Big pharma and Big insurance control availability and pricing of health care services in this country. We have the highest healthcare cost in the world because we are overcharged for drugs and services because insurance companies have no incentive to control cost of services, they get a roughly 20% over ride. They control cost and maintain profit margins by restricting access to services and demanding high co-pays and deductibles.
They have healthcare in this country in a head lock and innovative new companies have a hard time breaking into the system.
OVERVIEW
Cross-national comparisons allow us to track the performance of the U.S. health care system, highlight areas of strength and weakness, and identify factors that may impede or accelerate improvement. This analysis is the latest in a series of Commonwealth Fund cross-national comparisons that use health data from the Organization for Economic Cooperation and Development (OECD), as well as from other sources, to assess U.S. health care system spending, supply, utilization, and prices relative to other countries, as well as a limited set of health outcomes.1,2 Thirteen high-income countries are included: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. On measures where data are widely available, the value for the median OECD country is also shown. Almost all data are for years prior to the major insurance provisions of the Affordable Care Act; most are for 2013.
Health care spending in the U.S. far exceeds that of other high-income countries, though spending growth has slowed in the U.S. and in most other countries in recent years.3 Even though the U.S. is the only country without a publicly financed universal health system, it still spends more public dollars on health care than all but two of the other countries. Americans have relatively few hospital admissions and physician visits, but are greater users of expensive technologies like magnetic resonance imaging (MRI) machines. Available cross-national pricing data suggest that prices for health care are notably higher in the U.S., potentially explaining a large part of the higher health spending. In contrast, the U.S. devotes a relatively small share of its economy to social services, such as housing assistance, employment programs, disability benefits, and food security.4 Finally, despite its heavy investment in health care, the U.S. sees poorer results on several key health outcome measures such as life expectancy and the prevalence of chronic conditions. Mortality rates from cancer are low and have fallen more quickly in the U.S. than in other countries, but the reverse is true for mortality from ischemic heart disease.
Despite its high spending on health care, the U.S. has poor population health. [Exhibit 9]
On several measures of population health, Americans had worse outcomes than their international peers. The U.S. had the lowest life expectancy at birth of the countries studied, at 78.8 years in 2013, compared with the OECD median of 81.2 years. Additionally, the U.S. had the highest infant mortality rate among the countries studied, at 6.1 deaths per 1,000 live births in 2011; the rate in the OECD median country was 3.5 deaths.
The prevalence of chronic diseases also appeared to be higher in the U.S. The 2014 Commonwealth Fund International Health Policy Survey found that 68 percent of U.S. adults age 65 or older had at least two chronic conditions. In other countries, this figure ranged from 33 percent (U.K.) to 56 percent (Canada).13
A 2013 report from the Institute of Medicine reviewed the literature about the health disadvantages of Americans relative to residents of other high-income countries. It found the U.S. performed poorly on several important determinants of health.14 More than a third of adults in the U.S. were obese in 2012, a rate that was about 15 percent higher than the next-highest country, New Zealand. The U.S. had one of the lowest smoking rates in 2013, but one of the highest rates of tobacco consumption in the 1960s and 1970s. This earlier period of heavy tobacco use may still be contributing to relatively worse health outcomes among older U.S. adults.15 Other potential contributors to the United States’ health disadvantage include the large number of uninsured, as well as differences in lifestyle, environment, and rates of accidents and violence.
The Institute of Medicine found that poorer health in the U.S. was not simply the result of economic, social, or racial and ethnic disadvantages—even well-off, nonsmoking, nonobese Americans appear in worse health than their counterparts abroad.
Of all the trending (and trendy) topics in healthcare today, pricing transparency has grown quickly in popularity and focus. Whole companies are now committed to cracking this “secret code,” and then selling the information to us (as either employers or consumers) as a way to enable pricing comparison for healthcare services. The wisdom, of course, is that if we knew pricing we could wistfully bring “free market” influences to bear and those, in turn, would defy all logic of supply and demand or cost and value. The result would be sweeping (and desperately needed) pricing relief. As consumers, all of us could then easily shop for healthcare services in much the same way that we shop for other goods and services online. At least that’s the theory – and the hope. It’s definitely a big hope.
One big assumption (here in the U.S.) is that opaque pricing itself is the primary culprit of our healthcare cost crisis. How else do we arrive at almost $9,000 per capita annually? The Milliman Index (which I wrote about here) suggests that the average family of 4 spends about $20,728 per year on healthcare. That’s more than 7 times what the average household spends annually on gas ($2,912).
So let’s try to remove at least some of this mystery. We’ll start with a simple question. Who actually sets healthcare pricing in the U.S.? We’re a market-driven economy – so who’s the “market maker?” For a system that’s running at $3.5 trillion per year (about 18% of GDP) that seems like a pretty basic and important question. Personally, I think most Americans assume it’s a combination of the Government and Commercial Insurance companies which does pay for Medicare, Medicaid, the VA, Federal Employees and healthcare services on behalf of millions of beneficiaries. Those are definitely the public and private institutions writing the checks, but how are the prices actually calculated – and by whom?
Surprisingly, the organization that calculates pricing for almost all of U.S. healthcare is a little known cabal. Say what? How can that be? First of all, what’s a cabal? Wikipedia describes it this way:
A cabal is a group of people united in some close design together, usually to promote their private views or interests in a church, state, or other community, often by intrigue.
Lot’s of intrigue here – starting with a relatively obscure (and comparatively tiny) organization with a bulky name – the AMA / Specialty Society Relative Value Scale Update Committee. Today it’s known less formally as the Relative Value Scale Update Committee – or simply RUC (pronounced “ruck”). Here’s the member list of the RUC.
What factors contribute to cancer health disparities?
Complex and interrelated factors contribute to the observed disparities in cancer incidence and death among racial, ethnic, and underserved groups. The most obvious factors are associated with a lack of health care coverage and low socioeconomic status (SES).
SES is most often based on a person's income, education level, occupation, and other factors, such as social status in the community and where he or she lives. Studies have found that SES, more than race or ethnicity, predicts the likelihood of an individual's or a group's access to education, certain occupations, health insurance, and living conditions?including conditions where exposure to environmental toxins is most common?all of which are associated with the risk of developing and surviving cancer. SES, in particular, appears to play a major role in influencing the prevalence of behavioral risk factors for cancer (for example, tobacco smoking, physical inactivity, obesity, and excessive alcohol intake, and health status), as well as in following cancer screening recommendations.
Research also shows that individuals from medically underserved populations are more likely to be diagnosed with late-stage diseases that might have been treated more effectively or cured if diagnosed earlier. Financial, physical, and cultural beliefs are also barriers that prevent individuals or groups from obtaining effective health care.
