
A CT scan costs $1,100 in the US – and $140 in Holland - alweare
https://www.vox.com/policy-and-politics/2019/12/17/21024614/us-health-care-costs-medical-prices
======
erentz
Wife recently needed a CT scan of the chest. It was the correct imaging
modality for the potential DX in question. An X-ray would be useless as it
wouldn’t show the suspected issue. First insurance denied saying we had to
have an X-ray first and that X-ray needed to be abnormal in order to justify
the CT. But this would just be a waste of time and money since the X-ray is
useless for the suspected issue in question, and then it would also
undoubtedly caused problems because they would deny the CT when the X-ray
wasn’t abnormal.

It took 3 hours of my time. About 3 hours of medical assistant time and about
an hour of two different doctors time to get this simple 5 minute CT approved.
This is all on top of the time of admins at the insurance company.

The CT was done and low and behold did show an abnormality.

The charge was around $2000 to insurance which was lowered to about $1150 by
the negotiated rates. Of which we paid the $115 coinsurance (10%). We asked
what the cash price would’ve been to avoid all this, $450.

So our 10% coinsurance is actually more like 25% of the real price. And the
insurance companies denial and absurd process could only possibly make sense
over just always unquestionably paying the cash price if 1 in 3 CTs ordered by
doctors in such a scheme was fraudulent. I seriously doubt that would ever be
the case. And that’s still ignoring the personnel cost in this example. And
the opportunity cost of those personnel not being able to spend that time on
actual medical needs of other patients.

The system is disgustingly broken in this country, we need to move to a single
payer system and get these insurance companies out of the way.

~~~
glennvtx
No we do not. The government has screwed the system up enough, giving this
government even more control is a terrible idea. Just stop enforcing
monopolies, Force providers to have a clear pricing structure and let market
forces deal with it.

~~~
ezoe
From my Non-American view, this is a classic case for the need of regulation.
The government define a set of medical treatments that were scientifically
proved, don't allow the insurance companies to deny the request of medical
treatments from the doctor.

The only problems we face is some malicious doctors requests unnecessary
treatments, or malicious doctor and patient working together to request the
money for treatments that didn't happen. But these are trivial fraud
techniques and it happens anyway regardless of context so it can be dealt with
usual criminal law system.

~~~
wincy
The Affordable Care Act (Obamacare) included mandatory insurance funding for
homeopathy, chiropractors, acupuncture, and naturopaths. My wife worked at a
chiropractors office who got paid by Medicare to shock elderly diabetics legs
while they chowed down on candy bars. Homeopathy is one of the dumbest scams
known to man, and I don’t really know about the other two but I wouldn’t call
them “medicine”. The more government there is around to fund things, the more
dumb bloat there is and we’ll get more glorified massage therapists cutting
children’s “tongue ties” and selling amber teething necklaces for $40. Let
people waste their own money on this stuff.

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pcurve
Let's call it health industrial complex.

If you have a white collar job at any one of health care companies in the u.s.
(medical health insurance, hospital, pharma, device makers, pharmacy benefits,
retail pharmacies, doctors office) you know why healthcare is really expensive
in the U.S.

There are lots and lots of white collar jobs that are extremely handsomely
paid. So many duplication of functions across competing private companies. No
good standardization. Surgeons that make well into 7 figures. Thousands of
executives making tens of millions of dollars in total comps. Thousands of
highly paid IT professionals just at one large healthcare companies.
Pharmacists raking in $130-150k. Lawyers and malpractice suits. All #1 in the
world.

Somebody has to pay for all these rackets.(of which I'm also part of)

------
Shivetya
Oh please, cherry pick all you want. Healthcare is expensive in the US because
of government, not just the industry. From certificate of need rules to
conflicting regulation at nearly all levels and unreasonable coverage
requirements that do not take the patient into account.

throw in the simple fact the US Congress cannot even be shamed into fixing the
Veteran Affairs health system nor the Bureau of Indian Services and people
dare suggest we let take more control?

fixing US health care will require a lot of work but the first step in fixing
it is realizing all the bad players involved and that simply comparing to
other systems isn't helping anyone.

~~~
anongraddebt
The fact that other countries have effective health care systems run by the
government suggests that the conclusion we should draw from the VA fiasco is
that either the U.S. government is particularly incompetent or the
incompetence is local and limited to a specific department(s). I'm inclined to
believe the latter.

That being the case, a further conclusion I would end up drawing is that both
largely private and largely public health care systems work well, but that the
U.S. suffers from running a health care system that takes no opinion as to
which form it should take.

~~~
jjeaff
Seems obviously a problem of size. Can you point to a working healthcare
system in any other country that has a population anywhere close to the US?

Comparing us to countries that are hardly as populous as one US state is not a
fair comparison.

As anyone in the tech industry should know, there are a lot of unforeseen
issues that popup when scaling something. It's rarely as easy as adding more
CPUs or more people for that matter.

~~~
computer
If that were true, then solve the problem state by state.

~~~
jjeaff
That is what should likely happen and is already the case to a point. Much of
the existing programs are funded at the state level. But the federal
government is already meddling so you can't exactly do what works best for
you. You have to follow the federal ACA rules no matter what you implement at
this point.

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m0zg
A drug for my kid's IBS costs $1400 in the US and $30 in Russia (and moreover,
it's available over the counter there). Same exact drug. Made in Italy, so
it's probably cheaper still in Italy. It's not genetic or anything else that
would justify a high price - it's a simple antibiotic. Probably costs a dollar
a gallon to make.

I'm seriously considering finding a good clinic in e.g. Israel where I could
pay cash for treatment, and giving up US medical insurance entirely.
Thankfully now I can do that without paying a penalty. $15K/yr for a family of
3, with crazy deductibles is kooky. If I get cancer or something, getting
treatment in the US would be an insane proposition.

------
mbrodersen
What is the point of the US having the worlds largest GDP when even basic
health and education is denied or difficult for large groups of its citizens?

~~~
wincy
I mean it seems bad on paper but my uncle just recently got cancer and despite
having no money is now cured. He ended up on disability, but he received
prompt treatment. It just sort of works out. My daughter was born when I was
unemployed and this actually ended up being better for us, as the private
insurance would have had a copay but instead Medicaid applied retroactively
and then covered her 8 month NICU stay. Thank you, taxpayers, for supporting
my daughters $300,000 a month hospital stay.

Maybe some people’s lives get ruined by medical debt but I’ve never met them.
People just don’t pay and even mortgage companies just sort of shrug and
barely care when you’re getting a loan.

~~~
dsign
Do you realize how many complicated terms are in your first paragraph?
Assuming that everybody can figure out how all those mechanisms work, which is
a big stretch, it is terribly stressing to have a medical need of any sort.
And I know that because I have family there.

Compare it with the single-payer system where I live: it works really well,
and I don't need to add financial stress to any doctor visit.

------
bdcravens
My wife had a series of CT scans in the ER after a car accident. I noticed
that most of them were only paid out at 1/20th of the billed rate. I wonder if
the pricing is gaming the accounting, since most people either have some sort
of coverage, or can't realistically pay (so the hospital doesn't get the full
amount either way)?

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yread
One reason also is that the workers in healthcare in the Netherlands are not
paid much. As an IT person (clinical programmer, bioinformatician, application
specialist,...) there is no way to get above scale 60 in this table
[https://cao-ziekenhuizen.nl/media/45/download](https://cao-
ziekenhuizen.nl/media/45/download) Most get ~3k some with insane amount of
experience get ~4k brutto a month

~~~
adventured
It's the same reason the median radiologist in France will earn $150,000 while
radiologists in the US can easily earn four to six times that depending on
location. I know a radiologist in the middle of nowhere - one of the poorest
states in the US, small city - earning over half a million per year, or
roughly 15 times the median full-time income there. In major cities they can
get up around a million dollars per year.

The healthcare industrial complex racket is a wealth transfer from everybody
else to a million people working overly compensated jobs in the healthcare
sector, from admin to doctors to nurses to IT workers to insurance
salespersons.

Everyone complains about the wasted money in the military industrial complex.
The healthcare industrial complex is 5x worse when it comes to that, or
roughly a minimum of $1 trillion in overspending. The reason there are so few
suggesting spending cuts in healthcare, is because there would be a never-
ending line of strikes if you attempt to slash pay. The Democrat candidates
for President for example all know we have a vast overspending problem in
healthcare, they know taxes on the middle class have to go up to match Europe
(for the same reason their taxes are so high), and salaries have to go way
down in the healthcare field to similarly match Europe, and yet none of them
dare say it.

------
AbortedLaunch
Health care in the Netherlands is mostly financed via an income dependent fee
collected by the tax authority, supplemented with a fairly minimal mandatory
insurance. Assistance for “low” income families is available to help pay this
insurance.

The per treatment budgets do sometimes cause issues where budget for certain
treatments is consumed and patients have to wait to receive treatment.

~~~
bouke
Yes, it’s 6,9% over the total gross of all salaries, paid by the employer. See
also:
[https://www.belastingdienst.nl/wps/wcm/connect/bldcontentnl/...](https://www.belastingdienst.nl/wps/wcm/connect/bldcontentnl/belastingdienst/prive/werk_en_inkomen/zorgverzekeringswet/veranderingen-
bijdrage-zvw/percentages-zvw) (Dutch)

------
eucryphia
Depends where you shop

[https://surgerycenterok.com/blog-category/veterinarian-
cat-s...](https://surgerycenterok.com/blog-category/veterinarian-cat-scan-
prices/)

------
tsukikage
"but the US system has to actually pay for the R&D the rest of the world
piggybacks on", goes the standard counter.

------
glennvtx
I am in the US and my Ct cost $180, because i bothered to shop around, even a
little.

~~~
atombender
Coming from a country with excellent universal healthcare, I find it absurd
that you should need to "shop around" for any procedure.

~~~
exclusiv
For this case, it is silly for a CT. However, for procedures and surgeries,
not all doctors are equal. Do you have any choice in your country?

~~~
atombender
Yes, you can absolutely choose. There's a web site for finding
hospitals/clinics for your particular procedure, although your doctor can also
refer you directly. The web site tracks the wait time and (often) publicly
available quality metrics collected by the health authorities. Travel expenses
are covered to some extent if you don't want to use your local options.

------
nkkollaw
Next on Vox: "Magic mushrooms are illegal in the US — but they're legal in
Holland".

~~~
Bubbadoo
Actually, Colorado legalized magic mushrooms earlier this year. Go figure...

------
themagician
It's pretty disingenuous when articles are written about the US healthcare
system and they don't talk about methodology for how they determined the
price. It's absurd that a methodology is needed, but it is. Is it the average
price of the item on the chargemaster? Is it the average price billed to the
insurance company? Or is is the average price billed to the patient? Is it the
average price for those with insurance, those without, or both? If it's the
average price billed between insured and uninsured, is it weighted? And if we
are talking about uninsured, is it the average price billed or paid?

US healthcare is a disaster, but these kinds of articles are just promo pieces
for universal healthcare. Which I guess is the point, but I still find it
extremely misleading. I suppose this is what passes for journalism these days
though.

The only major healthcare provider I know of that posts prices actually
charged for most items, publically, is Kaiser. Even then you'd need to know
the relative breakdown of plans to determine the average cost paid by the
patient. That information may be available, I don't know.

~~~
Aeolun
Normally I think we wouldn't really need 'promo' pieces for universal
healthcare, since it's been proven to work literally everywhere (except the
US). Hell, even China has some form of universal healthcare.

------
glennvtx
My CT cost $180 in the US because i bothered to shop around.. I see these
articles all the time cherry-picking The only reason healthcare in the US is
high is government enforcing monopolies, Giving them more power over
healthcare is foolish. If you are the least bit smart you call around, that is
the nature of a market.

~~~
Aeolun
When my health is on the line, I do not want to do _anything_ like shopping
around. I want the hospital I'm currently at to do the thing for a reasonable
rate. Preferably the same rate as every other hospital in the country charges
for the same scan.

~~~
virmundi
The US is too large to have the same uniform price. The cost of materials,
rent, and labor vary radically across state lines. Second, for things like CT,
they might now be immediate. Therefore you can shop around. For example I had
an MRI. $200 after shopping around. Now it wasn’t an emergency, just a check
for cancer. Don’t let the assumed to be perfect be the enemy of the good.

~~~
Data_Junkie
The US is too corrupted with evil politicians to have adequate health care,
because you need adequate, healthy people to implement that and we have Donald
Trump and his kindred spirits. It's not rocket science, you have to care to
make changes, and they simply don't care. Melania said it best.

