11 ms·

Medical Care in the U.S is Bad, But Insurance Sucks Too

76 points by pauljonas 14y ago

mjn 14y ago
Yes, this non-transparent pricing, and weird discounts you can maybe ask for if you know how to ask (and if you figure out who to ask) drives me nuts. Sometimes you are better off being billed via your insurance; other times you're better off not using your insurance (even if you have one) and negotiating a cash price. And it's often hard to tell which one up front. Supposedly one of the downsides of more socialized systems are that they're bureaucratic, but I think the U.S. system, whatever you want to call it (it's not really either a functioning market or a properly socialized system) is somewhere near Peak Bureaucracy (certainly more than Denmark's, where I now live). It doesn't help that everyone bills separately: if you ever have to visit a hospital, you will get something like 15 different bills, because everyone from the anesthesiologist to the surgeon are apparently independent contractors, or at least bill that way. And you have to go through the same opaque negotiation process with each of them. And many of them are sloppy and contain errors, e.g. billing you for things that insurance actually should have covered. I'd be fine conceptually with a model where catastrophic care is insured and smaller expenses are paid for out of pocket. But then I'd like: 1) the catastrophic care to actually, 100%, guaranteed be covered, without loopholes, lifetime maxima, excluded conditions, etc.; and 2) the smaller expenses to be priced transparently up front.
- nonamegiven 14y ago
  "Yes, this non-transparent pricing," I have an appointment with my doctor soon. I asked them how much the appointment will cost. They called my insurance company. The got back to me, and the bottom line is nobody knows, and nobody will know until after the insurance company is actually billed. For any other service I'd just not buy it under those conditions, but if I don't go to the appointment then eventually I'll die.
  - davefp 14y ago
    To be fair, you'll eventually die whether you go to the appointment or not.
    - nonamegiven 14y ago
      By "eventually" I mean a cascading series of events and degradations. I won't die the day after the missed appointment, but I'd almost certainly die within the year from that specific disease. Otherwise I'd die at a presumably much later date, barring accidents and other new health issues. I'd prefer the later date.
    - ctdonath 14y ago
      Most people understand there's a difference between "we're all gonna die someday from something" vs. "if I don't do X within a relatively few days and do ongoing maintenance treatments Y I'm gonna die of disease Z in short order." To imply there's not a meaningful difference between several decades' longevity vs. dead in a month isn't fair.
      - to3m 14y ago
        Depends. I don't think I have ever actually heard anybody say something like "if I don't do this, I'll eventually die", without some humorous intent. I had to read the post a couple of times to convince myself this wasn't the intention here.
        maxerickson 14y ago
        Type I diabetics tend to be intensely aware of the consequences of neglecting their immediate care. (Looking at the above, I see that I should make it clear that just I'm bringing it up as an example of a group that approximately thinks like you say.)
  - elmuchoprez 14y ago
    I run into this situation a lot: Doctors often have a cash price and an insurance price, with the former being significantly less. I have a high deductible insurance plan, which means I effectively pay for most stuff out of pocket. So when I call, I ask them what the cash price is. I then explain my situation and ask if they'll honor the cash price since I'm paying out of pocket anyways. They always tell me no. I mean, I get that they probably can't start discounting insurance claims because of my deductible or else they'd have to do it for all insurance claims, but it really grinds my gears that for all my insurance premiums, I essentially get the privilege of paying a higher rate.
- yummyfajitas 14y ago
  In extremely free market health care systems, pricing tends to be extremely transparent. I had surgery in India. The doctors could all quote a price to me, accurate to within about 5k INR (final price ranged from 85k-150k). A price list with common procedures (blood test, urine test) was usually printed on a sign behind the receptionist.
  - VLM 14y ago
    Note the important point that "system" is not free market, merely at least some pre-planned surgery and common diagnostic procedures have a fixed price. I'm sure that the average purchaser is at an extreme knowledge disadvantage making comparison shopping nearly impossible, and critical care/emergency care does not allow the time for comparison shopping. Finally you did not elaborate on the competition... is there any? So its a free market in that some prices are posted, but not in pretty much any other way.
    - mjn 14y ago
      I'm not sure if he went to one of these kinds of facilities, but my impression there is a reasonably competitive market in medical tourism: there are hospitals in Jordan that target themselves at enticing foreigners to fly there for treatment, and compete directly against similar hospitals in Thailand, India, and other places. They generally target an upmarket crowd, though, with some increasingly specializing to target Americans specifically. (I've noticed some of their websites attempt to delicately telegraph, "this is a hospital for you, well-off foreigner; don't worry, it's not full of locals.")
      - VLM 14y ago
        The point I was kinda getting at is without a well informed consumer (good luck!) the best free market you can hope for is something rather like the process gamblers use to select a specific slot machine from a bank of slot machines. Or maybe a better analogy would be selecting a poker table in that you can select to sit down at the $5 ante table or the $10 ante table. Oddly enough given the strong asymmetry of knowledge and capital, the house always wins. Not much of a free market. Although I would agree that in the extremely limited area of price discovery of certain procedures, I'm sure they do better, mostly because we do so poorly its almost just statistically likely by random chance to be better.
- eli_gottlieb 14y ago
  I'd be fine conceptually with a model where catastrophic care is insured and smaller expenses are paid for out of pocket. But then I'd like: 1) the catastrophic care to actually, 100%, guaranteed be covered, without loopholes, lifetime maxima, excluded conditions, etc.; and 2) the smaller expenses to be priced transparently up front. No, for the sake of Return on Public Investment, I'd say we should not only cover catastrophic care but give full public support to preventative care as well.
  - mjn 14y ago
    Good point, and a reasonable objection to my suggestion (not very deeply thought out, I must admit). I would need to look at some numbers, but I do seem to recall that "major" care, comprising stuff like hospital visits, surgeries, chronic conditions, and end-of-life care, takes such a large percentage of the total healthcare spending that scrimping on regular doctors' visits, which are quite cheap in comparison, may be counterproductive.
    - eli_gottlieb 14y ago
      Yeah, that's the same data I've seen. Life-saving and end-of-life care is usually the most expensive, so the long-term rational way to save money (private and public) ends up being to prevent major health problems from occurring at all.
      - Vivtek 14y ago
        Which starves the medical "industry" - an economic catastrophe, in American terms!
      - mjn 14y ago
        I can sort of buy that, but I think it might be complex to determine what is cheapest overall, if that is really the main goal to minimize. For example, someone dying of a heart attack in their home is much cheaper than someone dying of cancer after a prolonged 2-year battle. So it would actually cost more money if you successfully prevented the heart attack only for the same person to die of cancer 10 years later: preventative medicine can't keep someone from dying entirely, so it doesn't always necessarily save money, if it pushes back the death to one that turns out to be more expensive than the earlier death would've been. What you want cost-wise is for all ends to be quick and with minimal intervention, whether they're earlier or later ends (actually that's what some might want as the person in question too, but that's a much bigger debate).
mcherm 14y ago
Yes, the medical situation in the US is badly broken, and everyone knows it. However, it is unlikely to get fixed within the next several decades. It took decades and an extreme swing in political power (one party fully controlling both houses of Congress and the presidency at once) to get a change to the law that said essentially "Keep doing it the same way you're doing it except that a little over 3/4 of the people with absolutely no insurance will now get insurance." Such a tiny step forward, still unclear whether it will actually hold, and this was the crowning achievement after decades of work. The way we pay for health care in the US may not improve in a substantial way for a LONG, LONG, time.
- mjn 14y ago
  It feels like one of those oddly contingent things that wasn't inevitable. Some decades ago, Richard Nixon and the Democratic-controlled Congress each had health-care-reform proposals, but weren't able to reach an agreement. So, nothing passed. But viewed from today's perspective they weren't really that far apart.
- VLM 14y ago
  "the medical situation in the US is badly broken" Those in power would disagree. If the purpose is to achieve a local maxima of profit they're doing pretty well. Privatize the gains, socialize the losses. If the purpose is to provide medical care, well, yeah, its a pretty epic fail. But that's not the purpose of the system. The system has to be bled completely dry before it can be redesigned and rebooted. Too many people are still paying in. That has to stop, before things can be improved.
  - twoodfin 14y ago
    Just how profitable do you think health insurers are, relative to, say, McDonald's?
    - muhfuhkuh 14y ago
      Just to compare apples to insurance here, the largest pure auto insurer (progressive) maintains ~5-6% profit margins according to filings, whereas Wellpoint one of the largest insurers in healthcare maintains a 7% margin.
jdludlow 14y ago
There isn't a shred of evidence in that article to support the claim that medical care in the U.S. is bad.
- bluedino 14y ago
  He never even says how much this procedure 'should' cost. He also exaggerates that it was a '5-minute visit', which we all know isn't true. There's paperwork, billing, the use of a room and supplies, a nurse or assistant is involved somewhere...
  - raverbashing 14y ago
    Yes The consultation looks much more overpriced than the procedure.
  - pimeys 14y ago
    When I was living in Finland, where I last paid my whole bill by myself (a private, specialist doctor), A 30 minute visit was 90 euros (115 USD). If you add some tests, they're usually 20-40 euros each. Of course this is free if you go to the public doctors. And now here in Germany, all doctors are private and the mandatory insurance will cover most of the expenses.
  - PeterisP 14y ago
    We have examples of private-paid costs by the same education-level doctors in first world countries that have higher cost-of-living than USA - say, Switzerland. Everywhere the full cost of the same procedure is at least twice less than USA. And before you say it, no, legal/malpractice expenses aren't the cause, because in USA that adds up to <5% of total medical budgets and can't explain the other 45% "bonus price".
  - VLM 14y ago
    Don't forget malpractice insurance, which is spectacularly expensive.
- Retric 14y ago
  I parsed it as: The doctor is charging over 5,000$ an hour for his time, that's terrible. Worse yet even with 200$/month insurance the guy ended up paying 70% of that rate. For many people moving to the US the cost of medical bills seems insane. PS: It's not that he is actually charging that for his time. It's just rolling a lot of overhead into it.
ben1040 14y ago
A few years back I changed jobs; under my previous employer my allergy shots were fully covered under insurance, and I wanted to determine which of my new employer's plans might cover them. At the time I was getting allergy shots on a weekly basis, so if I had to pay it could add up to $80-$100 a month. If "plan A" covered it and cost only $30/month more than "plan B," then it would be worth it to me. The plan summary from HR didn't say. I called the insurance company, but it was tough to get an answer from their CSRs without being a customer. Finally I got someone sympathetic who gave me their direct line and said if I could get the billing codes, they could run it against the terms of the policies my company negotiated and see what comes up. In the meantime they told me it would cost no more than $25 per injection, which was the limit to "usual customary and reasonable" in my area. So then I call my allergist's office. They told me I need to speak to their business manager, who only worked 3 days/week, and I of course called on one of those other two days. When I called back, she categorically refused to give me the billing code they'd use. I asked her to clarify whether she was unable to give me the code or if she was choosing not to do so, and she responded that it was the latter. So basically I just had to wing it and choose a plan. And a new allergist.
- UnoriginalGuy 14y ago
  > so if I had to pay it could add up to $80-$100 a month What the heck? Those are like $10~15 around here.
  - ben1040 14y ago
    My allergist charged a "rack rate" of $24 per injection, just under the $25 line that the insurance company said was UCR. It turned out the insurance company's contract with the allergist said he could charge me no more than $18.50, but the insurance company paid none of it. So even then it was $74/month, given that I had to go weekly. Because of the stupid game that I had to play, I had absolutely no way of knowing what that discount would be though. Could have been nothing, could have been a lot. Hence "could" add up to nearly $100 a month if I had to pay full price.
- erock 14y ago
skittles 14y ago
One conjecture he made is definitely wrong. Medical bills for uninsured individuals are usually higher than those for insured (due to insurance companies negotiating a better price).
- Dylan16807 14y ago
  For any particular place that that holds, I can almost guarantee its purpose is negotiating with insurance. Take away the insured and the price will drop tremendously as there is no need for extreme fake discounts.
  - talmand 14y ago
    I once had a scan done and the office offered a cash price that was lower than the deductible, but if I went through insurance they would have billed higher so that most likely I would have had to pay the entire deductible. I paid cash.
    - kdot 14y ago
      Thats THE problem with healthcare in the US, there are 4 market prices: - Actual Price - Cash Price (after you bitch about how absurd the actual price is) - Insurance Company price - Medicaid price I wonder if the US can ever get as low as $20/mo for cadillac coverage. Is the free-market model even applicable to health care?
      - VLM 14y ago
        "Is the free-market model even applicable to health care?" It works about as well applied to health care, as applied to police coverage, military defense, restaurant health inspections, road maintenance, and education. Not as well as when applied to a farmers market or factory widget production. Its a little harder for med because quite a bit of med care happens to medically uneducated people. Given a couple years of med school and some on the job experience, and a couple days to fully research each emergency room and cardiology department in the country, my neighbor could probably have made an intelligent free market decision when he had his heart attack. However, instead of a free market, the ambulance instead took him unconscious to the nearest ER, where they'll pretty much do what they want and then charge what they want. The true miracle of the situation is it may have been a financial disaster, but medically it all turned out OK. Decades of propaganda has taught me that only a free market can provide decent services, yet at least medical care works pretty well with a feudal system where you simply report to the nearest castle and pay whatever tax the feudal lord demands.
cpursley 14y ago
Somebody needs to create international healthcare insurance based in stable non-US jurisdiction similar to travelers insurance. Insurance that would cover medical tourism - flight, lodging and care for Americans.
- khuey 14y ago
  Most Americans can't afford to travel out of the country for routine medical care.
  - cpursley 14y ago
    Not for routine care - stuff of $10,000 or so. And the insurance would cover all travel expenses.
  - PeterisP 14y ago
    It feels like most Americans can't afford to NOT travel out of the country for routine medical care. If you can pay $1300 for the routine stuff described in the article, it'll probably be cheaper to do it outside. I don't know the prices in North America, but based on EU prices I'd guess it should cost less than $500 to fly across half continent and back, and $150 for the actual operation in any good Mexican hospital; which coincidentally adds up to half the USA price.
- jen_h 14y ago
  No kidding; after months and months dealing with the actual mechanics of the medical bills for a simple leg contusion (stupidly thought it was broken; won't do that again), if the big C ever hits, I think we're headed to Mexico to avoid bankruptcy of both time and money. Just dealing with the afteraffects of a simple ER trip for what turned out to be a bruise was eye-opening. I had the pleasure of dealing with a multitude of bills from random places (in some cases, lawyers' offices, who handle some doctor's bills from first charge--i.e., not collections--and boast on their web sites about being able to return "200% of what's owed"), determining what's legit and what's fraudulent, the paperwork sent back and forth between us and our insurance company and between the billers and our insurance company (who weren't paying anyway because we have a very high deductible, but you have to jump through massive hoops to get them to actually count your payments towards the deductible), the attempts of the medical billers to double-bill and continue to appeal the bill with two insurance companies months after I paid the bill (how they collect that 200%, I assume)...a total mess. Someone got paid 2k for a deep contusion, but I think most went to middle(wo)men and lawyers' offices. That 62% medical bankruptcies in 2007 in the US are actually insured persons (cite: http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf http://www.washingtonpost.com/wp-srv/politics/documents/amer...) is no surprise; what would surprise me is if it isn't 20%+ higher now.
bgruber 14y ago
just to clarify: $300 for a doctor visit isn't inflating costs because he's covered by insurance. in ny, which i think is safe to assume is comparable in cost to the part of CA i'm assuming the OP is in, that's the normal amount you'd pay for a specialist visit.
michaelochurch 14y ago
I loved the Michael Moore movie Sicko. Regardless of what you think of him in general, he did a good job with it. What surprised me was the fact that 95% of what he found was what insured people have to deal with. I feel like the only thing that has prevented our health insurance system from touching off a violent revolution is that severely ill people aren't exactly in top shape for carrying AK-47's into executive lobbies. The whole point of private health insurance is that sick people are the easiest to rob-- they don't fight back-- but they also have no money, so it's best to collect payment while they're young and well.
- paulhauggis 14y ago
  You actually took that movie seriously? Of course there is some truth somewhere in the movie, but the majority of it is stretched truths and shots intentionally doctored to make his point. "The whole point of private health insurance is that sick people are the easiest to rob-- they don't fight back-- but they also have no money, so it's best to collect payment while they're young and well." The whole point of a public healthcare system is that it forces you, at the threat of jail, to collect payments from you (essentially theft).
  - viraptor 14y ago
    How does it force you? Or do you think of every tax as a theft?
    - VLM 14y ago
      He's intentionally missing the social contract that its in direct exchange for health care, which all people need. (edited to add: There's already a social contract that refusal to provide emergency room care to everyone means criminal prosecution of the hospital/docs involved... its unfair they're not allowed to collect money at gunpoint, but it would be much fairer if they were allowed to do so.) I oppose mcdonalds because at the point of a gun a policeman will demand I pay them. Sounds awful, especially if I omit the fact I already ate the burger and I'm gonna need to eat another in the near future and the analogy breaks down even further in that McD would need a local geographic licensed monopoly on all food sales such that everyone living in the area must buy burgers from them.
11Blade 14y ago
The 1076 for the procedure and 300 for the visit were the full billable charges for those codes. If the insurance had covered them at their contracted rate, the provider would have received probably about 250 for the procedure and 50-120 for the office visit. Because it fell within your deductible, the initial bill to insurance would have been denied payment and sent back with "patient responsibility" and the 1376.00 would then be your problem. Since you don't have a contract with your provider he tries to get the whole thing. This is where you can discount it with negotiation. I am a medical provider, I believe that transparency will help the situation. I also believe that prices should be within a 5-10% window of each provider instead of a price variance of 100-400% depending on secretive contracts. Unfortunately even providers have been trained to game the system to maximise profit and productivity. It is common to hear surgeons talk about complicated patients and tell them to see a university guy because "frankly its not worth the time and effort" when they can get low hanging easy fruit that pays better/unit-time with less liability. I'd like to hear what the poster thinks he should have paid for his office visit and 5 minute procedure.
- mikeg8 14y ago
  Doing some simple math, if a doctor is making $200,000 a year or $250,000 a year working 40 hr weeks with 2 weeks of vacation, their hrly rate would be $100 or $125 per hour respectively. 5 minutes of just their time would be between either $8.33 or $10.41. Fine, throw in a couple bucks for the rubber gloves and scalpel. And something for electricity, paper, etc. Still should NOT me more than 40-50 dollars in my opinion. But I don't know much about this industry...
- cdjk 14y ago
  If the doctor is "in network" shouldn't the patient responsibility be the lower, negotiated rate? I thought was part of most insurance contracts, and one of the reasons insurance is helpful even if someone is healthy and has a high deductible. What you've described I think is largely responsible for a lot of the rising medical costs.
avaku 14y ago
Perhaps the hacker community could come up with some alternative solution, similar to bitcoin in finance, to try to force out the non-transparent pricing? ;)
binarymax 14y ago
I highly recommend reading the ebook here...It sheds light on actual costs and gives a very detailed analysis on the issues at hand: http://truecostofhealthcare.org http://truecostofhealthcare.org
cdjk 14y ago
What I think is really interesting is that my experiences with dental insurance are entirely different. I've gone to the dentist, found I have two cavities, and when I schedule my next appointment on the way out I'm given a detailed treatment plan that includes prices. It even includes details about how some fillings are more expensive because the insurance only covers amalgam fillings in the back but the dentist only uses composite fillings (for example). And it only takes a couple minutes to figure out the prices, and more importantly exactly what the insurance will cover. I realize that the set of things a dentist deals with is probably smaller than what a doctor does, but it seems like it's a much better model for insurance.
- rayiner 14y ago
  What's always surprised me is how cheap ophthalmic surgery is. I don't think opthalmic surgeons are exactly slumming it, but the cost of say getting a cataract removed is under $4k per eye with no insurance.
  - nathos 14y ago
    I wonder if there are a combination of factors at work here. Elderly target market + (mostly) elective procedure + low Medicare payments perhaps?
  - cdjk 14y ago
    That is interesting. I know the prices for things like LASIK are completely transparent, but that's because insurance isn't involved. I'd assume that insurance generally does cover cataract surgery, however. Some of the reasons might be that the procedure is fairly quick, the eye is easy to get to, it doesn't require general anesthesia, and doesn't require a full OR in a hospital (I think - correct me if I'm wrong). In that sense its closer to oral surgery than a gall bladder removal, for example.
- nathos 14y ago
  I think this is partly because dental insurance bears little resemblance to comprehensive medical insurance. In fact, for most people with a generally healthy dental history, it's often not worth paying for dental insurance, since it ends up simply being a pre-payment for services. Expensive procedures & oral surgery are often covered for only 50% of the final cost. In the US at least, I think dental "insurance" is really just a simplified way for employers to offer an appealing benefit to employees.
felipellrocha 14y ago
I wonder how long this is gonna keep going until someone gets pissed off, and creates a website to take care of the transparency issue by themselves- "upload your hospital bill here. We'll mine your bill for pricing data, anonymize you, and make the bill publicly available so people can shop for better prices".
nicholasjarnold 14y ago
> "...medical care is one of the core things that a 1st world country should make available to anyone, for cheap, by subsidizing it and enforcing transparency and price normalization for common needs..." Yes, exactly. This is pretty hard to accomplish in our current state of political inaction, misinformation and 24-hour news cycles. I'm sensing a build up to a tipping point on public awareness about how we're all being swindled by these hospitals and insurance companies, but perhaps I'm just paying more attention to this now that I'm starting to get a little older. For what it's worth, and for those of you who haven't seen this yet: http://truecostofhealthcare.org/ http://truecostofhealthcare.org/
Vivtek 14y ago
The ability of people in the States to insist that our health care system is "the best in the world" because of the action of the free market while simultaneously not understanding why prices are thus important is what usually leads me to believe that most Americans have no idea what a free market is. (Or what health care is, to be honest.)
saosebastiao 14y ago
Welcome to the US, where the solution to the problem of expensive health insurance is to make it illegal to not have it.
DanBC 14y ago
One thing that's a bit confusing: In both the UK[1] and the US[2] medication non-compliance is very high. Many people don't take their prescription meds properly. Many people are so bad at taking meds that the meds are ineffective - they may as well not take the meds at all. Rates are similar in the US and UK. About half of the UK £9billion budget for prescribed meds is sub-optimal spending because of medication non-compliance. And severity of illness doesn't seem to be a factor. People who've had an organ transplant often die after rejection when they stop taking the meds, even though they know that they must keep taking the meds. There's probably money somewhere if you can improve medication compliance. [1] Prescriptions usually cover 28 day supply of medication. Each line item on a prescription costs £7.40; but most people don't pay because there are many exemptions and if you need long term meds you can pre-pay. [2] I dunno how it works in the US.
steven2012 14y ago
I have Kaiser HMO in California. I think it's awesome, and the best health care I've ever had. I'm also from Canada, so I'm comfortable with the idea of socialized medicare. However, when I compare stories between me and my friends in Canada, there really is no comparison. I basically pay a $20-30 co-pay per visit (something that was completely foreign to me when I first moved to the US), and then anything and everything gets done for me. I have never experienced the horror stories you hear about where insurance companies try to opt for cheaper treatments or deny services to save money. Any test or procedure I needed, or even asked about, I could get. The longest I waited for things like a MRI was 2 days, and 9 days for an endoscopy. My doctor was willing to get me a CT scan the next day for this stomach problem I had. My friends in Canada have waited 4 months for an MRI and 3 months for a CT scan. My dad had to wait about 6-8 weeks to get a pacemaker installed, even though his heart was stopping for 5-10 seconds several times a day. Seeing a specialist takes months in Canada vs days with Kaiser. On weekends, if I get sick I don't have to wait in Emergency for hours like in Canada, I can just set up an appointment at one of the hospitals and see a GP in around 30-45 mins, and they have full access to all my medical records. The downside is that when I'm out of a Kaiser area, I have to pay out of pocket unless it's an emergency (I believe). The only time I felt vulnerable was when my family was out of state, and they didn't have Kaiser facilities there.
- mjmahone17 14y ago
  Which is part of the problem with reform: you happen to have a functioning HMO. What happens when you change employers? What happens when your employer doesn't offer insurance? You are one of the lucky few who has the connections, and deep-corporate-pockets (presumably, unless you're paying for your insurance out of pocket) to be able to get good insurance. But that isn't how most the country works. It's probably better for the masses to have the longer Canadian waits, rather than the quick-care American bankruptcies (or non-care).
- bluedino 14y ago
  It used to be like this for most people in the USA with insurance. Slowly, costs rose and benefits have been dropped. What used to be a $20 (or even $0!) co-pay became abused, people would visit the doctor every week, and since it didn't cost them anything, they had no reason not to go. These days you'll find a high-deductible plan that does the reverse - encourages people to NOT go to the doctor because until they've hit a $3,000 tab, the insurance won't kick in a single dollar.
gmack 14y ago
Granted, the OP indicates that indeed it is difficult to get advanced pricing because it entails asking the doctor for the code, then checking with the insurance company. But what's stopping people from voluntarily posting the procedure_code=>price information they obtain? Are there contractual/legal reasons that prevent you from sharing that information? If patients get that price in the normal course of getting healthcare, then why not share it all, and force transparency in the market?
- 11Blade 14y ago
  Medicare posts their fee schedule for every single CPT code.
  - gmack 14y ago
    Right, but presumably Medicare's prices are significantly lower due to its negotiating power (which is why "Medicare for All" may not be such a bad idea). As we can see from many of the comments here, the prices vary widely, even when you make the effort to find out what they are for your provider and insurer.
- deleted 14y ago
  [deleted]
- trolley 14y ago
  This comment made me wonder if such a thing (crowdsourced medical pricing) existed: turns out it does [1, 2, 3]. I would absolutely love to see resources like these take off, until using them is as common place as checking GasBuddy before filling your gas tank. [1] http://www.healthcarebluebook.com/ http://www.healthcarebluebook.com/ [2] http://clearhealthcosts.com/faq/ http://clearhealthcosts.com/faq/ [3] http://outofpocket.com/OOP/AddVisit.aspx http://outofpocket.com/OOP/AddVisit.aspx
viggity 14y ago
If your auto insurance included new tires, oil changes and gasoline, imagine what would happen to the price of both auto insurance and gasoline? They'd both skyrocket. So why the hell are we doing it with healthcare? Insurance is about sharing risk and a large part of the cost isn't sharing the risk it is about pre-paying for normal, expected ailments and when consumers become insensitive to cost prices are bound to rise. The healthcare industry is greatly in need of cost sensitivity and transparency.
- mjmahone17 14y ago
  What about healthcare insurance includes the cost of "gasoline"? In my knowledge, healthcare insurance doesn't cover food or water (besides, maybe, hospital food while you're in the hospital), and I really don't get the analogy.
codegeek 14y ago
Just some anecdotal data from my wife's pregnancy & delivery process and the costs/charges are just from her 2 days of hospital stay for her normal/vaginal delivery without any complications. - The hospital (NJ if it matters) billed the insurance company $30,000. She was there for usual 48 hours. The insurance company has a thing called "Amount Allowed" which knocked it down to $5880. Then our share of co-insurance came to about 20% of that = $920. - For baby, separate hospital bill of $8779. amount allowed = $2,232, our share = $566 - The Anesthesia consultant billed separately for $3000, amount allowed = $1100 and our share = $220 - OBGYN billed $4200, amount allowed = $2800, our share = $560 - Newborn clinic charge = $375, allowed = $375, our share = $289 (deductible not reached) - Neonatology for baby - $590, allowed = $100, our share = $100 (deductible not reached) So here is total just for Labor/delivery/baby which was 100% normal without any complications. - total bill = $52,824 - Allowed by insurance = $12,487 - Our responsibility to pay = $2655 I get chills just to imagine if we did not have insurance.
crusso 14y ago
It appears most states in the U.S do not require hospitals and medical providers to list their prices This and the tax breaks given to companies sponsoring health insurance plans that create a nearly immovable useless middle man are the root of all evil in the American healthcare industry.

76 points by pauljonas 14y ago

mjn 14y ago

Yes, this non-transparent pricing, and weird discounts you can maybe ask for if you know how to ask (and if you figure out who to ask) drives me nuts. Sometimes you are better off being billed via your insurance; other times you're better off not using your insurance (even if you have one) and negotiating a cash price. And it's often hard to tell which one up front. Supposedly one of the downsides of more socialized systems are that they're bureaucratic, but I think the U.S. system, whatever you want to call it (it's not really either a functioning market or a properly socialized system) is somewhere near Peak Bureaucracy (certainly more than Denmark's, where I now live). It doesn't help that everyone bills separately: if you ever have to visit a hospital, you will get something like 15 different bills, because everyone from the anesthesiologist to the surgeon are apparently independent contractors, or at least bill that way. And you have to go through the same opaque negotiation process with each of them. And many of them are sloppy and contain errors, e.g. billing you for things that insurance actually should have covered. I'd be fine conceptually with a model where catastrophic care is insured and smaller expenses are paid for out of pocket. But then I'd like: 1) the catastrophic care to actually, 100%, guaranteed be covered, without loopholes, lifetime maxima, excluded conditions, etc.; and 2) the smaller expenses to be priced transparently up front.

nonamegiven 14y ago
"Yes, this non-transparent pricing," I have an appointment with my doctor soon. I asked them how much the appointment will cost. They called my insurance company. The got back to me, and the bottom line is nobody knows, and nobody will know until after the insurance company is actually billed. For any other service I'd just not buy it under those conditions, but if I don't go to the appointment then eventually I'll die.
- davefp 14y ago
  To be fair, you'll eventually die whether you go to the appointment or not.
  - nonamegiven 14y ago
    By "eventually" I mean a cascading series of events and degradations. I won't die the day after the missed appointment, but I'd almost certainly die within the year from that specific disease. Otherwise I'd die at a presumably much later date, barring accidents and other new health issues. I'd prefer the later date.
  - ctdonath 14y ago
    Most people understand there's a difference between "we're all gonna die someday from something" vs. "if I don't do X within a relatively few days and do ongoing maintenance treatments Y I'm gonna die of disease Z in short order." To imply there's not a meaningful difference between several decades' longevity vs. dead in a month isn't fair.
    - to3m 14y ago
      Depends. I don't think I have ever actually heard anybody say something like "if I don't do this, I'll eventually die", without some humorous intent. I had to read the post a couple of times to convince myself this wasn't the intention here.
      - maxerickson 14y ago
        Type I diabetics tend to be intensely aware of the consequences of neglecting their immediate care. (Looking at the above, I see that I should make it clear that just I'm bringing it up as an example of a group that approximately thinks like you say.)
- elmuchoprez 14y ago
  I run into this situation a lot: Doctors often have a cash price and an insurance price, with the former being significantly less. I have a high deductible insurance plan, which means I effectively pay for most stuff out of pocket. So when I call, I ask them what the cash price is. I then explain my situation and ask if they'll honor the cash price since I'm paying out of pocket anyways. They always tell me no. I mean, I get that they probably can't start discounting insurance claims because of my deductible or else they'd have to do it for all insurance claims, but it really grinds my gears that for all my insurance premiums, I essentially get the privilege of paying a higher rate.
yummyfajitas 14y ago
In extremely free market health care systems, pricing tends to be extremely transparent. I had surgery in India. The doctors could all quote a price to me, accurate to within about 5k INR (final price ranged from 85k-150k). A price list with common procedures (blood test, urine test) was usually printed on a sign behind the receptionist.
- VLM 14y ago
  Note the important point that "system" is not free market, merely at least some pre-planned surgery and common diagnostic procedures have a fixed price. I'm sure that the average purchaser is at an extreme knowledge disadvantage making comparison shopping nearly impossible, and critical care/emergency care does not allow the time for comparison shopping. Finally you did not elaborate on the competition... is there any? So its a free market in that some prices are posted, but not in pretty much any other way.
  - mjn 14y ago
    I'm not sure if he went to one of these kinds of facilities, but my impression there is a reasonably competitive market in medical tourism: there are hospitals in Jordan that target themselves at enticing foreigners to fly there for treatment, and compete directly against similar hospitals in Thailand, India, and other places. They generally target an upmarket crowd, though, with some increasingly specializing to target Americans specifically. (I've noticed some of their websites attempt to delicately telegraph, "this is a hospital for you, well-off foreigner; don't worry, it's not full of locals.")
    - VLM 14y ago
      The point I was kinda getting at is without a well informed consumer (good luck!) the best free market you can hope for is something rather like the process gamblers use to select a specific slot machine from a bank of slot machines. Or maybe a better analogy would be selecting a poker table in that you can select to sit down at the $5 ante table or the $10 ante table. Oddly enough given the strong asymmetry of knowledge and capital, the house always wins. Not much of a free market. Although I would agree that in the extremely limited area of price discovery of certain procedures, I'm sure they do better, mostly because we do so poorly its almost just statistically likely by random chance to be better.
eli_gottlieb 14y ago
I'd be fine conceptually with a model where catastrophic care is insured and smaller expenses are paid for out of pocket. But then I'd like: 1) the catastrophic care to actually, 100%, guaranteed be covered, without loopholes, lifetime maxima, excluded conditions, etc.; and 2) the smaller expenses to be priced transparently up front. No, for the sake of Return on Public Investment, I'd say we should not only cover catastrophic care but give full public support to preventative care as well.
- mjn 14y ago
  Good point, and a reasonable objection to my suggestion (not very deeply thought out, I must admit). I would need to look at some numbers, but I do seem to recall that "major" care, comprising stuff like hospital visits, surgeries, chronic conditions, and end-of-life care, takes such a large percentage of the total healthcare spending that scrimping on regular doctors' visits, which are quite cheap in comparison, may be counterproductive.
  - eli_gottlieb 14y ago
    Yeah, that's the same data I've seen. Life-saving and end-of-life care is usually the most expensive, so the long-term rational way to save money (private and public) ends up being to prevent major health problems from occurring at all.
    - Vivtek 14y ago
      Which starves the medical "industry" - an economic catastrophe, in American terms!
    - mjn 14y ago
      I can sort of buy that, but I think it might be complex to determine what is cheapest overall, if that is really the main goal to minimize. For example, someone dying of a heart attack in their home is much cheaper than someone dying of cancer after a prolonged 2-year battle. So it would actually cost more money if you successfully prevented the heart attack only for the same person to die of cancer 10 years later: preventative medicine can't keep someone from dying entirely, so it doesn't always necessarily save money, if it pushes back the death to one that turns out to be more expensive than the earlier death would've been. What you want cost-wise is for all ends to be quick and with minimal intervention, whether they're earlier or later ends (actually that's what some might want as the person in question too, but that's a much bigger debate).

mcherm 14y ago

Yes, the medical situation in the US is badly broken, and everyone knows it. However, it is unlikely to get fixed within the next several decades. It took decades and an extreme swing in political power (one party fully controlling both houses of Congress and the presidency at once) to get a change to the law that said essentially "Keep doing it the same way you're doing it except that a little over 3/4 of the people with absolutely no insurance will now get insurance." Such a tiny step forward, still unclear whether it will actually hold, and this was the crowning achievement after decades of work. The way we pay for health care in the US may not improve in a substantial way for a LONG, LONG, time.

mjn 14y ago
It feels like one of those oddly contingent things that wasn't inevitable. Some decades ago, Richard Nixon and the Democratic-controlled Congress each had health-care-reform proposals, but weren't able to reach an agreement. So, nothing passed. But viewed from today's perspective they weren't really that far apart.
VLM 14y ago
"the medical situation in the US is badly broken" Those in power would disagree. If the purpose is to achieve a local maxima of profit they're doing pretty well. Privatize the gains, socialize the losses. If the purpose is to provide medical care, well, yeah, its a pretty epic fail. But that's not the purpose of the system. The system has to be bled completely dry before it can be redesigned and rebooted. Too many people are still paying in. That has to stop, before things can be improved.
- twoodfin 14y ago
  Just how profitable do you think health insurers are, relative to, say, McDonald's?
  - muhfuhkuh 14y ago
    Just to compare apples to insurance here, the largest pure auto insurer (progressive) maintains ~5-6% profit margins according to filings, whereas Wellpoint one of the largest insurers in healthcare maintains a 7% margin.

jdludlow 14y ago

There isn't a shred of evidence in that article to support the claim that medical care in the U.S. is bad.

bluedino 14y ago
He never even says how much this procedure 'should' cost. He also exaggerates that it was a '5-minute visit', which we all know isn't true. There's paperwork, billing, the use of a room and supplies, a nurse or assistant is involved somewhere...
- raverbashing 14y ago
  Yes The consultation looks much more overpriced than the procedure.
- pimeys 14y ago
  When I was living in Finland, where I last paid my whole bill by myself (a private, specialist doctor), A 30 minute visit was 90 euros (115 USD). If you add some tests, they're usually 20-40 euros each. Of course this is free if you go to the public doctors. And now here in Germany, all doctors are private and the mandatory insurance will cover most of the expenses.
- PeterisP 14y ago
  We have examples of private-paid costs by the same education-level doctors in first world countries that have higher cost-of-living than USA - say, Switzerland. Everywhere the full cost of the same procedure is at least twice less than USA. And before you say it, no, legal/malpractice expenses aren't the cause, because in USA that adds up to <5% of total medical budgets and can't explain the other 45% "bonus price".
- VLM 14y ago
  Don't forget malpractice insurance, which is spectacularly expensive.
Retric 14y ago
I parsed it as: The doctor is charging over 5,000$ an hour for his time, that's terrible. Worse yet even with 200$/month insurance the guy ended up paying 70% of that rate. For many people moving to the US the cost of medical bills seems insane. PS: It's not that he is actually charging that for his time. It's just rolling a lot of overhead into it.

ben1040 14y ago

A few years back I changed jobs; under my previous employer my allergy shots were fully covered under insurance, and I wanted to determine which of my new employer's plans might cover them. At the time I was getting allergy shots on a weekly basis, so if I had to pay it could add up to $80-$100 a month. If "plan A" covered it and cost only $30/month more than "plan B," then it would be worth it to me. The plan summary from HR didn't say. I called the insurance company, but it was tough to get an answer from their CSRs without being a customer. Finally I got someone sympathetic who gave me their direct line and said if I could get the billing codes, they could run it against the terms of the policies my company negotiated and see what comes up. In the meantime they told me it would cost no more than $25 per injection, which was the limit to "usual customary and reasonable" in my area. So then I call my allergist's office. They told me I need to speak to their business manager, who only worked 3 days/week, and I of course called on one of those other two days. When I called back, she categorically refused to give me the billing code they'd use. I asked her to clarify whether she was unable to give me the code or if she was choosing not to do so, and she responded that it was the latter. So basically I just had to wing it and choose a plan. And a new allergist.

UnoriginalGuy 14y ago
> so if I had to pay it could add up to $80-$100 a month What the heck? Those are like $10~15 around here.
- ben1040 14y ago
  My allergist charged a "rack rate" of $24 per injection, just under the $25 line that the insurance company said was UCR. It turned out the insurance company's contract with the allergist said he could charge me no more than $18.50, but the insurance company paid none of it. So even then it was $74/month, given that I had to go weekly. Because of the stupid game that I had to play, I had absolutely no way of knowing what that discount would be though. Could have been nothing, could have been a lot. Hence "could" add up to nearly $100 a month if I had to pay full price.
erock 14y ago

skittles 14y ago

One conjecture he made is definitely wrong. Medical bills for uninsured individuals are usually higher than those for insured (due to insurance companies negotiating a better price).

Dylan16807 14y ago
For any particular place that that holds, I can almost guarantee its purpose is negotiating with insurance. Take away the insured and the price will drop tremendously as there is no need for extreme fake discounts.
- talmand 14y ago
  I once had a scan done and the office offered a cash price that was lower than the deductible, but if I went through insurance they would have billed higher so that most likely I would have had to pay the entire deductible. I paid cash.
  - kdot 14y ago
    Thats THE problem with healthcare in the US, there are 4 market prices: - Actual Price - Cash Price (after you bitch about how absurd the actual price is) - Insurance Company price - Medicaid price I wonder if the US can ever get as low as $20/mo for cadillac coverage. Is the free-market model even applicable to health care?
    - VLM 14y ago
      "Is the free-market model even applicable to health care?" It works about as well applied to health care, as applied to police coverage, military defense, restaurant health inspections, road maintenance, and education. Not as well as when applied to a farmers market or factory widget production. Its a little harder for med because quite a bit of med care happens to medically uneducated people. Given a couple years of med school and some on the job experience, and a couple days to fully research each emergency room and cardiology department in the country, my neighbor could probably have made an intelligent free market decision when he had his heart attack. However, instead of a free market, the ambulance instead took him unconscious to the nearest ER, where they'll pretty much do what they want and then charge what they want. The true miracle of the situation is it may have been a financial disaster, but medically it all turned out OK. Decades of propaganda has taught me that only a free market can provide decent services, yet at least medical care works pretty well with a feudal system where you simply report to the nearest castle and pay whatever tax the feudal lord demands.

cpursley 14y ago

Somebody needs to create international healthcare insurance based in stable non-US jurisdiction similar to travelers insurance. Insurance that would cover medical tourism - flight, lodging and care for Americans.

khuey 14y ago
Most Americans can't afford to travel out of the country for routine medical care.
- cpursley 14y ago
  Not for routine care - stuff of $10,000 or so. And the insurance would cover all travel expenses.
- PeterisP 14y ago
  It feels like most Americans can't afford to NOT travel out of the country for routine medical care. If you can pay $1300 for the routine stuff described in the article, it'll probably be cheaper to do it outside. I don't know the prices in North America, but based on EU prices I'd guess it should cost less than $500 to fly across half continent and back, and $150 for the actual operation in any good Mexican hospital; which coincidentally adds up to half the USA price.
jen_h 14y ago
No kidding; after months and months dealing with the actual mechanics of the medical bills for a simple leg contusion (stupidly thought it was broken; won't do that again), if the big C ever hits, I think we're headed to Mexico to avoid bankruptcy of both time and money. Just dealing with the afteraffects of a simple ER trip for what turned out to be a bruise was eye-opening. I had the pleasure of dealing with a multitude of bills from random places (in some cases, lawyers' offices, who handle some doctor's bills from first charge--i.e., not collections--and boast on their web sites about being able to return "200% of what's owed"), determining what's legit and what's fraudulent, the paperwork sent back and forth between us and our insurance company and between the billers and our insurance company (who weren't paying anyway because we have a very high deductible, but you have to jump through massive hoops to get them to actually count your payments towards the deductible), the attempts of the medical billers to double-bill and continue to appeal the bill with two insurance companies months after I paid the bill (how they collect that 200%, I assume)...a total mess. Someone got paid 2k for a deep contusion, but I think most went to middle(wo)men and lawyers' offices. That 62% medical bankruptcies in 2007 in the US are actually insured persons (cite: http://www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf http://www.washingtonpost.com/wp-srv/politics/documents/amer...) is no surprise; what would surprise me is if it isn't 20%+ higher now.

bgruber 14y ago

just to clarify: $300 for a doctor visit isn't inflating costs because he's covered by insurance. in ny, which i think is safe to assume is comparable in cost to the part of CA i'm assuming the OP is in, that's the normal amount you'd pay for a specialist visit.

michaelochurch 14y ago

I loved the Michael Moore movie Sicko. Regardless of what you think of him in general, he did a good job with it. What surprised me was the fact that 95% of what he found was what insured people have to deal with. I feel like the only thing that has prevented our health insurance system from touching off a violent revolution is that severely ill people aren't exactly in top shape for carrying AK-47's into executive lobbies. The whole point of private health insurance is that sick people are the easiest to rob-- they don't fight back-- but they also have no money, so it's best to collect payment while they're young and well.

paulhauggis 14y ago
You actually took that movie seriously? Of course there is some truth somewhere in the movie, but the majority of it is stretched truths and shots intentionally doctored to make his point. "The whole point of private health insurance is that sick people are the easiest to rob-- they don't fight back-- but they also have no money, so it's best to collect payment while they're young and well." The whole point of a public healthcare system is that it forces you, at the threat of jail, to collect payments from you (essentially theft).
- viraptor 14y ago
  How does it force you? Or do you think of every tax as a theft?
  - VLM 14y ago
    He's intentionally missing the social contract that its in direct exchange for health care, which all people need. (edited to add: There's already a social contract that refusal to provide emergency room care to everyone means criminal prosecution of the hospital/docs involved... its unfair they're not allowed to collect money at gunpoint, but it would be much fairer if they were allowed to do so.) I oppose mcdonalds because at the point of a gun a policeman will demand I pay them. Sounds awful, especially if I omit the fact I already ate the burger and I'm gonna need to eat another in the near future and the analogy breaks down even further in that McD would need a local geographic licensed monopoly on all food sales such that everyone living in the area must buy burgers from them.

11Blade 14y ago

The 1076 for the procedure and 300 for the visit were the full billable charges for those codes. If the insurance had covered them at their contracted rate, the provider would have received probably about 250 for the procedure and 50-120 for the office visit. Because it fell within your deductible, the initial bill to insurance would have been denied payment and sent back with "patient responsibility" and the 1376.00 would then be your problem. Since you don't have a contract with your provider he tries to get the whole thing. This is where you can discount it with negotiation. I am a medical provider, I believe that transparency will help the situation. I also believe that prices should be within a 5-10% window of each provider instead of a price variance of 100-400% depending on secretive contracts. Unfortunately even providers have been trained to game the system to maximise profit and productivity. It is common to hear surgeons talk about complicated patients and tell them to see a university guy because "frankly its not worth the time and effort" when they can get low hanging easy fruit that pays better/unit-time with less liability. I'd like to hear what the poster thinks he should have paid for his office visit and 5 minute procedure.

mikeg8 14y ago
Doing some simple math, if a doctor is making $200,000 a year or $250,000 a year working 40 hr weeks with 2 weeks of vacation, their hrly rate would be $100 or $125 per hour respectively. 5 minutes of just their time would be between either $8.33 or $10.41. Fine, throw in a couple bucks for the rubber gloves and scalpel. And something for electricity, paper, etc. Still should NOT me more than 40-50 dollars in my opinion. But I don't know much about this industry...
cdjk 14y ago
If the doctor is "in network" shouldn't the patient responsibility be the lower, negotiated rate? I thought was part of most insurance contracts, and one of the reasons insurance is helpful even if someone is healthy and has a high deductible. What you've described I think is largely responsible for a lot of the rising medical costs.

avaku 14y ago

Perhaps the hacker community could come up with some alternative solution, similar to bitcoin in finance, to try to force out the non-transparent pricing? ;)

binarymax 14y ago

I highly recommend reading the ebook here...It sheds light on actual costs and gives a very detailed analysis on the issues at hand: http://truecostofhealthcare.org http://truecostofhealthcare.org

cdjk 14y ago

What I think is really interesting is that my experiences with dental insurance are entirely different. I've gone to the dentist, found I have two cavities, and when I schedule my next appointment on the way out I'm given a detailed treatment plan that includes prices. It even includes details about how some fillings are more expensive because the insurance only covers amalgam fillings in the back but the dentist only uses composite fillings (for example). And it only takes a couple minutes to figure out the prices, and more importantly exactly what the insurance will cover. I realize that the set of things a dentist deals with is probably smaller than what a doctor does, but it seems like it's a much better model for insurance.

rayiner 14y ago
What's always surprised me is how cheap ophthalmic surgery is. I don't think opthalmic surgeons are exactly slumming it, but the cost of say getting a cataract removed is under $4k per eye with no insurance.
- nathos 14y ago
  I wonder if there are a combination of factors at work here. Elderly target market + (mostly) elective procedure + low Medicare payments perhaps?
- cdjk 14y ago
  That is interesting. I know the prices for things like LASIK are completely transparent, but that's because insurance isn't involved. I'd assume that insurance generally does cover cataract surgery, however. Some of the reasons might be that the procedure is fairly quick, the eye is easy to get to, it doesn't require general anesthesia, and doesn't require a full OR in a hospital (I think - correct me if I'm wrong). In that sense its closer to oral surgery than a gall bladder removal, for example.
nathos 14y ago
I think this is partly because dental insurance bears little resemblance to comprehensive medical insurance. In fact, for most people with a generally healthy dental history, it's often not worth paying for dental insurance, since it ends up simply being a pre-payment for services. Expensive procedures & oral surgery are often covered for only 50% of the final cost. In the US at least, I think dental "insurance" is really just a simplified way for employers to offer an appealing benefit to employees.

felipellrocha 14y ago

I wonder how long this is gonna keep going until someone gets pissed off, and creates a website to take care of the transparency issue by themselves- "upload your hospital bill here. We'll mine your bill for pricing data, anonymize you, and make the bill publicly available so people can shop for better prices".

nicholasjarnold 14y ago

> "...medical care is one of the core things that a 1st world country should make available to anyone, for cheap, by subsidizing it and enforcing transparency and price normalization for common needs..." Yes, exactly. This is pretty hard to accomplish in our current state of political inaction, misinformation and 24-hour news cycles. I'm sensing a build up to a tipping point on public awareness about how we're all being swindled by these hospitals and insurance companies, but perhaps I'm just paying more attention to this now that I'm starting to get a little older. For what it's worth, and for those of you who haven't seen this yet: http://truecostofhealthcare.org/ http://truecostofhealthcare.org/

Vivtek 14y ago

The ability of people in the States to insist that our health care system is "the best in the world" because of the action of the free market while simultaneously not understanding why prices are thus important is what usually leads me to believe that most Americans have no idea what a free market is. (Or what health care is, to be honest.)

saosebastiao 14y ago

Welcome to the US, where the solution to the problem of expensive health insurance is to make it illegal to not have it.

DanBC 14y ago

One thing that's a bit confusing: In both the UK[1] and the US[2] medication non-compliance is very high. Many people don't take their prescription meds properly. Many people are so bad at taking meds that the meds are ineffective - they may as well not take the meds at all. Rates are similar in the US and UK. About half of the UK £9billion budget for prescribed meds is sub-optimal spending because of medication non-compliance. And severity of illness doesn't seem to be a factor. People who've had an organ transplant often die after rejection when they stop taking the meds, even though they know that they must keep taking the meds. There's probably money somewhere if you can improve medication compliance. [1] Prescriptions usually cover 28 day supply of medication. Each line item on a prescription costs £7.40; but most people don't pay because there are many exemptions and if you need long term meds you can pre-pay. [2] I dunno how it works in the US.

steven2012 14y ago

I have Kaiser HMO in California. I think it's awesome, and the best health care I've ever had. I'm also from Canada, so I'm comfortable with the idea of socialized medicare. However, when I compare stories between me and my friends in Canada, there really is no comparison. I basically pay a $20-30 co-pay per visit (something that was completely foreign to me when I first moved to the US), and then anything and everything gets done for me. I have never experienced the horror stories you hear about where insurance companies try to opt for cheaper treatments or deny services to save money. Any test or procedure I needed, or even asked about, I could get. The longest I waited for things like a MRI was 2 days, and 9 days for an endoscopy. My doctor was willing to get me a CT scan the next day for this stomach problem I had. My friends in Canada have waited 4 months for an MRI and 3 months for a CT scan. My dad had to wait about 6-8 weeks to get a pacemaker installed, even though his heart was stopping for 5-10 seconds several times a day. Seeing a specialist takes months in Canada vs days with Kaiser. On weekends, if I get sick I don't have to wait in Emergency for hours like in Canada, I can just set up an appointment at one of the hospitals and see a GP in around 30-45 mins, and they have full access to all my medical records. The downside is that when I'm out of a Kaiser area, I have to pay out of pocket unless it's an emergency (I believe). The only time I felt vulnerable was when my family was out of state, and they didn't have Kaiser facilities there.

mjmahone17 14y ago
Which is part of the problem with reform: you happen to have a functioning HMO. What happens when you change employers? What happens when your employer doesn't offer insurance? You are one of the lucky few who has the connections, and deep-corporate-pockets (presumably, unless you're paying for your insurance out of pocket) to be able to get good insurance. But that isn't how most the country works. It's probably better for the masses to have the longer Canadian waits, rather than the quick-care American bankruptcies (or non-care).
bluedino 14y ago
It used to be like this for most people in the USA with insurance. Slowly, costs rose and benefits have been dropped. What used to be a $20 (or even $0!) co-pay became abused, people would visit the doctor every week, and since it didn't cost them anything, they had no reason not to go. These days you'll find a high-deductible plan that does the reverse - encourages people to NOT go to the doctor because until they've hit a $3,000 tab, the insurance won't kick in a single dollar.

gmack 14y ago

Granted, the OP indicates that indeed it is difficult to get advanced pricing because it entails asking the doctor for the code, then checking with the insurance company. But what's stopping people from voluntarily posting the procedure_code=>price information they obtain? Are there contractual/legal reasons that prevent you from sharing that information? If patients get that price in the normal course of getting healthcare, then why not share it all, and force transparency in the market?

11Blade 14y ago
Medicare posts their fee schedule for every single CPT code.
- gmack 14y ago
  Right, but presumably Medicare's prices are significantly lower due to its negotiating power (which is why "Medicare for All" may not be such a bad idea). As we can see from many of the comments here, the prices vary widely, even when you make the effort to find out what they are for your provider and insurer.
deleted 14y ago
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trolley 14y ago
This comment made me wonder if such a thing (crowdsourced medical pricing) existed: turns out it does [1, 2, 3]. I would absolutely love to see resources like these take off, until using them is as common place as checking GasBuddy before filling your gas tank. [1] http://www.healthcarebluebook.com/ http://www.healthcarebluebook.com/ [2] http://clearhealthcosts.com/faq/ http://clearhealthcosts.com/faq/ [3] http://outofpocket.com/OOP/AddVisit.aspx http://outofpocket.com/OOP/AddVisit.aspx

viggity 14y ago

If your auto insurance included new tires, oil changes and gasoline, imagine what would happen to the price of both auto insurance and gasoline? They'd both skyrocket. So why the hell are we doing it with healthcare? Insurance is about sharing risk and a large part of the cost isn't sharing the risk it is about pre-paying for normal, expected ailments and when consumers become insensitive to cost prices are bound to rise. The healthcare industry is greatly in need of cost sensitivity and transparency.

mjmahone17 14y ago
What about healthcare insurance includes the cost of "gasoline"? In my knowledge, healthcare insurance doesn't cover food or water (besides, maybe, hospital food while you're in the hospital), and I really don't get the analogy.

codegeek 14y ago

Just some anecdotal data from my wife's pregnancy & delivery process and the costs/charges are just from her 2 days of hospital stay for her normal/vaginal delivery without any complications. - The hospital (NJ if it matters) billed the insurance company $30,000. She was there for usual 48 hours. The insurance company has a thing called "Amount Allowed" which knocked it down to $5880. Then our share of co-insurance came to about 20% of that = $920. - For baby, separate hospital bill of $8779. amount allowed = $2,232, our share = $566 - The Anesthesia consultant billed separately for $3000, amount allowed = $1100 and our share = $220 - OBGYN billed $4200, amount allowed = $2800, our share = $560 - Newborn clinic charge = $375, allowed = $375, our share = $289 (deductible not reached) - Neonatology for baby - $590, allowed = $100, our share = $100 (deductible not reached) So here is total just for Labor/delivery/baby which was 100% normal without any complications. - total bill = $52,824 - Allowed by insurance = $12,487 - Our responsibility to pay = $2655 I get chills just to imagine if we did not have insurance.

crusso 14y ago

It appears most states in the U.S do not require hospitals and medical providers to list their prices This and the tax breaks given to companies sponsoring health insurance plans that create a nearly immovable useless middle man are the root of all evil in the American healthcare industry.