In addition, there are end-stage renal dialysis facilities so
patients who have kidney failure go and get dialyzed.
There are nearly 6,000 of those in the country.
There are ambulatory surgical care centers where you get simple surgical
procedures outside of a hospital.
There are free-standing imaging facilities,
where you can get an MRI or a CT scan and not get it in the hospital.
In addition,
there are hospices in this country providing end-of-life care to patients.
It's again, an incredibly complicated system of getting care to patients.
In addition to that,
there are what are called manufacturers, pharmaceutical companies.
We have to develop drugs.
These big drug companies, Pfizer, Merck, GSK, Gilead, Novartis, Sanofi.
They develop drugs in the laboratory, then they test them in animals, then they move
on to human testing and apply to the FDA for approval to market their drugs.
They manufacture all the drugs we have in the country.
Typically, they have very high profit margins.
The average is somewhere between 14 and 15% profit per year, but
the best performing ones actually make around 33% profit.
A large portion of their profit, almost half, comes from the United States
even though the United States has only 310 million people and
the rest of the world has billions of people.
In addition to drug companies, there are device manufacturers.
There are over 7,000 manufacturers in the country and
they consume about 4.5% of total health care expenditures.
Some of them are big integrated companies like GE and Siemens.
Some of them are very specific device manufacturers such as Medtronic that make
heart pacemakers and other heart equipment like stents or like valves.
Again, like the drug manufacturers,
they typically have very high profit margins on medical procedures.
In addition to all of that,
there are private regulators of the medical profession.
There are the boards who test doctors,
such as the American Board of Internal Medicine.
There is the Joint Commission, which accredits hospitals.
There is the National Committee on Quality Assurance,
NCQA, which evaluates physician practices.
The system is very, very complicated.
But that's the kind of complication we need if we're going to get
care to a patient who we suspect has a heart attack to evaluate them.
To make sure that the hospitals and
doctors treating them are treating them well.
To make sure they have the drugs and the devices to treat them,
to make sure we can care for them at home if they need to be seen at home.
The American health care system is incredibly complicated and
to understand how to reform it, we really need to understand that complication and
the complication of how each part is paid.