How Hospitals Are Boning You, FOR FREEDOM
Insurance doesn't even cover the $4,000 E Plebnista fee.
As Yr Wonkette has mentioned once or twice, we are a total fanboi of Vox's Sarah Kliff, who is one of the absolute best reporters on health policy. Monday, to go along with a couple of neat new projects she's launching, she published a terrific, infuriating story about the biggest problem with any attempt to fix American healthcare, whether you're coming from a "free markets fix everything" or "we need Single Payer" perspective. The problem with any reform effort for healthcare is the price of medical services, and if your health reform doesn't address prices, you're not really reforming the biggest problem.
The problem is that nobody except hospitals and doctors' offices really know how much any given service will cost, and most of the time, they don't tell patients beforehand. As an illustration, Kliff offers the story of a three-year-old girl with a genetic disorder that gives her trouble digesting food; when she needed an MRI, her family, who buy insurance through the Affordable Care Act, decided to have the procedure done at a children's hospital that specializes in the girl's condition. The hospital was out of network, but their plan would cover half the cost of a "fair price" for the MRI. The parents had done their research and knew that a typical MRI scan costs about $2000 before insurance. Ah, but the hospital they went to was not typical. At all:
They were shocked a few months later when a bill arrived with a startling price tag: $25,000. The bill included $4,016 for the anesthesia, $2,703 for a recovery room, and $16,632 for the scan itself plus doctor fees. The insurance picked up only $1,547.23, leaving the family responsible for the difference: $23,795.47.
The hospital explained to Kliff that those charges were perfectly legitimate, although it did negotiate the bill down to $16,000, which the parents are now paying off, $700 a month, for-freaking-ever. And they were pretty sure they knew what they were getting into.
Kliff points out that compared to other civilized countries, Americans pay much higher prices for healthcare, and it's just nuts:
On average, an MRI in the United States costs $1,119. That same scan costs $503 in Switzerland and $215 in Australia.
A factoid for you to file away for the next healthcare argument you get into (what, you don't argue with people about healthcare?): Nope, healthcare costs aren't high because Americans abuse their insurance by going to doctors and hospitals more than in other countries, or because we adopt all the latest technologies. Kliff cites data from the Commonwealth Fund showing the average American goes to the doctor about four times a year. And elsewhere?
Dutch people go to the doctor, on average, eight times each year. Germans make 9.9 annual doctor trips. Japanese residents clock in an impressive 12.8 doctor visits each year — more than three times the frequency of their American counterparts.
“This is really counterintuitive,” says Robin Osborn, who directs the Commonwealth Fund’s international health policy program. “With all the specialists and everything, you’d think we use twice as much health care as everyone. But it’s actually just not the case.”
What's more, we spend less time actually meeting with our medical providers -- and we have shorter hospital stays -- than elsewhere in the world.
Attempts to make healthcare more available without addressing base costs only fix part of the problem. The Affordable Care Act did a great job of bringing down the rate of people without insurance, with its subsidized individual insurance and Medicaid expansion, and made healthcare affordable for people by shifting many of the costs around (including regulations to limit insurance company overhead), but healthcare costs still haven't been reined in. And conservative claims that if we went to a beautiful free market, where competition magically lowers costs, also don't hold water, especially when healthcare consumers have no idea how much a kid's MRI will cost.
In the interest of defining the problem better, Kliff has started a Very Important Project on American healthcare costs. She wants YOU to send her your ER bills to help build a database of how much hospitals charge for one thing: The Emergency Room facility fee, the charge that everyone who goes to the ER incurs the moment they get any treatment at all. It explains why a nervous parent's visit to the ER for a one-year-old with bleeding finger -- treated with a Band-Aid -- cost $629 (The Band-Aid was $7). Or why a woman who went to an ER in San Francisco after a bike accident, at the insistence of a cop who came to the scene, was billed a facility fee of $3,170 for a brief examination of her ring finger, which was badly bruised by her wedding ring. She had other treatment, but the facility fee made up the biggest part of the bill:
When she called the hospital for an explanation, a guy in the billing department explained:
"‘Well, you know, that information is designated by people who have degrees in medical billing,’” she recounted. “He asked, ‘Do you have a degree in medical billing?’ I was like, ‘Well, you got me there, I sure don’t.’”
Kliff wants to hear from people about ER bills because they're part of every hospital's billing, and they're typically kept secret. So if you've been to an emergency room lately, you can submit a copy of your bill at this secure site; Vox and Kliff's team promise to protect your privacy, and since the data on ER facility fees really is what matters, feel free to redact your bill yourself by blocking out any personally identifying information. And you might want to give a listen to Kliff's new nerd podcast, "The Impact," which is about how laws actually affect people.
[ Vox / ER bill project / The Impact ]
I have a Primary Urgent Care near me. It charges $200 per visit, during which they get you a diagnosis and prescriptions, and they can take x-rays there which are a little more expensive, but not exorbitant & crazy. If you have a serious problem, they will call an ambulance for you. It's good to be able to get a professional opinion that you DEFINITELY SHOULD go to the hospital when you are broke and just not SURE if the thing that's wrong with you is that bad.
But it's all suddenly very simple when you get the bill. Why is the price unknowable to the consumer only before the procedure? There is a process for determining the price. The discount rate has already been negotiated with the insurer. The hospital and providers involved have already set the prices for stuff and services. Somebody somewhere's job it is to create the bill. Why is this person unavailable for consult? Where the FUCK ELSE do we find out the price of something AFTER we buy it?????Can't the biller pretend to create the bill. Act as if the patient has received the treatment, in a simulation phase? Computers can do that now, right? Simulate things before they happen?