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If Europe is more expensive, why do Americans pay more for healthcare?

75 points by iamjeff 9y ago

donatj 9y ago
Because the healthcare costs are pushed onto everything else in Europe.
- kobeya 9y ago
  I'm not sure that's the whole story. Do European doctors and hospital administrators make $350,000/yr, plus kickbacks from the pharmaceutical companies? There's a lot of structural inefficiencies in the American system that are not incentivised to go away.
  - maxxxxx 9y ago
    The healthcare bureaucracy in the US is insane. Every doctor seeems to have several people whose only job is to deal with insurance. And every insurance must have a ton of people who evaluate and deny claims.
    - maxerickson 9y ago
      Every practice has those people. But billing complexity is one of the factors driving doctors to work for hospitals and large organizations rather than in their own practice.
      - maxxxxx 9y ago
        And hospitals are even worse at billing. They pretty much just make up charges and let the patient figure it out.
- realusername 9y ago
  The country is paying more for healthcare in the US as well, the single payer healthcare is just much more efficient.
  - fivestar 9y ago
    Yet as bad as our taxes are in the states, I'm still not losing upwards of 60% of my income!
    - ceejayoz 9y ago
      > I'm still not losing upwards of 60% of my income! Nor are Europeans. http://cdn.static-economist.com/sites/default/files/imagecache/1872-width/images/2012/10/blogs/graphic-detail/20121020_inc285_0.png http://cdn.static-economist.com/sites/default/files/imagecac... Side note: I pay $28k/year in premiums and copays for healthcare, so I'd happily accept the higher tax rates. Employer-paid premiums hide the true costs of the American healthcare system from most.
      - runako 9y ago
        > Employer-paid premiums hide the true costs of the American healthcare system from most. This. I'm actually shocked at the number of economists currently scratching their heads wondering where wage growth has gone, and when it will return. It seems obvious that the answer is that wage growth never left, it has simply been transferred wholesale to the health insurance side of the ledger so employees don't feel any richer.
    - gumby 9y ago
      I think if you add taxes + medical expenses you'll find you pay about the same or even more than in most of Europe.
    - corybrown 9y ago
      Top bracket for California and NYC works out to over 50%, but without free healthcare, education, and retirement.
    - 9y ago
- mortehu 9y ago
  If you take US spending on just Medicare and Medicaid and divide that by the total population (i.e. even people who aren't covered by those programs), you get a greater per capita number than all health care spending in UK (which covers all residents). So US is apparently just as willing as UK to spend federal money on health care, it just doesn't get as much in return.
- gumby 9y ago
  Well they are in the US too. They are in taxes, in the costs of goods (since many companies are paying for their employees' insurance) etc. You can strain it out of GDP to see how much it is: over 17% in the USA, 9.4% in Australia etc: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
andreiursan 9y ago
Europe was more expensive a couple of years ago. Now is much cheaper, just pick equivalent cities and compare them on Numbeo. e.g. Hamburg vs Seattle https://www.numbeo.com/cost-of-living/compare_cities.jsp?country1=United+States&country2=Germany&city1=Seattle%2C+WA&city2=Hamburg&tracking=getDispatchComparison https://www.numbeo.com/cost-of-living/compare_cities.jsp?cou... The past years I used to travel each year to US, in different parts (Dallas, Chicago, Seattle etc...) and I always had the impression that USA is way more expensive - from the perspective of someone who goes to a restaurant and enjoys good food and a good bottle of wine. Also health insurance is cheaper here, and my coverage is very good.
- deleted 9y ago
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- fivestar 9y ago
  US big cities are expensive, but there are plenty of places in the US that you haven't visited that are quite affordable to live in. You can't judge the whole US by NY, LA, and Chicago.
  - Sharlin 9y ago
    But aren't many of the inexpensive areas those that are dying due to deindustrialization? Those areas that gave rise to Trump?
    - tdb7893 9y ago
      Many cities in the Midwest are growing and fairly cheap. I was talking to someone from Des Moines and their rent was really low compared to larger or coastal cities
      - yeldarb 9y ago
        Des Moines is great. Cheap, good jobs, big enough to get decent concerts/theater tours, and small enough to feel a sense of community. Only downside is ~1-2 months of brutal weather in the winter. In response to the parent comment, the reason it's largely escaped these effects is that the economy is anchored in insurance and financial services rather than manufacturing. There's also a big ag-tech sector and growing bio-tech industry if you include Ames which is a university town about 30 miles North.
nroets 9y ago
Sad, but true: "the fact that this treatment is more readily available means U.S. patients (insured ones, anyway) who might not need it go under the knife just to be safe" I only had to make that choice once, namely with the removal of my wisdom teeth. I'm glad I insisted on local anesthetic.
- maxxxxx 9y ago
  I have noticed that in the last year a few coworkers had their wisdom teeth removed despite having no problems with them. It was sold as a prophylactic thing. Is that the latest trend? One coworker got a pretty bad infection and was miserable for weeks afterwards.
  - stantaylor 9y ago
    It's actually a very old trend. Only recently have researchers begun to say that you should only have wisdom teeth out if they are causing problems, not prophylactically. http://www.nytimes.com/2011/09/06/health/06consumer.html http://www.nytimes.com/2011/09/06/health/06consumer.html
  - fivestar 9y ago
    The problem with "dormant" wisdom teeth is that they are often misaligned and will push against the other teeth, ruining expensive orthodontic work.
  - accountyaccount 9y ago
    It's a lot harder to fix issues like crowding and alignment after the damage has already been done — and the pain is debilitating if you have an infection/issues due to wisdom teeth not coming in 'just right' as well. I'm on the fence about the rate we take them out, but there are solid arguments for it.
  - narrowrail 9y ago
    Not the latest trend. My grandfather went to Univeristy of Toronto School of Dentistry in the 1920's and his opinion was always remove the wisdom teeth. People in their 20s saying they're glad they kept them will probably regret it in their 50s.
Theodores 9y ago
There are some things that are expensive about the U.S. healthcare system that are totally unnecessary - for instance the epidemic in prescription painkillers of the opium variety - tens of millions of Americans are hooked on those things. The expense here is not the main problem, it is the millions of lives ruined by big pharma. There are other curious upsells that go on in U.S. healthcare, e.g. off-label prescriptions. That does not happen in Europe as the incentive is not there, the hospital/doctor is not profit motivated to get their patient on the hard drugs, as per the U.S. situation. Expense begins at birth if you are male - when medical staff get paid for circumcisions then they happen, in Europe there is not this financial imperative so the only people getting themselves circumcised are doing so for religious or actual medical reasons, not just because it is an upsell from the hospital. The more I find out about U.S. healthcare the leas I see it as that.
siderax 9y ago
I read somewhere, don't remember where that your healthcare system is more costly because of you're legal system. There are more legal risk and cost for doctor, hospital, etc.. in the US, so their insurance is (way) more costly, so their price is higher. But I don't have any data, so that's just an hypothesis. But if this is true, good luck to change that.
- ceejayoz 9y ago
  http://www.latimes.com/business/hiltzik/la-fi-mh-another-study-shows-why-tort-reform--20140919-column.html http://www.latimes.com/business/hiltzik/la-fi-mh-another-stu... > The notion has lived on despite copious evidence that that the so-called defensive medicine practiced by doctors merely to stave off lawsuits accounts for, at best, 2% to 3% of U.S. healthcare costs. As for "frivolous lawsuits," they're a problem that exists mostly in the minds of conservatives and the medical establishment. > A new study led by Michael B. Rothberg of the Cleveland Clinic and published in the Journal of the American Medical Association aimed to measure how much defensive medicine there is, really, and how much it costs. The researchers' conclusion is that defensive medicine accounts for about 2.9% of healthcare spending. In other words, out of the estimated $2.7-trillion U.S. healthcare bill, defensive medicine accounts for $78 billion.
  - BryanBeshore 9y ago
    Interesting points, but this still does not shed light on the effective insurance costs physicians pay (annually and over the life of a practice), in case a malpractice suit is brought against them.
    - ceejayoz 9y ago
      https://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/ https://prescriptions.blogs.nytimes.com/2009/08/31/would-tor... > Q. But critics of the current system say that 10 to 15 percent of medical costs are due to medical malpractice. > A. That’s wildly exaggerated. According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That’s a rounding error. Liability isn’t even the tail on the cost dog. It’s the hair on the end of the tail. Even at the 10-15% number, that's meaning the vast majority of costs still come from elsewhere.
blubbermonkey 9y ago
Other relevant reasons: single payer healthcare is less expensive because otherwise hospitals have more market power, which allows them to charge prices way above what it costs. Also, insurance companies here don't use cost effective analysis as much as Europe and will pay for the latest experiemental treatment, whereas Europe might ration its care for expensive relatively ineffective treatments.
- splintercell 9y ago
  > Other relevant reasons: single payer healthcare is less expensive because otherwise hospitals have more market power, which allows them to charge prices way above what it costs. I am sorry but that's like the opposite of economic logic. Ceritus paribus, more competition means lower prices. Regarding the actual topic, I've long maintained that a single payer system in America would be much more expensive than a single payer system in Europe because of different priorities of the American consumers (for instance, old people demographic in America, the pro-life nature where a big part of our insurance expenses goes towards saving premature newborn babies). The only way a single payer in America (or in any country) could be cheaper is by offering a different product to the consumers.
  - franciscop 9y ago
    I think that from the single payer wording OP means that the offer side remain constant while the demand (or the pockets' depth) increases => higher prices.
  - norea-armozel 9y ago
    >I am sorry but that's like the opposite of economic logic. Ceritus paribus, more competition means lower prices. It doesn't hold under empirical study of firms of any industry. Competition can be offset by jacking up prices or otherwise hiding the price. Prices are never set by the market, so everyone pays a ransom for the good or service in question, especially in healthcare.
    - deleted 9y ago
      [deleted]
namlem 9y ago
In urban areas, housing in Europe is typically cheaper than in the US. Rural and suburban housing is much more, though of course the US has a far larger supply of land.
Pigo 9y ago
Just this weekend my wife told me about a co-worker who was bragging about taking the ambulance to the ER the last time her son had a slight cough. Normally she goes through all the trouble of driving him there herself, but she didn't want to waste any gas. Apparently, any and all health matters end with a trip to the ER in her family. She said several other co-workers claimed to do this as well. Part of the reason is that they can ask for prescriptions for Pediasure and other baby-related goods while they are there, so that it'll be covered and they don't have to pay for it. I'd never heard of this. For most of these families, the fathers of their children stay home all day and don't work. I admire how these women pull long shifts and work everyday of the week. But when it comes to healthcare, I've heard some ponderous stories that shed some light on how some systems come to get over-worked and require so much money to operate. Maybe our community is the only one in America that this common, but it's a reality where I live. Yeah I get a little ticked off when my premiums continue to rise when I hardly ever seek any healthcare and my family is rarely sick, and insurance companies count on my never going to help shoulder the burden of the people who do go. I don't mind contributing some to help people who need it, but honestly it's reaching a breaking point with me. The company I work for can't afford to offer a plan better than Obamacare, so even the PPO plan is terrible.
- snarf21 9y ago
  This is one of the key factors: access. We can cut costs but that generally means removing access for a lot of people. There is a cost for having an UrgentCare and a CVS on every corner. This also means driving larger distances to get care which Europe doesn't have at the same scale given their density.Removing all that cost also means removing 100Ks of jobs (some direct, some indirect because even grocery stores make a killing on prescriptions). No one is going to vote for that. Instead we'll keep doing what we do with everything else, raise taxes on the middle class to pay for everyone else. We also need a better way to separate emergency healthcare insurance (which is what we have for cars) from regular routine things that should maybe be paid out of pocket or socialized. We also need to cut down on the abuse and that is what you are talking about. No ER for a cold and less unnecessary tests and cut back on cancer treatments for people over 80 (most everyone is at risk for cancer eventually, this is just a result of aging, not an unfortunate event for a 20 year old).
carsongross 9y ago
Most people are aware that the US pays the most for healthcare per capita. Most people are not aware that the US pays more per capita on socialized medicine than any country except Norway: https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File%3AOECD_health_expenditure_per_capita_by_country.svg https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h... In fact, the US spends more in socialized medicine per capita than many countries spend in total (public and private): France, the U.K. and Japan, for example. I think unfortunately only a collapse will offer opportunity for reform.
IshKebab 9y ago
Don't worry, the Tories will make our healthcare as expensive as yours soon enough.
anthonybsd 9y ago
I think the basic premise of the question is utterly flawed. Europe is NOT more expensive when it comes to just about anything except for certain categories of items (like cars and for good reason!). Take Germany for example. Childcare? Free or 200 EUR per month if you want extended hours. College tuition? Free. Rent? Fairly cheap. Food? Again, fairly reasonable. Almost any kind of -care or -service is cheaper in Germany as compared to the US.
- rubatuga 9y ago
  I heard Germany also has less working days in a year on average.
  - MagnumOpus 9y ago
    Well, a legal minimum of 20 vacation days (and 30 being the norm for full-time work), plus 9-10 public holidays that fall on workdays, plus as many days of paid sick leave as the doctor asks for. So maybe 220 days at work per year? I guess that is 6-10% less than in the US.
    - germanier 9y ago
      An average German employee works about 1.3k hours a year, in the US about 1.8k. There are some European countries where people work even longer on average. (Note that these numbers include all workers, so also part-time employees. There are also differences between countries on how they are exactly measured so comparisons should be taken with a grain of salt. But for a rough idea that should be enough). Source: https://data.oecd.org/emp/hours-worked.htm https://data.oecd.org/emp/hours-worked.htm
  - y4mi 9y ago
    Employers are required to Grant an absolute minimum of 4 weeks of vacation per year.(20 days in 5 workday contracts and 24 in 6 workday contracts) It's generally more the further you get in your career. I know a few people that aren't even in management yet with about 30 days (plus state holiday) and a 35 hours week.
hectorr 9y ago
There are a lot of bad reasons for this, and a lot of bad impacts, but there is at least one benefit for humanity: American healthcare dollars create intense competition to do to do aggressive and innovative biomedical research and product development.
- FullMtlAlcoholc 9y ago
  with maybe 10% of products reaching market and a focus on blockbuster drugs, not necessarily those which may save or improve lives
dmh2000 9y ago
for one thing, we Americans demand instant service even for the more expensive things. For example, I live in a small-ish town, and yet there are 3 clinics with an MRI machine within 15 minutes of where i live. If I needed one, I would be on the slab in the amount of time it took me to drive there and fill out the paperwork. Maybe an hour or two if someone was there ahead of me. I would never have to wait a day or more. I don't have the stats on other countries, but I bet most are not like that. And that shit is expensive. The way medical competition works in the US is that prices go up when there is more competition because the competing clinics need to keep purchasing the latest technology to keep up. As long as insurance covers the alternatives, we go to the best and most expensive. In the US we have WAY too much health care.
- 24gttghh 9y ago
  I'm not sure I believe "more competition drives medical costs higher".
  - ceejayoz 9y ago
    Healthcare competition is, at times, more like Gucci vs. Prada - expensive, intensive tests and treatment make people feel like they got better care, even when the patient just needed the healthcare equivalent of a $20 purse. There are companies all over the US that heavily market entirely unnecessary things like "full body scans", elective surgeries, etc.
  - toast0 9y ago
    It's pretty plausible. We don't have price transparency or price competition; generally when a doctor asks a patient to get an expensive test, if insurance covers it and it's not inconvenient, the patient will get it. So, if there are more places to get expensive tests, that's competition, but also is likely to lead to more expensive tests being done. This raises the question of efficacy of the tests for patients who wouldn't have had the test done when there was less access. If spending more for the tests improves health outcomes, that's valuable, and if it saves money on treatment that's even better.
- alkonaut 9y ago
joshuaheard 9y ago
Maybe Americans pay more for healthcare because we underwrite most of the medical innovation in the world. https://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/#403f5f5c1a71 https://www.forbes.com/sites/matthewherper/2011/03/23/the-mo...
_nalply 9y ago
As a tourist in SF I got whitlow. I went to a medic. He looked at my finger and then gave me a box of antibiotics. Then his assistant asked for $300. I balked and they reduced to $200. This sample of size 1 (one) is enough to tell me that something is off in the US.
- highpass 9y ago
  Increasing this sample size to two: One heated day I punched an object that ought not be punched. Little finger swelled up and didn't quite work correctly. A few hours later said finger was bandaged, and holding a bill for $3,400. No medication. Just looked at, x-ray'd, and bandaged into recovery position. $3,400. US. It would have been cheaper to fly back to the UK and have it looked at - three times over!
  - la_oveja 9y ago
    This is insane. I can't understand how Americans see this normal.
    - ac29 9y ago
      Most Americans dont see that as normal, healthcare is one of the top political issues in this country. However, the true costs of healthcare are extremely opaque. I'd guess the cost of the little anger incident above would be an order of magnitude less with insurance. To add another anecdote, I got a kidney stone ~5 years ago. The cost for ER admission, a CT scan, some lab work, prescriptions, etc was about "$20,000". However, nobody paid anybody $20,000. I paid something like $1000 and my guess is my insurance via their negotiated rates paid something like another $1000 on top of that. How we got there as a country is a long, complicated story.
- ac29 9y ago
  For someone with health insurance (as is legally mandated under the ACA) this would have cost about $30 ($20 office visit, $10 prescription). Completely agree that the prices they charge to the uninsured are insane. Not sure what the situation is for tourists, but for American citizens, my understanding is that you cant be refused treatment if you don't have insurance. And most (many?) people without insurance just dont pay the bill.
mahd43 9y ago
"Free" childcare, tuition etc in Europe is a myth. There's no such thing as free. on a salary of $150,000 you pay more than $75,000 in income tax in many EU countries, then add to that various other taxes like real estate tax etc. For that you get poor public schools, poor healthcare etc. Last time I scheduled an appointment at the FREE doctor I had to wait 4 weeks for him to see me. So I had to go to a private one and pay cash, after already paying huge sums of money for this supposedly cheap and awesome european healthcare.
- analyzethis 9y ago
  Counter example from Denmark, a European country: two weeks ago my son had a rash (no other symptoms), preventing me from dropping him off at daycare. I called the doctor at 8.30 a.m., had an appointment at the FREE doctor at 11. Problem solved in less than three hours.
  - mahd43 9y ago
    Yeah, sure, there's going to be positive counterexamples. Waiting times (specially for say for some types of surgery are an issue in Denmark also). Look, I have extensive experience from inside the the system, maybe I can write a more detailed post about how this works and some reasons why US healthcare can be so expensive, if anyone is interested in that. But just a quick example, health care costs on national levels fluctuate through the years, and so do collected taxes and hence how much of that pile is allocated to healthcare. This can result in a doctor treating your son differently in 2016 than in 2017, an neither the doctor or the hospital will tell you this. For example he might need a surgery, which will be done with an invasive surgical procedure (opening up a person with a scalpel), even though a non-invasive laser procedure is available and the hospital has all the necessary equipment & and the doctors trained. -- In short, examples of generally best health care systems in Europe are Switzerland, Netherlands, and NOT England (NHS) or France.
- la_oveja 9y ago
  I live in northern Spain, and I have a website that entering my SS number I can schedule an appointment tomorrow morning (14 hours from now). For FREE. And with good equipment, nothing to envy to private healthcare.
deleted 9y ago
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Vnac 9y ago
Based on my experiences as an American living in Europe, the premise of this is entirely wrong. At least in some cases- I'm a freelancer without kids living in Germany. For someone who is employed, older, has kids, or lives in a different country, the calculation may be different. But overall, Europe isn't the healthcare utopia people make it out to be. The cost of living in Europe is significantly lower than the US, not higher as the article suggests. Housing, food, everything. Overall I can live on much much less money than I did in the US. This may vary from city to city, but I think in many places in Europe this is true. But health care is much more expensive in Europe. For me, part of this is due to being a freelancer- the public system is unaffordable for me because I would have to pay double, and pay double with my income calculated at a higher rate than I actually make. The private system is similarly expensive. It costs far more than health insurance in the US would for me. But in general, health insurance is not cheap. Insurance also includes far less here than in the US. It doesn't include even basic preventative care when you are under a certain age. It also doesn't include stuff like birth control or STD tests. And even for things it covers, it's difficult to get any reimbursement at all from private health insurance. I've also found the medical system in Germany to be atrocious when you actually go to see a doctor. If you end up in the emergency room, you can get good care. But doctors seem to just wait until it gets that bad before doing much and often spout nearly-superstitious nonsense to justify not providing medical care. Maybe they just do this to me because I'm an immigrant though- possible Germans get better care. As a result, I only have cheap, crappy insurance here. It's currently cheaper and more effective for me to have decent insurance in the US, and fly home whenever I need to go to the doctor. The US medical system under the ACA is amazing, better than nearly all Americans realize.
- socialist_coder 9y ago
  Hmm, something here seems off. I've been living in Germany for the last 5 years, I'm self employed with a wife and 2 kids, and I'm on the public plan. It seems great. It scales with your income so it should always be affordable. Why are you having to "pay double"? The 2nd component here is that your premium is 99% of your total health care costs. And, very little arguing with the insurance company. Much nicer to deal with than back in the US where it's rarely 100% coverage and the insurance company is trying to screw you at any opportunity. > It doesn't include even basic preventative care My public insurance includes an every 2 years skin screening from the dermatologist, and dentist checkups / teeth cleanings pretty frequently. Other preventative care, I'm not sure of. > I've also found the medical system in Germany to be atrocious when you actually go to see a doctor. If you end up in the emergency room, you can get good care. I've been sick a few times. I've gone to a family doctor and an ENT specialist and both I thought were very good. Comparable to treatment I've received in the US. It's unfortunate your experience was so bad but I don't think that is the norm. I have 2 children so we have quite a bit of experience with the German system and it seems absolutely wonderful from my perspective. One of my kids was premature and I have 0 complaints about how they handled that. She also developed a very serious medical condition a few years later. She was on chemotherapy and required multiple surgeries. I don't know how the health care for this would be in the US but the German health care system handled it great, in my opinion. We've never had to fight with the insurance company on anything except for a $7000 club foot brace which took us a few back and forth letters to get. Not so bad though.
petilon 9y ago
The reason healthcare costs so much in the US is insurance. When insurance pays for everything patients don't care how much the medical providers are charging, and patients don't care if medical providers are providing unnecessary services. When somebody else (i.e., insurance) is paying, the individual consumer is encouraged to consume without any restraint. When all consumers behave this way, providers are able to charge high prices, which in turn causes insurance premiums to go up. (Look up "tragedy of the commmons"). The solution is to make the consumer participate in driving costs down. One employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, either in the current year or in the future). This means the max you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize medical spending? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.
- narrowrail 9y ago
  >The solution is to make the consumer participate in driving costs down. The insurance companies and hospitals do not want this, and they seem to prefer to have large administrative bureaucracies and collude on pricing. I'm glad there are many comments making the point about price transparency and competition. Edit: Just found this somewhat recent article: "those indecipherable medical bills theyre one reason health care costs so much" https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html https://www.nytimes.com/2017/03/29/magazine/those-indecipher...
dgudkov 9y ago
What stops US from adopting the Canada healthcare system? It's not perfect but at least reasonable. Why re-invent the bicycle?
tmaly 9y ago
I had a recent medical issue with my daughter in the Philippines. We brought her to the emergency room in Manila at the best hospital that had US trained doctors. All the tests, the stay, the treatment all came out to a total of about $140. Contrast this with a recent visit I had to the ER in the US. I have insurance, and my copay for the visit was $150. There is definitely something wrong with the pricing of healthcare in the US. I am not sure how to solve it given all of the parties involved, but I think adding transparency to the pricing would be a good first step. To those that do not know, the medical industry in the US has an anti-trust exemption. What that means is that they are not required to publish prices. That is why one patient can get a totally different price than another patient getting the same exact procedure. How can you begin to solve something if you cannot even measure it?
vladimir-y 9y ago
Because imho insurance companies is a sort of mafia, for me it looks like a conspiracy to rob people out is happening.

75 points by iamjeff 9y ago

donatj 9y ago

Because the healthcare costs are pushed onto everything else in Europe.

kobeya 9y ago
I'm not sure that's the whole story. Do European doctors and hospital administrators make $350,000/yr, plus kickbacks from the pharmaceutical companies? There's a lot of structural inefficiencies in the American system that are not incentivised to go away.
- maxxxxx 9y ago
  The healthcare bureaucracy in the US is insane. Every doctor seeems to have several people whose only job is to deal with insurance. And every insurance must have a ton of people who evaluate and deny claims.
  - maxerickson 9y ago
    Every practice has those people. But billing complexity is one of the factors driving doctors to work for hospitals and large organizations rather than in their own practice.
    - maxxxxx 9y ago
      And hospitals are even worse at billing. They pretty much just make up charges and let the patient figure it out.
realusername 9y ago
The country is paying more for healthcare in the US as well, the single payer healthcare is just much more efficient.
- fivestar 9y ago
  Yet as bad as our taxes are in the states, I'm still not losing upwards of 60% of my income!
  - ceejayoz 9y ago
    > I'm still not losing upwards of 60% of my income! Nor are Europeans. http://cdn.static-economist.com/sites/default/files/imagecache/1872-width/images/2012/10/blogs/graphic-detail/20121020_inc285_0.png http://cdn.static-economist.com/sites/default/files/imagecac... Side note: I pay $28k/year in premiums and copays for healthcare, so I'd happily accept the higher tax rates. Employer-paid premiums hide the true costs of the American healthcare system from most.
    - runako 9y ago
      > Employer-paid premiums hide the true costs of the American healthcare system from most. This. I'm actually shocked at the number of economists currently scratching their heads wondering where wage growth has gone, and when it will return. It seems obvious that the answer is that wage growth never left, it has simply been transferred wholesale to the health insurance side of the ledger so employees don't feel any richer.
  - gumby 9y ago
    I think if you add taxes + medical expenses you'll find you pay about the same or even more than in most of Europe.
  - corybrown 9y ago
    Top bracket for California and NYC works out to over 50%, but without free healthcare, education, and retirement.
  - 9y ago
mortehu 9y ago
If you take US spending on just Medicare and Medicaid and divide that by the total population (i.e. even people who aren't covered by those programs), you get a greater per capita number than all health care spending in UK (which covers all residents). So US is apparently just as willing as UK to spend federal money on health care, it just doesn't get as much in return.
gumby 9y ago
Well they are in the US too. They are in taxes, in the costs of goods (since many companies are paying for their employees' insurance) etc. You can strain it out of GDP to see how much it is: over 17% in the USA, 9.4% in Australia etc: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

andreiursan 9y ago

Europe was more expensive a couple of years ago. Now is much cheaper, just pick equivalent cities and compare them on Numbeo. e.g. Hamburg vs Seattle https://www.numbeo.com/cost-of-living/compare_cities.jsp?country1=United+States&country2=Germany&city1=Seattle%2C+WA&city2=Hamburg&tracking=getDispatchComparison https://www.numbeo.com/cost-of-living/compare_cities.jsp?cou... The past years I used to travel each year to US, in different parts (Dallas, Chicago, Seattle etc...) and I always had the impression that USA is way more expensive - from the perspective of someone who goes to a restaurant and enjoys good food and a good bottle of wine. Also health insurance is cheaper here, and my coverage is very good.

deleted 9y ago
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fivestar 9y ago
US big cities are expensive, but there are plenty of places in the US that you haven't visited that are quite affordable to live in. You can't judge the whole US by NY, LA, and Chicago.
- Sharlin 9y ago
  But aren't many of the inexpensive areas those that are dying due to deindustrialization? Those areas that gave rise to Trump?
  - tdb7893 9y ago
    Many cities in the Midwest are growing and fairly cheap. I was talking to someone from Des Moines and their rent was really low compared to larger or coastal cities
    - yeldarb 9y ago
      Des Moines is great. Cheap, good jobs, big enough to get decent concerts/theater tours, and small enough to feel a sense of community. Only downside is ~1-2 months of brutal weather in the winter. In response to the parent comment, the reason it's largely escaped these effects is that the economy is anchored in insurance and financial services rather than manufacturing. There's also a big ag-tech sector and growing bio-tech industry if you include Ames which is a university town about 30 miles North.

nroets 9y ago

Sad, but true: "the fact that this treatment is more readily available means U.S. patients (insured ones, anyway) who might not need it go under the knife just to be safe" I only had to make that choice once, namely with the removal of my wisdom teeth. I'm glad I insisted on local anesthetic.

maxxxxx 9y ago
I have noticed that in the last year a few coworkers had their wisdom teeth removed despite having no problems with them. It was sold as a prophylactic thing. Is that the latest trend? One coworker got a pretty bad infection and was miserable for weeks afterwards.
- stantaylor 9y ago
  It's actually a very old trend. Only recently have researchers begun to say that you should only have wisdom teeth out if they are causing problems, not prophylactically. http://www.nytimes.com/2011/09/06/health/06consumer.html http://www.nytimes.com/2011/09/06/health/06consumer.html
- fivestar 9y ago
  The problem with "dormant" wisdom teeth is that they are often misaligned and will push against the other teeth, ruining expensive orthodontic work.
- accountyaccount 9y ago
  It's a lot harder to fix issues like crowding and alignment after the damage has already been done — and the pain is debilitating if you have an infection/issues due to wisdom teeth not coming in 'just right' as well. I'm on the fence about the rate we take them out, but there are solid arguments for it.
- narrowrail 9y ago
  Not the latest trend. My grandfather went to Univeristy of Toronto School of Dentistry in the 1920's and his opinion was always remove the wisdom teeth. People in their 20s saying they're glad they kept them will probably regret it in their 50s.

Theodores 9y ago

There are some things that are expensive about the U.S. healthcare system that are totally unnecessary - for instance the epidemic in prescription painkillers of the opium variety - tens of millions of Americans are hooked on those things. The expense here is not the main problem, it is the millions of lives ruined by big pharma. There are other curious upsells that go on in U.S. healthcare, e.g. off-label prescriptions. That does not happen in Europe as the incentive is not there, the hospital/doctor is not profit motivated to get their patient on the hard drugs, as per the U.S. situation. Expense begins at birth if you are male - when medical staff get paid for circumcisions then they happen, in Europe there is not this financial imperative so the only people getting themselves circumcised are doing so for religious or actual medical reasons, not just because it is an upsell from the hospital. The more I find out about U.S. healthcare the leas I see it as that.

siderax 9y ago

I read somewhere, don't remember where that your healthcare system is more costly because of you're legal system. There are more legal risk and cost for doctor, hospital, etc.. in the US, so their insurance is (way) more costly, so their price is higher. But I don't have any data, so that's just an hypothesis. But if this is true, good luck to change that.

ceejayoz 9y ago
http://www.latimes.com/business/hiltzik/la-fi-mh-another-study-shows-why-tort-reform--20140919-column.html http://www.latimes.com/business/hiltzik/la-fi-mh-another-stu... > The notion has lived on despite copious evidence that that the so-called defensive medicine practiced by doctors merely to stave off lawsuits accounts for, at best, 2% to 3% of U.S. healthcare costs. As for "frivolous lawsuits," they're a problem that exists mostly in the minds of conservatives and the medical establishment. > A new study led by Michael B. Rothberg of the Cleveland Clinic and published in the Journal of the American Medical Association aimed to measure how much defensive medicine there is, really, and how much it costs. The researchers' conclusion is that defensive medicine accounts for about 2.9% of healthcare spending. In other words, out of the estimated $2.7-trillion U.S. healthcare bill, defensive medicine accounts for $78 billion.
- BryanBeshore 9y ago
  Interesting points, but this still does not shed light on the effective insurance costs physicians pay (annually and over the life of a practice), in case a malpractice suit is brought against them.
  - ceejayoz 9y ago
    https://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/ https://prescriptions.blogs.nytimes.com/2009/08/31/would-tor... > Q. But critics of the current system say that 10 to 15 percent of medical costs are due to medical malpractice. > A. That’s wildly exaggerated. According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That’s a rounding error. Liability isn’t even the tail on the cost dog. It’s the hair on the end of the tail. Even at the 10-15% number, that's meaning the vast majority of costs still come from elsewhere.

blubbermonkey 9y ago

Other relevant reasons: single payer healthcare is less expensive because otherwise hospitals have more market power, which allows them to charge prices way above what it costs. Also, insurance companies here don't use cost effective analysis as much as Europe and will pay for the latest experiemental treatment, whereas Europe might ration its care for expensive relatively ineffective treatments.

splintercell 9y ago
> Other relevant reasons: single payer healthcare is less expensive because otherwise hospitals have more market power, which allows them to charge prices way above what it costs. I am sorry but that's like the opposite of economic logic. Ceritus paribus, more competition means lower prices. Regarding the actual topic, I've long maintained that a single payer system in America would be much more expensive than a single payer system in Europe because of different priorities of the American consumers (for instance, old people demographic in America, the pro-life nature where a big part of our insurance expenses goes towards saving premature newborn babies). The only way a single payer in America (or in any country) could be cheaper is by offering a different product to the consumers.
- franciscop 9y ago
  I think that from the single payer wording OP means that the offer side remain constant while the demand (or the pockets' depth) increases => higher prices.
- norea-armozel 9y ago
  >I am sorry but that's like the opposite of economic logic. Ceritus paribus, more competition means lower prices. It doesn't hold under empirical study of firms of any industry. Competition can be offset by jacking up prices or otherwise hiding the price. Prices are never set by the market, so everyone pays a ransom for the good or service in question, especially in healthcare.
  - deleted 9y ago
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namlem 9y ago

In urban areas, housing in Europe is typically cheaper than in the US. Rural and suburban housing is much more, though of course the US has a far larger supply of land.

Pigo 9y ago

Just this weekend my wife told me about a co-worker who was bragging about taking the ambulance to the ER the last time her son had a slight cough. Normally she goes through all the trouble of driving him there herself, but she didn't want to waste any gas. Apparently, any and all health matters end with a trip to the ER in her family. She said several other co-workers claimed to do this as well. Part of the reason is that they can ask for prescriptions for Pediasure and other baby-related goods while they are there, so that it'll be covered and they don't have to pay for it. I'd never heard of this. For most of these families, the fathers of their children stay home all day and don't work. I admire how these women pull long shifts and work everyday of the week. But when it comes to healthcare, I've heard some ponderous stories that shed some light on how some systems come to get over-worked and require so much money to operate. Maybe our community is the only one in America that this common, but it's a reality where I live. Yeah I get a little ticked off when my premiums continue to rise when I hardly ever seek any healthcare and my family is rarely sick, and insurance companies count on my never going to help shoulder the burden of the people who do go. I don't mind contributing some to help people who need it, but honestly it's reaching a breaking point with me. The company I work for can't afford to offer a plan better than Obamacare, so even the PPO plan is terrible.

snarf21 9y ago
This is one of the key factors: access. We can cut costs but that generally means removing access for a lot of people. There is a cost for having an UrgentCare and a CVS on every corner. This also means driving larger distances to get care which Europe doesn't have at the same scale given their density.Removing all that cost also means removing 100Ks of jobs (some direct, some indirect because even grocery stores make a killing on prescriptions). No one is going to vote for that. Instead we'll keep doing what we do with everything else, raise taxes on the middle class to pay for everyone else. We also need a better way to separate emergency healthcare insurance (which is what we have for cars) from regular routine things that should maybe be paid out of pocket or socialized. We also need to cut down on the abuse and that is what you are talking about. No ER for a cold and less unnecessary tests and cut back on cancer treatments for people over 80 (most everyone is at risk for cancer eventually, this is just a result of aging, not an unfortunate event for a 20 year old).

carsongross 9y ago

Most people are aware that the US pays the most for healthcare per capita. Most people are not aware that the US pays more per capita on socialized medicine than any country except Norway: https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File%3AOECD_health_expenditure_per_capita_by_country.svg https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h... In fact, the US spends more in socialized medicine per capita than many countries spend in total (public and private): France, the U.K. and Japan, for example. I think unfortunately only a collapse will offer opportunity for reform.

IshKebab 9y ago

Don't worry, the Tories will make our healthcare as expensive as yours soon enough.

anthonybsd 9y ago

I think the basic premise of the question is utterly flawed. Europe is NOT more expensive when it comes to just about anything except for certain categories of items (like cars and for good reason!). Take Germany for example. Childcare? Free or 200 EUR per month if you want extended hours. College tuition? Free. Rent? Fairly cheap. Food? Again, fairly reasonable. Almost any kind of -care or -service is cheaper in Germany as compared to the US.

rubatuga 9y ago
I heard Germany also has less working days in a year on average.
- MagnumOpus 9y ago
  Well, a legal minimum of 20 vacation days (and 30 being the norm for full-time work), plus 9-10 public holidays that fall on workdays, plus as many days of paid sick leave as the doctor asks for. So maybe 220 days at work per year? I guess that is 6-10% less than in the US.
  - germanier 9y ago
    An average German employee works about 1.3k hours a year, in the US about 1.8k. There are some European countries where people work even longer on average. (Note that these numbers include all workers, so also part-time employees. There are also differences between countries on how they are exactly measured so comparisons should be taken with a grain of salt. But for a rough idea that should be enough). Source: https://data.oecd.org/emp/hours-worked.htm https://data.oecd.org/emp/hours-worked.htm
- y4mi 9y ago
  Employers are required to Grant an absolute minimum of 4 weeks of vacation per year.(20 days in 5 workday contracts and 24 in 6 workday contracts) It's generally more the further you get in your career. I know a few people that aren't even in management yet with about 30 days (plus state holiday) and a 35 hours week.

hectorr 9y ago

There are a lot of bad reasons for this, and a lot of bad impacts, but there is at least one benefit for humanity: American healthcare dollars create intense competition to do to do aggressive and innovative biomedical research and product development.

FullMtlAlcoholc 9y ago
with maybe 10% of products reaching market and a focus on blockbuster drugs, not necessarily those which may save or improve lives

dmh2000 9y ago

for one thing, we Americans demand instant service even for the more expensive things. For example, I live in a small-ish town, and yet there are 3 clinics with an MRI machine within 15 minutes of where i live. If I needed one, I would be on the slab in the amount of time it took me to drive there and fill out the paperwork. Maybe an hour or two if someone was there ahead of me. I would never have to wait a day or more. I don't have the stats on other countries, but I bet most are not like that. And that shit is expensive. The way medical competition works in the US is that prices go up when there is more competition because the competing clinics need to keep purchasing the latest technology to keep up. As long as insurance covers the alternatives, we go to the best and most expensive. In the US we have WAY too much health care.

24gttghh 9y ago
I'm not sure I believe "more competition drives medical costs higher".
- ceejayoz 9y ago
  Healthcare competition is, at times, more like Gucci vs. Prada - expensive, intensive tests and treatment make people feel like they got better care, even when the patient just needed the healthcare equivalent of a $20 purse. There are companies all over the US that heavily market entirely unnecessary things like "full body scans", elective surgeries, etc.
- toast0 9y ago
  It's pretty plausible. We don't have price transparency or price competition; generally when a doctor asks a patient to get an expensive test, if insurance covers it and it's not inconvenient, the patient will get it. So, if there are more places to get expensive tests, that's competition, but also is likely to lead to more expensive tests being done. This raises the question of efficacy of the tests for patients who wouldn't have had the test done when there was less access. If spending more for the tests improves health outcomes, that's valuable, and if it saves money on treatment that's even better.
alkonaut 9y ago

joshuaheard 9y ago

Maybe Americans pay more for healthcare because we underwrite most of the medical innovation in the world. https://www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-and-medicine/#403f5f5c1a71 https://www.forbes.com/sites/matthewherper/2011/03/23/the-mo...

_nalply 9y ago

As a tourist in SF I got whitlow. I went to a medic. He looked at my finger and then gave me a box of antibiotics. Then his assistant asked for $300. I balked and they reduced to $200. This sample of size 1 (one) is enough to tell me that something is off in the US.

highpass 9y ago
Increasing this sample size to two: One heated day I punched an object that ought not be punched. Little finger swelled up and didn't quite work correctly. A few hours later said finger was bandaged, and holding a bill for $3,400. No medication. Just looked at, x-ray'd, and bandaged into recovery position. $3,400. US. It would have been cheaper to fly back to the UK and have it looked at - three times over!
- la_oveja 9y ago
  This is insane. I can't understand how Americans see this normal.
  - ac29 9y ago
    Most Americans dont see that as normal, healthcare is one of the top political issues in this country. However, the true costs of healthcare are extremely opaque. I'd guess the cost of the little anger incident above would be an order of magnitude less with insurance. To add another anecdote, I got a kidney stone ~5 years ago. The cost for ER admission, a CT scan, some lab work, prescriptions, etc was about "$20,000". However, nobody paid anybody $20,000. I paid something like $1000 and my guess is my insurance via their negotiated rates paid something like another $1000 on top of that. How we got there as a country is a long, complicated story.
ac29 9y ago
For someone with health insurance (as is legally mandated under the ACA) this would have cost about $30 ($20 office visit, $10 prescription). Completely agree that the prices they charge to the uninsured are insane. Not sure what the situation is for tourists, but for American citizens, my understanding is that you cant be refused treatment if you don't have insurance. And most (many?) people without insurance just dont pay the bill.

mahd43 9y ago

"Free" childcare, tuition etc in Europe is a myth. There's no such thing as free. on a salary of $150,000 you pay more than $75,000 in income tax in many EU countries, then add to that various other taxes like real estate tax etc. For that you get poor public schools, poor healthcare etc. Last time I scheduled an appointment at the FREE doctor I had to wait 4 weeks for him to see me. So I had to go to a private one and pay cash, after already paying huge sums of money for this supposedly cheap and awesome european healthcare.

analyzethis 9y ago
Counter example from Denmark, a European country: two weeks ago my son had a rash (no other symptoms), preventing me from dropping him off at daycare. I called the doctor at 8.30 a.m., had an appointment at the FREE doctor at 11. Problem solved in less than three hours.
- mahd43 9y ago
  Yeah, sure, there's going to be positive counterexamples. Waiting times (specially for say for some types of surgery are an issue in Denmark also). Look, I have extensive experience from inside the the system, maybe I can write a more detailed post about how this works and some reasons why US healthcare can be so expensive, if anyone is interested in that. But just a quick example, health care costs on national levels fluctuate through the years, and so do collected taxes and hence how much of that pile is allocated to healthcare. This can result in a doctor treating your son differently in 2016 than in 2017, an neither the doctor or the hospital will tell you this. For example he might need a surgery, which will be done with an invasive surgical procedure (opening up a person with a scalpel), even though a non-invasive laser procedure is available and the hospital has all the necessary equipment & and the doctors trained. -- In short, examples of generally best health care systems in Europe are Switzerland, Netherlands, and NOT England (NHS) or France.
la_oveja 9y ago
I live in northern Spain, and I have a website that entering my SS number I can schedule an appointment tomorrow morning (14 hours from now). For FREE. And with good equipment, nothing to envy to private healthcare.

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Vnac 9y ago

Based on my experiences as an American living in Europe, the premise of this is entirely wrong. At least in some cases- I'm a freelancer without kids living in Germany. For someone who is employed, older, has kids, or lives in a different country, the calculation may be different. But overall, Europe isn't the healthcare utopia people make it out to be. The cost of living in Europe is significantly lower than the US, not higher as the article suggests. Housing, food, everything. Overall I can live on much much less money than I did in the US. This may vary from city to city, but I think in many places in Europe this is true. But health care is much more expensive in Europe. For me, part of this is due to being a freelancer- the public system is unaffordable for me because I would have to pay double, and pay double with my income calculated at a higher rate than I actually make. The private system is similarly expensive. It costs far more than health insurance in the US would for me. But in general, health insurance is not cheap. Insurance also includes far less here than in the US. It doesn't include even basic preventative care when you are under a certain age. It also doesn't include stuff like birth control or STD tests. And even for things it covers, it's difficult to get any reimbursement at all from private health insurance. I've also found the medical system in Germany to be atrocious when you actually go to see a doctor. If you end up in the emergency room, you can get good care. But doctors seem to just wait until it gets that bad before doing much and often spout nearly-superstitious nonsense to justify not providing medical care. Maybe they just do this to me because I'm an immigrant though- possible Germans get better care. As a result, I only have cheap, crappy insurance here. It's currently cheaper and more effective for me to have decent insurance in the US, and fly home whenever I need to go to the doctor. The US medical system under the ACA is amazing, better than nearly all Americans realize.

socialist_coder 9y ago
Hmm, something here seems off. I've been living in Germany for the last 5 years, I'm self employed with a wife and 2 kids, and I'm on the public plan. It seems great. It scales with your income so it should always be affordable. Why are you having to "pay double"? The 2nd component here is that your premium is 99% of your total health care costs. And, very little arguing with the insurance company. Much nicer to deal with than back in the US where it's rarely 100% coverage and the insurance company is trying to screw you at any opportunity. > It doesn't include even basic preventative care My public insurance includes an every 2 years skin screening from the dermatologist, and dentist checkups / teeth cleanings pretty frequently. Other preventative care, I'm not sure of. > I've also found the medical system in Germany to be atrocious when you actually go to see a doctor. If you end up in the emergency room, you can get good care. I've been sick a few times. I've gone to a family doctor and an ENT specialist and both I thought were very good. Comparable to treatment I've received in the US. It's unfortunate your experience was so bad but I don't think that is the norm. I have 2 children so we have quite a bit of experience with the German system and it seems absolutely wonderful from my perspective. One of my kids was premature and I have 0 complaints about how they handled that. She also developed a very serious medical condition a few years later. She was on chemotherapy and required multiple surgeries. I don't know how the health care for this would be in the US but the German health care system handled it great, in my opinion. We've never had to fight with the insurance company on anything except for a $7000 club foot brace which took us a few back and forth letters to get. Not so bad though.

petilon 9y ago

The reason healthcare costs so much in the US is insurance. When insurance pays for everything patients don't care how much the medical providers are charging, and patients don't care if medical providers are providing unnecessary services. When somebody else (i.e., insurance) is paying, the individual consumer is encouraged to consume without any restraint. When all consumers behave this way, providers are able to charge high prices, which in turn causes insurance premiums to go up. (Look up "tragedy of the commmons"). The solution is to make the consumer participate in driving costs down. One employer I know of has an excellent solution to the problem: Make employees pay 100% of the bill up to a certain amount, such as $6000. That's a large amount, but the employer then contributes a large amount to your Health Savings Account (HSA), such as $4000. This amount is for you to keep regardless of whether you have any health bills or not. (This money can be used for medical expenses only, either in the current year or in the future). This means the max you will spend out of pocket per year is $2000. How does this encourage the consumer to scrutinize medical spending? Because the first $6000 of medical spending in a year is "your money". This is money you'd be able to keep in your HSA if you didn't have any medical expenses. This gives the consumer a strong incentive to reduce costs, question charges, avoid unnecessary services, and so on.

narrowrail 9y ago
>The solution is to make the consumer participate in driving costs down. The insurance companies and hospitals do not want this, and they seem to prefer to have large administrative bureaucracies and collude on pricing. I'm glad there are many comments making the point about price transparency and competition. Edit: Just found this somewhat recent article: "those indecipherable medical bills theyre one reason health care costs so much" https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html https://www.nytimes.com/2017/03/29/magazine/those-indecipher...

dgudkov 9y ago

What stops US from adopting the Canada healthcare system? It's not perfect but at least reasonable. Why re-invent the bicycle?

tmaly 9y ago

I had a recent medical issue with my daughter in the Philippines. We brought her to the emergency room in Manila at the best hospital that had US trained doctors. All the tests, the stay, the treatment all came out to a total of about $140. Contrast this with a recent visit I had to the ER in the US. I have insurance, and my copay for the visit was $150. There is definitely something wrong with the pricing of healthcare in the US. I am not sure how to solve it given all of the parties involved, but I think adding transparency to the pricing would be a good first step. To those that do not know, the medical industry in the US has an anti-trust exemption. What that means is that they are not required to publish prices. That is why one patient can get a totally different price than another patient getting the same exact procedure. How can you begin to solve something if you cannot even measure it?

vladimir-y 9y ago

Because imho insurance companies is a sort of mafia, for me it looks like a conspiracy to rob people out is happening.