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Costs were definitely lower, but so was technology. An MRI machine is insanely expensive. Newer medications are extremely expensive. Robotic and virtual surgeries are the best, but are very expensive. What we are able to treat and how many more lives are saved is truly an amazing thing. If we want things to progress, someone has to fund it. We're really feeling it in Detroit with the unemployment rate over 7% and, the majority of those now laid off were also the ones with the best insurance (UAW) and we have no publicly funded hospitals in Michigan, unlike some other states (which is a problem at our state level).
Some argue that health care is not a right, but I will argue the other way. I can't see saying "Sorry, you're poor or underinsured, you die".
It most definitely is a complex issue. The way contracts for payment from insurers are figured is very screwy too. In the adolescent psych day treatment program I worked at from '94-2000, our cost per patient per day was $254. Blue Cross would negotiate a contract with the hospital to say "Well, we really like your cardiology services so we'll pay full price for that but we're only going to pay $150/day for your adolescent program and we'll call it even". So, we actually lost money on kids who had Blue Cross. Medicaid was more like "We'll pay 50% of your fee" so we have to set our fee at double what we need them to pay to break even. Another HMO might pay full price. Trying to budget what is going to come in based on the mix of the insured is nuts. Yeah, that program closed, even though it had great outcome statistics, it lost money. The inpatient psych program closed too. There are now no adolescent psych units at all in Wayne County, the county that Detroit is in. Patients who end up hospitalized have to go as far as 60 miles away. Nobody wanted to pay for it. It's tragic. Adolescent suicide rates have increased in this area since and the juvenile justice system has become overwhelmed with a lot of kids who actually need psychiatric treatment.
Emergency Rooms are the most expensive form of treatment but they are being used by those without insurance in place of primary care physician office visits because they are not allowed to turn people away. This has created so many issues from cost, to overcrowding, to "real" emergency treatment being delayed because they are overwhelmed with people who just have the flu, etc.
Overall, if you look at the model that hospitals try to operate under, it's ridiculous. I know there are for-profit hospitals in some states but in Michigan, all of them are non-profit. Any income they make has to go right back into the health system, mainly for capital improvements, expensive medical equipment, computer infrastructure, etc. It's easier to draw this, but I'm sure you can picture this.
Non-profit hospital in the center. Then you have all kinds of for-profit corporations feeding off of the hospital system: pharmaceutical companies, medical equipment/supplies, malpractice insurance companies, housekeeping and IT contracts, housekeeping supplies, food and food services, technology supplies... These hospitals, which are giving away tons of free care are being sucked dry by all of these other companies. Then people will argue that the doctors are making a ton of money. Well yeah, doctors make a lot of money. Don't you want to pay someone who is doing your brain surgery a lot so that you attract the brightest and best to this field? The people doing every day care are NOT making a lot of money. Even the accountants, IT people, etc. are not making as much as they could in other industries. The lowest paid employees in health care are the people who doing the most direct care.. the nurses aides/assistants.
We're down to three health care systems willing to keep a hospital open in Detroit and one of those is constantly teetering on the verge of bankruptcy. The only reason the other two systems can stay afloat is because their surburban hospitals carry them. There are health care systems that will only operate in affluent suburbs and don't give away any indigent care too. One of the things they've tossed around in this state is that all hospitals would pay a tax to the state which would then be redistributed to the hospitals that are providing the indigent care as a means of spreading the burden. Doesn't that sound insane in and of itself? (even though it would greatly benefit the health care system I work for, it still sounds crazy to me)
We want to have the best technology, the best care possible. We want hospitals and doctors to do everything they can to "fix" us, but *someone* has to pay for it.
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