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> I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) sufficient to do the job? Isn't some of that cost the healthcare provider's expertise and service? Would it be better if they prescribed morphine and charged you a magnitude more when ibuprofen would have done the job?

It's hard to argue the 600x markup is there to cover overhead when they literally have a facility charge there to cover overhead.

You also have separate line items for each of the things you mentioned -- doctors, nurses, staff, etc. You are paying for that expertise, often many times over, in addition to a $60 pill that retails for $0.10 at the local Walgreens (who also manages to make sure that it's not expired).

Absurdities like $60 Ibuprofen seem like an unforced error to me. This is the kind of blatant abuse that leads to voters getting collectively angry and getting the legislature involved.

You also have to cover uncompensated care, which is a significant chunk of change at any hospital in a major metro area. Besides, nobody actually pays the charges. Insurance companies don't, CMS doesn't, and even the uninsured can typically negotiate a bill down with a quick phone call. That's why the charges are all made up bullshit. It doesn't matter so why bother?

Most hospitals in the US are non-profits. You can go look at their financial statements yourself. They're not exactly raking in the dough. Running a hospital is enormously expensive, and if somebody comes in needing $1 million worth of care, then you're required by law to give it even if they can't pay.

That money has to come from somewhere. That's why Ibuprofen is $60.

This just isn't true. The costs of the uninsured are not driving ibuprofen up to $60.

The % of people who are uninsured has halved in the last decade, and this hasn't changed a thing for insurance billing.

I'm guessing you tell your clients, "I'm not really the right person to set up WordPress for you. I can do it, but it'll be incredibly expensive. You can probably do it yourself with a good online tutorial."

Hospitals aren't telling their patients, "We're not really the right institution to give you ibuprofen. We can do it if you really want us to, but it'll be incredibly expensive. You can just go buy some at the store for like ten cents." In fact, I bet that even if you have the presence of mind to decline their ibuprofen because you'd rather get your own, they'll strenuously argue against it, or even start treating you as not following medical orders.

In any case, it would be a lot more palatable if they'd charge marginal costs for marginal items, and charge overhead separately. It may well cost them something on the order of $60 to give someone ibuprofen, on average, but it does not cost them $60 more to give one more person ibuprofen. It would be more honest to charge two cents for the pill, and separately charge your fair share of the cost of the staff that obtains, vets, distributes, and administers that pill along with everything else you're getting.

I think the difference just having a hospital triage you and tell you 'ibuprofen will handle the pain, it's nothing serious' is _already_ worth a boat load of money and peace of mind.

I agree with you - it would be really interesting to see honest and transparent itemized bills, with separate items for overhead. I wonder if people would have the same problem with high bills in that case. Probably wouldn't like the total any more, but maybe it'd be easier to understand.

That’s definitely worth a lot. But the difference in price between “you just need ibuprofen, pick some up on your way home” and “you just need ibuprofen, so take this pill” should be minimal.

My understanding is that the $60 ibuprofen was a line item amongst other charges. Everything else you mentioned is likely covered by another line item in their bill. It's not as if they went to the ER and got a bill of $60. They perhaps got a bill of $500, of which the breakdown mentioned $60 for ibuprofen.

It's kind of like going to a mechanic and getting a bill of $200 for a single headlamp bulb, and another $300 for labor. Then the mechanic arguing that the $200 for the bulb includes the mechanic's expertise, knowing which bulb to buy, etc. Umm...no. All that is included in labor costs.

>This seems absolutely reasonable to me, I wish I could charge a 'fill my email with RFPs' type fees.

Do you not think that fee should encompass doctor's expertise, instead of sprinkling that over cost of materials?

My initial reaction when I read the piece was in agreement. I think it makes sense for ERs to have a facility fee. However, it doesn't explain how one hospital's facility fee can be, say, double that of another. Is it that one hospital is using Hue lightbulbs compared to the other?

A $5751 bill which is almost entirely a facility fee is ridiculous.

I would imagine a facility fee should be relatively fixed - it is the cost to maintain the facility and has nothing to do with a given patient's medical condition. As such, it is trivial for a hospital to publicize the fee and provide transparency.

In general, I think all the items they bill for are reasonable. The amounts, though? Not at all. When you start looking at the variation in how much is charged for the same items across different hospitals (or even within), there is no good model that can provide an explanation.

If they told me it would cost $60 for a simple Ibuprofen, I'd get out of bed and walk myself down the pharmacy on the first floor where they are regularly priced (in the SAME building), or send a family member down for that 10 minute walk to save $50 times how many you need to take. The pharmacists know the drugs I'm taking and interactions, yet the Ibuprofen isn't marked up a couple hundred percent.

They won't tell you that before they give it to you.

While my wife was recovering from surgery in Nevada, the surgeon literally said “I can have the hospital give her these pills I’m prescribing her (OxyContin or something similar), but it will cost you a lot less to get them from the pharmacy across the street and give them to her when you go home.”

I don't think this argument fully makes sense, because there are already separate charges for the services you describe. The physician who sees you will send you a bill, as will the facility.

> I charge clients similarly. I overbid projects that I don't really want to do. If you want me to setup Wordpress for you, I'll charge you out the nose. Granted, you get to accept my fees before I ever send you a bill. It's not a perfect analogy.

A more apt analogy might be you installing a Wordpress plugin that costs $10 for a client, then sending them a bill that looks like this:

$1,000 - Install fee

$1,000 - Plugin license

=========

$2,000 - Total

Then, when the client complains that you sold them a $10 plugin for $1,000, you say "Yeah, well, you weren't just paying for the plugin, you were paying for my time to install it" even though you had an additional charge for the time you spent installing it.

I don't think I have an issue with $60 Ibuprofen (or one thing being upcharged), it's everything being so upcharged, with the expectation that it's going to be negotiated down by an insurance company, and then if you don't have insurance, they try to get you to (or at least pretend) that they haven't overinflated everything and you owe them every penny, unless you just don't pay them, and only then will they consider accepting less.

> it's everything being so upcharged, with the expectation that it's going to be negotiated down by an insurance company

I agree with you 1000%. Highball the bill to the insurance company - fight with them - send the leftovers to the patient. That is totally unfair.

The law doesn’t require you to serve your customers regardless of their abality to pay. You don’t have a set of customers who have figured that out and come to you for services outside your core competencies.

The market also doesn’t expect you to accept payment terms much worse than NET30.

And a hundred other ways that healthcare is a tricky business. If we want to fix price transparency, we need to fix all that too.

> Isn't some of that cost the healthcare provider's expertise and service?

In theory maybe. Usually I would say these things are not exactly top priority and you are not getting your money's worth in the premium there. At best, of your list, you're paying for the instant availability, but what about the times where it's not instantly available? You're not paying for a guarantee of it.

In the UK patients pay a flat charge for a prescription which is around £10. For that reason I rarely prescribe something like ibuprofen or paracetamol outside of the hospital. I will always tell the patients to buy it themselves over the counter for around £0.16, unless there is a good reason to deliver it via a prescription.

As I understand it, the inflated prices are to cover price breaks given to other groups (especially Medicaid, but also Medicare): https://johnhcochrane.blogspot.com/2018/11/cross-subsidies-a... .

Insurance companies generally get “most favored nation” clauses so that they all pay the same price as each other. EOBs show the list price for a service, and the much smaller amount actually paid. The people who really get the short end of the stick are uninsured: they only see the list price and maybe an offer to negotiate.

> I charge clients similarly. I overbid projects that I don't really want to do. If you want me to setup Wordpress for you, I'll charge you out the nose. Granted, you get to accept my fees before I ever send you a bill. It's not a perfect analogy.

One can always forgo setting up WordPress, which is not always the case with healthcare.

Totally understood; that's one of the ways that it's not a perfect analogy.

Conversely if someone told me to setup Wordpress and that I could only charge $50, I'd change industries in a heartbeat.