I live in the US and am currently in Poland with my wife and 1-year-old visiting friends and family. Shortly after arriving, my son got a bad enough fever that we sought medical care. This past Monday night, at 9PM, an hour after the call, in the suburbs of a mid-sized city, a doctor came to our house and treated him (he's fine now). Cost us 140 zlots, or about 45 bucks. No bullshit paperwork where you fill out your name and address 4 times either...quick, professional, in and out.
I experience situations like this again and again while travelling abroad from the US, but this one put me in shock.
It's an equivalent of 2 days of work for an average person.
But my dad had to have few operations for cancer,and now takes a very expensive drug called Glivec($3000 for a box of 30 pills, needs two boxes per month), everything is completely refunded by the government as a part of public health care. He also needs to travel to Warsaw at least once per month to pick up his medicine from the hospital there(you can only do it in person because of how much it costs), which means he has to take a 4 hour train journey - he gets it completely refunded.
Fair enough point...it's actually more like ~$100 in a relative sense, as far as my working experience in Poland went. But even saying it's the same relative price as in America, consider that this is a foreigner, calling at 8PM for a 9PM home appointment, very quick paperwork, and cash payment like the doctor delivered a pizza (we even tipped her). Everyone else here that I know has public healthcare that's largely reimbursed, so they were actually appalled by the price...go figure.
It amuses me that the US is considered the land of free markets and competition. The complete opposite is the case for hospitals. For example if you wanted to open a new hospital that is more cost effective you most probably couldn't. You would have to get a certificate of need which essentially ensures that the existing hospitals remain profitable. http://en.wikipedia.org/wiki/Certificate_of_need
Due to most health care being employer based or provided by the government (medicare/caid, military, veterans etc) there isn't really any individual choice, and you can't really take your business elsewhere.
Very interesting case study in how simple changes lead to emergent complex systems. Who would have thought that taking health insurance away from the person and assigning it to the employer would lead here? With every band-aid we put on the system, it just flows around and makes itself more complex. All of these systems, the paymaster, the insurance companies, the employers, the drug companies, the trial lawyers, etc -- they live in an ecosystem we have created over time. This ecosystem was continually adjusted to solve one problem, thereby creating more complexity for all other areas.
For that reason, I do not believe a list of remedies is the way to go here. Especially trying to increase hospital taxes -- that has as much chance of working as spitting in the ocean increasing global sea levels.
Whatever we do, we have to fight the complexity actively -- even if it doesn't directly lower costs. We can understand these things as basic software architecture principles. A couple of small suggestions:
- Eliminate needless architectural tiers. Make it illegal for anybody but the patient to pay healthcare providers. If you have insurance, fine. The insurance company pays you, then you pay the provider.
- Decouple the hospital (building and administrative staff) from the services being provided
- Standardize components. Mandate that all services provided must be in a free and open market. That means open pricing (bidding), public consumer reporting, outsourcing if possible, and so forth.
- Require interoperability. One provider cannot require that another provider be used. It's the provider's responsibility to interface with other providers
- Establish naming conventions
You get the idea.
The point here is that we've been playing whack-a-mole. Some guy goes out and writes a wonderful article about the complexities and problems with the market. So new adjustments are made to fix them. They only create more problems, which some other guy goes out and writes about. Each iteration may take many years. Over time the amount of cruft and inefficiencies is staggering. If we continue with this strategy of fixing the problem it's just going to get worse.
This method of problem solving hurts. Let's not do that anymore.
Just switch to a national health service. The whole idea of paying as an individual, or having individual insurance, is just wrong. Society should insure society.
I don't think that solved the problem of cost, it simply changes who pays for it. Less scarcity, lower barriers to entry, and more competition are what decrease costs. That could be done with the government paying, but it's harder.
Also there is not the separation between provider and payer which results in providers angling for the most expensive treatments, only forced down by a payer who regards the patient as an unwanted liability. (This has been partially subverted in the British NHS by ill advised privatization.)
It absolutely solves the problem of cost. Medicare is an enormous organization and can have enormous influence over suppliers. The prices paid for routine treatments are a single digit percentage of what consumers pay.
There's numerous examples in this article about how Medicare pays more reasonable prices for things than anything billed out to consumers.
Insurance companies often get the same sort of deals, but they certainly don't pass on the savings.
There's numerous examples in this article about how Medicare pays more reasonable prices for things than anything billed out to consumers.
Yet the article says that the $800 billion a year the US government spends on Medicare is what's driving the federal deficit. So is Medicare part of the solution, or part of the problem?
The reason for high medical prices is high medical costs, which includes the insurance premiums doctors pay to maintain coverage should they be sued. A "national health service" sidesteps this by making it hard to sue the provider, who ultimately is the state, which also runs the court system. To "safeguard" people (and provide a sense of cost containment), a national health service designs regulatory processes and guidelines to control and manage costs.
Might work in the short run in a small and homogenized enough population, where everybody basically only needs the same type of care; beware if you ever get a rare condition, since there is no incentive to specialize, and the regulations for "edge cases" are written as they are discovered.
The real solution to high medical prices is to lower costs, foremost of which would be insurance premiums doctors need to pay to cover their practices. This can be accomplished through tort reform. The best part of this is that if you don't like insurance companies taking money, this reduces that purely by market action.
It's incorrect that you can't sue the NHS. But also, the quality of health becomes political, so democratic mechanisms rise to prominence as means to hold the system accountable. The press is ever-happy to pounce on medical malpractice.
The NHS does approve experimental and innovative treatments, and it does treat rare conditions. It also chooses whether to offer, or not offer, expensive new drugs. This, again, is democratically accountable - if it refuses a drug that is widely seen as life saving, the tabloids will pressure the politicians into turning up the heat and forcing it to change course. Also there absolutely is an incentive to specialize; the NHS pays a doctor's salary, so (provided it's willing to hire them) they do not have to pick a specialty that's profitable.
Moreover, the NHS, being free at the point of delivery, is willing to take on expensive treatment of poor people. In Britain, the idea that someone might go untreated perhaps for years for a quickly treatable illness, because going to hospital would bankrupt them, is seen as abhorrent and barbaric.
Ill health strikes randomly without regard to wealth; health of everybody benefits everybody. Therefore, everybody should pay according to what they can afford, everybody should be covered according to what they need.
I did not state that a national health service was impossible to sue, just that it is harder to sue; as especially with democratic processes dictating service levels, those same processes will also have to dictate operational mechanics to make sure everything is being done "by the book" (and "sustainable", according to some central regulatory body). Ultimately if a provider can prove they were following the letter of the regulations, their culpability is diffused back to the regulatory authority, and their liability diminished.
I was not targeting the British NHS, in fact, I didn't mention it. However, I would point out that:
> the idea that someone might go untreated perhaps for years for a quickly treatable illness, because going to hospital would bankrupt them, is seen as abhorrent and barbaric.
Is not the same as having a rare condition. You have added (1) quickly treatable, and are assuming (2) easy to diagnose.
To suggest that the 62M population of the UK is "small and homogenized" and needs no specialization…is the height of folly. The same can be said of Canada's 33M population. Both countries have world-leading treatment centres for a number of conditions (including some "edge cases").
Doctors here in Canada can still be sued for malpractice (and with few exceptions, doctors are NOT employees of the government; they are independent contractors), so that entire line of argument is bogus, like every single American argument I've ever heard against a true universal health-care system.
Second, if I were, then small and homogenized could just as easily apply to a geographically concentrated population with the same macro drivers of external illness vectors (climate, weather and epidemiological proximity). Odds are that if the flu is going around the UK, the person coughing has the flu.
[EDIT] Third, I did say might and the short run...sometimes social engineering problems can take a while to diagnose, and can be difficult to treat.[/EDIT]
And just like anywhere that regulations spring up (Canada or not), regulatory compliance becomes a de facto legal defense against malfeasance.
So the government can tell you how to run your own personal life health care like they can tell you how fast you can drive, how powerful (weak) your cell phone can be, etc.? That's not a world I want to live in. Isn't that the kind of world liberal loons thought Bush was going to lead us to? LOL too funny and too ironic. It seems liberals think as long as a liberal is in the Whitehouse then it's ok for government to take over our lives. Either way having our lives controlled by a conservative government or a liberal government; they are _still_ the Government which is supposed to be _us_!
>>So the government can tell you how to run your own personal life health care like they can tell you how fast you can drive, how powerful (weak) your cell phone can be, etc.?
I'm not sure if some of that was supposed to be irony. In terms of healthcare, the government pays almost half of the cost of providing care in this country. Not only does it give massive tax breaks to employer provided health insurance plans it also directly writes the regulations that govern almost every aspect of healthcare. In a sense, the government is already running your healthcare if not outright paying for it or compensating the hospital then running the system that provides or incentivizes the structure of the health insurance plan you have.
Breaks? One of the medications I was paying for on my personal plan recently is costing my new employer 3 times !!! what I was paying. Breaks? Puh-lease, are you brain-washed by deep thinkers like John Stewart?
You know why society has rules? It's because it's called society and not anarchy.
Libertarians, who would have you believe we should be free to do just about anything, fail to recognize that without a framework that defines acceptable behaviors, the social situation will quickly degrade into a free-for-all survivalist state not unlike parts of the world where the government has collapsed completely.
You can argue that the rules are too strict or too lenient, but arguing against rules period is insanity.
...That guarantees you the right to drive at any speed you want?
Sorry, laws are important, as are taxes. And while you may not use roads, the rest of us do. I don't have children, but I pay taxes for schools. I'm okay with it because education is important. While you may be able to afford health care, many cannot. You reap the benefit of healthy citizens as well. Healthy people, and people out of debt, promotes a better economy.
I work on a government contract. I've seen how much money the government can waste in general and I think this is the wrong solution.
If we do go to a government based system we need a way to make the government accountable for KEEPING costs down while still providing the best care they can to everyone. I don't think that just saying "let the government handle it" is the right mentality. We must first establish a mission for that (emerging) department of the government and keep them to it.
Also, how can we switch to a national health service, while we are over budget by about 40%? Sure, let's do it, but that would mean a reduction of government elsewhere by 40% first and THEN we could being to take other parts away while adding a national health service...
There are dozens of universal healthcare systems to study and implement against. Most are single-payer (France, the UK, Canada) but some are based on heavily regulated mandatory private insurance (Germany and Switzerland, IIRC; I could be wrong).
In every case, the government says "this is the price that you are allowed to charge for service X", which is based on cost-to-deliver plus a reasonable overhead (like the Medicare price in the U.S.).
Eliminate the for-profit healthcare crap like was described in this article and most of the American overspending on health services goes away. Not all of it, but most of it. As a side-effect, the health care system will become more efficient and could finally become an effective partner in providing health security (both for individuals and for the nation; having a functional health care system is arguably important for national security in an age where biologicals are a fear).
I'd add, the cost of medical education before one can practice in the U.S. has multiplied over the years and seems excessive compared to Europe, where medicine is traditionally a 6-year undergraduate program.
As a result, doctors needs to get paid far more, especially specialists.
You're right about the cost however the time issue is changing in many places:
Much of Europe: 6y med school then 4-6y specialist training (10-12 years)
Cost: minimal depending on country
Australia and the UK: 6 med school, or an undergrad and 4 years postgrad (min. 4y) + 2 years general training + 5-6 years specialist training (12-13 years)
Cost (aus): 7k per year of undergrad study
Pay (aus): 56k starting salary (up to 80 w/ overtime)
The US/Canada: 4 years undergrad, 4 med school, 5-6 years training - 14 years
Cost (us): 30-50k per year study
Pay (us) : ~45k intern
So the time taken to training completion is not drastically different (a year or two) but the total debt rung up does weigh on not just he doctors but everyone employed with a degree in the us:
Having said that, it is often said that doctors in the US earn more than their colleagues overseas: this is not true; although the top 0.05% may have higher earning capacity on average the US doctor earns about the same as elsewhere (certainly between the US and Australia anyway)
When you take int account lifetime debt and interest payments i feel that US doctors are getting a raw deal really
Who would have thought that taking health insurance away from the person and assigning it to the employer would lead here?
I would interject "who would think that a complex set of interlocking incentives would lead to improvements?" Who?
The whole arrangement seems like Ayn Rand's bad acid trip despite there being many articulate and intelligent people who have bought Coolaid, with and without personal gain involved.
Pile incentive on incentive till things are ready to break, rationally rearrange things up a bit till the process of exploiting perverse incentives takes hold again and things are once again ready to break.
And this situation "interesting" only from the outside. The intellectual irony is lost those dying or having their lives ruined.
A substantial portion of the country can see that marketization is simply something doesn't scale for medical care. State health care has pretty much been shown itself to be the only sensible way to organize health care in a modern industrialized society.
That won't take us there because the population of opportunists who make tremendous profits from exploiting the present perverse incentives is huge and they have essentially completed regulator capture and virtual state capture.
What will happen? It's mostly the relationship between a parasite and host. The parasite has an incentive to keep the host alive but an incentive to keep the host healthy. Sounds like the future.
I blame a large part of our problems on barriers to entry for the medical field. The AMA keeps doctor supplies artificially low and there's an enormous amount of red tape involved with providing medical services to people. The lower the barriers are for an industry, the higher the innovation and efficiency. Although, lower regulation does mean more risk for the consumer, so the game becomes making it easy for the consumer to navigate a risky terrain.
As an EMS provider, I see the same thing. I saw a man the other night who was "sick". An older gentleman, not a "frequent flier", but someone who genuinely should be in the hospital. He was suffering dizziness, and had passed out getting out of bed, and was now experiencing abnormally high blood pressure, a racing pulse, and while an ECG was clear, there was concern over heart issues.
I suggested we take him to the hospital. He refused. "I can't afford that. They're already chasing me for $16,000". He worried that they'd refuse to treat him. I informed him that legally, they were obligated to, but of course that would cost money.
In the end, he stayed home. His wife promised to either call us again if he got particularly worse, but both of them were reluctant, even then, for him to go via ambulance - "At least that way we can save about $1,000".
It is a sad day in a civilized, modern society when fundamental decisions on healthcare are made purely on finances, not quality of life.
> It is a sad day in a civilized, modern society when fundamental decisions on healthcare are made purely on finances, not quality of life.
I don't understand how you were sold on the idea that you are in a civilised society when one of the fundamental aspects of living in one is that your neighbours will help you when you can't help yourself.
A very good article that reminds me of an understanding that I've come to a couple of years ago - that free market capitalism and health care just don't mix.
Having the option to choose against a service, or being physically able to choose another service vendor if one is ripping you off are some of the core rules keeping the worst absurdities of capitalism in check.
Without them, the result is that people are being held hostage - pay here or die here. People aren't usually inclined to choose the second.
You may be interested to look at the Australian health system, with a dual system of free cover for all, and the option of private insurance and private treatment (option of staying in a hospital with nicer rooms and the ability to choose your own doctor) -
Good care is incentivised for all
(many of the expensive drugs mentioned in the article, for example rituximab and the breast cancer treatment drug Herceptin, and many other drugs that would cost >$50,000 for an individual, are bought by the government and made available for anyone who needs them for a maximum cost of $36.10)
And doctors can still earn good money in private practice if they so desire
As a side note I am currently an Australian medical student taking a surgical placement in a Boston hospital.
A surgeon in Australia can easily make the same amount of money as an American surgeon; they will earn on average twice as much during their training years (base salary for a first year graduate in aus is ~$56,000 extending up to ~$80,000 with overtime (paid hourly) vs ~$45k for an intern in the states who is salaried and not paid overtime.
First year attendings/consultants in Australia generally take home $200-250k, exactly on par with US doctors
With the added advantage of not having 200-500k in student debt (I have been a student for 10 years by the time I graduate later his year and will have $45k in student debt)
How is the US Healthcare system in anyway like a free market?
It's by far the most heavily regulated industry, every aspect of it. I believe government pays ~ 1/3rd of all healthcare costs.
Free market healthcare is veterinary, plastic surgery, lasik or maybe even dentists. Those sectors haven't seen skyrocketing costs.
You have apparently never been handed a $93k estimate for dental work, and are probably not aware that it is nearly impossible to find a dental plan that will pay for more than a couple thousand dollars of work (they all have caps that can easily be exceeded by getting work done on a single tooth).
$93k dental work sounds like an outlier. In a free market, $93k dental work should be as rare Bentley's on the road. There are very few people who can afford $93k procedures, so dentists/doctors will have to figure out how to do the procedure for a lot less or deal with the fact that their target market will be extremely small.
Besides, isn't the entire purpose of insurance to smooth out the outliers? $500k cancer treatment is an outlier, too, which is why I have medical insurance that covers it.
Corporate capitalism exists to provide the best of socialism and capitalism for the well-connected, entitled corporate elite and the worst of both systems for everyone else.
Odd, I prefer the term "corporate communism" for monopoly/oligarchy: A central board plans some aspect of the economy, just like Soviet Russia, once you get to a monopoly, with similar efficiencies.
Anyway, the US would probably benefit from a hybrid system: government provided baseline care with option to purchase private upgrades.
Very few medical expenses are related to life and death scenarios, so I think you're being a bit dramatic. When it comes to basic care, there's absolutely no reason why a capitalist approach wouldn't work, and work well. And insurance was supposed to be the way to protect against catastrophic life and death scenarios but it has become synonymous with basic health coverage.
> When it comes to basic care, there's absolutely no reason why a capitalist approach wouldn't work, and work well.
I disagree completely. Providing basic care as early as possible to people is the best way to catch problems earlier and reduce overall cost of treatment. Anything that gets in the way of a person seeking basic care, such as payment or wrangling with insurance, means that some people will choose not to seek or will delay seeking basic care. Universal health care options that do not require individuals to pay at time of service are far better for removing barriers to accessing basic care.
Preventative medicine is the most cost-effective, which from a profit perspective is the worst possible thing. If you want your for-profit hospital's revenues to go up, what you need is lots of critically ill patients.
Don't you have that the other way around? If you want profit, you'd want a bunch of healthy people paying you premiums. Critically ill patients are expensive, and if they die, they won't be paying premiums anymore.
Auto insurance companies want safe drivers who will never ding their car and continue paying a low but steady premium, not reckless drivers who wreck their car every month.
True, but even if they're not life and death - the implication is that you don't cut costs on health care, because somewhere down the line, you might regret it.
Also, of course, a lot of the things that may be minor in comparison to true life-and-death scenarios have very real consequences concerning the ability to take part it everyday life or being able to work.
Having two fingers cut off might not kill me, but I'm quite sure how I would react - even if somebody offered me a hefty cost to reattach them, I'd choose that over spending the rest of my entire life with only eight fingers.
Well you, as the consumer, have to decide what each service provided is worth. I would pay handsomely to have my fingers re-attached, but if I was on a tight budget I might think twice before going into the doctor for every sore throat (I do that now anyways despite having good coverage). It's up to the individual to decide how much care they want or require and are willing to pay for.
I like the thought that was the other reply to your initial comment: But what if that sore throat isn't just a sore throat, but something that will either get very expensive to fix, or kill you outright, the longer you wait? There are plenty of stories around where people thought they were just putting on weight, had some minor pain and it turns out - yup, giant tumor.
Universal health care that is either free or affordable without ruining your finances is absolutely possible today. Defending it behind some thin veil of "personal liberty" and the like is cute, but doesn't map to reality.
Sure a sore throat could be a sign of something worse. But most of the time, it is not. Running to the doctor every time you feel a little off is not practical, and it's expensive because doctors are relatively scarce. In systems where healthcare is "free", doctors give patients a couple of their time at most and are barely keeping up with the flow of patients. Nothing is free.
Doctors are not the ones getting filthy rich of this. At least not most of them. The money is sucked out of the system somewhere else (making it unstable for everybody involved - even doctors).
But that's besides the point anyways - the fact that people make health decisions based on their economic situation is fundamentally wrong.
Also - I live in Germany and even if it's N=1, I have yet to see the doom and gloom that I always hear is supposed to be my reality.
> the fact that people make health decisions based on their economic situation is fundamentally wrong.
People make all sorts of major decisions based on their economic situation, including what type of food to eat, where to live, and how much education to invest in. It's not fundamentally wrong, it's how the world works. It's up to individuals to determine what amount and type of health care, shelter, education, and food they need. Not some bureaucrat.
> I have yet to see the doom and gloom that I always hear is supposed to be my reality
I have yet to see it in my country (USA) either, but then again we are but two data points, aren't we?
The billing practices of medical providers in the US are appalling. I have seen statements where the "billed" amount was $15K and the "contract" amount actually paid (and accepted as full payment) was $1300 for one aspect of a one hour outpatient procedure.
The $1300 seems reasonable considering the people and resources involved but the game of financially destroying people without insurance in a nation where people are denied independent coverage for something as trivial as allergies needs to end.
Access to group health insurance alone can be reason enough to choose a corporate job over an entrepreneurial lifestyle once you have dependents.
"If you could figure out a way to pay doctors better and separately fund research … adequately, I could see where a single-payer approach would be the most logical solution,” says Gunn, Sloan-Kettering’s chief operating officer. “It would certainly be a lot more efficient than hospitals like ours having hundreds of people sitting around filling out dozens of different kinds of bills for dozens of insurance companies.” Maybe, but the prospect of overhauling our system this way, displacing all the private insurers and other infrastructure after all these decades, isn’t likely. For there would be one group of losers — and these losers have lots of clout."
A big lesson here is that once you create an industry - no matter how destructive it turns out to be - you cannot easily get rid of it without huge political costs due to the number of people who would wind up unemployed if you got rid of said system/industry (and who would wind up hating your and your political party, which may mean you start losing elections.) Who is going to risk that except for fanatics?
As a person coming from a EU country, I have absolutely no words for this. Like seriously, what the actual fuck America?? You will fight to the death to preserve your right to bear weapons,but any suggestion to make health care public and not let idiotic situations like this happen are fought with ferocity. What the hell.
If only the Second Amendment was "A healthy and fit population being necessary to the security of a free state, the right of the people to universal health-care shall not be infringed."
This part really upset me - "Unlike those of almost any other area we can think of, the dynamics of the medical marketplace seem to be such that the advance of technology has made medical care more expensive, not less. First, it appears to encourage more procedures and treatment by making them easier and more convenient. (This is especially true for procedures like arthroscopic surgery.) Second, there is little patient pushback against higher costs because it seems to (and often does) result in safer, better care and because the customer getting the treatment is either not going to pay for it or not going to know the price until after the fact."
A significant step forward would be requiring hospitals to disclose the cost of each procedure and then aggregating those data at the state and national levels. The marginal cost for this compliance should not be astronomical, given they're already itemising receipts. Or is there a Medicare cost database?
This is exactly what Castlight Health is doing. They are collecting cost and outcome data and partnering with employers to setup the most cost effective insurance they can.
like $283.00 for a “CHEST, PA AND LAT 71020.” That’s a simple chest X-ray, for which MD Anderson is routinely paid $20.44 when it treats a patient on Medicare, the government health care program for the elderly.
Because the government can force a cost upon a hospital that is not sustainable? Which in turn requires the hospital to recoup the costs elsewhere. One of the claims opponents have to ACA is that it will force private insurance out because the government will mandate its costs forcing private payers; companies and individual alike; to pick up the tab through higher billing from service providers.
Still one has to flinch when you see the pay some NON doctors get. Then again, its the same in education too. Some of the highest paid people in public and college education are not educators.
But you also see absurd discounts with private insurance companies - - eg you get testing done by Quest and get an $1000 bill, and then the insurance discount is $900 before the insurer even pays anything. That's not the government forcing unsustainable pricing, that's simply nonsense.
In no other industry is there such a difference between the sticker price and "discount", where those who can least afford to pay have to pay the most.
You essentially cannot, in the United States, get a group of doctors together to form a hospital as of the passage of Obama's healthcare reform act. (Technically, you can, but that facility cannot become Medicare certified, which is usually a death knell.) [1]
> Because the government can force a cost upon a hospital that is not sustainable? Which in turn requires the hospital to recoup the costs elsewhere.
Is this accurate? It was my understanding that payment practices with insurance providers is what causes the high sticker price of any given medicine or service in hospitals, even though insurance companies and programs like Medicare do not pay those prices, only those who pay out of pocket do.
Medicare and Private insurers are two separate things.
Insurance companies negotiate rates with hospitals/doctors/etc. Medicare _dictates_ rates which providers can either accept or reject.
The reason the Medicare cost of an Xray is ~$20 is because it was decreed to be that expensive. It has no bearing on the cost to provide the service since the hospital had no input in the reimbursement decision.
You can search and easily find reports about how doctors restrict the number of medicare patients they see because the reimbursement rates for care are too low.
Somewhat unsurprisingly, doctors who own an investment interest (or outright ownership of equipment / facility) are 3.7 times more likely to order CT/MRI scans.
That is purely human "greed".
I somehow doubt that self-selection of patients needing such imaging is occurring.
Which either says that other doctors are under-using MRI scans (doubtful, the US orders more CT/MRI scans per capita than any other country on earth by nearly seventy per cent, which to say that doctors elsewhere should be doing up to six times more), or that they're exploring their own "interest" at the cost of the consumer.
Health insurers negotiate a "discount" rate, that doctors tolerate for two reasons. The first is that the insurer will actually pay. The second is that, since insurers direct patients, they have leverage. One might call it extortion, in that the physician either needs to accept the insurer's rates, or end up "out of network" and get no patients from that insurer.
Uninsured patients have no leverage, and the vast majority of them never pay their medical bills, so the people who do pay get marked up severely.
Private health insurance and hospital bills are a brilliant, evil robbery.
Who is least likely to fight back against robbery? Sick people.
Health insurers get the best part of the deal. Knowing that sick people often don't have jobs and, as a group, rarely have money, they take the money when people are well.
I experience situations like this again and again while travelling abroad from the US, but this one put me in shock.