Seattle coronavirus survivor gets a $1.1M, 181-page hospital bill
seattletimes.com
seattletimes.com
Did they really use stuff that truly cost $1.1M on him, and did they need to? If they're charging some absurd amount for a room, maybe it's just a way of rationing at some level, not what is being consumed.
I wish people would look at more what was spent in resources than what the dollar amount of the treatment was - if the patient didn't pay, then what matters to society is what was spent by society, not what number was written down as part of weird accounting.
The article acknowledged "hospitals get paid only a portion of the amount they bill". It's not helpful or necessary to write anguished stuff based on your conviction that the accounting style is wrong. What matters is the effect on real people.
On the other hand, if the reason that drug costs for instance were so high was because unnecessary drugs were used, or because they were wasted, or because the manufacturing of them was inefficient, that's a real problem and I wish that an article like this would focus on it, delve into it. Just...don't write stuff about how America is terrible because big numbers are scary.
I can't tell if the article is meant to be pro or con universal coverage, or if the point is, America is terrible and always will be and universal coverage won't fix it. If the point is the latter, I think it's a cheap effort in support. If people take it seriously, it's very demotivational and makes me want to find a scapegoat for catharsis. Which for me, the default is adtech incentives these days.
Imagine if there were some way to cut out duplicative overhead and administrative costs from all these counter-parties and cut-outs...
You can't say that in fact $400B is being transferred, just because a number that big can be or is written down, and if it is, that it's inappropriate, without reference points and context. Anything that affects large numbers of people involves big numbers, so negative reactions to billions or trillions in and of themselves are useless or harmful.
Their health systems are as competent as those in the states, despite the fear mongering by your health industry of years-long wait times, queues, etc.
So yeah, if the job we don’t understand results in massive underserving of your nation’s health needs, perhaps your disgust is misdirected.
A good resource, that I suggest all Americans consult so that they can stay alive is: http://HealthData.org
I consulted that website for years for trusted data on global health systems. Ironically, it is the same group that runs the IMHE coronavirus predictive models in the US. It is an amazing group, run by the University of Washington, which has a phenomenal public medical school.
Anyways, the wild part is that countries like Croatia compete with the US, for overall quality of care as a whole (not medical errors!). You know, a former Yugoslav war-torn, economically damaged country, that is up and rising thanks to being a new member to the European Union. It also has its geographic challenges in distributing care, due to having about 50 inhabited islands. One island is a 2 hour and 45 minute ferry ride away. If you get extremely sick, it is a 5 hour boat ride back to the mainland. There is no air ambulance service.
The US is really going the wrong way, and for shocking reasons. Also, Americans are generally unaware of how low the bar has been actually set, which is actually extremely low. It is also the system's fault, not the doctors. We really do have incredible doctors in the US.
[1] https://www.npr.org/sections/health-shots/2016/05/03/4766361...
It appears to me that you're just saying in very general terms, that healthcare in the US is terrible, and making it clear that is inherently true irrespective of whether government provided coverage is available.
If American health care is terrible because it is American, then the criticism is pure hate and cannot be constructive in any way. It used to be that the criticism was framed in the context that sensible developed countries cover healthcare for everyone and the US should get on board with this common sense modern approach.
Coverage isn't a totally solved problem; that's not something to dispute. But where it is solved, the rhetoric, the pat phrases, should change, they should react. If the US is terrible just as ever, then the reasons were never serious. They were rationalizations for pure antipathy.
That's true, but there's a very distinct difference between private insurance companies and other jobs I don't understand.
Most of the time, if someone has a job I wasn't aware of, after it's explained to me I understand the reason it exists and it largely makes sense.
In addition, most jobs don't have a readily available comparison of "And this other place doesn't have that job, instead does this, and it has these better results."
In the case of private insurance, we have several examples of other countries that have socialized healthcare and have notably better outcomes. We have studies showing that our private insurance industry is flawed as implemented in america.
The point I feel like making is that people have all the stock phrases and the same narrative about the US health care system when we aren't talking about the private insurance companies. When we aren't talking about people who are uncovered, abandoned by the government. Which makes me feel deceived, that people were making honest critiques in the first place lo these many years, rather than propagandizing against America because it's American.
There are companies that are not-for-profit and part of public organizations, which are just like insurance companies but handle administration for Medicaid members. Are these useless, are these parasites? I don't believe hardly anyone who has an opinion on the system even knows such things exist. If they do have some purpose, in a public system, maybe popular criticism of insurance in general is too facile.
India is going through an interesting phase of aping the "insurance system" of the US over the last 10 years or so (maybe longer, but that's not the main point), but a lot of people are too poor to afford health insurance. Only people who go to the more expensive hospitals use insurance, as a rule of thumb. And guess what? The costs for many procedures have increased 4-5x over this period at those hospitals which do ask for insurance, which still beats inflation handily.
On the other hand, the vast majority of people don't have insurance, which means people get to pay actual medical costs for the trivial stuff like cold and fever, and common ailments. These costs generally track inflation.
On seeing this, and realizing that except for some really complicated stuff, India's healthcare system is generally quite OK, I have come to the conclusion that the insurance industry in the US is just a complete scam. Insurance is supposed to be something you use in case of a catastrophe, and I don't know how it ended up as such a mandatory thing in the US.
As for it staying like it is, laws in the US radically favor entrenched monied interests because of lobbying, and we have a huge amount of political propaganda convincing uneducated voters to vote against their own interest to the extent that votes even could do anything.
Correct. I came to that conclusion as a chronically ill university student back in the early 2010s. I also had never experienced other health systems before, at that point, but I had graduate student TAs ask me what I thought of the US healthcare system, and I said "it's a scam and a rip-off". The dude who asked me had an appendicitis surgery on student insurance, and he agreed as he paid a lot of money for the procedure.
For example: Blood products in general (medication developed by publicly traded companies and formally approved by governmental bodies), which are regularly required for some rare diseases, generally cost around twice as much in the US compared to the rest of the developed world that has universal healthcare (excluding Switzerland).
I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, and I require a self-administered blood product to quite literally, stay alive. It is called subcutaneous immunoglobulin. It is the only treatment that has ever worked: I have tried about 10 different medications, plus combinations of them, to no avail.
Anyways, the cost of this blood product (immunoglobulin--both intravenous and subcutaneous forms) in developed countries that have universal healthcare (excluding Switzerland and the US) is 40 Euro per gram. Right now, the exchange rate, Euro to US Dollar is 1 Euro per 1.13 US Dollar. So, currently, this blood product costs about USD $45.01 per gram.
My US-based private medical insurance, pays for this medication at a contracted rate of USD $100 per gram. The provider (the billing party) is a very well known Pharmacy Benefits Management company, and bills for the medication at a rate of USD $500 per gram.
I take very close to 250 grams per month of subcutaneous immunoglobulin.
Let's do the math:
What my insurance pays to the provider every month, for the blood product, via claims filed over the past 2 years = ($100/gram)(250 grams/month) = USD $25,000/month
What the provider bills, and what I could theoretically owe, if something goes wrong = ($500/gram)(250 grams/bill) = USD $125,000 per bill
So, if for some reason a mistake is made, with respect to honoring a prior authorization, I can literally end up with a bill over USD $100,000 for a "one month's supply" of medication, with no resolve.
What a government in Europe (excluding Switzerland) pays per month for the medication (and I never have to worry about owing) = ($45.01/gram)*(250 grams/month) = USD $11,252.50/month
Also, $400,000 to seal a hospital room seems excessive. I don’t imagine how it could possibly cost that much. Add a few hepa filters to pull negative pressure, and you’re already pretty close (not counting decontaminating the doctors on the way in and out, but still, $400K?)
The typical narrative I hear around large healthcare bills is “racked up large charges because insurance will pay it” which is the opposite of what I would expect given the incentives I understand. Do insurance providers have a non-obvious incentive to keep costs high?
So a doctor can charge you 10k, but the insurance company itself will only end up paying 2k to cover it (and you pay your deductible).
So the charged price is entirely divorced from reality.
You get fucked when you don't have insurance, because you can't participate in this process
In most but not all cases the insurance companies pay less because they have pre-negotiated rates with the hospital and not due to challenging a bill. Even when parts of a bill are challenged by an insurance company the issue is more frequently resolved without involving the courts.
I have a chronic condition which requires monthly visits to a doctor. For every visit the doctor bills the insurance company $380 and the testing lab bills $75. For every visit the insurance company reduces the charges paid to $90.60 and $14 which are the rates they have pre-negotiated with the doctor and lab for these particular services. No court or case by case negotiation required.
This is not accurate. Cash payers just have to go through the administrative part themselves, cobbling together charity and self-negotiation, eventually landing on a payment plan that doesn't get reported to credit agencies.
As well, people don't really go bankrupt from medical costs that often. Hospitalizations cause about 4% of bankruptcies among nonelderly adults. Among uninsured, this rate is about 6%. They mostly go bankrupt because they lose their jobs and income [0].
Of course in a "free market" system, competition based on premium price should counteract this. However, due to another complex set of factors, this pressure does not seem to be very effective. (This includes the US system being employer based, and again the relatively oligopolistic structure of insurers). That said, I'm still very surprised there's not more competitive pricing pressure in the US, despite what seems to be some strong potential corrective forces, like employers self-insuring to reduce their costs.
(setr's comment about the "retail" price not being the real one is true, but it's also true that insurers still pay more in reality in the US vs. other Countries).
[not a pro on the regulations, so please correct me]
A lot of the medical system payments come from the government, and I think this may be the force that sets a lot of the prices, more than, say, private companies negotiating, due to both the aggregate $$$ value and fewer negotiating parties in the gov't group. Thus the high prices might result from poor negotiating incentives on the Gov't side:
1) gov't is bad at it 2) they don't have the proper incentives to control their costs 3) capture by private companies (lobbyists for providers etc.) 4) I think their may be some areas where the Fed Gov't is not allowed to negotiate by law. (drug prices?)
There are also weird rules where sometimes Medicare is legally required to get the best rate of anyone.
Healthcare industry is completely insane and to an earlier comment not a free market
On the one hand you'd think insurance would want the lowest prices possible, but that would also shrink the magnitude of float that they have to generate profit off of. So in reality, prices stay high.
As long as insurance is at the same time generating money via capital allocation and financial management, you'll still have the perverse incentive for price maximization in place.
In other words - if you get a low bill, everyone else will expect a low bill and there will be a lot of drama.
If everyone gets a high bill, but then they get a special discount, they are usually overjoyed and happy. If someone tries drama, they are stuck with the high bill.
Henry Ford once balked at paying $10,000 to General Electric for work done troubleshooting a generator, and asked for an itemized bill. The engineer who performed the work, Charles Steinmetz, sent this: "Making chalk mark on generator, $1. Knowing where to make mark, $9,999." Ford paid the bill.
[0] https://www.smithsonianmag.com/history/charles-proteus-stein...