayment as the upper limit for calulating the ability to repay so someone earning $20k a year and single with a $5k debt could repay that in two years most likely but a person earning $10k might not so would have to pay $10 a month regardless of the size of the debt.

[Caehlim]

This stuff is scary to hear about. I live in Australia and it's almost unthinkable how much Americans have to pay for their medical care.

I pay a little extra to see the doctor, because the private G.P. I like to go to doesn't have all their bills covered by the government. However out of the $60-70 bill, the government still covers $30-$40. If I wasn't willing to do that though, I could easily go to a surgery that's a bit further away which does have it set up so that the government covers the whole cost. The wait times are a bit higher at those places, but not by too much.

If I walk down to the chemist and need to purchase any sort of medicine, the price is always very low as well because they are all subsidized. This is good for me because I'm allergic to penicillin and that raises the costs of a surprising range of medicines.

What's really scary though, is that one of our major political parties seems to want to use America as their role-model in providing medical care. (The party is named the Liberals but we don't mean the same thing as Americans do when we use that word, they are our right-wing party similar to America's republicans).