3 ms·

Unfortunately, there's no fair market for medical services, surgery, diagnosis, scans, tests and medicines in the US. It is so damn opaque, that I get to know t

Unfortunately, there's no fair market for medical services, surgery, diagnosis, scans, tests and medicines in the US. It is so damn opaque, that I get to know the total out of pocket expenses a month after a visit to the doctor. with extreme regulations, often stifling competition, Americans are getting ripped off every day with convoluted billing mechanisms. An example is my Echo cardiogram experience in a span of 3 months: USA: $700 out of pocket, with a blue cross blue shield insurance by an employer with dependent (premium is ~$400 per month). Insurance company paid for the echo: $2000 3 weeks: Total time taken from Cardiologist suggesting echo, to getting echo done, to cardiologist receiving reports and sharing diagnosis. India: Without insurance or any other bs, cost of echo, was ₹1200 (less than $20), which I was informed upfront. Total cost with doctor charges was ₹ 2200 (~$30). When they mentioned the echo cardiogram cost, I had to double check to make sure I didn't hear it wrong. 3 hours: Total time taken, including one hour wait even though I was on time for appointment, Cardiologist has an echo cardiogram machine in the same room. Echo taken 15 mins before cardiologist arrives, and Cardiologist gives me the diagnosis. If only there was a portal between US and India, that competition to cheaper access to healthcare would improve the costs in the USA.

epmaybe 8y ago
Not discounting your anecdote, because it's something I too have been incredibly frustrated with. However, how would you possibly know the full out of pocket cost for a visit until billing is complete? For simple things, I completely understand the frustration, as an echo should be an echo. However, what if they needed to run more tests, or did more for you as a patient and thus didn't know what to bill until your hospital stay (or even outpatient visit) is completed? As for your point about costs being drastically different in other countries for the exact same thing: I totally hear you, and wish there were more competition. How do you hit that healthy balance of competition and quality, though? Regulation is one way that comes to mind.
- rootusrootus 8y ago
  When I saw a doctor while visiting Hyderabad, it was pay-as-you-go. Walked in the door, paid a small fee to register as a patient. Consulted with a cardiologist, then paid for an EKG with my credit card. After that, consulted another cardiologist, who said let's do an echo. Paid for that, then had it done (by an actual cardiologist, no less, not just some technician), then visited an electrophysiologist. Got prescribed a beta blocker, went downstairs, paid for that, left. Total bill ended up 4500 INR, or about 75 USD. Then I flew home to the US a few days later, got a Holter monitor for a day and a visit with my primary care physician and a cardiologist. Billed a couple weeks later, 1000 USD. After insurance. For what it's worth, I could buy the Holter monitor and a bunch of disposable supplies for it for about half what I was charged for borrowing it for 24 hours. Our system is so terribly broken.
- calvinbhai 8y ago
  "Billing is complete" is a term that makes sense in the US, where the health insurance companies, equipment and pharma manufacturers dictate the final price, and the healthcare provider can get only so much from the patient + insurance, which should also cover the costs + profits considering the emergency care where those without money/insurance should also be treated. The main difference with this experience in India and in US is that in the US, the tests and treatments needed may cost a million dollars, but I'm not asked to pay up front. In India, no matter the cost or severity of the situation, unless I pay up front in full I wont get the healthcare attention that I need (unless I have a private insurance) Having seen what regulation did to taxis in US, and how Uber broke the transportation service industry off it's shackles, I think US healthcare market is ripe for disruption. Replicating the Indian healthcare model is certainly not ideal, but there are enough things that can be copied by the US to improve the certainty of costs for treatments and tests.
nailer 8y ago
> . with extreme regulations, often stifling competition, Americans are getting ripped off every day with convoluted billing mechanisms. I'm not American, but have enough exposure to US politics that I can imagine how any scenario to change this will go: - Republicans don't want to upset donors and thus leave uncompetitive market in place, despite preaching the free markets all the time - Democrats don't want to upset donors and thus leave uncompetitive market in place, having taxpayers pay ridiculous prices and pretending this is "free". - Anyone who tries to encourage competitors to charge, say $50 for a liter of saline (still a very healthy markup for purified salty water) instead of $98 (the normal price for purified salty water) will be hit by politicians (funded by PACs) that are 'looking out for the safety of Americans' by limiting the market to existing players. Nothing will ever happen and Americans will never have competitively priced healthcare.
- calvinbhai 8y ago
  agreed. Insurance and pharma companies are supposed to be among the largest donors and no politician, Democrat or Republican, Sesnsible or not, would dare to take them on.

epmaybe 8y ago

Not discounting your anecdote, because it's something I too have been incredibly frustrated with. However, how would you possibly know the full out of pocket cost for a visit until billing is complete? For simple things, I completely understand the frustration, as an echo should be an echo. However, what if they needed to run more tests, or did more for you as a patient and thus didn't know what to bill until your hospital stay (or even outpatient visit) is completed? As for your point about costs being drastically different in other countries for the exact same thing: I totally hear you, and wish there were more competition. How do you hit that healthy balance of competition and quality, though? Regulation is one way that comes to mind.

rootusrootus 8y ago
When I saw a doctor while visiting Hyderabad, it was pay-as-you-go. Walked in the door, paid a small fee to register as a patient. Consulted with a cardiologist, then paid for an EKG with my credit card. After that, consulted another cardiologist, who said let's do an echo. Paid for that, then had it done (by an actual cardiologist, no less, not just some technician), then visited an electrophysiologist. Got prescribed a beta blocker, went downstairs, paid for that, left. Total bill ended up 4500 INR, or about 75 USD. Then I flew home to the US a few days later, got a Holter monitor for a day and a visit with my primary care physician and a cardiologist. Billed a couple weeks later, 1000 USD. After insurance. For what it's worth, I could buy the Holter monitor and a bunch of disposable supplies for it for about half what I was charged for borrowing it for 24 hours. Our system is so terribly broken.
calvinbhai 8y ago
"Billing is complete" is a term that makes sense in the US, where the health insurance companies, equipment and pharma manufacturers dictate the final price, and the healthcare provider can get only so much from the patient + insurance, which should also cover the costs + profits considering the emergency care where those without money/insurance should also be treated. The main difference with this experience in India and in US is that in the US, the tests and treatments needed may cost a million dollars, but I'm not asked to pay up front. In India, no matter the cost or severity of the situation, unless I pay up front in full I wont get the healthcare attention that I need (unless I have a private insurance) Having seen what regulation did to taxis in US, and how Uber broke the transportation service industry off it's shackles, I think US healthcare market is ripe for disruption. Replicating the Indian healthcare model is certainly not ideal, but there are enough things that can be copied by the US to improve the certainty of costs for treatments and tests.

nailer 8y ago

> . with extreme regulations, often stifling competition, Americans are getting ripped off every day with convoluted billing mechanisms. I'm not American, but have enough exposure to US politics that I can imagine how any scenario to change this will go: - Republicans don't want to upset donors and thus leave uncompetitive market in place, despite preaching the free markets all the time - Democrats don't want to upset donors and thus leave uncompetitive market in place, having taxpayers pay ridiculous prices and pretending this is "free". - Anyone who tries to encourage competitors to charge, say $50 for a liter of saline (still a very healthy markup for purified salty water) instead of $98 (the normal price for purified salty water) will be hit by politicians (funded by PACs) that are 'looking out for the safety of Americans' by limiting the market to existing players. Nothing will ever happen and Americans will never have competitively priced healthcare.

calvinbhai 8y ago
agreed. Insurance and pharma companies are supposed to be among the largest donors and no politician, Democrat or Republican, Sesnsible or not, would dare to take them on.