Musicmystery
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Joined: 3/14/2005
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There's nothing inherently evil about US health care costs. They've simply evolved differently because the US climate differs significantly relative to countries with a different focus.
1) Any successful business has a range of products from lower cost entry level offers to the high priced elite programs that pay most of the bills. A yoga studio, for example, might offer low cost drop in rates, but survives because offering teacher training brings in thousands per prospective teacher. In the US, where available health care is rationed primarily by ability to pay, this model is favored. Thus, we develop a lot of new, exciting, cutting edge procedures and technology -- that's also very expensive, because people (or their insurance companies) can and will pay (at least in some instances, enough to make the research and development profitable). These high cost procedures drive up health care costs. The rest of the world then benefits from the secondary adoption of the new technology, which is less expensive.
2) The US is litigious, because the legal climate is very open to bringing lawsuits, with no significant cost if the lawsuit is later found to be without merit. Defending against a lawsuit, though, even a frivolous one, is expensive -- so expensive that defendants will not uncommonly settle simply to spare the higher cost of a trial. This puts the focus on preventing lawsuits in the first place. Consequently, if there's any doubt at all, medical practitioners will order tests and procedures, simply to cover their butts (and there's no penalty for prescribing too many tests). This adds significant cost where often good judgment would indicate the tests aren't really indicated.
3) We have a business model for hospitals, and that means they each have their own equipment, their own pharmacies, their own everything, a costly inventory. Even though there are 10 pharmacies in town, the hospital needs a fully stocked one too. And each of the six hospitals in a medium sized city has its own MRI machine, etc. Further, they have to turn a profit, or the endeavor would not be worth doing (they'd invest elsewhere instead). In Canada, some hospitals specialize -- just a certain kind of surgery, for example -- which allows them extreme efficiency relative to being stocked and ready for anything. And, having a pharmacy that dolls out single pills rather than bottles of them is expensive (and risky, as precautions must be made for sterile handling)...while at the same time not ethically allowed to sell patients a whole bottle.
4) We don't have a comprehensive health care system for our citizens, the way single-payer countries do. Even the ACA is just a procedure to get more people into the existing structure, and Medicare is really about what to do with poor people more than a comprehensive health care solution. A system not designed to provide affordable health care to all isn't ever going to provide affordable health care to all.
5) Business-based insurance worked well at a time when health insurance was a rarity -- it did get more people insured. But it was never designed to insure all citizens. Trying to prop it up to try to do so is not efficient -- and therefore not cost effective relative to single-payer countries.
6) Putting insurance in the hands of insurers means they, in many instances, improve their business model by cutting more costly offerings. That's the mess that's driving up costs of some plans because of the ACA, which no longer allows those shortcuts. (States with already higher standards, like New York, aren't seeing these increases).
7) Putting the burden on businesses exacerbates the problem, as they struggle to keep employee coverage while the cost continually climbs at double digit rates. They become forced to control costs somehow, and since they can't do it as provider of the medical services, they can only pass on the cost or opt for less coverage.
8) In short, we don't have a system designed to provide universal, affordable health care, so it's no surprise that's not what happens. And, politically in the US, from the Truman administration on, there's partisan opposition to anything remotely resembling socialized medicine, partly on blind ideology, partly to protect private business interests with the medical industry. The ACA is a band-aid -- and even the band-aid has fierce political opposition. Frankly, there's a political segment that doesn't want affordable universal health care, and actively works to prevent it.
That's why health care costs are so high in the US.
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RE: US Health Care Costs - 
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