Fascinating graphic from the Washington Post as to Why an MRI costs $1,080 in America and $280 in France:

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Click for larger interactive graphic

Source: Washington Post

Category: Politics, Really, really bad calls

Please use the comments to demonstrate your own ignorance, unfamiliarity with empirical data and lack of respect for scientific knowledge. Be sure to create straw men and argue against things I have neither said nor implied. If you could repeat previously discredited memes or steer the conversation into irrelevant, off topic discussions, it would be appreciated. Lastly, kindly forgo all civility in your discourse . . . you are, after all, anonymous.

71 Responses to “Comparing Medical Procedure Costs in US vs Overseas”

  1. mcelus says:

    Data we all knew to be true, but nice to have the visual. So next to that, let’s see a similar chart of the average length of time those in the U.S. wait to have each procedure vs. other countries. I suspect it would be the exact opposite. Doesn’t mean we don’t have a lot of waste in paperwork, liability insurance coverage for docs, and outright fraud…but if our health care is so bad, then why do foreigners still come here to have work done? Beyond that, as a society, and not just the U.S., we need to have a “comin’ to Jesus” session with ourselves about when to stop throwing dollars at someone who is 87 and on their 3rd bypass…we’re throwing productive dollars at very unproductive people.

    Also, can someone explain why health care is not like technology — i.e. the more it is used, the more it seems to cost vs. technology where it is just the opposite? Is it because there is no scale in patient to doctor care? Is there any relationship between rising costs of the overall system to the systematic cutbacks in what the gov’t through Medicare will pay for a procedure? I have long been of the mindset that reductions in gov’t spending to try to reign in their costs are being directly transferred to the private market.

    Maybe it is some combination of both of the above plus a raging obesity and over-testing problem?

  2. Petey Wheatstraw says:

    Goddamned French Socialists!

    I’d rather be gouged for non-elective healthcare and insure corporate profit margins than to let a gubment doctor or agency save my life. Hell, I’m going to die anyway — some corporate person should make some money off it. Same goes for my family. If we can’t afford it, we’ll pray to Jesus.

    — A. Republican

    P.S: I probably did something to deserve my disease, anywho, so I view bankruptcy as taking personal responsibility.

  3. chavan says:

    I’m not sure it answers the Why but it certainly demonstrates the delta.

  4. rd says:

    Unfortunately, it doesn’t say “why”. It only says it does.

    The universality of the US having higher costs for pretty much everything in medicine is a fairly strong damnation of the current system, both public and private. Unfortunately, it is just another sector, like the financial sector, that has been able to buy Congress and State legislatures and use full-blown propaganda techniques to convince people that exorbitant costs are necessary.

  5. TLH says:

    Health care is controlled by the insurance cartel, drug cartel, and hospital cartel. Our elected officials accept bribes, i.e. political donations. If our elected officials solved the problem, the political donations would end.

  6. nofoulsontheplayground says:

    Eventually the prices in the US will become more competitive due to a number of factors. One of these factors is the new RNA therapy developed by MIT that could eventually cure every virus known to man, including HIV:

    http://www.sciencedaily.com/releases/2011/08/110826134012.htm

    The same therapy can be used against cancer cells, obliterating them in 75% of the trials so far.

    There is also a cure for diabetes and all manner of liver ailments coming in the next several years. These and other advances will substantially reduce the numbers of chronically ill patients, which in turn will cut per capita health care expenditures.

    Add in the advent of medical tourism, and you will get a more flat world as far as medical procedures are concerned.

  7. Overseas American says:

    Having lived overseas for the last 14 years, I thought I might enlighten folks who haven’t had that sort of experience.

    The Netherlands: I currently live in The Netherlands, where I have spent 9 of the last 14 years. It might be good to know how they educate doctors in The Netherlands:

    1) If you get a certain minimum GPA in high school, you can enter the lottery to attend medical school.
    2) If you win the lottery, you go to medical school which, for a General Practitioner, includes 2.5 – 4 years of classroom education and 2 – 3.5 years of practical hands-on education (Residency) for a total of 6 years of education. That compares to 8 years of classroom education and a minimum of three years residency in the US.

    In the nine years I have lived in The Netherlands, no doctor or nurse has ever taken any physical measurement of my body. Nine years, no weight, no blood pressure, no temperature, no pulse rate, and don’t even think about something as complex as cholesterol.

    In The Netherlands, you are assigned to your neighborhood doctor. There is no choice in the matter. My neighborhood doctor had never heard of lactose intolerance, which affects about 20% of the adults on the planet, before I educated him.

    Before we took our young children to Africa for a vacation, the doctor wrote a prescription for some vaccines and we had to go to the pharmacy, pick up the vaccines and needles and we were supposed to vaccinate our children DIY-style. My wife refused and made the secretary at the doctor’s office do it.

    Before 2008, if a mother had labor outside of office hours (8am – 5 pm), no pain medication was allowed http://www.expatica.com/nl/essentials_moving_to/essentials/having-a-baby-in-holland-997_9468.html

    The good new is I can go to the doctor for $15 in The Netherlands. The bad news is you get what you pay for, anywhere in the world.

    France: It got up to 104 degrees F in France in 2003. 15,000 people died of heat related injuries. Very few Frech hospitals have air conditioning or ice machines.
    http://www.usatoday.com/weather/news/2003-09-25-france-heat_x.htm

    Canada: A colleague of mine had a spinal injury. He bypassed the 6 month waiting list to get a socialized medicine MRI scan by using his private health insurance. The doctor there looked at the MRI and said, “You need immediate surgery, but the waiting time for a hospital bed is 6 months.” My colleague asked him what the effect of waiting 6 months would be and the doctor told him it was likely that he would be paralyzed in one leg. My buddy went to The States the next day and had his surgery a day after that.

    I agree that American health care is expensive and I have no doubt that there are many places where we could trim non-value adding overhead and excessive care, but don’t kid yourselves, the grass is NOT greener on the other side of the fence.

    P.S. I am writing this from Houston, where I just had eye surgery. I thought it was worth a month of my time to get it done here.

  8. MidlifeNocrisis says:

    I’m curious to know why 3 brand new hospital/health centers have been built within 23 miles of my house within the last 7 years. Looks to me like there is alotta cash flowing into health care…….. (and I live in a somewhat rural part of the Midwest)

  9. farmera1 says:

    Why, here’s some whys.
    1) US doctors largely get paid by piece work, the more procedures, operations etc they do the more money they make. Lots of unnecessary surgeries done, I know this from first hand experience with Drs wanting to cut on me. (One reason the Drs at Mayo are so much better than the average US doctor is that Mayo doctors get paid a salary. They don’t like to operate unless it is for the benefit of the patient. Most drs judgement is compromised by the profit motive)

    2) The US doesn’t negotiate with drug companies about price. That is why prescriptions cost so much less in Canada the government negotiates prices . In the US the VA does negotiate prices and it works out fine at a much lower cost.

    3) Much of the cost for health care is spent on the last month of life. Often procedures unwanted by patients are done at huge costs.

    So we have the absolute most costly, and the one of the most ineffective systems in the industrialized world. Our longevity is way down the list and infant mortality is very high. But we do get to pay exorbitant prices.

    So the two things that are absolutely going to bankrupt this country is the health care system and the military.

  10. Petey Wheatstraw says:

    mcelus:

    Last summer, I had a very frank discussion with a British expat who runs a chemical facility in the Tidewater region of Virginia. This fellow is no anti-corporatist.

    To my surprise, his take is that Americans are either stupid or crazy for rejecting healthcare systems similar to the Europeans.

    His anecdote:

    His mom, in her 90s, gashed her leg on a coffee table (if you have ever dealt with the elderly, they ase slow to heal, and such an injury can be quite serious). A doctor mada a house call and treated her leg. Over the next few weeks, a nurse-practitioner came to his mom’s house to change dressings and provide additional care and medications. As he said, “no one got a bill. Sure, we pay higher taxes, but if I would have been an American, I would have had t return to England to look after my mom, and the bills would have eaten her up.

    I also go to Canada frequently, and I always make it a point to ask what they think of their healthcare system. I have never gotten a negative response, and the only person who said they had to wait for treatment said it was for an elective procedure, and the the wait was still reasonable.

    If you want to know what others think of their healthcare systems, or about the details of how those systems work, in a practical sense, you should ask. You would probably be surprised.

  11. Petey Wheatstraw says:

    MidlifeNocrisis:

    At first glance, I thought your handle was MidlifeNecrosis

    All of the building is probably in anticipation of the guaranteed profits that will result from the Frankenstein healthcare Bill foolishly passed by our fuckwitted Congress and President.

  12. jd351 says:

    @ Overseas American: You present a somewhat compelling story up until this part:

    Canada: A colleague of mine had a spinal injury. He bypassed the 6 month waiting list to get a socialized medicine MRI scan by using his private health insurance. The doctor there looked at the MRI and said, “You need immediate surgery, but the waiting time for a hospital bed is 6 months.” My colleague asked him what the effect of waiting 6 months would be and the doctor told him it was likely that he would be paralyzed in one leg. My buddy went to The States the next day and had his surgery a day after that.

    Pure BS, no one get seen and scheduled surgery in one to two days in the US . Plain and Simple , with the exception of life threatening illness. Lets be real!!!!!

  13. Petey Wheatstraw says:

    http://en.wikipedia.org/wiki/World_Health_Organization_ranking_of_healthcare_systems

    US is at 37th place, between Costs Rica and Slovenia.

    Netherlands ranks 17th, France is 1st, Canada is 30th.

    By cost: US is 1st, Netherlands is 9th, France 4th, and Canada is 10th. Costa Rica is 50th, and Slovenia is 29th.

  14. AtlasRocked says:

    Hello, I am Joe Medical-Care Marketer. I have two markets I can work on today. Hmmm.

    I can either spend my time selling US citizens medical care for what each citizen can afford, as I watch the employment rates go to all time lows,

    -or-

    I can sell medical care to the government, who will take all the money citizens can afford for medical care via taxes, PLUS borrow money from the next generation to pay me, thus yielding an additional 50% income, PLUS guaranteed living adjustment $s per year I can send a lobbiest to boost, PLUS any per year “baselining” revenue increase that congress uses.

    Hmmm….where should I spend my marketing time?

  15. MidlifeNocrisis says:

    @ Petey

    Is this a discussion on health care or politics???? Obamacare/Romneycare….. doesn’t much make a difference to me, other than the fact that we have a healthcare situation within the United States that needs to be fixed.

  16. theexpertisin says:

    Overseas American…

    Thank you for your personal observations on the reality of foreign medical care in the countries you are familiar with.

    jd351…

    I must disagree with you on your “BS” to prompt surgery for a serious medical condition in the States. I have had two serious medical surgery situations in two different locations in the U.S. On both occasions my surgery was practically immediate and performed with the greatest care and expertise.

    I have traveled extensively. Outside of being able to obtain some antobiotics without a script at local pharmacies, I found the level of care in supposedly civilized Europe to be haphazard and on several occasions rude and rushed. One exception, Switzerland. First rate in every respect.

  17. algernon says:

    The US has a very socialized system. 85% of people with Medicare, Medicaid, or good ins. consume as if someone else was paying. Several countries in Europe have average % out of pocket costs to the consumer higher than the US.

    Ideally, we would return to a free market in medicine which we had before WW2 & the distortions started by IRS treatment of health ins.

  18. AtlasRocked says:

    Housing, cars, food, healthcare. Big needs.

    -Housing is a human need. The housing industry, largely privately funded, understands how much money the customers have, and designs houses for each income level citizens can afford.
    -Food is a need, the food industry designs products for rich and poorer to eat.
    -People need cars. The auto industry, largely privately funded, understands how much money the customers have, and designs automobiles for rich and poorer citizens to afford.
    -Needs are met, the industries are healthy and not loosing money, and need little gov’t support. Their size adjusts up and down to fit the available money.

    Healthcare is 50% funded by the government. It’s costs are beyond what many many Americans can afford without government funding and subsidies. It is growing every year with the government funding changes, which always go up so it never shrinks, and the costs are way above what the citizens can afford.

    Ironic isn’t it: Healthcare, which gets the most subsidies of all our needs, is the only one of the 4 major “need” market in America that is sick.

    Quick – we need to get the government to subsidize 50% of cars , homes and food so healthcare doesn’t look sick and it doesn’t look like it’s causing the deficit to blow up.

  19. MikeW says:

    “Vaginal delivery”?

    I’m telling you, you can get everything delivered these days.

  20. kubrick says:

    I am a radiologist in NYC. I interpret all of the above mentioned scans and bill for them.

    See that beautiful graph with all of the numbers? Makes so much sense, right? It would if the actual costs were correct and would explain the problem with the system.

    But those costs are not correct by the largest stretch of imagination.

    This is the average amount insurance companies PAY us for the following scans:

    MRI = between $380-$500, some pay $800 but they only send the check 40-50% of the time. The other ones you can try to litigate but it takes 18 months and you have to pay the lawyer more than the cost of the lost income so it averages to $400. Across the board in Manhattan you get about $500 in private outpatient center (without naming names, if you are at a high-end boutique place and don’t see Medicaid, Medicare you may make $600-800 a scan). These boutique centers though are probably less than 5% of imaging in the country, probably less than 1%. Boroughs about $400 average.

    ***Hospital will get $800-1000 and more because they are much more powerful and have negotiated both rates that are 30-60% more than outpatient centers but also have the ability to pressure an insurance company from preventing you to practice in the area, so that they can get the inflated fee****

    CT scan $240-$300 or so but averages less than that. Oh and if you do and abdomen and pelvis, you do not get $522 + $584 as the chart indicates but $300 total. Assuming you get paid.

    MRI machine costs about $1 million. CT machine costs about $600k.

    If you are a hospital or large powerful old institution, you get a pass to do whatever you want. If you are young and try to do something different or more cost effective, you get closed out of all of the insurance panels and cannot practice. By the way, before you get closed out of the panels you have to shell out the $1.6 million and then apply. At that point it is at the will of the hospital giants.

    If you think it is bad now, wait until 2014 when all of the practices have shut down or been absorbed by the hospitals. A hospital that went bankrupt in the tri-state area recently was paying the executive officers 7 digit salaries following the bankruptcy for more than a year.

    I haven’t yet figured out why the $1,000+ MRI scan number keeps showing up in the press. It drives me crazy. I graduated 2005 from residency, it has never been in that range in my time as a practicing doctor in NYC and I can’t imagine that the rates in the rest of the country are that much more (and have asked colleagues all over the country). I do know that they (federal govt) are trying to get support to close all outpatient institutions in this country and funnel the business to the hospitals and ultimately create managed care organizations (like mini-HMOs) out of the hospital systems. I could see that this would be a good way to transfer money to the wealthy because the private hospitals (the ones that benefit) are usually owned by private equity and/or wealthy investors who will then receive a nice fat income stream as long as doctors make sure you don’t get scanned.

    And in case you are wondering the amount you would be charged out of pocket to have an MRI done without insurance would probably be in the $2000+ range. This is usually done to buffer the decreasing reimbursements from the insurance company. It is usually less than 1-2% of the entire revenue of the center in most places and does not change the $400-500 avg MRI reimbursement.

    Also I have been to other countries. Despite what the statistics show (the numbers are wrong), on Earth you can actually travel to those countries and find out how much it costs to buy the machine and what you get paid, etc. I can assure you the profit margin is much higher in a lot of countries. Shockingly it is higher in most developed countries because machines, lawyers, staff, rent are much cheaper.

    Also I don’t know how much MRI in Germany or European countries cost, but my guess is that the graphic is wrong about all of them.

    Finally the salary of a US radiologist is very high compared to other positions, I agree. But per hour it is not that much more than that in other countries. In fact, there are countries where it is much more. And, if you use $/hr and purchasing power parity to compare them, we are probably at the bottom of the top 10, maybe even worse.

  21. Petey Wheatstraw says:

    MidlifeNocrisis:

    “Is this a discussion on health care or politics????”

    Yes.

    The above charts are a result of politics/policy. The fix will be political/policy. If you think this is not true, please explain the vast gulf of care vs. cost in terms other than politics/policy.

    Maybe American diseases and their treatments and costs are exceptional, by nature.

  22. Francois says:

    @Oversee American:

    I’m a Canadian expat living in the US. I practiced as a physician in both countries. So, I’m very aware of the differences between the two health care systems.

    What you wrote:

    “The doctor there looked at the MRI and said, “You need immediate surgery, but the waiting time for a hospital bed is 6 months.” My colleague asked him what the effect of waiting 6 months would be and the doctor told him it was likely that he would be paralyzed in one leg.”

    is total and utter bullshit. I mean…dude! Do you really think people on this board are stupid? No Canadian doc would be THAT heartless, to the point of letting a patient ending up paralyzed.

    Believe it or not, they’ve swore the Oath too; moreover, forcing a patient to wait for a surgery in these conditions would be negligence, legally liable, not only in a Court of Law, but in a Professional Discipline Board. Professional Discipline Boards can be very nasty with those who tend to bend over to the bean counters, government or not. Licenses have been revoked for less than that!

  23. Francois says:

    For comparison about who drives costs where and why, versus Maryland, who succeeded in controlling HC costs:

    http://www.healthbeatblog.com/2010/01/in-massachusetts-elite-providers-drive-health-care-spending-what-does-this-say-about-the-dartmouth-research-marylan.html

    http://www.healthbeatblog.com/2010/02/massachusetts-problem-and-marylands-solution-we-dont-have-to-wait-for-washington-part-2-.html

    http://www.healthbeatblog.com/2010/02/how-maryland-broke-the-curve-a-solution-for-massachusetts-part-3.html

    As for why the costs keep rising, why don’t people ask those who already profit from health care?

    http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0715v1
    http://www.healthbeatblog.com/2010/02/providers-with-clout-demand-double-digit-increases.html
    http://www.healthnewsreview.org/blog/2011/02/direct-to-consumer-hip-joint-commercials.html
    http://www.healthbeatblog.com/2011/03/high-ceo-salaries-at-nonprofit-hospitals-under-scrutinyonce-again.html
    http://thinkprogress.org/health/2011/10/06/337491/partnership-for-astroturf-repeal/

    BTW, don’t believe the hysterical idiots who can’t help screaming “TORT REFORM IS NEEDED NOW!!” as if the volume of their screeching could replace serious data, available here:

    http://content.healthaffairs.org/cgi/content/full/29/9/1569

    I could go on and on! But I can’t finish this post w/o mentioning the worst gang of Korporate bastards in America, ie. ALEC

    http://www.healthbeatblog.com/2011/08/alec-the-industry-sponsored-group-behind-state-efforts-to-sabotage-health-reform.html

  24. slowkarma says:

    I have now been personally involved in two cases in which Mexican citizens with critical problems were told that they’d have to wait long periods for surgery. One involved a tumor on the optic nerve, which would surely blind the young girl who had the problem, and the other was breast cancer, in which the cancer had not yet metastasized, and a mastectomy was urgently needed. Both of these persons found that the wait was so long for the operations that they chose to have them in the US and pay for them privately. Both operations were successful, and the girl is not blind and the woman is not dead. I know these are anecdotal, but as I said, I’ve been involved two times in my life, and the same thing happened each time — no space in Mexico, despite their national medical program, quick action in the US.

    @jd321 — The woman with breast cancer (who had her records from Mexico, which demonstrated the urgency of the problem) went to a surgeon in Pasadena, Ca., on a Monday and had the operation on a Thursday. I drove her.
    I had a mild heart attack four years ago, drove myself to a local hospital, they did the chemistry that said that I had, in fact, had a heart attack, and the next day was taken to St. Johns Hospital in St. Paul, Mn., for an angioplasty in which they wound up placing two stents. In fact, for critical problems, you get extremely fast action here.

    There are a number of hospitals along the northern border which advertise in Canada for “optional” surgery — which can have a pretty wide range — to be done quickly here in the US. That’s because the wait for optional surgery, like hip replacements, can be very long there.

    The US has high costs, but it also has pretty good medicine.

    I was told by a doc in the main public hospital in Minneapolis that one reason we rank lower on “outcome” surveys than many European countries is that we actually have a third-world country living here in the US, that has no insurance, no medicaid and no medicare — these are the approximately 11 million illegal aliens who don’t see a doctor until the situation is very bad, both because they can’t afford the medicine and because they are afraid to go in early because of the legal question of their status. That’s the equivalent of 1/6 of the population of France, which is often rated best in medical care.

    The situation is really not amenable to graphics, IMHO.

  25. formerlawyer says:

    Atlantic had an illuminating piece on the French Healthcare System and its American cousin?
    http://www.theatlantic.com/business/archive/2012/03/france-and-us-health-care-twins-separated-at-birth/254033/

  26. Event_horizon says:

    As a cataract surgeon, I can break down the costs for that procedure:

    What is BILLED to a patient’s insurance / medicare is inconsequential. Nationally, Medicare (and consequently private insurance) REIMBURSEMENT for cataract surgery is:

    $600 to the surgeon
    $500-600 to the anesthesiologist
    The remainder to the hospital (or private outpatient surgery center, which typically contain costs better)

    Thanks to hospital lobbying, it is increasingly difficult to open private ASCs

  27. kwabena says:

    Huh. For those who love the US health care system, you can keep it. I’m currently overseas, where I was able to get major dental work done with the best materials available – and the ENTIRE cost (without insurance) was about what my out of pocket would have been in the US with the BEST insurance plan offered by my employer. No wait involved.

    Oh – and by the way – the REASON I needed the dental work is because of decay that occurred years ago when I was a penniless student and couldn’t afford even basic preventative care in the US. And the REASON I couldn’t afford basic preventative care in the US is that there IS no low cost option for health care in the US. Even sub-standard materials and methods would be preferable to none. While I am now able to afford basic health care in the US – I still remember, and begrudge the country for, the experience I had when I was younger, still struggling to “make it”. You shouldn’t have to worry about dying at 20 or drastically jeopardize your future health just because of the high cost of health care.

    PLUS – the fact that people DO choose to wait to go to the doctor, because of costs, only makes their treatment THAT MUCH MORE EXPENSIVE in the long run. At a time when every employer is running scared because of runaway health inflation, should we ignore that effect? Our health care system is TRULY f*ed up.

    And finally – while I understand why labor costs might be higher in the US – could someone please explain why putting someone in a machine and pushing a darned button should cost so much more in the US than elsewhere?

  28. super_trooper says:

    @Overseas American,
    Why would a doctor in NL care about lactose intolerance affecting “20% if the world’s population” (it is higher) when it is extremely rare in northern Europe. It shows your lack of knowledge. Lactate intolerance is very unusual among the native population in northern Europe. Diary products have been a primary source of energy for 1000s of years. People have adopted to the died and do NOT turn of lactase synthesis as the get older. This is a gain of function adaptation that has been shown to be beneficial. In contrast, in southern Europe, less diary products are consumed. Hence the adaptive “need” to tolerate lactose (via expression of lactase) is decreased. In Sicily 70% of the population is lactose intolerant.

  29. river says:

    Here is an old article that is eight pages long, but I thought it brought up some valid points:

    http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

    I am not a world traveler and don’t know much about how long it takes to get life saving surgery in other countries. And I don’t know how many people actually come to the united states to get treated because they can’t get treatment in their own countries (which I wonder if there are multinational insurance companies or international bankruptcy rules, since most treatment that you would actually have to flee your country to get treated would be prohibitively expensive in the US, it seems).

    But I found the article compelling.

    “The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.”

    Read more http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande#ixzz1oUysMKCp

  30. Apinak says:

    There are dozens of examples of good single-payer systems and no examples of successful privatized health care systems, so naturally the U.S. is determined to retain a failed system.

    It is also completely predictable that when you have a ‘free-market’ based health care system you will get very good care for the rich and bad care or no care for the poor and a number of people syphoning off profits. That is the very basis of a free-market system. I guess the people in charge see this as a feature not a bug.

  31. sickmint79 says:

    oh please, as if this system we have is anything close to a free market.

    a guy i know online was looking for an MRI with no insurance around us in chicagoland. i think there are a few places that offer lower prices for this service, i found one that will do any type of MRI for $600. why is it $1080 here and $280 in france? we have a broken price discovery mechanism (not as a result of a free market) and they have a price control.

  32. [...] WaPo shows at a glance how expensive US medical treatment [...]

  33. Sickmint79 –

    I think you suffer a small lack of understanding. France doesn’t have price controls per se. To be clear, the providers (Doctors, Radiograph & MRI centers, Laboratories and many hospitals ) are private, run their own business and are absolutely free to set prices as they see fit. However, the reimbursement rates specified by the state insurer are set at specified levels, the french equivalent of the canadian usual&customary charge. These are not as parsimonious as UK NHS, rates, always above marginal cost for labs and providers, but tethered to reality by cost-plus thinking – the way you would expect to negotiate monpolistic (hospitals) or oligopolistic providers (MRI, XRay heart surgeons). A lab is free, like in america, to charge twice or five times the going reimbursement rate. In practice, they will have no customers, since no one could afford to pay the incremental difference, and “Top-Up” insurance which is a free market where one can buy cover to pay this difference between actual charges and reimbursement rates, also have limitations that make it a stupid commercial policy to set prices stupidly high.
    The reminbursement rates are sensibly adjusted for regional disparities, i.e. higher in Paris and other higher-cost metropoles. What this means practically, is that there is little in the way of stupid pricing. The price IS the price. Whether I have insurance or pay out of pocket (which I do since I am not resident there), there is no two-tier price structure – one for the state and one for the unlucky sod who walks in off the street. Now you can call it what you will, but this system doesn’t in any way deter supply, and few if any shortages of any service exists across the system. As anywhere, if I want to see the top specialist, I will wait a long time for the appointment. One could argue she should charge triple and see half or a third of the patients, but in reality double the price would curtail business by more than one half, and in any event this mode of thinking is so far from her world. She will charge a 15% premium, have an eternally-full schedule, and do better than her less expert peers. It seems to work well for all, as far as I can tell….

    I wrote some more here for anyone who wishes to read (and there are some good comparative comments to the post):

    http://nihoncassandra.blogspot.com/2011/07/price-isummmerrrr-wrong-part-2.html

  34. AtlasRocked says:

    Let’s don’t forget this perfect correlation, too: All those great European health care countries are far more debt per capita than the US, and they also tax at a far higher rate per capita. The pattern is only broken by Canada, the darling of health care advocates. 1 country with nationalized health care has less debt per capita than us and higher taxes.

    Ooooooooooooooops. What a minute. Canada is hiding debt at the Province level: “The report said the slow decline of Ontario’s manufacturing sector is partly to blame for the malaise that will see the deficit double and net debt rise to 50% of GDP by 2017/18. But it did not gloss over the culpability of a Liberal government that has failed to keep spending in line with revenue growth.”

    http://fullcomment.nationalpost.com/2012/02/15/drummond-report-will-test-mcguintys-pledge-not-to-raise-taxes/

    Nationalizing health care in a democracy is just a stupid idea, the people cannot vote to limit the benefits of ANYTHING in a healthy manner. Plato observed this failure 2400 years ago, and our founding fathers avoided putting benefits as a power at the federal level for this specific reason Plato observed:

    “….In their ignorance they tend to vote for politicians who beguile them with appearances and nebulous talk, and they inevitably find themselves at the mercy of administrations and conditions over which they have no control because they do not understand what is happening around them. They are guided by unreliable emotions more than by careful analysis, and they are lured into adventurous wars and victimized by costly defeats that could have been entirely avoided.”

    He’s talking to YOU, Barry, and your merry band of nationalized healthcare advocates. You’re ideas have been failing consistently for 2 millenia. And they are 100% failing right now. 100% !!!!

    Gammon’s Law also Damns your efforts: He was led to enunciate what he called “the theory of bureaucratic displacement.” In his words, in “a bureaucratic system . . . increase in expenditure will be matched by fall in production. . . . Such systems will act rather like `black holes,’ in the economic universe, simultaneously sucking in resources, and shrinking in terms of `emitted production.’”

  35. harryhope says:

    I’m a US citizen living in France for the past eight years. There’s a lot of misinformation contained in the comments here about French health care.

    The doctors are well trained and highly professional (apparently unlike the Netherlands). Take blood pressure, weight, etc routinely. What is different, effective and less expensive is that for the most part treatment is carried out by GPs while specialists diagnose and prescribe the treatment. This means one doctor (GP) treats all a patient’s problems so the caretaker is thoroughly knowledgeable about each patient and the various treatments provided. In cases like my irregular heartbeat, a cardiolgue treats me but writes a letter to update my GP after every office visit. In the US it’s not unusual for multiple doctors to treat one patient without communication or coordination. When my GP refers me to a specialist, he writes a letter explaining my problems with detauls of my health status. All the doctors have one examination/office room. Notes are typed into a computer at the doctor’s desk where they are readily accessible along with letters from specialists. My US experience is records hand written as the MD runs from exam room to exam room and they not readily accessible.

    Long waiting periods in France are a myth. Five days for my pacemaker. One or two days to see my GP (who is a GP not a specialist doctor of internal medicine). He’s as good a doctor as I’ve ever had. Educational costs are much lower. GPs who are the majority of doctors are not specialists. In the US it seems every doctor is a specialist with higher education costs and fees. In France it’s high school directly to medical school. Engineers do it. Why not MDs?

    My MRI cost me €145 or less than $200. And it was provided in a for profit hospital together with a consultation with a radiologist 15 minutes later where I was given 2 DVDs providing 3 dimensional images. One for my specialist and one for my GP.

    One thing about the US medical system I find mind boggling is prescriptions. In Europe it’s by the box. I present my prescription to the pharmacy and I’m given a box of the medication. One trip and no waiting. There is no need for a highly educated and highly paid pharmacist to count out pills, put the pills in a container and a label on the container. That seems parasitic to me after experiencing the European system.

    My monthly blood test costs roughly $13 and the results are emailed to my GP the same day.

    France is rated #1 in health care at a fraction of the US cost, about 60%. The US is rated 16th to 32nd depending on the outcome criteria used.

  36. super_trooper says:

    PBS Frontline did an in depth report on the health care systems in Germany, Japan, Taiwain, UK, France and Switzerland. They all have different systems. The idea here is, why not pick the best pieces from already established systems and make the US “the best in the worls”

    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

  37. Petey Wheatstraw says:

    Cassandra Does Tokyo:

    Awesome. Especially this: “One could argue she should charge triple and see half or a third of the patients . . .”

    Thanks.

  38. kubrick says:

    again:

    the average $ collected for MRI in the U.S. in an outpatient center is $400-500 per MRI, not $1,080

  39. Petey Wheatstraw says:

    kubric:

    I don’t know where the number cited comes from, but I do know, from the consumer end of the spectrum (and as a consumer who uses very little other than proper diet and exercise, in the way of healthcare), that getting even moderately sick or injured in the US can bankrupt a middle class person.

    I believe that the difference is due to the corporatization of healthcare — not greedy doctors. Healthcare is now a for profit industry, not a basic societal responsibility. As such, it serves the shareholder, not the patient or public health, generally.

    Who has not heard of physicians in the US fighting with insurance companies for treatment of a patient, while the insurer fights even harder, and with a larger war chest, to limit the care/protect the profit margin?

    If you think about it, this explains the gulf between cost and outcomes.

  40. A says:

    4P World: Power & Profit take Precedence over People.

  41. doug says:

    History lesson: Blue Cross Blue Shield was started by Doctors and Hospitals to make sure they could be paid.

  42. constantnormal says:

    The leading cause of personal bankruptcy in the US remains health care bills.

  43. Qmalc says:

    I live in Switzerland. Several years ago, I had to have a medical proceedure while on vacation in the US. I told the hospital I would pay cash and them submit it to my insurance back in Switzerland.

    I was totally suprised when I was told that the proceedure cost 75% less if paying cash. It is amazing the amount of money that is over-charged for medical proceedures just to subsidize the uninsured and unreimbursed costs from the insurance companies.

  44. constantnormal says:

    I should not throw out unsubstantiated statements. Apologies. Here’s a link to a google search …

    Google: The leading cause of personal bankruptcy in the US

  45. Bridget says:

    I wonder how they arrived at the ” price” for care in the US. There is a significant difference between sticker price and the price actually paid after network discounts, for the insured. And I know for a fact that some providers offer discounts to self pay patients.

    At any rate, any time you have a group of people spending other people’s money to benefit themselves, costs are going to be high. The semi free market solution is to abolish the employer subsidy for health insurance and make basic, high deductible, cheap insurance available to all. The other solution is Obamacare, or worse.

    Either way, I do believe that “quality” of care as we know it will suffer in the long run. I’m talking about the short wait times, the dazzling advances in technology, the incredibly highly trained medical staff, all of these wonderful things about our health care system are fueled to a large extent by money. Choke off the money, and we’ll have less good stuff. It’ll be cheaper, though.

  46. Bridget says:

    I wonder how they arrived at the ” price” for care in the US. There is a significant difference between sticker price and the price actually paid after network discounts, for the insured. And I know for a fact that some providers offer discounts to self pay patients.

    At any rate, any time you have a group of people spending other people’s money to benefit themselves, costs are going to be high. The semi free market solution is to abolish the employer subsidy for health insurance and make basic, high deductible, cheap insurance available to all. The other solution is Obamacare, or worse.

    Either way, I do believe that “quality” of care as we know it will suffer in the long run. I’m talking about the short wait times, the dazzling advances in technology, the incredibly highly trained medical staff, all of these wonderful things about our health care system are fueled to a large extent by money. Choke off the money, and we’ll have less good stuff. It’ll be cheaper, though.

  47. kubrick says:

    @petey

    i got that number because i am a radiologist and bill that study every day in my practice and know exactly what we receive

    also a lot of insurances were started by doctors but that doesn’t mean they are doctor friendly.

  48. kubrick says:

    @petey

    i got that number because i am a radiologist and bill that study every day in my practice and know exactly what we receive

    also a lot of insurances were started by doctors but that doesn’t mean they are doctor friendly.

  49. Petey Wheatstraw says:

    kubrick:

    I caught that you were a doctor. I don’t think docs, generally, are getting wealthy off of their professions (at least not beyond a reasonable ROI).

    BTW, I’ve got this problem . . .

    ; )

  50. Bridget says:

    The iron triangle of health care:

    You can have quality health care. You can have inexpensive health care. You can have universal health care. If you are really smart, you can have two out of three. But under no circumstances can you have all three at once.

  51. NMR says:

    Since we all know the US is spending about twice as much as everyone to run a healthcare system why would that be? It’s the costs stupid, so these numbers for actual procedures aren’t exactly a surprise although we do somewhat add to the problem by the very complicated way in which we fund it all. Fact of life, demand for healthcare is inelastic so the providers (who are all running businesses) can charge more or less what they want unless there is some countervailing force. This is the magic ingredient present in all these other systems and absent in ours. It’s called the government. Forget US insurance companies who are essentially oligopolies who have an incentive to see ever rising medical costs so exercise very little brake on the process. This is not the case in those systems overseas where governments use insurance companies as intermediaries (eg. France) because the entire process of funding and delivery is fairly tightly controlled by govt.

    All this anecdotal stuff is largely worthless and is almost always the product of folks with agendas. You don’t run $2.5 trillion economic systems on the basis of anecdote. But if we want to trade anecdotes I’d say on the issue of quality ours is good but not as good as France where I lived for a few years and but better than Britain where I’ve also lived. This is probably explained by the non anecdotal fact that France spends around 9% of GDP whereas the Brits only spend around 7.5%. Either way we’re paying substantially more and it’s not because French management skills are far greater than ours.

    Ultimately our healthcare model is unsustainable (they’re going have great difficulties sustaining these European ones but at least they have a headstart). This means a lot of oxes are going to get gored when the govt ultimately steps in as it will have to. It won’t be pretty.

  52. Don Levit says:

    The cost of health care is very important, as that is directly reflected in one’s premiums.
    Not only does the cost vary between countries, but it varies considerably between insurers, and even more variation in and out of network.
    The median family income is $50,000.
    The average family group premium is $14,000.
    This ratio is not sustainable.

    One way to drive down costs is to increase the deductible.
    An increase to $25,000 reduces the premium by 60%.
    An increase to $50,000 lowers the premium 80%.

    To do so, most families will need an underlying primary policy, which pays from dollar one.
    I and 3 of my partners have had 2 meetings with Milliman, an actuarial firm, in designing a policy which is paid-up with every monthly premium.
    If the person, never makes another premium, his coverage is still available.
    The goal is to build up to $25,0000 to $50,0000 in paid-up coverage, depending on contributions (which are very affordable compared to today’s policies) in 2-4 years.
    It is a very cost-effective way to pay catastrophic claims periodically, which is about the best we can do in today’s economic environment.
    We look forward to getting the actuarials from Milliman in 3-4 weeks.
    Don Levit

  53. kubrick says:

    @petey

    good one. whenever i go see my gf’s family (they are in a rural town), they line up to see me. sadly i know little about primary care any more but their other option (no doctor) is not any better.

    btw the main driver behind healthcare problems in the u.s. is actually not just related to health. it is pervasive in our culture. we live in a country where there are 30+ yr mortgages, car leases, furniture leases, etc. people are accustomed to having others pay. this all worked as long as we had a working, growing population (baby boomers) as well as increases in productivity. it will not work as we transition into an aging population quite as well. this is the problem with all community based systems (social security, insurance, etc). they are quite sensitive to demographic drift. humans and societies expect constant progress. but in a community based payment system, the curve of progress will largely follow the curve of demographics.

    the combination of easy credit and demographics is definitely an important part of this equation.

    lot of other problems, here is one; currently i have a digital records system but i cannot connect to other doctors in the area without paying $6,000-$10,000 per link. as my referral base (and most centers) are in the hundreds of doctors, this could cost over a million dollars. obviously that is not feasible. it does no good to have everyone on medical records if the info is not easily shared by doctors. they should mandate at the govt level, a protocol for medical records that all software/emr vendors have to use that involves no link. trust me, this is not a technical issue but one of large companies, controlling these regulations. the large companies that charge $100k+ for their software fear the day when a small inexpensive but better startup exists. they make sure (for now) that you don’t choose them by making their interfaces not work!

  54. DeDude says:

    Oversee American, is a BS-ing troll who makes up stories (facts) to fit his right wing narrative. It’s just that he got a little in over his (uneducated) head with this one and stretched his invented “reality” just far enough that everybody could see he was making it up.

    The long waiting time stories about european health care has no connection with reality. So they use anecdotal stories to try and support their narrative. All emergency care is handled immediately and urgent care is handled within reasonable timeframes. The only waiting times I have heard of on urgent care was someone down the street from me who had to wait 4 month while his insurance company tried to deny him coverage for his cancer treatment – he is dead now.

  55. gman says:

    …”demographics is definitely an important part of this equation.”

    Most the 1st world nation who do thing more cost effectively have much worse demographics than the US.

    See Japan and France. We are “young” country in comparison.

  56. BillG says:

    @Kubrick
    What do 30 year mortgages and the fact that people lease stuff that they probably don’t in other countries have to do with wanting to make other people pay?

    Also, if the real cost of an MRI is not $1080 as Wapo is saying but $500 (but only at outpatient centers) or $800 (at a hospital) then you’re still charging about twice to three times what they do in France ($281) and if Wapo is overstating US costs then they could very well be overstating French costs too. Why do you need to bill twice as much for the same procedure as a French doctor? They’re using the exact same imaging machines you are. Does it have anything to do with US radiologists taking home twice to three times what French radiologists do because that’s my suspicion?

    On a somewhat related note, this country would save a lot of money on healthcare if we made it easier for old people to retire overseas. Right now you can’t even use Medicare overseas when doing so would save the government buckets of cash.

  57. gman says:

    The article does not deal with one of the most glaring problems in the system. Prescription drugs! Same exact drug in Canada (longer life expectancy than US) cost 50-70% less. US throws billions down the drain for the same exact drug.

    I am always amazed how the “free market” is not allow to arb this out. The biggest self described “free market people” advocates, were the ones tripping over themselves to protect monopoly rents.

  58. kubrick says:

    @BillG

    Has to do with the fact that people here expect a high level of care and STAT service for everything but want to only pay for socialized service where people pay 50+% tax rates and are willing to wait for care. Medicaid patients here scream when they wait 2 hrs. How do you think they will react to waiting 2 weeks?

    Why do we need to charge 2x? Have you ever run a business? What do you think the doctor takes him in his pocket if the reimbursement is $400 per scan???! Subtract the rent, staff, contrast, tech, manager, billing, legal, lease cost of machine. Btw it is much more to buy a machine in the US then in other countries, about double or sometimes triple. Every item I listed costs more. If you do 200 scans per month (not easy by any stretch) you make $0. if you do 150 or so, you lose about $300k per year.

    In China you can charge $180 per MRI and break even at 50 studies per month! I know because I am looking at markets all over the world as I am having a hard time surviving on my own in the U.S. after paying expenses and stressing about the insurances.

    Also in healthcare in the U.S. there are between 10-17 workers for each doctor to keep up with the billing. When I visited India the tech was the secretary. Their staff cost per year? $5000 per yr! My staff cost per year $400k per year! Although I don’t think we need that many employees and would be better off without these workers and a more stream-lined billing system, you do realize that this would cut ~10%+ jobs in this country, probably 20% in some areas. A lot of people are living off of the medical system via jobs. No doubt the politicians here are worried about this.

    Ok let’s talk straight income. Have you actually analyzed $/hr of the doctors or are you just going by the total income? You do realize if you work 35 hrs a week (mandated in French law for most doctors) you will make about 70% of a counterpart working 50 hours a week right? Are you comparing that doctor’s income to the purchasing power parity and other jobs in that country? Do you realize also that if a doctor makes half of the American equivalent, usually the teachers, lawyers, engineers, bankers salaries are also scaled similarly?

    Are you aware that there are US doctors travelling to other parts of the world now because the pay is better? My next door neighbor is an ER doc (we both live in NYC). Where does he work? Montreal 12-15 days a month and then vacation. What is his pay? $225-250k per year. There are radiology jobs in Quebec for $600k+

  59. kubrick says:

    by cost u mean revenue, you fail to mention the entire expense side of the equation. in france, all the employees, lawyers, machines are also much cheaper.

  60. kubrick says:

    and, no, the machines are not the same. in tokyo you can buy an MRI for $200k and start working. you cannot bill to insurances using those MRIs in america b/c once again patients in the U.S. all seem to think that they deserve the best even if they cannot afford it.

    i would love to open an MRI center in the U.S. and charge $200 per month and use an older machine. i honestly don’t think for most people it would make a difference. i cannot do this or i would risk losing my license.

  61. kubrick says:

    finally the difference in income is much less than people think when account for $/hr and purchasing power parity as well as ratio of other jobs, for ex, pay ratio lawyer:doctor, pay ratio banker:doctor. these ratios are higher in america

  62. BillG says:

    So French bankers and lawyers are less overpaid than they are here too? That doesn’t sound like a bad thing. Overall the typical French worker is not making half what a US worker is. They make a little less and that probably makes running a medical practice a little cheaper but that’s not the major difference. This is France we’re talking about – not India.

    One reason I’d suspect their professionals aren’t making what they are here is probably because their low population growth has not meant a need for expansion of their professional schools on the scale of what we’ve seen here and thus there hasn’t been an opportunity for any profession to resist that expansion to enrich their members.

    Aside from that, are you saying that there are licensing requirements that mandate the use of newer MRI technology? If so then that’s pretty poor policy in my opinion. I doubt all the machines in France are that old but if you are required by law to replace them every other year then that would get expensive.

  63. kubrick says:

    BillG, do you honestly think GE would let us use an older machine when they are trying to sell the new one with the highest margin? I agree it is a horrible policy and created to keep costs high and protect GE, Siemens, etc profit margins. They do the same with drugs, ie, no generics for several years with monopolistic control. Even the exact same GE 1.5T machine from the same year is sold at different prices in different countries. It may be $1 million in the US, $500k in France, $300k in Japan, $100k in Mexico. GE can do whatever they want. Because of expensive shipping cost and import tax, you can’t really get by on importing the machine at a cheaper rate.

    Btw I agree with you on a lot of points. My father is an engineer and I make 5 times what he makes. He probably has done more for society than I have (I say this sincerely).

    If you could allow a computerized system of medical records without the lawyers squashing it, remove the long patent protections on drugs, remove restrictions on forced use of newer equipment for reimbursing, decrease malpractice and legal costs, and cut pay you would do very well in making a better medical system. I would add to that remove or tax the business guys associated with these processes. Whatever doctors make, multiply x 5 and you have an idea as to how much the business owners of practices are making.

    Ultimately if you cut the pay to the doctors directly, the way the system is setup now, all it will do is allow the business owners to get higher profit and increase their margins.

  64. kubrick says:

    oh (and now i am dreaming) i would also wish for student loans under $100k instead of $315k (which is what i hit)

  65. super_trooper says:

    @kubrick,
    ” It may be $1 million in the US, $500k in France, $300k in Japan, $100k in Mexico”
    Or it may be not until you provide a reference. Maybe the relationship is the same as with drugs. One buyer buying in bulk vs many smaller buyer. You get a bigger discount. In short, you get a bigger discount buying 100 instruments vs 2. Why should I as a consumer pay for that? Get together with all hospitals in the country and buy them in bulk.

  66. harryhope says:

    kubrik

    There are several way to reduce student loans. Here’s three. 1) Start medical school right after high school as they do in Europe. Engineers and architects do that in the US. Eliminates 4 years undergraduate college. 2) Prevent universities receiving federal funds from making a profit on MD ed. 3) Decrease number of specialists in the US as they do in Europe by having specialists consult, diagnose and direct GPs in carrying out their prescribed treatment. GPs would replace most specialists over a period of time.

  67. kubrick says:

    @super trooper

    http://www.npr.org/templates/story/story.php?storyId=120545569

    scroll 2/3s way down. that guy says they cost 1/10th in japan. i think that may be over stretch, a quick search i did yrs ago was closer to 1/7th cost compared to america

    i am looking in india at a $90k machine right now
    partner bought a $120k machin in caribbean 2 yrs ago
    i know u can buy hitachi in china for $80k
    i bought a $1.1 million machine in us last year, in order to pass ACR certification
    when i say “may” it is because there are over 50 models of mri with many different software add-ons, coils, etc.
    i am not able to provide a list here breaking down every machine sold in every country.
    i was a chairman at a hospital in nyc in the past and i can tell you we get discounts for sure. instead of $1.1 million i could have got it for $1 million. large institutions often get 10-20% discount over small ones. it is still close to 7 digit purchase. u can buy cheaper here also but then ACR may not certify and you may not get paid, it is a big risk. i know of several who are stuck in that position and ultimately went bankrupt.
    as a consumer u will pay about 50-60% more at the hospital btw for that cheaper machine

    @harryhope

    i agree with all of the above.

  68. kubrick says:

    would also add that when i am able to get a 0.5T magnet or 0.3T, it can be hard to get some radiologists to interpret the exams. there is a fear that a tumor or osteomyelitis or subtle stress fracture will be missed and then the patient sent to a center with a better MRI. if it is seen on the better MRI, you will get sued. in these other countries the doctors don’t worry about this. they don’t pay $60-200k out of pocket for malpractice either

  69. harryhope says:

    @kubrick

    Re malpractice. I’m a recently retired federal litigator. There’s a simple way to minimize malpractice awards. Let juries decide liability and judges award damages. Good lawyers can fool juries and get silly damage awards but they won’t fool judges who are incredibly conservative. Not conservative in a political sense but in a way that minimizes excess. Many, maybe most, damage awards under such a system will be less than the cost of litigation which will give malpractice lawyers pause for thought.

  70. kubrick says:

    u have good ideas harryhope.