Mind=blown @ American medical system

[skarms]

So basically if you don't have insurance you're fukked? isn't the only way to get insurance from companies/schools/etc.?

like if you don't have a job and you get into an accident, your medical bills would be crazy expensive right? I've heard of people in hundreds of thousands of dollars in debt..

Read this post from reddit
http://www.reddit.com/r/Foodforthoug...or_the/c9vfh22

I work for a major medical center doing business stuff, so I'm at least aware of how the various hospitals in my state are doing, how pricing works and what the market dynamics are. There are a few things that should be pointed out....
First, you're right. The charge rate certainly doesn't correlate to quality metrics.
The charge rate listed in the data (available as an 11MB excel file at CMS.gov) has nothing to do with anything. It's not a real price. It doesn't correlate to the price anyone pays except for the extremely rare millionaire who doesn't have insurance. Medicare doesn't pay it, 95% of uninsured people can't pay it, insurance companies don't pay it.
It's primarily a negotiating trick, with some accounting tricks thrown in for good measure.
People need to understand how pricing works, because it's the cancer at the heart of healthcare.

At any given hospital, there are a hundred different prices for any given procedure. Medicare and Medicaid pay all hospitals the same amount for Procedure X. Most hospitals lose 20% (or more) on that Medicare price and make it up on the private companies.
Every single private health insurance company pays a different price, very often 150% of what Medicare is paying. Each plan negotiates prices all on its own, in secret. They have no idea what other insurance companies pay. It's in no one's interest to share that price. It hurts hospitals' future negotiations if their lowest negotiated price is public and it hurts payers negotiations if it gets out that they overpay some hospitals.
The hospital says "X costs us $50K, Y costs $60K, $Z costs $20K."
The insurance company they're negotiating with says "we normally pay $25K, $35K and $9K for those procedures. How about we give you 50% of your charge rate?"
The hospital says "OK".

As a result, at a single hospital there can literally be 100 plans paying different prices for your gall bladder removal. Multiply that by 3,000 hospitals in the country. There are maybe 3,000,000 different prices for that surgery out there. All completely secret. You can imagine how that might create problems.
So basically, this charge rate is nothing more than a bit of insight into a hospital's chosen negotiating tactics. They either price high and discount a lot, or price low and discount a little.
Uninsured people are screwed no matter what. If you're uninsured and land in the hospital, you're likely going bankrupt. It's almost irrelevant whether it's a $200K bill or a $100K bill. You're going bankrupt. You might think this pricing was designed to extract money from that uninsured population, but hospitals get so little money from them that most don't think about trying to squeeze them more using this charge rate.
A vast majority of that care is just written off.

If the charge rate doesn't correlate to real prices, it definitely doesn't correlate to quality. There's very often an inverse relationship between cost and quality to begin with. Medical errors are expensive and the places that reduce them save a ton of cash in lawsuits, readmissions (in cases where they're penalized for them), etc. For example, we're an awesome hospital you've heard of, but some organ transplants cost 35% less at the best-of-the-best place, because they do it so frickin' well. That's real cost. Not fake charge book cost. Usually, the better the care, the cheaper it is.
The odd thing about this story is that it isn't new. Dartmouth Health Atlas has been publishing similar data for decades. It's great to see it being covered, because it's insane and a clear symptom of a deeper problem, but I was surprised to see it on the front page of the Times.

And every time I write something about this, I have to add: neither insurance companies nor hospitals are (on the whole) getting particularly rich off of this. As crazy as it sounds, this is not the result of unusual greed or a morally corrupt industry. It's a historical artifact more than anything. Non-profit hospitals (which is almost all of them) earn an average of 2.5% operating margin and that's shrinking. I dunno about for-profit hospitals, but they're still not raking it in like people think they are. Health insurance plans earn more like 3.5% on average. If you chart the most profitable sectors of the economy, that puts them pretty far down the list. Drug companies, in comparison, are deep into double digit margins.
Of course, that's relatively small profit on a truly mind-boggling amount of money (17% of the american economy) so it has a gigantic effect. It also tends to concentrate a lot of pain on people who can't afford to pay it.

Anyway, that low profit margin gets at why no one breaks out and tries to be more transparent. A tiny downtick in your reimbursement rates will sink you. As our contracting guy says, last time our main payer got slightly miffed and decided to throw some business across town, we laid off 500 people the next year.
This is just how the system works. It's not a conspiracy. It's a perfect example of how a a bad system forces a bunch of rational actors to do absolutely bat**** crazy things. Everyone could stand to earn and do a lot more if things were rationalized and we did away with this system of invisible prices. That's the tragedy of the commons for you.

All hospitals and insurers are forced to play this game. Whether that's a big 100-facility for-profit chain, a gigantic charity-oriented catholic system, an academic research center or your community hospital. This is how money moves in the system. Any real fix stands to hurt so many players that it's pretty unlikely we'll see change from a political standpoint. I'm kind of hoping the whole thing just collapses under it's own weight and something better can arise from the ashes.
Crap, sorry this comment got kind of out of hand... it's hard to stop adding detail sometimes.
[edit: woah, front page and gold? y'all are awesome!]

[Revzman]

Yes, Americans are so uncivilised it's unreal.

[SwiftRick]

Insurance companies are evil.

Brb paying monthly for health insurance
Brb pays deductible
Brb headaches
Brb doc wants a CT scan
Brb prior-auth needed for CT scan
Brb not allowing for CT scan because they "Think" it's not worth looking into

[Team Punishment]

God forbid you get a job. Please not that.

[skarms]

Insurance companies are evil.

Brb paying monthly for health insurance
Brb pays deductible
Brb headaches
Brb doc wants a CT scan
Brb prior-auth needed for CT scan
Brb not allowing for CT scan because they "Think" it's not worth looking into

jesus. i can't imagine how many people get a serious injury and just forget about it because of the medical bills associated, so they rely on a natural healing process instead of a doctor.. I live in canada and i've made plenty of visits for the slightest things just to be on the safe side, I'd probably be bankrupt if I was born in the US lol.

God forbid you get a job. Please not that.

Well the economy is pretty tough nowadays, the unemployment rate is pretty high in the US.

[TryHarderFish]

in on another american hate thread

[UMadPhaggots]

American medical system is the biggest joke in the world. Perpetuates a downward spiral for the poor - no wealth -> no health -> no wealth -> etc. Any Yank who claims "poor people just need to work harder so they can afford health care" should try making a decent/reasonable living when their own health is in the gutter. Health is a basic human right which unfortunately 99% of the world's population does not have proper access to, come at me *******s

[scullin]

Did not read, but even if you do have insurance you're fukked. Certain things aren't even covered or barely covered and even certain drug co-pays can be crazy.

[ThatRussianDude]

What i love the most is how they require an xray when you and the doctor obv knows theres nothing broken. Brb i have a torn acl, brb every doctor tells me to do an xray every visit just to make sure the knee isnt broken. Dumb fks

[MaddFinch]

Or you could just go to work and pay for it like you would car insurance or home owners insurance, or do you think that should be paid through taxes as well?

[THE-BEEF]

When I got let go from my job the first thing I did was get bare bones health insurance. It doesn't cover that much but if I ever do need to go to the hospital I know I won't have to worry about owing thousands. I don't get how people don't think of it as a priority.

[Team Punishment]

What i love the most is how they require an xray when you and the doctor obv knows theres nothing broken. Brb i have a torn acl, brb every doctor tells me to do an xray every visit just to make sure the knee isnt broken. Dumb fks

If you're suspected of an acl tear, you'll get an MRI, not an X-ray.

[Revzman]

No surprise Muricans ITT are equating healthcare to home and car insurance. Materialism of peace. There are some things more important than money, cars and who has the biggest house. One day you'll understand that.

[SwiftRick]

What i love the most is how they require an xray when you and the doctor obv knows theres nothing broken. Brb i have a torn acl, brb every doctor tells me to do an xray every visit just to make sure the knee isnt broken. Dumb fks

It's called being proactive and not being reactive

Or you could just go to work and pay for it like you would car insurance or home owners insurance, or do you think that should be paid through taxes as well?

The thing is people do work and pay for it.

What's dumb is health insurance will do everything to try and not pay for it by claiming they don't think it's necessary. You should see the nurses go ballistic doing prior auths with insurance companies

[ThatRussianDude]

Or you could just go to work and pay for it like you would car insurance or home owners insurance, or do you think that should be paid through taxes as well?

u dont have pay for car insurance to protect your life, no1 cares if u have car insurance for yourself. Basic insurance only covers the damages u do to others. U really think they give a fk what happens to u? Lmao

[sayso]

lol doesn't bother me I'm covered by 2 insurance plans

you *******s jelly?

[skarms]

lol doesn't bother me I'm covered by 2 insurance plans

you *******s jelly?

not really

[ThatRussianDude]

If you're suspected of an acl tear, you'll get an MRI, not an X-ray.

Ofcourse u need MRI. But before u can get an MRI, they make u get an xray. This is how it is in new york. I had to get 2 xrays done before they let me get the MRI. Thats the whole point, of how they are money hungry

[Bro_montana]

i can confirm, american healthcare is a fukin joke.

[CommonPheasant]

Healthcare is not a basic human right because it requires the labor of others in order to produce it. Saying you have a right to healthcare is saying you have a right to the labor of others.

Rights are things that the government is not allowed to take away from you, like the right to free speech, right to bear arms, right to assemble, etc, not things that are given to you.


This point soars right over the head of most people, which is part of why we're in so much trouble.

[DIL22]

Someone I know was diagnosed with cancer about 6 months ago. Because of the chemo/radiation/doc appointments he was forced to give up his job. The insurance/severance and everything lasted a while, but recently he lost insurance because he can't afford the payments while being unemployed. He talked to a social worker for the state and received insurance through the state(welfare). He talked to the hospital and they were willing to cover his deductible until the insurance started covering him 100%.

American health policy really isn't anywhere near as bad as foreigners believe, and from what I've read our health care system is a lot quicker than socialist health care.

[SystemTrend]

Yes it is a joke

[CraigC1982]

Profit/Loss and healthcare should be as far away from each other as humanly possible surely.

[SwiftRick]

Yes it is a joke

Womans rights.

Now that's a joke

[SystemTrend]

Womans rights.

Now that's a joke

yes it's right there with it. brb american with health insurance checking in.

[MaddFinch]

u dont have pay for car insurance to protect your life, no1 cares if u have car insurance for yourself. Basic insurance only covers the damages u do to others. U really think they give a fk what happens to u? Lmao

You'd care if I totalled your car and put you in the hospital without having it.

[DrWavey]

No surprise Muricans ITT are equating healthcare to home and car insurance. Materialism of peace. There are some things more important than money, cars and who has the biggest house. One day you'll understand that.

This

[DrinkinSizeOn]

read the whole post. work in health care as a business system analyst. work very closely with our billing and forecasting team (building charges/orders into the system) and everything this guy says is true. the pricing and reporting i do in our system is ridiculous. to talk to a doctor for 15 min for a cold is nearly 180$. so much other bs, but they give me a paycheck and insurance so no cares here..

[AndrettiFamily]

Healthcare is not a basic human right because it requires the labor of others in order to produce it. Saying you have a right to healthcare is saying you have a right to the labor of others.

Rights are things that the government is not allowed to take away from you, like the right to free speech, right to bear arms, right to assemble, etc, not things that are given to you.


This point soars right over the head of most people, which is part of why we're in so much trouble.

Lol at healthcare not being a basic right.
Also lol at the Gubbmint not being able to take away the 1st and second amendments. They basically already have. Sure you have freedom of speech when in your house, but soon as you get a large crowd of listeners you're censored as fuk. Plus they're trying to ban guns as we speak

[CommonPheasant]

I think it's funny that so many people hail the "free" healthcare systems such as those in Scandinavia.

brb paying a base 60% income tax rate yet thinking healthcare is "free".


I'd rather pay $130/month for health insurance through my employer (as I do now) than have "free" healthcare such as described above.