The US Healthcare System: Does it Need to be that Expensive?

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usa healthcare systemusa healthcare system

The costs of the US healthcare system, by 2018, reached $3.6 trillion or $11,172 per person.  As a share of the nation’s Gross Domestic Product, health spending accounted for 17.7 percent. It goes without saying that that’s a lot of money, but does it really need to cost the American people so much? 

Key Questions

The Zero Theft Movement is committed to eradicating the rigged layer of the US economy. One by one, we need to pinpoint and democratically decide by vote which areas of the economy are rigged against the American public. 

In this two-part exploration, we will take a deep dive into the US healthcare system to try to understand where the $3.6 trillion figure comes from and whether it’s justified. Our intention here is to spark good faith debate and voting in order to see if the public believes the US healthcare system is rigged. 

The Zero Theft Movement unites citizens in the fight against the rigged layer of the economy. See how much crony capitalists and corrupt officials are ripping off from us, according to the public.

US Healthcare Spending Compared to Other Countries

The International Federation of Health Plans (IFHP) intermittently conducts a survey comparing the price of healthcare services around the globe. Its most recent report was released in 2017, and covered the following nine countries: Australia, Germany, Holland, New Zealand, South Africa, Switzerland, the United Arab Emirates, the United Kingdom, and the United States of America.

Below, you will find two charts taken directly from the IFHP survey linked in the previous paragraph. You will notice the IFHP uses the US healthcare system as the benchmark or point of comparison for pricing.  

medical prices in 2017drug prices in 2017

Apart from a few outliers such as cataracts surgery in New Zealand, the survey shows that medical and drug prices consistently cost more in the US than in any other country. The IFHP concluded that “the median prices paid by private insurance for health care services in the United States was almost always higher than the median prices in the eight other countries included in the…study.” 

Investopedia quoted the chief executive of the IFHP, Tom Sackville, on the supposed misconception that the US spends more than any other country on health care due to more time spent in a hospital, more time visiting the doctor, and higher frequency in procedures. “That’s not the case. It appears it’s quite an efficient system—they don’t overuse it…But each time they have an item, an episode of care, it costs two or three or five times more than it should, by international standards.’”

We urge you to check out the survey for yourself to see more of the pricing data. Bypass surgery, according to the IFHP, cost the most in the US at $78.1k. The second costliest place to have that same procedure was New Zealand, coming in at $37.8k.

KEY QUESTION

  • Are medical prices for the same procedures significantly cheaper in other developed countries than they are in the US?

US Healthcare Cost

The Commonwealth Fund, a private foundation dedicated to improving the US healthcare system, published a cross-national comparison in early 2020. The foundation utilized health data published by the Organisation for Economic Co-operation and Development (OECD) to evaluate US healthcare system spending, outcomes, risk factors and prevention, utilization, and quality versus 10 other high-income countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom).

As it stands, the U.S. government cannot negotiate drug prices for Medicare Part D due to a non-interference clause. If the government was allowed to negotiate, would that reduce drug prices? Join the debate on the Zero Theft voting platform…

Key Findings

  • “In 2018, the U.S. spent 16.9 percent of gross domestic product (GDP) on health care, nearly twice as much as the average OECD country. The second-highest ranking country, Switzerland, spent 12.2 percent. At the other end of the spectrum, New Zealand and Australia devote only 9.3 percent, approximately half as much as the U.S. does.”

GDP percentage

  • “Per capita health spending in the U.S. exceeded $10,000, more than two times higher than in Australia, France, Canada, New Zealand, and the U.K. public spending, including governmental spending, social health insurance, and compulsory private insurance, is comparable in the U.S. and many of the other nations and constitutes the largest source of health care spending.” 
  • “In the U.S., per-capita spending from private sources, for instance, voluntary spending on private health insurance premiums, including employer-sponsored health insurance coverage, is higher than in any of the countries compared here. At $4,092 per capita, U.S. private spending is more than five times higher than Canada, the second-highest spender. In Sweden and Norway, private spending made up less than $100 per capita. As a share of total spending, private spending is much larger in the U.S. (40%) than in any other country (0.3%-15%). 
  • “The average U.S. resident paid $1,122 out-of-pocket for health care, which includes expenses like copayments for doctor’s visits and prescription drugs or health insurance deductibles. Only the Swiss pay more; residents of France and New Zealand pay less than half of what Americans spend.” 

KEY QUESTION

  • Looking from the ‘top-down,’ is the US the biggest spender on healthcare by a significant margin (not by dollar amount but by percent of GDP)? 
  • Are US citizens spending much more out of pocket than residents of other high-income countries?

MRI Costs

Ester Bloom, senior editor at CNBC Make It, published an article recounting her experience with the US healthcare system in 2018. Bloom discusses her GP finding a lump and ordering an MRI for verification. This ‘$400 emergency’ could have ended up being a “four-figure emergency, and a potentially life-threatening one…”

The following is an excerpt from her article linked above:

The hospital where I was sent to get my MRI could charge $2,000 or even $3,000 for the scan. I had no way to know. The average cost in the U.S. is $1,119, according to a 2014 survey by the [IFHP], and everything in New York City is notoriously expensive. (By contrast, the scan costs only $130, on average, in Spain and $215 in Australia.)

No one said anything to me about price when scheduling the scan. But the problem is not just that healthcare is expensive in America…the prices are also secret.

It took persistence and several calls back and forth to the hospital, the doctor’s office and my insurance company, but I finally found out that the hospital I was initially referred to would charge about $1,000 of which I would be responsible for $859.50

I promptly canceled my appointment and spent an afternoon polling other providers, and double-checking with my insurance company, until I found two more affordable options: a stand-up MRI place in my neighborhood, where the cost to me would be $505, and a storefront operation in midtown Manhattan where the cost to me would be $450.

U.S. drug prices are reportedly 2.56 times those in other countries. Are those prices from a free market, or is there financial foul play afoot?

The Merry-Go-Round Game

Clear Health Costs, a New York City-based journalism company, brings “transparency to the healthcare marketplace by telling people what stuff costs.” The company published an article, which includes an email they’d received from a reader.

My doctor at Tulane University Medical Center had suggested an abdominal MRI as part of a portfolio of check-ups to better understand the possible trajectory of a hereditary condition that might affect me.

I’m 27 years old, and wanted to know more, and so I said sure, let’s do it. 

About a month later, on the day before my procedure would take place, I got a call from Tulane asking how I planned to pay for my MRI the following morning. 

“How much is it?” I asked.

“Well, your deductible is $5,000,” I was told. 

“Yes, but how much is the procedure?” I asked again.

“Your deductible is $5,000, ma’am,” came the response. 

We played this merry-go-round game of call and response for about 10 minutes before the caller gave up, saying she’d call later with the cost of the procedure I’d otherwise be undergoing just 18 hours later. She finally did: I would be asked to pay $4,458 for an abdominal MRI without contrast, which really should have been higher, but I’d already met a couple hundred worth of my deductible. 

I checked the prices of similar MRIs in my area. The price discrepancy was so great—I was quoted a number about 10 times higher than the average I was seeing on ClearHealthCosts’ app—I was sure I was using it incorrectly. 

To test my theory, I requested the CPT and diagnostic codes my doctor listed at Tulane and called Doctors Imaging in Metairie, one of the services listed on the application. 

I was wrong: Tualne was just that much more expensive. 

I ended up canceling the appointment the following morning and made one for a week later at Doctors Imaging. In the end, I paid $672,68 for the exact same service for which Tulane wanted to charge me $4,458.

How Much Does a Heart Attack Cost?

In 2019, Johns Hopkins surgeon and professor Dr. Marty Makary published The Price We Pay: What Broke American Health Care—And How to Fix It. Makary’s book thoroughly investigates the US healthcare system and reveals the machinations behind the multibillion-dollar sector.

The doctor recounts one startling anecdote that we have quoted below: 

Henri and his dad went to the closest emergency department, where the doctors discovered Adam had suffered a minor heart attack. The doctors stabilized him with medication and he spent a night in the facility. The next morning the doctors recommended a heart bypass operation—electively, that is, sometime in the coming weeks. Before Adam got discharged, a hospital representative came to his bedside to talk about finances. He explained that the operation would cost $150,000. 

Henri and his parents had no way to know whether this was a fair price. They called a family friend who put them in touch with a good heart surgeon in France. Over the phone, the French surgeon explained that the quality of the operation would be the same in France as it would be in the United States. The family timidly asked how much the operation would cost in France. “About 15,000 U.S. dollars,” said the French surgeon. 

Soon after, the local hospital representative who provided the $150,000 quote visited Henri’s dad again to ask about their plans. “Quite honestly, we are thinking of having the surgery in France for $15,000,” Adam said. Without hesitation, the hospital representative dropped the price to $50,000. Alarmed at the sudden discount, Adam politely declined the offer and booked his flight to France. But as he walked out of the facility, the hospital representative approached him in the hallway one last time. Desperate to close the deal, the hospital official made a final offer: “Okay, we’ll do it for $25,000.”

KEY QUESTIONS

  • Is there a lack of transparency in pricing for medical treatments? 
  • Does the public have to take multiple unnecessary and unmentioned steps to find out where they can get the same procedure done for a cheaper price?
  • Are medical procedures in the US being priced much higher than they should be, especially considering healthcare prices in other high-income countries ?

Part II Awaits…

In part II, we investigate the costs uninsured citizens have to pay when they need medical support and what Congress is (or isn’t doing) to outlaw potential rigging in the US healthcare system.

Eradicate the Rigged Layer with the Zero Theft Movement 

The rigged layer of the U.S. economy rips all of us off, including YOU. Crony capitalists and officials who have succumbed to regulatory capture have created the 50 years of wage stagnation and violations of antitrust laws. 

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Standard Disclaimer

The ZeroTheft Movement does not have any interest in partisan politics/competition or attacking/defending one side. We seek to eradicate theft from the U.S economy. In other words, how the wealthy and powerful rig the system to steal money from us, the everyday citizen. We need to collectively fight against crony capitalism in order for us to all profit from an ethical economy.   

Terms like ‘steal,’ ‘theft,’ and ‘crime’ will frequently appear throughout the article. ZeroTheft will NOT adhere strictly to the legal definitions of these terms (since congress sells out). We have broadly and openly defined terms like ‘steal’ and ‘theft’ to refer to the rigged economy and other debated unethical acts that can cause citizens to lose out on money they deserve to keep.