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    Cost, not access, is underlying problem facing American healthcare


    Simply put, those attempting to preserve the current system want to force Americans to pay a monthly premium to health insurance companies attached to deductibles that are high enough to ensure that the $1200 ECG will be subsidized by your bank account.  The current solution proffered for those that don't have this type of cash lying around is to have the taxpayer pick up the exorbitant bill.


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    Currently, low-income patients qualify for tax credits that amount to subsidies from the federal government to insurance companies to keep costs low.  While this is laudable and certainly a good deal for sick patients that are poor, the path is one that is unsustainable even for the richest country on the planet.  Perhaps even more damning, this approach still leaves around 20 million patients without healthcare.

    Healthcare's access problem is its cost problem.  Lower the unit price of care, and the path to universal access to healthcare becomes much easier.   Interesting things happen in healthcare arenas free of third-party payers.  One such example is coronary calcium scans - low dose CT scans of the chest that demonstrate the presence of calcium in the coronary arteries.  Using this tool to screen patients is a controversial topic among cardiologists, and insurance companies have refused to pay for this since its inception.


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     Remarkably, all this has done is make a coronary calcium scan affordable to almost everyone.   Indeed, in any given city almost every hospital offers this scan. (In Philadelphia, for example, the cost runs from roughly $50 to $185).  Hospitals understand in this case that you can't sell what the buyer can't afford to buy.

    The effects of the deep pockets of third-party payers that are poor negotiators is even more profound. It trickles down to affect the very cost of goods.  Sellers of stress test machines, for instance, know all too well what Medicare pays for stress tests, and set their charges accordingly.

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    Anish Koka
    Anish Koka is a cardiologist in private practice in Philadelphia trying not to read the writing on the wall. Follow him on twitter ...


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    • [email protected]
      I agree with the high costs: of medication (some of which are generics), hospitalizations, and procedures are driving the cost of healthcare up. The confounding problem for the uninsured patient is they pay ten times or more what the insurances contracted rate is for labs, hospitalization, medications, and to a lesser degree physicians charges. My brothers son recently was air ambulanced for 90 miles with a charge of $35,000(charged by the state of Pennsylvania). He stayed for half of a day in a nuero intensive care unit where they didn't even do nuero checks every four hours and was discharged to home; and the charge $20,000. How about a 5 g tube of Denavir cream for herpes cold sores,from Mylan, the people who made the Epi Pen famous, would you believe over $800. When does this insanity stop? Another problem is that those who have pre-existing conditions are now grouped in with a small group of mostly small business people in the ACA plans. This has caused the insurance rates for these small businesses to skyrocket. To make any plan work that covers high cost, previously uninsurable patients, there must be enough healthy patients to offset there costs. This is the major problem with the current affordable care act. I suggest we open the Federal Employees Health Benefits Plan to anyone who wants to join. This will increase the cost of healthcare to federal employees but not to the degree the current ACA plans have increased the cost to small businesses and should make insurance more affordable to those currently in the ACA plans
    • [email protected]
      Inflated medical costs, caused by our reliance on third party payment, is absolutely the big problem. We are not underinsured, we are overinsured. Dr Koka's recognition of this situation is a welcome addition to the public's understanding.
    • [email protected]
      Dr. Koka is correct that the healthcare crisis is driven by the excessive and unfair prices charged for medical services. If a hospital is happy to perform an ECG for the $12 paid by Medicare, then it is unfair for a patient to be charged $1200 for that same ECG. It is tempting to address this inequity by government edict; price controls to force hospitals to charge every patient the same reasonable fee for the same service. This is how the problem of preexisting conditions was addressed by ObamaCare, which prohibits insurance companies from considering them. The problem is that nobody, no matter how smart they are, can set prices or mandate services better than the free market, in the long run. All prior attempts throughout human history to fix prices or mandate services have failed, including ObamaCare (its collapse is imminent). India is no exception, nor is Canada, where patients suffer from excessive waiting times for needed procedures. The rich in England have the option of an "upper class" private hospital system, as an alternative to the rationed care at their National Health Service. Canada's more stringent Single Payer system enforces egalitarian care, but still allows the rich to leave the country as "medical tourists", to receive timely care on a cash basis in other countries. The answer is always to provide more freedom, more transparency, more choices, more patient empowerment and more negotiation on prices. Monopolies must be smashed. The best way to accomplish all of this is to introduce free market solutions and competition, and to allow patients to purchase their own tests without the delay and hassle of an overworked doctor in the middle. A prescription for any medical item or service should allow the patient to shop around and negotiate his best deal. In the short run, the poor must be subsidized with socialist charity. In the long run, the poor should share in the prosperity created by free minds working in free markets.
    • [email protected]
      I agree with you but part of the problem is frequently a patient doesn't know what a charge is going to be. An uninsured patient spends two days on a med surg floor in California. Four weeks later there is a $35,000 bill. Labs on an uninsured patient are done by his doctor to work up a rheumatologic problem. Three weeks later the patient receives a $2,000 charge from the lab. Unfortunately, in the current system the patient has no clue what the charge will be in advance of the bill. Its like a store sending you the television you like (without knowing the price) and after it sits in your home for three weeks the store sends out a $12,000 bill to you.

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