
As Hospital Prices Soar, a Single Stitch Tops $500 - 001sky
http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html?hp&gwh=DF1AF32938798D69F843BE0154523457
======
davidbanham
How on earth can you think a free market solution is appropriate for emergency
medical care? For elective procedures, sure. For the ER? How do you expect the
consumer to have perfect knowledge, rationality and freedom of choice in that
scenario?

If your kid is gushing blood, you call an ambulance to take them wherever they
can get patched up the fastest. To expect someone to shop around until they
find an equilibrium between supply and demand in that situation is ludicrous.
It is absolutely the role of government to provide a safety net in these
situations.

Source: I live in a first-world country and thus have universal health care.

~~~
te_platt
It's not hard. Limited only by your imagination.

Emergency calls dispatched to competing ambulance/hospitals. Competing
emergency dispatch services, say 911, 922, 933,... Customized emergency
dispatch services - We'll have a life flight helicopter on call for only $99 a
month! Plus any ideas from millions of people looking out for their best
interests.

~~~
nikatwork
Everything old is new again! We could have rival ambulance gangs battling to
take custody of an unconscious patient, just like the New York fire crews of
the 1800s. [1]

[1] [http://jason-cochran.com/blog/when-gangs-of-thugs-put-out-
yo...](http://jason-cochran.com/blog/when-gangs-of-thugs-put-out-your-fires-
boss-tweed-obamacare-and-big-pharma/)

------
cesarbs
I had a panic attack in the beginning of the year which lead to severe PVCs in
my heart. I freaked out and thought I was about to have a heart attack, so I
decided to go to the ER. They hooked me up on an EKG and told me I was OK and
that it was just anxiety. After more than an hour of monitoring and a few
blood tests, they let me go home.

A few days later a $4K bill came through the mail :(

I'm appalled by the cost of health care in the US. For routine stuff the level
of treatment and the expertise of doctors is not different than in Brazil,
where I come from, but here I pay orders of magnitude more than I used to pay
there. Health care here is so expensive that my wife said the other day that
next year she's doing all her medical exams when she goes to Brazil.

What is the reason for such absurd prices in the US?

~~~
malyk
Had the exact same thing happen except my bill was only for $1800 after
insurance.

The kicker was that when I called the insurance company to ask about the cost
they told me that it was unknowable in advance because they have rates
negotiated with each hospital individually. When I asked if there was any way
to estimate my out of pocket expense of if there was any cap they told me no.

So, there's literally no way to know what it's going to cost, at least with
blue cross, because the rates are negotiated on a per facility basis and not
public.

Not really a free market for sure.

------
gatsby
Fantastic article. For more info on why US healthcare costs are so high, I
recommend a recent article from PBS:
[http://www.pbs.org/newshour/businessdesk/2013/11/why-does-
he...](http://www.pbs.org/newshour/businessdesk/2013/11/why-does-health-care-
cost-so-m.html)

"Administrative costs of running our health care system are
astronomical...Duke University Hospital has 900 hospital beds and 1,300
billing clerks. The typical Canadian hospital has a handful of billing
clerks."

~~~
jorde
Time magazine had another good one earlier this year: Bitter Pill
[http://livingwithmcl.com/BitterPill.pdf](http://livingwithmcl.com/BitterPill.pdf)
(pdf)

------
rdtsc
> Orla’s forehead was sealed with a dab of skin glue for $1,696.

On Reddit, where this stuff is discussed more, I just urge people if they can
get away with it (they are conscious and can hide their wallet, for ex), to
just give them a fake name. Almost $2k for a dab of skin glue? No! I don't
care what complicated politico-economical factor lead to that. Free market,
over-regulated market,expensive doctor's education loans, health insurance
lobbyists, politicians, aliens, terrorists, gnomes. Doesn't matter. Putting
that on the bill and sending to a parent is criminal. Fuck everything about
it. Lie and cheat them and run away without feeling bad. They can say "oh but
because people cheat it is so expensive", doesn't matter. They are stealing
and screwing over the sick and disadvantaged, if you can turn right back and
screw them, do it. Everybody for themselves.

~~~
refurb
Have you seen the profit margins for the hospitals with these high prices?
They certainly aren't raking it in.

I agree that's stupid, but that's how the system works for paying for medical
care in the US. From the perspective of the hospital, it makes perfect sense.

~~~
sjtgraham
> Have you seen the profit margins for the hospitals with these high prices?
> They certainly aren't raking it in.

The entire notion of hospitals being profit-making enterprises where people
die when they can't afford to pay is literally absurd.

~~~
SilasX
Er, the profit margin metric exists whether or not the hospital is for-profit.
All operations have a "difference between income and expense".

------
bobbles
The problem with medical pricing seems to be the same as pricing for students
and pricing for housing. When people can borrow the money or have it payed by
insurance, the prices skyrocket to match the available funds.

It completely screws anyone not 'in the game'.

Luckily medical costs are generally reasonable here in Australia, but we still
see crazily inflated housing prices due to residential property being treated
like a stock.

Huge tax incentives are given to those 'investing' in property while 'buy to
live' buyers like families get screwed.

Also, having your employer involved AT ALL with your medical insurance/bills
is fucking insane.

------
lsh123
The skyrocketing prices in healthcare and education have the same root
problem: too many non-essential people (read: clerks) are on the payroll (e.g.
search for "Dean-to-Professor ratio"). The government will not solve this
problem, it will make it worse.

I think the only real solution to the problem is to break both hospitals and
universities into smaller pieces with more direct correlation between
performed work and rewards. Right now gigantic organizations ("too big to
fail") in hospitals and universities make it impossible for staff members to
see how the money is spent. The smaller doctor offices can be more effective
and offer lower prices to patients. Same goes to smaller schools. This is one
of the examples where scale makes things worse, not better.

Of course, you also have to have shared facilities with expensive equipment.
However, these facilities does not need to be a part of the
hospitals/universities. For example, there are already 3rd party labs that
provide services to hospitals and doctors. Same can be done for other
procedures (e.g. MRI) and this can also help to use equipment more
efficiently.

------
consultutah
There is such an easy "American" solution to this: published pricing -
[http://kfor.com/2013/07/08/okc-hospital-posting-surgery-
pric...](http://kfor.com/2013/07/08/okc-hospital-posting-surgery-prices-
online/)

When you organize your startup, just give me 10% for the idea... ;)

~~~
Aloisius
As mentioned in the article, California already requires this[1] and yet the
examples from this article are from California. Not much of a solution.

[http://www.oshpd.ca.gov/chargemaster/](http://www.oshpd.ca.gov/chargemaster/)

------
refurb
These high chargemaster prices are a consequence of how insurance companies
pay providers. Private insurance companies never pay the list price, but
rather a percentage of it.

It's sort of like if your boss asked you to something and offered to pay 200%
of your costs. You'd certainly have an incentive to overstate them!

~~~
pyoung
Many of the subjects in the article had insurance. Even with the insurer
negotiated discounts, the prices are still insane.

------
pcurve
In Japan, stitching of that size would've been around $20-30. And that's not
patient portion. That's the amount doctor is reimbursed by the government.

------
vignesh_vs_in
The thing that scares me most about US is not NSA spying but health care
system.

People can get broke by breaking their fingers.

------
md224
As technologists, what can we do to tackle this issue? What tech companies are
focused on bringing down medical costs?

------
rikacomet
Could this be the problem rising from US having a increased reliance on
Allopathic System of Medicine?

In India, Allopathic System exist together with other 4 big system, namely
Unani (Old Greek), Chinese, Ayurveda & Homeopath.

Yes, all practitioners have to register themselves to a certain extent with
the medical board of India, but the system is not as highly centralized, and
is more like professionals working mostly as practitioners, instead of hired
workforce.

This can be ironically put as something similar to free market, since the
prices are being defined by market forces.

The war over Polio, which India as per WHO has won, would not have been
possible if polio vaccine drops were made free, and also their administration,
for all people, including upper class.

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

What I'm sure about is this that if I were to travel to US, to get hurt, and
get such a bill, I would go bankrupt over night.

3000$ you can buy Tata Nano!

Also, its worth mentioning, that there is a creed of medical practitioners
called "Pehelwaans" (word meaning=wrestler), which is one of the most
autonomous individuals around. A stitch for comparison costs around 1$ from
them. They appeared out of the sportpersons treating themselves in medieval
India, and then making that into community business.

In simple words, compare Pehelwaans with Calculator, very few functions, cheap
yet effective in daily life. Both PCs and Calculator exist in real world, same
way, Allopathy has been adapted by people for serious stuff, while traditional
fields stay prevalent for simple stuff.

Practically speaking, just google how India has become a medical tourism
destination, and people from both lower income groups like in Africa, as well
as from higher income group from US are coming here.

As of right now, in terms of skill of doctors, US still has the upper hand by
far for rare diseases, and everything out of the ordinary. Which is good in
one way, but seriously, I'm very disturbed by the fact that 500$ for a few
stitches!

heck I could buy a high end phone for that much!

~~~
xerophtye
You seem to be flagged, i can't imagine why. Probably for criticizing modern
medicine? Either way i see what you are saying. That "not-fully-qualified-as-
a-doctor" professionals seem to be the go-to people for minor injuries like
stitches and sprains, while for major injuries you go to a hospital. Makes
sense. Why open a whole computer when you just want to know 121451*1231 right?
And i guess that does bring the price down because these people aren't buried
under education loans for their medical studies

~~~
rikacomet
yes 100% thats what I meant

------
HorizonXP
As a Canadian, I think it would be really cool if every doctor/hospital visit
you went to in Canada, you got an e-mail copy of the invoice showing how much
it cost, and how much was covered, just so people would start to understand:

a) how much they're costing themselves in taxes b) so they could see how
awesome we have it compared to others.

I should build this. I have the connections to make it happen. Hmm...

~~~
xerophtye
Go for it! (Btw you DON'T get bills? as in not ACTUAL bills stating how much
it cost you? The bill just goes to the insurance/govt?)

~~~
HorizonXP
Sure, we do get billed. But as a patient, I never see it. The only bill I've
ever seen is for ambulance rides, if I ever need to take one. That's ~$35-45.
I've never received charges for anything else.

When I used to volunteer at the ER, I saw patients come in to pay some bills
related to wheelchair rentals or crutches. Sometimes they had their
prescriptions filled at the pharmacy, and they had to pay for that. But again,
that's the extent of the bills that patients would see.

I once saw a guy come in via ambulance, screaming in pain. The paramedics
rushed him in, and yelled to the staff that they needed a Resusc room
immediately, since the guy had no detectable pulse or pressure, and she
suspected he had a triple-A (I found out later that this was an abdominal
aortic aneurysm.). The nurses fumbled to clear a room for them, but they
eventually did. A quick ultrasound by the ER Dr. to confirm, and he was
wheeled off to surgery.

That "bill" likely cost the taxpayers of Ontario upwards of $50k by my
uninformed guess. Not sure if he survived or not, AAAs typically have
extremely high mortality rates and have to be addressed within 30 minutes. In
any case, I do appreciate the fact that him and his family don't have to worry
about a thing, except getting better and appreciating life. However, I'm not
sure what value it would provide for them to know the financial cost. _shrug_
Something worth thinking about.

(Recounting this story makes me somewhat regret not continuing along the path
to medical school. _shrug_ Guess I have to contribute in a different way.)

------
downer93
Time to start sacrificing credit ratings and default like fuck all on these
bullshit bills.

I'll run the gauntlet. I'll take the devil's mark as a freeloader. Hunt me to
the ends of the earth, credit machine. You'll never catch me on my motorcycle.

------
iterationx
The left says big business is the problem and the right says big government is
the problem. And around and around we go.

I was watching a show about venomous snake bites they charged this poor woman
$80,000 for 100 bucks worth of anti-venom.

------
xerophtye
Wow... Things like these actually make me glad I am in a developing country.
We have top of the line medical facilities as well (we have sucky ones too),
but even the best hospital in town[1] wouldn't cost this much. Heck a few
stitches would gost me entire annual health insurance there!

[1] Aga Khan University Hospital, Managed by AKDN, the 2nd largest NGO in the
world (2nd only to the UN)

------
jonah
"Hospital profits raise eyebrows as medical costs continue to soar" [2010]

[http://thehill.com/blogs/healthwatch/corporate-
news/116745-h...](http://thehill.com/blogs/healthwatch/corporate-
news/116745-hospital-profits-raise-eyebrows-as-medical-costs-continue-to-soar)

------
31reasons
What can we do about this ? Is this a technological problem ? Who is
protecting the status-quo ? What exactly makes healthcare so expensive in the
US than other first world countries ? Thats what I want to know.

------
nopal
Are there any sites crowdsourcing provider charges?

There have been some data sets released by CMS, but they're far from
comprehensive.

------
jonah
And how much of that is "profit"?

~~~
beagle3
Amortized over the uninsured people who don't eventually pay list price, and
the insured people whose insurance only pays 20% of the list price? (oh, and
over the billing department that is 10 to 100 times bigger than it is anywhere
else in the world) - not much profit.

~~~
jonah
I did a quick look following your response. It seems that many hospital's
profits aren't terribly bad.

"Forbes found 24 hospitals with more than 200 beds make 25 cents or more for
every dollar of patient revenue they take in."
[http://thehill.com/blogs/healthwatch/corporate-
news/116745-h...](http://thehill.com/blogs/healthwatch/corporate-
news/116745-hospital-profits-raise-eyebrows-as-medical-costs-continue-to-soar)
[http://www.forbes.com/2010/08/30/profitable-hospitals-hca-
he...](http://www.forbes.com/2010/08/30/profitable-hospitals-hca-healthcare-
business-mayo-clinic_slide.html)

Bloomberg ran a lengthy story on how hospital consolidations are running up
prices for all manner of procedures.
[http://www.bloomberg.com/news/2010-08-20/hospital-
monopolies...](http://www.bloomberg.com/news/2010-08-20/hospital-monopolies-
ruin-mri-bill-as-sutter-gets-price-it-wants.html)

------
stuaxo
I needed some stiches in Croatia, it came to about 40 euros.

------
astrodust
This should be more specifically _in America_. The title seems overly generic.

~~~
rcthompson
It's an article in the New York Times, an American newspaper. By default, it
is about America. Not every news article needs to declare a globally unique
namespace.

~~~
astrodust
Ah, I forgot this was "Hacker News America".

~~~
rcthompson
My point has nothing to do with where HN is focused. The NYT is an American
newspaper written for an American audience, so when they refer to "the
healthcare system", it is implied that they are talking about the American
healthcare system. If this were an article in an Indian newspaper, I would
likewise assume that it was talking about healthcare in India. That doesn't
make HN into "HN India".

~~~
astrodust
Adding an American specific context to headlines talking about the healthcare
system do serve as a reminder how exceptional the American system is. Many
issues cut across international lines, as with technical articles, but this is
not one of those things.

The New York Times is an international newspaper, it covers stories from all
parts of the world. While they have a default America implied, yes, but why
does this habit have to carry over to Hacker News?

~~~
rcthompson
> why does this habit have to carry over to Hacker News?

Because HN submissions are generally expected to be titled the same as the
page/article being submitted, and this policy seems to be enforced by
moderators. But luckily, HN also shows what domain the submission links to, so
what you see is

> As Hospital Prices Soar, a Single Stitch Tops $500 (nytimes.com)

from which you can determine that the article is most likely about American
healthcare.

------
ctdonath
Both my kids required a few stitches near their eyes. Did I opt for the $30
suture kit and do it myself? or did I opt for on-demand (there & ready,
patients or not) doctor analysis (risks of fractured skull or aggressive
infection), sedatives (both wriggled & screamed as I held them still, how much
worse without?), experienced threading, and whatever other ideals applied?

"Sure you can buy a hamburger for a dollar. But then you'd have to eat it." \-
local restaurant ad

~~~
PeterisP
Half an hour job for a $200.000/year professional is $50; doubling for
overhead is a roughly $100 cost for that service. Doubling it again for
profit&stuff is $200 reasonable price.

Charging $2000 for a $200 service is the problem here, especially since that
is not an informed market price, but an ultimatum set without a market
negotiation or possibility for competition.

In most countries, including first world countries with medical facilities and
doctor training comparable or better than USA, the full price would be $100 or
less - disregarding who'd pay that bill (you, insurance or government), that
is the full price charged by hospitals for such a service.

~~~
ctdonath
Same service? Remember, your kid. And it's not just the service; you _could_
go to the urgent care clinic instead of the hospital[1] and pay less; you
_could_ go to your regular doctor and pay even less; heck, I know people who
just keep sutures & glue on hand and just patch the kid up themselves. There's
also the matter of demand & supply: are you confident you'll get immediate
treatment if needed? that an ER staff is on hand if that small cut suddenly
proves itself a skull fracture and whatever unseen complications ensue?

I'm not going to argue that the pricing is perfect; I am going to argue that
there's a whole lot more behind that price than just overcharging. I've looked
both my kids in the eyes while holding them still while being stitched up for
one injury or another, thought thru a range of what-ifs, and had no problem
paying the bill knowing there was more to it than just a little sewing. When
both the doctor and urgent care clinic take one look at the injury and say
"not here, she needs a hospital for this" and pass on billable treatment,
there's a reason.

[1] - seems different cultures have different notions of what the term
"hospital" entails. Methinks this confuses the discussion a great deal.

