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In the US people gripe about prescription costs but the hospitals are the real villains. Especially if you look at what an uninsured patient would pay. I rece

In the US people gripe about prescription costs but the hospitals are the real villains. Especially if you look at what an uninsured patient would pay. I recently had a planned, non-emergency outpatient procedure that did not involve any incisions, nor medications, lasted about 2-3 hours. Hospital billed $100K, insurance negotiated to about $20K. The actual doctor only got $2-3K. Makes me wonder why doctors don’t build their own hospitals…

robocat 3y ago
> Hospital billed $100K, insurance negotiated to about $20K But those numbers have no relation to reality. The amount you would pay as a private individual would be something else again. > The actual doctor only got $2-3K Could the doctor do the procedure on the street with their bare hands? That $2k also gets taxed and pays for education (it isn't disposable). I think you are hinting that you think the worker should get much more of the profit - but I'm unsure what economic theory that is called.
- lolinder 3y ago
  > But those numbers have no relation to reality. The amount you would pay as a private individual would be something else again. Exactly. The worst horror stories I've heard aren't of uninsured billing—self-pay individuals typically get a steep discount from what I've seen—it's the out-of-network hospital bills (especially pre-No Surprises Act) that consistently screw people over. In those cases the hospital would bill the insane number they officially ask for from insurance companies, the insurance company says "nope" and pays the portion they consider fair, and then the patient is (or at any rate used to be) on the hook for the remainder. If they were billing as uninsured the hospital wouldn't have come up with the insane number they started with, but now that's on record and that's the number they want.
  - robocat 3y ago
    Gotta love me some cooked numbers & incentives for perverting. An obvious incentive is that the insurance company wants a big number so they can sell the patient on just how amazing their insurance is!
    - deathanatos 3y ago
      Yeah. For example, from Google… > The average salary for a Therapist is $31.40 per hour in United States And yet my insurance is billed at $1,000/hr. They knock this down (thankfully!) to $20/h, and merrily claim to have saved me 98% of the bill! Wow! And yet … I'm paying 64% of the therapist's salary. If I were uninsured, Google says that I would most assuredly pay nowhere near $1k/hr. I.e., the "98% saved" bit is hot, steaming bull.
DavidPeiffer 3y ago
> Makes me wonder why doctors don’t build their own hospitals… Doctors are not allowed to own hospitals. That was one of the stipulations of the ACA (Obamacare). Link to the AMA, though not endorsing them as saints on the topic of healthcare costs. https://www.ama-assn.org/about/leadership/end-restrictions-physician-owned-hospitals-expand-quality-care https://www.ama-assn.org/about/leadership/end-restrictions-p...
- FireBeyond 3y ago
  Thank fuck for that, to be honest. Doctors who own DI practices on the side, or shares therein, tend to vastly over-refer their patients for DI. I shudder thinking about this applied across a whole trauma center.
rjtavares 3y ago
You don't know why doctors don't build their own hospitals, yet feel you are knowledgeable enough to identify "hospitals" as the real villains of the whole system?
SoftTalker 3y ago
Doctors used to work mostly out of their own individual or small group practices. The regulatory and administrative burdens of doing this has forced most of them into working for large corporate health organizations.
- freeAgent 3y ago
  Yup, the regulatory and payment/insurance burden is extreme and basically requires outsourcing. That's why solo or private practices are dying to the extent they aren't already dead.
spease 3y ago
> Hospital billed $100K, insurance negotiated to about $20K. The actual doctor only got $2-3K. You’re interpreting this wrong. For a hospital to be in-network, it has to have a contract in place with the insurance company that sets its reimbursement rates. What’s closer to what’s happening in your example is that the hospital knows that the insurer will only reimburse 20% of the “cost” of the service, so it inflated the nominal cost fivefold to ensure the actual cost of the service is covered by the insurer. Of course that creates an awkward situation when the insurance turns out not to cover it and a private individual gets hit with the nominal cost. But to anyone who doesn’t think to question it, it’s great for the insurance company. It looks like they stood up to some asshole hospital, they’re giving you an amazing deal, and that healthcare would be impossibly expensive without them. Not that everyone else is jacking up their posted prices for the purpose of negotiating with the insurance companies. > Chargemaster rates serve as baselines when negotiating the rates at which these payers will reimburse hospitals, which is why they're often much higher than actual costs. A Health Affairs study found that in 2013, the typical hospital with 50 or more beds marked up the costs contained in its chargemaster more than fourfold. Some services such as CT scans have charge-to-cost ratios of almost 30, while others like routine inpatient procedures are much lower at only 1.8. > Insured patients do not normally pay chargemaster rates, since their payer reimburses at the negotiated rate and passes on any co-pays and below-deductible responsibilities. https://healthcaremba.gwu.edu/blog/chargemaster-hospital-administrators-need-know https://healthcaremba.gwu.edu/blog/chargemaster-hospital-adm...

robocat 3y ago

> Hospital billed $100K, insurance negotiated to about $20K But those numbers have no relation to reality. The amount you would pay as a private individual would be something else again. > The actual doctor only got $2-3K Could the doctor do the procedure on the street with their bare hands? That $2k also gets taxed and pays for education (it isn't disposable). I think you are hinting that you think the worker should get much more of the profit - but I'm unsure what economic theory that is called.

lolinder 3y ago
> But those numbers have no relation to reality. The amount you would pay as a private individual would be something else again. Exactly. The worst horror stories I've heard aren't of uninsured billing—self-pay individuals typically get a steep discount from what I've seen—it's the out-of-network hospital bills (especially pre-No Surprises Act) that consistently screw people over. In those cases the hospital would bill the insane number they officially ask for from insurance companies, the insurance company says "nope" and pays the portion they consider fair, and then the patient is (or at any rate used to be) on the hook for the remainder. If they were billing as uninsured the hospital wouldn't have come up with the insane number they started with, but now that's on record and that's the number they want.
- robocat 3y ago
  Gotta love me some cooked numbers & incentives for perverting. An obvious incentive is that the insurance company wants a big number so they can sell the patient on just how amazing their insurance is!
  - deathanatos 3y ago
    Yeah. For example, from Google… > The average salary for a Therapist is $31.40 per hour in United States And yet my insurance is billed at $1,000/hr. They knock this down (thankfully!) to $20/h, and merrily claim to have saved me 98% of the bill! Wow! And yet … I'm paying 64% of the therapist's salary. If I were uninsured, Google says that I would most assuredly pay nowhere near $1k/hr. I.e., the "98% saved" bit is hot, steaming bull.

DavidPeiffer 3y ago

> Makes me wonder why doctors don’t build their own hospitals… Doctors are not allowed to own hospitals. That was one of the stipulations of the ACA (Obamacare). Link to the AMA, though not endorsing them as saints on the topic of healthcare costs. https://www.ama-assn.org/about/leadership/end-restrictions-physician-owned-hospitals-expand-quality-care https://www.ama-assn.org/about/leadership/end-restrictions-p...

FireBeyond 3y ago
Thank fuck for that, to be honest. Doctors who own DI practices on the side, or shares therein, tend to vastly over-refer their patients for DI. I shudder thinking about this applied across a whole trauma center.

rjtavares 3y ago

You don't know why doctors don't build their own hospitals, yet feel you are knowledgeable enough to identify "hospitals" as the real villains of the whole system?

SoftTalker 3y ago

Doctors used to work mostly out of their own individual or small group practices. The regulatory and administrative burdens of doing this has forced most of them into working for large corporate health organizations.

freeAgent 3y ago
Yup, the regulatory and payment/insurance burden is extreme and basically requires outsourcing. That's why solo or private practices are dying to the extent they aren't already dead.

spease 3y ago

> Hospital billed $100K, insurance negotiated to about $20K. The actual doctor only got $2-3K. You’re interpreting this wrong. For a hospital to be in-network, it has to have a contract in place with the insurance company that sets its reimbursement rates. What’s closer to what’s happening in your example is that the hospital knows that the insurer will only reimburse 20% of the “cost” of the service, so it inflated the nominal cost fivefold to ensure the actual cost of the service is covered by the insurer. Of course that creates an awkward situation when the insurance turns out not to cover it and a private individual gets hit with the nominal cost. But to anyone who doesn’t think to question it, it’s great for the insurance company. It looks like they stood up to some asshole hospital, they’re giving you an amazing deal, and that healthcare would be impossibly expensive without them. Not that everyone else is jacking up their posted prices for the purpose of negotiating with the insurance companies. > Chargemaster rates serve as baselines when negotiating the rates at which these payers will reimburse hospitals, which is why they're often much higher than actual costs. A Health Affairs study found that in 2013, the typical hospital with 50 or more beds marked up the costs contained in its chargemaster more than fourfold. Some services such as CT scans have charge-to-cost ratios of almost 30, while others like routine inpatient procedures are much lower at only 1.8. > Insured patients do not normally pay chargemaster rates, since their payer reimburses at the negotiated rate and passes on any co-pays and below-deductible responsibilities. https://healthcaremba.gwu.edu/blog/chargemaster-hospital-administrators-need-know https://healthcaremba.gwu.edu/blog/chargemaster-hospital-adm...