One of the last tweets was the most interesting - "Just looking at Stanford's 2011 vs 2020 data, you can see charges going up more than 300% in some cases"
That is absolutely insane to me. I really don't understand how that's possible at all - I know no one really pays sticker price on any medical bills but still.
> I really don't understand how that's possible at all
The MBA-ization of healthcare - they realized they could, so they did. Mostly because the business processes around medical billing have become so convoluted, with so many layers of middlemen, that it's essentially impossible for a layman to understand and reason about.
It seemed like an opportunity for more people to just learn some of the skills for these expensive procedures so out of curiosity, I looked up what army field medics learn. It's a 16 week course. Stitches, bone setting, and minor surgeries should be done by the equivalent of barbers.
The prices are a perfect storm of what is essentially a unionized tightly gatekept profession, obviously perverse inventives in insurance, and the consequent inflation.
Swap debt for insurance, and you have the dynanic of the education market as well. Both of them are artifacts of regulatory capture.
Arguably, instead of teaching kids to code we could teach them to handle 50%+ of emergency room visit causes and the resultant widespread competence and research impact would make medicine progress at the rate tech has. I suspect the main reason we don't have biohacker first aid kits for routine procedures is drug controls on anesthetic, but there is a already robust global black market for drugs that could meet this need. A list of procedures sorted by risk and pain could be solved pretty fast. Of course there will be wildly irresponsible malpractice, but compared to the consequences of the current system, it probably nets out, and for medical industry people who don't think it would, they aren't really in a position to object to a free market in health services.
If we can create a market, knowledge networks and a disitribution system for 3D printed guns, we should apply the same ethos and skills and come for medical care next. We need a Cody Wilson of medicine.
Those numbers make kind of no sense. We had a 5 days delivery+postpartum at Stanford and were billed ~200k (insurance paid 50k, we paid 600$) which I found insane already. So 100k billed for stitches makes even less sense.
i live in Mexico, when my son was born we went to a private hospital.
i know Americand are imagining a horrible 3rd world facility, but its not. its a beautiful hospital with very kind people who take great care of you. we got the fancy big suite, so we could accommodate a bunch of family and friends. we were there for four days and i ended up paying about 4k USD, out of pocket, without insurance.
and I think this is where the problem is. I personally have friends who are doctors here (private sector) they have great lives financially, (nice cars, big house, trips to europe, etc). I get a feeling healthcare professionals in the US arent satisfied with upper middle class, they want to be hyper rich.
Maybe if youre the only person that can save me from a strange cancer you should be hyper rich, but not if youre doing regular procedures.
What I learned the hard way is that non-us citizens who need minor medical help should go to a drop-in clinic, not a hospital. In the few times I have done that, the fees were reasonable. The one time I went to a hospital to treat an infection in my thumb, I had to pay over $5,000. The same procedure in Canada would have cost me $50.
That is true for citizens too. Going to the hospital in the US, especially the emergency room, is crazy expensive. Unless I'm actually going to die imminently, I'm not going to the hospital. And if I actually know I'm going to die then there is no point in bankrupting the family by going to the hospital.
Do they really have a way to track you down as a non-citizen for nonpayment? I know it's not the most ethical to skip out on a bill but charging incredible fees to foreigners who don't understand the American system doesn't seem that ethical either.
I’m not saying the price is ok, but I’m guessing based on the description that includes a plastic surgeon given its a wound to the face. Generally speaking they’re going to charge a huge premium for one of those guys because that’s the going rate: people don’t like scars on their face.
I’d be curious what the price is for non-face stitches.
It doesn't include a plastic surgeon. That CPT code is very specific and translates to "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes".
So, how much of a premium would that plastic surgeon get? Even if it’s $50k ($2k per millimeter of stitchwork), that still leaves over $40k to explain.
Also, can a wound sized 2.5cm or less that can be stitched up be complicated to stitch? I would think/guess many of them would be glued nowadays.
Looking with European lens and reacting to people that think the universal healthcare is the solution to this problem: no, it is not.
The universal healthcare solves the insurance problem, not the cost of the hospital. What US needs is not insurance for people that don't pay for it, but reasonable prices at hospitals. We have this in my country: we have both public and private insurance and public and private hospitals. The competition in the system means private hospitals will never have such prices, otherwise there will never be clients.
Instead of universal insurance coverage, you need strong competition to hospitals so there is a market price that is closer to the costs. Here the private hospitals cost more, but offer a much better quality; still, the prices are double and most middle class people can afford to pay it without insurance if needed, so these stiches would be maybe $100 while in public hospitals it would be $50-60 and covered by the public insurance. Even here in Europe there is no full, unlimited insurance, emergency care is free but everything else is covered by a mandatory insurance every employee has (paid only by employee, not the employer) and it covers the spouse and kids (under 18 years old or in college) of the insured person. That means there are people without insurance and they receive only emergency care for free, nothing else.
So can anyone who is in the medical field shed some light on this? Because if I was under obligation to list prices but didn’t want to I would probably inflate them like this too since I can give arbitrary 99% discounts.
Without a requirement that hospitals list their prices by billing code and must actually charge that price to everyone across the board with no adjustments or discounts laws like this are basically useless.
Even then it would be kinda useless, because of the difference between hypothetical billing codes 22934a "Stitches, easy location, no complications" and 22934z "Stitches, weird location, infection present, uncooperative patient, resistance or allergy to common anaesthetics". Which is often very much up to interpretation and discussion as well.
From experience cost shopping, Stanford tends to be by far the worst. A simple EKG would cost over $3k, compared to around $1k or so at other providers.
Though just a few years back, it was like pulling teeth to get the insurance negotiated prices (which I pay entirely having an HDHP). Hopefully, more transparency results in more cost shopping, but it's been a surprisingly slow social change.
Price transparency will only help by putting pressure on providers for PR purposes, but it will not cause free market dynamics because much of the health care sector is not a real market. Take stitches, who would actually shop around before having the stitches done? You would go to your usual hospital and pay whatever the price ends up being. All urgent care is not a market from the point of the patient, because there is no real opportunity to choose providers. Insurers have to follow the patient or be blamed for not supporting out of network care, so insurers have little market shaping power either.
Guessing this is the starting figure they use for negotiating with insurance companies, who laugh at them and counter with $395, at which point Stanford says ok yes thank you daddy. But they can't use a different price for you if you don't have insurance. So just send them a couple hundred bucks and tell them to fuck off
As a Canadian, I am constantly flabbergasted when American friends tell me "Yeah, but a single-payer system would be way too expensive! Taxes would go up!".
It does not occur to them that in a single-payer system, the incentive on everyone is to find ways to lower the cost of healthcare, while in a privatized healthcare system the incentives are reversed. And examples like this twitter post show the result of those incentives.
Of course, you also have to contend with things like "medicare is not allowed to negotiate drug prices"... except now there's even _more_ motivation for drug companies to bribe politicians to get things like that encoded into law.
While I'm a proponent of universal healthcare, it does have some negatives.
From the outside the Canadian healthcare system looks good. But I have friends in Canada who complain that it’s very very hard to get an appointment for a basic check up. They have to wait anywhere from 2 to 6 months. Also, they just end up going to emergency for anything. Your experience might vary. The same with UK also I hear.
I am no big fan of the American healthcare system but I don’t think any country (don’t bring up Switzerland and Singapore as examples, they are too small and don’t have the diversity, size and complexity of the US) has demonstrated an ideal healthcare model.
"It does not occur to them that in a single-payer system, the incentive on everyone is to find ways to lower the cost of healthcare, while in a privatized healthcare system the incentives are reversed."
I don't think this is completely true. That greatly depends on the population. Regardless of single payer or private insurance, it's the underlying mentality of the people, or restrictions placed by the plan (which people then complain about). Many people think they have coverage, so they might as well use it. This can happen extremely often and for minor things. Think people going into the doctor or urgent care because they have cold symptoms (for less than a week) and want antibiotics. Most people want the easiest, most beneficial thing, like why diet and exercise when you can just take a pill for your type 2 diabetes, cholesterol, or blood pressure?
People don't think about costs during the most costly parts of life - end of life care. People want doctors to do "everything" to extend a person's existence, even if the outcome isn't likely to result in extended life. When the system does make choices about who to treat or how to treat, there is generally some public backlash (like NY letting many elderly die because they thought they needed to save the ventilators/beds for younger covid patients).
It's the views and intelligence of society that dictate behavior-based costs. This includes what restrictions are placed on both supply and demand sides.
When I say things like that to my Canadian friends, what I mean is: “I am not confident in the ability of the government to implement a reasonable single payer system. I am concerned that regulatory capture, small government politics, and special interest groups will result in system that is worse than what we currently have.”
You had mentioned hospitals being incentivized to reduce costs. They could do that by avoiding sick patients. Or not treating sick patients.
Some “providers” already have this business model.
Also, it’s all but guaranteed hospitals would seek to increase revenue by providing non medical services at high expense.
$2000/meal. $500/night parking. $500 for a hospital gown.
America needs to address its weak administrative state, underfunded and under-qualified civil service, and overall shitty public sector before taking on a massive project like this.
People say taxes would go up because every plan for single payer would involve taxes going up. Pretty much no one things you can squeeze major cost efficiencies out of the system.
The interesting part of socialized healthcare isn’t that it’s run by the government but that the cost burden is borne by the highest wage earners, i.e. the California and New York knowledge workers who make up a large part of this community. If your friend is part of this cohort then his concern is probably founded. Less so if he’s a line cook or even an IT admin in Wisconsin.
I weakly support single-payer because it would at least hopefully save me from spending hours dealing with the vagaries of medical provider billing and free people from worrying about health insurance when job-searching, but I don't see much reason to believe it would lower prices in America.
There's some kind of horrific cost disease going on in America. Sure, the insurance doesn't help, but it's not the main problem. The cash price - with a discount - for me to get the five-minute opinion of a nurse practitioner is $125-$150. Self-insured companies are paying 20k+ in premiums for an employee's family health insurance plan.
This is reflected in the fact that a lot of hospital systems in the US are already publicly owned! Taxpayers in much of the US are already paying directly to built facilities and pay doctors and nurses for anything their billing doesn't cover. (Not even counting the VA system.) 64 million Americans are on Medicaid, about 20% of the population; [1] 18% of Americans are on Medicare. [2] (There's some overlap, so those aren't strictly additive.) More Americans than Canadians are already the beneficiaries of public health care! And Medicare/Medicaid is already the one of the biggest US government expenditures. [3] Whatever natural incentives are in place are already there. It may be the case that specific government policies are partly responsible for hamstringing cost-cutting, but I see no reason to believe those policies and worse ones wouldn't perpetuate themselves.
There's a lot of factors driving the crazy costs in the US. Unfortunately, I don't see a reason to believe single payer would do anything but mildly slow the rise, unless combined with a lot of very unpopular policies.
> the incentive on everyone is to find ways to lower the cost of healthcare
why is this? Here in Chicago all govt run institutions are out of money with out of control budget overruns. eg: public transport( CTA) , usps ect. Not to mention pensions/pension debts which have spiraled out of control.
There has been a massive disinformation campaign pushed on the American people saying “socialism medicine” would be much more expensive and you’d have to let grandma die. That Canada hates their system and you have to wait for days to get seen.
Any evidence to the contrary is met with “but my freedom”, idk how to fight back against this
The fact that there isn't price transparency into all procedures at all facilities is a true market failure. Facilities are incentivized to to maintain opaque pricing so they can gouge.
My advise is to respond to the bill and let them know you'll only willing to pay $200 and that's all you can afford. Negotiations with these predatory billers go a long way.
Do these things really have purposeful list prices?
I had to go to the hospital for an allergic reaction on a visit to the USA. They let me go with $600 in cash.
When I asked for an itemized receipt, it has thousands in charges but nobody there really seemed to care if I paid that. The insurance company was welcome to pay if it wanted to though.
Does the European Central Bank calculate inflation in the US? - but healthcare is almost always part of CPI, so people doing CPI calculations would typically include this and this would be part of inflation calculated uuing CPI. And yes, healthcare costs have risen much faster than inflation as a whole.
[+] [-] atlasunshrugged|4 years ago|reply
That is absolutely insane to me. I really don't understand how that's possible at all - I know no one really pays sticker price on any medical bills but still.
[+] [-] daniel-thompson|4 years ago|reply
The MBA-ization of healthcare - they realized they could, so they did. Mostly because the business processes around medical billing have become so convoluted, with so many layers of middlemen, that it's essentially impossible for a layman to understand and reason about.
[+] [-] motohagiography|4 years ago|reply
The prices are a perfect storm of what is essentially a unionized tightly gatekept profession, obviously perverse inventives in insurance, and the consequent inflation. Swap debt for insurance, and you have the dynanic of the education market as well. Both of them are artifacts of regulatory capture.
Arguably, instead of teaching kids to code we could teach them to handle 50%+ of emergency room visit causes and the resultant widespread competence and research impact would make medicine progress at the rate tech has. I suspect the main reason we don't have biohacker first aid kits for routine procedures is drug controls on anesthetic, but there is a already robust global black market for drugs that could meet this need. A list of procedures sorted by risk and pain could be solved pretty fast. Of course there will be wildly irresponsible malpractice, but compared to the consequences of the current system, it probably nets out, and for medical industry people who don't think it would, they aren't really in a position to object to a free market in health services.
If we can create a market, knowledge networks and a disitribution system for 3D printed guns, we should apply the same ethos and skills and come for medical care next. We need a Cody Wilson of medicine.
[+] [-] tyingq|4 years ago|reply
CPT 12011 - "Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes"
See: https://www.cms.gov/medicare/physician-fee-schedule/search?Y...
[+] [-] the_svd_doctor|4 years ago|reply
[+] [-] jayski|4 years ago|reply
i know Americand are imagining a horrible 3rd world facility, but its not. its a beautiful hospital with very kind people who take great care of you. we got the fancy big suite, so we could accommodate a bunch of family and friends. we were there for four days and i ended up paying about 4k USD, out of pocket, without insurance.
and I think this is where the problem is. I personally have friends who are doctors here (private sector) they have great lives financially, (nice cars, big house, trips to europe, etc). I get a feeling healthcare professionals in the US arent satisfied with upper middle class, they want to be hyper rich.
Maybe if youre the only person that can save me from a strange cancer you should be hyper rich, but not if youre doing regular procedures.
[+] [-] lordnacho|4 years ago|reply
[+] [-] herodotus|4 years ago|reply
[+] [-] annoyingnoob|4 years ago|reply
[+] [-] rasz|4 years ago|reply
[+] [-] chrisseaton|4 years ago|reply
[+] [-] atlasunshrugged|4 years ago|reply
[+] [-] tw04|4 years ago|reply
I’d be curious what the price is for non-face stitches.
[+] [-] tyingq|4 years ago|reply
There are different codes for more complex work:
Intermediate repair (CPT codes 12031 – 12057)
Complex repair (CPT codes 13100 – 13160)
[+] [-] Someone|4 years ago|reply
Also, can a wound sized 2.5cm or less that can be stitched up be complicated to stitch? I would think/guess many of them would be glued nowadays.
[+] [-] RNCTX|4 years ago|reply
[+] [-] rasz|4 years ago|reply
according to this some manage >15% and profits are best ever https://www.forbes.com/sites/robertlaszewski2/2020/02/05/pro...
[+] [-] AdrianB1|4 years ago|reply
The universal healthcare solves the insurance problem, not the cost of the hospital. What US needs is not insurance for people that don't pay for it, but reasonable prices at hospitals. We have this in my country: we have both public and private insurance and public and private hospitals. The competition in the system means private hospitals will never have such prices, otherwise there will never be clients.
Instead of universal insurance coverage, you need strong competition to hospitals so there is a market price that is closer to the costs. Here the private hospitals cost more, but offer a much better quality; still, the prices are double and most middle class people can afford to pay it without insurance if needed, so these stiches would be maybe $100 while in public hospitals it would be $50-60 and covered by the public insurance. Even here in Europe there is no full, unlimited insurance, emergency care is free but everything else is covered by a mandatory insurance every employee has (paid only by employee, not the employer) and it covers the spouse and kids (under 18 years old or in college) of the insured person. That means there are people without insurance and they receive only emergency care for free, nothing else.
[+] [-] Spivak|4 years ago|reply
Without a requirement that hospitals list their prices by billing code and must actually charge that price to everyone across the board with no adjustments or discounts laws like this are basically useless.
[+] [-] corty|4 years ago|reply
[+] [-] chrisseaton|4 years ago|reply
[+] [-] usaar333|4 years ago|reply
Though just a few years back, it was like pulling teeth to get the insurance negotiated prices (which I pay entirely having an HDHP). Hopefully, more transparency results in more cost shopping, but it's been a surprisingly slow social change.
[+] [-] Joeri|4 years ago|reply
[+] [-] xtracto|4 years ago|reply
I got one at an ER in an "expensive " private hospital here in Mexico. I paid less than $50 USd for the EKG and a doctors' checkup.
I understand that I the US salaries are 3X what in Mexico but even that doesn't justify the $1000.
[+] [-] wly_cdgr|4 years ago|reply
[+] [-] mensetmanusman|4 years ago|reply
If people are traveling for medical tourism and it is profitable, it seems like we could incentivize other countries to set up shop here.
[+] [-] mabbo|4 years ago|reply
It does not occur to them that in a single-payer system, the incentive on everyone is to find ways to lower the cost of healthcare, while in a privatized healthcare system the incentives are reversed. And examples like this twitter post show the result of those incentives.
[+] [-] 1helloworld1|4 years ago|reply
[+] [-] RHSeeger|4 years ago|reply
While I'm a proponent of universal healthcare, it does have some negatives.
[+] [-] victor106|4 years ago|reply
I am no big fan of the American healthcare system but I don’t think any country (don’t bring up Switzerland and Singapore as examples, they are too small and don’t have the diversity, size and complexity of the US) has demonstrated an ideal healthcare model.
[+] [-] giantg2|4 years ago|reply
I don't think this is completely true. That greatly depends on the population. Regardless of single payer or private insurance, it's the underlying mentality of the people, or restrictions placed by the plan (which people then complain about). Many people think they have coverage, so they might as well use it. This can happen extremely often and for minor things. Think people going into the doctor or urgent care because they have cold symptoms (for less than a week) and want antibiotics. Most people want the easiest, most beneficial thing, like why diet and exercise when you can just take a pill for your type 2 diabetes, cholesterol, or blood pressure?
People don't think about costs during the most costly parts of life - end of life care. People want doctors to do "everything" to extend a person's existence, even if the outcome isn't likely to result in extended life. When the system does make choices about who to treat or how to treat, there is generally some public backlash (like NY letting many elderly die because they thought they needed to save the ventilators/beds for younger covid patients).
It's the views and intelligence of society that dictate behavior-based costs. This includes what restrictions are placed on both supply and demand sides.
[+] [-] pyuser583|4 years ago|reply
You had mentioned hospitals being incentivized to reduce costs. They could do that by avoiding sick patients. Or not treating sick patients.
Some “providers” already have this business model.
Also, it’s all but guaranteed hospitals would seek to increase revenue by providing non medical services at high expense.
$2000/meal. $500/night parking. $500 for a hospital gown.
America needs to address its weak administrative state, underfunded and under-qualified civil service, and overall shitty public sector before taking on a massive project like this.
[+] [-] rayiner|4 years ago|reply
[+] [-] unknown|4 years ago|reply
[deleted]
[+] [-] closeparen|4 years ago|reply
[+] [-] Amezarak|4 years ago|reply
There's some kind of horrific cost disease going on in America. Sure, the insurance doesn't help, but it's not the main problem. The cash price - with a discount - for me to get the five-minute opinion of a nurse practitioner is $125-$150. Self-insured companies are paying 20k+ in premiums for an employee's family health insurance plan.
This is reflected in the fact that a lot of hospital systems in the US are already publicly owned! Taxpayers in much of the US are already paying directly to built facilities and pay doctors and nurses for anything their billing doesn't cover. (Not even counting the VA system.) 64 million Americans are on Medicaid, about 20% of the population; [1] 18% of Americans are on Medicare. [2] (There's some overlap, so those aren't strictly additive.) More Americans than Canadians are already the beneficiaries of public health care! And Medicare/Medicaid is already the one of the biggest US government expenditures. [3] Whatever natural incentives are in place are already there. It may be the case that specific government policies are partly responsible for hamstringing cost-cutting, but I see no reason to believe those policies and worse ones wouldn't perpetuate themselves.
There's a lot of factors driving the crazy costs in the US. Unfortunately, I don't see a reason to believe single payer would do anything but mildly slow the rise, unless combined with a lot of very unpopular policies.
[1] https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-... [2] https://www.statista.com/statistics/200962/percentage-of-ame... [3] https://datalab.usaspending.gov/americas-finance-guide/spend...
[+] [-] dominotw|4 years ago|reply
why is this? Here in Chicago all govt run institutions are out of money with out of control budget overruns. eg: public transport( CTA) , usps ect. Not to mention pensions/pension debts which have spiraled out of control.
[+] [-] browningstreet|4 years ago|reply
[+] [-] tashoecraft|4 years ago|reply
Any evidence to the contrary is met with “but my freedom”, idk how to fight back against this
[+] [-] unknown|4 years ago|reply
[deleted]
[+] [-] shdh|4 years ago|reply
My advise is to respond to the bill and let them know you'll only willing to pay $200 and that's all you can afford. Negotiations with these predatory billers go a long way.
[+] [-] MattGaiser|4 years ago|reply
I had to go to the hospital for an allergic reaction on a visit to the USA. They let me go with $600 in cash.
When I asked for an itemized receipt, it has thousands in charges but nobody there really seemed to care if I paid that. The insurance company was welcome to pay if it wanted to though.
[+] [-] bawana|4 years ago|reply
[+] [-] sjg007|4 years ago|reply
[+] [-] jbverschoor|4 years ago|reply
[+] [-] 542458|4 years ago|reply