An American Sickness: How Healthcare Became Big Business and How You Can Take It Back

by Elisabeth Rosenthal

The type of healthcare we get these days is exactly what the market’s financial incentives demand.

“They don’t care whether the claims go up or down twenty percent as long as they get their piece.

Insurers have no incentive to manage costs?

The money chase was on: no one was protecting the patients.

This is not a healthcare system, it’s an industry, and at every point there’s a way to make money.

2008.

We treat patients like widgets, when we should be treating them like family.

The government placed the value of the tax advantage to hospitals at $12.6 billion in 2002 and in 2011 at $24.6 billion. How to keep that tax benefit while spending the least amount possible on “charity care and community benefit” has become the job of some hospital accountants and consultants in the business of medicine.

Since the terms of outpatient insurance apply, observation status typically means far larger co-payments. Mr. Silver’s insurer negotiated a rate of $12,000 for the stay.

This is another way you get hit with surprise medical bills. How can an ordinary citizen keep up with this shell game? Its three card monty, and the loser pays thousands of dollars.

Then, around 2010, many of these doctors’ groups, who worked at in-network hospitals, simply stopped contracting with any insurers at all, leaving unsuspecting patients with tens of thousands of dollars in surprise medical bills.

The anesthesia was administered by a nurse-anesthetist, but an anesthesiologist “did a drive by” as Mr. Jordan lay on a stretcher prior to the procedure, saying “Hi. How you doing? Do you have any questions?”

Nonetheless, he ultimately saw bills from both the doctor and the nurse using the same billing codes for the same amount, each somewhere between $2,000 and $3,000.

When one man attempted to remedy the situation by prying off the gel, he discovered the familiar old 400 mg tablet of Asacol inside. The research and development to create Delzicol had apparently involved slapping on a new layer to obtain continued patent protection.

This makes me ill. When we justify high prices by saying r and d costs are high, do we rally get the whole story?

Act,

Wiley act, 1906 Food, drug and cosmetic act, 1938 Were designed to protect the public against pirates, not corporations. Today piracy is legal.

By the mid-1990s, the basic rules of engagement, determined by the FDA and the U.S. Patent and Trademark Office, had been settled to the lasting benefit of business: a strong patent system and no pricing restrictions led to a profound shift of pharmaceutical investment into the United States and away from Europe, where government price setting was increasingly common. By 2002 global drugmakers were spending 82 percent of their money in the United States. The U.S. pharmaceutical industry has grown twice as fast as the economy at large since 1990.

The reason drug prices are so high in the us is tha congress has sold a territory to the pirates, and made legal their plunder.

The Supreme Court has protected drug advertising under the guise of free speech.

the hospital lab charged $772 for a vitamin D test. Only three weeks earlier, the exact same test at a commercial lab had cost just $16.70.

By 2011 ambulance transport was no longer primarily a charitable service but such a good business that America’s two largest private sector providers, Rural/Metro and American Medical Response, were both bought by private equity firms that year.

From the manufacturers’ standpoint, if diabetes could be cured there would be no need for insulin, pumps, and monitors, all lucrative products.

Theres a potential cure for diabetes, but no one wants to fund it because there is no profitable business model?

The American healthcare system is rigged against you.

Unless you’re part of the 1 percent, you’re only ever one unlucky step away from medical financial disaster.

Every other developed country in the world delivers healthcare for a fraction of what it costs here. They use a wide range of tools and strategies that line up with each country’s values, political realities, and medical traditions. Some set rates for healthcare encounters. Some negotiate prices for drugs and devices at a national level. Some have the government administer payments. Some mandate transparency. Some governments own hospitals and pay the doctors who work in them; others limit new hospital construction and the purchase of new machines. Most heavily subsidize medical school training. Although we tend to brand other countries as deploying “socialized medicine,” almost all use unique hybrids of government intervention and free market forces. Let’s look at a few basic tools that underpin their relative success at reining in cost.