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One hospital charges $8,000 — another, $38,000

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Re: One hospital charges $8,000 — another, $38,000

#21

Post by rdl »

ck2 wrote: post #7

Always tell them you are paying in cash. Take bill home and sumbit to insurance if you are lucky enough to have insurance. You just saved the system at least 75% of the cost.

The weird thing about having an HSA is that because I pay essentially 75% of a lot of things out of pocket (as long as I'm below my deductible), it often makes sense for me to negotiate and "pay cash" rather than running through my insurance. And yes, the doctors, pharmacies, etc. drop the prices a lot.

One of the weird things going on right now is that Doxycycline (a common antibiotic) has gone up in price 10-20x in the past couple months. A bottle which used to cost me $12 generic is now...$350! (due to a crazy FDA recertification process for the manufacturers)

My local pharmacist laid in a huge supply at the old price, and when I told him I was on an HSA (and where he saw my insurance deductible of around $250), he sold me the prescription for cash for $30.

Still covered for anything serious (essentially any ER visit, cancer, serious illness, imaging, etc.), but for anything else, I'm highly incented to negotiate like I would for any other product. Best of both worlds.

Re: One hospital charges $8,000 — another, $38,000

#22

Post by olefoo »

yitchelle wrote: post #18
ck2 wrote: post #7

Always tell them you are paying in cash. Take bill home and sumbit to insurance if you are lucky enough to have insurance. You just saved the system at least 75% of the cost.

"if you are lucky enough to have insurance." This is one of the many sad points about the health system. Luck should have absolutely NO relation to whether you can afford reasonable health care. Reasonable health care should be available to Joe Blow who is earning minimum wage at your local city council and to Mr. Burns who is earning 20x more than Joe Blow.

Mr. Burns is falling down on the league tables then, CEO's should be earning at least 500 times the average workers wage http://go.bloomberg.com/multimedia/ceo-pay-ratio/

Clearly he is undercompensated.

Re: One hospital charges $8,000 — another, $38,000

#23

Post by olefoo »

DanBC wrote: post #6
mitmads wrote: post #2

"a health system that can set prices with impunity because consumers rarely see them — and rarely shop for discounts"

Why aren't the insurance companies working to drive prices down? I understand the theory: People buy insurance; the insurance companies 'police' medical providers and regulate (through the market) the pricing of services. From the outside it doesn't look like that works. From the outside it looks like very many more (often unneeded) tests are conducted. And it looks like the insurance companies are not squeezing the…

The equation is something like:

  ( (gross_revenue + interest_on_capital) - cost_of_care ) = profit
In other words, the greater throughput, the greater profit.

Re: One hospital charges $8,000 — another, $38,000

#24

Post by olefoo »

cmircea wrote: post #14
drawkbox wrote: post #12

Earlier quoted context omitted.

It isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem. Not sure how you fix it, maybe by temporarily making it i…

Or how about have national healthcare? Like every other decent country on this planet?

Only after we have explored every other possible solution. This is America, and no socialism is possible; unless you are a homeland security contractor.

Re: One hospital charges $8,000 — another, $38,000

#25

Post by seanmcdirmid »

ck2 wrote: post #19
yitchelle wrote: post #18

Earlier quoted context omitted.

"if you are lucky enough to have insurance." This is one of the many sad points about the health system. Luck should have absolutely NO relation to whether you can afford reasonable health care. Reasonable health care should be available to Joe Blow who is earning minimum wage at your local city council and to Mr. Burns who is earning 20x more than Joe Blow.

Great news, they solved this in a very profitable way. In a few years it will literally be a crime to not have insurance. So cannot afford it? Not their problem - YOUR problem. Yay 'murica.

The nice thing about making something mandatory is that their is then outrage when people can't afford what they must have. Society can't ignore the problem anymore and must attack it head on.

Can't afford insurance? Well, here is a subsidy, or why not just go on medicaid? Can't afford insurance and make $60K a year; well, maybe individual plans should be more affordable...single payer is looking more desirable. Oh, you make $100K a year and STILL can't afford insurance (let's say no family is involved). Well how the f*ck are you spending your money? Oh, you just don't want to buy it because you are young and invincible? That's not how insurance works.

Yeh for America; they are finally catching up with the rest of the developed world!

Re: One hospital charges $8,000 — another, $38,000

#26

Post by seanmcdirmid »

cmircea wrote: post #14
drawkbox wrote: post #12

Earlier quoted context omitted.

It isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem. Not sure how you fix it, maybe by temporarily making it i…

Or how about have national healthcare? Like every other decent country on this planet?

Careful there. A lot of countries have quasi private/public systems with law-enforced mandates. For example, Switzerland.

Re: One hospital charges $8,000 — another, $38,000

#27

Post by nostromo »

I wonder, since we strangely expect employers to provide healthcare insurance in the US, what if employers just decided to provided actual healthcare.

Imagine taking all of the health premiums Google pays for its employees, and instead of feeding it in to a broken system, you build a world class health facility in Mountain View that's free to employees.

Re: One hospital charges $8,000 — another, $38,000

#28

Post by roel_v »

cmircea wrote: post #14
drawkbox wrote: post #12

Earlier quoted context omitted.

It isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem. Not sure how you fix it, maybe by temporarily making it i…

Or how about have national healthcare? Like every other decent country on this planet?

Describe "national healthcare". I see people who like to bitch about the US throwing this term around a lot, but what do you mean by it? One single, state-organized health care provider that gets funded 100% by other taxes or a flat-fee contribution that is the same for everybody? State-set price controls? Price controls on what - costs of procedure or insurance plan? What about coverage of those plans, determined by the state?

Re: One hospital charges $8,000 — another, $38,000

#29

Post by DanBC »

anateus wrote: post #10
DanBC wrote: post #6

Earlier quoted context omitted.

Why aren't the insurance companies working to drive prices down? I understand the theory: People buy insurance; the insurance companies 'police' medical providers and regulate (through the market) the pricing of services. From the outside it doesn't look like that works. From the outside it looks like very many more (often unneeded) tests are conducted. And it looks like the insurance companies are not squeezing the…

Most private health insurance in the US is provided by employers. Thus, the people paying for the services are not the patients but insurance companies, and the insurance companies are selected by employers not the patients.

But that says nothing about why insurance companies are not pushing prices down.

They get paid by employers, but they'd make more profit if the health care they buy is cheaper. Since I regularly hear that prices are cheaper if you negotiate with the doctors it seems that insurance companies are not doing that negotiation.

So, given that they appear to be losing out on some profit, why? Why aren't they pushing the costs down?

Re: One hospital charges $8,000 — another, $38,000

#30

Post by ck2 »

seanmcdirmid wrote: post #25
ck2 wrote: post #19

Earlier quoted context omitted.

Great news, they solved this in a very profitable way. In a few years it will literally be a crime to not have insurance. So cannot afford it? Not their problem - YOUR problem. Yay 'murica.

The nice thing about making something mandatory is that their is then outrage when people can't afford what they must have. Society can't ignore the problem anymore and must attack it head on. Can't afford insurance? Well, here is a subsidy, or why not just go on medicaid? Can't afford insurance and make $60K a year; well, maybe individual plans should be more affordable...single payer is looking more desirable. Oh,…

What about the unemployed who cannot afford the mandatory insurance - and won't get assistance unless they trek 20 miles across the county (without a car) EACH WEEK to prove they are still unemployed yet looking for work? Seem right?

Basically they didn't solve health care costs, they just dumped the cost onto the entire taxpayer base, the same way walmart keeps low prices by keeping their employees on food stamps.

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