22 ms·
Your heart attack bill: $3,300 in Arkansas, $92,000 in California
- gamegoblin 13y agoIt always surprises me to see to see my state (Arkansas) in a headline. Just wanted to throw out there that Arkansas actually has pretty good hospitals and whatnot. There are a strangely high number of multinational companies (Tyson, Walmart, Axciom, JB Hunt, among others) based here who donate lots of money to various institutions, most notably UAMS (University of Arkansas for Medical Sciences).
- sixothree 13y agoI think the only thing relevant about this article is the linked dataset.
- sabat 13y agoIt's relevant mainly because HN covers almost anything of interest to the hacker community, including medical issues.
- jaynos 13y agoSame thing about the Washington Post article from earlier today. I'm not sure why it wasn't a direct link to the data with a headline of "Feds release huge hospital cost data base". I don't know if there is a useful service to pull out of the data (other than analyzing it for journalists) since most people don't have much control over where they are hospitalized and if they do have control, they shop by doctor, not price. Insurance coverage means that I have no skin in the game when it comes to price (unless the insurance company puts a hospital on the out of network list).
- kmfrk 13y agoSpeaking of, which editors are people viewing the .csv in? I don't get the best performance in Sublime Text 2 on a pretty decent desktop.
- dangrossman 13y agoExcel in Office 2013, which I pay a $99/year subscription to use on 5 PCs/tablets.
- cpncrunch 13y agoThe insane part is that the hospital only receives a tiny fraction of the billed amount from the insurance company, yet uninsured people have to pay the full amount. The US healthcare system is broken on many levels, and I don't think anyone has the balls to really fix it. Some ideas: [1] Free basic medicare for everyone, but allow people to pay for faster/better service. This is the way it works in the UK, and it works very well. The basic service is fine for most people, but if you want a room to yourself or you want to jump the queue, you can pay to get US-style service. Overall it works out much cheaper and fairer than the US system. [2] Set up a system that allows uninsured people to get the same rates as the insurance company. It's a bit of a scam at the moment - basically the hospitals seem to be out to screw you if you're not insured.
- scarmig 13y agoIt's quite possible to get a lower rate than what's billed to the insurance company if you're uninsured. Maybe not at all hospitals, but at many.
- cpncrunch 13y agoPerhaps, but it seems to be down to your negotiating ability.
- amorphid 13y agoI had a major bike accident in 2006 and was taken to a hospital emergency room. The hospital told me they take my insurance. They really meant they'll bill my insurance. My insurance company didn't have a negotiated rate with the hospital and the treatment was considered out of network. Instead of paying only the maximum out of pocket cost of $4,000 USD per year, insurance only offered 50% and I got hit with a bill for $50,000. It eventually got worked out months later after months of fighting the hospital, doctors, and insurance, but it sucked big time.
- visarga 13y agoHealth care but Financial death.
- awkward 13y agoI imagine a large difference is the number of patients with health insurance - if Arkansas has significantly more uninsured, then they need to recoup costs on them. If California has enough insured patients, then their "cost" is a figure they expect insurance to bargain down from.
- gamegoblin 13y agoFalse. Arkansas has fewer uninsured. http://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_States http://en.wikipedia.org/wiki/Health_insurance_coverage_in_th...
- awkward 13y agoThank you for that.
- Trapick 13y ago"Health care in the US is idiotic" doesn't really warrant a headline anymore, everybody gets it.
- mikeash 13y agoNo, they really don't. Many people are resisting reform because they don't see why we should change a system that they see as working well already.
- grecy 13y agoDo you think it's possible to show or educate those people that in fact the system is dysfunctional? Any ideas how?
- mikeash 13y agoI think that continuing to discuss the bad parts, like this, is helpful, albeit only gradually. The people with this attitude are generally either young, healthy people who have never needed serious medical attention, or people who have always had stable jobs that offer good insurance, and have never seen a hospital bill that didn't have 95% paid by the insurance company first. They've never been injured on the job and then forced to pay a year's salary for the surgery they need to continue working. They've never been prevented from starting a business because their employer's group plan is the only way they can afford their life-saving medication. They've generally only seen the system work. In the rare cases they've seen it fail, it has always been for people they don't know closely, and it always looks like an anomaly. Showing these people that these problems are real, common, and affecting a huge number of people is a start.
- fnordfnordfnord 13y agoPublish data showing the disparity of medical costs across the US?
- lotharbot 13y agoI know a lot of people who are against certain commonly suggested reforms, but none of them think the US system works well. Instead, they think certain proposed reforms will make an already poor system even worse.
- kmfrk 13y agoWithin smaller areas, too: https://twitter.com/HuffPostData/status/332244607805050880/photo/1 https://twitter.com/HuffPostData/status/332244607805050880/p.... $7,044 vs. $99,690 between New York and New Jersey! Might be worth that drive.
- curt 13y agoHow is this surprising? We've completely taken the free-market out of health care. The only way it will ever be solve is if we re-introduce market forces back into the mix. The other problem is all the government regulations that tie the hands of people that would do the innovating. That's one of the big reasons California is at the extreme. They continually add requirements to medical insurance that increase the cost. The solution is simple, let the free-market, ie us, decide what we want.
- nawitus 13y agoThat's not the only way. Government based healthcare works very well in a number of European countries.
- mseebach 13y agoGenerally it just works.
- runn1ng 13y agoAnd, as a consequence, our doctors got paid much less and the state-owned insurance companies are still hemorrhaging money.
- curt 13y agoWhere does it work well? A small country with a homogenous population can pull it off but there isn't a single large country where it works. They keep their costs down by rationing coverage with wait-lists. I know a few people from the UK where their family members lived in daily pain and had to wait YEARS for their number to be called. They also limit the availability to the best medications and procedures to keep costs down. Also the quality is also quite poor, hundreds of people in the UK have died of dehydration in the hospital because the staff forgot to give them water.
- princess3000 13y agoYou realize that every single thing you enumerated could easily be applied to for-profit insurance companies in America, right? Just checking.
- CanSpice 13y agoAnd my heart attack bill in Canada is $0.
- DanBC 13y agoIn England the treatment is free at the point of delivery to almost everyone[1] Any meds will be about £8 per item per month. Discounts are available if you need to buy lots of meds. And many people are covered by various exemptions and won't have to pay anything. (EG: People taking thyroxine will get a medical exemption certificate and not have to pay for any prescription medication at all). You don't need to use NHS hospitals. You can go to private health care any time you like. You don't get to opt-out of the national insurance payments. I'm not sure if there are any private emergency rooms. And there's a recent "protective" change where some cancer patients have to pay for all of their care if they buy a few specific (not effective, not efficient, very expensive) meds. Some pharma groups have been unscrupulous in targetting very ill people with bad, and expensive, meds. They funded patient advocacy groups to agitate for changes to prescribing rules to allow for these ineffective meds to be available on the NHS. I've been careful to say "at the point of delivery" because I recognise that there is a tax burden that needs to be paid. [1] In theory only emergency stuff is available unless you're entitled or you have equivalent national insurance or you have private insurance, but in practice "health tourism" is said to be a problem here.
- steve-howard 13y agoOh, really? Nobody mentioned this in the last thousand times people discussed US health care. Glad you brought it up.
- MisterBastahrd 13y agoI have several Canadian friends and they've all told me that they never understood the price of healthcare until they had to take their dog to the vet. They all pay for it, of course, during the course of their lives, but they don't ever have to worry about not having access to it or being bankrupted for it. The medical industry hates this, of course, because it means that hospitals can't charge $2 for an aspirin that can be bought 100 to a bottle for less.
- 13y ago
- Noelkd 13y agohealthcare is something that should be like water.
- kmfrk 13y agoEven drinking water is subject to regulations, though. Nothing is ever that simple. :)
- mikeash 13y ago"Even"? Drinking water is heavily regulated for good reasons. It's also extremely cheap. There are a lot of other examples of highly regulated industries providing cheap services, something I wonder of others are aware of when they talk about the need to reduce regulation to cut costs. Health care as a regulated public utility like electricity, water, and phone lines doesn't seem like a bad model to shoot for.
- machrider 13y agoPerhaps in this market, Arkansas can leverage economies of scale.
- cperry 13y agoI'd highly recommend checking out the linked dataset.[1] One quick observation: subtract Average Covered Charges from Average Total Payments and sort to see what procedures are most overcharged: 7 of the top 10 are "207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS". Average overcharge among those top records is 601K. What is going on that they routinely charge 601K more than they collect? I'm excited to see what all everyone else comes up with. [1] http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html http://www.cms.gov/Research-Statistics-Data-and-Systems/Stat...
- danbruc 13y agoA picture is worth a thousand words? http://upload.wikimedia.org/wikipedia/commons/f/f8/HC-Graph.jpg http://upload.wikimedia.org/wikipedia/commons/f/f8/HC-Graph.... Source: http://en.wikipedia.org/wiki/Health_systems#Cross-country_comparisons http://en.wikipedia.org/wiki/Health_systems#Cross-country_co...
- jstalin 13y agoIt should be no surprise that the more government "regulates" and subsidizes health care, the more expensive it gets. And the answer to high costs is always more regulation! I keep reading more about doctors who are opting out of the medicare system and switching to cash-only services. In the name of providing care to all, the system is breaking down and stratifying. Obamacare is an abomination of payoffs to special interest that will do nothing to reduce health care costs. Health care must be rationed. It is a finite good. The question is how it gets rationed. Market forces? Private insurance? He who can pay? Whoever the government decides gets it? The bottom line is that the more government decides who gets it, the more expensive it becomes. There's gotta be a happy medium, and my intuition informs me that the happy medium is closer to the free-market side than the mega-regulation side.
- clicks 13y ago> Health care must be rationed. It is a finite good. Instead of FWD.us initiative of bringing over competent technology people from abroad, maybe we should instead try to attract more doctors/medical professionals from India/China into coming here.
- jdminhbg 13y agoI dunno about "instead of," but not granting citizenship to any qualified doctor who wants it is pretty stupid on our part. Easy for me to say, though, since the AMA won't run ads about me killing babies for voting for such a thing.
- steve19 13y agoI don't think that is the answer. Can every student in the USA who is willing and capable of being a doctor get into med school? I would guess that this is probably not the case. Increasing the number of doctors produced locally would seem to me to be a much easier way of increasing supply.
- fancyketchup 13y ago> Can every student in the USA who is willing and capable of being a doctor get into med school? No, but it's not because they aren't good enough. In grad school, I TA'd a physics class for pre-med students, which were widely considered to be one of the most miserable and obnoxious groups to teach. Each student felt entitled to an A, even though the department mandated that only 25% of students could receive an A. In reality, probably more than 80% of the class earned an A, and I would have felt comfortable that most of the rest were smart enough to one day give me medical advice. Yet, less than 45% of people who applied to one or more medical schools [1] are admitted (and this is a self-selected group: those without 4.0 GPAs, three extra-curriculars, and a side-business of helping old ladies across the street generally don't apply). I would estimate that only about the top 15% to 25% of the class actually applied. So, from undergrad pre-med to MD, there is about a (hand-wavy) 90% attrition rate of people who are probably smart enough and probably willing to work hard enough, and who have the desire to become doctors. > Increasing the number of doctors produced locally would seem to me to be a much easier way of increasing supply. I agree, but the medical profession is not willing to allow this to happen. Each medical school has a quota, and nobody wants to rock the boat. The trouble is, there isn't really any way to force medical schools to admit more students. [1]http://en.wikipedia.org/wiki/Medical_school_in_the_United_States http://en.wikipedia.org/wiki/Medical_school_in_the_United_St...
- glaugh 13y agoHere's a quick and dirty visualization of the distributions for each kind of care across lots of different hospitals: https://www.statwing.com/open/datasets/c5fc084c00d24cf221c1727fb9e4f179fb32e860#workspaces/3934 https://www.statwing.com/open/datasets/c5fc084c00d24cf221c17... Other visualizations today: NYTimes -- http://www.nytimes.com/interactive/2013/05/08/business/how-much-hospitals-charge.html http://www.nytimes.com/interactive/2013/05/08/business/how-m... Washington Post (low on the page) -- http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-hospital-charges-8000-another-38000/ http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/o...
- mikecane 13y ago>>>Your heart attack bill: $3,300 in Arkansas, $92,000 in California And: Your rent bill: $600 in Arkansas, $2,500 in California.
- djvu9 13y agoHealth care in the US is the most broken one on this planet (I have been in Hong Kong and China). It is even worse than the communism countries like China. In China at least all the prices are listed before you decide to take the treatment. And the price is the same for everyone. Not to mention it is much lower than in the U.S. (abdomen sonogram is like $30 or less while in the US you can easily get billed $1200). The ultimate solution IMO would be globalized free market just like the IT industry. If doctors and medical professionals from other countries can come to the US as easy as software engineers, I would expect the cost will go down to a level that we don't even need to be insured.
- lucidrains 13y agoThis is absolutely a reality I am vouching for. Right now the AMA (American Medical Association) actively places roadblock in the way of foreign doctors who want to practice in the US by forcing them through additional testing and years of training. We commonly joke that the purpose of one of our medical exams, Step 2 CS, functions to weed out foreign non-English speaking doctors (there is a whole section of the exam devoted to english proficiency), and for AMA to profit from the exam admission fee.
- jonnathanson 13y agoMildly apropos of this topic, I've had the same surgery (kidney stone removal, sorry for TMI) performed in both California and Arkansas. Random! Fancy my chances of seeing an article like this. The procedure in AR was much cheaper, involved less invasive and expensive procedures, and was performed every bit as competently, if not more so. When I look back at the experience, I think a lot of it came down to the sheer amount of redundancy and unnecessary procedure baked into the treatment in CA. I could speculate about the reasons why (fear of litigation being much higher in CA, for instance), though the article does a good job accounting for some of them.
- CygnusXII 13y agoI went through a cardiac event, and in the end it cost me $12,000.00 to find out I was fine. That was just the cardiac part of the testing. I also spent a grand or two to find out where the problem lie neurologically. Turns out the same nerve that allows you to know you're having a heart attack, can also have totally unrelated issues itself, and basically give false positives.
- ihodes 13y agoI just want to clarify a few things, as it would be charitable to say that there are a few misunderstandings in this thread. I am working on a company that is trying to solve some of these issues; this is a complicated industry that I am still learning much about: hopefully some of what I have learned will be of interest to some of you. The PPACA (Obamacare) is seeking to address this very issue by changing medical reimbursement form a fee-for-service model (e.g. $40,000 to remove a splinter and $10,000 for blood tests and $5,000 for aspirin) to a capitated payment model with additional incentives for providing good outcomes (providing good service). This means that a caregiving organization would get $N a year to care for you, as a male patient with a heart disease in your mid fifties, with N varying as demographics and conditions change. This change will necessitate a sea-change in the way doctors and other caregiving organizations will treat their patients. In fact, it will result in the creation of a new type of healthcare organization (accountable care organizations, or ACOs) with the primary purpose of bringing down the costs of healthcare (and improving health outcomes). This is a paradigm shift in medical practice. CMS (Centers for Medicare & Medicaid Services) is spearheading this change; something which would be virtually impossible to do without such a large (read: government) player taking the first move. There are a million problems with CMS and the government in healthcare, but this is one of the greatest things they have ever done.
- euroclydon 13y agoIf ACOs are similar in spirit to corporate wellness programs, I think they are going to take paternalism and nagging to a level we can not even yet imagine. It wasn't long ago that we were talking about the patient who was educated about their condition, but now it seems we're to form major financial engagements with organizations whose central premise is that they care more about our health than we do -- scary!!
- bobbydavid 13y agoTo me, the scarier thought is a new conflict between hospitals and pharma. Currently, drug companies market directly to consumers. consumers ask for drugs from doctors, and get prescriptions health care companies have to pay for. Doctors have no reason to deny patients what they want (and the sexy pharma rep keeps encouraging them too). In the new system, the same "entity" writing the prescription is paying for it, as well as "paying" for the cost of not taking it. I imagine doctors will have an incentive to examine the cost/efficacy of a drug, but pharma will hate that. To get around it, pharma will probably launch marketing saying "if your doctor doesn't give you this drug, shes killing you". ACO's fighting drug companies, using the human psyche as the battleground.
- clamprecht 13y agoA North American friend of mine went to Cuba a few years ago. He had a piece of glass in his elbow that had been there for a few years. He knew it would cost at least $700 to have it removed in the US, so he never did it. When he was in Cuba, he went to the hospital to have it removed. They did it, straightforward, normal hospital. The final bill? $7. That's SEVEN dollars (although he paid Cuban currency, of course). This same friend was in Papua New Guinea a few years before that (he lived there). Similar story - he was cutting wood and hit his toe with an axe. It wouldn't stop bleeding after a long time, so he went in to a local hospital and got stitches. I forgot what the exact bill was, but it was on the order of $5 (five US dollars). Again, it was a normal hospital, not some grass hut or something. I'm not sure what this all means, except that if I need some expensive medical care that I am able to plan ahead for, I plan to look at places like Thailand for reasonable health care costs. Emergencies, of course, are different, so I may have to go to an American emergency room in that case. And I suck it up for my yearly physical (around $150).
- jusben1369 13y agoOne of the problems when we discuss "healthcare" is the wide variety of price points for healthcare. So at one end of the market you have fully insured people asking for and/or being prescribed an array of drugs. Often quite literally they take a new drug to offset the harsher side effects of another drug so that it builds to the point whereby they'll start their day with 6 - 10 different pills. At this end of the market you could apply market forces and have significant results. If people more fully feel the burden of cost with those drugs they might very well tackle the underlying causes around obesity, diabetes etc. "If you could drop 30 or 40 pounds you'd probably find you're spending $200 less per month on medication" Sign me up! However, at the middle of the market and the most serious end of the market you're looking at procedures and ailments that can cost $10,000 to $250,000. Here, if you have free market forces at play you're asking people (including many parents) to make horrible decisions between what they can afford and what is best for the quality of life for years or decades. Some will be comfortable with that I know but it appears, given the acceptance and re-election of Obama, that the majority of people in America are more open to the government running healthcare. (I wrote a blog post where I said that the fear of being financially and emotionally destroyed by healthcare was now on par with foreign invasion. As such, just as no one wants free market forces in terms of national defense they now don't want free market forces in healthcare - shameless plug and done! http://jmlite.tumblr.com/post/46257541683/why-healthcare-in-the-us-should-be-thought-of-as http://jmlite.tumblr.com/post/46257541683/why-healthcare-in-... I think free market forces can be applied at certain price points but I can't see how it can be the driving principle across the entire spectrum. I think state run pricing and procedures that cover 80% + of the population with a legitimate private option for those with the drive or means to pay is the best possible outcome from a tough position.
- lucidrains 13y agoThe amount of bullshit I've seen in the hospital gives me little faith that any policy change will solve the problem. The real solution lies in producing safe consumer usable technology that moves all diagnostics out of the hospital. When we can get our comp, CBC, liver enzymes all with a drop of blood on a 1$ chip, when everyone and their neighbors own low cost portable MRI machines, when we can all read our EKG right on our cellphones and have it be interpreted for us 24/7 holter monitor style. Then it would only takes a team of engineers to produce software to quickly crunch all the data to produce a picture of our health... and save everyone from that expensive trip to the hospital.
- TheCondor 13y agoSo answer me this. Why is not like every other tech startup not making medical equipment and software then? It's a market that is growing, prices are going up, the software they use is terrible.. You're telling me we can't make a device that takes an xray and is more portable, safer, faster, and radically cheaper? (just as one example) And then there is the money.. you can have 3000% variance for the same service?!? and every VC in the world isn't just begging to get in? I just can't believe that the regulations and the red tape can overwhelm and even defeat the greed.
- lotharbot 13y agoSeveral YC companies/founders have talked about how incredibly difficult it is to work in anything that even remotely touches healthcare. The regulations and the red tape create market barriers so significant/costly to overcome that many VCs don't have the resources to break into those markets.
- terio 13y agoEverything related to medical devices is very capital intensive. From regulation compliance, to quality procedures, to patents and licensing, you need a lot of specialized people working for years to bring a product to market.
- NamTaf 13y agoAs an outsider living in a country with socialised healthcare, the US's healthcare system honestly scares me enough to consider not working there. I understand that insurance is almost always provided by jobs and that it can be comprehensive if the job is decent, but I still fear the risk that some set of circumstances may conspire to leave me uncovered for something, or that the insurance situation might be sticky enough that although I am 'covered', I must wear the out-of-pocket costs whilst fighting to get reimbursed. Yes, I'm paying it every year and may never use it but the nature of insurance is that I'm Doing It Right if I never have to use it. I also struggle to align myself with the attitude that 1.5-2.5% of my wage is worth more than the safety net that I and my fellow countrymen can rely on to be mostly protected from most life-threatening health issues if and when they need it. To me, the well-being of all of the people in my society (no matter how poor or rich) is worth 1.5-2.5% of my wage. It's certainly fascinating looking in from the outside as the US wrestles with topics such as universal healthcare, gun laws, etc. It strikes me as stemming from core philosophic viewpoints that seem to be ingrained in the US psyche but absent from many other western nations. In the end, I'm very grateful that I live somewhere with socialised universal healthcare.
- visarga 13y agoBonus: you get a second heart attack when you see the bill.
- goggles99 13y agoA big factor as to why can be explained in two words.. "Illegal Mexicans"
- TheRealGL 13y agoAnd death, everywhere, if you fail to look after yourself properly. Prevention is free.
- crazy1van 13y agoWant lower prices? Encourage a system where people directly pay their own money. If all cars cost a $1000 co-pay no matter what car you bought, who's gonna buy the Honda Accord? However, throw price into the mix and Honda Accord becomes a very popular choice. There's no huge, magical saving of money by running all medical spending through insurance providers. In the end the doctors are going to get paid. It is a matter of whether you pay them directly or pre-pay an insurance provider and they pay the doctor. Insurance is about mitigating the risk of rare but financially ruinous events (eg, cancer or serious trauma). There isn't any risk to mitigate with a flu shot or a bad cold or a mammogram. You insure your car against accidents, not oil changes and flat tires. As for the poor problem, that can be solved separately by providing the poor a stipend for health care. No need to re-architect the whole system because it doesn't work for 100% of the population.
- terio 13y agoThe problem with that is that buying health care is far more complex than many other purchases. Now doctors simply will not provide an estimate for their services, and when you visit the doctor you don't know what kind of procedure they will have to perform on you at the visit. In my view the system is so screwed up that will end up socialized pretty soon.
- crazy1van 13y agoI think if people have to start paying their money, they will not tolerate that kind of behavior from doctors. Think about when you take your car to the auto mechanic. Generally you pay some money for diagnosis. Then if the mechanic recommends a fix that is cheap, you let him just go ahead. But if the fix is very expensive, you might call around several places to make sure the price is reasonable. Of course, you'd never call around if the price was a $20 co-pay no matter which mechanic you went to. Certainly, not the perfect analogy, but I think it points to the ridiculous nature of our current system and how such a ridiculous system will of course lead to costly behavior. This analogy is for more predictable things like shots, checkups, bad colds, etc. For catastrophic illness and trauma, that's why you have insurance.
- bane 13y agoTo all the people who think the free market and medical care are compatible: Boom! You just had a heart attack, you'll be dead inside of 15 minutes. Now, go shop around to find the best price for your treatment.
- maaku 13y agoSomebody PLEASE do an app with this data. If I have to schedule <expensive-medical-treatment>, I would love to know which of the dozen odd regional medical centers has the lowest price. Or at least which ones have excessively large prices.
- jparker165 13y agoI've been working on this exactly for a couple months with a similar dataset, and will clearly now bring in the medicare data. Email me (jparker165@gmail.com) if anyone wants to learn about the project or contribute.
- rooker 13y agoSerious question - can you negotiate your hospital bill like insurance companies can?