4 ms·

Most of the difference here is that our hospitals have to fob off the money they lose from treating patients without health care onto those that do. They charge

Most of the difference here is that our hospitals have to fob off the money they lose from treating patients without health care onto those that do. They charge a lot more because every 5th or 6th person coming into the emergency room has no health care, must be given treatment, and will never be able to pay for it. Thus, we all take on that burden through a backdoor, round the corner, through the mailslot, rather than just by dealing with it and giving everyone health care....

EGreg 13y ago
That doesn't really explain how the healthcare can cost 5x or more. What you've said is that every 5th or 6th person is a free rider (presumably due to laws such as the COBRA http://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Reconciliation_Act_of_1985 http://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Rec...) ... if that was the source of the added costs, it would suggest they would only be 1.2 or 1.5x higher, not 5x or more.
- Nrsolis 13y ago
  The #1 reason healthcare costs more is because of over-treatment. When providers are paid by the procedure, suddenly everyone needs a procedure (or ten). Combine that with third-party responsibility (insurance pays doctor, employer pays for insurance), opaque pricing structure (doctors are the only ones that can tell you if a procedure is necessary or not), and you have a "market" that is "broken". Put simply, everyone wants "the best care" when they never have to actually pay for it. And as long as providers are incentivized to provide "the best care", they will do it, as lost as "best" equals "expensive".
  - mjn 13y ago
    Over-treatment doesn't explain why the same treatments cost more, though. The base charge for simply occupying a hospital bed for one day is absurdly high in the U.S. compared to just about any other country (Canada comes close, if you're a non-Canadian and therefore actually liable for it).
    - Nrsolis 13y ago
      Actually, it does explain it. Lots of people are admitted that don't need to be and nobody ever questions it. And since we have such a high proportion of non-insured here, those admissions raise the cost for everyone else who DOES have insurance.
  - jfb 13y ago
    "Fee for service" is one of the big drivers of cost inflation. Taking on the AMA requires a bigger person than anyone in Washington today.
- mnutt 13y ago
  COBRA, from my understanding, doesn't give anyone a free ride. It just means that the former employee has to pay the costs themselves: COBRA does not, unlike other federal statutes such as the Family and Medical Leave Act (FMLA), require the employer to pay for the cost of providing continuation coverage. Instead it allows employees and their dependents to maintain coverage at their own expense by paying the full cost of the premium the employer and the employee previously paid, plus up to a 2% administrative charge (50% for the latter 11 months under the disability extension).
  - EGreg 13y ago
    Not that part of COBRA - the part where hospitals can't turn away emergency room patients for failure to pay.
- michaelochurch 13y ago
  COBRA doesn't mean you get free healthcare. It means you pay the rate that your employer did, plus a 2% administrative fee. It's better than individual coverage because individual plans are made more expensive to counteract adverse selection (i.e. people who buy plans are sicker than those who don't) but it's not really affordable for someone who just got laid off.
  - EGreg 13y ago
    Not that part of COBRA - the part where hospitals can't turn away emergency room patients for failure to pay.
Retric 13y ago
That's important but add in increased pay, litigation, and huge medical billing overhead. Just think every time a company negotiates prices both sides spend time which is why stores list prices and don't let you negotiate but car dealerships do.

EGreg 13y ago

That doesn't really explain how the healthcare can cost 5x or more. What you've said is that every 5th or 6th person is a free rider (presumably due to laws such as the COBRA http://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Reconciliation_Act_of_1985 http://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Rec...) ... if that was the source of the added costs, it would suggest they would only be 1.2 or 1.5x higher, not 5x or more.

Nrsolis 13y ago
The #1 reason healthcare costs more is because of over-treatment. When providers are paid by the procedure, suddenly everyone needs a procedure (or ten). Combine that with third-party responsibility (insurance pays doctor, employer pays for insurance), opaque pricing structure (doctors are the only ones that can tell you if a procedure is necessary or not), and you have a "market" that is "broken". Put simply, everyone wants "the best care" when they never have to actually pay for it. And as long as providers are incentivized to provide "the best care", they will do it, as lost as "best" equals "expensive".
- mjn 13y ago
  Over-treatment doesn't explain why the same treatments cost more, though. The base charge for simply occupying a hospital bed for one day is absurdly high in the U.S. compared to just about any other country (Canada comes close, if you're a non-Canadian and therefore actually liable for it).
  - Nrsolis 13y ago
    Actually, it does explain it. Lots of people are admitted that don't need to be and nobody ever questions it. And since we have such a high proportion of non-insured here, those admissions raise the cost for everyone else who DOES have insurance.
- jfb 13y ago
  "Fee for service" is one of the big drivers of cost inflation. Taking on the AMA requires a bigger person than anyone in Washington today.
mnutt 13y ago
COBRA, from my understanding, doesn't give anyone a free ride. It just means that the former employee has to pay the costs themselves: COBRA does not, unlike other federal statutes such as the Family and Medical Leave Act (FMLA), require the employer to pay for the cost of providing continuation coverage. Instead it allows employees and their dependents to maintain coverage at their own expense by paying the full cost of the premium the employer and the employee previously paid, plus up to a 2% administrative charge (50% for the latter 11 months under the disability extension).
- EGreg 13y ago
  Not that part of COBRA - the part where hospitals can't turn away emergency room patients for failure to pay.
michaelochurch 13y ago
COBRA doesn't mean you get free healthcare. It means you pay the rate that your employer did, plus a 2% administrative fee. It's better than individual coverage because individual plans are made more expensive to counteract adverse selection (i.e. people who buy plans are sicker than those who don't) but it's not really affordable for someone who just got laid off.
- EGreg 13y ago
  Not that part of COBRA - the part where hospitals can't turn away emergency room patients for failure to pay.

Retric 13y ago

That's important but add in increased pay, litigation, and huge medical billing overhead. Just think every time a company negotiates prices both sides spend time which is why stores list prices and don't let you negotiate but car dealerships do.