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As a Canadian who has also lived in America, I am consistently mortified by the costs of health care in the states. Are they intentionally designed to force th

As a Canadian who has also lived in America, I am consistently mortified by the costs of health care in the states. Are they intentionally designed to force the lower class into even more poverty (I’ve seen $50 being charged for a pill of Advil - first hand) - or is it just an unintended side effect? I find it harder to believe it’s accidental than intentional. EDIT: Due to jiveturkey’s pathetic and wholly inaccurate defense of this system, and my inability to post in this thread further, I need to specify I was changed $740 to see the doctor and identify the issue. The pill itself cost $50. Please don’t defend this pathetic slavery of the lower class, guys, unless you’re a part of it. I’ve actually got a photograph of this bill somewhere on my backup drive I’d love to share. EDIT 2: And before any of you say this isn’t intentional, please look up Martin Shkreli. The only difference between him and the other guys at the top of the industry is that he got caught. Get real, guys. Please. Most of the comments here are beyond sad - I’m glad this has so many upvotes from people who silently disagree.

thorwasdfasdf 7y ago
I think they're doing it just because they can. there are some long winded explanations about this being about the negotation process between the hospitals and insurance companies but that's no exucuse. at the end of the day, it's just unmitigated greed on the part of the hospitals.
- toomuchtodo 7y ago
  It's politics as well. The Democratic candidate campaigning on maintaining the status quo is leading against the candidate who is campaigning on single payer. There's not much left to do when larger cohorts of voters prefer an inefficient, wasteful system (or a candidate who supports such a system). What we currently have is what people are voting for. I've tried to make everything stated above objective in keeping with forum guidelines. Personally, I find the situation incredibly demoralizing. Perhaps the outcome of COVID-19 is a demonstration as to why healthcare needs to be fixed.
  - pstuart 7y ago
    The Overton Window has slid so far to the right that such remedies are considered to be radical. Sigh.
    - kortilla 7y ago
      Single payer healthcare for all has always been radical in the US. The Overton Window shifting to the left over the last decade is what has allowed Bernie to have any relevance at all.
      - toomuchtodo 7y ago
        Has it been? Those 65 and older (Medicare), those on assistance (Medicaid), and current/past military service members (Tricare) all appear to be very satisfied with their single payer healthcare. I genuinely don't understand why this is considered a radical idea when so many citizens are happy with this public benefit. This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea... "Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all."
        kortilla 7y ago
        Yes, they are happy with it just like they are happy with social security income. The radical part (in the US) is suggesting that it should be available to everyone regardless of age (or veteran/military status) without any concrete plans to pay for it. > This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy. Then you are being willfully myopic if you can’t possibly envision people who don’t have faith in the government to not cause a meaningful regression in care by destroying the private market. You can both be unhappy with the current opaque healthcare market and not support Medicare for all.
- deleted 7y ago
  [deleted]
pengaru 7y ago
I don't think it requires any more than an indifference towards the welfare of others from those who believe they can afford any kind of healthcare they would ever need while simultaneously pursuing a minimal tax bill.
munk-a 7y ago
They are not - the effect these prices have on the poor is an unintended[1] consequence of the true aim. Extracting the most money possible from insurance payors - honestly, if hospitals could bill "You owe us 50$ or as much of that that your insurance would cover" then they would. Nobody actively wants to impoverish the poor (except for a small number of utterly terrible people) but payors force cost pass on to their subscribers as a way to keep the costs from getting too crazy and and the uninsured get hit by the full bill that providers want to extract out of payors simply because it's impossible for them to under bill without getting hit by lawsuits. That paragraph was an attempt to be really fairly voiced so just to follow up - this system is utterly rotten and terrible, the US has one of the worst health care systems in the world when it comes to the non-super rich - and even for them there are better options - and it needs to be fixed. 1. Edit note: Originally I used "unavoidable" here which was a poor word choice that's been pointed out below.
- lostgame 7y ago
  Unadvoidable? That’s disgusting, untrue, and exactly what I believe they’d say. It’s unavoidable to charge me $50 for an Advil? When I’ve paid $740 for the doctor to see me and identify the issue? Give me a f*ing break. If you really think that’s the case maybe you should analyze what costs are actually like for health care in other countries. That’s disgusting. Just no. EDIT: Do you work for the US health industry? :/ EDIT 2: Yes, this commenter works for the industry.
  - munk-a 7y ago
    I work adjacent to the industry and can clearly see what a rotten pile of crap it is - I'm also actually a US/Canadian border straddler, I emigrated from the US to come up here in fact. Please don't take any of my statement above as any sort of excuse for the market's behavior, these companies hold profit over the well being of patients - otherwise they wouldn't be so willing to stick poor people with such high bills. But, it is a private market and what's happening is all that can be expected. Again, the US really needs to look at Medicare for All - partially just because it'd end up providing better care for less money. Canada's system isn't perfect, I supported the NDP in their push for national Dental and Pharma, and I'll continue to do so, but it's worlds better than the US.
deleted 7y ago
[deleted]
paxys 7y ago
It isn't intentionally designed, just a side effect of the system as it exists today. There are two ways to bring healthcare costs down in America: 1. Insure everyone — no exceptions (by the government or through private insurance) 2. Let hospitals (and ERs) deny care to those that can't pay Since neither of them is happening anytime soon, Advil is going to keep costing $50.
- jacobush 7y ago
  No. Cost per outcome is still higher. More is wrong.
- tguedes 7y ago
  I don't see how #1 solves anything. The biggest issue which leads to all the cascading effects is the hospitals can charge a ridiculous amount for goods and services, with some hospitals charging more than 1000% more than what the government thinks they should (https://www.theatlantic.com/health/archive/2015/06/hospitals-that-charge-1000-more-than-they-should/395099/ https://www.theatlantic.com/health/archive/2015/06/hospitals...). I had a colonoscopy done a year ago and the prices pre-insurance ranged anywhere from $7000-$16000 depending on the location, all within network. I ended up paying just $1300 because of my insurance with a couple hundred covered by my HSA account. Why is there such a drastic price difference between places? Why are hospitals and other care providers that have a monopoly over an area able to act like a monopoly and have complete control over pricing? Everything else is just a 2nd order effect.
  - paxys 7y ago
    The reason hospitals charge more is (1) they need to recoup the cost of the services they are otherwise providing for free and (2) they have no leverage to negotiate with insurance companies and drug manufacturers. Having a national or privatized healthcare system that covers everyone will greatly help with both of them.
jiveturkey 7y ago
> I’ve seen $50 being charged for a pill of Advil - first hand A paper plant was having a problem with their mill. They brought in a consulting engineer to help them with the problem. He took a look at the machine and after a few minutes, drew an X on it in chalk. "Hit it there with a hammer". It worked! "How much do we owe you?" "$10,000" "That's absurd! I can't pay you that for literally 2 minutes of your time! I need a detailed invoice." The engineer wrote up an invoice: chalk mark $5 knowing where to put it $9995 ========= The patient in your example did not pay $50 for an Advil. There is a lot wrong with US healthcare, but this isn't it. It's about misaligned incentives.
- lostgame 7y ago
  It’s pathetic you’re defending this, and terribly evident you have never had to live in poverty in the states. It’s also patently, blatantly false. I paid $740 to see the doctor to identify I needed an Advil. I paid $50 for the Advil! Your post literally incited a large amount of rage in me. Defending people like Martin Shkreli- which the pharma industry is full of - or the medical industry itself’s rape of the lower class - is pathetic, selfish and just straight up wrong. EDIT: I’m unsure, as well - how I was unable to downvote this comment.
  - jiveturkey 7y ago
    eh? I grew up in poverty on public assistance and didn't have a decent job until I was 25. I've been hungry. etc etc. I know about being poor, ok. I also didn't defend the behavior. Get out of your personal shell and re-read it. You paid 0.05 for the Advil. You paid $49.95 for everything else that goes along with it, when you get an advil at an advanced medical care facility. You would understand that if you comprehended my post. Do you realize that when you go to any store and buy a coke for $1.50, you are only paying maybe .25 for the soda (incl. the bottle it comes in)? .75 or so is shipping and .50 is to the retailer. Every product has non-production costs associated with it, and that is what you pay for when you get a $50 advil at any kind of medical facility.
    - lostgame 7y ago

thorwasdfasdf 7y ago

I think they're doing it just because they can. there are some long winded explanations about this being about the negotation process between the hospitals and insurance companies but that's no exucuse. at the end of the day, it's just unmitigated greed on the part of the hospitals.

toomuchtodo 7y ago
It's politics as well. The Democratic candidate campaigning on maintaining the status quo is leading against the candidate who is campaigning on single payer. There's not much left to do when larger cohorts of voters prefer an inefficient, wasteful system (or a candidate who supports such a system). What we currently have is what people are voting for. I've tried to make everything stated above objective in keeping with forum guidelines. Personally, I find the situation incredibly demoralizing. Perhaps the outcome of COVID-19 is a demonstration as to why healthcare needs to be fixed.
- pstuart 7y ago
  The Overton Window has slid so far to the right that such remedies are considered to be radical. Sigh.
  - kortilla 7y ago
    Single payer healthcare for all has always been radical in the US. The Overton Window shifting to the left over the last decade is what has allowed Bernie to have any relevance at all.
    - toomuchtodo 7y ago
      Has it been? Those 65 and older (Medicare), those on assistance (Medicaid), and current/past military service members (Tricare) all appear to be very satisfied with their single payer healthcare. I genuinely don't understand why this is considered a radical idea when so many citizens are happy with this public benefit. This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy. https://news.gallup.com/poll/186527/americans-government-health-plans-satisfied.aspx https://news.gallup.com/poll/186527/americans-government-hea... "Americans' satisfaction with the way the healthcare system works for them varies by the type of insurance they have. Satisfaction is highest among those with veterans or military health insurance, Medicare and Medicaid, and is lower among those with employer-paid and self-paid insurance. Americans with no health insurance are least satisfied of all."
      - kortilla 7y ago
        Yes, they are happy with it just like they are happy with social security income. The radical part (in the US) is suggesting that it should be available to everyone regardless of age (or veteran/military status) without any concrete plans to pay for it. > This leads me to believe that the only cohort who believes it to be radical is that which is to be disrupted by such a policy. Then you are being willfully myopic if you can’t possibly envision people who don’t have faith in the government to not cause a meaningful regression in care by destroying the private market. You can both be unhappy with the current opaque healthcare market and not support Medicare for all.
deleted 7y ago
[deleted]

pengaru 7y ago

I don't think it requires any more than an indifference towards the welfare of others from those who believe they can afford any kind of healthcare they would ever need while simultaneously pursuing a minimal tax bill.

munk-a 7y ago

They are not - the effect these prices have on the poor is an unintended[1] consequence of the true aim. Extracting the most money possible from insurance payors - honestly, if hospitals could bill "You owe us 50$ or as much of that that your insurance would cover" then they would. Nobody actively wants to impoverish the poor (except for a small number of utterly terrible people) but payors force cost pass on to their subscribers as a way to keep the costs from getting too crazy and and the uninsured get hit by the full bill that providers want to extract out of payors simply because it's impossible for them to under bill without getting hit by lawsuits. That paragraph was an attempt to be really fairly voiced so just to follow up - this system is utterly rotten and terrible, the US has one of the worst health care systems in the world when it comes to the non-super rich - and even for them there are better options - and it needs to be fixed. 1. Edit note: Originally I used "unavoidable" here which was a poor word choice that's been pointed out below.

lostgame 7y ago
Unadvoidable? That’s disgusting, untrue, and exactly what I believe they’d say. It’s unavoidable to charge me $50 for an Advil? When I’ve paid $740 for the doctor to see me and identify the issue? Give me a f*ing break. If you really think that’s the case maybe you should analyze what costs are actually like for health care in other countries. That’s disgusting. Just no. EDIT: Do you work for the US health industry? :/ EDIT 2: Yes, this commenter works for the industry.
- munk-a 7y ago
  I work adjacent to the industry and can clearly see what a rotten pile of crap it is - I'm also actually a US/Canadian border straddler, I emigrated from the US to come up here in fact. Please don't take any of my statement above as any sort of excuse for the market's behavior, these companies hold profit over the well being of patients - otherwise they wouldn't be so willing to stick poor people with such high bills. But, it is a private market and what's happening is all that can be expected. Again, the US really needs to look at Medicare for All - partially just because it'd end up providing better care for less money. Canada's system isn't perfect, I supported the NDP in their push for national Dental and Pharma, and I'll continue to do so, but it's worlds better than the US.

deleted 7y ago

[deleted]

paxys 7y ago

It isn't intentionally designed, just a side effect of the system as it exists today. There are two ways to bring healthcare costs down in America: 1. Insure everyone — no exceptions (by the government or through private insurance) 2. Let hospitals (and ERs) deny care to those that can't pay Since neither of them is happening anytime soon, Advil is going to keep costing $50.

jacobush 7y ago
No. Cost per outcome is still higher. More is wrong.
tguedes 7y ago
I don't see how #1 solves anything. The biggest issue which leads to all the cascading effects is the hospitals can charge a ridiculous amount for goods and services, with some hospitals charging more than 1000% more than what the government thinks they should (https://www.theatlantic.com/health/archive/2015/06/hospitals-that-charge-1000-more-than-they-should/395099/ https://www.theatlantic.com/health/archive/2015/06/hospitals...). I had a colonoscopy done a year ago and the prices pre-insurance ranged anywhere from $7000-$16000 depending on the location, all within network. I ended up paying just $1300 because of my insurance with a couple hundred covered by my HSA account. Why is there such a drastic price difference between places? Why are hospitals and other care providers that have a monopoly over an area able to act like a monopoly and have complete control over pricing? Everything else is just a 2nd order effect.
- paxys 7y ago
  The reason hospitals charge more is (1) they need to recoup the cost of the services they are otherwise providing for free and (2) they have no leverage to negotiate with insurance companies and drug manufacturers. Having a national or privatized healthcare system that covers everyone will greatly help with both of them.

jiveturkey 7y ago

> I’ve seen $50 being charged for a pill of Advil - first hand A paper plant was having a problem with their mill. They brought in a consulting engineer to help them with the problem. He took a look at the machine and after a few minutes, drew an X on it in chalk. "Hit it there with a hammer". It worked! "How much do we owe you?" "$10,000" "That's absurd! I can't pay you that for literally 2 minutes of your time! I need a detailed invoice." The engineer wrote up an invoice: chalk mark $5 knowing where to put it $9995 ========= The patient in your example did not pay $50 for an Advil. There is a lot wrong with US healthcare, but this isn't it. It's about misaligned incentives.

lostgame 7y ago
It’s pathetic you’re defending this, and terribly evident you have never had to live in poverty in the states. It’s also patently, blatantly false. I paid $740 to see the doctor to identify I needed an Advil. I paid $50 for the Advil! Your post literally incited a large amount of rage in me. Defending people like Martin Shkreli- which the pharma industry is full of - or the medical industry itself’s rape of the lower class - is pathetic, selfish and just straight up wrong. EDIT: I’m unsure, as well - how I was unable to downvote this comment.
- jiveturkey 7y ago
  eh? I grew up in poverty on public assistance and didn't have a decent job until I was 25. I've been hungry. etc etc. I know about being poor, ok. I also didn't defend the behavior. Get out of your personal shell and re-read it. You paid 0.05 for the Advil. You paid $49.95 for everything else that goes along with it, when you get an advil at an advanced medical care facility. You would understand that if you comprehended my post. Do you realize that when you go to any store and buy a coke for $1.50, you are only paying maybe .25 for the soda (incl. the bottle it comes in)? .75 or so is shipping and .50 is to the retailer. Every product has non-production costs associated with it, and that is what you pay for when you get a $50 advil at any kind of medical facility.
  - lostgame 7y ago