Regarding "greedy doctors:" As a surgeon in training about to enter the work-force I ask people to consider my greed: 4 years undergrad, 4 years medical school, 5 years general surgery training, 2 years fellowship, $250,000 education debt about to be unleashed onto me as soon as I graduate.
Has anyone considered what physicians in other countries sacrifice to become doctors? In many countries education is free and in others it requires less training time, and in some instances with better clinical outcomes. The system is broken on many levels, and is influenced by many factors. Though I gave my late teens and all of my twenties up for this (and yes it was my choice), I shall spend the next ten years paying for it with my "excessive" salary. All this only to be criticized that I am not trying to save someone's life for free and to be demonized as being greedy.
If anyone else wants to make this investment of time, energy, finance, sweat, tears and 15 years of training, and is willing to keep being called names go ahead...... I bet you won't. However, if you need an operation to save your life in this country, I bet you'll be glad someone made this absurd sacrifice.

Well said TejB
I'm also in healthcare and my sentiments echo yours. Anyone who thinks physician income justifies what it takes to become a doc, doesn't know the first thing about medicine, or business for that matter. For the greedy, they can make much more in other businesses for much less effort.
I tell younger people looking for career advice to look elsewhere if they want to make money. If they're wiling to make huge sacrifices to help people, then medicine might be for them if they don't mind 50-80 hour workweeks, night/holiday/weekend duties, insurance company idiots telling you what you can't do, etc, etc....

In the US the coronary angioplasty costs about 2-3 times higher than other developed countries (as stated in the article) but if the US physician would not get paid at all the price difference still would not change much given the high hospital fees.

About the cost of angioplasty and stenting in the US based on medicare payment:

Cardiologist fee: $838 for one vessel, each additional $233

Hospital fee: $10,371-$18,227

Left heart catheterization/coronary angiogram:

Cardiologist fee: $$316/$259

Hospital fee: $3,041.39- $11,465.04

Example taken from the numbers cited from the article : average cost for angioplasty in US: $14,378 substract $838 Doctor’s fee=$13,540 non physician cost of procedure compared to total procedure cost in Germany $3,347??? Where does the >$10,000 difference go? Currently the US hospitals get additional increase in reimbursement while physicians get a cut.

As a cardiologist I can comment on the bill from your cardiologist:
the bill usually shows the “maximum allowed rate” that is not the actual amount paid. The take home pay is for an angioplasty: $838-15% patient who don't pay -50% office cost- x% tax=$220-$240. independently whether the procedure was 30 min or 3hrs long or at 9AM or at 2AM. Plus if there is a mistake everything can be taken away from a physician in a lawsuit.

Compare this that I have paid to my lawyer: I wrote a letter 1 paragraph (1/3 of a page) my lawyer read it for 3 minutes - corrected 1 single word - the charge for this is $300, it was at daytime, I went to his office. Many of my angioplasty cases are at 2AM and I have to run to the hospital after I am called to be there in 20min as we must to provide 7/24 free call coverage to hospitals.

If it would be so lucrative and easy to be and to become a physician here in the US the number of physicians/1000 population would not be 2.4 compared to the OECD average of 3.1 - so the US is among the last one in the OECD countries. This means that there are 25-30% less physicians in the US per population and the US MDs are doing 25-30% more work than the OECD physician.

Why does the US need to let in foreign medical graduates in such a large number if the US youth would be that motivated to become a physician?

Compare this to number of lawyers per population:
USA: 397 /100,000 people
Japan: 23 / 100,000 people
Canada: 26 / 100,000 people
UK: 251 / 100,000 people
http://www.law.harvard.edu/...

I wonder anyone compared the cost of physician lawsuits's here in the US and their frequency to the other countries listed above:

"The United States had 50 percent more malpractice claims filed per 1,000 population filed than the United Kingdom and Australia, and 350 percent more than Canada."

"The cost of defending malpractice claims, including awards, legal costs, and underwriting costs, was an estimated in 2001:

USA: $6.5 billion
Canada: $237 million "
a 27.4 fold difference

faculty.unlv.edu/ccochran/H...

We keep missing the elephant in the room. As long as we have a profit motive in the US, we will continue to over-treat people, keep them sicker for longer, prescribe expensive drugs, and want them to have to foreclose their houses in order to survive cancer. Bad food will also continue to proliferate in the markets because it is so profitable for all health related industries for people to get and stay sick. Health care is not a business in the other countries. It's a right. That's the big difference. Own up to it and stop blaming people for being fat.

The cost of healthcare in America is high in large part because of investors that demand a profit or a dividend -- not to mention the workers/executives in the industry that don't deal directly with patients or patient care, but take away some of our dollars as wages. If basic healthcare was a not-for-profit system in America we would pay far less and likely would be better off for it.

It's also high because 31 percent of every health care dollar goes to administrative overhead - not the 9-10 percent suggested here. The OECD only considers the cost of the insurance industry in overhead, but not the enormous costs the industry imposes on doctors and hospitals that drown in paperwork dealing with thousands of different plans with different rules and regulations. Slashing that with a single payer system would save $400 billion a year, enough to cover all the uninsured and improve coverage for everyone else. See www.pnhp.org for details and more research.

Other countries can still "attract the best students to medicine" despite much lower income potential because other countries don't require their medical students to take on a quarter million dollars in debt to be doctors, their government covers tuition. This is true in almost all the nations mentioned, the government either covers or heavily subsidizes tuition. Doctors who don't start their careers with a $1500 a month loan payment are much better able to 'contain costs' by lowering their own fees and salaries.

another issue not mentioned... if you happen to have "good" insurance in the US (or just seem like you can afford more), doctors and dentists sometimes focus on you for more tests and procedures, because you can pay. in a single-payer system, this incentive would not exist, and they could focus on whomever needed more treatment.

We the People, we cannot change greed easily. We can try to change ourselves by living a healthier life. What will never settle with me is the fact that many of us will make claims that we are the greatest country in the world, yet we don't have a healthcare system worth a penny. My dear readers, if there is anything more important in our life or in our existence more than our health, then we are not the greatest country in the world. Humanism, is an important aspect of our life as well, regardless of our differences. If somehow greed can be controlled, maybe we can restore more humanism, therefore we will be able to develop a better healthcare system.

The only reason the five year survival rate for breast cancer is higher than in other countries is because over the last decade the US has started diagnosing people with breast cancer (stage 0) that were never before counted as having cancer. Only about 30% of these people go on to develop cancer, but now all are treated as though they have cancer. This is one way the medical industry skews statistics.

As always in this broken country another of our "systems" is broken and gone to corruption. There is NOT ONE politician not a single one who is not on the take from the industry and for that reason alone we will NEVER have real health care. Also no one media outlet covers the cost of having our so called monopoly system where we give doctors a complete and utter monopoly on drugs. We are the ONLY country that does so and it shows. It's high time to bring the insurance companies to justice sadly they own the courts out right and we the people will never have access to any kind of quality health care despite Obamacare twisted desire to STILL satisfy the ones who have brought our system down.

The information in this segment should be a major issue in all campaigns for national office -- i.e. president, senator, and representative. Not only is health each individuals most precious asset, the inefficiency of the U.S. health care system is severely dragging on the U.S. economy and its competitiveness in the world. The data showing what we spend versus what other countries spend to achieve middle of the road results SCREAMS that change is necessary.

Ironically, covering everybody with a single payer system is patently cheaper and more effective then our current healthcare system. Obamacare, if it stands, still leaves our country far from systems that clearly work better around the world. We could and ought to adopt single payer, universal, national healthcare while still keeping robust private alternatives for individuals who choose to augment or replace such a public system.

I think it is the insurance companes which are the root cause for all this mess. Why should the same procedure be charged different amounts depending on your insurance?

I have lived in a rural area of SW France for several months over the past several years and have had personal experience with healthcare there. I am wondering why cancer care is not as successful in France as in the US.
Breast cancer screening and colorectal screening are provided on a universal basis and is easily accessible even in rural areas. But I see that many people do not take advantage of free screening. I also observe that many people continue to smoke cigarettes - even women who are pregnant are not accepting the well-publicised message that smoking and pregnancy do not mix.
Administrative cost associated with health insurance reimbursement is lower there. France uses one standard form for health insurance reimbursement and so doctors do not need a cadre of office workers to determine what is covered and what is not and at what rate.

These statistics are so damning of the American health care system.
Convert to a single payer system with control over the cost of medicines and surgical operative procedure costs. Then concentrate on a system that has your medical history and record in a say National health service database and millions of dollars of unnecessary tests can be eliminated.
Oh by the way it does not prevent a separate on top system if you can afford for so called private funded care at a ( specialist more expert hospital??) private profit run hospitals.
The single payer system funds you up to national rates and the rest is your co-pay.
Take profit out of the system for doctors hospitals and too high profits for medications and unnecessary " tests via a national medical data base US medicl costs are reduc d by 1/3rd at least.
The global stats say the USA does not have the best health care in the world, but it proves it remains the most expensive!!
Regards,
J.V.Hodgson.

Bravo! Its about time we had some discussion on healthcare costs and how they compare in other countries. We observed a similar difference when we lived in France during the 1990's. It seemed odd that in the land of the $3 coke and the 5$ gallon of gas (at the time) that healthcare was 50 cents on a dollar. It certainly didn't seem much less developed or effective based on our direct experience and the people we knew either.

This is an excellent article. I hope a lot of people read it!

Health for all should be the goal. In USA the number of people on Medicaid and people who dont like to buy medical insurance runs into millions, plus the free Care and treatments at all Emergency centers for non buyers (who could really afford) and for non documented people runs into Billions of dollars which has to be borne by the the Tax payers every year.
With so many private insurances refusing to pay for different treatments, for cancer, for kidney dialysis, different diagnostic tests, many surgeries or only paying partially. We are only getting desperate and getting frustrated, What worse could a Fed Govt run program be? Medicare for elderly and disabled is one good program and a testimony that the Fed Govt medicare health program has been running and has been managed properly until now (eventhough there is talk of medicare cut backs,etc from long time which did not happen). Including everyone in the health care program (including freebies, non buyers,etc, ) is called the ObamaCare. With more and more baby boomers getting eligible for Medicare, more and more people should be paying into the health system to cater to the need of every individual health needs. Reducing millions of freebies who do not take responsiblities of their health, Hospitals and medical emergency places should not be continued to be treated as some Social welfare places by these millions of uninsured, underinsured, or people who can afford but who do not take responsibility of their health or who don't want to pay into the system.

Out of control greedy doctors, pharmaceutical cartels, and the medical industry in general....shame on you with your unbridled materialistic greed and exploitation of disease for profit.

Going $230,000 in debt to train 11 years in order to open your tobacco clogged artery at 3:00 a.m. is not exactly a good reward for the greedy, Mr. Cynical.
There's more money to made in business than being a doctor whose reimbursement is tied to whatever govt'/ins. compainies dictate. I don't know of any docs that make millions a year running their practices, but I know of plenty of CEOs that make that and more.
But don't fret Hippocrates. As reimbursements come down to the level of expenses, your "greedy doctors" will be leaving the profession soon enough, and the college aged will look at the years and costs of training and say it's not worth the aggravation.

They can't help it if they are forced to work in a country that requires people to pay for their health.

Medical doctors in the USA pay a very large part of their income for medical insurance. It varies hugely according to their specialty and the state in which they work. Most of us could support a family very nicely on the high rates a surgeon pays.

I have had my negative experience with the US Healthcare system that makes me eager for the type of solutions you point out. I really appreciate the 'Outcome' oriented approach outlined in both this piece as well as the associated documentary, given my own training in TQM through work.

I also appreciate the obvious inclusion of Physicians in this effort as they have got to be looking for a solution that places the Hippocratic oath back on the table.

The cost of healthcare and pharmaceuticals is high in America due to slip and fall doctors and people who are sue happy. If you truly want to decrease healthcare costs set a maximum of what a doctor or hospital can be sued for, unless it is proven that the said entities are being sued for Gross Negligence. If you do this then you will see a reduction in the cost of healthcare based on thew reduction of what a doctor must pay for malpractice insurance. A government ran healthcare system is not the answer. There is a reason for a $3 coke and gas at $5 per gallon in France and this is due to the fact everyone pays for the so calle "free insurance." America does not need this Socialist agenda used here and there is alos a reason why cancer isnt treated as well in other countries as it is here in America. Governments can not run a healthcare system and hope to put money into research and development to help against the fight of diseases it just doesnt work. These forms of healthcare will fail and continue to fail. Here in America we DO NOT DEPEND on the government to supply us with things. We do it for ourselves. That is what is means to be called the Land of the Free and Home of the Brave. And that is how we like it.

"If you truly want to decrease healthcare costs set a maximum of what a doctor or hospital can be sued for..."
Here are some quotes on that from an article in the Cleveland Plain Dealer: "In 2005, Missouri capped non-economic damages at $350,000 per defendant
and made it more difficult for cases to be filed in Jackson County and
St. Louis -- venues seen as favorable to plaintiffs...

But -- and here's where the debate gets sticky -- overall health
care costs in Missouri continue to rise. The same is true in states that
have enacted even more stringent tort reforms, such as Texas.

"Which suggests that a tort system run amok is, at best, only a small contributor to the nation's health care costs."

Tony Head,
Please do not share conservative and outdated propaganda in this thread. You can always visit Fox News, they welcome comments like yours. I am suggesting you gather all of the facts and report to us what our (US) government is controlling, providing, and regulating as of today. Based on your comment, you will be shocked and most likely you will not respond to my challenge. :D

Tony, thank you for the summary. It is clearly obvious you are brainwashed by the conservative media and your surroundings. Please do not take this personal, I deal with people like you all the time. And surely, we don't need our government to control and/or do things for us. Please, before you post here your conservative propaganda and believes from 18th century gather facts and see what our government does control daily. I am pretty sure you will be surprised. Yes, gather facts before you post here. If I have offended you in any way my deep apology.

Twenty years ago an anesthesiologist told me his malpractice insurance was $100 thousand per year. Can you imagine what a gynecologist pays today? A doctor is the only one producing revenue in a small clinic. That revenue must be distributed to staff, supplies, taxes, utilities, and rent of building and equipment. I suspect Obamacare will drive more doctors into retirement or into hospital staff positions. Small towns will be greatly under served.

Can it be calculated what US health costs would be if one simple step was taken...namely, forbidding any and all non-tobacco cigarette ingredients that are known toxic and carcinogenic, and are un-tested?

For starters, ban pesticide residues, especially dioxin-creating chlorine chemicals, and chlorine-bleached paper. Also, ban use of radiation-contaminated phosphate fertilizers, and formaldehyde, and ammonia, burn accelerants, addiction-enhancing substances, the many kid-attracting sweeteners, aromas, flavorings and soothing substances, and the non-organic industrial waste cellulose used as "tobacco helper" or even as entire contents of a cigarette. (No labeling of that is required even by the most "concerned" anti smoking officials.)

Since many so-called "smoking related" illnesses are identical to symptoms of exposures to pesticides, radiation, and dioxins, and since many of those diseases are impossible to be caused by smoke from any natural plant, the path is obvious...to save lives and money. To not demand removal of such contaminants is a huge and undeserved gift to the cigarette industry...but if public officials are economically beholden to many parts of that industry (including their insurers and investors), we can see why the focus is only on blaming the victims and the conveniently-"sinful" natural plant.

Life expectancy is determined by how you take care of yourself, not what your healthcare system does for you.

You seem to miss one MAJOR point of differentiation...end of life care, and who decides when to stop providing treatment.

This is the biggest unspoken piece to the puzzle. It's a topic that is ugly, uncomfortable, and difficult, but also critically important if we are talking about how to allocate medical resources to improve outcomes without increasing overall cost.

When it comes to cancer care, the US advantage is distorted by what is called lead time bias. The US does more screening and finds more cancers, including ones that won't kill the person who has it. The 5 year look back exaggerates the survival time.

Our Healthcare system needs to have more competition to bring costs in line. How about Medicare putting together medical tour groups to overseas hospitals for knee replacements. Two weeks in India, new knee, resort living while recovering, half the cost to medicare? Many happy results reported by some who pay their own way. Johns Hopkins runs a hospital in Panama-similar outcome.

Maybe Americans should allow the Canadians to compete with them.

I used to have the typical U.S. expat attitude that life in other countries is as good as or even better than the U.S. Based on my expat experience, I do have good things to say about health care in some countries - especially France. But experience following a very serious automobile accident I was in has taught me that when you are in real trouble, the U.S. really does have the best health care in the world.

I agree with LowaExpat comment but I am still perplexed
about less talk about quality of care for each patient per dollars. Do American
paid top dollar for excellence healthcare or not?
I understand good healthcare
is important for me but also encounter many citizens declared rather have more their
money than the government controlling their healthcare even they don’t have
one. This very interesting problem needs to be address.

I have spent time in US hospitals and Canadian hospitals and there is a night and day difference between them in how you are treated. In my most recent contact with an American hospital I walked in the door and was confronted with a large sign in which the hospital talked about its mission and its focus on quality care for the patient, avenues in which you could comment on your experience. In a Canadian hospital you are an inconvenience, even though they like the number you represent when it comes to their reimbursement.

Not sure which hospitals you're refering to, but the ones I've been in (in the US) couldn't care less about you. If you have insurance, your odds of getting treated with respect go up, but its certainly no guarentee.

I've had two serious operations in Canadian hospitals and was treated well. Private room excellent surgeon. The big difference was that I had no worries about money. After a four day stay the doctor came in and asked me if I felt like leaving. I said yes. He said great, arrange a date for a check up. I packed my things waved goodbye to the nurses and walked out the front door. No papers no sign. No worries about financing or whether my insurance company would retroactively refuse coverage.

I was never treated as an inconvenience in any Canadian Hospital and I have been in more than one in my lifetime. A couple of times with serious Injuries.

Really?? Which hospitals and for what? I have experienced both and don't recall anything about which you describe. Canadian hospitals were just as effective, and didn't require a 'meeting' in the finance office.

one thing for sure health care will get worse with obamacare.
ask your doctor why.

Yes, I'm sure you're doctor will be unbiased.

I earlier commented that the U.S. does have the best health care in the world - I know from experience living in many countries abroad - and PBS has taken my comment down - twice. I found out the hard way that U.S. health care is the best in the world after being in a serious automobile accident abroad.

does this include the extra tax paid by citizens of the other counties to pay for this 'free' health care?

Healthcare has to be paid for somehow, do you agree? I would rather pay a smaller amount to a single payer system where the goal of the system is to ensure better health for all citizens, rather than pay exorbitant amounts to an insurance company whose only goal is profit at my expense, and to whom my health means exactly nothing, and to whom I have to beg to get treatments even when prescribed by a physician.

In Canada health care is paid for out of tax revenue like SS in the U.S.. Roughly half is covered by the provinces half by the feds. There is no other charge for most procedures. In some cases you can pay for things like MRIs and other tests if you wish. It varies from province to province. Health care is the largest part of most provincial budgets.

Yes, it includes tax payments.

Wow the way these stats are presented is absolutely deplorable. Every chance the author gets to twist around a stat to prove his biased opinion is taken advantage of.. For example .. Compare life expectancy to Japan? Just so happens he randomly selected the country with the longest average life expectancy? Or stating 3000 less .. Instead of saying 5000 suggests a greater gap than is actually there when read quickly .. Deplorable article ... Every nasty trick in the book is used and reused in this filth

The author also compare the US to all the other OECD countries. And... the US is below the OECD average despite spending far more on health care.