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The inflated charges by medical doctors are a primary reason that the US medical system is so costly, and appears mostly overlooked in healthcare debates. The high charges by doctors need to be capped, and better monitored to prevent fraud. US doctors are even allowed to charge Medicaid and Medicare too much.

The average salary of general practitioners in the United States is almost double that of other high-income countries. Specialists are even more overpaid. The US pays almost twice as much for medicines. Administration costs are 8% compared to 3% in other countries. [1]

A 2011 study by Laugesen et al. shows how much US doctors overcharge Medicaid-Medicare compared to other high income countries. They charge private insurance even more. This fleecing must be stopped. For instance: “Public program fees for uncomplicated, initial hip replacement surgeries (not revision surgeries) ranged from $652 in Canada and $674 in France to $1,634 in the United States. The difference in public program fees is roughly comparable to the difference in national health spending across these countries.” The study compared Australia, Canada, France, Germany, and the United Kingdom to the United States. Public payers paid 27% higher fees to US primary care doctors for office visits and private payers paid 70% higher fees, compared to the other countries. Orthopedic doctors were paid 70% more by public payers and 120% more for private payers in the US,compared to the other countries, for hip replacements. Not surprisingly, US primary care and orthopedic doctors also earned higher incomes than doctors in the other countries. They concluded “that the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending…“[2]

Without more stringent cost/fee caps, and more monitoring for overcharges, Medicaid and Medicare are unsustainable. Until this is addressed, Medicare for All cannot work. If this is addressed, private insurance should be more affordable. There should be incentives to stop smoking, use nicotine patches, and lose weight, too. To help save healthcare costs, France has pushed to reduce smoking and get patients to use nicotine patches.

It is probably necessary to limit medical malpractice pay-outs, however, in order to reduce medical charges, as in some countries. Medical malpractice insurance is apparently very costly, and may be one reason for the inflated charges.

Almost 60% of nonelderly were covered by workplace plans in 2018. The figure was almost 70% in 1999. [3] A single payer “Medicare for All” system lets businesses, who often pay for employee healthcare, off the hook. As many large businesses excel at avoiding taxes, this puts a further burden on the individual taxpayer. This may be why some European countries make the employer pay for employee medical care, at least in part.

As Bernie Sanders co-chair Ro Khanna pointed out in a tweet, Medicare for All will save businesses a lot of money, because they don’t have to pay to insure their employees. Thus, Sanders’ “Medicare for All” is a corporate subsidy. It is actually another form of social welfare for big business, which will be largely born by the middle classes, since most companies find ways to minimize their taxes. Once businesses stop paying, it will be difficult to make them start providing healthcare again. Once personal income taxes go up to 50% or more, it will be difficult to make taxes go down again, once “Medicare for All” proves unsustainable due to high costs. The high taxes will be used to service the debt and people will simply be even more poor, and even more unable to afford medical care.

The key to medical coverage for all is regulation and not socialization. With regulation the current system would be more affordable and without regulation Medicare for all will fail. While Canada provides Medicare for all, it is under the auspices of the provincial governments, and is highly regulated with cost/fee caps. Canada has low federal taxes, but generally high provincial taxes, because the provinces pay for Medicare for all.

Furthermore, emergency rooms in poor areas have been overburdened in Canada, because the working poor generally find it easier to go to the ER, rather than going to a doctor. Walk-in clinics have attempted to help this problem, but there is apparently no incentive to encourage people not to use the ER. (They apparently have issues with their nursing home care services, too).

Without cost caps Medicaid and Medicare are unsustainable, without even speaking of Medicare for All. Not only are US doctors allowed to overcharge, as compared to most other countries, some doctors overcharge Medicaid-Medicare above what they are allowed [4]

The cost of medical school should be reduced or ideally made free. Drug costs should also be reduced with cost caps. An extension of patents might allow drug developers to recuperate investment without high costs.

Bernie Sanders’ ignorance of Canada is simply astounding considering that he lives right across the border. He came back from the Soviet Union praising their metro (subway) system, whereas he could have driven 95 miles to Montreal and seen an amazing metro system. Furthermore, Vickers appears to have been involved with creating both of them: “The main engineering designs, routes, and construction plans [for the Moscow Metro] were handled by specialists recruited from the London Underground“. https://en.wikipedia.org/wiki/Moscow_Metro

Canada does not have a unified national health care system; instead, the system consists of 13 provincial and territorial health insurance plans that provide universal health carecoverage to Canadian citizens, permanent residents, and certain temporary residents. These systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government… Approximately 70 percent of expenditures for health care in Canada come from public sources, with the rest paid privately (both through private insurance, and through out-of-pocket payments).https://en.wikipedia.org/wiki/Medicare_(Canada)

The Canadian system doesn’t entirely cover pharmaceuticals. Lower costs apparently come from cost-caps: “Most Canadians have some access to insurance coverage for prescription drugs through a patchwork of public and/or private insurance plans. The federal, provincial and territorial governments offer varying levels of coverage and decide who is covered and what the patient and plan pays. The publicly-funded drug programs generally provide drug plan coverage for those most in need, based on age, income, and medical condition. Many Canadians and their family members have drug coverage linked to employment and some Canadians may have no effective drug coverage and pay the full cost of prescription drugs.https://www.canada.ca/en/health-canada/services/health-care-system/pharmaceuticals/access-insurance-coverage-prescription-medicines.html

Canada used to have liability caps for medical malpractice pay-outs, though we were unable to find documentation on this topic. Thus, doctors save on medical malpractice insurance, which may not have been taken into consideration in some of the studies. Some other countries have liability caps/pools.

In total, Medicare inappropriately paid $6.7 billion for claims for E/M services in 2010 that were incorrectly coded and/or lacking documentation, representing 21 percent of Medicare payments for E/M services that year. We found that 42 percent of claims for E/M services in 2010 were incorrectly coded, which included both upcoding and downcoding (i.e., billing at levels higher and lower than warranted, respectively), and 19 percent were lacking documentation. Additionally, we found that claims from high-coding physicians were more likely to be incorrectly coded or insufficiently documented than claims from other physicians.” See: “IMPROPER PAYMENTS FOR EVALUATION AND M ANAGEMENT SERVICES COST MEDICARE BILLIONS IN 2010https://oig.hhs.gov/oei/reports/oei-04-10-00181.pdf

The 2011 study by Laugesen et al. compared the fees paid to doctors by public and private payers both for primary care (general practitioner) office visits, as well as for hip replacements. The study compared Australia, Canada, France, Germany, and the United Kingdom to the United States. Public payers paid 27% higher fees to US primary care doctors for office visits and private payers paid 70% higher fees, as compared to other countries. Orthopedic doctors were paid 70% more by public payers and 120% more for private payers in the US, compared to the other countries, for hip replacements. US primary care and orthopedic doctors also earned higher incomes than doctors in the other countries. They concluded “that the higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, were the main drivers of higher US spending…” See: “Higher fees paid to US physicians drive higher spending for physician services compared to other countries.” Laugesen MJ1, Glied SA.Health Aff (Millwood). 2011 Sep;30(9):1647-56
https://www.ncbi.nlm.nih.gov/pubmed/21900654 The above article has a lot of important detail and is available online for free.

Unlike Bernie Sanders, we have extensive first-hand experience with the medical system in multiple Canadian provinces; multiple European countries, as well as multiple US States. In our experience, US doctors charge too much and are generally worse than useless idiots. In this context, it is unfair to force people to have overpriced insurance and/or high taxes for these overpriced crappy doctors. Charges must be capped; doctors monitored for fraud; and the cost of med school reduced so that decent smart people can afford to go to med school. Better to pay for good food and good housing, which are more important to good health, than crappy over-priced doctors. In the past, we found, for instance, a doctor charging over 15 times what a Canadian doctor had charged with our insurance company only allowing the US doctor to charge 5 times what the Canadian doctor had charged, for the same thing. That taught us that private insurance actually works to try to keep prices down. But, price caps, as in Canada, are far more effective. Because the doctors go into the profession to care for patients in Canada, rather than to get rich, they are generally much nicer and much more caring. And, the Canadian doctors are still well off compared to many Canadians. More recently, it has come to our attention, that the latest fad with US doctors is apparently to charge Medicare (and private insurance), while not rendering the service. US doctors used to make their money by overdoctoring; now they apparently do it by underdoctoring-charging for services not rendered, as documented here: IMPROPER PAYMENTS FOR EVALUATION AND MANAGEMENT SERVICES COST MEDICARE BILLIONS IN 2010https://oig.hhs.gov/oei/reports/oei-04-10-00181.pdf

According to at least one healthy American centenarian, the key to longevity in the United States is “staying away from doctors.” Unfortunately, not everyone is able to avoid them.

And, as my grandmother said: “Woe be unto the doctors and lawyers, ye hypocrites, for ye lade men with burdens grievous to be borne, and ye yourselves touch not the burdens with one of your fingers“. This isn’t exactly what the Bible said, but it’s her version and it’s true. “Woe be unto the doctors and lawyers” is apparently a common misquotation, for reasons which should be evident.

Notes:
[1] https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_in_the_literature_2018_mar_papanicolas_hlt_care_spending_us_other_countries_jama_03_13_2018_itl.pdf
[2] “Higher fees paid to US physicians drive higher spending for physician services compared to other countries.” By Laugesen MJ1, Glied SA.Health Aff (Millwood). 2011 Sep;30(9):1647-56
https://www.ncbi.nlm.nih.gov/pubmed/21900654
[3] “Coverage at Work: The Share of Nonelderly Americans with Employer-Based Insurance Rose Modestly in Recent Years, but Has Declined Markedly Over the Long Term” Published: Feb 01, 2019 https://www.kff.org/health-reform/press-release/coverage-at-work-the-share-of-nonelderly-americans-with-employer-based-insurance-rose-modestly-in-recent-years-but-has-declined-markedly-over-the-long-term/
[4] https://www.propublica.org/article/some-doctors-still-billing-medicare-for-the-most-complicated-expensive-office-visits
IMPROPER PAYMENTS FOR EVALUATION AND MANAGEMENT SERVICES COST MEDICARE BILLIONS IN 2010https://oig.hhs.gov/oei/reports/oei-04-10-00181.pdf

Additional information:
Health Care Spending in the United States and Other High-Income Countries“, by Papanicolas I1,2,3, Woskie LR1,2,3, Jha AK1,2. JAMA. 2018 Mar 13;319(10):1024-1039. https://www.ncbi.nlm.nih.gov/pubmed/29536101

https://www.oregonlegislature.gov/salinas/HealthCareDocuments/4.%20Health%20Care%20Spending%20in%20the%20United%20States%20and%20Other%20High-Income%20Countries%20JAMA%202018.pdf

https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Canada_and_the_United_States