Why Does Healthcare Cost So Much In This Country

Does healthcare cost as much as my insurance company claims?

Yes and No.  The insurance companies have contracts with hospitals and the ability to pay.  Based upon the number of patients who will likely seek care they negotiate prices for certain services.  The list price is likely tremendously higher based upon the market control of the insurer.For example, personally I had a rotator cuff tear and underwent outpatient surgery to repair it.  The bill for a 1.5 hour operation was $39,340.  Per agreement with my insurer the insurance company paid $4,100 and I had a $200 co-pay.  That was "payment in full".  I received nor paid any further bills.  Subsequently the anchor backed out and I had another operation by the same surgeon at the same hospital but they also scoped my knee and injected some platelets from my blood into another area.  The bill was similar but now a different insurance company paid around $12,000 and I paid $100.  Probably the second set of operations took more equipment but probably not more time or effort.  The second set had many more billing codes I am sure, but was much easier.What I am saying is that often the difficulty of an operation and time is not rewarded and that the list price has almost nothing to do with anything once under a contract.  So Americans who have a group health plan care little about what is charged because the know they will only pay what is "usual reasonable and customary" an insurance industry term.As a surgeon I got paid per CPT code.  It mattered not if I spend 1 hour fixing it or 7 hours if I got paid at all.   For the uninsured patient the $39,340 bill (assuming it was an emergency) is unfathomable.

Why does America spend so much more per capita on healthcare than countries with universal healthcare?

Three reasons …The U.S. healthcare system is largely for-profit (even though many healthcare facilities/providers use a non or no-profit designation — that’s really just a tax designation for IRS reporting purposes).The U.S. healthcare system is based on a fee-for-service model. When tied to “for-profit,” this means more services = more revenue/profits. Fee-for-service pricing is universally common, but not when it’s tied (as it is uniquely in the U.S.) to #1 above — and #3 below.The U.S. healthcare system stands alone as being designed around “selective health coverage.” All the other industrialized countries use a system of “universal health coverage.” The U.S. selects or “tiers” coverage by …Age (twice — 26 & 65)Income (Medicaid)EmploymentMilitary Service (VA)Heritage (Indian Health Services)UninsuredIn combination (as evidenced by this next chart), it creates a system that winds up being both a global embarrassment AND a perpetual national crisis.We could change this. We should change this, but Lawrence Lessig nailed it with this quote:You know, when Bernie was talking about single-payer healthcare people rolled their eyes. Not because it was a bad idea, but because there’s no chance to get single-payer healthcare in a world where money dominates the influence of how politicians think about these issues.Now, we don’t have to implement a single-payer system. In fact, I’m not convinced a single payer system is a good cultural fit, but our decades long battle with actuarial math is
unwinnable. In the end, universal health coverage is inevitable. Not for any political reason, but because it’s the most efficient economically — and the most equitable.Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death. Martin Luther King, Jr. — March, 1966The reason we argue, fuss and fight over healthcare reform (like Obamacare) isn’t because it doesn’t work, but because it jeopardizes the status quo — a status quo that’s built on enormous revenue and profits.How many businesses do you know that want to cut their revenue in half? That’s why the healthcare industry won’t change the healthcare industry. Rick Scott — Florida Governor