261–270 of 345 posts
Doctor's fee $750
Anesthetician's fee ~$150
Hospital facility fee ~$24,000
Hospital facility fee, cash price ~$9,000I 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…
As another poster mentioned, physician salaries account for 8-10% of medical costs, but more importantly decreasing those salaries may not even decrease the cost that patients see.
Let's take the ED as an example... For the past several years, the average salary of an ED provider has been decreasing (due to the increase of physician assistants / nurse practitioners, who are paid less), but the cost-per-visit to an ED increased 235% between 2008-2017 even though ED utilization remained stable [1].
In the last decade, a lot of small physician-owned emergency medicine groups have been bought up by large corporations or health systems. As these large groups proliferate, they raise prices (to the tunes of 2x or more) [2, 3, 4], pay their employees the same or less, and take the rest as profit. So even if provider salaries go down (which these large groups often do anyways after a consolidation), little would change for the patient.
While some of these groups are led by a CEO with a MD, the physicians and other providers who actually see patients do not have a say in how things are run. In fact, some of these groups don't even show the providers how much they are billing for each patient, so it's really hard for them to do much about it [5].
But couldn't physicians/PAs/NPs protest, quit, or even start a competitor--shouldn't they? However, the larger markets (where the majority of patients are) are typically also the most concentrated, so sometimes it's the choice of one large group vs. another large group. I suppose one could move to a different town, but it's hard to uproot a family, and furthermore since these large areas are more desirable there's no shortage of folks who would take their place. And unfortunately for several specialties (EM included) it's very difficult to start a competitor, since one would also need to either secure a hospital contract (not happening if the competitors are health systems) or build their own facility ($$$$$).
None of this is meant to dismiss the issue, and I think physicians will continue to feel the brunt of the blame as long as prices remain high, but I hope it sheds a different perspective onto the issue.
Disclosure: Am in healthcare.
Sources: 1. https://www.healthcostinstitute.org/images/pdfs/ARM2019_ER_P... 2. https://www.nytimes.com/2017/07/24/upshot/the-company-behind... 3. https://www.reuters.com/article/us-unitedhealth-envision-hlt... 4. https://www.mass.gov/files/documents/2019/02/20/2018%20Cost%... 5. https://www.aaem.org/resources/key-issues/corporate-practice...
5. McKesson the largest U.S. pharmaceutical distributor 6. UnitedHealth Group 7. CVS Health
Can't you tell why?
Are "cash" prices always cheaper than what's billed to insurers? What if one starts an "alt-isurance" company that just gives people cash for their medical bills that operates completely outside the medical industry network?
It's pretty hard to pull off an external company since many hospitals won't even tell you what their negotiated rates are (I have an HDHP where I'd think the point is to shop around, but can't because of the lack of price transparency).
For what it is worth, goodrx.com is doing a variant of this with drugs.
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…
5. McKesson the largest U.S. pharmaceutical distributor
6. UnitedHealth Group
7. CVS Health
So you know why...
Wouldn't it be nice to have an ultrasound and not know the price, nor care? That's what countries with single-payer are like. America needs to give up on this nonsense. There should be riots.
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…
The existence of a public system keeps the prices for the private system in line. They can't get too ridiculous because there is always the free option available.
In NZ, I have found that diagnostic on the public system to be plenty fast enough. Then when it comes to treatment option you can weigh a quote of getting it done privately immediately vs waiting for a specified amount of time.
And due to the public system I wouldn't even think twice about going to the doctor as soon as I have any kind of issue at all.
Are "cash" prices always cheaper than what's billed to insurers? What if one starts an "alt-isurance" company that just gives people cash for their medical bills that operates completely outside the medical industry network?
It's tough to figure out the plan that works well for non-routine things. But then again, bigger operations are tough for everyone who doesn't have the best employer-based HMO/PPO plans.
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…
Alone, a fever under 104°F that isn't for an extended duration isn't something you should take an otherwise healthy four-year-old to the ER for.
If you go to an ER for a non-emergency, you are definitely going to overpay for what you get, by an even wider margin than you usually overpay because of the need for those customers that pay to subsidize the costs of those who skip out on bills.
In this day and age when most insurance companies and many primary care practices have 24-hour advice lines, most people have access to the internet, etc., the rate of people who otherwise have access to general healthcare using the ER for non-emergencies should be lower than it is.
Earlier quoted context omitted.
> the physicians who treat garden-variety diseases can be trained much less expensively. So, how do you make sure that only garden variety patients see the medical assistant, while seriously sick ones or those who have only telltale signs of a 1-10k illness see the real doctor? If those rare ones don't get to the doc they die.
Seeing a GP isn't necessarily a guarantee that you will get diagnosed properly. Most PAs know their limits and will consult with a doctor if they're not comfortable. Doctors complain about malpractice insurance, but the rates are high for a reason. I was misdiagnosed when I had cancer, my wife was mis-prescribed when doing fertility treatments. Hell, being rich doesn't help; look at Bill Paxton and Neil Armstrong.
so, because even the best make mistakes, that's a good reason to let under-trained (relative to an MD) people with even less skill make mistakes? Not following your logic here.
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…
> I took my 4 year old to the ER because he had a 103 fever. Alone, a fever under 104°F that isn't for an extended duration isn't something you should take an otherwise healthy four-year-old to the ER for. If you go to an ER for a non-emergency, you are definitely going to overpay for what you get, by an even wider margin than you usually overpay because of the need for those customers that pay to subsidize the costs…