And to think that we are going to be smothering this vibrant, competitive, free marketâŚ
Great idea, Jillian Bernstein! Faith in young people, reconfirmed.
The answer, when it comes to healthcare? Socialism. There, I said it.
Letâs be a honest - even an actual free market healthcare system would, in itself, probably be a step up right now. What we have right now is⌠what is the word for a system based on deceiving and stealing money through collusion and obfuscation?
Hell, Iâm not even sure if itâs really even a /market/, forget âfreeââŚ
Question: âWill you drop the cost of your fancy new Hep C pill from $1,000 each after youâve recouped your R&D costs?â
Answer: âNot so much.â
Iâve known this for a long time. I worked at a hospital and parking was huge. Its amazing how many people base their decision to go to a hospital on parking. In some consumer metrics, itâs number one or two. Woe betides the employee who parks in a lot for visitors and patients.
Donât just blame the hospitals: Patients have stupid reasons for picking one hospital over another, ranging from âI was born there.â to the emergency room wait time in a previous visit. As for hospital pricing transparency, this has always driven me crazy. It insults my intelligence when they pretend theyâre some kind of artisanal service and they simply canât give you a price until theyâve built you some kind of bespoke MRI.
Yep, kudos to her. I can think of no other business that is so lacking in transparency, and so completely divorces what they charge from their actual costs of providing a service.
Iâve tried to get costs for medical procedures from Group Health in Seattle, supposedly a consumer friendly cooperative HMO, without success. Providers have no idea what will be billed for the treatments they suggest, and are sometimes shocked when told the simple two second squirt of liquid nitrogen for a maybe suspicious skin patch becomes $300 âoutpatient surgeryâ- and two squirts is twice as much. Even after the fact, after getting billed almost $300 recently for a routine 15 minute office visit, they could not explain what the charges were for, or what the codes signified- just that each subject you discussed (if a computer code was entered) was essentially another visit as far as their billing was concerned. Of course, when most people only have a copay, this is just accounting- but if you actually pay the full bill, itâs deadly.
Nobodyâs going to mention insurance companies? Jeezem. They are just as bad as hospitals.
Sometimes worse; because they take your money upfront and wonât even tell you what coverage you are actually buyingâŚ
That said, though, while insurance companies are total scumweasels and should be burned to the ground, part of their persistence is derived from the fact that you (without having arm-twisting power on par with a large medical insurance company) simply cannot get prices, much less the best ones, for all sorts of medical procedures.
Insurance, as a risk-pooling thing for catastrophically expensive happenings would still be a thing; but bringing insurers (and their profit margins) into routine medicine, where almost no risk pooling takes place, is supported largely by the fact that itâs so difficult to even touch anything more serious than a bottle of cough syrup at the corner pharmacy without being handed a cryptically semi-itemized and shockingly large bill that turns out to bear almost no relation to reality.
Meanwhile in CanadaâŚ
âParking fees are a penalty for having a disease,â says cancer specialist Dr. Bob Winston. âIt seems like an unfair tax on my patients.â
Do high hospital parking rates keep you from your appointments? Should we pay for hospital parking at all?
http://www.cbc.ca/marketplace/episodes/2012-2013/hospital-parking-pain
Wow. Just wow.
Itâs definitely a âsystemâ. Itâs not a rational one, though. Itâs not even anywhere near as rational as the stock market, which is erratic & unpredictable, but still rational. The US health system is like an elementary school playground, actually. The rules are stated as rational things to rely on, but depending on who is in power at any particular moment, those rules are subject to immediate, retroactive and harshly unpredictable changes at unpredictable times for reasons or no reason at all.
Youâre going to pay; they have a target figure for profit, and if they donât get it there theyâll get it elsewhere. The only question is whether itâs explicitly called out so you can consider alternatives, and by that argument having it separate is a huge advantage.
I had to have two surgeries back-to-back a couple years ago. The second time my surgeon was assisted by another doctor that wasnât a âpreferred providerâ on my insurance. My insurance refused to pay a dime of his bill.
I was given a bill by someone I never met, had no idea would be assisting with my procedure, and was given zero say in the use of. Thereâs a lack of transparency for you!
Itâs not just hospitals itâs labs and imaging facilities also. I have a health insurance policy with a high deductible so Iâve tried price comparison on tests and procedures and given up. My attempts are usually fruitless. I get such answers as: âWe only give that information to doctors.â âWe need to know the procedure code; the doctorâs order doesnât give enough information.â âYou have to ask your insurance company. (From the provider.)â âYou have to ask the provider. (From the insurance company.)â
There is no health care market. There is only a health insurance market.
They will have to tell insurance companies, and the insurance companies will not put the higher-priced hospitals in their networks. Another win for Obamacare. (4 Realz). Itâs a feature and not a bug.
Prices are normally made available to the party who is paying for them. In our system, that is predominantly an insurance company or the government (both of whom watch prices very carefully).
If we ever get to a single payer system (as we should), consumers will be completely disconnected from pricing. If we were to move towards a more free market system (which we shouldnât), consumers would be very aware of pricing. Until either of those things happen, people paying out-of-pocket are kind of in a pinch.
You want something that is much more home hitting? Try asking them how much it costs to set a broken arm. Or leg. I called 4 of the hospitals in my area, and only ONE would even begin to talk to me.
The calls usually went with me calling up and asking who does the billing for procedures. And they say that the doctors make up the prices. Okay, except that none of the doctors that I could actually talk to knew how much anything cost. They sent me off to the nurse and secretaries and they didnât even know. So I asked them who submits the bills? Billing, was the answer. Okay, so send me there.
The people in billing donât actually know or care what things cost either. They were trying to get me to give them an account number over and over again. I kept telling them I didnât have one, I wanted to know how much it cost for the procedure. They said they would have to send me off to the doctor, and when I said I already called them they said they couldenât help me.
The last place actually had someone whoâbless her heartâunderstood my question. She looked up someone elses info who had a broken arm, and while she stressed to me over and over again she could NOT tell me anything about the patient (and I had no desire to even know any of that info) that she would tell me the cost submitted to the insurance company for each part of the procedure.
I honestly forget the numbers, but it came out to just over 8 thousand dollars. X-Rays and the doctor coming in for all of a half hour was 2/3 of the cost. The rest was the actual cast, and the pain medication that was given through an IV, and the cost of the room.
And that, is why we canât have nice things. Because it costs 8 freaking thousand dollars to set a bone in plasterâsomething humans have been doing for centuries.
I had an x-ray once at my universityâs health clinic when I had no insurance. I think the total cost of the visit, x-ray, antibiotics and urine test* was less than $300. I wonder if the difference in cost between what you and I saw has to do with the type of x-ray (higher detailed x-rays for breaks?) or the type of doctor. I would be surprised if my university was subsidizing the cost of something like x-rays.
*Too much information about what was wrong with me follows: I had to pee in a cup before they would have any one look at me. Since I had been peeing blood right before I had come in, my body did not want to do this. I ended up sitting in the waiting area and sobbing from the pain while I tried to drink water. Soon after I was able to pee in the damn cup, I started throwing up. I am pretty sure it was from the pain. They were never able to figure out what was wrong with me.
