Good Comrades, I have done some analysis. The conclusions must never see the light of day, or else our grand glorious plans will be ruined!

Here is the analysis so that you know what to look for when denouncing those who might bring these items up:

Medicine and Healthcare: What are the ways to contain medical costs in the US without a single payer system?

In short, it ends up coming down to repealing any law that grants anti-competitive privileges to any health care providing organization. But I'll start by addressing the myths propagated by both the left and right and exposing them as negligible.

It can't be attributed to any of the factors that are often touted as root causes.

First, as most often promoted by Republicans, medical malpractice suits:


The dollars spent on medical malpractice suits are trending down. Even at their peak, they were less than $20 billion dollars.
One doctor's personal perspective on it:
Medical Malpractice: Myths and Realities

To put those numbers in perspective, the net expenditure on health care in 2012 was pretty close to$2,700 billion. (I left it in billions so it's easier to put the numbers side by side).[Another common argument on tort reform is that the cost of defensive medicine is high and is 100% attributable to fear of lawsuits. But a Price-Waterhouse-Cooper analysis indicates that defensive medicine accounts for only $200 billion, a paltry amount compared to the total cost of our health care system. Furthermore, since care providers profit from ordering "defensive" procedures, there is no reason that eliminating lawsuit phobia would reduce that expenditure]

If 100% of all medical malpractice dollars were to cease, that would put us down to . . . $2,680 billion.
Wait, what? I thought all the costs were coming from ambulance chasing lawyers!
Funny how putting numbers on things makes you look at them differently.
(note: I personally support some form of tort reform, but not because it will be a big cost saver).

Next on the list, cost as most favored by the left as the root cause,uncompensated care and shifting the cost to those who pay.
Note the scale again: billions. In 2010, the total uncompensated care added up to $41 billion.

Compare that again to the net spending:$2,700 billion.
It's more significant than medical malpractice,but it's still insignificant compared to the total spending.

Now for another lefty myth:uninsured people's costs being shifted to insured people:
If we assume that all 15.4% of uninsured people are paying absolutely $0 on themselves and 100% of their costs are being shifted on to us, and that they don't get any more or less in care than the rest of us do, how much would it reduce everyone else's bills?[furthermore, the Center for Disease Control has analyzed the ER usage behaviors of the insured and uninsured, and have concluded that their ER use habits are identical. Only 6% of all ER use is for "preventable" conditions," and that same statistic applies both to the uninsured and the insured.]

About 15%. So . . . following the rate of health care inflation, that would put the insured person's costs to about the 2011 or 2010 rate.Gee, that sounds like where all the costs are coming from, doesn't it!
But it doesn't reduce total expenditures. At all. Just the insured person's expenses.

By the way, those who choose not to pay with insurance can bargain with the billing office to set up payment plans to pay in cash significantly less than the bill -- and in fact less than the insurance company is willing to pay out.

Another favorite thing to look at, occasionally mentioned by both left and right but not as often as it should be:Allowing drug re-importation.

It looks like they're on to something at first glance, but wait until I get to the actual impact to see what I think.

Here's the price of Plavix by country:
Nexium:
Here's an average in 2005 and 2010, normalized to Canada:
Now . . . what would happen if people could buy genuine pharmaceuticals in any country and import them to the U.S.A?

First, the price in the U.S.A. would drop dramatically. After all, if you can buy 10,000 pills in Canada for $1/pill and sell them in the US for $1.20/pill, you make yourself 10,000 x $0.20 = $2,000. And at $1.20/pill, that's a lot cheaper than the $1.91/pill they're being sold for here, so I can guarantee you'd have a great market of buyers.
Second (and there always is an unintended consequence), the prices everywhere else would have go up in order to compensate for the lost US revenue. Countries with single payer systems are able to keep the cost of medicine down by saying "we will not pay more than $x for this drug," and drug companies have been okay with it because they can just pass the cost of R&D on to US customers. So either the other countries will end up having to pay more or they'll just stop buying the drug. In either case, the US isn't the sole source of R&D compensating revenue and is no longer shouldering the burden for the rest of the world.

The question isHow much would it drop?
In 2007, the total spent on retail pharmaceuticals netted around $225 billion. If I make the assumption that it hasn't moved much since then, that the cost of pharmaceuticals will drop to become equal to everywhere else, and that big pharma will be okay with getting the same margins in the US as everywhere else, then it will cut roughly in half, down to ~$120 billion. That's theupper bound on cutting, assuming the average is average of all total sales.

Compare $120 billion to $2,700 billion. It's certainly a lot more than any of the previous numbers, but still doesn't add up. Not to mention that $120B is an upper bound.

What if I assume that the revenues are coming from high-margin blockbusters with price differentials comparable to Plavix?

Then that puts a cutting boundary down a lot further. Without actually using a calculator, let's say it cuts it to ~$30B total spent, so just to be generous let's say it saves us $200B. (Not using calculated numbers, just really rough estimates on the proper scale).

Now compare that $200B cut to the $2,700B total. That number is still good, but it's still not enough to call it a root cause.

This is getting really fun now, isn't it?Arithmetic is a harsh mistress and she doesn't care about your political opinions.

Now on to some real good stuff: lack of price transparency and lack of level billing.
Andy Grove, former CEO of Intel, had a really interesting insight into this problem. Here's an article he wrote that was published by Wired magazine:
Peeling Away Health Care's Sticker Shock
He brings up, as one example, the cost of an appendectomy. First, it's impossible to find out up front. Then when you get the bill, it could be orders of magnitude different than somewhere else.This is without complications -- just the routine procedure!
Some of his sources:
The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy
How much does an appendectomy cost? Somewhere between $1,529 and $186,955

What would happen if we were to enforce level billing in health care -- that is, the hospital must charge the same amount for the same procedure under reasonably similar conditions, and must publish their price or be subject to lawsuits for racketeering and/or billing fraud -- how would it change the total costs?

Fortunately we have an example of a health care entity that has done just that -- TheSurgery Center of Oklahoma.
The prices for most of their services are under $10,000, including the anesthesiologist, pre-and post-surgery consultation and follow-up care (see:https://www.surgerycenterok.com/p...) I don't know about you, but that looks pretty close to the minimum there.
The catch? The prices they post are the cash prices.

If we use the median price and assume all the prices are at the median (not a good assumption as the total money spent is skewed toward the higher side), but makes the math easier), then assume that level billing would fix prices closer to the Surgery Center of Oklahoma (a decent assumption, as the provider wants to attract patients to their facilities), then that brings the total cost of procedures down to about 1/3rd of what they are now.

1/3rd. That brings $2.7 trillion down to$0.9 trillion.

Now we're getting somewhere, aren't we?

Now for another fun fact:Unreasonable markup by providers.

Here's a background story for that claim:
$80K Bill Stings Worse Than Scorpion
A woman was stung by an Arizona Bark Scorpion, which sting can be lethal if untreated. She rushed to the hospital and received the treatment. Her treatment was simply to be injected with two doses of Anascorp, a relatively new scorpion anti-venom. Each dose of Anascorp is distributed to hospitals for $3,800 -- expensive, but just wait. The hospital billed her $80,000 -- that is, about $40,000 per dose.That's a 40x markup!No, it's not a 400% markup, it's a4,000%markup.

What's worse is that the drug is available in Mexico, where it is made, for about $100 per dose.The 40x markup to the hospital could be understandable given drug reimportation laws, but to add an additional 40x markup is insane!

And no, this is not an isolated incident.
Hospitals mark up cancer drugs by 10 times their value
Cost Spotlight: A 443% Markup on Prescription Drugs
There are hundreds, if not thousands more articles on different ubiquitous instances. If you have ever been to the hospital and have been given Tylenol, Aspirin or Ibuprofen, you should have looked at your bill. $10 for a single dose? Are you kidding? At that price, I would have called my wife to drive over and buy me a whole bottle from the corner store instead of accepting it from the hospital!

The cost differentials and massive markups point to only one possibility:
The medical system is a monopoly or cartel.

Only a monopoly or cartel can get away with that kind of crap. A real market, with the rule of law properly enforced (such as thehttps://en.wikipedia.org/wiki/She...andhttps://en.wikipedia.org/wiki/Cla...) would introduce competitors who still make large profits -- large enough to make them filthy rich -- by undercutting the competition by doing the same thing but with greatly reduced markups and perhaps slightly reduced margins on services.

And there is clear legislation that establishes medical providers as effective monopolies:https://en.wikipedia.org/wiki/Cer...laws. There are plenty of other supplements that protect the monopoly status of providers, but CON laws are a large part of the root of how the monopoly/cartel is maintained.

Certificate of Need laws require any prospective provider of any medical service (such as running an MRI clinic) to obtain a certificate of need from the local hospital or largest care provider, where that largest provider indicates that the new prospective provider will be providing a service that the largest provider cannot supply enough of.

For a fair comparison, it would be as if you invented a new microprocessor for computers, all entirely with your own architecture and intellectual property, but you had to go to Intel and ask for their permission before you would be allowed to sell it. Do you think Intel would give you the okay if it had the potential to take any market share from them?

Enforce Sherman and Clayton, and repeal any laws that grant exceptions to them.

Comrades, this information is devastating to our position. We must hide it at all costs!

I feel we need to hear a rebuttal from a Feelings Czar.

Dedhedvedev wrote:I feel we need to hear a rebuttal from a Feelings Czar.

It is all right. Peoples who cling to Dear Leader probably cannot read numbers (or cursive) anyway, so they will not be deceived into leaving him.

Science Czar, take two People's Cubes and call me in the morning.

You're welcome. Oh, and that'll be $30,000.

Comrade Otis
Doctor of Dictatorship
Karl Marx Treatment Center

Aw, darn. Those peoples cubes give me a massive headache.

*gulp*

Oh, well, at least it's better than converting from the Party.

I'll just get the Money Czar, Comrade Bernanke to print me up your payment. It's not like it's worth anything anyway.

Dear Czar,

Each dose of Anascorp is distributed to hospitals for $3,800 -- expensive, but just wait. The hospital billed her $80,000 -- that is, about $40,000 per dose.That's a 40x markup!No, it's not a 400% markup, it's a4,000%markup.

I believe an errant zero has invaded your keyboard. If the hospital pays $3800 and sells for $40,000, how is that a 40x increase? Is this the new math I hear so much about?

Captain Craptek wrote:Dear Czar,

Each dose of Anascorp is distributed to hospitals for $3,800 -- expensive, but just wait. The hospital billed her $80,000 -- that is, about $40,000 per dose.That's a 40x markup!No, it's not a 400% markup, it's a4,000%markup.

I believe an errant zero has invaded your keyboard. If the hospital pays $3800 and sells for $40,000, how is that a 40x increase? Is this the new math I hear so much about?

Nay, you have misread. Prior to that point I indicated the sources of the drug, which when considering the 10x markup by the hospital combined with the 4x markup between the distributor and the company, it's a 40x markup. Furthermore, it is manufactured in Mexico for about $100/dose. When I stated the markups, I ignored the markup from manufacturing to initial sale across the border, allowing them the benefit of their *spit* profits.

Comrades, we all know that the only chart or graph that matters is this one:

Science Czar wrote:

Captain Craptek wrote:Dear Czar,

Each dose of Anascorp is distributed to hospitals for $3,800 -- expensive, but just wait. The hospital billed her $80,000 -- that is, about $40,000 per dose.That's a 40x markup!No, it's not a 400% markup, it's a4,000%markup.

I believe an errant zero has invaded your keyboard. If the hospital pays $3800 and sells for $40,000, how is that a 40x increase? Is this the new math I hear so much about?

Nay, you have misread. Prior to that point I indicated the sources of the drug, which when considering the 10x markup by the hospital combined with the 4x markup between the distributor and the company, it's a 40x markup. Furthermore, it is manufactured in Mexico for about $100/dose. When I stated the markups, I ignored the markup from manufacturing to initial sale across the border, allowing them the benefit of their *spit* profits.

Confusing. Why not just import more poisonous scorpions into the USSA so more doses are needed and bring the price down. Now THAT'S clear thinking!

Captain Craptek wrote: Confusing. Why not just import more poisonous scorpions into the USSA so more doses are needed and bring the price down. Now THAT'S clear thinking!

Craptek, you are brilliant! We can start by releasing them at any and all TEA Party conventions and town halls where those rambunctious kkkapitalists may be!

Science Czar wrote:

Captain Craptek wrote: Confusing. Why not just import more poisonous scorpions into the USSA so more doses are needed and bring the price down. Now THAT'S clear thinking!

Craptek, you are brilliant! We can start by releasing them at any and all TEA Party conventions and town halls where those rambunctious kkkapitalists may be!

Comrade,

I had a load of these little Mexican creatures crated and ready to ship to Texas. But alas, Comrade Meow found a hand drill!

Captain Craptek wrote:

Science Czar wrote:

Captain Craptek wrote: Confusing. Why not just import more poisonous scorpions into the USSA so more doses are needed and bring the price down. Now THAT'S clear thinking!

Craptek, you are brilliant! We can start by releasing them at any and all TEA Party conventions and town halls where those rambunctious kkkapitalists may be!

Comrade,

I had a load of these little Mexican creatures crated and ready to ship to Texas. But alas, Comrade Meow found a hand drill!

Mexican Food.jpg

Proper care must be taken to ensure Party Apparatchiki are not interspersed in said Tea Party crowds. Look for Racist and Nazi Party related signages.