Ultimately that's irrelevant, because you don't choose the services you get in a hospital, "I" do. If I come in and recommend this or that test, are you going to check the price? Of course not, because the issue is only partially hidden prices. Its also knowledge asymmetry and fear. I think most doctors only recommend tests they feel will be helpful and in my current position I have absolutely no incentive to order extra or unnecessary testing, so I try not to.
I suspect (but I guess it hasn't been proven) that moving away from fee-for-service towards Medical Home type payments will resolve a lot of this as long as quality measures are carefully monitored and decreases in quality are appropriately sanctioned.
Why are the rates of over-testing and over-diagnosis so high?
It is something health systems are aware of and working on, but if you go to the doctor with lower back pain and they say, get a better pair of shoes, take epsom salt baths, and deal with it, you might get frustrated. It doesn't cost the physician anything to order an MRI, but that procedure alone can costs $10k to your insurance, and may very well not reveal anything novel from the physical. But both the patient and physician feel more confident and there is no incentive against the physician for ordering the test. This particular example is such an issue, that a national quality measurement standards org has a measure dedicated to it:
https://www.ncqa.org/hedis/measures/use-of-imaging-studies-f...
And now that we are monitoring it (at some cases, down to the physician level), we can see awareness grow and individual physicians are changing their ordering habits. Very cool.
And you can’t mention a tax increase without mentioning the savings of not having to pay for private insurance.
You can not just import other nations healthcare systems. Those are cheaper because the doctors and nurses earn less and the service is worse.
Rob Delaney is a great example of an American who experienced both US and U.K. systems in depth. Look him up.
You posted a source yourself:
https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
Salaries are almost twice as high. Those other countries also tend to have higher taxes and other salary deductions, so doctors earn less.
> Other countries have better health outcomes, so that pretty much kills your “worse service” claim.
No it doesn't. Not every US citizen actually receives the service, because they want to (or have to) save money, kicking the problem down the road, exacerbating the issue. Americans also tend to be more obese.
You call the "cancer survival" rate a cherry pick, but it's actually a good indicator how good the actual treatment is and how timely it is administered.
> Rob Delaney is a great example...
One guy's opinion isn't "evidence" either. I could give you individual health care horror stories from single payer countries, but that would be emotional manipulation.
This is evidence that harm is being caused. It's not evidence of a good health care system.
Why are male incontinence products so prevalent in the states? It's because men are pushed to get PSA and similar screening for prostate cancer. This means the US detects a lot of slow growing cancer that's unlikely to kill someone (which improves the 5 year survival stats), but it also means that the US then provides treatment to those men. That treatment has side effects.
That isn't the end result.
> No it doesn't. Not every US citizen actually receives the service, because they want to (or have to) save money
So by “better” service you mean no service for the poor. That’s better? This is how you spin a system with worse health outcomes into something “better” — again, without citing a shred of evidence.
You keep saying this but you've never provided any evidence, and it's clear the US care is worse across a range of indicators.
Some people say the US system works best for the rich and healthy, but even they suffer because of the weird amount of over-testing and over-diagnosis that happens.
By the way, health insurance in Switzerland is entirely private, but its affluent citizens are forced to buy insurance by law.
Source? This term was invented by Sarah Palin and was judged 2009’s Lie of the Year by PolitiFact.[1]
> In America, everyone gets every treatment
You have no idea what you’re taking about. There are 28 million uninsured Americans and millions more who are unable to afford treatment due to high deductibles.[2]
You cherry-picked one statistic, but overall the U.S. has worse health outcomes vs other high income countries while spending 2X as much.[3]
[1] https://en.wikipedia.org/wiki/Death_panel
[2] https://www.cnbc.com/2018/09/12/rates-of-uninsured-in-us-hol...
[3] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
The lie (or at least misrepresentation) was that Obamacare had a "death panel clause" in it. An argument could be made that it still does:
https://www.washingtontimes.com/news/2017/jun/14/obamacare-d...
For the equivalent in the UK:
https://www.bbc.com/news/health-28983924
> You have no idea what you’re taking about. There are 28 million uninsured Americans and millions more who are unable to afford treatment due to high deductibles.[2]
Your source doesn't actually say that. It only says 28.5 million Americans are uninsured for whatever reason. A high deductible implies low monthly premiums. To give the example of the NHS, it's 13% of your paycheck - you don't have the choice. If everybody was forced to buy insurance, premiums could be lower as well. Obamacare is just a "have your cake and eat it too" system that cannot work in the long run.
You "Medicare for all" proponents simply need to own up to the cost and not keep bullshitting about how some European country has better care at less cost and therefore the US could have the same. It's just not comparable. Several countries like Germany or Australia also have a public-private mix system. That option shouldn't be off the table either.
> https://www.bbc.com/news/health-28983924
What do you think this means? How are you understanding this article? Because I'm pretty sure it doesn't mean what you think it means.
Are you honestly saying US insurance companies don't do exactly the same thing?
Insurance companies cannot prohibit you leaving the country.
Neither will developed-world single-payer systems, in virtually all cases. It sounds like you're referencing the Alfie Evans case, which a) was unusual enough to receive international headlines and b) involved a terminal, untreatable minor incapable of making their own decisions.
Hell, even in the UK, you can opt for private treatment - they've got a dual private/public system, as do many single-payer systems.
Completely untrue in the UK. We have private healthcare alongside our NHS system. You can pay for it through insurance, or you can sell your house and pay for it in cash.
Doctors proposed a plan. The parents disagreed with that plan. The doctor's had to go to court to get permission to go ahead.
Contrast this with the US system. Doctors propose a plan and if the parents disagree it is them who have to go to court to stop the doctors.
I certainly don't think it's "exactly the same", but that's not my point. I just wanted you to move the goalpost from "there are no death panels" to "okay, there are death panels, but they are everywhere, potato/patata!". Kinda like this guy:
https://www.dailykos.com/stories/2017/5/8/1660050/-Death-Pan...
https://www.telegraph.co.uk/news/health/news/6127514/Sentenc...
[1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
That's what I'm hoping for by making procedure prices transparent.
[1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...
Either way, whether it is 2% or 8% the bill will be astronomical. You would have to cut health care worker's salaries significantly to make a big dent in it. I'm not saying that shouldn't happen, but you better own up to it.
Having been through several hundred thousand dollars of chargemaster charges with one of the hospitals on this list I can confidently say this info is not consumer-friendly at all.
First of all, did anyone look at the damn PDFs? Do you have any idea what a "HCHG SP EVAL MTN FLUOR SWAL 75" is or a "HCHG XR RIBS BILAT W PA CXR"? Does this really equip the typical healthcare consumer with the ability to "shop 'n save"? No. They are going to ask their health insurance provider if the hospital is in network, and the health insurance bureaucracy has the experts who pour through and negotiate all this crap.
Second, even if you had about a year of your life to educate yourself about the hundreds of myriad codes like this that are involved in various procedures and take it upon yourself to compare hospitals, this would be like comparing hotels based on their rack rate. You might get a sense for things but nobody pays that. Everything is negotiated down. Even for the uninsured who usually either get a 50%+ discount or pay whatever they can pay and kill their credit or go bankrupt. Which is not to imply in any way this is affordable for anyone, just that chargemasters aren't a super useful way to compare pricing even if you could figure it out.
Third, it's a free market fantasy that more "consumer" info will fix this system. Many patients are not in a position to comparison shop anyway. It is the epitome of a market failure.
If you want to fix this system we need Medicare For All.