Hey billing geeks, I have had this idea to compare US prices to the ones listed in the German GOÄ, which is the central price catalog negotiated with German health insurers. It is binding for German doctors participating in the public healthcare system (Kassenärzte; Kasse = insurance carrier). This is somewhat analogous to medicare pricing I believe.
If this were at all possible, and I don't have high hopes looking at the obfuscation in the published US hospital pricing data, it would shine a light on the insane pricing insurers in the US get away with. Being able to quantify would allow to direct comparison, and hopefully convince some people to vote for the right party to change the greed and human suffering we currently have to put up with.
Edit: Here a PDF of the GOÄ [0]. It has multiple pricing as well, which is used when a private insurance carrier pays. Private insurance can be used as well, giving preferred access and treatment.
> Private insurance can be used as well, giving preferred access and treatment.
Well, actually, the contracts doctors have with the public insurance carriers forbid giving preferred access. So handing out earlier appointments to privately insured people is verboten. But no doctor obeys this, and punishment is practically nonexistent.
Differences in offered treatments are allowed, the catalogue that private insurance pays for is usually larger.
US commercial medical insurers don't "get away with" pricing. They negotiate treatment prices with providers, who constantly try to raise prices. The most common way to handle pricing is as a multiple of whatever Medicare set. So if Medicare agreed to pay $20 (just making up a number) for CPT code 71045 (chest x-ray) then a commercial insurer might agree to pay 1.5× of that.
The out of pocket amounts paid by plan members for insurance premiums and co-pays on employer sponsored group plans are largely under employer control (within limits imposed by the Affordable Care Act). There's nothing stopping your employer from giving you free insurance with $0 co-pays.
Thanks for the clarification. You are right, providers are the profiteers in the system. Often they’re set up as not-for-profits, avoiding taxes. Good examples are Stanford Health and Sutter Health. Their prices are extreme, and they expand like crazy. The profits are then ploughed into posh buildings and executive salaries.
Edit: there was a Time article about this topic, which I can’t find. But this is another good one from them:
Related: I'd love an app or web site that lets me type in a medical procedure needed by someone close to me. After an AI chat conversation where I clarify the procedure and list any possible complications I'm aware of, the app would use databases (such as the database linked to this thread) to give me a list of estimated pricing nearby (and far away, if the prices are high.) All estimates would give a range (for example, $3500 +/- $1500.)
Does such a thing exist? It seems possible with 2023 tech, although it probably needs to know health insurance details to do its job well. I think millions of US citizens would subscribe.
It might exist soon. There are a few other companies working with the hospital (and much larger payer/insurer) price data, but it's a _very_ small community. It's been said that you need a screw loose to really enjoy digging into the data.
Even beyond just collecting and organizing the disparate files (which Alec has been doing a yeoman's job of with an all-volunteer force), you quickly realize that many of the quoted prices are just flat out wrong, or, at best, misleading. Even people in the business struggle to make sense of them.
An example: you look at a hospital MRF to see the cost for a knee surgery on a BCBS plan and it just happens to be exactly 3.5x the Medicare rate. Then you look at all their other quoted prices in the MRF and realize they're _all_ 3.5x Medicare. Someone in the billing department was really lazy putting together that MRF! Then you look at the BCBS MRF and see a rate which is 1x Medicare. Definitely not right. So you ask the BCBS affiliate what gives and they say the hospital you're looking at is on the ancient APC billing codes which means the HCPCS code you were looking at for the knee surgery would never be billed by this hospital and all the rates you just looked at are complete bunk. Now, take that knowledge and make a simple-to-use, mostly correct user-facing website! Because if you quote the wrong $ amount, the internet will roast you alive.
As I said, it might exist sometime in the next few years, but it will take a lot of behind the scenes effort to make it work.
This is absolutely right. And to complicate things even more: the hospital might actually bill 3.5x the Medicare rate to BCBS, but they’ll then expect to get paid some totally different number that they’ve negotiated separately with BCBS that’s somewhere between Medicare’s allowable and the ludicrous 3.5x they bill.
Supposedly all these new laws around price transparency are aimed at exposing the "real" rate, not the inflated rate on the initial bill. 3.5x Medicare is actually somewhere around "reasonable" and is what a commercial plan like BCBS will actually pay. 10x to 50x is what would appear on the initial bill.
It's hard to escape the conclusion that the whole thing is a massive protection racket (i.e. pay monthly premiums or get a shockingly large bill weeks after the fact that you have no way of negotiating down except making kissy faces to the billing clerk). The only reason it hasn't been litigated on those grounds is that there are too many entities involved so whomever you prosecute first will cry foul and blame the other guy.
You’re not wrong! I for one am very excited about the potential benefits these Transparency in Coverage have for patients. Just the ability to shop the best rates for common procedures can save thousands per year for some.
Sadly, I’ve noticed most businesses utilizing this price transparency data are primarily selling to hospitals/providers so they can negotiate better contracted rates with insurance plans.
You're right, and I'm one of them (tynbil.com). Problem is, that's where the money is right now and those are the only customers willing to put up with slightly wrong data.
On the optimistic side, what will happen sooner rather than later is that most billing codes will converge to an average market rate. Right now, there's no invisible hand guiding reimbursement rates because no one knows what anyone else is getting.
Once a market rate is established, it'll be easier to compare providers. Provider A will be 15% less across the board than Provider B, but might have younger docs or lower quality scores.
> Does such a thing exist? [...] I think millions of US citizens would subscribe.
Yes, such thing exists.
My friend just had an endoscopy & colonoscopy together. She was able to get a price estimate through her hospital's portal both with and without her insurance, prior to her procedures, requiring no special interaction besides picking the service she was interested in and if she wanted to see the price with or without insurance.
The system seem to show her anything and everything she needed, from a routine office visit, these procedures, to delivering a baby. It not only includes the price at that facility but also a range from low to high, and where the facility fits. It also gives breakdown of the fees, although not deep enough.
The service seems to be by a company called Epic (www.epic.com), based in Wisconsin.
> The service seems to be by a company called Epic (www.epic.com), based in Wisconsin.
Lol, that mom and pop shop.
That’s the largest EMR vendor in North America and second in the world.
They’re the provider of the patient portal frontend amongst other things but there’s a lot more behind the scenes that must be done (with varying levels of quality) that is institution specific. Just using Epic does not make this work.
Exactly. IF you're a hospital system paying 10's of millions of dollars annually to Epic, and IF you want to pay for Epic's price estimation tool and offer it to consumers, then, yes, your patients can get a rough estimate of the cost of their elective surgery.
I grew up in Madison, Wisconsin. Most of my graduating high school class works for Epic. Their campus rivals Google's. Fun fact, they bought all the farm land you can see to the horizon and rented it back to the farmers for below market rates just to ensure the view from their campus was unobstructed by new development.
If you think anything about Epic is free or in the patient's best interest, check out their auditorium: https://cuningham.com/portfolio/epic-deep-space-auditorium You could host a Taylor Swift concert in there and have unused seating.
> You could host a Taylor Swift concert in there and have unused seating.
Taylor Swift regularly sells out venues with capacity of 70k+ (football stadiums), it's doubtful she would even consider an 11k venue unless it was a private event.
From your own link that seems to be only for marketplace plans and maybe select private ones, only applies for scopes done for colorectal cancer screenings specifically (not for any other conditions or risks), and even then only for adults 45 to 75.
So I would say your statement is extremely disingenuous to say the least.
It generally applies to all commercial medical insurance plans regulated under that Affordable Care Act. Most clinical care guidelines only justify colonoscopies for patients within that age range unless they have unusual risk factors; outside that range the risks and costs outweigh the benefits. Colorectal cancer is very rare before age 45. The procedure itself carries a small risk of bowel perforation, as well as side effects from sedation.
It's only of limited helpfulness because the charging system for US healthcare is utterly bonkers.
Might well be the actual care runs you $3500, but then you need to add $1000 for the aspirin they gave you, $800 for some gauze, and another $2500 for that MRI, because by jove it will be amortized.
And at that point, you have a negotiable bill - because all health care bills in the US are open to negotiations. The insurance strategy to negotiation is usually a simple "yeah, we only cover that much, and you'll like it". The private strategy is reminding hospitals that they only make cents on the dollar if it goes to collection.
Don't get me wrong, price transparency would be an enormous step forward for the US, but it's still just one step on a long road, and it won't be as useful as you'd hope.
> I think millions of US citizens would subscribe.
And why would millions of US citizens be interested in such a service? If they have insurance, insurance pays most of the costs. And this is the reason medical costs are on an upward spiral in the US: consumers are not incentivized to shop around.
A lot of US citizens have moved to "high deductible" health insurance plans, which means they pay for most medical procedures up to some yearly maximum (such as $10k.) The advantage is the monthly premium is significantly less. Those people are very incentivized to shop around.
This is pretty much the default option for your average person who doesn't have employer-provided healthcare. And the "significantly less" monthly premium is still in the range of hundreds of dollars. It's outrageous.
I think the reason medical costs are on an upward spiral is not consumers not shopping around. It's that it's extremely hard to get a price for healthcare, that hospitals are being bought up by investment companies uninterested in improving outcomes but very interested in jacking up the price of service, and that it is perfectly legal to have the only cure for debilitating, potentially fatal illnesses like hepatitis C cost $24,000.
You should take a look at the prices of medical procedures not covered by insurance, such as plastic surgery. The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. When consumers spend out of pocket, they are very much interested in seeing the price before they do the procedure, and hospitals can't and don't hide the price.
> The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around.
You are doing some extremely heavy lifting here with this sentence alone by trying to connect two unrelated clauses. Consider the following: Is Water expensive? Is it expensive due to an innate characteristic of water, or is it expensive due to scarcity?
Now with that in mind, why is water the first thing price gouged during a crisis? People need fresh and clean water and you have individuals selling water at a premium.
The same principle applies for healthcare. Plastic surgery is optional and on an indefinite timeline, so there is no patient lock in. If you have a severe injury or a heart attack or a stroke you cannot shop around. You cannot pre-shop for conditions you don't know you have. And so you pay the crisis premium.
> You cannot pre-shop for conditions you don't know you have.
In some ways you can. When hospitals acquire a reputation for being pricey without offering better care, people tend to avoid them, and even in a crisis the hospital's name won't be the first that pops into your head.
You jest, surely, but keep in mind that one of the most financially significant decisions to be made is going to be the hospital which the ambulance transports you to. Some insurance plans charge a premium for mileage when it's not the "closest available", and you can imagine the damage if the chosen facility is "out of network" or not otherwise covered.
I am trying to not take your comment personally. I understand that many medical services are not urgent. Part of the problem in the US at least is that ERs are obligated to stabilize any patient that walks through the door, regardless of ability to pay. So you end up with people misusing the ER for chronic non urgent care.
I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)
Focusing on the uncommon situations needing immediate attention implied that you haven't actually dealt with the system much. If your original comment wasn't reflective of your personal experiences, then don't take it personally. When people talk about the ability to compare prices (as one can do in basically every other industry), it's nonsensical to direct focus towards the small amount of cases that require (and generally get) immediate attention, rather than the bulk of the medical system that shamelessly books appointments months away.
If there were well-defined prices, it would clearly be horrible to use that fact to further cement a fiction that a contract has been created with someone under medical duress (or further justify high prices when supply is being limited by the cartel). But reforming the industry has to start somewhere, and price signals are basically the only way we've found to coordinate large scale distributed behavior - regardless of who might be paying.
I’ll be honest when I don’t have an urgent issue it’s hard to layer on additional mental load to compare prices. When my wife was diagnosed with cancer, how do I realistically compare prices? What services should I ask them to quote? How do I know what to ask for? How do I realistically compare two offers? What if they left out an important part of care that the other side included? What single entity even has all the information I need? For example even for a single outpatient surgery you have to include the hospital cost, the surgeons cost, the anesthesiologist, and that’s just what I can think of off the cuff. each one of those entities has their own billing department, costs etc. so who do I call?
You're still buying into their paradigm wherein they've created endless needless complexity to confuse the market. The entire point is that this complexity needs to be nipped in the bud with singular prices for each significant line item, just as every other industry operates.
The equivalent would be when you're hungry and need to buy food at the grocery store, asking how you can manage that since you are going to have to pay for the food cost, the shelf space cost, the trucking cost, the refrigeration cost, the cashier, the bagger, etc. In actuality, the grocery store comes up with a single price that they're comfortable selling an item of food for, puts in on the shelf, and you can take it or leave it at that price.
The only way the medical industry can get away with their ridiculous bullshit is seemingly through a bunch of laws they bought whereby they can saddle people with debt without actually having done the work of forming a contract. Hence why you can visit a single business, and then end up getting a slew of bills from arbitrary providers that you had no relationship to. That simply cannot happen in other industries, where the only basis for billing is having formed a contract.
The equivalent for cancer is they'd lay out several treatment options (as they're already doing while ignoring prices), listing the price for each, the price and recommended frequency for followup monitoring, etc. You could then ask different providers for how much their treatment cost. Ideally the places administering treatment would be unbundled from the doctors doing the diagnosis, and the diagnosing doctors' office could give you a list of competing treatment providers. I know I'm hand waving away a lot of details here, but the whole point is that the intrinsic complexity of the problem needs to be modeled around cost, rather than treating it as an afterthought, creating a bunch of accidental complexity that ignores cost, then trying to manage it after the fact.
(And note that this is still orthogonal to who is ultimately paying, whether legitimate insurance to pool risk, subsidies for those who can't pay, etc. It's easiest to see what the current system is lacking when you look at things that "insurance" doesn't cover. For example a hospital stay, I would guess most people here would pay $100/night to have a single room rather than a shared room with a roommate always setting off their bed alarm etc. But there's simply no way to express that to the system currently, creating a zero-sum environment of scarcity, rather than a positive sum environment of abundance)
I love what you say, but how does one realistically implement this today? I can’t exactly call up a hospital and say “cut the bullshit. I need a single price for procedure x”. They’ll just laugh and hang up the phone. (I’ve tried- most recently for a vasectomy). As you say, the industry is fat and happy and has no reason to bend to my will no matter how much sense it makes in the long run.
My point is that we have a whole bunch of policy nerds hand waving this complexity away and saying “enjoy your hsa- go forth and price compare as the invisible hand of the free market will provide!” Unless there is force from above, there certainly is no way the masses can navigate the system and force change themselves.
And the truth is that stuff does happen that’s not anticipated. My wife’s surgery was supposed to be routine. I would have had no idea ahead of time that there would be a lingering internal infection afterward. Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”.
If a tradesman screwed up a plumbing job, he would be called back to fix it at no cost. Instead I’m (or in this case my insurance) is stuck with >$100k of bills from the ICU to bring her back from the brink. I consulted with several malpractice attorneys who basically said unless the surgeon was drunk and slurring his words while operating, there is no case. The standard of care is so low.
I'm definitely not hand waving away regulatory things that need to change to make things sensible, especially in a way that doesn't just bless the current corrupt system with a new veneer of justification.
High level points, from what I can tell -
1. The laws/regulations enabling the current system/cartel need to be scrapped. This includes the ability for providers to unilaterally assign arbitrary debts to patients, and the regulations enshrining the existence of HMOs (I assume these exist because HMO "networks" look exactly like what an 80's Coase fallacy drunkard would think constitutes competition)
2. New regulation / anti-trust enforcement needs to be applied to providers, such that they must publish clear prices for standard services that are comparable across providers, and straightforward hourly rates for anything that cannot be captured on there (with any nonconforming bills being considered attempted fraud).
3. New regulation / anti-trust enforcement needs to be applied to insurance companies, outlawing "provider networks" and rephrasing all insurance coverages purely in terms of prices, applying to any medical service from any licensed medical provider. That parallel "medically necessary" approval system needs to be entirely eliminated.
> Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”... The standard of care is so low
Routinely experiencing that dynamic of poor care [0] from the medical industry is exactly what makes me shake my head at the simplistic "fix it by having the government take it over" narrative. Ballooning costs and individual ability to pay is a problem, yes. But the much larger problem is the utter waste of medical talent, because the system has been designed around terms of top-down paperwork-filling rather than responsiveness to patients. The doctor should have been working for you, and you should have been able to get more time/attention for the doctor to have taken you seriously. But that was impossible because the "insurance" company dictated that you got one tiny follow up appointment, with the doctor focusing on filling his seat during that appointment, doing the bare minimum that conforms to the top-down standard of care, and avoiding doing anything extra that might create legal liability.
[0] Although not as much malpractice and completely avoidable as yours. I'm sorry for what you both went through.
In my experience, ER in the US can bill you at the highest rate pretty frivolously.
I've been in the ER for "difficulty breathing", which was billed at the highest level, although still made to wait ~2 hours in waiting rooms before seeing _any_ medical professional.
I've also been in the ER when brought in by an ambulance, in which case I was seen immediately.
These were both billed at the highest level, when the 1st case clearly shouldn't have been.
Well when the hepatitis C drug Sovaldi (sofosbuvir) was first introduced it cost $84K for a course of treatment, so $24K now is a lot less. And that is hardly the only cure: several other pharmaceutical companies have brought competing drugs to market so there are multiple options.
Branded prescription drug prices are high mainly due to patent rights. But without patent exclusivity, most of those drugs wouldn't have been developed in the first place. It now often costs $1B+ to take a new candidate drug through phase-3 clinical trials; that money has to come from somewhere and private companies won't invest in that research unless they can expect to profit. The countries which impose strict price caps on prescription drugs generally don't do much new drug development. For example, during the past few years US drug companies have launched about twice as many new drugs compared to European countries.
Because prices are more or less regulated and controlled.
e.g. the Swiss healthcare system is privatized to a much higher degree than the US one (no Medicare/Medicaid equivalents) but 'basic' insurance plan prices and deductibles are fixed so prices still remain reasonable.
You can have both? Regulated minimum insurance coverage, maximum premiums/deductibles and transparent prices and an option to shop around for non emergency cases. You still want providers competing either on price and service quality (I don't see any issues with that as).
The problem with fully public systems in Europe nowadays is that you end up with two tiers. There is public option with poor service and several month long queues for poor people. People with higher incomes can get reasonably priced private insurance which lets them skip the queue, shop around for "better" doctors/service etc.. In this case it still ends up being subsidized by the public because higher income = better than average health and the government still ends up paying the bill for high cost treatment for serious diseases or emergencies.
A well regulated fully private system with income based subsidies just seems like the more fair and efficient option and it should be better at handling supply issues.
The main issue US seems to have is massive inefficiency and IMHO both regulation and increased competition is the best (and most feasibly) way to solve this.
There's a reason medical providers refuse to tell you the cost before a procedure. They honestly do not know, there are just so many complications and unforeseen events that can happen. While the Trump executive order forced some consolidation of medical codes there's still a massive difference between providers, so you can't even compare the lists of two hospitals since they're not charging for the same things.
Their prices are all-inclusive with followups on case something goes wrong and therapy for procedures that need it.
The founder was on econtalk (https://www.econtalk.org/keith-smith-on-free-market-health-c...) where he also claimed that their prices have been steady and that surgeons earn more there than at other hospitals. Meanwhile insurances don't want to work with them because they don't get to advertise how much money was saved from the Brutto cost based on their negotiation with the provider because they would have to pay the sticker price like everyone else.
If they can't predict a complication, shouldn't they be setting an ahead of time fee that will on average cover it? Why does the provider get to push the unpredictable risk onto the patient who has less control than they do?
Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.
I agree the fee for service is a bad model. Capitated payouts have seen a lot of success in Medicare and kaiser Permanente. But that's just how it works today.
FWIW, it's not the surgeon, it's the hospital. Surgeons are paid a fee for each surgery that is a 90-day global fee: any postop appointments, any re-operations, any hospital visits within that 90 days get not a nickel.
If the amount to bill the patient's insurance is determined after the complication, it's not an unpredictable risk, it's a fact. If it can't be predicted, then it more or less exists for each procedure, but that isn't reflected in the cost, the patient that has the bad experience gets charged extra for it.
Insurance exists to cover losses from unexpected events. Medical complications are unexpected events.
Your hungover surgeon is a bullshit strawman - most complications have nothing to do with provider malice or incompetence.
Again since that seems to be the angle you are starting with you clearly have no interest in a grown up discussion or too ignorant and also full of hubris to understand any of this (which fits in perfectly well on this site).
If you throw a massive clot after a surgery and stroke out who’s fault was that if all the standard protocols for clot prevention were followed. Maybe you’re a smoker (or not) and 5 years later that unknown cancer will finally declare itself.
> more or less exists for each procedure
This is extremely misleading as it does not exist in any meaningful level of risk across the entire patient population.
I think you're getting hung up on a joke about the hung-over doctor. The problem is that whatever the complication is, it should be amortized over all the deliveries of that treatment, not the one case where it happens to occur.
If they can predict the complication, they can bill for it ahead of time.
It is all insurance in the end, but the incentives created by pushing the providers to bill ahead are better than the ones created by letting them bill for what they do.
Depressingly, this is closer to reality than most people realize. It's not just the risk of complications in treatment, it's also that most providers send off several hundred or thousand claims in a 1-2 week period and get a lump sum check a few months later from the insurance company. Believe me when I say the best and brightest in finance are not working in billing reconciliation in hospital systems. Most are only capable of saying "oncology reimbursements are up 0.7% this month yoy" and not much more.
They are pointedly uninterested in calculating what your particular surgery will cost you or your insurance. All they know is that you're one of 200 this month and your insurance pays, on average after all the adjustments and adjudications, about 15% less than average so please be quiet and don't make a fuss.
Car mechanics are perfectly fine giving estimates, explaining possible complications and contingencies, working on a time and materials basis, and even doing well-defined services on flat fees despite the long tail of things that can go wrong.
The reason medical providers don't know is because they don't care to know. Their systems are purposefully complex so their computers can do battle with the "insurance" company computers. And when you try to ask a doctor this highly relevant question, they condescendingly feign as if money shouldn't matter despite it being the foremost thing in many people's minds.
Emergency care is less than 3% of medical spending. Everybody loves to bring it up but it isn't really an issue. Of course nobody is suggesting you shop around for emergency care. The big issue is chronic condition care, and you really should be able to compare prices for that.
The problem for me is emergency care is where I’ve easily spent the most healthcare dollars.
Providers already treat you with disdain and the back office in most doctors offices can hardly function as it is. When you ask how much something will cost, you will get somewhere between a blank look - if you’re lucky - to outright disgust that you could ask such a pedestrian question. You wouldn’t understand how complex medicine is and what could happen, you pleb. So how could we do something like give you a dollar amount?
I think you might be taking it a bit too personally. I live in New England, and people are very blunt and straightforward here. I've gathered, asking if certain things are covered, that the office staff (and even moreso the providers), genuinely have no idea how any of this shit works. People are to the point here, so some of them will tell me as much, and I learn it's pointless to ask those questions at time of care. Wait for the garbage to go into the system, garbage comes out, and then we can maybe talk... Because this is totally how legitimate businesses operate, and bears no resemblance to how the mafia would determine what you owed in protection money. But arguing with the front desk staff would be rather pointless. You just go along with the madness, just like citizens of the USSR did when everything was falling apart around them, and hope the whole thing crashes and burns sooner than later.
In other parts of the country, people are passive aggressive and it's extremely annoying. They won't admit they don't know, because it's all about appearances. Patients faced with such responses would become irate. What do you mean you don't know?! The workers hate themselves for not knowing, and they know this whole thing is a scam even better than you do. They hate themselves for participating in the scam, and so the cognitive dissonance manifests as rudeness towards you.
Believe me, these people don’t give a shit. I am well aware of cultural differences across regions. They see your meddling questions as just another annoyance in their day and the faster they can get you to go away the better. 99% of their patients don’t know to ask, so you are just seen as a pedantic pain in the ass.
Your point of cognitive dissonance is an interesting one. But ultimately it doesn’t matter what their state of mind is; if you are treated badly as a patient you will just give up to save your own mental energy. After all you’re seeing a doctor because something is wrong already. Why am I layering on managing the precious feelings of the doctors back office personnel on top of all that too?
No one is perfect, and too often, stress makes people behave in ways they're not proud of. That's mostly understandable. But I think you're vastly overstating the mental burden of trying to be kind and having a bit of empathy in general.
Why bother? Because they're just working stiffs trying to put food on the table like the rest of us. They're not responsible for the existence of this detestable system any more than you are.
Only issue is that you cannot get a bundled price. For example, you know what a colonoscopy costs but only the procedure and not all the addition care that may come with it.
Most large medical insurance companies already have some sort of cost estimator tool for their plan members. You can log into the member portal and search for common procedures to get estimates of what different network providers typically charge.
Admittedly, I haven't looked in a few months but the last time I used that tool it gave me some outrageous range like $2.000-10,000. Not particularly useful.
All 3 of the health insurance plans I've used recently have a tool like this in their portal. They have the data; it's the average of what the providers have charged other members.
I mean, it's just the 'cost.' Not necessarily the 'cost to the patient.'
I understand that it's helpful to see for people who are under/uninsured, but for most of the people it'll just max out at out of pocket/annual deductible max (which for example is like $250 per annum for me).
Further, what hospitals charge to insurance is not necessarily the rate insurance pays either. My counselor charges my insurance $400 an hour, but insurance negotiates it to like $80, of which I pay $0.
The counseling office charges people who do not have insurance like $96 per session.
What hospitals charge is not necessarily cost to patient is all I'm saying.
Using insane prices and then marking them down to reasonable levels "as an insurance discount" only has a few possible purposes and none of them are good:
1. Ripping off anyone without insurance who doesn't realize they may be able to negotiate it
2. Misrepresenting the true cost of healthcare for anyone who goes off the "original price"
3. Establishing that insurance companies have to push for deep, 90%+ discounts on everything, meaning nobody can offer sane pricing because the insurance company will say "But <HOSPITAL> gives us 95% off!"
I recently had a genetic test done. They told me that if my cost after insurance was more than $200 they'd notify me ahead of time so I could decide how to proceed, one option was a simple pay-cash option for $250. Turns out the "Amount billed" to insurance was $ 25,000, which was then "discounted" by about $ 24,600 and they were paid $400 or something. So, this is a service the lab is happy to provide for $250 -- and they make money at that price, yet in some fantasy universe, $ 25,000 is in play. This is why people want to burn the US health system to the ground.
Curious question, if the amount 'billed' to your insurance was as you say, 25000, and if a patient went there and they were told without insurance they'd get charged say, $300 (slightly higher than with-insurance price), does it matter to that end user, or the users with insurance that the insurance is being charged $25 grand?
Ultimately the end user is paying $250/300. Eg, my counselor example.
The problem comes when insurance denies the claim for whatever reason. Now, the provider is going to try to bill you the $25,000. It's up to you to either get your insurance to cover the procedure properly or to negotiate it back down to something close to the $300 price. They won't just offer it to you after processing through insurance.
The inflated procedure costs help shape the premiums we all pay for (either directly, or through our employers, or though the overhead costs of business with employees where we shop and do business). It's just a sneaky way to extract as much value from society as they can get away with.
"What hospitals charge is not necessarily cost to patient is all I'm saying."
It is cost to the patient in the form of ever rising insurance premiums and deductibles (mine is $3000 and a lot of people have even higher deductibles).
Your counselor example also shows the insanity of US healthcare pricing. $400 vs $80 vs $96. How is anybody supposed to make economical decisions with such crazy pricing differences? There should be a regulation that providers charge the same price for the same procedure, no matter if they are insured or not or what insurance they have.
I mean, to an extent I agree. I just think that the current pricing structure is lack of competition and a result of overregulation (I may be wrong?) in how hard it is to get into healthcare market. If you make it insanely hard only certain companies will be able to get in and they can then charge whatever they want.
Which specific regulations could we remove to cut prices without seriously impacting care quality?
Generally the level of regulatory compliance necessary to enter the healthcare market is proportional to the risk of patient harm. If you want to sell healthcare analytics software not directly involved in patient care then there are basically no more regulations on vendors than in any other software market. On the other hand, if you want to start a new company to make implanted pacemakers then you'll have to spend years working through FDA compliance issues because a single tiny error can easily kill a patient.
The US still spends almost triple (per capita) what any other country spends on healthcare. Between the hospitals and the insurance companies, Americans are definitely getting a bad deal.
This is true only until insurance decides not to pay arbitrarily. In my case I was stuck with a $112k bill. Hospital offered 50% self pay discount. Now what?
Totally possible that it was an invalid denial, too. I don’t know if insurers face any consequences for just denying some percentage of claims initially, and then only paying out for customers who push back.
If they continue to accept the rate that the insurance company reimburses at, it is not reasonable to describe them as charging some other rate. They know what the insurance is gonna pay when they provide you the service.
Don't forget that they first send bills for that absurd amount to anyone who's uninsured, or anyone unlucky enough to go to an out-of-network facility. If you don't contact them and find a solution, like signing up for retroactive Medicaid or negotiate somehow, they will 100% sell your debt to a collection agency and can basically ruin your life. This does happen every day to people. I don't think it should be okay for prices orders of magnitude above what they actually accept from insurers, to be used to bill uninsured patients.
Insurance: "Look how much we saved you! (Don't question our value.)"
And maybe even the medical provider being able to write off the difference as a business loss or being able to say: "Look how much we discounted your service!"
This only matters to end user if they actually pay for insurance themselves. If their employer covers it (as mine does), I don't think they care that much how much their insurance 'saved' them if the net cost ends up being $0.
Very, very few employers offer an insurance plan without any employee premium. And I would be shocked if those insurance companies didn't highlight to the employer how much was "saved".
Even those employers that do pay 100% of the insurance premium could have paid more to their workers if the insurance costs were less.
Employers who pay less on benefits (pay less health insurance premium, pay fewer vacation days, pay less FICA, etc.) have more cash available. They could use that to pay higher salaries. I'm sure you've heard and that you actually do take into consideration the "full compensation package" when evaluating one job against another.
Also not trying to fight. "Could have paid you more" does actually happen in the right type of competitive environment -- though most employers are more likely to avoid direct salary increases to instead increase other parts of the "full compensation package". It's relatively much easier to later reduce those other things than it is to reduce direct salary, if things go sideways down the road.
We're gotta work with whatever the hospitals give us.
The most common codes we see are CPT/HCPCS codes (coupled with revenue codes), or DRG codes. When the hospital provides any one of REV, CPT, HCPCS, MS-DRG, APR-DRG, APC, NDC, or EAPG, we break them out into their own columns.
We keep all the code metadata -- that is, we leave the code strings mostly intact, and then extract the code itself into a separate column. This preserves things like "CPT4" or whatever, as a string, but we do not have a way yet of splitting CPT codes into multiple subtypes. So we haven't lost any data, but we haven't totally figured out how to query it perfectly well either.
Is the data US only? I wonder if there is a global version? On quick glance didn't find the provenance of the data. Would you mind sharing how the data is collected? I'm working with an asian insurer to bring price transparency to the public. If there is a trustable global database would benefit the world hugely. There are, for example, non urgent medical procedures that people can undergo in different countries
Queries on DoltHub need to go to S3 to fetch all the chunks. This only works for databases < 1GB generally. You will get much better performance if you clone the database locally.
In Poland I pay mandatory health insurance, it is 9% of my income.
Instead they provide healthcare with queues up to few years for non life treating conditions.
Also common story is there could be up to 6 months between diagnosis of cancer and start of the treatment.
Public healthcare can also suck balls indeed, but to compare the same things, I would rather pay for well-functioning public healthcare than for well-functioning private healthcare. The other insurer's incentives (max profit) are just less likely to be aligned with mine (good health) in the private system.
The Swiss fully private system seems reasonable, Netherlands also to a degree. They are pretty efficient. Private but heavily regulated seems like a good balance.
That has probably more to do with Poland being overall piss poor compared to the countries that always rank top on health care things (like Norway) rather than how you're paying for it.
Long queues are common for countries with public healthcare.
The big difference with private - you can choose how much do you pay and what you'll get. With public you get poor experience no matter how much you pay. And
sum is not limited: more you earn more you pay :(
As someone who just tried to schedule an appointment with a new PCP and being told my first available appointment would be in August, I'm not at all sold on the idea that long queues are unique to public health care systems.
I'm not sure what kind of health insurance I could buy in the US that would give me short queues. Lower deductible, more ancillary services, sure, but what's the plan that says "no more than a week to schedule any kind of appointment you need"?
I pay a lot for premium healthcare in the US through my job and right now I've been in a queue for months just to see a doctor. So...it's not any different here, except we pay for it.
The US public spending on healthcare per capita is more than most countries' combined private and public spending. So they pay the tax and also pay insurance.
This is awesome. As someone who lives in the U.S, had a heart attack (double bypass), and a week hospital stay...I want to see if $298,000 was the right price.
As good or better medical care as any hospital in the world, with much nicer facilities and warmth in their care. No good if it's an emergency, but great if you can plan ahead.
Also magnitudes off in accuracy sadly. I’ve known a few groups who’ve tried to reconcile it against actual charges and you might as well just use a random number generator.
A group of students I mentor have been working on the reverse version of this startup actually...towards this very idea.
They are trying to figure out how to have people submit their bills and gather actual billing data and compare what actually happens with what is claimed. Gives them a better data set for comparison and evaluation and to spot 'oddities'. I imagine health insurance does the same thing...but its opaque and invisible to consumers.
It doesn't matter how much it costs because there is no such thing in America as informed consumer consent. If you're unconscious, they will treat you, bill you, and you become liable for an arbitrary debt. The Founding Fathers revolted for this type of arbitrary taxation but too many modern Americans are too docile and accepting of mistreatment and exploitation.
I met a woman in a coffee shop in Redding CA who was about to defend her home, clothing, and means of transportation from creditors who forced her into bankruptcy while she was dying of stage IV cancer. This is the state of healthcare as a business first in America.
I went to get a standard STD panel at an urgent care a few weeks back. I asked how much it would be beforehand (since I don't have insurance). The front desk person said "between $100 and $200". I left and paid $340 - which pissed me off but whatever. Then, the following week, I received a bill from the lab testing for $380. That infuriated me. In total I spent $720 after being initially quoted max $200.
I tried to fight it but medical billing places remind me of the South Park episode about Cable Companies (where they're rubbing their nipples as the callers describe how they're being exploited). Truly an asinine system.
You have to demand a coded bill ahead to time or you must refuse treatment. If it's not in writing, then there's no evidence. If they refuse, then you have to be willing to walk away.
Also, pay by check including the phrase "payment in full".
Agreed. I will be trying to get a coded bill beforehand but most places will tell you "everything we do is an estimate". Which is so bullshit, but brings me back to my original point: they know they can fuck you, and they enjoy doing it.
I had not reached the deductible on whatever plan I had at the time when I made an office visit for chronic sinusitis. I had been suffering for at least 6 months. It was affecting my work.
The doctor was an hour late. My visit was terse and his recommendation was to use a saline nasal spray. Then he charged me $140.
But I'm sure some right wing jerk in this thread is going to whine about how other countries pay more in taxes or something equally useless.
Hahah I always love the useless appointments where it would be better care to talk with a nurse on Telehealth. I wonder if MDs realize their actions are losing them the war.
I used to think it was dumb that NPs are gaining further ability to treat patients, but my last few experiences with MDs has been so poor that I am no longer "rooting" for them. If that makes sense.
My story really isn't a story of price, but of quality and patient experience. I am hoping patients can start seeing these things before visiting a doctor.
The problem is that people grow up with this ridiculous state of affairs, among many others, so there is no point of reference, and even when a moment of clarity hits that something might be wrong, there is a sense of hopelessness that nothing can be done because everyone else is still half-alseep.
Even prior to that, I believe health care providers are required to get written agreement from you in order to require you to pay (which you wouldn't be able to do unconscious).
I've read [1] that Healthcare facilities often practice a dark pattern here though by combining both the consent to accept treatment and costs into one form/signature.
But regardless of that, AFAIK, if you never consent to payment, you're not legally obligated to pay. Of course it would always be better if none of this shenanigans existed but... Yeah.
so speaking for myself, but I had a medical provider (medical equipment rental company) falsify my signature. Among other medical billing misadventures. My wife and I both have Ph.D.s I say that not to gloat but to reinforce how broken a system we have.
You asked about consent - I recently had a hospital visit that included an ambulance trip. I was in no condition to provide consent, my wife didn't provide consent, but you better believe we got the bill (well insurance got the bills). That was just the start of the abject scams that exist throughout the medical system.
I needed a wheelchair to leave the hospital and they had me sign one page of something (on an ipad, while I'm high on opioids) and then replicated that signature onto other documents I didn't sign. They, on a recorded phone call, tell me I signed three documents, I note that they are pixel for pixel identical signatures - and that I only have one of the three documents as a hard copy. They still say I owe them $12, well the debt collectors do...I remind them each time they call that they are going to spend more trying to collect this than its worth. Its been sold at least four times.
Since then I have contacted:
* my health insurance company's fraud line - they don't take reports from patients
* state attorney general - no response
* CMS - no response (theory - if they are doing this to me they are doing this to others)
Broadly, from that one accident, I have had a lawyer send letters to two companies, filed suit against one, and simply decided I'm going to ignore 2 bills entirely because they are transparently fraudulent (IMHO). No one - short of an actual lawyer who used words like 'class action' has been any help in getting them to fix things. The other story, my health insurance company is repeatedly uninterested in being overbilled for every physical therapy visit...by hundreds of dollars per visit, across more than 20 visits.
Thats a fun story. Orthopedic surgeon prescribed PT, simplest way is to do PT through the in clinic PT clinic. I go in twice a week for a month and pay my normal PT copay. Then the insurance starts getting really high bills and I get a request for more money. They listed the orthopedic surgeon as providing the PT. I contact the company, they say that is their 'billing policy'. I point out that the orthopedist is not licensed to provide PT, 'thats our policy'. The difference for me is $10 per visit for a specialist rather than normal copay. THe difference for the health insurance was around $300 per visit. I contact my health insurance - they poke aroudn and find out that the orthopedist owns the PT clinic - which 'employs' no physical therapists. The PTs are all employees of a separate corporate entity so it doesn't through any red flags in billing. Insurance ghosts me - literally, I have a case number from the fraud department that they have no record of or notes on.
My wife and I had a conversation today about how we spend, between medical and general life bills, at least 3 hours per month ensuring we are not misbilled, or ripped off, or not provided the services we pay for. We find issues every month. There is a point where this is a generalized business model of fraud on customers and it needs to be stopped - there ought to be criminal charges.
The idea that Australian healthcare is "free" is rather ridiculous. We have Medicare Levy of 2%, Medicare Levy Surcharge of up to 1.5% (both calculated on your income _before_ income tax), plus according to my latest tax receipt about 20% of the income tax goes towards healthcare as well.
On top of that (and in conjunction with Medical Levy Surcharge) the government pushes everyone to have private health insurance, and it makes a huge difference in terms of wait times for "elective" hospital procedures (i.e. anything that won't kill you very soon).
All in all, last year I paid some AUD16k getting no medical services at all.
Paying all that you're still out of pocket for anything serious, as specialists (anesthetists, urologists, gynos, you name it) are typically charging way above Medicare standard fees and private insurance doesn't cover that completely.
Yes, it amazes me when folks come on to a site like HN and decry socialized medicine as “free”. You rob your neighbor for substandard care, and usually have a smugness about it.
Disagree about the robbery part - As an Australia am I also robbing my neighbor to pay for the fire service, or the public roads I'm driving on or the public school I attended? Public health system is just another part of the governments tax revenue I'm happy for it to be distributed this way.
Of course some things are justified expenditures for taxes, I’m not a minarchist, but those things should be thought through very carefully. Healthcare is a commodity unlike power generation, roads, or perhaps even fire service. On that sense I’d argue it’s just a direct $$ transfer at that point and essentially stealing.
That "stealing" argument doesn't fly in Australia, just like disability and unemployment pension are not seen as stealing, even though they are much more redistribution-y.
I wasn't poor even before I moved to Australia, and I would go to a store, buy some crap for a week (far from everything I needed) for $X, then see a notice saying "hiring cashiers, $2X a month". I'm probably speaking for a lot of Australians - I want none of that working poverty here, and high minimum wages and Medicare always were big parts of that.
Well it's not robbery as there seems to be no electoral pressure to abolish it, and it's generally in line with Australian concept of mateship and supporting your neighbour.
A minimum wage worker pays more like 1k in taxes per year towards healthcare, still somehow "$1000 for a couple of stitches" strikes people more than "$1000 for nothing at all", and somehow people seem to be grateful to the "free healthcare" for getting a 4-man 10-hour surgery "for free" rather than their neighbours. Go figure.
What on earth did your friend have wrong with his hand that he agreed to surgery on the same day as an initial consult? I know we run a ton of expensive diagnostics in the U.S. to rack up bills, but surgery is not without its risks, not to mention the pain of recovery in the best case - financial considerations aside.
Australian public hospitals have first class surgeons. In this case they recommended surgery. They're not doing it for financial gain, why not trust their advice?
Your alternative is to go to another surgeon for a second opinion but you can only do that in the private health system, and that will take months or maybe longer and cost you alot of money.
Because doctors are humans, and humans make errors. I would never go into surgery without having at least a radiologist confirm the results of what the surgeon was seeing unless it was a life or death emergency.
Also, because people heal naturally at a variable rate. Not every tear or break needs invasive treatment.
> What on earth did your friend have wrong with his hand that he agreed to surgery on the same day as an initial consult?
Obviously I don't know what happened there, but as an example having a broken bone in their hand which is badly set would fit. It would cause you to have "pain in your hand" and it would require immediate surgery to avoid further damage.
Unpopular truth but if you have a job paying at least $100k in the US with decent employer's insurance, you probably receive the best healthcare in the world in terms of availability, quality, and cost. It just sucks for everyone else, especially the unemployed.
I assume it's unpopular because the vast majority of people in the US aren't earning 100k being employed with decent insurance ?
To your point, rich people in the west have prime access to world class care, and if it's not an emergency they'll fly to wherever they need to get the best clinics they can afford. People flying to Korea for plastic surgery is a thing.
Even at upper middle class you can go through non subsidized clinics if you want prioritized and/or special care.
> To your point, rich people in the west have prime access to world class care, and if it's not an emergency they'll fly to wherever they need to get the best clinics they can afford. People flying to Korea for plastic surgery is a thing.
I feel like a lot of such medical tourism has more to do with cost than quality of care.
Another factor is how much the employer pays for this which indirectly leads to a smaller paycheck as well. You are also at the mercy of your employer for what health plans are available. You might have to change doctors of your employer changes who they work with or if you change employers.
For a conversation about healthcare, household income is probably more relevant than personal income (since members of a household usually, but not always, are in the same health care plan)
About a third of American households make 100k a year. Median household is about 70k a year:
Perhaps the relevant thing is "household where at least one person makes >100K/yr" since the benefits are probably tied to the type of job.
But I suspect the person making the claim was just picking an arbitrary number where most people in that salary band will have decent benefits, and can usually afford the out of pocket portion also
> Perhaps the relevant thing is "household where at least one person makes >100K/yr" since the benefits are probably tied to the type of job.
I think you're reading too much into the OP's off-hand guesstimate. At every company I've worked for, the engineers earning $200K are on the same health insurance as the high school graduate in the warehouse earning $40K/year. The higher compensation makes it easier to clear the deductible/out of pocket maximum hurdles, obviously, but there wasn't a secret insurance plan that got unlocked at higher compensation.
If you're unemployed, you almost certainly qualify for Medicaid in 41 states. It's the best insurance money can't buy. It covers everything. You pay for nothing. In fact, it's illegal to charge you for anything. Balance billing doesn't exist. You cease to be a mark for the healthcare racket if you can engineer your income to $0 on paper. The vast majority of medical providers will accept it. It is the best insurance I've ever had. If it were possible to get private insurance for $0 premiums, or pay $500 a month out of pocket for individual Medicaid coverage, I'd pick Medicaid every single time. I cannot overemphasize how much I despise the private insurance racket. The only reason we don't have a public option is because it would destroy the private racket overnight.
Mental healthcare is a different story, but it's not any better with private insurance. Every therapist or psychiatrist in the insurance racketeer's provider directory is either dead, moved out of state, or not taking patients. "Ghost networks," they're called...
The worst insurance I've ever had was at a FANG, via United Healthcare. It covered nothing. Hardly anyone accepted it, apart from the on-site health clinic. It was worse than a university health plan, for god's sake. As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.
Unpopular truth on this forum: the healthcare system in this country is owned and operated by organized crime entities. It is completely illegitimate. It consumes 19% of GDP of the richest country on the planet, and Americans are some of the least healthy people outside of active war zones. Unless you're using your doctor as your Xanax dealer (John Mulaney explains how that hustle works: https://www.tiktok.com/@funkytownmc/video/722624028419819447...), this system sucks for you too.
I would be shocked if the Mexican cartels weren't deeply involved with United Healthcare and all these other corporate gangsters. This industry is the greatest crime of all time.
Good luck finding high quality doctors though, especially specialists, that take Medicaid and don't make you wait over an hour beyond your scheduled appointment time. The reimbursement rates for Medicaid are notoriously low, and as a result, a lot of doctors severely limit the number of patients they'll see on it.
I kept the same PCP at an Ivy League affiliated medical center. I had to see a couple specialists, no issues whatsoever with them accepting insurance. It might vary by state, but that's not my experience whatsoever. Private insurance plans are far worse in this regard.
It's really just mental healthcare and dentistry that are basically impossible, but again, not much better with a private health plan.
Take the blinders off, stop pretending you're not getting robbed, and maybe we can fix it. There is no silver lining to private healthcare. You're not getting better care. Social determinants of health are very real, but they're driven by those 9 states without Medicaid expansion dragging the averages way down, a lifetime of bad care before the ACA, and also that medicine can't solve the many problems caused by poverty.
We would all be better off in literally any other system. Everyone thinks they're an above average driver. Everyone thinks they'll live longer than average. The truth is, you're just not that special. Unless you're a politician that gets to go to Walter Reed, or you have a wing in the hospital named after you, you're getting the abysmal standard of care that everyone gets.
I tried to find a GP for a young adult on Medicaid this year, and the first half dozen that I tried (selecting specifically places that said on their website they took Medicaid) would not take a new patient on Medicaid. So yes, your experience as someone who already had a doctor may be much better than it is for the normal Medicaid recipient, who did not start with private insurance.
At the same time, I was looking for a new dentist for myself and for this kid. There are a half dozen dentists who would see me within ten minutes walk. I finally found her a dentist some 20 minutes drive away (bonus: she can't drive).
And the mental health provider we found who would take Medicaid did intake for new patients on Friday mornings between 9am and 12 noon, no appointments, recommend you arrive early in order to be seen.
Have you tried to find a new GP for an adult with private insurance recently? Many areas have a shortage in general. This has little to do with insurance coverage, and everything to do with the bad incentives of the medical profession. Who would become a GP with your MD, when you can make twice as much money as a specialist instead? It's like getting a CS degree from Stanford and deciding to become a sysadmin at a high school with it, instead of becoming a SWE.
Conversely, I'm surprised you found a dentist and a mental health provider that takes any insurance at all, and didn't have a months-long wait list. I've almost always had to self pay for both...
Yes, in fact several of the doctors I called would have been happy to take her on if she had private insurance. This has everything to do with insurance.
> As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.
The sad truth about those stats is that if you split them by social class, you get two distinct groups: disenfranchised people with some of the worst health outcomes in the world, and privileged people with some of the best.
The childibrth related mortality rate for black american women is 3x higher than for white women, for example.
The US is also extremely segregated, and a substantial percentage of black Americans live in those confederate states that have not expanded Medicaid yet. Texas has a higher maternal mortality rate than Iran.
Geography is a greater determinant of health than race. People die a full 7 years earlier on average in Mississippi than California or Massachusetts, and 6 years earlier in West Virginia.
There's a clear correlation with income here, but one can easily argue that both income and life expectancy are downstream of policy. Red state policies are simply bad for your health and your wallet.
I don't think this in an unpopular truth. USA is renowned for having some of the best healthcare in the world. It's the equity and access to the healthcare that is the issue. Not quality of healthcare.
The big problem is that 1) the potential cost is essentially unbounded and can end up being ruinous even for someone relatively well-to-do 2) there is an unfortunately high likelihood of losing the job and insurance coming on the heels of getting a diagnosis where you really need care.
Availability maybe. Quality is questionable/regional. Cost absolutely definitely not.
Add up what a person making $100k pays in insurance premiums, plus what the employer kicks in on those same premiums, plus the deductibles and co-pays for every procedure, plus drug costs even with insurance and it's not even in the same ballpark. Even if you are healthy and don't go to the hospital the premiums are huge for even basic health plans.
I was unemployed for a year and paid under $200/month for a good insurance through market place, which I happened to use twice. That's not a lot of money. And I don't think the US healthcare system is as terrible as people think it is, particularly after Obamacare. There's a lot of variation of course, if you are in a big metro area chances are you have access to one of the best doctors and facilities in the world. I have colon cancer and heart disease screenings and I pay a few hundred dollars combined every few years. Copayments to see specialists are $35. Xrays are free, medicines are a few bucks. Biggest expense to date was shoulder surgery at under $2000 out of pocket, but I was taken care of by one of the world lead experts in the subject. For something that can alter your life forever I happily pay to have promptly access to such level of care instead of being on a wait list to be operated by the next available doctor picked by the system. From that perspective $2000 is cheap.
At some point in that process you should be able to get onto Medicaid and/or Social Security Disability. Of course that can take a while and it's not easy for a patient to deal with cancer treatments and navigate those systems simultaneously.
Disability in America is a death trap imma be honest with you, if you’ve never personally tried to navigate it I don’t think you should be recommending it anywhere. It’s normal to be denied, then spend over a year on the appeal, and then you must never own more than a small amount of money.
I am not "recommending" disability. I totally understand that it can be difficult to navigate the application process. But anyone who meets the eligibility criteria should go ahead and apply to hopefully get some financial support.
I never claimed that Medicaid and disability were "golden". Go back and read my comment again. Those are last resorts for people in bad situations. But anyone eligible should go ahead and apply, at least to get the process started.
Even so it's a maddeningly complicated system. If you end up in front of a doctor outside of your magic network, you might end up with a sudden several thousand dollar bill instead of $400.
Minor mistakes and games can also create odd billing situations that are opaque and difficult to fight.
My recent ER visits have all resulted in $1K-$2K or more (don’t remember exact numbers). A stupid sling costs about $100 in the ER. All due to deductible, Co-insurance and other provisions.
It is $100 for just the co-pay. Depending on your state, there are the balance bills, mystery bills, lab bills, xray bills, random radiologist bills from affiliated practices, and a host of other things that come in the mail ~6wks later.
Worst thing, the ER doctors, and radiologists in many cases as you noted, seem to always be subcontracted to some other agency which bills separately from the main hospital.
Been in ER in the UK, Aus and NZ. Never paid a cent. And that's included overnight stays, drugs, ICU, 2 weeks ward stay, cardioversions and more. Yay for free healthcare.
Hospital beds aren’t inherently that expensive. The physical room + attention from medical professionals + deprecation on equipment doesn’t add up to such an extreme number as to be particularly problematic.
It’s a huge range of negative feedback loops that drive US medical costs into insane territory. For example insurance companies require more documentation which means doctors can treat fewer people and thus need to change each of them more. High costs mean fewer people can afford services which means more time in collections and charging those who can pay more. High medical costs drive up malpractice payouts for medical treatment which drives up malpractice premiums which drive up medical costs. etc etc.
The tax rates are also substantially higher. I'm certainly not defending the atrocious health care system in the United States, but Australia's healthcare system certainly doesn't come at zero cost.
Nobody expects it come without a cost. But I would sure as hell prefer paying roughly the same in taxes as what my premium is in order to not have to worry about leaving the doctor or hospital with a lifetime of debt.
We here in the US also pay "tax" for healthcare, it just inst called tax. It is called {co-pay, co-insurance, deductible, balance bill, annual employee premium, annual employer premium}
Depends on your bracket I suppose. According to this [0], an individual $180k salary in AUS is taxed at about $58k. In USD would be about $44k. But... I pay $12k in health insurance, so they're reasonably close.
I think AUD < USD though, so spending power is probably a lot different. Don't think you can do a real thorough comparison in an HN post.
A US person making 180k is taxed more than 58k if they live in CA. 24% federal, 9% CA, plus social security and Medicare. If they live in SF then there's also a local tax.
That's the difference between US and other countries. I make close to that amount and I'd still have to worry if insurance will cover 3 days hospital stay.
I went to the doctor a few weeks ago, spent a couple minutes there, got a quick test done, then left. I received a bill for a couple hundred bucks (after insurance paid most of it) the other day.
He arrived around lunchtime, had to wait 9 hours or so to be seen, they scheduled him for surgery the next day and booked him in that night, then two days post surgery (general anesthetic) to keep an eye on him. I'm not a doctor, don't know the details.
9 hours to be seen? I thought only Canada was fucked up. I think all the countries with "free" healthcare end up with having absurd waiting times. I had some issue with harmones and the family physician referred me to endocrinologist. I called his office and guess what? There was a 6 month waiting period. They gave me an appointment 6 months away. Luckily I was traveling to Mexico in a couple weeks. I saw an endocrinologist there (no appointment, just walk in). He told me if i had waited 6 months, it would have taken a drastic irreparable toll on my health.
US healthcare is absolutely horrible. Both outrageously expensive and utterly lacking in availability. This is why average longevity in US is declining while it is growing in other developed countries.
> Both outrageously expensive and utterly lacking in availability.
US healthcare is easy to access. I've used it at every economic tier and it has never been difficult to get access to proper care. It is obnoxiously expensive.
> This is why average longevity in US is declining while it is growing in other developed countries.
It's growing in most, not all of course. Britain as one example is seeing something between stagnation and decline in its life expectancy, despite their vaunted NHS. And for seven decades it has lagged increasingly behind its peers, being ahead of only the US in its peer group. Universal healthcare will only take you so far.
"Life expectancy in the UK has grown at a slower rate than comparable countries over the past seven decades, according to researchers, who say this is the result of widening inequality.
"The UK lags behind all other countries in the group of G7 advanced economies except the US, according to a new analysis of global life expectancy rankings published in the Journal of the Royal Society of Medicine.
"While life expectancy has increased in absolute terms, similar countries have experienced larger increases, they wrote. In the 1950s, the UK had one of the longest life expectancies in the world, ranking seventh globally behind countries such as Denmark, Norway and Sweden, but in 2021 the UK was ranked 29th." [0]
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"A new analysis of global rankings of life expectancy over seven decades shows the UK has done worse than all G7 countries except the USA." [1]
The NHS has been driven to the point of bankruptcy over the last 13 years with austerity and underfunding. In the UK if you can afford it, you go private for most common procedures. Most people can’t so are stuck with long waiting times and worse outcomes.
Life expectancy in the US has been declining due to other factors like substance abuse (fentanyl poisoning), obesity, violence, and vehicle crashes. The healthcare system can have only a limited impact on those.
The idea that Australian healthcare is "free" is rather ridiculous. We have Medicare Levy of 2%, Medicare Levy Surcharge of up to 1.5% (both calculated on your income _before_ income tax), plus according to my latest tax receipt about 20% of the income tax goes towards healthcare as well.
On top of that (and in conjunction with Medical Levy Surcharge) the government pushes everyone to have private health insurance, and it makes a huge difference in terms of wait times for "elective" hospital procedures (i.e. anything that won't kill you very soon).
All in all, last year I paid some AUD16k getting no medical services at all.
Paying all that you're still out of pocket for anything serious, as specialists (anesthetists, urologists, gynos, you name it) are typically charging way above Medicare standard fees and private insurance doesn't cover that completely.
The US's Medicare levy is 2.9% and 30% of the total Federal budget[1] is spent on healthcare (that doesn't include state and local spending). The US spends more taxpayer money per capita than Australia and gets much, much less to show for it.
[1] Sorry: 30% of Federal outlays are spent on healthcare, only some of that is part of the "budget"
It does. Dentistry is excluded from Medicare entirely, and with many "elective" procedures (i.e. ligament repairs, endometriosis removal, tonsillectomy) you might have to wait it pain for months until you're seen, unless you have private insurance and are willing to pay the "gap".
That doesn't mean to say that it's as bad as in the US, but it does exist.
I'd also go out on a limb and say that there are more poor people in the USA than in Australia per capita, which might factor into how many people can't afford healthcare.
Yeah, you have to wait for months in the US, too. I have no idea how this talking point got started but whoever came up with it clearly hasn't dealt with healthcare in the US. Months-long waits for non-emergency appointments have been the norm for decades.
9 hours to be seen? I thought only Canada was fucked up.
Pretty sure there are a LOT of hospitals in the US where that's an expected or short time in the ER waiting room, and once you're taken in (into a room and charges accruing) you may well wait a another hour or more before being seen by a doctor.
Note that all of these places should prioritize you if you come in with heart attack or stroke symptoms.
That makes sense. Emergency room triage happens really quickly in my experience (even if you walk in, usually less than 10 minutes). If it's clear your life is in serious danger, then even faster! Once they know your condition isn't life threatening, you get to wait until they have some free time to see you, however long that is.
Problem is most hospitals are setup to be overloaded aka "every day is a bad day" - god forbid you have some staff sitting around twiddling their thumbs! Better to just have just enough staff that the place doesn't fail.
In the US I’ve had to wait just as long, I had a broken arm and was required to wait like 8+ hours to even get x-rays. The absurd wait times for health care are not any better with private health care. I’d say they are substantially worse because you wait just as long AND have an unknowable bill every time you go to the doctor. I routinely am quoted prices, pay them upfront, and then sent a bill for more after (all but one dentist I’ve seen has done this sometimes doubling the costs).
TLDR; The US system isn’t “free” and it is still shit.
If it's free I guess you'd prefer even staying a week instead of working months to pay it with your fun budget.
And the clarification comment says only ~8h were wasted waiting to be seen. The rest of the 3 days was probably justified (might be surprising if you are expected to be at work unless you die).
It depends on the type of surgery, op room schedule, doctor availability, any kind of needed prep for the patient, etc - but 2 nights is not that unexpected. (Am also not a doctor, but stayed in hospital for 2 months, so seen people undertaking various surgeries in that time).
Life hack: whenever you're about to use the word "just", pause and think.
Saying "just" implies the thing you're commenting on is somehow simple, and isn't much effort. If anyone had trouble doing the thing that you can "just", will likely not feel great hearing it.
Are you suggesting getting the Medicare data is easy, and it's also easy to browse? If so, could you link us to the alternative / better resource?
I use it all the time, it’s just CSV files you can download. So yea, gonna say anybody who can open excel can do it, which is basically any adult who can use a computer.
Having universal healthcare 100% free at the point of use is unusual. French people, like most Europeans, do pay out of pocket for healthcare, it's just heavily subsidized and regulated.
The system is different because it's designed to have a pricing system with health insurances and also far away from perfect. But the treatments etc are standardized.
But that's objectively false. Unless you have supplementary (ussually employer provided) insurance you have to pay a portion of the fee for every visit or procedure.
France is one of the worst countries you could have picked... lol.
If this were at all possible, and I don't have high hopes looking at the obfuscation in the published US hospital pricing data, it would shine a light on the insane pricing insurers in the US get away with. Being able to quantify would allow to direct comparison, and hopefully convince some people to vote for the right party to change the greed and human suffering we currently have to put up with.
Edit: Here a PDF of the GOÄ [0]. It has multiple pricing as well, which is used when a private insurance carrier pays. Private insurance can be used as well, giving preferred access and treatment.
[0]https://www.pvs-bremen.de/fileadmin/user_upload/redakteure/p...