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It's true that healthcare is terrible in the U.S. if you don't have health insurance, but he overstates his case. Chris compares a 1 in a 1000 nightmare scena

It's true that healthcare is terrible in the U.S. if you don't have health insurance, but he overstates his case. Chris compares a 1 in a 1000 nightmare scenario to his very average experience. A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery was 130% of the Indian gdp per capita. And the issues with rounding errors has to do with the large amount of health insurance in the U.S. not necessarily free market vs. regulation. When the majority of consumption in a market is driven by enterprise customers, the pricing can become strange and very unfriendly to individuals. [0]https://pricinghealthcare.com/prices/IowaCityASC/spine-back https://pricinghealthcare.com/prices/IowaCityASC/spine-back [1]http://www.backsurgerycost.com/how-much-does-a-discectomy-cost/ http://www.backsurgerycost.com/how-much-does-a-discectomy-co...

yummyfajitas 11y ago
It's very true that I don't know what average costs are, in either country. The only prices I know are the price at the place I went (one of the top facilities in the region) and a few nearby hospitals. Several were significantly cheaper and if I earned in INR I'd probably have gone to one of them. But I figured that given how much I enjoy walking, why not just spend $700 more to go to the best guy?
clamprecht 11y ago
Take a look at http://reddit.com/r/personalfinance http://reddit.com/r/personalfinance for a few weeks and you will see that there really is a problem.
FireBeyond 11y ago
Not three years ago, with "comprehensive" insurance, I paid $7000 for a kidney stone, with a full total approaching $50-60K. For a kidney stone. I had to have two surgical procedures, admittedly - they went in to remove the stone, found long-standing infection, closed up and catheterized. A week of antibiotics later I had it shocked. But still... $60K for a kidney stone.
- Someone1234 11y ago
  That can no longer happen (since January 1, 2014). Insurance policies now have out-of-pocket maximums thanks to Obamacare. The 2016 limits are: $6,850 for self-only coverage and $13,700 for a family plan. So you would have stopped hemorrhaging money at $6,850, and then the insurance company would have been 100% responsible for the rest.
  - clamprecht 11y ago
    Still, $60,000? That's more than an average US salary for an entire year.
    - Someone1234 11y ago
      What?
  - FireBeyond 11y ago
    I realize that. I work in the health "insurance" industry (as a vendor). Notwithstanding that, it was considered a voluntary procedure, though there was no way the stone would pass (11mm x 6mm) - average ureter size is 3-5mm and I had to sit in the billing office and work out a 'financial solution' with them prior to authorizing surgery (negotiating anything while in this much pain would probably be considered close to coercion). As an aside, I really dislike "Obamacare", as a name. The Affordable Care Act. As an aside, a survey a few years ago asked self-identified Republicans this: "Would you prefer some form of affordable care act as an alternative to Obamacare?", to which many replied in the affirmative. There's too much potential for bias.
    - steve-howard 11y ago
      On the flipside, Obama has endorsed the usage of "Obamacare," because he does in fact care: http://www.cbsnews.com/news/on-bus-tour-obama-embraces-obamacare-says-i-do-care/ http://www.cbsnews.com/news/on-bus-tour-obama-embraces-obama...
davidw 11y ago
The US health care system sucks. I'm generally happy to be back in the US, but not about this particular aspect of it. It's more bureaucratic than Italy, costs more, isn't appreciably better, and wastes people's time more. What's more, even though Italy has a single payer system, there is also private care available that is quick, cheap and efficient - which it has to be, since the competition is "free" (tax funded). The US has neither a free market, nor a good government provisioned system, but some mess that's neither fish nor fowl.
- xacaxulu 11y ago
  I'm a dual US/EU (Italy) citizen. This 1000 times. The fact that the US system is more Byzantine than the Italian system is mind-blowing.
mindslight 11y ago
> the large amount of health insurance in the U.S. not necessarily free market vs. regulation Erm, health insurance companies are essentially the opposite of a free market. They're as close you can get to government run without actually being called "government". With USG's recent push to make patronizing these behemoths mandatory, even the last little sliver of "exit" has been lost.
staringispolite 11y ago
An error that large may be rare, but the overall experience of massive/unexpected financial load is fairly common via my experience hearing from customers (full disclosure: I founded a medical tourism startup called Emissary two years ago: https://www.emissarymed.com https://www.emissarymed.com) We talk to people all the time who don't have insurance (20-30M last time I checked), don't have dental insurance (~150M), or whose insurance comes with coverage caps as low as $1K-$2K that render insurance effectively useless for them in large operations. Most of the time, customers we talk to actually don't even get as far as the author did, because they can't afford the estimate, let alone the risk of over-shooting it. They just avoid getting treatment (and often get worse in the meantime). The trick then is how to find a doctor you can both afford AND trust. If you'll excuse the plug, we started Emissary to solve that when a friend's mother had this problem. Our mission is to help connect people to high-quality options they can afford, regardless of where they live in the world.
- jl87 11y ago
  Love it.
akg_67 11y ago
As a patient, US healthcare is terrible even if you have health insurance. Patient is at the bottom of totem pole in US healthcare, and just a number for doctors, hospitals and insurance companies and everyone else involved in the system. Just a couple of anecdotal personal recent experiences with US healthcare. 1. Recently I witnessed the trouble my primary care physician (PCP) had to go through with insurance company to get approval to perform CT scan. I couldn't believe the 30 minutes, my PCP had to spend on the phone with the United Healthcare person. This is the doctor spending time on the phone explaining all the medical reasons for recommending CT scan and not some administrative person in doctor's office. This is in contrast to a friend's experience whose PCP kept prescribing pain killers and other prescriptions instead of pushing insurance company for further tests for abdominal pain. The friend later was diagnosed with stage 4 cancer when showed up at ER with same symptoms. 2. While researching a local major hospital rated highly for quality of surgery, I came across the reports of quite a few cancer patients complaining about hospital quickly discharging patients after major surgery and restricting pain medication while in hospital. The claims don't make sense as hospital is rated so highly for Quality of Surgery and might be considered anecdotal. Until I found that two of the measuring criteria for Quality of Surgery was how long a patient stayed in hospital after surgery and dosage and duration of pain medication administered after the surgery. Talk about incentive misalignment. There is all the incentive for surgeon and hospital administration to discharge you quickly to maintain and improve Quality of Surgery rating.
- Fomite 11y ago
  Have you considered that discharging patients to their home, and moderating their pain medication, may actually be signs of quality care? "The patient gets what they want" is not the only sign of quality.
  - eric_h 11y ago
    That is certainly true. Nevertheless, I believe the parent's point stands. "Gamifying" metrics such as time-to-discharge and pain medication usage will certainly alter the incentives of such an institution.
  - 11y ago

yummyfajitas 11y ago

It's very true that I don't know what average costs are, in either country. The only prices I know are the price at the place I went (one of the top facilities in the region) and a few nearby hospitals. Several were significantly cheaper and if I earned in INR I'd probably have gone to one of them. But I figured that given how much I enjoy walking, why not just spend $700 more to go to the best guy?

clamprecht 11y ago

Take a look at http://reddit.com/r/personalfinance http://reddit.com/r/personalfinance for a few weeks and you will see that there really is a problem.

FireBeyond 11y ago

Not three years ago, with "comprehensive" insurance, I paid $7000 for a kidney stone, with a full total approaching $50-60K. For a kidney stone. I had to have two surgical procedures, admittedly - they went in to remove the stone, found long-standing infection, closed up and catheterized. A week of antibiotics later I had it shocked. But still... $60K for a kidney stone.

Someone1234 11y ago
That can no longer happen (since January 1, 2014). Insurance policies now have out-of-pocket maximums thanks to Obamacare. The 2016 limits are: $6,850 for self-only coverage and $13,700 for a family plan. So you would have stopped hemorrhaging money at $6,850, and then the insurance company would have been 100% responsible for the rest.
- clamprecht 11y ago
  Still, $60,000? That's more than an average US salary for an entire year.
  - Someone1234 11y ago
    What?
- FireBeyond 11y ago
  I realize that. I work in the health "insurance" industry (as a vendor). Notwithstanding that, it was considered a voluntary procedure, though there was no way the stone would pass (11mm x 6mm) - average ureter size is 3-5mm and I had to sit in the billing office and work out a 'financial solution' with them prior to authorizing surgery (negotiating anything while in this much pain would probably be considered close to coercion). As an aside, I really dislike "Obamacare", as a name. The Affordable Care Act. As an aside, a survey a few years ago asked self-identified Republicans this: "Would you prefer some form of affordable care act as an alternative to Obamacare?", to which many replied in the affirmative. There's too much potential for bias.
  - steve-howard 11y ago
    On the flipside, Obama has endorsed the usage of "Obamacare," because he does in fact care: http://www.cbsnews.com/news/on-bus-tour-obama-embraces-obamacare-says-i-do-care/ http://www.cbsnews.com/news/on-bus-tour-obama-embraces-obama...

davidw 11y ago

The US health care system sucks. I'm generally happy to be back in the US, but not about this particular aspect of it. It's more bureaucratic than Italy, costs more, isn't appreciably better, and wastes people's time more. What's more, even though Italy has a single payer system, there is also private care available that is quick, cheap and efficient - which it has to be, since the competition is "free" (tax funded). The US has neither a free market, nor a good government provisioned system, but some mess that's neither fish nor fowl.

xacaxulu 11y ago
I'm a dual US/EU (Italy) citizen. This 1000 times. The fact that the US system is more Byzantine than the Italian system is mind-blowing.

mindslight 11y ago

> the large amount of health insurance in the U.S. not necessarily free market vs. regulation Erm, health insurance companies are essentially the opposite of a free market. They're as close you can get to government run without actually being called "government". With USG's recent push to make patronizing these behemoths mandatory, even the last little sliver of "exit" has been lost.

staringispolite 11y ago

An error that large may be rare, but the overall experience of massive/unexpected financial load is fairly common via my experience hearing from customers (full disclosure: I founded a medical tourism startup called Emissary two years ago: https://www.emissarymed.com https://www.emissarymed.com) We talk to people all the time who don't have insurance (20-30M last time I checked), don't have dental insurance (~150M), or whose insurance comes with coverage caps as low as $1K-$2K that render insurance effectively useless for them in large operations. Most of the time, customers we talk to actually don't even get as far as the author did, because they can't afford the estimate, let alone the risk of over-shooting it. They just avoid getting treatment (and often get worse in the meantime). The trick then is how to find a doctor you can both afford AND trust. If you'll excuse the plug, we started Emissary to solve that when a friend's mother had this problem. Our mission is to help connect people to high-quality options they can afford, regardless of where they live in the world.

jl87 11y ago
Love it.

akg_67 11y ago

As a patient, US healthcare is terrible even if you have health insurance. Patient is at the bottom of totem pole in US healthcare, and just a number for doctors, hospitals and insurance companies and everyone else involved in the system. Just a couple of anecdotal personal recent experiences with US healthcare. 1. Recently I witnessed the trouble my primary care physician (PCP) had to go through with insurance company to get approval to perform CT scan. I couldn't believe the 30 minutes, my PCP had to spend on the phone with the United Healthcare person. This is the doctor spending time on the phone explaining all the medical reasons for recommending CT scan and not some administrative person in doctor's office. This is in contrast to a friend's experience whose PCP kept prescribing pain killers and other prescriptions instead of pushing insurance company for further tests for abdominal pain. The friend later was diagnosed with stage 4 cancer when showed up at ER with same symptoms. 2. While researching a local major hospital rated highly for quality of surgery, I came across the reports of quite a few cancer patients complaining about hospital quickly discharging patients after major surgery and restricting pain medication while in hospital. The claims don't make sense as hospital is rated so highly for Quality of Surgery and might be considered anecdotal. Until I found that two of the measuring criteria for Quality of Surgery was how long a patient stayed in hospital after surgery and dosage and duration of pain medication administered after the surgery. Talk about incentive misalignment. There is all the incentive for surgeon and hospital administration to discharge you quickly to maintain and improve Quality of Surgery rating.

Fomite 11y ago
Have you considered that discharging patients to their home, and moderating their pain medication, may actually be signs of quality care? "The patient gets what they want" is not the only sign of quality.
- eric_h 11y ago
  That is certainly true. Nevertheless, I believe the parent's point stands. "Gamifying" metrics such as time-to-discharge and pain medication usage will certainly alter the incentives of such an institution.
- 11y ago