Hospital Prices Are About To Go Public in the US (ajc.com)

Prices hospitals charge for their services will all go online Jan. 1 under a new federal requirement, but patient advocates say the realities of medical-industry pricing will make it difficult for consumers to get much out of the new data. From a report: A federal rule requires all hospitals to post online a master list of prices for the services they provide so consumers can review them starting Jan. 1. The health care industry nationally has a reputation for having little price transparency, which can make it difficult for consumers to price compare. But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look, consumer advocates say. That's because the final bill a patient receives is almost never the same as the sticker price for the services they received. Insurance companies negotiate discounts on the sticker prices. Co-pays, co-insurance, deductibles also add other layers of complexity that bring discounts or increased costs before a final charge is determined.

Comments

Extra charges

[Anonymous Coward]

Doc: Do you smoke?
Me: No.

$130 smoking consultation charge.

Re:Extra charges

[saider]

Hopefully this is the first step in getting rid of insurance companies. The hassle of all this is what the insurance companies use to stay in business.

1. Billing errors are almost always in their favor. You either spend your valuable time haggling with them to correct it, or it gets paid because you don't notice it or don't have time to deal with it.

2. The time you spend correcting their mistakes also requires people working in the insurance company to correct them. Insurance companies are regulated by the state, and so they often need to justify their rates. The customer service people serve that purpose. The rates are often negotiated such that they are allowed to make a 10-30% profit on their "service". More expenses means more profit. This behavior, which would normally kill a business, becomes something that strengthens it because of the way government has their fingers in this industry.

4. Doctors now have full time people who do nothing more than haggle with the insurance companies to get paid. This further drives up the cost of care, which again benefits the insurance companies.

5. Because we have turned healthcare into an "insurance" product, you decouple a service from its price because everything is handled in aggregate. Remember from Finance 101, insurance products are designed to "make you whole" if an unlikely event occurs. Healthcare is a certainty, so paying for it as an insurance product makes no sense. That'd be like having "food insurance" or "housing insurance" to pay for your groceries and rent/mortgage. It is unnecessary and only adds cost. Then the added cost becomes a barrier and the insurance companies sell themselves as helping to overcome the barrier that they erected.

6. Healthcare is a giant jobs program. All those people haggling over costs would be out of a job things changed significantly. This is the main reason the system won't change.

7. Individuals cannot change the market because they do not purchase the insurance. Their employers do. Therefore, health insurance companies' customers are not the people receiving the service. Insurance companies provide just enough service to entice HR directors to choose them. Employers are interested in a healthy workforce, but at the end of the day it is a dollars decision that the employee does not get to make. This serves to distort the market.

Personally, I think the solution is to eliminate health insurance, and take the premiums that companies pay and just deposit that into the employee's health savings account. Then let the employees buy whatever they need. If they want insurance they can choose the plan that is right for them. Kinda like buying car insurance They can also just save the money and pay providers directly - but they need the up-front pricing information to make those decisions. For those that need assistance, the government or charities can deposit money into people's HSA is they need assistance. Then the market will return to something more normal simply because *** the people making the decisions are the people receiving the service. ***

Re:Extra charges

[thegarbz]

Healthcare is a certainty, so paying for it as an insurance product makes no sense. That'd be like having "food insurance" or "housing insurance" to pay for your groceries and rent/mortgage.

I was with you right up until that. Healthcare is not a universal certainty. When my kid was brought into this world it popped out, cried a bit and we had it home no fuss a short while later.
When my friend's came into this world it turned blue, straight into open heart surgery due to being born with transposition of the great arteries.

Now five years later and my kid hasn't had much more than butterfly stitch at a doctor. That same friend of mine had his in the emergency room getting a custom metal plate inserted in her head to replace her shattered skull when she landed face first on a rock after dismounting a trampoline.

My wife hasn't been to the doctor in 2 years. I have endless back problems and had a hernia done. Healthcare is a perfect example of how one person's life can be completely unburdened while another's can financially bankrupt them. The latter is definitely not a certainty.

That said I live in a first world country which has socialised healthcare so the concept of using insurance to fix this problem just seems so dumb.

Re:Extra charges

[greythax]

And you don't think there are abuses now?

BTW, I pay my taxes, more than most, and I know exactly what I am asking for. If one can call a road free, one can call universal healthcare free.

Re: Extra charges

[burtosis]

I'm not sure you are following this correctly. First off the people and politicans of the same party are in different boats as the flood of healthcare money goes to politicans and not the people. Even republican voters prefer single payer options at around 60% and democrats around 90% although if you call it single payer it drops republican support about 15 points over Medicare for all. In contrast 0 republican politicans support single payer, and almost 0 democrat politicans do as well because to not do so would erode thier campaign coffers. Republicans continually lose thier shit over single payer again and again - just visit Fox News for an example.

The real takeaway is that republican voters feel the finnancial inequality and hard times and are afraid of the change because there isn't enough money now and so how do we pay for it. Back in reality corporations have been stealing lying and griftng so much citizens don't have any money and even the Koch brothers bias study showed single payer would be 3 trillion dollars cheaper over the next 10 years despite full participation of the citizens and increased use. with single payer somewhere beteeen 70-80% approval across all people the real reason we don't have single payer is we don't live in a democracy, or even a representative democracy

Re:Extra charges

[ShanghaiBill]

Car analogy: Auto insurance covers catastrophic events like collisions. But what would happen if it also included gasoline?

So every time you refuel, you fill out a form, take it to the insurance department at the gas station, sit in the waiting room for 30 minutes while they negotiate the price with your auto insurance company, and when you are finally approved, you sign more forms indicating that you understand that gasoline is flammable and contains carcinogens and should not be consumed internally or sprayed in anyone's eyes. Then they dispatch a highly trained professional to dispense the gas, which is time consuming because there is a different nozzle specified by each insurance company, and your company requires the use of a low cost nozzle that doesn't quite fit your car. Finally, you receive a binder with all the forms and receipts for your tax records.

What would this do to the cost and hassle of owning a car?

Re:Extra charges

[ShanghaiBill]

Great. Because, there won't be any abuse of the system problems with that.

You should use evidence based reasoning.

Plenty of countries have healthcare that is free at point-of-use. They have mechanisms to prevent abuse that work well.

In many countries, when you "go to the doctor", you see a screening nurse or PA first, when you walk in the clinic door. 80-90% of the time that is as far as you get, because your ailment is something routine, and the nurse just hands you some pills and tells you to go home and get some sleep and drink plenty of fluids. Many times there is ZERO paperwork. There isn't even a record that you were there, and the nurse may not even ask for your name. You just walk in, get some quick advice, maybe some free pills, and then you walk out. The cost to the healthcare system is maybe $5, if that.

In America, even a sniffle means 30 minutes sitting in the waiting room next to people coughing up phlegm, several insurance forms, and a whole team of people to interface with the insurance companies, prepare and clean the treatment rooms, confer with the malpractice attorneys, etc.

Re:Extra charges

[ShanghaiBill]

Cadillac plans are taxed, but most employer provided health insurance is not. This is a problem, because involving employers in the health insurance business adds a whole additional layer to the process that insulates the people receiving care from the people paying for it.

Having your employer provide heath insurance MAKES NO SENSE WHATSOEVER and you only think it does because you are used to it have been conditioned to think it is normal.

In Maoist China, each factory ran their own school for the children of their employees. So if you changed jobs, your children had to switch to a new school. That is obviously completely idiotic. But you can only see that because you are outside the system and you have seen a better way.

Employer provided heath insurance IS JUST AS STUPID. If you work for, say, an auto parts store, and they provide health insurance, then your major healthcare decision is being made by someone who:

1. Knows nothing about healthcare.
2. Has zero bargaining power.
3. Has no particular incentive to care about quality of service

We should remove all tax benefits of employer provided health insurance and transition to a system that makes sense.

Re:Extra charges

[thegarbz]

I did say insurance was a dumb system for this. Let me tell you my car analogy for your example with my current healthcare system.

Every time I refuel I swipe a government issued card.

No that's it. Done. Oh but what if I wanted to pick which fuel I got and where I got it from? Well that's where private fuel insurance comes in. That involves me swiping ... a different card and then paying the excess. Done. Oh and at the end of the year I can claim the excess from my tax deduction but my accountant sorts that out.

Forget the idea of socialised healthcare. America the king of Insurance companies can't even get insurance companies right without over complicating the system.

Re:Extra charges

[Gavagai80]

Failing to buy gasoline actually greatly decreases your chances of being in an expensive accident that insurance will have to pay for (since you won't be able to drive far). Failing to buy routine medical checkups and routine necessary meds, on the other hand, greatly increases the expensive emergency coverage the insurance has to pay for later. Take a look at the costs of ambulances for the homeless, for example. It's in the interests of the health insurance companies to pay for the cheaper routine stuff to limit the expensive stuff.

Re:Extra charges

[Shaitan]

"I was with you right up until that. [Need for h]ealthcare is not a universal certainty."

Yes it is or near enough. Just because everyone doesn't have the same health issues and needs doesn't change the fact that everyone has them sooner or later. Insurance is the myth of pooling risk. You'd use a non-profit for that. Insurance is gambling and worse you are betting against yourself.

Re: Extra charges

[Richard_at_work]

You can't use the financial struggles of the British NHS as any example of socialised healthcare in a negative sense, because it's financial struggles are caused by a significant decrease in funding in real terms by the current government, plus a shift to treating its staff so badly that they are leaving NHS employment in droves.

The *entire* point of the current governments attitude to the NHS right now is *precisely* so in a few years time it can point to all the people saying "the NHS doesn't work" and use them to support a sell off to private ownership on the cheap.

It's already started - NHS bodies were recently forced to sell off "excess property" at a "three for one" sale price, which meant that a significant amount of NHS real estate was sold at firesale prices to property developers hand picked by the current government.

Why does the NHS have "excess property"? Because various services have been underfunded or defunded, meaning NHS trusts had to reduce and consolidate service provision, meaning NHS trusts now had extra wards and facilities they can't afford to provide services from. It wasn't a case of NHS trusts holding on to real estate to build an empire.

The only reason to hold the current state of the NHS up as an example of anything is as an example of deliberate mismanagement by the government.

Take for example waiting times - waiting times are an issue, so what does the government do about it? Decree that GP surgeries have to open in the evening and weekends to allow patients better access to their GPs. Does it matter that GP surgeries struggle to provide their current level of care? Not one bit. Is there extra funding for opening late and at the weekend? Not in any meaningful manner.

My wife, a GP, already worked from 7.30am to 7pm to cater for a normal 8am-6pm surgery day - 40 patient appointments a day, plus 4 home visits, plus 10 telephone consultations, plus 100 repeat prescriptions to sign for.

And now she's being told that she needs to work later and at the weekend. For no extra money.

Hospitals were told they were spending too much on locum doctors. So the government mandated a cap on locum rates. Now hospitals struggle to get locum doctors, meaning rota gaps, cancelled appointments and operations.

There are many examples of a GP practice closing and the practice partners themselves having to take second mortgages or loans out so they can pay their other staff a redundancy package.

We left and migrated to New Zealand. Not because of the NHS, but because of the governments management of the NHS.

At last count, out of the 132 people that graduated medical school with my wife, 94 now live and work outside the UK.

Every bad thing you can show about the NHS as an example of a "failing single payer system" is completely calculated by the current Conservative government, its things they have done deliberately because their end goal is to shift the UK to an insurance backed scheme like the US. This has been proven time and again.

Smokers and the obese have their routine operations cancelled? Good, they are the complex cases and raise the risks significantly even in "routine" operations. Complex cases and increased risk means it costs more to do the operation, and to insure the operation. Less money in the pot means you have to start taking responsibility for your own health - lose weight or stop smoking and your risk goes down, and your operation done.

how do you manage?

[pereric]

As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system. Most other 1:st world countries (in Europe, Japan, South Korea ...) have some variation on a single-payer system, where hospital visits and drugs are in most part paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance.

In Sweden, a visit to a doctor, district nurse, psychologist or physiotherapist always cost $10-$20 (free for children below 18 years old and the elderly). A hospital visit is $20-$40, regardless of what procedures are administrated. (hospitals also seems to base the procedures applied based on medical need, rather than what can be billed). On top of that, there is a yearly cap so no citizen need paying more than $150 each year in hospital fees, and no more than $150 each year for prescription drugs.

And, to the point, the average EU citizen pay much less (including paid via taxes) for equal 1:st world class health care than the US citizen.

For example, the British spend around half the US amount on health care per capita, despite having by several measures higher quality:
https://www.bbc.com/news/uk-42...

Re:how do you manage?

[JaredOfEuropa]

paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance

We in the Netherlands went with a great combination of public and private health care: the expense of a partly publicly funded health care system combined with expensive commercial care providers and a mandatory private insurance. And costs, while not as high in the USA yet, are perpetually on the rise. The only ones happy with this scheme are the insurance companies, who sell us the insurance while at the same time placing an insane administrative burden on hospitals. By the way, if you think this sounds a little like Obamacare, that's because it is kind of similar. At least, that suffered from the same weakness: the insurance companies (though Obamacare might still have been better than the current system in the US, hard to say)

Re:how do you manage?

[pereric]

That was not really an answer ...
I don't think US spending money on inefficient and unequally accessible health care help the security of other countries? Or do you think so?

Re:how do you manage?

[CrimsonAvenger]

As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system.

To make a long story short, it's fallout from WW2.

Wage/Price controls during WW2 made it difficult for businesses to recruit talent - it wasn't like you can pay them more to get them to leave their current job.

So, someone had the bright idea of offering Medical Insurance as part of the pay package. Legal, since Medical Insurance wasn't covered by the Wage/Price controls.

Anyways, by the time the notion of Single-Payer got some momentum, Medical Insurance as a benefit of your job was so embedded in the economy that getting rid of it was next to impossible.

In the long run, Medicare will probably be gradually extended to cover everyone, which will give us Single-Payer by default. But it's hard to deal with the economic disruption (the Insurance Industry is HUUUUGE! and will pretty much vanish with Single Payer) quickly, so it'll be a while.

Re:how do you manage?

[Anonymous Coward]

The meme among American conservatives is that the only reason other countries can afford universal healthcare is because they have weak militaries.

It's completely bonkers for many different reasons:
1) Universal healthcare is much more economically effective in relative and absolute terms.
2) Countries with strong militaries (Sweden during the Cold War, France now) still "afford" healthcare partly because of 1).
3) Sweden gives 1.4% of its GDP to foreign aid compared to 0.2% of the US and still "affords" healthcare partly because of 1).
4) The US gets a fuckton of influence and business because of its strong military.

Once they realize what an utterly stupid argument this makes, they turn to the argument of "diversity". Sweden is a less "diverse" country (read: has fewer mooching n*****s) so therefore it magically somehow works.

Re:how do you manage?

[I75BJC]

The point was that the USA is providing a Security Umbrella over European countries. Some of these European countries do not have to provide All of their military security and spend the money on healthcare. A recent news story on the Intra-European military exercises stated that the German Military used pieces of wood (broomsticks?) painted black because they didn't have the funding for ammunition for firearms and ammunition. Clearly, Germany is spending necessary military/security monies for some other purpose.

Re:how do you manage?

[I75BJC]

Please don't state Your Opinion as if it were a Fact! From personal experience and from MSM news articles, the UK healthcare system is overworked, underfunded, inefficient and, in the case of persistent news articles, Unable to Perform Necessary and Usual Procedures/Surgery to save lives -- particularly, the lives of the senior/aged patients and the youngest patients. These 2 groups are the vulnerable people in UK society and are being sacrificed because the UK won't or can't spend the monies that the USA will and can.

Re:how do you manage?

[kick6]

As an outsider (living in Sweden, Europe) I am a bit curious

No you're not. This is entirely in bad faith. Yo're also leaving out a major...major cost: innovation. America basically pays for the entire world's new treatments. Your "vastly more affordable yet somehow equal" care only advances because the American market incentivizes people to create the next greatest treatment. So, I guess, if your current care is SO GREAT that you won't need any new cancer treatments ever, then enjoy your commie-med.

Re:how do you manage?

[pereric]

Are you really sure? Take Sweden for example. 10 million inhabitants, but being the source of a high amount of medical innovation, and creating a nice home market for an disproportionately large amount of biotech companies. Also, the fact that higher education is free of charge (you only pay for books) plus significant public spending on medical research is probably contributing.

When it comes to incentives, it's interesting that leaving research completely to market forces creates little incentives for products or procedures that cures diseases, but much more for products that you have to use continuously all life.

https://www.lif.se/en/about-li...

Re:how do you manage?

[DarkOx]

It might be that those companies are simply dipping their fingers into every honey jar. Build a complex in Sweden where you can take advantage of the tax situation, public education etc..then drive a ton of revenue from the American market where you can charge whatever you want to large pool of patients outside medicare etc.

The geographic location the research is done does not change where the revenue to support it ultimately comes from and that is mostly from America and other countries where price controls are largely absent.

Re:how do you manage?

[jellomizer]

It isn't as malfunctioning as people are lead to believe. What is reported are the problems, and the sad cases where people fall threw the gaps in the system.
However Most Americans get health insurance at a discounted rate, and their employer pays for part of it, and you pay for part of it out of your paycheck (pre-tax)
Depending on which state, we can have different choices on insurances to choose from, so we can choose to pay less out of our paycheck, but pay more upfront, or agree to pay certain amount until we hit a limit then the insurance company pays the rest.

Being people are paying more for services, they are more picky on their health care they can choose. So Health Care institutions invest in the latestest medical technology, procedures, they work hard to be available for the patients and give treatments rather quickly. The biggest problem with socialized medicine is long wait times for non-emergancy procedures, with sometimes rundown hospitals.

This system works for most Americans (hence why there is so much debate around fixing it).

I am not implying they are not serious problems in the system.

There is Government offered insurances Medicaid, and Medicare, for the people who are retired, under long term disability, or impoverished. but there is a gap between people who are eligibility and those who can afford insurance by themselves (working poor). The Affordable Care Act (Obama Care) started to address this problem however couldn't get prices low enough to make it worth it.

What caused these high prices? Well it is actually mostly the Government insurances. Thinking they are tough negotiators they set the prices to about 1/3 of the listed cost. This in turn caused the health care institutions to raise their prices, where private insurance companies took the brunt of it. Then the private insurance companies wanted to be more inline with what the government was paying, so it cause the prices to increase even further.

Re:how do you manage?

[Vanyle]

I have a friend who lives in Denmark, When she was younger she had to have a double mastectomy because she was unable to get the care needed prior to this for breast cancer because of their financial system.

Just recently her husband had died because he was unable to get into a doctor for breathing trouble for around 4 weeks. Turned out he had a pulmonary embolism. Great health care system there.

And for those that are wondering, she pays about 50% income tax, plus around 25% VAT (this is from random conversations, so not sure if 100% accurate)

Re:how do you manage?

[Anonymous Coward]

Well, since you asked...

The American Health Care System is:

- Posting this as an anonymous cowards so that Google data whorebots don't match my medical history to my e-mail address.
- Having a birthday in May and losing my parents health care coverage before my first full-time job with benefits starts in August.
- Calling an insurance company in April and being offered a decent plan for $85/month until my full-time job starts.
- Finding out 10 years later that this plan was only a "short-term" plan, and that full-coverage plans were about 4x the cost.
- Visiting my friend in the hospital after he fell off a roof, and seeing him with a smile on his face. Asking him why he had a smile on his face, and him telling me that the ambulance driver asked him the same question. Asking him why he had a smile on his face after he fell off the roof, and him saying that he had already been to the hospital once this year, that he met his deductible, and that everything now was free.
- Going to my first union meeting and finding out that the new contract had a 0% raise, "but they'll still covering single-payer health care 100%".
- Thinking after my first union meeting that I'd rather get a raise.
- Finding out at my second union meeting that health costs were $405/month, and thinking, "I could earn 40% more a paycheck if it wasn't for health care."
- Thinking for five years that the old people in our union were holding down my salary.
- Finding blood in my stool after five years of work and thinking, "What the hell is wrong with me?"
- Choosing to Google my medical issue rather than going to a doctor, and finding out that I probably have an "Anal Fissure".
- Going to a doctor anyways, because an anal fissure is literally a pain in the ass, and having the doctor tell me, "Let's schedule a colonoscopy."
- The doctor justifying that a colonoscopy is necessary at the age of 28, because I may have this unpronounceable disease that affects about one-in-a-million people, and it's better to be safe than sorry.
- Going to have a colonoscopy done, then having the surgeon telling me post-op that my long intestine was "clean as a whistle", then showing me a photo of an anal fissure he found.
- Receiving a bill for $850 and saying to myself, "So this is what everyone complains about."
- Finding out five years later that most hospitals charge far more than $850 for a colonoscopy.
- Getting sick repeatedly and refusing to go to the doctor to avoid a $200 bill.
- Reluctantly going to the doctor after being sick for four days, getting x-rayed and three vials of blood drawn, testing negative for pneumonia, mono, the flu, and who knows what else, and getting three different bills (doctor, lab, and x-ray) totaling $600, and saying to myself, "I should have stayed home."
- Having a baby five years later, and finding that I had to quickly shop for a new health insurance policy for an unborn baby, because the moment he popped out of the womb, he would be billed $12,000 for services rendered.
- Finding out that the most affordable insurance for the newborn was a high-deductible plan with a $6,000 deductible.
- Finding out that, between the wife's deductible and the newborn's deductible, I owed $9,000 for a newborn. Thinking, "no wonder people wait later in life to have children."
- Being told by the hospital that I could pay as little as $50 a month towards the $9,000 bill, because even that was a better deal for the hospital than selling the bill to a collections agency.
- Finding out that I had cancer at the age of 32 and saying to myself, "Fuck my deductible. I want to live."
- The doctor telling me during my cancer screening that most doctors graduate from medical school with $250,000 - $350,000 in debt, and that his house payment is lower than his loan payment. And he lived in a $300,000 house.
- Finding out that my total bill for cancer surgery and radiation treatment cost $24,000, and that I only owed a $500 deductible.
- Seeing my final bill and understandin

Re:how do you manage?

[Shotgun]

The Europeans sacrifice the young and the old. The US sacrifices the poor. What we're saying here is that there really isn't enough for everybody to have all the want all the time.

At least in the US, we can choose. If I've worked all my life to save a nest-egg, I can choose to spend it on EOL care, or I can choose to take a leisurely swim to Europe. Europe, having leaders that are smarter than the rest of us, makes those decisions for me. (Because, I can't have the nest-egg if they've taxed it out of me beforehand.)

Re: how do you manage?

[apoc.famine]

Because that's a mental illness, which luckily would be covered so you could get help.

Re:how do you manage?

[Shotgun]

Things cost more because most of the R&D happens here. Europe is often the beneficiary of that.

And the military meme IS boring. That is why I'm happy that Trump is pulling out of Syria. If ISIS re-constitutes itself, Europe will be the recipient of most of the terrorist attacks. Let them send their people and money in to fight them.

Re:how do you manage?

[liquid_schwartz]

As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system. Most other 1:st world countries (in Europe, Japan, South Korea ...) have some variation on a single-payer system, where hospital visits and drugs are in most part paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance.

The advantage the EU and Japan have is that they don't have a huge underclass. This is changing as the EU is now committing suicide by importing a huge underclass. In California for example 1/3 of the state, a huge chunk of that illegal or anchor babies, is on free healthcare. Free. No co-pays to visit a doctor, no cost for medicine, no monthly fee. This is supported by virtually all legally working adults paying *lots* in taxes and getting nothing in return. It's unsustainable and will bankrupt the state. Working adults however pay hundreds a month just to have insurance, and the anger grows. To say that illegal immigration is killing the state is spot on. Citation: https://www.sacbee.com/news/lo...

Re:how do you manage?

[zlives]

as to your second point, again nothing is stopping you from saving for your nest-egg as a EU citizen.

i pay 20+k a year for my employer provided healthcare for my family and save a max 18k for my 401K... clearly we can manage the numbers either way

Re: how do you manage?

[zlives]

I would compare Canada rather than a third world country like Brazil to get a better equivalent scenario.

There are limitations even in Canada and they kinda do a funny thing about number of caregivers and specialists because in the end it is the Govt of Canada that pays them.

Re:how do you manage?

[arth1]

And for those that are wondering, she pays about 50% income tax, plus around 25% VAT

To be fair, when Americans cite numbers like these, they don't consider that the income tax includes both medical and retirement, and that a VAT is only applied to the final price, not every single step like US sales tax. The latter is a significant difference.
If a US product is sold four times from it leaves the primary industry until the end user buys it from a retailer, at an average of 6% sales tax, that equals a 26.25% VAT. In reality, far higher because factories and distributors also add their profit margins, which are also subject to multiple instances of sales tax.

One of the reason for cost difference for purchases in Europe compared to the US is due to the US being caveat emptor. In Europe, warranties and reclamation rights are mandated by law, and the typical mandatory warranty is stronger than the best you can pay extra for here in the US. Another reason is the wage level, where factory and retail staff in Europe earn a lot more than their US counterparts, with much better benefits. This raises the costs, but much of that is funnelled back into the system because the staff is better paid and pay more taxes and spend more money. So the standard of living is not worse - rather the opposite.

Re:how do you manage?

[gawbl]

...To say that illegal immigration is killing the state is spot on. Citation: https://www.sacbee.com/news/lo...

Excerpted from your link (https://www.sacbee.com/news/local/health-and-medicine/article160786554.html):

"A large majority – 83 percent – of Medi-Cal enrollees are U.S. citizens, according to data from June 2014. The second largest proportion of enrollees, at 10 percent, are qualified noncitizens, a term for permanent residents, refugees, people granted asylum and others. Both citizens and qualified noncitizens are able to access the full scope of Medi-Cal benefits and services. Another 7 percent are undocumented and can only access emergency and pregnancy-related resources. "

Time to stop

[DNS-and-BIND]

All this "oh we can't tell you the real price" bullshit needs to come to a screeching halt. This is just cartelism, or guildism, or whatever you can call it. It's an industry screwing us over because it can, and claiming technical difficulties prevent it from changing. It was bullshit when Microsoft did it with Internet Explorer and it's bullshit with hospitals.

All the same a good government requirement

[mysidia]

Now all we need is a Nondiscrimination law --- that is, to say,
  a federal rule against price discrimination or blanket pricing deals in that: A healthcare provider may not charge individuals a higher price than a partner insurance company would pay for the same service.

Re:All the same a good government requirement

[140Mandak262Jamuna]

The most expensive people to care for are the old people. And people older than 65 are already in the government plan, because no private company wants to provide coverage for them.

Just start gradually reducing medicare eligibility age from 65 to 50. Cover all children below 10, call them unborn Americans and their hosts and give pre natal care and cover child birth for free. Gradually raise it 18.

Slowly allow people to buy into medicare. Eventually we will have a single payer system.

Re:All the same a good government requirement

[Shotgun]

Or, just tax employer insurance like the income that it is, then watch as insurance slowly stops being tied to a job. Then people can buy insurance or pay their doctor out of pocket. The doctors that don't have two extra people on staff to haggle with insurance companies will be able to charge less, and will get the patients that are paying out of pocket.

You're single payer wetdream of getting someone else to support you, still requires a lot of payers that must also support a cadre of visible and hidden salaries whose job is nothing more than pointlessly shuffle papers around.

Re:All the same a good government requirement

[Anonymous Coward]

PSA: OP's source is a white supremacist organisation.

"Insurance" isn't what the US has

[bradley13]

Privatized medicine can work. There are clinics in the US that offer a menu of fixed-price services, and take direct payment (no insurance). No bureaucracy leads to reasonable prices - everybody wins.

The problem comes when the government intervenes too much. In the health insurance market, insisting that everyone must be covered, regardless of health problems or pre-existing conditions - that's no longer insurance, and has led to the problems the US is facing. Let the private insurance market work - it worked just fine for most people, most of the time, over many decades.

For people who cannot qualify for private insurance, the government can become the health care provider of last resort. That's basically where Medicare/Medicaid would come into play. Essential services only, no cosmetic or optional treatments. This is also where people would land, who get ill or injured, but couldn't be bothered to pay for insurance.

The situation in countries like the UK is actually not too dissimilar. The NHS provides health care for everyone, as long as you don't mind waiting months or years for anything that's not immediately life threatening. Meanwhile, there is a perfectly functional private insurance market for people who don't want to wait - the prices are reasonable, and coverage is good. As far as I can tell, the government basically ignores the private market - which is probably why it works.

Re:"Insurance" isn't what the US has

[jbmartin6]

It hasn't been insurance for a long time. "Health care plan" might be more accurate. Insurance is just a form of gambling, in order to hedge against unlikely events. If something is a certainty, it becomes a payment plan, since the premiums will just include the inevitable costs. That's why car warranties do not cover brake pads, oil changes, etc. Those are certainties. There are things like catastrophic coverage which are more like real insurance. That's interesting about the private side of UK health care, I'd like to learn more about it if you have any good links around.

Near-pointless change in healthcare

[Pollux]

But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look

Correct. Because nowhere on the chargemaster is a service that says "colonoscopy". Good luck getting the average American to interpret ICD-10-PCS code descriptions. According to this website, a screening colonoscopy should receive the following three codes:

Z12.11: Encounter for screening for malignant neoplasm of the colon
Z80.0: Family history of malignant neoplasm of digestive organs
Z86.010: Personal history of colonic polyps

No word for "colonoscopy" that I can see. Furthermore, this doesn't include the anesthetist charge, recovery, the room charge (which is always charged for with surgery, inpatient or outpatient), or the food charge. Other hospitals even throw in itemized charges for IVs, needles, hoses, gowns, laundry, and tissues.

It'd be like shopping for a car, and before you go, you have to look up online the costs for all the individual parts that make up a car. Except most Americans don't know every single nut and bolt, camshaft and wiring assembly, window and panel, that goes into one. And you get to the car lot, ask how much the cost is, and the salesman says, "We have all our costs online." You get your car, you drive it home, and then you get a bill in the mail three months later for five times what it really should cost.

What health care really needs is the sticker price posted right in the window.

Re:Near-pointless change in healthcare

[Lothsahn]

What health care really needs is the sticker price posted right in the window.

That's what this group is trying to do:
https://brokenhealthcare.org/

Almost passed in Colorado. Killed by the insurance lobbyists.

Insanity

[Anonymous Coward]

I broke my clavicle skiing several years back, a non-unionizing break, and had to have a plate installed. After the surgery I got a "This is not a bill" statement from the plate manufacturer, telling me the cost of the plate is $7800. I then later got a "this is not a bill" statement from the hospital, telling me the cost of the plate to them is $3400. I then got a "this is not a bill" statement from the insurance company telling me their non-negotiated cost for the plate is $1100. I then later got a "this is not a bill" statement from the insurance company telling me their negotiated cost for the plate is $391, and they're covering all of it, so I don't owe anything. I guess my question is, is anyone anywhere actually paying $7800 for this plate, or is that all bullshit?

Re:Insanity

[Anonymous Coward]

yes, non-insured folks get billed $7800, which they often just don't pay.

The bill gets sold to a 3rd party for $10, which buys in a hope they can recover something from the individual (``we'll ruin your credit history if you don't respond!'' letters). The $7800 then gets subtracted from the revenues of everyone involved as a "loss", and is used to offset $7800 in profits that they don't have to pay taxes on now.

Re:how do you manage -- Very Well Overall!

[I75BJC]

I have lived under the British (UK) health care system and it Sucks! The reports of wait times for surgery, scans, procedures & treatment are much longer than in the USA. The overall Quality is much poorer than the USA. The overall "out-of-pocket" price may be lower but the human costs are definitely lower. USA Federal Government intervention/take-over of the America health care system is the ruin of both health insurance (a la, Obamacare) and health care (restricted treatments, proscribed treatments, etc.). My Carpal Tunnel Syndrome surgery was performed in Memphis, TN. At the time of my surgery, Memphis had more MRI machines than the entire country of Canada (a 1st World Country with single payer health insurance/care). While I can't speak about Sweden's health insurance/care system, I can address the British and Canadian systems with some sort of personal experience. The reports from the MSM in the USA all seem to note that 1-payer systems are "cheaper" for the consumer but the quality is still inferior to the USA.

Re:how do you manage -- Very Well Overall!

[dasunt]

I have lived under the British (UK) health care system and it Sucks! The reports of wait times for surgery, scans, procedures & treatment are much longer than in the USA. The overall Quality is much poorer than the USA.

I've done the US system, and I've run into a few issues.

The US system can be horrible, or it can be great. It depends on how much you are willing to pay. For example, the doctor prescribed the textbook prescription for an ailment. My insurance company denied it. I had to go back and forth with them, the doctor, and the doctor had to call them before it was covered.

If I could pay out of pocket, I would have gotten the prescription right away. As it was, it took about two weeks for the insurance company to okay the treatment.

"Americans pay anywhere from 2 to 6 times more..."

[Futurepower(R)]

Quote from the parent comment: "... start with letting American purchasers buy FDA-approved compounds on the world market, ..." Why pharmaceuticals are cheaper outside the United States. (Sept. 28, 2015)

Quoting:

"According to the International Federation of Health Plans, Americans pay anywhere from two to six times more than the rest of the world for brand name prescription drugs."

Compare drug prices among reputable online pharmacies. ("Prices collected March 2018")

Discount Drugs from Canada

Re:how do you manage -- Very Well Overall!

[houghi]

The quality may be inferior to that of any country. That does not mean a lot.

  Car comparison: The Rolls Royce and the Bentley are far superior in quality than that of a Toyota Yaris, But if I am unable to buy one, that is meaningless.

The fact that average age is declining in the US is a telling tale how people are litteraly dying because they can't pay for their health. If people do not have the money, they will not go the the anual checkup at their doctor. They will not go to their docter when they are ill, because they need the money for food and rent.
People walk around with papers that say they do not want to be saved in case of an emergency, so they are not a financial burden on their family.

So when you look at the total population, the quality of the UK is better, because people are actually able to get help.

(following numbers are made up)
If there are 100 people and 90 can't get help, it does not matter that the 10 others get 10 times as great help.
It is better to give 100 people average help. Yes, that will result in the occasional death if that person would be one of the 10. The oposite of people NOT dying is also true for the people whou would have died if they where in that 90 bracket.

And just out of curiosity, how much did you pay for that surgery?

Re:OMG WTF!!

[fluffernutter]

Yeah, canadian here, I can see a doctor just fine. I've had *multiple* serious health issues in my family and I can attest to the fact that i was always seen right when I needed to be.

We used to have medical insurance, not health plan

[raymorris]

Insurance is for unusual events you can't budget to pay cash for. Home insurance covers if your house gets destroyed by a tornado, not replacing the $5 flapper valve in the toilet. Car insurance is for when your car gets totalled, not for oil changes.

Can you imagine if you had to deal with insurance companies and their forms every time you replaced a toilet flapper or painted a wall? It would easily triple the cost. (Insurance company employees have to get paid to deal with this stuff.)

Taking a kid to the doctor every now and and again for something like an ear infection is normal, expected, and affordable. A bilteral cleft palate is neither normal nor affordable. We used to have "major medical insurance" for unexpected medical costs you couldn't slap in your monthly budget. It was affordable. For an ear infection, you handed to the doctor a 20 dollar bill and that was it - no insurance company bureaucracy adding expense.

We've confused routine healthcare with catastrophic illness, and in the process we've greatly increased the cost of the routine stuff by adding ridiculous amounts of bureaucracy.

Re:how do you manage -- Very Well Overall!

[arth1]

My boss went in for his annual check up, and when the doctor asked if there was anything bothering him or he felt the doc should know about, my boss just said "I've been feeling tired".
That answer adjusted his 15 minute visit from a routine health check-up that's more or less covered under his insurance to a consultation that cost him $160 out of pocket

I had a similar experience. Annual check-up was supposed to be covered in full by my insurance plan, and when I went in, there was even a sheet I had to sign stating that any other concerns raised would be billed. I made doubly sure I did not ask a single question, and did not bring up any health issues (not that I had any).
Yet, I ended up with bills on top for several hundred dollars that were not covered by what the insurance company paid for the annual.
The doctor noticed a mild anaemia and ordered extra tests to be done on the blood I had already given (without consulting me), and I of course was billed for that. And billed for an "office visit" so she could tell me that I had a mild anaemia (something I already knew, and which is perfectly normal for someone who runs a 10k every day).
Then they tried to bill me for a follow-up that I said I didn't want.

The biggest problem is that I have no way to not pay for this. They get to decide what to bill for, whether true or not. I can contest until I'm blue in the face, but that does not stop them from sending the bills to collection. And the insurance company doesn't give a fuck either - they follow scripts and won't ever go "wait a minute... you didn't order this?" If the doctor's office submitted the paperwork correctly, that's all they care about. They have no script for "the doctor is billing for something the patient never agreed to".

The end result: I no longer will have an annual physical.

The only thing I will use non-ER doctors for now is writing prescriptions for things like antibiotics. Otherwise, they're worse than useless.

Re:how do you manage -- Very Well Overall!

[arth1]

I too have lived in Europe with universal healthcare.
And my experience is that the European system was way better. No arguing with insurance companies over treatments, and having to accept substandard treatments because they're cheaper.
No avoiding going to the doctor because the co-pays alone can be a fortune.
No three-month wait for an appointment to see a cardiologist.

But most of all, the quality of treatment is superior outside the US, because the US system is tailored to increase profits while reducing the liability for doctors and hospitals, meaning it's test-heavy and risk-averse.
As an example, I have bilateral total hip replacments, done in Europe. The doctors consulted with me before the procedure and gave me alternatives. I opted for uncemented threaded implants, which allows me to run as much as I want, do yoga, and pretty much function better than with the original hips. They will never have to be replaced, although the ball caps can be replaced with minor surgery. The risk is slightly higher during the initial surgery, but the quality of life afterwards is immensely better. This is not even an option for insurance-paid surgery here in the US. The slightly higher risk and higher cost of a longer surgery prohibits it. US hip replacement patients are always given cemented screwed hips, and told that they must not run or do anything hard, for the rest of their life. And that the hips will last for around 20 years.

Another example is laser vision correction surgery, which was available in the Soviet Union and then in Europe long before it became available in the US. Yet the average American thinks it's an American invention not available elsewhere...

And non-NSAID, non-opioid pain medications? There are several whole groups of medicines that have been successfully used in Europe for decades now that aren't available in the US, mostly due to lobbying from the existing drug producers.

And people here in the US accept that crap? And think they have the best healthcare in the world?

It sucks. It really does. For anything serious, I book a plane and go back to the country for which I still hold a passport. Because the service is so incredibly much better, focused on quality of life for the patients, and not maximizing profits and minimizing liability for hospitals and their marionettes.
It's truly a world of difference, and not in favour of my new country.

Since when is offering discounts to big customers

[rsilvergun]

discrimination? That's what the current system is, after all. You're getting "Group Rates" negotiated by a company (your insurance company) on your behalf.

The real problem here is that you're trying to fit the square peg of healthcare into the round hole that is capitalism. Capitalism works great for things that you buy periodically, can obtain and understand all or nearly all relevant information on, lend themselves to competition and are relatively low risk for the individual. Think twinkies, soda pop, video games and even cars.

Capitalism breaks down when paying for healthcare because you can't do any of that. You can't comparison shop for a heart transplant, you'll pay anything for it since without it you die and you can't understand what makes one hospital better than another for a transplant (and no, looking at a few statistics isn't enough, how much do you know about the doctor doing the transplant? The heart being transplanted? The staff who will care for you before and after?).

Oh, and this is before we discuss how your insurance company has every incentive to try and avoid paying for your care. RE: Pre-existing conditions.

This is why folks in the know (like the doctors and nurses themselves) want single payer. But you're taught from childhood that the only answer to any problem is capitalism. When I took econ 101 in high school socialism wasn't even discussed. Capitalism was at fait accompli. A given. No other competing solutions or systems were brought into play. They didn't even try and bad mouth it, it was just capitalism rah-rah-rah for 6 months. It's tough to get out of that mindset. And I assure you, that's by design. Go look up why pubic schools were formed sometime. They're not there to teach you to be a good citizen, they're there to teach you to be a good worker. I'm not saying that's the only thing they do (don't get me wrong, I support public schools), but we need to think about where we came from and where we're going.

Now the $20 is the co-pay (after paying health pla

[raymorris]

Back when we had medical insurance, you'd pay the doctor $20 to cover the cost of keeping the lights on for the 20 you were there, and that was it.

Now, you first pay the health plan $1,000 / month, then you pay the doctor $20 copay, which they use to pay the full-time employee they need to handle insurance paperwork.

So basically, you would claim that people not going to the doctor for an ear ache before was because they couldn't afford $20 for the doctor, but now that it's $1,000/month plus $20 for the visit they can more easily afford it?

Not saying I agree or disagree with that arithmetic just want to make sure I fully understand what you are saying.

BTW predictable pattern for gross ineffeciency

[raymorris]

Btw, you'll find that gross ineffeciencies tend to end up badly. That's the case pretty reliably.

It's a frequent pattern that someone will propose something to make things more fair* (fair meaning having the same results from vastly different actions), and someone else will point out that the proposal is grossly inefficient - it wastes a lot. The person making the original proposal may concede that it's inefficient, or it may just be plainly obvious that it's wasteful, but proponents will say that the increase in fairness* is worth the waste.

In such cases, if you actually work through all the costs you'll almost always find that gross inefficiency, being wasteful, has a stronger effect that the balancing "fairness" aspect, such that the people whom the proposal was supposed to help are actually harmed.

--
* Distinguishing two different views of fairness.
Consider yesterday my daughter ate some Christmas stocking candy which she had saved. She chose not to eat it all on Christmas because she wanted to have some for later. Her cousin are all of hers immediately. Some people would forcibly take her candy my daughter and give it to her cousin, because it's "not fair" that my daughter still has hers, while the cousin no longer has any. Others would say taking it is very unfair. My daughter should be able to enjoy the benefits of her earlier sacrifice, they say.