1) There is 2% in medical malpractice insurance cost. Most of it ends up in the pockets of lawyers, filing weak cases to score in the lawsuit lottery.
2) There is 10% defensive medicine.
3) There is 20% spent on worthless end of life care that tortures dying old people, solely motivated by a need to protect oneself from litigious, scapegoating, greedy, family members.
4) There is at least 20% for unproven, gold plated worthless regulation and accreditation standards. As the authorities impose phony standards of care from evidence based medicine, shouldn't the authorities prove that every new standard imposed at the point of a gun has been proven to achieve better patient outcomes. This requires pilot studies and controlled experiments in every larger settings. All new standards are garbage science until proven otherwise. These accrediting and licensing authorities should be sued every time they impose their garbage standards.
5) There is 10% overhead for insurance disputes and billing. This includes about 2% ($31 billion) just to deal with insurance forms, reviewed here (requiring free registration). The lawyer has immunized these HMO companies from any accountability. Even valid claims of insurance bad faith will fail. They are now huge, mature industries. They no longer need unfair and unjustified immunities. Strong lobbying efforts should end their unconstitutional immunities. The first lawsuit should be for the free labor, and its resulting unjust enrichment, pre-authorizations being for their benefit, that they intentionally forced from doctors, something like $trillion.
6) There is the cost of medical errors, perhaps up to 5%. Every medical error is caused by the lawyer. Instead of thorough investigations and system changes to prevent them, errors are covered up because they will take down the entity when lawyers get a hold of the reports. Such reports are testimony against interest, an exception to the hearsay rule. Every word will be blown up in a poster or Power Point in front of the jury, and read aloud, over and over.
7) There is the retention of incompetent, unethical, and dangerous staff, costing another 5%, because employment lawyers would destroy the place if they were fired.
8) There is more self-care. People are fully capable of learning how to diagnose and treat a higher level of disorders than cuts and colds. Make many non-addictive medications available over the counter, most of which are safer than those available one, in use and in overdose. People should be able to read about the management of a minor, non-lethal ailment, its medication management, then to take a low dose of a medication over the counter. The package insert should be written at the sixth grade level.
9) The biggest untapped mine of medical advance, at no additional cost, is the off label use of many medications. End the draconian punishments for off label promotion by drug companies. And fund a lot of research into exploiting the medication we have now. One person's horrible side effect is another's life saver. Headache patients accidentally died from unknown internal bleeding caused by aspirin. The blood thinning side effect has saved countless heart attack patients.
Get rid of the oppression and plunder of the pestilential land pirate, and health cost would be 50% lower, have higher quality, with errors nearly gone. And, you would have enough money left to buy the uninsured top of the line executive grade health insurance.
8 months ago