Needless to say that this American hospital would not even have admitted us without a certified check in advance, so we had spotted them the $20k. Over the next six weeks I get literally dozens of bills. I get a bill from the attending obstetrician who wasn't even present. I get bills for anesthesia that wasn't administered. I get bills in total of over $31k. I was uninsured but I'm not some chump, so my attorney sent these people sternly worded letters and we held the line at $20k which I think anyone would agree is already a ridiculous price in the first place.
Point is, nobody in this system has any idea what the price of anything is. There's no rate card. It's a collective emergent phenomenon that prints invoices. Nothing more.
If you hold a man hostage for a month or a year you go to jail for a year or two. If you intentionally overbill a man so that he must work an extra year worst case scenario you... send a sternly written letter and pay them the original amount?
If we're talking about mens rea, then I doubt it; my wager is tied to how it's in no one's incentive to care that leads to these outcomes. Medical providers are clueless and totally disconnected from administrative functions, hospital billing systems are optimized towards dealing with horrible leviathans that spew sulphur and vomit acid and all of this operates on a scale that makes makes the cost of delivering babies a rounding error.
I'd imagine someone forgot to properly code the procedures/the paperwork isn't set up to give a shit and they were simply charged the default set of procedures.
Blah blah, single payer public systems, blah blah aligning incentives around cost structures, etc. Atul Gawande has a great few articles on this.
For an industry of people who have had to spend over a decade jumping through academic hoops, and whose job seems to require a great deal of precision, it is unbelievable they lack competence in something most high school drop outs master McDonalds - namely, standardized pricing and itemized billing (not to mention customer service).
I don't think it's incompetence that makes pricing variable; rather, its lack of accountability. It's hard to find out where the price tag comes from, so why not charge as much as you think you could get from each patient? If you ask your doctor for an itemized breakdown of your bill, they (may eventually) give it to. The prices are often exorbitant and arbitrary.
In reality I went to the doctor once, got an xray, he gave me a splint and said don't take it off for 8 weeks. I never went back for a second visit because it wasn't needed assuming I followed the treatment of did not bend my finger for 8 weeks. I called billing and asked for an explanation and the bill went from a couple thousand to a couple hundred.
Incidentally, totally agree. In any hospital, all you have to do is dispute the charges and demand documentation, and all of the sudden the bill is slashed tenfold! So, basically, the system is setup to screw the uninsured americans who may not know their rights or have the ability to challenge the hospital.
The really big gap between the U.S. and the rest of the developed world on medical costs isn't the cost of individual procedures (once you've taken into account what insurers actually pay), but the much larger amount the U.S. spends on last-6-months-of-life "heroic care". If that were brought more in line with international norms, the overall cost-per-person numbers would be much better.
If I get table 4 right, people who manage to live past 85 years will have 1/3 of their health care spending after their 85th birthday (not entirely accurate, but a reasonable simplification).
Medicare is already transitioning to capitation.
Meanwhile, while not ideal, ACA has already significantly slowed down the growth of costs. Amazing what just adding some price transparency can do.
Perhaps, but to the individual, the first problem is by far the gravest. One can feel outraged if the taxpayers are paying too much in general, but that is not exactly a life or death situation like not being able to pay for medical aid.
Also: Why can't you fix both problems?
Or is that what the patient has to pay?
If you want a doctor to attend (instead of simply a midwife) you have to pay him out of pocket (but if you have private insurance it might cover that too).
What it costs to the French medical system is anyone's guess. The French medical system is financed by the taxpayer. In theory, it's financed by a tax on salaries, but since it's in perpetual deficit and the deficit is covered by the state, it's in fact paid for by the taxpayer -- which is just as well, since everyone is covered.
It's a system of fully socialized medecine; there are pros and cons to such a system; it's not all good, but it's certainly not as bad as the American system (before or after Obamacare).
But in all cases, social security pays exactly what you are billed.
In most cases you pay yourself the hospital, clinic, doctor, whatever, and social security then gives you part of the costs (depending on the procedure) and if you have one, your private health insurance gives you the rest (or less, depending on your plan, of course).
The tendency is at removing the unnecessary payment by the patient before being reimbursed, but for now this at least serves as a way to ensure you know exactly how much was paid for the procedure, and to prevent too many excesses (since, well, the patient has to be able to pay, even if he gets reimbursed).
Many EU countries are trying to boost their birthrates, so the state covers most/all of it.
So no, it is certainly not "free".
(And yes, people in Scandinavia stating things are "free" is a rant-trigger for me.)
Everyone here knows that it's not "free" but subsidised by taxes. That's what "free" means when talking about healthcare, free at the point of service, and free as equally available to everyone.
How else would it work? Are the doctors without pay and with no equipment?
Not only that, but if you're using money, it's much easier to use someone else's money instead of your own, you just won't be too careful about how you spend it. In fact, if you've got a "limitless" supply of other people's money, you just won't give a fuck about what you do with it. This is one reason why public healthcare (and public anything) turns to shit sooner or later.
Sounds logical on paper but doesn't bear out in reality - just about every country where health care is provided via "confiscated funds" pays dramatically less for better outcomes than the USA where people are responsible for spending their own money.
The Parasite(tm) is more bedtime-story boogeyman than observed reality. They exist, but in far fewer numbers than reported, and their effects on the system far less grave than prognosticated.
In Canada, where I'm from, most of the people I know avoid doctors and hospitals unless they really aren't feeling good. They don't want the hassle of waiting and waiting again to see specialists or get a procedure of some kind done.
The canadian socialized system is still really, really slow though for non emergency care but I never believed it was because of parasites wasting hospital resources.
The US healthcare system is truly fucked, but serves as another great example of how people use someone else's money. That's why healthcare is so absurdly expensive there. Patients generally aren't using their own money to pay for medical services, and so, insurance companies get charged ridiculous prices behind the scenes, and the customer doesn't care. Businesses are forced to buy insurance, right?
Well, without the "forced middlemen" of insurance companies, and with customers paying for whatever services they use, you can bet your ass that health care would be massively cheaper. Competition drives quality up, and prices down.
>> The Parasite(tm) is more bedtime-story boogeyman than observed reality
I hadn't even heard of that "theory". But I bet I would have, if I were still watching Bill Maher's show.
You're right in that some parasite patients are not the problem. The whole system is.
Think about it. If you're running a hospital on a "limitless" supply of other people's money (as in, "public healthcare"), you're just not that concerned with efficiency, nor the quality of your services, because you don't have to be. It doesn't matter if your customers are unhappy, because you'll still be getting your money! .. It's blindingly obvious that this kind of system is doomed, but of course, healthcare is not socialized in order to make it better. It's socialized to make the masses dependent on the State.
Procedures are so expensive, doctors so highly paid, and insurers so profitable that the US is essentially subsidizing all that while still not providing universal healthcare.
In the UK we're both taxed less AND don't have to have private insurance due to the above. (It does have some downsides though, particularly in not being able to easily 'shop around' or get access to cutting edge/experimental medicine.. it's a bit one size fits all.)
EDIT: hm, not sure about 'experimental', but top quality/teaching hospitals anyway.
There might be a problem that many airlines won't let pregnant women fly past a certain number of months, for fear they will deliver the baby in the air; so maybe you have to move to the target country months in advance, significantly adding to the total cost...?
Those five thousand would cover 90% of the expenses involved in all steps of pregnancy (prenatal care and checkups, 4D ultrasound imaging, etc) and the delivery itself.
And living here a few months would cost way less than 15.000 dollars :)
Breast excision of lesion procedure: $2,569
Gall bladder procedure: $4,212
Cardiac Catheterization (no angioplasty or stints): $4,900
Knee Arthroscopy: $3,039
I wrote about it here:
The CEO of SafeWay, started a company that sells this data. Unfortunately its typically only sold to companies that self insure and have ~10,000 employees. You can watch him talk about the data and the company here:
You are correct though, the reason why hospitals do this is because the system is entirely setup to support this kind of behavior.
And the odds of making it to the hospital in time if you need an emergency c-section or start bleeding out are pretty slim.
With midwives, you actually have human attention on you during a birth, rather than doctors and nurses that drop in occasionally and can miss stuff. My hospital birth came closer to having problems because there was another emergency on the floor and no one paid attention to me for hours (when perhaps they should have).
That sounds unbelievable! how can it be? it has to be a marginal case. I know at least two people that had babies in the US and barely pay anything (neither for the delivery nor for other medical acts before and after). They were PhD students or postdocs.
What I am wondering is on average how much an american pays for having a baby?
In the end, we opted for homebirth midwifery care, which was fantastic in every way. We ended up paying around $2k for six months of prepartum care, delivery, and six weeks of postpartum care. In the event of an emergency, insurance would've covered a hospital transfer.
It was such a good experience we did the same thing for #2, and we're planning on delivering at home if we have more children in the future.
Well you ended up screwing yourself. Maybe you have never spoken to an American who didn't have health insurance and so didn't know, but, medical bills are settled later for less than half the insurance price and all hospitals have to admit you regardless of ability to pay by federal law championed by Kennedy.
An emergency room cannot refuse treatment to a women in labor.
What did the reply in writing actually say?
Seems almost as if this was merely a "retainer" paid in advance against the expected cost.