This post is not about MFA, or a public option, or employer-based insurance.

[kentuck]

Rather, it is a question about why does Medical care cost so much?

No doubt, when we are sick, we want the best care possible.

But why are we spending trillions of dollars on a medical system that does not care for 40 million Americans? Where does all that money go? Are Americans getting a good deal for the prices they pay?

Should medical care be in the business of primarily making profits over attending to the medical needs of the American people?

How much profits are enough? Is the problem really with a MFA system that is going to cost $30 trillion dollars over the next decade? Or is the problem with a medical system that charges $30 trillion dollars?

Why do we always ask about how much it is going to cost us, rather than why is it costing us so much?

[Hoyt]

1. MFA is seen as a way to get costs under control by putting all health care on a fee schedule similar

to Medicare, or Medicaid (which is 20 to 30% lower) if we can't afford Medicare rates when it comes down to it.

Per capita, our country has more than twice the CT/MRI scanners and performs more than twice the number of knee replacements as countries with a universal system. Those are two metrics of the utilization of care. Doctors who profit directly off tests, order them more than when someone else profits.

Our doctors, nurses, and others make more than those in other other countries with universal systems, but not twice as much. CEOs make more.

There's a lot of costs to wring out of the system. Of course, we are wringing it out of some of the best jobs in the country.

[Wounded Bear]

2. Because nobody really knows who is paying...

Most people (?) get their health insurance through their employers, and for them, it's usually a matter of doing paperwork. They don't really look at the costs involved unless they have a co-pay or until they get past their deductible. Then they get an eye-opener when it's too late.

Whose costs are we trying to reduce? The government? Individuals? Hospitals? Clinics? All that gets lost in the weeds of wrangling for turf in all this. Ins cos don't want to give up revenue streams. And yet, they're often the ones paying $300 to pharma for aspirin tablets.

[forthemiddle]

3. Where does all the money go?

It goes to Urgent Care centers every few miles.

It goes to having radiology services in every doctors office.

It goes to having stand alone mammography centers.

It goes to every physician office having its own complete laboratory on site.

These are just a few of the many services that people have become accustomed to that I don’t see them wanting to give up. The USA has so many overlapping services that the general public loves. Although we all say we would rather have everyone have access to healthcare, I really doubt when these things are taken away anyone will be happy.

Right now if I have a minor ankle injury, I can go less than a mile down the road and be treated in our local orthopedic urgent care. If I develop cancer, I can go to our local beautiful Cancer care center that does nothing but treat cancer. Do you really think that once single payer comes into effect that we will have private entrepreneurs spending capital to keep these places open?

[Midnightwalk]

4. Random thoughts

Any healthcare system is going to be incredibly complicated because it will be huge and medical care is complex to begin with.

No complex system runs indefinitely without problems creeping in. The biggest problem I see is that we haven’t taken regular steps to address the flaws. Neglecting to address problems let them grow and metastasize.

I won’t go in to insurance companies because that’s obvious. They aren’t the only problem by far. One unintended consequences of ACA was the medical loss ratio which gave insurance companies a disincentive to negotiate better prices. After losing congress in 2010 we’ve spent 10 years defending what we had and not fixing things like this.

The mistaken belief that the market could address problems. The idea behind HMOs was exposing costs to patients would make them pick cheaper options. Demand for health is inflexible. The sick want to get well. Well people don’t want to see doctors or get treatment. We’ve known this for decades

Trolling. I don’t know how else to put it. Why should we allow pharmaceutical companies to gouge us? Why should hospitals be able to charge differently depending on who pays the bills. How is it legal for your bill to explode because an out of network provider becomes part of the mix if your treatment? All of these things could be addressed but have festered and grown. The system is riddled with random trolls who want to add thousands to cost.

Malpractice and defensive medicine. If you are harmed by a mistake you face devastating bills, loss of income and pain and suffering. I’ll concentrate on the first two. If medical care were free to the user, bills wouldn’t be a factor. If we provided decent income to truly disabled people, income would be less of a factor. We do neither so there is a strong reason to sue and strong reason not to limit suits. That means doctors need to carry expensive malpractice insurance and need to practice defensive medicine.

Defensive medicine means expensive tests are ordered unnecessarily. Guess what? Special labs are set up to do those tests and they became profit centers (see trolling above)

I agree cost control should be a bigger focus. That brings immediate relief and makes expanding medical care to all easier.

[Nature Man]

5. A doctor's lifestyle is NOT cheap

luxury cars, Vegas trips, big houses, etc. don't pay for themselves.

[Hermit-The-Prog]

7. "Doctors" employed by health insurance companies to deny coverage?

[hunter]

8. Imagine the worst "customer service" job in the world.

That's what being a primary care health provider is like.

Some days are good, people are pleasant and you can help them, other days it's just asshole after asshole.

Literally assholes sometimes.

I respect people who work hard for their money. I respect those who help their fellow man and try to make the world a better place.

Too many wealthy people in the U.S.A. have never worked hard, nor have they ever done anything to make the world a better place.

Some of the worst wealthy people in the world want to deny healthcare to anyone they have no use for.

[Mister Ed]

10. Nor is her education.

Is it really surprising that someone who has worked as long and as hard as it takes to become a doctor is well-paid?

I don't think physician's pay is such a big piece of the pie when it comes to medical costs.

Now, executive pay.... that's another story.

[Hermit-The-Prog]

6. Part of the problem is that GOPers have been attacking the system for decades.

Loopholes for profiteering and restrictions on the use of Medicare's market power for negotiating prices are just a couple of examples. See GOPer fanaticism against the ACA.

[marlakay]

9. I worked in third party medical administration

For a few years, best paying job I ever had. There is a ton of money in administration.

Just having a government run non profit admin would save billions. Hospitals are charging too much from tests like scans you can get for a few hundred in Europe charging thousands here.

Actually when I was in my 20’s before you were allowed to have profit from medical I didn’t have healthcare for awhile but it was no problem as going to doctor or emergency was affordable then.

So basically if you just said no profit on sickness thats the answer to me.

[Recursion]

11. US doctors make twice the OECD average income for doctors

And the US spends twice the OECD average on health care. I'm not saying it's aliens, but it's aliens.

[Bettie]

12. The other question is

why is 30 trillion for bombs or an invasion of another country, never questioned at all, but health care for the people who live here is "too expensive"?

The problem is that our national priorities skew too much toward war and death to ever consider the lives of the people who live her as worth spending on.