$1,944 for a coronavirus test? Readers helped us spot an unusual trend
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I briefly worked in healthcare at a tech startup. The thing you quickly learn is that the market for healthcare is fundamentally broken. You could invent something that saves a patient $10,000 and they will never know. The hospital and doctors won't care about saving money. And the insurance company has no leverage to make them. And it will never make it onto the patient bill in a way that they understand.
And as much as doctors and hospitals love to paint insurance as the bad guy, the only reason things like prior authorization is a pain in the ass is because doctors don't actually put in any effort into prescribing generics or really learn how much anything costs. This is highly unusual in most professions: Imagine if your roofer grabbed whatever shingles they liked best and billed you for it after they were up. Now imagine every roofer worked the same way.
Anyone selling you an easy solution is lying. Anyone selling you a "reform" solution is also lying. We need a holistic approach to this that means the government needs to hire a bunch of experts that are given a lot of power to change the system to make it work.
This is not to say that doctor's pay shouldn't be addressed, but the system doesn't get reformed because every discussion on fixing it gets derailed into a discussion of doctor's pay, which is literally the highest-effort lowest-payoff part of the problem. And the situation stays bad because of this dynamic.
Not on it's own, but doctor shortage can still contribute to medical costs.
Do doctors make more mistakes due to high patient loads?
Are preventable items missed because doctors can't spend enough time with patients?
Would people be less likely to abuse the ER and/or wait to address conditions if they could get a primary care appointment more easily?
If doctors had a little more slack in their schedules, might they innovate in other ways?
If we had more doctors, would it be harder for mega-hospital chains to gobble up the supply of doctors in your area, leaving more independent practices to innovate in other ways?
What if your pharmacist could do most of the practical things that matter to you about your medication, rather than requiring prescriber permission?
What if you could do X by going to a psychologist or optometrist, or some other profession that doesn't currently exist, instead of going to an MD or PA or LPN?
What if you could just buy certain things directly without a middleman?
US healthcare is over regulated in general (in many areas, even as it's arguably underregulated in others).
Right now US healthcare is very hierarchical, with physicians at the top, nurses close by. Other professions and services are subsidiary to them. You don't get to choose a provider based on skillset per se, you are forced to abide by this hierarchy.
That's the real economic cost, the restrictions in provider and service choice.
That's not entirely a bad thing. It would be bad for Medicine to turn out like Law, with a huge glut of unemployable graduates after a long, expensive training program (IIRC, an intense 7 years post-college, minimum). There's a need to balance demand with the need for all (or nearly all) the graduates to be able to find a job.
Also, you're neglecting Osteopathic schools, which aren't controlled by the AMA but graduate students with the same practice rights.
> The number of doctors allowed to graduate hasn't changed in 40 years.
Do you have any data to back that claim up? The Association of American Medical Colleges says enrollment rates are increasing:
> In response to concerns that a projected doctor shortage could impact patient care, the AAMC in 2006 called on medical schools to increase first-year enrollment by 30%. That target was reached in 2018-19, when first-year matriculation reached 21,622 students. Osteopathic schools increased their enrollment by 164% during this same time period, with 8,124 first-year students enrolled. (https://www.aamc.org/news-insights/us-medical-school-enrollm...)
More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots.
You can get all the theory, but not be able to get the requisite practicum. Even if you do get a slot, you also get treated like a stevedore from what I have heard.
> More people may be interested but nobody can practice until after residency, and you have a large pool of hopefuls basically in a lottery for residency slots.
But my understanding is that residency capacity is matched to graduating class sizes, at least in the US. The selectivity is intentionally placed up front (at med school admission) so the path is clear to residency and licensure as long as the student doesn't totally fall apart (which the selectivity is supposed to guard against).
IIRC, it's foreign medical school graduates may have trouble getting a US residency.
https://www.fiercehealthcare.com/practices/more-medical-stud...
https://health.wusf.usf.edu/npr-health/2019-07-03/american-m...
The above sources indicate residency matching is decoupled from graduation from Med school, and if I recall correctly, there is actually a legal cap on the number of residency slots.
https://www.aha.org/news/headline/2019-03-14-bill-add-15000-...
So everything I've seen suggests we actually have a dysfunctional system with no up front brakes. Our Medical education system maximizes fiscal extraction from hopefuls, but the residency slots don't scale elastically or in any way matched with demand. Quite literally, it seems to take an act of Congress to change the calculus of residency slots.
I could still be wrong, and welcome the removal of the veil of mistaken impressions, but that's the gist of my current understanding.
For the data, I had done a quick search and found this (which only goes to 2010):
https://www.researchgate.net/figure/Trends-in-the-Number-of-...
However, digging more, even the AAMC is saying you need residency slots:
https://www.medicaleconomics.com/view/enrollment-rates-rise-...
Increasing first-year enrollment is a good first step, but doesn't move the needle on the number of doctors who can actually practice because the number of residencies is still limited.
Which are determined by federal government Medicare funding, btw. From your link:
> Federally supported residency training slots have been capped by Congress for more than 20 years, limiting the spots for medical school graduates to undergo additional training in a residency program before they can practice medicine.
So maybe this is more of a "call your congressman" issue.
> In March 1997, months before the Balanced Budget Act was enacted, the AMA even suggested reducing the number of US residency positions by approximately 25% from 25,000 to fewer than 19,000. “The United States is on the verge of a serious oversupply of physicians,” said the AMA and other physicians’ groups in a joint statement. Since most states require at least some residency training for medical licensure, reducing the number of residency positions would curtail the supply of doctors in the US.
> Fast forward two decades, and what once seemed like a glut now looks like a shortage. The growth in the number of residency positions—and thus the number of doctors—slowed after the passage of the Balanced Budget Act. From 1997 to 2002, the number of residents in the US increased by just 0.1%. Although the number of positions has increased since then, each year thousands of residency applicants fail to secure a position. Factor in an aging population and a projected increase in demand for health care services, and the US is now forecasted to experience a shortage of 46,900 to 121,900 physicians by 2032. Absent a meaningful response from Congress, it will be doctors—particularly residents—and their patients who pay the price.
- https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastati...
Yet, only a few places currently try to convert PhDs to MDs; most places are overwhelmingly geared up for undergrads coming straight out of pre-med programs.
Politics does not do sensible, it does what is expedient.
Consider the US preaching about democracy and consent of the governed and then funding radicals to do a coup and start a civil war to oust a democratic president they don't like in a sovereign state. Why?
In stark contrast, the number of hospital administrators, along with their salaries has ballooned over the same time period - even at non-profit systems.
Seems like a healthy person would go to hospital only for emergencies or major projects like birth. On the other hand, I know there are entire hospital systems in southern states that cater to elderly and are basically Medicare billing factories.
I'm hesitant to blame doctors, since I myself find it impossible to learn how much anything costs until after being billed for it. Is it any easier for the doctors?
(Note: clearly the doctor in this article is scamming his patients, but I'm talking about the situation in general)
(In my case, I also pay before getting whatever it is, but it's possible to have the charge added to your bill instead.)
They don't want to bankrupt themselves, but they can raise rates and keep more money when they pay more.
It can be the case that the market isn't very competitive, but it isn't the case that the companies can just arbitrarily raise rates.
https://en.wikipedia.org/wiki/Health_maintenance_organizatio...
And there are other dynamics in play. Here is a nasty example:
Employers care that premiums only increase by X% per year. Fine. As such, insurance will try to protect its contract with employer by going to the hospital provider, and demanding a low premium increase.
Hospital says fine but "OK - but you agree to our increase of list price by 50%.... don't worry, we give you a discount on that amount. Insurance won't pay that increase"
Insurer says "Great! In fact, let's push it to 100%? OK?"
How did we come to this? Insurer and Hospital agreeing to increase price by 100% and discount that 100% back down?
Its because of the incentives.
Insurance will use this to go back to employer and say. "We got you that x% cap on increase in premiums. Employer, by the way, you still owe us money from the 100% discount we got you from the hospital bills " Employer says OK and pays a ~3% premium on the 100% 'discount' ("claims repricing" in industry parlance).
Meanwhile, Hospital goes back to the government. "We had losses from discounts given to govt patients totaling X in discounts". Now hospitals recoup some of that money. (in industry parlance Disproportionate Share Hospital (DSH))
Meanwhile, people with no insurance have to pay these inflated list prices...with no insurance discount whatsoever. HR staff gets promoted or leaves the job, because they did a great job securing that X% cap. The new person does not know what "claims repricing" is. It remains in the contract.
Premiums go higher next year.
What seems to be happening lately is a consolidation wave on every level of medical business in order to counter-act that. Most of the smaller private practices in my area have been bought up by large healthcare organizations named after various medieval saints.
Public health insurences (there are over 100, but they are all organized in an umbrella organization) give out licences to doctors to be allowed to practice on publicly insured patients. The doctors get some amount of money they can spent on patient-specific prescriptions, but in general the doctors only prescribe the active ingredient. When the patient goes to the pharmacy to get their prescription, the pharmacy looks up the insurence and hands the patient the medicine that the insurence dictates. A doctor can prescribe a specific medicine but has to pay for it themselves (mostly from the money the insurences previously provided, see above).
Insurences check about 10% of all hospital bills and just don't pay what they deem unnecessary. Hospitals are therefore careful not to do things the insurences didn't approve of. There is an open catalog of therapies that the public insurences will definitely pay and how much it may cost, so it's not a secret.
They will also push for modern treatments if they reduce recovery time and have less risks.
There is a lot more to the system but that's the gist.
For example my mother in law had an unusual cancer and after her treatments she had a rest spa paid for; once the treatments could no longer help she had in home care. In the US, good luck.
- It's priced according to income, not health condition
- You will never, ever be refused necessary healthcare, and you'll know it's covered before work begins
- You are not punished for using your insurance, and the premiums won't change
- There is no deductible, except a 5-10€/month co-pay for prescriptions
- Your employer/employment has no impact on your coverage, or the insurer you choose
This is for the public system. The private system is a bit more complicated, but generally, the same rules apply. The only difference is the pricing structure, and the possibility of having a deductible (usually ~1000€/year).
American expats tend to have trauma that affects their insurance choices. My job is to reassure them that our system is completely unlike the American system.
If you want a plain English overview of the system, you can have a look here: https://allaboutberlin.com/guides/german-health-insurance
> The ninimum is 200€, [...] If you make more than 58050€ per year, you pay around 400€ per month. This is the maximum contribution (Höchstbeitrag). If your salary is higher than 58050€, you will not pay more.
For private insurance (possible if you earn above 64k or are a freelancer) its not linked to your income so rates vary.
> Private is cheap when you are young If you are young and healthy, you could pay as little as 175€ per month (350€ for freelancers) for private insurance. If you make a lot of money, this is much cheaper than public insurance.
But there are deductibles and fees can go up if you have frequent health issues. Freelancers cannot be covered by the public system so it only works when you're an employee, otherwise you're on private insurance.
The article linked above gives better, more recent figures on those limits.
Yes, the Pflegeversicherung is a separate thing, but it's charged by the health insurer, it's mandatory, and private insurers include it into the price. It's much simpler to bundle those things together.
Exceptions being if you're under 55 and earn less than the limit amount (something like 65k EUR roughly) or if you earn under 450 euro per month (the so-called mini job).
If you're older than 55, you're f'ed, good luck with your private insurance in old age, 'case you're not allowed to go public. They've taken this measure because people were using private insurance for long stretches and then switched to public as they were reaching retirement, straining a system they haven't contributed to
It also means that in a bid to save money, self-employed people pick an option that's cheaper now (private), but will cost them a lot more over time, with no option to switch back.
Normally, if you switch to private, you must stay on private. This prevents people from getting cheap private insurance when they're young, and cheap public insurance when they're old. In practice, you can just get a low income job for a year at age 50, and get forced back onto the cheaper public system. It's a solid financial decision.
The same thing ultimately happens here where the young and healthy leave the public pool, leaving the older and sick. As rates go up, the cycle continues.
I don’t see how anything except a $0 for everyone really works. Otherwise you just have people gaming the system (like the 50 year old in your example working a year of low paying job to qualify)
That's a nice description of: https://en.wikipedia.org/wiki/Principal%E2%80%93agent_proble...
> This is highly unusual in most professions: Imagine if your roofer grabbed whatever shingles they liked best and billed you for it after they were up. Now imagine every roofer worked the same way.
I mean, this basically is my experience with contractors, auto mechanics and most other professions where there's a lot of information asymmetry between consumers and providers. In a capitalist exchange, buyer and seller are opponents and both will use the others' lack of knowledge to their advantage (or be outcompeted by others that do).
It's a fundamental dilemma of our world. The more expertise a task requires, the more important it is to hire someone to do it instead of doing it yourself. But the more necessary that person is, the less qualified you are to evaluate their performance.
The unique feature of the medical care system that's different from most other professions is that there's multi-way asymmetry.
An auto mechanic generally does have some rough idea of how much a given repair costs (inclusive of labor and materials) or at least can easily inform him/herself. It's a basic two-party information asymmetry where the professional making the decision has more information than most consumers.
In medicine, physicians often have no idea themselves what the total cost of treatment will be, and there are various structural and economic factors that discourage or make it very difficult for physicians to find this information. This is a very different type of information asymmetry, where both the providers and the consumers lack information.
The only reason? Don’t put in any effort? How is this comment not flagged dead?
This is patently false and essentially slanderous. (I guess libelous since we’re on a written medium)
If you and the rest of the public had any idea how much your insurance company literally does not give a shit about you, when you are for example battling cancer, there would be pitchforks in the street.
There are a lot of good people in the health insurance industry that want to improve health outcomes and make a profit and are swimming upstream as well against those systemic forces (just maybe the market isn't the best way to distribute healthcare...) but as a whole it's not the health insurance companies reining in the costs of frivious doctors and hypochondriac patients, it's the incredible layer of bureaucracy and arbitrary decisions there that soak up a ton of monetary resources, constrain doctors into not even being able to do the preventative care work they want, and lead to all sorts of perverse incentives like showing up in ER 5x a year, instead of getting to show up at your GP and nutritionist every week, etc
If insurance didn’t push back, costs would be even more bonkers!!
Medicine is a pretty difficult art as is. I'm not entirely convinced that I want my MD to be price conscious over being outcome conscious. If it comes down to choosing one over the other, I'd rather my MD focus on their practice and not their billing.
Cant’t believe this isn’t an ethics violation, it is like going into the car dealership to change my oil and them charging me to take apart the engine because “It could catch a wider range of issues”.
I know what service I want and would consent to, this “Technically correct but costs 50x as much” is harmful.
[0] This is the doctor’s response when asked why he is testing for ~20 other respiratory diseases in the drive-through coronavirus line.
> But in interviews, asymptomatic patients said they had also received the more expensive test.
This is why organizations like the United States Preventative Services Task Force exist. They review studies and recommend best practices for medical screening. They do recommend against asymptomatic screening for a lot of tests.
This kind of stuff is pretty par for the course. They try and up-sell. If you agree then you're on the hook for the bill. That's just how the industry works. But businesses that make a habit of being sleazy don't survive long because the bill must be agreed upon beforehand and customer is free to go elsewhere with little friction and there isn't all sorts of gatekeeping and regulatory capture constraining supply.
This is hard to believe. If anything they are more disposable.
https://www.bts.gov/content/average-age-automobiles-and-truc...
I feel like the disposability angle comes from having relatively expensive parts/repair costs with low value older vehicles, which results in them being retired because of the economics of having someone else repair them.
Never mind that makes them way safer and saves tons of lives. Some people want to crash up derby their car every weekend.
"They don't make them like they used to" has always been a nostalgic crock of shit, like the people who think the NES was the golden age of video games, despite the vast majority of the 700 or so releases being utter trash for $60 that sometimes didn't even work!
Nobody's ever done an 80s Town Car vs a 2010 Town Car at 30mph because a crash test where the result is "both drivers would have walked away" is boring and doesn't make for the kinds of DARE-esque media that the people who do crash testing have found it worthwhile to put out.
With significant and well engineered crumple zones and fairly expensive components, modern cars are significantly easier to total.
There's no real reason slow speed crashes have to be as damaging as they are. It's just a result of what our tests our and natural optimization toward them. If the NHTSA reintroduced a "is the vehicle drive-able after a minor hit" type crash things would get a lot better very quickly.
Of course, if it breaks, it's full of all these complex little systems that let modern cars run for hundreds of thousands of miles at 40mpg, and you'll need to pull in a professional, but they break a LOT less frequently.
Now almost nobody needs to check the oil that frequently (though it'd be good practice) and even lower end cars routinely last to 100,000 miles.
I'm driving a 2010 Honda Civic with 100k miles and fully expect to replace it with a newer vehicle out of concern for safety, desire for an electric vehicle, and wanting some better creature comforts. The thing will probably run to 250k miles, which would take me another 13 years to achieve.
As a kid, we had a van that made it to 150k miles and my parents friends were amazed it was still on the road. I've personally owned 4 or 5 vehicles older than that, all in better shape than that van at 150k.
It wasn’t unusual to be stranded on the side of the road because your car stopped working. Maybe once per year? You rarely see that now.
And if your car hit 100k miles/160k km, that was pretty much it’s life span. Now hitting 300-400k km is not that unusual.
And good luck starting your car in the 80’s if it got cold out. Or too hot out. Fuel injection has made cars way more reliable.
We brought them coffee and bagels the next day.
My own story is when I went to an ENT for something unrelated and he asked me if it was okay to pull out a hair he saw on my ear and I said yes, and then the bill had a $500 charge for it.
This is though the same thing car dealers do. They always want to up sell services.
If each test has a 1% chance of returning a false positive (and false positives are possible in most tests), there's a significant chance that one of the 20 will return a false positive, which will then prompt unnecessary treatments, further tests, etc.
The general medical guidance is to only test when there's a legitimate suspicion that a patient has the illness. In this case, these patients wouldn't have been tested for a wide range of respiratory issues anyway, and given the pandemic it's much more likely that they've got coronavirus, so they really shouldn't be tested for the other things, especially if asymptomatic.
We 100% should be using these kinds of tests way more often. If this was such a rapid multi-test, the villain here is the billing department and insurance.
It's a beautiful rhetorical technique. Very effective.
> Physicians Premier ER charged Dr. Zachary Sussman's insurance $10,984 for his COVID-19 antibody test even though Sussman worked for the chain and knows the testing materials only cost about $8. Even more surprising: The insurer paid in full.
https://www.texastribune.org/2020/09/05/austin-texas-coronav...
I wish we could fix this broken system. The only way to fix it now is open-heart surgery while driving.
I think if insurance carriers had the ability to verify the charges before paying we would see naturalized reform from sheer market power. No one will pay for a $5k thing if the site says it's $350.
>Insurers that sell individual and small group health coverage must spend at least 80% of premiums on medical claims and quality improvements for members. No more than 20% of premium revenue can be spent on total administrative costs, including profits and salaries. For insurers that sell large group coverage, the minimum MLR threshold is 85%.
>Insurers that fail to meet these guidelines (ie, they spend more than the allowed percentage on administrative costs, for whatever reason) are required to send rebates to the individuals and employers groups who had coverage under those policies. From 2012 to 2019, under the MLR rule implementation, insurers rebated $5.3 billion to consumers.
https://www.verywellhealth.com/health-insurance-companies-un...
Insurance Companies probably see these extra costs as a good way to meet their spend targets.
I was not able to find any source but have heard that the government is giving healthcare providers monetary assistance for Covid-19.
Looking at those two factors and no-one has any reason to try and control cost.
[0] https://www.nytimes.com/2020/08/05/health/covid-insurance-pr...
Published back in November.
The actual article is: https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...
> The Families First Coronavirus Response Act ensures that COVID-19 testing is free to anyone in the U.S., including the uninsured.
https://www.hhs.gov/coronavirus/community-based-testing-site...
The issue here is these testing sites were performing more than a covid 19 test and then billing for those tests without a person's consent.
> Dr. Murphy wasn’t just billing for coronavirus tests, as his patients thought. He was billing for 20 other respiratory pathogens, too.
The issue at hand in the article is the amount being charged to insurance companies for the latter - due to lobbying and obscure regulations (which the article points out the Trump administration attempted to overcome), it is not uncommon for medical providers to charge insurance companies exorbitant amounts for services, and also charge them for unnecessary services.
Complete madness.
https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct... <—-This is the actual story she wrote.
When users share their bills and EOB, provide them with an automated analysis of their bills: what seems weird, which billed items were far above average prices, etc.
This information can be precious when negotiating with the doctor's office, when Yelp/google-maps reviews, or when contacting your politicians about the absurdity of health care costs.
edit : added more details
I know a couple of people who worked at these COVID testing sites in NYC (area near Columbia University), Brooklyn and in New Jersey for $15/hour. If one wants to work there, s/he doesn't even need to have work permit (because these sites hire foreign medical graduates for cheap labor). One just need to be able to draw blood, if necessary and that's the main requirement to work there.
All of these clinics are owned by doctors. I'm 100% sure these clinic owners get reimbursed more than $15 per test from the US government. It is a financial windfall for those entrepreneurial doctors and clinic owners who are willing to ignore proper screening in hiring COVID testers at the sites.
As for the predatory equity firms that control many of them, I'd be delighted to see them thrown out of the US ... after their owners serve serious jail-time.
Edit: While we're at it, how about 1 year of jail time for every US citizen who has died of opioids made by US pharmas. They can divide that time up however their employees decide is fair.
> she was “shocked” to see a drive-through coronavirus testing site bill her insurance $1,944
You would be surprised how many "COVID Testing Sites" are scams. Pure scams.
Many of them are not even able to bill your insurance, probably because Insurance companies would refuse to pay the fees they are charging for. So you will be paying out of pocket for them.
I actually did shop this around, trying to find a legit one. Several of the ones I called charged $400 for a "screening visit" which is basically the person that comes to your car window and asks if you have any COVID symptoms. If you say "yes I have a cough" or you list any other symptom of COVID (which is almost anything) then they will determine that you should get a COVID test. This screening visit is laughable. Many of the people screening you aren't even licensed medical professionals in any way. Even more disgusting, half of them are volunteers. They think they are helping the community and have volunteered. They simply listen for a single symptom and when they hear it then they give you the test. This screening cost ranges from $200 - $600 in my area. But the average was $400. Then they administer the test which can be charged $99 - $299. Many of these "drive up testing sites" that you see advertised are legit scams. They want people to see the sign, pull up in their car, get the test without asking any questions, and they will get a surprise bill of $500 - $1000+ in a few months. The other charge that you often get is a test results charge. Some of these testing sites are charging you for the phone call they make to tell you the test results.
So be very wary if you are getting COVID tested. THere are a lot of places out there doing COVID testing that are PURE SCAMS!
Good news: there are some legit ones. But you need to really do your research ahead of time. I eventually went and got tested at a testing site that is operated by my state. They are authorized to bill the CARE Act which was the emergency bill that allows for free COVID testing and COVID care. They were also authroized to bill your insurance. They bill insurance a flat $99 fee. And if your insurance doesn't cover it then the CARE Act can cover the rest.
So please be careful out there. If you are getting COVID testing, make sure to do some research and go to a legit testing site. Call them and see if they can bill the CARE Act. Even if you have insurance, you want to go to these sites because they are the "official ones". If they are doing it legit enough that the CARE Act covers them, then the insurance companies will also cover tests from that same place. Make sure there are no additional costs for screening or delivering results. If they have any of those costs or are NOT covered by the CARE Act, then run. Those places are likely profiting off the pandemic and will surprise you with expensive bills that your insurance will refuse to cover.
https://www.econtalk.org/christy-ford-chapin-on-the-evolutio...
1. It’s very hard to shop around to find better prices or better service.
2. People often make choices like “Do you want this expensive life saving procedure or not?”
3. The average person isn’t informed enough to understand what their medical treatment needs are. Patients ask doctors what their recommendation is. Doctors often have an incentive to sell the most healthcare they reasonably can.
4. My ability to pay for healthcare is directly tied to my employer. There simply are less jobs that provide good healthcare than people that would like them. My ability to change positions in society is limited by my desire to continue to have access to affordable healthcare. This is practically a freedom limiting mechanism.
5. I’m limited in my choice of which healthcare to purchase based on my Insurance policy. My choice in insurance policy is similar to a suburbanite’s choice in an ISP. I have very few choices.
The average person isn't informed about anything other than however they make money from 9-5
Consumer ignorance is not an excuse for a crappy market.
It is unreasonable to expect every consumer to be an expert in every commerce transaction that takes place in their daily lives.
Is the price of specialization and sophistication the movement of decision power away from the source of decision quality information? I find it paradoxical to use regulation as a response to the fact that "it is unreasonable to expect every consumer to be an expert" in that it is likewise unreasonable to expect regulators to be expert in the context and values of each individual consumer.
When I want finical advice I hire an expert that gets paid the same no matter where I invest my money, because his incentive is to give me the best advice so I stick with him. If I get finical advice from someone that gets commission based on selling specific investments then the advice is more likely to be less than the best.
6. Prices are often unknown at time of service.
No amount of research can make up for hospitals that haven't decided how much your surgery will cost until after the fact.
I recently paid a hospital invoice, and received a receipt covered in "PENDING FINAL BILL". I can't tell if the hospital will refund me some excess, or charge an extra $1000.
To extend the metaphor elsewhere in this thread, it's like going into a garage and being told that an oil change will cost between $40 and $400. It depends. We'll let you know.
https://www.healthcaredive.com/news/hospitals-pledge-to-figh...
However, it looks like that practice won't be allowed for much longer:
https://www.cnn.com/2021/01/04/politics/hospital-price-trans...
1. Almost impossible to shop around 2. Instead this is a Dr's or a public system policy choice. 3. Dr's incentive is to minimize costs 4. Your ability to aquire healthcare is based on limited availability and your condition. If you are critical you will get immediate care, if you need a MRI - perhaps 6 months, if you need a specialist i.e. liver doc, sleep study, orthopedic surgeon etc, 1+ year 5. You have very little choice. Finding a family doc is very constrained
OBVIOUSLY, this depends on the province as health care is a provincial domain.
6. Pricing is almost impossible to know ahead of time, even if you ask.
Trust me, I have asked how much something will cost ahead of time and no one can tell you.
One time I had to go into a specialist for my leg. I had hurt my MCL, but the doctor wasn't sure if it was torn or pulled. So he sent me to a specialist to give advice on whether surgery was needed. Before I made the appointment I asked the receptionist how much it was going to cost for this appointment. She couldnt tell me. I asked her to figure it out and call me back. She never did. I called back before my appointment and talked to the clinic manager. She again refused to quote me a price.
In the end I went to the appointment. The doctor listened to me, then grabbed my leg and twisted it a few different directions and asked me to describe the pain as he did so. Then he told me it was a simple pull. I didn't need surgery. I just needed to rest. No prescriptions, no medications rendered, no operations performed, no diagnostic tests given. A simple 15 minute doctor visit.
3 months later I get the bill. It was $800. I had to pay it all out of pocket because this specialist was out of network. I had tried to get a price ahead of time and couldn't. The doctor didn't do anything for me except tell me to rest. The visit cost him 15 mins of his time. Nothing more. At this rate, he is billing $3,200 per hour. Possibly more because the 15 minute time estimate is me being generous. It was very possibly closer to 10 minute visit.
Another one that I won't go into detail with because it would take too long was for a pinched nerve in my back. I went to urgent care because the pain was so bad I couldn't stand. Again, a simple question+answer with the doctor revealed the pinched disc in my back. No xrays or diagnostic tests were given. She prescribed me a pain killer and a steroid to reduce inflamation which would allow the disc to naturally slip back into place. Because I was traveling and so was again out of network when this happened, I asked the receptionist as I was checking in how much a simple visit runs. She of course can't quote me anything. I pressed her and said, "what is the base price. I know it is more if they have to run tests and do things, but what is the cost of the visit". She refused to tell me. As I was now wheelchair bound because I couldn't stand, I had no choice but to gamble and get the help and learn the price 4 months later. The visit cost me $1,900. I had to pay 100% out of pocket. Despite having insurance that I already pay $500 a month for.
Furthermore I had $120 in out of pocket expenses on the medications.
Not only can you not figure out a price ahead of time, but it is equally crazy that I pay this much out of pocket when I have insurance that I pay $500 a month for ($6,000 per year). And no don't tell me to "get better insurance". That means finding a different employer and guess what... it's not like you can see what insurance the other employers have until after you start working there. There is no way to really shop insurance, you are stuck with what your employers offers, usually with 2-3 options from the plans they have selected.
You hit the nail on the head. Compared to buying a car, computer or apartment I'm not choosing to have a particular disease or accident. It just happens to us (yes, we can prevent some). Once you have a medical condition you are forced to "shop" for a solution in a "free market" so you can escape that situation. This is when people become vulnerable and the US healthcare model takes full advantage of their position.
The fundamental premise, though — that the market is not ideal for healthcare —- remains. For shoes and smartphones, the market is fine. For MRIs and insulin, it is not.
If you hadn't opened with that I think we could have gotten another two or three people extending the chain of indirectly stating as much.
"If the image of medicine I have conveyed is one wherein medicine lurches along, riven by internal professional power struggles, impelled this way and that by arbitrary economic and sociopolitical forces, and sustained by bodies of myth and rhetoric that are elaborated in response to major threats to its survival, then that is the image supported by this study."
- Evelleen Richards, "Vitamin C and Cancer: Medicine or Politics?"
> The patients who went to one of these drive-through testing sites had no chance of knowing what charges they would face beforehand.
This is just stupid. There are similar stories about the cost of going to the ER. If all health care providers were required to be transparent about pricing up front, then there might be some possibility for people to shop around.