3 ms·

A lot of the inflation in medical prices comes from how the incentives in the US medical system are lined up (e.g. "Usually hospitals get paid only a portion of

A lot of the inflation in medical prices comes from how the incentives in the US medical system are lined up (e.g. "Usually hospitals get paid only a portion of the amount they bill, as most have negotiated discounts with insurance companies."). So, UHC doesn't just mean that the cost is paid for, but that the price itself wouldn't be so astronomical. I'd really love to see a comparison between 1) the $1MM bill 2) the "actual" negotiated money that changes hands 3) what it would cost in other countries with different healthcare systems.

noobaccount 6y ago
What’s the link between “everyone has a way to pay” and “hospitals won’t overbill”?
- hedora 6y ago
  If the hospitals get paid what they bill, then they won’t have to add nonsense charges to make up the difference.
indiannotation 6y ago
I reside in India and I have also lived in the US, so I can comment on 3. India is going through an interesting phase of aping the "insurance system" of the US over the last 10 years or so (maybe longer, but that's not the main point), but a lot of people are too poor to afford health insurance. Only people who go to the more expensive hospitals use insurance, as a rule of thumb. And guess what? The costs for many procedures have increased 4-5x over this period at those hospitals which do ask for insurance, which still beats inflation handily. On the other hand, the vast majority of people don't have insurance, which means people get to pay actual medical costs for the trivial stuff like cold and fever, and common ailments. These costs generally track inflation. On seeing this, and realizing that except for some really complicated stuff, India's healthcare system is generally quite OK, I have come to the conclusion that the insurance industry in the US is just a complete scam. Insurance is supposed to be something you use in case of a catastrophe, and I don't know how it ended up as such a mandatory thing in the US.
- theonemind 6y ago
  I think that inelastic demand and relative difficulty of ability to price compare lead to it pretty naturally Once you have an insurance layer in the system. I mean, if you get shot, and the ambulance rushes you off to a hospital, you (literally) can’t haggle and shop around. As for it staying like it is, laws in the US radically favor entrenched monied interests because of lobbying, and we have a huge amount of political propaganda convincing uneducated voters to vote against their own interest to the extent that votes even could do anything.
- disabled 6y ago
  > The insurance industry in the US is just a complete scam Correct. I came to that conclusion as a chronically ill university student back in the early 2010s. I also had never experienced other health systems before, at that point, but I had graduate student TAs ask me what I thought of the US healthcare system, and I said "it's a scam and a rip-off". The dude who asked me had an appendicitis surgery on student insurance, and he agreed as he paid a lot of money for the procedure.
disabled 6y ago
> I'd really love to see a comparison between 1) the $1MM bill 2) the "actual" negotiated money that changes hands 3) what it would cost in other countries with different healthcare systems. For example: Blood products in general (medication developed by publicly traded companies and formally approved by governmental bodies), which are regularly required for some rare diseases, generally cost around twice as much in the US compared to the rest of the developed world that has universal healthcare (excluding Switzerland). I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, and I require a self-administered blood product to quite literally, stay alive. It is called subcutaneous immunoglobulin. It is the only treatment that has ever worked: I have tried about 10 different medications, plus combinations of them, to no avail. Anyways, the cost of this blood product (immunoglobulin--both intravenous and subcutaneous forms) in developed countries that have universal healthcare (excluding Switzerland and the US) is 40 Euro per gram. Right now, the exchange rate, Euro to US Dollar is 1 Euro per 1.13 US Dollar. So, currently, this blood product costs about USD $45.01 per gram. My US-based private medical insurance, pays for this medication at a contracted rate of USD $100 per gram. The provider (the billing party) is a very well known Pharmacy Benefits Management company, and bills for the medication at a rate of USD $500 per gram. I take very close to 250 grams per month of subcutaneous immunoglobulin. Let's do the math: What my insurance pays to the provider every month, for the blood product, via claims filed over the past 2 years = ($100/gram)(250 grams/month) = USD $25,000/month What the provider bills, and what I could theoretically owe, if something goes wrong = ($500/gram)(250 grams/bill) = USD $125,000 per bill So, if for some reason a mistake is made, with respect to honoring a prior authorization, I can literally end up with a bill over USD $100,000 for a "one month's supply" of medication, with no resolve. What a government in Europe (excluding Switzerland) pays per month for the medication (and I never have to worry about owing) = ($45.01/gram)*(250 grams/month) = USD $11,252.50/month

noobaccount 6y ago

What’s the link between “everyone has a way to pay” and “hospitals won’t overbill”?

hedora 6y ago
If the hospitals get paid what they bill, then they won’t have to add nonsense charges to make up the difference.

indiannotation 6y ago

I reside in India and I have also lived in the US, so I can comment on 3. India is going through an interesting phase of aping the "insurance system" of the US over the last 10 years or so (maybe longer, but that's not the main point), but a lot of people are too poor to afford health insurance. Only people who go to the more expensive hospitals use insurance, as a rule of thumb. And guess what? The costs for many procedures have increased 4-5x over this period at those hospitals which do ask for insurance, which still beats inflation handily. On the other hand, the vast majority of people don't have insurance, which means people get to pay actual medical costs for the trivial stuff like cold and fever, and common ailments. These costs generally track inflation. On seeing this, and realizing that except for some really complicated stuff, India's healthcare system is generally quite OK, I have come to the conclusion that the insurance industry in the US is just a complete scam. Insurance is supposed to be something you use in case of a catastrophe, and I don't know how it ended up as such a mandatory thing in the US.

theonemind 6y ago
I think that inelastic demand and relative difficulty of ability to price compare lead to it pretty naturally Once you have an insurance layer in the system. I mean, if you get shot, and the ambulance rushes you off to a hospital, you (literally) can’t haggle and shop around. As for it staying like it is, laws in the US radically favor entrenched monied interests because of lobbying, and we have a huge amount of political propaganda convincing uneducated voters to vote against their own interest to the extent that votes even could do anything.
disabled 6y ago
> The insurance industry in the US is just a complete scam Correct. I came to that conclusion as a chronically ill university student back in the early 2010s. I also had never experienced other health systems before, at that point, but I had graduate student TAs ask me what I thought of the US healthcare system, and I said "it's a scam and a rip-off". The dude who asked me had an appendicitis surgery on student insurance, and he agreed as he paid a lot of money for the procedure.

disabled 6y ago

> I'd really love to see a comparison between 1) the $1MM bill 2) the "actual" negotiated money that changes hands 3) what it would cost in other countries with different healthcare systems. For example: Blood products in general (medication developed by publicly traded companies and formally approved by governmental bodies), which are regularly required for some rare diseases, generally cost around twice as much in the US compared to the rest of the developed world that has universal healthcare (excluding Switzerland). I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, and I require a self-administered blood product to quite literally, stay alive. It is called subcutaneous immunoglobulin. It is the only treatment that has ever worked: I have tried about 10 different medications, plus combinations of them, to no avail. Anyways, the cost of this blood product (immunoglobulin--both intravenous and subcutaneous forms) in developed countries that have universal healthcare (excluding Switzerland and the US) is 40 Euro per gram. Right now, the exchange rate, Euro to US Dollar is 1 Euro per 1.13 US Dollar. So, currently, this blood product costs about USD $45.01 per gram. My US-based private medical insurance, pays for this medication at a contracted rate of USD $100 per gram. The provider (the billing party) is a very well known Pharmacy Benefits Management company, and bills for the medication at a rate of USD $500 per gram. I take very close to 250 grams per month of subcutaneous immunoglobulin. Let's do the math: What my insurance pays to the provider every month, for the blood product, via claims filed over the past 2 years = ($100/gram)(250 grams/month) = USD $25,000/month What the provider bills, and what I could theoretically owe, if something goes wrong = ($500/gram)(250 grams/bill) = USD $125,000 per bill So, if for some reason a mistake is made, with respect to honoring a prior authorization, I can literally end up with a bill over USD $100,000 for a "one month's supply" of medication, with no resolve. What a government in Europe (excluding Switzerland) pays per month for the medication (and I never have to worry about owing) = ($45.01/gram)*(250 grams/month) = USD $11,252.50/month