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US Healthcare Spending - Who Pays?
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Doug I.
(idester) - MLife

Locale: MidAtlantic
US Healthcare Spending - Who Pays? on 10/09/2012 21:35:11 MDT Print View

A really fascinating, interactive graphic that illustrates healthcare spending from 1960-2010.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: US Healthcare Spending - Who Pays? on 10/09/2012 22:22:21 MDT Print View

That is very interesting, but no clever poem or anything? : )

Wow! - healthcare spending has gone up 80X from 1960 to 2010 - no wonder we're having problems paying for it

And in 1960, most health care was paid for by consumers

in 2010, consumer relatively little, private insurance and government have about equally taken over the consumer portion

Dave U
(FamilyGuy) - F

Locale: Rockies
Re: Re: US Healthcare Spending - Who Pays? on 10/09/2012 22:46:50 MDT Print View

Give someone a job that pays decent and they can pay for their healthcare themselves.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Re: Re: US Healthcare Spending - Who Pays? on 10/09/2012 23:04:59 MDT Print View

"Give someone a job that pays decent and they can pay for their healthcare themselves."

That depends.

Currently my monthly healthcare cost is more than one-third of my total income.

--B.G.--

Mary D
(hikinggranny) - MLife

Locale: Gateway to Columbia River Gorge
US Healthcare Spending - Who Pays? on 10/09/2012 23:28:46 MDT Print View

Who pays? It's whoever pays the insurance premiums and the increasingly larger co-pays: usually the employer and the individual.

For Medicare, it's all who have contributed to Social Security and Medicare, although that pot is rapidly running out.

For Medicaid, and of course the insurance premiums for federal, state and local government employees, it's all of us who pay taxes.

I spent 10 years as an accountant for a large HMO (I retired 12 years ago) and I can tell you that medicine nowadays is primarily a high-tech industry, relying more and more on expensive equipment which is outdated in only a few years. I remember a discussion with department heads in the radiology department back in the late 1990's, in which they were complaining about the depreciation recommendations from the American Hospital Association (which, at least at that time, were the standard). Most of their equipment was completely outmoded in half the time recommended by the AHA. I recommended that they petition the administration for a shorter depreciation period and provide the statistics to back it up. As a result, the depreciation period was cut in half--which of course doubled the radiology equipment cost. On the other hand, the former method was completely unrealistic because they were expensing outdated equipment long after it had been replaced.

Randy Martin
(randalmartin) - F

Locale: Colorado
Re: US Healthcare Spending - Who Pays? on 10/09/2012 23:58:10 MDT Print View

The notion that everyone is entitled to extraordinary world class healthcare where multimillion dollar machines are deployed in every hospital is not sustainable. The level of healthcare that is sustainable for everyone is still good but it's a hard message to people that have become accustom to an unending rise in premium services.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: Re: US Healthcare Spending - Who Pays? on 10/10/2012 07:25:37 MDT Print View

That's a good example of how graphics can be misleading.

What jumps out at you is that the difference from 1960 to 2010 is the shift from an individual paying, to insurance and medicare

But health care costs 80 times as much in 2010 as 1960 - that's the problem

Like you said Randy, we use too many expensive machines. And they're not very effective.

A medical provider makes money if they can do an expensive double blind study that shows something is marginally effective, even if they have to do 10 studies and throw out the 9 that show no statistical improvement.

And end of life care can be expensive. Even if it's hopeless and you're just making the person miserable.

We should do more analysis of what health care is effective and let people know the results so they'll know what treatments to choose. The Republicans call this "death panels" because they represent the medical providers that are making huge profits and passing on a little as political contributions. Not that the Democrats are much better...

Doug I.
(idester) - MLife

Locale: MidAtlantic
Re: Re: Re: US Healthcare Spending - Who Pays? on 10/10/2012 08:41:40 MDT Print View

"Like you said Randy, we use too many expensive machines."

That's not what Randy said. He said the idea that everyone should have access to them is unsustainable.

"And end of life care can be expensive. Even if it's hopeless and you're just making the person miserable."

If you're making the person miserable, then it's not end of life care, it's simply end of life treatment. I agree there's too much of that going around, and not enough good palliative care.

Part of the issue, of course, is few people want to accept death, and think that everything possible should be done to keep them alive, regardless of quality of life.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: Re: Re: Re: US Healthcare Spending - Who Pays? on 10/10/2012 09:27:44 MDT Print View

There was a good episode of Frontline on PBS recently

They showed one person at end of life that decided it was hopeless so they went home and eventually died, but seemed to have some quality in their limited time.

Another person showed no sign of awareness. The son thought the person was aware and insisted the person be left on venitlator and so forth. The bill to Medicare was $5 million and counting. No obvious answer - I don't think anyone should "pull the plug" if the patient or representative says no.

One thing is there should be better statistics on what's effective so we can make good decisions.

Another thing is to let your relatives know what you want done in such a case. Went through this with my mom and the fact that she let us know to "pull the plug" in such a case was helpful.

Sarah Kirkconnell
(sarbar) - F

Locale: In the shadow of Mt. Rainier
Re: US Healthcare Spending - Who Pays? on 10/10/2012 15:51:29 MDT Print View

My Mom had specifically asked to not be resuscitated and had it in her medical directive and power of attorney. When my Mom passed away it was very hard to look the other way and not try to save her. Everyone honored it outside of her older sister. I understood why she wanted it and have one similar to hers.

Frankly though I am grateful my Mom was given 7 additional years to be with us - an expense some wouldn't have agreed with. My Mom was on dialysis for those years due to renal failure. The RF didn't kill her directly, rather the dialysis slowly did, by weakening her heart (7 years is a long time). My Mom was widowed and was on disability so yes, she was on public healthcare. She worked hard her whole life, trying to make her community a better place. Should we say she didn't deserve any help later on? She was still a capable human those 7 years.

Statistics only work so well and can be skewed to fit how they are needed.

And on medical cost? We paid around $4,000 this year for the birth of our third son out of pocket + the cost of our health insurance (for 5 it isn't cheap, even though my husband works for a global company with good benefits). I had a low key experience (unlike with my first 2 children) and the total "billing" before insurance got to it? Over $35,000. For a 3 day hospital visit with no emergencies. My second son was billed at over $50,000 for a 3 day visit in 2010 with $2500 out of pocket. That doesn't include out of pocket for Maternal-Fetal OB's with both babies. They bill at $1500 a visit plus cost of their ultrasounds performed ($1,000 each one billed) or my regular OB visits. I had to take my youngest son to a pediatric cardiologist when he was 3 months old, that was billed at a couple thousand for an in office visit/ultrasound. He has a small murmur. I did have to drive to a large city to have him seen.

I have no idea how much my first son cost. He was born premature, with his birth saving both him and my lives. Those fancy machines can and do make a difference.