Open source hospital price database
dolthub.com
dolthub.com
If this were at all possible, and I don't have high hopes looking at the obfuscation in the published US hospital pricing data, it would shine a light on the insane pricing insurers in the US get away with. Being able to quantify would allow to direct comparison, and hopefully convince some people to vote for the right party to change the greed and human suffering we currently have to put up with.
Edit: Here a PDF of the GOÄ [0]. It has multiple pricing as well, which is used when a private insurance carrier pays. Private insurance can be used as well, giving preferred access and treatment.
[0]https://www.pvs-bremen.de/fileadmin/user_upload/redakteure/p...
Well, actually, the contracts doctors have with the public insurance carriers forbid giving preferred access. So handing out earlier appointments to privately insured people is verboten. But no doctor obeys this, and punishment is practically nonexistent.
Differences in offered treatments are allowed, the catalogue that private insurance pays for is usually larger.
The out of pocket amounts paid by plan members for insurance premiums and co-pays on employer sponsored group plans are largely under employer control (within limits imposed by the Affordable Care Act). There's nothing stopping your employer from giving you free insurance with $0 co-pays.
Edit: there was a Time article about this topic, which I can’t find. But this is another good one from them:
https://time.com/198/bitter-pill-why-medical-bills-are-killi...
Does such a thing exist? It seems possible with 2023 tech, although it probably needs to know health insurance details to do its job well. I think millions of US citizens would subscribe.
At least from my understanding.
And why would millions of US citizens be interested in such a service? If they have insurance, insurance pays most of the costs. And this is the reason medical costs are on an upward spiral in the US: consumers are not incentivized to shop around.
“Hold please 911, I need to first get three competing quotes for ambulance service”
I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)
I've been in the ER for "difficulty breathing", which was billed at the highest level, although still made to wait ~2 hours in waiting rooms before seeing _any_ medical professional.
I've also been in the ER when brought in by an ambulance, in which case I was seen immediately.
These were both billed at the highest level, when the 1st case clearly shouldn't have been.
If there were well-defined prices, it would clearly be horrible to use that fact to further cement a fiction that a contract has been created with someone under medical duress (or further justify high prices when supply is being limited by the cartel). But reforming the industry has to start somewhere, and price signals are basically the only way we've found to coordinate large scale distributed behavior - regardless of who might be paying.
The equivalent would be when you're hungry and need to buy food at the grocery store, asking how you can manage that since you are going to have to pay for the food cost, the shelf space cost, the trucking cost, the refrigeration cost, the cashier, the bagger, etc. In actuality, the grocery store comes up with a single price that they're comfortable selling an item of food for, puts in on the shelf, and you can take it or leave it at that price.
The only way the medical industry can get away with their ridiculous bullshit is seemingly through a bunch of laws they bought whereby they can saddle people with debt without actually having done the work of forming a contract. Hence why you can visit a single business, and then end up getting a slew of bills from arbitrary providers that you had no relationship to. That simply cannot happen in other industries, where the only basis for billing is having formed a contract.
The equivalent for cancer is they'd lay out several treatment options (as they're already doing while ignoring prices), listing the price for each, the price and recommended frequency for followup monitoring, etc. You could then ask different providers for how much their treatment cost. Ideally the places administering treatment would be unbundled from the doctors doing the diagnosis, and the diagnosing doctors' office could give you a list of competing treatment providers. I know I'm hand waving away a lot of details here, but the whole point is that the intrinsic complexity of the problem needs to be modeled around cost, rather than treating it as an afterthought, creating a bunch of accidental complexity that ignores cost, then trying to manage it after the fact.
(And note that this is still orthogonal to who is ultimately paying, whether legitimate insurance to pool risk, subsidies for those who can't pay, etc. It's easiest to see what the current system is lacking when you look at things that "insurance" doesn't cover. For example a hospital stay, I would guess most people here would pay $100/night to have a single room rather than a shared room with a roommate always setting off their bed alarm etc. But there's simply no way to express that to the system currently, creating a zero-sum environment of scarcity, rather than a positive sum environment of abundance)
My point is that we have a whole bunch of policy nerds hand waving this complexity away and saying “enjoy your hsa- go forth and price compare as the invisible hand of the free market will provide!” Unless there is force from above, there certainly is no way the masses can navigate the system and force change themselves.
And the truth is that stuff does happen that’s not anticipated. My wife’s surgery was supposed to be routine. I would have had no idea ahead of time that there would be a lingering internal infection afterward. Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”.
If a tradesman screwed up a plumbing job, he would be called back to fix it at no cost. Instead I’m (or in this case my insurance) is stuck with >$100k of bills from the ICU to bring her back from the brink. I consulted with several malpractice attorneys who basically said unless the surgeon was drunk and slurring his words while operating, there is no case. The standard of care is so low.
High level points, from what I can tell -
1. The laws/regulations enabling the current system/cartel need to be scrapped. This includes the ability for providers to unilaterally assign arbitrary debts to patients, and the regulations enshrining the existence of HMOs (I assume these exist because HMO "networks" look exactly like what an 80's Coase fallacy drunkard would think constitutes competition)
2. New regulation / anti-trust enforcement needs to be applied to providers, such that they must publish clear prices for standard services that are comparable across providers, and straightforward hourly rates for anything that cannot be captured on there (with any nonconforming bills being considered attempted fraud).
3. New regulation / anti-trust enforcement needs to be applied to insurance companies, outlawing "provider networks" and rephrasing all insurance coverages purely in terms of prices, applying to any medical service from any licensed medical provider. That parallel "medically necessary" approval system needs to be entirely eliminated.
> Multiple subsequent visits where we shared complications with the surgeon were handwaved away as “you’re just not used to recovery from surgery”... The standard of care is so low
Routinely experiencing that dynamic of poor care [0] from the medical industry is exactly what makes me shake my head at the simplistic "fix it by having the government take it over" narrative. Ballooning costs and individual ability to pay is a problem, yes. But the much larger problem is the utter waste of medical talent, because the system has been designed around terms of top-down paperwork-filling rather than responsiveness to patients. The doctor should have been working for you, and you should have been able to get more time/attention for the doctor to have taken you seriously. But that was impossible because the "insurance" company dictated that you got one tiny follow up appointment, with the doctor focusing on filling his seat during that appointment, doing the bare minimum that conforms to the top-down standard of care, and avoiding doing anything extra that might create legal liability.
[0] Although not as much malpractice and completely avoidable as yours. I'm sorry for what you both went through.
You are doing some extremely heavy lifting here with this sentence alone by trying to connect two unrelated clauses. Consider the following: Is Water expensive? Is it expensive due to an innate characteristic of water, or is it expensive due to scarcity?
Now with that in mind, why is water the first thing price gouged during a crisis? People need fresh and clean water and you have individuals selling water at a premium.
The same principle applies for healthcare. Plastic surgery is optional and on an indefinite timeline, so there is no patient lock in. If you have a severe injury or a heart attack or a stroke you cannot shop around. You cannot pre-shop for conditions you don't know you have. And so you pay the crisis premium.
In some ways you can. When hospitals acquire a reputation for being pricey without offering better care, people tend to avoid them, and even in a crisis the hospital's name won't be the first that pops into your head.
https://www.statnews.com/2022/12/15/prisons-cant-afford-hep-...
Branded prescription drug prices are high mainly due to patent rights. But without patent exclusivity, most of those drugs wouldn't have been developed in the first place. It now often costs $1B+ to take a new candidate drug through phase-3 clinical trials; that money has to come from somewhere and private companies won't invest in that research unless they can expect to profit. The countries which impose strict price caps on prescription drugs generally don't do much new drug development. For example, during the past few years US drug companies have launched about twice as many new drugs compared to European countries.
https://www.efpia.eu/publications/downloads/efpia/the-pharma...
e.g. the Swiss healthcare system is privatized to a much higher degree than the US one (no Medicare/Medicaid equivalents) but 'basic' insurance plan prices and deductibles are fixed so prices still remain reasonable.
The problem with fully public systems in Europe nowadays is that you end up with two tiers. There is public option with poor service and several month long queues for poor people. People with higher incomes can get reasonably priced private insurance which lets them skip the queue, shop around for "better" doctors/service etc.. In this case it still ends up being subsidized by the public because higher income = better than average health and the government still ends up paying the bill for high cost treatment for serious diseases or emergencies.
A well regulated fully private system with income based subsidies just seems like the more fair and efficient option and it should be better at handling supply issues.
The main issue US seems to have is massive inefficiency and IMHO both regulation and increased competition is the best (and most feasibly) way to solve this.
We provide this for the most common ICD codes, and will be adding more in the future.
Yes, such thing exists.
My friend just had an endoscopy & colonoscopy together. She was able to get a price estimate through her hospital's portal both with and without her insurance, prior to her procedures, requiring no special interaction besides picking the service she was interested in and if she wanted to see the price with or without insurance.
The system seem to show her anything and everything she needed, from a routine office visit, these procedures, to delivering a baby. It not only includes the price at that facility but also a range from low to high, and where the facility fits. It also gives breakdown of the fees, although not deep enough.
The service seems to be by a company called Epic (www.epic.com), based in Wisconsin.
Epic is the biggest provider of hospital information systems in the US by market share. The hospital was probably using their software.
Lol, that mom and pop shop.
That’s the largest EMR vendor in North America and second in the world.
They’re the provider of the patient portal frontend amongst other things but there’s a lot more behind the scenes that must be done (with varying levels of quality) that is institution specific. Just using Epic does not make this work.
I grew up in Madison, Wisconsin. Most of my graduating high school class works for Epic. Their campus rivals Google's. Fun fact, they bought all the farm land you can see to the horizon and rented it back to the farmers for below market rates just to ensure the view from their campus was unobstructed by new development.
If you think anything about Epic is free or in the patient's best interest, check out their auditorium: https://cuningham.com/portfolio/epic-deep-space-auditorium You could host a Taylor Swift concert in there and have unused seating.
Taylor Swift regularly sells out venues with capacity of 70k+ (football stadiums), it's doubtful she would even consider an 11k venue unless it was a private event.
So I would say your statement is extremely disingenuous to say the least.
Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.
That’s what you think is the common root cause of complications?
You clearly are not interested in a productive discussion.
As for a fee for unpredictable occurrences - that’s what insurance is.
Your hungover surgeon is a bullshit strawman - most complications have nothing to do with provider malice or incompetence. Again since that seems to be the angle you are starting with you clearly have no interest in a grown up discussion or too ignorant and also full of hubris to understand any of this (which fits in perfectly well on this site).
If you throw a massive clot after a surgery and stroke out who’s fault was that if all the standard protocols for clot prevention were followed. Maybe you’re a smoker (or not) and 5 years later that unknown cancer will finally declare itself.
> more or less exists for each procedure
This is extremely misleading as it does not exist in any meaningful level of risk across the entire patient population.
It is all insurance in the end, but the incentives created by pushing the providers to bill ahead are better than the ones created by letting them bill for what they do.
Their prices are all-inclusive with followups on case something goes wrong and therapy for procedures that need it.
The founder was on econtalk (https://www.econtalk.org/keith-smith-on-free-market-health-c...) where he also claimed that their prices have been steady and that surgeons earn more there than at other hospitals. Meanwhile insurances don't want to work with them because they don't get to advertise how much money was saved from the Brutto cost based on their negotiation with the provider because they would have to pay the sticker price like everyone else.
They are pointedly uninterested in calculating what your particular surgery will cost you or your insurance. All they know is that you're one of 200 this month and your insurance pays, on average after all the adjustments and adjudications, about 15% less than average so please be quiet and don't make a fuss.
The reason medical providers don't know is because they don't care to know. Their systems are purposefully complex so their computers can do battle with the "insurance" company computers. And when you try to ask a doctor this highly relevant question, they condescendingly feign as if money shouldn't matter despite it being the foremost thing in many people's minds.
Providers already treat you with disdain and the back office in most doctors offices can hardly function as it is. When you ask how much something will cost, you will get somewhere between a blank look - if you’re lucky - to outright disgust that you could ask such a pedestrian question. You wouldn’t understand how complex medicine is and what could happen, you pleb. So how could we do something like give you a dollar amount?
In other parts of the country, people are passive aggressive and it's extremely annoying. They won't admit they don't know, because it's all about appearances. Patients faced with such responses would become irate. What do you mean you don't know?! The workers hate themselves for not knowing, and they know this whole thing is a scam even better than you do. They hate themselves for participating in the scam, and so the cognitive dissonance manifests as rudeness towards you.
Your point of cognitive dissonance is an interesting one. But ultimately it doesn’t matter what their state of mind is; if you are treated badly as a patient you will just give up to save your own mental energy. After all you’re seeing a doctor because something is wrong already. Why am I layering on managing the precious feelings of the doctors back office personnel on top of all that too?
Why bother? Because they're just working stiffs trying to put food on the table like the rest of us. They're not responsible for the existence of this detestable system any more than you are.
Even beyond just collecting and organizing the disparate files (which Alec has been doing a yeoman's job of with an all-volunteer force), you quickly realize that many of the quoted prices are just flat out wrong, or, at best, misleading. Even people in the business struggle to make sense of them.
An example: you look at a hospital MRF to see the cost for a knee surgery on a BCBS plan and it just happens to be exactly 3.5x the Medicare rate. Then you look at all their other quoted prices in the MRF and realize they're _all_ 3.5x Medicare. Someone in the billing department was really lazy putting together that MRF! Then you look at the BCBS MRF and see a rate which is 1x Medicare. Definitely not right. So you ask the BCBS affiliate what gives and they say the hospital you're looking at is on the ancient APC billing codes which means the HCPCS code you were looking at for the knee surgery would never be billed by this hospital and all the rates you just looked at are complete bunk. Now, take that knowledge and make a simple-to-use, mostly correct user-facing website! Because if you quote the wrong $ amount, the internet will roast you alive.
As I said, it might exist sometime in the next few years, but it will take a lot of behind the scenes effort to make it work.
Some of the folks working on this problem:
It's hard to escape the conclusion that the whole thing is a massive protection racket (i.e. pay monthly premiums or get a shockingly large bill weeks after the fact that you have no way of negotiating down except making kissy faces to the billing clerk). The only reason it hasn't been litigated on those grounds is that there are too many entities involved so whomever you prosecute first will cry foul and blame the other guy.
Sadly, I’ve noticed most businesses utilizing this price transparency data are primarily selling to hospitals/providers so they can negotiate better contracted rates with insurance plans.
On the optimistic side, what will happen sooner rather than later is that most billing codes will converge to an average market rate. Right now, there's no invisible hand guiding reimbursement rates because no one knows what anyone else is getting.
Once a market rate is established, it'll be easier to compare providers. Provider A will be 15% less across the board than Provider B, but might have younger docs or lower quality scores.
Might well be the actual care runs you $3500, but then you need to add $1000 for the aspirin they gave you, $800 for some gauze, and another $2500 for that MRI, because by jove it will be amortized.
And at that point, you have a negotiable bill - because all health care bills in the US are open to negotiations. The insurance strategy to negotiation is usually a simple "yeah, we only cover that much, and you'll like it". The private strategy is reminding hospitals that they only make cents on the dollar if it goes to collection.
Don't get me wrong, price transparency would be an enormous step forward for the US, but it's still just one step on a long road, and it won't be as useful as you'd hope.
SELECT `hospital_id`, `row_id`, `line_type`, `description`, `payer_category`, `payer_name`, `standard_charge` FROM `rate`
Adding an 'order by' clause makes the query time out.
"CC" in many of the descriptions seems to mean "complications and comorbidity". "MCC" is Major Complication or Comorbidity. Some other abbreviations can be looked up here: https://www.asha.org/practice-portal/professional-issues/doc...
https://www.england.nhs.uk/pay-syst/national-tariff/national...
I understand that it's helpful to see for people who are under/uninsured, but for most of the people it'll just max out at out of pocket/annual deductible max (which for example is like $250 per annum for me).
Further, what hospitals charge to insurance is not necessarily the rate insurance pays either. My counselor charges my insurance $400 an hour, but insurance negotiates it to like $80, of which I pay $0.
The counseling office charges people who do not have insurance like $96 per session.
What hospitals charge is not necessarily cost to patient is all I'm saying.
It is cost to the patient in the form of ever rising insurance premiums and deductibles (mine is $3000 and a lot of people have even higher deductibles).
Your counselor example also shows the insanity of US healthcare pricing. $400 vs $80 vs $96. How is anybody supposed to make economical decisions with such crazy pricing differences? There should be a regulation that providers charge the same price for the same procedure, no matter if they are insured or not or what insurance they have.
Generally the level of regulatory compliance necessary to enter the healthcare market is proportional to the risk of patient harm. If you want to sell healthcare analytics software not directly involved in patient care then there are basically no more regulations on vendors than in any other software market. On the other hand, if you want to start a new company to make implanted pacemakers then you'll have to spend years working through FDA compliance issues because a single tiny error can easily kill a patient.
Insurance: "Look how much we saved you! (Don't question our value.)"
And maybe even the medical provider being able to write off the difference as a business loss or being able to say: "Look how much we discounted your service!"
Even those employers that do pay 100% of the insurance premium could have paid more to their workers if the insurance costs were less.
Not trying to fight, I've just never seen it.
Also not trying to fight. "Could have paid you more" does actually happen in the right type of competitive environment -- though most employers are more likely to avoid direct salary increases to instead increase other parts of the "full compensation package". It's relatively much easier to later reduce those other things than it is to reduce direct salary, if things go sideways down the road.
Well, that's one way to characterize tax laws, sure. The American healthcare system too, for that matter.
1. Ripping off anyone without insurance who doesn't realize they may be able to negotiate it 2. Misrepresenting the true cost of healthcare for anyone who goes off the "original price" 3. Establishing that insurance companies have to push for deep, 90%+ discounts on everything, meaning nobody can offer sane pricing because the insurance company will say "But <HOSPITAL> gives us 95% off!"
I recently had a genetic test done. They told me that if my cost after insurance was more than $200 they'd notify me ahead of time so I could decide how to proceed, one option was a simple pay-cash option for $250. Turns out the "Amount billed" to insurance was $ 25,000, which was then "discounted" by about $ 24,600 and they were paid $400 or something. So, this is a service the lab is happy to provide for $250 -- and they make money at that price, yet in some fantasy universe, $ 25,000 is in play. This is why people want to burn the US health system to the ground.
Ultimately the end user is paying $250/300. Eg, my counselor example.
I helped make this. AMA or email me at alec@doltub.com.
The most common codes we see are CPT/HCPCS codes (coupled with revenue codes), or DRG codes. When the hospital provides any one of REV, CPT, HCPCS, MS-DRG, APR-DRG, APC, NDC, or EAPG, we break them out into their own columns.
We keep all the code metadata -- that is, we leave the code strings mostly intact, and then extract the code itself into a separate column. This preserves things like "CPT4" or whatever, as a string, but we do not have a way yet of splitting CPT codes into multiple subtypes. So we haven't lost any data, but we haven't totally figured out how to query it perfectly well either.
https://www.dolthub.com/repositories/dolthub/transparency-in...
https://www.dolthub.com/repositories/dolthub/transparency-in...
https://www.dolthub.com/repositories/dolthub/transparency-in...
Also common story is there could be up to 6 months between diagnosis of cancer and start of the treatment.
Would you like to pay such healthcare tax?
The big difference with private - you can choose how much do you pay and what you'll get. With public you get poor experience no matter how much you pay. And sum is not limited: more you earn more you pay :(
I'm not sure what kind of health insurance I could buy in the US that would give me short queues. Lower deductible, more ancillary services, sure, but what's the plan that says "no more than a week to schedule any kind of appointment you need"?
'SELECT * FROM `rate` where hospital_id = "XXXXXX" ORDER BY `hospital_id` ASC, `row_id` ASC LIMIT 200;'
As good or better medical care as any hospital in the world, with much nicer facilities and warmth in their care. No good if it's an emergency, but great if you can plan ahead.
They are trying to figure out how to have people submit their bills and gather actual billing data and compare what actually happens with what is claimed. Gives them a better data set for comparison and evaluation and to spot 'oddities'. I imagine health insurance does the same thing...but its opaque and invisible to consumers.
I met a woman in a coffee shop in Redding CA who was about to defend her home, clothing, and means of transportation from creditors who forced her into bankruptcy while she was dying of stage IV cancer. This is the state of healthcare as a business first in America.
I tried to fight it but medical billing places remind me of the South Park episode about Cable Companies (where they're rubbing their nipples as the callers describe how they're being exploited). Truly an asinine system.
Also, pay by check including the phrase "payment in full".
The doctor was an hour late. My visit was terse and his recommendation was to use a saline nasal spray. Then he charged me $140.
But I'm sure some right wing jerk in this thread is going to whine about how other countries pay more in taxes or something equally useless.
I used to think it was dumb that NPs are gaining further ability to treat patients, but my last few experiences with MDs has been so poor that I am no longer "rooting" for them. If that makes sense.
https://www.consumerfinance.gov/ask-cfpb/what-is-a-surprise-...
Anaesthesiologists seem to be the worst offenders
I've read [1] that Healthcare facilities often practice a dark pattern here though by combining both the consent to accept treatment and costs into one form/signature.
But regardless of that, AFAIK, if you never consent to payment, you're not legally obligated to pay. Of course it would always be better if none of this shenanigans existed but... Yeah.
[1] https://play.google.com/store/books/details?id=EViEDwAAQBAJ
You asked about consent - I recently had a hospital visit that included an ambulance trip. I was in no condition to provide consent, my wife didn't provide consent, but you better believe we got the bill (well insurance got the bills). That was just the start of the abject scams that exist throughout the medical system.
I needed a wheelchair to leave the hospital and they had me sign one page of something (on an ipad, while I'm high on opioids) and then replicated that signature onto other documents I didn't sign. They, on a recorded phone call, tell me I signed three documents, I note that they are pixel for pixel identical signatures - and that I only have one of the three documents as a hard copy. They still say I owe them $12, well the debt collectors do...I remind them each time they call that they are going to spend more trying to collect this than its worth. Its been sold at least four times.
Since then I have contacted:
* my health insurance company's fraud line - they don't take reports from patients
* state attorney general - no response
* CMS - no response (theory - if they are doing this to me they are doing this to others)
Broadly, from that one accident, I have had a lawyer send letters to two companies, filed suit against one, and simply decided I'm going to ignore 2 bills entirely because they are transparently fraudulent (IMHO). No one - short of an actual lawyer who used words like 'class action' has been any help in getting them to fix things. The other story, my health insurance company is repeatedly uninterested in being overbilled for every physical therapy visit...by hundreds of dollars per visit, across more than 20 visits.
Thats a fun story. Orthopedic surgeon prescribed PT, simplest way is to do PT through the in clinic PT clinic. I go in twice a week for a month and pay my normal PT copay. Then the insurance starts getting really high bills and I get a request for more money. They listed the orthopedic surgeon as providing the PT. I contact the company, they say that is their 'billing policy'. I point out that the orthopedist is not licensed to provide PT, 'thats our policy'. The difference for me is $10 per visit for a specialist rather than normal copay. THe difference for the health insurance was around $300 per visit. I contact my health insurance - they poke aroudn and find out that the orthopedist owns the PT clinic - which 'employs' no physical therapists. The PTs are all employees of a separate corporate entity so it doesn't through any red flags in billing. Insurance ghosts me - literally, I have a case number from the fraud department that they have no record of or notes on.
My wife and I had a conversation today about how we spend, between medical and general life bills, at least 3 hours per month ensuring we are not misbilled, or ripped off, or not provided the services we pay for. We find issues every month. There is a point where this is a generalized business model of fraud on customers and it needs to be stopped - there ought to be criminal charges.
The booked him in to stay the night and did surgery the next day and he stayed for two more days then went home.
Without a bill.
Thank goodness for Australia's healthcare system. It's far from perfect, but when it works, it really works well.
I think all the countries with "free" healthcare end up with having absurd waiting times
This is such a common trope that the USA tradeoff is that we pay to get higher quality expedited care, but it's just not true
It’s not health-care, it’s health-don’t-care.
US healthcare is easy to access. I've used it at every economic tier and it has never been difficult to get access to proper care. It is obnoxiously expensive.
> This is why average longevity in US is declining while it is growing in other developed countries.
It's growing in most, not all of course. Britain as one example is seeing something between stagnation and decline in its life expectancy, despite their vaunted NHS. And for seven decades it has lagged increasingly behind its peers, being ahead of only the US in its peer group. Universal healthcare will only take you so far.
"Life expectancy in the UK has grown at a slower rate than comparable countries over the past seven decades, according to researchers, who say this is the result of widening inequality.
"The UK lags behind all other countries in the group of G7 advanced economies except the US, according to a new analysis of global life expectancy rankings published in the Journal of the Royal Society of Medicine.
"While life expectancy has increased in absolute terms, similar countries have experienced larger increases, they wrote. In the 1950s, the UK had one of the longest life expectancies in the world, ranking seventh globally behind countries such as Denmark, Norway and Sweden, but in 2021 the UK was ranked 29th." [0]
---
"A new analysis of global rankings of life expectancy over seven decades shows the UK has done worse than all G7 countries except the USA." [1]
[0] https://www.theguardian.com/society/2023/mar/16/life-expecta...
[1] https://www.lshtm.ac.uk/newsevents/news/2023/uk-drops-new-gl...
Emergency care is typically easy to access. Non-emergency care is pretty easy to access in some places and quite inconvenient in others.
On top of that (and in conjunction with Medical Levy Surcharge) the government pushes everyone to have private health insurance, and it makes a huge difference in terms of wait times for "elective" hospital procedures (i.e. anything that won't kill you very soon).
All in all, last year I paid some AUD16k getting no medical services at all.
Paying all that you're still out of pocket for anything serious, as specialists (anesthetists, urologists, gynos, you name it) are typically charging way above Medicare standard fees and private insurance doesn't cover that completely.
[1] Sorry: 30% of Federal outlays are spent on healthcare, only some of that is part of the "budget"
There are people in the US who say "I cannot afford to go to the doctor" when they are sick; this does not happen in Australia.
That doesn't mean to say that it's as bad as in the US, but it does exist.
I'd also go out on a limb and say that there are more poor people in the USA than in Australia per capita, which might factor into how many people can't afford healthcare.
TLDR; The US system isn’t “free” and it is still shit.
Pretty sure there are a LOT of hospitals in the US where that's an expected or short time in the ER waiting room, and once you're taken in (into a room and charges accruing) you may well wait a another hour or more before being seen by a doctor.
Note that all of these places should prioritize you if you come in with heart attack or stroke symptoms.
If you're lucky, for certain situations, the system is set up VERY well.
Other situations, not so much.
I'm happy to live in Canada, where I just don't worry about the cost of things.
Problem is most hospitals are setup to be overloaded aka "every day is a bad day" - god forbid you have some staff sitting around twiddling their thumbs! Better to just have just enough staff that the place doesn't fail.
And the clarification comment says only ~8h were wasted waiting to be seen. The rest of the 3 days was probably justified (might be surprising if you are expected to be at work unless you die).
For me, I would pay $100 for the ER and then schedule outpatient that day or later some other time and pay up to $350 for the surgery.
The tax rates seem similar though with Australia being 23.6% and US 22.6% [0] (average for single worker no kids, of course there are variations).
[0] https://www.oecd.org/tax/tax-policy/taxing-wages-australia.p...
It’s a huge range of negative feedback loops that drive US medical costs into insane territory. For example insurance companies require more documentation which means doctors can treat fewer people and thus need to change each of them more. High costs mean fewer people can afford services which means more time in collections and charging those who can pay more. High medical costs drive up malpractice payouts for medical treatment which drives up malpractice premiums which drive up medical costs. etc etc.
Do you for example have data showing that life expectancy in this group is higher than, e.g., the life expectancy of an average citizen of France?
To your point, rich people in the west have prime access to world class care, and if it's not an emergency they'll fly to wherever they need to get the best clinics they can afford. People flying to Korea for plastic surgery is a thing.
Even at upper middle class you can go through non subsidized clinics if you want prioritized and/or special care.
Being even mildly rich will always help.
About a third of American households make 100k a year. Median household is about 70k a year:
But I suspect the person making the claim was just picking an arbitrary number where most people in that salary band will have decent benefits, and can usually afford the out of pocket portion also
I think you're reading too much into the OP's off-hand guesstimate. At every company I've worked for, the engineers earning $200K are on the same health insurance as the high school graduate in the warehouse earning $40K/year. The higher compensation makes it easier to clear the deductible/out of pocket maximum hurdles, obviously, but there wasn't a secret insurance plan that got unlocked at higher compensation.
I feel like a lot of such medical tourism has more to do with cost than quality of care.
Mental healthcare is a different story, but it's not any better with private insurance. Every therapist or psychiatrist in the insurance racketeer's provider directory is either dead, moved out of state, or not taking patients. "Ghost networks," they're called...
The worst insurance I've ever had was at a FANG, via United Healthcare. It covered nothing. Hardly anyone accepted it, apart from the on-site health clinic. It was worse than a university health plan, for god's sake. As to quality, you say it's the best in the world, but the fact that the US now has a life expectancy lower than China, Cuba, and Albania determines that this is a lie.
Unpopular truth on this forum: the healthcare system in this country is owned and operated by organized crime entities. It is completely illegitimate. It consumes 19% of GDP of the richest country on the planet, and Americans are some of the least healthy people outside of active war zones. Unless you're using your doctor as your Xanax dealer (John Mulaney explains how that hustle works: https://www.tiktok.com/@funkytownmc/video/722624028419819447...), this system sucks for you too.
I would be shocked if the Mexican cartels weren't deeply involved with United Healthcare and all these other corporate gangsters. This industry is the greatest crime of all time.
The sad truth about those stats is that if you split them by social class, you get two distinct groups: disenfranchised people with some of the worst health outcomes in the world, and privileged people with some of the best.
The childibrth related mortality rate for black american women is 3x higher than for white women, for example.
Geography is a greater determinant of health than race. People die a full 7 years earlier on average in Mississippi than California or Massachusetts, and 6 years earlier in West Virginia.
There's a clear correlation with income here, but one can easily argue that both income and life expectancy are downstream of policy. Red state policies are simply bad for your health and your wallet.
It's really just mental healthcare and dentistry that are basically impossible, but again, not much better with a private health plan.
Take the blinders off, stop pretending you're not getting robbed, and maybe we can fix it. There is no silver lining to private healthcare. You're not getting better care. Social determinants of health are very real, but they're driven by those 9 states without Medicaid expansion dragging the averages way down, a lifetime of bad care before the ACA, and also that medicine can't solve the many problems caused by poverty.
We would all be better off in literally any other system. Everyone thinks they're an above average driver. Everyone thinks they'll live longer than average. The truth is, you're just not that special. Unless you're a politician that gets to go to Walter Reed, or you have a wing in the hospital named after you, you're getting the abysmal standard of care that everyone gets.
At the same time, I was looking for a new dentist for myself and for this kid. There are a half dozen dentists who would see me within ten minutes walk. I finally found her a dentist some 20 minutes drive away (bonus: she can't drive).
And the mental health provider we found who would take Medicaid did intake for new patients on Friday mornings between 9am and 12 noon, no appointments, recommend you arrive early in order to be seen.
This is in WA.
For whatever bloody reason they just don't exist in anything near enough quantity.
Conversely, I'm surprised you found a dentist and a mental health provider that takes any insurance at all, and didn't have a months-long wait list. I've almost always had to self pay for both...
Add up what a person making $100k pays in insurance premiums, plus what the employer kicks in on those same premiums, plus the deductibles and co-pays for every procedure, plus drug costs even with insurance and it's not even in the same ballpark. Even if you are healthy and don't go to the hospital the premiums are huge for even basic health plans.
This is a hard lesson for many later in life and why social safety nets are so important for everyone.
Minor mistakes and games can also create odd billing situations that are opaque and difficult to fight.
My recent ER visits have all resulted in $1K-$2K or more (don’t remember exact numbers). A stupid sling costs about $100 in the ER. All due to deductible, Co-insurance and other provisions.
Also $350 for surgery?
You must have a really nice plan.
It is $100 for just the co-pay. Depending on your state, there are the balance bills, mystery bills, lab bills, xray bills, random radiologist bills from affiliated practices, and a host of other things that come in the mail ~6wks later.
Worst thing, the ER doctors, and radiologists in many cases as you noted, seem to always be subcontracted to some other agency which bills separately from the main hospital.
Wife said “no no no I’m not a citizen” and they said “yeah we’re so sorry about the cost” and she laughed.
Counting premiums, we paid $48k out-of-pocket for healthcare here in the US last year.
Australian public hospitals have first class surgeons. In this case they recommended surgery. They're not doing it for financial gain, why not trust their advice?
Your alternative is to go to another surgeon for a second opinion but you can only do that in the private health system, and that will take months or maybe longer and cost you alot of money.
Also, because people heal naturally at a variable rate. Not every tear or break needs invasive treatment.
Obviously I don't know what happened there, but as an example having a broken bone in their hand which is badly set would fit. It would cause you to have "pain in your hand" and it would require immediate surgery to avoid further damage.
On top of that (and in conjunction with Medical Levy Surcharge) the government pushes everyone to have private health insurance, and it makes a huge difference in terms of wait times for "elective" hospital procedures (i.e. anything that won't kill you very soon).
All in all, last year I paid some AUD16k getting no medical services at all.
Paying all that you're still out of pocket for anything serious, as specialists (anesthetists, urologists, gynos, you name it) are typically charging way above Medicare standard fees and private insurance doesn't cover that completely.
A minimum wage worker pays more like 1k in taxes per year towards healthcare, still somehow "$1000 for a couple of stitches" strikes people more than "$1000 for nothing at all", and somehow people seem to be grateful to the "free healthcare" for getting a 4-man 10-hour surgery "for free" rather than their neighbours. Go figure.
I wasn't poor even before I moved to Australia, and I would go to a store, buy some crap for a week (far from everything I needed) for $X, then see a notice saying "hiring cashiers, $2X a month". I'm probably speaking for a lot of Australians - I want none of that working poverty here, and high minimum wages and Medicare always were big parts of that.
I think AUD < USD though, so spending power is probably a lot different. Don't think you can do a real thorough comparison in an HN post.
[0] https://www.trendingaccounting.com/2022/06/comparing-tax-rat...
We here in the US also pay "tax" for healthcare, it just inst called tax. It is called {co-pay, co-insurance, deductible, balance bill, annual employee premium, annual employer premium}
Lets not kid ourselves, we pay dearly in the US.
It comes at a lower cost than what people in the US already pay.
That's right... if we converted to public health care in the US, you would actually pay LESS money than you do now for health care.
0
In europe(DACH) there is something called "drg" for example.
For example here(switzerland)
https://www.bag.admin.ch/bag/en/home/versicherungen/krankenv...
(Hard to find ressources in english)
The system is different because it's designed to have a pricing system with health insurances and also far away from perfect. But the treatments etc are standardized.
France is one of the worst countries you could have picked... lol.