Because EVERYTHING to do with healthcare in the US is more expensive- including the operating costs of the hospitals and doctors. For just one example, all those to-one-degree-or-another socialized countries on your charts don't have NEARLY the malpractice premiums we do in the US.
There are things Medicare doesn't totally suck at, and there are things it does absolutely horribly. One thing it does horribly is paying for almost any surgical procedure. If you bill only Medicare for any procedure, yes, you are taking a loss. A cardiothoracic surgeon makes less money for a quadruple bypass that takes him all day than a plastic surgeon gets for an augmentation mammoplasty that uses 1/8th of his OR time for the day- because it ain't Medicare paying for the mam aug! I would get reimbursed better for my patient's postop pain management than for his cholecystectomy. (Though I'm currently salaried, so I don't bill- my hospital does.) One learns to code stuff that arguably isn't relevent for one's postop patients- like including their hypertension in the list of things you treated while they were in the hospital, despite the fact that you merely kept them on their usual outpatient medications.
I mean- consider that Mediare's policy is to REDUCE its reimbursement rates for everything periodically. Not increase them, mind you, as if to account for inflation, etc. They reduce them regularly. Logically, eventually that policy must fail. Because, eventually, no doctor will accept Medicare. Unless the government makes it mandatory, at which point medical school enrollments will disappear. Heck, cardiothoracic and trauma fellowships can't fill all their slots NOW! Nobody wants to take that abuse and get paid crap for it.
And, yes, Medicare won't pay one more cent than their "official" reimbursement rates, and they are notoriously miserly and find every possible opportunity to short you, so why bother billing it? All that does is result in the patient getting the excess bill- which will then go into arrears and get sold to a collection agency, and pretty soon Katie Couric will be talking about the heartless hospitals, et., etc. But if you have reasonable insurance then, yes, the hospital will bill the full price- because they have a reasonable chance of actually getting reimbursed, unlike with Medicare. (The average reimbursement rate in the US is something like 33% at the moment. So there's no point in quoting these outrageous bills- they aren't getting paid, anyway. Which should tell you that if the system WORKED CORRECTLY the average bill would be about 1/4 of those outrageous ones.) And, yes, those losses from taking care of Medicare patients DO get passed on to everyone else. That should enrage you- and motivate you to lobby for fixing Medicare. But either way you're going to pay for it- either in your bills as now, or in higher taxes to fund Medicare. So what's the use in complaining? The solution is to fix the things making everything so expensive- not complaining about how reimbursements work. :o)
Personally, I also find the lobbying power of the pharmaceutical and insurance industries rather repugnant. I would like to see political contributions limited to $500 or some other reasonable arbitrary sum per person per candidate per annum. (Recall that corporations are legally people.) I would also specify that a majority-owned subsidiary does NOT get another $500 to give away. That way the rich and the corporations don't get much more say than I do.
Mary is 100% correct that ERs get used like primary care clinics by the uninsured, and that the insured underwrite it. So all of the conservative whining about how they don't want illegal immigrants covered in any public healthcare plan are idiotic. We will all pay for those uninsured illegals anyway. (But it looks good to their equally irrational constituents when they make a show of it. Yet accomplishes nothing.) Further, because of this ERs are simply overwhelmed right now- which leads to complaints about long wait times, etc. Bummer. Solution? Fix the insurance problem.
I also agree that there are large inefficiencies in the US system. But that's sort of what you have to accept with such a distributed system, with so much freedom of choice on the part of the patients. If you don't like it, vote in socialized medicine. I won't argue.
Predictably, I also back malpractice tort reform. The problem is, I will admit, that I have no better idea how to fix it than anyone else does. Patients do need to be able to seek redress through the courts when they've been hurt and have a valid case- but too many are frivolous, or are just a case of trying to blame someone when something bad happens even if no one is at fault. There was a study that showed that the only variable affecting malpractice awards in the US was how badly the plaintiff was hurt. NOT whether it was actually the healthcare provider's fault. I guess juries just think "that poor guy needs SOMETHING, and the only people he can get the money from is the doctor/hospital/etc."
Thus US healthcare providers unequivicollay DO practice defensive medicine, for fear of lawsuits. A good example- even if I am quite certain that I have diagnosed someone correctly, but there is a very low chance something else may be going on and I can rule that out with a CAT scan, I get the CAT scan. Because GOD HELP ME if that happens to be the one time the weird thing is going on. I'd loose everything. And the patient pays for that, as do you all when the patient can't pay the bill and the cost gets foisted off on you.
Is it worth it to spend $400 on abdominal CAT scans to find that 1/10000 thing that might hurt a patient? $4,000,000 to save one guy, and keep me from getting sued into poverty? (Or, keep my premiums down...)
It is to me.
Are their doctors and hospitals who order CAT scans because they own the scanner, and make money off of it? I am certain there are. But I imagine that there are also doctors who are practicing defensive medicine, and figured that if they were ordering all those scans that they may as well make a buck off of it, and bought their own scanner. Don't kid yourself- it is easy to attack doctors. In some ways we are easier targets than lawyers. But most of us DID get into medicine for altruistic reasons.
Anyway- these are the difficult decisions any healthcare plan must make. If you don't want to pay that $4 million, then protect me from the lawyers. Otherwise, stop whining. :o)