11 ms·

Diagnosis: Insufficient Outrage

107 points by jejune06 13y ago

BadCookie 13y ago
What if every clinic had to make a price list of procedures publicly available, and could not legally charge people different amounts for the same procedure (regardless of insurance status and so on)? That would solve at least some of the problems. But I think it's obvious that almost no one actually wants to fix the broken system, because too many people are making too much money from it. (Doesn't that apply to almost everything in the United States nowadays? It's pathetic.) I'm happy to see the author pointing the finger at hospitals and doctors. It doesn't seem like that happens often enough. (When I say "doctors" I really mean specialists. I don't think that GPs are as much to blame.)
- rquantz 13y ago
  By "almost no one" you mean "probably most people, but some people who make lots of money from the current system are using part of that money to bribe politicians not to fix it, and we live under a government where that is tolerated."
  - BadCookie 13y ago
    I suppose I meant "almost no one" who actually has the power to do it. So yeah, what you said.
- rustynails77 13y ago
  Most of the West has free healthcare - and it works pretty darn well, considering. I would imagine many people are still shocked that healthcare is not free in the US. This is yet another reminder of how lucky we are ... those of us who are covered by free health (eg. in Commonwealth countries).
  - gregsq 13y ago
    Actually Indonesia, a country clawing its way out of third world status, is in the process of introducing universal health care, [1] so it's not only commonwealth countries. Hopefully, this 'socialised' system can be implemented in such a way as to flourish within the rapidly growing economy to come. In the UK, after we've charged you nothing in the NHS, we'll give you the bus fare home. 1. http://www.marketplace.org/topics/world/health-care/indonesia-aims-universal-healthcare http://www.marketplace.org/topics/world/health-care/indonesi...
    - haldujai 13y ago
      Yes but try getting an appointment with a doctor in a reasonable time under NHS. It's been a while since I've left the UK but I remember getting appointments with a primary care physician using private insurance I would get one the next day, with NHS the next month.
      - arethuza 13y ago
        It does seem to have got worse in the last few years - not that I go to a GP often (maybe once every 3 or 4 years) but I was used to getting an appointment within 1 or 2 days and the last time the only appointement was about a week away. However, it is worth noting that recent published statistics (for 2011/2012) show that: "85 per cent could see or speak to a doctor or nurse within two working days compared to 90 per cent in 2009/10." Note that this is for NHS Scotland - there actually isn't a single NHS for the entire UK. http://www.scotland.gov.uk/Publications/2012/05/8250/3 http://www.scotland.gov.uk/Publications/2012/05/8250/3 One of the problems with the NHS is that it seems to suffer from having regular waves of (probably very expensive) management re-organisation inflicted on it in efforts to make it "more efficient" - often with non-medical managers being incentivized on performance, so they end up gaming the metrics. Still, I think the NHS and the concept of "free at the point of delivery" championed by Nye Bevan "In Place of Fear" are still fantastically important to society the UK - though nobody claims it is perfect. Clearly the absolute best level of individual care are to be found elsewhere (probably in the US). However, when I see quotes elsewhere in this thread such as: "I broke my knee this spring but didn't go to a hospital on my families request because the last time I broke a bone I reset it myself and the hospital still charged $8k." Those pretty much fill me with horror/fear that anyone has to put up with that - which is precisely the reason the NHS was created.
- crs 13y ago
  I actually had a discussion with my doctor on this very subject. He was complaining that he could not actually advertise prices as it is apparently considered price fixing if doctors do that (or so he says). He also told me he would be stupid not to bill the highest possible price he could for things because he doesn't know exactly what the insurance companies will accept and he could be leaving money on the table otherwise. So don't try to distinguish between specialists and GP's, they all do it.
  - BadCookie 13y ago
    Interesting. It's cool that your doctor tried to be honest with you about it. It would be so much better if you were his customer and not your insurance company. Since I have an HSA, I write checks to every doctor that I see. (My company buys me high deductible insurance and puts $6k into an HSA each year for my family.) When I visit my GP, it's $72 for usually 20 minutes of his time and I can get in to see him the same day. Specialist appointments are $800+ for what often feels like a more cursory conversation that I waited a month or two for. That's why I am not as quick to blame GPs. They have to rent office space and hire office staff on top of acquiring an expensive education, so the price that they charge (to someone with insurance like me, anyway) feels pretty justifiable.
leetrout 13y ago
This rings so true. When I had graduated college I was in a 3 week lull between graduation and a job around January when I was struck with a kidney stone. No health insurance. I took a trip to the ER around 10pm one evening in agonizing pain and was treated like a drug addict. I wasn't even triaged for over 2 hours (peak flu season) and everyone acted like I was just trying to score pain meds. Finally, after 3.5 hours, I was sent for a CT and only after the CT confirmed a stone was I given non-narcotic pain meds (Ketorolac) and send home to wait it out. Total time in the actual ER was ~1.5 hours (of a >5 hour trip) for a hospital administered dose of an NSAID only after a CT scan. $4800. Took me over 2 years to pay all of it off. It pretty much wrecked my personal finances (threats from collection agencies finally forced me to put it all on my credit card). I've been jaded about hospitals ever since. I've also had another stone in the years since and was diagnosed with a ~$100 sonogram. And I used acetaminophen and ibuprofen to manage the pain for a couple weeks. I'm still shocked that I had to wait so long and go through such a costly imaging procedure to justify a short prescription of a non-narcotic pain reliever. I could go on another rant on an intelligent adult not being allowed to order a simple blood panel for self quantification.
- BadCookie 13y ago
  Oh, but you can order your own blood tests. I've done it before. Google "order own blood tests." I've used Health One before to run a test that I wanted done. I had insurance, but I didn't want to go through the awkwardness of convincing my doctor that it was worth doing, and I think it was only $40.
  - leetrout 13y ago
    Thanks very much for dropping that name. I had looked once before but somehow missed Health One. I was specifically looking for testosterone and thyroid previously (before starting a new training plan) and they seemed to be off limits with the providers I had located. Awesome to see those listed and a participating lab within 10 miles of my home.
    - clicks 13y ago
p37307 13y ago
I have seen all of my doctors office swallowed up by hospitals in the last year. In Southwestern Ohio Mercy Health Systems and TriHealth are buying them up. They are following the lead of Christ Hospital who started this years ago at an alarming rate. As far as my rates go, I did notice almost everything, even items done at the local office, was an outpatient procedure billed by the mother hospital, at least in part. Also something I have noticed in the increase in lab work. I am a chronic patient, I have a heart implant, feeding tube and an infusion pump that puts baclofen directly in the spinal area. With co-pays going out of this world under this new system, we have elected to do many things at home that used to be done at the office. Changing out my feeding tube used to cost a few hundred dollars and jumped to over $6000 last fall. My wife now changes it at home. I have my Baclofen pump refilled at home instead of the office by a third party. I elected to send my heart readings over the phone instead of going into the office, except twice a year. Finally, when I make all my appointments within days of each other when possible and make them share lab results. They don't like this but I can't afford all the extra charges out of pocket. Even the monthly b-12 shot had a significant rate increase. Once again, I choose a cheaper route. The local non-affiliated walk-in clinic for the b-12 shot. It is nice to see this article. It explains alot. At 41 with a form of Parkinson's Plus, the nickle and diming has to stop. I don't know where the $$$ is going to come from.
- xxpor 13y ago
  NE Ohio is the same way. University Hospitals and Cleveland Clinic own everything. One of the last independant hospitals, Parma Regonal, was purchased by UH this past week.
  - caw 13y ago
    My uncle works for a hospital system that's doing the same "buy up everything" plan. He says it's because once they own all of the medical providers in the county, then they will be able to dictate the price to the insurance, instead of the other way around. What can the insurance companies tell their customers? Go to the next county for healthcare? Another relative of mine just merged his surgical practice into the hospital system's. The overhead on his practice was getting too high, in particular malpractice insurance.
jakobe 13y ago
I don't get how a cardiac stress test can cost 2000USD. You put someone on a home trainer, let them pedal for 20 minutes, and look at their EKG. It's usually performed by a nurse, and the doctor spends 30 seconds looking at the EKG (the analysis of the EKG is even partially automated). If there was actual competition on the market, I'm sure a health service provider would find a way to perform the test for 75USD.
- haldujai 13y ago
  People who have stress tests administered often have underlying cardiac or pulmonary disorders that can be aggravated. A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.
  - lostlogin 13y ago
    Yes - it pays to have a big defib (not one of the 'press button now' mall variety), an experienced and qualified staff member or 5 with high level CPR training, and some good cardiac event type drugs, and a load of proper monitoring gear (heart rate, BP, etc). While these things aren't especially cheap, they would pay off fairly quickly at a decent clinic, and I was involved in the purchase of most this stuff for sub $10k US recently for a clinic (but got a mall style defib as our needs are different). Staff would be the greatest cost. That said, at 2k per test, most expenses for the year would be paid of in the first week or 3 at a busy clinic surely?
    - haldujai 13y ago
      $2000 isn't that ridiculous depending on the circumstances, but $75 is impossibly low with America's system. In Canada they bill ~$200 +/- 100 depending on the details. A comparable figure in the states (again factoring insurance non-payment issues and convenience factors, i.e. how soon you can get it, having facilities close by) would be reasonable at $800-$1500.
      - 13y ago
jeswin 13y ago
I was visiting the US (from India) a couple of months back. In the hurry to get to the airport, I forgot to get Medical Insurance. Unfortunately, I got pink eyes while I was there. I haven't found America all that much more expensive than urban India. In fact, compared to cities in India, a few things might even be cheaper. But not medicine. An eye doctor's visit costs $180, for Pink eyes! A comparable facility here would have charged me about $8. I totally get the different standards of living and associated expenses. But medical treatment stands out so much that I can't imagine how an uninsured person could afford hospitalization or even moderately complex treatment in the US.
- xxpor 13y ago
  I think most people just don't go to the doctor for pink eye (including me and 3 other people I know that got it in the past year).
  - jeswin 13y ago
    I wasn't planning to either. But buying any medicine requires a prescription in the US, which may be fine depending on how you look at it. What I was trying to say was that I found treatment 10x more expensive in the US; while other expenses are merely higher and generally affordable.
    - xxpor 13y ago
      I'm agreeing with you. We don't get medicine for things like pink eye, we just let it run it's course.
      - cmccabe 13y ago
        now that is silly. you don't know what kind of infection it is unless you go to the doctor. You really need to get a health plan if you don't have one. If you're young it might only be $100/$200 a month, even if you're unemployed.
- abraham_s 13y ago
bit_cromwell 13y ago
Prescription: Free Market Competition
- saraid216 13y ago
  If only we could just bottle that, it would sell so hard.
- namlem 13y ago
  Why don't you elaborate instead of just yelling "free market!" and waving your hands? How might we encourage competition effectively?
  - zanny 13y ago
    Eliminate drug patents, remove the annual cap on medical students in doctoral programs, remove that requirement entirely from a medical license and let anyone practice medicine that wants to (albeit with some regulation requiring a practitioner explicitly state their qualifications, and you would have to prosecute impostors). That would probably lead to what we have today - people only trust literal doctorates from top medical schools - but you could open new medical schools to placate demand, and hopefully reduce the workload required to obtain a medical license (the current 8+ years of schooling is excessive for any profession) or provide some kind of doctoral certification program outside the bounds of academia, though I have no intimate knowledge to know how you would do it. It does become buyer beware, but it also means you would have treatment at most pay grades. Also, if it wasn't illegal to produce chemical compounds (really, that is dumb, and all the arguments of how they produce progress because of profit motive is pointless if nobody can afford the result, and the investment funds in big pharma would find other avenues to stimulate growth and research). The costs of care would fall absurdly fast if there weren't a dozen golden gates on the road to being a medical professional or medical facility, I wouldn't even mind if they just reduced the barriers, but they are too high and too plentiful right now.
  - noonespecial 13y ago
    No one can open a new, competing hospital without the permission of the lousy overpriced hospitals that its intended to compete with. Yes, you need your competitor's permission to enter the market. Its the law. http://en.wikipedia.org/wiki/Certificate_of_need http://en.wikipedia.org/wiki/Certificate_of_need
haldujai 13y ago
A large portion of this cost is because some people don't pay, and they can run huge tabs. Meidicine is a business, and that cost has to be shifted to other patients to compensate. In socialised systems, like Canada, physicians actually make more money because the government always pays so it's not a greed issue. The downside is that the government has limited funds, so the amount of beds, ORs, and advanced equipment is severely limited and wait lists are rediculous, ER times between 6-8 hours, chemotherapy wait lists of 8 months, surgeries 1 year + for the worst of surgeons. Alberta is the exception as they have rediculously deep pockets from oil revenue. It's a trade off, this is a case of you get what you pay for. Free healthcare only works when the state has money to blow on quality care, I.e Texas with the Scottish Rite hospital. You can't directly compare life expectancies with the US and places like France (which have free or near free healthcare) and conclude that it is just as good, if not better than America's. There are many confounding variables here (I.e their very short work weeks).
abraham_s 13y ago
How much does the Affordable Care Act addresses this? I know insurance can't be denied to people with pre-existing conditions and there can't be any life-time expense caps. But is there any measure to address the high cost of health care in US?
- haldujai 13y ago
  Insurance providers don't pay these sky high rates so it effectively reduces the out of pocket expenses of patients, significantly.
- zanny 13y ago
  Effective next year up to 400% of the poverty line is eligible for some fraction of their expenses covered under Medicaid. If you are beyond that threshold is the infamous "uninsured tax". Note that 400% of the poverty line is around $50k a year.
  - mathgladiator 13y ago
    I wonder where the 400% came from; that seems very... odd
    - zanny 13y ago
      The poverty line is a sliding scale based on household size, so for a 4 person household that threshold is 94,200. It is basically the "you make enough money that you can either get insurance through work or the flat rate we are forcing insurers to pay".
Qantourisc 13y ago
Seriously, just copy the EU on healthcare. You might need to pay extra taxes, and take an extra insurance against hospitals fees. But it's all very affordable. If it wasn't for A) getting the same answer for most of my ills: inflammations :p B) The doctor being very busy. C) Basic respect to not stress our medical system. One would go for the tiniest medical complain.
- jamesaguilar 13y ago
  Doctors and medical facilities would need to make a lot less money. That is the source of most of the cost difference. The vehicle of payment is maybe a secondary cause. It might be good to change it, but if it's not directly responsible for the majority of the difference in what doctors are getting paid, it's not going to fix the problem.
  - zanny 13y ago
    My Uncle is a doctor, went the full 9 years at Tulane and everything. He had to close his own practice because Medicare paid dirt, insurers would delay payments for years, and malpractice insurance was thousands a month. He was running around a 2,000 a month deficit when he had to fire his secretary and close down. He now works in a general hospital as a surgeon, and is actually happier not having to try to haggle getting paid or getting people to pay more. Some doctors may be profiting off this, but the principle beneficiary is private insurance companies, at least from my experiences. Doctors spend an eighth of their life learning some of the hardest science and discipline of any profession and you do want to compensate the good ones well. We need more people entering medicine, not fewer.
    - jamesaguilar 13y ago
      The overhead of insurance companies are minimal. Less than five percent of the overall spend (edit: this is wrong, it is more like 8%, see [1]). As much as you prefer to think of your uncle as the good guy and faceless insurance companies as the bad guy, a big part of the problem is he makes between 150% and 200% what his European and Canadian counterparts make. http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doc.... Ahmdahls law makes it nearly inevitable that we'll pay doctors less if we want to reduce our overall costs. 1 http://tbd-consulting.typepad.com/healthcare_talent/2010/09/breakdown-of-us-spending-23-trillion-yearly-for-heathcare.html http://tbd-consulting.typepad.com/healthcare_talent/2010/09/...
bmmayer1 13y ago
Yes, if prices are skyrocketing it must be a "Crime" caused by all the dirty capitalists enriching themselves. There could be no possible explanation for it. Unless, of course, you want to consider: 1) The stifling HIPAA regime that makes it almost impossible for small, potentially competitive practices to stay open without insane amounts of overhead, explaining their sellouts to larger at-scale healthcare corporations 2) The necessity to offset insanely low negotiated and subsidized Medicare/Medicaid rates with bills on the uninsured, thus bifurcating healthcare recipients into "pays too little" and "pays too much" categories with no in-between 3) The employer-provided insurance scheme--another government-subsidized program--which hides prices from consumers and incentivizes providers to hike up prices 4) Let's not forget about the inability for insurance companies to hedge risk and lower costs by selling insurance across state lines 5) Obamacare destroying any potentially new avenues for innovation by forcing the uninsured to buy into a broken system What would happen if a doctor or hospital today started practicing medicine at affordable prices, competitively? What's stopping that from happening? If you look for what isn't there instead of what is there, you'd see how we've completely eviscerated any hope of competition, innovation or lower prices in our system. The "moral outrage" we should have as Americans is not toward the doctors who--as even this article grudgingly acknowledges--are good people working in a bad system. The outrage we should have is toward the captured healthcare-industrial complex that has a stranglehold on our Congress and President, using its influence to send more profits its own way at the expense of patients. High prices are not a crime. Bad policy is.
- pyre 13y ago
  | The necessity to offset insanely low negotiated | and subsidized Medicare/Medicaid rates My understanding is that insurance companies often get rates lower than Medicare. It goes something like this: 1) Government mandates the rates for procedure X to make sure that the government is getting the 'best' deal. 2) Hospitals charge insurance companies using these rates (they aren't allowed to be lower, or it wouldn't be the 'best' deal). 3) Insurance companies trim the difference between the Medicare rate and the real rate from the bill with newspeak like, "charge beyond negotiated rates," or, "over-charge of contractual limits." It basically amounts to the hospital charging the 'correct' rate, the insurance company refusing to pay that rate, and the hospital not pushing it any further since this is all laid out in their formal agreements. So, I'm not sure if Medicare can be said to have 'insanely low' rates, if the insurance companies end up with even lower rates. (I'd love for someone to correct me if my understanding is wrong, though)
batbomb 13y ago
On the proton therapy: As a particle physicist whose best friend just finished (photon) radiation therapy for brain cancer, I know a good chunk about this. First off, not all proton therapy is the same. It's heavily dependent on the linac and gantry a hospital has. UCSF has proton therapy in Davis or somewhere targeting glaucoma and stuff, which is completely different than the facilities at Loma Linda or Massachusetts General. Of higher energy proton therapy centers, there's only about 5 such facilities in the US. As far as general hadron therapy goes, there's none. So a proton therapy center in Washington isn't likely to serve just Washington and/or Baltimore, it's likely to service Virginia, West Virginia, Maryland, New Jersey, and even farther out possibly. On top of that, it's still heavily research based, and moving pretty quickly as we've moved towards modeling human tissue with GEANT4 and Monte Carlo simulations. Anyway, while I don't know the specifics of the proton therapy centers mentioned, the assumption that a proton therapy center would just service Washington/Baltimore metropolitan areas is silly. After LLNL shut down their proton therapy center/experiment, we don't even have any proton therapy centers in the Bay Area.
Shivetya 13y ago
Well look past the hospitals and insurance companies when you want to assign blame then. The government creates the laws these entities operate under. Congress knew damn well what would happen when they used the force of government to compel prices for Medicare/Medicade. Insurance companies got on the ride because of size. Yet it falls to Congress to be the one to look out for the little guy but that was not their concern. Their concern was to maintain the steady flow of campaign contributions. The ACA was more of a payoff to insurance and hospital industries than looking out for the public. The reason why most members didn't read the bill is because its contents were not important, its effect on their position was what mattered. For years Federal law has prevented people from shopping across state lines for medical insurance. For years it has been adding elective treatments and surgeries as requirements to even the simplest policies which in turn reduced their affordability. The solution, try to put everyone in the pool by force of law and reap the rewards of insurance companies and hospitals suddenly with more business than they had means to process.
xentronium 13y ago
Here, in Russia, basic medical assistance is mostly free (or costs peanuts compared to US), but on the flip side you have to sit through enormous queues, talk to incompetent doctors and doctors themselves might extort you. Paid medicine is better and sometimes better qualified, and you get better service, but it's totally out of budget for anyone below middle class. Good news is that you won't be charged bajillion dollars after you broke your hand, bad news is that you'll have to wait and suffer in horrible insanitary that is Russian polyclinic. I have mixed feelings about our health care system. I believe, it will gradually disintegrate as doctors from soviet era get older and retire.

107 points by jejune06 13y ago

What if every clinic had to make a price list of procedures publicly available, and could not legally charge people different amounts for the same procedure (regardless of insurance status and so on)? That would solve at least some of the problems. But I think it's obvious that almost no one actually wants to fix the broken system, because too many people are making too much money from it. (Doesn't that apply to almost everything in the United States nowadays? It's pathetic.) I'm happy to see the author pointing the finger at hospitals and doctors. It doesn't seem like that happens often enough. (When I say "doctors" I really mean specialists. I don't think that GPs are as much to blame.)

rquantz 13y ago
By "almost no one" you mean "probably most people, but some people who make lots of money from the current system are using part of that money to bribe politicians not to fix it, and we live under a government where that is tolerated."
- BadCookie 13y ago
  I suppose I meant "almost no one" who actually has the power to do it. So yeah, what you said.
rustynails77 13y ago
Most of the West has free healthcare - and it works pretty darn well, considering. I would imagine many people are still shocked that healthcare is not free in the US. This is yet another reminder of how lucky we are ... those of us who are covered by free health (eg. in Commonwealth countries).
- gregsq 13y ago
  Actually Indonesia, a country clawing its way out of third world status, is in the process of introducing universal health care, [1] so it's not only commonwealth countries. Hopefully, this 'socialised' system can be implemented in such a way as to flourish within the rapidly growing economy to come. In the UK, after we've charged you nothing in the NHS, we'll give you the bus fare home. 1. http://www.marketplace.org/topics/world/health-care/indonesia-aims-universal-healthcare http://www.marketplace.org/topics/world/health-care/indonesi...
  - haldujai 13y ago
    Yes but try getting an appointment with a doctor in a reasonable time under NHS. It's been a while since I've left the UK but I remember getting appointments with a primary care physician using private insurance I would get one the next day, with NHS the next month.
    - arethuza 13y ago
      It does seem to have got worse in the last few years - not that I go to a GP often (maybe once every 3 or 4 years) but I was used to getting an appointment within 1 or 2 days and the last time the only appointement was about a week away. However, it is worth noting that recent published statistics (for 2011/2012) show that: "85 per cent could see or speak to a doctor or nurse within two working days compared to 90 per cent in 2009/10." Note that this is for NHS Scotland - there actually isn't a single NHS for the entire UK. http://www.scotland.gov.uk/Publications/2012/05/8250/3 http://www.scotland.gov.uk/Publications/2012/05/8250/3 One of the problems with the NHS is that it seems to suffer from having regular waves of (probably very expensive) management re-organisation inflicted on it in efforts to make it "more efficient" - often with non-medical managers being incentivized on performance, so they end up gaming the metrics. Still, I think the NHS and the concept of "free at the point of delivery" championed by Nye Bevan "In Place of Fear" are still fantastically important to society the UK - though nobody claims it is perfect. Clearly the absolute best level of individual care are to be found elsewhere (probably in the US). However, when I see quotes elsewhere in this thread such as: "I broke my knee this spring but didn't go to a hospital on my families request because the last time I broke a bone I reset it myself and the hospital still charged $8k." Those pretty much fill me with horror/fear that anyone has to put up with that - which is precisely the reason the NHS was created.
crs 13y ago
I actually had a discussion with my doctor on this very subject. He was complaining that he could not actually advertise prices as it is apparently considered price fixing if doctors do that (or so he says). He also told me he would be stupid not to bill the highest possible price he could for things because he doesn't know exactly what the insurance companies will accept and he could be leaving money on the table otherwise. So don't try to distinguish between specialists and GP's, they all do it.
- BadCookie 13y ago
  Interesting. It's cool that your doctor tried to be honest with you about it. It would be so much better if you were his customer and not your insurance company. Since I have an HSA, I write checks to every doctor that I see. (My company buys me high deductible insurance and puts $6k into an HSA each year for my family.) When I visit my GP, it's $72 for usually 20 minutes of his time and I can get in to see him the same day. Specialist appointments are $800+ for what often feels like a more cursory conversation that I waited a month or two for. That's why I am not as quick to blame GPs. They have to rent office space and hire office staff on top of acquiring an expensive education, so the price that they charge (to someone with insurance like me, anyway) feels pretty justifiable.

leetrout 13y ago

This rings so true. When I had graduated college I was in a 3 week lull between graduation and a job around January when I was struck with a kidney stone. No health insurance. I took a trip to the ER around 10pm one evening in agonizing pain and was treated like a drug addict. I wasn't even triaged for over 2 hours (peak flu season) and everyone acted like I was just trying to score pain meds. Finally, after 3.5 hours, I was sent for a CT and only after the CT confirmed a stone was I given non-narcotic pain meds (Ketorolac) and send home to wait it out. Total time in the actual ER was ~1.5 hours (of a >5 hour trip) for a hospital administered dose of an NSAID only after a CT scan. $4800. Took me over 2 years to pay all of it off. It pretty much wrecked my personal finances (threats from collection agencies finally forced me to put it all on my credit card). I've been jaded about hospitals ever since. I've also had another stone in the years since and was diagnosed with a ~$100 sonogram. And I used acetaminophen and ibuprofen to manage the pain for a couple weeks. I'm still shocked that I had to wait so long and go through such a costly imaging procedure to justify a short prescription of a non-narcotic pain reliever. I could go on another rant on an intelligent adult not being allowed to order a simple blood panel for self quantification.

BadCookie 13y ago
Oh, but you can order your own blood tests. I've done it before. Google "order own blood tests." I've used Health One before to run a test that I wanted done. I had insurance, but I didn't want to go through the awkwardness of convincing my doctor that it was worth doing, and I think it was only $40.
- leetrout 13y ago
  Thanks very much for dropping that name. I had looked once before but somehow missed Health One. I was specifically looking for testosterone and thyroid previously (before starting a new training plan) and they seemed to be off limits with the providers I had located. Awesome to see those listed and a participating lab within 10 miles of my home.
  - clicks 13y ago

p37307 13y ago

I have seen all of my doctors office swallowed up by hospitals in the last year. In Southwestern Ohio Mercy Health Systems and TriHealth are buying them up. They are following the lead of Christ Hospital who started this years ago at an alarming rate. As far as my rates go, I did notice almost everything, even items done at the local office, was an outpatient procedure billed by the mother hospital, at least in part. Also something I have noticed in the increase in lab work. I am a chronic patient, I have a heart implant, feeding tube and an infusion pump that puts baclofen directly in the spinal area. With co-pays going out of this world under this new system, we have elected to do many things at home that used to be done at the office. Changing out my feeding tube used to cost a few hundred dollars and jumped to over $6000 last fall. My wife now changes it at home. I have my Baclofen pump refilled at home instead of the office by a third party. I elected to send my heart readings over the phone instead of going into the office, except twice a year. Finally, when I make all my appointments within days of each other when possible and make them share lab results. They don't like this but I can't afford all the extra charges out of pocket. Even the monthly b-12 shot had a significant rate increase. Once again, I choose a cheaper route. The local non-affiliated walk-in clinic for the b-12 shot. It is nice to see this article. It explains alot. At 41 with a form of Parkinson's Plus, the nickle and diming has to stop. I don't know where the $$$ is going to come from.

xxpor 13y ago
NE Ohio is the same way. University Hospitals and Cleveland Clinic own everything. One of the last independant hospitals, Parma Regonal, was purchased by UH this past week.
- caw 13y ago
  My uncle works for a hospital system that's doing the same "buy up everything" plan. He says it's because once they own all of the medical providers in the county, then they will be able to dictate the price to the insurance, instead of the other way around. What can the insurance companies tell their customers? Go to the next county for healthcare? Another relative of mine just merged his surgical practice into the hospital system's. The overhead on his practice was getting too high, in particular malpractice insurance.

jakobe 13y ago

I don't get how a cardiac stress test can cost 2000USD. You put someone on a home trainer, let them pedal for 20 minutes, and look at their EKG. It's usually performed by a nurse, and the doctor spends 30 seconds looking at the EKG (the analysis of the EKG is even partially automated). If there was actual competition on the market, I'm sure a health service provider would find a way to perform the test for 75USD.

haldujai 13y ago
People who have stress tests administered often have underlying cardiac or pulmonary disorders that can be aggravated. A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.
- lostlogin 13y ago
  Yes - it pays to have a big defib (not one of the 'press button now' mall variety), an experienced and qualified staff member or 5 with high level CPR training, and some good cardiac event type drugs, and a load of proper monitoring gear (heart rate, BP, etc). While these things aren't especially cheap, they would pay off fairly quickly at a decent clinic, and I was involved in the purchase of most this stuff for sub $10k US recently for a clinic (but got a mall style defib as our needs are different). Staff would be the greatest cost. That said, at 2k per test, most expenses for the year would be paid of in the first week or 3 at a busy clinic surely?
  - haldujai 13y ago
    $2000 isn't that ridiculous depending on the circumstances, but $75 is impossibly low with America's system. In Canada they bill ~$200 +/- 100 depending on the details. A comparable figure in the states (again factoring insurance non-payment issues and convenience factors, i.e. how soon you can get it, having facilities close by) would be reasonable at $800-$1500.
    - 13y ago

jeswin 13y ago

I was visiting the US (from India) a couple of months back. In the hurry to get to the airport, I forgot to get Medical Insurance. Unfortunately, I got pink eyes while I was there. I haven't found America all that much more expensive than urban India. In fact, compared to cities in India, a few things might even be cheaper. But not medicine. An eye doctor's visit costs $180, for Pink eyes! A comparable facility here would have charged me about $8. I totally get the different standards of living and associated expenses. But medical treatment stands out so much that I can't imagine how an uninsured person could afford hospitalization or even moderately complex treatment in the US.

xxpor 13y ago
I think most people just don't go to the doctor for pink eye (including me and 3 other people I know that got it in the past year).
- jeswin 13y ago
  I wasn't planning to either. But buying any medicine requires a prescription in the US, which may be fine depending on how you look at it. What I was trying to say was that I found treatment 10x more expensive in the US; while other expenses are merely higher and generally affordable.
  - xxpor 13y ago
    I'm agreeing with you. We don't get medicine for things like pink eye, we just let it run it's course.
    - cmccabe 13y ago
      now that is silly. you don't know what kind of infection it is unless you go to the doctor. You really need to get a health plan if you don't have one. If you're young it might only be $100/$200 a month, even if you're unemployed.
abraham_s 13y ago

bit_cromwell 13y ago

Prescription: Free Market Competition

saraid216 13y ago
If only we could just bottle that, it would sell so hard.
namlem 13y ago
Why don't you elaborate instead of just yelling "free market!" and waving your hands? How might we encourage competition effectively?
- zanny 13y ago
  Eliminate drug patents, remove the annual cap on medical students in doctoral programs, remove that requirement entirely from a medical license and let anyone practice medicine that wants to (albeit with some regulation requiring a practitioner explicitly state their qualifications, and you would have to prosecute impostors). That would probably lead to what we have today - people only trust literal doctorates from top medical schools - but you could open new medical schools to placate demand, and hopefully reduce the workload required to obtain a medical license (the current 8+ years of schooling is excessive for any profession) or provide some kind of doctoral certification program outside the bounds of academia, though I have no intimate knowledge to know how you would do it. It does become buyer beware, but it also means you would have treatment at most pay grades. Also, if it wasn't illegal to produce chemical compounds (really, that is dumb, and all the arguments of how they produce progress because of profit motive is pointless if nobody can afford the result, and the investment funds in big pharma would find other avenues to stimulate growth and research). The costs of care would fall absurdly fast if there weren't a dozen golden gates on the road to being a medical professional or medical facility, I wouldn't even mind if they just reduced the barriers, but they are too high and too plentiful right now.
- noonespecial 13y ago
  No one can open a new, competing hospital without the permission of the lousy overpriced hospitals that its intended to compete with. Yes, you need your competitor's permission to enter the market. Its the law. http://en.wikipedia.org/wiki/Certificate_of_need http://en.wikipedia.org/wiki/Certificate_of_need

haldujai 13y ago

A large portion of this cost is because some people don't pay, and they can run huge tabs. Meidicine is a business, and that cost has to be shifted to other patients to compensate. In socialised systems, like Canada, physicians actually make more money because the government always pays so it's not a greed issue. The downside is that the government has limited funds, so the amount of beds, ORs, and advanced equipment is severely limited and wait lists are rediculous, ER times between 6-8 hours, chemotherapy wait lists of 8 months, surgeries 1 year + for the worst of surgeons. Alberta is the exception as they have rediculously deep pockets from oil revenue. It's a trade off, this is a case of you get what you pay for. Free healthcare only works when the state has money to blow on quality care, I.e Texas with the Scottish Rite hospital. You can't directly compare life expectancies with the US and places like France (which have free or near free healthcare) and conclude that it is just as good, if not better than America's. There are many confounding variables here (I.e their very short work weeks).

abraham_s 13y ago

How much does the Affordable Care Act addresses this? I know insurance can't be denied to people with pre-existing conditions and there can't be any life-time expense caps. But is there any measure to address the high cost of health care in US?

haldujai 13y ago
Insurance providers don't pay these sky high rates so it effectively reduces the out of pocket expenses of patients, significantly.
zanny 13y ago
Effective next year up to 400% of the poverty line is eligible for some fraction of their expenses covered under Medicaid. If you are beyond that threshold is the infamous "uninsured tax". Note that 400% of the poverty line is around $50k a year.
- mathgladiator 13y ago
  I wonder where the 400% came from; that seems very... odd
  - zanny 13y ago
    The poverty line is a sliding scale based on household size, so for a 4 person household that threshold is 94,200. It is basically the "you make enough money that you can either get insurance through work or the flat rate we are forcing insurers to pay".

Qantourisc 13y ago

Seriously, just copy the EU on healthcare. You might need to pay extra taxes, and take an extra insurance against hospitals fees. But it's all very affordable. If it wasn't for A) getting the same answer for most of my ills: inflammations :p B) The doctor being very busy. C) Basic respect to not stress our medical system. One would go for the tiniest medical complain.

jamesaguilar 13y ago
Doctors and medical facilities would need to make a lot less money. That is the source of most of the cost difference. The vehicle of payment is maybe a secondary cause. It might be good to change it, but if it's not directly responsible for the majority of the difference in what doctors are getting paid, it's not going to fix the problem.
- zanny 13y ago
  My Uncle is a doctor, went the full 9 years at Tulane and everything. He had to close his own practice because Medicare paid dirt, insurers would delay payments for years, and malpractice insurance was thousands a month. He was running around a 2,000 a month deficit when he had to fire his secretary and close down. He now works in a general hospital as a surgeon, and is actually happier not having to try to haggle getting paid or getting people to pay more. Some doctors may be profiting off this, but the principle beneficiary is private insurance companies, at least from my experiences. Doctors spend an eighth of their life learning some of the hardest science and discipline of any profession and you do want to compensate the good ones well. We need more people entering medicine, not fewer.
  - jamesaguilar 13y ago
    The overhead of insurance companies are minimal. Less than five percent of the overall spend (edit: this is wrong, it is more like 8%, see [1]). As much as you prefer to think of your uncle as the good guy and faceless insurance companies as the bad guy, a big part of the problem is he makes between 150% and 200% what his European and Canadian counterparts make. http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/ http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doc.... Ahmdahls law makes it nearly inevitable that we'll pay doctors less if we want to reduce our overall costs. 1 http://tbd-consulting.typepad.com/healthcare_talent/2010/09/breakdown-of-us-spending-23-trillion-yearly-for-heathcare.html http://tbd-consulting.typepad.com/healthcare_talent/2010/09/...

bmmayer1 13y ago

Yes, if prices are skyrocketing it must be a "Crime" caused by all the dirty capitalists enriching themselves. There could be no possible explanation for it. Unless, of course, you want to consider: 1) The stifling HIPAA regime that makes it almost impossible for small, potentially competitive practices to stay open without insane amounts of overhead, explaining their sellouts to larger at-scale healthcare corporations 2) The necessity to offset insanely low negotiated and subsidized Medicare/Medicaid rates with bills on the uninsured, thus bifurcating healthcare recipients into "pays too little" and "pays too much" categories with no in-between 3) The employer-provided insurance scheme--another government-subsidized program--which hides prices from consumers and incentivizes providers to hike up prices 4) Let's not forget about the inability for insurance companies to hedge risk and lower costs by selling insurance across state lines 5) Obamacare destroying any potentially new avenues for innovation by forcing the uninsured to buy into a broken system What would happen if a doctor or hospital today started practicing medicine at affordable prices, competitively? What's stopping that from happening? If you look for what isn't there instead of what is there, you'd see how we've completely eviscerated any hope of competition, innovation or lower prices in our system. The "moral outrage" we should have as Americans is not toward the doctors who--as even this article grudgingly acknowledges--are good people working in a bad system. The outrage we should have is toward the captured healthcare-industrial complex that has a stranglehold on our Congress and President, using its influence to send more profits its own way at the expense of patients. High prices are not a crime. Bad policy is.

pyre 13y ago
| The necessity to offset insanely low negotiated | and subsidized Medicare/Medicaid rates My understanding is that insurance companies often get rates lower than Medicare. It goes something like this: 1) Government mandates the rates for procedure X to make sure that the government is getting the 'best' deal. 2) Hospitals charge insurance companies using these rates (they aren't allowed to be lower, or it wouldn't be the 'best' deal). 3) Insurance companies trim the difference between the Medicare rate and the real rate from the bill with newspeak like, "charge beyond negotiated rates," or, "over-charge of contractual limits." It basically amounts to the hospital charging the 'correct' rate, the insurance company refusing to pay that rate, and the hospital not pushing it any further since this is all laid out in their formal agreements. So, I'm not sure if Medicare can be said to have 'insanely low' rates, if the insurance companies end up with even lower rates. (I'd love for someone to correct me if my understanding is wrong, though)

batbomb 13y ago

On the proton therapy: As a particle physicist whose best friend just finished (photon) radiation therapy for brain cancer, I know a good chunk about this. First off, not all proton therapy is the same. It's heavily dependent on the linac and gantry a hospital has. UCSF has proton therapy in Davis or somewhere targeting glaucoma and stuff, which is completely different than the facilities at Loma Linda or Massachusetts General. Of higher energy proton therapy centers, there's only about 5 such facilities in the US. As far as general hadron therapy goes, there's none. So a proton therapy center in Washington isn't likely to serve just Washington and/or Baltimore, it's likely to service Virginia, West Virginia, Maryland, New Jersey, and even farther out possibly. On top of that, it's still heavily research based, and moving pretty quickly as we've moved towards modeling human tissue with GEANT4 and Monte Carlo simulations. Anyway, while I don't know the specifics of the proton therapy centers mentioned, the assumption that a proton therapy center would just service Washington/Baltimore metropolitan areas is silly. After LLNL shut down their proton therapy center/experiment, we don't even have any proton therapy centers in the Bay Area.

Shivetya 13y ago

Well look past the hospitals and insurance companies when you want to assign blame then. The government creates the laws these entities operate under. Congress knew damn well what would happen when they used the force of government to compel prices for Medicare/Medicade. Insurance companies got on the ride because of size. Yet it falls to Congress to be the one to look out for the little guy but that was not their concern. Their concern was to maintain the steady flow of campaign contributions. The ACA was more of a payoff to insurance and hospital industries than looking out for the public. The reason why most members didn't read the bill is because its contents were not important, its effect on their position was what mattered. For years Federal law has prevented people from shopping across state lines for medical insurance. For years it has been adding elective treatments and surgeries as requirements to even the simplest policies which in turn reduced their affordability. The solution, try to put everyone in the pool by force of law and reap the rewards of insurance companies and hospitals suddenly with more business than they had means to process.

xentronium 13y ago

Here, in Russia, basic medical assistance is mostly free (or costs peanuts compared to US), but on the flip side you have to sit through enormous queues, talk to incompetent doctors and doctors themselves might extort you. Paid medicine is better and sometimes better qualified, and you get better service, but it's totally out of budget for anyone below middle class. Good news is that you won't be charged bajillion dollars after you broke your hand, bad news is that you'll have to wait and suffer in horrible insanitary that is Russian polyclinic. I have mixed feelings about our health care system. I believe, it will gradually disintegrate as doctors from soviet era get older and retire.