
Your heart attack bill: $3,300 in Arkansas, $92,000 in California - sinnerswing
http://money.cnn.com/2013/05/08/news/economy/hospital-bills/index.html
======
jonnathanson
Mildly apropos of this topic, I've had the same surgery (kidney stone removal,
sorry for TMI) performed in both California and Arkansas. Random! Fancy my
chances of seeing an article like this.

The procedure in AR was much cheaper, involved less invasive and expensive
procedures, and was performed every bit as competently, if not more so.

When I look back at the experience, I think a lot of it came down to the sheer
amount of redundancy and unnecessary procedure baked into the treatment in CA.
I could speculate about the reasons why (fear of litigation being much higher
in CA, for instance), though the article does a good job accounting for some
of them.

------
curt
How is this surprising? We've completely taken the free-market out of health
care. The only way it will ever be solve is if we re-introduce market forces
back into the mix. The other problem is all the government regulations that
tie the hands of people that would do the innovating. That's one of the big
reasons California is at the extreme. They continually add requirements to
medical insurance that increase the cost. The solution is simple, let the
free-market, ie us, decide what we want.

~~~
mikeash
You can get the free market back in health care once you can convince society
in general that it's acceptable to let poor people die of treatable diseases.
Until then, it's simply a question of how it'll be heavily regulated, not if.

~~~
anonymoushn
This is a red herring. It is not surprising that the cost of care can vary
wildly when the customer cannot possibly know the cost of care before
purchasing it. Even a person with no immediate need for care cannot obtain the
best price since no hospital will provide him or her with a price up front.

"Posting prices publicly" is not the same thing as "completely deregulating
the industry" or "repealing EMTALA."

~~~
DannoHung
How shall emergency rooms operate? Also, how shall people make an initial
determination on care when no diagnostics have yet to be performed?

~~~
DanBC
"Each blood test: cost $X" "Each x-ray: cost $Y"

etc etc.

That way patients can ask the doctors if the tests are actually needed.

You're right that emergency care becomes a lot more complicated.

~~~
tsotha
>That way patients can ask the doctors if the tests are actually needed.

How does this work? If a doctor prescribes a blood test, he's already said
it's needed. Put yourself in a doctor's shoes for a minute. You told the
patient he needs a blood test. Then he asks you whether it's actually needed.

How can you possibly say "Nah, just kidding. We don't need that one"?

~~~
DanBC
One of the most important questions you can ask of a doctor is "what happens
if we do nothing?"

~~~
tsotha
That works for treatment, but not so much for tests. If you don't know what's
going on you don't know what happens if you don't do anything.

~~~
wfunction
Doctors order tests to help them choose the right treatments.

If they have absolutely no idea what the possibilities are then they wouldn't
be ordering tests anyway.

~~~
tsotha
>Doctors order tests to help them choose the right treatments.

No they don't, except in very rare cases. Doctors order tests to make a
_diagnosis_. The treatment follows from that.

>If they have absolutely no idea what the possibilities are then they wouldn't
be ordering tests anyway.

I'm not sure a doctor would have "no idea what the possibilities are" unless
you don't have any symptoms. If you don't have any symptoms, why are you at
the doctor's office?

~~~
wfunction
> > Doctors order tests to help them choose the right treatments. > No they
> don't, except in very rare cases. Doctors order tests to make a diagnosis.
> The treatment follows from that.

What I said didn't contract what you said. If test => diagnosis => treatment
then test => treatment.

~~~
tsotha
Without a diagnosis, how could a doctor possibly know the answer to the
question "what happens if we do nothing"?

~~~
wfunction
I never said without a diagnosis.

~~~
tsotha
It's pretty rare to arrive at a diagnosis without tests.

------
NamTaf
As an outsider living in a country with socialised healthcare, the US's
healthcare system honestly scares me enough to consider not working there.

I understand that insurance is almost always provided by jobs and that it can
be comprehensive if the job is decent, but I still fear the risk that some set
of circumstances may conspire to leave me uncovered for something, or that the
insurance situation might be sticky enough that although I am 'covered', I
must wear the out-of-pocket costs whilst fighting to get reimbursed. Yes, I'm
paying it every year and may never use it but the nature of insurance is that
I'm Doing It Right if I never have to use it.

I also struggle to align myself with the attitude that 1.5-2.5% of my wage is
worth more than the safety net that I and my fellow countrymen can rely on to
be mostly protected from most life-threatening health issues if and when they
need it. To me, the well-being of all of the people in my society (no matter
how poor or rich) is worth 1.5-2.5% of my wage.

It's certainly fascinating looking in from the outside as the US wrestles with
topics such as universal healthcare, gun laws, etc. It strikes me as stemming
from core philosophic viewpoints that seem to be ingrained in the US psyche
but absent from many other western nations.

In the end, I'm very grateful that I live somewhere with socialised universal
healthcare.

------
cpncrunch
The insane part is that the hospital only receives a tiny fraction of the
billed amount from the insurance company, yet uninsured people have to pay the
full amount.

The US healthcare system is broken on many levels, and I don't think anyone
has the balls to really fix it.

Some ideas:

[1] Free basic medicare for everyone, but allow people to pay for
faster/better service. This is the way it works in the UK, and it works very
well. The basic service is fine for most people, but if you want a room to
yourself or you want to jump the queue, you can pay to get US-style service.
Overall it works out much cheaper and fairer than the US system.

[2] Set up a system that allows uninsured people to get the same rates as the
insurance company. It's a bit of a scam at the moment - basically the
hospitals seem to be out to screw you if you're not insured.

~~~
aton
UK doesn't not work as described in [1], and I don't think any other country
works like that.

In the UK, if you have a certain income (as low as £8,000), you must pay for
national insurance, whether you like it or not, whether you're going to use it
or not. If you want to use the faster/better service, that is private
insurance, then you have to pay for your private insurance, as well as
national insurance, both in full.

~~~
ryguytilidie
"whether you're going to use it or not"

Wat? This is the exact use case of insurance. It protects you should you need
it, but ideally you won't.

~~~
mseebach
The point is, you're forced to pay for the government "insurance" (which is
actually called insurance, although it's not actually insurance), even if you
have private insurance on the side that pays for most things the government
insurance would, and more. Thus, "don't need it".

~~~
cpncrunch
But NI covers other stuff such as unemployment. Also, I'm pretty sure it's
still cheaper than US health insurance in total.

~~~
mseebach
No, NI is just tax. It doesn't "cover" anything.

The point still stands: even if you have private health insurance, you still
have to pay your share of the NHS, even if that share is not a line-item
anywhere.

~~~
DanBC
> It doesn't "cover" anything

Yes, it does "cover" other stuff, and gaps in your NI payments can leave you
not getting that other stuff. That's why you're allowed to top up your NI
payments.

EDIT: Also, while it's true about health insurance (if you go private you have
to pay both) it's not true for pensions. You get a reduced rate of NI if you
opt out of the national pension scheme and opt in to a recognised provider.

~~~
mseebach
"Other stuff" is state pension. Which is an earned entitlement, not an
insurance.

------
ihodes
I just want to clarify a few things, as it would be charitable to say that
there are a few misunderstandings in this thread. I am working on a company
that is trying to solve some of these issues; this is a complicated industry
that I am still learning much about: hopefully some of what I have learned
will be of interest to some of you.

The PPACA (Obamacare) is seeking to address this very issue by changing
medical reimbursement form a fee-for-service model (e.g. $40,000 to remove a
splinter and $10,000 for blood tests and $5,000 for aspirin) to a capitated
payment model with additional incentives for providing good outcomes
(providing good service). This means that a caregiving organization would get
$N a year to care for you, as a male patient with a heart disease in your mid
fifties, with N varying as demographics and conditions change.

This change will necessitate a sea-change in the way doctors and other
caregiving organizations will treat their patients. In fact, it will result in
the creation of a new type of healthcare organization (accountable care
organizations, or ACOs) with the primary purpose of bringing down the costs of
healthcare (and improving health outcomes).

This is a paradigm shift in medical practice.

CMS (Centers for Medicare & Medicaid Services) is spearheading this change;
something which would be virtually impossible to do without such a large
(read: government) player taking the first move. There are a million problems
with CMS and the government in healthcare, but this is one of the greatest
things they have ever done.

~~~
euroclydon
If ACOs are similar in spirit to corporate wellness programs, I think they are
going to take paternalism and nagging to a level we can not even yet imagine.
It wasn't long ago that we were talking about the patient who was educated
about their condition, but now it seems we're to form major financial
engagements with organizations whose central premise is that they care more
about our health than we do -- scary!!

~~~
bobbydavid
To me, the scarier thought is a new conflict between hospitals and pharma.

Currently, drug companies market directly to consumers. consumers ask for
drugs from doctors, and get prescriptions health care companies have to pay
for. Doctors have no reason to deny patients what they want (and the sexy
pharma rep keeps encouraging them too).

In the new system, the same "entity" writing the prescription is paying for
it, as well as "paying" for the cost of not taking it.

I imagine doctors will have an incentive to examine the cost/efficacy of a
drug, but pharma will hate that. To get around it, pharma will probably launch
marketing saying "if your doctor doesn't give you this drug, shes killing
you".

ACO's fighting drug companies, using the human psyche as the battleground.

------
crazy1van
Want lower prices? Encourage a system where people directly pay their own
money.

If all cars cost a $1000 co-pay no matter what car you bought, who's gonna buy
the Honda Accord? However, throw price into the mix and Honda Accord becomes a
very popular choice.

There's no huge, magical saving of money by running all medical spending
through insurance providers. In the end the doctors are going to get paid. It
is a matter of whether you pay them directly or pre-pay an insurance provider
and they pay the doctor. Insurance is about mitigating the risk of rare but
financially ruinous events (eg, cancer or serious trauma). There isn't any
risk to mitigate with a flu shot or a bad cold or a mammogram. You insure your
car against accidents, not oil changes and flat tires.

As for the poor problem, that can be solved separately by providing the poor a
stipend for health care. No need to re-architect the whole system because it
doesn't work for 100% of the population.

~~~
terio
The problem with that is that buying health care is far more complex than many
other purchases. Now doctors simply will not provide an estimate for their
services, and when you visit the doctor you don't know what kind of procedure
they will have to perform on you at the visit.

In my view the system is so screwed up that will end up socialized pretty
soon.

~~~
crazy1van
I think if people have to start paying their money, they will not tolerate
that kind of behavior from doctors. Think about when you take your car to the
auto mechanic. Generally you pay some money for diagnosis. Then if the
mechanic recommends a fix that is cheap, you let him just go ahead. But if the
fix is very expensive, you might call around several places to make sure the
price is reasonable. Of course, you'd never call around if the price was a $20
co-pay no matter which mechanic you went to.

Certainly, not the perfect analogy, but I think it points to the ridiculous
nature of our current system and how such a ridiculous system will of course
lead to costly behavior.

This analogy is for more predictable things like shots, checkups, bad colds,
etc. For catastrophic illness and trauma, that's why you have insurance.

------
djvu9
Health care in the US is the most broken one on this planet (I have been in
Hong Kong and China). It is even worse than the communism countries like
China. In China at least all the prices are listed before you decide to take
the treatment. And the price is the same for everyone. Not to mention it is
much lower than in the U.S. (abdomen sonogram is like $30 or less while in the
US you can easily get billed $1200).

The ultimate solution IMO would be globalized free market just like the IT
industry. If doctors and medical professionals from other countries can come
to the US as easy as software engineers, I would expect the cost will go down
to a level that we don't even need to be insured.

~~~
lucidrains
This is absolutely a reality I am vouching for. Right now the AMA (American
Medical Association) actively places roadblock in the way of foreign doctors
who want to practice in the US by forcing them through additional testing and
years of training. We commonly joke that the purpose of one of our medical
exams, Step 2 CS, functions to weed out foreign non-English speaking doctors
(there is a whole section of the exam devoted to english proficiency), and for
AMA to profit from the exam admission fee.

------
gamegoblin
It always surprises me to see to see my state (Arkansas) in a headline.

Just wanted to throw out there that Arkansas actually has pretty good
hospitals and whatnot. There are a strangely high number of multinational
companies (Tyson, Walmart, Axciom, JB Hunt, among others) based here who
donate lots of money to various institutions, most notably UAMS (University of
Arkansas for Medical Sciences).

------
clamprecht
A North American friend of mine went to Cuba a few years ago. He had a piece
of glass in his elbow that had been there for a few years. He knew it would
cost at least $700 to have it removed in the US, so he never did it. When he
was in Cuba, he went to the hospital to have it removed. They did it,
straightforward, normal hospital. The final bill? $7. That's SEVEN dollars
(although he paid Cuban currency, of course).

This same friend was in Papua New Guinea a few years before that (he lived
there). Similar story - he was cutting wood and hit his toe with an axe. It
wouldn't stop bleeding after a long time, so he went in to a local hospital
and got stitches. I forgot what the exact bill was, but it was on the order of
$5 (five US dollars). Again, it was a normal hospital, not some grass hut or
something.

I'm not sure what this all means, except that if I need some expensive medical
care that I am able to plan ahead for, I plan to look at places like Thailand
for reasonable health care costs. Emergencies, of course, are different, so I
may have to go to an American emergency room in that case. And I suck it up
for my yearly physical (around $150).

------
jstalin
It should be no surprise that the more government "regulates" and subsidizes
health care, the more expensive it gets. And the answer to high costs is
always more regulation!

I keep reading more about doctors who are opting out of the medicare system
and switching to cash-only services. In the name of providing care to all, the
system is breaking down and stratifying. Obamacare is an abomination of
payoffs to special interest that will do _nothing_ to reduce health care
costs.

Health care must be rationed. It is a finite good. The question is how it gets
rationed. Market forces? Private insurance? He who can pay? Whoever the
government decides gets it? The bottom line is that the more government
decides who gets it, the more expensive it becomes. There's gotta be a happy
medium, and my intuition informs me that the happy medium is closer to the
free-market side than the mega-regulation side.

~~~
clicks
> Health care must be rationed. It is a finite good.

Instead of FWD.us initiative of bringing over competent technology people from
abroad, maybe we should instead try to attract more doctors/medical
professionals from India/China into coming here.

~~~
steve19
I don't think that is the answer. Can every student in the USA who is willing
and capable of being a doctor get into med school? I would guess that this is
probably not the case.

Increasing the number of doctors produced locally would seem to me to be a
much easier way of increasing supply.

~~~
fancyketchup
> Can every student in the USA who is willing and capable of being a doctor
> get into med school?

No, but it's not because they aren't good enough. In grad school, I TA'd a
physics class for pre-med students, which were widely considered to be one of
the most miserable and obnoxious groups to teach. Each student felt entitled
to an A, even though the department mandated that only 25% of students could
receive an A. In reality, probably more than 80% of the class earned an A, and
I would have felt comfortable that most of the rest were smart enough to one
day give me medical advice.

Yet, less than 45% of people who applied to one or more medical schools [1]
are admitted (and this is a self-selected group: those without 4.0 GPAs, three
extra-curriculars, and a side-business of helping old ladies across the street
generally don't apply). I would estimate that only about the top 15% to 25% of
the class actually applied. So, from undergrad pre-med to MD, there is about a
(hand-wavy) 90% attrition rate of people who are probably smart enough and
probably willing to work hard enough, and who have the desire to become
doctors.

> Increasing the number of doctors produced locally would seem to me to be a
> much easier way of increasing supply.

I agree, but the medical profession is not willing to allow this to happen.
Each medical school has a quota, and nobody wants to rock the boat. The
trouble is, there isn't really any way to force medical schools to admit more
students.

[1][http://en.wikipedia.org/wiki/Medical_school_in_the_United_St...](http://en.wikipedia.org/wiki/Medical_school_in_the_United_States)

------
cperry
I'd highly recommend checking out the linked dataset.[1] One quick
observation: subtract Average Covered Charges from Average Total Payments and
sort to see what procedures are most overcharged: 7 of the top 10 are "207 -
RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS". Average
overcharge among those top records is 601K. What is going on that they
routinely charge 601K more than they collect?

I'm excited to see what all everyone else comes up with.

[1] [http://www.cms.gov/Research-Statistics-Data-and-
Systems/Stat...](http://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-
Data/index.html)

------
glaugh
Here's a quick and dirty visualization of the distributions for each kind of
care across lots of different hospitals:
[https://www.statwing.com/open/datasets/c5fc084c00d24cf221c17...](https://www.statwing.com/open/datasets/c5fc084c00d24cf221c1727fb9e4f179fb32e860#workspaces/3934)

Other visualizations today:

NYTimes --
[http://www.nytimes.com/interactive/2013/05/08/business/how-m...](http://www.nytimes.com/interactive/2013/05/08/business/how-
much-hospitals-charge.html)

Washington Post (low on the page) --
[http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/o...](http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-
hospital-charges-8000-another-38000/)

------
CygnusXII
I went through a cardiac event, and in the end it cost me $12,000.00 to find
out I was fine. That was just the cardiac part of the testing. I also spent a
grand or two to find out where the problem lie neurologically. Turns out the
same nerve that allows you to know you're having a heart attack, can also have
totally unrelated issues itself, and basically give false positives.

------
danbruc
A picture is worth a thousand words?

[http://upload.wikimedia.org/wikipedia/commons/f/f8/HC-
Graph....](http://upload.wikimedia.org/wikipedia/commons/f/f8/HC-Graph.jpg)

Source: [http://en.wikipedia.org/wiki/Health_systems#Cross-
country_co...](http://en.wikipedia.org/wiki/Health_systems#Cross-
country_comparisons)

------
kmfrk
Within smaller areas, too:
[https://twitter.com/HuffPostData/status/332244607805050880/p...](https://twitter.com/HuffPostData/status/332244607805050880/photo/1).

$7,044 vs. $99,690 between New York and New Jersey! Might be worth that drive.

------
Trapick
"Health care in the US is idiotic" doesn't really warrant a headline anymore,
everybody gets it.

~~~
mikeash
No, they really don't. Many people are resisting reform because they don't see
why we should change a system that they see as working well already.

~~~
grecy
Do you think it's possible to show or educate those people that in fact the
system is dysfunctional?

Any ideas how?

~~~
fnordfnordfnord
Publish data showing the disparity of medical costs across the US?

------
jusben1369
One of the problems when we discuss "healthcare" is the wide variety of price
points for healthcare. So at one end of the market you have fully insured
people asking for and/or being prescribed an array of drugs. Often quite
literally they take a new drug to offset the harsher side effects of another
drug so that it builds to the point whereby they'll start their day with 6 -
10 different pills. At this end of the market you could apply market forces
and have significant results. If people more fully feel the burden of cost
with those drugs they might very well tackle the underlying causes around
obesity, diabetes etc. "If you could drop 30 or 40 pounds you'd probably find
you're spending $200 less per month on medication" Sign me up!

However, at the middle of the market and the most serious end of the market
you're looking at procedures and ailments that can cost $10,000 to $250,000.
Here, if you have free market forces at play you're asking people (including
many parents) to make horrible decisions between what they can afford and what
is best for the quality of life for years or decades. Some will be comfortable
with that I know but it appears, given the acceptance and re-election of
Obama, that the majority of people in America are more open to the government
running healthcare. (I wrote a blog post where I said that the fear of being
financially and emotionally destroyed by healthcare was now on par with
foreign invasion. As such, just as no one wants free market forces in terms of
national defense they now don't want free market forces in healthcare -
shameless plug and done! [http://jmlite.tumblr.com/post/46257541683/why-
healthcare-in-...](http://jmlite.tumblr.com/post/46257541683/why-healthcare-
in-the-us-should-be-thought-of-as)

I think free market forces can be applied at certain price points but I can't
see how it can be the driving principle across the entire spectrum. I think
state run pricing and procedures that cover 80% + of the population with a
legitimate private option for those with the drive or means to pay is the best
possible outcome from a tough position.

------
awkward
I imagine a large difference is the number of patients with health insurance -
if Arkansas has significantly more uninsured, then they need to recoup costs
on them. If California has enough insured patients, then their "cost" is a
figure they expect insurance to bargain down from.

~~~
gamegoblin
False. Arkansas has fewer uninsured.

[http://en.wikipedia.org/wiki/Health_insurance_coverage_in_th...](http://en.wikipedia.org/wiki/Health_insurance_coverage_in_the_United_States)

~~~
awkward
Thank you for that.

------
CanSpice
And my heart attack bill in Canada is $0.

~~~
refurb
You might want to reconsider your number when you file your taxes every year.

~~~
ux-app
I genuinely don't get this line of thinking. I understand that the US prides
itself on individualism, but I can't understand the utter lack of empathy.

I know you're disputing the 'paid $0' part of the OP's comment, however your
response comes across as quite glib and seems to imply that the OP genuinely
thinks that _nobody_ paid for his care.

Yes people in countries with 'socialised' health care pay for health care that
benefits others. Yes this is a good thing.

Let's use Australia as an example of a more empathic way to approach this
issue.

Recently there has been a federal budget shortfall. There isn't enough money
to pay for a National Disability Insurance Scheme (NDIS) [1]. Our two major
parties both agree that funding should come from a ($350/year) levy.

I'm not disabled. I don't know anyone that is disabled. I'm not rich so
$350/year is not pocket change. All considered, I'm still more than happy to
pay my share to make disabled people's life easier.

[1] [http://www.abc.net.au/news/2013-05-05/gillard-says-ndis-
levy...](http://www.abc.net.au/news/2013-05-05/gillard-says-ndis-levy-should-
be-permanent/4670266)

------
sixothree
I think the only thing relevant about this article is the linked dataset.

~~~
kmfrk
Speaking of, which editors are people viewing the .csv in?

I don't get the best performance in Sublime Text 2 on a pretty decent desktop.

~~~
dangrossman
Excel in Office 2013, which I pay a $99/year subscription to use on 5
PCs/tablets.

------
lucidrains
The amount of bullshit I've seen in the hospital gives me little faith that
any policy change will solve the problem.

The real solution lies in producing safe consumer usable technology that moves
all diagnostics out of the hospital. When we can get our comp, CBC, liver
enzymes all with a drop of blood on a 1$ chip, when everyone and their
neighbors own low cost portable MRI machines, when we can all read our EKG
right on our cellphones and have it be interpreted for us 24/7 holter monitor
style. Then it would only takes a team of engineers to produce software to
quickly crunch all the data to produce a picture of our health... and save
everyone from that expensive trip to the hospital.

~~~
TheCondor
So answer me this.

Why is not like every other tech startup not making medical equipment and
software then? It's a market that is growing, prices are going up, the
software they use is terrible.. You're telling me we can't make a device that
takes an xray and is more portable, safer, faster, and radically cheaper?
(just as one example) And then there is the money.. you can have 3000%
variance for the same service?!? and every VC in the world isn't just begging
to get in?

I just can't believe that the regulations and the red tape can overwhelm and
even defeat the greed.

~~~
lotharbot
Several YC companies/founders have talked about how incredibly difficult it is
to work in anything that even remotely touches healthcare. The regulations and
the red tape create market barriers so significant/costly to overcome that
many VCs don't have the resources to break into those markets.

------
bane
To all the people who think the free market and medical care are compatible:

Boom! You just had a heart attack, you'll be dead inside of 15 minutes. Now,
go shop around to find the best price for your treatment.

------
mikecane
>>>Your heart attack bill: $3,300 in Arkansas, $92,000 in California

And: Your rent bill: $600 in Arkansas, $2,500 in California.

------
maaku
Somebody PLEASE do an app with this data. If I have to schedule <expensive-
medical-treatment>, I would love to know which of the dozen odd regional
medical centers has the lowest price. Or at least which ones have excessively
large prices.

~~~
jparker165
I've been working on this exactly for a couple months with a similar dataset,
and will clearly now bring in the medicare data. Email me
(jparker165@gmail.com) if anyone wants to learn about the project or
contribute.

------
Noelkd
healthcare is something that should be like water.

~~~
kmfrk
Even drinking water is subject to regulations, though. Nothing is ever that
simple. :)

~~~
mikeash
"Even"? Drinking water is heavily regulated for good reasons. It's also
extremely cheap. There are a lot of other examples of highly regulated
industries providing cheap services, something I wonder of others are aware of
when they talk about the need to reduce regulation to cut costs.

Health care as a regulated public utility like electricity, water, and phone
lines doesn't seem like a bad model to shoot for.

~~~
brazzy
Except that I literally cannot find two industries that are less comparable in
any meaningful way: mass produced commodity goods on one side, complex and
neccesarily individual services provided by highly trained and specialized
professionals on the other.

------
visarga
Bonus: you get a second heart attack when you see the bill.

------
TheRealGL
And death, everywhere, if you fail to look after yourself properly. Prevention
is free.

------
rooker
Serious question - can you negotiate your hospital bill like insurance
companies can?

------
machrider
Perhaps in this market, Arkansas can leverage economies of scale.

------
goggles99
A big factor as to why can be explained in two words.. "Illegal Mexicans"

