David Belk

December 7, 2013

I am David Belk. I'm a doctor who has spent years trying to untangle the mysteries of health care costs in the US and wrote a website exposing much of what I've discovered AMA!

The name of the website is The True Cost of Healthcare: http://truecostofhealthcare.org

I've also written blogs for Huffington post which can be found here: http://www.huffingtonpost.com/search.php/?q=david+belk&s_it=header_form_v1

And here is my proof that it's really me doing this: http://truecostofhealthcare.org/proof_for_reddit

I have to sign off now because my wife is getting angry about the fact that I've been on the computer for eight hours without a break (I'm also starting to get delirious) Thank you all for your question and I really wish I had time to answer them all but, if I tried I would probably end up in divorce court. I'll try to answer more questions tomorrow.

I'm back! The wife and kids are in bed now so, again, AMA

Got to go for the night. My eyes are starting to gloss over.

I'm Back if anyone is still interested AMA

do you like hamburger

Are we overcharged? Is it true doctors just write prescriptions to get more money? What is your stance on vaccines for babies? Are they more dangerous to get then to not get like some people claim? Edit: I apologize, I submitted the same question twice. No need to answer twice.

Do you believe universal health-care to be a possibility in the US in the future?

Yeah, sorry, I was thinking single payer.

You would like it to happen, though?

This one of the reasons I think the US needs to break apart into a handful of smaller countries. If this happened, certain parts would very likely implement European-style single-payer systems and finally make some progress, without being held back by the other regions.

Would you agree that it has to do with the fact that there are too many insurance companies with too much money in politicians pockets? Being in the insurance billing industry for over 20 years, I very strongly believe that this is the reason that we would never, ever get to socialized medicine, or a single payer universal health care due to the number of lobbyists from every single major insurance company (BCBS, UHC, Aetna, Cigna, to name a few) that has too much money in too many politicians pockets.

I would love to hear your response to my comment.

Agreed. So, it seems to all stem down to politics and money. How would you propose this being changed? If not for "every" industry, but for the health care industry, which you are an expert in?

What about state by state? A few states lead by example first.

Have you ever watched John Bergman's videos on You Tube? If so, do you believe "If diet is wrong, medicine is of no use. When diet is correct, then medicine is of no need." ?

It's true. My grandmother lived on her own until 89, still taking care of her house and lawn and growing vegetables. When she required care, after rarely having visited a doctor in her life, she lived until 94, lucid to the end. My father is now 86 and gets quarterly checkups but still maintains his own place and drives. He never would have gone to a doctor either if my mother hadn't made him. I know that's not the norm but it does support your statement.

What are your thoughts on the subject of improperly tested meds being rushed through their clinical trials by an FDA that accepts "consultation" fees from the same drug companies they're supposed to be monitoring? How often would you say dangerous drugs go to market without proper testing or necessary rejection, and how many lives are affected?

What is your stance on getting your baby vaccinated? Some people think it is worse to vaccinate your baby then to not. What do you think?

What can be done, realistically, to change the view of healthcare in the U.S. and to get people to wake up and make a change? Also, did you see Michael Moores doc. Sicko, your thoughts on it?

Mind expanding on what you thought was wrong?

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Because of this...the numbers of different bills one occurs from one stay in the hospitals, I don't believe limiting hospital charges would be enough to fix our system. I think we need a system that places realistic prices on all specialists, tests, labs, etc. Not just the part the hospital charges. Although the hospital charges are most likely the most inflated.

I used to get a yearly exam from my doc for a little over 100 a year. Now because he has joined forces with our local hospital, and billing is through them, the bills for the same visit have been $350 and $475. Thank goodness I had Medicare, but it was affordable for me without insurance until he joined the hospital. Now without Medicare I'd never be able to see him. And he's just a family practice doctor...not a specialist.

Is there a way to ELI5?

Whenever healthcare is talked about, the concept that we are the "only western" or "only 1st world" country that exists with this ass-backwards medical system is always thrown around... How come our government/population is so complacent with this standing? It blows my mind that that statment can be so casually spoken without ANYONE being embarassed and subsequently affecting any change!

The only use for pennies is to keep yourself from getting more pennies.

And despite a few attempts we have refused to adopt the use of dollar coins which would save our economy billions.

Great post but USA HAS adopted Metric system

I am a Norwegian, who have lived in the US. When I follow the health care debate in the US, it seems to me that American's are generally unaware or simply refuse to believe that it is better anywhere else. There is all this scaremongering about socialized medicine and what not. If all I knew about alternative health care systems was what was thrown at me from American media, I would not dear change either.

What would be your ideal healthcare system? I.e. What country do you believe has it "right"?

What do you think of this PBS Frontline episode that examines five different national health care systems? http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

My extrapolation of the way hospitals work is that they'd react to a cap by doing the shittiest, half-done job, bill you for the full amount, and run you right out the door...

Also superfluous billing items. Yeah he came in for a mole removal, let's add a full urinalysis, blood work, and semen analysis, 5-day hospital stay, 12 different medications, 8 "expert consultants", and full-body x-rays.

Price controls? Really?

That is a great documentary, I highly recommend it

Why do you think price caps would work on a national scale?

our system is messed up in a ways, but to say that their are no good things about it is sorely misleading, and it sounds like more of a political statement than some truths..

I was just in the hospital, came in to the ER for high BP, they hit me with Lorpressor, one bag of saline in an IV, and one day of my regular meds. They billed 745$ for pharmacy. 745$ I figured that if I paid what I pay the pharmacy the pills would have cost me less than 10 bucks,

Do you forsee any downside to implementing this across the country?

Why don't you interview a non-biased hospital president? Would you like an email? I can provide one for you. If you're going to investigate healthcare systems, why don't you investigate the bullshit stories that go with it?

Plus, a state-by-state system would appease a lot of right-leaning centrists like myself who want the federal government the fuck out their business.

So you dont believe putting a cap on bills would have any negative effects, such as creating service/care shortages or destroying wages? I believe that hospitals charge so much in order to offset the lowball number the insurance companies pay out, since they only pay a small percentage of whats actually billed anyways. So does this mean the hospitals are at fault, or the insurance companies?

Price controls?

I agree that they overcharge massively, nobody is disputing that. I just feel like trying to introduce a nation-wide cap on a service industry's pricing can create shortages, among other possible negative effects that are unknown. I acknowledge that this would still probably be a better solution than what we have now, but i wouldn't base legislation on one isolated example of success... Just playing devil's advocate here.

I don't know if I can take your study/website as a whole seriously if you omitted the role of the AMA as a powerful player in resisting change to the current system.

What makes our system so unique is that it seems to found a way to have all the flaws of every other health care system while avoiding any of the benefits.

Complete garbage. I think that's actually worth calling a lie.

What about the argument that statistics showing national cancer survival rates seem to say Americans do get the best health care?

make data available to consumers. have a website that lists hospitals/doctors prices.

while avoiding any of the benefits.

Correct me if I'm wrong, but does not a lot of medical research, breakthroughs, and development happen in the US?

I wasn't looking to be "happy" I was just asking a question.

Perhaps. Too much reddit can do that to a person.

while avoiding any of the benefits

That's simply not true. Having lived in many countries, America definitely has the best health care system if you can afford it. The problem is that most people can't afford it, but if I got seriously sick I would choose a good American hospital ten times out of ten.

Well, cancer is one of the top two causes of death (would be interesting to see some cardiology-related stats). Don't mistake me as a flag-hugging 'murican; I posed the question simply because I believe in challenging my beliefs whenever possible, and I presume you have a better answer than this, as amusing as it is.

What do you think of this PBS Frontline episode that examines five different national health care systems? http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

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Interesting blog post! In it, you write:

California hospitals billed an average of nearly $4 for every dollar they received [...] California hospitals report their bad debt losses each year, and it averages less than 2 percent of what they bill, not 75 percent

If California hospitals bill $4 for every $1 they receive, what's happening to the other $3? If it's not bad debt, what is it?

What are your thoughts on accountable care organizations? Will they bring down costs and improve care or will they make not much of a difference at all?

That is the big question. In the Hospital we have something called the 30-day re-admit rule. I.e. If you get re-admitted within 30 days of a previous admission for whatever reason the Hospital gets $0 for the 2nd stay. I love the concept of preventative medicine, in theory it makes a ton of sense. But how do you provide incentive to Docs/Hospitals to get people to not use their services. In reality because of denial in payment for things like the 30-day re-admit rule. We need to provide follow up and take certain measures to ensure they stay out of our Hospital not because we get paid for it, but because we will be denied payment and eat the entire cost of labor/medications/everything else if we don't. Its more stopping the bleeding than it is profitable.

I live in the UK so I don't know much about your healthcare system, but I'm curious: the general consensus over here is that people in the USA might be avoiding going to see medical professionals due to the costs. Do you think this is true at all?

This makes me feel seriously ill to watch. Bad enough to be ill but then to be ripped off by the ones who are supposed to help look after you, that's unbelievable. I hope this changes soon.

You seem to be doing a great job :)

Hi, I'm the head actuary of a workers comp insurance company. Can you please explain why you seem to be putting the blame on insurance companies for what is clearly medical providers overcharging using inflated sticker prices? Insurance companies that can't effectively negotiate prices go out of business, there is nothing 'in it for them' to negotiate bad prices. Could they do better? Probably but it's disingenuous to blame them for the provider's billing practices.

Billing fraud is a very common problem in the provider community and there are always tons of bad apples who are inflating prices, upcoding charges and prescribing less effective treatments that make them more money. Providers offices will close and open across the street with a different legal name so they can continue their shakedown operation.

Insurance companies have to negotiate prices with practically every provider entity in the state in order for them to have adequate coverage, it's impossible for them to always get the cheapest price.

In the last decade provider consolidation, particularly with hospitals and certain high need specialists, has caused providers to capture huge pricing power and the ability to force large increases onto the insurance companies. There are areas where provider groups are operating with near monopoly pricing power.

Using insurance companies as a scapegoat is part of what got us to where we are now because it allowed us to ignore the real underlying problems.

Have you presented to a government funded emergency department in a large metropolis? Because literally 70% of what we see on a daily basis are

• the homeless
• people who don't understand how the medical system works

They come into the UCC or ED for med refills. Over half the time, it is for narcotic pain killers and they leave pissed when we tell them that we don't treat chronic pains. Isn't education the true issue at hand?

I am in Texas and did not mean to across as divisive. I agree with many of your points, but feel that a fundamental problem with current system is how it addresses patient education. It is a huge, huge burden in the UCC and ED.

Being Canadian an living in the USA I have had the chance to end up using every aspect of the system. Insured, uninsured and in Canada free.

Even though I have a really good insurance plan now in the usa I can wholeheartedly say that this country and its people have been shoveled so much bullshit it's mind boggling. The system is unfair and the worst in any country I have visited. It's a "for profit" sham that has ruined the quality of life for so many humans that the government should be ashamed.

The people are so brainwashed it saddens me. They refuse to believe a single payer government controlled system will make the country so much richer and stronger. They only need to look north to see it in action. Yet they refuse.

As someone with insurance I can assure you its still a minefield of what will and won't be covered for whatever dumb reasons.

How is this possible? I live in Australia and I've never payed a cent for GP appointments or Lab tests or X-rays.

How can the richest country in the world not have free health care. Isn't it a human right?

UK here too and we soon forget how lucky we are to have the NHS and how great it is. We take it for granted how we can go see a medical professional for free (you have to pay for some dentistry and other things). But then I think that everyone should feel like that.

The NHS is the nearest thing we have to a national religion. No politicians would dare try and change the basic principles of that.

We certainly do not pay provider sticker price, if that's what you're claiming. However we have the luxury of the state setting reimbursement rates for 95%+ of procedures. This doesn't stop providers from trying to charge us the sticker price though.

Look most of what you've said is correct but then you inexplicably keep trying to blame or insurance companies for actions taken by the hospital:

"He'll pay, out of his own pocket, 4 dollars for every dollar of care he gets, all so the hospitals and the insurance companies can pretend medical care is way more expensive than it actually is"

What? You said the insurance company is the buyer... sometimes that buyer is desperate and has to pay the $80,000. How can you possibly conclude that insurance companies are purposely paying $60,000 extra just to 'pretend medical care is way more expensive than it actually is'. That's like blaming an uninsured person for getting stuck with a sticker price bill.

No the truth is hospitals price gouge any sucker they can. Private insurance, work comp, medicare, medicaid, the uninsured... it doesn't matter. If you didn't negotiate a price ahead of time they will bill you an insanely high 'usual and customary' charge. Insurance companies are in the exact same boat as an uninsured person. If you work out a price ahead of time you can get a decent price but if not you'll get price gouged.

Here again: "This recent LA Times article shows how insurance companies have found ways to punish people with high deductible policies by getting them to pay hospitals more than even the uninsured pay."

No it really doesn't. This doesn't help insurance companies at all. If anything it costs them more money as patients burn though their deductible quicker. All this shows is that providers are practicing classic price discrimination. The lowest price is reserved for the most price sensitive meaning cash payer. If you have insurance or HSA then they will charge you more because on average you are richer and less price sensitive. There is no way you can blame the insurance company for how the provider chooses to bill people.

"allows both insurance companies and hospitals to randomly and arbitrarily victimize unsuspecting people on a daily basis"

Again how is the insurance company randomly victimizing people? By being forced to pay confiscatory prices that take money directly from their bottom line?

"As long as so many hospitals and insurance companies can continue to amass huge fortunes through obscuring real prices and confusing people"

Wrong. Health insurance is one of the least profitable industries. I suggest you listen to an excellent episode of Ira Glass's This American Life called Less is More. This is the best piece of journalism I've ever encountered on this topic. His conclusion about insurance companies was 'Insurance companies are not always as powerful as you would think.'

Can you see Obamacare leading up to Universal Single payer? IOW, is it possible that Obama re-packaged RomneyCare as a stepping stone to achieve the eventual goal of necessitating a single payer system?

Understood.

It's my opinion that we need to adopt a German-style health insurance system coupled with a Japanese-style fixed billing scheme. If I break my ankle, it should cost $xxx regardless of who my insurer is or where I got the cast installed. If I need treatment for early-onset Lyme disease it should cost $xxx regardless of my health insurer or what medical firm or hospital is providing the medical help.

You have hit the nail on the head in this regard.

How do you feel about patents and how they are used in pharmaceutical firms? These firms spend billions to find a drug that help save lives. Should they be able to sell their product at a higher price?

I have year-round sinus congestion issues. There is a nasal spray that almost completely eliminates my symptoms (heavenly!) but it would cost me about $140/mo to purchase it. My insurance doesn't cover it and there's no generic.

What's your take on this? It's not life threatening, so should I just live without? Do you think that it's reasonable for a drug company to charge that price with the help of the government (preventing other companies from producing the same drug)? Something else?

Veramyst is the one that really works.

It's not often I get to school an attending and get away with it. So here goes. Veramyst is not Flonase.

Source:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147057/

at costco

Is this the same stuff at £7 ($11) ? http://www.boots.com/en/Pirinase-hayfever-0-05-nasal-spray_12408/

Since this is on the topic of med costs, I'll ask you:

I've been using generic doxycycline for years. It's never been a high cost thing, only a few dollars a month. Suddenly it shot up to $200+. With insurance. The pharmicist doesn't know why. What's the deal? Fortunately I was only taking it for acne, so I just dropped it because I didn't need it that bad. But seriously, can you explain it?

What do you think of needymeds.org. I've seen it used at a volunteer pharmacy I help out at.

Isn't fluticasone going OTC next year?

Would a better reform of healthcare in the US have been to rein in costs rather than to make the changes the Affordable Care Act is attempting to make?

That's a great idea. For the motorcycle accident you referenced in the article, what would the cost have been in the Maryland hospital system, instead of the Sacramento, CA hospital at $31613?

Also, would it stand to follow that the monthly premiums paid by healthy individuals under the Affordable Care Act mandate would be substantially lower if the Maryland system was enacted nationwide?

There needs to be more transparency with what the healthcare insurers are paying for these procedures. Not the bills. The hospital can bill whatever they want. But it doesnt matter. They get paid whatever the insurance company contracted with them.

The problem is the insurance companies are scum, and they deny payment when it is due. They are profit making machines. And they are the main reason why the "bill" is so high. But if you break down the collections the numbers start to average out.

I think you are way off base with your analysis of healthcare "costs". You are analyzing the bill sent to the patient. That's not a cost. The cost only comes once the bill is paid. These numbers are inflated, everyone knows that. The numbers are inflated to offset all the Zeros they collect. The hospital will set the bargaining chip high, with the knowledge that they won't come close to collecting that number.

Why do you look at these numbers and say that the healthcare costs are high, when hospitals are losing money left and right? Do an analysis of the bills versus the collections.

Is there anything that can realistically be done to stop the monopolization of medical supply companies? Part of the reason hospital visits cost so much is the fact that the supplies are ridiculously overcharged by the few approved suppliers.

As a libertarian, my belief is that monopolization through overregulation is the main reason for the insane price of healthcare. I'm curious about your ideas of how anti gouging laws would work better than a lowered market regulation allowing for (at least I believe) more competition within the healthcare market driving down prices.

Totally disagree with the latter point. Regulations always help to create an unfair advantage for someone. Lack of regulation means a level playing field. People would go to the provider that was either the best price or the best at what they do.

Of course there were, it was called Feudalism. You can't "beat everyone up" if you don't have an unfair advantage, and the only way to get an unfair advantage is to have the rules work in your favor.

What measures to do you take so as not to be killed by the government?

I want to believe that you're kidding… But I have this nagging feeling that you're being completely serious.

As a soldier who know's a thing or two about sniping, just because there are no tall buildings around doesn't mean that a sniper cant get you. Just thought id let you know that:)

On the other hand, I'm a busy and sporadic person and I can firmly say I have not been sniped yet.

If the government wanted you dead or detained, you'd be dead or detained. End of story.

David Belk, thank you for the work you are doing. I have seen your work in the past and even cited it in a paper I wrote.

If I ran for President of the United States, could I hire you in as one of my advisers if I got elected? If you accepted, what would be some of your immediate policy advice (list a top 3 or a top 5...I know you're probably short on time. If you can give a super long and thorough answer, that'd be great)?

Quick question about your price-cap idea, as that seems to be your main point. If there were price caps on medical products, wouldn't that create a shortage, as the hospitals and medical companies would begin trying to cut costs where they could, such as salaries of nurses and doctors, which would lead to less people entering the medical profession, leading to overworked medical professionals and hospitals that couldn't keep up with demand?

Also, many people fear that if the cost of health care went down, research would decrease. While I'm all for lower health costs, research is very important too. How valid are those fears?

What are your thoughts on people who abuse the system? I work in health care, and it seems to me that the people who are the most abusive to our current system, are the people for whom everything is subsidized. If we simply give everything away for free, what are the incentives to lead healthier lives?

What made you decide to do this research?

I noticed that on your website that you put every single aspect of the health care system on the list of why it's so expensive except for one: providers. By providers I mean physicians. Why did you leave that out?

If you were given full power to rewrite out healthcare system from the ground up as you saw fit, would you do something completely new? Mix and match of different countries?

I'm American, was recently travelling in New Zealand and Australia for 3 years. My house mate hurt himself on a rock surfing once and I drove him to the hospital, they did tests, gave him pain killers, they thought he ruptured his kidney. After 7 hours he left (he was fine, week off work with painkillers) and didn't have to pay a dime. I should point out we were both long term travelers, we were working full time and paying taxes, I think it's different for people just passing through.

Anyway, I've broken my arm twice and have seen first hand what a clusterfuck the American medical system can be, and was amazed at how awesome it was in New Zealand.

I remember a post on reddit a few weeks-month ago showing how these tiny little metal hospital trays cost $700+. If memory serves, the poster compared it to the corruption/over pricing we saw during Taft's presidency, do you consider this an accurate comparison?

in this context it's mainly referring to massive markups on price where corrupt people are pocketing the difference.

Are you familiar with the recent conflict between the FDA, DEA, and drug manufacturers over amphetamine quotas (which has caused a significant spike in the cost of Ritalin and generic equivalents)? Do you have any thoughts on what could be done to prevent situations like it?

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The current system under the ADA requires persons to have Health Insurance or else that person will face a fine. I know alot of people who are between the ages of 18-25 who find it cheaper to not have Health Insurance and pay the fine, and recent polling supports this trend.

Do you see a problem with this trend of younger healthier people not entering into the system?

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The owners of Reddit should step up and do something really important for this society that will cost them very little, simply by leaving this post at the top of the Reddit website for a few months, instead of "featuring" other irrelevant post that they like to feature on top. Do it Reddit, do it for this nation, this guy is exposing a lot of things and is showing us how to deal and pay for health issues and most importantly how to impact the healthcare community in a huge way.

EDIT: Who ever gave me a month of reddit gold thank you! I was never expecting anything from anyone for just typing a comment i felt needed to be said, thank you so much, I'm not sure what to do with it though :/

You wouldn't have to keep answering questions necessarily. Just keeping the information already giving at the top would be helpful.

No offense, Dr, but in this age of web development, your site could really do with a visual overhaul. I am guessing that thousands more people would read the information you are trying to present with some simple upgrades to the way in which you've constructed your site.

Or just convert it to a WordPress template and call it a day. A couple of pictures, graphs, charts, etc and you're good to go.

As it stands, its pretty awful and uninviting.

(I know this is an AMA, but I would really like for people to read what he's wrote and form their own conclusions, and I believe reformatting would do a great service to the work he's performed).

What do you think about doctors' salaries in the US? How should they be changed, if at all?

How much of the cost of health care is attributable to the fact that insurance policies, for lack of a better way to put it, are trying to nickle and dime you at every step of the way? In other words, at what point do the bureaucratic costs of administering all of these various plans, all of which are ridiculously complicated, exceed the cost savings of denying care?

Would you please explain what you mean by 'protection racket'?

Remember when HMOs were all the rage? The pure HMO has declined significantly, mostly because of two reasons. The administrative costs were so high that a great deal of the savings was lost. And nobody liked them (except those who earned a living off of them).

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How can QALY be used in this country to reduce the cost of health care?

For a half second i thought this was about Doctor Who. :(

Did this really happen and I missed it, or are you joking?

I would to tell you my situation, then you could comment on it.

Several years ago I had to have an umbilical hernia (I was an adult) repaired. I did not have health insurance of any kind and so paid cash for everything.

So, in my state, no specialist or surgeon will see you unless you first get a referral from a GP or family care practice....

It was obviously something that required surgery, since there was this soft fleshy bit poking in from the side of my navel; I had already diagnosed myself before I was able to get to my GP. I go in, tell him I think I have a UH, he pokes and prods for a few minutes ... yes, he agrees. ** Bill: about $140 (first time visit adds about $75 over a regular visit).**

Surgeon's visit - I pay one price, $850 or so, for all consult and the surgery itself. Note that the surgeon is the guy who is most responsible for the patient outcome in all this! I think I visited him 1 or 2 times prior and 1 time after surgery.

I have a prescription for an abdominal CT scan. I call around - the 2 hospitals in the area want between $2750 and $4000 including interpretation.

I remember an outpatient imaging place that my wife used a while back for an MRI - we call them, and find out that one of the above hospitals, BOUGHT THEM OUT AND THEN SHUT THEM DOWN - why did they do that, doesn't make sense or does it???...

But, they have 1 independant place that the hospital did not buy, still running in a depressed area 3 hours' drive away. Their price? "Well if you pay on the day of service with cash or credit card, the price is $264."

It gets better - the owner of this imaging clinic, who sold off the other branches to the big hospital? He is the Head of Radiology Deparment at a well-respected hospital about 1 hour away. So the hospitals bought him out, only because he was undercutting their prices!

CT scan in hand, surgeon ready to go ... I check out surgery prices at the places the surgeon has privileges at...

Hospital 1 - flat fee, about $3500 Hospital 2 - won't give me a price over the phone - because they charge by the minute! And it will matter if the OR is used for 45 or 55 minutes as to the price ... note how stupid this is, because ORs are not utilized anything near 8 or 12 hours a day, continuously

** Shiny-new Surgical Center, cleaner, less hectic, nicer nurses, etc. - $1800, but, "oh, if you pay cash or credit card on the day, the price is $1200"**

Anesthesia - $660 (note: almost as much as the surgeon, just for a nurse anesthetist!)

Add up the difference between what I paid cash for and what the "retail price" was ... to me, the shocking 10X difference in abdominal CT scan makes you wonder, "what exactly, is a fair price for CT scans?"

I welcome your comments on any part of this.

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I even have insurance. I have traicare dental through the military (im a spouse) and I used up my entire years worth of insurance with one root canal.... Sometimes even with insurance you get boned... Oh I also had to pay for half of it out of pocket... My dental only covers half of anything but "preventative" is 100%, and that is REALLY GOOD dental apparently.... If the prices weren't so ridiculously high, it wouldn't have used up all of my coverage... Oh and it was a $2600 a year coverage, and think about it, I payed half and it still used all of that, so that is nearly $5200 for ONE root canal and crown, and that is with the price insurance companies get!!!

Thank you so much. I know everybody is sharing horror stories, so here's mine: I had surgery for kidney stones a few months back and beforehand the hospital quoted me a figure as my cost, the rest to be covered by insurance, and we set up a payment plan for six months. Two weeks post-op, I started receiving bills from the hospital, and somehow my out-of-pocket expenses had gone up by several thousand dollars. I also started receiving nickel-and-dime bills (from $15 up to $300) for doctors and radiologists and labs, and I'm still getting these even now. My six month payment plan will now take around four years to pay off total, and I'm paying a few thousand more than my out-of-pocket maximum according to my insurance policy, but any attempt to fight it meets with derision and hang ups. One billing specialist tried to tell me I shouldn't have had the surgery if I didn't understand the word estimate. If I don't pay, I'm worried it will ruin my credit.

Scam hardly seems like a strong enough word, really.

When are you doing to hire a professional web designer to make your website more appealing to read and navigate through?

I think a really easy route to go would be to use a content management sytem like Joomla, Wordpress, or Drupal. All of which have great support groups here on Reddit and it's very easy to keep them maintained versus updating a non-content management system website.

if you need help, just hit me up

Would you be receptive If I put something together and sent it to you?

A doctor can't afford a website?

Prices aren't like they were two decades ago. Clean web design can be implemented for less than $200.

Why don't you start a kickstarter campaign. I am sure you would get tons of funding to get underway with a mass marketing campaign.

Edit your home.htm file, line 23. Move the letter 'e' to the other side of "</strong></span>". It current displays as: The True Cost of Healthcare. Actually just take the <strong> tag out in general. It could really go.

Open your theme.css file, line 37. Change 'Times' with 'Helvetica'. I replaced Times because Times screams 'old internet'.

Difference: http://i.imgur.com/1bOBLoT.png

This is hardly a complete fix, but it's a step in the right direction (in my opinion, of course) but it's a step nevertheless.

edit: Judging by the code it looks like you're using a WYSIWYG editor. Hopefully you can reflect these changes in whatever editor you're using.

Hi Dr. Belk. I don't know if you are still here, but I am a web developer, and I believe very passionately that American's deserve better care, and that more generally, we deserve a government that actually tries to solve problems. Under a few conditions, I would be willing to volunteer my services to help you get the site up to 2013 standards. Please PM me. I can and will help you.

One thing to note is that the copy is a big part of the reason your site looks so bad and you don't really need a designer to fix that. Get rid of the all-caps text and the sentences where each word is capitalized. Get rid of the exclamation points. That stuff makes you look like a crank.

Edit your home.htm file, line 23. Move the letter 'e' to the other side of "</strong></span>". It current displays as: The True Cost of Healthcare. Actually just take the <strong> tag out in general. It could really go.

Open your theme.css file, line 37. Change 'Times' with 'Helvetica'. I replaced Times because Times screams 'old internet'.

Difference: http://i.imgur.com/1bOBLoT.png

This is hardly a complete fix, but it's a step in the right direction (in my opinion, of course) but it's a step nevertheless.

edit: Judging by the code it looks like you're using a WYSIWYG editor. Hopefully you can reflect these changes in whatever editor you're using.

many people rely on medicare, now doctors are starting to stop accepting medicare patients. what is the easiest political solution to this?

Where are you practicing? Medicare is one of our lowest by about 10%. We tend to be on the low end of reimbursement compared to the rest of the state (Rochester, NY). You must be even worse off.

I'm from the UK so only know about the NHS, which is heavily overstretched but in my opinion a very good healthcare system. From my very limited knowledge of the US system, it seems so messed up that in a western country that one hospital admission can bankrupt a person if they are not insured, which leads to patients not getting health issues checked and causing further distress to the family during medical emergencies.

What do you think of the British system(pros and cons)? And what would the implications be of implementing the British system in the US?

What can I do to help you?

I enjoyed the part about the "free" samples. My first "chronic pill taking" was for a psychiatric disorder, and when i got my first prescription it was the first time i'd ever been prescribed something other than Allegra for allergies. I was given a free sample of Lexapro, which at the time had no generic. It cost $200+/month before I hit my deductable, and even then $50/month after. And when I raised a few concerns about it my Dr. suggested I stay on it for over a year. After I finally decided it wasn't working, I was switched to a med that would "work just as well," and go figure, had a generic. Since then I've been on four different drugs (I'm hard to medicate and the initial diagnosis wasn't correct anyway), all of which had generics. But when I have to find a new doctor, they ALWAYS want to give me Lexapro (which just recently got a generic) free samples first.

You know what feels good? Paying less than $20/month for three generics (instead of $300+ brand-name) before deductable, and $0 after.

Course now I'm re-thinking the pricing of those generics, but still.

Wow. My co-pay just went up to $40 for 3-months of my blood pressure meds, and apparently Costco sell a years worth for <$30. I'm indignant, but I just want to be clear who I should be mad at: my insurance co., the drug makers, Rite Aid, the terrorists, or all of the above?

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I would fully support some kind of kickstarter program for you. I'm sure many of us would.

http://www.kickstarter.com/hello?ref=homepage

I want people to see this which is why it is not a pm. You have a phenomenal point, but your website is sensationalised like a scam to attract unintelligent people. Present your findings and research in a less pissed off way and you will attract more fans. I understand your frustration but do not let it affect your presentation of the powerful material you have found.

I will admit I am lenient towards conservative, and I obviously dislike Obamacare. Everywhere I look everyone keeps saying "single payer system."

My problem is, I don't trust the government enough with all the scandals, corruption, and no money to pay for my insurance. Does the single payer system have some way to avoid that? I don't want it to end up like the IRS and targeting people based on their political views.

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Not to be an over simplification, but is Obamacare as currently written good or bad for America?

Do you have any qualifications in economics?

I have MS so I take a specialty drug called copaxone. With my insurance my copay is/would be over $6000/month. That's gone up about $1000 in the last year. Since there is no way that amount is even remotely affordable I'm able to qualify for the copay assist program. That brings my bill to about $35/month. The organization that admins the copay assist is the manufacturer. So, do they write off the balance? Their reaping in money from my insurance and essentially waiving the cost to me. How is this? Are taxpayers having to foot the bill? How and why is this happening? Do you know if obamacare will address this issue is any way?

This is very relevant to me. Can you provide some source material on drug manufacture cost vs. price? Especially for Copaxone?

My girlfriends dad is a pharmacist; he only has one client who takes copaxone he said its a very expensive drug - no generic and he pays a lot for it. basically he said your list of medications on your YouTube were all cheap drugs and out of the thousands of medications you found a list of 70. I'm assuming your speaking of the pharmaceutical company is making all the money because he's making literally dollars on the prescription

Monoclonal antibodies that are generic are called biosimilars. The FDA has already set up a process for biosimilars and the first biosimilar came out November 2013 (tbo filgrastim). Many monoclonal antibodies will be coming out in the next 3 years.

It will be tough for companies to prove similar efficacy. The increase in research to make a Mab, production costs, and possibly trial data will result in less of a discount. For generic drugs it is about 30% cost of brand, right now for biosimilars it is 80% of brand (for tbo filgrastim and from what I've heard). Hopefully as this new area progesses the FDA will be able to streamline the process lowering the barrier to entry while still making sure there is safe and effective care.

I'm curious how you come up with your $50 generalization? Does this include R&D, navigating the cumbersome FDA trials process, etc. or simply manufacturing?

I wasn't providing an opinion either way, just wanted some clarity on how you arrived at that number.

The current pharma model is high risk/moderate reward. As I watch the big companies cut back their pipelines and focus on specialty products and smaller disease states, I start to wonder what impact it will have on innovation.

What is wrong with the Affordable Care Act? Why are so many people, including those who don't have healthcare, against it? I really want to know why it's bad for the country.

So do you personally think it's good for the country?

Is insurance strictly needed? (There are many things we buy that do not involve insurance companies.)

Is it not in the interest of insurance companies that health care becomes increasingly expensive to firstly, scare people into buying insurance and, secondly, justify high premiums?

How do we know that without insurance in fact many of these things would be affordable? (Could be paid on time, if extremely expensive.)

Mathematically, making a bet with a negative expectation is hard for me to swallow.

Hello, and thanks for doing this AMA, I'm a premed student who's studying for the MCAT at the moment.

Do you have anything you'd like to impart onto students who are looking to get into health care, given what you know of its financial hardships?

What role do you see mhealth or other wearable technology in driving down costs?

mHealth- using mobiles as a foundation for different smart apps / addons to help people manage their health better

http://en.wikipedia.org/wiki/MHealth

Wearables - any sort of technology that's worn instead of carried. eg: http://www.misfitwearables.com/inspiration/wearables_saving_lives_since_1975

Thankyou very much for your time though :)

That's dedication.

Slightly not relevant, but you may know anyhow. Why is it that doctors can bill whatever they fill like after the fact. Anything else you do, you're notified of prices before they get done. I recently went to an ENT doctor who looked at my throat, then I got a bill over $300 because he used a special tool. I think I would of dealt with the scratch in my throat if I knew it was going to cost $300. Thanks

Maybe a stupid question, but something I always thought would be obvious:

If end-of-life care accounts for so much of the cost, why not make living wills mandatory? (Could be implemented at every point of healthcare interaction, via the IRS, etc).

Death panel crazies wouldn't have to worry either because someone could still specify that they want all possible methods used to keep them alive, but I suspect that most would not.

This would also solve the problem of family members keeping them alive when they don't know what they actually want.

I've worked in home health care for the past decade. Despite the rampant misuse and fraud, do you believe home health an become part of the solution?

What it's the most earth shattering discovery of your investigation?

I mean if anyone were to be a little turned off by this, wouldnt it be the people involved in healthcare? I mean its definitely warranted, but arent you basically telling them their services shouldnt be as costly as they are? its logical, but a lot of doctors are narcissistic and driven by monetary gains.

You are fucking with their business model. I doubt they will thank you for it.

What about marijuana does it help with cancer!

Why isn't a cost-benefit analysis part of a doctor's treatment plan? It seems like we are spending insane amounts of money on people that are about to die.

I've had this with my great-grandmother. Her doctor recommended a pretty broad set of very expensive tests. He did a great job of explaining what we could find out. It turns out that no matter what the test told us, she was going to die. We didn't do any of the tests and instead focused on making her comfortable. The set of tests would have cost thousands of dollars and wouldn't have been any fun for her.

As a Brit, I'm well aware that our health service costs a lot of money to run (around £100bn/year) and tales abound of inefficiency and wasted resources, but in reality this comes out to around £1500 per person per year which seems like incredibly good value compared to the cost of US health insurance plans that I've observed.

Does health insurance in the US absolutely cost more than this? Is the cost due to insurance providers ripping off consumers, or just hospitals charging exorbitant rates for procedures?

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What did you think about the long article in Time by I think Bill Brill on how costs are passed on to the patients via the chargemaster?

It strikes me that if the industry could agree on a uniform chargemaster, things would be much better. Could this be done?

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What is your opinion of Kaiser Permanente?

As a PSW trying to become more integrated in the field, what is your best advice? I am taking many different certifications to help my chances improve and to help a wilder group if people.

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"Better" healthcare in Colombia? That seems a little ridiculous, unless you're talking about the cost. Everything I have read is that the quality of health care in the U.S. is second to none, but the problem is the price.

I honestly appreciate that you're trying to improve health care in this country, but don't you think you'll have more impact if you stick to facts and not throw out hearsay and anecdotes? If you can't factually back up a statement like that, with the particular metric that was supposedly "better", maybe it would be wiser not to make the statement.

Also, if you're ignorant of how the quality of United States health care (irrespective of price) compares to other countries, perhaps you shouldn't make statements regarding that, either.

Like I said, I appreciate the obvious work you've put into this. But just as a point of feedback, things like this make me question every conclusion you might make. How much else in your analysis is based on just "I only know what they told me"?

I hope this isn't coming off as too harsh, but if you want to influence people, as you seem to want to, I think it's crucial to stick to well-documented facts. Otherwise, you end up looking like (say) Michael Moore, who might have some good points, but it's buried in obvious sophistry.

Hi Dr. Belk!

I work in EMS, and I'm interested to hear what you think would be an alternative solution for all the people who call 911 to go to the emergency room by ambulance for things like hurt toes, colds/general sickness, toothache, etc. These people not only clog up emergency services but their insurance plans will not cover these non-emergency ambulance rides. On top of that, the ER becomes overcrowded with people who don't need emergency services, and the hospital has to shell out time, money, and other resources to care for them.

Any ideas on a better way to handle this?

As a UK medical student I've been considering working in America for a while.

However, the thought of turning someone down for treatment because of lack insurance/funds just feels fundamentally wrong!

The other day, I was talking with one of my supervisors, and he said something along the lines of: "Countries like the US spend a lot more of their GDP on healthcare costs yet can't deliver a service that is not as inclusive as the NHS despite the UK spending less of the GDP on healthcare".

I mean you hear about doctors ordering a lot of investigations and expensive tests to justify the costs they claim from the insurance companies... but were they really necessary? Do their results alter the patients treatment? It just seems wrong on so many levels.

But how and why has this come to rise? I mean surely with the amounts of money being spent in the US a more inclusive service can be provided. My understanding of Obamacare is that it covers the poorest of the poor. Why can't it go a step further to cover more of the population?

On a different line, I totally disagree with the culture of suing doctors that is well established within the US and slowing crossing the pond over to the UK! God help us and all the new and upcoming generations of doctors against these malpractice issues!

/rant

I'm a 2nd year medical student and I read your "conclusion" webpage.

What I’m proposing isn’t radical. We in the healthcare industry need to place an honest value on everything we do, sell our products only for what they are worth and involve a third party for payment only when absolutely necessary! In what other business would this be considered radical?

Doesn't that contradict what you said here?:

We all know how important an MRI can be, or an Emergency Room visit, and as long as people think an MRI really costs $4,000, and an ER visit costs $4,500, maybe they'll resign themselves to paying big insurance premiums, and we can all tell ourselves that it's the only way we can continue to have "the best health care in the world."

Healthcare costs a lot because people value their health more than anything so they are willing to spend/borrow/sell anything to get the care they need.

What's your opinion on these doctors and can their model be expanded elsewhere? http://www.surgerycenterok.com/

I'm of the opinion that healthcare costs are high because of the disconnect between service and payment. Not only by who pays but also when it is paid. Would a mechanic be content to receive his payment never or months later?

The cost/regulatory barrier to practicing medicine in the US (lobbied for in the past by the AMA which has recently began changing their tune) means that a doctor can often charge what most people would consider "dishonest". As long as healthcare demand goes up and supply of new doctors is limited, most of these suggestions aren't going to change the cost of healthcare dramatically without affecting the quality (queues and/or long drives to get certain procedures).

As a doctor could you tell me just how the affordable care act affects you and just doctors in general?

Is there any way to make health care costs public, so that everyone can see exactly what the costs are at all times? Not just what the hospitals charge, but what insurance actually pays, and what the actual costs of each thing costs? So if the hospital bills you for $1000, you can see that it really only cost them x amount, insurance paid out y amount, the bill to you was z amount, and v amount vanished into thin air by being waived, or by costs being reduced through deals, etc.

After looking at your website, I understand this is kind of what you are trying to do, but is there a better way to do it nationwide?

I have an underlying medical condition- Ulcerative Colitis. Got diagnosed about 6 years ago. Its fairly mild, controlled by daily meds. I'm under a low-key but always available 'watch' by my docs and nurses, and I can turn to them at any time. Case in point: I had a little bit of "gastric flu" last week for 4 or 5 days, and a bit of a lazy gut for a day or so afterwards. Got some cramps because I couldn't pass wind, called my docs to get an emergency appointment. In there an hour later, and he confirmed that all was well.

Now, I'm lucky because I'm in the UK, and this is all paid for out of general taxation. I'm a taxpayer. We get a better deal all round because of the economy of scale that a country buying its healthcare from providers can give. Its not perfect, but it sounds about 1,000,000% better than in the US.

What I've never understood is why those who defend it say that the American system is democratic, that other nations are 'socialist' (as though that's degenerative). Why can't America just see that they have a system that's designed to bilk them?

Why is an insurance based system preferred over a healthcare service funded directly from taxation? UK citizen here also.

So what's the way to convince people to see how bad the system is? I see a lot of information already about how bad it is but they never seem to take affect. Realistically, how would you convince people to read the information that you put on your website? What's going to stop someone and make them think, "hmm...I think I'll learn a bit more about how health insurance works in this country."

I'm an RN at a children's hospital in the US, but I'm looking for a change. Would you recommend home health as a growing field, or something else?

Many people get extremely comprehensive health insurance plans through work, since these benefits are tax free. The problem I see with these extremely comprehensive plans is that they make it so you don't care how much anything costs, since everything is covered and the co-payments are so low.

How can we expect medical prices to come down when so many people don't care how much anything costs?

I read recently that Vermont is adopting an all-inclusive, single-payer system that will be funded through Medicare, Medicaid, ACA money and tax increases (slight). Do you see this program working out for Vermont? As a follow up, what are the primary hurdles for other states instituting a similar system?

Thank you for doing this. I'm sure it's no easy task to navigate through the disaster that is health care.

My question is, how have the healthcare companies responded to you exposing them and their methods?

Dr. Belk,
I am a 45 year old male who is in nursing school now. I have been politically active for much of my life and this is an area that is near and dear - but I've been at a complete loss as to what to do about it. As a nurse, I feel like I'll have a voice to enact change in this arena; How would you recommend that I get involved? What can I do - especially once I'm an RN and work in a large-ish health-care system - that will help?

Mystery? What's so mysterious about profiteering?

Would you rather treat 100 duck sized horses or 1 horse sized duck?

thank you for doing this. hope i'm not too late. as an immigrant I'm amazed that Americans somehow "fear" government control of the healthcare system but have no problem letting healtcare insurance agencies basically doing whatever the flip they want. Am i right in this? and what do you think?

Damn, probably way too late for this, but what the heck...

Would it be possible to create a non-profit health care company, the healthcare equivalent of AAA?

It doesn't take much imagination to think that it could grow very quickly as it's costs for members would immediately be lower than the rest of the bloodsuckers out there. And then as it grew, it's purchasing power could then be used to drive down related costs. It's morally outrageous that these companies make the profits they do off the literal pain & suffering of this country.

What country has the best health care system, and why is it Denmark?

Dr. Belk thank you for this AMA. I was just accepted to medical school and hope to be part of a movement towards positive change.

Thank you.

Any advice for those of us just starting out (most doctors tell me to stay away, or be a PA)?

How have people tried to discredit you? Have you been physically harmed or threatened?

If you could sum up why it's so expensive in a reddit response, what would you say?

the biggest driver in our health care costs are attornies.

How big an issue are lawsuits and malpractice insurance? I suspect not as large a part as we're often led to believe.

Why is the health care in the US so expensive?

I lived there for a couple of years and my impression was, that the system was broken beyond repair. As insurance costs so much parties involved on all levels ( e.g. doctors, hospitals, medical devices makers) are more likely to charge a lot as a general rule. Is that a correct impression?

I'm a physical therapist, and we are constantly fighting an uphill battle for reimbursement and authorized visits as well as seeing a growing trend of patients coming in with $40-60 copays (PT for 2-3x/wk for several weeks can start to really add up). Any thoughts on these "specialty" areas of health care and what we as providers can do to be better advocates for patient access?

One thing I always hear is that ER costs are so high because the uninsured use them. However, I also hear that ER costs are low as a percentage of healthcare spending (reason.com and politifact.com). What are your thoughts on the laws the US has in place to accept ER patients unconditionally (with triage, of course), but that does not reimburse the hospitals that are effected by the mandate?

What are your thoughts on Epic? (and/or the EMR bonanza over the last few years in general) Specifically the fact that a majority of hospitals purchasing the software end up with lower bond ratings, bloated IT costs, and (arguably) limited improved efficiencies leading to cost savings?

I'm going to have to disagree with you on a part of this...

The sales process in these EMRs goes on for more than a year in most cases. "Sight Unseen" isn't correct - although "sight unseen" by the employees who will have every aspect of their daily life upended is accurate.

That said - you mention "my practice", which makes me think you are/used to be a primary care physician, and at most, worked in an office with less than 10 doctors. In that case - I can't speak from experience in that market and I could very well see where you do have to make a purchase with very little information.

Is it safe to say then, that the primary driver for your purchase was the fact that the government came up with Meaningful Use and basically said that you HAD to have SOMETHING...or else. My understanding is that practices like yours in the last year and coming year (2013/2014 - as penalties are starting) essentially have two choices. (1) Buy your own (POS) EMR, or (2) Join up with the local 'major' hospital and get an extension of their platform. (Most hospitals are pushing this method as a model for growth right now within the community and increasing the speed of consolidation in the healthcare market --> which will either lead to increased prices (less competition) or lower prices (scale of economies) ...all depending on which theory of economics you believe will prevail.

My mother is dying of cancer and I sold my jaguar to help with costs. Apparently since my mom is catholic she has some charities that can extend a helping hand to her so she's finally getting the care she needs. But what a fucking nightmare this healthcare system has been.

Thank you so much for doing all this.

do you receive any attacks from the religious right?

what country do you think "does it the best"?

Do you prefer taco stands or chain restaurants?

What are your thoughts on currently-available health care price transparency tools like Castlight Health and HealthCare Blue Book?

Disclosure: I'm an engineer at Castlight Health. Curious to know what you think of the potential for impact here.

Do you think deregulating the health care market is the solution, or have we just implemented the wrong regulations?

I would disagree. You think businesses that did stuff like that would stay afloat and people would continue to buy their products?

The company doesn't exist today because everybody forgot about the incident. That's not how the free market works. They were most likely bailed out. More importantly, are they still poisoning kids with antifreeze? and is it only because of government regulations? I would say that morals would and a desire to stay in business would keep businesses developing high quality/safe products

Sorry if this is a duplicate, I scanned through your answers quickly before writing this. You seem to suggest that capping the amount hospitals can bill as a way to help healthcare costs significantly.

However I don't actually see how this addresses a huge problem that I came to understand working at a CAH. EMTALA requires hospitals to treat all people the same in an emergency situation (stabilization and transfer at bare minimum, and who is going to accept a transfer of an uninsured patient). So when uninsured people have massive, costly emergencies, the hospital system eats that cost. Consequently, they overbill anywhere else they can to keep themselves in the black.

With the caveat that yes, most hospital system administrators salaries are INSANE, and yes some hospitals are doing quite well financially, how do you propose we address the problem? EMTALA requires hospitals to spend money they won't get back, which especially in CAH and the like would quickly eat them alive if they couldn't overbill elsewhere. I certainly would never want anyone to be turned away from emergency medical care, but the question becomes, who foots the bill when the patient can't?

Can you list 5 things( that contribute to high costs) that should tackled head on first? Things are the readily fixable.

Based on what you know about the ACA, do you feel it will bring in enough revenue to break even and bring costs down enough to be effective?

I think a major first step is to have a system in which you can compare apples to apples. A universal code system where the code for each item, like an 80mg aspirin is listed the same for a hospital, insurance company and billing system. This way you can, as a consumer, can see what is charged by hospital, what is paid by insurance and the additional cost like billing system per transaction costs. Don't think its not much? Your talking 100 of billions.

cant the U.S just increase everyones income tax by like 0.7% and then for every medical thing ever at non-private hospitals, the government pays ? im pretty sure thats how they do it in my country (australia) 1% or so of our income is taxed and goes towards medicare, and whenever we do anything, from see a GP to getting neurosurgery, you just tell them your medicare number and thats it, you dont have to pay anything, including hospital stays. we have private clinics and stuff too, they take the government money AND charge out of pocket, but our public healthcare is the bomb so no need for private clinics i understand this would be harder to do in america at the federal level, but maybe the state level? what are your thoughts david?

Approximately how much money would the country save if everyone followed a whole-foods plant-based (vegan) diet, therefore greatly reducing rates of obesity, diabetes II, heart disease, etc?

How much blame so you put on physicians? Many act as though they are burdened by insurance companies, but they turn a hefty profit through them.

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No offense, but your website has very poor visual design. I hope you find a visual designer who can make it more inviting to read. Stark color scemes, a scattering of wordy titles and fonts, and huge paragraph blocks of text are major turn-offs for the average visitor, unsure if they want to read it or not.

Any thoughts on the medical school system in the US? Is the high amount of time and money required worth it or are there things that can be changed to make it more similar to, say, the UK model?

The idea of putting a price tag on life/death is quite disheartening...

I know I'm late but I'm just letting you know that I agree with your movement 100% and that I wanted to thank you for actually confronting it head on. It takes balls, and you got some big ones. I'll be sharing this website every chance I get. Good luck my friend!

I suppose you are familiar with the articles of Steven Brill, like the recent Bitter Pill: Why Medical Bills Are Killing Us in Time? There seems to be a lot of overlap, but I don't find Brill cited anywhere on your site.

Confession: I haven't read that article (don't subscribe to Time) but Brill's discussion with Ira Flatow on Science Friday covers the main point, which is that the ACA contains provisions that would go far toward clarifying the healthcare marketplace but the administration hasn't gotten around to writing the regulations that would implement it.

Commenting to read later, looks like an awesome AMA

you said

the price of all medications and medical services should be easy to access the same way the price of everything else we buy is.

Sure, All well and good. But drug prices fluctuate wildly. and frequently. and drastically. Who's going to keep this list up to date and accurate? Sometimes us people in the pharmacy don't even know the price has gone up as much as it has until we get the invoice. just make sure they can't spike the price up 1000% because of a "raw ingredient shortage" or at least require them to prove it.

What did you think of Michael Moore's Sicko documentary?

I just watched your talk with the Alameda Rotary Club video and you absolutely blew my mind at several points. I'm a paramedic and about to finish nursing school and I thought I knew a lot more about the finances of the healthcare system than I actually did.

Thank you for that extremely eye-opening video.

My only question is this. Do you think there could be some alternative structural solution to providing healthcare financing to the average American? I'm thinking of some sort of healthcare-cooperative that people could pay a subscription fee to be a member of, that would negotiate with labs, pharmacies, and hospitals on behalf of the cooperative members at the true market values rather than the inflated nonsense we see in their billing documents.

Does such a thing already exist? How would people create it if it did not?

Thanks for the work you are doing. This is an important message to get out there and you seem to be doing a great job. I hope to see you on the major networks and making the daytime talkshow rounds someday soon.

EDIT: Hell, Oprah might be interested in your message. I'm sure the majority of her viewers certainly would be, at least.

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If you could sum up your findings in 1-2 sentences, how would you state it?

Have you considered writing a guide to finding and comparing a reasonable health care plan?

Since you are aware of the confusing nature, it would be really helpful to have some sort of guidelines concerning deductibles, copays, and prescription costs.

Do any of your proposed findings or solutions involve Tort Reform?

I have a high deductible health plan, so I always want to avoid spending money on procedures. I always ask how much a procedure costs when a doctor suggests it. It is absolutely amazing to see how little doctors know about billing. They have no idea how much anything costs because no one ever asks or cares. Do you think high deductible health plans are a good way to get consumers interested in health care costs?

One of the biggest costs for a medical practice is PAYROLL. Maybe we should get patients to file charts, clean surgical equipment, and wash dishes in the cafeteria in exchange for services rendered. Medical barter system. I'll remove your wart in exchange for snow plowing our driveway.

I've read that 60-70% of all Bankruptcies in the US are due to medical bills. Medicine for profit is part of the problem. What the f@#k is wrong with our species? NO money = no life. Good luck with that humans.

Robots son. Lots of robots.

Where is the money going? Who is making the profit? If hospitals are overcharging, one would assume they are rolling in dough but that's not true. From what I can tell insurance doesn't make much. Hospitals are hemorrhaging money. So is it doctors being overpaid? Is it the supply companies overcharging? What supplies? Why isn't there more competition then?

Let's also not forget that there is an implicit subsidy given to companies to offer health insurance. Insurance started to get offered during World War II, when the government used price controls to prevent wages going through the roof. After the war the system where companies could offer benefits instead of wages continued.

To this day it is "cheaper" for companies to offer $1 in benefits (health being the primary one) than a corresponding $1 in wages.

Dr Belk I'm curious what your opinion is on the French healthcare system. As I understand it the system is basically that there is a public option available to everyone paid for through payroll taxes and that companies still offer private insurance (I saw a stat I think in Forbes that about 70% of healthcare is covered through the public option and 30% private insurance). Considering that the World Health Organization ranks France as having the best healthcare system in the world I'd start there, but I'd love to hear your take on it.

There's a mistake on your medications page.

Novolog isnt $25.

Novolin is $25, novolog is around $300. Novolin is plain human insulin first synthesized in the 80s, which absorbs slowly when injected subcutaneously, novolog is modern insulin, modified molecularly to absorb faster into the bloodstream (though still not as fast as from a functioning pancreas).

Thank you! I love people like you and appreciate your wok at uncovering something so foreign and important to all of us here in the US.

One tip, though. Seek a professional web designer. The site you currently have looks very scattered and makes me not want to read it. Otherwise, I found some very interesting information on there.

Again, thanks, and good luck in the future on this work.

Okay I'll keep it simple, Obama Care, good or bad ?

PLEASE upvote this so David can see it. David, I'm a co-founder and chief designer at Medko, a startup that helps people find quality and affordable care outside of the US (http://www.medkohealth.com/). I'm also a bay area native.

I saw one of your comments about the quality of your site and would love to talk with you about offering my web design services, free of charge. I'm confident we can coordinate enough via Skype and Email to get you something much more professional.

You can contact me at: dev @ medkohealth (dot) com.

Michael

So hospitals are the biggest form of bankruptcy in the United States.

http://www.cnbc.com/id/100840148

Are they just that corrupt? Or is it the fact that the US is so big and spread out that the infrastructure increases the price? Someone posted that while CA hospitals only receive 25% of what they bill, they are claiming fiscal loss of only 2%..... This sounds like major corruption and doctor's are still some of the highest paid jobs (yes school is expensive, but that's an entirely separate problem).

So I guess the real question is how can hospitals hurt people so much while claiming to be helping?

What's your opinion on the Canadian healthcare system?

Hi there. I'm currently entering medical school and I'm curious how all of these changes will affect doctors. I'm honestly not concerned about making money because I plan on doing work with Doctors without Borders or a similar organization. I'm only concerned about paying off the 300,000 or so dollars in debt I will have when I'm done with school. If we lower the costs of healthcare (which I am in favor of 100%), will medical schools also have to lower their costs? If they don't, how will doctors ever be able to pay off their debt?

So what insurance company have you found, if any, that is decent and takes care of their customers?

What is your opinion on the consolidation of the lab test market into two companies? Quest & Labcorp

In my view this is yet another blatant violation of anti-trust laws in this country. Prices for lab tests have increased as competition decreased, and yet every one of these mergers and acquisitions along the way claimed that it would benefit consumers. With only two companies in the market it's also likely that they collude to keep prices high, but even if they don't, in many places there is NO competition since only one of these two serve that particular region.

Why do you think a review site (such as Yelp) does not exist for doctors, hospitals or for any other aspect of the health care industry? It has been implemented on a very small scale in the past such as RateMyMD and Yelp itself, but for something we pay so highly for it seems there is a surprising lack of consumer input.

I would LOVE to know how accurate John Green's video on this topic is without having to do days of research. http://youtu.be/qSjGouBmo0M

What would be the easiest part of this that we could change. (What is "Step One" to fix this system?)

on a scale of 1 - paris hilton, how fucked are we.

you sir win the internet and my all time allegiance.

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It takes a life's work to figure out that American healthcare is a racket?

how does one "write" a website?

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My mother can get a prescription at one pharmacy for $30, and the same exact one for $3 dollars at the County pharmacy that my county's employees are allowed to use. Rediculous!

Hi Dr. Belk. First, thanks for doing this AMA.

I am currently a student and am leaning towards studying medicine so that I might be a psychiatrist. I feel inspired to devote my study and practice to learning to heal mental illness, as I have a special sympathy for those who experience the strange breed of pain and suffering that such diseases cause. I am discouraged to enter medicine in America, as the state of the medical field seems particularly flawed. Do you have any advice for someone such as myself who wishes to practice healing amid this broken, poisonous system?

Well that's a solid bummer.

I will likely get overlooked, but my biggest question is, have you come across any evidence of someone dying due to insurance either refusing to pay, or dropping them (when it was still legal) and thus leaving them with no ability to pay for something like chemo or expensive medications that were necessary for them to survive?

I know it isn't about the cost of health care, but I've been looking all over. I'm admittedly liberal, and have heard the idea for a long time - but until challenged recently, I realized that I've never actually read anything about it.

Of course, there are people who have lost coverage and gone on to die because of a lack of insurance, but I'm talking about someone who died because they lost their insurance mid-treatment and was unable to pay the bills, thus being denied treatment. Given that Drs are only required to get a patient stable, not continue to give them treatment after, I'm just curious.

Hopefully you (or someone else) could answer this question. I just don't like repeating a line that isn't true, or at the very least, is said but not entirely supported by facts.

What I'm hoping to find, at some point, is an article related to say a 14 yr old teenager who, because they exceeded a lifetime cap or via some other means was denied insurance when they previously had it, ended up losing their ability to get chemo and thus died whereas with the chemo they could have survived.

Perhaps part of the issue is that in situations like these charities will take over. Perhaps part of it is that settlements are made in private that keep them under lock and key.

But I anticipate the moment that someone dies because a plan was cancelled and someone failed to fill out the paperwork in a timely manner or meet with someone regarding new coverage, that they will get denied treatment and every conservative outlet will rail on this about how Obamacare killed someone. They'll ignore the fact that millions of uninsured people are able to get coverage that otherwise would not have, and that those people would have died of routine illnesses simply because they could not afford to go to a doctor previously - but it will still be focused on.

And so, because for so long people have said that insurance companies have thrown people off and killed them because of it, I don't want to have to say "well, we said it for a long time".

I know it seems stupid, the amount of people who will live and/or benefit from the ACA far outweighs those who have been the "losers" of the ACA. But I still want to be able to go to my annoyingly conservative family when they bring this up and tell the to STFU because I'm already about to disown them for the crap they say (seriously).

That's a frightening thought. I could not cap my insurance if I tried. I had 7 surgical procedures over 2 years, and it all came to roughly €60k. My plan caps at 3m/annum.

Also why did ibuprofen cost me 600 dollars when it was given to me at the hospital?

I am sorry I have nothing to contribute to the conversation. However, I thought you should know how I was mislead by the first 4 words after your name, and had to reread it a few times to understand that "doctor who" is not who you are. I became uninterested immediately after realizing that. I kept reading it wanting it to be Doctor Who who has done... but yeah... HI Yes I am an idiot.

Just how the proof_for_reddit was done makes me love this guy. :) Doing it all himself, and interested enough in things to learn to do it himself. And what could be a cause more worthy of attention than this in the US today? Well done, sir.

Dr. Belk, have you done research on the state of dental care as well? Isn't it even worse because most dentists refuse to take Medicare/Medicaid patients? And dental insurance usually have a yearly coverage limit of $1000-$1500?

A root canal or a crown will set you back couple thousand dollars. Also, I've read an infection from the mouth can lead to a heart attack.

What is your opinion of ObamaCare? It's a given that it's imperfect and not going to fix everything, but do you think we're better to have it than not to have it?

Mr. Belk, what is your opinion regarding the possibility of there being a group of globalist elites, an "Illuminati," if you will, who dictate the goings-on of the world and are seeking to establish what is commonly referred to as a New World Order?

I'd like to know WHY the general population continue to "support" the current system. It seems that every time a government tries to bring in a new system that models the same as other countries (Australia, UK, NZ) the self interest groups that DON'T want change drag out the rent-a-crowd to shut down the debate and bring into question "socialized medicine, and freedom" queue flag waving and all that stuff.

What is more important? "Freedom" or the ability to be CARED for?

Just say "It's like the Fire Department, and Postal Service, both are Government funded, which means you get cheap stamps, and free service when you need a fire put out".

god fucking dammit reading through this thread really, really pisses me the fuck off.

wow, I really didn't expect that YOU of everyone here would respond :) first off.. THANK YOU. Thank you, thank you, thank you for what you are doing. This entire subject is SO confusing and frustrating, and intimidating for a 25 year old facing the real world. You're a beacon of truth, and coming across your website earlier this year has shifted the way I think about a lot of things, really. I sent your link to one of my good friends, who works for a medical device company, and he swears that this website was the singular best thing he has ever come across.

I'm 25, and will be dropped from my father's really great healthcare plan in just a few weeks. It just seems like american healthcare is so complicated, everything is so convoluted, and the ones in power are SO fucking greedy and stuck in their ways, that we as a society will never actually progress. It just seems like the vast majority of Americans are absolutely stuck in this mentality of "why would I ever pay for some lazy person's healthcare when I have to work so hard to get it. Do you REALLY think more handouts are the way to go?"

I just... I want to know that if I get in a car accident, or my right ball starts throbbing to the point I want to keel over and die that I can simply go to the doctor, and know that I will be taken care of, because I'm a fucking human and other humans should want to help me. Instead it just feels like the main incentive for anyone and everyone to be in healthcare is the massive paychecks. No one wants to take responsibility for "the system" or its obvious flaws, and instead we get the small group, who is in control, benefitting immensely (weird, that NEVER happens....) while the vast majority of citizens are afraid that even a simple visit could potentially ruin them. I just want to know that if people get sick, other people want to help them and not because it's really, really profitable to do so.

I know I'm making sweeping generalizations, but I don't know how else to convey my feelings..

You've been doing this for a while. If you're still doing what you're doing, considering what you know, there must be some hope, right?

......^right?

At my local clinic/hospital/nursinghome (all same facility) they do "extra" unneeded and sometimes unwanted tests. I discovered they only do this with patients who have insurance. They do it to increase revenue. They are really big about xrays for everythting, even in small children. My son had about 20 xrays before he was 2. Every time i would take him in for anything, caugh, fever,etc, they would do exrays just to check them out.

My husband went in for his frequrnt heartburn, they did CT, MRI, Eco, and still never treated his heartburn, just told him to take OTC meds. Is this common everywhere to increase sale? Or is it just this crappy clinic?

Dr. Belk, have you shared your research with Harvard School of Public Health? If you could get connected with a group over there who is working on healthcare reform, this valuable information may help with future reform/policies. The Harvard name brings a lot of cachet and influence. Massachetts first implented Romneycare, which Obamacare is based on as you no doubt know. MA legislators have a long history of sponsoring healthcare bills for the benefit of all. Elizabeth Warren is also very pro consumer protection.

This guy John McDonough might be a good person to get connected with: http://www.hsph.harvard.edu/news/magazine/health-care-reform-mcdonough/

Contact info including email addy available at below:

http://www.hsph.harvard.edu/john-mcdonough/

'I am David Belk. I'm a doctor who...'

... C:

In the US, Cancer survival rates are much better than they are in the UK. You might not expect that to be true with all those uninsured people in the US, but it is.

http://www.dailymail.co.uk/health/article-136377/US-v-UK-The-breast-cancer-survival-stakes.html

http://www.pop.org/content/cancer-survival-rates-far-worse-great-britain-us

Not a simple issue(more in the links) but the fact that the uninsured in the US have a better breast cancer survival rate than those covered in the UK does make you do a double take: http://www.factcheck.org/2009/08/cancer-rates-and-unjustified-conclusions/

Why do you think that the cancer rates are better in the US then they are abroad, even though there are so many uninsured in the US?

What do you see as the biggest driver of healthcare costs in the U.S.? Patents, the fact that most research happens here, insurance itself, medicare/medicaid, malpractice, etc?

If the American healthcare system is so bad, why does it have the highest cancer survival rates in the world for every single type of cancer, including twice the survival rates for certain types of cancer as countries like Sweden and Denmark?

Would you prefer a system where more people die but is more 'fair'?

Does America have lower survival rates than these countries for other diseases?

Totally irrelevant. This study shows more Americans are dying, but doesn't show whether that is because Americans are living less healthy lifestyles or because they have poor quality healthcare.

I would have expected more than a random google search for news articles from someone who has apparently been studying this for years.

Have you discovered any evidence suggesting Obama is literally Hitler?

From my quick perusal of your posts, it's apparent that you like the Maryland way of doing things with regards tpluo healthcare.

I have a fond appreciation for the Finland way of doing things with regards to healthcare.

Care to share your thoughts - plus or minus? Finland keeps coming up on top as a society that excels on all metrics.

Your site is out of date. When will you update it to include the ACA?

Thanks for your reply. OK, then your site is current, relative to the changes the ACA brought to the market?

Why are drugs so much cheaper in Canada than they are for the exact same drug in the US? Do you think Canada's health care system is better or worse off than the States and other countries. Whos health care system do you most admire/envy?

If all Americans had healthcare, what would it cost the average family of four to have a good plan? I'm assuming to portion of my healthcare that covers expenses for uninsured patients would go away.

But if people with high blood pressure and high cholesterol, and don't currently have insurance, go to the ER at dire times, passing on some of the cost to those of us with insurance. Wouldn't the overall costs go down if the people with these health problems had insurance and sought treatment sooner?

ELI5 this to me, I don't undertstand

Do you think capitation and The DRG method of charging is a viable option?

Could you elaborate further and how these things benefit or hurt both hospitals and consumers?

What about straight forward paying? Would it make it more cost efficient? Because I heard that it cuts costs. Like this http://americablog.com/2013/06/doctor-in-maine-stopped-taking-insurance-lowered-prices.html Do you think it would be something good to have?

More or less government involvement?

could you be more specific?

Way late to this one and I'm too lazy to read through so I'm sorry if it's been covered before but isn't the high cost because of the legal system? I mean the insurance companies are stockpiling money for the inevitable lawsuits. The system allows for lawsuits for monetary gain and we the consumers are the ones that pay for it right?

"...I am a Doctor Who..." So...... You're the doctor? Just The Doctor?

What are your thoughts about that whole "Death Panel" bill that failed in 2008-2009ish? Quite a few people mentioned it would have not only helped people live longer (ironic), but it would also greatly reduce health care costs.

Was it true that the "Death Panels" were really about giving severely ill patients more freedom of choice of being in/out of a hospital? For example being able to be moved to a nursing home/assisted living facility/families house if there was not much doctors could do for them in the hospital? Or was that more confusing chatter?

What would you thinking of forcing health insurance companies to be non profit?

Related American healthcare discussion thread: http://www.reddit.com/r/news/comments/1rz2m6/as_hospital_prices_soar_a_single_stitch_tops_500/

Best IAmA so far. Really sad i missed it :(

First off all just want to say thanks to Dr. Belk. He is one of the few medical professionals out there who dare to stand up against the corruption in the healthcare system and the pharmaceutical companies manipulation.

Many physicians out there know about the corruption in the healthcare system very well, but they choose to ignore it. Ignore the The Hippocratic Oath they took on their graduation day, and instead walk upon the road of greed.

I know this might sound silly, but you are a role model to me. And i just hope one day after im done with Medschool that i can become someone like you.

Good luck with your quest, and i hope your message is spread.

"I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm."

How long until you're assassinated.

I thought for a second this was a Doctor Who post.

No, that was William Hartnell

Thanks for doing this AMA!! I had my mother in-law come visit us and she seemed to have some pain in the ribs (rib fracture we later found out), so we went to the ER at the County Hospital to have her checked. She was visiting and had no health insurance, and none of the hospitals would be upfront with the costs. They checked her vitals and after waiting for 2 hrs outside (and not actually going inside the Emergency Doors or seeing a doctor), we gave up hope and went to a nearby private Urgent Care clinic which charged us $162 including everything (vitals + doctor visit) Yesterday, we received an invoice from the ER: $128 for the ER visit. What should I do ? Should I ask for an itemized receipt, because I do not know what they did that could have caused $128. All they took was her vitals.

This thread has been reinforcing my desire to move out of the country.

I'm 28 female no health "issues" until this year. My major issue this year? Unexpected pregnancy. My only drs appointments the last 8 years has been my yearly visit to renew my birth control. Ironic I know.

I'm a part time flight attendant, so no insurance options and my husband is self employed and he makes pretty decent money and since we are both healthy we decided it makes more sense to keep a savings account instead of paying 2/k a month for individual coverage.

Our state is opting out of the expanded income guidelines for the Aca. My best option for coverage with out bankruptcy and draining all of our savings was to move in with my mom 1000 miles away and apply for insurance in another state.

Dr. Belk,

Thank you for this post.

This local Dr. in the US opted out of accepting insurance and as a result his prices (on his website) are drastically reduced. He was interviewed and Huff. Post still has it.

http://www.huffingtonpost.com/2013/05/29/dr-michael-ciampi_n_3354120.html

What can you comment about this video interview?

His website - price list page:

http://ciampifamilypractice.com/Our_Prices.html

I am interested in your insight and comments into this practice model.

Thank you!

Dr Belk, I am late to this but I hope you can answer this question. It is very important. Do you think that an analyst AI like IBM's WATSON can replace a general practitioner? When I go to the my GP, most of my illnesses are extremely easy to diagnose. I personally do it myself but I can't buy my own medicine. I have to go to him where he spends about 1 minute thinking about it and sends me out the door and I pay almost 200 dollars for it. I envision a future where a computer can diagnose a patient and if the illness is serious or the diagnosis is inconclusive, the computer can advise the patient to see a specialist. One should also have the freedom to buy medicine without a prescription. I know the medical association won't like it because they're there to protect the trade. As noble as medicine is, it is still a trade and a highly profitable one. I believe that this sort of freedom in medicine will lower the cost of healthcare dramatically. For example, if a patient needs a blood test, he can take his own blood with a kit and send it in. The costs would be dramatically lower. I know people who do lab tests, they just throw it on a machine. We could have general medical education in school. Taking blood is extremely easy. It is much easier than auto mechanics and we learn that in school. It's just that in American culture, medicine is sacred and only a doctor can perform it. That's just not right. Obviously I would need a real doctor to set a broken bone or do any kind of treatment that requires technical skills but those situations are very rare for an individual.

How does an outsider like a nurse or doctor identify and quantify administrative waste?

How do we get data? Admin controls all of it

So if generics drugs are so much cheaper, why has generic phenobarbital and cephalexin increased in price so much lately? I own a veterinary practice, and some of my clients have been requesting that I send their prescription to Wal-fragging-Mart so they can get it for $4.

Awesome! There are so many confusing pricing in vet med, like why enrofloxacin is so expensive in pill form, even a generic chewable, compared to the injectable brand name! And why Clavamox hasn't gone generic? It's been Clavamox since I was a high school kid cleaning shelves at a vet clinic.

Awesome! There are so many confusing pricing in vet med, like why enrofloxacin is so expensive in pill form, even a generic chewable, compared to the injectable brand name! And why Clavamox hasn't gone generic? It's been Clavamox since I was a high school kid cleaning shelves at a vet clinic.

You are a paid hack who continues the false narrative of hospitals/providers and insurers being evil.

They all are operating as the government regulations mandate. They are not malevolent on purpose. (in most cases)

I was wondering how Dave (and my fellow Redditors) feels about Health Savings Accounts? It seems to me that it would be far more efficient and secure for people to pay into these instead of the Ponzi scheme we call Social Security… I envision something that is withheld from payroll, rolls over annually in perpetuity and can only be used for healthcare expenses. A portion of the withholding could even go towards a nationalized catastrophe insurance in lieu of SS. Any thoughts?

Why do doctor visits cost more if you're not insured? Example: I went to a urgent care center because I thought I broke my foot. I sat in the waiting room for 2 hours, then saw the nurse/doctor/xray technician for a combined time of about 10 minutes. I ended up paying 270$, just to be told my foot is fine. I understand I'm paying for the doctors expertise, but I hardly took up ANY of his time, I spent more time talking to the nurse and xray tech. Face to face time? Less than 5 minutes.

Is the insurance industry the bad guy in this sordid USA medical bankruptcy tragedy? I think they are; here's an anecdote to illustrate my view on the topic:

As an undergrad student, I dated a girl whose stepdad was the VP for a major health insurance company in the area I went to school. The guy described his job as "schmoozing," and he proceeded to take us out to the finest steak dinner I've ever had (several hundred dollars a head), and I had the privilege of watching a university basketball game from their corporate suite (wasn't carded at the open bar despite my being under 21 at the time, excellent view, other big shots present, etc.). Of course I benefited from his largesse, courtesy of his being a good schmoozer, but I was just the poor college student in this story, so I think I can be forgiven. This was right around 2009 during the financial crisis, and he retired with an awesome benefit package and took his earnings down to somewhere in Mexico, where he presumably now lives in a fancy villa on the coast, with the money of the poor sob stories on this page.

So I'll repeat my question: Is the insurance industry the bad guy?

I know I'm late for this but would really like to hear your opinion about the accuracy of Michael Moore's documentary, Sicko.

Yeah, found it. Thanks for the response and for the work that you're doing. I've shared some of your videos.

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Hey David, I'm an internal medicine intern and interested in this sort of thing. In your hospital financial analysis you common on county hospitals and profits. My understanding is that for a lot of these hospitals (county or not), they are not-for-profit, meaning that no individual or part of the hospital is keeping these profits. Instead, I thought all these profits should in theory be put back into making the hospital better. In other words, these hospitals should be taking the "profits" and re-investing them into hospital repairs, building new hospitals, and expanding capacity. Is that not what is happening? thanks!

hey david, one more point of confusion as I was reading through your hospital financial analysis piece. Towards the end you comment that hospitals like usc county, almaeda county and olive view county make 1 billion, 700 million and 600 million in profit, but when i looked at your financial summary report for each hospital the profit graph appears to be much less than that. were you commenting on the revenue instead of profit? just wanted to clarify. by the way, it's awesome that you've compiled all this data! Thanks for spreading the word and for doing this AMA!!

Can I mention something that I have to get off my chest? I am a medic and I do pulseoximetry on every patient I get. This takes all of 8 seconds and it is a job a nutless monkey could do. When I go to the Dr for a checkup, I get charged seven dollars for it. How is this possible?

David, what is your take on centralized electronic health records, such as with the Carte Vitale, as used in France? It seems that much of the administrative cost and waste in America could be remedied with such a tool. Why aren't these more widespread?

Some folks might see it that way, sure. But do you think there's any hope that such a system would improve the delivery of care while controlling costs? It seems those virtues would outweigh the concerns of the tin-hat set.

Your last edit is that you are still answering questions so I'm gonna hope I'm not too late. In your opinion, is Obama care a step in the right direction or the wrong one? If right, what still needs done, if wrong what do you think would work better. Thanks for doing this.

Do you get paid via fee for service, capitation, or salary? What do you suppose is the best method in terms of effectiveness in increasing overall healthcare for the patient and physician?

Also, with Obamacare in effect, how would these systems change?

I'm very simplistic about healthcare. I just don't see the necessity of health insurance beyond its use for catastrophic care. We have become accustomed and accepting of its arcane ways. I just see it as a leach siphoning millions(or is it billions?) of dollars that would be put to better use as payment for service between patient and doctor. Can't someone just write a computer program that automates insurance?

What's your thoughts on the costs of medical malpractice insurance and it's effect on healthcare costs?

What is your position on physician ownership in hospitals, specialty centers and capturing ancillary services revenue from services and procedures that they order?

Also, what did your research show about payor mix in physician owned facilities?

Who do you think is to blame for so much misinformation in regards to how our health care system works here in the US? I mean, if you listened to the past two Presidential elections you'd think both parties lived in separate countries.

The insurance lobby is one of the (3)most powerful lobbies in DC. the ACA is a windfall for insurers (as i understand it, Insurance is a huge racket and now MANY more people will be forced to pay premiums each month because of ACA - vs single payer) so why in the world are the republicans trying to shut it down? isn't the GOP financed by the insurance lobby? Haven't the Insurance giants paid for the republican influence as much as dems' influence if not more?Thanks!

Hi! Would you comment on the seeming proliferation of drugs that are now prescribed that are required to be taken every day forever - i.e., for DVT, asthma, etc. I am skeptical of any drug that must be taken without question into infinity and beyond - thank you!

I've always thought that it makes no sense for health insurance to be an employment benefit. Why not my car insurance? Why not my groceries? Are there other countries where you access to medical care is so tightly tied to your employment?

Nobody would disagree with that. I just think the unintended side effects have destroyed any advantage to having health insurance be a benefit. It's helped drive up the costs big time.

Access to health care should not be tied to your employment status. I was really hoping that Obamacare would ban the practice of employer provided health insurance.

I'm graduating as an FNP in a few short months (hurray) and I find that the biggest issue running with my "rural, low-income, low health knowledge" population is access to the right medications. I refer to GoodRX.com multiple times a day for price checking/availability/coupons. How do you manage this with your patients?

Why did you decide to write a website/blog rather than submit your proof and argument to reputable (and considerably more public) news sources?

Thanks for doing this AMA! I'm curious as to what you think might be the most feasible healthcare system for the US. For example, do you think a single payer system would work here? Obviously every system has its flaws, but some are more/less flawed than others.

It's fine, I'm surprised you're still answering questions. Thanks a bunch, I"ll definitely check it out.

Do you believe executive compensation is part of the problem? I know the top earners in several small systems who make between $300K and $1 million yearly. That seems like too much for a basic management job. When you get three to seven of them in one hospital, you are really looking at big money just to pay the top 1% who do not perform any patient care and are not usually MDs.

Not sure if this will be seen. But would you agree that the simple answer to the problem is implementing a single payer system like Vermont is doing?

I started a company rating MDs on efficiency of healthcare costs and am currently seeking vc. I am in talks with a Medicaidprogram in one state to save them 10 percent or so by identifying the worst offenders. Reach out if you'd like to chat.

Do you have a link to donate to? I truly believe that many people, when they read your writings, and watch your videos (like I have been doing for the past hour), they will just have their mind blown, and will want to know more.

You should get a Paypal or something set up with a "Donate" link on your page. It would really help with website management, resources to keep doing research, you know! Keep up the work. I have already shared some of your videos on my Facebook, and have posted a link to your site on my Facebook.

Hi David, I think what you are doing is amazing and I wish you the best of luck with your mission. Is there anything we can do at help?

To my question, how long have you been a doctor, and did you have a defining moment that brought you to action?

Why are countries such as Canada able to run on free healthcare and here in the US we have to pay exorbitant costs for life-saving procedures?

First, thank you much for your work explaining the truly dysfunctional US healthcare system!

It seems like a root cause of problems in the US is the almost religious belief that capitalism is the ultimate socio-economic system. Healthcare in the US has evolved with "for-profit" entities placed at the heart of what is an essential social service. This inherent conflict of interest continually tries to monetize healthcare, leading to a rising US GDP expenditure whereas socialized countries like Canada are able to reduce their GDP expenditure on healthcare. Do you think there's a fundamental shift from a capitalist perspective on healthcare to a socialist one that needs to occur before real progress can be made?

Also, US politicians simply refuse to support a single-payer system which seems to be integral to the success of socialized healthcare systems. Without single-payer, do you think the US can ever hope for universal healthcare on par with Canada or UK?

Thanks for working your way to my question!

I'm glad that this AMA got such attention and hope that your work can bring some sanity to the US healthcare system.

As a Brit I can't help but feel this is karma for throwing all our tea into the harbour that one time...

I've perused your site a bit. It seems that your main point is that health care is not nearly as expensive to provide as we Americans believe (I'm inclined to agree). So who gets the extra money? Is there a way to chart that? Doctors? Hospitals? Insurance Companies? I'm sure it's all 3 and more, but who's the big player and by what margin. If we're going to make changes to healthcare, this is the first piece of info I'd like more transparent.

Also, you use the word "abuse" here and there to describe insurance company's actions toward patients. Do you get the sense that this is malice? greed? indifference? or that they believe (much like many doctors) that this is just the way it's done and changing it would be more trouble than it's worth. "All the other companies do it this way; we're just one of the flock". Is it possible that our legislative / legal climate encourages their "tactics" (loaded word... wasn't sure how to rephrase).

Do you think that US corporations are going to try and force their employees off company plans and into something provided by the AMA? I ask because I've seen my costs triple last year and this year I get a sir charge for covering my wife because she could get coverage from her employer.

It seems really really important that you prepare for meetings with people who have power, and it seems like you're going to need some very specific policy recommendations, no? What would those be?

This interview was transcribed from an "ask me anything" question and answer session with David Belk conducted on Reddit on 2013-12-07. The Reddit AMA can be found here.