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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

#71

Post by spodek »

digitalengineer wrote: post #44

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…

Seems like an opportunity for a simple web page for people to report their fees and could search what others paid.

Not sure if it would make money, but I bet a lot of people would like it and benefit from it.

Anybody up for it?

Does it already exist?

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

#72

Post by dkhenry »

So great I now know that hospitals charge different fees which is still pointless since my federally mandated heath insurance will pay either one of those prices at no difference in cost to me. In reality I can get my hip replaced at any institution and pay nothing more then the $300 a month I pay for my health insurance. So in the real world the price of all those procedures _to me_ is $300 a month.

This is not a free market. Making these prices public isn't going to make it a free market. No problems have been fixed. Only new and novel problems have been introduced.

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

#73

Post by lucian1900 »

smcl wrote: post #64
lucian1900 wrote: post #49

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.

> Medication is always exactly £7 Except in Scotland, Northern Ireland and Wales where since 2011 it is always exactly £0 http://www.bbc.co.uk/news/uk-12928485

Yes, it can get even better of course :)

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

#74

Post by lucian1900 »

rdl wrote: post #60
lucian1900 wrote: post #49

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.

So my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage. (I also think the top US care, if you are in the right place, is better than the top NHS care, but only for cancer or very rare diseases; for everything common they're comparable, but NHS covers everyone, so the average quality of care…

I make £32k/year, which is certainly less than $70k.

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

#75

Post by gojomo »

rdl wrote: post #20
Jayschwa wrote: post #16

Earlier quoted context omitted.

One good aspect doesn't make it a boon. In my personal experience, the law has made insurance less affordable. I'm in between jobs and bought an inexpensive short-term, high-deductible plan. However, the plan has been deprecated (no renewals after a certain date) because it does not meet all provisions of the ACA.

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)?

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

#76

Post by jnorthrop »

dkhenry wrote: post #72

So great I now know that hospitals charge different fees which is still pointless since my federally mandated heath insurance will pay either one of those prices at no difference in cost to me. In reality I can get my hip replaced at any institution and pay nothing more then the $300 a month I pay for my health insurance. So in the real world the price of all those procedures _to me_ is $300 a month. This is not a fr…

You're completely missing the bigger picture. You may be paying a fixed rate for your care, but if healthcare costs continue to rise unabated then you won't be paying $300/month next year, you may be paying $500/month. In addition the mandate to get everyone into the coverage pool plays a factor in helping keep your costs low.

If hospitals can charge rates set seemingly at random, and the "customer" has little or no opportunity to understand what the cost of their choices are, or even make a choice of where to go, then the system will likely continue to spiral out of control. And it is out of control.

My company, with 50 employees, will paying in excess of $500k for healthcare benefits this year. That doesn't even include the contribution required from the employees. That cost has risen ~12% every year. You are deluded if you see recent attempts to control these costs as only introducing new problems. Something has to be done.

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

#77

Post by humanrebar »

rdl wrote: 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 be taxed as income or 2) individual healthcare purchases must be tax-free.

1) is an obvious political non-starter. 2) is a huge new loophole in the tax code and an accounting nightmare.

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

#78

Post by humanrebar »

epistasis wrote: post #9

This is why the ACA is such a boon for people that thonk health care should be a free market. It takes the free market ideals and embraces them; the accusations of socialism are more telling of the accuser than the accused. That's not to say that I think health care should be a free market, just that its the goal of the ACA, and the current situation in the US is much less free a market, and due to employer provided…

The sickest among us are by far the most expensive to provide healthcare to: the dying, the elderly, the disabled, the chronically ill. The ACA does a lot to limit costs for those age groups through mandating coverage for pre-existing conditions, introducing caps on premiums, and removing dollar limits on how much coverage an individual is entitled to (both annually and over a lifetime).

You can argue that those are beneficial steps, but they certainly distort the economics of making healthcare decisions.

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

#79

Post by dkhenry »

jnorthrop wrote: post #76
dkhenry wrote: post #72

So great I now know that hospitals charge different fees which is still pointless since my federally mandated heath insurance will pay either one of those prices at no difference in cost to me. In reality I can get my hip replaced at any institution and pay nothing more then the $300 a month I pay for my health insurance. So in the real world the price of all those procedures _to me_ is $300 a month. This is not a fr…

You're completely missing the bigger picture. You may be paying a fixed rate for your care, but if healthcare costs continue to rise unabated then you won't be paying $300/month next year, you may be paying $500/month. In addition the mandate to get everyone into the coverage pool plays a factor in helping keep your costs low. If hospitals can charge rates set seemingly at random, and the "customer" has little or no…

No your deluded if you think people will shop around for something that has no direct influence on their finances. Your absolutely correct that ideally everyone would do the "right thing" and make the financially prudent decision that benefits society and shop around for a good price on a procedure. However no one will do that. Most people don't care because like I said it doesn't influence me and even if I did the "right thing" I am bound by both my fellow employees ( via our small pool ) and US tax law ( by medicare and insurance subsidies ) to split the cost of _everyone's_ actions so unless a majority of society gets on board my actions matter little.

In effect I will continue to go to the nice hospital for elective surgery because its nice there, ya so what they charge someone else 300% more for the same stuff, the food is better and I get free TV in my room.

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

#80

Post by DanBC »

humanrebar wrote: post #78
epistasis wrote: post #9

This is why the ACA is such a boon for people that thonk health care should be a free market. It takes the free market ideals and embraces them; the accusations of socialism are more telling of the accuser than the accused. That's not to say that I think health care should be a free market, just that its the goal of the ACA, and the current situation in the US is much less free a market, and due to employer provided…

The sickest among us are by far the most expensive to provide healthcare to: the dying, the elderly, the disabled, the chronically ill. The ACA does a lot to limit costs for those age groups through mandating coverage for pre-existing conditions, introducing caps on premiums, and removing dollar limits on how much coverage an individual is entitled to (both annually and over a lifetime). You can argue that those are…

The other distortion is that there's not much in the way of preventative health care.

Diabetes is expensive and has a bunch of complications, yet obesity and excess sugar consumption is a serious problem that doesn't get much help.

Some mental health problems respond much better to early intervention. Leaving them means the person drifts along, not thriving, sometimes leaving work or staying at minimum wage. (Or, in England, on disability benefits). Getting treatment early (which can be as little as 14 sessions of 1 hour per week of talking therapy) can effectively cure some people, and provides remission and resilience for others. But, again, this kind of stuff isn't as widespread as it needs to be.

Note this isn't any kind of human rights argument for better healthcare. It's firmly financial benefit.

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