Let’s 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, I’m not even sure if it’s really even a /market/, forget ‘free’…
Question: “Will you drop the cost of your fancy new Hep C pill from $1,000 each after you’ve recouped your R&D costs?”
Answer: “Not so much.”
I’ve 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, it’s number one or two. Woe betides the employee who parks in a lot for visitors and patients.
Don’t just blame the hospitals: Patients have stupid reasons for picking one hospital over another, ranging from “I was born there.” 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 they’re some kind of artisanal service and they simply can’t give you a price until they’ve 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.
I’ve 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 “outpatient surgery”- 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, it’s deadly.
Nobody’s going to mention insurance companies? Jeezem. They are just as bad as hospitals.
Sometimes worse; because they take your money upfront and won’t even tell you what coverage you are actually buying…
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 it’s 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 Canada…
“Parking fees are a penalty for having a disease,” says cancer specialist Dr. Bob Winston. “It seems like an unfair tax on my patients.”
Do high hospital parking rates keep you from your appointments? Should we pay for hospital parking at all?
Wow. Just wow.
It’s definitely a “system”. It’s not a rational one, though. It’s 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.
You’re going to pay; they have a target figure for profit, and if they don’t get it there they’ll get it elsewhere. The only question is whether it’s 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 wasn’t a “preferred provider” 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. There’s a lack of transparency for you!
It’s not just hospitals it’s labs and imaging facilities also. I have a health insurance policy with a high deductible so I’ve tried price comparison on tests and procedures and given up. My attempts are usually fruitless. I get such answers as: “We only give that information to doctors.” “We need to know the procedure code; the doctor’s order doesn’t give enough information.” “You have to ask your insurance company. (From the provider.)” “You have to ask the provider. (From the insurance company.)”
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). It’s 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 shouldn’t), 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 didn’t even know. So I asked them who submits the bills? Billing, was the answer. Okay, so send me there.
The people in billing don’t 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 didn’t 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 coulden’t help me.
The last place actually had someone who–bless her heart–understood 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 can’t have nice things. Because it costs 8 freaking thousand dollars to set a bone in plaster–something humans have been doing for centuries.
I had an x-ray once at my university’s 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.
You don’t need a doctor or a hospital or an insurance company to splint a broken arm. Get a friend with a plank and some gaffer’s tape and a pint of bourbon.
When I broke my ribs a few years ago I didn’t even bother going to the ER, because I knew that they’d do exactly the same thing I was going to do myself — strap a big Ace bandage around my chest — but charge me a couple thousand bucks to sit around waiting in a dingy plastic chair for a few hours first. If a lung got fatally punctured, well, I wouldn’t be around to bemoan my condition. So it goes.
That’s great for the generic stuff. But every so often, there are medical cases that REQUIRE the services of high-end hospitals and high-end doctors. You either get it. . . .or get a “bad outcome”, for values of “outcome”.
And suddenly. people who decide that they MUST save their child, are going bankrupt to do so.
So, what have we really gained ???
Surprisingly, that’s not what the numbers show. Studies have been done on this over the last decade, and while I don’t have a link to them they indicate that results at the “big name” hospital are often no better than at the hospital down the street.
Sure, if a particular specialist is needed, you want to be where that specialist works. But it’s the doctor, not the hospital, that matters.
Of far greater import in terms of getting well are whether the hospital follows checklists, whether it maintains sanitation protocols in rooms and in operating theaters. Many big name hospitals don’t. Many big name doctors don’t, either.
I will agree that more studies on this question are needed, that more numbers are needed, and more transparency is needed. But based on the studies I’ve seen as a reporter, the high-priced spread doesn’t justify the high price in terms of results.
Well, that’s the whole point: on far too many of the new Obamacare plans, the only way to cut costs was to shrink the allowed provider pools to the “affordable” phyisicians.
So, as has already been the case with many cancer patients, they can’t use the hospitals OR the doctors that have been managing their care and continued survival. Likewise, if you NEED Doctor X to save you child’s life. . .but neither he nor the hospitals he practices at are in your plan. . . .You either suck it up, and pay the bill. . .or watch your child die.
Not a good choice, EITHER way. . .
