
Medical Care in the U.S is Bad, But Insurance Sucks Too - pauljonas
http://www.techfounder.net/2013/04/02/medical-care-in-the-u-s-is-bad-but-insurance-sucks-too/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+Techfounder+(techfounder)
======
mjn
Yes, this non-transparent pricing, and weird discounts you can maybe ask for
if you know how to ask (and if you figure out who to ask) drives me nuts.
Sometimes you are better off being billed via your insurance; other times
you're better off not using your insurance (even if you have one) and
negotiating a cash price. And it's often hard to tell which one up front.

Supposedly one of the downsides of more socialized systems are that they're
bureaucratic, but I think the U.S. system, whatever you want to call it (it's
not really either a functioning market _or_ a properly socialized system) is
somewhere near Peak Bureaucracy (certainly more than Denmark's, where I now
live). It doesn't help that everyone bills separately: if you ever have to
visit a hospital, you will get something like 15 different bills, because
everyone from the anesthesiologist to the surgeon are apparently independent
contractors, or at least bill that way. And you have to go through the same
opaque negotiation process with _each_ of them. And many of them are sloppy
and contain errors, e.g. billing you for things that insurance actually should
have covered.

I'd be fine conceptually with a model where catastrophic care is insured and
smaller expenses are paid for out of pocket. But then I'd like: 1) the
catastrophic care to actually, 100%, guaranteed be covered, without loopholes,
lifetime maxima, excluded conditions, etc.; and 2) the smaller expenses to be
priced transparently up front.

~~~
nonamegiven
"Yes, this non-transparent pricing,"

I have an appointment with my doctor soon. I asked them how much the
appointment will cost. They called my insurance company. The got back to me,
and the bottom line is nobody knows, and nobody will know until after the
insurance company is actually billed.

For any other service I'd just not buy it under those conditions, but if I
don't go to the appointment then eventually I'll die.

~~~
elmuchoprez
I run into this situation a lot:

Doctors often have a cash price and an insurance price, with the former being
significantly less. I have a high deductible insurance plan, which means I
effectively pay for most stuff out of pocket. So when I call, I ask them what
the cash price is. I then explain my situation and ask if they'll honor the
cash price since I'm paying out of pocket anyways. They always tell me no.

I mean, I get that they probably can't start discounting insurance claims
because of my deductible or else they'd have to do it for all insurance
claims, but it really grinds my gears that for all my insurance premiums, I
essentially get the privilege of paying a higher rate.

~~~
mjn
I haven't tried it, but would it be possible to just not give them your
insurance information, and pay cash? I realize then it wouldn't count against
your deductible, but you could basically reserve the insurance for cases where
you ended up in the hospital then. Or would that approach cause possible
troubles with later coverage if something major ended up being a continuation
of a visit that started initially "outside" the insurance?

~~~
elmuchoprez
That would work. It just requires some planning (which is my fault for not
doing).

The problem is that my deductible is like $1300 or something. Now I don't
remember the last time I spent $1300 on medical services in a year. On
average, it's probably more like $500-$600 (I'm young-ish and reasonably
healthy). So based on that data, I should probably get the highest deductible
possible and just reserve using my health plan for catastrophic events.

But my employer only offers one level of deductible, so I can't really shop
for a higher deductible. And with my employers contribution to the current
plan, it's still cheaper than if I were to buy an even higher deductible plan
on my own.

But still, if I have a $1300 deductible but only typically spend $600/year, I
should still be paying cash. That said, I should probably be going to the
doctor more than I do. I'm getting to an age where preventative care is
becoming more important. I have some minor, non-life threatening issues that a
doctor could probably help me out with if I was willing to go see a doctor.
Under this way of thinking, I should probably commit myself to paying the
annual deductible and just go to a doctor whenever I feel like it.

But it's a pain to find time for the appointment, I don't enjoy the medical
"process" any more than any red blooded American man, and the whole idea of
"going to the doctor just because you can" bothers me on ideological levels...
so I don't go. But I keep "using" my insurance because I hang onto the idea
that I "should" go. So like I said, it's just bad planning on my part.

That said, I know that's a giant whiny rant. I fully recognize that there are
plenty of people who need legit medical care for serious things and can't get
it, and here I am complaining that I can't find time in my day to schedule all
the medical care I could ever want for $1300.

~~~
potatolicious
> _"and the whole idea of "going to the doctor just because you can" bothers
> me on ideological levels"_

I don't follow, can you elaborate?

~~~
elmuchoprez
One of the problems with healthcare in the US that for a long time, lots of
people had insurance that would cover everything. So people would go to the
emergency room over a stomach ache or schedule a doctors appointment because
of a runny nose. Why not? So long as they paid the premiums, there was no
incremental cost for going to the doctor. And while you're there, get some
tests. Hell, get all the tests! Why not, you're not paying for them. And since
the doctor knows you're not paying for them, they can bill whatever they want
for them.

The net effect is that you have a bunch of people consuming excessive and over
priced medical services. This means lines get longer and overall costs,
especially for the uninsured, go through the roof.

On that note, I think the high deductible health plans make a lot of sense.
I'm covered if something really expensive happens to me, but I still have to
front the first $1300 and then another $1500 or something at a 20% co-pay. So
my total exposure is only $2800, which won't break the bank if I get into a
serious accident. But it's enough to make me think twice about going to the
doc over trivial issues.

Some people would argue that you shouldn't have to think about cost with a
doctor - if you think you need to see a doctor, then see a doctor. But that
really can, and has, gotten out of control if you completely disconnect people
from the price of healthcare the way US insurance has for a long time.

~~~
mjn
I used to have that view, but from what I've read more recently, the cost of
doctors' visits is basically negligible in the overall U.S. healthcare
picture. Almost all the money is going into major medical expenses: hospital
visits, surgery, end-of-life care, nursing-home care, and chronic conditions
with expensive medication. So either doubling or halving the number of times
people go to the doctor for colds, by changing incentives on that front, just
doesn't seem like it'll move the needle on healthcare costs.

If anything, some of the actuaries seem to think people aren't going to the
doctor _enough_ : my dad's corporate health insurance plan recently changed
their policies to incentivize going to the doctor more often, by giving you a
discount for various kinds of visits: you get a discount if you have an annual
physical, and another discount if you have less-frequent major workups / lab
tests done.

~~~
crusso
_hospital visits, surgery, end-of-life care, nursing-home care, and chronic
conditions with expensive medication_

Any list of major costs in the medical system that doesn't include legal
expenses is highly suspect.

~~~
mjn
Depending on which estimate you believe, legal expenses (including direct and
indirect) account for about 1-3% of overall US healthcare costs. Not nothing,
but not in the range of what we're spending on, say, end-of-life hospital care
(10-20%).

~~~
crusso
Okay, fair enough. I remember reading about substantially higher percentages
in the past, but googling just now turned up a best guess of 2.4%. I couldn't
find any details on how they calculated the indirect nature of defensive
medicine, but what they did have didn't seem to be very comprehensive.

------
ben1040
A few years back I changed jobs; under my previous employer my allergy shots
were fully covered under insurance, and I wanted to determine which of my new
employer's plans might cover them. At the time I was getting allergy shots on
a weekly basis, so if I had to pay it could add up to $80-$100 a month. If
"plan A" covered it and cost only $30/month more than "plan B," then it would
be worth it to me.

The plan summary from HR didn't say. I called the insurance company, but it
was tough to get an answer from their CSRs without being a customer. Finally I
got someone sympathetic who gave me their direct line and said if I could get
the billing codes, they could run it against the terms of the policies my
company negotiated and see what comes up. In the meantime they told me it
would cost no more than $25 per injection, which was the limit to "usual
customary and reasonable" in my area.

So then I call my allergist's office. They told me I need to speak to their
business manager, who only worked 3 days/week, and I of course called on one
of those other two days. When I called back, she categorically refused to give
me the billing code they'd use. I asked her to clarify whether she was
_unable_ to give me the code or if she was _choosing not to do so_ , and she
responded that it was the latter.

So basically I just had to wing it and choose a plan. And a new allergist.

~~~
erock
feel lucky you don't have a kid with medical problems.

I've had to drag out accepting an offer from a company so I could find out
100% if my child's doctor was covered by their insurance or not. In the end I
had to turn it down because he wasn't in the network, and having to pay the
20k out of network deducible would have ate any net gain I would have gotten
by taking that job, I had to turn it down.

I felt bad dragging out the process so long, but I really had to cover myself,
and at least on their side they were 100% understanding.

This sucked, however we're still lucky. We had her (hopefully) last surgery
last week. While staying in the Ronald McDonald house (her surgeon just moved
further away from us) we got to hear tales of people having their house
foreclosed on, due in part to their kid going through leukemia treatments
(they were/are insured btw).

You shouldn't have to lose your house because of medical necessity

~~~
ben1040
I hope things go well for your daughter.

And I hope in the future you might have an opportunity to to sign on with that
employer later -- it sounds like if they're understanding while you tried to
sort out the insurance questions, then they'd probably be good people to work
for.

~~~
erock
I tried reaching out to them a few months after it all went down, and my wife
could pick up insurance. The main contract they had was set to be cancelled
(they also canceled contract with 15 other companies) so in the long run it
worked out for me.

oh, and my Daughter is fast to recovery, just need to keep her from bouncing
off the walls for another with week, which is impossible for any 5 year old.

------
mcherm
Yes, the medical situation in the US is badly broken, and everyone knows it.
However, it is unlikely to get fixed within the next several decades. It took
decades and an extreme swing in political power (one party fully controlling
both houses of Congress and the presidency at once) to get a change to the law
that said essentially "Keep doing it the same way you're doing it except that
a little over 3/4 of the people with absolutely no insurance will now get
insurance." Such a tiny step forward, still unclear whether it will actually
hold, and this was the crowning achievement after decades of work.

The way we pay for health care in the US may not improve in a substantial way
for a LONG, LONG, time.

~~~
Vivtek
"everyone knows it"

No, see - that's the problem. The vast majority of the electorate has no idea
either that our system is broken or that other countries actually do things
better - indeed, that it is even _possible_ , in principle, to do anything
better than current practice in the United States.

~~~
muhfuhkuh
One sticking point in my mind is that people always seem to conflate our
pharmaceutical and medical technology industry with our healthcare and health
insurance system, which are different areas completely.

They think that if we don't have the expensive, privately-held bureaucratic
system we do, then GE can't charge what it does for its MRI and CT scanner
machines and exit the market, and then Grandma will die a horrible, painful
death in a ditch outside Waukegan. Or, if pharmaceuticals don't charge
_insured_ patients $10000 a dose of some new drug, that our system will
collapse because no one will make medicine in America ever again (never mind
that 5 of the top 10 largest drug makers are outside of the US in countries
that have abundantly socialist healthcare systems).

~~~
maxerickson
A little bit of devil's advocate versus your last point, how many of those
makers refuse to do business in the U.S.?

That is, if there is some structural pricing advantage in the U.S., what is
stopping those companies from benefiting from it?

~~~
Vivtek
I'm not sure I even understand your point. Bayer and Pfizer, for instance, do
lots and lots of business in the US. His point is that Switzerland - like
every industrialized nation in the world, with one exception - has a
socialized health care system, and still somehow manages to have an economy
that includes health care providers.

~~~
maxerickson
They said "never mind that 5 of the top 10 largest drug makers are outside of
the US in countries that have abundantly socialist healthcare systems".

If the companies do (significant) business in the U.S., then the mere
existence of those companies isn't useful evidence against the fear "that our
system will collapse because no one will make medicine in America ever again".
The specifics of where the pharma companies are getting their research dollars
are more interesting than the specifics of their incorporation.

(but I don't personally fear that research funding would go away, and I accept
that those companies have huge revenues outside the U.S., etc.)

------
cdjk
What I think is really interesting is that my experiences with dental
insurance are entirely different. I've gone to the dentist, found I have two
cavities, and when I schedule my next appointment on the way out I'm given a
detailed treatment plan that includes prices. It even includes details about
how some fillings are more expensive because the insurance only covers amalgam
fillings in the back but the dentist only uses composite fillings (for
example). And it only takes a couple minutes to figure out the prices, and
more importantly exactly what the insurance will cover.

I realize that the set of things a dentist deals with is probably smaller than
what a doctor does, but it seems like it's a much better model for insurance.

~~~
rayiner
What's always surprised me is how cheap ophthalmic surgery is. I don't think
opthalmic surgeons are exactly slumming it, but the cost of say getting a
cataract removed is under $4k per eye with no insurance.

~~~
cdjk
That is interesting. I know the prices for things like LASIK are completely
transparent, but that's because insurance isn't involved. I'd assume that
insurance generally does cover cataract surgery, however.

Some of the reasons might be that the procedure is fairly quick, the eye is
easy to get to, it doesn't require general anesthesia, and doesn't require a
full OR in a hospital (I think - correct me if I'm wrong). In that sense its
closer to oral surgery than a gall bladder removal, for example.

------
Vivtek
The ability of people in the States to insist that our health care system is
"the best in the world" because of the action of the _free market_ while
simultaneously not understanding why prices are thus important is what usually
leads me to believe that most Americans have no idea what a free market is.
(Or what health care is, to be honest.)

------
steven2012
I have Kaiser HMO in California. I think it's awesome, and the best health
care I've ever had.

I'm also from Canada, so I'm comfortable with the idea of socialized medicare.
However, when I compare stories between me and my friends in Canada, there
really is no comparison. I basically pay a $20-30 co-pay per visit (something
that was completely foreign to me when I first moved to the US), and then
anything and everything gets done for me. I have never experienced the horror
stories you hear about where insurance companies try to opt for cheaper
treatments or deny services to save money. Any test or procedure I needed, or
even asked about, I could get.

The longest I waited for things like a MRI was 2 days, and 9 days for an
endoscopy. My doctor was willing to get me a CT scan the next day for this
stomach problem I had. My friends in Canada have waited 4 months for an MRI
and 3 months for a CT scan. My dad had to wait about 6-8 weeks to get a
pacemaker installed, even though his heart was stopping for 5-10 seconds
several times a day. Seeing a specialist takes months in Canada vs days with
Kaiser. On weekends, if I get sick I don't have to wait in Emergency for hours
like in Canada, I can just set up an appointment at one of the hospitals and
see a GP in around 30-45 mins, and they have full access to all my medical
records.

The downside is that when I'm out of a Kaiser area, I have to pay out of
pocket unless it's an emergency (I believe). The only time I felt vulnerable
was when my family was out of state, and they didn't have Kaiser facilities
there.

~~~
mjmahone17
Which is part of the problem with reform: you happen to have a functioning
HMO. What happens when you change employers? What happens when your employer
doesn't offer insurance? You are one of the lucky few who has the connections,
and deep-corporate-pockets (presumably, unless you're paying for your
insurance out of pocket) to be able to get good insurance. But that isn't how
most the country works. It's probably better for the masses to have the longer
Canadian waits, rather than the quick-care American bankruptcies (or non-
care).

------
cpursley
Somebody needs to create international healthcare insurance based in stable
non-US jurisdiction similar to travelers insurance. Insurance that would cover
medical tourism - flight, lodging and care for Americans.

~~~
khuey
Most Americans can't afford to travel out of the country for routine medical
care.

~~~
PeterisP
It feels like most Americans can't afford to NOT travel out of the country for
routine medical care.

If you can pay $1300 for the routine stuff described in the article, it'll
probably be cheaper to do it outside. I don't know the prices in North
America, but based on EU prices I'd guess it should cost less than $500 to fly
across half continent and back, and $150 for the actual operation in any good
Mexican hospital; which coincidentally adds up to half the USA price.

------
11Blade
The 1076 for the procedure and 300 for the visit were the full billable
charges for those codes.

If the insurance had covered them at their contracted rate, the provider would
have received probably about 250 for the procedure and 50-120 for the office
visit.

Because it fell within your deductible, the initial bill to insurance would
have been denied payment and sent back with "patient responsibility" and the
1376.00 would then be your problem. Since you don't have a contract with your
provider he tries to get the whole thing.

This is where you can discount it with negotiation.

I am a medical provider, I believe that transparency will help the situation.
I also believe that prices should be within a 5-10% window of each provider
instead of a price variance of 100-400% depending on secretive contracts.

Unfortunately even providers have been trained to game the system to maximise
profit and productivity. It is common to hear surgeons talk about complicated
patients and tell them to see a university guy because "frankly its not worth
the time and effort" when they can get low hanging easy fruit that pays
better/unit-time with less liability.

I'd like to hear what the poster thinks he should have paid for his office
visit and 5 minute procedure.

~~~
mikeg8
Doing some simple math, if a doctor is making $200,000 a year or $250,000 a
year working 40 hr weeks with 2 weeks of vacation, their hrly rate would be
$100 or $125 per hour respectively.

5 minutes of _just_ their time would be between either $8.33 or $10.41. Fine,
throw in a couple bucks for the rubber gloves and scalpel. And something for
electricity, paper, etc. Still should NOT me more than 40-50 dollars in my
opinion. But I don't know much about this industry...

------
codegeek
Just some anecdotal data from my wife's pregnancy & delivery process and the
costs/charges are just from her 2 days of hospital stay for her normal/vaginal
delivery without any complications.

\- The hospital (NJ if it matters) billed the insurance company $30,000. She
was there for usual 48 hours. The insurance company has a thing called "Amount
Allowed" which knocked it down to $5880. Then our share of co-insurance came
to about 20% of that = $920.

\- For baby, separate hospital bill of $8779. amount allowed = $2,232, our
share = $566

\- The Anesthesia consultant billed separately for $3000, amount allowed =
$1100 and our share = $220

\- OBGYN billed $4200, amount allowed = $2800, our share = $560

\- Newborn clinic charge = $375, allowed = $375, our share = $289 (deductible
not reached)

\- Neonatology for baby - $590, allowed = $100, our share = $100 (deductible
not reached)

So here is total just for Labor/delivery/baby which was 100% normal without
any complications.

\- total bill = $52,824

\- Allowed by insurance = $12,487

\- Our responsibility to pay = $2655

I get chills just to imagine if we did not have insurance.

------
avaku
Perhaps the hacker community could come up with some alternative solution,
similar to bitcoin in finance, to try to force out the non-transparent
pricing? ;)

------
DanBC
One thing that's a bit confusing: In both the UK[1] and the US[2] medication
non-compliance is very high. Many people don't take their prescription meds
properly. Many people are so bad at taking meds that the meds are ineffective
- they may as well not take the meds at all. Rates are similar in the US and
UK.

About half of the UK £9billion budget for prescribed meds is sub-optimal
spending because of medication non-compliance.

And severity of illness doesn't seem to be a factor. People who've had an
organ transplant often die after rejection when they stop taking the meds,
even though they know that they must keep taking the meds.

There's probably money somewhere if you can improve medication compliance.

[1] Prescriptions usually cover 28 day supply of medication. Each line item on
a prescription costs £7.40; but most people don't pay because there are many
exemptions and if you need long term meds you can pre-pay.

[2] I dunno how it works in the US.

------
michaelochurch
I loved the Michael Moore movie _Sicko_. Regardless of what you think of him
in general, he did a good job with it. What surprised me was the fact that 95%
of what he found was what _insured_ people have to deal with.

I feel like the only thing that has prevented our health insurance system from
touching off a violent revolution is that severely ill people aren't exactly
in top shape for carrying AK-47's into executive lobbies.

The _whole point_ of private health insurance is that sick people are the
easiest to rob-- they don't fight back-- but they also have no money, so it's
best to collect payment while they're young and well.

~~~
paulhauggis
You actually took that movie seriously?

Of course there is some truth somewhere in the movie, but the majority of it
is stretched truths and shots intentionally doctored to make his point.

"The whole point of private health insurance is that sick people are the
easiest to rob-- they don't fight back-- but they also have no money, so it's
best to collect payment while they're young and well."

The whole point of a public healthcare system is that it forces you, at the
threat of jail, to collect payments from you (essentially theft).

~~~
viraptor
How does it force you? Or do you think of every tax as a theft?

~~~
VLM
He's intentionally missing the social contract that its in direct exchange for
health care, which all people need.

(edited to add: There's already a social contract that refusal to provide
emergency room care to everyone means criminal prosecution of the
hospital/docs involved... its unfair they're not allowed to collect money at
gunpoint, but it would be much fairer if they were allowed to do so.)

I oppose mcdonalds because at the point of a gun a policeman will demand I pay
them. Sounds awful, especially if I omit the fact I already ate the burger and
I'm gonna need to eat another in the near future and the analogy breaks down
even further in that McD would need a local geographic licensed monopoly on
all food sales such that everyone living in the area must buy burgers from
them.

~~~
crusso
_missing the social contract that its in direct exchange for health care,
which all people need_

You're stating a moral imperative without indicating any boundaries. What are
the limits of healthcare that are required to fulfill this supposed "social
contract"?

~~~
VLM
Well played sir, I'll see your Continuum Fallacy and counter with a classic
Argument to Moderation, your play sir.

~~~
crusso
Throwing out fallacy names doesn't address the problem with your statement.

You mentioned a Social Contract requiring healthcare. I'm asking you what the
limits are of that supposed contract. If there aren't any in your view of
morality, then be honest and say it. If there are, then throw us a bone and
let us know where you think they lie.

~~~
VLM
Aaand that would be a false dilemma fallacy, demanding that we as a nation
should not change the system until a dude on the internet explains in full
detail his theory of everything. Or the alternative that a dude on the
internet should not speak an opinion on "X" until he accomplishes unrelated
task "Y".

The meta-point is it is a strong indication of consensus tipping point
approaching for a culture when the opposition on a topic has nothing left but
sophistry and fallacies to stand in the way of progress, morality, and
civilization. There are certain analogies to creationism, AGW denial,
opposition to gay marriage. I don't say that (solely, LOL) to tarnish the
reputation of the opposition, but to focus on the similarity of technique in
superficially unrelated topics, to draw attention to possibly unnoticed
similarity of technique.

Try to provide a logical argument for existing barbarism which I can't pick
apart as a mere fallacy. I theorize there is no such argument, although proof
of a negative is such a bummer. I'm willing to admit I'm wrong and switch my
position given a good enough argument, although I predict no argument exists
at all, much less a good argument.

~~~
crusso
_demanding that we as a nation should not change the system until a dude on
the internet explains in full detail his theory of everything_

While you're throwing out Logic terms, that's known as a "Straw Man".

 _There are certain analogies to creationism, AGW denial, opposition to gay
marriage_

Here you continue to build upon your imagined opposition rather than just deal
with the question I asked before.

 _Try to provide a logical argument for existing barbarism which I can't pick
apart as a mere fallacy_

Hah, you made me think of this: <http://www.youtube.com/watch?v=D1n5CQe1krI>

All I've seen you do so far is to invent Straw Men without just answering a
simple question regarding the moralistic statement you made.

No one is curing cancer here or achieving world peace. We're just discussing
topics of the day on HN. My hope is that people can do so in an honest
straight-forward manner without warping facts or throwing up weak smoke
screens like you've done here in this thread... but ah well.

------
felipellrocha
I wonder how long this is gonna keep going until someone gets pissed off, and
creates a website to take care of the transparency issue by themselves-
"upload your hospital bill here. We'll mine your bill for pricing data,
anonymize you, and make the bill publicly available so people can shop for
better prices".

------
nicholasjarnold
> "...medical care is one of the core things that a 1st world country should
> make available to anyone, for cheap, by subsidizing it and enforcing
> transparency and price normalization for common needs..."

Yes, exactly. This is pretty hard to accomplish in our current state of
political inaction, misinformation and 24-hour news cycles. I'm sensing a
build up to a tipping point on public awareness about how we're all being
swindled by these hospitals and insurance companies, but perhaps I'm just
paying more attention to this now that I'm starting to get a little older.

For what it's worth, and for those of you who haven't seen this yet:
<http://truecostofhealthcare.org/>

------
binarymax
I highly recommend reading the ebook here...It sheds light on actual costs and
gives a very detailed analysis on the issues at hand:
<http://truecostofhealthcare.org>

------
gmack
Granted, the OP indicates that indeed it is difficult to get advanced pricing
because it entails asking the doctor for the code, then checking with the
insurance company.

But what's stopping people from voluntarily posting the procedure_code=>price
information they obtain? Are there contractual/legal reasons that prevent you
from sharing that information? If patients get that price in the normal course
of getting healthcare, then why not share it all, and force transparency in
the market?

~~~
11Blade
Medicare posts their fee schedule for every single CPT code.

~~~
gmack
Right, but presumably Medicare's prices are significantly lower due to its
negotiating power (which is why "Medicare for All" may not be such a bad
idea). As we can see from many of the comments here, the prices vary widely,
even when you make the effort to find out what they are for your provider and
insurer.

------
skittles
One conjecture he made is definitely wrong. Medical bills for uninsured
individuals are usually higher than those for insured (due to insurance
companies negotiating a better price).

~~~
Dylan16807
For any particular place that that holds, I can almost guarantee its purpose
is negotiating with insurance. Take away the insured and the price will drop
tremendously as there is no need for extreme fake discounts.

~~~
talmand
I once had a scan done and the office offered a cash price that was lower than
the deductible, but if I went through insurance they would have billed higher
so that most likely I would have had to pay the entire deductible.

I paid cash.

~~~
kdot
Thats THE problem with healthcare in the US, there are 4 market prices:

\- Actual Price

\- Cash Price (after you bitch about how absurd the actual price is)

\- Insurance Company price

\- Medicaid price

I wonder if the US can ever get as low as $20/mo for cadillac coverage. Is the
free-market model even applicable to health care?

~~~
VLM
"Is the free-market model even applicable to health care?"

It works about as well applied to health care, as applied to police coverage,
military defense, restaurant health inspections, road maintenance, and
education. Not as well as when applied to a farmers market or factory widget
production.

Its a little harder for med because quite a bit of med care happens to
medically uneducated people. Given a couple years of med school and some on
the job experience, and a couple days to fully research each emergency room
and cardiology department in the country, my neighbor could probably have made
an intelligent free market decision when he had his heart attack. However,
instead of a free market, the ambulance instead took him unconscious to the
nearest ER, where they'll pretty much do what they want and then charge what
they want. The true miracle of the situation is it may have been a financial
disaster, but medically it all turned out OK. Decades of propaganda has taught
me that only a free market can provide decent services, yet at least medical
care works pretty well with a feudal system where you simply report to the
nearest castle and pay whatever tax the feudal lord demands.

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crusso
_It appears most states in the U.S do not require hospitals and medical
providers to list their prices_

This and the tax breaks given to companies sponsoring health insurance plans
that create a nearly immovable useless middle man are the root of all evil in
the American healthcare industry.

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jdludlow
There isn't a shred of evidence in that article to support the claim that
medical care in the U.S. is bad.

~~~
bluedino
He never even says how much this procedure 'should' cost. He also exaggerates
that it was a '5-minute visit', which we all know isn't true.

There's paperwork, billing, the use of a room and supplies, a nurse or
assistant is involved somewhere...

~~~
PeterisP
We have examples of private-paid costs by the same education-level doctors in
first world countries that have higher cost-of-living than USA - say,
Switzerland. Everywhere the full cost of the same procedure is at least twice
less than USA.

And before you say it, no, legal/malpractice expenses aren't the cause,
because in USA that adds up to <5% of total medical budgets and can't explain
the other 45% "bonus price".

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saosebastiao
Welcome to the US, where the solution to the problem of expensive health
insurance is to make it illegal to not have it.

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bgruber
just to clarify: $300 for a doctor visit isn't inflating costs because he's
covered by insurance. in ny, which i think is safe to assume is comparable in
cost to the part of CA i'm assuming the OP is in, that's the normal amount
you'd pay for a specialist visit.

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viggity
If your auto insurance included new tires, oil changes and gasoline, imagine
what would happen to the price of both auto insurance and gasoline? They'd
both skyrocket. So why the hell are we doing it with healthcare? Insurance is
about sharing risk and a large part of the cost isn't sharing the risk it is
about pre-paying for normal, expected ailments and when consumers become
insensitive to cost prices are bound to rise.

The healthcare industry is greatly in need of cost sensitivity and
transparency.

~~~
mjmahone17
What about healthcare insurance includes the cost of "gasoline"? In my
knowledge, healthcare insurance doesn't cover food or water (besides, maybe,
hospital food while you're in the hospital), and I really don't get the
analogy.

