
Medical equipment pricing is completely broken when a sling costs $200 - ilamont
https://www.latimes.com/business/story/2019-09-12/medical-equipment-pricing
======
brink
I just got an itemized bill today for a minor fall I took a couple months
back..

On top of the nearly $6k in other charges from the hospital, they charged $531
for one dab of superglue or "liquid stitches" on my forehead for something
that would have healed by itself.

One of my friends died two years ago from pneumonia. He didn't go to the
hospital when symptoms first started because he was afraid of the bills that
would come from it.

They don't ask you if you want to spend $500 for a dab of glue on your
forehead, they just do it and you're essentially writing them a blank check in
the process. I hate our medical system.

~~~
oppositelock
I went to the ER with chest pains seeming like a heart attack. They did an
EKG, determined it wasn't a heart attack, then a blood test, which determined
it was low potassium, and did a chest x-ray just in case. I received a saline
IV and potassium pills as treatment, and went home after a couple of hours.
The bill was about $18,000 for this. The insurance negotiated rate was about
$1,500, of which I had to pay about $600, then over the next weeks, I received
about 20 bills, each of which was for a large amount, bit the resultant
patient "responsibility" was about $20 - all from shell organizations like "CA
ER Physicians", or "Hospital Diagnosticians", etc. It's such a mess!

Another example was the birth of my child. We prepared for this by setting up
an FSA, and having really good PPO coverage that year, supposedly, with a 10%
copay. After all the billing shenanigans, my copay was about 30% and well
above the out of pocket maximum. How does that happen? You can go to an in-
network hospital, and be treated by a mix of providers, all of whom bill
separately. Some will be in-network, others will be out of network, so you are
in effect deducting against two out of pocket limits.

Medical billing is fraudulent. Medical insurance is fraudulent. These people
are all acting in violation of tons of existing laws - I don't understand why
this isn't prosecuted.

~~~
repiret
They’re not shell organizations, hospitals just outsource tons of stuff,
frequently including physicians. (In fact, in California, hospitals may not
legally employ physicians to practice medicine)

~~~
abhorrence
How does this work with institutions like Kaiser? Are their hospitals not
technically hospitals? Or are the physicians all technically contractors
there?

~~~
ConcernedCoder
They are all salaried employees, so Kaiser can work from a 'fixed cost'
perspective ( as told to me by a surgical nurse ).

~~~
privateSFacct
100% false! That would be totally illegal. California CLEARLY bans hospitals
from doing this.

~~~
ConcernedCoder
I mean, you can even google it like I did, from this page:
[https://www.ophthoquestions.com/posts/why-i-left-kaiser-
and-...](https://www.ophthoquestions.com/posts/why-i-left-kaiser-and-why-you-
might-want-to)

"For those who are not familiar with the Kaiser system, here is a very
abbreviated explanation. Kaiser Permanente is an HMO, and consists of the
Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente
Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and
they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried
from the pool of insurance premiums and provide service only to the Kaiser
patients. In the Kaiser model, services are prepaid, so there is no financial
incentive or penalty to providing or receiving medical care."

------
tryitnow
I went to the ER last year. They ended up making me stay overnight.

I was hit with a bill for over $10K, with much of that falling on me.

I also used to work in corporate finance and I have a good intuition for how
billing works.

Before I even got the bill I mentally prepared myself for it by telling myself
that it's going to be a long drawn out process.

I waited and waited and received an initial bill a few months after my
hospitalization. It was for the aforementioned amount.

I called and politely asked to have it itemized. Naturally,that took several
more months.

The bill was reduced, but the itemization was incorrect, so I asked for a
correct itemization.

I went through a few more iterations of this. Each time the bill got lower and
lower.

Eventually, I had to pay something like $1.5K out of pocket, which would have
been a lot less if I didn't have an HSA.

The whole process took almost a year.

If you ever have to go to the hospital, just assume that it will take forever
and nitpick the bill (within reason) and continue to challenge it. They will
often give up and reduce your bill. Whatever you do, never pay a bill that is
not itemized. As a former finance professional I am shocked that hospitals can
get away with this, this would never fly in the B2B world, professionals
always push back against "mystery bills" that show just the bottom line
number.

~~~
mwambua
What do you mean when you say the itemization was incorrect? Do you mean that
the prices that they list were incorrect, or that the items didn't make sense
given the treatment you received?

In either case, what reference do you use to ascertain correctness? I feel
like information asymmetry is a problem for a lot of patients. It's hard to
tell if you actually need a treatment, or if you're being charged fairly for
it.

~~~
brycehamrick
Upcoding is extremely common and almost never comes with any consequences.
It's routine for staff at the hospital to add line items for things that never
actually happened. I've personally seen procedure codes for neuropsychological
testing in the ER when the staff never completed those exams, as an example.
The billing codes require very specific actions to have taken place in order
for the insurance companies to reimburse. It's not often done out of malice,
the codes added are likely what should have taken place but the hospital staff
are overworked and end up cutting corners.

~~~
sizzle
This is outright fraud.. I wish I could wear a bodycam into the hospital and
have the footage confirm everything I'm billed for is actually administered
and necessary for the diagnosis I'm provided by the physician.

------
awb
Just to pile on about how ridiculous medical costs are:

After giving birth my wife was offered Ibuprofen. On the bill we were charged
$80 for the 2 pills she took. This was before Obamacare.

After Obamacare I twisted my ankle and the doctors insisted I wear a cheap
fabric boot with stiff plastic plates while it healed over the next couple
weeks. I asked how much it cost and they said $280. I took it off and refused
it while they gave me dirty looks.

A medical facility is basically a monopoly. The switching costs are high and
there are no prices on anything.

Unfortunately getting everyone insurance was only the tip of the iceberg of
the actual problem. We still have a long, long way to go before we have real,
competitive medical pricing with high quality care.

~~~
nickjj
Yeah it's nuts.

Someone I know sprained their ankle. They recommended that he should use a
cane for a while and said they had one to give him. When the bill came weeks
later it was $200 for the cane that looked really close to what you can get
for $20 at Walmart.

The really messed up thing is I drove him to the doctor and I carried some of
the paperwork out (wasn't the bill) so he could use both hands to move around
safely. When I was outside I held the piece of paper up and a gust of wind
bent the paper in such a way that I ended up with a really nasty paper cut.
Like a 2 inch slice on the inside of my finger. One of the worst paper cuts
I've ever gotten.

So I went back into the medical center and I asked them if I could get a band-
aid. They asked why, so I explained. I got a few smirks from them (they
borderline laughed in my face) and they told me that they weren't allowed to
give away medical supplies and that I should go a few blocks away to a CVS (a
local drug store). Meanwhile just to be insured costs $450 / month for the
bare minimum (which I don't pay for but I've payed many thousands in fines for
not having insurance).

~~~
crankylinuxuser
Yeah for spite, I would have bled all over their counter and caused a
biohazard mess. If you laugh at me like that, I'm not going to be pleasant.

------
ttul
My son broke his femur at school. He was transported to hospital where he
underwent surgery to insert rods. He stayed for four nights in a state of the
art, brand new children’s hospital, brimming with wireless tech. The nursing
care was top notch.

I had to pay for parking.

Once he was back at school, the school district brought out occupational
therapists who assessed his new disability and provided extra assistance while
he was wheeling around.

He has had four follow-up visits with the orthopedic specialist. In a month or
two he will have another surgery to have the rods removed.

I will then have to pay for parking again.

Welcome to Canada.

~~~
Bootwizard
Is the parking $20,000?

~~~
dwild
The parking is actually quite expensive, when my stepmom had cancer, I went a
few time with a car and it was 16$ per day. That hospital made 60 millions in
parking fees in 2015 as a reference...

That was the time I understood how lucky we are, when the final diagnostic
fell, it was the first thing that came to my mind, what would have they done
if it wasn't free... they would have to decide whether they try to give her a
few more years and pay hundred thousands, or just watch her suffer a few more
months. Sadly even with the amazing care she got, she died less than a year
later, but at least they got that time and they never had to worry about the
cost of it.

------
janesvilleseo
I’m sure going to get downvoted for this but.... I just don’t pay my medical
bills I pay my dentist and eye doctor bills since those are different. But I
just let my insurance pay their part and I walk away from the rest. I haven’t
had anything catastrophic yet. But have and do have bills in the 1,000s.

My credit score is great in the 740+ range.

I know big stuff they could take me to court or put a lien on my property.
They haven’t yet.

It’s my little protest against all of this crazy healthcare prices and system
we have here in the US.

~~~
RandomBacon
Do you go to a different dentist and eye doctor each time?

Also, if you had to go to an emergency room, would you give them fake personal
info so they can't send you bills?

~~~
janesvilleseo
I pay my dentist and eye doctors. Those are treated differently. There really
isn’t eye insurance and dentists usually have normalish prices compared to
other doctors.

I mean I can ask my dentist how much it’s going to be and he can actually give
me a price before my procedure.

But as I stated above the insurance pays their portion so it’s not like
nothing is being paid. Just not the 900% markup.

I don’t recommend doing this. I’m sure it will bite me eventually but it’s
been 10+ years. And yes I haven’t had any major or catastrophic medical event
in my life. So the bills haven’t been in the +10k range. I’m pretty sure once
it gets there they will put a lien or sue me.

I go the same facility every time. I haven’t been denied. My family hasn’t
been denied.

If I did go to an ER for something serious I would give them my real name and
info. I do have insurance and it will pay a portion. Depending on the size I
might pay it. I might not. Just haven’t had anything really large.

~~~
nickjj
I think one of the reasons why most dentists can give you a straight up price
on the spot is because they own the practice which means they are the decision
maker when it comes to prices. Plus with a dentist, there's a pretty decent
chance you're not dealing with insurance companies. With a hospital you're
dealing with a million layers of abstraction at both the hospital and
insurance company level.

I'm definitely not defending hospitals and most doctor's offices but I think
that plays some part in it. There's also a decent amount of dental competition
when it comes to routine work such as cleanings, so prices wind up staying
somewhat reasonable where as with a hospital there's no competition really due
to how insurance works.

~~~
pnutjam
I always use dental insurance and always get a price before a procedure, and I
have six kids.

------
habosa
My girlfriend fell skiing and tore her ACL. We were taken down to the
mountainside clinic. They were just gonna do a basic check and give her some
Advil and a brace.

I asked how much it would cost. They said they were not ALLOWED to tell me.
Which is different than not knowing. I told them what insurance I had. They
said many people came in with that insurance. I asked how much of the
procedure is normally covered. Also apparently a secret.

I just can't see how it's legal to bill someone for services received while
refusing to give information on what it will cost. If the bill had been $50k
what recourse would I have had?

~~~
nojvek
What are you gonna do? You’re injured. Gonna go somewhere else? Everywhere
it’s the same. The greatest scam of our time.

------
ericd
We had a call with someone who works on the pricelist/chargemaster for a major
metro hospital recently, they set their prices by taking the Medicare
reimbursement rate, and multiplying by 8.

~~~
Gibbon1
If any other business tried billing people like hospitals and doctors do,
people would go to prison.

~~~
pkulak
At least if it was an inelastic good like health care.

Gas goes up a quarter and elected officials are thrown out of office. $600 for
a drop of super glue? Okay then.

~~~
AaronFriel
That $600 is just monopoly money to the majority of constituents, because they
have insurance of some kind or they're on Medicare/Medicaid. So those people
are usually, not always, but usually fine.

And that of course is part of the problem. Medical billing is like playing
numberwang or who's line is it anyway. No two numbers on a bill seem to be
correlated in any way to another except as upper or lower bounds.

When someone without coverage comes in then, they have to play that stupid
game with all the numbers, and of course they either ignore it and go into
debt, pay the cash price if they're able, or they manage to negotiate it down
by orders of magnitude - proving the price didn't matter anyway.

------
HorizonXP
I realize that this article and the HN comments are centred on the US, but
here's a link to the Schedule of Benefits (i.e. the costs) for all insured
services that are compensated for by the Ontario Health Insurance Plan (OHIP):
[http://www.health.gov.on.ca/en/pro/programs/ohip/sob/](http://www.health.gov.on.ca/en/pro/programs/ohip/sob/)

Meaning, while most Canadians do not know what our healthcare actually costs,
it's all itemized, standardized, and freely available.

I just looked it up and was surprised to see that C-sections are only about
$80 more than vaginal delivery (we just had a kid), so it's nice to know that
there isn't much incentive for doctors to push one over the other. I realize
that's a gross oversimplification, since there's probably a lot of other
billing codes that get tacked for surgeries.

~~~
metaphor
Thanks for the reference. I'm not Canadian, but it was _very_ enlightening to
browse through and surprisingly well organized.

------
dhdudxbeub
When my wife was 25 weeks pregnant she started feeling ill and we noticed her
blood pressure kept going up. We went to the hospital. Turns out she was
pretty sick she so they made her stay for 4 days.

A few weeks later we had our son’s ashes and a $148,000 bill.

~~~
tehlike
Adding insult to the injury. Im sorry for your loss...

We lost our first, and er visit costed us much less. Few thousands... Didnt
have the energy to fight that time...

~~~
dhdudxbeub
:( sorry - it sucks

We had insurance so we didn’t pay that crazy amount but it’s just absurd what
these places charge.

~~~
tehlike
I was assuming that. Even still, 148k bill, and an unimaginable situation is
still a shocker.

I am willing to fight, even though my out of pocket is also very small.

------
jmugan
Some states have price gouging laws to keep people from being taken advantage
of when they are in a vulnerable state, you can't charge $30 for a gallon of
gas after a hurricane, I don't understand why hospitals are any different.

~~~
sjg007
That'd be a good argument to try. It would probably work.

------
WA
As a German, this whole thread reads entirely bizarre. The US health system is
the blind spot of the nation. The kind of fuckery you people have to endure
every day and the kind of thought processes it requires, is astonishing.

As a German, you don’t have to spend any brain cycles on health insurance or
medical costs. If you’re self-employed, you maybe need to think about getting
private insurance. Besides that: health care is just there for you. You don’t
have to pay almost anything from your own pocket (besides glasses and some
depending on the age).

The financial aspects usually can’t ruin you. Prices are "normal". I had a US
friend over a while back. She had a tooth ache. The dentist fixed it and the
bill was like 180 bucks or so. She couldn’t believe how cheap it was compared
to the US. And this wasn’t some shitty job with inferior materials or
whatever.

~~~
stjohnswarts
Why is insurance tied to "employers" in Germany? That seems antithetical to
the "healthcare for all" that I keep hearing about Germany and other European
countries. Why would a private contractor be on their own for health care?
Taxes? I mean even as a contractor I still have to pay taxes like everyone
else.

------
yalogin
The whole ecosystem has evolved to loot people when they are at their most
vulnerable moment. There is no two ways about it. It goes unchecked because
insurance companies cover a bulk of the cost and so most ordinary people don't
see it. The poor and uninsured get the bad end of the stick but no one cares
about them. Just a pathetic state of affairs.

------
isostatic
I live in the UK. My father had a stroke a couple of days ago. He’s in
intensive care on a ventilator.

Total bill so far: £2 parking. Also the coffee machine in the relatives
waiting room was out of sugar.

~~~
ianmcgowan
I'm from the UK, but live in the SF Bay Area, and this is the single biggest
thing I don't get about the US (with education costs being second). I kind of
get the libertarian view of not wanting to trust the government but when the
alternative is some kind of Mad Max dystopian hellscape (where people are
literally dying), surely looking around the world for alternatives that
actually work makes sense?

~~~
sarcasmOrTears
It's not libertarian. The US system is cronyism, statism at its finest,
possibly illegal. Honestly, I think with current US laws and a willing
political force, a lot of top players in the current US healthcare system
could be punished, even with the death penalty (especially if reinstated at
the federal level).

Dreams aside, in order to have a free market healthcare, which is what
informed libertarians want, you need to abolish medical license, the FDA,
patents and many other State's interventions. There is a reason why the
healthcare system in the US is insane, and it's because the laws are made so
that cronies have the monopoly on your health. Neocons are pathetic when they
defend the current system.

Without the free market (the real one, not the scam you have in the US),
healthcare will be a mess more than any other industry and at that point is
better to have a single payer, universal system, because in the end they have
the same problems of the current US system but at least you don't get ruined.

~~~
lotsofpulp
A functioning market is one where multiple market participants exist (both
buyers and sellers) and both are able to make educated choices.

How can a market like this exist when the buyer is incapacitated, not to
mention even when not incapacitated, the buyer is not sufficiently educated to
understand what they are buying?

~~~
sarcasmOrTears
You could buy the services of an expert in medical decision-making who will
negotiate for you when you're incapacitated.

Also, supposedly people aren't total dicks. At the moment the healthcare
industry rewards a lot of psychos due to its incentives. Hopefully with a free
market the dicks would be weeded out due to increased choices. Also having a
free market means that there would be an incentive to make medicine more
accessible, while still correct, because more people could be willing to
become healers, maybe specialized healers. Who knows, what's certain is that
we have not discovered the full potential of humans healing other humans and
the current regulations are a big brake on new systems and innovations.

So, for now I'm ok with the whole single-payer/universal healthcare deal.

~~~
stjohnswarts
Or you can just not do free market on something that should be a human right
given the capabilities of modern medicine. It shouldn't be left up to market
forces to decide who gets help. That kind of makes sense for some things like
TVs and laptops but not life and death when for the most expensive items your
only choice is life and death.

------
eblanshey
If healthcare costs are so astronomically high, why are so many Americans
supportive of mandatory insurance that forces insurance companies to pay those
prices? It sounds as bizarre. It's like if a normal pair of shoes cost $1000,
and people decided shoes are a right and everyone should subsidize each
other's $1000 shoes. How about fixing the root problem first: a pair of
regular shoes shouldn't cost a thousand dollars! Find the laws that enable
this to happen (patent, IP laws, etc) and change them! Forcing everyone to pay
those prices seems to mainly benefit the very people charging those ridiculous
prices and enables it to continue.

~~~
stjohnswarts
A lot of rural areas tend to vote for their party rather than for what makes
sense.

------
droithomme
_> Hillary Schuler-Jones, a Breg spokeswoman, declined to answer questions
about the price of the Deluxe Shoulder Immobilizer. “It is important to note,”
she said, “that Breg’s customer is not the patient, but the healthcare
provider.” In most cases, “we don’t sell our products directly to patients,
and we therefore don’t have a patient price list.”_

This is pretty infuriating given that the article previously said that Breg
_directly billed the patient_ in a "surprise billing".

A company with seemingly no connection to the hospital directly bills the
patient $200 for a $12 item and then when asked about this by a journalist
says "We don't sell direct to patients" and refuses all further comment.

If they don't ever sell direct to patients then the bill must be fraudulent,
sent by an imposter.

Curiously enough last year I received one of these sorts of fraudulent scam
bills. A traffic camera ticket. It had my name but no street identified, no
license plate or car description, no drivers license number, and no photo of
the alleged infraction. The mailing address was to a location far away from
the city, neither location which I had driven in recently, and the company I
was supposed to write the check to didn't have a lot of information about who
they were online. I was not allowed to contest it unless I signed an agreement
to accept private arbitration results. I went to the city it allegedly came
from and asked at their courthouse about it and the clerk told me "You are
required to pay this" but said she was not able to verify anything about the
ticket, give me a license plate number, or the name of an intersection or
photograph, referring me instead to the arbitration and saying that "privacy
laws" prevented her from saying anything else. So I didn't pay it, ignored it
and never heard about it again. As far as I'm concerned it was a scam. If it
really came from the city it was unconstitutional because there was no due
process. It also wasn't served, it was mailed bulk rate and not even
registered, which such mailing is not a valid server process in this
jurisdiction.

Given that this company Breg says they don't sell to patients, the patient has
a legal basis for refusing to pay this bill claiming to be sent from them,
because the company itself has claimed in an official statement to a
journalist that the bill is fraudulent.

~~~
RandomBacon
> asked at their courthouse about it and the clerk told me

Sounds like they were in on the scam. What would be the appropriate method to
legally-resolve this and shut it down?

Contact the state's Attorney General?

------
arbuge
I was charged $50 for 2 tylenol when I had my appendix taken out. The CVS down
the street would sell you a 24-pack for $5.

Of course, that was just a minor component of the final $50,000 bill ($4k for
me after insurance), but it still sticks out in my mind many years later
because it was an easily comparable baseline.

Health insurance companies get alot of the blame for the broken healthcare
system in America but I place most of it on the providers - doctors,
hospitals, and drug companies. They bill an order of magnitude too much.
Sometimes more. Attacking doctors seems to be a much less politically
palatable option than attacking big insurance corporations, even though those
doctors are essentially gouging their loyal patients with no qualms about it.

~~~
brandoncordell
The hospital charged me $1,700 for 1.5mg of xanax during a 3-day stay. It's
utterly ridiculous what they're allowed to get away with.

------
14
I live in Canada. I have visited the ER probably 5 times in the last year with
different kid ailments. I pay MSP about 30$ a month CAD and that covers me and
my kids. I do pay out of pocket for medications but any visits to the doctor
or hospital are completely covered. Work benefits covers 80% of the meds I
have to pay out of pocket. I don't have to second guess when to go in I just
go in when things get bad, no questioning will this visit leave me financially
unable to feed my family and take care of my health in other ways. I just go
in. I hope you guys get something better working for you.

------
yumraj
This is identical to what had happened in my case, the patient was my son who
had fractured his arm.

Had taken him to Stanford Emergency, he got a a cast and a really cheap sling.

Received a bill from a Texas based company, don't remember the name, for about
$200-$300, for the sling. Looked online, there were bunch of BBB reviews about
this, including about calling them where the issue was settled. Same sling on
Alibaba.com was $1-$2.

I called them up. I was told we were out-of-network for the sling, even though
Stanford hospital was in-network. However, since we were in CA, we are kinda
protected if we don't know this (in/out of network) in an emergency room.

I had the option of asking Stanford and insurance company to refile, or pay
them $20 (from original invoice of $200-$300). I paid them $20 to settle the
claim.

------
cosmodisk
Reading this in Europe.I'm sure if I'd go with article alone to my American
colleague on Monday, he'd defent the system even if he'd have to die for it.
Knowing he's a healthy 20something man with affluent parents that could
potentially bankroll even a year's stay in a private hospital- I could
understand it to certain degree, however I fail to understand why nobody
really is up for changing this system,where millions upon millions left woth
no choice but to struggle anything but basic medical care.

~~~
mikeash
Essentially everyone wants to change the system. The problem is that half of
the voters want to fix it by having the government provide universal coverage,
and half want to fix it by getting government out of the picture as much as
possible and letting the market solve everything.

~~~
crooked-v
Of course, when it comes to health care, 'letting the market solve everything'
actually means 'letting poor people die'. Sometimes it even means 'letting
poor people die because poor people deserve to die' (look up prosperity
gospel).

------
danans
I have very good insurance by US standards through my FAANG employer. My son
recently got a full body reaction to poison oak exposure. No hospitalization,
just a couple dermatologist visits, 30 minutes each.

 _After_ insurance paid its portion, I got a bill for $800 in out-of-pocket
charges.

~~~
refurb
How much of that was your deductible?

Generally really good insurance has a 10% co-insurance charge. But the first
$X amount is entirely borne by you.

------
alluro2
Writing this from basically a 3rd world country, Serbia, which you might have
heard of in context of a series of armed conflicts, civil wars and highly
corrupt governments (current one being orders of magnitude worse)...Even after
all that, and civil infrastructure and industry having been bombed back 50
years into the past (by NATO), we still have free high quality education and
free healthcare...Those are simply the basic functions of a society - a lot
can not function and be in a bad shape, but if you don't have these - what
_do_ you have from a government? How the US managed to get it perverted to
this extent, is beyond me...

------
thayne
I don't understand the arguments that private health care is better because of
competition. What competition? I can't comparison shop for health insurance,
if I don't use what my employer chooses I have to pay thousands of dollars
more in premiums for an even worse plan. And then I am limited in the
providers available by the network. Not to mention that comparing prices is
impossible when you don't know the price until months after you receive the
service.

------
kbutler
My son had a minor in & out surgery earlier this year. Could have done it in
the office, but the doctor recommended a surgical center that was out of my
insurance network. "Our patients have been very happy with the price."

I called the surgical center, and was told it was a flat fee of $500, payable
in advance, for which I received a receipt: "Facility fee".

We did the surgery. The doctor's bill was well under a thousand dollars.

Almost six months later, the surgical center sent a bill to my insurance for
$48,000 as a half-dozen line items, each listed as "facility fee". My
insurance says they paid $25,000 and the patient responsibility of about
$10,000.

We haven't seen a bill from the surgical center, and I told the insurance it
was either a billing error or fraud, as it was 100x the price I was quoted and
accepted up-front.

------
diogenescynic
Reposting s comment I saw on something similar:

>My wife has Stage IV breast cancer. She has been a public school teacher for
20 years and we have pretty good health insurance. She continues to work. She
will teach as long as she can because she wants to...and financially she will
need to.

>Even with good health coverage, we have STILL spent thousands of dollars the
past couple years out of pocket. If/when she takes medical retirement, it will
get much worse. It will cost her 75% of her retirement income just to purchase
health insurance. The rest will go to copays, gas for hospital trips, etc. Oh
by the way, we still pay thousands in federal taxes each year, while
corporations and the rich avoid most taxes and pay very little. It's fucking
criminal. Fuck everyone who developed this system and fights to maintain it.

From this thread on medical bankruptcy being a uniquely American phenomena:
[https://www.reddit.com/r/politics/comments/d10ab6/medical_ba...](https://www.reddit.com/r/politics/comments/d10ab6/medical_bankruptcy_is_an_american_scandal_and/ezgp0mc/)

~~~
Ididntdothis
I have seen this with people who had cancer. Even with insurance they slowly
got sucked dry. They spend hours and hours on the phone with insurance and
doctors and if you don’t have a lawyer on retainer or really good nerves all
the billing mistakes slowly bankrupt you. It’s a horrible system where the
patient is just a football to be kicked around between hospitals, doctors and
insurance.

------
golover721
Another thing that bugs me in the whole "medical cost" disaster that is the
USA. Whenever you talk to Doctors or other medical practitioners about the
situation they blame the hospitals, or the insurance companies or <fill in the
blank here> but ultimately they are complicit in the mess, but they don't want
to rock the boat, its just shameful.

~~~
chillacy
The whole system of massive school debt and massive salaries for doctors
resting on the AMA artificially limiting the supply and scope of doctors? Yea
I'd say so.

~~~
Paul-ish
> AMA artificially limiting the supply and scope of doctors?

I see people say this, but what does this mean? Should we not certify our
doctors? Should just about anyone be able to hang out their shingle?

~~~
tlb
You could increase the supply of doctors without impacting quality, by
training more doctors. Medical schools are the main bottleneck, and their
sizes are regulated by the AMA to constrain supply.

~~~
lotsofpulp
Schools are not the bottleneck, residency spots are the bottleneck. Residency
spots are governed by the federal government (Congress) and someone, somewhere
must be lobbying to keep the number of spots low.

[https://www.huffpost.com/entry/who-pays-for-resident-
sal_b_1...](https://www.huffpost.com/entry/who-pays-for-resident-
sal_b_12967008)

------
narrator
This is why I like Kaiser so much. If you make it to a Kaiser emergency room,
and you have Kaiser health insurance, you are not going to get an out-of-
network surprise bill. Everyone at Kaiser works for Kaiser and is paid a
salary by Kaiser and the Kaiser hospital is the only one that bills you.

~~~
sprucely
Kaiser is great for critical care and general practitioner stuff. But they do
most of their cost-cutting in specialty care; the stuff that is rare or tends
to not be easily diagnosed while having a major impact on patients' quality of
life. Just lookup lawsuits and Kaiser mental health.

~~~
smsm42
Same experience here: routine care is ok, emergency care is great, hospital
also pretty good, but trying to get them to refer you to proper specialist and
figure out what's wrong when you yourself don't know it (e.g. not a cold or
broken leg when it's obvious but kinds of conditions where you may need to ask
several specialists to figure it out) is a long uphill battle and they are
very reluctant to cooperate. It's a bureaucracy which likes doing what they
know and hates complex cases and exceptions.

------
lightgreen
The hospital sling was $200 according to the article.

Amazon sling is $12.99 to $16.99 according to the article.

So hospital sling is 12-15 times more expensive.

So I suspect that the original writer of the article correctly wrote that
hospital sling is 10 times more expensive.

Then the editor came and decided that 10 times more expensive looks not as
scandalous as 900% more expensive.

The result is false precision
[https://en.wikipedia.org/wiki/False_precision](https://en.wikipedia.org/wiki/False_precision)
and bad journalism.

~~~
jameshart
I have no idea what you're complaining about here.

If they had taken the $12.99 price (an actual exact price, with 4 actual
significant figures of precision), the $200 bill (also an actual price paid,
with five significant figures of precision) is actually, _really_ -not-false-
precisely, 1440% more expensive than amazon.

They allowed in the article that the sling might be a bit nicer than the ones
on amazon - it had some padding. So they rounded its value up to roughly $20,
giving, as you suggest, 10 times more expensive, as an estimated factor. Let's
assume that's only good to one sig fig. That's fine for an estimate, and
consistent with the 'probably worth a bit more than the ones on Amazon, let's
say somewhere between $16 and $25' methodology.

"900% more expensive" is a perfectly accurate restatement of "10 times as
expensive" to a single significant figure. Would you rather they went with
"1000% more expensive" to make it feel more Benford's-law-comliant in its
imprecision? That would surely have _helped_ your supposed sensationalist
editor, right?

"900% more expensive" is _literally just another way of writing_ "ten times as
expensive".

So I really don't know what kind of editorial sensationalism conspiracy you
are trying to posit here. Wouldn't a sensationalist have gone with the 1440%,
and nefariously rounded it up to 1500% to punch up the headline?

This seems like a weak place to try to hang an argument about the innumeracy
of the press....

~~~
lightgreen
> "900% more expensive" is literally just another way of writing "ten times as
> expensive".

No, it is not.

Same way as "ten times more expensive" is not the same as "10.000000 times
more expensive".

Using percentages here implies high precision.

> Would you rather they went with "1000% more expensive"

"10 times more expensive" sound just right.

> I really don't know what kind of editorial sensationalism conspiracy you are
> trying to posit here.

Sorry, no sensation here. Just false precision which is a bad sign.

------
robomartin
The cost of medical equipment in the US often has very little to do with the
BOM costs (Bill of Materials, the cost of the parts required to manufacture
the product). Medical equipment providers have massive and onerous regulatory
burdens on top of certification requirements. Even a relatively simple product
an cost tens of millions of dollars to bring to market after design and
engineering is completely done.

This is one of the key problems with the US healthcare system and why talk of
this or that insurance scheme (regardless of content) is absolutely
ridiculous.

To use a parallel, it's like talking about selling a $10 burger for less
without changing the underlying cost structure that causes a burger to have to
be sold for $10.

Anyone who proposes a "new and improved" insurance scheme betrays an utter
lack of understanding of the most fundamental of concepts: If you don't do a
thing about baseline costs there is no insurance-based solution that can ever
"fix" the problem.

This means taking a very hard look at the cost (in time and money) of the
regulatory burden as well as the other element of that cost structure: Tort
reform. Both of those factors increase the cost of absolutely everything even
remotely related to the medical industry. Fix that first and then medical
insurance will magically become cheaper and better.

------
rolph
i wonder if a hospital would still charge you if you refused thier price gouge
materials and used your own purchased at a proper price, as in "thanks for
setting the bone, i dont need your sling i have my own and it will do fine,
here is my lawyers contact card."

~~~
coreyoconnor
IIRC prior to being treated you agree to be financially liable for the costs.
Prior to even knowing that that will be or even the costs involved. Or even if
you know what is involved are you going to understand what a reasonable cost
is? EG: Sling is easy but what about a x-ray study? Is that 200$ or $150?

Just like a proper capitalist system! You know, like when you agreed to pay
whatever for your iPhone prior to even know it'll work.

~~~
inetknght
> _You know, like when you agreed to pay whatever for your iPhone prior to
> even know it 'll work. _

I can contact Apple for help with any issues I have with my iPhone. I can
contact my carrier for any issues I have with my iPhone. I can return my
iPhone within a grace period if I don't like it.

Try doing any of that for medical costs.

~~~
coreyoconnor
For fun I do this: I ask them how much it'll cost upfront. (they can rarely
even give bounds). Ask about refund policy (?!?!?!). Tho must be done nicely
as the person handling the questions is no way responsible for the absurdity.

I know these won't actually succeed in adding a bit of capitalism but it does
succeed in highlighting the absurdity.

------
pxeboot
Has anybody ever hired a high powered attorney to challenge medical billing in
the US? This feels like something one or two successful lawsuits could change
really quickly.

Hospitals seem to have done an amazing job of charging just enough after
insurance for the upper/middle class to be willing to pay to avoid hurting
their credit scores, but so much that everybody else just doesn't pay and
files for bankruptcy if anybody ever comes after them.

------
sangd
It's not the hospital alone. I went to my Kaiser optometry for my wife's
glasses yesterday, and they said it would cost $375 for her pair. Her
insurance would cover $175 + $100 discount, and the rest she has to pay. She
has a Platinum coverage with Kaiser.

We went home and she ordered 5 pairs online for $50. The anti-reflective
coating cost $90 at Kaiser, but only $6 online.

Fortunately, I don't wear glasses.

~~~
ianmcgowan
Kaiser is actually the best/most European option, if it's available to you.
This exact thing happened in my family, but the lesson I took away is being
grateful to Kaiser for letting us know the price ahead of time, and all but
forcing us to go a different (much cheaper) route for my wife's glasses. Don't
hate the player, hate the game, and all that...

------
chanon
I live in a developing country ... Thailand.

Reading things like this, stories in this thread, and about how people are
avoiding seeing the doctor because they're afraid of the bills ... makes me
realize in some ways Thai people actually have a higher quality of life than
many in US in this respect.

Costs are order of magnitude(s) lower. A night in the hospital is typically
5,000-10,000 baht or $166-$333. And the quality of care is at a good standard
.. so much so that Thailand has become a Medical Tourism destination:

[https://www.health-tourism.com/thailand-medical-tourism/](https://www.health-
tourism.com/thailand-medical-tourism/)

If you have some money, you can pay more for faster service and more attentive
care at more expensive private hospitals.

And if you can't pay, you are still covered by Thailand's Universal
Healthcare:

"What Thailand can teach the world about universal healthcare"
[https://www.theguardian.com/health-
revolution/2016/may/24/th...](https://www.theguardian.com/health-
revolution/2016/may/24/thailand-universal-healthcare-ucs-patients-government-
political)

"Thailand: At the forefront of Universal Health Coverage"
[https://medium.com/health-for-all/thailand-at-the-
forefront-...](https://medium.com/health-for-all/thailand-at-the-forefront-of-
universal-health-coverage-d1bb9c0c3e79)

Thailand is a relatively poor country, but we are still able to do this. In
the US, I guess some people would rather die than admit needing help from the
government ... or trying to clamp down on healthcare costs cause it would be
too much 'regulation'?

~~~
m101
Sounds like people should take some time off work and fly to Thailand for
treatment. Any reason why there isn't more medical tourism?

They do this in the UK for getting dental treatment in Eastern Europe where
fillings can cost €20 each.

~~~
javajosh
Well, one reason people don't become medical tourists are concerns about
quality. Americans in particular are still convinced, despite ample evidence
to the contrary, that our medical system is the highest quality in the world -
and that this justifies the costs.

I believe this is false. Healthcare quality is basically the same in all
first-world countries, the only difference is cost structure. (My wife had a
c-section in Germany and our total cost was about 100 euros for an optional
private room.)

~~~
chronial
> Healthcare quality is basically the same in all first-world countries

While this statement is correct, my understanding is that there are still
small quality differences, and the US is in fact the word leader in quality.
Thinking about it, this also makes sense – if you are willing to pay extreme
amounts to doctors, you should also see at least some improvements in quality.

But we are talking something like <1% better quality for +100% the cost, so
this is clearly not worth it. But if I was a billionaire with a difficult
disease, I would definitely at least consider going to the US for treatment.

------
drtillberg
Does anyone else find this business arrangement between the DME provider and
the hospital to be fishy?

> they dispense the product on Breg’s behalf and Breg follows up with its own
> bill.

My intuition tells me that this relationship may have generated a little side
hustle for the hospital, which if it really occurred would be extremely
illegal. That reporter should dig a little more.

------
blhack
Has anyone here ever worked in this industry? I'm curious what the
justification for these prices is?

I can't imagine it is quite the scrooge mcduck caricature where the people
reaping these profits are literally _trying_ to defraud people. I would love
to talk to a health insurance insider or something and ask them to justify
this stuff.

~~~
noelsusman
I've spent my whole career working for hospitals primarily dealing with cost
data.

There's not much incentive to create a sensible pricing structure because very
few patients actually pay the posted prices. Most revenue comes from the
government or insurers, and neither of them give a fuck what you charge for a
sling. Hospitals have limited resources, and dealing with insurers is a big
enough operation as it is. Most chargemasters are created by multiplying
acquisition cost or Medicare rates by some absurd number (typically 8-10) and
calling it a day.

Frankly, I see this whole thing as a red herring. I get why people get upset
about it, but if you ended this practice then the money would just shift
somewhere else. Hospitals are mostly non-profits with small margins, so the
money has to come from somewhere. Instead of charging 10 times cost for
everything they would just dump it all into a generic fee. This kind of stuff
isn't actually relevant to the core problem of why healthcare is so expensive
in the US.

It's definitely not a scrooge mcduck caricature situation. Like I said, most
hospitals are non-profits who post their financial statements online. You can
probably go look at your local hospital's statements to see what kind of
margins they're working with. There are exceptions, but I'd bet they're pretty
low.

~~~
Paul-ish
Non-profit just means they don't pass money on to shareholders, right? That
doesn't mean there isn't management taking a large cut. Recently a hospital
near my family was bought up by CHI[1], making them the only game in town. Is
there any reason to believe prices wont go up?

* [https://en.wikipedia.org/wiki/Catholic_Health_Initiatives](https://en.wikipedia.org/wiki/Catholic_Health_Initiatives)

------
exabrial
Yes it's called lack of competition. It's hard to blame them when you face
jail time for offering an alternative

------
socialist_coder
Is any organized collective action from the public possible here?

What if we had a service that would take your itemized bill and spit out the
fair market prices. Then, you would tell the hospital/doctor/insurance that
you would pay this price and nothing more.

If enough people did that, could it actually work?

------
sparrish
Reminds me of the brief hospital visit I had in Paraguay where I needed to
have a friend or relative always with me because the hospital didn't stock
anything. If ibuprofen, bandages, syringes, antibiotics, etc were needed, the
hospital staff would tell me and I would have my friend or relative run across
the street to buy the necessary supplies from one of the pharmacies so the
doctor or nurse could treat me.

Cheap hospital bill, cheap pharmacy bill, pain in the butt for my friends and
relatives.

------
KboPAacDA3
Would this change if the government paid 100% of the bill?

------
blackflame7000
The insurance wouldn't be so much of a problem if things like saline solution
didn't cost $595 (personal experience)

------
etairaz
Such a long article, and the reporter never bothered to talk to a doctor and
get reassurance that indeed the hefty price of the sling is unjustified. This
isn't journalism, it's gossip. Sling may or may not be overpriced. Amazingly,
you can't tell from this 1000 worder

------
iamgopal
Why medical tourism not a big thing ? All incidents mention could be cure in
India at nice competent hospitals at fraction of this bill including air
travel. What is the biggest problem in this space ?

~~~
paulcole
First sentence of the article:

> Cathy Birker-Hake tripped over a hose in her Valley Village backyard not
> long ago, dislocated her shoulder and made a beeline for the emergency room.

Nobody’s hopping on a plane to India with a dislocated shoulder.

------
kartayyar
I went to a travel medicine clinic, and got two shots.

The cost for the shots was ~200$, and ~300$ for consultation, which was a PA
giving me printouts about information of what diseases are found in which
countries.

What a scam.

~~~
Keverw
Interesting. I know some places require yellow fever but think that’s the only
one commonly required. Seems common for South America. I think a world cruise
be fun if ever rich enough so sounds like would need to get it.

Personally not a fan of vaccines for multiple reasons, but I got a feeling at
some places if you just wanted only what was required they’d try to convince
or guilt you into getting the others. Maybe though if knowing you are going to
go on a trip where you need it, get it elsewhere... say you go vacation in
Europe, probably cheap enough to self pay even without being covered by their
insurance. Plus the ingredients can vary by country too. I guess the one
approved for Canada and the one approved for the US are different yellow fever
wise.

------
agumonkey
I asked MDs about that, beside the normal certification fees there's also
market dynamics at play. They know they can raise prices because hospitals and
doctors can spend more.

------
ck425
Shit like this makes me incredibly grateful for the NHS. It's one of the best
things about the uk and I'm incredibly proud to be joining it next month.

------
novalis78
The sling for $400 is what triggered my personal ‘down the rabbit hole’ of the
in-transparent hospital cartel system. pricepain.com was one outcome.

------
dmh2000
Where does she get insurance for 1500 annually? 'And that doesn’t include the
nearly $1,500 she pays in annual insurance premiums.'

------
mexicanandre
Australian here. We just had a baby. Emergency c-section - 5 night hospital
stay,

Amazing care. Amazing team and happy healthy wife and baby

Total cost? $0

Yep we do it well

------
jmpman
What does the same medical equipment cost in countries with nationalized
health care?

------
sabujp
ibuprofen also costs $80 a pill at a hospital ..this was 7 years ago, no idea
what it costs now!

------
lightedman
You think $200 for a piece of cloth is bad?

Lil 8mm screw in my leg. I got a bunch. $800 each. TLSO brace, $4,000.
Literally a modified dirtbike chest and back plate.

The medical system is entirely broken. Ditto the insurance system.

------
nextstep
Medicare for All! Please fix this, America

------
HillaryBriss
yes. something is very wrong. everyone in America has known that for decades.
the LA Times very often states the obvious in its headlines.

------
supernova87a
Well, popcorn in a movie theater also costs 10x more than it should, because
they have you as a captive audience.

And it doesn't help that the price is basically opaque and paid for by
insurance, for a person who doesn't care about the price at that moment.

It's a ridiculous system.

~~~
altmind
Movie theater does not give you the popcorn and tell you the price a week
after. Also, you can say no to the popcorn in a movie theater; you cannot
control the fine details of your treatment.

~~~
blisterpeanuts
A movie just isn't the same without popcorn :)

And you're a captive audience; they don't allow you to bring in your own
supply.

~~~
salawat
This is why I've considered and End-Server License Agreement. In providing
service to me as a User, yada-yada-yada yada.

If I actually went through the trouble of formally writing one up, and
spreading it far and wide on the winds, and could actually get a significant
portion of the population serving it in instances of predatory policy/pricing,
and refusing the product such that a meaningful impact was made on service
provider's bottom line, I've often wondered whether or not an equilibrium
could finally be established where businesses stopped looking at customers who
don't complain as people not yet sufficiently fleeced.

------
AnimalMuppet
You know, I've recently seen here on HN complaints about "product
substitution" at Amazon - getting, not what you ordered, but something that
Amazon thinks is equivalent. I'm not sure medical supplies is where you want
that to happen. I'm therefore not sure that the comparison of price to Amazon
is fair.

Note well: Yes, hospitals also gouge you. I am not claiming otherwise.

~~~
kjksf
Clearly they used Amazon as a proxy for "place you can buy it".

The important part is being over-charged 900% over retail price, not the exact
retailer you buy it from.

Also, it's a sling, not an anti-HIV drug. Hardly a "medical supply".

------
georgeburdell
So I work in manufacturing. On one of our systems, we recently upgraded the
fleet to a $10k computer with a 22nm processor running RHEL 7 supplied by the
system vendor. We had all of the install files and could have bought a $2k
computer and gone through an extended install and qualification process, and
closing the door to some support from our vendor, but we didn’t. We paid the
extra $8k for a guarantee that it would just work and that we could get the
exact same computer for years to come.

I see these high prices for what appear to be commodity items in a similar
light. You are paying for a certain amount of comfort that the sling will just
work. Amazon is not going to care if the sling, which might be a cheap knock-
off, rips apart while you’re walking and unseats your unhealed bone.

~~~
mdorazio
Here's where that analogy falls apart: If your 10K computer fails, your vendor
will fix it under the support contract for free. If the hospital-provided
sling falls apart and you go back to the hospital, _they 'll charge you
again_. In most cases, the product is the same one you can get yourself
elsewhere, and it still doesn't come with a guarantee.

~~~
kube-system
While that is absolutely true, there is a level of confidence in knowing that
the one from a hospital was sourced from a legitimate supplier and that it
likely meets some level of quality control standards, legal standards, and
supply chain controls.

But this is more of a criticism of Amazon than anything, as those things would
be true for a drugstore as much as it would be for a hospital.

~~~
mdorazio
Agree on that - things sourced from Amazon are increasingly likely to be
suspect quality these days.

