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It's great that people are talking about health care reform. Even if a lot of misinformation is driving irrational fears in people. One thing I haven't seen enough of is a discussion about healthcare costs; the costs and fees charged by the hospitals and other providers. Sure, as we've pointed out here repeatedly, it offensive that the health insurance companies raised insurance premiums by 70% or 80% over the last 9 years, and it's offensive that they're spending a troubling amount of that money on marketing, claims denials, executive salaries and expensive trips to exotic islands. But people also need to be thinking about and talking about the costs charged by American hospitals and clinics. What am I talking about? Check out these charts. This first one compares the cost of a "routine office visit" in Canada, France, Germany, the Netherlands, Spain and the United States. 
(Source: IFHP report) You can see from this chart that the low range cost of a routine office visit in the U.S. is roughly double the average cost for a routine office visit in any of these other countries. The high range is maybe four or five times what it costs in these other countries. Do you think that's because we have such better outcomes here? If so, you're wrong. Remember, the American health care system is ranked thirty-seventh (37th) in the world. Even if our system weren't thirty-seventh, do you really think a routine visit with YOUR doctor is worth 4 or 5 times more than a routine visit with a German doctor? The answer is "no." Our doctors aren't 4 times better. They just aren't. Here's something to consider, also. If you were to ask American doctors whether they think our healthcare system can be fixed with some minor tweaking, their response would be "no." When American doctors were asked this question 82% said our health system either needed "fundamental changes" (67%) or that the system needs to be completely rebuilt (15%) (source at p. 31). Even our doctors are demanding major overhaul of our healthcare system. Okay here's another one: 
(Source: IFHP report) Lipitor -- a fairly common cholesterol-lowering drug -- costs $125 to $334 in the U.S., and has an average price, among these other 6 nation, of $44.83. Is Lipitor really worth three to seven times more in the United States than it is in Spain or Germany? That's the problem with talking about healthcare in the context of the question "what is it worth?" If someone asked you, "If there was a pill you could buy that would save the life of your parent or spouse, how much do you think that drug is worth?" The answer is "Everything I own." That's why the whole capitalist supply/demand discussion makes no sense when talking about healthcare. That's why hospitals and clinics and health insurance companies are robbing America blind. It's because you can't ask the quesiton "What is Lipitor worth?" Lipitor should cost whatever it costs to produce Lipitor, plus a reasonable profit. And here's the last chart.  (Source: IFHP report) You know, the folks who want to absolve doctors of responsibilty for their medical negligence will tell you the main problem in medicine is the "defensive medicine" component of medical care. They'll tell you doctors shouldn't have to give tests to people in order to avoid being held responsible for failing to use a test they should have used. Well I had a personal experience recently to relay. My son was born less than three months ago. When he was born, one of the nurses noticed a faint heart sound that wasn't quite right. The doctor told us about it and said, "I think we should keep him in the neonatal infant care unit (NICU) for a couple days to make sure this isn't a big deal, and we should also shoot some pictures of his heart." He said, "It probably isn't a big deal, but we want to play it safe." Now, were I one of these knee-jerk "tort reformers" or a soulless editor at the Bismarck Tribune, I'd cry "DEFENSIVE MEDICINE!!!" and demand that if the doctor thought it was probably not a big deal, then they shouldn't do the test. Well, I'm a parent AND I have a soul. If my son has a heart sound that the doctor wants to "play it safe" about, I'm all for a little "defensive medicine." If you have a soul and if it were your kid, you would too. The idea of "defensive medicine" is to play it safe today so you (or your family members) are not attending a funeral tomorrow. I personally appreciated that the doctor wanted to do "defensive medicine." My son spent a few days in the NICU, and that was a medically responsible thing for the doctor to do. Eliminate or reduce a patient's ability to hold a negligent doctor accountable and you eliminate the need for doctors to practice "defensive medicine." Do that and more of your friends and family members will die younger. Having said all that, the idea that a CT scan in America is "worth" $1,800 (or even $950) while the same CT scan is "worth," on average, $276.50 in other countries, is troubling. There is reason for all of us to worry that the legislation being considered in both the house and senate might not do enough to force down American hospitals' and clinics' oppressive pricing. Hospitals and medical clinics today are like kidnappers. They're holding all of us hostage. The difference between American hospitals and a kidnapper who holds a gun to your loved-one's head while demanding money is that the hospitals don't even have to hold the gun. "If you don't want the trigger to be pulled by someone (or something) else you need to give us $1,800 for this CT scan. If you don't, you're loved one is probably gonna die soon, and it will be your fault because you didn't pay us." "Okay. Okay," you say to the kidnapper. "Here's your $1,800. Please, please, please... Just don't let my family member die." This is a hostage crisis. We don't need legislators; we need some seriously hard-assed hostage negotiators. The problem is that we have two kinds of legislators in Congress right now: (1) Republican obstructionists who want nothing other than failure for the majority party Democrats, and (2) Democrats, who are split between the ones who care about fixing the problem, and the ones who seem to care more about protecting their campaign coffers than they care about fixing the problem. And the good legislators -- though they are hardly hard-assed hostage negotiators -- are being attacked from the flank not just by the obstructionists from the Party of "No" but also by these pharmacy-industry-funded astro-turf groups, insurance companies and other hostage-takers in the healthcare game. It's a hostile environment for anybody to get anything good done. Bring on the hostage negotiators. (Hat tip to Ezra Klein at the Washington Post and M)
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. "The premise that medical malpractice awards have been rising dramatically in the United States in recent years, driving up the cost of healthcare and forcing physicians out of practice, is not supported by relevant evidence." Laska and Forrest, "Faulty data and false conclusions: the myth of skyrocketing medical malpractice verdicts" Commonwealth Institute, Oct. 6, 2004. 
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