Medical Care in the U.S is Bad, But Insurance Sucks Too
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Supposedly one of the downsides of more socialized systems are that they're bureaucratic, but I think the U.S. system, whatever you want to call it (it's not really either a functioning market or a properly socialized system) is somewhere near Peak Bureaucracy (certainly more than Denmark's, where I now live). It doesn't help that everyone bills separately: if you ever have to visit a hospital, you will get something like 15 different bills, because everyone from the anesthesiologist to the surgeon are apparently independent contractors, or at least bill that way. And you have to go through the same opaque negotiation process with each of them. And many of them are sloppy and contain errors, e.g. billing you for things that insurance actually should have covered.
I'd be fine conceptually with a model where catastrophic care is insured and smaller expenses are paid for out of pocket. But then I'd like: 1) the catastrophic care to actually, 100%, guaranteed be covered, without loopholes, lifetime maxima, excluded conditions, etc.; and 2) the smaller expenses to be priced transparently up front.
I have an appointment with my doctor soon. I asked them how much the appointment will cost. They called my insurance company. The got back to me, and the bottom line is nobody knows, and nobody will know until after the insurance company is actually billed.
For any other service I'd just not buy it under those conditions, but if I don't go to the appointment then eventually I'll die.
To imply there's not a meaningful difference between several decades' longevity vs. dead in a month isn't fair.
(Looking at the above, I see that I should make it clear that just I'm bringing it up as an example of a group that approximately thinks like you say.)
Doctors often have a cash price and an insurance price, with the former being significantly less. I have a high deductible insurance plan, which means I effectively pay for most stuff out of pocket. So when I call, I ask them what the cash price is. I then explain my situation and ask if they'll honor the cash price since I'm paying out of pocket anyways. They always tell me no.
I mean, I get that they probably can't start discounting insurance claims because of my deductible or else they'd have to do it for all insurance claims, but it really grinds my gears that for all my insurance premiums, I essentially get the privilege of paying a higher rate.
Our 'system' is broken. When will it be fixed?
The problem is that my deductible is like $1300 or something. Now I don't remember the last time I spent $1300 on medical services in a year. On average, it's probably more like $500-$600 (I'm young-ish and reasonably healthy). So based on that data, I should probably get the highest deductible possible and just reserve using my health plan for catastrophic events.
But my employer only offers one level of deductible, so I can't really shop for a higher deductible. And with my employers contribution to the current plan, it's still cheaper than if I were to buy an even higher deductible plan on my own.
But still, if I have a $1300 deductible but only typically spend $600/year, I should still be paying cash. That said, I should probably be going to the doctor more than I do. I'm getting to an age where preventative care is becoming more important. I have some minor, non-life threatening issues that a doctor could probably help me out with if I was willing to go see a doctor. Under this way of thinking, I should probably commit myself to paying the annual deductible and just go to a doctor whenever I feel like it.
But it's a pain to find time for the appointment, I don't enjoy the medical "process" any more than any red blooded American man, and the whole idea of "going to the doctor just because you can" bothers me on ideological levels... so I don't go. But I keep "using" my insurance because I hang onto the idea that I "should" go. So like I said, it's just bad planning on my part.
That said, I know that's a giant whiny rant. I fully recognize that there are plenty of people who need legit medical care for serious things and can't get it, and here I am complaining that I can't find time in my day to schedule all the medical care I could ever want for $1300.
I don't follow, can you elaborate?
The net effect is that you have a bunch of people consuming excessive and over priced medical services. This means lines get longer and overall costs, especially for the uninsured, go through the roof.
On that note, I think the high deductible health plans make a lot of sense. I'm covered if something really expensive happens to me, but I still have to front the first $1300 and then another $1500 or something at a 20% co-pay. So my total exposure is only $2800, which won't break the bank if I get into a serious accident. But it's enough to make me think twice about going to the doc over trivial issues.
Some people would argue that you shouldn't have to think about cost with a doctor - if you think you need to see a doctor, then see a doctor. But that really can, and has, gotten out of control if you completely disconnect people from the price of healthcare the way US insurance has for a long time.
If anything, some of the actuaries seem to think people aren't going to the doctor enough: my dad's corporate health insurance plan recently changed their policies to incentivize going to the doctor more often, by giving you a discount for various kinds of visits: you get a discount if you have an annual physical, and another discount if you have less-frequent major workups / lab tests done.
Any list of major costs in the medical system that doesn't include legal expenses is highly suspect.
1) People go to the emergency room precisely because they don't have insurance, and what's more, they wait until the last moment (ie, when it's most expensive to treat) [1].
2) If people were really getting so many tests done and going as early as possible, surely the U.S. would be far ahead of most other countries in terms of preventative medicine [2].
[1] - http://www.cdc.gov/nchs/data/nhis/earlyrelease/emergency_roo...
[2] - http://www.commonwealthfund.org/~/media/Files/Publications/I...
To expand on your example, the insurance company contract with the mechanic says that the insurance company will be billed the lowest advertised price. Of course, that contract also says that they will only pay $3k for the services required. The cash customer still hands to be billed the full $7k, however, or risk getting in trouble with the insurance company. That's why it's always a cash discount, and the bill will be for $7k even if they will take less (if you know to ask).
These numbers seem extreme, but they're not that far off - take a detailed look at an EOB sometime.
I'm convinced this is at least partly responsible for the rapidly increasing health care costs in the US.
I am still trying to find someone to pay. Now having talked to my Doctor before I have asked the questions about rates and such. The only points that stuck with me are, negotiated rates with government providers are too low for him cover his costs, insurance companies have rates which are more favorable because they need the business, and his higher base rates are because collections is rotten to deal with.
One day I hope to pay my bill, I would have to have a collector show up but my Doctor cannot accept the payment as of yet and I legally cannot use my HSA funds for something I do not have a bill for.
They extend an offer, you agree the price, you agree to buy and they sell. But they're suggesting that you buy, and consume the product, before agreeing a price?
Is it just that they don't know what's happening at the doctors? ie, they could offer a base price of $X per 15 minute appointment; $Y for writing a prescription; $Z for referring on for other tests?
Or can they not even tell you how much a basic 15 minute consultation would cost?
In a way it's a very small version of someone suing me, and I settle even though I know I could win. Cost/benefit, and the game is rigged against me.
Insurance is the root of all health care evil.
Pretty much anything custom-made works like that (have you never bought bespoke furniture?) - the seller will do the work and then bill you for how much it turned out to cost. You can sue them if it's unreasonable.
Over here we have a Bismarck health system (baseline coverage is publicly funded, supplementary insurances are available from the same companies for a premium), and the last time I had to go see the doctor it was free. I think I paid 15 NIS (about $4 USD) to fill the antibiotic prescription my doctor gave me.
America really needs to fix its health-care system, by now its decay has become incredibly low-hanging fruit. You have the rest of the civilized world to cherry-pick for efficient, caring health systems!
Call the doctor and get the procedure code. Then ask for the amount that is going to be billed and the tax id of the person or company that will be sending the bill to the insurance company.
You may need to get multiple procedure codes and talk to multiple billing departments. For example, I recently wanted to find out how much an MRI would cost. There's a fee to perform the MRI and a separate fee for reading the images. These are performed by different people, and therefore billed by different people.
Next, call or livechat your insurance company. Ask them to run a test claim. Give them procedure code(s), the amount billed, and the tax id of party sending the bill. The insurance company can then tell you what the allowed amount is, that is, how much the insurance company and the medical provider have agreed upon for the specific procedure. If you have a deductible that you haven't yet met (and the procedure isn't something covered or partially covered before the deductible, such as preventative care), the allowed amount is the amount you will be billed by the medical provider.
Obviously, this is a cumbersome process. Running the test claim took about 10 minutes in my case. This is apparently not a process that the insurance company has optimized for. But by going through the process, you are sending a signal that price transparency is important.
With MRIs, it turns out that at least one local company has recognized the value of price transparency: https://twitter.com/xn/status/311886680145666048 (They also happen to be about $400 cheaper than the amount my insurance company negotiated with a large hospital.)
One example: How can I know/believe that practices aren't widespread to deny myself and others coverage we are actually due per our contracts?
There is also widespread, systemic spreading of cost that is outside of any contract (i.e. insurance) authorizing and mandating such. Widespread enough to warrant investigation for fraud.
If the regulators weren't totally co-opted and owned by the industry, it would be rife for investigation and perhaps charges of corruption. Under existing laws -- no new laws needed.
I had surgery in India. The doctors could all quote a price to me, accurate to within about 5k INR (final price ranged from 85k-150k). A price list with common procedures (blood test, urine test) was usually printed on a sign behind the receptionist.
I'm sure that the average purchaser is at an extreme knowledge disadvantage making comparison shopping nearly impossible, and critical care/emergency care does not allow the time for comparison shopping. Finally you did not elaborate on the competition... is there any? So its a free market in that some prices are posted, but not in pretty much any other way.
Although I would agree that in the extremely limited area of price discovery of certain procedures, I'm sure they do better, mostly because we do so poorly its almost just statistically likely by random chance to be better.
I have no idea where this "you can't shop for medicine" meme came from. India prove it false.
No, for the sake of Return on Public Investment, I'd say we should not only cover catastrophic care but give full public support to preventative care as well.
Worst-case scenario: you have a heart attack, but someone calls 911 (or 100, or whatever the ambulance number is near you). You get to the hospital, and are treated very expensively to stabilize you and save your life. You now probably have to take heart medicine for the rest of your life, also an expense. Then cancer kills you over a protracted two-year battle, 15 years later.
The plan summary from HR didn't say. I called the insurance company, but it was tough to get an answer from their CSRs without being a customer. Finally I got someone sympathetic who gave me their direct line and said if I could get the billing codes, they could run it against the terms of the policies my company negotiated and see what comes up. In the meantime they told me it would cost no more than $25 per injection, which was the limit to "usual customary and reasonable" in my area.
So then I call my allergist's office. They told me I need to speak to their business manager, who only worked 3 days/week, and I of course called on one of those other two days. When I called back, she categorically refused to give me the billing code they'd use. I asked her to clarify whether she was unable to give me the code or if she was choosing not to do so, and she responded that it was the latter.
So basically I just had to wing it and choose a plan. And a new allergist.
What the heck? Those are like $10~15 around here.
It turned out the insurance company's contract with the allergist said he could charge me no more than $18.50, but the insurance company paid none of it. So even then it was $74/month, given that I had to go weekly.
Because of the stupid game that I had to play, I had absolutely no way of knowing what that discount would be though. Could have been nothing, could have been a lot. Hence "could" add up to nearly $100 a month if I had to pay full price.
I've had to drag out accepting an offer from a company so I could find out 100% if my child's doctor was covered by their insurance or not. In the end I had to turn it down because he wasn't in the network, and having to pay the 20k out of network deducible would have ate any net gain I would have gotten by taking that job, I had to turn it down.
I felt bad dragging out the process so long, but I really had to cover myself, and at least on their side they were 100% understanding.
This sucked, however we're still lucky. We had her (hopefully) last surgery last week. While staying in the Ronald McDonald house (her surgeon just moved further away from us) we got to hear tales of people having their house foreclosed on, due in part to their kid going through leukemia treatments (they were/are insured btw).
You shouldn't have to lose your house because of medical necessity
And I hope in the future you might have an opportunity to to sign on with that employer later -- it sounds like if they're understanding while you tried to sort out the insurance questions, then they'd probably be good people to work for.
oh, and my Daughter is fast to recovery, just need to keep her from bouncing off the walls for another with week, which is impossible for any 5 year old.
The way we pay for health care in the US may not improve in a substantial way for a LONG, LONG, time.
Those in power would disagree. If the purpose is to achieve a local maxima of profit they're doing pretty well. Privatize the gains, socialize the losses.
If the purpose is to provide medical care, well, yeah, its a pretty epic fail. But that's not the purpose of the system.
The system has to be bled completely dry before it can be redesigned and rebooted. Too many people are still paying in. That has to stop, before things can be improved.
But #3 is showing cracks as corporate-jobs-for-life get less common. In a world where you change jobs more frequently, now there are messes of coverage gaps, COBRA, etc. Not to mention that this arrangement discourages freelancing and entrepreneurship, since you must work for a large corporation with a group plan to be part of a health-care pool, a connection that otherwise seems rather arbitrary (why should where you get risk-pooled for health-care purposes depend on who you work for? only because corporation-tied pools are a way of minimizing adverse selection in the pool).
Switzerland also has a system based on compulsory insurance within each canton. The state doesn't operate the healthcare directly, but residents of each canton have to buy insurance from one of a small number of nonprofit insurance providers available in their canton, which end up doing the risk pooling.
It might be simpler for "regional and bigger" hospitals and specialty clinics to back bill the patients local hospital.
The swiss model looks similar to how we used to bill old fashioned landline long distance telephone lines in the USA. Other than the profit/non-profit thing.
#2 is the most common way in the US but not necessarily through just unions. It's all about group plans and whatnot in an effort to control pricing. The problem is that this method doesn't cover everyone and discourages certain types of employment as described elsewhere in this thread. In some cases, large unions use the benefits as leverage against their members for various reasons and/or against the employer as a PR tool such as "they are hurting our kids!" type of tactic.
#3 is part of my point as one of the reasons that companies went wild on offering health benefits to workers was to get around a government enforced wage freeze during war. There were companies that offered such benefits before but during the wage freeze it started to become normal to be offered the benefits.
I find it fascinating that after decades of escalation in the problems in US healthcare and insurance the best solutions anyone can come up with and/or get passed is to increase the very thing that almost everyone agrees is broken. "He's been shot three times and he's dying! What should we do?" "Shoot him three more times and see if that helps. Otherwise, we'll have to think of something else."
No, see - that's the problem. The vast majority of the electorate has no idea either that our system is broken or that other countries actually do things better - indeed, that it is even possible, in principle, to do anything better than current practice in the United States.
They think that if we don't have the expensive, privately-held bureaucratic system we do, then GE can't charge what it does for its MRI and CT scanner machines and exit the market, and then Grandma will die a horrible, painful death in a ditch outside Waukegan. Or, if pharmaceuticals don't charge insured patients $10000 a dose of some new drug, that our system will collapse because no one will make medicine in America ever again (never mind that 5 of the top 10 largest drug makers are outside of the US in countries that have abundantly socialist healthcare systems).
That is, if there is some structural pricing advantage in the U.S., what is stopping those companies from benefiting from it?
If the companies do (significant) business in the U.S., then the mere existence of those companies isn't useful evidence against the fear "that our system will collapse because no one will make medicine in America ever again". The specifics of where the pharma companies are getting their research dollars are more interesting than the specifics of their incorporation.
(but I don't personally fear that research funding would go away, and I accept that those companies have huge revenues outside the U.S., etc.)
I realize that the set of things a dentist deals with is probably smaller than what a doctor does, but it seems like it's a much better model for insurance.
Some of the reasons might be that the procedure is fairly quick, the eye is easy to get to, it doesn't require general anesthesia, and doesn't require a full OR in a hospital (I think - correct me if I'm wrong). In that sense its closer to oral surgery than a gall bladder removal, for example.
In the US at least, I think dental "insurance" is really just a simplified way for employers to offer an appealing benefit to employees.
My main point is that I've never been to a doctor where I've had to schedule a followup appointment and been presented with a itemized invoice (and the dentist's office can usually prepare it in under 5 minutes).
I'm also from Canada, so I'm comfortable with the idea of socialized medicare. However, when I compare stories between me and my friends in Canada, there really is no comparison. I basically pay a $20-30 co-pay per visit (something that was completely foreign to me when I first moved to the US), and then anything and everything gets done for me. I have never experienced the horror stories you hear about where insurance companies try to opt for cheaper treatments or deny services to save money. Any test or procedure I needed, or even asked about, I could get.
The longest I waited for things like a MRI was 2 days, and 9 days for an endoscopy. My doctor was willing to get me a CT scan the next day for this stomach problem I had. My friends in Canada have waited 4 months for an MRI and 3 months for a CT scan. My dad had to wait about 6-8 weeks to get a pacemaker installed, even though his heart was stopping for 5-10 seconds several times a day. Seeing a specialist takes months in Canada vs days with Kaiser. On weekends, if I get sick I don't have to wait in Emergency for hours like in Canada, I can just set up an appointment at one of the hospitals and see a GP in around 30-45 mins, and they have full access to all my medical records.
The downside is that when I'm out of a Kaiser area, I have to pay out of pocket unless it's an emergency (I believe). The only time I felt vulnerable was when my family was out of state, and they didn't have Kaiser facilities there.
These days you'll find a high-deductible plan that does the reverse - encourages people to NOT go to the doctor because until they've hit a $3,000 tab, the insurance won't kick in a single dollar.
If you can pay $1300 for the routine stuff described in the article, it'll probably be cheaper to do it outside. I don't know the prices in North America, but based on EU prices I'd guess it should cost less than $500 to fly across half continent and back, and $150 for the actual operation in any good Mexican hospital; which coincidentally adds up to half the USA price.
Just dealing with the afteraffects of a simple ER trip for what turned out to be a bruise was eye-opening.
I had the pleasure of dealing with a multitude of bills from random places (in some cases, lawyers' offices, who handle some doctor's bills from first charge--i.e., not collections--and boast on their web sites about being able to return "200% of what's owed"), determining what's legit and what's fraudulent, the paperwork sent back and forth between us and our insurance company and between the billers and our insurance company (who weren't paying anyway because we have a very high deductible, but you have to jump through massive hoops to get them to actually count your payments towards the deductible), the attempts of the medical billers to double-bill and continue to appeal the bill with two insurance companies months after I paid the bill (how they collect that 200%, I assume)...a total mess.
Someone got paid 2k for a deep contusion, but I think most went to middle(wo)men and lawyers' offices.
That 62% medical bankruptcies in 2007 in the US are actually insured persons (cite: http://www.washingtonpost.com/wp-srv/politics/documents/amer...) is no surprise; what would surprise me is if it isn't 20%+ higher now.
If the insurance had covered them at their contracted rate, the provider would have received probably about 250 for the procedure and 50-120 for the office visit.
Because it fell within your deductible, the initial bill to insurance would have been denied payment and sent back with "patient responsibility" and the 1376.00 would then be your problem. Since you don't have a contract with your provider he tries to get the whole thing.
This is where you can discount it with negotiation.
I am a medical provider, I believe that transparency will help the situation. I also believe that prices should be within a 5-10% window of each provider instead of a price variance of 100-400% depending on secretive contracts.
Unfortunately even providers have been trained to game the system to maximise profit and productivity. It is common to hear surgeons talk about complicated patients and tell them to see a university guy because "frankly its not worth the time and effort" when they can get low hanging easy fruit that pays better/unit-time with less liability.
I'd like to hear what the poster thinks he should have paid for his office visit and 5 minute procedure.
5 minutes of just their time would be between either $8.33 or $10.41. Fine, throw in a couple bucks for the rubber gloves and scalpel. And something for electricity, paper, etc. Still should NOT me more than 40-50 dollars in my opinion. But I don't know much about this industry...
What you've described I think is largely responsible for a lot of the rising medical costs.
- The hospital (NJ if it matters) billed the insurance company $30,000. She was there for usual 48 hours. The insurance company has a thing called "Amount Allowed" which knocked it down to $5880. Then our share of co-insurance came to about 20% of that = $920.
- For baby, separate hospital bill of $8779. amount allowed = $2,232, our share = $566
- The Anesthesia consultant billed separately for $3000, amount allowed = $1100 and our share = $220
- OBGYN billed $4200, amount allowed = $2800, our share = $560
- Newborn clinic charge = $375, allowed = $375, our share = $289 (deductible not reached)
- Neonatology for baby - $590, allowed = $100, our share = $100 (deductible not reached)
So here is total just for Labor/delivery/baby which was 100% normal without any complications.
- total bill = $52,824
- Allowed by insurance = $12,487
- Our responsibility to pay = $2655
I get chills just to imagine if we did not have insurance.
About half of the UK £9billion budget for prescribed meds is sub-optimal spending because of medication non-compliance.
And severity of illness doesn't seem to be a factor. People who've had an organ transplant often die after rejection when they stop taking the meds, even though they know that they must keep taking the meds.
There's probably money somewhere if you can improve medication compliance.
[1] Prescriptions usually cover 28 day supply of medication. Each line item on a prescription costs £7.40; but most people don't pay because there are many exemptions and if you need long term meds you can pre-pay.
[2] I dunno how it works in the US.
I feel like the only thing that has prevented our health insurance system from touching off a violent revolution is that severely ill people aren't exactly in top shape for carrying AK-47's into executive lobbies.
The whole point of private health insurance is that sick people are the easiest to rob-- they don't fight back-- but they also have no money, so it's best to collect payment while they're young and well.
Of course there is some truth somewhere in the movie, but the majority of it is stretched truths and shots intentionally doctored to make his point.
"The whole point of private health insurance is that sick people are the easiest to rob-- they don't fight back-- but they also have no money, so it's best to collect payment while they're young and well."
The whole point of a public healthcare system is that it forces you, at the threat of jail, to collect payments from you (essentially theft).
(edited to add: There's already a social contract that refusal to provide emergency room care to everyone means criminal prosecution of the hospital/docs involved... its unfair they're not allowed to collect money at gunpoint, but it would be much fairer if they were allowed to do so.)
I oppose mcdonalds because at the point of a gun a policeman will demand I pay them. Sounds awful, especially if I omit the fact I already ate the burger and I'm gonna need to eat another in the near future and the analogy breaks down even further in that McD would need a local geographic licensed monopoly on all food sales such that everyone living in the area must buy burgers from them.
You're stating a moral imperative without indicating any boundaries. What are the limits of healthcare that are required to fulfill this supposed "social contract"?
You mentioned a Social Contract requiring healthcare. I'm asking you what the limits are of that supposed contract. If there aren't any in your view of morality, then be honest and say it. If there are, then throw us a bone and let us know where you think they lie.
The meta-point is it is a strong indication of consensus tipping point approaching for a culture when the opposition on a topic has nothing left but sophistry and fallacies to stand in the way of progress, morality, and civilization. There are certain analogies to creationism, AGW denial, opposition to gay marriage. I don't say that (solely, LOL) to tarnish the reputation of the opposition, but to focus on the similarity of technique in superficially unrelated topics, to draw attention to possibly unnoticed similarity of technique.
Try to provide a logical argument for existing barbarism which I can't pick apart as a mere fallacy. I theorize there is no such argument, although proof of a negative is such a bummer. I'm willing to admit I'm wrong and switch my position given a good enough argument, although I predict no argument exists at all, much less a good argument.
While you're throwing out Logic terms, that's known as a "Straw Man".
There are certain analogies to creationism, AGW denial, opposition to gay marriage
Here you continue to build upon your imagined opposition rather than just deal with the question I asked before.
Try to provide a logical argument for existing barbarism which I can't pick apart as a mere fallacy
Hah, you made me think of this: http://www.youtube.com/watch?v=D1n5CQe1krI
All I've seen you do so far is to invent Straw Men without just answering a simple question regarding the moralistic statement you made.
No one is curing cancer here or achieving world peace. We're just discussing topics of the day on HN. My hope is that people can do so in an honest straight-forward manner without warping facts or throwing up weak smoke screens like you've done here in this thread... but ah well.
Yes, exactly. This is pretty hard to accomplish in our current state of political inaction, misinformation and 24-hour news cycles. I'm sensing a build up to a tipping point on public awareness about how we're all being swindled by these hospitals and insurance companies, but perhaps I'm just paying more attention to this now that I'm starting to get a little older.
For what it's worth, and for those of you who haven't seen this yet: http://truecostofhealthcare.org/
But what's stopping people from voluntarily posting the procedure_code=>price information they obtain? Are there contractual/legal reasons that prevent you from sharing that information? If patients get that price in the normal course of getting healthcare, then why not share it all, and force transparency in the market?
[1] http://www.healthcarebluebook.com/
I paid cash.
- Actual Price
- Cash Price (after you bitch about how absurd the actual price is)
- Insurance Company price
- Medicaid price
I wonder if the US can ever get as low as $20/mo for cadillac coverage. Is the free-market model even applicable to health care?
It works about as well applied to health care, as applied to police coverage, military defense, restaurant health inspections, road maintenance, and education. Not as well as when applied to a farmers market or factory widget production.
Its a little harder for med because quite a bit of med care happens to medically uneducated people. Given a couple years of med school and some on the job experience, and a couple days to fully research each emergency room and cardiology department in the country, my neighbor could probably have made an intelligent free market decision when he had his heart attack. However, instead of a free market, the ambulance instead took him unconscious to the nearest ER, where they'll pretty much do what they want and then charge what they want. The true miracle of the situation is it may have been a financial disaster, but medically it all turned out OK. Decades of propaganda has taught me that only a free market can provide decent services, yet at least medical care works pretty well with a feudal system where you simply report to the nearest castle and pay whatever tax the feudal lord demands.
This and the tax breaks given to companies sponsoring health insurance plans that create a nearly immovable useless middle man are the root of all evil in the American healthcare industry.
For many people moving to the US the cost of medical bills seems insane.
PS: It's not that he is actually charging that for his time. It's just rolling a lot of overhead into it.
If you really think cutting into your ear and stitching it up is a good idea for a DIY project, well, it's a free country.
Well, it's actually not a free country in this regard. It's illegal to pay some guy with good hands but no degree to do it for him.
There's paperwork, billing, the use of a room and supplies, a nurse or assistant is involved somewhere...
The consultation looks much more overpriced than the procedure.
If you add some tests, they're usually 20-40 euros each. Of course this is free if you go to the public doctors. And now here in Germany, all doctors are private and the mandatory insurance will cover most of the expenses.
And before you say it, no, legal/malpractice expenses aren't the cause, because in USA that adds up to <5% of total medical budgets and can't explain the other 45% "bonus price".
There's unlikely to be any solution though, barring a massive shift in public opinion. True reform would reduce a bunch of insurance companies to smoking craters and would certainly involve some sort of tax increase, both of which would be regarded by most in government as unacceptable outcomes.
As it is, the horrible expenses paid by the sick help to subsidize those who can't pay (who are anyway discouraged from getting regular care as much as possible). Costs are already distributed, just not evenly, because you only pay the horrible prices when you get sick. And most people prefer not to think about it until then.
The expenses are covered not just (or mainly) by the sick but by the insured. There's a reason my insurance is nearly $500 a month, though I"ve never been sick or injured and rarely visit a doctor (I've thus contributed probably $50,000 to healthcare without consuming any). Given my general health, young age, and low chance of catastrophic injury, the only explanation is that i'm subsidizing other people's care.
There are clearly indirect costs that go into inflating insurance premiums. I find it very hard to understand why it's acceptable to pay in one way (high premiums, catastrophic care bills) but not in another (nationalized health care). I've never heard an argument against it that didn't strike me as pure FUD. [Incidentally, not trolling Republicans here—I'd love to hear a good explanation that goes beyond distaste for anything government-run.]
At the very least, it is by definition not 'free market economy' since you can't even choose where to buy based on price if they aren't telling you the prices.
The healthcare industry is greatly in need of cost sensitivity and transparency.