
If hotels billed like hospitals - meghan
http://www.washingtonpost.com/blogs/ezra-klein/post/if-hotels-billed-like-hospitals/2012/02/16/gIQAVH0sHR_blog.html
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phamilton
We just had a baby and I got a fully itemized bill, down to the total time
spent with a head nurse vs the lower down nurses (billed at different rates).

I agree that I would have liked to have known that if my wife buzzed for a
refill on her water bottle that we would be billed for the nurses time at
$120/hr.

But even if I had known that, the total bill was discounted from 10k to 7k due
to an agreement my insurance has with the hospital, and then my 80 | 20 kicked
in and our out of pocket expense for a delivery, care and 48 hour stay was
$1400 + a $300 copay. So many factors involved would have made estimating my
final cost pretty difficult.

And that may be the point. It's not so much about transparency, it's more
about how complicated the billing actually is.

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joezydeco
10K? Wow. My last child was delivered 4 years ago, standard exit method with
no complications, and the tab was $26K (before discounts, of course).

I can't imagine the bill if it was a c-section or if neonatal was involved. It
would easily double and go up from there.

The funny thing is that the obstetrician gave us a fixed price for the entire
pregnancy. All checkups and the standard delivery was one price. It was the
hospital (and the randomly-chosen anesthesiologist) that ran up the price.

~~~
phamilton
This was in Provo, UT, a student town where 50% of students and many of those
couples have at least one child while attending school (my wife and I are one
of those). The city therefore has a significantly higher than average
birthrate but since the student population is transitory the population
doesn't really grow that much. The effect of all this is that the hospital has
an abnormally large amount of childbirths, and has become pretty darn
efficient at it.

That probably contributes to a lower cost.

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bcrescimanno
What really troubles me, that I didn't see represented in this video, is not
so much the total amount of the bills but the sheer number of them. These
days, a hospital visit results in bills from (at the very least)

* The hospital * The doctor (or doctors) who may have spent a total of 10 minutes with you * The lab company that did your blood work (if it was done) * The lab company that did you CT scan / MRI / Ultrasound / X-Ray / other expensive diagnostic exam. * The pharmacy that provided any medications you were given while at the hospital.

What's worse, is that if you look, most triage areas have a sign stating all
the services are independently operated and you'll receive these separate
bills. Confusing and obnoxious--but ok. The trouble begins when you discover
that, though your insurance is accepted by the hospital, it's not accepted by
one of the _other_ people or services (of which you had no real choice but to
use the service available on-site) isn't. The hospital might assign you a
doctor that doesn't take your insurance and then you're screwed.

~~~
jonhohle
A family member recently received minor surgery at a hospital. After the
procedure was complete, she received a bill for surgeon's assistant, who
didn't accept the family member's insurance (the surgeon did). This was a man
she never met before entering the operating room, had no idea would be in the
operating room, and never saw again.

~~~
joezydeco
Every surgical procedure I've had or seen so far, including my wife's two baby
deliveries, has been performed in a hospital or outpatient surgical facility
where the anesthesiologists are independent contractors.

You have no idea who will be there and no idea if they will take your
insurance. But their bill will be the first one that shows up in your mailbox,
_guaranteed_.

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felixmar
Here in the Netherlands every medical procedure has a standardized declaration
code. On the site of the NZa (Netherlands Healthcare Authority) you can check
the current and historical cost of a procedure for each hospital.

For example go to <http://dbc-tarieven.nza.nl/Nzatarieven/zoekSnel.do> and
fill in declaration code 085090, the code for a MRI. The NZa determines a
maximum tariff for many procedures. For other procedures the cost is
negotiable between healthcare insurers and providers.

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Shivetya
The primary difference, health care is other people's money. We shop where the
government policies hide the true cost of our care by minimizing or
eliminating out of pocket expenses.

Being on a HSA program now at work really brings home the costs of health
care. It shows quite quickly that there is no free ride.

Long term health care will never be free, there will have to be minimum
payments/co-pays and the like. Otherwise people will simply abuse it, showing
up for every real and perceived problem. I am not saying we do not offer free
care to people who cannot pay, but damn, I see people claiming a need for
other to pay all the while having eight dollar a month cell phone plans, high
speed internet, and car payments that are in some cases what my rent used to
be.

~~~
bdunbar
_Long term health care will never be free, there will have to be minimum
payments/co-pays and the like. Otherwise people will simply abuse it,_

People never value what they don't pay for: it's just the way folk are.

One can see this on a micro level: buy your teenager a laptop. Make sure you
buy the extended warranty: you'll need it.

~~~
swombat
_Long term health care will never be free, there will have to be minimum
payments/co-pays and the like. Otherwise people will simply abuse it,_

 _People never value what they don't pay for: it's just the way folk are._

That is completely ridiculous in view of the example of the little-known
country called the United Kingdom. People don't pay for healthcare directly,
and they don't abuse it. This thread is ridiculous.

~~~
gaius
_People don't pay for healthcare directly, and they don't abuse it_

You know, when Aneurin Bevan was setting up the NHS, he said the cost of
operating it would go down over time as the population got healthier...

~~~
bdunbar
I wonder if he was deliberately lying, or if he sincerely believed that.

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pixie_
In summary there's no force to drive down health care costs if prices are not
made public. If I need an x-ray, I want to be able to shop around with quality
and price information made public.

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b3cmin
$200 = ($50 space per night to put self + 20 cleaning + 0.2 mint + 1.80 water
+ 3 air conditioning + other low-tech things)(1+percentage profit)

$20,000 = ($2,000 for 50 years of training for 5 docs + $3,000(1 + percentage
unnecessary to prevent lawsuit) state of art chemicals & tests + 2,000 admin +
whatev other stuff)(1+ percentage profit)

if the hotel industry was run like the hospital industry it would still cost
$200-400 or so for an ok room. The price size is the big attention grabber in
the video. preventing potentially imminent death, and legal responsibility for
it, is EXPENSIVE.

also, in a hotel you decide whether to eat chocolate. in a hospital, you might
be unconscious or have no clue wtf 'vancomycin' is. so doctors decide. video
misses this consumption-decision aspect.

wishing for a free, transparent market in medicine is naive, at least now.
healthcare can't be 'disrupted' as easily as javascript library trends. but we
might at least wish for a standardized 'economy' emergency set of options that
uses off-patent stuff and restricts procedures. ER docs would hate binding
rules but it does make a difference in unexpected ER cost, even choosing cheap
vs expensive antibiotics.

if you plan 3 months ahead to pay 10k for plastics penis enlargement, that's a
somewhat different issue.

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schwit
Why aren't hospitals and doctors REQUIRED to post prices?

~~~
smackay
Probably for the same reasons that programmers don't - for all but the
simplest of procedures there may be unforseen complications, particularly
since they mostly deal with legacy "applications"

~~~
TamDenholm
Should we[1] be shopping around for doctors? Hire a doctor like you would a
Web Developer, what are your prices, experience, show me some of the stuff
you've done before, etc. This is typically done with cosmetic surgery but
should be we doing it with required but not emergency situations?

[1] when i say "we" i mean you Americans, i'm in the UK and have the NHS

~~~
bdunbar
_Should we[1] be shopping around for doctors?_

My wife did this with

* Her cardiologist. He did a _great_ job of heart surgery after her heart attack, but she wasn't thrilled about the way he ran his clinic on her follow-up visits. So she got another guy. That this guy was closer to the house is an unexpected bonus.

* Her orthopedic surgeon. Visited several guys when it came time to replace her knees. Picked one she liked who is also uber-competent.

Digression: Ten years ago when this guy was a middle-aged doctor knee
replacements were a hand-crafted affair. Now the doctor runs the operation but
a kind of CNC machine does the actual cutting, uses lasers to measure things
and customize the new knees.

CNC machines cutting new knees: it's an awesome century so far.

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TamDenholm
The terrible acting aside, this is a good way of pointing out how pricing
models are totally different and specific to certain industries.

Some people can really take the piss because its standard in the industry but
totally adhear to normal payment standards in another industry.

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gersh
What law allows hospitals to do this? If they don't tell you the price
beforehand, and they don't publicly post the prices, legally, how do you ever
owe them any money?

How do hospitals collect these bills? Can the hospital sue you to collect on
these bills?

~~~
runako
The law that allows them to do this is the body of laws around contracts. You
sign a contract of treatment that says you'll pay what they decide you owe. If
you don't sign it, they won't treat you.

>If they don't tell you the price beforehand, and they don't publicly post the
prices, legally, how do you ever owe them any money?

If you ever go to an actual hospital, you'll see how absurd this question is.
First, there are never any prices posted. Second, good luck even getting an
answer about how much anything costs. A friend had to try three different
facilities (thankfully a non-urgent matter) before he could even find a
facility where they could quote a price.

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squozzer
It points to the absurdity of those who claim US healthcare is a "free
market". It's a cartel whose hooks are WAY deeper in the political system than
just about any other industry, including oil, agriculture, or telecom.

Don't like it? Then your choices are either go elsewhere or die.

It's tempting to advocate a UK-style system, but I'll need more proof that NHS
is not a political tool to depopulate the opposition.

Yes, some of us septics/savages watch the PM Q-time and never a session goes
by without someone in the opposition complaining about hospitals and clinics
in their district closing...

~~~
paulhauggis
A government-run system has the same problem. When the government is running
the system, if it's terrible, you have nowhere to go. Private care most likely
won't be available to you either, unless you are extremely rich.

I also have a problem with the government getting even more involved in my
life.

~~~
lambersley
I'm not so sure this is completely the fault of Gov'ts. Healthcare services
have less that -1 (1) price elasticity (2). That is to say, regardless of the
price, the demand for those services go relatively unaffected. Would this be
any different without Gov't intervention? Unlikely IMHO.

With Big Tobacco, "elasticity of demand for cigarettes is quite low. The
amount of cigarettes purchased will remain reasonably unchanged..." (3)

(1) <http://oheschools.org/ohech2pg7a.html> (2)
<http://en.wikipedia.org/wiki/Price_elasticity_of_demand>
(3)[http://en.wikipedia.org/wiki/Cigarette_taxes_in_the_United_S...](http://en.wikipedia.org/wiki/Cigarette_taxes_in_the_United_States)

~~~
paulhauggis
"Would this be any different without Gov't intervention? "

When the government gets involved in any industry, they are allowed to play by
different rules (because they make the rules) making it very difficult for
private companies to compete.

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pragone
The one item missing here is a hot-topic of mine: emergency care. Not only are
emergency services as expensive as the rest of medicine, but worse than that
is the providers have a legal responsibility to care for the individual, who
in turn has zero responsibility to actually pay the bill.

The other missing factor is that in a lot of cases, medicare/medicaid don't
actually cover the actual cost of the procedure/service being provided; this
leads providers and practitioners to charge more for those with better
insurance in order to keep their businesses afloat.

~~~
wtvanhest
_worse than that_

Are you saying poor people should just die when they are injured?

The emergency situation is the only time it should be reasonable for Dr.s to
not have to provide webbased standard billing.

~~~
pragone
Not at all. I'm just pointing out how screwed up the system is that the
government requires practitioners to treat people but doesn't provide the
financial resources to pay for it. I've worked in systems that basically were
bankrupt repeatedly because they kept providing the services they couldn't
afford.

My point isn't that the providers shouldn't be legally required to provide the
care (the truth is we would and do anyway); rather, something needs to be done
about how costs are distributed in order to prevent hospitals, clinics, urgent
cares and 911 services from going out of business.

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ctdonath
The initial bill is written KNOWING that it will be discounted. Prices are
obviously jacked up so they get negotiated down to something reasonable, just
like any scenario where haggling is normal.

I was just in the ER and got the claim forms. Price paid was about 1/10th the
initial bill.

If hotels billed like hospitals, they'd offer rooms for $1000/night and settle
for $100 when you flashed a Hotels Club card, which everyone would have, pay a
flat rate for + deductible, and would use to the max to squeeze every penny of
value out of that flat rate.

~~~
ww520
What are the ways to negotiate the hospital bill down? What leverages the
patient can apply after the service has been delivered?

~~~
ctdonath
Step #1: call hospital billing.

Thing is, almost nobody bothers with even that first simple step.

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JVIDEL
Well it seems to me we are all in the wrong industry!

I'm sure none of these healthcare guys have to deal with fierce competition
from all over the world, exponentially increasing automation, the constant
threat of outsourcing, etc...

Someone mentioned how the hospital charged him $125/hour for a nurse and all
she did was bring a glass of water to the patient. Try to extrapolate that
situation to IT and see what kinds of crazy numbers you get.

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angersock
So, why is it again that we don't just run hospitals like any other civil
service (police, fire, defense), fund them with taxes, and treat the care as
something that a civilized government should provide?

Having given government a monopoly on force, it would seem that we should
expect it to heal as well. This is absurd.

~~~
cperciva
The fire department turns up when your house is on fire, sprays water on the
house, and goes home when the fire is out. Their work is well defined and
self-contained.

Medicine is a completely different situation: As people get sicker, you can
dump practically unlimited amounts of money on them to extend their lives by a
few more days. If you're not willing or not capable of deciding who is worth
treating (aka "government death panels") and don't want unsustainable
government spending, the only solution is to not get into the business at all
(and let insurance companies take the blame for saying that little Johnny's
cancer is too expensive to treat).

~~~
angersock
Then we probably need to come to terms with losing our loved ones, because
this is intractable. I'd rather have "death panels" than the current
situation.

~~~
cperciva
I agree. I just hope we can have panels which weigh diseases impartially. The
UK did this for a while via their National Institute for Health and Clinical
Excellence, measuring the cost per QALY, but now the politicians have stepped
in and decided that cancer treatments are "special" and should be funded up to
a higher limit -- which is really saying that they're willing to kill two
people who don't have cancer to save the life of one person who has cancer.

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tpurves
Downvote for problems only Americans have.

~~~
angersock
Downvote for being a shithead.

