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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

#91
post #90

Earlier quoted context omitted.

That still sounds like a terrible deal to me. In the UK, I pay around 10% of my salary for national health care and get free care for any problem I might have (and so does my girlfriend, of course). Medication is always exactly £7 (or similar, it might have changed slightly recently) regardless of what it's for.

And that leads to perverse incentives; If you have no incentive to help control costs, then it falls upon the NHS to control costs through delays and denial of service.

Empirically, this is false. Perverse incentives and perverse pricing pervades the US system. Whereas the UK system provides equivalent health at half the cost.

Certainly your thought is a common one, the idea that individuals can be incentivized to cut costs was the motivation behind high-deductible plans. High-deductible plans were initially priced much lower than they are now, because the insurance companies thought that individuals on those plans would control their costs much better. However, that was not observed, and the insurance companies have raised rates faster than with other plan types, and HDHPs are now not nearly as good deal as they once were. (At least in my area.)

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

#92

I do not understand why there is no public list online with the basic costs of operations (including all the variables). With price transparency a lot of this unequal treatment and prices would surface. I understand there are a lot of variables, but not like it wouldn't be possible. (I understand a treatment at Hopkins would be more expensive than say at your local hospital, but at the very least it would be clear ho…

Here's a link to the guide that Ontario doctors use to figure out how much to charge for health care provided to the uninsured (i.e. non-Canadians): http://oscarresourceplone.oscartools.org/OntarioBilling/omat.... It's not a price list, but it gives you a breakdown and shows you what the variables are that are taken into account. This is provided by the Ontario Medical Association.

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

#93
post #17

I have to admit I was against ACA for a variety of reasons, but if the first step is increased price transparency and exposing that data, it will do a lot of good. The best reform I can think of would be a combination of individually purchased (vs. employer) HSAs, where poor people get grants of up to the the full deductible per year in some kind of special account IFF they sign up for HSAs, and price transparency. E…

That's not a political reality. Since healthcare bought by an employer counts as an tax-deductible expense and healthcare bought by an individual gets no such breaks, there is a huge incentive (equal to the marginal tax rate) for individuals to have someone else write the checks for the bulk of their healthcare costs. Before market-based healthcare will work, either 1) employer-provided health insurance benefits must…

#2 is solved by HSAs. HSA purchases are tax-free.

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

#94
post #75
post #20

Earlier quoted context omitted.

My long-term HDHP went from $80/mo to $118/mo, which is high in percentage terms, but still not a big deal IMO. In the process they gave me unlimited lifetime coverage, added free preventive care, etc. -- which IMO seems actuarially impossible, but I'm on the buy side of this transaction.

Can you share the name of your provider (or their peer set)?

It really varies by state. I went to an online insurance comparison app (I should promote Leaky or SimplyInsured here, but at the time in 2010, I used ehealthinsurance), searched for HDHPs, then picked based on reputation. I picked a Blue Shield provider with no lifetime cap (or a $6mm lifetime cap, I forget).

The only states I know are WA and CA. In WA, I like Regence Blue Shield; plans seem to be in the $100-150/mo range now.

In CA, there are also a lot of HDHPs in the $100-150/mo range. I'd specifically avoid Kaiser as an employer giving coverage, as some people really dislike Kaiser since you must use a Kaiser doctor, hospital, or other facility, but if you're an individual and like a Kaiser doctor, it might be a good choice. Otherwise a lot of people I know use Health Net, Anthem, etc.

I'm not a lawyer nor am I a licensed insurance agent so I'm hesitant to recommend specific plans.

I think these rates are low due to being HDHPs and the "best" patient group; 26-35 year old single male. Those are exactly the people who don't get individual insurance unless they're cautious people who join AAA, change oil on time, buy fire extinguishers, look both ways before crossing the street, etc. (and thus exceptionally good risks), and even then seek to minimize contact with doctors. I suspect the unhealthy ones are particularly likely to take jobs with insurance, or be on medicaid/prison/etc., in that bracket, or are so irresponsible as to have no insurance (because hey, even $120/mo is better spent on beer).

Rates don't seem that much worse for women (which is weird, since I'd assume most women get enough extra covered services covered now by an HSA to destroy the actuarial model for a $100/mo plan). The rates 4x once you add children, though. I tried also plugging in numbers for people born in 1969, 1959, 1950, and rates do go up, but only maybe 4x, too. So the prices are generally within a 10x range per insured, at least for healthy people or in places where there is no medical underwriting, tops, and under ACA, that will converge to 4x (although I'm sure by raising the low end by 50-150% and only lowering the top end by a trivial amount.) I always assumed all insurance was $500+/mo/insured, since that's what the group rates for small businesses seem to be, but that's due to adverse selection and inefficiency I think.

The real problem seems to be if you're unhealthy when looking for insurance, or have children (particularly with high medical costs), or have an acute high-cost event, or are poor enough that $100-200/mo is a hardship (even though I think $100-200/mo for health insurance, whether paid by the individual or the government, is pretty reasonable), or are, worst case, so unhealthy that you're also poor and thus doubly screwed.

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

#95
post #94
post #75

Earlier quoted context omitted.

Can you share the name of your provider (or their peer set)?

It really varies by state. I went to an online insurance comparison app (I should promote Leaky or SimplyInsured here, but at the time in 2010, I used ehealthinsurance), searched for HDHPs, then picked based on reputation. I picked a Blue Shield provider with no lifetime cap (or a $6mm lifetime cap, I forget). The only states I know are WA and CA. In WA, I like Regence Blue Shield; plans seem to be in the $100-150/mo…

Wow, this is insanity: I priced some NY (10024) and MA (02139) zip codes on ehealthinsurance and the coverage looked approximately 5x CA or WA rates. I'm not sure if that's specific to the site and their mix of carriers, or if insurance really is that much more expensive on the East Coast.

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

#96
post #90

Earlier quoted context omitted.

And that leads to perverse incentives; If you have no incentive to help control costs, then it falls upon the NHS to control costs through delays and denial of service.

Empirically, this is false. Perverse incentives and perverse pricing pervades the US system. Whereas the UK system provides equivalent health at half the cost. Certainly your thought is a common one, the idea that individuals can be incentivized to cut costs was the motivation behind high-deductible plans. High-deductible plans were initially priced much lower than they are now, because the insurance companies though…

Didn't exactly that also happen with HMOs from 1973 onward (once they had a federal regulatory framework)?

It seems like an underlying problem is that whenever a "cover somewhat less, save money, charge a huge amount less" plan is put in place, there are incentives in individual cases (through lobbying or whatever) to add coverage, killing the cost savings.

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

#97
post #95
post #94

Earlier quoted context omitted.

It really varies by state. I went to an online insurance comparison app (I should promote Leaky or SimplyInsured here, but at the time in 2010, I used ehealthinsurance), searched for HDHPs, then picked based on reputation. I picked a Blue Shield provider with no lifetime cap (or a $6mm lifetime cap, I forget). The only states I know are WA and CA. In WA, I like Regence Blue Shield; plans seem to be in the $100-150/mo…

Wow, this is insanity: I priced some NY (10024) and MA (02139) zip codes on ehealthinsurance and the coverage looked approximately 5x CA or WA rates. I'm not sure if that's specific to the site and their mix of carriers, or if insurance really is that much more expensive on the East Coast.

Thanks for all your pointers and observations! I will likely be in the market for an HDHP soon and these will give my own search a running start.

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

#98
post #68

Earlier quoted context omitted.

$216 sounds like only your part of the payment. Do you know how your employer's contribution (the bulk of the total cost) changed? Sounds like they saved a lot of money.

This is exactly it. The company I work for is fairly open, and I know how much they pay every pay period for my health insurance, and it is about 3x as much as I pay for the plan. This guy's company sounds like they changed providers, pushed almost all the cost to the employee (under the mask that it costs the employee the same), is saving a ton of money, but tells the employees to blame the ACA. While I work for a d…

yeah, and that's called inflation and is the direct result of the Government actions and not your employers fault.

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

#99
post #67

Earlier quoted context omitted.

8000 USD for a hospital treatment does not seem insanely expensive for me. Hospitals are by definition expensive - 24/7 on-site staff, highly trained experts (doctors), lots of expensive machines. A simple bed in a hospital is far more complicated and expensive than your standard home mattress. Hospitals need to overprovision on a constant basis since the can't just return a "503 Retry Later" in case of emergencies.…

> a fifth of the highest price? may be because those higher charges are more bureaucracy than actual value adding?

or maybe because there are developers who are $30 and hour and there are developers who are $100 an hour ?

Isn't that the same with the doctors? Isn't that the same with the equipment?

Isn't that the same with the medication?

Who cares if they can kill you on the cheap? The point is to save lives no matter what the cost.

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

#100
post #88

Earlier quoted context omitted.

That's not a political reality. Since healthcare bought by an employer counts as an tax-deductible expense and healthcare bought by an individual gets no such breaks, there is a huge incentive (equal to the marginal tax rate) for individuals to have someone else write the checks for the bulk of their healthcare costs. Before market-based healthcare will work, either 1) employer-provided health insurance benefits must…

Individual healthcare purchases (not insurance) can be deducted from your taxes, either explicitly if you're filing a long form, or implicitly if you're claiming the standard deduction. I don't see why it would be a huge burden to make individual health insurance tax deductible.

Only healthcare expenses over 7.5% of adjusted gross income are tax deductible. Plus, the poor and lower-middle class don't tend to much in income taxes (if any), so they wouldn't qualify for the discount.

In contrast, corporations always write off employee healthcare premiums on their taxes. The issue isn't just the fairness of who pay taxes when, it's also about the distortions in healthcare markets caused by these policies.

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