We need to change the way that doctors are reimbursed.  Under the current system, they are paid only for performing procedures, so they perform alot of unnecessary ones in order to overcharge..  The standard of care would change dramatically if their compensation was based  upon actual resutls achieved with their treatments.  Patients also need to accept more responsiblity for their own heath.   Likewise, doctors need to accept their patients as partners in makiing medical decisions and get off of their ego trips.    Somebody mentioned accupuncture as cost- effective treatment for many comditions but alot of MDs really bristle at the mere mention of non-conventional/natural  healing modalities that rely on they bodys own healing wisdom, such as accupuncture, chiropractic, chinese medicine, homeopathy, energy medicine, and dismiss these as "quackery" .    Their emphasis on drugs and surgery gives them the illusion of control over the patients healing process, while, in reality, the patient might be healing in spite of what they have done, rather than because of what they did.

Interesting you would suggest this...the state of Texas has limited the malpractise awards a few years ago. Now the cost of malpractise insurance has dropped to such a degree that hospitals in Texas are increasing their capital expenditures for new equipment and upgrading physical facilities. We need to be aware that healthcare funding is more and more a zero sum game.

The scary thing about "defensive medicine" is that the physician is often not fully aware that their practice patterns have changed and that becomes the new standard of care. I don't think this is easily measured. The legal system is not the appropriate forum for deciding standard of care and quality issues.  Malpractice does not really address the issue of quality and is more focused on bad outcomes which may or may not be the result of negligence.  These people often need financial support, but the adversarial legal system just sucks a significant amount of those dollars away from medical care.  I think we would all be bettered served by a system that monitors quality and deals with true malpractice but also compensates people with bad outcomes.  This would reduce health care costs bec ause the standard of care would be established up front and not by a hired gun who has the luxury of second guessing once the diagnosis is known.

I must admit that I am quite interested in simplifying the present system. Let's face it the present system with the multitude of plans that all seem to pay for procedures in different fashion. That god I have a billing service who can figure this stuff out. The follow up on what got paid and what didn't is a disaster

RUrbanczyk MD

I respectfully disagree that it is myth that malpractice risk encourages greater health care costs, usersuz1.  I sometimes order tests that I suspect won't be positive, to rule out unusual conditions that may masquerade as something common, and only because I understand the rules trial lawyers operate under, and the risk to me if the 1 in a 100 condition (or less common) turns out to be present.  Every physician I know acts similarly.

I agree with you, usersuz1 that private insurance companies don't have the collective interest of our country in mind in acting as intermediaries between patients and providers, but then they shouldn't, because they are businesses, charged with making a profit, or if they are organized as a non-profit, like many hospitals, aimed at sustaining and building their business.  If a single payer system was set up to actually save administrative costs and simplify provider's lives, I'll bet many of today's providers would do the formerly unthinkable and "vote' in favor of it.

I must admit I'm at a loss to understand why people believe that law suits have no affect on the behavior of individual people. The reality is that 45% of all suits that have been settled actually had no evidence of Malpractise when independently reviewed. That study is from the Harvard school of public health I think. I don't know where you get your info though.

RUrbanczyk MD

I just love to hear that propaganda repeated about the prevalence of malpractice lawsuits driving up the cost of health care, even in the face of several studies showing nothing of the sort. Take it from me, you've never been hurt til you've been hurt by a doctor, and the chance of proving it in a court of law is close to zero. The source of the false claims about lawsuits comes from the source of the problem at the heart of America's health care: insurance companies. It's like this: doctors treat patients, that is the primary relationship in the medical care equation. So why do we have this highly compensated gargantuan bureaucracy that stands in between the doctor and the patient? Why, to prevent them from meeting up! That's right, the role of HMO's and their ilk is to deny coverage to as many people as they can get away with. And they are taking a third of the money available for health care in return for this dubious service. Get rid of them, throw the b--------s out.

I completely agree Phoenix. It has become acceptable in our society to be a fat, lazy, amoking drunk. Unless we can stop people from killing themselves, we will never get on top of the healthcare problems facing the United States.

I couldn't agree more...the radiologist has got it. The problem remains that we need to change focus from consumer medicine which places a priority on Botox and get back to medical care.

RUrbanczyk

We need to realize that as a society we need to make a decision about the end of life. We spend

80% of the healthcare dollar in the last 6 months. No other healthcare system spends their finances at the end of life. We also need to realize vey few malpractise cases ever go to trial. The majority are settled by the malpractise carrier long before trial. lets face it we have tremendous over head built into the medical system and it's not just Blue Cross who has problems.

Subspecialty care is much more expensive and not necessarily better.  The estimate of 10% defensive medicine in my experience as a radiologist is low--we see so many more normal exams from the ER than we did even 5 years ago largely because of pressure to move people through the system quicker and to not miss anything.  These ER physicians are most likely to get sued as they have no relationship with the patient prior to this one encounter. The amount of money that is wasted every year on administrative costs is staggering.  We need to quit trying to tweak the system and completely start over.  Patients need to know what things cost and bear some of the responsibility, Physicians need to have accountability for quality and the legal system needs to get out of the way.  I believe we need a system that compensates for bad outcomes and ensures quality of care  by truly monitoring physicaian quality without spending a fortune on malpractice attorneys who don't know and don't care about actual quality of care but just want to hit the lottery based on someone else's bad luck (by MD spouse of user/provider, MD).

Providers "overprovide" because society here expects every effort, even in the twilight years, and because of fear that our legal system will lead to their financial ruin because a paid "expert witness" in the hands of a glib John Edwards will successfully claim in front of a jury (that struggles to understand  the often complex issues) that they didn't follow the standards of care.

Administration costs are not surprisingly high because of the myriad private insurers, the need to "speak their many tongues", and because they like any business seeks market share, and spends more accordingly.  I never thought I'd say it, but I'd be happy with a single payer system, as long as it was accompanied by legal reform.

GrandpaMike,  I actually DID read a story on BBC online about a British man who died from a heart condition while waiting to see a specialist.  I am sure people die on waiting lists to see specialists in Canada as well.  It is a myth that other countries spend less on health care only because they spend less on administrative costs.  They also have far fewer specialists as well as less access to the latest technologies and drugs.  They also spend less time with their doctors.  As I stated, I do agree with the emphasis in other countries in really spreading out the costs of health care, and that is something that this country could do more of.  

It is sad that comments always rotate around access to subspecialists. We need to understand a basic fact. Subspecialist access has no bearing on life expectancy. The people of Florida see far more subspecialists than they do in South Dakota yet the people of South Dakota live longer. The

medical consumer needs to change basic notions about medical care.

RUrbanczyk MD

What is sad is the comment that suggests that patients need to see a cardiologist otherwise they are going to die. The research is quite clear that seeing a subspecialist frequently has no bearing on your life expectancy. People in florida see far more subspecialists than they do in South Dakota yet they live longer in South Dakota. People need to get over the present notions about what constitute "good" medicine.

RUrbanczyk MD

So are we giong to do something about it?

The last time I checked published statistics I discovered that in Canada the average wait time to see a cardiologist was 26 weeks.  I wonder how many Canadians die when they can't see a heart doctor for 6 months.  I guess that does keep the cost down though.

Sorry to disagree but national healthcare hasn't worked anywhere and we would be no exception.  Canada has the solution?  With a 12 month wait for non-emergency MRIs?  Canadians come to the US and pay to use our health system because the wait there is too long.  I've been to Australia and with their national health plan they are now encouraged to get privatized insurance and receive tax credits because their national system is being run down.  Sorry guys, but as the article says 31% of the costs is admin driven.  If we could just fix all the malpractice insurance our doctors need that would cut costs even more...

My Mother fell ill a year ago, and passed away.  She was in the hospital for 6 days and died around 1:30pm on the 7th day.

My Mother had health insurance and my father also had heath insurance on my mother as a double layer of protection.

My mothers medical bills for just 6 1/2 days were $ 125,000.00

The Hospital and Doctors billed us over and over and sometimes double and tripple billed us

It took me and my father 8 months to finalize her bills and that was with the help of a professional insurance man that my fathers company provided.

In the end, we overpaid my mothers bill but never seen a dime returned to us.   The hospital just wrote it off.

I was astounded to see hot much the hospital charged us.  1 minor surgery to insert a tube into moms throat took literally 20 minutes and cost us $ 19,000.00. The doctors would walk in and say hi how are you and leave with in 2 mintues and charge us $ 300.00 for each visit.

It's amazing how hospitals and doctors can charge these high prices, and get away with it.

A visit to the hospital can cause total financial ruin.  

We need National Health Care. Our country will go bankrupt if we keep doing what we are doing

Healthcare and our litigiousness - these two need to be addressed, now that Wall Street, the banking system, Detroit, and the overheated housing markets have been humbled. All of the above exhibit the same symptom: driven by greed, not need and manipulated by the greediest of the greedy. Healthcare can't be "reformed" when managed by people who are really no different to those who brought down Wall Street and the others: we came to realize it really wasn't about the client or the customer, but the arrogant leadership of the greedy. They talk a good game about caring for the sick, but it isn't about the sick, it is about profits!

Chris22- certainly we need to have universal health care so that you would not have to pay that astronomical sum.  I do believe in risk pooling for catastrophic illnesses as they do in other parts of the world.  I believe in a Public/{rivate system rather than a purely public system or "single payer."  In many single payer or more purely publicly funded health care system countries, you would not have had access to the latest cancer drugs and your chances of survival would have been lower.  In Britain, if you went private to buy the latest cancer drugs, you would have to forfeit all treatments by the National Health Service.

We, as Americans, are always reluctant to admit that other countries might do some things better than us.  Well apparently they know one thing: nationalized health care works.  As an American who became ill while on a job in Canada,  I would take the canadian system any day of the week over my high priced ineffective american HMO.  I may be a republican, but I know good healthcare when I see it.

It is time to start paying attention to the successes of our neighbors and allies when it comes to making healthcare available and affordable for every citizen.  

There are things we can do for ourselves which would help right now: as written in a previous comment -- lose weight ( for those who are obese), and use acupuncture for non-emergency health conditions. There are affordable treatments offered by Community Acupuncture clinics, usually in the range of a sliding scale from $15-$40 for follow-up visits. The patients decide what to pay within that range. Acupuncture is effective for many conditions, and very safe. For more info and a listing of clinics, see (communityacupuncturenetwork.org)

I have been fighting lung cancer for 30 months and very successfully. I have had chemo a total of 23 months  and 2 different rounds of radiation totaling 31 days. I accidenatally received a bill after the first 5 rounds of chemo which took place within the first 4 months, the cost for 5 rounds was $330,000. There is something very wrong with that. My life is on the line and I would be thrilled if we went to a national healthcare system

The insurance system (how to pay for care) is only one facet of the problem.    The way that our medical doctors are trained, the endless hours of sleep deprivation and cult-like pharmacuetical company brainwashing leaves patients in real danger.  Alot of  the medicines produced by pharaceutical companies are patterned after natural substances, but the formulation/chemical structrue must be altered from naturally occruing substances in order for a patent to be issued so as to become profitable.  Sometimes that reformulatiion makes the drug carcinogenic, such as in the case of hormone replacement drugs that were perscribed for menopausal women. I have not been to a primary care doctor in a decade, because the last one I had I caught in the act of workers comp insurance fraud.   The only doctor I see regularly now is a chiropractor, because he provides real pain relief without drugs or surgery.   Treats me alot better than MD's too.

Hartless beest,

I think you misunderstood what I was saying about obesity.  The point is, should we blame our DOCTORS for persons being obese?  Obesity is not CAUSED by our health care system.  It has something to do with our culture, what is allowed to be advertised, our fast food culture and so on.  We are obese DESPITE our health care system.  It is not the health care systems fault, unless the health care providers say nothing to their patients about being obese.  It might have more to do with the Public Health system.   I lived in Greece awhile back and still keep in contact with persons there.   I ask you to go to www.Athensnews.gr and read the article about the healthcare crisis there.  Greece, according to the World Health Organization supposedly has the 14th best health care system in the world.  According to the article, many doctors and pharmacists are not being paid, hospitals are grossly understaffed and underfunded, and therefore cannot give good care.  If you read the actual press of the countries that you think have great healthcare systems, you might come in for a rude shock.  I was completely for a single payer system until I started reading the horror stories of other countries health care systems, such as on BBConline.  When Michael Moore lauded the Canadian system, some Canadian officials actually went up to him and said he overrated the Canadian system, which of course has waiting lists.  Of course we need to change some things about our system, esp. we need to be universal, but we shouldn't so to speak "throw out the baby with the bathwater," because there are many things that our healthcare system does right.  I think the problem is the Republicans, who actually DO want to eliminate everything good about our system, such as Medicare, Medicaid and employment based health care.  Fewer persons now get health insurance from their employers than when George W. Bush took office.

A single payer system will not even help much with a society as unhealthy as ours...unfortunately.

The comment "we persist in thinking like Americans."   refelects a frustration with  the stubborn American mindset.    But can Americans learn from past mistakes?  If Obama's election is any indication, to use Sarahs favorite expression "You Betcha!"     It is heartening to see even conservatives are finally seeing something is wrong with heath care.  Even Bush and the big three are starting to admit something is terribly wrong with the way we have been living and behaving.    Everrything is a health care issue, from physical health to mental health to social heatlh to econonmic health .. Let us pray that one day we will all see clearly that putting profit before people, before human rights and human dignity  is un-American.

I suspect that about 50% of the health care cost could be eliminated by going to a single payer system. You would save the commission expense (10%), most of the adjusting expense (eliminate the guys that get paid to deny coverage - 10%), exorbitant executive pay (10%), Corporate profits (15%) and a dramatic cut in paperwork (5%).

Unfortunately, Newsweek's bias during the Presidential campaign makes many people suspicious of their credibility on any political issue. What we need is a single payer system, like the rest of the world uses, very effectively, I might add.

I love the line "we persist in thinking like Americans."  If Begley hates American thinking so much... the door is wide open!  Adios!  Feel free to think like a Canadian after you haved moved there.  

Simple greed has to figure in this problem heavily.  Aside from the usual excuses the industry slides by on,  basic corporate greed is surely at the base.  Exactly how we expect to just pass a few laws and promise better oversight to have this system become workable again is a real question.  It seems that to get at greed,  we need to surgically remove it like a growing cancer.  Corporations are greedy by nature.  They excuse that quest for a 'healthy bottom line'  as their 'responsibility'  to the stockholders.

On the other hand,  if we hand the operations to the federal government,  we all can expect a IRS-like mess to prevail foir many years to come.

So what's the answer?  Cheap plane tickets to Mexico and Canada?  That's what many of us are already doing (myself included).  It's the only way I can get medical care and prescription drugs.  I am not really insurable,  and if I was I couldn't pay the insurance or the deductibles.  I am not an illegal immigrant so I can't show up at a hospital and expect anything for free,  or at reduced rates.  If I don't take good care of myself and my medical conditions,  I will end up losing my retirement in shamefully wasteful,  expensive,  and uncaring system that still tries to excuse it's greedy behavior as reasonable corporate policy.  I guess maybe the best thing is to plan to remove yourself to some foreign country at a planned age and stay away from the dogs that will eventually chew us all to pieces here.    

dw1989@yahoo.com states that, “Rates of obesity have nothing to do

with the quality of healthcare.”

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

WRONG!!   Obesity is an important factor relating to various health problems.  

The United States Government doesn’t flinch at spending outlandish amounts of  $$$$$ on its military ----- even though much of it is wasted -----, yet it deprives millions of its own citizens a decent, basic healthcare system despite the fact that the SLOBS running the government in Washington DC are blessed with superb lifetime medical coverage without having to fork out outrageous premiums.  

Where healthcare is concerned, the U.S. is still living in the DARK AGES and Americans could learn a great deal from other industrialized countries.

I love it when the experts diagnose what "we" Americans are doing wrong.  For years, surveys have shown that  "we" have wanted single payer national health insurance.  The problem isn't what "we" think-- it's that the government has catered to the wealthy powerful corporations.  Our government was set up precisely to protect the individual citizen from abuses of power, but instead has joined with the powerful businesses to soak the individual.  Besides, healthy people don't consume medical services, and so they are worthless to an economy that is measured only in dollars.  Civilized countries years ago realized that health care was the right of every citizen, instead of our tax money going to further enrich those who exploit us.   We are the victims of a bad system; stop blaming us. Why can't Newsweek tell it like it is?

Myra Jones

Bradenton, florida

I was going to bring up the personal responsilbility factor, but couldn't say it better than Phoenixrising56.  Well said and very true.  As an RN for nearly 20 years, I speak for many when I say we wish people would take better care of themselves.  Almost all ilness we see is either completely preventable or would be much less severe if patients maintained better health.  That's great news... almost all illness is preventable!!  Heart disease, hypertension, emphysema, obesity, diabetes, kidney failure from diabetes, all alcohol and drug related disease.....a very large chunk of sickness could be prevented.  And if a patient is a victim of cancer, trauma, infection, or a genetic disorder, their underlying health is a huge factor in their recovery.  So PREVENTION has to be the priority for the health care system and we can start educating early...in preschool as a matter of fact.

And I would go one step further in not only lowering premiums but actually giving financial incentives , ie. cold hard cash,  to those who maintain their health.  This would be MUCH cheaper than the expensive care we provide now when it's too little and too late.  Lastly,  huge amounts of money are spent to postpone the inevitable, death.  Let us treat elderly patients with dignity and make them comfortable, but spending millions and denying their comfort just because we can keep them alive longer (with no increase in quality of life) is not cost effective or beneficial to society in general.

Sick & tired of that kind of America-bashing articles...

Everyone in good faith knows that the health care problems & poor statistics exist because of the underworld of addicts ,alcoholics & trailer park trash people.

In a huge nation of 300whatever million,there are millions of  uhealthy sociopaths who ...clogg the system & the numbers...

            One of the biggest problems with the health care system is that most people haven't enough

of and incentive to maintain better health.

            If people smoke, drink heavily, use drugs, become overweight due to a poor diet, and don't

get enough exercise they will pay the same for health care as people who are health conscious,

in most health care insurance plans.

            Insurance companies, should require their clients to get an annual check-up, and the results

of the check-ups should be forwarded to the insurance companies.

            If the results of the check-up indicate that the clients are at risk due to some behavior or

lifestyle choice that could threaten their health, the insurance companies should raise the cost

of the premiums to the clients accordingly, and in accordance with the number of risk factors.

            If people fail the get annual check-ups, the insurance companies could treat them as

if they are at risk and adjust their insurance premiums accordingly.

            This type of personal responsibility for health care, with a financial risk tied to the

health risks will encourage more people to take better care of themselves.

            The cost, and quality of health care would come down in time, as more people try to

save money by staying healthy.

            This idea of personal, individual responsibility for health care would not sit well with

many people, and many people would not be able to afford health insurance.

            Did not say that everyone would like it, just that it would work.

            We would move to affordable health care, and a healthier society.

We continue to fool ourselves thru our views of the medical buyer-seller relationship wherein we think it's OK to not know the costs of services. The average American does not have the initiative or technical capability to SHOP for the lowest costs and this opacity needs removed by some hard nosed decisions by the Congress: Pay the tuition and living costs of new physicians who will practice family medicine; ban drug advertising; force current and future physicians to accept computerized healthcare and business systems; force negotiations with drug sellers. I utilize an HMO for my Medicare needs and find that these modest costs and a regular routine of physical exercise keeps me pretty healthy. This formula will work for 70% or more of Americans and can reduce costs dramatically until the last 2 years of life when expenses will rise as we try to push away from the inevitable, death. All of these costs should be negotiated by tknowledgable and trusted regulators. Who wants to spend their "golden" years doing research?

Don't we have the most expensive lawsuit in the etire world.  Number 1, bar none.

It is absolutely NOT true that Europeans have better cancer survival rates than America.  Numerous articles in the British press and studies in Lancet have indicated that America has better cancer survival rates than ALL European countries.  Britain recently tried to improve these cancer survival rates, but was not successful.  European countries save money by sharply limiting the number of and access to specialists.  Rates of obesity have nothing to do with the quality of health care.  We need to insure everyone, but I think the quality is better here, if you can afford it.  I have lived in Europe and know this to be true.  I think definitely we need universal health care, but I basically think we can streamline the system we have and expand what we do well on, such as Medicare, Medicaid, the VA as well as GROUP private policies from employers.

Prices should be integrated into e-health records.  That way a patient can know how much something costs and, knowing the exact prices, is one less thing a doctor has to remember.  I would prefer that my doctor's head was filled with the minutiae on treating my illness and not on the nitty gritty of how much the med costs.  I would think this could be easily automated.

Also, doctors make less in other countries, but they don't graduate with $250k in debt like I will.  There is a new generation of doctors now who are deeply in debt and need a high income to handle this.  The old generation enjoys this high income and had much lesser debt.  I argue the compensation should be decreased and this debt forgiven or worked off.  This would increase the ranks of lesser paid docs and decrease specialists, too.  

But, frankly, the article is straight on.  We value the individual in this country and that is a strength as well as a weakness.  

Another problem: Because we don't have single payer, we don't negotiate en-mass for the best price on treatment for life or death illnesses like cancer. This allows doctors and pharma to charge exhorbitant fees and get paid incomes that are three to nine times higher than incomes in other countries. And the courts enforce these 'your money or your life' transactions, for healthcare only-- no other industry gets away with this kind of coercive conduct. The U.S. healthcare system is a disgrace, and the fault lies not just with spineless politicians and special interests, but also with the courts. Medical bill collections has become a big-- and disgusting-- business here in the U.S.