A few things to consider: 1) You can't turn an operating room immediately. A 1hr surgery requires significant prep time _AND_ cleaning time. These rooms are used for many different kinds of surgeries — changing everything takes time. To make matters worse, each surgeon has their own preferred set up, and it needs to match that. 2) All medical supplies are expensive in part because your body is pretty sensitive, and y…
So, it sounds like we need to stop coddling the doctors and standardize on a particular set of tools.
This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+ £600 for initial scan). I could have got it done for free on the NHS but it would have messed up my term time at university. Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medi…
We don't really have any price signals for the vast majority of our health care system, when in reality only a tiny minority of it is hard to price (emergency care is hard to price).
One thing to be aware of in how all of this stuff works; oftentimes medical billing codes don't map 1:1 to exactly how things work in the hospital, so the medical staff puts together a statement of everything they did, and then the billing staff (approximately) maps it to billing codes. This means that they'll overshoot on some codes to make up for other acts and overhead that doesn't have an exact billing code, and…
His expense report comes back from accounting with everything approved except the umbrella. He appends a note to the report explaining that the umbrella was destroyed in the line of duty and resubmits. Back comes the expense report, with a rather severe note from accounting to the effect that umbrellas are not on the list of allowable expenses.
...Our frustrated manager tears up the old report, then sits down and fills out a whole new form: $3.94 for lunch, $12.75 for laundry charges, and so forth. Which he sends to accounting with a note attached: SEE IF YOU CAN FIND THE UMBRELLA NOW!
The most useful aspect of this article is the pie charts and line-item comparisons. Ignore the dollar amounts themselves. Why? Because almost no one pays that. Why? - In California, MediCal (state-wide health insurance safety net) pays about 20% of the cost (not price) of treatment for those without insurance. So if a surgery costs $10k, MediCal says "Here's your $2k. That's all you get." - Nationwide, Medicare pays…
This is true, but often the discounts aren't as steep as you'd think. I had a mitral valve replacement a couple years back (at age 29, due to a one in a million condition), and the insurance company was billed ~350k for the surgery + recovery in hospital. Even after their discounts, the total still came to $~250k (this is not the normal price - I had a complicated recovery, and spent an abnormal amount of time in the cardiac ICU). I, however, only had to pay ~$4,500 or so (high-deductible plan).
It seems to me that the balance of power has shifted far over to the providers and away from the insurance companies. Would allowing more mergers give them more bargaining power and bring these costs down? Or is that just too simple?
There is a lot of cultural resistance in the US to any kind of price pressure on health costs. This problem will exist regardless of whether you have a private or government system.
Interesting read, and a valid criticism of the costs associated with ACL repair in the US. It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there. My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including ph…
There's a slow trend toward doctors not taking insurance. A few of the higher profile cases have seen private practices reduce their prices between 50% and 80%, while still making a very healthy profit. For those that need charity care, they're actually able to provide it due to having a huge block of resources (time and money) not being tied up dealing with insurance claims.
I commend your move toward transparent prices for the services you provide in the medical industry.
A few things to consider: 1) You can't turn an operating room immediately. A 1hr surgery requires significant prep time _AND_ cleaning time. These rooms are used for many different kinds of surgeries — changing everything takes time. To make matters worse, each surgeon has their own preferred set up, and it needs to match that. 2) All medical supplies are expensive in part because your body is pretty sensitive, and y…
So, it sounds like we need to stop coddling the doctors and standardize on a particular set of tools.
This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+ £600 for initial scan). I could have got it done for free on the NHS but it would have messed up my term time at university. Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medi…
A few things to consider: 1) You can't turn an operating room immediately. A 1hr surgery requires significant prep time _AND_ cleaning time. These rooms are used for many different kinds of surgeries — changing everything takes time. To make matters worse, each surgeon has their own preferred set up, and it needs to match that. 2) All medical supplies are expensive in part because your body is pretty sensitive, and y…
So, it sounds like we need to stop coddling the doctors and standardize on a particular set of tools.
The issue with that is that no hospital is willing to be the first.
Hospital: We're going to lower costs by not letting doctors choose their equipment.
Talented surgeons: Welp, don't want to work there.
Patients: Why would I go to the hospital that doesn't have any of the good surgeons?
When I was in college, I couldn't afford health insurance (no parents + financial aid does not cover it). I played rugby (generally not the safest sport) for two years, in addition to playing pickup basketball all four years. I very fortunately did not sustain any major injuries. Six months after graduating (and getting a job with health insurance), I tore my ACL while playing pickup basketball. The costs were as ins…
You wouldn't have paid anything like $68k. As mentioned in the article, those prices are inflated for charging the insurance company, who in turn negotiates a much better actual price. Similarly, the hospital would have likely worked out a better deal with you. Or, if you qualified (and it sounds like you would have), then Medicaid would have initially picked up the tab and they would have negotiated a better deal fo…
The hospital would have worked out a better deal with you if you asked. However, if you don't ask, and just put yourself horribly into hock to pay them, they'll take the money. Likewise, if you refuse to pay, and they have to go to collections or the like, they'll apply the full, inflated amount.