Topic: Private enterprise bankrupting America? - page 7. (Read 10903 times)

Of course - international comparisons are had and will always be an approximation.  The big picture remains the same - Americans are being overcharged and if it could sort out its health costs, the country's fiscal situation would be transformed.

Wait, before moving on... do you understand what I am saying about that chart or not?

Thank you.  Feel free to contact them about methodology in their charts.  Is the price gouging is the bigger issue.

I really don't see how this is difficult to understand?

Nova Scotia Public Coverage:
Total Cost to Citizen = Share of Public Sector Fee + Share of Other Tax Dollars (that go to healthcare)

US Private Coverage:
Total Cost to Citizen = Insurance Premiums + Deductibles

The WaPo chart compares Nova Scotia public sector fee to Insurance claims. It is not a valid comparison. The claim rate is not even in the second equation (although it is related to to the premiums). The public sector fee is only a portion of what the Nova Scotian citizen actually pays, they pay additional taxes on top of this.

It is impossible to say which citizen pays more from the WaPo chart. It compares two completely different things, it is useless. On top of this, it groups together all angiograms, which will have wildly different costs. It needs to be established that the same proportions of each type of angiogram are performed on both populations.

I agree that US healthcare is overpriced, but that chart does not support this fact.

The angiogram.  It shows the US citizen pays more.  Even at the lowest commercial rate, the US citizen pays more.

Can you post the specific number you are referring to?

The Kaiser Permanent figures in the WaPo article show that the US citizen pays more.  Are you disputing that?

I don't understand, are we ignoring the misleading numbers in the WaPo article now or has it been acknowledged that we cannot trust the media to inform us?

I like this quote:

He mentions one change made during the Civil War and three things that many people consider scams that made the rich richer and the poor poorer. Anyway, if American's spend twice as much per capita as the rest of the world I want to know where that money is going. Insurance premiums? Hospitals? Pharm companies are definitely making more in the US, but prescription drugs "only" account for a couple hundred billion dollars a year. It seems like we should be able to figure out how much money is going where but I never see anyone quantifying this.

Another article with the same basic facts.

http://www.nytimes.com/2012/03/06/health/policy/an-interview-with-victor-fuchs-on-health-care-costs.html?ref=science

Money quote:

It is explained in the words below the chart. For "Canada", the number refers to the fee doctor's charge the Nova Scotian government for each angiogram. For the US, the three numbers refer to the 25th, "average", and 95th percentile commercial (not VA, medicare, or medicaid) insurance claims made for angiograms. The wide spread is likely due to the different types of angiograms (cerebral, coronary, renal, etc), more expensive procedures if there are complications, etc.


Incorrect, all three numbers are commercial insurance claims. They represent the 25th, "average", and 95th percentile claim values.


No, the chart tells us nothing about the total cost of care. Any amount over the $35 fee is somehow covered by the government from a different source of revenue. We also do not know if the percentage of different types of angiograms is the same between Nova Scotia and the US. Some types may be more common in the US and thus pull up the average price. This cannot be gleaned from those numbers. They do not show what you are supposed to think they show.


Perhaps, but that information is not present in these charts. We need to know the actual cost to the hospital of performing the different types of angiogram in each country. That way we can see if the US insurance providers are being overcharged compared to the public Nova Scotian insurance provider.

The chart you link to says the charge is for performing the scan.  It also says that the US cost commercial cost if $164 but that average fee charged in the US is $798.

Does that not reinforce the central point?

US citizens get charged more and the reason is purely a case of "charge what the market will bear." 

I have seen elsewhere that the average cerebral angiogram (yes there are many different types of angiograms being grouped together here) cost over $400 to perform in Ontario in 2002. So the money to perform these procedures is coming from somewhere besides the fee displayed in the chart.

http://www.ncbi.nlm.nih.gov/pubmed/12500380

For "Canada" (every country's number is calculated different), it is the fee that the Nova Scotia government pays to the doctor. This fee is negotiated once a year with the provincial medical association, most likely (I am guessing) there are various deals made so that equipment and property subsidies are traded for lower fees on certain procedures the politicians have heard complaints about.

Wait, do these numbers include the government subsidy that people pay indirectly through taxes? Or are these just direct out of pocket costs?

And oh yea, even the disclaimers of the WaPo's source says " Do not use this for anything important, also be wary of comparing across countries":

Below each chart:


So sorry, inau. Your policy of "the numbers reported in the news are correct until proven otherwise" has led you to draw conclusions that even the source of the data says not to. I guarantee that if we find the primary sources, there will be even more uncertainty that has been obfuscated at each step as this information traveled from the researcher's collecting it to your eyes.

I stand by my original post.

So, you think that, in Canada, it costs $35 in supplies (anesthetic, contrast dye, ), as well as technician and doctor time for an angiogram?

The numbers are misleading 90% of the time, in my experience... So here is the source of that data:


-Prices represent public sector fees for the province of Nova Scotia

-U.S. costs are based on commercial claims data from Thompson Reuters MarketScan Research Databases. The claims data was compiled by Deloitte Consulting LLP on behalf of Kaiser Permanente Health Plan. Any opinions or conclusions expressed herein regarding the data are not those of Deloitte Consulting LLP. Because a broad range of prices were available, the national 25th percentile (low), average, and 95th percentile are presented.

http://www.ifhp.com/documents/2011iFHPPriceReportGraphs_version3.pdf

Lets see what WaPo is comparing. First of all the numbers represent different things for each country, so let's focus on canada and the US. They are comparing the "public sector fees" in Nova Scotia (pop <1 million) with the "average commercial claim" in the US (pop > 300 million). Here are a few questions that need to be answered before comparing these numbers:

1) Is this "average" the median or the mean?
I don't know and Thomson-Reuters are dicks about releasing the data or even white papers explaining the data. The US price appears skewed toward the lower end though.
2) Are "commercial claims" the initial claims, or final adjusted claims?
-Ditto.
3) Who pays for the property and lab equipment in Nova Scotia? Do the doctor's have to recover costs here, or are those costs "off the books" (funded by taxes beyond the public sector fees reported in this chart)
- I don't know

The numbers presented are useless (they cannot support anything) without knowing the answers to these questions.

Exactly -- one cannot claim to be either rational or open-minded if one assumes the opponent is always wrong, and then works from that assumption.
The numbers are correct until they are proven wrong.

Pretty much all profit is made on a mis-alignment of information. I don't think I've ever heard of a private enterprise subsidizing some customers by charging others more...although if you think about it, the base supply/demand curve could be seen that way - "reduce the price to get more customers", is the same effect but under a different name.

Hospitals vs clinics are similar to 24hr megamarts vs local grocery stores. They just have more stuff, are open all the time, and because you don't know what you want/need until you get there, you'll usually end up going to the bigger place.

That does seem high. All my x-rays, whether at hospitals or clinics, typically cost from $90 to $300

She wasn't sure if the clinic was open and didn't have access to a phone or computer to check. She wasn't expecting anything like a $1400 charge from the hospital, either.

ETA: fwiw, she refused the splint they wanted to put on, as well as bandages. Someone pushed her from the entrance to the ER, did the x-ray, and gave her 2 Vicodin pills. She requested an itemized list -- waiting on it.