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The True Cost of Healthcare in the US

truecostofhealthcare.org

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Re: The True Cost of Healthcare in the US

#91

Post by rubyrescue »

jasonlotito wrote: post #81
rubyrescue wrote: post #74

Earlier quoted context omitted.

Well, I can't find any canadians who don't want their system. I can't find any (non-partisan) news sources complaining of a even a small number of people who would opt out of the Canadian system. Tommy Douglas, the founder of the system, is repeatedly voted the most popular Canadian in history... And...anecdotally every Canadian friend of mine loves to likes the system. I'd love to see some, any, hard evidence that t…

My wife, who is Canadian, used to love the health care system in Canada. After actually relying on it, she came to despise it. We left Canada and came to the US precisely for health care for my son (who is also Canadian). He received more care in the first 2 weeks here then he ever received in Canada. She now sings the US health cares praises. I could go on and on about the abuse my son received at the hands of the C…

sorry to hear about that. Your comment is very helpful as most, in fact, all Canadians I know are from big cities, and so I now have a richer set of anecdotes... ;)

Re: The True Cost of Healthcare in the US

#92

Post by rubyrescue »

noarchy wrote: post #77
rubyrescue wrote: post #74

Earlier quoted context omitted.

Well, I can't find any canadians who don't want their system. I can't find any (non-partisan) news sources complaining of a even a small number of people who would opt out of the Canadian system. Tommy Douglas, the founder of the system, is repeatedly voted the most popular Canadian in history... And...anecdotally every Canadian friend of mine loves to likes the system. I'd love to see some, any, hard evidence that t…

I live in western Quebec, home to two of the worst hospitals in the country (those in Hull and Gatineau). Getting a family doctor here requires years of waiting, and many will go across the river and pay out of pocket to see a doctor in Ottawa. You'll no doubt find some Canadians who live in areas where things are working out pretty well. People in the US don't often realize that the Canadian system is not monolithic…

As I said to your sibling comment, it's helpful to hear of your experience.

Re: The True Cost of Healthcare in the US

#93

Post by JoshTriplett »

Spooky23 wrote: post #67
specialp wrote: post #60

Earlier quoted context omitted.

For example 1: The reason why the hospital charges so much is the fact that it gets stiffed for a lot of emergecy patients without insurance. Many hospitals are on the brink of bankruptcy especially in poorer areas. This does not always reflect in the huge disparity in prices people pay, but is a big factor. Hospitals try to offset their losses by charging paying customers more. The real problems here especially with…

That's also a symptom. One root cause is that the Federal government (ie. Medicare) must get the best deal. If you give anyone else a better deal than Medicare, you are committing an act of fraud, and DoJ will go after you. This is known as a price floor. Layer upon this the web of contractual arrangements surrounding different insurance providers, and you get to a place where you need to mark up the MSRP of a proced…

> One root cause is that the Federal government (ie. Medicare) must get the best deal. If you give anyone else a better deal than Medicare, you are committing an act of fraud, and DoJ will go after you. This is known as a price floor.

Interesting; I don't see any obvious reason why other insurance companies couldn't do exactly the same thing by contract.

Can you charge Medicare for things Medicare makes you do that other insurance companies or individuals don't, such as billing them for time spent processing their red tape?

> Layer upon this the web of contractual arrangements surrounding different insurance providers, and you get to a place where you need to mark up the MSRP of a procedure to safely operate as a business.

Sounds a lot like selling enterprise software: corporate purchasers expect to receive a discount, so you can either antagonize them by not giving them what they expect, or mark up the price enough that you can offer "discounts" back to the real price.

Re: The True Cost of Healthcare in the US

#94

Post by seehafer »

jbooth wrote: post #51
thatswrong0 wrote: post #9

Earlier quoted context omitted.

I think it's a bit more complicated than that. It's easy to look at other countries and say, hey, that works there, therefore it will work here. But not all governments are created equal. If the government in the U.S. had a better track record, maybe it would be more palatable. But as is, I don't see single payer being the solution to our problems.

Other countries are pretty diverse with how they implement single-payer. Britain has NHS, Canada has private hospitals with government handling the insurance. One thing in common: They all suck, yet are all much better than our system.

"They all suck, yet are all much better than our system."

By what measure? If you're trying to see a specialist -- say, to get a surgeon -- soon, our system is far superior, which is why Canadians routinely cross the border to take advantage of our system.

A still simplistic and incorrect but fairer appraisal would be to say that the NHS and Canada's Medicare are optimized for everyday care and our healthcare system is optimized for specialty care.

Re: The True Cost of Healthcare in the US

#95

Post by nhashem »

larrywright wrote: post #43
nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

One of the ideas I've heard discussed is that the only way we will ever get the cost of health care down is if consumers are back in the drivers seat with how the dollars are spent. Right now it's disconnected. I go in to have something done, the doctor bills my insurance company, and I really don't know (or care) how much it costs, unless I happen to look at the insurance paperwork. The same goes for pharmaceuticals…

Unfortunately healthcare is not a market you often willingly participate in. Some health needs can be anticipated, and doing more to encourage consumer empowerment would definitely lower prices. Think about cosmetic surgery or LASIK. Every participant in that market is voluntary, so all the providers are motivated to do it cheaper and better.

But when you have a major health crisis, your "empowerment" is just fundamentally limited. If you get into an accident with a loved one and they're unconscious, you're not doing to be in a position to decide whether you should go to the hospital 1 mile away, that may be X% more expensive than the one 5 miles away. Your ability to price discriminate is also fundamentally limited by your own knowledge of medicine. If you have a tumor and one doctor suggests taking medicine A which costs $50,000, and medicine B which costs $5,000, is A better than B? Is it 1000% better? If it's only 2% better, unlike any other consumer product, are you trying to optimize for "value" or "not actually dying"?

There's definitely things we can do in terms of government policy to encourage more customer empowerment to bring down costs. But ultimately you have a market with unvoluntary participation and opaque pricing, which means Adam Smith can't really do his thing.

Re: The True Cost of Healthcare in the US

#96

Post by larrywright »

rubyrescue wrote: post #56
skylan_q wrote: post #50

Earlier quoted context omitted.

Because there are thousands of Canadians every year that go bankrupt because of health care costs. Actually, there are. They go the US to get care that's not offered in Canada. The care here is about as good as former soviet bloc countries. If there was a chance that an illness such as cancer could kill me, I'd get out of Canada in a heartbeat and embrace poverty if it meant keeping my life.

It's just not true that large numbers of Canadians go to the US for healthcare. You need to supply evidence of this. The numbers are vanishingly small.

I'll ignore for a second that you asked the parent for evidence, and then proceeded to make a statement without providing any evidence yourself.

>> The numbers are vanishingly small

Maybe as a % of the overall Canadian population, perhaps. What about the % of critically ill? People with cancer? My aunt is an oncology nurse at one of the best hospitals in the nation, and she sees a lot of Canadians who come to the US for treatment that they can't get at home.

So yes, people with the flu or a broken arm probably aren't flocking here for care. People with serious illnesses? You bet they're coming here.

Re: The True Cost of Healthcare in the US

#97

Post by dtparr »

larrywright wrote: post #43
nirvana wrote: post #21

Back when he was alive, Milton Friedman did a study of the costs of health care in the US from 1900 to the 1970s. (I think the first study was in the 1970s, and it was updated in the 1990s) What he found was that the funding mechanism of health care over that time had shifted from patients paying out of pocket to government paying hospitals and government incentivized (by making it a tax write off for employers) and…

One of the ideas I've heard discussed is that the only way we will ever get the cost of health care down is if consumers are back in the drivers seat with how the dollars are spent. Right now it's disconnected. I go in to have something done, the doctor bills my insurance company, and I really don't know (or care) how much it costs, unless I happen to look at the insurance paperwork. The same goes for pharmaceuticals…

My family is actually on a plan similar to the one you describe (high deductible and a spending account).

Before I used it, it seemed fine. I tend to do alot of research regarding upcoming tests/procedures and such, and so adding in an element of cost/shopping around wasn't too much more hassle.

In practice, it's been awful. I have no problem shopping around, but it's been essentially impossible to get the information I need to make an informed decision.

As an example, our primary care physician determined a procedure was needed and provided a list of specialists in the general area who were equipped to do it. So I filtered those for in-network providers using the insurance's website and then called those practices. Out of the 4: 2 refused to quote me the price at all; 1 gave me such a run-around that I eventually gave up; 1 (whose employee started our conversation with "We don't normally give this out, but Jane said I had to") gave me the price they would bill if I were uninsured. None of the 4 were actually able to tell me what they would bill me.

However, I did manage to get them to list the CPT codes relevant for the procedure, so I then called up the insurance company. Despite being able to list specific providers and the exact codes they would bill, the insurance refused to quote the member rate. The best they would do was give me that average cost for that CPT in my area which is useless if what you're trying to do is shop around within your area.

So, I don't disagree that people having a more direct link to the actual cost of their treatment wouldn't be a good idea, but until the system adjusts to provide up-front visibility into those costs, the only effect from that linkage is going to be post-procedure sticker-shock.

Re: The True Cost of Healthcare in the US

#98

Post by larrywright »

nhashem wrote: post #95
larrywright wrote: post #43

Earlier quoted context omitted.

One of the ideas I've heard discussed is that the only way we will ever get the cost of health care down is if consumers are back in the drivers seat with how the dollars are spent. Right now it's disconnected. I go in to have something done, the doctor bills my insurance company, and I really don't know (or care) how much it costs, unless I happen to look at the insurance paperwork. The same goes for pharmaceuticals…

Unfortunately healthcare is not a market you often willingly participate in. Some health needs can be anticipated, and doing more to encourage consumer empowerment would definitely lower prices. Think about cosmetic surgery or LASIK. Every participant in that market is voluntary, so all the providers are motivated to do it cheaper and better. But when you have a major health crisis, your "empowerment" is just fundame…

You make some very good points, and I think you're spot on for the most part. I think HSAs have more benefit for the lower end of the cost spectrum, such as routine care, or minor medical issues (sprains, fevers, and the like). But I don't know what percent of the total US healthcare spend is on those types of items, vs cancer treaments and MRIs. So maybe it won't help as much as I'd like to think.

Re: The True Cost of Healthcare in the US

#99

Post by jes5199 »

robinh wrote: post #8
ambiate wrote: post #4

Earlier quoted context omitted.

If necessary, I will pay the penalty. I assume the credit for health care costs and taxes charged on health care should make up for any penalties incurred by the PPACA. If I read correctly, my penalty should only be $950-1300. Inevitably, with my insurance rates, I would spend that on 2 months of health coverage for my small family. Just to break down costs: $600/mo health for wife/kid. $7200/yr. vs ~200/mo + 1000 pe…

I'm not in the USA, but 'only $950-1300'? That's more or less what I pay for a whole year of health insurance in the NL. How much does insurance cost in the USA?

when I left my last job, I had the option to continue the health insurance the company was paying for, for up to a year (this rule is called "COBRA"). It costs me about $1100 per month, to cover two people.

Re: The True Cost of Healthcare in the US

#100

Post by zaidf »

dave48 wrote: post #75

Hi, My name is David Belk and I wrote the website. I noticed a lot of traffic from here this Morning. I'd just like to say thank you and, are there any questions I can answer? I'm having a busy Morning but I'll be free in about an hour.

I have a question that I think about a lot and for most part, have not found an answer that makes logical sense.

Why do insurance companies play such hardball with compensating private practices or medical groups? It would seem like it is in the interest of insurance companies for private practices to flourish given that the same thing done at a hospital costs the insurance companies 3-6 times more money.

Most doctors that I ask this question suggest there is a conspiracy where insurance companies are in bed with hospital. Frankly, I don't buy it. I'm probably missing something and I'd love to hear someone's take who has thought about these issues deeply as you clearly have.

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