[bufferoverflow]

Another high cost of healthcare source is the lack of competition on price. You have zero idea how much each procedure costs. Imagine going to a supermarket where there are no price tags, and you must buy the items once you pick them off the shelf. It's madness.

[cure]

It's worse.

If you have insurance, the price tag will be X, and they will pay for some part (most?) of it.

If you don't have insurance, the price tag can easily be 100X and it's your responsibility.

If you have insurance, but you happened to pick up that can of pepsi from the left aisle (out of network) instead of the right aisle (in network), they won't cover it, and you're stuck with the 100X price. You won't know that before you buy the can of pepsi, of course.

If you try to ask your insurance if they cover the specific can of pepsi from the left aisle, they may or may not tell you. They may or may not give you the right answer, and if they tell you it's covered but then refuse to cover it, it's your problem (and again, the price will be 100X).

[zaroth]

It should be illegal to charge two different people two different prices for the same procedure at the same facility.

The whole model of negotiated rates, rebates, etc. needs to go.

I also think the concept of networks is bizarre on the face of it. A certified medical provider should be covered to perform procedures in their area of expertise. Period.

Personally I like the idea of anyone who wants to be able to buy into Medicare A & B. And if you don’t have Medicare then you can always pay the Medicare rate of the procedure at 100% (versus having Medicare where your copay is 20%).

If insurance companies can’t compete with that then great.

[davidjnelson]

I agree with you. I wonder what it would take to get rid of those discounts in terms of legislature and how individual voters could work together to fix it. The current system is ridiculous. A $17 procedure should not be billed at $1,200 "because they can".

[dmix]

So the solution is more layers of administration over the prices of the pseudo marketplace?

[zaroth]

How is that a fair representation of what I proposed?

I think part of the problem is absolutely opaque, discriminatory, and predatory pricing.

I went to get a basic blood count last month. I gave the lab my insurance card, but they must have copied a number wrong, because when I got the bill they had me down as self insured, and had a bill which said;

  Lab Services     :  $1,541.00
  Patient Adjust   : -$  385.25
  Total Due        :  $1,155.75

I called back and gave them my insurance card and they said ignore the bill a new one will come in the mail.

Last week I got the new bill:

  Lab Services     :  $   17.12
  Insurance Pay    :  $   12.12
  Total Due        :  $    5.00

Yes, I absolutely think it should be illegal to try to bilk a cash carrying customer over $1,000 for a $17 blood count test.

[hopler]

You missed the part where you chose an in-network can (hospital) that is filled with out-of-network soda (doctors).

[wsgeorge]

That's funny. I'm not familiar with the US, but are costs not disclosed at all until after they're incurred?

[jarito]

That's generally true in the states, but it is even worse. You as the patient don't see the actual price before the procedure (unless you ask). After the work is done, you then get a statement saying how much the procedure cost, what your insurance paid and what you owe. All those numbers are opaque and negotiable. Even better, it is common for insurance and the provider to continue sending you bills for months after even common procedures like child birth. It's a total mess.

[mikeash]

Even if you ask, they may not be able to tell you. Many places are just not set up to be able to give that information beforehand.

[logosmonkey]

Yeah, mostly a hospital could tell you what they will probably charge but they don't have all the variables to come up with what the actual negotiated charge will be nor what your co-pay would be.

[logosmonkey]

Oh and just wait until you get to the sleazy methodology for charging those rates. Childbirth for instance, the room will be billed to the Mother for the days before the birth. So the Mother probably meets their deductible, then as soon as the child is born the room and all the things in it get billed to the child who now has a new deductible to hit before the insurance company has to pay their full amount.

[skwb]

Costs in healthcare aren't very "real". US providers use what they call a charge master to determine prices. So while an "IV" may show up on the bill, it's not the actual IV you're purchasing when you're in the hospital. Behind that number the hospital has factored in all sorts of cost centers such as part of the nursing staff cost for example. These "costs" therefore do not represent the true actual cost of providing the service, but rather the charge that the insurance company will pay. Insurance companies have a negotiated rate that they will then pay to the hospital. One of the major "hidden" problems in our current healthcare market is that there exists extreme consumer price insensitivity (since most cases are covered by some type of insurance) alongside large consolidation of healthcare providers.