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U.S. health care's widespread overbilling problem

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Re: U.S. health care's widespread overbilling problem

#161

Post by emilecantin »

ChemicalWarfare wrote: post #97
wvenable wrote: post #74

Earlier quoted context omitted.

I'm a Canadian, what's wrong with our system from your perspective? (No system is perfect; there is always room for improvement and trade offs) Just two weeks ago, my wife had an emergency appendectomy. She went to the free clinic first thing Sunday morning as she had terrible pains all night. They immediately referred to the local hospital. She had the ultrasound in the afternoon and Surgery at 3:00pm. She's been of…

>> I'm a Canadian, what's wrong with our system from your perspective? longer wait times for non-emergency treatment and (most of the time) not being able to pay cash and get the procedure done without the wait. personally know ppl in Canada (Toronto, so not some little town in the boonies) who had to wait few months to get an MRI. on the US side - takes 2 weeks or so to get the insurance company's approval (they do…

On the other hand, if your condition is serious, it can be _very_ fast. My daughter had an MRI done about 2 hours after the doctor ordered it (this was after a concussion so we were worried about possible brain damage. Don't worry, she's fine, it was just a scare).

Re: U.S. health care's widespread overbilling problem

#162

Post by tptacek »

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

A few years ago my daughter needed a last-minute CT scan, the results of which would determine whether it was safe for my wife and I to go to a conference (long story). The hospital couldn't get authorization for the CT scan from Blue Cross, due to some glitch. "No problem", they said, "we'll just do the test tomorrow." Big problem for us, though; our flight out was the next day.

I ended up negotiating a price for the CT on the spot; none existed. They simply couldn't tell me how much the test cost. I had to extravagantly over pay in order to get the test done at all.

Re: U.S. health care's widespread overbilling problem

#163

Post by tptacek »

beat wrote: post #149
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions!

There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

Re: U.S. health care's widespread overbilling problem

#164

Post by tptacek »

DougWebb wrote: post #137
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And y…

Hang on. The comment you're replying to is complaining that they can't get a price for a single test, a discrete unit of health care. That's not like not being able to get a price for a completed Rails app; it's like not being able to get a price for a Macbook. I think you've moved the goalposts a little.

Re: U.S. health care's widespread overbilling problem

#165

Post by yellowstuff »

EvanAnderson wrote: post #11
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with bot…

My dental hygienist once told me to get 3 cleanings a year. I told her my insurance covered 2. She told me that it was like chemotherapy- you should do what's medically necessary whether or not your insurance covers it.

Re: U.S. health care's widespread overbilling problem

#166

Post by biomcgary »

Johnny555 wrote: post #79
cptskippy wrote: post #21

Earlier quoted context omitted.

A lot of trades give you estimates but you don't know the actual cost until the work is complete. Auto repair, construction, plumbing, electrical, etc. There are plenty of fixed costs that can be accounted for easily but there are a lot of unknowns that can't be seen ahead of time. That's why quotes and shopping around so prevalent because it allows for competition in price. However in healthcare that's not an option…

One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. And I may very well decide not to do it. They may tell me that I need a $1000 timing belt replacement when I ask for a $200 water pump replacement, and I may decide not to do it. I can even ask them to put everything back together and tow the car somewhere else for repairs. If they tell me I need a $3000…

I've often thought this could be solved by requiring a doctor to carry "estimate" insurance. The patient's bill would be the quoted price and the doctor's insurance would cover any complications leading to additional costs. This would have the additional benefit of increasing the costs of doctors with frequent complications. This would only work for immediate complications from surgery (i.e., less likely to be impacted by patient compliance).

Re: U.S. health care's widespread overbilling problem

#167

Post by froindt »

sidlls wrote: post #78
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Price transparency is not going to fix much, if anything. It may induce rage increased blood pressure on the front end (prior to receiving service), but ultimately health care is often a "must have." Having a price list in hand doesn't suddenly make the price conscious consumer more of an expert regarding the necessity of various services estimated. Nor does it really encourage competition between competitors.

There is significant difference in the price different places charge for services. It's not necessarily deciding whether or not to do the treatment, but can also encompass consumers being cognizant of cost and choosing providers who are cheaper.

Here is a planet money podcast which goes through some examples of significant expenses being saved.

http://www.npr.org/sections/money/2015/10/02/445371930/episo...

Re: U.S. health care's widespread overbilling problem

#168

Post by Spooky23 »

tptacek wrote: post #163
beat wrote: post #149

Earlier quoted context omitted.

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

I've got news for you... you already have government price floors on all hospital procedures.

Re: U.S. health care's widespread overbilling problem

#169

Post by Spooky23 »

yellowstuff wrote: post #165
EvanAnderson wrote: post #11

Earlier quoted context omitted.

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with bot…

My dental hygienist once told me to get 3 cleanings a year. I told her my insurance covered 2. She told me that it was like chemotherapy- you should do what's medically necessary whether or not your insurance covers it.

That's probably good advice. The extra $80 for a cleaning is cheaper than many of the dental procedures that many folks will need.

Re: U.S. health care's widespread overbilling problem

#170

Post by ams6110 »

tptacek wrote: post #163
beat wrote: post #149

Earlier quoted context omitted.

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?
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