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The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

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Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#251

Post by usrusr »

saiya-jin wrote: post #138
refurb wrote: post #46

Earlier quoted context omitted.

The plastic surgery and vision correction industries work pretty well in the US. You see price competition and patients have the ability to shop around and make choices that are important to them (references from other patients, doctor personality, etc). Now contrast that with going to a hospital for a procedure where you have time to shop around. Can you get a price? No. Can you easily get appointments with doctors…

Exactly the same situation is in rest of the world, no patient is shopping around. just goes usually to closest/biggest hospital. Yet we don't have this tragic mess US has. So its not about shopping around, rather some other reason like regulations, wrong dynamics between hospitals and insurances etc. You don't have better equipment nor doctors in US compared to biggest hospitals in Switzerland for example. Yet we ha…

I believe that in the end, it boils down to culture, with all the regulatory dysfunction and market dynamics acting as intermediary.

In the US getting wealthy seems to be almost implicitly well respected, no matter how you got there. At least if it's not obviously illegal. You found a tweak to squeeze more money from health insurances? Good for you, let them suffer for their apparent weakness. There's apparently still a threshold of where even success cannot vindicate the way to get there (that Oxycotin family comes to mind) but that threshold is super high. I believe that this threshold is much lower almost everywhere else on earth and that this has an influence on individual decisions on all levels. It doesn't even remotely make people elsewhere angels or something like that, but it's a little bit of friction in every decision towards "take what you can"

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#252

Post by t0suj4 »

TheOtherHobbes wrote: post #212
mbreese wrote: post #162

Earlier quoted context omitted.

> example of the benefits of free market economy Healthcare is rarely a good example of the free market. Medical decisions aren’t made by comparing costs between providers. And if you’re in rural America, you’re lucky if you have any provider. Price transparency would be nice, but maybe not as helpful as you’d like. Let’s say you’re in the middle of a rural area and the ER says you need stitches — but they cost $6000…

But that's exactly how a free market does work. It's exactly what any rational person would expect from a corporate free-for-all designed for maximum extraction potential based on maximising political power differentials. Good state-owned care smooths out the inequalities, so farmers in the middle of rural area will at least have affordable access to basic care, and more advanced care will be within easy travelling d…

When the state or its delegates decide who can offer what service to whom it cannot be free market.

What's preventing you from opening a clinic and stitching people for $300?

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#253

Post by hsbauauvhabzb »

300bps wrote: post #183
nyamada wrote: post #18

My daughter here in France had a bike accident two months ago which requires 14 stitches in her foot. We received 3 follow-up visits from nurses to clean and redress her wounds -- We pay about 100€ a month for supplemental private insurance on top of the public health insurance here -- Total cost for us? about 40€. We would have had to pay about 100€ more for the nurses' visits, but the mutuelle covered it. These are…

I live in the US and my employer pays for my very excellent health insurance. For my family of 4 the most I will pay in any one year is $750. About 1/3 of people in the US have excellent healthcare and benefits. You don’t often hear from us.

Don’t forget your employer doesn’t ‘pay for your healthcare’, they have a budget set aside from your annual salary - if they didn’t have to pay as much for your healthcare they’d be able to pay you more (and capitalism suggests if a competing employer did and yours didn’t, the former would win long term).

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#254

Post by ModernMech »

mbreese wrote: post #162
helloguillecl wrote: post #8

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance . The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And…

> example of the benefits of free market economy Healthcare is rarely a good example of the free market. Medical decisions aren’t made by comparing costs between providers. And if you’re in rural America, you’re lucky if you have any provider. Price transparency would be nice, but maybe not as helpful as you’d like. Let’s say you’re in the middle of a rural area and the ER says you need stitches — but they cost $6000…

I’d go as far as to say the healthcare market in America is the opposite of a free market. Everything about it is anti-free, from the information asymmetry, to lack of local choices, down to an inability to even assent to participate in the transaction (due to incapacitation etc.).

It’s hard to even call this a market, let alone a free market. According to the Wikipedia entry on markets, “the usage of the price mechanism to convey information is the defining feature of the market”. It’s notable that in The American healthcare market, the price of your treatment is usually discovered after you’ve agreed to purchase the treatment (or it’s been administered without your consent). In fact, often it’s impossible to figure out what you will pay until after the fact due to how complicated answering that question is.

And even if it were a free market it’s debatable we wouldn’t want to keep it that way. In a commodity free-market of peas for example, a mismatch of supply price and demand price means that some people will pay a suboptimal price for peas while others will be priced out of the market entirely, and they will have to go without peas.

In a healthcare market, when someone is priced out they go without healthcare, which means worse and more expensive outcomes down the line. The old adage about how an irrational market can stay irrational longer than you can stay solvent comes to mind — a healthcare system motivated to maximize profit will price you out of the market longer than you can stay alive.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#255

Post by gus_massa »

willcipriano wrote: post #203
JshWright wrote: post #180

Earlier quoted context omitted.

The uncertainty comes from not knowing exactly what services will be performed, who will be performing them, and how much the insurance company will cover (which has a ton of variables, many of which aren't known until everything is settled). In my opinion, getting away from the fee for service model is one of the routes we ought to be taking to address healthcare spending in the US (if you're charging per service, y…

In other professions if you make a bid and fail to capture required work, you eat it generally speaking. Contractors, many of whom are small businesses or individuals, do this all the time. They also give estimates like "If we find mold behind the wall, it will be an extra ten thousand". Medicine is also odd in that you have to pay for the doctors mistake. If the doctor prescribes a less effective drug, it has no eff…

The most insane part are the out of network professionals. It's like you have a deal with the plumber to fix tout kitchen for $100. But in the middle of the fix, you hear a surprise ring in a front door and it's a helper of the plumber that comes an does something. And the next day the plumber notifies you that you must pay an additional $500 for the other guy.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#256

Post by maxerickson »

vidarh wrote: post #99
chiph wrote: post #59

Earlier quoted context omitted.

There's three areas that I'm aware of. Certificates of Need, which some states require before you can offer certain services (like MRI/CT scanning). Supply contracts, where a hospital has a pre-set price for consumables like IV solutions, scalpels, and bandages with a supplier. And advertising. The Certificate reduces competition because they impose geographical exclusivity. If you want to buy a MRI machine for your…

The certificate of need business seems bizarre. I live in London, and the place is so crowded with clinics offering cheap MRIs it's ridiculous, despite the fact you'll get them covered in the NHS I'd you actually need them (literally the very first ad I found for MRIs offered them for 200 pounds).

The incumbent providers like the restriction on competition.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#257

Post by SamoyedFurFluff »

Retric wrote: post #225
refurb wrote: post #46

Earlier quoted context omitted.

The plastic surgery and vision correction industries work pretty well in the US. You see price competition and patients have the ability to shop around and make choices that are important to them (references from other patients, doctor personality, etc). Now contrast that with going to a hospital for a procedure where you have time to shop around. Can you get a price? No. Can you easily get appointments with doctors…

Dentistry is paid for by insurance and is relatively cheap either way. Healthcare in the US is expensive for several reasons. Excessive paperwork and bureaucracy, unpaid bills, required service, 24/7/365 services, complex diagnosis, lawsuits, medical school, regulatory capture, etc etc. Changing any one of them isn’t going to fix pricing. We really need to change several pieces at the same time and the industry reall…

I’m pretty sure most of this is also what, say, EU has to deal with. They most certainly have bureaucracy, unpaid bills, 24/7/365 services, complex diasnosises…

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#258

Post by trixie_ »

sofixa wrote: post #223
trixie_ wrote: post #191

Earlier quoted context omitted.

A free market wouldn’t be dumb enough to give a teenager a loan for 100k. That idiocy is reserved for the government.

Hence the free market would have excluded any teenager who doesn't have rich parents from higher education. Hardly a good thing.

Free market brings prices down and quality up. The government tried to ‘help’ 50 years ago and now the prices have become so distorted that without government help you would need to be rich to go to school.

People like you think the government should solve a problem that they themselves created.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#259

Post by Semaphor »

blntechie wrote: post #153
addicted wrote: post #34

Earlier quoted context omitted.

No one is lying. The system is filled with massive inefficiencies. 1) Insurance companies don’t pay sticker prices. They pay negotiated rates. At the same time, hospitals have to pick up a lot of ER costs that are never covered. They might be making money but reasonable amounts at best (also that’s probably not true either considering how many hospitals are shutting down in the US). 2) The negotiated rates insurance…

Distinctive thing I found in the US is that hospitals are always big and do everything under one roof. There are some smaller clinics run by chains in some states but they operate primarily only for insurance money and are not common. At the bottom of the chain, some doctors run their own operations from a strip mall like place but they again provide very minimal service. Meanwhile, in developing countries, it's not…

> Distinctive thing I found in the US is that hospitals are always big and do everything under one roof.

It’s the same in Germany, so I’m not sure that actually is what makes things different.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#260

Post by fennecfoxen »

gus_massa wrote: post #241
boplicity wrote: post #165

Earlier quoted context omitted.

> Really any healthcare procedure that is not typically covered by insurance has seen costs go down over time. Health "insurance" companies are incentivized to raise the cost of care. Why? Their profits are capped to a percentage of the cost of care. The only way for them to make more money is to have more revenue -- which they do by increasing the cost of care!

Bakeries are also incentivized to raise the cost of bread, in spite they have no official cape of the profit (unless you consider 100%?). The difference is that if a bakery tries to charge you a ridiculous price, you can politely decline tu buy, or buy and promise never to return.

The difference is that the customer pays 100% of the entire price. The industry doesn’t have a plan where you pay $0.10 for an eggs benedict brunch, or 10% a year after spending $100, and then get to charge your employer or your fellow citizens massive sums.
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