I own a company which pays/processes medical claims. It's not just that docs make too much, trust me. The hospitals are making money hand over fist, as are the insurance companies - and the Rx providers, PPO networks, case management firms, claim's processors.
That list of middle men is the primary reason costs are goind up exponentially; for every runny nose; 3 nurses a doctor, billing clerks, and at least 1 person from each of the above firms have to touch that piece of paper (claim). The overhead is completely ridiculous.
Copays & low deductibles, frankly, are the problem. As you recognize, people don't pay for their own healthcare - it is paid for by their employer, and they don't realize AT ALL how much it costs.
Remember a couple of years back, when "Claritin" went over the counter? There were news stories all over the place complaining about it now being "more expensive". "I used to pay $15 for a 30 day supply, now it's $25" or some such quote from some poor allergic type. What had happened? Insurance wouldn't cover over the counted meds, so the patient had to pay the "full" price. What the nice reporter didn't tell you is that the ACTUAL cost of the drug, since it was now OTC had dropped from $140 to $25. A very rare, actual cost reduction in healthcare. (Schering Plough fought, and spent, like to keep that drug from going over the counter for 9 years before it happened - lawmakers from both sides of the aisle were on the take from them). Point being that the patient thought their $15 copay had something to do with the cost of the drug, it did not.
Another major problem is that people just don't die as easily anymore.
A person I am familiar with was in an accident in September. He didn't die, 5 year ago, without question, he would not have lasted through his first night. Now, with newer surgical techniques and drugs (expensive ones) - he is still alive nearly 90 days out. He is basically a vegetable (although thankfully showing progress) and has run up over $1 million in charges.
So, what 5 years ago, would have cost, maybe $10K in heroic last minute effort and a helicopter ride, is now over a million dollars more than that. Insurance is paying for that, we are all paying the premium.
Same thing going on in a big way w/all of the cancer & heart-disease people out their - they are living longer, incuring more & more claims, etc.
Baby boomers are in their 50's now, bunch of 'em, not on Medicare yet, and that's when the expensive stuff begins to start en mass.
In short, family practioners & internists aren't the reason healthcare is more expensive. New technologies, ridiculous overhead (brought on by wrong-headed plan design by the insurance carriers - as well as govt. tax policy), and consumers not affected by actual price have conspired to create
an untennable industry.
I know how to fix it, but they won't listen to me.
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