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The Man Who Was Treated for $17,000 Less

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Re: The Man Who Was Treated for $17,000 Less

#61

Post by jusben1369 »

rprospero wrote: post #52
jusben1369 wrote: post #44

Earlier quoted context omitted.

I see this argument a lot. It's really unhelpful if you're trying to resolve the big challenges. The reality is that around about 90% of all healthcare spend can be done in a normal, thought out manner. The car accident/heart attack/ambulance can I negotiate my surgery dialogue is such a small part that using it really distracts away from the main issues. This was an incredibly disturbing story. It's a pity that it t…

The reason that it comes up a lot is because it's not that small of a part. Before I met her, my wife went to the hospital with severe pneumonia. She was there for over a week, partially due to a surgical error by the hospital. During this time she was fired because she ran out of sick days. This cancelled her insurance. The hospital then charged her $30,000 for a bunch of procedures that she never had the chance to…

Hey, that's a horrible story. What this article highlights is that due to the dysfunctional nature of the current healthcare system a procedure that all parties agreed to do the surgery at $3000 vs the original quote of $30,000. If the system was fixed your current wife might have faced a bill of $4000 vs $30,000 based on an extrapolation. Still not great but a lot better.

You could get there two ways. You could have clear transparent pricing for hospitals and you could look at that pricing ahead of time and determine your preferred hospital in case of an emergency. Or the government could set hard prices (as we're starting to see now in MA which is leading the way in the US in terms of this direction)

Re: The Man Who Was Treated for $17,000 Less

#62

Post by Smudge »

bmmayer1 wrote: post #28
joshuahedlund wrote: post #23

Earlier quoted context omitted.

I like this argument, too, but the common response is that Lasik and cosmetic surgeries are elective - voluntary improvements to your body that are a sort of luxury that lend themselves to competition (shopping around, taking your time). By contrast, a lot of expensive medical procedures are much more critical and time-sensitive (you could say the demand is much less elastic), which makes it a lot harder for competit…

What the commenter suggested is exactly the situation right now: the hospital sets the prices as astronomically high as possible because they can get away with it, because the patients aren't paying it. Don't you think introducing patient choice into the equation would put some downward pressure on prices? And certainly if it puts any downward pressure on prices, it's a better situation than we have now.

If you're having a heart attack, are you really in a position to negotiate on price? At all? I get that there might be some downward pressure, but what prevents the hospital from just laying an absurd bill on you after the procedure?

Re: The Man Who Was Treated for $17,000 Less

#64

Post by derekp7 »

munificent wrote: post #33

God, what a terrible article. So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a "self-pay" (or uninsured) patient. Yeah, how well does that strategy work when you're having a heart attack and are moments from death? I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasona…

My definition of reasonable: 1) First establish a reasonable hourly rate for each person in the OR (doctor, anesthesiologist, assistants). Add all that up. Then add in the amortized cost of the equipment used (knives, heart monitor, bed sheets), add in the medicine costs, then add a 20% overhead fee (guess) for the operating room / hospital. Somehow I don't come out to a figure anywhere near to a hundred grand (or 20 or 50k).

Re: The Man Who Was Treated for $17,000 Less

#65

Post by roc »

> "Most people are unaware that if they don't use insurance, they can negotiate upfront cash prices with hospitals and providers substantially below the "list" price."

Substantially below list, but still well above what insurance providers pay.

Even when you can self-insure in the US, if you actually find yourself needing medical care, it would have been cheaper not to.

Except on the short-term scales and/or when you're young and may well not need to see a doctor for several years at a go.

Re: The Man Who Was Treated for $17,000 Less

#66

Post by javajosh »

There is no such thing as a free-market in health-care. Period.

Patients are not customers. We don't shop. And you know what the biggest tell-tale about that is? Hospitals don't advertise. Sure, you see ads for a handful of elective procedures like teeth whitening and boob jobs - but when did you see an ad for hernia surgery?

Now, it would be an interesting world where there was indeed some sort of marketplace for healthcare, where when you're doctor tells you you need something, from medication to a test, you can punch it into an app to get the best price. Providers could compete with each other on price.

But here's the thing: do we really want to buy healthcare based on price? I don't. And I know too many people in other parts of the world (Canada and Australia, to be exact) who have nothing but good things to say about their socialized healthcare.

I believe in capitalism's power to generate wealth, but I also believe that healthcare should be socialized in the US. It is horrible the way people are overcharged for procedures, and that happens because there is NO MARKET.

Re: The Man Who Was Treated for $17,000 Less

#67

Post by roc »

joshuahedlund wrote: post #23
bmmayer1 wrote: post #4

"Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care." Sadly, most people forget this. They think that healthcare is somehow immune from the laws of economics, that it is "special."

I like this argument, too, but the common response is that Lasik and cosmetic surgeries are elective - voluntary improvements to your body that are a sort of luxury that lend themselves to competition (shopping around, taking your time). By contrast, a lot of expensive medical procedures are much more critical and time-sensitive (you could say the demand is much less elastic), which makes it a lot harder for competit…

The real point to them being elective luxuries is that the would-be consumer can actually walk away entirely. You needn't get lazik from anyone. The same can't be said of many/most medical procedures.

You can't research the market and just skip getting a knee replacement altogether, the way you could with lazik. To say nothing of more serious problems.

Re: The Man Who Was Treated for $17,000 Less

#68

Post by roc »

baddox wrote: post #16
bmmayer1 wrote: post #4

"Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care." Sadly, most people forget this. They think that healthcare is somehow immune from the laws of economics, that it is "special."

Many people will unabashedly say that they believe healthcare to be special. It's not uncommon to hear people say that they don't believe profit motive has any place in healthcare. I don't buy it. I don't see how healthcare is any more special than, say, food production (both are obviously vital to health), yet I think most people have come around to recognizing that profit motive is a spectacular way to organize the…

If the goal is to celebrate the free market, food production is probably not a great analogy. In the US it's heavily subsidized, regulated, watched and manipulated to ensure that the market doesn't act too much like a free market. [1]

Housing and Utilities are that way too. When you get right down to it, every vital fundamental service is backstopped in similar ways. At least inasmuch as disqualifying them from being great examples.

Which rather deprives us of a simple analogy between "How Health Care Might Be" and some other current market for a vital human need.

[1] Which may well work itself out in the end, but is given to trouble in the short run from things like fraud, bubbles, panics and crashes -- things society has voted that they like less than government manipulation of the market.

Re: The Man Who Was Treated for $17,000 Less

#69

Post by alex-g »

javajosh wrote: post #66

There is no such thing as a free-market in health-care. Period. Patients are not customers. We don't shop. And you know what the biggest tell-tale about that is? Hospitals don't advertise. Sure, you see ads for a handful of elective procedures like teeth whitening and boob jobs - but when did you see an ad for hernia surgery? Now, it would be an interesting world where there was indeed some sort of marketplace for he…

Where I live (Philadelphia) I see a lot of advertisements for hospitals, and for treatments for serious conditions like cancer. Not so much "we'll do it for $whatever", but certainly language like "we are the best hospital in the region for (issue)".

Re: The Man Who Was Treated for $17,000 Less

#70

Post by pdonis »

rprospero wrote: post #52
jusben1369 wrote: post #44

Earlier quoted context omitted.

I see this argument a lot. It's really unhelpful if you're trying to resolve the big challenges. The reality is that around about 90% of all healthcare spend can be done in a normal, thought out manner. The car accident/heart attack/ambulance can I negotiate my surgery dialogue is such a small part that using it really distracts away from the main issues. This was an incredibly disturbing story. It's a pity that it t…

The reason that it comes up a lot is because it's not that small of a part. Before I met her, my wife went to the hospital with severe pneumonia. She was there for over a week, partially due to a surgical error by the hospital. During this time she was fired because she ran out of sick days. This cancelled her insurance. The hospital then charged her $30,000 for a bunch of procedures that she never had the chance to…

the reason that the other scenario comes up so often is that the remaining 10% can be completely catastrophic.

And the reason that it can do so is that the 10% of cases where the patient really, genuinely has no choice are lumped in with the 90% of cases where there is a choice.

The article makes this point: it notes that what most people call "health insurance" is actually a prepaid health plan: they pay premiums in advance for predictable health care expenses--the 90% of cases--at prices that a third party negotiates. The whole point of "insurance" is supposed to be that it protects you against unpredictable expenses--the 10% of cases--by spreading risk. But our system of "insurance" is broken because it doesn't separate the two things.

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