This is a very complex dynamic so answers are not as easy as choosing a scapegoat. The short answer is all of the above. There is absolutely NO question that some doctors take advantage with unnecessary tests and "buddy" referrals. An elderly family friend who is on Medicaid recently went to the ER for a chest X-ray for pnuemonia. The test was negative but the lady was admitted for eight days and no diagnosis ever given. The admission was purely for revenue for the hospital. Insurance companies must share the blame. BCBS says it only makes a few cents on the dollar from premiums yet it can afford a 6-digit marketing campaign and multiple websites to shifr the blame from them. And yes, we do live in a world full of hypochondriacs. We all know people who are healthy enough to do whatever they choose but constantly run to doctors.

I have said before and will again. If other insurance types can get it right, by charging based on the individual's personal history and record, then why can't health care? If you have a history of costing the insurance company then you pay more. If you don't then you pay accordingly. My car insurance doesn't go up beacuse my neighbor can't drive and crashes twice a year or because my car is red or whatever. It goes up when I get tickets and have at-fault crashes. I pay a third of my income for health insurance beacuse Dr. Brown's golf buddy needs referrals, insurance company executives want to be marketing webmasters and my neighbor has a BMI of 35 and runs to the doctor every week.

Claiming that health insurance companies have an affect on the cost of health care is the same as claiming that your auto insurer has an affect on the cost of auto repair. It's just the opposite. And why aren't lawyers and their frivilous-law-suit-filing clients listed as one of the choices. I'm sure a lot of the unnecessary tests and procedures are prescribed and performed to cover the doctors from junk malpractice suits, which drive up malpractice insrance premiums, which in turn drives up the cost of health care.

How about none of the above? Illegal aliens and uninsured patients get the rest of us gouged.

My health bills amaze me every time. When I went to my endocrinologist last for a diabetes check-up, my insurance was billed a $220 facility fee, $108 to test my A1c from a finger*, $8 to check my blood sugar, and $165 to talk with my MD for 25 minutes. I was in the office a total of 45 minutes. No wonder they say insurance gets reimbursed pennies to the dollar... they charge phenomenal fees for every little thing. I think I got charged like $50 one time to get my pulse-ox taken. Good grief.

Really the larger issue behind this question is that our current health system is optimized for catastrophic care. We lack a wellness mentality.

What amazes me is the penchant to consistently blame "the cost of healthcare" on "unhealthy individuals" as though cancer patients choose to get cancer, athletes choose to break limbs, and children choose to get sick.

And don't blame all of this on the obesity epidemic, either. Always be skeptical of research methodology and its funding.

I think thatwhat the Doctor/Hospital charges and what medicines cost are the probelms. If you pay $155 for a 30 day supply of pills, but if the get the generic it's only $8 then there's a problem.... I had back surgery 1 year ago, and they gave me a something to help me have a bowel movement, then they charged me $12. It looked alot like the Dulcolax, I have at home in my cabinet and I think I paid $3 for 24.

Ever go to a body shop and get an estimate then tell them you want to pay out of pocket? If not, well the same repair by the same shop is dramatically less. Of course heath insurance companies contribute to health care costs. BUT you first have to understand that the cost of health care means different things to different people. If I only go to the Doctor once a year for a physical (ex: $50 copay) but I pay $800 a month for health insurance (I do) then my annual cost of health care is $9,650. And yes it's outrageous and yes I place appropriate blame on the insurer. If my neighbor constantly runs to the doctor and gets all these unnecessary tests and referrals and pays the deductible and copays, then their health care cost is much different than mine and they are naturally going to place the bulk of the blame on the doctors. If one were to read every post on this site one fact is abundantly clear. Every person wants to assign blame for the problem to some other group than one they belong. And of course, if I was an employee of BCBS I'd be on here too pointing fingers at everybody but the source of my bread & butter.

BCBS of NC needs to reconsider the price of their premiums. I became a member over 12 years ago. My insurance premium increased by $5-$10 from my application time to my membership, which was before I even became a member. Ever since my membership started, my insurance has increased EVERY year. I DO NOT overuse or abuse my insurance. I'm healthy, do not smoke, am not overweight, never had surgery or major health problems since I've been a member, but my insurance still increases. If you notice, the last reasons for increase were due to 3 health issues that became dominant with BCBS members. All 3 of these reasons were due to obesity. I'm not obese so why do I have to pay more because of those that are obese? BCBS of NC needs to think of a more valid, reasonable, sufficient and equal way to charge premiums. Making us pay more money each year only makes one want to overuse their insurance to get their money's worth. Think about it BCBS of NC!

AMEN! BCBSNC did the same to me when I first joined, except my actual premium was WAY more than $10 higher than their quote. It seems like BCBS has their own discreet form of socialized medicine. Rather than the people who tax the system bearing the burden of cost, BCBS prefers to spread out the costs, making us all pay more. If you think about it, that is the sole purpose of this and thier other websites. It's a risk analysis for targeted premium increases. Some gopher at BCBS offices monitors these sites and provides managment summaries. I'm sure it goes something to the effect of "72% of our customers support rate increases for the obese, or 69% of our subscribers would support us if we jacked up smokers a little more". In the past Blue Cross Blue Shield has been sued and fined for denying due medical treatments to their customers and for underpaying doctors. BCBSNC has also come under fire for a failed attempt to convert to for-profit status in 2003, a year in which they posted a record profit of $196 million and most customers saw their rates rise by more than 10%. Profits approaching a quater of a BILLION annually and already outrageous premiums going up by double digits? This is the very reason that the government is having to get involved in the health care industry.

I agree. We also have an aging population; should we blame them for living so long? As we get older we are naturally going to need more health care. The question shouldn't be why is health care getting more expensive, but what are we going to do to make sure that despite rising costs, we all get the health care we deserve?

The HCI premium is not for what actually is covered each year but the risk you represent to the insurer for what they might have to cover each year. It's insurance.

One reason I hear from providers I know is patient noncompliance. Patient has an issue, is treated and told to quit doing whatever led to the problem like drink or smoke and then keeps drinking or smoking. Or does not clean the wound, etc.

From the comments here it seems like BCBS needs to educate folks on what Insurance actually is.

I think it should be illegal for drug companies to advertise their products to the general public as it would save the consumer and insurance companies LOTS of money. Please lobby for this!

Also, please lobby for limits on malpractice settlements as this would save us all even more money.

BCBS, you left off government as one of the answer choices. Of course the reason prices sky rocket is because of government mandates on insurance companies and doctors.