Wasn't directed specifically at you Mike, just a generalized gripe.  I do have some ideas though:

 

- Every service provider (hospital, doctor's practice, lab, etc.) required to publicly publish their rates and prices for standard procedures/meds/tests further broken out by the cost for uninsured (cash)/ insured / medicaid.  There are few other businesses where we tolerate complete opaqueness of pricing and zero ability to comparison shop.  Why do we tolerate it in medical care?

 

- Next step after the above - no disparity in pricing.  The procedure/supply/test/med is billed at *one* price, irrespective of how the provider gets paid (ok, credit card surcharges are fine).  No more punishing the uninsured at the price level.

 

- Stop enforcing prescription drug cross-border policies and support a first-sale doctrine for them.  If the pill costs $5.00 in the US and $0.50 in Mexico then it should be encouraged for people to go shopping where cheapest, not threatened with a felony conviction.

Publishing prices won't do very much, except for things like drugs which are finite known quantities and qualities.  If doctor X posts one rate and doctor Y posts another, what do you do with that?  You have no clue of the quality difference between the two.  Maybe one should be charging three times what the other does.  The same goes for tests, when do you use one versus another.  A better doctor knows when the $50 test will answer his question and not order the $5,000 test for the same thing - if he does not have to fear that he will be sued because there is a 0.01% chance the cheap test might miss something.  We all make these decisions everyday.  You don't use critical defense ammo for a range visit, unless you are spending someone else's money.

Au contraire Howard - Medicaid has forced lots of standardization on procedures and tests.  If a doctor orders a test you'd have the ability to price it out and compare as opposed to just go where he/she recommends and see what the bill is afterwards.

 

To use your analogy - You don't just always buy your ammo at the range, you comparison shop from different retailers.

There are problems throughout the entire healthcare system.

 

First, costs are astronomical.  But we have to ask why this is...  Is it because we allow frivolous lawsuits?  Because we have "doctors" doing their residency pulling 60-80 hrs a week and therefore making stupid mistakes because they're sleep deprived?

 

Second, we have this idiotic insurance system.  When I was a kid, we didn't call it "health insurance" we called it HOSPITALIZATION.  It simply was catastrophic care.  This kept the insurance costs low.

 

Third, the US absorbs the costs for R&D, and then FDA approval on what appears to be nearly every drug on the market which drives costs WAY above material costs.  Further, with the laws the way they are, the pharma industry has to plan on recovering their R&D and testing costs BEFORE the drug ends up going generic.

 

Fourth, we have entitlement society which EXPECTS that they should get shit for FREE.  Sorry, IMO you should have to pay out of pocket for the $5 generic drugs at walmart.  You should have insurance coverage however for $16,000 per treatment chemo drugs.  You should not get contraception of any kind for free.  Don't be a dumbass, get your boyfriend to buy a condom, they're not that expensive and (wait for it) they're cheap INSURANCE for what COULD occur.

 

Fifth, we can't refuse treatment at ER's to anyone, even if they don't belong here.  I understand that people needing emergency care should be able to get it.  I wouldn't want to be in a foreign country, cut off my finger and then know that they were not going to re-attach because I was there illegally (though likely if I were in Mexico illegally that's exactly what WOULD happen)...  But we have to draw the line somewhere.

 

My 2 cents.

DirtyDigz, you have missed my point.  You (well at least I) are not qualified to determine which test you need.  Sure you can see who charges less for a test, but that is not the issue.  Will a blood test answer the question?  Maybe it is an enzyme test that is needed?  Perhaps a CAT scan or maybe even an MRI.   That is the issue.  If there is a 99.999% that the $20 blood test will give the correct diagnosis then why should some doctors be ordering the MRI at $5,000 (or whatever) to get a 99.999999% answer.  That is the trade-off that needs to be made and the average patient does not have that ability.

 

And yes I comparison shop, but if I am spending your money - well why should I both to comparison shop?  That is the problem with the insurance system.

Don't forget that health insurance companies will help to reduce the overall cost of services. If they get a bill from a hospital they will negotiate for a lower price... try doing that with out coverage. Sometimes, the cost paid is FAR lower the the initial bill.

But insurance is the cause of hospital prices being so high. They mark everything up cause they know it will get marked down. Look what they charge you for an aspirin in a hospital.

But insurance is the cause of hospital prices being so high. They mark everything up cause they know it will get marked down. Look what they charge you for an aspirin in a hospital.

This. Our medical world is one giant cycle of charging too much and haggling down and increasing prices and haggling down over and over again.

 

Capitalism dictates that insurance companies are in the business to get paid - they have a large incentive to screw over their clients because it's good for the bottom line.

 

Way high prices for the uninsured do a good job of coercing people to buy insurance.

 

 

 

Of course the system is broken (actually, I think it's working exactly how it was designed....just broken for us) but allowing ourselves to be coerced into having health insurance is fiscally prudent, at this juncture, should something go wrong - but in the meantime, we should work to reform it.

 

I also think the ACA fails at this reformation, and I do NOT think it's okay to force someone to buy a product.... but I'm not sure what the answer is.

Actually its the government involvement that has broken the insurance system, much as it has broken just about everything it touches.  Prices would be much lower if we had real competition, not what the government has done.  Insurance is regulated by each state and you get a different policy in each state which makes the system very inefficient.  If there were one standard, with different levels of coverage, across the county we would have lots of companies all competing on equal footing for our business.  That is what drives prices down.

You guys should read the link Dirtydigz provided. It has some really interesting information on the pricing game, the "rising costs" of healthcare, and some other important topics. It's long but worth the read. The doctor did his research.

 

http://truecostofhealthcare.org/

First check what the "college insurance" covers, where it covers you, and during what part of the calendar year

 

DO NOT GO WITHOUT SOME FORM of HEALTH INSURANCE. Pardon my French but that is STUPID beyond belief. Here's why.

 

If god forbid you get into an auto mishap, or suffer an accident, or require hospitalization for any reason for even a week, YOU and YOUR FAMILY (if you're a  minor) are on the hook for the entire bill.

 

My next door neighbor contracted an infection after foot surgery. Seven days at Newton Hospital. The bill was $72,000. This is no joking matter. (Luckily she has great insurance). My wife recently had a kidney stone removed. Her insurance gave the surgery center and doctor about $3,500. The actual bill -- the one we'd have to pay if we had no insurance -- was $25,000 for prepping, a 20 minute procedure, and maybe two hours in the recovery room.

 

What should you do, now that you've heard the lecture?

 

Get a policy that covers catastrophic events only, if they still sell them. Sit down with your parents, your bank accounts in hand, and determine how much you can afford to self-insure. If it's $5,000 then get a policy with a $5,000 deductible, etc.

 

Repeat: DO NOT GO WITHOUT HEALTH INSURANCE.

 

Any idea the cost of a catastrophic policy? 

Actually its the government involvement that has broken the insurance system, much as it has broken just about everything it touches.  Prices would be much lower if we had real competition, not what the government has done.  Insurance is regulated by each state and you get a different policy in each state which makes the system very inefficient.  If there were one standard, with different levels of coverage, across the county we would have lots of companies all competing on equal footing for our business.  That is what drives prices down.

 

Sound like a Ron Paul guy. 

Any idea the cost of a catastrophic policy? 

You have to find that out yourself. Tons of sites online for getting quotes.

 

I saw something that was < $1600 per year, but that may have been before the ACA was hatched out of Nancy Pelosi's rectum.

Just keep this in mind. My wife's office was told to no longer send people to the obamacare marketplace. Hopefully that a good sign

And for the guys complaining about cost. I pay $11 an hour into my insurance out of my package.

Wage Rates

BACK

EFFECTIVE MAY 1, 2013 TO APRIL 30, 2014

Journeyman’s Base Rate 41.79 per hour

Health & Welfare Fund

General 11.85 per hour

Mesothelioma Fund .04 per hour

Pension Fund 11.26 per hour

Annuity Fund 4.75 per hour

Scholarship Fund .04 per hour

LMCT .05 per hour

Industry Fund .15 per hour

Apprentice Fund .96 per hour

TOTAL JOURNEYMAN’S PACKAGE $70.89

(Dues Assessment . . . . $2.84 + $.12 per hour worked)

(Market Recovery Fund . . . . $.12 per hour worked)

(Building Fund . . . . $.25 per hour worked)

(Vacation Fund . . . . $1.25 per hour worked)

Just keep this in mind. My wife's office was told to no longer send people to the obamacare marketplace. Hopefully that a good sign

Sounds like Obamacare is going down hill?

 

In my economics class we were talking about Obamacare, so far it was like only 27,000 signed up and they need it to be at 7-7.5 million. Also discussing how they had to bring a top notch computer person about the site to fix so when you apply you get your insurance by Jan 1st but the computer tech was saying its highly impossible to reach that time lol. Lastly she the teacher was saying Obamacare needs us young and healthy to sign up for them to make any money cause its already given the sick and old will sign up, so she asked out class who is signing up for Obamacare, all you heard was NOPE from everyone lol.

Based on my life experience in two countries... what I've never been able to get is why Procedure A (let it be chest x-ray, ultrasound, minor surgery or something else which is not a masterpiece of some cutting edge technology, but rather a routine procedure done multiple times a day by any reasonably qualified doctor in any place in the world) can cost, let's say, ~$300 in a independently operated private outpatient facility in Moscow, Russia (so NO contribution from state insurance; price includes all operating costs of the facility, doctor's/technician's salary, materials, drugs etc), and the very same procedure can be billed at ~$9'000 in an ER in some US city.

 

Just don't take me wrong - I perfectly know about the difference in salaries of doctors that can be sometimes underpaid in Russia, difference in taxation systems, different operating costs etc., but that would've explained (at least in my view) 1.5 - 2 or maybe 3 times difference, but not more. I just can't get how the difference for some procedures can literally be 20-30 times (and that's not a joke, I used some medical care in Russia and even in best private institutions it can be 10-20-30 or even more times cheaper than the similar procedure in the US).

 

More surprisingly - when we get from general therapeutic / surgical treatments to dental treatments (i.e. for procedures that are less commonly covered by health insurance in the US and more often paid out of pocket, so naturally becoming a subject of more intense competition), this price difference almost disappears - extraction of a complicated wisdom tooth can cost anywhere around $1000-2000 both in the US and in private facility in Moscow. Another miracle? Or just a pure fair competition between dentists everywhere?

 

I'm just trying to apply it to any other field of the economy. Can you imagine a gas price in the US to be at, let's say, $3 per gallon and in Canada at $60 per gallon?

Or an iPhone being sold at $300 in the US and $7000 in China? Etc. etc. Sounds crazy, but that's exactly the case with healthcare costs...

 

This just does not fit into my understanding of the world...

I write on and about the healthcare system. The problems are deep-rooted, systemic, and nearly impossible to unravel. Everything is connected to everything else, like a badly-made toy.

 

We could have, and should have had, healthcare reform but for two factors: 

 

1) The democrats believe that they can fix everything with 2800 pages of fabrications, additional taxation, and -- as usual with every entitlement -- that it just has to work out because they want it.

 

2) Until recently the republicans have not given a shit.

 

As Mark Steyn has written, with remorse, even the socialized systems are a better deal than the tangled, interconnected web of narrow self-serving interests that we deal with. Get over it, guys, we have not had a free-market healthcare system since at least the 1960s. We in fact have the worst of socialized medicine and the worst of semi-free markets.

 

We could have HC reform if we recognized, first of all, that it is an eight, nine, ten-year problem and not a two-week fix via lobbyist-authored nonsense extracted from Nancy Pelosi's rear end (or was it a caesarian?).

 

The problem demands at least two years of study, and the recruitment of the top minds in economics, operational excellence, science, medicine, sociology, history, philosophy. The policy equivalent of the Manhattan Project. 

 

We need to figure out why doctors don't know what they charge, why hospital bills have become works of fiction, why medicines and procedures really and truly are so f*****g expensive, and why the current system KILLS between 150,000 and 200,000 people every year.

 

Virtually nobody except for the poor need a soup-to-nuts policy with free doctor visits. Everybody should be means-tested for a reasonable deductible, which would be paid from a Medical Savings Account or "Medical IRA." That could be implemented over the first year and would dramatically lower insurance premiums. 

 

Additional savings could be gained during the study and deployment periods.

 

I'm 100% certain that every single person in this country could be covered in one way or another, for significantly LESS money than we spend now.