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If you want to fix medicine, increase transparency. Earlier this summer, I had white spots on my throat and needed to go get checked for strep. I called around
by tfha 8y ago
If you want to fix medicine, increase transparency. Earlier this summer, I had white spots on my throat and needed to go get checked for strep.
I called around, and finally settled on a facility that told me they could check for strep for just $59. I go in, get my throat culture, then get my bill.
"Well yeah, the throat culture was only $59. But the nurse had to do it and it's $120 to see a nurse. Also, the doctor has to check in before any operation is performed, and that's $200. After all other fees, your total bill is $400".
There's no way that should be legal. I was quoted $60.
- microcolonel 8y ago> There's no way that should be legal. I was quoted $60. Well, part of the problem is that the state now assumes that consumers are not qualified to take care of themselves, and that the only people who are qualified are state-approved high-demand professionals. Oddly enough, opioid overdoses were not higher when you could just buy the stuff over the counter; but people have forgotten that people used to be responsible for their own well-being, and are convinced that they should not be trusted to defer to experts when they see fit.
- gbacon 8y agoSome things should simply be left to Our Betters.
- HarryHirsch 8y agoAfter the Alfie Evans circus I'm inclined to agree. You need to be properly trained to be able to recognize what is in the best interest of the patient and that that is the only thing that matters.
- ibeckermayer 8y agoIt’s bizarre that “capitalism” is frequently blamed for the moral atrocity that is the American medical industry when really it’s one of the most clear cut examples of a state-mandated cartel
- thelasthuman 8y agoI'd be a great business man to if people were legally required to purchase my product.
- deleted 8y ago[deleted]
- jahaja 8y agoThat is just absurd. We accept that kings will naturally strive to uphold their power, that feudal lords will protect their privileges, and so on. But somehow, some seemingly dogmatic people firmly believe that despite the entire incentive structure pointing in that direction, genuine agents of capitalism are not furthering their own interests through the means of state power.
- deleted 8y ago[deleted]
- fucking_tragedy 8y agoCitizens United is one such example.
- nybble41 8y agoOf course they are. But that is not capitalism. You can't blame the free market for people "furthering their own interests through the means of state power" when the very existence of state power is antithetical to free markets. The "free" in "free market" refers specifically to the absence of legitimized and systematic aggression, of which state power is the foremost example.
- jahaja 8y agoThis is a completely and utterly ahistorical redefinition together with selective reasoning. The theological fantasy where capitalism is freed from its state component would not differ either with regards to these incentives, the state would just be replaced by "private-property lords" which you'd stamp as legitimate and welcome the voluntary toil of the propertyless masses.
- pjc50 8y agoI'm very suspicious of that factoid, given that limiting Paracetamol purchase size was very effective at reducing overdoses in the UK. Also, the US has seen a recent huge rise in opioid overdoses ...
- deleted 8y ago[deleted]
- ergothus 8y agoAny time you try to define what your insurance will cover, all you can get is s nkn binding estimate, yet most places have you sign an agreement to pay in full based on that estimate, even if the estimate is wrong.
- vidanay 8y agoYes sir, we can replace your spark plugs for only $4.00 each. It costs $75 to pull the car into the garage, the lift fee is $105, it's $21 to open the hood, $64 to unplug the wires from the old plugs, $64 to plug the wires into the new plugs, then there's $18 to close the hood (gravity assist discount), and another $75 to put the car back in the parking lot. Don't worry, changing your plugs is only $16.
- jacobwilliamroy 8y agoMy (motorcycle) mechanic quotes me based on the parts and the amount of time required to do the repair. So she'll say "A new set of tires is $130, and the shop labor is $110 an hour. If you only bring in the wheels, then labor is just $50." I'm not sure what magical force is causing my mechanic to behave this way. It could be personal preference, some kind of regulatory requirement, pressure from competing shops, etc. Whatever that force is, it doesn't seem to exist in the american sickness and treatment system.
- dasil003 8y agoNever once in 20 years of automobile ownership has a mechanic tried a stunt like that on me.
- MiguelHudnandez 8y agoPrecisely. Yet it is completely normal in American medicine. And worse, the actual patients are rarely aware of the total amount billed or paid because their insurance company handles it.
- assblaster 8y agoIf they didn't itemize, you would complain that all you see is a bill for $1000, at $500/hour. You would be asking what goes into that hourly rate.
- hippich 8y agoTry to open auto shop (it is painful but doable) and hospital. I bet issue lies in that difference.
- stickfigure 8y agoAutomobile mechanics are required to provide a written estimate in advance. I don't see why health care should be any different. Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures.
- enraged_camel 8y ago>>Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures. That is true, but emergency care disproportionately results in bankruptcies compared to other forms of care.
- falcolas 8y agoI imagine this is directly related to the inflated costs of emergency care. A dose of ibuprofen (two tablets) costing in the $40+ range?
- skellera 8y agoWell they have to pay for storage and for that very well paid employee to pass you the pills. Moderate sarcasm. But really that’s a deeper issue with insurance causing most of that. If you don’t have insurance, most hospitals will severely discount the costs that you are originally charged if you just work with them. It shows those prices are bullshit to begin with.
- ryandrake 8y agoEven if they are willing to give you a discount if you don’t have insurance, those ibuprofen pills are still going to be charged 10x or 100x over their cost. Health industry knows nobody can shop around and get quotes and regulators are unwilling to protect patients. It’s no wonder we are in the mess we are in. My locality has a ballot initiative up this year that would put a % cap on what hospitals can charge over their costs, and boy oh boy are the industry mouthpieces out in force to oppose it! They are having a field day with patients’ wallets, they know it, and they don’t want it to end.
- ryanlol 8y agoWhy would you pay?
- Waterluvian 8y agoIt is just insane to me that you have a medical issue and you're calling around for quotes. I know we have had this conversation to death for decades now but it just makes me so angry.
- nostromo 8y agoWhy? The most efficient provider should get his or her business. That way we can treat more people for strep and increase human welfare.
- mrep 8y agoProbably because if we had universal healthcare, you wouldn't have to call any because you would get the same service for free.
- mitchtbaum 8y agoHow would the universe provide healthcare?
- mrep 8y agohttps://en.m.wikipedia.org/wiki/Universal_health_care https://en.m.wikipedia.org/wiki/Universal_health_care
- WoodenChair 8y agoIt's true that you wouldn't have to call around, because you wouldn't have to compare the cost of out-of-pocket providers. It's not true that you wouldn't have to pay. You would pay through taxes, or someone else would pay through taxes. And you would pay in terms of the waiting time, which becomes an alternative form of payment in public systems.
- jimktrains2 8y agoInteresting that everyone makes this argument for things that aren't already covered by taxes. No one sits and argues that you do have to pay for the interstate system in a discussion about the cost of using it as the turnpike. No one thinks that no end user cost (what people usually mean when they say free) <> no money spent.
- rlpb 8y agoWhat happens if you insist on paying only the $59 that you were quoted?
- dev_dull 8y agoThey send it to a ruthless collections company and ruin your credit.
- rlpb 8y agoThat sounds like an entirely separate uniquely American problem. Don't you have laws that prevent disputed bills from affecting credit scores? Edit: and wouldn't this lead to lawsuits against medical practitioners for extortion if it can be proved that they make a habit of doing this to patients?
- drtz 8y agoNo, because it is just an estimate. Every medical estimate in the US will include language that explains services other than those in the estimate may be provided, and you'll be responsible for paying for them. The provider is under no legal obligation to only perform the estimated services.
- ryandrake 8y agoAlso, in America, doctors will always have you sign an agreement before they see you and before the price is known, that essentially says, “you agree to be responsible for paying any amount the doctor asks for, without any limit.”
- FeepingCreature 8y agoHow is this legal? I mean, you can just straight up make it illegal. There's no fundamental law that says you have to allow such predatory practices.
- vvillena 8y ago
- valas 8y agoTransparency is good and all, but there is anther way. In most advanced economies professional bureaucracy figures out the costs. Ordinary folks focus on getting healthy, not on costs.
- lj3 8y ago> In most advanced economies professional bureaucracy figures out the costs. This works terribly for most advanced economies, Britain and Canada in particular.
- ori_b 8y agoAs a Canadian living in the USA, I can say that it works less terribly than the American alternative.
- lj3 8y agoNot if you have cancer. https://www.ctvnews.ca/health/health-care-wait-times-hit-20-weeks-in-2016-report-1.3171718 https://www.ctvnews.ca/health/health-care-wait-times-hit-20-...
- ori_b 8y agoAgain, I have lived there, and the numbers seem on the upper end of plausible for non-essential surgery like breast reduction, but extremely bogus for anything important. A day or two was normal for routine treatments. The official government figures, where about half of patients get care within 24 hours, and about 90% within 48, are much more in line with my experience.
- lj3 8y agoI know someone personally who had to wait months to see somebody. He said screw it and came to the states for care instead (dual citizenship). He was able to see a specialist immediately and found out he was grossly misdiagnosed.
- yalogin 8y agoThe real issue is not a big percentage of the population care about the prices. A good chunk of them are covered by employer based insurance or government medicine. Only the poor and unemployed care about it and unfortunately they don’t have the gravity to change things in the US. Only the wealthy and entities able to fund a 301c can influence things. Point is I do t know what asking around for prices is going to do. By definition if you are asking around you don’t matter to the politicians.
- jihoon796 8y agoThe lack of transparency is due to perverse incentives in the healthcare system stemming from overly complex legislation. As a country, the US hasn't decided whether healthcare is a fundamental right or privilege. As a result, we constantly make political decisions that straddle the line without ever really going one way. The biggest culprit is the "fee-for-service" model of reimbursement, where healthcare providers (physicians) are reimbursed based on the quantity of care rather than patient outcomes. Each procedure has a code (CPT) that is used to bill insurance. Billing for each of these codes is completely arbitrary and up to provider/payer negotiations. The fee-for-service model is a clear example of a perverse incentive. Who reimburses the fee-for-service model? Either the government (Medicare/Medicaid isn't even entirely government-run, as many states rely on a for-profit Medicare Administrative Contractor) or private health insurance companies. The perverse incentives can now be seen from both the provider's side and the payer's side: hospitals and physicians negotiate to get the best reimbursement rates that they can. And of course, because these insurance companies want to make money, they make it "difficult" for providers to get paid for each procedure and will find any reasonable way to deny the claim from going through. Because of this, providers artificially raise the amount charged to the payers as high as they think they can get away with in the hopes that insurance will pay up. Meanwhile, patients suffer greatly as there's no transparency.
- datavirtue 8y agoYou are way off base. The original WSJ article has links to other articles detailing how hospitals merge themselves into a monopoly that has to be accepted by the insurer. The hospital sets the prices. They also go into how these large hospital systems gobble up doctors offices and use the same leverage to increase prices and tack exhoribiant fees--just like the experience of the person you are replying to.
- themagician 8y agoIt’s worth noting that Kaiser does this. They post a fee schedule for just about every routine procedure in every region they operate in. There is no abiguity about what an MRI costs. Transparency won’t fix healthcare in the US, but it is a starting point. Hell, it’s fundamental to simple free market economics. It’s silly to say we have a free market healthcare system when there is virtually no cost information about goods and services until after purchase.
- conanbatt 8y agoAnd Kaiser has 7 minute primary care appointments, and a high rate of physician burnout.
- amanaplanacanal 8y agoDo you think that's because they post their prices?
- conanbatt 8y agoIts because of their pricing structure as a vertically integrated system.
- rebuilder 8y agoAlternatively, socialize the costs. I've never bothered to figure out what going to the doctor would cost me, because it's so cheap here. I don't understand how it's economical to have a workforce with poor health care.
- jacobush 8y agoOr you know, do both! Socialize the costs, but unevenly, then inflate the costs, spread them across as many middlemen as possible, and charge left and right!
- tptacek 8y agoThat sucks. The CVS Minute Clinic will quote you $99-129 for a strep throat visit, which includes the culture and the script if you actually have it. Nurse practitioners are, I think, the future of primary care. This stuff is all bad, but it's useful to remember that primary care is actually a small fraction of the overall price of health care. Where we're really spending the money is on long-term and end-of-life care.
- leesalminen 8y ago> Nurse practitioners are, I think, the future of primary care. Agreed. When I visit my PCP, I normally meet with a NP. I’ve been quite happy with the quality of care received. > Where we're really spending the money is on long-term and end-of-life care. With the boomers entering the end-of-life phase of their lives it will be interesting to see if we will be able to change culturally and realize the huge sums of money spent with little benefit to the economy. I’m struggling with this myself currently as my parents are aging (quickly). They don’t have unlimited savings to spend on health care. While I have ample resources, I’m not convinced shelling out $1MM is worth it for them to live with a marginal quality of life for just a couple of years. Just writing that makes me feel like a terrible person but I try to think rationally and without emotions. Edit to add: I’m genuinely curious about your thoughts on this, @tptacek. I’ve always respected and appreciated your opinion here on HN.
- shanusmagnus 8y agoOur unwillingness, on a national level (and perhaps on a civilizational level, though I don't know very much about other countries) to speak plainly about this issue, and address it directly, is one of the most fundamental problems in all of healthcare.
- kryptk 8y agoIf I suspect strep, I make a same-day appointment with my family doctor, show my government issued health card, get swabbed and have a result in a few minutes. I then smile at the receptionist and walk out; there is no bill for seeing your doctor or having tests run. If I need antibiotics, my employer provided insurance covers the full cost and I pay a fixed $10 or so fee to the pharmacy. You live a few hundred km south of me I bet, and in every way except this our world is very similar.. but you guys have far deeper problems then just transparency. Your entire view of healthcare is wrong.
- tfha 8y agoFor other reasons, I don't have a family doctor. All the doctors my insurance will pay for require making appointments >9 months in advance, and I fly so much with work that I can't commit to that type of lead time. Twice I've missed appointments, and both times instead of letting me reschedule the practice informed me that I was no longer allowed with them, and that missing an appointment is considered a big offense. One day I'll figure it out but at 24 years old it's not a huge deal to me.
- Brakenshire 8y agoAnd just a reminder the US doesn’t even spend much less taxpayer money than Canada and other Western countries. The US taxpayer spends about 8-9% of GDP on healthcare, and gets this result. Other countries spend the same and get a free universal healthcare system.
- fma 8y agoAt least you got a quote...I've been told by providers that they only accept insurance patients (no up front cash), and they can't tell you till they bill you...Not sure why this is the only industry like that. You don't go to a restaurant and get the pricing after you eat. Heck when you go to a buffet you don't get billed based on how many plates you get.
- tlb 8y agoMy veterinarian charges around $60 for office visits. A surgery with general anesthetic might be $1000. It's about 10x cheaper than a human doctor, maybe 100x if you go to a random emergency room. Veterinary medicine involve all the same steps as for a human patient. I can usually get appointments the same day too. It's a totally free market, where vets compete on price and service.
- refurb 8y agoSame with medical procedures in the US that aren’t covered by insurance - cosmetic surgery, LASIK surgery, etc. The free market works pretty dam well for those.
- ChuckMcM 8y agoThis is something I've been advocating for in California. Basically the equivalent to the auto repair law that guarantees that the repair is done to the quote or they tell you it will cost more and you have the right to take their quote elsewhere[1]. [1] If the technician later determines that it will take additional work and will cost more to fix your car than the original estimate, someone from the shop must contact you, describe the additional work and cost, and get your permission to proceed. -- https://www.bar.ca.gov/Consumer/Auto_Repair_Guide.html https://www.bar.ca.gov/Consumer/Auto_Repair_Guide.html
- RaceWon 8y agoI work at a small community hospital about 225 beds. They have 9 VPs, 44 directors, and 44 assistant directors. This in addition to the Medical Staff Supervisors. Seems a bit much... no.
- wonderwonder 8y agoThat's pretty frustrating. I had a related experience where I needed antibiotics. As it was the weekend, I just went to a local walk in clinic. The person in front of me did not have insurance and his cost to see the doctor was $90. I had insurance and my out of pocket was initially $45, a couple weeks later I got the remainder of my bill for using out of network: $135. So in total I was charged double the individual without insurance plus the cost of my medication. It seems that a major driver of insurance and medical costs is that doctors are allowed to charge different pricing for the same service. In this case, paying a monthly fee for insurance ended up costing me more.
- King-Aaron 8y agoImagine a system where you go to the GP, and just make a walk-in appointment. You sit for ten to fifteen minutes, see your GP. They check you over, direct you to go see the nurse, who checks your throat. Then afterwards, the GP tells you that they'll phone you later on with the results. You walk back past the reception desk, ask what the bill was, and they either say "that'll be $40 which you can claim back by taking the receipt around the corner to Medicare", or they'll say "Oh nothing to pay, it's all bulk billed". You walk out having either spent nothing, or spent a few bucks which you get back after a five minute walk up the road. That was my recent experience.
- H1Supreme 8y ago$400 for a strep test is highway robbery.