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Why an MRI costs $1,080 in America and $280 in France

washingtonpost.com

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Re: Why an MRI costs $1,080 in America and $280 in France

#91

Post by shingen »

Want to get our costs down to competitive levels?

85% of all healthcare costs in America are for those over the age of 65. America has the leading health care system for the elderly. We pay for 80 year olds to have surgeries that they can't get in Canada or France.

Nobody wants to talk about it though, because it's not a nice thing to say, that grandma is buying six extra months at a price of a million in treatment.

Socialized medicine will slice the most money out of treatment for people in that demographic. It's by far the largest savings spot. Good or bad, you can debate that endlessly; but that's exactly what will happen.

Re: Why an MRI costs $1,080 in America and $280 in France

#92

Post by Nitramp »

tzs wrote: post #16

What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways. For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the governm…

I think what all of these countries have in common is that they have a strong entity negotiating prices on behalf of the patients, drastically lowering the price, and to a varying degrees also dictating what treatment is appropriate.

It'd be really nice if health care could work like a regular market, but evidence and intuition suggest it simply doesn't. As others have commented, people don't comparison shop even if they could. It's a bit like having no idea how a car works or what could be wrong with it, and then being asked to pick the best mechanic and strategy to fix it. Except of course, that it's not a car but your life or somebody else's depending on the right choice. I think it's unrealistic to expect a working market economy to develop under such circumstances.

One or multiple big entities negotiating prices and dictating treatment comes at the cost of less freedom for the providers and also less freedom for the consumers. Whether it gives better or worse care I wouldn't be too sure - on the one hand, special cases won't get specialised treatment, on the other hand trusting the decision of what needs to be done effectively to the provider sounds like it will cause over-treatment.

The freedom aspect probably drives the USA to the current system, but given the measurable effects, it just seems like bad policy.

Re: Why an MRI costs $1,080 in America and $280 in France

#93

Post by [deleted] »

underwater wrote: post #68
tzs wrote: post #16

What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways. For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the governm…

This kind of problem seems fairly widespread in America. Americans are incredibly self-confident, innovative and have achieved a great deal as a nation. They are also extremely proud of their country. Unfortunately this combination often leads them to assume things are good purely because they are American. They tend to accept their own familiar values and ideas and readily dismiss alternatives because that would be…

[deleted]

Re: Why an MRI costs $1,080 in America and $280 in France

#94

Post by ramblerman »

" If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive."

Also world peace would break out and poverty would be eliminated.

I liked the article, and I think this is most certainly a pressing problem for this country. But the facts are strong enough to independently make a strong case. No need for the hyperbole

Re: Why an MRI costs $1,080 in America and $280 in France

#95

Post by Joeri »

Newgy wrote: post #90
underwater wrote: post #68

Earlier quoted context omitted.

This kind of problem seems fairly widespread in America. Americans are incredibly self-confident, innovative and have achieved a great deal as a nation. They are also extremely proud of their country. Unfortunately this combination often leads them to assume things are good purely because they are American. They tend to accept their own familiar values and ideas and readily dismiss alternatives because that would be…

A major driver of U.S. costs that isn't discussed in the article is our parasite lawyer class, who drive up the cost of insurance for doctors and lead to widespread over-testing or "defensive medicine". Few Americans are proud of our litigious society.

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. Tort reform is a diversion, not a solution.

Re: Why an MRI costs $1,080 in America and $280 in France

#96

Post by shingen »

yaix wrote: post #80
asmithmd1 wrote: post #39

High health care spending is yet another way the US subsidizes other countries. From the article: "This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.” In the past 30 years have you heard of any medical innovation…

> High health care spending is yet another way the US subsidizes other countries. Look at the US's trade deficit and dollar devaluations of the past 50 years to see who is subsidizing who. But that's beside the point. Look at it less nationalistic and rather as corporations vs. consumers. American consumers are "subsidizing" large corporations in an oligopolic market.

Your 50 years is a radical exaggeration. America had a budget surplus and stable dollar 12 / 13 years ago. Which is why gold was $270x / ounce, and oil was $12 to $20 and gasoline was still $1.

Trade deficits are mostly irrelevant so long as you aren't accumulating debt, and your domestic economy is highly productive.

I run a huge trade deficit with Amazon.com for example, as do all of their customers. That's ok because I'm being productive elsewhere, and the profits I'm generating through work make it possible to run that deficit. The same concept works at a macro economic level.

America ran trade deficits during almost the entire 19th century. There was more money (eg British investment) and goods flowing in, than out. The huge profits being generated domestically by the productivity gains, made it possible to finance that deficit without debt accumulation.

http://www.cato.org/publications/trade-policy-analysis/ameri...

Re: Why an MRI costs $1,080 in America and $280 in France

#97

Post by phren0logy »

Joeri wrote: post #95
Newgy wrote: post #90

Earlier quoted context omitted.

A major driver of U.S. costs that isn't discussed in the article is our parasite lawyer class, who drive up the cost of insurance for doctors and lead to widespread over-testing or "defensive medicine". Few Americans are proud of our litigious society.

Malpractice suits are about 2% of healthcare costs, and that percentage is stable, so you're not going to make a huge difference by focusing efforts there. Tort reform is a diversion, not a solution.

I am a physician, and I teach in a medical school. Although they are 2% of total costs, they drive up the cost in unnecessary procedures that patients demand without medical indication. Those $1080 MRIs are often ordered to avoid a lawsuit. That adds up to a lot more than 2%.

Re: Why an MRI costs $1,080 in America and $280 in France

#98

Post by phren0logy »

shingen wrote: post #91

Want to get our costs down to competitive levels? 85% of all healthcare costs in America are for those over the age of 65. America has the leading health care system for the elderly. We pay for 80 year olds to have surgeries that they can't get in Canada or France. Nobody wants to talk about it though, because it's not a nice thing to say, that grandma is buying six extra months at a price of a million in treatment.…

Although I disagree with your flippant tone, it's a fact that over 30% of medical costs come from care delivered in the last 6 months of life. Obviously you'd expect some top-heaviness here, but it makes one wonder about the cost of futile care (both in $$ and human suffering).

Re: Why an MRI costs $1,080 in America and $280 in France

#99

Post by phren0logy »

veidr wrote: post #61
rdl wrote: post #7

Earlier quoted context omitted.

MRI specifically is overused and kind of crappy in Japan. In the rest of the world, the standard is for a 1-3T MR study; in Japan, you get a lot of 0.5 and even lower (0.2T! wtf) MR studies. They're used for a lot of health screenings, whereas in the rest of the world they're more often used for actual problems.

I call bullshit on your first point--that MRIs are "overused" in Japan. MRIs aren't something that can really be overused. Unlike CT scans, or pretty much any non-MRI method of imaging the inside of the body, they don't harm the patient. Even though you are right that many of the MRI machines in Japan are lower-resolution cheaper models, that is largely because there are way more MRI machines here, and they are used…

>MRIs aren't something that can really be overused.

Not on the basis of exposure to anything dangerous, but certainly they can be overused on cost grounds. That is the case in the US. They are routinely ordered without an adequate indication; we order many times more than physicians in other countries.

Re: Why an MRI costs $1,080 in America and $280 in France

#100

Post by phreanix »

rsanchez1 wrote: post #2

Anyone who has insurance doesn't care about the price. They only care about the deductible. When people shop around, they look for the insurance companies that provide the lowest deductibles and stick with them. After that, there's no pressure on the providers to lower prices. The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles. The provide…

"The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles."

I'm sorry, this is wrong. The insurance companies actually DO negotiate lower prices. I recently had surgery and through my billing statements watched as first the hospital attempted to charge an obscene amount (that would have bankrupted me several times over had I not had insurance), then having my insurance company go through every line in the bill to let them know the max amt they will pay for each service provided. This was recently Reported on, I'll try and find the article.

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