Health pricing is a weird fixed pricing with all sides in insurance companies, medical suppliers and doctors holding the cards to get the highest prices within the gamed rules with the consumer left out in the cold and each bill a random output that is rarely known beforehand.
Part of the problem is healthcare provided through work that skews pricing for large companies over individuals/small/medium businesses and entrepreneurs.
If we can't get healthcare removed from employers and have both a private and public option based on Medicare for all. We AT LEAST need legislation to bring in CLEAR pricing for insurance cost and non-insurance rates, similar to the CFPB mortgage Loan Estimate and Closing Disclosure that show all pricing clearly in one sheet of paper both the estimate and the final mortgage.
What other product do we buy that the price is not known until after the product/service is rendered? At least some idea of an estimate is even hard to get as each part of the medical pricing matrix scam (insurance companies, medical services/suppliers, doctors, pharmaceuticals) try to keep pricing shrouded to stick it to people wherever they can.
The consumer healthcare experience is horrible in the US healthcare system and employers being the insurance companies main customers is a major part of this problem but pricing can be helped with clear regulations and needs to be now.
I had this experience with imaging (MRI), cost 10% more with insurance than without.
I asked a friend in the healthcare industry about this - they said that since insurance companies negotiate all the services at once - the insurance company is trying to lower the total cost for the whole insured pool, this often means that they will marginally overpay for high margin services in order to get big discounts for the really costly things. The hospital makes more gross margin, and the insurance company lowers it’s total spend. The offshoot is that individual people may bear the brunt of this grand bargain...
No idea if it’s true, but had a ring of truth to it...
> I had this experience with imaging (MRI), cost 10% more with insurance than without.
Depending on where you went it could have been much more than 10%. Non-emergency imaging is definitely one of those things you ask about other locations and if they have cash pricing. When I needed an MRI if I was to use my insurance it was going to be ~$1000 because of high deductible plan. A different place took payment at the time and it was $350. According to the doctor who wanted me to get the MRI, hospitals are far and away the most expensive places to get one.
Healthcare and profit don't go together. This is just exhibit n° 31415926535897932384626433.
What happens in the software world when you see twentyseven useless levels of abstraction? Exactly the same. You smell a rat.
In my ideal world:
* Healthcare research funding to come from the public sector and donations only.[0]
* Healthcare products can only be sold once the production process is verifiably fully publicly documented. This means independent reproduction by multiple reputable non-profits.
* Market based generics manufacturers handle production. Competitors (for profit or non-profit) jump in if pricing gets out of hand.
* Healthcare education free to students.
* Only non-profit healthcare services allowed.
* Compensation for people providing healthcare services is linked to median income.
[0] This is not such a big difference as one would think, as more than half of the basic research in the field is actually publicly funded already.
>Healthcare research funding to come from the public sector and donations only.
And I suppose the public will indirectly vote on where research goes and where it does not? I don't trust any party in power to have a monopoly on healthcare research without a private sector counterbalance. But I'm open to reconsidering the current allocation.
Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum.
If the us tried to become your ideal world, you would lose a huge chunk of the doctors you have, and the amount of medical services you would provide will be lower than it is today.
Not sure if this is required - the UK manages to have a socialist health care system (the NHS) for the vast majority and a relatively small private healthcare system for those who want treatments not covered by the NHS, or a nicer room etc.
I'm not sure I'd be happy with completely banning access to private healthcare - although I'd prefer it if the NHS was resourced to a level where there really wasn't much need to to go private (which certainly used to be the case).
This all assumes that healthcare is a human right, which I am not so sure about. Why should health education be free but not engineering education? I'd hazard an argument that not everyone deserves healthcare, so it would be difficult to make it a Right.
Something is very wrong with the whole medical insurance system in the US. Having recently been exposed to it, I keep discovering new surprises and being shocked regularly.
What I found most bizarre is that Americans who are "temporarily" in the US (e.g. expats, visiting) can get health insurance with better terms and at about 1/10th the price of what residents are offered.
That could be because for the really expensive stuff they'll pay for you to be transported back to your home country, where your primary insurance will treat you.
Consider that the average healthcare consumer pays an insurance company a premium and a co-pay so that the insurance company can reimburse a doctor whose rates are higher to offset the cost of administrative salaries for assistants to deal with the insurance companies. If you think about it, it's basically a form of racketeering which happens to be legal because the doctors and the insurance companies aren't formally colluding to needlessly increase the administrative complexity of the system, and because there is no legal response, the insurance companies are incentivized to raise administrative complexity and cost over time (since inelastic demand has no effect on preventing revenues from rising from pure cost increases).
If you're an expat, you really need one of those insurance polices in addition to regular US insurance, as you'll discover when you try to claim.
My colleague spent weeks on the phone arguing with the insurance company while debt collectors from the hospital hounded him after a simple ER visit. In the end someone at the insurance company paid his bill with their corporate credit card because they couldn't figure out a way to get it paid through the system. This despite the fact that the insurance company claimed to have a 'network'-type relationship with the hospital (which the hospital denied any knowledge of). They stopped offering coverage for the US altogether after that because it was too expensive.
My parents are still trying to get their travel insurance to reimburse them after an ER visit while on holiday.
Accident vs. long term sickness, maybe? If you’re a visitor to the US and are diagnosed with cancer you’re not going to stick around and rack up a 250k in medical fees (and I expect it’s not covered anyway).
Heathcard insurance premiums are using community rates - priced on the overall risk / claim rate of the population of people covered under a certain policy.
My guess is that expats and visitors from other countries are a healthy and lower risk group (because they’re also wealthier) than the general population.
Under the NHS most patients pay a "prescription charge" which is intended to encourage patients not to seek prescription meds when they needn't do anything. (Several big categories like pregnant women are exempt from charges, and if you use lots of medicine you can "prepay" a fixed fee of about £100 each year to stop getting charged regardless)
The charge is more than some cheap OTC medicine you might get prescribed, e.g. hay fever tablets are pennies per box and the charge is almost £10. But pharmacists are required to tell you if you could just buy it yourself for less - they collect the charge so they have the opportunity to point this out whereas your doctor needn't know if you pay or not.
Logically the charge must also be bigger than the price for some of the cheapest prescription-only medicine and there's no way to avoid paying extra in the UK as far as I know in this case.
Over 90% of prescriptions are free, because they're prescribed to exempt groups (children, the elderly, people on benefits). It's a slightly peculiar system that doesn't make a huge amount of sense.
The charge is more than some cheap OTC medicine you might get prescribed
I've had both similar, and opposite, experience in the U.S.
My wife has a prescription for an OTS drug. Getting the prescription filled with insurance costs $35. But buying it OTC costs $22-25, depending on the store.
I have a prescription for an OTC drug. Getting the prescription filled with insurance costs $3.55. But buying it OTC costs $10-$12.
It's like they always say in health care — ask questions, keep records.
There's also a focus amongst GPs to not prescribe cheaply available drugs, with safeguarding allowances. The NHS pays flat processing fees on classes of drugs. A 10p box of paracetamol ends up costing the CCG £4 to dispense via a high street pharmacy.
This crackdown is at least partially due to the perennial social media posts doing the rounds telling people how to get "free" Calpol for their kids.
I am on the same exact medication. I live in Italy.
My 90-day supply is 15 euro (5 euro per box), but the government covers most of it through the healthcare system, so I end up paying 3 euro (1 euro per box).
I have a doctor friend who's made it a habit to recommend that patients use GoodRx anytime they go to pick up prescriptions. Doctors can only be so involved in the pharmacy side of the transaction and a lot of pharmacists aren't able to intervene.
It's sad that it requires a 3rd party app to help people not get screwed over by the current US medical system.
I do wonder if insurance paying for everything under the sun is part of the issue. I remember hearing talk of medicine for some chronic conditions being available over the counter (migraines, diabetes, asthma, etc.). The way I see it, my car insurance only covers a limited number of issues. Unfortunately, health insurance has historically come on the wrong side of things (e.g.: pre-existing conditions BS)
Health insurance in the US isn’t insurance. It’s a scheme to try and spread around the costs of providing healthcare to everyone, and everyone tries to pass the buck to those with the least power in the system. Large employers with young, healthy office workers win, and poorer taxpayers who don’t have health insurance or independent contractors who have very little power lose. The people who have nothing get medical care, but it’s not ideal, but they don’t have anything to pay with either.
So try not to be in the middle - the ones with enough assets to take, but not enough to defend against having them taken (e.g. not being part of a group that can negotiate out of it).
God forbid we actually come out and say we, as a country, want to support each other. A large portion of our fellow citizens would rather play this game of hot potato, but don’t have the balls to turn poor people away from the emergency room and tell them to die.
Another example of how distorted prices are in this market. Price discovery is nearly impossible. Some places can't even tell you how much a drug cost without insurance because they don't even know!
I am skeptical of claims that the US heathcare system could be fixed solely by better consumer medical information. But this is one area where consumers can often save money - just by asking their pharmicist when they go to fill a prescription to run the cost both under insurance vs cash pay.
One wonders what value health system administrators are providing when such a high percentage of negotiated drug plans result in higher prices than cash prices.
Not from the US. But how in God sake does this make any possible sense? I mean if the insurance doesn't want to insure a certain medication, then you just pay it for yourself (provided they explain why; or that your contract said so).
That used to be the way it worked. You'd go to the doctor and he'd charge you, say, $35 for a basic exam, and you'd pay in cash.
Since health insurance became widespread, now doctors charge crazy amounts. My doctor charges something like $210 for a basic exam, or $185 for the "negotiated rate" to the insurance company.
I saw on television once that the reason we're in this mess has to do with WWII. With so many working-age people fighting overseas, finding workers was hard for companies, so they started raising wages. The government was afraid of war + inflation, so it put limits on pay raises. So, instead, big companies started offering health care benefits. And thus, an industry was born.
At least that's what I remember from the TV. I can't cite the show or channel, but I do watch a lot of PBS and virtually zero YouTube.
But how in God sake does this make any possible sense?
The US health care system doesn't make sense.
Health insurance began as a perk to attract more qualified people and became the expected norm at some point and typically covered the entire family. When that no longer made sense for employers, benefits began eroding and it became more common for benefits to only cover the employee. Employees had to pay extra to cover family. Then the ACA decided the way we fix this mess is we require everyone to purchase insurance.
It's crazy enough that I would seriously consider leaving the country if I thought there was any way for me to pull that off. But I don't see that as at all feasible currently.
The costs are not made clear to the consumer. Usually how it works in the US is you give your insurance information to the pharmacy, then then the pharmacy tells you how much you have to pay. You may be told what portion the insurance paid, but that’s a portion of a cost the insurance company negotiated. You aren’t told what it would have cost if the insurance was never involved.
It’s explained in the article. PBMs are responsible for the raised prices.
Which, by the way, is absurd to me as an American. I think at this point most Americans agree there are major flaws in our system, it’s just a disagreement about how to fix it.
I think the telmisartan story is cherry picked to tell the story the author wanted to tell.
I’m on that drug, and have a good health plan that charges the lesser of copay or actual cost for drugs.
That drug was going generic two years ago, and it took the generic manufactures awhile to ramp up. The generic drug cost more than the name brand version for a few months and was constrained — the pharmacies my my area had difficulty doing a 90 day fill.
It ultimately didn’t drop to super cheap status until they were approved to sell it in a normal pill bottle — previously it was sold in blister pack form.
Watch "drug Short" on the "Dirty Money" series on Netflix. It pretty enraging, and you are likely already familiar with the story, Valeant Pharma and Martin Skrelli....
I live in Dubai. I used to get glasses made for AED 100 - AED 200 (USD 27 to USD 54) when I was young, based on what I remember from visits to the opticians with my dad. No insurance.
Sometime after that insurance was introduced. Now, as an adult I pay AED 100 - AED 200 (USD 27 - USD 54) [basically the same amount] as 20% co-insurance when getting glasses.
Note 1: USD and AED are pegged.
Note 2: There has been inflation, but not that much. Tea increased from AED 1 to AED 1.5. Taxi increased from AED 10 to AED 20. Clothes increased 50% perhaps.
Not sure how widely known or common this is for medications but I take PrEP (Truvada) and the maker has a free "co-pay" card on their website that basically covers $4800/year in copayments (well above the $50/month I would ever pay).
I'm sure there's some shady big pharma economics behind why these exist in the first place, but at the very least I'm getting a very expensive drug for free.
I'm not sure I understand this article. I take a few drugs the cost of which is less than the co-pay and I pay that lesser amount when I pick up my prescription from a major US pharmacy chain. They have my health insurance info and would charge the co-pay if the amount were more. But they don't because the retail price is less.
[+] [-] drawkbox|7 years ago|reply
Part of the problem is healthcare provided through work that skews pricing for large companies over individuals/small/medium businesses and entrepreneurs.
If we can't get healthcare removed from employers and have both a private and public option based on Medicare for all. We AT LEAST need legislation to bring in CLEAR pricing for insurance cost and non-insurance rates, similar to the CFPB mortgage Loan Estimate and Closing Disclosure that show all pricing clearly in one sheet of paper both the estimate and the final mortgage.
What other product do we buy that the price is not known until after the product/service is rendered? At least some idea of an estimate is even hard to get as each part of the medical pricing matrix scam (insurance companies, medical services/suppliers, doctors, pharmaceuticals) try to keep pricing shrouded to stick it to people wherever they can.
The consumer healthcare experience is horrible in the US healthcare system and employers being the insurance companies main customers is a major part of this problem but pricing can be helped with clear regulations and needs to be now.
[+] [-] cascom|7 years ago|reply
I asked a friend in the healthcare industry about this - they said that since insurance companies negotiate all the services at once - the insurance company is trying to lower the total cost for the whole insured pool, this often means that they will marginally overpay for high margin services in order to get big discounts for the really costly things. The hospital makes more gross margin, and the insurance company lowers it’s total spend. The offshoot is that individual people may bear the brunt of this grand bargain...
No idea if it’s true, but had a ring of truth to it...
[+] [-] antjanus|7 years ago|reply
1. ultrasound cost around $300 with insurance...$150 without
2. ER visit cost $4K with insurance....$900 without
3. specialist visit with insurance cost around $200...$150 without
And don't get me started on labs.
It's really a rip off to use insurance for anything other than:
1. general doctor visit (cheap co-pay, pretty expensive cash option)
2. really expensive shit (c-section w/o insurance runs $25-$30K -- cost me around $5K with insurance)
Anything in between seems to be cheaper when you pay individually.
As a disclaimer this is "gold-level" insurance coverage which costs around $1200-$1300/month for a family of 4.
[+] [-] matwood|7 years ago|reply
Depending on where you went it could have been much more than 10%. Non-emergency imaging is definitely one of those things you ask about other locations and if they have cash pricing. When I needed an MRI if I was to use my insurance it was going to be ~$1000 because of high deductible plan. A different place took payment at the time and it was $350. According to the doctor who wanted me to get the MRI, hospitals are far and away the most expensive places to get one.
[+] [-] siruncledrew|7 years ago|reply
[+] [-] tantalor|7 years ago|reply
[+] [-] markvdb|7 years ago|reply
What happens in the software world when you see twentyseven useless levels of abstraction? Exactly the same. You smell a rat.
In my ideal world:
* Healthcare research funding to come from the public sector and donations only.[0]
* Healthcare products can only be sold once the production process is verifiably fully publicly documented. This means independent reproduction by multiple reputable non-profits.
* Market based generics manufacturers handle production. Competitors (for profit or non-profit) jump in if pricing gets out of hand.
* Healthcare education free to students.
* Only non-profit healthcare services allowed.
* Compensation for people providing healthcare services is linked to median income.
[0] This is not such a big difference as one would think, as more than half of the basic research in the field is actually publicly funded already.
[+] [-] creaghpatr|7 years ago|reply
And I suppose the public will indirectly vote on where research goes and where it does not? I don't trust any party in power to have a monopoly on healthcare research without a private sector counterbalance. But I'm open to reconsidering the current allocation.
[+] [-] namdnay|7 years ago|reply
Honestly, this isn't necessary, as long as you have single payer (or close to it). When the government is the one paying for 99% of healthcare, they have huge clout enforcing razor-thin margins and high efficiency on the provider side. Just look at how the massive supermarket chains are able to keep the margins of the upstream supply chain at a minimum.
[+] [-] conanbatt|7 years ago|reply
[+] [-] arethuza|7 years ago|reply
Not sure if this is required - the UK manages to have a socialist health care system (the NHS) for the vast majority and a relatively small private healthcare system for those who want treatments not covered by the NHS, or a nicer room etc.
I'm not sure I'd be happy with completely banning access to private healthcare - although I'd prefer it if the NHS was resourced to a level where there really wasn't much need to to go private (which certainly used to be the case).
[+] [-] MertsA|7 years ago|reply
This should be 31415926535897932384626434.
[+] [-] jbob2000|7 years ago|reply
[+] [-] jwr|7 years ago|reply
What I found most bizarre is that Americans who are "temporarily" in the US (e.g. expats, visiting) can get health insurance with better terms and at about 1/10th the price of what residents are offered.
Someone is being had, I'd say.
[+] [-] MrMorden|7 years ago|reply
[+] [-] solatic|7 years ago|reply
[+] [-] zb|7 years ago|reply
My colleague spent weeks on the phone arguing with the insurance company while debt collectors from the hospital hounded him after a simple ER visit. In the end someone at the insurance company paid his bill with their corporate credit card because they couldn't figure out a way to get it paid through the system. This despite the fact that the insurance company claimed to have a 'network'-type relationship with the hospital (which the hospital denied any knowledge of). They stopped offering coverage for the US altogether after that because it was too expensive.
My parents are still trying to get their travel insurance to reimburse them after an ER visit while on holiday.
Basically everyone is being had.
[+] [-] underwater|7 years ago|reply
[+] [-] larrysalibra|7 years ago|reply
My guess is that expats and visitors from other countries are a healthy and lower risk group (because they’re also wealthier) than the general population.
[+] [-] howard941|7 years ago|reply
[+] [-] maxxxxx|7 years ago|reply
[+] [-] tialaramex|7 years ago|reply
The charge is more than some cheap OTC medicine you might get prescribed, e.g. hay fever tablets are pennies per box and the charge is almost £10. But pharmacists are required to tell you if you could just buy it yourself for less - they collect the charge so they have the opportunity to point this out whereas your doctor needn't know if you pay or not.
Logically the charge must also be bigger than the price for some of the cheapest prescription-only medicine and there's no way to avoid paying extra in the UK as far as I know in this case.
[+] [-] jdietrich|7 years ago|reply
https://www.pharmaceutical-journal.com/news-and-analysis/pre...
[+] [-] reaperducer|7 years ago|reply
I've had both similar, and opposite, experience in the U.S.
My wife has a prescription for an OTS drug. Getting the prescription filled with insurance costs $35. But buying it OTC costs $22-25, depending on the store.
I have a prescription for an OTC drug. Getting the prescription filled with insurance costs $3.55. But buying it OTC costs $10-$12.
It's like they always say in health care — ask questions, keep records.
[+] [-] yipeedipee|7 years ago|reply
[+] [-] oliwarner|7 years ago|reply
This crackdown is at least partially due to the perennial social media posts doing the rounds telling people how to get "free" Calpol for their kids.
[+] [-] DanBC|7 years ago|reply
[+] [-] crivabene|7 years ago|reply
[+] [-] brd|7 years ago|reply
It's sad that it requires a 3rd party app to help people not get screwed over by the current US medical system.
[+] [-] arenaninja|7 years ago|reply
[+] [-] lotsofpulp|7 years ago|reply
So try not to be in the middle - the ones with enough assets to take, but not enough to defend against having them taken (e.g. not being part of a group that can negotiate out of it).
God forbid we actually come out and say we, as a country, want to support each other. A large portion of our fellow citizens would rather play this game of hot potato, but don’t have the balls to turn poor people away from the emergency room and tell them to die.
[+] [-] ohazi|7 years ago|reply
Having thought about it for all of thirty seconds, I can't see any downsides. Can anyone convince me otherwise?
[+] [-] doctorless|7 years ago|reply
[+] [-] dev_dull|7 years ago|reply
[+] [-] dv_dt|7 years ago|reply
One wonders what value health system administrators are providing when such a high percentage of negotiated drug plans result in higher prices than cash prices.
[+] [-] wallace_f|7 years ago|reply
Good question. This was also discussed last week on HN[1].
Since 1970, the number of doctors is up 150%, in line with pop. growth, while healthcare administrators up by 3200%.
1-https://news.ycombinator.com/item?id=17756845
[+] [-] alex_hitchins|7 years ago|reply
[+] [-] csomar|7 years ago|reply
But how could it be possible that you pay more?
[+] [-] reaperducer|7 years ago|reply
That used to be the way it worked. You'd go to the doctor and he'd charge you, say, $35 for a basic exam, and you'd pay in cash.
Since health insurance became widespread, now doctors charge crazy amounts. My doctor charges something like $210 for a basic exam, or $185 for the "negotiated rate" to the insurance company.
I saw on television once that the reason we're in this mess has to do with WWII. With so many working-age people fighting overseas, finding workers was hard for companies, so they started raising wages. The government was afraid of war + inflation, so it put limits on pay raises. So, instead, big companies started offering health care benefits. And thus, an industry was born.
At least that's what I remember from the TV. I can't cite the show or channel, but I do watch a lot of PBS and virtually zero YouTube.
[+] [-] DoreenMichele|7 years ago|reply
The US health care system doesn't make sense.
Health insurance began as a perk to attract more qualified people and became the expected norm at some point and typically covered the entire family. When that no longer made sense for employers, benefits began eroding and it became more common for benefits to only cover the employee. Employees had to pay extra to cover family. Then the ACA decided the way we fix this mess is we require everyone to purchase insurance.
It's crazy enough that I would seriously consider leaving the country if I thought there was any way for me to pull that off. But I don't see that as at all feasible currently.
[+] [-] Arcsech|7 years ago|reply
[+] [-] willio58|7 years ago|reply
Which, by the way, is absurd to me as an American. I think at this point most Americans agree there are major flaws in our system, it’s just a disagreement about how to fix it.
[+] [-] AnIdiotOnTheNet|7 years ago|reply
It isn't designed to make sense, it's designed to obfuscate.
[+] [-] unknown|7 years ago|reply
[deleted]
[+] [-] Spooky23|7 years ago|reply
I’m on that drug, and have a good health plan that charges the lesser of copay or actual cost for drugs.
That drug was going generic two years ago, and it took the generic manufactures awhile to ramp up. The generic drug cost more than the name brand version for a few months and was constrained — the pharmacies my my area had difficulty doing a 90 day fill.
It ultimately didn’t drop to super cheap status until they were approved to sell it in a normal pill bottle — previously it was sold in blister pack form.
[+] [-] samstave|7 years ago|reply
https://www.netflix.com/watch/80149535?trackId=14170289&tctx...
[+] [-] aceon48|7 years ago|reply
[+] [-] nobrains|7 years ago|reply
Sometime after that insurance was introduced. Now, as an adult I pay AED 100 - AED 200 (USD 27 - USD 54) [basically the same amount] as 20% co-insurance when getting glasses.
Note 1: USD and AED are pegged.
Note 2: There has been inflation, but not that much. Tea increased from AED 1 to AED 1.5. Taxi increased from AED 10 to AED 20. Clothes increased 50% perhaps.
[+] [-] dawhizkid|7 years ago|reply
I'm sure there's some shady big pharma economics behind why these exist in the first place, but at the very least I'm getting a very expensive drug for free.
[+] [-] ghaff|7 years ago|reply