Pretty soon you're talking about real money
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@xenon said in Pretty soon you're talking about real money:
The US has a weird system.
The insurers are the customer, patients just a necessary input.
My understanding is that often the physicians and practitioners have no idea what the procedures they do ending up costing. There’s no mechanism in the system to understand the cost / benefit of treatment A vs treatment B.
As in treatment A maybe be 10x more expensive than treatment B, but only slightly more effective in trials. (Or even essentially the same level of effectiveness)
The system is set up that way though. An analogy I heard on an econtalk podcast was that it’s like going to dinner and splitting the bill. You know everyone else might order steak, so you order surf and turf too. Everyone does. We all split the bill and insurance pays. So everyone gets the absolute best that money will buy, at all times.
There’s few market mechanisms in place to keep the cost down. The hospital often doesn’t even know its cost for procedures.
It’s not a market system. It’s a system where we have unlimited private money going in to a system without cost controls.
Where do you come up with this stuff?
Almost none of what you say is true.
Maybe you have one or two anecdotes.
But of course there are cost controls, and audits and accounting rules.
There is lots of competition in insurance and services and medicine.
Your post is not anywhere near reality.
@Copper Is there cost competition on standard of care?
I thought there would be tiered healthcare in the U.S. when I moved here (as in better stuff for people who had more money and better insurance). But if you're insured, everyone seems to get the "gold standard of care". Your insurance just tells you how much out of pocket you're going to pay.
And the U.S. definitely has the best of the best in terms of equipment, drugs and services. (doesn't always equate into best healthcare outcomes though)
A lot of this perspective is from listening to a recent talk by Vivian Lee
The interesting insight for me is that on standard of care - typically physicians aren't looking at cost effectiveness, they're looking at efficacy.
We have physicians here - I'd love to hear from @George-K if he ever thought about treatments and made decisions on the dimension of how much they would cost?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
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I think most of what Xenon said is defensible. At least if you allow for some exaggeration (e.g. there are some cost controls, not none, they're just very weak).
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I just paid the $1400. The place is indeed out of network, while literally all the surgeons they work with are in network. They have a strict 15 day policy from the date they mail the first statement, which I am unaware of ever receiving but which they say they mailed on June 29. They bill the insurance company as out of network. Their business model is apparently to get the tiny fraction that the insurance company pays out of network providers, and a little bit more from the patient. It is unclear to me whether my insurance company would have covered 100% of this had they been in-network - I think they would have, since my deductible is covered. The surgery center gave me a story the morning of the surgery that they would be charging 15k to insurance, who would cover 90% and I was responsible for 10%. That story was completely fabricated as far as I can tell.
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@Copper Is there cost competition on standard of care?
I thought there would be tiered healthcare in the U.S. when I moved here (as in better stuff for people who had more money and better insurance). But if you're insured, everyone seems to get the "gold standard of care". Your insurance just tells you how much out of pocket you're going to pay.
And the U.S. definitely has the best of the best in terms of equipment, drugs and services. (doesn't always equate into best healthcare outcomes though)
A lot of this perspective is from listening to a recent talk by Vivian Lee
The interesting insight for me is that on standard of care - typically physicians aren't looking at cost effectiveness, they're looking at efficacy.
We have physicians here - I'd love to hear from @George-K if he ever thought about treatments and made decisions on the dimension of how much they would cost?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
@xenon said in Pretty soon you're talking about real money:
@Copper Is there cost competition on standard of care?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
Of course there is competition.
And of course the better doctors cost more.
Here is a program I used up until last year.
It was not covered by insurance, I paid for it myself so I could have access to the doctor I wanted. Believe me, this was a cost increase.
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@xenon said in Pretty soon you're talking about real money:
@Copper Is there cost competition on standard of care?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
Of course there is competition.
And of course the better doctors cost more.
Here is a program I used up until last year.
It was not covered by insurance, I paid for it myself so I could have access to the doctor I wanted. Believe me, this was a cost increase.
@Copper The most expensive thing we've done in the U.S. is have kids.
In SF our OB gyn's resume was ridiculous (Harvard, Standard med school, head of OB at UCSF... lots of other prestigious positions).
In Seattle our OB was fantastic - but a bit more "normal" on the qualifications and earlier in her career (we actually loved her, since she had more time to spend with us).
Don't know what they cost - wasn't any different for us.
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That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
Education is extremely important.
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That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
@Horace said in Pretty soon you're talking about real money:
That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
If they are in network, that would seem to be a bit high for your part. Have you received your EOB's on their services?
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@jon-nyc Dont know if you would be willing to share, but what was the gross cost for your medical procedure?
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I don’t know what I spent, it was probably capped at a few grand per year for co-pays.
We even had some reimbursement for relocation, but I was listed long enough that we burned through it. So I probably spent 20-30k of my own money (over, say, 2014-16) if I had to guess.
Most of it didn’t feel like medical bills. Like buying a home oxygen concentrator or paying rent or renting furniture.
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@89th I paid the $1433 and am now hoping the 98k bill just magically disappears. I received no receipt of payment, though the woman on the phone said she'd send me one. Nor have I ever received a bill. The only bill received so far is the one sent to my insurance company. So basically the process is that this surgery center sends a huge out of network bill to the insurer, gets pennies on the dollar for it, and accepts some other "small" amount from the patient. I have to trust the system that the balance of the 98k bill is not legally passed on to me. Having seen no paper yet, I really don't know.
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Horace said, "I have to trust the system..."
No kidding. He actually said that. Look at his post!
It looks like his typing, far as I can tell.Scary, might be Covid-20 or something.
Too much sun? Bad water. Drunk on Jon. Found religion.Ax, help him help him!! Soon he'll be drowning in trust, and then, blam! No return from utopia.
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You either trust the system or you move to Canada.
