“Why is healthcare so expensive?”
Ever ask yourself that question after getting an MRI or paying for an operation?
Perhaps, you wouldn’t be surprised to know that the US is the global leader in the total amount spent on healthcare. And it’s not all that close.
In part I (The US Healthcare System: Does it Need to be that Expensive?), we explored medical costs in the US vs other high-income countries, as well as looked into the transparency (or lack thereof) in the healthcare system.
In this second part of our two-part exploration, we will further investigate whether we need to be spending so much on healthcare, potentially exorbitant prices of uninsured citizens, and initiatives by legislators and regulators to reduce costs.
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. This article is intended to spark debate and voting on the potentially rigged US healthcare system—by no means is all the available evidence included here.
Key Questions
- Is there credible research that suggests healthcare does not need to cost as much as it does in the US?
- Do experts claim costs for medical care are out of control?
- Are uninsured citizens charged unethically high prices for healthcare?
- Did Obamacare actually reduce healthcare costs?
- Does Congress have an ethical obligation to investigate and/or fix when costs are out of control in the healthcare system?
- Do legislators and regulators provide public documents so the public knows where rigging might be occurring?
- Do they investigate and litigate (when warranted)?
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 Price We Pay
In part I, we quoted the section on Henri, the heart bypass case, from The Price We Pay: What Broke American Health Care—and How to Fix it. The book by Dr. Marty Makary, a Johns Hopkins surgeon and professor, provides great insight into the healthcare industry from an insider. We have found another short excerpt from the book that specifically touches on research that sought to answer the question: why is healthcare so expensive?
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In a study conducted by the University of Iowa, researchers called 101 US hospitals and asked them what they would charge for the same type of heart bypass operation. Only about half of the hospital—53 of them—would even provide the price. And for those hospitals that did, the average price was $151,271…The range of prices was astounding, from $44,000 to $448,000. Did they use gold-plated surgical instruments? No. Was the center that charged ten times more the one with the best outcomes? Nope. Heart surgery outcomes are publicly available. The research showed no correlation between surgery price and quality.
To understand the mystery of why some healthcare bills seem to defy logic, I asked my research team to dig deeper, to find out exactly how much medical bills were being marked up. The analysis revealed some markups to be 23 times higher than what was paid by Medicare (the government’s insurance program) for the exact same services.
Healthcare Waste
A study published in the Journal of the American Medical Association (JAMA) attempted to estimate the levels of waste in the US healthcare system between 2012-2019, in 6 previously developed domains [failure of care delivery, failure of care coordination, overtreatment, or low-value care, pricing failure, fraud and abuse, and administrative complexity] determined by the Institute of Medicine and Berwick and Hackbarth.
The review yielded 71 estimates from 54 unique peer-reviewed publications, government-based reports, and reports from the gray literature.
Computations yielded the following estimated ranges of the total annual cost of waste:
Failure of care delivery, $102.4 billion to $165.7 billion;
Failure of care coordination, $27.2 billion to $78.2 billion;
Overtreatment or low-value care, $75.7 billion to $101.2 billion;
Pricing failure, $230.7 billion to $240.5 billion;
Fraud and abuse, $58.5 billion to $83.9 billion;
Administrative complexity, $265.6 billion.
The estimated annual savings from measures to eliminate waste were as follows:
Failure of care delivery, $44.4 billion to $97.3 billion;
Failure of care coordination, $29.6 billion to $38.2 billion;
Overtreatment or low-value care, $12.8 billion to $28.6 billion;
Pricing failure, $81.4 billion to $91.2 billion;
Fraud and abuse, $22.8 billion to $30.8 billion.
No studies were identified that focused on interventions targeting administrative complexity. The estimated total annual costs of waste were $760 billion to $935 billion and savings from interventions that address waste were $191 billion to $286 billion.
KEY QUESTIONS
- Do the outcomes of the US healthcare system justify the price, relative to the spend of other highly developed countries?
- Is there credible research that suggests healthcare does not need to cost as much as it does in the US?
- Do experts claim costs for medical care are out of control?
As it stands, the U.S. government cannot negotiate drug prices for Medicare Part D due to a non-interference clause. If the government were allowed to negotiate, would that reduce drug prices? Join the debate on the Zero Theft voting platform…
Uninsured Americans
We can narrow the exploration to those who might be at the most risk, to ask: why is healthcare so expensive for uninsured Americans?Statistics
In late 2019, the United States Census Bureau released data on health insurance coverage for the year prior. The organization found:- 8.5% of people, or 27.5 million, did not have health insurance at any point in the year.
- 91.5% of people had health insurance coverage for all or part of the year.
- 67.3% of the population was covered through private health insurance, 34.4% by public health insurance.
- Employer-based insurance covered 55.1% of the population for all or part of the year.
Cost Research
In a 2017 JAMA-published study, Tim Xu, MD, investigated the variation in emergency department vs internal medicine excess charges in the US.“ In this analysis of Medicare billing records from 2707 US hospitals in 2013, different emergency departments charged between 1.0 and 12.6 times what Medicare paid for the services. Excess charges, or “markups,” on specific services were greater when performed by an emergency medicine physician compared with an internal medicine physician.
…the ongoing trends of uninsurance, hospital consolidation, and narrowing insurance networks since the implementation of the Affordable Care Act are poised to increase the potential for patient financial harm in the years to come. Now, more than ever, protecting uninsured and out-of-network patients from highly variable hospital pricing should be a policy priority.”
Gerald F. Anderson, the health economist at the Johns Hopkins Bloomberg School of Public Health, conducted similar research as Dr. Tim Xu’s. It’s important to realize that Anderson used data from 2004, so while his insights definitely pertain to high costs for the uninsured at that time, they probably do not have the same degree of relevance now.
” Hospitals do not charge every patient the same price for medical care. Uninsured patients and those who pay with their own funds are charged 2.5 times more for hospital care than those covered by health insurance and more than 3 times the allowable amount paid by Medicare…”
Practical Terms
Perhaps, it’s easiest to understand the position of the millions of uninsured citizens when we put it in more practical terms. Consider two scenarios: (1) you have a medical plan and use network providers, or (2) you have no insurance at all.
Note: The following figures are just for the purpose of illustrating the scenarios.
| (1) With Insurance | (2) Without Insurance | |
|---|---|---|
| Hospital Charges | $8,000 (discounted rate for health plan) | $12,000 |
| Health Plan Pays | 100% (in-network hospital) | 0% |
| Patient Cost | 0% | 100% |
| Patient Pays | $0 | $12,000 (plus interest if you have to pay in installments) |
KEY QUESTIONS
- Do uninsured citizens sometimes have to pay much more for the same treatments than insured citizens?
- Are uninsured citizens charged unethically high prices for healthcare?
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.
Obamacare: Success or Failure?
The Affordable Care Act (ACA) of 2010, otherwise known as Obamacare or H.R. 3590, had three primary goals: boosting the number of insured citizens, improving the quality of care, and reducing healthcare costs/spending.
The Congressional Budget Office (CBO), in partnership with the Joint Committee on Taxation (JCT), estimated the amount of savings the ACA would bring over the 2010-2019 period. In a letter to Speaker of the House Nancy Pelosi, the groups write: “…H.R. 3590 and the reconciliation proposal—would produce a net reduction in federal deficits of $138 billion over the 2010–2019 period as a result of changes in direct spending and revenue… Approximately $85 billion of that reduction would be on-budget…”
Oncologist Dr. Ezekiel J. Emmanuel penned an article about the positive effects of the ACA for STAT, claiming:
” In 2017 alone, health expenditures were $650 billion lower than projected and kept health care spending under 18 percent of GDP — basically a tad over where it was in 2010 when the ACA was passed. It did all of this while expanding health coverage to more than 20 million previously uninsured Americans….health care spending in 2017 was $2,000 less per person than it was projected to be. And for the 176 million Americans who have private employer-sponsored insurance, their lower premiums averaged just under $1,000 per person.”
In response to Emmanuel’s piece, Kip Sullivan, JD, and Stephen Soumerai, ScD, for MedPage Today, disputed the claims the oncologist had made:
“ Emanuel’s essay correctly notes that Obamacare reduced the ranks of the uninsured, but his claim that it reduced healthcare spending is false. Emanuel concluded that the ACA, which he helped write, ‘reduced healthcare spending a total of $2.3 trillion from 2010, the year the ACA was enacted, to 2017. He went on to make an equally astonishing and erroneous claim about health insurance premiums. He alleged they fell by $1,000 per worker, and ‘about $4,000 for family coverage from 2010 to 2017….Healthcare spending as a percent of the gross domestic product continued to rise after 2010 at about the same rate it has risen for the last 50 years. Premiums for family coverage for American workers also rose after 2010 at the same rate as before 2010.”
KEY QUESTION
- Did Obamacare actually reduce healthcare costs?
- Has the country spent more year by year, even after the enactment of the ACA?
Congress & Healthcare
The government, including legislators and regulators, is meant to represent the public, protect our interests over all else. But in terms of healthcare, have they been doing so? Are they doing enough to keep costs down? Or are they potentially aiding and abetting rigging in the healthcare sector? The University of Southern California’s Center for Health Journalism published a perspective article submitted by attorney Steven Weissman.“Congress functions as a harmonious well-oiled machine to inflate medical prices. Every politician in the House and Senate is silent as to the actual cause of gigantic insurance premiums, which is the rising prices of medical services. Congress turns a blind eye to the pricing of medical services despite the fact that the official U.S. projection confirms national health costs will continue to be driven by the skyrocketing pricing of medical services.
The idea that health insurance premiums are the problem is propaganda by the industry which spends more on lobbying than the defense, aerospace, and oil and gas industries combined. The healthcare industry has been uniquely authorized to price gouge consumers through the elimination of legitimate pricing for medical services and price competition.”
We have explored other areas of the US healthcare system, where you can see for yourself whether our legislators and regulators are doing right by the American public.
Investigations into the US healthcare system
➤ Medicare Part D and the Curious Non-Interference Clause
KEY QUESTIONS
- Does Congress have an ethical obligation to investigate and/or fix when costs are out of control in the healthcare system?
- Do legislators and regulators provide public documents so the public knows where rigging might be occurring?
- Do they investigate and litigate (when warranted)?
So…Why is Healthcare so Expensive?
After seeing the evidence presented in this article, where do you stand on the US healthcare system?
Should citizens, insured and uninsured, be paying as much as we do? Do we receive markedly better health outcomes for the billions more we spend as a country and as individual citizens? Why is healthcare so expensive…
Now’s the time for you to voice your opinion and help your fellow citizens pinpoint whether this area of the economy has been rigged. Yes or no, regardless of what you believe, we strongly encourage you to join in.
Your vote helps citizens figure out how much is getting ripped off and by whom. That gives us the power, based on strong evidence, to start holding that gaming the system accountable for profiting unethically. All of us must decide democratically, by a vote.
If you are still undecided, your fellow citizens have investigated the issue and presented their own cases for why they believe or don’t believe the corporate tax rate should be viewed as rigged economy theft.
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 50 years of wage stagnation and violations of antitrust laws.
The Zero Theft Movement seeks to end the corporatocracy and rid moneyed interests from politics. Our mission is and will continue to be, on waking up 330 million American citizens to the truth. We can all profit from an ethical, powerful, and safe economy if we stand up against the crony capitalists.
Will you refuse this call to action, or take action to eliminate the rigged layer of the economy?
View how much is being stolen, according to the public
Investigate your areas of interest
All areas of our economy could be experiencing rigging by crony capitalists and corrupt officials. We need to systematically investigate each instance in order to find out if the best evidence suggests it is truly rigged.
Investigations into government contracts
➤ State and Local Government Contracting: Tax Money Wasteland?
➤ Government Contracts: Is $586.2 Billion Being Spent Well?
➤ The Big Dig: A Hole in the Heart and Wallets of Bostonians
Alternatively, find an area that interests you most.
Serve your fellow citizens as a citizen investigator
The success of our movement rests in your hands, the leaders willing to dedicate time to conduct investigations into potentially rigged areas of the economy. With your valuable work, the movement has no solid ground to stand on, no foundations, no proof, to actually hold those corrupting our system accountable for their actions.
Commitment to nonpartisanship
The rigged layer causes all of us to suffer, regardless of our political allegiances. If we are to eliminate rigged economy theft, we have to set aside our differences and band together against crony capitalists and corrupt officials.
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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.