Proof That the U.S. Health Care System Is a Rip-Off

If you live in the United States, you know how incredibly expensive health care is here. If you're extremely healthy or lucky, you don't know that health care costs are not just high—they're obscene. Here's a cheerful snippet from a story on Medscape. (Read the rest here; I believe free registration is required.)

NEW YORK (Reuters Health) Jul 12 – Coronary artery bypass graft (CABG) surgery is nearly twice as costly in the United States as in Canada, although the clinical outcomes are no different and average length of stay is shorter in the U.S., a new study shows.

"I think that adds some fuel to the fire for a single payer system in the U.S., which would substantially reduce costs," the study's lead author, Dr. Mark J. Eisenberg of Jewish General Hospital in Montreal, told Reuters Health.

The researchers compared the cost and outcomes for 12,017 consecutive CABG patients treated at five U.S. and four Canadian hospitals. The group included 4,698 U.S. patients and 7,319 Canadian patients, and all of the hospitals were using the same cost accounting system.

Mean U.S. in-hospital costs were $20,673, compared to $10,373 for Canadian patients, Dr. Eisenberg and his team report in the July 11 issue of the Archives of Internal Medicine. Length of stay was 16.8% longer for the Canadian patients. After the researchers controlled for clinical and demographic factors, they found U.S. CABG treatment was 82.5% more expensive. . . ." [emphasis mine]

Did the Canadians in the study have to wait longer than the Americans to have the surgery? (All of you USians have heard of Canadian waiting lists for expensive procedures, haven't you?)

In the original research article in Archives of Internal Medicine* on which the news story is based, the researchers do mention waiting lists. To control for the chance that having waiting lists reduces health care costs, the researchers gathered data for patients in both Canada and the United States for whom bypass was elective (had to wait) and those for whom it was an emergency. Canada still came out with much lower surgery costs. After all confounding factors were controlled for, the procedure still cost 74.8% more in the United States than in Canada. This was because, the researchers said, the costs of the procedure and all supplies are spread throughout Canada, which is not the case in the United States. Quality of patient care during the procedure and hospitalization was pretty much equivalent, they said.

So when is this conversion from our train wreck of a health care system to a single-payer system going to happen, and why doesn't it seem to be on any politician's agenda?

It will happen sometime in the nebulous future after Bush is no longer president, and it's not on politicians' agenda because (1) they're all covered by a cushy government-sponsored insurance policy (check out your senators' and representatives' premiums here) and (2) they're given high enough salaries that they experience out-of-pocket health care expenses as chump change.

If the spousal unit and I didn't have to pay just over $900 a month in health care policy premiums (family rate, whether 2 people or 9), we could

• Afford to make payments on two brand-new cars (not that we want them) or




• Stop requiring my in-laws (who live in a small apartment within our home) to pay us rent or



• Afford to do a home remodel that includes replacing the 35-plus-year-old upstairs bathroom (nothing fancy, mind you—we just need to replace what's falling apart, which is everything), build a small addition that would allow me to have my very own office (I'm working editing miracles at a tiny kitchen table, dammit!), and replace the 35-plus-year-old rough-hewn cedar shingles and asbestos (!) shingles on the outside of the entire house with vinyl siding.

I suppose I shouldn't gripe; at least we already have a home, even if it does need a lot of expensive work. But damn! I should've been a CEO of a health care plan.

Then again, maybe not. I wouldn't want to be one of America's most hated.

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*Eisenberg MJ, Filion KB, Azoulay A, et al: Outcomes and cost of coronary artery bypass graft surgery in the United States and Canada. Arch Intern Med 2005;165;1506–1513. [The article was published July 11, 2005.]

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