- If you compare dollars spent on typical illnesses in the US, in Canada (universal single-payer system), in Great Britain (universal government-run system complimented with pay for service/insurance for those who can afford it) and in Germany (mandatory, often subsidized insurance based in workplace) what are the differences? In other words, I'm not looking for percent of GDP overall, I want to know how much it costs to have a baby, get your gallbladder removed or treat stage one breast cancer of a particular variety. I want to know how much well-baby care costs, how much a knee replacement costs or how much cataract surgery costs. How much are birth control pills? Pap smears? And by cost, I'd like to know both the cost and the amount the typical patient pays out of pocket. Take some typical patients and follow them through the system. What happens? Who decides? Who pays? What does it cost?
- I want to know what you get for your money in each of those cases. If you are having a baby, how many ob visits, how many ultrasounds, how long do you spend in the hospital (and in the US, if there is a difference for the insured and the uninsured, I'd like to know that too). If I get a positive mammogram, what happens here (assuming I'm insured, and assuming I'm not) and when does it happen? What about there? What are the survival rates? What if I have back pain? What treatment options are available, and how do I go about getting them?
- I want to know who gets my money (or the patients' money in other countries). How much do doctors make? Nurses? Nurses' Aids? Hospital administrators? Drug companies? Insurance companies? Insurance company employees? Government employees?
I personally think we need to define the problem before we can solve it, and right now I don't think it is defined. Is our problem that Pap smears cost so much that women can't afford to get them without a government subsidy? If so,why do they cost so much? Who is making the money? Do they cost what they do only because they have a steady source of customers willing to pay that amount--in other words, if demand for Paps went down, would the price follow, or would they even go up in price because of economies of scale? Is our problem that too many women who don't really need Pap smears are getting them , or getting them too often? Or, are Pap smears something that given their current price, if they weren't covered by insurance, that the average American woman would consider money well spent to have one as often as she currently does? I said Pap smears just because they are a regular part of healthcare for many women; you can substitute any other medication or procedure and ask the same questions.
How much of our total healthcare bill is for relatively normal items, and how much for extraordinary things? In other words, if you spend $1,000 per term healthy baby for hospital care after birth, and $100,000 for care of one premie, (those numbers are just made up, but you get the idea) and the cohort you are studying has 99 normal babies and 1 premie, the total cost for hospital care for newborns is $199,000, or an average of almost $2000 each. However, no baby cost close to $2,000. Is our problem that normal doctor visits cost too much, or than treating cancer costs too much, or both? If so, how do we bring the cost down?