You sound extremely angry every time questions about US health care or insurance come up. We all have our own experiences. I have seen how my father was treated in Italy, my mother and I in Germany and in France. We had a friend who went from family doctor to successful gastric cancer surgery n three days two weeks ago.
A hospital is not a hobby but a company. Patients get itemized listings about charges, what was billed, what was adjusted and what insurance covered.

Where do you get the idea from that I'm "angry?" I'm no longer concerned with the US medical establishment other than when I go back to visit the US. As an accountant by training, I'm simply explaining that health insurance in the US is going to cost more than elsewhere because medical care and treatment there costs more (by a rather large factor) than in most other countries. There are a variety of reasons for this.

It is simply a liability issue. Nicely carded up pills cannot be identified by staff. Personally I would rather let the residing physician order a new prescription than rely on how staff in an other facility handled medication.

Which is pretty much what I said - it's related to the liability issue. The one big difference is that in the US the patients pay a portion of the cost of prescription drugs themselves, so medications that cannot be "brought with" on admission to a hospital or nursing home basically go to waste - which may then reflect on the cost side of things. (I know that was a big concern for my Dad when he found he couldn't use the prescription meds he had "already bought and paid for.") I understand why it has to be that way, but I also understand why it should be a concern for someone coming from another system where meds are less expensive and health care coverage a bit more uniform.

Who is "they"? "They" sell unapproved drugs to the public? Show me one patient who is paying asking price.

I think the referent was pretty clearly "the regulators." In Europe (at least) the cost of new drugs is one of many factors taken into consideration when drugs are approved (or not) for use and/or reimbursement by the national health care system. In the US, Medicare is specifically prohibited from negotiating drug prices to get a better deal. Again, one more reason drugs cost more in the US than elsewhere. (And why insurance that covers prescribed drugs costs more in the US than elsewhere.)

I use compounded topical anesthesia on scar tissue - retail 13k/tube, insurance 6k/tube, patient 17/2 tubes. In Germany I was told that I have to live with the pain and the potential loss of use of a foot.

There are prescription items that are available in Europe that are not available in the US - and vice versa. They also use different medications for the same conditions in different countries and cultures. It's one of those facts of expat life that can be difficult to understand at first.

Read the very small print of travel insurance. Ferry flights will generally take place when services comparable to country of origin cannot be provided. You can take out ferry coverage through specialized providers. Is it worth it for the US?

Admittedly it depends on the particular coverage you buy. But when buying travel health policies here in Europe, there is some interest on the part of the insurer in getting the insured back to their home country, where they are covered (in full, normally) for their recovery. For certain categories of visas that require private health insurance, it's fairly common to require a repatriation clause in the contract (obviously, just for serious illness or injury).

It's simply a fact that medical care in the US is significantly more expensive than in most other countries, particularly those with national health care systems. I was simply advising the OP that comparing the cost of health insurance elsewhere with the cost of health insurance in the US is pretty much comparing apples and oranges.
Cheers,
Bev

 

I'm simply explaining that health insurance in the US is going to cost more than elsewhere because medical care and treatment there costs more (by a rather large factor) than in most other countries. There are a variety of reasons for this.... Which is pretty much what I said - it's related to the liability issue.

This isn't one of the reasons U.S. medical care is expensive, or at least it's not a material reason.

The U.S. is running perfect experiments to answer this question definitively. Several states have severely limited medical malpractice awards, a few to the point of making them simply uneconomic for patients and their attorneys to pursue. And what happened? Nothing much to costs. Medical care is still just about as expensive. Maybe a 1 or 2% difference, maybe. Yes, that's including so-called "defensive medicine." (In reality there's already lots of motivation to practice "defensive medicine" in any fee-for-service medical system.)

Liability might be the excuse in this particular anecdotal story, but it's not the real reason. The real reason was already given: captive patients can be charged more for their prescription drugs. If that's legal, then that's what'll happen in a profit-maximizing care facility.

It's exactly the same reason why Americans are not legally permitted to import their prescription drugs in large quantities from, say, Canada. It has nothing (or at least vanishingly little) to do with safety. Canadians aren't dropping dead from unsafe drugs -- the very idea is laughable. It has everything to do with government acting to protect a captive market. Consequently there are many Americans that take regular medically-related trips to, say, France for particular drug treatments. (That doesn't work for everyone, but it works for a non-trivial number.)

 

I've moved this discussion over to the lounge area, since it really is rather off-topic from the OPs question.

Malpractice insurance and the litigious climate in the US are only two of a large number of factors making medical care and treatment in the US "so expensive." Whether these are major factors or not is up for debate (or certainly seems to be back there).

Over-testing and waste factor in here, as does the for-profit nature of the medical services industry in the US. Even the way that doctors practice adds to the costs - certainly in comparison to how doctors run their practices elsewhere. The cost of drugs comes into play, the regulatory environment (for medical workers, pharmaceuticals, insurance and all the other participants) and even the oft debated income disparity in the US.
Cheers,
Bev

 

I rather know that my family is well taken care than skimp on a few bucks.

Some of the numbers being posted recently sound unreasonable and questions do not get answered.


Bev - childless due to an everyday annual OBY procedure in Europe. BTW - private pay.

 

Bev - childless due to an everyday annual OBY procedure in Europe. BTW - private pay.

Friend of mine in the US is childless (and divorced) because of a routine US prescribed birth control device. I'm childless because I'm simply not interested in kids.

Medical fees are simply higher in the US than in most other countries in the world. The reasons are many and varied. One of the supposed goals of the ACA is to reduce medical costs - or at least to slow the increases. It will take time - and lots of it - to see the desired result.
Cheers,
Bev

 

OTOH, the ACA has extended coverage to several million folks who didn't have any medical coverage before. And while it has increased premiums for some, it has reduced them for those with "pre-existing conditions" or at least given them a choice of insurers that they didn't have before.

But what we're actually discussing here is the simple fact that medical care in the US is more expensive than elsewhere and therefore it is logical that health insurance in the US would cost more than medical insurance or health coverage (through the State) in other countries. Take the example of a "standard" hospital bill for an appendectomy. Not what the patient ultimately pays after insurance, but what the insurance or health system pays the hospital and doctor(s) for the operation and standard care. (And thus what a visiting tourist would have to pay if they didn't have travel insurance.)

Now maybe you get better (or at least different) treatment in the US. But my appendicitis here was one of the things that convinced me that getting travel health insurance when I visit back in the US was a REALLY good idea, even though the travel health insurance for the US costs about twice as much as for anywhere else in the world.
Cheers,
Bev

 

Premiums did not increase for some but for everyone and taxation on services and slogan promises such as "you can keep your doctor" hit those who have been paying to have coverage. It is surprising how many just opted not to have coverage. For those not familiar with the system options for non-covered are/were not always known.

A tourist not having travel coverage is on his own in my book. Most credit cards even offer coverage and I have not heard of a plan ticket being bought with cash/check in a while. As said before - I do not know where some of you buy your insurance. My mother is in her 70s and it runs her about 150 Euros/year for medical/dental not including maintenance but she does not need that.

 

Just a question - your mother's 150€ a year insurance is travel insurance, correct?

I just checked one of the sites I have used in the past for travel insurance and they have an annual policy available for about 178€ for up to 30 days of travel - almost 200€ for 60 days of travel, including "worldwide" coverage for the US. (Though that includes 21 days of "winter sports" - I kind of doubt your mother needs that.) I used Germany as the country of residence. But this company doesn't seem to insure those over 65. There are others that do.

Normally for single trip coverage, I've been quoted about 38€ for a two to 3 week trip to the US. Not sure if that's going to change after I hit 65.
Cheers,
Bev

 

She has 90 days. No winter sports even though there was a nice slope with flood lights for night skiing east of Atlanta. She is over 70, bikes, small planes, shooting.

 

ObamaCare isn't working?

 

The reason is simple - US medical care does not place any emphasis on value for money nor appropriate medical care.

Instead its the most expensive drugs for everyone, and innumerable unnecessary activities for fear of litigation.

Go in for a sprained wrist and its a CAT scan, an xray, a blood test and a dozen other things - 99% of which are in practice found to be unnecessary but nobody ants to be sued so they do everything.

The reason the UK NHS is judged the best in the world is partly because of an organisation that many out here or the US will not have heard of called NICE - National Institute for Clinical Excellence. What they do is simple - they analyse and agree prices with every medical company on behalf of the NHS and judge value for money for any item or drug. They start off with a generic drug, say, Aspirin, and then anyone wants to sell a branded drug alternative, to the NHS has to either beat the price. or to show a proven medical advantage to their brand.

This is why the NHS doesn't waste money on drugs people hear about on the TV and assume the NHS will provide it. Its only controversial as far as people wanting massively expensive drugs being told that the £90,000 of drugs to prolong a persons life for six months when they are in their 80's really isn't good use of resources so they will spend the money on say employing more nurses - or of course, the drugs company drops it prices.

By and large it works, and you just have to look at the US and UAE and you'll understand why the cost there is far higher than the NHS and the level of care is poorer overall.

Basically its the fault of US patients and lawyers who will both sue to get the highest inappropriate care regardless of logic.

NHS is the world's best healthcare system, report says | Society | The Guardian

http://www.theguardian.com/society/2014/apr/23/breast-cancer-drug-turned-down-nhs-use-high-cost

 

The reason the UK NHS is judged the best in the world

I was discussing this in the pub with a few Americans who have een in the UK for a while. The general feeling was one of intense frustration with their system, and certainly the view that the NHS was better overall.
However, they did seem to think that they had experienced better (or at least faster) care in the US - the problem was the amount it cost, not the standard of care per se. Does that sound fair? I'm interested in what the experience will be like.

 

As far as I can tell, the main problem with medical care in the US is that "it's the best care money can buy" - just don't forget to bring money. Even with insurance, there are hefty "co-pays" (back in my days in the US, these were called "deductibles"). And often, the co-pays will inhibit people from seeking treatment until the pain is unbearable or the illness or condition has advanced to the point of requiring more intensive and more expensive treatment.

On arrival in Europe, it has taken me several years to adapt to the European system, where if you're sick you go see a doctor. In the States, there is a "cost justification" evaluation - am I sick enough to pay the office visit co-pay?

And, there is always the problem of having to wait weeks or months to get an appointment with a specific doctor (usually a specialist). Seems much the same whether you're in Europe or in the US. Also, not all doctors are taking on new patients - either due to the type of insurance you have (in the US) or because they're getting close to retirement, or even just because their calendars are already bursting with appointments. Some issues are universal.
Cheers,
Bev

 

Bev - looking at waiting periods for services such as MRI, mammogram, specialists in Europe ...

 

OK, here in France MRIs generally take about 6 weeks, due to a shortage of equipment. Certain specialists - ophthamologists for example - can take 2 to 3 months, up to a full year. My DH has to book his opthalmo appointments a year in advance, but I can't stand his eye doctor. My ophthalmo can usually fit in an appointment in 6 to 12 weeks (depending on the time of year and the vacation schedule). Have heard very similar times for many areas in the US.

The US also has the same "distribution" issue as France. In some areas there just aren't certain specialists. If you're willing to travel to Paris, you can probably see someone much sooner. But most doctors in the US want to practice in NYC or Boston. Out in the boonies, "your mileage may vary."
Cheers,
Bev

 

New Haven is considered to be within the NYC area as far as desirability of an area in which to practice. Try some of the smaller towns in the Midwest or Southwest. Or in states like Idaho, Montana or Wyoming. Things may take a bit longer there. Or you can travel to the closest large medical center.
Cheers,
Bev

 

Well, we have to remember that the U.S. is a huge nation with vast expanses that have relatively few people. You can't compare the small and compact nation of France with the great distances and immense rural areas of the U.S. and say the U.S. medical system is lacking because there are so few doctors in those rural stretches. It just doesn't compute to expect the wide range of medical specialists to live in tiny Montana towns or Kentucky hill country. They'd starve to death!

Even internists have a hard time surviving in the rural stretches. The U.S. govt does offer to forgive student debt of new doctors who agree to relocate to those isolated areas for a period of years, but again, the specialists would just be twiddling their thumbs out there.

Even if the U.S. had a top down medical system, I'm sure the federal govt could never justify ordering specialists to relocate to those isolated areas of tens of thousands of square miles.

Those rural areas were established long before modern medicine advanced to where it subdivided into the specialities and technologies that could do so much to prolong healthy lives, and then those rural areas went on to lose a great deal of their population, making it ever more difficult to serve them as residents in the populated areas.

Therefore, I'd hold to my belief that 90 percent of Americans have ready access to top medicine. People who live in those rural areas love the isolation, love being away from the rat race, and they choose that knowing the downsides. There's probably a lot fewer people percentage wise with high blood pressure problems out there.

 

The entire U.S. healthcare system is a business that puts profits above treatment. As a result, you see drugs that only a doctor can prescribe getting advertised to regular people. Sounds horrible to say, but if a drug company gets you on a maintenance medication, you're a customer for life.