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    Cost, not access, is underlying problem facing American healthcare


    In 2010 Medicare chose to reduce reimbursements for stress nuclear imaging studies by 36%.  Many practices fled to join hospitals which had been spared these cuts - but nuclear imaging in the outpatient setting never actually died as feared.  The cost of doing imaging simply got lower, leaving the cardiologists who survived with lower, but still manageable margins.


    Editorial: Mr. President, physicians fight when things get tough


    There are at least two approaches to lowering healthcare costs- either have an authority set prices (the government of India recently started setting a ceiling for the price of coronary stents), or reduce the imprint of deep-pocketed third-party payers in the healthcare market.

    The wrong thing to do is to listen to the supposed defenders of patients seeking to preserve the right of Americans to keep paying into a broken system that enriches a precious few, bankrupts the nation and keeps healthcare out of reach for millions of Americans.


    Dr. Koka is a cardiologist in private practice in Philadelphia.


    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]---.com
      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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