People using an emergency room are not in a position to negotiate price or seek an alternative service. An unconcious accident victim can't say, "That price is crazy I am going to the hospital across town."
Single payer is the only viable solution.
That's not true. Plenty of European systems are not single payer and work fine.
Edit: a common thread among these systems is that the private payers are not for profit and highly regulated.
The public system premiums are a % of income. The private is a flat cost, so as you make more become much more attractive (even costing less in many cases).
Doctors are sometimes private only or have separate private insurance waiting rooms. Hospitals have separate public and private rooms/beds, etc.
It's a two-tier system that works pretty well, at least in comparison to the US system.
My info is a few years dated, but is based on having been a patient in both US and German hospitals. From friends, I've heard the English system is similar in some respects to the German.
Amazingly to me, the German system was instituted under Otto von Bismark in the 1800s.
https://en.wikipedia.org/wiki/Timeline_of_healthcare_in_Germ...
https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
This ensures that the system works better than the US system, as the hospitals do not need to deal with having to treat uninsured patients who cannot pay. This is a major problem for the US healthcare system, and a critical threat to the solvency and continued operation of many hospitals, especially rural hospitals and clinics.
More to the point...is this the America we want to live in?
Turned out alright, I think. I'm still concerned I'll get an "oh by the way" bill in the mail.
I would say single payer, or a single regulatory arbiter of procedure and drug prices (within a multi payer context).
When you look at the healthcare costs GDP, the single payer systems still tend to come out ahead multi-payer + regulatory oversight (its one more level of abstraction you pay a complexity cost for...).
As someone who works for a medical billing agency either would make my life easier, having to juggle dozens of insurance contracts and rates stinks. France does the latter, insurance companies and the state plan negotiate and a single group - at the best this could make a good stepping stone to single payer in the US.
This statement is close to the fallacy "Something must be done. This is something. Therefore it must be done."
Consider counterexamples: http://marginalrevolution.com/marginalrevolution/2013/08/a-f...
What really pisses me off is that the HSA max contribution has not kept up with family OOP max. I contribute the max every year and can't end up with $8,500 saved.
I had a decent insurance plan prior to Obamacare. Now it's 3x as much and a HDP. Don't even have dental insurance anymore; use the HSA for that. Work for a Fortune 100 Company too.
Your HR department is shit. I manage a 30 person company and our benefits are better than what you've mentioned.
Funny thing about HR directors is that they don't last more than 1 year before rotating out. Don't want them to become too attached to the people they are there to screw.
Honeywell; thermostats?
You're probably now paying the 'true' cost of healthcare. (Of course, inflated by the peculiarities of the American system.)
At that level a company that wants a good plan can demand no exclusions for pre-existing conditions (an issue prior to ACA), same-day partner additions, better drug tiers, lower copays, etc. Often they pay less per person than a 1,000 person company does for a much worse plan.
I know because I looked. Two employers ago we got acquired by a very large company (over 80k employees). They paid ~$800/mo for my family. When I moved to a startup, they were paying ~$1200/mo and the benefits were worse. I'm back at a large company again and it's back to ~900/mo for a better plan.
You are getting screwed because the company has decided to do so.
Ha ha, didn't have to tell me that! I bet my coworkers we won't have company health insurance in a few years. Gotta keep that stock high.
Crazy thing is, now that I'm middle age, and my 401k approaches 7 figures, I'm beginning to care more about fund performance to get me to retirement in 20 years than benefits. It's all coasting from now.
http://www.riverradiology.co.nz/diagnostic-solutions/price-l...
$500 NZ versus $11000 US - maybe there is something wrong with your health system.
Average price for a CT scan is probably between $1000 and $2000 though.
In Russia fully out-of-pocket (no insurance, no subsidy) CT scan will cost you $50-$200 (depending on body part).
So, this is likely around its prime cost. And the rest of your $(3000-200) is split and pocketed by hospital shareholders and insurance company.
I spent 4+ hours before a small outpatient procedure at a local hospital trying to find out if the anesthesia group and surgeons were in-network. I never got a straight answer -- no one knew the answer and I was forced to roll the dice.
Hospitals are currently more like co-working spaces where each room (ORs, radiology, etc.) is rented out. The support staff is included, but everyone else is their own small business.
If you're bleeding, and someone hands you a price quote, what are you going to do?
Or if you're unconscious, they can't even hand you a price quote. (I guess they could shove it in your pocket.)
I know the one time I needed to go to the ER, for emergency surgery, I'd have done it if they'd said it was a million billion dollars, because my life was literally on the line. I wasn't going to go shopping around, because leaving that ER would've meant death.
What's a price quote supposed to do in those situations?
We just need universal coverage, whether single payer or actually universal insurance.
I think you may be getting downvoted for your last sentence, but the points you're making are very real.
I work for a medical billing company owned by a competitor to EmCare, we participate it a large number of insurance networks at each site we staff because it's the best way to get reimbursed - I'm rather shocked the hospital didn't investigate how their contracted providers handled insurance contracts and billing.
The problem with trying to provide quotes for emergency services is you don't know ahead of time what E&M code will apply to the visit, what labs will be run, what procedures may be required for treatment, and since physician and facility billing are separate the right hand doesn't know what the left is doing.
I also have some suspicions about the jump from 6% to 28% rates for billing what I assume is a 99285 (highest level non-trauma ED E&M code) and why it may explain the lack of their participation in insurance networks, but I don't want to tread into libel territory so I'll keep my mouth shut.
Disclaimer: I work for MedAmerica Billing Services, Inc. a subsidiary of CEP America - these views, opinions and statements are my own and don't necessarily reflect those of my employer.
I'm always one to call for legislation and price controls, because time and time again, without the legislation in place, situations like this arise. It's the sad reality. Regulating companies is apparently our only hope to keep people from constantly being stepped on.
Sarcasm aside: this problem is solved, and it's called insurance. Private entities sell it. The government does it too. It works. We just need to make sure everyone actually has it.
It's not that the patients don't have insurance, it's not even that they go to a hospital without an agreement in place with their insurer - it's that the ER has a number of people outside that insurance contract, you don't know who they are, you don't get to choose whether they treat you, you just get a bill at the end - despite being insured, and choosing a hospital recognised by your insurer.
Insurance is not the solution for this problem.