Price transparency would help, but it wouldn’t solve the duress problem. After a car crash we all want to go to the nearest hospital rather than the most price efficient one.
[1] https://www.annemergmed.com/article/S0196-0644(13)00313-2/ab...
Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending.
Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere from $10->$15.
I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible.
I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all falls to my deductible. (Insurance paid nothing)
So it cost me almost 3x as much to go during the day than it costs during the ER - but my insurance paid out about 6x as much for the ER visit. I wonder how many "ER Abusers" have figured out it's actually cheaper for THEM to go to the ER than "normal doctors"?
https://www.investopedia.com/ask/answers/051415/what-differe...
Most health insurance plans have a few services that are copay-limited even before you hit your deductible. i.e., the $40 for an office visit to your primary care doctor, $90 to see a specialist, and in my case $500 for the ER visit. Imaging and procedures are my problem from the start, up to the deductible though ... apparently unless they happen in the ER.
Like I said way up-thread, the way it's structured puts the incentives in the wrong place for me. Had my two visits for ER and scans been in the opposite order, I would have been out of pocket the same total.
Anyway - I'm done arguing with you. I know how my plan works and what I've paid this year, whether you believe me or not.
But then I live in Australia.
> You need medical equipment to handle all types of injury/trauma.
This is equipment that most hospitals already have for other reasons. It's not like they have ER MRIs that sit idle and then an MRI for everyone else.
Further, a lot of that diagnostic equipment simply isn't needed in most cases. For ER related problems, xray machines are commonly all that's actually needed. Those are fairly cheap in the grand scheme of things.
> You need physicians and nurses and supporting staff.
A lot of the need for that gets cut dramatically by having a single payer system. The reason we have big ERs is because they are required to treat before seeking payment. As a result, many uninsured and underinsured people are using the ER as a primary healthcare system. Give everyone 0 or low deductible healthcare and you'll see the number of ER visits drop dramatically.
Emergency care is not actually uncommon. Heart attacks, car accidents, these are the leading causes of death. It's completely reasonable to expect this to legitimately consume 10% of healthcare resources.
> Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere from $10->$15.
This is just opportunism, but it isn't really the core of the problem.
Emergency care is inherently expensive for a specific reason. You need an emergency heart surgeon on premises in case anybody needs heart surgery regardless of whether anybody does at any given time. You also need a neurosurgeon and one for every other specialty, and all the supporting equipment. It's very expensive, which is why it amounts to 10% of healthcare costs.
They then try to recover some of those costs by massively overcharging for ibuprofen and band-aids, which is silly (charge insurers the actual cost for emergency heart surgery instead), but it's not going to be a source of major net cost savings just to do the accounting differently.
It seems like most people's greatest fear around hospitals is a surprise ER visit that blows through their savings.
I'm not saying this makes for some total solution - just reacting to rejection of the market dynamic having any worth. It's foolish to cast aside entire paradigms of approaches because they don't fully solve every corner case. (The dual would be to ask how single payer healthcare solves purely elective procedures like cosmetic surgery. It doesn't.)
Obviously any market dynamic for urgent care needs to recognize that no contract has been formed, and so hospitals can't unilaterally set charges under a fallacious idea of contract. For instance when your car gets towed under duress (accident on the highway, expired papers, etc), the state sets the rates they're allowed to charge. They're still inflated, but at least within a factor of 2-3x the usual market.
(FWIW I think single payer is a good pragmatic way forward)
Rather my point was that when you need urgent or critical medical care there should be a baseline assurance of a solution to your predicament as you may not be in a position to shop around.
Your analogy with restaurants is not a good one, since you are unlikely to be in a situation where you're about to starve to death, and the only restaurant in town has 3 Michelin stars, grocery stores don't exist, and passers-by are not qualified to give you food :)
In a different thread I pushed the lack of a contract argument, and got back a more fitting legal theory that hospitals are allowed to charge you under the idea that you not paying would be "unjust enrichment" - they treated you, incurred expenses doing so, and therefore its your responsibility to compensate them. But that still doesn't support them charging you some arbitrarily high price, rather just expecting to be reimbursed for their costs. And so such bills should actually be constrained by the lowest rate they have with contracted insurances.
As for the analogy, I've been pretty hangry to the point where I wouldn't have been able to form a contract. It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation.
Eh, the overall food market doesn't quite fit as an analogy here. I know I'm not alone when I say I have close to a year of food storage; it's not really the same for surprise healthcare bills.
(Although maybe with the rise of big surveillance and fine grained price discrimination we'll start to see these situations in other markets get exploited more)
https://www.foley.com/en/insights/publications/2019/12/price...
I believe this was fought out in court this past summer and upheld.