Or we could use the method basically every nation on the planet uses: the government negotiates the price.
A “market-based solution” only works when both sides have power. If you charge me $4k for a Playstation, I wont get one. Market forces say you’re asking too much and I vote with my wallet to just not get one. If you’re charging me $400k to NOT DIE, then I’m paying $400k, going bankrupt trying to, or dying. I have no leverage because I’m, again, literally dead if I don’t buy your “service”.
Edit: Also consider from your example.
Let’s say you shatter your fucking femur. I hope you’ve got $6,375 sitting around or… well you’ll probably die. You sure as shit wont ever move again. Good luck getting together that cash from wherever you’re writhing in agony. Most people could never afford that and since they don’t take insurance and you pay up front or gtfo, they’d be 100% fucked.
Or your jaw gets broken real bad. Car accident, maybe some fucker just hits you. Hope you got $19.050 sitting around or… well good luck getting around with a fractured jaw.
I mean if you’re sitting on like $100k you aren’t doing anything with and wont need, it sounds like a decent enough service. Most people are sitting on negative money.
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My favorite healthcare trick is to compare veterinarian procedure prices with similar procedures on humans. Virtually nobody carries pet medical insurance, so the prices tend to reflect what people can actually pay versus “magical money somehow showers from the sky”.
Just out of curiosity, what does an x-ray cost in the US? I just had a chest xray at my doctor’s and it cost me about $12. Granted, I only pay 30% thanks to national health insurance but even that only comes to less than $40.
For patients not covered by health insurance, a chest X-ray typically costs about $200-$400 or more, with an average of $370, according to NewChoiceHealth.com.
Cost depends on the provider and the number of views taken. For example, at Marietta Memorial Hospital[2] in Ohio, a chest X-ray with two views costs about $200. At Berger Health System[3] in Ohio, a one-view chest X-ray costs $203 and a two-view, $250. At Saint Elizabeth Regional Medical Center[4] in Nebraska, a chest X-ray costs $207 for a single, frontal view; $295 for two views, frontal and lateral; and $331 for special views such as lateral decubitus. And at Dartmouth-Hitchcock Medical Center[5] in New Hampshire, a chest X-ray with two views costs about $290 after the uninsured discount.
Wow, that’s crazy. My doctor was able to show me multiple angles so I guess I had the more expensive kind. So I guess the major problem with US Healthcare is that things that should cost $50 instead cost $300? I’m in Japan btw. I didn’t mention that in my previous post.
I didn’t check the price vs Medicare for the surgery, so I’ll take Magnet word that it is more than medicare reimbursements, and there is some creative advertising going on.
So let’s use your broken leg as an example (typically of course in a car accident your or the other parties auto insurance pays) but let’s say you broke your leg riding a bike.
The ACA bronze family plans typically have a deductible of around $9-10K before any benefits are paid. Then they pay 40% up to the outpocket limit of 13K. The list price on leg surgery is almost certainly more than $15,000 Which means that if you break your leg with ACA you need have $13K laying around not $6,375. Not to mention you also have to pay $1,020/month (LA price for a 55 year old couple) fpr this affordable insurance… Silver plans have 7K deductible but cost $1300/month
Which makes your total health care expenditures $25,000 for ACA plan. Even for the case of 19K broken jaw. You are marginally better of skipping the insurance.
So please explain why ACA insurance is better than this?
Oh I know government run health care is the magic bullet.
The US government runs one of the largest single payer systems covering 44 million persons, medicare.
Kaiser Health foundation has the 2009 medicare cost per person of $10,365 add another $2500 to cover it inflation over the last 6 year and we are looking at just under $13K/person
The US government also runs a large single payer single provider system that covers 8 million veterans. Now finding pricing information about the VA system is notoriously hard (hence the on going scandals.) But the best I could find is big range of cost depending on which center. From $7K in Texas to $30K in San Francisco with the best guess of $10K/year (many maybe vets use a combination of VA and private or medicare insurance).
So while it maybe true that a generic government can do a better job lowering healthcare cost. I see no evidence, that the US government can.
I look forward to some good links showing me why I’m wrong.
Well the first step would be voting out every politician who’s too busy sucking healthcare industry cock to notice their constituents are dying. Sure, that would include every Republican at every level of government, but we’d also get to toss Democratic presidential hopeful Cory Booker, so that’s fun!
There’s nothing surprising about it. It’s because Medicare is forbidden to negotiate prescription medicines prices in bulk by law. Since Pharma is the biggest factor in healthcare cost increase (even in more efficient single payer systems), this law that forbids more strict regulation is probably the main cause the US can’t get their prices lower.
You also have the constant lobbying in those cases where price negotiation is allowed (but this is not unique to the US -we have our fair share of it in the EU, for example-, while the inability to regulate prescription drug costs is indeed unique among developed world government ran healthcare systems).
No, because if you have insurance then the list price is irrelevant. For a tibial plateau fracture, the surgeon will get paid around $1000 and the hospital will get paid around $7000 if there are no complications. Add another $100-$200 for the inevitable x-ray or three, take 40% of that, and you’ll still end up paying less than $4000.
It doesn’t matter what the “list price” is, even if it’s one hundred billion dollars the hospital will have to eat the difference.
The ACA wasn’t designed to control costs, for the most part. It was designed to get people who didn’t have insurance, insurance.
It has some cost saving measures,but minimal large ones, mostly because those were off the table.
If the US wants to bring health care costs under control, it will require government action AND it will impact the health care industry’s bottom line. Thus far, the health care lobbyists have always won.
A couple years back I needed an ankle x-ray, but not badly enough that I needed it right away. I called 3 hospitals – 2 of them were unable or unwilling to quote me a price, and the third I ended up having to call multiple numbers because no one knew who I should talk to. Eventually got the right number but they had ridiculously short hours every day (something like 9-12, 1-4) and long hold times. When I finally got through they told me it was going to cost ~$1,000 out of pocket.
I went to an urgent care center with no appointment, waited about 20 minutes and paid $75. Fun aside - my doctor lost the disc I had to bring in (because for whatever reason they couldn’t get the info directly from urgent care) and decided to tell me everything was fine. There’s still plenty of days where it hurts when I put pressure on it but I don’t have the time to line everything up and deal with the run around.
The charges may be the same. But the charges are irrelevant. Medicare/insurance pays a predetermined amount and lets the hospital bill the patient a predetermined amount. Any charges beyond that amount must be written off (except for self-pay patients, who are the only ones actually responsible for whatever hospitals charge).
Insurance providers do not generally pay the chargemaster rate, they pay a prenegotiated rate with the health care provider network. The rest is written off by the provider. And in practice, the anchor price during those negotiations is set by the Medicare reimbursement rate, not the chargemaster rate.
I’m sure there are some exceptions, like superplatinum insurance policies that pay close to chargemaster rates in order to ensure a high-end cosmetic surgeon is available to the rich clients. But in Strollen’s example, we are talking about a routine visit to the ER for a broken leg. It’s quite unlikely the hospital will recover anything near what they charge, and therefore it’s misleading to start a discussion of patient costs from that amount.
