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One hospital charges $8,000 — another, $38,000
- mitmads 13y ago"a health system that can set prices with impunity because consumers rarely see them — and rarely shop for discounts"
- girvo 13y agoKind of defeats the whole "free market" thing, doesn't it?
- drawkbox 13y agoIt isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem. Not sure how you fix it, maybe by temporarily making it illegal to allow a company to provide health benefits through insurers to fix this. Employers should only be allowed to give you the money for an individual plan (most startups sometimes do this instead). Employers don't pay your auto insurance, home insurance or other insurance. Maybe a one time convert of employer groups to individual groups managed for risk, then, for privacy, for business, for better health care the individual has that (also probably a back up plan for those in need). Why should employers know about your health? This is ancient thinking where you stayed with a company forever. It's also a privacy thing. I think it would also combat ageism. It will also make starting companies and competing much easier with less friction. It would also allow employees to more easily go from job to job, when you have an employer plan it is a scary predicament sometimes. Cost can only be competitive if they are seen, they will be seen if it is moved away from employer provided.
- cmircea 13y agoOr how about have national healthcare? Like every other decent country on this planet?
- roel_v 13y agoDescribe "national healthcare". I see people who like to bitch about the US throwing this term around a lot, but what do you mean by it? One single, state-organized health care provider that gets funded 100% by other taxes or a flat-fee contribution that is the same for everybody? State-set price controls? Price controls on what - costs of procedure or insurance plan? What about coverage of those plans, determined by the state?
- cmircea 13y agoState organized and owned healthcare. You pay for it as a taxpayer and don't have to worry about going bankrupt because of a disease that can happen to anybody. For an example, the UK's NHS. Private healthcare is still perfectly legal and fine, as is private health insurance, if you deem the state services are not suitable for you. Hospitals should be helping people, not ripping them off >.<
- drawkbox 13y agoPossibly, but you can't make that leap directly, people/industries don't move that fast. First step is move away from company provided, I am sure there would be renewed interest for it in many against it now, or some workable private and public system where prices are known, more direct.
- olefoo 13y agoOnly after we have explored every other possible solution. This is America, and no socialism is possible; unless you are a homeland security contractor.
- cmircea 13y agoWhat the hell? State provided healthcare = Socialism?! That's bullshit. What about the police department? Or the fire department? Or the post office?
- gordaco 13y agoNo captive market can ever be a free market. And everything health-related is a captive market, because you can't afford not to pay for the service.
- chii 13y ago> because you can't afford not to pay for the service. you mean you can't afford to not _have_ the service? you can certainly be unable to pay!
- gwgarry 13y agothat means capitalism is working right?
- stephen 13y agoI blame employer-provided health insurance. It leads to people thinking "hey, it's free!". The story I've heard is that at some point (WW2-ish?) there was some sort of government-induced cap on wages, so employers couldn't compete for employees merely on a cash salary. So, as an unintended consequence to the original government action, employers started offering health insurance as a non-cash benefit. (Please correct me if I'm wrong, I am admittedly going on hearsay.)
- gwright 13y agoThat seems accurate. Here is some history regarding health insurance in the US that backs up that story: http://www.ebri.org/publications/facts/index.cfm?fa=0302fact http://www.ebri.org/publications/facts/index.cfm?fa=0302fact
- DanBC 13y agoWhy aren't the insurance companies working to drive prices down? I understand the theory: People buy insurance; the insurance companies 'police' medical providers and regulate (through the market) the pricing of services. From the outside it doesn't look like that works. From the outside it looks like very many more (often unneeded) tests are conducted. And it looks like the insurance companies are not squeezing the providers of health care, but are squeezing the patients.
- anateus 13y agoMost private health insurance in the US is provided by employers. Thus, the people paying for the services are not the patients but insurance companies, and the insurance companies are selected by employers not the patients.
- DanBC 13y agoBut that says nothing about why insurance companies are not pushing prices down. They get paid by employers, but they'd make more profit if the health care they buy is cheaper. Since I regularly hear that prices are cheaper if you negotiate with the doctors it seems that insurance companies are not doing that negotiation. So, given that they appear to be losing out on some profit, why? Why aren't they pushing the costs down?
- refurb 13y agoThey are pushing costs down. That's why when you get a bill from your insurance and it says "Procedure X - $5000" followed by "Negotiated rate - $1000 accepted". Insurance companies figure out what stuff should actually cost, then enter into contracts with providers that says "Hey I know you're still making a decent profit if I only pay you $100 instead of $150, so take $100 and you'll make it up on volume when you become one of my preferred providers."
- gwgarry 13y agoThe insurance companies are going to "negotiate" with the hospitals in which the hospital's bargaining position will be to offer fewer services, or the reduce the level of service provided. That's what it looks like from the inside. The insurers put as much money in their pockets. And the hospitals do the same. The patient gets hit with a large bill and fewer sub-par services. Everyone wins. Except the patient.
- saber_taylor 13y agoDoes this mean there should be an app so you can comparison shop while in an ambulance? Hey no, I want to go to Hospital B.
- ck2 13y agoAlways tell them you are paying in cash. Take bill home and sumbit to insurance if you are lucky enough to have insurance. You just saved the system at least 75% of the cost.
- yitchelle 13y ago"if you are lucky enough to have insurance." This is one of the many sad points about the health system. Luck should have absolutely NO relation to whether you can afford reasonable health care. Reasonable health care should be available to Joe Blow who is earning minimum wage at your local city council and to Mr. Burns who is earning 20x more than Joe Blow.
- ck2 13y agoGreat news, they solved this in a very profitable way. In a few years it will literally be a crime to not have insurance. So cannot afford it? Not their problem - YOUR problem. Yay 'murica.
- anonymous 13y agoJust like the old law against unemployment back in what was known as the Socblock and the soviets ran the country. Too many people unemployed? No problem - being unemployed is now against the law and a criminal offence.
- seanmcdirmid 13y agoThe nice thing about making something mandatory is that their is then outrage when people can't afford what they must have. Society can't ignore the problem anymore and must attack it head on. Can't afford insurance? Well, here is a subsidy, or why not just go on medicaid? Can't afford insurance and make $60K a year; well, maybe individual plans should be more affordable...single payer is looking more desirable. Oh, you make $100K a year and STILL can't afford insurance (let's say no family is involved). Well how the f*ck are you spending your money? Oh, you just don't want to buy it because you are young and invincible? That's not how insurance works. Yeh for America; they are finally catching up with the rest of the developed world!
- epistasis 13y agoThis is why the ACA is such a boon for people that thonk health care should be a free market. It takes the free market ideals and embraces them; the accusations of socialism are more telling of the accuser than the accused. That's not to say that I think health care should be a free market, just that its the goal of the ACA, and the current situation in the US is much less free a market, and due to employer provided insurance, barely a market at all. No price information is communicated to consumers, and the ACA will start to do that.
- Jayschwa 13y agoOne good aspect doesn't make it a boon. In my personal experience, the law has made insurance less affordable. I'm in between jobs and bought an inexpensive short-term, high-deductible plan. However, the plan has been deprecated (no renewals after a certain date) because it does not meet all provisions of the ACA.
- rdl 13y agoMy long-term HDHP went from $80/mo to $118/mo, which is high in percentage terms, but still not a big deal IMO. In the process they gave me unlimited lifetime coverage, added free preventive care, etc. -- which IMO seems actuarially impossible, but I'm on the buy side of this transaction.
- gojomo 13y agoCan you share the name of your provider (or their peer set)?
- rdl 13y agoIt really varies by state. I went to an online insurance comparison app (I should promote Leaky or SimplyInsured here, but at the time in 2010, I used ehealthinsurance), searched for HDHPs, then picked based on reputation. I picked a Blue Shield provider with no lifetime cap (or a $6mm lifetime cap, I forget). The only states I know are WA and CA. In WA, I like Regence Blue Shield; plans seem to be in the $100-150/mo range now. In CA, there are also a lot of HDHPs in the $100-150/mo range. I'd specifically avoid Kaiser as an employer giving coverage, as some people really dislike Kaiser since you must use a Kaiser doctor, hospital, or other facility, but if you're an individual and like a Kaiser doctor, it might be a good choice. Otherwise a lot of people I know use Health Net, Anthem, etc. I'm not a lawyer nor am I a licensed insurance agent so I'm hesitant to recommend specific plans. I think these rates are low due to being HDHPs and the "best" patient group; 26-35 year old single male. Those are exactly the people who don't get individual insurance unless they're cautious people who join AAA, change oil on time, buy fire extinguishers, look both ways before crossing the street, etc. (and thus exceptionally good risks), and even then seek to minimize contact with doctors. I suspect the unhealthy ones are particularly likely to take jobs with insurance, or be on medicaid/prison/etc., in that bracket, or are so irresponsible as to have no insurance (because hey, even $120/mo is better spent on beer). Rates don't seem that much worse for women (which is weird, since I'd assume most women get enough extra covered services covered now by an HSA to destroy the actuarial model for a $100/mo plan). The rates 4x once you add children, though. I tried also plugging in numbers for people born in 1969, 1959, 1950, and rates do go up, but only maybe 4x, too. So the prices are generally within a 10x range per insured, at least for healthy people or in places where there is no medical underwriting, tops, and under ACA, that will converge to 4x (although I'm sure by raising the low end by 50-150% and only lowering the top end by a trivial amount.) I always assumed all insurance was $500+/mo/insured, since that's what the group rates for small businesses seem to be, but that's due to adverse selection and inefficiency I think. The real problem seems to be if you're unhealthy when looking for insurance, or have children (particularly with high medical costs), or have an acute high-cost event, or are poor enough that $100-200/mo is a hardship (even though I think $100-200/mo for health insurance, whether paid by the individual or the government, is pretty reasonable), or are, worst case, so unhealthy that you're also poor and thus doubly screwed.
- khebbie 13y agoIn this regard USA is a development country
- rdl 13y agoI have to admit I was against ACA for a variety of reasons, but if the first step is increased price transparency and exposing that data, it will do a lot of good. The best reform I can think of would be a combination of individually purchased (vs. employer) HSAs, where poor people get grants of up to the the full deductible per year in some kind of special account IFF they sign up for HSAs, and price transparency. Employers who currency pay for your entire insurance could give you an equivalent amount (plus deductible) which goes into your Health Savings Account. You're then effectively paying an army of 300 million to constantly search for the best prices (or rather, to find third party organizations to search for the best prices for them). $3-5k/person is actually not that unreasonable for the poorest 30mm people and those covered by medicare/va/medicare-for-kids/etc. I'm confident this could drop the prices of procedures by >10x, comparable to other countries. Americans are really good at driving down costs when they know the costs and are paying them out of pocket; look at how much cheaper it is to buy an iPhone in the USA vs. where it's made.
- humanrebar 13y agoThat's not a political reality. Since healthcare bought by an employer counts as an tax-deductible expense and healthcare bought by an individual gets no such breaks, there is a huge incentive (equal to the marginal tax rate) for individuals to have someone else write the checks for the bulk of their healthcare costs. Before market-based healthcare will work, either 1) employer-provided health insurance benefits must be taxed as income or 2) individual healthcare purchases must be tax-free. 1) is an obvious political non-starter. 2) is a huge new loophole in the tax code and an accounting nightmare.
- greedo 13y agoIndividual healthcare purchases (not insurance) can be deducted from your taxes, either explicitly if you're filing a long form, or implicitly if you're claiming the standard deduction. I don't see why it would be a huge burden to make individual health insurance tax deductible.
- humanrebar 13y ago
- nostromo 13y agoI wonder, since we strangely expect employers to provide healthcare insurance in the US, what if employers just decided to provided actual healthcare. Imagine taking all of the health premiums Google pays for its employees, and instead of feeding it in to a broken system, you build a world class health facility in Mountain View that's free to employees.
- s_henry_paulson 13y agoYou would still need health insurance unless everyone agreed to never leave a 10 mile radius of the work hospital.
- ck2 13y agoBecause of the profit involved in preventing that, I am betting it's not legal.
- Mvandenbergh 13y agoLarger employers (including Google probably) already under-write their own schemes, the "insurance" company actually only manages billing in those cases.
- cmelbye 13y agoBut then what happens when they need care when they're not near the company hospital? You'd need to set up company run hospitals all around the state and the country to manage the costs. And suddenly, you've reinvented Kaiser.
- reycharles 13y agoKaiser Permanente (http://en.wikipedia.org/wiki/Kaiser_Permanente http://en.wikipedia.org/wiki/Kaiser_Permanente) is a »integrated managed care consortium« (health insurance, I guess). I did not know that.
- azernik 13y agoYeah - they're basically the outgrowth of Kaiser Shipyards doing exactly what nostromo proposed back in the 40s, and then letting other people buy in to their network.
- gordaco 13y ago8000, 38000, both insanely expensive. I haven't seen a single sane price in the whole article.
- Xylakant 13y ago8000 USD for a hospital treatment does not seem insanely expensive for me. Hospitals are by definition expensive - 24/7 on-site staff, highly trained experts (doctors), lots of expensive machines. A simple bed in a hospital is far more complicated and expensive than your standard home mattress. Hospitals need to overprovision on a constant basis since the can't just return a "503 Retry Later" in case of emergencies. There's certainly ways to save money on the lowest price, but the spread is far more interesting - given that you should get a solid treatment in each of the hospitals, why does one manage to offer you a fifth of the highest price?
- chii 13y ago> a fifth of the highest price? may be because those higher charges are more bureaucracy than actual value adding?
- LekkoscPiwa 13y agoor maybe because there are developers who are $30 and hour and there are developers who are $100 an hour ? Isn't that the same with the doctors? Isn't that the same with the equipment? Isn't that the same with the medication? Who cares if they can kill you on the cheap? The point is to save lives no matter what the cost.
- axefrog 13y agoWhy does the US tie health care to employment? Why is it not tied to the individual and thus transferrable between employers?
- dalke 13y agoAs I understand the history, during the wage freeze of WWII, companies used medical insurance as a form of compensation. This also helped the companies because the men left behind tended to be not as healthy as those who were conscripted. Once you think of it as compensation, you can see why the benefits are tied to the employer. "Join us; we have good healthcare."
- rdl 13y agoIt started as a legacy of wage controls during WW2 (they added a bunch of fringe benefits to compete without technically breaking the law), but continues because medical insurance is tax deductible for an employer who buys it for his employees, but NOT for an individual who buys it for himself or his own family. So it essentially costs an individual 20-55% more than it could cost an employer. (There's also the risk-pooling aspect; an employer can get a group rate with guaranteed issuance because it's assumed they will be selecting employees for moderate to good health (or else they'd be disabled vs. working), or at worst randomly, with only random-in-population odds of high-cost dependents. There's an adverse selection with voluntary individual insurance; healthy people would rationally not get insurance if it were really expensive relative to their expected utilization, whereas someone with a chronic condition or high risk actually would get insurance even at a relatively high cost. Which in turn drives up the costs per insured, which drives up the rate...eventually becoming uneconomic. In practice, a lot of people with chronic conditions in their families actually do seek out stable jobs with big employers with good insurance to cover it, vs. doing startups or whatever, which imposes a loss on the economy if they would otherwise have been the next Elon Musk.) The Republicans in 2008 (McCain?) were actually arguing for making medical insurance non-deductible for employers and I think deductible for individuals, which was then seized upon as "taking away your health insurance". Ironically that position of moving insurance away from employers seems to be a long-term goal of the ACA/ObamaCare.
- digitalengineer 13y agoI do not understand why there is no public list online with the basic costs of operations (including all the variables). With price transparency a lot of this unequal treatment and prices would surface. I understand there are a lot of variables, but not like it wouldn't be possible. (I understand a treatment at Hopkins would be more expensive than say at your local hospital, but at the very least it would be clear how much more expensive it actually is. EDIT: One way to do it nationwide would be to ask people to send in their bills (anonymized).
- chao- 13y agoOperations are one type of unknown cost, but the problem extends to all parts of medical treatment. I know of at least one company (SnapHealth [1]) trying to solve this problem, from one small angle: tests and doc visits, as opposed to operations. But what I think you're asking for (and I would agree with) is a public list ala some regulatory mandate to publish costs of specific treatments? [1] - https://www.snaphealth.com/ https://www.snaphealth.com/
- digitalengineer 13y agoYes. The minimum cost for a standard operation/procedure (without complications). X people doing the check-in, X-doctors for the procedure, X time in hospital bed to get well again, X time with checkups afterwards... You get the idea... EDIT: Forgot the link you send in. Looks good!
- spodek 13y agoSeems like an opportunity for a simple web page for people to report their fees and could search what others paid. Not sure if it would make money, but I bet a lot of people would like it and benefit from it. Anybody up for it? Does it already exist?
- greedo 13y agoI think that healthcare providers would have to start this process. The bills and statements are far too opaque for the end user to properly decipher. As an anecdote, I was treated for cancer several years ago; trying to wade through the morass of bills, statements, treatments, third/fourth/fifth levels of providers, was simply unfeasible. And hospitals naturally have a desire for this type of billing info to remain opaque since it dissuades any criticism of fee schedules.
- yoster 13y agoNot surprising at all considering healthcare in the states is just "big business" as usual.
- cwmma 13y agoThe table this is based on uploaded to fusion tables. https://www.google.com/fusiontables/DataSource?docid=1VlO_qd-JvxWE_HF7jFDyScvpMQV0AZArZL4y1us https://www.google.com/fusiontables/DataSource?docid=1VlO_qd...
- dkhenry 13y agoSo great I now know that hospitals charge different fees which is still pointless since my federally mandated heath insurance will pay either one of those prices at no difference in cost to me. In reality I can get my hip replaced at any institution and pay nothing more then the $300 a month I pay for my health insurance. So in the real world the price of all those procedures _to me_ is $300 a month. This is not a free market. Making these prices public isn't going to make it a free market. No problems have been fixed. Only new and novel problems have been introduced.
- jnorthrop 13y agoYou're completely missing the bigger picture. You may be paying a fixed rate for your care, but if healthcare costs continue to rise unabated then you won't be paying $300/month next year, you may be paying $500/month. In addition the mandate to get everyone into the coverage pool plays a factor in helping keep your costs low. If hospitals can charge rates set seemingly at random, and the "customer" has little or no opportunity to understand what the cost of their choices are, or even make a choice of where to go, then the system will likely continue to spiral out of control. And it is out of control. My company, with 50 employees, will paying in excess of $500k for healthcare benefits this year. That doesn't even include the contribution required from the employees. That cost has risen ~12% every year. You are deluded if you see recent attempts to control these costs as only introducing new problems. Something has to be done.
- dkhenry 13y agoNo your deluded if you think people will shop around for something that has no direct influence on their finances. Your absolutely correct that ideally everyone would do the "right thing" and make the financially prudent decision that benefits society and shop around for a good price on a procedure. However no one will do that. Most people don't care because like I said it doesn't influence me and even if I did the "right thing" I am bound by both my fellow employees ( via our small pool ) and US tax law ( by medicare and insurance subsidies ) to split the cost of _everyone's_ actions so unless a majority of society gets on board my actions matter little. In effect I will continue to go to the nice hospital for elective surgery because its nice there, ya so what they charge someone else 300% more for the same stuff, the food is better and I get free TV in my room.
- deleted 13y ago[deleted]