I am surprised to see insurance companies win this. An insurance company is primarily a claim processing organization. The non-profit plans don't always make money on operations and it is often the interest earned on the float that puts them in the black. Insurance companies largely estimate what a client will utilize based upon analysis of their experience with that client. They are constantly under pressure to reduce costs and that is the service they are trying to sell to their clients - employers. So, in effect, if one says that insurance companies are the most responsible that will roll up to an employer. the employer who pays for their employee's health care is paying a premium to the insurance company to handle the claim, build the provider network and create policies around what they cover. In effect, if employee's didn't consume a lot of health care an insurance company would theoretically charge them less. So, one of the primary drivers of health costs is the health of the population. We all know that obesity and diabetes are two of the fastest growing diseases. These diseases usually indicate a future of more serious diseases. This leads up back to simply the answer "people" who need to consume medical services drive costs. Look at the profit margins. Pharma targets north of 50% gross margins, med device the same, Providers and insurance companies operate on much lower margins.
CC - 8 years ago
All the above.
We American’s have unhealthy lifestyles, we want the most expensive (best care) possible, we want someone to be responsible for payment (government, employer) and another party to be responsible for making us better (providers). We as patients don’t want to be responsible for any part of our healthcare.
When government gets involved it pushes out competition, adds layers upon layers unnecessary of bureaucracy and is extremely inefficient. In your health system look at the number of employees that add no “real” value to the care of patients. Its level after level of bureaucracy, for some reason government thinks adding in more layers will drive cost down?
Insurances companies contribute to the cost as well. They find loop holes and various other reasons to postpone or deny payment. They also contribute to the inefficiency of our healthcare system.
In the previous post it talks about how we are almost a one payer system anyway. Why do we think continuing down the path is going to fix the issue? What has government ever done to help drive down cost? Nothing! It’s a political football that politicians use to beat up one another. Both sides prefer to do nothing about the real cost. Depending on who is in office we zig we zag but nothing really gets done. We all know “real” change isn’t going to be popular and most likely painful. We prefer to ignore the issue.
Matt - 8 years ago
Government is most responsible. While all parties drive the cost up government involvement is the main cause. They accelerated employer provided insurance with wage and price controls during WWII. An unintended consequence. It changed the customer from being the patient to the employer.
Most patients stopped caring how much treatment cost as they were not paying for it. Then patients wanted a change from it being insurance to cover unexpected large bills to covering routine care. Employers put the requests to insurance carriers who oblige and premiums go up. Now providers not feeling real market pressure increase charges. Eventually Patients / Employers complain about high premiums and government responds with ACA which further increases costs by adding coverage mandates.
Leaving us with a system with virtually no incentives for anyone to reduce costs. An increasingly unsustainable system is the result.
The only other sector of the economy on the same course is Higher Education. Again as a result of government involvement.
Mobile Man - 8 years ago
Wait... Can I change my answer? Oh... Never mind.... I'd just want to change it again...
VFJ - 8 years ago
In my opinion, Government. As the policymakers, they set the tone for what the market can get away with it.
observer - 8 years ago
I would gladly declare that who is MOST responsible is insurance companies. They are the ones who have yet to have fluctuation on margins, unlike providers and med device over the last 15 years. They just add new products, layer services, or exit non-profitable areas. In my career training, I deliberately sought experience in all the constituents of healthcare, in this order -- provider, government, pharma, med/dev, supply chain, healthcare tech....when the ARA and ACA were signed, I made a deliberate move to be part of it, joined one of the top 3 insurance firms in a director-level role. I was disgusted by the lack of healthcare experience of my peers. Leadership are recycled sales people with no regard for what they represent. Large incomes, and folks who are pawns to the actuaries who dictate all in the back offices. All programs , outside of operational logistics, are PR to close large employer deals. Insurance only cares about signing the American Airlines or Apple to manage self-funded employer plans. They have zero regard for the member, members are not their customers. The waste is shocking, profits overwhelming. And how the ACA was truly written FOR insurance, yet they are the first to bail!!!!
Cosmos - 8 years ago
Having trouble making up your mind? These graphs might help:
Where does healthcare spending go?
http://healthcare-economist.com/wp-content/uploads/2014/12/2013spending.png
Who pays for it?
http://i.huffpost.com/gen/2348654/original.jpg
How about ALL the above plus the general public.
If you really want to control health care costs you must first answer these questions.
Is health care a right or a privilege?
If it is right then all are entitled to all it offers now and tomorrow including all advances...and all the attendant costs. No way to control that.
If it is a privilege, then where does the 'right' (eg basic care) end and the privilege begin? And who and how do we decide where that line is?
No one (particularly politicians) wants to deal with the basic question: What price life?
Countries we compare the USA to that have lower costs and roughly equivalent technologies and care levels have answered that question. We chose to ignore it.
I am. I expect miracles. I gladly pay my premium and deductible for miracles. Okay, maybe providers or payers should protect me from my irrational behavior. Perhaps some day we'll all be faced with some sort or personal accountability around our health status coupled with rational expectations we manage weight, blood pressure or other aspects of health. The downside of a reduced demand is the scary thought we'll be inundated with more infomercials about potions, injections, mystic food preparation or other must-have treatments needed to restore lost revenues streams.
Cynic - 8 years ago
This was a tough one! Everyone really shares a part of the puzzle. The biggest problem is that we have such a huge layer of administrative hurdles and associated costs (for staffing and for clinicians and patients to jump through to get needed care). The utilization review processes and billing audits (as well as the time needed to document for and bill for those inane E&M codes and other mandated documentation) are all significant drains on health care. Single payer would be s big improvement as long as it's not designed by the people who gave us meaningless use. But the various forces in the US delivery system won't allow a rational single payer system to emerge. So we're stuck with the bizarre combination of having shortages of cheap and effective older drugs vs being charged an arm and a leg for an epi-pen.
Ashter - 8 years ago
Doctors are the gate keepers to nearly all health care services and most insurance companies attempt to negotiate prices down but no one is forcing doctors to earn less. Staff costs drive the bulk of our health care costs and specialists who have salaries in the 300k to 500k are not adding any real value to our system compared to those that make 125k.
We don't need single payer but we do need cost controls like most of the rest of the developed world - where they far exceed our outcomes. Since taxpayers already are paying for the bulk of both health care (via medicare, medicaid and government employees) and pay for 85% of medical training (residency and internships are paid for by CMS at a cost of 100k a year per doctor) it is time to admit we already have a single payer (government) but we need to focus on costs not just access.
I am surprised to see insurance companies win this. An insurance company is primarily a claim processing organization. The non-profit plans don't always make money on operations and it is often the interest earned on the float that puts them in the black. Insurance companies largely estimate what a client will utilize based upon analysis of their experience with that client. They are constantly under pressure to reduce costs and that is the service they are trying to sell to their clients - employers. So, in effect, if one says that insurance companies are the most responsible that will roll up to an employer. the employer who pays for their employee's health care is paying a premium to the insurance company to handle the claim, build the provider network and create policies around what they cover. In effect, if employee's didn't consume a lot of health care an insurance company would theoretically charge them less. So, one of the primary drivers of health costs is the health of the population. We all know that obesity and diabetes are two of the fastest growing diseases. These diseases usually indicate a future of more serious diseases. This leads up back to simply the answer "people" who need to consume medical services drive costs. Look at the profit margins. Pharma targets north of 50% gross margins, med device the same, Providers and insurance companies operate on much lower margins.
All the above.
We American’s have unhealthy lifestyles, we want the most expensive (best care) possible, we want someone to be responsible for payment (government, employer) and another party to be responsible for making us better (providers). We as patients don’t want to be responsible for any part of our healthcare.
When government gets involved it pushes out competition, adds layers upon layers unnecessary of bureaucracy and is extremely inefficient. In your health system look at the number of employees that add no “real” value to the care of patients. Its level after level of bureaucracy, for some reason government thinks adding in more layers will drive cost down?
Insurances companies contribute to the cost as well. They find loop holes and various other reasons to postpone or deny payment. They also contribute to the inefficiency of our healthcare system.
In the previous post it talks about how we are almost a one payer system anyway. Why do we think continuing down the path is going to fix the issue? What has government ever done to help drive down cost? Nothing! It’s a political football that politicians use to beat up one another. Both sides prefer to do nothing about the real cost. Depending on who is in office we zig we zag but nothing really gets done. We all know “real” change isn’t going to be popular and most likely painful. We prefer to ignore the issue.
Government is most responsible. While all parties drive the cost up government involvement is the main cause. They accelerated employer provided insurance with wage and price controls during WWII. An unintended consequence. It changed the customer from being the patient to the employer.
Most patients stopped caring how much treatment cost as they were not paying for it. Then patients wanted a change from it being insurance to cover unexpected large bills to covering routine care. Employers put the requests to insurance carriers who oblige and premiums go up. Now providers not feeling real market pressure increase charges. Eventually Patients / Employers complain about high premiums and government responds with ACA which further increases costs by adding coverage mandates.
Leaving us with a system with virtually no incentives for anyone to reduce costs. An increasingly unsustainable system is the result.
The only other sector of the economy on the same course is Higher Education. Again as a result of government involvement.
Wait... Can I change my answer? Oh... Never mind.... I'd just want to change it again...
In my opinion, Government. As the policymakers, they set the tone for what the market can get away with it.
I would gladly declare that who is MOST responsible is insurance companies. They are the ones who have yet to have fluctuation on margins, unlike providers and med device over the last 15 years. They just add new products, layer services, or exit non-profitable areas. In my career training, I deliberately sought experience in all the constituents of healthcare, in this order -- provider, government, pharma, med/dev, supply chain, healthcare tech....when the ARA and ACA were signed, I made a deliberate move to be part of it, joined one of the top 3 insurance firms in a director-level role. I was disgusted by the lack of healthcare experience of my peers. Leadership are recycled sales people with no regard for what they represent. Large incomes, and folks who are pawns to the actuaries who dictate all in the back offices. All programs , outside of operational logistics, are PR to close large employer deals. Insurance only cares about signing the American Airlines or Apple to manage self-funded employer plans. They have zero regard for the member, members are not their customers. The waste is shocking, profits overwhelming. And how the ACA was truly written FOR insurance, yet they are the first to bail!!!!
Having trouble making up your mind? These graphs might help:
Where does healthcare spending go?
http://healthcare-economist.com/wp-content/uploads/2014/12/2013spending.png
Who pays for it?
http://i.huffpost.com/gen/2348654/original.jpg
How about ALL the above plus the general public.
If you really want to control health care costs you must first answer these questions.
Is health care a right or a privilege?
If it is right then all are entitled to all it offers now and tomorrow including all advances...and all the attendant costs. No way to control that.
If it is a privilege, then where does the 'right' (eg basic care) end and the privilege begin? And who and how do we decide where that line is?
No one (particularly politicians) wants to deal with the basic question: What price life?
Countries we compare the USA to that have lower costs and roughly equivalent technologies and care levels have answered that question. We chose to ignore it.
I am. I expect miracles. I gladly pay my premium and deductible for miracles. Okay, maybe providers or payers should protect me from my irrational behavior. Perhaps some day we'll all be faced with some sort or personal accountability around our health status coupled with rational expectations we manage weight, blood pressure or other aspects of health. The downside of a reduced demand is the scary thought we'll be inundated with more infomercials about potions, injections, mystic food preparation or other must-have treatments needed to restore lost revenues streams.
This was a tough one! Everyone really shares a part of the puzzle. The biggest problem is that we have such a huge layer of administrative hurdles and associated costs (for staffing and for clinicians and patients to jump through to get needed care). The utilization review processes and billing audits (as well as the time needed to document for and bill for those inane E&M codes and other mandated documentation) are all significant drains on health care. Single payer would be s big improvement as long as it's not designed by the people who gave us meaningless use. But the various forces in the US delivery system won't allow a rational single payer system to emerge. So we're stuck with the bizarre combination of having shortages of cheap and effective older drugs vs being charged an arm and a leg for an epi-pen.
Doctors are the gate keepers to nearly all health care services and most insurance companies attempt to negotiate prices down but no one is forcing doctors to earn less. Staff costs drive the bulk of our health care costs and specialists who have salaries in the 300k to 500k are not adding any real value to our system compared to those that make 125k.
We don't need single payer but we do need cost controls like most of the rest of the developed world - where they far exceed our outcomes. Since taxpayers already are paying for the bulk of both health care (via medicare, medicaid and government employees) and pay for 85% of medical training (residency and internships are paid for by CMS at a cost of 100k a year per doctor) it is time to admit we already have a single payer (government) but we need to focus on costs not just access.