71–80 of 202 posts
My wife is a Dentist in Bangalore, India, and it's amazing what I hear. Basically Cost(Flight to india + treatment cost) The more you think about it, the more crazy it seems on multiple levels. Edit, typed .
Yep. Medical tourism exists when the cost of local healthcare is inflated by profit-seeking to flatly unaffordable levels, resulting in grotesque health outcomes and extreme behaviors such as traveling thousands of miles or committing crimes in order to end up in prison for care. I would like to coin a term for this kind of disturbing extreme behavior incentivized by extreme distortion of society: fever spasms. It so…
Yep. Can confirm: US hospitals and other care providers are total d-bags when it comes to billing. It doesn't help that for anything remotely complicated you end up receiving 2-3 different bills from each of 5-6 different entities (the hospital, a couple of doctors or departments in the hospital, a couple of labs, a GP for your checkups afterward, et c.), only one of which from each will actually be the one you need to pay. It can easily take most of a year to sort all the crap out, especially if you have any kind of dispute with insurance or billing error from the providers (the bigger the procedure, the closer the probability of this approaches 100%). Makes for a totally stress-free recovery. eye roll
It's like it's designed to screw up people's credit, even when they're trying to pay what they owe.
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If that is the reason, why do many countries, such as India in the article, have systems that work efficiently and simply?
India's system works efficiently and simply for those who can afford it, which is a minority of the Indian population. For the ~70% of Indians in rural areas, and especially the ~50% who are living in poverty, they often have little access to health care. What they do have access to is often substandard.
This is not some failing of the medical system, it's just a failing of India to be a wealthy developed nation.
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I guess not. Which does seem a little weird now that I think about it. Not sure why cars would be different.
Because the law allows you to go to any mechanic to get your car fixed, and they can't negotiate with every mechanic in the market. Most auto insurers have "approved" repair shops, and if you go to one of those, the rates can be cheaper than cash.
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> In everything else e.g. car repairs, the cash price is always lower than insurance covered price For starters, insurance smooths risk. It is not there to save you money. By definition, insurance will always cost more than than paying out-of-pocket in the long run [0]. Think of insurance as a luxury that mitigates (but does not eliminate!) the worst-case scenario for you. It costs more (a premium[1]) because this lu…
In general, Medicare and Medicaid reimburse the least - the amount that they reimburse is actually less than COGS (not on all individual services, but in the aggregate, it amounts to 7% less)[2]. As a result, providers have to overcharge private insurers and uninsured patients in order to cover their own costs. I don't understand how doctors paying less to medicare/medicaid causes them to have to overcharge other cus…
Sort of.
It's less the case for outpatient practices unaffiliated with any hospital network, which is why the disparity between insured cost and out-of-pocket costs for those practices tend to be smaller. But unaffiliated outpatient practices are a dying breed.
For hospitals, it's more complicated. In theory, this would be true. In practice, almost all hospitals other than the ones the VA operates do take both Medicare and Medicaid because of a confluence of other regulations that makes it unfeasible to refuse care to them. That said, despite this, the amount of money that hospitals lose on public insurance has increased to the point where a number of large hospital networks have discussed rolling back the services they offer to Medicare patients (such as outpatient care) or even cutting it off entirely.
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Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. Here's another example: https://www.washingtonpost.com/business/economy/new-machine-... "Anesthesiologists tried to stop Sedasys. They lobbied against it for years, arguing no machine could possibly replicate their skills or handle…
> Part of the problem is you can thank the stranglehold the AMA has around the US healthcare system to keep the number of doctors artificially low so their salaries remain ridiculously high. The AMA is a common scapegoat, except that the AMA has literally nothing to do with the number of of doctors supply-side. You're probably thinking of the AAMC, which has nothing to do with the AMA, and is responsible for the numb…
A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery was 130% of the Indian gdp per capita.
And the issues with rounding errors has to do with the large amount of health insurance in the U.S. not necessarily free market vs. regulation. When the majority of consumption in a market is driven by enterprise customers, the pricing can become strange and very unfriendly to individuals.
[0]https://pricinghealthcare.com/prices/IowaCityASC/spine-back [1]http://www.backsurgerycost.com/how-much-does-a-discectomy-co...
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> In everything else e.g. car repairs, the cash price is always lower than insurance covered price For starters, insurance smooths risk. It is not there to save you money. By definition, insurance will always cost more than than paying out-of-pocket in the long run [0]. Think of insurance as a luxury that mitigates (but does not eliminate!) the worst-case scenario for you. It costs more (a premium[1]) because this lu…
In general, Medicare and Medicaid reimburse the least - the amount that they reimburse is actually less than COGS (not on all individual services, but in the aggregate, it amounts to 7% less)[2]. As a result, providers have to overcharge private insurers and uninsured patients in order to cover their own costs. I don't understand how doctors paying less to medicare/medicaid causes them to have to overcharge other cus…
It's true that healthcare is terrible in the U.S. if you don't have health insurance, but he overstates his case. Chris compares a 1 in a 1000 nightmare scenario to his very average experience. A $112,000 error happens in the U.S. but is rare. Typically the type of surgery he mentions costs between $20,000-$50,000. Or 50-100% of a the U.S. gdp per capita. This is smaller than in India where the cost of his surgery wa…
The only prices I know are the price at the place I went (one of the top facilities in the region) and a few nearby hospitals. Several were significantly cheaper and if I earned in INR I'd probably have gone to one of them. But I figured that given how much I enjoy walking, why not just spend $700 more to go to the best guy?