Nope not even close. Chicago, Illinois Adventyne health. A simple panel will run you $2,822.06.
Insurance will cover $2,010.04
Leaving you with a bill of $812.02
That’s actually on par with the last test I received out of another medical group.
They should have to post their prices just like any other industry. Would you agree to any other service in your life without knowing how much it cost beforehand? Plus, we trust our heathcare service providers to be honorable and take care of us. That is why they are in business? We were recently charged $635, for standard screening, out of pocket for simple bloodwork required quarterly for my husband. This was because we had not met our crazy high deductible yet, but the hospital did not discount the pricing for the insurance company by much ($100). The insurance company told us to go to a private lab next time to get better pricing but our experience was the opposite last year. For a different blood test it was $1800! We have begun refusing the testing whenever possible, and if necessary, the meds. Why this industry gets away with not having to share pricing up front and SCREENING their customers instead of the customer screening them is beyond me. Also, many doctors check your coverage and order anything they will cover, just because they can. Things are goofed up.
For profit medicine is unethical and should be illegal. What have Health insurance companies ever done for us but create a false expectation of insanely high costs to justify their own existence AND to make a ton of $$ off of patients.
MEDICARE FOR ALL.
I wish I were Canadian every time my health insurance company insists I died six months ago. I’ve been hit with over $100,000 in healthcare bills because, as it says on the bill, “patient was not alive at time of procedure.” Seriously.
I haven’t had to pay these stupid bills, but I’ve spent dozens of hours trying to explain that I’M NO DEAD YET to my insurance company, Health Partners.
It’s funny, but it’s not. Especially since I’m recovering from Stage 4 Lymphoma with Severe Sepsis. Some days I wonder if Health Partners is right.
5
I propose a health care “menu” law: every healthcare provider must publish an online price menu of all services.
I'm a medical practitioner, self-employed so v. crappy insurance ($1100/mo, $6500 deductible).
I needed an imaging test.
It has been a part time job to find out WHAT IS THE DAMN COST? Over 3 days, at least 15 people spoken to I finally got an idea, but not a promise of cost.
Oh, if you are cash pay it's $180, but since you have insurance you will be charged $950 -- yes, even tho insurance won't be involved since there is a $6500 deductible.
Oh, and there will be a separate charge for the radiologist reading. Call them to find the cost.
Medicare for All. It can't get worse for the consumer that it is now.
14
How does Maryland keep such tight reign on medical costs?
2
A few months ago I had some lab tests done for digestive issues. I was told they were all very routine tests. One of them, my insurance decided not to cover. I got billed $950. Fortunately I was able to get a letter from the doctor, and submit it to my dad's employer (I am on his health plan). The insurer decided to cover that test after all. When I got the adjusted bill, they paid $150 and my co-pay was around $20. That the hospital expected me to pay $950 out of pocket for something that only cost $170 to the insurer, is criminal. Basically if you don't have health insurance, and you aren't in the 1%, you don't have access to healthcare.
13
As an experiment before I went to Costco for an eye exam for prescription glasses, I called my healthcare provider for comparative pricing, name starting with K and ending with a variation on "permanency" a so-called HMO.
I went through 23 handovers of various experts and employees over an hour on the phone before the final person said she could not find an answer. I had to actually go in and pay for it. Once you handover a credit card the price is known. This is internally published but it seems the information is held in a version of "Ft. Knox." Maybe we should have these people secure our financial and credit card systems from being hacked...
13
I haven’t found it nearly so hard to find out the cost of prescription eyeglasses. However, given that there is a virtual monopoly in the US, the prices don’t differ much from one provider to another. Buying them overseas costs about 1/3 to 1/4 of what they cost in the US.
1
@Gary Valan Last year we were members of that same HMO. My primary care doctor pushed me into scheduling a 3D mammogram for "baseline" imaging. I let her set up the appointment. After I got home, I contact the central help desk and discovered that mammogram would cost $1,230 out of pocket. (Individual annual deductible was $2,750 on an annual premium of ~$28,000 for a family of four.) Another family member needs routine annual blood tests....the HMO insisted on running them quarterly, at a cost of $300 and up each time. They're all about the upsell, and what's stunning is that many people cite this HMO as the healthcare model to emulate.
What is really needed is a required estimate process - much as we have for mortgage lenders, and, in most states at least, car repair, electronic repair, home remodelling projects, etc.
The same logic applies - you have a situation where you depend on experts to determine what needs to be done, and determining the components of cost that go into that can be complex.
Those who argue "you can't shop for healthcare because everything is an emergency" are wrong - and simply not paying attention to not only the facts (less than 10% of healthcare is done on an emergency basis) but their own experience - where likely out of many, many healthcare needs in their lives nearly zero (for most people) have been done without prior scheduling.
The Medical Good Faith Estimate would be the answer, and there's no particular reason it can't be implemented - except that it would seriously impact the profitability of the medical industry by making it harder for them to not tell you what they're going to charge until the job is done - and that's why our legislators will never do it...
http://toddmaddison.com/healthcare/mgfe
4
Two problems:
when you need the product ( healthcare) you usually don’t have the luxury of time to shop for the cheapest provider. The cheapest provider may not be in your doctor’s hospital or healthcare system.
The underlying tension between profits and healthcare is unsolvable.
Solution???
Healthcare like in the rest of the developed world.
11
The lack of price discovery is the key to this problem.
A free market medical system, the one we had before ‘third party payers,’ is the only real solution. Cash only procedures (mentioned in the article) have gotten cheaper and the quality increasingly better. Opaque prices and subsidized procedures contribute to higher prices and thus less availability. Having my insurance company and my healthcare provider whispering behind my back about costs is not the way to provide for my healthcare. Sounds like price fixing, racketeering and collusion to me and is that supposed to be a bad thing?
In our rush to to overreach and ‘just do something’ with a lurch towards socialized/single payer medicine; I hope we can step back, be honest with ourselves, and consider this:
Access to a waiting list is not access to healthcare.
3
I pretty much assume that if any medical procedure beyond basic preventive visits is ever needed, that our deductible of 3,500 is going to be used up.
1
I just had this done and received the EOB. The lab billed $537. My insurer got me a "discount" of $474. They paid $42 and I owe around $19. Looking at the chart for my location, that's about the mid-range of the high/low negotiated rate.
It's a jungle out there and the sorry thing is, if you aren't part of the insurance game it's even worse.
9
@Ginger I just had this done two days ago as well. I shopped in advance (for a comprehensive metabolic panel, CPT code 80053), and instead of paying $165 at the provider my doctor would have had it done at, found one closer to me - with "walk-in" availability that day (instead of an appointment in 3 days), for $37.50.
The idea that medical procedures are not shoppable is clearly false in most cases.
1
The difficulty is that one cannot always walk in, and you need a doctor’s order for a blood test or x-ray.
3
@Todd Maddison If price is the only object then shopping makes sense …. but what about the quality of the lab work. Maybe a lower price is sometimes made more possible by cutting corners. Very hard to identify that....
Medicare is not mentioned in the article but some of the comments say that Medicare pays much less than $100 for the panel. It might be interesting to collect reader data for Medicare payments for this procedure. Send in your city, state, date and cost for this procedure? One of the comments to this article has the actual Medicare procedure number
2
Some years ago, I ran two different hospital-based addiction treatment programs. It was most uncommon for any would-be participant to ask the cost of treatment. They knew their insurance would cover it.
Even I did not know what we were paid per patient, which probably varied based on insurance company. I watched the macro-finances: were we making money or losing money? We were supposed to be a profit center to offset cost centers such as heart and cancer treatment.
It makes no sense.
3
This is pure insanity. To leave something as important as healthcare in the hands of for-profit entities is criminal. If a person loses a job (and insurance) and falls ill, it's game over. No other country has such a lack of compassion for its people. It's basically profits over life. What is the true value of our freedom when anyone can get sick and then become a debtor for life. We MUST eliminate private insurance and private medical facilities. A "Medicare for all" system integrated with a "VA for all" hospital/clinic system is the only way to solve this crisis.
13
@Pete What's insane is the root cause of the problem, the cost, not "who's paying for it".
Covering up the problem and hiding it - by making "someone else" pay the bill - doesn't solve it.
What we need is a required advance estimate process for medical procedures. That would go a long way toward eliminating this...
3
@Todd Maddison Having huge layers of bureaucracy devoted to price negotiations, billing, and marketing of HMOs drives up prices a lot.
1
Not knowing ahead of time what a medical procedure costs is NEWS to someone? And it VARIES WIDELY over different parts of the country? Why is this news? This has been the most basic feature of our broken healthcare system since at least the 1990s. Lack of transparency is the primary m.o. of the insurance and hospital industries.
11
In 1964 I went to work for the Technicon Instruments Corporation. Technicon was the world leader in automated blood testing and I spent twenty plus years selling blood testing systems. During my tenure at Technicon I sold blood instruments to major hospitals and private laboratories. These machines could analyze up to 60 patients per hour and each patients blood was tested for 20 parameters, ie Glucose, BUN etc.
The per patient cost to the hospitals varied from $2.00 to $5.00 and this only rose according to what inflation added to the price.
Today the blood panels you get from your health care provider does not cost them more than twenty dollars per patient....What they charge you is outrageous and if you pay seven hundred dollars you are being robbed.....it is deplorable to be paying these ridiculous amounts and because we have the government system we have now that represents corporations and does not represent American citizens .....Sad and disgusting
17
Where can we teach future healthcare leaders morality?
1
It also depends on your insurance company. We currently have United Healthcare, and my copay for a test I get regularly is $8.74. They pay promptly. We used to have Health Net and had higher copays. They had still not paid their share of blood tests more than a year after we had switched providers.
2
@Mike Carpenter The problem is really the actual cost - not which insurer pays what - and the fact that that cost is not exposed to market competition like every other product or service in our country...
3
Another factor is the payor mix for the individual hospital. Hospitals that see significantly more Medicaid and/or Medicare patients have to make up reimbursement differences with higher private negotiated rates. A Medicare for all system would simplify some things but you can also know that private insurers will more than likely sell products that fill in the gaps where Medicare coverage is lacking.
@David Hewett What i'm hearing is that Medicare and Medicaid negotiated price is fair and hospitals and labs are making money.So your talking about their need to make up for reimbursement differences is code for feeding the predatory capitalists and higher private negotiated rates you mean all they can steal and get away with.Shameful and Wrong!
To have this and other similar tests done by Quest in Tampa Florida I was asked to give pre-approval for a co-pay of $79.
The actual price of these tests for self pay is some $400.
The actual price paid by my insurer, Blue Cross-Blue Shield: $24 with ZERO co-pay from me.
I understand the concept that if you buy a lot of something you'll pay less for it. So a fleet car purchaser might pay $20,000 for a car for which a member of the public would pay $23,000.
If Quest can make money from selling these tests to Blue Cross- Blue Shield for $24 then I accept that a self-pay patient should expect to pay $30. But $400!!
21
In Canada we don't have to worry, it is free. Canadians get free healthcare, well almost free. We do pay a little higher taxes, but it is worth the cost.
19
Big picture - when you're not paying a bill out of pocket, you frankly don't care. I look at restaurant menu prices because I'm paying the bill. No one looks at healthcare because "insurance" is paying. It's a beautiful system cooked up by health care (doctors, hospitals, vendors) and the insurance industry. This is in the same vein as $1000 epinephrine shots and Pharma Bro's antics. An epi shot would cost $2 in the free market. The other $998 is because they can. We charge $20,000 for a knee operation in our clinic that we'll do for $3,000 cash. People would be amazed at the cost savings if they paid cash. This only works in the free market though - when people feel the pain and burden of the healthcare that they consume. When "insurance" is paying, you get $1000 blood tests and $1000 epi pens. You see how may epi pens you sell at $1000 when it's that pen or paying rent that month. Magically, the vendor will be selling at $2 then, and still making a profit. People are afraid of the idea of paying for their own healthcare - and that's how the insurance companies want it, as does the healthcare industry. It's frustratingly easy to solve the healthcare crisis. And just think, instead of your boss spending $12,000 a year on your insurance coverage, you get it as wages. From age 20-50 that's $360,000 in your pocket. Now that you're old, you can afford that $3,000 knee surgery on the free market. Aetna won't like it. But every middle class consumer will. Trust me.
14
@Donald Driver
If you're the retired Packer, I think you should consider writing occasional Opinion pieces in the manner of Doug Glanville!
1
@Donald Driver
Alas, that's not the way it works. If you are sick, you have two choices: pay what they charge, or refuse care. My family has a $4,000 deductible. do you think we don't care about the price of our health service? They do it because they can, and the more free market we get, the worse it would be. What we need for starters is a non-for-profit system, regardless of whether it is single payer or any other system.
9
@MR
It is how it works. I work in healthcare. I understand deductibles. Let's fast-forward past your deductible then. Now there is no reason to stop using healthcare, as it became less onerous. For a family, I'm sure you can hit that number and then you can consume without regard to cost.
Here is an easy concept - in real world healthcare, you can have two of the following three: cost, access, and quality. I'm gathering you want access for all and high quality like Bernie does. Then the cost will be insurmountable. I want the best surgeon to give me the best treatment when I want. Taxes will go up, but more likely - national debt will go up. No one cares about that - dems or republicans.
Or to contain costs, access might go down. Maybe certain operations will be eliminated. Certain meds will be taken off the formulary. But you and Bernie and AOC need to think about that. And if you turn the screws and pay doctors $10 an hour to contain costs, the quality of medicine will suffer. Top students will go into finance where the real money is.
It’s not health care, it’s a casino!
11
What is missing from the article is a more detailed discussion of why the Baltimore and Portland lab tests are so much lower. And why neither city is mentioned in the C-section delivery statistics. My guess is that there is a level of state regulation which is not present in other states. Given the debate over Medicare for All, this type of information would have been very useful.
Norman Levy
11
@norman.levy - My guess is that Baltimore has a large Medicaid population and the negotiated rates reflect that.
2
I was looking for stats in Hawaii. There is nothing. Honolulu is a metropolitan area. We are more than 2,000 miles from the mainland. We cannot drive to another state. Comps would help.
7
"For years, Jeanne Pinder, who runs the consumer-oriented website Clear Health Costs, has been collecting the cash prices for medical procedures around the country. She said the only health care services with predictable pricing were the cash-only treatments that insurance doesn’t cover, like Lasik eye surgery, Botox and tooth whitening."
These are services where there is still a real marketplace in which the consumer interacts directly with the provider in a competitive marketplace. Continual tinkering with the current system in which large monopolistic 3rd parties control the health care dollar is not a solution. Neither are any of the currently popular policy initiatives promoted by either political party. A system in which 20-40% of every healthcare dollar is diverted to non-clinical ends cannot successfully survive. Regulatory "bending" of the cost curve to a percentage that is merely 3-4X GDP growth as opposed to 7 or 8X, doesn't solve the problem, but merely postpones the ultimate reckoning with bankruptcy.
One possible solution is for patients to pay for healthcare out of pocket with a national backup plan that insures every American against financial ruin in the case of a medical disaster. The backup plan could be progressive in the sense that a "deductible" could be determined based on income with that deductible being close to if not zero for the truly impoverished.
Result = marketplace similar to Lasik/Botox with assurance that all can access healthcare.
6
@Mike Z
The elephant in the middle of the room in your reasoning, is that nobody needs Lasik or Botox to stay alive and be functional. you can shop around and decide whether to do it or not (if you have enough money, what percentage of the population is completely priced out of that market anyway?). You cannot shop around if you have an accident or your baby has a fever, or wait it out until the prices go down if you have cancer.
5
It's too easy to 'game' the system. I paid a $30 copay to see a specialist, and then got a second bill for $78 as my share of the 'facility' fee -- right, the little exam room where the doctor saw me for 20 minutes (that's what they said when I called the billing department, and I confirmed it with Carefirst).
BCBS Carefirst didn't pay a dime of that (much larger) facility fee, yet allowed them to pass on $78 of that (unknown) fee to me! For many people, having the cost of a specialist visit jump unexpectedly from $30 to $108 (or more!) would be a financial blow.
Why would BCBS Carefirst allow such a clearly bogus charge, when other in-network specialists presumably are paying for their own 'facilities' when they see patients? Makes no logical sense, and it violates the BCBS coverage agreement that it will cost $30 to see an in-network specialist, plus the cost of any tests. But who has the power to intervene?
18
@Kim Gandy I am a retired physician in private practice. It never occurred to me to charge a separate fee for the use of my office. After I retired , a few years ago, hospitals started to buy private practices and hired the physician who sold them their practice. This made possible to charge two fees for the visit, essentially doubling the fee in one stroke. What is amazing is that the insurance companies and Medicare simply paid the new fees.
6
Yes check yourself into a hospital and you’ll get a separate bill from everyone down to the janitor who mops the hall. Here’s an idea: they could lease furniture rather than buy it and just have the furniture company bill the patient.
1
Thank you! We need a lot more reporting, constantly, on this kind of information so people can react to it, and so big pharma and other players in the scam that is healthcare in the US nowadays can't get away with it just with a few million $ in campaign contributions. We are paying with our lives!
7
Inflation, real numbers, always hidden in last 20 years. All presidents complicit during this time period.
1
This also applies to the ambulance industry. I understand an emergency is in the eye of the beholder but when it is clear your event is not an emergency and you still want a ride in an ambulance to the ER you have no idea what is will cost because I (the paramedic) do not know either. More importantly it never occurs to you to ask that question. You think your insurance will cover it. Guess what? It rarely does. Just as this article says it is negotiated between the ambulance provider and the insurance company. Then when reimbursements aren't enough the ambulance company raises their fees hoping the insurance company will pay a wee bit more. If not they'll go after you and your credit rating. A bill is a bill. It's a cat and mouse game. Who provides a service and doesn't give you an estimate first? *Then* you agree to the procedure (fixing my toilet or taking me to the hospital in an ambulance or maybe even Uber? I suggested posting base rates *inside* the ambulance where patients could see them. Quel horreur! I was told-that will discourage people from going with us to the hospital via ambulance. Duh! 90% don't need an ambulance! It's a racket and it's got to stop. I know. I've been part of it for 30 years. You'll arrive at the hospital in the same shape whether you take an ambulance or Uber in most cases and you are not seen faster just because you arrived by ambulance. THAT is a myth. It's called "triage" for a reason.
9
@Bill D. I suspect many ambulance co's also have cut deals with hospitals, just last week a family member fell and hit their head and injured ribs. The ambulance crew tried to insist on the hospital of THEIR choice, where none of us will go, none of the patients doctors practice from--- eventually by **threat** of saying we would drive on our own did we get to a different one, the exact same.distance away, but **owned** by a different system. The same volunteer corp charges well over a $1000 for a 45 minute transport, and many insurers refuse to pay.
5
I live in southern California and have many relatives who are in the Bay area. Sutter Health, a private hospital network dominates healthcare in the Bay area and is many times more expensive. Employers have found themselves hostage to plans that include Sutter Health and the results are clear. The two charts in the article shows the dramatic cost differences between Los Angeles and San Francisco.
6
The lack of price transparency is PRECISELY the reason that HDHPs will not work. I am so tired of hearing the old saw from economists that HDHPs mean patients "have skin in the game" so they will be more price sensitive. I can find out the price of a car, a home, heck, a boat, in advance and make cost-conscious decisions. Trying to find out what I will be charged for a medical procedure in advance is an exercise in frustration.
And then you have to ask yourself, when you get the explanation of benefits, how the diagnostic center or lab could possibly stay in business if they accept 10 cents on the dollar of their inflated "prices"? The problem is not health care costs or health care spending, it's PRICES. Only the folks who can't afford health insurance pay "sticker" price: in other words, those who can least afford Cadillac prices are the ones who pay them.
17
It sucks getting old. In the last 10 years I've had a triple bypass, bowel surgery, and treatments for prostate cancer and bladder cancer.
What doesn't suck is living in British Columbia where health care just recently switched to 100% taxpayer funding for residents who qualify and you don't have to worry about paying the bills.
Previously there was an annual fee based on income. Eliminating that reduces administration costs.
Of course if you don't wish to sign up, which cost nothing, you can always pay full price. The sign on the emergency room entrance says that if you are not covered there is an $800+ charge per visit for starters.
13
This anomaly in blood testing has existed for decades, tolerated (abetted?) by both political parties in Congress and the White House. The government should set the prices, and the prices should be available easily to patients. This will happen only when a President has e big enough mandate to take on the medical-government complex.
6
This is why we need to make sure that Elizabeth Holmes is able to continue her ground breaking work . . . from prison, for many years to come.
4
First of all, the CMP (AMA created panel, purchased by the Federal government annually) is comprised of 14 tests. The material cost for reagents is <$1.00. The cost to have an analyzer that runs those tests is about $150,000 (one time or leased over years; but that analyzer runs 80 other tests, some that are significantly more money).
Second, the CMP was always included as part of a physical until the ACA (Obamacare) was instituted. Because HHS (health and human services) did not call that out as preventative testing in their implementation of the ACA, it is no longer included.
Third, labs and healthcare organizations price this panel based on covering all of their costs; not even related to lab testing. It's like the $100 aspirin on your hospital stay receipt. It didn't cost $100, but the hospital is balancing costs across departments, etc. This actually started when the Government expanded Medicare and created Medicaid as they pay very little to the provider as a way to control their costs - and the provider makes it up elsewhere.
It's a shell game. Has been since the 60s, but much worse since the mid-90s when the government started picking winners and losers.
6
I had a routine blood panel done early in 2019. My EOB from my Medicare Advantage policy stated a billed amount of $1141, and a plan discount of the same amount. So, no out of pocket cost to me. It also said that $1141 was the amount the plan approved, whatever that means. Yes, I am glad not to pay anything. But the extreme sticker price along with the full discount are a puzzle.
1
After switching plans 8/2018 from a plan where all providers were in network, no copay, coinsurance or deductible, to a top Medicare Supplement, we had our annual blood work done. Before changing plans, cost to husband and wife was $0. After changing - SURPRISE - "not covered" told we owe $1,800.
1
There are five registered health industry lobbyists for every member of congress. Why are we surprised?
Why do our broadband services, especially the now necessary internet cost much more than in other countries?
Two problems, same answer.
This is a perfect, perhaps best example ever of the failure of the much vaunted "market place." It works well for cellular service and air travel, for the most part.
Some markets just need to be regulated. There is no logical (beyond influence) argument otherwise.
13
Ketchup and drywall are not likely urgent necessities.
But you're seeing an oncologist and he says that a blood test is necessary and he can do it right there, are you going to go shopping around for the best price??
4
@AJ No, nor should you have to do so. Vampires everywhere.
5
@AJ And you can't even if you wanted to. Trust me, I tried to shop around for a procedure a year ago, was told the price was "secret" and would depend on the code used in the bill. Unh hunh.
5
Very good reasoning for Medicare for All, or whatever you want to call a single payer system for everyone.
We are so backwards (as well as expensive) compared to the rest of the world.
I'm not saying our medical care is less -- but the way it is organized and paid for is absolutely prehistoric!!
15
Complete pricing transparency and single-payer healthcare. Abolish stand-alone private insurance. Lab tests are not hamburgers, it costs the same to run the sample through the machine whether you're doing it 20 times a day or 400...there should be no difference what it costs to do the test, and how much the consumer is charged.
12
This is just another reason why a single buyer market would be a better solution. I am not saying it is the BEST solution, just that it would work better than what we currently have. Having to undergo a procedure without knowing beforehand how much it is going to cost is just plain crazy. How would you like buying a house without first knowing how much your monthly mortgage payments will cost?
12
It would also be challenging for me as a consumer to understand what a much lower price means. When I buy ketchup, I know that if I buy the really cheap stuff it may be more watery.
Even though I am not someone who always assumes that paying more means better quality, there is, in retail, a reality, e.g., clothes bought at Target may have shallower seams and less fine fabric than something bought at Macy's. How, then, do I know in healthcare that the blood test costing $57 will be just as good as the one costing $257 (the range given for Chicago in the chart)?
As someone with a medical background, I might decide to trust that a metabolic panel is a metabolic panel no matter the price. Others, though, may not have that confidence. No one wants to go with what's cheapest if the outcome could have long term or even life or death consequences.
2
@Anne-Marie Hislop Here, you are addressing another issue. I believe there are supposed to be minimum standards that all labs in the US should satisfy. In that regard, the quality of a blood test should not vary significantly from one lab to another. This would not be the case with other procedures, a surgery, for instance, where the mastery of the professional performing it can vary considerably.
1
@RoseMarieDC
Yes, the quality should not and may not vary much. That said, many consumers would still have a hard time picking a cheaper test fearing that cheaper equates to less "good" (accurate, complete, whatever).
With this logic, healthcare, quality of life, and life expectancy should be better in the US than Canada or New Zealand, the reality is quite the opposite. The difference really is the intent of healthcare (as a human right vs a for-profit) and the number of middle men which include not only the insurance companies but the hospital administrators too!
The expenditure on medical staff versus administrative staff has disproportionately exploded on the administrative overhead side, where the medical and patient care side have only modestly grown over the past 30 years.
3
The 'free market' is mostly a lie anyway. Not that a centrally 'planned economy' is any better. What is needed is transparency.
3
Metabolic test panels have been automated for decades. There is no technological reason why pricing should be above $50. As many of the graphs show, $15 - $50 is a reasonable range. Having spent decades working in healthcare, I can just about guarantee that the multi-hundred dollar prices came from hospitals. How does this happen? Because the Medicare cost reporting system allows hospitals to load overhead onto billable items such as tests in a way that only government allows (think the $600 toilet seat on the USAF plane); and then the hospital uses variations of the formula to further mark up private insurance bills. All this is completely legal. Only for hospitals. In a previous job I worked with a physician group to obtain an MRI machine. The Medicare rate was $350 to $750 per scan, depending on the part of the body in question and we were planning to charge an average of $700 to private insurers and full fee patients. The local hospital and the imaging center it controlled charged $2,000 to $3,000 for the identical services. It is the same for surgical centers, birthing centers, and privately owned labs and imaging centers. We are profitable every day at moderate charge levels. For all outpatient services, stay away from anything owned by a hospital. You will save a lot of money.
8
@Paul One of the country's largest insurers will reimburses a hospital 5x the Medicare rate while reimbursing independent clinical labs 40 % of Medicare reimbursement.
go figure
1
@Paul,
If Medicare pays between $350 and $750 depending on the part of the body being scanned, than an average charge of $700 sounds like a hefty markup as well. $700 is quite a lot of money to somebody who is paying out of pocket (especially if it is because they are uninsured or underinsured).
I would be interested in hearing why scans cost more depending on the body part - are some body parts more complicated to scan than others?
It certainly makes sense that hospitals would charge more for a service that they deliver to patients, 24/7, sometimes in situations where the analysis is time critical. Being able to do a scan in an ER right away requires a certain amount of overcapacity, which contributes to elevated costs. If hospitals are charging more for outpatient scans than private offices, is it because they are compensating for the cost of services provided in other areas of the hospital?
In other countries MRI scans cost far less than they do here.
We need comprehensive reform in how we fund our healthcare system. I believe that in every other country with universal healthcare, those prices are regulated. I think the variations in price depending on who is paying make even less sense than the variations depending on who is getting paid and are part of the reason prices are so opaque.
1
I remember Stanford University Hospital charging over $10,000 for a MRI of my acoustic nerve around 20 years ago. It was not an emergency situation. Later I got some MRIs for free while helping my roommate (a PhD in biomedical engineering) with his research.
I’ve basically given up on good, affordable health care here, even though I am insured (on a high deductible plan) by a fancy pants private university. It’s too hard to get prices, the waits are still awful. I have paid through the nose for specialist visits “casually” recommended to me by other doctors, visits that turned out to be unnecessary. When I broke my foot in Costa Rica last year I was delighted to have all the imaging and visits come to $120. The clinic is run by a Cuban doctor whom my mom (who lives there) sees. I will be doing my routine bloodwork and checkups there now when I visit.
This is simply insane. How is transparency in pricing not something EVERYBODY in Congress can’t agree on? At least get this aspect of health care fixed.
Imagine if you went to the Toyota dealer to buy a Camry and the salesman told you, “commit to the purchase. Two weeks after you pick up the vehicle we’ll send you a bill and let you know how much it will cost.”
23
Insurers have to prove their value by negotiating discounts on inflated prices given by hospitals. A hospital charging an exorbitant amount knows that they're only going to be reimbursed a percentage of that, which allows the insurance company to pat themselves on the back. This isn't free market healthcare. This is an oligarchy or even worse, a cartel.
I'm surprised that there is no mention of actual free market solutions. Direct primary care or direct pay care is popping up all over the country. Doctors and specialist from primary care to surgeons are posting cash rates. When patients do business directly with a physician (cutting out middlemen), prices and costs decrease for care, meds, and labs. You can also access your physician. As a bonus, these doctors price according to local markets. A practice in a rural area might only charge $25/month. Market forces can correct this. We just need government to get out of the way.
5
@Christopher Habig Market forces can not correct the huge and inevitable ignorance of the consumer in the health care marketplace. Most of us don't know what, or how good, the service or product we're buying in health care really is. And with 40% of the public unable to come up with $400 cash, their bargaining power for many serious health care purchases is greatly diminished. "Government" should be understood as, "us together," not as a foreign, adverse, entity. That it often doesn't function that way is a separate issue.
4
@elshifman I do appreciate your definition of government, but fear it ceased to be that long ago. Higher utilization of a primary care physician can significantly decrease the downstream, more expensive care. Unfortunately CMS has handcuffed funding for residency positions. We have a doctor "shortage" due to government program intervention. It's worthy of a head shake and heavy sigh.
This doesn't actually make any sense. The Medicare price for the lab test 80053 is about $20, and a national Medicare survey in 2016 showed the national median price was in the same basic range. It does make sense the median price in some cities is, say, $17 or $25, but it doesn't make any sense at all that the median price (typical price) in Miami is $200, unless it's an unweighted median, which would be a dumb way to show the data. The data is so far off with a median of $200 it isn't credible. Labs can't possibly be getting a median price of $200 for a $15 test in Miami. It's like saying the average high school student in Miami is 28 feet tall.
2
@Bruce Quinn Why do you think labs would not charge more if they can? More rich people who don't care what the cost is. People who want the best and are willing to pay for it. That being said, could just be bad data. Don't know but all anomalies are not a mistake.
There is a proprietary database published by Igenix that all medical billers use. According to one source I just found in a search, there are almost 900 million entries for procedures that are listed by locality and price. Every insurer, and probably every hospital, knows and has access to this database and knows everyone's specific prices. If you dispute a charge, this is also where a reduced charge, "usual and customary" is found.
I am not sure how this connects to the broader problem of pricing, but Igenix is the automaton that produces a number, and, save for the cost of accessing the database, it seems that all costs could be revealed at the push of a button.
7
On top of this pricing mystery lies the ridiculous bureaucracy of the process. A physician requested a blood panel for our son, and we set up an appointment with a major, nationwide diagnostic company. Arriving early for the appointment, we still had to walk down to the specific room to remind the staff that we were there and checked in. Then, it still took nearly an hour for the technician to transcribe—keystroke by keystroke—the basic information into their system, and finally perform the test.
It is inexcusable that we do not have the technology in place for our blood panel request to already be in their system. The QR code I was provided with for the appointment should have instantaneously brought it up so that we could get to the procedure.
3
@Andre Hoogeveen, For many years now, I go online to Directlabs.com on my own to have blood work...which is then done through a Quest or Labcor location at a fraction of hospital/Drs costs and I have the results, in hand or digitally sent to providers. I have German relative, who is a doctor and he was shocked to think such a thing was possible.
3
@Jonathan
Many thanks. It's empowering every time we can positively bypass PCP gatekeepers and proactively take the initiative in monitoring and taking care of our own health.
Because of this nonsense countless individuals are filing for bankruptcy every year. Price transparency is the only way market mechanisms work. Because we have never been able to structure the system so market forces work, single payer healthcare is where we need to go.
7
@Nancy Anyone covered by a qualifying health plan has annual and lifetime maximum out of pocket protections thanks to Obamacare. Particularly if you stay in network there are significant financial protections in place. Choosing to be uninsured removes those protections and is an extremely poor choice.
@beth
My experience as a self employed person, decades of private insurance. The insurers use their very own creative math to decide what will apply to the deductible and therefore max out of pocket. Fully insured one year I had 16K in medical bills even with a 10K Max OP. Plus of course the 8K in premiums to Blue Shield. President Obama helped by making my insurer actually pay for some preventive care although the rates went up. But it did not fix our broken insurance market which in my opinion is simply legalized racketeering. Insurance companies add a profit margin of 20-30% to virtually all medical care in our country, a simple fact for which there is not an alternative..
8
@Alan There are separate in-network and out-of-network deductibles. Your example of $10k MOOP is probably the in-network limit.
I don’t disagree that costs are out of control, but people simply do not understand how their benefits work as they exist now.
Great article. You can get a lot of national lab price data variation for free on the Medicare website, but it's nationwide price data, not arranged by state. http://www.discoveriesinhealthpolicy.com/2019/05/nyt-highlights-crazy-range-of-payer.html
Nice to see South Florida living up to its reputation as the epicenter of health care fraud.
8
My advise is stop wasting time "pondering" over these type of articles. You will be no less helpless after finishing reading as you were before. Use your time more efficiently and effectively. Vote for Bernie Sanders - and such articles will become redundant.
5
@Daulat Rao But what happens if hospital or physicians refuse to accept Medicare? What about the 20% Medicare doesn't cover? Will hospitals or physicians groups be able to sustain themselves in their current form on when only receiving reimbursement set a CMS fee schedule?
Simply implementing a "Medicare for All" system without addressing the underlying problems of cost and delivery of service, some of which are addressed in the article, will not solve our healthcare dilemma.
Claiming a vote for Bernie Sanders will cause these types of issues to become redundant is sophomoric.
2
@Joe P.
Physicians and Doctors will not "refuse" to accept medicare, because they will get paid, just as they are being paid today.
The 20% that is not covered today will become a "non-issue because the new medicate will cover 100%.
There is no reason why hospitals and physicians will not be able to "sustain" themselves - because that word will no longer be equated to "obscene profiteering".
The argument that underlying cost and delivery issues will not be addressed under medicare for all is a fake to it's core.
@Joe P. Will hospitals or physicians groups be able to sustain themselves in their current form on when only receiving reimbursement set a CMS fee schedule?
No, they will not. In a single payer system, everyone is the same and care for some gets better and for some gets worse. People who fear getting worse care are against this. Doctors and hospitals are against this.
We as patients have the right to know the real price of our medical care (tests, images, visits, etc) prior to receiving care. Revealing these secret prices would reduce the incredible variance in pricing, create a competitive market, and allow us to shop for the best price instead of write a blank check.
HHS is seeking comment on two proposed rules (below) which include price transparency in healthcare. I encourage you all who are outraged at these hidden prices to submit a comment and tell HHS that we need to see the real prices before we receive care!
Here are the docket numbers to submit a comment on the Federal Register:
CMS (Medicare/Medicaid) Interoperability and Patient Access proposed rule:
CMS-2019-0039
ONC (Health IT) Interoperability and Information Blocking proposed rule:
HHS-ONC-2019-0002
8
@Linda B You're generally right, and transparency is a great objective, but if we really want the light-of-day on health care costs and prices, we need to mandate publication of hospital annual medicare cost reports and utilization figures.
Ketchup? Hamburgers? Let the market charge whatever it wants. Your health, your life, doesn't rely on whether you get your ketchup or your hamburger. But your health? Your life? These may very well depend on a blood test, a C-section, or any other medical procedure.
So what are the health insurance and the medical services industries doing in the capitalist system? It's a travesty. It's a immoral scam foisted on American Janes and Joes.
6
Seriously, you are saying that thousands of working families are pushed into poverty each year because of the cost of treating an illness.
It is incomprehensible that the most powerful nation the world has ever known doesn’t have the ability to flood the pharmacy’s from the poor parts of New Orleans or any other state with cheap generic medicines.
1
How can we avoid being pawns in this game?
3
Healthcare pricing to me (a nurse) is like going to a car dealership, buying a car and only AFTER you get home with it do you find out the price.
3
A missing topic in this article is the effect of hospital consolidation and monopoly pricing powers driving up prices. I’m surprised the Carnegie Mellon researcher didn’t mention it since it’s a hot topic in Pittsburgh and across PA right now.
The University of Pittsburg medical behemoth hospital system (UPMC) is marching across the state buying up every community hospital and medical practice it can find and requiring that they take UPMC insurance and deny or deem Blue Cross Blue Shield out of network thereby eliminating their negotiating power. After the acquisition is complete and the town is served by primarily UPMC prices across the board increase.
The state attorney general has been forced to take UPMC to court over this clearly monopolistic practice.
Think about that for a minute. The PA AG is spending tax payer dollars to sue a supposedly non profit (non tax paying) hospital system affiliated with a public (state supported) university/ medical school. And he is “winning” but at what cost to the patients of PA?
I’m now paying among the highest costs in the country for routine medical care and as a tax payer I’m paying the state’s legal team to fight the biggest health care system in the state UPMC (which by the way has an in house legal department larger than most law firms in the state).
This is the definition of crazy.
20
@JAS, include in your report the fact that as UPMC takes control, county by county, they are able to suppress labor costs (mostly nursing) and blackball employees who have little option but to either work for UPMC or leave the state. This is happening all over the country.
2
A market cannot function when pricing is opaque or withheld from the patient even when requested
It cannot also function when the supplier (medical providers) knows more about the product s/he is selling than the consumer (patient); check pricing of items on medical bills that can be bought online for a nasty shock. Price markups can be as high as 3,200%; a $32 dollar painkiller shot that would cost as much as $1 on goods) or a $1,192 angled resectoscope could be bought for $200 (box of five angled resectoscopes)
Finally, a market cannot function when the consumer is in an emergency and there is no way to "go shopping" for suppliers, as the research on the $180,000 appendicitis done in 2012 BEFORE Obamacare) shows
The myth of a free market for healthcare is a very profitable reality for some and a very painful and expensive one for the rest.
8
Medicare recently paid $6,000 for stitches (actually that new "zip-tie" substitute for stitches) in a 9" gash in my lower leg. The episode involved just two 15 minute visits. I deliberately went to an urgent care facility operated by the local hospital in western Florida, thinking that such would be less expensive than an ER. Meanwhile, this tax-supported, "non-profit" county hospital sits on $1,000,000,000 in cash and investments (yes, billion with a "B.") Something rotten in Denmark?
7
None of this nonsense would happen in Denmark. It is a very American rottenness.
7
Having had a previous heart surgery 20 years ago, my cardiologist scheduled a Cat Scan. I had never had one before. It wasn’t necessary, but a precaution to see if anything was bad. A “good baseline” test they said.
When asked if it was covered by my insurance she dodged the question and said I should refer to my insurer but it should be covered. When I asking my insurer, they couldn’t give me a straight answer either.
Only until after the procedure did a bill come for $650! For a test that wasn’t needed. I was assuming “it was covered” meant I’d maybe pay a $25 copay.
Now I have the money for this but what about poorer patients? How can they make decisions about these tests?
The fact that no one could give me a straight answer on what the cost was before the test was and is outrageous.
14
I am a doctor based in the UK but have worked overseas. This happens all over the world including the UK.
The blood test problem is worse than the article suggests because I have also seen the panels unbundled and the components billed individually-sometimes double billing the same tests. Patients can’t tell and insurers also often don’t know what the panel includes.
Some panels contain unnecessary tests - for example iron is added to a standard electrolyte profile so that one or more pointless additional test are ordered.
Also kickbacks are paid by labs to physicians. Where direct payments are illegal, labs pay admin fees or pay the physician as a phlebotomist - often at a significant rate.
This is seen as not harmful as once the blood is drawn it does not affect the patient if multiple samples are ordered.
But it is harmful as it wastes resource.
It’s good that the NYT has highlighted the lack of transparency- but that’s the tip of the iceberg.
9
I wonder what "Middle Class Joe" would have to say about this - if anything... Depends on how much money "Middle Class Joe" is getting from Insurance and Pharma. Recall that Biden's Democratic colleagues in the Senate, Joe Lieberman and Max Baucus helped kill Single Payer, while a few years earlier, another fraud-for-rent, Representative Billy Tauzin of Louisiana became CEO of PhRMA, a pharmaceutical company lobby group, soon after writing the legislation that prohibited the government from negotiating Medicare drug prices. Because he's steeped in this long tradition of being the servant of big business, Biden is my last choice among the front-runners.
10
Ahhh, free-market principles at work for our “best health care system in the world!” Good thing we don’t have pesky regulators messing around! (Sarcasm).
10
@H Don't forget that the very rich do get the best health care in the world in the US. That's why rich people from all over the world fly here for health care.
Vote blue, America. The Republicans have no intentions to fix this.
10
Insurance companies and medical hospitals and labs are no different from mafioso operators demanding protection money. Jail them.
7
Requiring hospitals to publish their negotiated prices isn’t enough. They should be legally required to give patients a complete price list prior to having elective procedures.
The day of my surgery for breast cancer at Chicago’s Northwestern Memorial Hospital they informed me that they were out of network for my Blue Cross Blue Shield insurance policy. Given that I needed the surgery done soon I asked the cost of it. They said it would be $5000. I agreed to pay that out of pocket. The actual cost was $27,000. I later complained to them about the wildly inaccurate cost quote I was given but being unethical slimeballs, they didn’t care. It was also to their financial advantage when they told me they accepted my insurance, followed by changing their story on the day of my surgery.
19
Why do we consider our healthcare to be better than every other first world country when we clearly spend the most and have the worst outcomes? Is it because we are so egotistical for our country that we just assume this is so, or is it intentional propaganda that we are fed?
16
The cost gouging, secrecy and profiteering is criminal.
9
I am currently in Australia and having a minor medical problem. I called two walk-in clinics. They told me exactly what the costs would be, because they know exactly what the government will reimburse. No shadows, no secrets. (And the price was quite reasonable.)
A few weeks ago, I tried to find out how much a minor lab test would cost me in Oregon, and it took multiple phone calls and several days to find out the answer was $9 to $90 and the actual number will be a surprise.
This situation is ridiculous and the US is unique.
21
We have the worst of all possible worlds with healthcare in this country. It doesn't function as a free market because the dominant player (the government) does nothing to control prices (and actually drives prices up.) At the same time, many people are left uncovered or uncared for. The middlemen, big pharma, suppliers, insurers, and device makers are all laughing their way to the bank.
9
Why is it not illegal to charge patients for amounts they never agreed to? I recently had a lab test done where both my insurer and the lab effectively refused to tell me in advance how much it would cost. I spent 5 hours calling and emailing insurance and the lab over the three weeks prior to doing the test. Insurance (Anthem) repeatedly told me they could not tell me what my out of pocket would be because it’s based on the contracted rate with the lab, and “they don’t have access to that info” (seems like a lie because Anthem is one party to the contract). The lab (Natera) re-directed me to multiple phone numbers and email addresses, all of which went into a black hole that never got answered. My doctor ordered the test anyway because medicine couldn’t wait, and Natera ran it without my consent on pricing. I know I can contest the bill when I get it, but shouldn’t this be illegal in the first place? How are there no consequences for insurers and providers who refuse to provide cost information when asked?
16
@Ellen
I have had exactly the same thought. I wonder what happens if we take the lab, clinic or hospital to small claims court for what is essentially racketeering? What about when you're in an urgent situation and they call in out-of-network doctors without your permission?
6
The price discrepancies are amazing. Even more amazing is that folks who are supposedly happy with their employer sponsored health insurance plans really have no choices. The plan provided is the plan they get. The employee has no choice. Take it or leave it. I guess it is better than having no insurance at all. But there is no consumer choice here!
2
Insurance companies are driven by pure Machiavellian principles. Divide and conquer by promoting the people’s desire to access health insurance through the employer, which paves the way for such insane variations. And then when the costs become too expensive for the employer, it deploys copays, formularies, deductibles and max benefits to offset its final responsibility, with no recourse for the employee. The only winners in this system are the corporate health care execs (including pharma) who have become the princes of this country.
4
@Susan
Did you read this article carefully? It’s vendors (hospitals, device makers, labs, physician groups, big pharma, etc, etc) who are gouging the consumers, not the insurance companies.
@EnderWiggins - The entire system is a mess (and I’ve worked for one of the insurance companies mentioned in this article for the past 3 years). I have seen an assistant surgeon (not contracted with us) bill 10 times what the primary surgeon billed (contracted, and he was actually paid about 1/2 of that charge, therefore the patient was responsible for paying 20x more for the AS); radiology facilities that bill under different names and tax ID numbers out of the same office and those three business names had drastically different contracted rates; a group of contracted surgeons who owned their own surgery center and didn’t tell patients the center wasn’t contracted; medical equipment companies who told the patient the insurance denied the claim and had them pay out of pocket when they hadn’t even sent in the claim; places that advertise as urgent care centers but bill as an emergency room. Ive seen us deny a claim when the MRI was done the day after the authorization expired; process a claim for a contracted doctor at out of network rates because the authorization was entered into the database wrong. I have been a supporter of universal healthcare for over 30 years, and my experience working in the industry has only strengthened that support.
I just got a surprise lab bill for $680 for a routine Pap smear test. No one informed me of the cost prior to the test. I only found out when I received the bill. But that is only part of the problem. The real question is WHY is lab legally able to charge this amount? Where are the consumer protections against this type of price gouging? This is a test that costs less than $10 to perform, even when accounting for overhead, technician fees and a reasonable profit. We have usury laws on place to protect consumers against excessive interest rates and other predatory behavior. The market for lab services is obviously broken and our elected officials have an obligation to protect their constituents from this type of predatory behavior. But the only sound I hear coming Congress is silence.
15
@SMS
I too became fed up with my own private GYN office overcharging for these basic tests and so I go now for my routine PAP smear procedure and GYN visits to- Planned Parenthood. They are a dream to work with and I am more than happy to give them my health care business since I know they need the support. They saved me.
7
I actually incurred this bill while I was home visiting my parents. I had just moved from Switzerland to România and I thought it would be easier to just set an appointment at my parent’s house since I hadn’t had time to get a local recommendation where I live. I will never make that mistake again. In Europe, the same doctor’s visit and all tests would have been less than $50 or $100 in Switzerland. The service would have been at least as good. I gave birth to children in Germany and Switzerland and the costs were far lower and the mortality rates for mother and child much better. The sad state of the American healthcare system and it’s capitulation to special interests is one of the reasons I don’t see my self coming back for the foreseeable future.
4
The drug company's and Medical establishment have bought and paid their Congress people. Lobbyist's keep it going. Free market Capitalism is greed in this case. Gov't run health care works and is our best option.
4
I have to say in light of the recent NYT investigations into direct to consumer telemedicine, this is the opposite end of the spectrum. Better care in theoretical terms only, and absolutely zero price transparency.
Google “Net Fee Schedule LabCorp Net Fee Schedule VADMHMRSAS Contract” to see how much this stuff costs for a typical hospital system. A CBC w/ diff is less than $3 bucks a pop at cost.
1
I recently had a surprise bill for a bone density test. I ended up paying 300 dollars. When I went to the hospital to have it done, I paid 100 up front, then was billed for 200 more. I know, as the consumer, I am supposed to be informed, but my doctor had not informed me ahead of time if my test was preventative or diagnostic. If, preventative it would have been entirely covered, if diagnostic it would cost me what it ended up costing me. Three phone calls later, after the test, and after the billing, I found all this out. This type of obfuscation is obscene! Also, why would insurance pay or not pay for the very same test but under different labeling? What a scam, indeed!
3
@Silvana
Vendors do not provide such information, or would be very vague on what they would tell u
We never got estimates for a OBGYN procedure and minor surgeries even when requested several times. Ditto for most other procedures
Don't get us started on price gouging and almost impossible to decypher medical bills that would make the Enigma machine creators laugh
The system is broken, but very profitable for some as it is
2
Just because someone presents you with a bill doesn't mean you have to pay it. Payment of the billed amount is only required if you agreed in advance to do so. Any ambiguity about whether there is an agreement is resolved against the doctor/healthcare provider. Absent an agreement, you are only obligated to pay the fair value of the services provided. It would be very very hard for a healthcare provider to successfully argue that the value of their services is $10000 when they charge someone else $100 for the same thing. More people should aggressively push back when presented with ridiculous bills.
4
@David
People who are sick may not have the capacity to fight for their rights. Of course, insurance companies know this. Corporate greed compels them to abuse, rather than serve their customers.
1
@David try going back for followup care when you don't pay the bill. The best bills to contest are after you die. Your estate can play some serious hardball then.
Without much clout or haggling, I was able to get a metabolic panel price from Quest for about $10. Many of my patients are poor and lack insurance (even now) so I charge them, well, umm, $10 too. That makes me a fool I suppose but all the more so when my chihuahua's veterinarian charges me about $300 for the same test.
One day healthcare will be disrupted but it may be a while... It may not.
3
@Mark, no, you are not a fool, but a doctor with a moral compass and empathy for your patients. How lucky they are to have you. I know this likely rings empty under the circumstances, but you have my (and many other readers') deepest admiration. I thank you.
2
News flash. Insurance companies, hospitals, pharmaceutical companies and Pharmacy Benefit Managers charge whatever they want because nobody is stopping them. They get away with it by creating complexity which obscures what they are doing. This complexity covers up the fact that they are shifting costs to the backs of sick people through high health insurance premiums, high deductibles, high co-pays, high co-insurance rates, narrow networks, denial of payment for routine procedures and medications. These immoral and unethical business practices will continue as long as the perverse incentives baked into our for profit health care system remain. These perverse incentives will go away only when we have a single payer universal health care system.
8
I just went for one of these at my local GP practise here in London, UK. Cost to me £0. Cost to NHS almost certainly under £100. The benefits of "socialized" medicine.
And the cost of such a test in the private health system in the UK is moderated by having a widely available and used "free" system.
6
In talking about the working of free markets, the focus often seems to be on price competition as ensuring good outcomes. The US healthcare system is obviously dysfunctional in this regard. But when a system where the government sets the prices is mentioned, then some people are sure to say that the quality and availability of care are sure to go down if there is no price competition. However, there are other areas for competition which are actually more relevant to good outcomes. When Taiwan expanded its government health insurance system 25 years ago to include the entire population and all licensed healthcare providers, public and private, the providers could opt out of joining the system, but they were all eager to participate. In addition, over the past 25 years there has been a great expansion in the number of healthcare facilities providing the various kinds of care covered by the insurance. And the whole system has become far more patient centered than it was in the past. The facilities compete with each other not on price but on the quality and convenience of the care they provide. In healthcare at least, this is the center of "good outcomes."
4
Without price pressure on health care suppliers, cost will continue to increase exponentially. A fully market driven economy with prices easily available for consumers to price shop could work, but seems extremely unlikely given the AMA and existing hospital/insurance interest in maintaining the status quo. Alternatively, single payer system can control costs by edict, seems like this is the only realistic way to check escalating costs.
1
@Cardinal Biggles
Free market principals do not apply in health care. If you needed a heart transplant or gall bladder surgery or breast cancer surgery would look for the cheapest hospital, the cheapest doctors?
1
The single easiest solution to the problem of the high cost of healthcare is to de-centralize it and allow for competition. Hospitals become separate entities offering practicing privileges to physicians. No more physicians owned by hospitals. No more physical therapists or rad techs owned by hospitals. Nor orthopedists, nor surgeons, etc. No more clinics in hospitals. Nor urgent cares. Private practice will return. Physicians will care about their patients because if they don't, patients won't return. Radiologists can open their own facilities and hire rad techs.ER groups can open their own urgent cares. More facilities, more jobs, more competition. Right now we are paying for BIG BUSINESS and its excesses. It's time to go back to the way it was before healthcare became an industry.
2
I recently disputed a $3000 chest x-ray bill after finding out that I could get the same service, in the same city, for as little as $60; i.e. for 1/50th of the cost. Once I reached the top management at the hospital, I was assured that this was a mistake, got many apologies and eventually the charges were entirely dropped. Before reaching the top echelons, I spoke to several clerks at the hospital's financial department who insisted that the original bill was correct (I was offered a 15% discount ....), which makes me strong doubt that this was a mistake, especially as it was a routine procedure (one clerk said he is so used to charge this sum that he doesn't even think about it). This is likely what some people end up paying unless they fight back.
To put the cost in perspective: a radiologist capable of some pretty basic diagnosis (at least in my case) could with 6-7 patients/week (!) and a procedure which takes 5-10 min, rake in $1 million per year. Talk about a system which has completely lost perspective of reality! A car mechanic is obliged to disclose the costs before he initiates any work on your car, for medical establishment this is something unheard of - unbelievable!
10
@Jan
The radiologist certainly didn't get your $3,000 or even a significant fraction of it. More likely she got something like $50, if even that much. Most of your $3,000 would have gone to the hospital or other facility.
4
@Jay and all the people and administrators he spoke to on the phone have to be paid. And their health insurance has to be paid and health insurance is expensive. A lot of mouths to feed in the bureaucracy.
What about the Kaiser plan, where the medical system and the insurance system are one in the same. Would like to hear from medical professionals and hospital officials within the Kaiser system to see if they see the excesses reported in the story, or if some of the corruption is rooted out.
4
Range of cost for a C section in the Us 7.5k to 24k. Price in the Philippines I paid at the best hospital in Cebu $650.
5
Cost of new baby first office visit in 1992 at well known San Francisco pediatrician’s office connected with California-Pacific Medical Center US$300. Same routine new baby office visit in 1996 in Neutral Bay, NSW, Australia AUD 50.
For two thirds of the country, including metro areas with two million residents, there are only two insurers participating in Obamacare. There is no way that the rates are competitive, with only two companies. The hospitals charge high rates, enhancing their profit and the insurers have no alternatives but to pay the high charges.
The Obamacare scheme was logical to academics living in mega cities. It doesn't work for the rest of us.
2
You blame this situation on Obamacare? This isn’t a problem that originated with the ACA (Obamacare). The biggest failing in the ACA, IMO, is that it didn’t address this sort of thing.
I called to schedule CT Scan at hospital and was told price was $4000. I contacted my doctor concerning seemingly high price and he sent me to an independent imaging company. Its price was $395. I don't know if market principles could be utilized to lower the cost of healthcare, but clearly the market is currently broken. We complain about predatory lending. It is time we address predatory pricing in healthcare. I suspect that the borrowers seeking a payday loan know they are likely dealing with a predator. I doubt patients are as wary of their health care providers.
9
@Turner Boone Hospitals ALWAYS cost more than a free standing facility -- i.e. lab test, radiology exams. It's not a true predatory pricing. The hospital simply has higher overhead than a little radiology facility that cranks out 50 MRI/day. It has to cover all the under-paid or non-paid exams that were done for patients who came to ER, in addition to other higher costs of keeping its doors open. The regulatory burden is also much less for those independent facilities.
1
@Turner Boone
An acquaintance's child had contracted the flu and her doctor prescribed Tamiflu. She said she was glad she had insurance, but shocked at the $100 copay. Per a quick search on the internet, later in the day, It turns out the price for the uninsured is $47. Her employer is obviously being overcharged by the insurer for drug coverage.
4
The health care provider/ your doctor who ordered the scan does not get a penny of the $4000 you pay for the CT scan. Which is as it should be. But just so you know, all that money goes to the hospital.
1
These practices will continue as long as the US Heath care remains:
1. A disease care system
2. Fee for service with doctors incentivized to prescribe more test procedures
Most other developed economies have figured it out and this country with the world’s largest econ9my can not provide decent affordable care to its citizens - sad.
8
@Swathi Many doctors may be incentivized to order more tests because they don't want to be sued by unhappy patients or the patients INSIST on a particular test. Too much hassle to educate the patient. Easier to just order it.
5
@Sadie while fear of lawsuit is real, risk is fairly low. The original comment was spot on. Physicians get paid more for ordering tests, prescribing meds, and doing procedures. They make almost nothing for counseling about lifestyle changes.
2
@Swathi
Costs will continue to escalate beyond inflation as long as big medicine is able to conceal price and quality parameters from the public.
Medicare has price controls on services. Despite the price controls, Medicare pays more for services than other countries pay. Medicare-for-all will still cost double what other countries pay. But there will be long waits to get non emergency services.
2
In light of all the comments favoring medicare for all and/or getting rid of insurance companies, one question is important. Are there price variations when medicare is paying for these things? Likely less, but how much less? There must be some regional variation at a minimum.
@Larry Figdill The variation is due to cost of living factor that is included in the reimbursement. The same test would be reimbursed at a higher rate in NY city than in rural area. That is why hospitals and doctors cannot survive on Medicare patients alone. Higher payment is necessary from commercial payers to make up for the low Medicare payments. Unfortunately, decreasing Medicare rates put downward pressure on the rates that commercial insurance plans set. This in turn forces hospitals and health groups to join forces and become bigger, wanting to have a greater leverage on the insurance company. It simply becomes an arms race and the patients get stuck with higher premium and deductible.
2
@Sadie
Medicare reimbursements are higher than what are paid in countries with socialized medicine, although lower by around 30-40% than insurance negotiated rates. Hospitals contend the rates are below the cost of care and use the argument to raise prices to cost shift.
If Medicare for all became government policy, the Medicare price list would be indistinguishable from our current private reimbursement rates. Big medicine is not going to give up their seven and eight million dollar executive salaries, and they have the money to buy Congress.
States with big political pull have always gotten bigger Medicare reimbursement rates and its not derived from higher costs.
This type of variation exists in markets where there are more than the buyer and seller involved in the transaction.
One party providing the service, one that receives the service and another that pays for the service (generally an insurance company)
Where the person receiving the service isn’t paying, they have no motivation to check the price. Upfront price transparency is a must if we’re to combat companies gouging the system.
3
This phenomenon probably results from the fact that people buy health insurance plans, not health services. The health insurance plans may negotiate differently in different markets, and may pay more for one procedure and less for another. Thus the real comparison for consumers is how much they spend on health insurance in different markets.
@Larry Figdill
There is little variability in insurance premiums if you back off the out-of-pocket expenses.
This article discusses two issues - price discrepancy and price transparency and implies that the latter will help alleviate the former. It does this in a way that spectacularly fails to address the prospect of having both transparency AND price discrepancy, which is basically what you will get if patients are the ones who are subject to negotiating lower prices.
Consider the case of a patient whose doctor orders a blood test. There is a lab in the doctor's office building down the hall where the test costs twice as much as at another lab that is 30 minutes away by car. If the patient is responsible for footing the bill, then there will be patients willing pay the extra for the convenience, the patients who will travel the extra 30 minutes away, and the patients who can't afford the test down the hall but also don't have the means to go 30 minutes away.
Despite the fact that the article gives several reasons markets in healthcare don't always serve patients best, it doesn't suggest the kind of solutions employed by every other country - gov't regulations of prices, or an all-payer solution.
We are currently seeing how market oriented solutions, such as restricting patients to narrow networks of providers are putting undue burdens on patients.
In a fully functioning market system, people will pay for convenience and speed. When it comes to healthcare, in many cases those will reflect on quality of care as well.
3
@DebbieR
If the patient is aware of the price discrepancy and is paying it out of his deductible, the convenient lab will lower its price.
My father, who passed away recently, was sent a bill by Quest Diagnostic for a blood test that the insurance didn't cover. The bill came out to approximately $700. You can imagine the anguish and frustration I felt at looking at a bill for a man who was recently deceased.
2
@James Negotiate with Quest. Call them and demand to pay less. It works in amazing ways. Be your own advocate.
1
If individuals and small businesses ever see exactly how much they are subsidizing big businesses (with better negotiating ability) and Medicare, Medicaid etc., the blood will be on the streets, not in the test panels.
4
Another well-kept secret in medicine that greatly impacts cost and needs some transparency: the giant variation in physician salaries.
Huge salaries: neurosurgery, orthopedic surgery (radiation oncology (a field with VERY few emergencies and VERY rare calls on nights and weekends), radiology.
Miniature salaries: family medicine, internal medicine, pediatrics, palliative medicine.
The gaint salaries mentioned above drive a lot of health care cost.
14
A recent renal ultrasound for me was billed to my insurance for $952. The negotiated price was $67.
A BMP, basic metabolic panel blood test was billed at $135, negotiated price was $17.
Go figure
4
Healthcare pricing is broken through and through. Many patients are being gouged and there is no recourse for them. For instance, a patient can go to a doctor who tells them there's nothing he can for for them. Patient goes for a second opinion and gets successfully treated. Patient still pays both doctors. You wouldn't pay the carpenter or the mechanic for "There's nothing I can do for you." But you get to pay the doctor. Sometimes you get to pay extra for that initial doctor when he's in a hospital; you get to pay a threshold charge - sometimes to the tune of $600 (as was my wife's case), even though they might also not help you (as was also my wife's case).
We're currently personally stuck in a healthcare system run by an insurance company. That is a different experience altogether; everything is designed much like any insurance company; they don't want to pay for anything and will even discount, out of hand, outside doctors' opinions, even the opinion of the surgeon who once partially cured my back and actually saw first-hand the damage.
I'd literally be dead 3 times over if I'd believed the first doctors. Ruptured appendix, intestinal blockage 3 months later, and another ongoing for 17 years until I could no longer eat solid food. Each time a doctor said there was nothing he could do and passed doing anything else for me.
There's a lot more broken in healthcare than blood tests, but I guess it's a start.
6
@James Devlin
You got bad diagnoses that had nothing to do with insurance or who was paying the bill. The other side of government interference is that we have no transparency to the quality of care provided. You're not the only person who went to the doctor with appendicitis and was given a muscle relaxant and sent home with a bellyache.
In a free market, there would be a Medical Consumer Reports database rating physicians and hospitals and other providers. In our universe, price, quality, even government inspections are trade secrets or governed by laws protecting privacy.
If you got food poisoning traced to a restaurant, the failed health department inspection would be public. If you died from an infection introduced at a hospital or nursing home, the state or federal government might inspect and give them failing grade for procedures, but there is no way you would be able to find out that the infection rate at hospital A is four times what it is at hospital B and therefore decide to have your knee replacement performed at hospital B.
This article is sad and I feel for the Americans that are actively trying to advocate for a better system.
My daughter recently had surgery. We have private health insurance and chose to use it so we could choose our doctor and not wait 6-8 months to go through the public system (which would have been completely free).
When I reflect on our experience it is a world away from what is faced in the US. Before I booked in her surgery I was able to call our health insurance and they gave me an itemized break down of cost; what our insurance would pay, what medicare would pay and what the out of pocket amount would be.
We choose to have private health insurance because we can afford it and use it in the hope that it lessens the strain on the public system for those that don't have the choice.
19
The company I work for, which self insures but hires out the processing and negotiating, changed from one major to another. The exact same procedure in the exact same facility using the exact same equipment had a street price on the EOB about mediflation different 1 year apart (200+-, several percent). The negotiated price was 3x different-- and once above the deductible this is paid by the company I work for. Someone in HR needs to be re-assigned as a Walmart greeter, I find it hard to believe that the company is saving any money with this new national major. I presume the new major gets a percentage of the gross for processing, giving them incentive to negotiate as poorly as possible without losing the account. In other words, the NYTimes article should also examine perverse incentives for insurance companies to negotiate higher, not lower, prices.
8
@MH
With a self insured employer, the employer, who is paying the bulk pf the bills. gets a share of volume rebates from the insurers and the pharmacy benefit managers.
It's difficult to assess the total cost of plan one to plan two unless you see the national spreadsheet/model.
If the employer workforce distribution has a concentration of employees in a competitive market, they could be saving big bucks there and have to pay higher prices in a region that has a small number of employees. The insurance companies that manage transactions for the self ensured employers generally have nationwide provider networks, but they do tend to be more robust in some areas. When I was transferred by my national employer, I changed to the alternate insurer when I moved from Mobile, AL to Memphis, TN. BC/BS great network in Mobile; United Healthcare great in Memphis at that time.
These days the results from blood work take hours and sometimes minutes to be made available, unlike just a few years ago when they took two or three days.
This leads me to believe that little human labor is involved. So how much do these new blood analyzers cost and how long do they last? One gets the feeling that they are cash cows, with the cost to the lab for each test being quite low.
7
I recently opened my own medical practice.
I could not find out what I would be paid for a visit before I saw a patient. I do not find out until the bill is paid.
The reimbursement for visits is barely enough to cover the costs of staff, rent, insurance, electronic medical records. And as doctors we are constantly told we have to do and document more and get paid less per visit.
I think all patients should post their bills online minus their personal identifying information to show what their insurance company pays.
Their is tremendous discrepancy across areas of medicine with some getting overpaid and others underpaid.
43
@Doc Who Recently Opened Practice This is absolutely true for any doctor in private practice. It is also the reason so many doctors are no longer in private practice. The Insurance companies negotiate much higher payments with hospitals than with private practitioners. And they find ways to deny payments for any number of reasons. And often those negotiated payments to private practitioners are not renegotiated for 10 -15 years despite the increase in daily operating costs over that time. Trying to stay afloat and offer quality care as a private practitioner is next to impossible in today's healthcare marketplace.
1
@Doc Who Recently Opened Practice
Big medicine believes it is a trade secret for you to know how much you are being paid and for the consumer to know how much he will pay. Such is the way of socialism.
1
It would be very informative to know the Medicare reimbursement for the same procedures and tests.
3
@Gerry Power They are never as high. Some are ridiculous, as in $9 for an x-ray. But what happens is that private practice physicians limit the number of Medicare patients they will take.
1
@Gerry Power
It would also be useful to understand why a high volume, highly profitable hospital system in NY is paid a reimbursement that is 150% of what a rural hospital in Arkansas is paid. Blue states argue that they have high cost of living at their charity hospitals, but apparently haven't heard about economies of scale.
There are some services that should be substantially cheaper to provide in a dense urban environment and more expensive in middle population areas.
Maybe you have to pay a pediatrician more in the suburbs of NYC than in the suburbs of Little Rock. But the lab test in a lab where they are processing 1,000 tests per week should be substantially cheaper than one in which they are processing 100 or 50 per week.
Rather than applying logic, they give NYC a 50% bump over the national average.
This pricing scheme is also a way to keep primary care physicians (PCPs) out of private practice and is essentially killing primary care.
Here's the scheme: An insurer's payment for a PCP's services is, I think, intentionally low --insufficient to pay their salary with overhead. The institution with a lab can pay the doctor's salary and overhead, as it is so highly overpaid for labs, radiology, etc. Now the PCP, who owes up to $200K just for their medical education, is trapped into working at an institution. The institution expects the PCP to see too many patients daily, in order to get these additional labs, radiology, etc. ordered. This is a net gain for the hospital/ medical group. This 'engine' drives the institution's finances.
This scheme is also killing primary care, as PCPs must work long hours to create the time to hear their patients. These long, busy and often complicated days cause stress. After all, our patients' lives are in our care. We must make the time to listen carefully. PCPs are retiring early, and more medical students are choosing other fields of medical practice due to this very problem.
Too many of the business people in medicine are going for profits rather than the community's good health. Some of these business people also make incredible salaries-- far more than the doctors are making.
IMO, virtually everyone in healthcare should take an appropriate form of the Hippocratic Oath.
21
@yankeefan sounds about right and mirrors my experrience with large medical facilities and testing. Unfortunately for the patients, how can these doctors who supposedly took an oath look at their patients with a straight face and subject them to these unnecessary tests? Their licenses should be revoked. No wonder our insurance is so expensive. I'm one of the fortunate ones; I'm retired but I still have the same insurance with my former employer picking up 2/3 of the premium. But just because I have insurance doesn't mean I'm not sensitive to waste.
I'm still searching for a good primary care office that's not connected with a large medical facility for the very reasons you outline. I try to respect the doctor's time and not run in every time I have an ache.
@yankeefan
The other delightful aspects of the Obamacare law are (1) doctors in private practice have to implement automated records if they have any Medicare patients, even if Medicare patients are a small proportion of their practice, or they would be charged a penalty against billings. The systems cost a minimum of $100,000 to establish, and if their patients used more than one hospital, they had to pay a link charge {plus annual updates} for each other provider their patients did business with.
(2) If a local hospital bought out the practice, Medicare pays a higher reimbursement rate to physicians who are employees of a hospital than private practitioners. Many hospital chains bought up practices. You are going to the same doctor, but Medicare [and private insurance] is paying more for your office visit, lab tests, imaging provided at a hospital owned imaging center. You insurance premiums and/or what your employer is paying are higher so that big hospital chains can get bigger payments and so insurers 15-20% for profit and overhead is calculated on a higher base medical cost.
That is why the Medicare trust funds are depleting at a faster rate than before Obamacare. The policy wonks claim it is because baby boomers are retiring, which is having an impact. But it is being exacerbated by an extra 10% bogus inflation by hospital systems.
IMO, the government should disallow all of the antitrust and contractual suppression of price and quality data.
3
@Ann Personally, I get no benefit from ordering labs, radiology, etc. for my patients. I order what I think is best for the patient's diagnosis or care. So they can't make me 'bilk' the system. However, the tests I want to see are, I'm sure, are overpriced. It is so frustrating.
This problem has been around for ages. Sadly, it hasn't been addressed in policy with the urgency that it should have been, and while governments are quick to blame the insurance companies for high profits, the reality is that the prices on provider side of the market are really what is distorting the market. The ACA was all for good with government subsidizing healthcare, but the solution has to be more viable.
America is literally fighting over who's going to pay the healthcare bill rather than asking why the bill is so big in the first place.
13
The assertion that healthcare costs are best served by a market as opposed to regulated or open prices is, IMHO, a fraud -- in order for a market to function there must be open access to information. Then the purchaser is in a position to make an informed choice. In an environment where critical information, like the cost, is kept secret, there can be no fair market -- it is at best a monopoly with rigged prices. Why other places (like where I live) fund healthcare out of taxes and provide service to all registered residents (not just citizens). And probably why medical costs are one of the leading causes of personal bankruptcy in the US.
12
This is the result of the AMA and other health businesses claiming that markets are the way to deliver health care. They posit that markets are efficient, which is true but only in highly competitive markets where everyone is fully informed.
American health care is about as far from the ideal that health businesses claim lead to efficient outcomes. It is long past due to clean this mess up either with government regulation or provision of health care.
6
After a sleep study, it was recommended that I use a C-Pap machine. The C-Pap specialist in pulmonologists' office could not give me the monthly rental cost or outright purchase cost of the machine. She told me that no one had ever asked her about costs before and that I shouldn't worry about it because I had insurance that would "probably" pay for "most" of it. I asked her if she shopped at stores where there weren't any prices on the items and she wouldn't know the price until she received her monthly credit card statement.
30
And this, right here, is the problem with the GOP platform on healthcare. Republicans seems to think healthcare is like any other consumer good. It isn't:
1. You can't always choose your doctor. Not within a reasonable definition of "choose." If you live in LA, you aren't going to Louisville for your C-section. If you have a heart attack, you can't even choose your local ER.
2. You can't reasonably decide not to buy healthcare in many cases. New iPhone too expensive? Fine, live with your old one. Need cancer treatment? Yeah...
3. Even if 1 & 2 above were not the case (say, you're getting a knee scope because your daily runs hurt), you can't choose based on pricing, as this article makes very clear.
4. It's one of very few markets that requires a middleman. Auto dealers, real estate and travel agents ... can't really think of any others. And of course, they aren't playing by the same rules as insurance companies--dealers make a few hundred bucks on a car; brokers a few percentage points that are often negotiable and are in the contract; travel agents get paid a commission by the vendor, not the traveler.
That Republicans don't seem to understand any of this is ridiculous, but not surprising. They elected Trump.
18
@truth
No they defected to Trump.
@truth
And there is one missing piece. For a market to function, exchange has to be voluntary
Needs such as cancer treatment or emergency surgery throw the voluntary dimension out of the windows; can anyone imagining going shopping for the least expensive hospital when having a heart attack?
1
The insurance companies and politicians are closely "coupled".
Most politicians would not know how or what to do on the job if there were no lobbyists.
3
These contracts are unenforceable. Patients have no choice but to enter into them; they have no idea what the price is; and, they have no power to negotiate. Why, then, are hospitals getting away with aggressive billing and sending patients to collection for contracts that are outrageous and unenforceable at the get go. First, do no harm. First, outlaw suing patients.
4
Medical Billing is nuts... the provider doesn't know what you will owe, but makes you pay up front, then adjust later. I once got a bill for 25 cents due to the difference between estimate and actual. The bill was printed on fancy paper and sent to me via first class mail. It must have cost the provider at least $10 to print and send that bill. They didn't quite know what to do with the quarter I gave them on condition they print me a receipt. Please can we go single payer and stop the craziness?
9
Healthcare is ~ 20% of US GDP. So a lot of the commenters sharing their war stories here are surely benefitting through employment on the status quo.
Thank you NYT, this is the kind of important reporting we need more of about healthcare.
The AMA and health industry in America mirrors far too closely the incredulous standards of the drug cartels south of the border, than what civilized, first-world countries should live up to.
However..., in my opinion, the NYT articles over past years reviewing findings from scientific studies on health issues have too often been failing to reach the high standards the NYT has become so respected for in the News and other divisions. I hope that someday this section of reporting on Health studies may also better serve the world at-large that so depend on the incredible service the NYT 'mostly' lives up to.
2
Once an average price is negotiated a cost of living and health care should be added or deducted. The should be known and there should be no deviations. If you don't like the price don't take medicare or medicaid and be prohibited from accepting private insurance reimbursement. I wonder what the average insurance reimbursement is compared to what a non insured person would pay. Insurance companies routinely negotiate steep discounts. No sane person should ever pay cash without demanding a negotiation.
America it is time to dump this racket and mess. Why the private market fails Americans.
Patients can save through bypassing their insurance company, doctor's office, or hospital pricing via directlabs.com. You pay this company that has negotiated amazingly low pricing, print out the requisition form, and then go to Quest labs for your blood draw. I have recommended this to my patients for years.
2
It’s a travesty...I read my insurance charges once and it literally said “insert needle into vein—$15!”
3
This is vulture capitalism at its best. It's time to take the profit motive out of our healthcare system. This cannot continue. Keep these expose articles coming.
10
This is exactly the kind of thing that would not be allowed to happen under a universal health care system run by the federal government.
The Times ran a piece on the price of a colonoscopy a few years ago that demonstrated similar variances.
5
Leave the US for medical care and see the true price of things
2
I went in for a blood test on a warm and sunny day.
The doctors and the nurses poked me without much delay.
They pumped it out like gasoline, but bothered I was not;
I figured they could tell me all the bugs that I had caught.
I tipped my hat and left them with a song upon my lips,
thinking modern medicine my ills would soon eclipse.
But came the clinic bill another day without sunshine;
for all that simple blood work I was charged amounts malign!
I couldn't pay it off if I would live a hundred years;
my faith in modern medicine has turned to shaken fears.
The bill collectors call me, and my car now has a lien;
I suffer from insomnia, and think I burst my spleen.
I do not know the cure for debt, I doubt there's really any.
I feel as if I've been impaled upon a spinning jenny!
10
I found a report to hospital executives that compares the hospital price for a routine EKG across all U.S. hospitals. It's mind-boggling to think a common procedure like this can be so widely priced. Here's the link before it gets taken down to the public: https://docs.google.com/spreadsheets/d/1y-K2W3gl0wxhnQ2p1GhTCSR0W4G3unOqp7DG-tT_OOs/edit#gid=1385752644
5
Reading the comments, most people assume the provider, particularly in the ER knows the costs. We don't. I have, for example, tried to find out the cost of a stat HIV test, something NYS requires I offer to everyone in the ED over the age of 12. No information available. However, I will treat you in the ED regardless of your ability to pay, or even if you will give us your name. We consistently lose money.
Lab tests ordered are ordered to determine medical care, and because we know our lab values are standardized. Not all labs run at the same level of precision, and many treatments and medication are based on levels, and trending levels. Some of the variation in the chart shown in this article seems egregious to me, but some doesn't. Examining outliers seems more valuable than criticizing what may be normal variation based on quality. Written by an ER RN.
3
The hospitals that over charge beyond what is customary and reasonable are literally sucking patient blood when they perform metabolic blood panel tests.
In this socialist hellhole a blood test costs the patient $0.00.
15
Health care costs would drop 20% presto if all medical procedures were priced. This includes anything from dental X-Rays, to a mammogram, to an MRI, to an EKG, to a colonoscopy.
I don't understand why such a proposal would be so controversial.
9
My two daughters needed the identical blood test. One I took to the local hospital lab and paid $800. The other I took to Tricore labs down the street and paid $53. Apparently nobody including the prescribing doctor knew about this pricing difference.
14
@Me,
Unfortunately, I've seen the same thing and it really decimates low-income people. My PCP was telling me her uninsured patients pay hundreds for a Vitamin D test. So I sent her the link to the on-line test outfit I often use (my post below.) But I wonder if doctors in large hospitals are allowed to advise patients to use something other than the hospital lab (it takes $$ away from the hospital.)
Hospitals and other providers could easily charge everyone (insured, or not) the same rate if that was a reasonable and fair price for the service. We will never know what a fair and reasonable cost is because health insurers use strong-arm economic tactics (one might, tongue in cheek, call it negotiating) to force providers to accept agreed upon payments that must be deeply discounted from the price they charge the noninsured. In this system, you only really see the price you pay for "protection". In effect, insurers are like gangs where you must either join or, good luck going it on your own.
5
Also, the difference between the costs for a cash payer and one who is insured is astronomical, especially at hospitals. I had an outpatient test that my insurance reimbursed the hospital at about $500 but it was billed at over $7,000. No wonder people without insurance can't afford healthcare.
9
@LiquidLight
I suspect the outrageous costs for the uninsured serve to drive persons to get insurance while enabling the insurers to charge even more. Hospitals probably like the resulting more steady revenue. We are long overdue for laws which would limit how much an uninsured person can be charged - say to no more than 2-3X what an insured person would pay.
6
Information and transparency are key to competitive markets. But there are other barriers - you are often locked into a provider for example. All business people know the tricks to maximize profit. And it isn't like hospitals are swimming in cash either so if you just cut costs maybe the hospitals would go bankrupt. You won't know until you have a model for how the entire system operates, define standards for care, for quality outcomes, and then deal with our own feelings that more medical care is better medical care.
4
Grocery stores should learn from this.
They should not put prices on the food and instead let the consumer find out at checkout.
The consumer will then make healthier food choices if cost was no longer a pesky factor they could pay attention to.
6
This comparison doesn’t quite work since grocery stores would have to tell you the price after you ate the foods.
Additionally, you’d have to blind your customers from exactly what food they’re consuming since too often patients don’t understand completely what they are receiving.
Finally, you’d need a “nutritionist” to serve as customers’ grocery-selector who also doesn’t know the prices or your ability to pay to advise purchases of products.
Imagine the absurdity!
@Tongue in Cheek
And what would happen if at checkout we could just show our "food plan" card, and then take our groceries home? (Or maybe a $5 co-pay.)
Don't expect Medicare for All to fix this situation, that is if it is patterned exactly from Medicare. If you download the databases provided on cms.gov you will find the same insane variations. Even within the same geographic area you will find that the charges for the same procedures vary by a ten to one ratio. And these aren't $11 tests. These are procedures that cost in the tens of thousands of dollars. Notably not-for-profit hospitals charge the lowest fees.
That has a lot to do with why I am rather unenthusiastic about MfA. If it looks anything like Medicare, no thanks. And you can bet in the current climate of bribery and corrupt campaign finance that MfA will be a giant candy store for wealthy corporate donors.
7
@J.I.M.
" in the current climate of bribery and corrupt campaign finance"...
While you are correct, I think that must change also. It would be sad to throw up our hands and admit it has to be either, or.
2
@Charles Absolutely true but I don't see any candidate championing the idea of fixing what I call The One Issue to Rule Them All. No corruption fix, pretty much no nothing. The number of looming near existential problems keep mounting, all of them entrenched by corrupt interests that don't want to lose their piece of the zero sum game. A zero sum game operates over a zero time span, "What's in it for me in this instant." There is no future in a very real sense.
1
This is another reason for a universal government run health care system like an improved Medicare for all. It also gives another reason why such a program would be more efficient, giving better care at much lower cost.
All other developed countries have a universal. government run system. They all have a single entity that gathers data, analyzes it, and makes recommendations based on medical reasons, not profit, return to stockholders or physicians' income.
We cannot do this since private insurance companies regard such data as proprietary. They will not even tell you how much they will pay for a given procedure.
After the government provides all citizens with good decent care including mental, dental eye care, etc., then we can allow private insurance to sell private insurance in additional to the basic coverage for stuff like cosmetic surgery, fancier rooms and food in hospitals. etc.
We must eliminate the need for private health insurance.
PS There is more detail in Elisabeth Rosenthal's great series "Paying Til It Hurts," http://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html?action=click&contentCollection=U.S.&module=Kicker®ion=Header&pgtype=article
16
@Len Charlap Actually, with the exception of the UK, all western European countries have a strong private health insurance market. If "free healthcare for all" worked, they would have it. But it doesn't work.
2
@Erik Yes they have heavily regulated private markets. The heavily regulate part is what keeps them for resembling the American mess.
2
Who told you Healthcare was ‘free’ in Western European countries or Canada? It’s more affordable and it covers those citizens but it’s not free. Taxes and $charges for healthcare pay for universal coverage. By the way, the life expectancy in all of those countries is significantly better than America. Especially for moms and newborns.
3
I had a three day hospitalization for surgery this month and got my first billing statement from the hospital today: $214,000, no itemization, no details. My share of cost was much lower of course, Medicare is better than most commercial plans and covered almost everything. But again, there was no explanation of what I was paying for. Hospitals and insurers act like they are above questioning and that we will just blindly pay their arbitrary demands, or go bankrupt trying. Its incomprehensible and reason enough, by itself, to jettison the current system.
39
When my eldest daughter was 14, she needed a very serious dental operation. When I tried to find out exactly what was covered,our rep told me unofficially that they would only pay for laughing gas in any dental procedure. When I told this to the surgeon, he said there was no way he would use anything as unreliable as laughing gas on a 14 year girl for this operation. If I insisted on laughing gas, I would have to find another surgeon. So I told him I would pay him and see if I could get the money back from my insurer.
The operation went fine and when I submitted the bill, the insurance company refused to pay for the anesthetic, $800. After yelling, I finally got the name and address of someone with authority in the insurance company.
I wrote a letter to her and received no reply, but a week later I got a check for $200. So I sent her a longer letter, and I got the surgeon to write a letter, a copy of which I also sent. Again, no reply, but I got a check for $200. I began to see a pattern. So I sent her the same letter with another copy of the surgeon's letter. A week later, I got another check for $200.
The next time I sent the letter that referred to the surgeon's letter, I omitted the surgeon's letter to see if anyone would notice. A week later I got a check for $200. Now I had the entire $800 they owed me, but purely as a matter of scientific curiosity, I sent them the letter again. A week later I got another check for $200.
53
@Len Charlap
Well in the past we have experienced similar occurrences with insurance companies fighting for payments for services for our disabled son. The model is to deny and for those that wish to pursue and go through the painstaking process of appeals and paperwork will have a better chance of getting some or all reimbursement. In your case however based on the description provided your approach is tantamount to insurance fraud. Which too is plentiful in the system also driving costs higher. Sort of like a credit card paying for the fraud when you fly to the a foreign nation and suddenly illicit charges appear on your statement. Someone pays for this. Yes it is the lowly patient, consumer lowest man/woman other on the totem pole.
1
@Len Charlap
Im a physician myself and often suspect that no one in the insurance industry knows or pays attention to what they do. Somewhere they have a set of 'if this, then that' responses and you seem to have found one that works. Congratulations.
10
@caesar schwartz - Lighten up. I only did it once to see if the insurance company had any idea of what they were paying. I guess I could have continued, thereby increasing my income by $20K or so, but I didn't.
1
I cut my hand on a mandoline. Went to the local Brooklyn emergency room for a few stitches. While the in-take person took my insurance details I asked how much it would cost for the stitches. She looked at me like I was from Mars - I should know better than to ask such an idiotic question, I'd jut have to wait for the bill like everyone else. Talk about idiocy!
23
@Binky they know exactly What the base procedure cost and could easily pull up the information. I ask a a clinic if my medicare would cover a procedure. The office was full of medicare patients yet they told me to call medicare.
1
I put off a colonoscopy for a year because of this. All I got from the insurance company was that preferred physicians should have a lower cost but that they couldn't share what that cost was. I explained my frustration that how could I plan to make sure I could pay for it, when I don't know the cost. Their suggestion was just to make sure I had the money to pay the deductible on the full "list" cost, and then wait to see the ultimate cost. I asked if it was a possibility that perhaps one provider with a lower "list" cost, may ultimately have a higher negotiated cost than another provider whose "list" price was higher but had a lower negotiated cost. They said yes, that was a possibility. ARGGG! And don't get me started on the colonoscopy being "covered" but possibly the anesthesia not being covered! Thanks for that previous article in the NYT for letting me know to watch out for that!!
10
@flightfan I ran into that earlier this year I got a 1000 bill for anesthesia. I think it was because they listed my secondary plan as my primary. I told them I was on medicare and had an additional plan from blue cross. Not sure why the omitted medicare the office was full on older people. I am still waiting to find out if the anesthesia was covered. A procedure that is not even necessary of a colonoscopy. I was on light sedation for my first two and watched.
Oddly they warned that not all insurers would cover the anesthesia but they couldn't tell me if it was covered by medicare, probably 50% of the patients have medicare.
Medicare for all of single payer can't come fast enough. Compared to an American hospital a Canadian billing office is small. Imagine all the infrastructure we could build with the freed up hospital and private insurance office workers. American productivity would probably jump 4%
3
Clearly, there is a misunderstanding here shared by the writers and the commentariat. The point of private health care (i.e the part of the system that charges money for stuff) is to make money, not improve health. Same for health insurance. People do this to get paid and if they can make more money, they will. If you don't regulate this like we do for electricity or water or pay for it out of taxes like fire and police, this is what you get. So, seems like the system is working fine, except maybe for the idiots who agree to accept $40 for something that costs them $20 when they can easily charge $400 for it! I thought a 95% margin was standard.
11
@Steve
So is there anything you would not regulate to minimize the personal gain of the suppliers? Food? Housing? Entertainment?
Seems like profit-driven investors and producers have generated quite a bit of the stuff that people want.
@Bob Krantz
You suggest it is OK to charge $183,000 for an emergency appendectomy. Or is it too much? Maybe $50,000 is OK then?
What is a reasonable profit?
Is 3,000 percent markup OK? What about 3,300 percent? (both percentages taken from hospital bills for items that could be bought online)
There is nothing VOLUNTARY in the healthcare market. One gets treatment, studies, and surgeries, because one has a problem that has to be fixed; I have not seen patients shopping for healthcare while suffering a stroke
I went to my PCP with some pain in my side that later at a different hospital, turned out to be kidney stones.PCP sent me to a high end ER, They thought maybe it was my heart,
I am 76 female.MDs said surely my heart,
All my admitting blood tests perfect,
Enzymes perfect,
Blood pressure perfect
I said it’s not my heart (I’m an RN BSN
40 years)
No heart disease
$85,000. Later Heart doc comes in to discharge me,
Says “ Well....you have a perfect heart,
We think you have shingles so I’m giving you a bottle of 30 Morphine pills”
I said I don’t have shingles,
He says Well.....
Maybe you will!
They ran a Ton of tests that I said I didn’t need,
When I protested,
They’d get in my face......
Like the Wolf in Little Red Ridinghood....
And say
“ You don’t want to go home and have a heart attack tonight do you?”
I wanted to say
No, Mr Wolf I don’t........
9
@Awake
I sure hope the $85,000 included the cost of treatment for the kidney stones. This is what passes for health "care" today with many physicians -- doctors order a battery of tests, don't listen to the patient, appear to guess what's wrong based on age, etc. The problem is the fee-for-service system; the more tests and services provided, the more money they make. Many physicians here don't accept Medicare, which is also fraught with fraud. I saw an article in NYT about a hospital where doctors are paid a salary. It'd be nice to have people go into medicine because they want heal people. But that would mean also addressing the costs of their education, liability insurance, etc.
2
$952??? They should be sued for fraud.
1
Single payer. No secrets. Everyone pays the same.
Eliminate the enriched middle men.
26
No surprise here. Healthcare in the U.S. is just another business for profit.
And whatever you do, don't ever think that the health insurance industry cares about you, regardless of how much phoney advertising is shoved in your face. They're on a par with Traitor Trump when it comes to telling the truth.
17
@george eliot Why to you think so many foreign doctors run to the US Money from heaven.
As a nurse I can give you more examples. How about let’s start with taking pharmaceutical ads off TV and save us all some money. No where else in the world does this.
59
Basic economics- give a monopoly on providing medical treatment and prescribing medicine, get corruption and rent-taking. 150 years ago medical treatment was anarchic, today pharmacists, physicians, nurses, psychologists could all safely prescribe. Change the laws, take away monopoly.
I shared classes with Harvard med students also getting MBA's; they unapologetically were in medicine for he money- and expected to enter practice making $400,000-that was 10 years ago. No other country allows this corruption. Doctors in Canada and UK make under $200,000 and do quite well. Double for the hospitals-the crystal palaces and cathedrals of today.
We don't even get what we pay for; outcomes are mediocre compared to other advanced countries; US public health is that of a middle-income country.
We have to give single payer care a try to eliminate this outrageous greed.
11
Healthcare is the only service where you agree to pay any and all costs before you know what you are buying or how much it will cost and when you are not in any position to shop around
And- those charging do not have to stand by their estimates because they are not binding
It really is highway robbery
21
This article and many of the comments seem rather disturbing.
Outrageous price gouging , thievery, deception, immorality.
But i'll withhold final judgement until some insurance and hospital
executives comment and explain how this is all perfectly reasonable and fair.
1
@ASU The Insurance CEOs are doing such a great job for us that our premiums go up faster than the stack market and we have the worst health of any industrialized nation. They absolutely have earned their > $20m annual compensation. Cant wait for their respionses.
3
All that money sloshing around creates perverse incentives for privatised health care.
No wonder it costs more and delivers less health.
5
The continued hosing of Americans by the healthcare industry continues unabated. On another note, your sub-headline states that discrepancies like this are "unimaginable" in other industries...not exactly. I'd like for someone to explain how the price of gas can swing 20% IN ONE DAY...for product that's already been refined, delivered and is in the ground!
4
I've ran into this 2 other times. I was in a car accident with 3 broken limbs. After I was released to rehab I was there for 2 mos while my limbs healed. Just before release, the rehab center sent a rep to my bed saying that I had "overlooked" a request for payment. I asked how could I have overlooked it when I was discharged straight from the hospital to rehab. Next they sent their 2nd level to my bed asking me to sign a 23 page contract agreeing to pay anything they charged. I declined. Then their 3rd level called me demanding $5k. I asked would I get $5k since I had been in rehab for 2 months. She told me to borrow it from my kids or take out a loan. When I declined she said it was against their policy to allow me to stay and directed them to withhold physical therapy. Fortunately I was going home in a few days. I did get a bill; after insurance my portion was about $1500. I paid in full.
Another hospital I was admitted thru ER. One overnight stay they said my portion was $800. I paid. I have Medicare A and ins; I noticed the $800 sitting on my acct as a credit. While trying to resolve this, I saw another of their doctors. When i declined a procedure they would have charged ins for, they billed me $55 for an office visit and turned me over to a collection agency. I paid the $55. It took me another 8 months to get a refund of $525. Imagine being turned over to a collectoin agency for $55 while they owed me hundeds.
never again
10
I understand that patients should have ‘menu-pricing’ available to them before entering any hospital but if your aorta has been punctured and you’re bleeding out, it’s probably not the best time to decide if your doctors are in-house or if the procedure stacks up well compared to the competition.
The Health Care industry is in dire shape. Just today, headlines about $143,000 bill to remedy a young girls accidental encounter with a copperhead snake. If there’s a nationwide rebellion among consumers regarding health care costs, the industry only has itself to blame. The outrageous greed of these companies is staggering.
And of course, if we had Medicare-for-all, I wouldn’t be posting anything here now, and those poor parents would be financially solvent. Or at least more solvent than they currently are.
3
Folks, you don't need to pay hundreds or thousands for blood tests. Just use an on-line ordering service.
The one below (Life Extension) uses Labcorp for the testing. $26 for a basic lab test (CBC.) $56 for a thyroid test, etc. You just set up an account, pay, get the test, they email you a PDF within a day or two for basic tests. There are two other firms (Request a Test, and Walk-in Lab.) One of those (I forget which) lets you choose either Labcorp or Quest.
(Disclaimer: I'm not suggesting that people do this in lieu of seeing doctors, or doing their tests, but there are tests I want done that the med community will say I don't need to do. I disagree, and it's my body, my health, and my money.)
https://www.lifeextension.com/Vitamins-Supplements/Blood-Tests/Blood-Tests
3
I tried to get costs for a test that my regular doctor said to me, "oh, you need to get this recheck - sometimes people that don't, find that their situation is far gone." That's the "scare tactic". He told me to go to the same doctor who did the test last time.
The doctor that did my test the last time was not "on my plan" and his associate who was, is known to have a poor bedside manner so was not recommended by the office staff. I had 8 months before I would be on Medicare, which would cover the test.
I had corporate insurance the first time my "covered" test was performed. That one cost me nearly $2K. It was "100% covered". That was a bold faced insurance coverage lie. The basic test was apparently covered - not the laboratory costs, or the other costs for the additional test also performed - "while we're there, you should get this one, too" recommended the specialist. Ka-ching said the cash register.
I asked the admin at the doctor's office how much. She had no clue how to tell me an estimate. She said that there were too many components (and providers) into which she had no insight - hospital outpatient suite, laboratory used by the doctor, etc. Only she could "estimate" that doctor's fees.
So, truly, it's "everyone for themselves" from every perspective except you, the patient. You know nothing. They know their potential upside and profit. By design this is. "Free enterprise medicine". Yup. Nobody wins on this one. Especially we the patients.
5
A relative of mine went to an in-network hospital ER (urgent care wouldn't handle her illness). A few weeks later she got a phone call from someone saying she needs to argue with the insurance company to cover the bill. The ER copayment was already paid, but the physician was out of network (of course). He was billing $1800 for seeing my relative for 5 minutes. But an itemized bill was never issued for his, or the ER's, services. Finally my relative was sent a letter asking her to dun the insurance company for more money. I called the number and a person in India answered the phone by saying, "Hello?" No identification, no bill, and the company's name had changed from the time the bill was issued. How can you dispute a bill for services you have no idea were provided or no from a company that doesn't have a name?
But I'll bet that the balance that the insurance company doesn't pay will be sent to a collection agency that can ruin my relative's credit.
In any other business, this would be fraud. It is fraud.
11
RE : Huge price discrepancies like that are unimaginable in other industries. Also unusual: not knowing the fee ahead of time.
Not in other countries. Check France, Germany, Switzerland
Core problem : In no other industry is the US government as involved (not a problem in other countries) and hence subjected to so much pressure by campaign donors (the core problem in the US)
Click on the two links below, to see how the two largest pressure groups , Health Insurances companies AMA/MDs profited from the ACA
https://www.economist.com/sites/default/files/imagecache/640-width/images/print-edition/20151205_FNC666_0.png
https://www.medscape.com/slideshow/2018-compensation-overview-6009667#3
3
I say we put Mueller on the case. I'm sure he'll discover that this article may, or may not be true. And then he will slink off his cushy life in the private sector.
3
No surprise that costs in San Francisco are so high. The health systems here are secretive, controlling and greedy. Worst health care city I have ever lived in.
5
I recently had a heart monitoring procedure done. The company that provided and monitored the equipment billed my insurer $2,200. Under the company's agreement with the insurer, the the insurer paid the company $187. I did not have to pay anything for this, but it points out another inequity in our health system: Someone who does not have insurance would likely be billed the full $2,200 and would be dunned by a collection agency to pay it. Generally, it's poorer people who have no health insurance, and as a result the costs to them for health services are much higher than insurers pay for the same services.
7
It's worth noting that Maryland is the only state to set rates for hospital services.
9
where they have you at a disadvantage is this is your health. You rely on your doctor to recommend what's good for you or needed, not for what lines their pockets.
As a homeowner or car owner, you know to take recommendations with a dose of skepticism. Like when you take your car in and they say "you should have your system flushed" . Or the "I wouldn't bother repairing that A/C again" report at your home.
But your health? You don't know if you really do need every test, every procedure they recommend. Or if they just want to run it because you have insurance. That's the feeling I was getting. Or if they do really need to "see" you every three months. For what? I didn't bring any medical issues up nor was I asked to be treated for anything else. I have a couple of meds that are working well for me and I've been taking for years. It isn't a good feeling to have to second guess your health care provider trying to determine if something is really needed or not. I even hesitated switching to a new med my doctor recommended because the current one was working and I wasn't confident they weren't being compensated for recommending it.
Insurance or not i try to stay away unless I need a refill on my meds unless something is really bothering me.
3
Economic 101: In order to manage costs, consumers have to know the prices of the services they are getting.
Just providing that transparency would go a long way to helping to bring down healthcare costs.
6
As a health care provider (formerly known as a doctor) I am not in favor of socialized medicine. I am, however, in favor of socializing/standardizing labs in this country. The amount of money and time wasted on ordering labs, getting lab results, comparing labs, waiting on the phone in the middle of the night for lab results, etc. is astonishing. If patients only knew how often labs are just repeated when the doctor can’t get their hands on prior results. Every lab reports results in their own uniquely annoying and frustrating format. Figure out the simplest, most user friendly format, standardize it, save some money and move on to focusing on other more important things.
6
@Anon
What if under a social national plan the healthcare providers get as much or more money as they do now but the for-profit, excessive and secretive bureaucratic layer be eliminated?
I don't think anyone wants the vast majority of doctors and nurses, etc. to be paid less.
Because of a change in health insurance where the insurance pays for almost nothing towards the cost of healthcare while still charging over $1,000 a month for 2, my wife started asking healthcare providers how much their services cost to pay them directly. They uniformly claim they can’t tell you how much it will cost. When asked how they expected us to decide whether or not we could afford a surgerical procedure when they couldn’t tell us how much it would cost we were told that’s your problem. The healthcare system in the US is failing.
31
@DSD -- we paid over $16,000 out of pocket for a broken wrist.
Even if you try to shop around and ask for pricing, most providers won't give you a number. Example, I am trying to schedule a mammogram. It should be covered but both the insurance company and imaging center I'd like to visit have said that there could be a charge, and they can't tell me why ("it depends") or how much that charge will be (once again, "it depends"). I have a high deductible health plan and can afford to pay my deductible, but as a consumer, I'd really like to know simply how much. I get the feeling insurance and providers have an attitude of "you can't put a price on health, why are you even asking the cost?!?".
19
As a "health care consumer" (the American term for a sick person), the only value in my knowing the range of prices for a given test or procedure is if the absurdity motivates me to demand public insurance and government controls on medical prices. I'm sure there are politicians out there who think we're all dying to be empowered to shop around for our medical tests and emergency surgeries, but not me.
7
@Martin may be we should stop paying healthcare coverage for Congress and let them go through the same process as we all do ( WITHOUT SPECIAL DEALS OR AIDES TO DO THE DIRTY WORK FOR THEM), then we probably will get this healthcare mess solved once and for all, especially those who suggested to give all the Medicare recipients each a given amount and shop insurance coverage ourselves in open market ( euphemism: freedom of choice). of course, this day will never come. so Congress is living in the high space, never know the regular citizens' pain.
7
This is exactly why the Republican concept of letting the "market" solve health care is such a joke. Pricing information is the ONE THING essential for a market to work. As this article points out very clearly, health care is virtually the only industry where price information is not available to the consumer. Good luck getting a market to function without prices.
50
@Keith W.
As you note there health care system is not an effective market. The answer is to make it a better market by providing price transparency.
4
The only possible way that such price discrepancies exist is because prices are opaque and the pt is usually covered by insurance and thus isolated from the cost. Both factors discourage pt from price shopping. If for example 1 car dealer sold Honda’s for $20,000, and another sold them for $100,000, the second dealer would quickly be out of business. People will never care about medical prices unless they pay a substantial amount of the cost themselves. It’s as if I were shopping in a store where there were no price labels and when I got to the register the insurance company paid.
4
please note the reams of comments in which people say they ask what a procedure costs but get no answers.
1
I recently had a blood test. Due to a coding error by my doctor's office, Medicare denied the claim. Medicare normally pays about $13 for this specific test and LabCorp accepts that as payment in full. But since it was denied by Medicare, LabCorp billed me for $107, the "list price" of the test. I tried to get the doctor's office to correct things. But Medicare denied the claim again. I offered to pay LabCorp $16 for the test - more than Medicare would pay. But they would accept nothing but the full $107. Their argument was essentially that since Medicare denied the claim, they were within their rights to rip me off.
12
@RT No.
By Federal Medicare Regulations they have to charge you the "list price." It's against the law to negotiate a different price with a Medicare Beneficiary.
4
@RT I recently had the same experience with LabCorp. My previous doctor retired. So now I have a new doctor who is requesting essentially the same blood test profile. The difference is that I now have to pay $72 out of pocket for the same test I used to pay $40 out of pocket for. It all depends on the codes the doctor office submits and I am convinced they use the codes that maximize their reimbursement from insurance. The current system encourages abuse. Labs can charge basically whatever they want for tests without justification so long as the insurance company is paying a portion of the fee. The same is true with drugs where pharmaceutical companies reformulate an old drug by blending in a small component of a new one and increase the price 5000%. This is out of control and outright fraud that doctors, labs and pharmaceutical companies are committing and no one is doing anything about it because of "free market".
4
@Me
Isn't Medicare wonderful! Clearly, we need Medicare for All!
3
I had some blood work done as part of a standard physical exam. The lab billed $502.62. After the "negotiated discount" from the insurance company, the insurance company paid $0, and I paid $25.
So did the lab lose a ton of money? Or are their "list prices" entirely fictional?
(My guess is that it's the latter.)
39
This is one of the reasons that Health Savings Accounts don't really work. The theory was, that the wrong people, i.e. insurers, were buying medical services and that consumers would, as they were spending their own hard-earned dollars "shop" for services. Well, the truth of the matter, as this article points out, is that you can't shop for services because nobody will tell you in advance what things cost. Secondly, in small town America there is usually only one provider. Providers provide services on a take-it-or-leave it basis.
43
@Robert
Health Savings Accounts work if you have the money to put away and the good health to not need services. I agree that the GOP implication is that the consumer will then spend their money wisely....but you can't comparison shop very easily.
However, I do ask what it costs, because I have a high deductible.
As long as hospitals and doctors are paid for treating patients rather than for keeping patients healthy, this will be the inevitable outcome. Even Medicare and Medicaid don't adequately address this problem. However there are a few integrated healthcare groups which run their own insurance programs as well as healthcare delivery. I'm very please with Kaiser Permanente which for many years has delivered great integrated healthcare for myself and my family.
3
@John S In my experience, KP's prescription drug costs are higher than PPO plans. Their formulary is also very limited and excludes some very popular medicines. I left Kaiser for that reason and discovered that my CVS managed pharmacy costs are a fraction of what I was paying at Kaiser.
2
Wouldn't be great for an organization to bargain for the lowest prices at hospitals, not have the profit motive behind all its decisions, be on the consumers side and not have a terribly high management cost? Oh wait that is Medicare and Medicaid.
15
When your car breaks down, garages are required by law to provide you with a written estimate/breakdown of the repair costs. They incur penalties if they don't do this. Why do we not require the same for humans? Veterinarians, dentists and cosmetic surgeons do this as a matter of common courtesy. It is not difficult. It is good business practice. That our country tolerates this level of secrecy for something so critical for survival as healthcare is astounding.
82
Several months ago I was about to have a metabolic blood panel test done for my annual "wellness" exam. Medicare no longer covers annual physicals. The local area hospital's fee was over $ 300.00. I called the Nordex Lab which is located directly across the street from the hospital and was told that their fee was around $ 50.00. They were professional, and there was no waiting period, and I have yet to receive their bill. So, check with a local lab before getting ripped off by your local hospital. One has to be one's own advocate.
20
@Maggie2
The trouble is that when you get a blood test, you don't just get a blood test, you get a quality control system behind it that makes sure your test is accurate, calibrated properly, etc. An academic hospital is more likely to be using the best procedures than a stand-alone lab that is competing on price.
The other issue is whether you need a particular test in the first place. Do you need a metabolic blood panel? Do you need to test for vitamin D levels?
https://www.nytimes.com/2018/08/18/business/vitamin-d-michael-holick.html
Vitamin D, the Sunshine Supplement, Has Shadowy Money Behind It
The doctor most responsible for creating a billion-dollar juggernaut has received hundreds of thousands of dollars from the vitamin D industry.
By Liz Szabo
New York Times
Aug. 18, 2018
https://www.nytimes.com/2017/04/10/health/vitamin-d-deficiency-supplements.html
Why Are So Many People Popping Vitamin D?
By Gina Kolata
New York Times
April 10, 2017
There was no reason for the patients to receive vitamin D tests. They did not have osteoporosis; their bones were not cracking from a lack of the vitamin. They did not have diseases that interfere with vitamin D absorption.
1
I have always advocated that service providers, like labs, should be required to charge the same amount to everyone whether that person is insured or not. They can set whatever price they want but once it is set they cannot negotiate discounts to that price. Doing this would make prices much more transparent, fostering a more open market for the consumer, and takes away the awful practice of making the uninsured pay more than those with insurance.
14
@Scott Werden
Agree. Wondering what is happening on island since largest hospital system Kaizer-ized? [Used to live there.]
One tactic I employ is to dispute what I feel are unreasonable charges. I write a letter, explaining my case, and I show what Medicare would reimburse for each CPT code. When they reply, saying "we don't care what Medicare reimburses", I know they've received my dispute. Then I might send them a check for the amount that Medicare would pay, and I might mark the check "Paid In Full". Once that check is cashed, the rest of the bill is no longer owed. See UCC § 3-311.
22
@Justin Love it!
1
@Justin
Sorry Justin. According to Medicare rules, a healthcare provider cannot charge you < or = Medicare prices if you are a cash-paying patient. If you are insured, your insurance company negotiated the price for the service. Some insurance companies, in fact, have negotiated prices which are less than Medicare. Any provider is quite correct to tell you, what Medicare pays is not relevant to what your payment is. Take it up with your insurance company, not the provider.
Thank god we have the NHS in UK. My wife has blood tests a few times a year and the most stressful thing is waiting for the results.
I think it's time for the USA to follow the health systems of Europe where procedures are bought by the state rather than insurance companies/hospitals.
But, I forgot that the profit centres in the US health system (insurance companies, hospitals, labs,etc) will do everything in their power (helped by lots of lobbying money) to prevent universal access to healthcare.
As Donald would say ... "SAD!"
42
Working in a hospital, I can say that the doctors on my team have no clue how much our patients are being billed. I was once talking to them about a patient who received a large bill and they said, "but I thought he had insurance?" We treat critically sick patients, and every day they are ordering test after test, doing procedure after procedure. They aren't doing it for the money and they aren't getting kickbacks for any of it - they truly believe each thing is in the best interest of the patient. But no thought whatsoever goes into the concept of how much this all will cost the patient, and whether that extra CT scan (or whatever) is ABSOLUTELY necessary.
56
@Beth
This is so true. I recently had my primary physician order some medication for me. When I went to Pharmacy, they told me it cost over $300...and told me lower cost options. I called my dr to see if the other meds would work as well (they did)...and he was, clearly, unaware of the cost and I am insured.
My dr is great but I've just learned ov er the years that most have no clue what we have to pay for things, even if we are insured. They order what they professionally believe is the best...and it isn't about them earning boatloads of money. The lesson I've learned is you have to be active in your own healthcare.
22
@WeThePeople: We had a similar experience. The doctor wanted my husband to take a particular medication, but warned us that it was very expensive. The cheaper, not as effective, alternative had serious side effects. We asked for the "expensive" better drug since we have a good drug plan. The pharmacy charged $5 for the entire amount of pills, that they said should have cost $1325! The doctor was amazed but happy for us. What would have happened to the person with no insurance who couldn't afford the retail price?
3
@Beth
I call this willful ignorance since the cost debate has been going on for years. Of course docs don’t know the exact prices of certain tests, medications and procedures because the insurance industry is opaque about those things. But to act surprised over outrages charges despite of insurance coverage is absolutely dishonest.
To find out the cost you must know the billing code - which is often something the physician or provider is not sure of until after the visit. For labs the codes would be known - depending on which labs are requested and how your insurance company breaks down costs. Medical coders work to bill things in a way that the bill will be reimbursed - but physicians don't always know the correct billing code. So yes, it must be transparent but if you have ever dug into the ICD-10 you'd know that the possibility for complications - and codes - is overwhelming. Single payer would eliminate this.
17
@Nnaiden My daughter works for a health insurance company. She was injured skiing and had to have a simple fabric sling for her right arm at the local ER after the XRay. A CNA struggled to put the simple sling on her arm, my daughter showed him how to do it. When she received the co-pay bill a few weeks later, it had been coded and billed as though a complicated rigid sling brace had been supplied and applied. She knew which billing code was incorrect, notified the hospital and her insurance and is still arguing with both because the co-pay amount difference was staggering.
6
A similar situation exists with prescription pharmaceuticals.
Unless you inquire with your pharmacist, you may not realize that purchasing a 30-day supply (perhaps the maximum allowed by your insurance plan) and paying the deductible under your insurance coverage - may cost you more in deductible payments - than simply paying cash for a full 90-days supply.
Of course it makes no sense that your co-pay should exceed the cost of the medication - unless, of course, you are an insurance company or a pharma company seeking to maximize profits.
Time for a one-payer system and transparent pricing.
16
I have frequently been advised by a pharmacist to not claim for my meds, just pay cash. e.g. I had vertigo and the $25 co-pay Rx turned out to be an OTC travel sickness remedy you can buy for $5.
Perhaps insurance companies with "too much revenue" has to find places to spend it - in order to keep it. So they find "things" where they will agree to very high price but to which they can reliably predict their exposure.
1
Call me crazy, but I don't want to be treated by my doctors, hospitals or other medical services providers like a business treats its customers. I want to be treated like a patient.
I don't have and don't want to spend hours researching the perfect balance between cost and quality when it comes to medical care. What I'd like is a single payer system that has some power to negotiate, and that gets the profit motive out of health care.
32
if the medical industry wants to be treated as a market it must comply with market rules. Otherwise regulate it, including prices.
17
@James brummel
How wonderfully succinct! Now let's put the short version on a bumper sticker.
I think every patient should be given a menu of charges like any other business. They only way medical and legal services get away with this highway robbery is that they have you by the neck (or some other part.) I am a Kaiser member and most charges are covered, but Kaiser requires us to take an annual physical exam and so I have the standard tests done. When one looks at the fees for all these standard test involving maybe 5 minutes with a technician and then a bunch of machine-run, computerized tests, the Kaiser price
mounts close to $1000 (at least retail, not what my insurance pays).
A few years ago The Times ran an article about colonoscopies which varied in Vienna from $350 to $23,000
on the Upper East Side. It's no wonder that 16% of our GDP is in health care, about double what is paid in Western Europe in the most advanced economies. But what politician will ever have the guts to challenge the medical or legal professions?
16
Bernie Sanders
7
@MG
Ditto. Bernie Sanders.
Joe Biden has spent his entire political life protecting insurance companies, banks and credit card companies while denying help to consumers such as the right bankruptcy protection. Biden is not going to challenge the medical or legal professionals.
I want to defeat Donald Trump as much as the hundred million other people who are going to vote to turn him out.
But I want REAL change in the health care systeand I know we won't get that from Joe Biden.
3
@MG
Surely you joke. All of his calculators are broken.
How's the health care in Caracas?
I have a blood test here in France every 6 months. Shamefully I don’t know what it actually costs since I have no out of pocket expenses (except for the vitamin D levels, 12 Euros). So I just looked it up on my reimbursement page on the Social Security website. The actual cost was 120 Euros. Between Social Security and my secondary insurance (la "mutuelle") it was covered. But no one wants to hear this tale of socialism so before anyone starts in on me about the high taxes I pay, etc etc. ... I’ll say au revoir.
63
Price really doesn’t matter if you don’t have choice of providers.
6
@Terry providers of what?
Here on Vancouver Island
You go to your doc - he fills out a form
Go down 2 floors to Life Labs
Somebody takes my blood
Life Labs bills the Government - don't know much
2 days later, my results are online
BTW Life Labs is a Private Company with offices all over Canada.
So what more choice do I need.
4
@John Owen The subject is price comparisons. You need more than one provider if you want to compare prices. If there's only one provider, price doesn't really matter.
I don't think 11 dollars covers the cost of this test
you need to draw blood, which requires 10min from a trained person; you need the blood tube, butterfly needle
then you have cost of the reagents and the instrument for the test itself, and the IT to report the results (without error) back to the clinician
maybe they can do this for eleven bucks, but I am skeptical
3
Well, if you pay the technician 40$ per hour, 10 min will come less than 7$, tubes and needles cost pennies, run probably cost $1 or 2. Plenty of room
@ezra abrams
They can't do it for eleven dollars--something smells very fishy.
1
This the "market" at work...right? No regulation. Caveat Emptor. Do we all really buy into this kind of predation?
What additional data do we need to know the markets do not "naturally" lead to improved social welfare if unregulated?
This is the "freedom" to be exploited...
11
“One person buys one hamburger, and another buys 1,000,” she said. “And it completely makes sense that the guy who buys 1,000 hamburgers gets a better price.”....Which is one reason why Medicare for all will cost less than what we are doing right now. When there there is an advantage in size in negotiating prices, nothing is bigger than all of us.
31
Healthcare is an inelastic market - you get it or you suffer. And with no visibility to pricing, even providers often can't tell, you have no ability to make an informed decision.
In my experience, bills come from everywhere - labs, facilities, doctors, anesthesiologists, nurses, etc. No one can tell you ahead of time who will send you a bill, when it will be due, and what you have to pay. I joke that even the phlebotomist sent me a bill after 2 months.
9
@dan-o
Absolutely true. And if you sit on them a few weeks, more and more insurance kicks in on some--they become lower--yet at the same time new ones show up and in their turn start their life cycle.
All while getting revised balances on the first batch.
I just set up a spreadsheet and let 'em roll (while asking for detailed billing).
If I was super sick and could afford it, billing would be the first thing I would outsource.
1
When a CARTEL (oligopoly) negotiates prices, they GO UP. When a single payer (monopsony) negotiates the same prices, they GO DOWN. Bernie Sanders has it right. Dump healthcare insurers. Well managed advanced technology will do the same job much cheaper.
17
A slightly higher dosage of the same drug can also cost 10x more. The the cost is known neither by the doctor or the patient ahead of time. If the patient has insurance, they may never learn of the difference. It's a racket, plain and simple, and should be illegal racketeering.
11
One of my best friends recently moved to Canada after becoming a Canadian citizen. His wife is Canadian and she became a US Citizen here before the moved. He just got his proof of coverage for him and his family of 3 for Canadian Healthcare. I must admit I am a little jealous. Some day hopefully the rest of us won't have to become dual citizens in order to enjoy single payer.
12
Insurance companies are evil right? Let's see how many of us are willing to do away with the tax subsidies of employer sponsored insurance... recommend if you agree!
3
Finally some real news! More of this. More news items that threaten corporations with the truth by informing citizens of pertinent facts.
16
It's nuts. I got T-boned by a driver who did not look before he leaped (he was anxious to get to get across the street to a McDonalds). The doctor I saw advised MRI's (at another facility that... he and his family just happened to own).
I went there as instructed and the two MRI's were $4,500 apiece. The machine was not even in the building. It was in a trailer outside the building.
The doctor had written a prescription that incorrectly requested MRI's where I did not have any pain. I had to go back for a third MRI. That's $13,500.
I then noticed a sign outside a facility in a nearby city - MRI's for $350. After much wrangling my insurance negotiated a final payment of $2,800 apiece. Needless to say, my unshakeable trust in the medical profession was rendered throughly shaken.
Yes - healthcare is the only commodity you are instructed by the provider (in this case a "caregiver") to purchase without being told, in advance, what it's going to cost.
Do they take advantage of the buyer's ignorance in an unscrupulous manner? Does the sun rise every morning in the East?
I'd take "socialist" healthcare and government controlled pricing any day of the week over the current self-serving gouging of the uninformed public. Whatever happened to the Hippocratic Oath? It's become the hypocritical oath!
32
@Robert
just so you know, i believe it is illegal to refer a patient for testing to a facility that the referring physician has a financial interest in.
I have to sign documents about this every year
10
@Robert
Here's a story by a health care reporter at Vox whose orthopedist recommended she get an MRI at an academic medical center, which charged $800. The insurance company asked her if she would be willing to go to a private center instead, which charged $400. As an experiment, she did. But the orthopedist told her that the $400 MRI wasn't as good as the ones from the academic medical center.
https://www.vox.com/2015/10/19/9567991/health-care-shopping-mri
I have run into this problem first hand for years. I have a medically complex child who requires weekly blood work, and our insurance policy will not cover for any non-emergency services out of state. That means any time we have wanted to go on vacation, we need to track down where to get blood work done *and* try to nail down the price. Our insurance pays 9 dollars for each basic metabolic panel. Out of state we have been quoted cash pay prices every between 27 dollars to 360. One place had a cash pay price of 30 dollars for the full metabolic panel of 7 tests, but if she only needed three of those tests (sodium, BUN, creatinine)then it was going to be 674 dollars. It took me three hours to get her doctor to rewrite the order so we could be charged 30 dollars. The only place we have had success with easy to find explanations of cash pay prices have been hospitals in Southern Florida. Everywhere else, forget it—- it’s hours on the phone talking to a half dozen people.
9
@Motherofmultitudes
The ultimate irony is that we could choose to emergency room at no direct cost, as insurance would pick up the cost for any emergency provided care. This has actually been directly suggested to me by multiple representatives when calling insurance to address out of state coverage issues. We have declined to do so.
5
Where health is involved, and definitely where lives are at stake, there should be regulation. As a society, we have to decide that profit is less important than being able to get medical treatment at a reasonable cost. The insurance companies and the hospitals are looking for profits at the expense of people who are sick.
16
Basic healthcare for all Americans should not be provided by those with a profit motive.
Sanders has it right: basic services should be guaranteed to all citizens and paid for by the government, using a "health tax" that would offset most health insurance premiums.
Notice I said "most". The Sanders detractors will tell you he is out to kill the private insurance industry, but I don't believe that is the case. Medicare doesn't cover everything.
Many in countries around the globe still have "complementary" private insurance that covers things that are not included in the government-run system. Kind of like the Medicare supplements, the insurance companies still have business.
The "Medicare for all" system as I envision it would still have these supplemental policies and the cost of procedures would be known by the underwriters, who would no longer then negotiate what the prices are - since they cost would all be public and uniform. With a lot less profit.
13
Going on Medicare w/supplement confirmed for me what a racket the health care industry is. My Beverly Hills gastroenterologist previously charged $225/visit and reimbursed me the difference after he received payment from the insurance company. He now accepts the $65 Medicare pays for the same service. Looking at EOBs for other practitioners is a laugh a minute as they bill in the hundreds and thousands and get a fraction of that bill rate. Last year a friend sought consultation at MD Anderson in Houston for cancer. He was a Kaiser enrollee at the time and therefore would be paying out of pocket. The hospital insisted it had to do all its own testing so the cost would be ... $25,000. For a consult. But if my friend paid the bill within a week of services, they would cut the bill to $17,500. Once he retired and went on Medicare and a generous employer-paid retiree supplement, he found treatment in LA and has paid little out of pocket. It doesn't have to be this way.
9
It would be a mistake to only show the "negotiated" pricing because it leaves out the real costs. Instead, require them to show their actual cost of doing the test. That would be the really shocking number to see in relation to their "price."
Medicine should be regulated like utilities. A utility has to prove to a regulator that what they want to charge is not exorbitant in relation to their costs. And the State Public Utilities Commission can set their profit level. There is no reason at all that the vast majority of medicine cannot be done this way.
19
Note that numerous studies have shown that in medicine "price" has no relation whatsoever to quality or reliability of a given medical service.
And these blood tests are so commoditized and automated in the industry that they are basically free to do for the company.
even at the lowest price mentioned they easily make 90% or more profit on each and every one.
8
@Joe Rock bottom absolutely correct I run a lab providing these kind of tests in the U.K.
Full cost recovery including, building costs and staff and training, equipment and reagents and allowing a % which will need repeat and follow up tests. You are in the £3-5 range.
Once everything is in place the marginal cost of doing an extra single test is a few cents or penny’s.
4
The very concept of having a "free market" in health care is absurd when the vendors, hospitals and insurance companies are in collusion to ensure that absolutely no one sees the real costs and prices are simply fantasy and depend only on negotiations - in which the consumer has absolutely no input.
Then again, a noted philosopher quipped that 'No corporation worth its campaign donations is forced to compete in a free market.'
23
I do believe this was the motive behind including a public option to the affordable care act; the public healthcare facilities would publish their fees, creating a baseline for private hospitals to compete with.
Right now when conservatives say that the way to fix healthcare is to create more competition, they never address the fact that you can't compete in an uniformed market.
Between my employer and my contributions and my max out of pocket, my family is paying over $30k a year into health care. You'd think there was room for profit in there somewhere with a universal healthcare system...
I'm also healthy, and don't go to the hospital. family checkups and tests throughout the year gets us to our max out of pocket.
12
in 1990, nearly 30 years ago, I was scammed by my insurance for a brain surgery bill. Having a brain tumor was terrifying, as you might imagine. Finding treatment, a hot priority! Months afterward, recovering nicely (thank you excellent surgeons at Syracuse) I get a multi-thousand dollar bill for "surgeons' fees beyond reasonable & customary for your region."
Not once during my preparation for this life-altering event did I think about shopping for a cheaper brain surgeon. In fact, I had to travel far from home just to find ONE DOCTOR who could do this particular surgery. The bill came as a complete shock. The insurance co suggested I should have shopped around. I had my wages garnished for this debt.
THIRTY YEARS later and we STILL can get clear pricing info on medical procedures and materials. Why? because if we knew, we wouldn't patronize the companies that currently rip us off. Directly or indirectly, we all pay for this outrageous price gouging.
51
@Patrise really....you should have shopped for a cheaper Brain Surgeon? How does one go about that? Google Brain Surgeons and see what their Yelp Reviews are?
15
Not only is the medical profession price gouging, they are ordering unnecessary test, either because that is the way they always practiced medicine or they are "encouraged" to do so by their corporate bosses. When a doctor orders a test, first ask if it is absolutely necessary. Many times it is not. For instance, the rule is that annual pap tests are not necessary for most women who have negative tests in the past. That doens't stop doctors from doing them every year because they always did and sending them to labs that charge enormous fees. Medicine is no longer a profession; it is big business.
6
In many cases the patient pushes for the additional/ useless tests. My docs have caught on to my approach: tests ONLY if they inform treatment need/options, and lowest-cost effective meds if needed rather than the latest ones with unknown efficacy.
4
@S.L.
as often as not it is the patient demanding tests. I cannot even begin to count the number of times patients come to ED demanding unnecessary CT scans, x-rays, blood work etc.
Then they complain about me when I don't order them and adversely affect my "patient satisfaction score". This score has been shown to have a negative correlation with quality of care.
2
@S.
Are doctors sued for doing more testing or less?
This should be an easy question to answer. You apparently need to go to a different GYN as mine never try to give me a Pap test yearly--every five years with a negative history.
This fantastic article shines a bright light on one of the multiple abuses within the medical-pharmaceutical-hospital complex. No one can claim it relates to the cost of living since NY, Seattle, and Washington are on the low end while the people of Florida and Texas are being punished. No one can claim the cost is related to "innovation" in this standard panel that has been used for many decades. The higher costs paid by insurance companies in some markets does not relate to their generosity. Those costs to the insurance industry get redistributed to all of us in terms of higher insurance premiums.
We must also consider what is so often ignored. How often are these tests repeated and duplicated without a clear and thoughtful reason and how often is important information missed when the tests are abnormal? Most patients have to also pay for a physician visit to order the test and then to review the result which likely will lead to more tests.
The reality is that our healthcare system is paternalistic, fragmented, secretive, and not driven by outcomes and efficiency. It is driven by corporate interests and paperwork without utility that obfuscates the real facts showing our declining collective health and life span compared to other progressive industrialized nations.
We need a single payer system driven by outcomes and efficiency. Those outcomes cannot be driven by patient satisfaction because more tests and patient satisfaction are closely aligned.
7
Florida rates could be a case of the patient [snowbirds] asking for the fancy/ useless tests. Or could it be the age of the sample, and medicare?
1
@Tamza
Medicare very carefully controls the cost. For example, Medicare pays about $10.50 for a CBC (complete blood count) while the actual charge is as variable as reported here. Medicare payment is the same across the country.
1
Free market capitalism doesn't work when the market participants do not have access to relevant information.
10
I had an ambulance ride last month at a rate of $40 per mile. I can't see how that rate can possibly be justified except as a means to squeeze the last drop of money possible
16
@Vimy18
Unfortunately, it sounds like you missed this gem:
https://www.nytimes.com/2018/10/01/upshot/uber-lyft-and-the-urgency-of-saving-money-on-ambulances.html
10 years ago, a physician treating me at the Georgetown University doctor's practice referred me to the main lab in the Pasquerilla Building for a thyroid panel.
At the lab, where about 50 people sat in the waiting room, I asked how much the thyroid panel would cost, explaining I was uninsured. The administrative person I asked said they didn't know. So did the next 3 people. All of them told me they didn't know. When the bill finally came to my home for the thyroid panel it was over $500.
With newly diagnosed thyroid disease, I contacted another physician in town in private practice for 30 yrs, & asked him for a 2nd opinion. During that visit, I showed him the bill from the Georgetown U. in-house lab. He was horrified at what I'd been charged & offered to take over my care & send my labwork sent out. The same thyroid panel sent from his office cost me $30.
At another point, this doctor wanted me to have a coronary calcium scan. Because I was uninsured, he called a local radiology lab t & arranged for me to have the scan for free. I asked him how he managed it & he replied "I send hundreds of patients there. I told them if they charged you anything, I'd stop my referrals."
Medical pricing is a scam. The fact not one of the 4 administrative people I asked at the Georgetown U. doctors practice lab could/would tell me the price for my test - that lab probably does thousands of thyroid panels daily - showed criminal contempt for their clients.
126
I have heard, but not yet confirmed, that seeing hospital-system-affiliated docs charges are higher. Justified on grounds that they have to amortize the overhead of all hospital services/facilities. Similar justification is given for emergency room charges being high - need to have ‘standby’ specialists and services.
Use non-hospital facilities whenever possible.
10
@Tamza
This physician is on the faculty of a medical school in the area (not Georgetown U. ) But as far as I know, his clinical practice is private and not affiliated with the teaching hospital.
2
Went for an ultrasound at an NYC hospital, a few blocks from my obgyn who just performed the same ultrasound a day ago (I have GD because of the pregnancy and was told I needed to do a thorough check at the hospital as well). My 5th ave Manhattan provider charges $200 and my insurance makes me pay the 'negotiated' price of $90. The hospital doctor (completely random person assigned to see me) charged $350 for the same code and procedure. How was I supposed to know or predict this? This is not 'free market'. This is a total scam. I have no power to find out the price before I come in (I tried on multiple occasions!) and I have no power to fight it back after the services have been provided. This is outrageous. The hospital dr wanted me to come back every week, on top of my regular doctor's visits. No way. This is a plain robbery, I am still in a deductable phase. These greedy insurances and management companies left us no choice but to pay what THEY secretly negotiated.
28
There’s a fundamental error in how we talk about “cost” of health care in this country. The cost of any particular test is not what the insurance companies pay; it’s what it actually costs to deliver the service...the labor of medical and support staff, other operational costs, capital costs of the technology and buildings, etc. Any other rational business determines the cost to create the product or service it provides, and then sets prices for profit to the tolerance of the customer and the market. Because our non-system is reversed, setting the prices with no relation to real cost of delivery, we’ll continue to be strangled by insurance companies who pay outrageous salaries to executives while being accountable on,y to shareholders. Meanwhile, health care providers avoid and flee a toxic environment insensitive to patients, providers, and communities.
11
I see Miami at the higher-end of the chart comparing common blood lab tests and around $700 as the most expensive of the Miami range. I had a recent such "common" test and the lab billed it out at $1,200. Not to mention the name of the lab company to protect the guilty, here's a hint. I wonder what their true quest is.
7
Years ago i was charged ‘full price’ [about $2000] for some tests that the doc office had coded incorrectly. I pushed back that i would only pay what i would have [about $80] if coded correctly. The doc waived all charges so as not to have an ‘error’ on their record, and the lab accepted the $80 as payment in full]. Dont know what would happen today in such situation.
1
Curious if these or other researchers looked at the *sellers* in these markets ... market concentration/competition, public/private/training hospitals, etc. There's likely a story to be told there, too.
1
I was diagnosed with advanced cancer 9 months ago, and since last summer I have received a dizzying array of new (to me) medications, tests, and treatments. Fortunately I still have good insurance through my employer, but the veil of pricing is often lifted a bit when the bills for deductibles and co-pays come in.
For the first time in my life I realize how precarious life is, both from Stage IV cancer and from the newly found fear that one day I will be devoured by medical costs. Which will come first?
10
I wish you peace and a complete recovery. I have a friend who beat stage 4 cancer. Hugs.
Wanna bring health care costs down? Do what other nations have done--totally eliminate the health insurance business. Now doctors have to waste their time attempting to convince a high school grad that a procedure is needed for a patient. Sad that a physician has to give up time to beg for approval from an insurance company. Ban health insurance companies. Keep the docs.
106
@danielp29 Yes! In value chain analysis, the health insurance business is completely non-value-added - it just siphons money away from actually delivering care.
11
@danielp29
Many countries have not eliminated the health insurance businesses. In some, one can choose the company much the same way a senior can purchase a Medicare supplement plan in the USA. All of these are highly regulated to provide a government set minimum service, plus extras, on which the public makes their choice. Many of these companies choose to increase their profits by trying to keep their customers as healthy as possible.
3
These prices reflect how hospitals make money to off set the people that they HAVE to treat that are uninsured.
If everyone had access to healthcare in a sensible way we wouldn’t need to talk about these wild price fluctuations.
In other countries prices are set...it it just barbaric to associate such profit making with peoples health.
I’ve seen it from both sides as a RN working in hospitals and briefly for an insurance company where my role was to try to deny as many health services as possible to people who paid a heavy price for their insurance.
Seeing how well healthcare works in foreign governments through our military service in both Europe and Asia I’m always taken back how Americans do not demand more for their tax dollars.
I wish that more Americans could travel to see first hand other countries highway systems, modern airports, education and health care systems. It’s frankly embarrassing that people say America is number one, the best when in reality we pay the most for incredibly poor outcomes compared to other countries.
17
@J These are lab prices billed to insurance companies. They are not hospital charges.
1
@J Americans must be made aware that the Insurance Industry is the only industry that spends hundreds of millions trying NOT to deliver a product people have paid for. It is time for Medicare For All. Advanced technology will easily replace middlemen insurees at much less cost.
12
@Scott D
hospitals do the same thing at even bigger mark-ups. Just TRY to find the cost of your cardiac cath, MRI or lap chole before you go in - and prices run the gamut.
2
My insurance statements typically come back with two prices: one what supposedly was charged, which often seems excessive and another price, what the insurance company pays, which sometimes seems too low.
Is list price what is called a "moon price" in other countries, that is, a charge rarely if ever imposed, but used to make claims of "sales"? Or is it a real price that some poor people
without insurance (or without good insurance) pay?
I have no idea. In either case, the public loses.
3
I do not believe in signing blank checks to anyone or anything. This is what I do when I go to a healthcare facility. The technology exists where the consumer/patient can be informed prior to signing a consent for both the services to be rendered and paying costs not covered by insurance to know out of pocket expenses. Whenever I go for healthcare insurance billed services I either do not sign the consent or add to my signature that I will only be responsible for payments authorized by my insurance. Even though I have read consents that state changing the language of the form is not allowed I have yet to have an intake person refuse to process my consent. I have successfully prevailed in being financially responsible for two separate excessive charges by using the above practice.
Healthcare costs are out of control and the onus falls on the consumer who has little recourse when it comes to the billing practices of healthcare facilities. Until Congress effectively protects its citizenry it is up to the individual to protect himself/herself as best as possible.
5
@BBKing-- A dear friend of mine recently died of cancer. Over four months, every time I took her to the same hospital for an emergency or routine scheduled treatment she had to check into the Admittance Office for insurance purposes. That happened at least five times I took her in. They would ask the same questions over and over and solicit her signature on at least three pages. Ask about costs? The admittance clerk is trained to say, "Sorry, I have no idea"!
5
The argument that a full-disclosure, single-payer health care system will cause mass unemployment in the insurance market is not the argument to fight AGAINST this type of system. We are capable of retraining unemployed people!! I believe the insurers along with pharma have a death grip on our health care system, and while I think Bernie's overall platform will not be good for America, his health care vision is spot-on. He should be the health-care czar.
11
@J. G. Smith Then Bernie should remain a member of Congress where legislation to make the changes he proposes comes from. It can't be done with executive action.
1
I always laugh when articles recommend finding out in advance what a procedure will cost, or what the out-of-pocket will be. Anyone who has ever tried this -- even with all the codes in their possession -- will find it impossible. Overworked office staff can't get overworked insurance drones to even look these things up, and even when they give you a price, no one will stand behind it and guarantee that that is actually what the bill will be. Get it in writing? HA! My under-65 husband needs a cataract operation which is not covered. Medicare would cover it. Their reimbursement is $797. We are getting cash-payment quotes of over $4000.
32
@Heidi Yorkshire
Isn’t it interesting that amazing technology exists for things we don’t REALLY need...for example I can play complicated games online with someone in Tanzania or research info about Game Of Thrones minutiae but there apparently isn’t a computer program available to medical operations that an employee could reference quickly to find out the cost of any procedure or test on demand? Mark Zuckerberg, are you there? Can’t some tech genius help out their country and come up with one?
4
Clearly the present profit-oriented health-care system is criminal in its ethics even though the laws permit these crimes. Shame on us as a society for permitting this. The solution must, in the end, be to drive profit-taking out of health care. The rest of the developed world does not allow this madness, and America spends more money and has poorer outcomes. We are fools in what we permit, and we are collaborators in moral crimes in permitting this.
12
@Che Beauchard...There is nothing wrong with profit. Grocery stores make a profit, the prices are marked right on the shelves. The problems with the cost of healthcare is there are too many middle men with their hands in our pockets.
1
It hasn't always been this way. Back before about the mid 90's, doctors billed the patient, and the patient submitted the bills for reimbursement. It sounds like efforts to manage the rising cost of care have actually made it worse.
7
The lack of transparency in health care pricing is absurd. My own personal small example. In recent years I've had some knee issues one of which required arthroscopic surgery. In addition, I had a couple of MRI's to determine the issue. I attempted to discuss cost with my doctors, the MRI provider and my insurance company. No one could ever tell me how much anything would cost. My doctor was very honest about it. He said I get asked this a lot and I don't know the answer. I know how much we'll submit to your insurance but I don't know what they'll actually allow or what they'll charge you. Plus you have fees owed to the surgery center and the anesthesiologist among others which go through same process. Even with the MRIs which were one service provided by one provider (except the small radiology diagnosis fee), none of the parties could tell you how much it would cost. No one at the insurance company could ever look anything up concerning cost beyond "market average" which were not accurate (Aetna told me the average cost to an insured in my area for a lower leg MRI was $750 - got my bill, it was about $2,000). Its all fine and good to say people should be informed consumers, but its pretty much impossible to do that in our current system.
13
@Charles And yet when one goes in for elective surgery, they ask for one check in advance that covers all those things; the doctor, hospital, anesthesiologist, etc.
1
I don't why my hospital (Spectrum Health) in Grand Rapids has an an additional fee professional fee of five dollars tacked on to my lab tests
3
@Frank to pay the people making 10 dollars an hour doing the lab work
1
People just don't appreciate that private jets, third homes and college bribery is expensive too.
32
The whole system is a legalized stick up.
No different than a hoodlum sticking a gun in your stomach and demanding your wallet and watch.
6
I'm very much a free-market libertarian, but our healthcare is anything but a free market. Free markets are based on the principle that consumers know the price of the good or service they are purchasing, which is entirely impossible in healthcare. I'm all for these disclosure laws. Information makes markets work.
6
@Jeff...Free market is also based on a knowledgeable consumer that has the option of switching providers or indefinitely delaying a purchase. When you examine things carefully you come to the realization that with healthcare, a government run single payer system actually comes closer to the free market model than what we are doing now.
4
Blood test in Halifax cost $15. period, and that's one of the few things that are not covered by our universal health care system. It's time for you to listen to Bernie. Glad we don't have those beloved health care insurers Trump boasts about.
21
@bruceo
You must be very young. You don't remember when Stephen Harper proposed changing the health care insurance system in Canada to conform to the US model.
This stops when we the people demand basic reform in health care pricing, starting with full disclosure. US spends 17% of its GDP on health care compared to 13% on average among comparable European countries and Canada.
We can't wait for Congress to require health care providers and insurers to disclose real prices. For the same reason that we can't wait for Congress to fix our tax system and ensure that rich companies like Amazon pay their fair share--or any--tax. Why won't Congress act?
For yrs, on dozens of occasions, the R-controlled House voted to repeal Obamacare. Do you ever wonder why the D-controlled House doesn't vote out a tax reform package or truth in health care pricing bill? Because the donor class, which patronizes both parties at the expense of the people, won't let them.
10
@maqroll....Disclosure would help, but for a free market to work the consumer also has to have the option of switching providers and indefinitely delaying a purchase. Never mind the fact that most healthcare consumer don't have a medical degree so they themselves can decide what steps and procedures are required.
3
Imagine if you went to the grocery store and a dozen eggs would cost $2 or $90 based on your brand and category of "egg insurance." If you had no insurance, you'd be on the hook for the $90 eggs. If you could afford low-cost insurance your price would be $50 after a $40 "rebate." You get $2 eggs but only if you pay $100 a month for high quality egg insurance.
The health care system has, over the last 30 years, grown into a predatory monster that is strangling the country and endangering the financial future of all of us.
Reform would be nearly impossible even if Congress weren't bought and paid for by drug companies, doctors groups, hospitals and insurance companies.
But given that the Senate, the White House and the Republican Party are all paid tools of the health care lobby, there will be no reform. This runaway, outlaw industry is going to continue to bleed the American economy dry. This won't stop until the entire American population is impoverished.
356
@Tom
this does occur - for luxury items
eg, the cost of a bottle of scotch whiskey varies by >10fold
ditto for jewelry, art etc
the cost of an apt varies by more then 10x across the country, I think
candy - now that we have "luxury" candy, you can pay a dollar or 10 for chocolate
1
@Tom
I agree with everything you said, but sadly, history shows us that the Democratic party is just as complicit in their being beholden to the health care lobby. It's really disgusting.
18
@ezra abrams - 1. In the cases you mention, what you get is the same no matter what you py. In the case of medical care, the care may vary tremendously, but you have no way o knowing which is better.
2. In addition, in your cases, you know the cost up front. This is not true in health care.
16
I'm in IOP (Intensive Outpatient) care now where they charge either $625 per urine screen or $1325 ($625+$700). The additional $700 charge which appears on most urine screens cannot even be explained by the lab the IOP facility uses.
The lab walked me through requesting assistance (told me how to lie) since they don't take Aetna insurance but the lab is receiving the full amount for others whose insurance covers the screens.
How the heck do urine tests cost such an exorbitant amount? This is utterly ridiculous. It seems scandalous to me. Now when they order everyone to be screened after they've just done screens a couple nights prior, my first thought is we're being tested to generate income.
This is no way to run health care. Both parties should be able to get together and work out a way to avoid such abuses.
8
You might want to consider comparing the cost of office space. I would venture to say it costs much much ... much much ... much much more to maintain an office in San Francisco or New York.
I had an aortic valve replacement via TAVR (through leg) at NYU Langone. Overnight in hospital. Charge was $370K, insurance paid $360K.
3
Who says our health care system is broken?
2
Giving people such knowledge is simply Anti-American, Anti-Freedom, job killing Federal Regulation. No Real American would ever want this sort of Information public. It is the start of a slippery slope that will lead to Cuban style communism and national poverty. Every Conservative is against this type of knowledge being made public, and the country has consistently voted against such a government takeover of the best heath system in the world, according to al Republicans.
10
More evidence of the gross irrationality of the private sector. Believers in the "free market" as a solution to health care should be forced this explain this absurd lack of price integrity. It's essentially theft, as patients are vulnerable, often don't have the option of shopping around, don't know the price ahead of time, and insurance pays most of it so they don't necessarily care. Anyone but the most deluded right wing fool can see this for what it is; looting and profiteering from sick and vulnerable people and the insured pool as a whole.
9
@Melmoth
Here's your explanation: government approved greed which leads to campaign contributions and other "favors".
4
@Melmoth....There is nothing wrong with a free market. The problem with healthcare is several of the necessary requirements for it to work are absent. Most consumers of healthcare don't have a medical degree so they can't independently evaluate what is required. Further a free market requires the consumer to be able to switch providers and to indefinitely delay a purchase. The truth is that when you examine how a free market works, a government run single-payer system actually comes closer to meeting the requirements than what we are doing now.
3
Only Trump can fix this . . . .
2
@Blue in Green
"Only I can fix this." - one of President Trump's documented 10,000 lies in office.
3
Until patients/consumers have quality choice in health care providers/hospitals and transparency in pricing, there is no health care “market”. Technology has revolutionized transactional transparency in real estate, travel, hospitality/accommodations, transportation, insurance, financial management, etc. and wrested some of the control of these markets from their respective stakeholders. Health care is long overdue for the same type of transparency revolution. I don’t oppose single-payer, but transparency is a much simpler and more straightforward place to start addressing these issues.
5
This is why we need federally financed health insurance (which is NOT the same as "government medicine." If everybody were covered by Medicare, Medicare would waste no time in establishing reasonable uniform prices for medications, tests, and procedures with allowance for differences in local cost-of-living. I find it shameful that, as a physician, the overall care that I have provided in the emergency room has probably bankrupted more people than the number of lives it has saved.
60
@Phil Brewer
That would be so if the republican party were loyal patriotic Americans who wanted the people to have the benefit of self government.
Since it is not true of them your idea will not happen until they are made to go the way of the Dodo
8
@Phil Brewer
Medicare is forbidden, by federal rules, from negotiating prices for medications. I lost my thyroid to cancer, now on Synthroid. I ordered the same drug -- same brand name and not generic, Health Canada approved -- from my favorite Vancouver pharmacy. got a three month supply for less than the copay under Medicare for one month's worth!
6
@Phil Brewer
The State of Maryland already works this way. For 25 years we have received a lump sum distribution from the Federal government for healthcare. And no matter who you insurance is from, *all* healthcare claims are reimbursed at the going Medicare rates. Note that the lab test in Baltimore is so inexpensive that we are at the bottom of the list.
2
When I tried to find out the cost of a procedure, I got the run-around, and when I persisted, my doctor's office chose to refer me to another doctor rather than tell me the cost. Last year I needed a diagnostic test for cervical cancer. I'm on Medicare, but Medicare doesn't cover everything. So I called Medicare to find out the cost and if it was covered in my case. After a number of calls and long times on hold, I got the amount Medicare would pay for the procedure. But Medicare couldn't tell my if the procedure was covered in my case; Medicare said the doctor's office would have to call to get that information. So I called my doctors office. They called back to say they didn't perform that test, and referred me to another doctor. I called back and got someone else, who was happy to schedule me for the procedure, until I asked about the cost. Then once again they told me to go elsewhere. So my doctor's office was willing to lie to a patient rather than give price and coverage information.
33
@Marjorie Buy a Medicare Supplement or a Medicare Advantage plan if you want to have coverage for what Medicare excludes or limits.
@beth
No additional health insurance would cover her from medical providers' lies
@Sylvie That's not what this article is about.
I have two primary concerns with an analogy in this article. First off, the insurance company is not buying 1,000 of anything. Individual patients are buying one apiece, and the insurance company is merely the paying agent or bundler. Much more important, no one NEEDS a hamburger, and as the author points out, if someone does, they know the price in advance and have the option of shopping elsewhere.
I find it really distressing to receive laboratory bills where the list price of a test is more than $1000 but the insurance company price is less than $10--a frequent occurrence. I am fortunate to have insurance, but would gladly pay more if that were the price of equal access to health care for all--and if there were some assurance that all would receive the care they need.
8
Health care is not a free market. The reality of health care makes it close to a monopoly, where hospitals can charge whatever they want and people have little choice but to pay. Healthcare is not easy to price because health is not easy to price. This is why we need regulations and single payer system.
16
@Kris
There are plenty of health care expenditures that are not urgent and you have choice (where to give birth, where to get a MRI, hip replacement, repair an ACL, etc...)
Even without going to single payer, making health behave like a free market would be an immediate benefit to society. Today it is almost impossible to find prices and make an educated decision where to spend your healthcare money.
1
@ModerateNerd
Even in those circumstances where choice is possible it is eliminated via total price opacity
The truth about our economy even when it was well regulated is that most sellers are trying to steal from you as much over what is reasonable profit as they think they can get.
It is stealing because it is over and above the reasonable profit margin which is 15% or less depending on the thing being sold.
11
This argues that national health care is needed. Health insurance companies are not going allow a level playing field. Its bad enough that pharmaceutical companies are taking once inexpensive drugs and making them extremely expensive. The crazy quilt of costs makes medical services unpredictable. Hence the reason why US health care has the worst medical outcomes and the highest cost.
10
“One person buys one hamburger, and another buys 1,000,” she said. “And it completely makes sense that the guy who buys 1,000 hamburgers gets a better price.”
Yes, that is the argument for a public option or medicare for all.
Does any other country have this disparity in pricing, particularly within markets?
78
A very hot topic among laboratory medicine professionals is Appropriate Laboratory Test Utilization i.e using laboratory tests wisely by not overordering and ordering only when appropriate; however, there is a darkside to this topic; namely, that hospital labs want to decrease their inpatient tests to save resources and increase their testing for outpatients where the reimbursement is quite lucrative relative to the hidden cost of the test. A comprehensive metabolic panel for reagents costs about 2 -3$ when labor and related costs are added in; maybe 10% for an entire CMP; that's why the cost of the test is kept secret! because they are very inexpensive at the volume they are done.
8
Next time somebody tells you that great medical care requires allowing the invisible hand to work its quality-raising, cost-cutting magic, show them this article.
10
My insurance (blue cross Illinois) has started a program that sends me a check if I agree to go to their provider of choice for things like MRI'S. So the last time I had a MRI I got a check for $100 instead of a bill for $400.
14
Clearly, there is no real substantial market in health care -- customers do not even know the price before buying and collusion and monopolies are allowed
So why call our health care system a market-based system?
Sure, there are some market =-based features to our system. But there are market-based features to Medicare and Medicaid, and they are called government systems.
If we cannot even call our system by a meaningful name and if we cannot describe it in a way that matches with its reality, how do we expect to have serious discussions about reforms or major changes?
We need a central clearing house for health care information to be able to continue our discussion of this. A Congressional Committee should put together the key numbers: How much are employers paying for health needs of their employees, how much are the employees paying in premiums, in co-pays, in deductibles, in co-insurance; how much are those whose medical insurance is not offered by their employers paying for insurance and out-of-pocket expenses. How much does Medicare cost on average per person. Are Medicare payment schedules sufficient to fund the health care system if extrapolated for everyone.
Only when such numbers are made known can we begin to know cost vs benefits of any change. And if these are not forthcoming we should probably assume the costs would be less and the benefits more, otherwise why is the insurance industry (and Big Pharma and hospitals) so reluctant to post the numbers?
34
@JustThinkin
I fully agree with this. People are quick to jump to the conclusion we need single-payer healthcare, but if no one is watching the pricing carefully, any insurance system will continue to be overpriced. Force transparency in pricing and let the free market do its thing. This should be politically palatable for both parties and make an immediate difference for the many millions of Americans on high-deductible insurance plans. Might help those on HMOs too!
1
@JustThinkin I call it a for-profit system rather than a market based system (or a rights based system).
2
@Josiah
That is better than market-based, but some of our current system is non-profit. But this of course requires that we agree with how "non-profit" is used commonly -- If an organization is non-profit its officers, CEO, etc. can still get exorbitant compensation. This is a detail, but can confuse the issue if "non-profit" is not explained when it is used.
2
The price for medical diagnostic procedures or therapy needs to be governed by a negotiated price list -- just as other public utility charges are. I can conceive of no defensible reason why they should exceed what is charged for the same in Germany, France or Canada. Arguments to the contrary are sophistry.
21
As a practicing physician this sad article is no surprise. Some additional thoughts. The only health care services which obey market forces are those services which do not involve the insurance industry such as cosmetic plastic surgery, Lasik eye surgery, Botox etc. Its not the cash payment, it is the third party insurance company which destroys the market forces controlling costs. I think the statement by the Carnegie Mellon economist needs to be broadened. instead of "Some of these really simple diagnostic tests-what the heck? It does mean, in a sense, the market is broken in terms of problems with market power" The statement should read "In terms of health care pricing, the market is broken." We should either return to a free market system with all the pain and suffering of those who do not have ready resources to pay for healthcare will endure or join the company of the other developed nations with universal health care. Given that health care is 17.9% of GDP in the US about twice that of the other developed nations and we rank 30th in life expectancy, infant and maternal mortality, I think the choice is clear.
150
@David Sharkis
While insurance companies are a big part of the problem, I can't let Doctors off the hook David. Most healthcare providers I've encountered do little to help the patient navigate the pricing. They cannot provide estimates of what the visit or procedure will cost. They make treatment decisions without thinking about more cost effective alternatives. Yes, the pricing landscape is complicated thanks to the insurance companies, but most doctors I've worked with put very little effort in to providing quality and COST EFFECTIVE care to their patients. They know this matters to patients, but don't care to change how they prescribe treatment.
3
@ModerateNerd
If your doctor won't tell you what basic visits and procedures cost - change doctors.
1
@ModerateNerd
Many doctors cannot figure out the pricing because in order to be compensated by insurers they have to sign confidential contracts with each and every one, sometimes multiple contracts with an insurer to cover different plan types. Each insurer has their requirements, making what appears to be a simple procedure a very complex equation depending on the patient's coverage. It would be simpler if they modeled payment on the game Twister and we would know we hit the jackpot when the spinner instructs left elbow on green dot.
10
Imagine going onto a car lot, being told which car to buy, driving away with it, and then being told 3 months later how much the car cost you. Also, you need to pay it within 2 weeks or be fined, despite the provider's egregious billing delay.
This is how healthcare billing works, and it is utterly despicable.
322
@MC Even better.... your car you bought constantly breaks down and you find out you were sold a lemon and aren't allowed to return it.
I recently left a rural ER in massive pain due to a fall. They called it muscle strain after xrays. I went to a local ortho in CT and they diagnosed two fractures in the pelvis (using same xray) and a shattered acetabulum (hip socket) using a CT scan. Now the ER wants their $3600 despite missing the diagnosis.
72
@MC
And imagine the price you were billed for that car is 87 TIMES more than your cousin was billed for that exact same car in his town.
34
@MC You mean this is how healthcare billing "in the U.S." works. And it's a big reason Vermont Senator Bernie Sanders is running for President; he intends to correct this situation.
12
As long as healthcare is considered a for profit business in the US... this will not change. Worse... the power to negotiate and to reap discounts rests with the plan administrators.. the insurance companies.
Note: I'm all for medical professionals earning a good salary, my issue is with the corporations that own and control so much of the healthcare supply chain.. and work to maximize profit over health.
Until we have some derivative or equivalent to medicare for all where a single administrator controls and enforces fee structures and middleman companies are removed from the equation ... this nonsense will just keep getting worse. And it disproportionately benefits the more wealthy consumers who have better plans available to them, while the poor have medicaid style umbrellas ... leaving the middle class in the balance for the "big squeeze". Corporations know where the squeeze play is.... it rests with the middle class.
41
@Chuck For profit or non-profit the situation is the same. Until very recently MN required ins companies to be non-profit to sell plans in MN. It was the same situation/same game. BTW - United Health Care (a for profit insurer) was successful in getting that law changed.
2
This is the prime reason we will not have an affordable health care system any time soon. These companies simply make too much money of of their secrecy and opaqueness. And they have the money to buy off all of Congress.
118
Professor Starc: "The variation in prices in health care is much greater than we see in other industries."
One datapoint indicating that free market principals do not work in healthcare. Another datapoint is the cost of diagnostic scanning tests has increased as the number of scanners has increased.
While a capitalist at heart, I'm convinced by evidence that market based solutions to our healthcare issues will not work.
8
Price gouging is illegal in times of war or other emergency. We are in a continuing health care emergency, and the medical/insurance industrial complex is at war with the public. Make price gouging illegal, and require all insurers and providers to publish all pricing.
14
good piece.....and explains exactly why a Medicare-for-all type of nationwide program would cost *far less* than then what we have now.
when 20%-30% of your bill goes to pay for the salaries, time, paperwork and theadministrative costs absolutely required to negotiate all these little side deals for not only your insurance company but also your Dr's office and the hospital or other provider, its pretty easy to see how close to a full elimination of these inefficiencies would unequivocally result in a much lower and much less variable pricing structure.
and thats even before you factor in the crookedness of the biggest crooks; big pharma.
I have to several very specific but common blood tests done annually. if I book thru an online provider, that processed by the exact same lab my Dr uses, one costs $30. even AFTER my insurance provider pays (and I have good coverage) my out of pocket is higher then if I book it direct. what kind of a nitwit cant figure out which option is better? and note that laziness, familiarity etc on part of some consumers allows the discrepancies to exist.
4
Markets are wonderful things.
But markets simply do not work for healthcare.
None, and I mean none, of the necessary features for functional markets are present when it comes to just about any kind of healthcare.
So we should have zero markets in healthcare.
You need a totally different system.
Dahhhhh.
8
This is common practice in drug rehab clinics across the country-- scheduled blood tests, required common procedure in rehabs, are ALWAYS billed at hundreds of dollars each.
Single-payer health insurance-- covering public health clinics, hospitals, rehabs, labs, mental health providers, and pharmacies-- is the only way to bring costs under control, and to provide affordable and quality healthcare to all Americans.
7
It's even worse than that. The $11 price is a 10X markup from what it actually costs to do the test! These tests are fully automated and they run millions per year in a single lab. No one touches that blood tube once it gets to the lab. It is put on a machine and goes thru the testing and prints out a result. Doctors are not involved. Med Techs sign off that the results are correct. They are still making 90% profit on each test. I have seen panels of 10 tests that have a total in-house cost of $100 (labor, reagents, machines, maintenance, overhead included) , but they charge $1,000 for it. That is universal in the medical field.
62
I was a medical technologist in one of my former lives. There is no such thing as a simple diagnostic test. All tests have to be run with controls, standards, have to be performed by someone that knows what they are doing, and is certified to do so.
All tests have measurable error and some unmeasured error.
On top of that, the cost of a test is difficult to measure.
2
@Milque Toast pretty sure that's not true. You measure the input costs, add a percentage for margin and, voila, there is the cost of the test. Not really rocket science.
10
There is no rational reason to have secrecy, either from insurance or from the stakeholder, in such pricing. These secret arrangements will always undermine any kind of government regulatory policy. Why should this be allowed?
3
Is there anything wrong with this math?
My net pay in 2018 was $40,000
For health and dental $5,300 was taken pre-tax.
My employer paid $23,200 for my health.
Total employee&employer health expenses = $28,500
$40,000 + $28,500 = $68,500
41.6% of $68,500 is $28,500
It's really discouraging to see 41.6% of my income going to healthcare, even more when copay and prescription expenses are taken into account. One would hope that employers pass savings to employees or that at least I never have to worry about any medical expenses. I'll also feel good about pitching in so the less fortunate can be worry free regarding any type of medical treatment.
185
@Jidcman What you have written about is extremely important and it is rarely mentioned in the health care cost debates. Employer provided insurance is so costly that over the last decade much, if not most, of the gains in overall employee compensation has gone to health insurance rather than salary. Expensive health insurance is also a driving force in companies' decisions to to not increase full-time positions. When people suggest that changing to a universal health care system in the US would be "too expensive", I don't believe they are looking at all the costs of our current system. I am fortunate to have excellent "employer provided" health insurance. Nevertheless, I support a change to the US system because I recognize the limitations, basic unfairness and the ultimate un-sustainability of such employer-provided insurance.
98
@Jidcman EXACTLY. I remember when the Obama administration started requiring that separate tax document about what my employer paid for health coverage. I remember everyone told me it was because the government was laying the groundwork to start taxing our health benefits. I remember being absolutely floored to find out that my employer was paying thousands upon thousands upon thousands of dollars (like 6k ish) so that I could have a health plan with a deductible so high that I couldn't afford to go to the doctor. I had to pay $150 dollars or so just to get antibiotics after I'd been sick for three weeks and couldn't take it anymore. I guess my employer was paying 6k so that I didn't get charged 1k for my doctor's visit? HOW IS THIS RATIONAL?!?!?!
49
@Jidcman
Relax ... the President has a plan . It's going to cover everyone , at a "tiny fraction " of the cost ! Interestingly,
you might get sick of being so healthy and paying so little for it.
We just have to wait for the plan and for Trump to formulate the plan. Maybe he'll put Steven Miller on it.
23
Private insurance companies take our money for premiums and then deny payment for many services. There is no concern for actual health care only keeping the shareholders happy and continuing the greed that is the American corrupt health care system.
120
As someone with thyroid disease, I get regular blood tests. I have never paid more than $30. When my doctor stopped taking insurance (which has become all too common), I switched doctors. He sent me to an affiliated lab in the same building and the lab billed $1,200! Because it was not an "approved lab" even though in was an in-network facility, the insurance only covered part and there was a $500 deductible (which would not have applied if it was an "approved lab"), so I was on the hook for about $580. The insurance company offered no assistance. After I filed a complaint, the doctor's office was able to get the lab to accept the amount the insurance had paid as a "one time courtesy". Ridiculous!
137
@RAR,
So what are you doing (and paying) now for thyroid tests?
@RAR I also have thyroid problems (and have had for over 20 years, becoming hypo as a young adult). I have seen the same nonsense; I have also seen an increase in the price of thyroid medication (I take Armour, because none of the others have worked reliably) from $9 for a 90 day supply (I always paid the real cost of the drug, because the insurance deductible was higher), to today, when the same dose costs $153 for a 90 day supply. None of the Medicare Part D plans sold in my area cover ANY of the full-spectrum thyroid medications.
The tests (and some insurance policies will only cover testing for TSH, not the full thyroid panel) run along the lines you have discussed.
Thing is--when your thyroid is balanced, you’re healthy. When it goes off, things get out-of-wack.
11
@Paul B. I was told by the insurance company to go to an approved chain called LabCorp and then it would just be a modest copay (no deductible). The lab who billed me was classified as a "hospital lab" (even though it wasn't in the hospital) by the insurance company (in network) but completely different billing policy.
2
My doctors office started calling me a week before my scheduled exam to come in and get labs done. i have ins thru my employer. When I was in the chair, my arm bound waiting to be stuck the lab tech casually mentioned "we don't know what your ins will cover so we need a credit card auth for $50. As he stood there waiting I reached for my purse feeling stupid and intimidated. I gave him the card. Only then did he draw the blood.
It bothered me so much I called the doctors office later asking why they didn't tell me in advance the lab tests were billed separately from the office visit. I would have called my ins company to ask about coverage and decide if I could afford the tests The office didnt understand. they kept telling me how my insurance wasn't "transparent" and how things"come up". No, I understand if I'm there and there's a concern. This was just in advance of a routine office exam.
Long story short, I picked up my results, they were fine, I cancelled my upcoming appt and didn't return to them. I'll know going forward to ask any doctor what's included in an office visit and follow up with my ins co for coverage details. My insurance did cover 100% but this office lost me as a patient.
68
@Ann It's like going to a hotel and having to put down a credit card in case your insurance company does damage to the room.
6
@Ann I made an appointment with a new allergist and when I got to the office, the first thing they asked for was a $400 deposit, in case my insurance would not cover all the tests they expected to do on me as a new patient. I have excellent full coverage. I said I just wanted an office visit without extra tests but that was unacceptable to them. I guess they had new, fancy machines to pay for. Walked out. The greed of the medical community is astounding.
23
@Ann My husband and I are retired and when we moved to a new state to be closer to our grandchildren we had to buy a new individual insurance policy since we could no longer be in network with his retirement plan and the cost of the out of network policy was outrageously expensive. We wanted to find a GP for annual physicals which is supposedly fully covered by our policy, but they wanted us to pay upfront $100 each to cover tests which were not covered by the insurance. When we questioned it, the additional tests were not necessary since we are both healthy. We stopped going to that office needless to say, but as a healthcare consumer, you have to be constantly vigilant that you are not being overcharged or being charged for unnecessary tests. Also you have to make sure that you are not charged for an office visit if they want to discuss your test results with you. The healthcare industry is trying all the tricks in the book to get your money from you. A scam!!
5
How long are we supposed to put up with this? Honestly, people, vote smart and in your own interest!
150
@Deborah "How long are we supposed to put up with this? " As long as people keep voting for right wing politicians this will continue.
46
@Joe Rock bottom
Don't let Democrats off the hook either. The medical/pharmaceutical/insurance industry complex is one of their biggest donors.
10
@Joe Rock bottom Here's the voting problem: I can vote for one representative in the House and one representative in the Senate. So I can affect 1% of the Senate and 1/435th of the House or .22%. Since our Congress is bought and paid for by special interest groups, we would need a national organization, funded by tax-payers and employers, with enough heft to threaten a veto proof number of Congresspeople with not being re-elected if they don't overhaul our current system which is virtually universally despised and considered corrupt and greed-ridden.
5
"Your Money or Your Life"
-Official motto of the American Hospital Association
191
@Green Teano, it frequently is:
"Your money AND your life."
13
The shroud of secrecy around the entire healthcare industry is the biggest economic scam in US history.
We hear we cannot have universal healthcare because it will be "too expensive" and we need a "free market".
What free market? The only "free" part is the free ride that insurance companies, pharma, device makers etc. get rigging this system in their favor.
A free market requires informed consumers and choice. A consumer has neither here.
433
@Kelly
Well, those who get government services have no "choice" either.
Just try to sue a government agency, which has the iron-like protection of governmental immunity.
I'm confused by the chart on test prices. What do the the "10th percentile" and "90th percentile" refer to? If they reference the prices shown on the bar, does that mean 10% of tests are priced above the higher bound shown and 10% below the lower bound? Also, is the dot the median price in the market (50% higher; 50% lower)? If so, how can the median price be the same as the lower bound (as in Milwaukee), unless 50% of tests are below that price?
It's interesting that if you draw a line through all the bars at San Francisco's median price (assuming it's the red dots), then all but five markets have median prices below $120. The outliers are Miami, Houston, Tampa, Dallas and Atlanta, all in states that failed to expand Medicaid. It's outrageous that some insurers and providers in most markets wind up penalizing consumers with high deductible plans by failing to negotiate reasonable rates. But we also seem to have a state-specific or regional problem.
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@Merrill Consider the sequence: 10, 17, 17, 17, 17, 17, 18, 19, 177, 200. In this sequence (ranked for your convenience), the 10th percentile and the median happen to be the same: 17. This kind of distribution with a long right tail is called right-skewed.
The fact that the upper half of all blood tests see much larger price variation may suggest a selection story. Sicker patients select into the more costly facilities, and even the same procedure may cost more when performed on these patients. It would be interesting to explore whether the patients who are subject to higher prices of the same test are indeed sicker. Distribution of the prices conditional on, say, diagnosis, would be a good starting point.
I also strongly dislike the fact that the Upshot ranked the cities based on the 90th percentile price, rather than the median. It confuses readers who are less experienced with statistics. Facts are more important than sensationalism.
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Health care is a for profit industry. Consumers (insured patients), once they have paid their annual premiums rightly think they should use as many services as possible. Why pay thousands of dollars for something and not use it? Insurance company profits are limited by law to a percentage of premium income; increasing this income increases profits. So when insurance companies negotiate with sellers (so called providers), both sides have an incentive to have prices as high as possible. So the insurance companies and the sellers approach setting costs as the French Kings looked at taxation-"like plucking a live goose, the most feathers for the least hissing". We are the geese.
We need to be very careful of those who promise easy solutions.
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@Michael Feely
They also make money by denying coverage.
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I know what I am about to say refers to dental, rather than medical, procedures. But the impact is the same. I see a dentist who, if you have insurance of any sort (even very partial), charges you the amount the insurance co. allows (minus what the insurance co. pays). What that means for me is that without any insurance, he charges me alot. With any insurance, his fees go down. So I take minimal dental insurance at market rates and pay less.
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@J
There are other dentists.
@J: Your dentist is unusual. Most dentists will balance bill you for what the insurance doesn't pay, at least with respect to procedures. Many or most will take whatever the insurance pays for cleanings.
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@J My latest dentist has discussed the costs of dental plans with me, and has stated that most dental plans aren't worth it. A $30 premium x 12 =$360, you get preventative, 2 visits at $100 each for free, some small breaks on fillings and crowns, that is it. So if you have reasonable personal dental hygiene, daily brushing and flossing, most dental insurance costs more.
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One reason I suspect that hospitals set high list prices is to create artificially high "bad debt" write-offs for the uninsured.
Remember, almost all US hospitals are, ostensibly, non-profits - and as a result, though they may pay the managers, chief executives and practice leaders enormous pay checks, they do not want to appear to be making a profit. By setting high rack rates, the hospital can then take a very large bad debt "write-off" when they have an uncollectible uninsured patient - in effect putting it on the cost side of the balance sheet, or at least having that option.
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@MacK
You are making an incorrect analysis. If the hospital bills $1000 and then "writes off" $900, it has income of $100. If it bills and collects $100, it has income of $100. There is no advantage, tax or otherwise, to the write off.
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@MacK
They collect on 10% and sell the 90% unpaid debt. So they come out ahead.
The lack of price transparency in health care can be Kafkaesque, to say the least. In trying to decide whether or not to use my wife's (very expensive) health insurance to pay for a TENS unit, we called her insurance company. After a long phone call with several transfers, we were told they would pay 50% of the cost from a specific supplier. 50% of what? Well, we would have to call the supplier (the only one within 150 mi) to find out. So, calling the number they gave us, and after a similar long series of conversations and transfers, the supplier would not tell us a price. This apparently was between them and the insurance company they contracted with. But all we had to do was order one and they would send us the price (along, presumably, with the bill). So, after a little web research, my wife found the number for their warehouse and was happily given the price; $250-$400.
Of course, at that point we ordered a pretty good one off of Amazon for less than $100, allowing our insurance company to pay nothing.
I simply cannot understand why Blue Cross would "negotiate" a price that is well over the typical on line one, even when paying only half.
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@Bob Same thing with my wife's first brain biopsy. It was out of network (most neurosurgeons are) and they told us to bring a down payment of $5,000 for the surgery which was the next day. I asked the total cost so I could tell the carrier, they said it was up to our carrier what they reimburse the Dr. The carrier said it was up to the neurosurgeon. Neither side wanted to go first, just in case they left money on the table.
At the end, it was $35k for the in network hospital that hosted the surgery and recovery, and $35k for the neurosurgeon. Total time of surgery was about an hour.
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@Bob
The insurance company gets a volume rebate so does not pay 50%. Only you do.
Could it also be that most people buy ketchup with money from their own pocket, in a direct transaction? How much would ketchup cost if third (and fourth) parties managed the financial transaction, and we never saw any money change hands?
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De facto criminal is the only term to describe it.
Start a universal, affordable, quality health care service that the rest of our peer countries have run for by private industry but price regulated by the gov't.
The rest of our peer countries do it 1/3 to 2/3 cheaper with better results re life expectancy, infant mortality rates etc. etc. and everybody is covered unlike in this country (pre ACA) with up to 50 million people uninsured.
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Mandatory public disclosure of negotiated prices would eliminate the disparities very quickly, but the new price wouldn't necessarily be the lowest price. Hospitals still have significant pricing power and would make sure to cover their costs. But public disclosure is a start.
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Secrecy is half of the problem. The other is that a multitude of private insurance companies, which exist to collect premiums and deny benefits so that shareholders can be enriched, don't have anything approaching the bargaining of a federal single-payer system.
These price ranges are morally abhorrent, and should be illegal.
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secret prices are negotiated in secret between hospitals and insurance companies, whose executives are very well paid
eliminate the insurance companies
medicare for all
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@true patriot
Unfortunately, the shocking price disparity in routine lab work has nothing to do with healthcare financing (private insurance vs single payer), rather, the effect of healthcare system consolidation. My primary care practice used to outsource my annual bloodwork to a well-known national lab. Cost? $160.00. The primary care practice was bought out by a giant hospital system and all of a sudden, routine annual bloodwork cost $1400.00. My insurer refused to pay for hospital bloodwork and instead mandated that it be done by that same outside lab. Cost? $160.00. Doctors and hospitals are quick to enunciate the "savings" that a single-payer healthcare system would bring but are loathe to contemplate what it would actually mean to them. My brother-in-law is an orthopedic surgeon in Australia and he makes $250,00.00 per year. Hardly a an example of poverty, however, I know one NJ orthopedist who makes $25,000.00 per day....before lunch.....performing arthroscopies. A single-payer healthcare system would be his worst nightmare.
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@rich I hope the orthopedist starts having bad dreams, like the rest of us have each time we encounter the medical system in this country.
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@true patriot
I received a bill for $116,252 for day surgery. This from recently combined healthcare systems (monopoly) that promised to cut costs.
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If you are one of the 50 million plus Medicare beneficiaries finding the exact price of a medical test or procedure is easy. Simply search Google "CPT" code for the test or procedure you want. Then search "CMS Physician Fee Schedule Lookup" and punch in the CPT code and where you live. The search results will provide the price. The vast majority of health insurance beneficiaries don't care one bit about the price of a medical test or procedure - especially after they hit their deductible. Most people do care about the price of their health insurance premium. Last month's CPI report showed a year-over-year bump of 9% - that was the highest "out of pocket" expense increase of all the other expenses we had.
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@John Booke Thanks. I get paperwork from my supplement plan and rea it ALL. I know how much they pay for the tiny little filters for my CPAP machine, my meds, tests, and so on. I also know how much various places bill for some of these things. I never fail to be surprised.
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I have to take Warfarin pills to control the state of my blood. I attend my doctor's surgery at intervals. There a "nurse practitioner" determines by testing my blood what my dosage is to be in future and when I should be retested. The cost of travelling 3 miles in my car is all I pay.
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@irdac
In fairness, the nurse is working under the supervision of the practice Doctors (GPs) who, in turn, has the backup of the local hospital coagulation lab - and the hematology doctors who run that.
Believe me, adjusting warfarin is 99% child's play and the rest requires a lot of expertise. You don't always know which you're dealing with.
Are you still on warfarin? You do know the NHS uses much more modern anticoagulants now? Ones that don't require regular blood checks. No such thing as a free lunch though. The newer drugs bring with them a whole set of new challenges.
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@nolongeradoc
Wow, it seems should Artificial Intelligence take over decades into the future and make decisions that might seem more "informed", the result of improved narrowing of options, as in the case where Watson is being applied to cancer treatments, its main obstacle is still human intervention. Eliminating humans seems as if it ought to be in the plans of AI just taking over from these hopeless profiteers.
It is long time past for drastic reform.
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"The Trump administration may eliminate this secrecy, making numbers like the ones in these charts more common and easier to find. As The Wall Street Journal has reported, the administration has asked for comments on a proposal to require doctors and hospitals to publish negotiated prices."
Trump 2020
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@D
Why wasn't this Trump 2016? Now I have more faith in Biden 2020, or Warren 2020, or Sanders 2020, or Buttigieg 2020.
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@D
If properly implemented, this change under trump would nevertheless be about the only positive administration decision of the past two+ years.
I’m actually kind of shocked when they appear to get something right.
In the meantime, in nearly every other aspect of healthcare, they’re attempting to neglect or harm others in this country- and reject superior programs by all of the major democratic candidates.
Sorry- by no means should he be re-elected on one narrow issue like this.
trump-in-prison 2020 would be much better.
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@D all that says is that the administration has asked for comments. Now come the hospitals, lobbyists, pharmaceutical companies and so on. How many individuals will comment??? How many people would even know it was happening and how to comment????
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Uninsured patients, who don’t get the benefit of negotiated rates, bear the full brunt of the cost, as do insured patients who have not met their deductible. As a doctor, I don’t know how much the test costs (I don’t even know how much my services cost; they’re managed by billing services in another state since I am part of a large health care organization). Health care has become so opaque and complex that I welcome Trump’s effort to address this (perhaps the only good thing he’s advocated).
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@AKM OMG - even the doctors don't know what they charge or what the tests cost!
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@AKM - When did Trump make an effort to address this?
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@East/West It is stated in the article. The administration is trying to publish rates to increase transparency
3