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Insured price $2,758, cash price $521

latimes.com

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Re: Insured price $2,758, cash price $521

#111

Post by wisty »

skadamou wrote: post #68
johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

Those numbers do seem to be a bit higher than the national salary averages for physicians [1]. However, physician pay only amounts to something like 8% of total health care costs [2]. I'm not saying that doctor pay at Vanderbilt isn't driving up their healthcare costs but this doesn't seem to be the whole story when it comes to national healthcare costs. [1] https://www.merritthawkins.com/news-and-insights/blog/job-s…

The structure is a messed up mix of the red tape and regulation of a government bureaucracy, monopolistic behaviour (try getting 3 quotes for a procedure like you would for a bathroom renovation), subsidies, freeloaders, and weird incentives.

The government has decided it's too stupid to run hospitals. But it's also decided that it needs to ensure both the supply of hospitals, and to maintain standards. So instead of just telling doctors what to do (and paying them enough to ensure a steady stream of high quality medical students) it tries to get all the red tape and subsidies right, while the private sector (hospitals and insurers) try to figure out how to outsmart the government and make the system more expensive.

The US government spends a similar amount (per captia or as a percent of GDP) as Canada on its public funding (Medicare, Medicaid, VA, and so on). But the US system is so fantastically inefficient (due to weird incentives and massive amounts of bureaucracy and profit seeking) that unlike Canada it can't even offer basic universal healthcare (despite spending an insane amount of tax dollars).

Re: Insured price $2,758, cash price $521

#112

Post by AnthonyMouse »

evrydayhustling wrote: post #71
avocado4 wrote: post #41

Earlier quoted context omitted.

https://www.politico.com/agenda/story/2017/10/25/doctors-sal... Providers are the core problem. Various doctor associations (AMA et al) have strangled supply side of healthcare through State licensure and scope of practice laws. Just read medical forums to get an idea of what an average doctor thinks about competition in the form of midlevels: https://www.auntminnie.com/Forum/tm.aspx?m=581583 "Don’t teach your mid le…

That forum is amazing! Thanks for the primary source! That said, two quibbles/questions: Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping a…

> Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse.

It's gatekeeping that causes that.

There are complex procedures that require a decade of medical training and simpler ones that don't. If you take the doctor with the extensive training and have them do only the complex procedures, it's easy to justify paying them mid six figure salaries that cover their costs.

But if you have regulations that require that same doctor to spend three quarters of their time doing simple procedures that could reasonably be done by a PA or a nurse, the average value of their services drops and they have a harder time commanding a salary that can pay for their schooling and insurance.

Re: Insured price $2,758, cash price $521

#113

Post by [deleted] »

drblast wrote: post #107

Insurance is not supposed to make routine things more affordable. It's supposed to spread the risk of catastrophic loss from unlikely events around to a large group of people so you don't have to worry about losing your house if you get struck by lightning. Everyone needs routine medical care at some point so an insurance model doesn't work there. You don't have gas or grocery insurance, do you? If that were a thing…

[deleted]

Re: Insured price $2,758, cash price $521

#114

Post by nonbel »

rolltiide wrote: post #108
nonbel wrote: post #75

Earlier quoted context omitted.

> things like birth control aren't insured Why would you use insurance for something you know you are going to need? I got new glasses and an eye exam and they were surprised I didn't pay via insurance? Why would I want to pay extra to insure for something I know I will need to get? This makes no sense at all.

privileged people have the option of using pre-tax + employer funded FSA/HSA accounts, where a wide array of hygienic purchases, medical purchases and even copays can be paid for and further subsidized. These are part of your overall “insurance package”, in conversation this is typically called being insured with no regard to whether an insurance company is actually picking up the tab.

Wouldn't the "privileged" prefer to have actual money they could spend as they want instead of be forced to use it for a single purpose, including the extra cost of a middle man? It sounds like some sort of tax scam.

Re: Insured price $2,758, cash price $521

#115

Post by aianus »

robocat wrote: post #92
aianus wrote: post #29

Earlier quoted context omitted.

As mentioned below, the price doesn't matter when nobody is available to see you. Also, the opportunity cost of sitting around with a broken hip waiting to be seen can be higher than going to a privatized country/province and paying for the surgery, in which case you're a super-sucker who paid extra taxes for decades just to end up paying out of pocket for surgery anyways. Anyways, the US system is probably worse ove…

> Also, the opportunity cost of sitting around with a broken hip waiting to be seen This example is bad. New Zealander here: a broken hip will be fixed in reasonable time, and I think if you have private insurance it likely would be diagnosed, fixed, and recuperated in the same hospital. Private insurance does help if you need a hip replacement. On public, you will wait for a long time, and you will be in pain for a…

I live in Canada and my experiences are with the Canadian health care system in Ontario.

Edit: I have friends that live in the US and work in tech and enjoy better care. Like I said, the Canadian system is much better if you're poor but the US system is better for tech-worker income and above. This is why it sticks around: powerful people and voters in the US are likely to be old or rich-enough and enjoy good care.

Re: Insured price $2,758, cash price $521

#116

Post by triceratops »

skadamou wrote: post #68
johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

Those numbers do seem to be a bit higher than the national salary averages for physicians [1]. However, physician pay only amounts to something like 8% of total health care costs [2]. I'm not saying that doctor pay at Vanderbilt isn't driving up their healthcare costs but this doesn't seem to be the whole story when it comes to national healthcare costs. [1] https://www.merritthawkins.com/news-and-insights/blog/job-s…

Reducing US healthcare costs sounds similar to reducing carbon emissions. Cuts need to come from everywhere because the system as a whole is inefficient. There's no single silver bullet.

Re: Insured price $2,758, cash price $521

#117

Post by techie128 »

seanmcdirmid wrote: post #78
neya wrote: post #66

Earlier quoted context omitted.

Then how do you explain countries like India where it's drastically affordable and high quality at the same time?

You pay at the entrance, not at the exit. Also, standards of care, facility costs, and compensation for medical professionals is much lower.

I am sure you have data to back up your claim that "standards of care, facility costs, and compensation for medical professionals is much lower." Care to post it?

Re: Insured price $2,758, cash price $521

#118

Post by dragonwriter »

wisty wrote: post #111
skadamou wrote: post #68

Earlier quoted context omitted.

Those numbers do seem to be a bit higher than the national salary averages for physicians [1]. However, physician pay only amounts to something like 8% of total health care costs [2]. I'm not saying that doctor pay at Vanderbilt isn't driving up their healthcare costs but this doesn't seem to be the whole story when it comes to national healthcare costs. [1] https://www.merritthawkins.com/news-and-insights/blog/job-s…

The structure is a messed up mix of the red tape and regulation of a government bureaucracy, monopolistic behaviour (try getting 3 quotes for a procedure like you would for a bathroom renovation), subsidies, freeloaders, and weird incentives. The government has decided it's too stupid to run hospitals. But it's also decided that it needs to ensure both the supply of hospitals, and to maintain standards. So instead of…

> The US government spends a similar amount (per captia or as a percent of GDP) as Canada on its public funding (Medicare, Medicaid, VA, and so on).

As of 2016, Canada's public spending was 7.4% of GDP, the US's was 8.5%; and the US per-capita GDP is higher, too, so I don;t think its really "a similar amount" per capita, and only loosely so per GDP. But, yeah, the big difference is that the US spends even more than the publicly spending in private healthcare spending, while Canada (like most other first-world countries) spends far less privately than the public share.

https://www.healthsystemtracker.org/chart-collection/health-...

Re: Insured price $2,758, cash price $521

#119

Post by alexhutcheson »

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

ER bills are always shockingly expensive. If you don't think your condition is life-threatening, it's normally both faster and much cheaper to go to an urgent care clinic if one is open.

However, for potentially very serious problems (possible heart attack, stroke, serious injuries, etc.) you have no choice - you need to go to the ER and deal with the bill afterwards.

Re: Insured price $2,758, cash price $521

#120

Post by uoaei »

HarryHirsch wrote: post #58
Stratoscope wrote: post #9

Beyond opaque and variable pricing for the same service, there is also the question of whether something simpler would do the trick. Some years ago, I thought I might have broken my finger. I went to the doctor and it was actually the physician's assistant who saw me. I'd explained at the front desk that I had a high-deductible policy and I would be paying in full for the visit. The PA said "Usually we would send som…

With a hand injury one might lose fine motor skills, they should be taken seriously by patients and physicians. In any other first-world country the physician would have taken an x-ray, treatment cost would be nominal, there is some form of universal healthcare in place, but in America you have a choice! Your money or your range of motion! More worrying is that people support the racket! A tuning fork, like a barefoo…

Exactly the situation with me and my shoulder. Never got it looked at, because I was in college and it "only hurts a little but it doesn't interfere with normal life goings-on". Now it's still screwed up and I know a lot more about human skeletomuscular back and shoulder anatomy.
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