I know this will attract a lot of people who have suggestions for healthcare.<p>Let me add my big one: price transparency.<p>I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price.<p>On the 10th call, I finally got someone to tell me what the out-of-pocket price would be without insurance. She told me a range! It was $96-$115. This was close to the range that google says was about average for the procedure.<p>So this was not a case of over-charging, or unfair pricing. I really did not know if the test was $10,000 or $100 till this call.<p>If they just made the pricing transparent, I think a lot of the problems would evaporate.<p>(Although I think the profit centers would suddenly become the emergency medicine section of the hospital.)<p>I know this article focuses on fraud, but the non-fraud part of the healthcare is just as broken, and probably costs more.
To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can accept a mistake from time to time but this seems to be pervasive.
I think this is a great argument for a single payer system. Let the government and hospitals duke it out. When it's the government's money that is being lost, the government might actually care and start negotiating with these providers. Even if it doesn't, at the very least, patients lives won't be ruined by bills for services that they had no control over or knew the cost of beforehand. Not only that, but the government can afford it. When they're losing trillions of dollars on the defense side, I'm certain they can pay for every medical procedure in the country and still have plenty left over. This whole idea that the government doesn't have money to pay for healthcare and other necessary social services is such fucking bullshit when they have the ability to lose trillions in defense and just shrug it off. That's not even mentioning the money that isn't lost on the defense side. Unfortunately, I don't think people have the capability to push their government to spend that money correctly. But that's a different problem altogether.
It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured.<p>It's a ridiculous system.
At the risk of spiking my blood pressure I will write a few words on this topic. I will start by saying this:<p><i></i>The whole system is fucked.<i></i><p>I am referring to the system that facilitates American residents getting healthy and staying that way.<p>What is the basis of my claims? I admit that I am a healthy 33 year old white male and I probably have only seen that tip of the iceberg. I am also a father of 3. My oldest daughter was born with a chronic health problem, diagnosed at 19 weeks gestation.<p>Since her birth, a little over 7 years ago, we have received a bill from the hospital that provided her care at least once per week. This continues today, despite not having had <i>any</i> services provided in almost a year.<p>If I paid all of these bills, bankruptcy would be my only recourse. I try to communicate with my insurance provider (employer provided), to determine what's legitimate, and what should be covered. In the end, I'm mostly left to my own devices to pay for <i>the services that I think I received.</i> Every year we pay the deductible, and every year we get billed for significantly more.<p>As another example, not along ago, my third daughter was born. Due to the complications of my wife's first pregnancy we received care from two different OBGYN facilities, one local to us, and one at the delivering hospital.<p>Though the local facility was only responsible for less than 10 checkups, they claimed that we still owed our entire deductible to them, prior to delivery. We paid half.<p>A week prior (this much is hilarious in itself) to delivery by a doctor from the other facility, we received a bill for the full deductible amount, due to them also.<p>When the delivery actually happened, it took less than 2 hours, and we stayed one night. We also had 3 checkups at this other facility. Our bill of course is the same as everybody else's, regardless of whether they had a C-Section and stayed for 5 nights, or had 30 hours of labor. I could actually be OK with this (I'm onboard for socialized healthcare), if they could get the billing part right.<p>Again:<p>* I am constantly billed directly by healthcare providers over and above what my insurance policy says I should pay.<p>* I pay almost 25% of my yearly earnings in insurance premiums.<p>* I end up deciding what I will pay and what I will not pay. I admit that this is probably not the best situation for anyone.<p>The whole system is fucked.
"The United States remains one of the only advanced industrialized democracies in the world without universal coverage.<p>While this in and of itself is not a problem, the United States also spends more on health care as a percentage of GDP than any other advanced country in the world and has worse health outcomes – with lower life expectancy, higher infant mortality and higher obesity rates than comparable countries like Australia, Canada, the United Kingdom, Germany, France and Japan."
- <a href="http://theconversation.com/three-reasons-the-us-doesnt-have-universal-health-coverage-67292" rel="nofollow">http://theconversation.com/three-reasons-the-us-doesnt-have-...</a>
I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care.<p>Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?
My friend's wife resigned from a nursing position over this issue. A superior asked her to falsify billing records to say they were providing a higher level of care than they actually were, and she refused.
They don't even mention the harm caused by fraud that involves inventing conditions and treatments out of thin air. Those doctor's notes follow you around forever when you go to do things like purchase disability insurance or seek treatment.<p>Suddenly you are no longer a healthy individual you are an individual with a history of condition X and Y which you have never even heard of. And because a doctor wrote it down it's now a reality and the patient is a liar!
There are so many variables that affect healthcare cost here in the US. Looking from outside, things are different than looking from inside. There is something really wrong with current US healthcare system, and it's really difficult to put a blame on one or two things.<p>Side note, I work IT in healthcare, so I sometimes view "interesting" things to say the least. A while back I stumbled upon a document that was accidentally shared. It showed accounts receivable in collections agencies for one hospital in our system. Between 2009 and 2012, there was $154m dollars in collection agencies from delinquent accounts. Remember, this is just one hospital that is actually in a more upscale location. We have some hospitals who are always in red due to their locations.<p>Then you deal with inflated prices for services and drugs. I really don't even know if they can ever fix this part.
Another issue not mentioned, but associated with the same pool, is that hospitals get dramatically more money for the same procedure than a private practice doctor. Not even upcoding.<p>Fortunately, Medicare is looking at this problem now. <a href="http://www.compassphs.com/blog/health-navigation/medicare-to-stop-paying-more-to-doctor-office-if-owned-by-hospital-system/" rel="nofollow">http://www.compassphs.com/blog/health-navigation/medicare-to...</a>
I would love to go to a doctor that had a price board hung in their waiting room so I'd know up front what the cost would be.<p><pre><code> Well-baby checkup: $120
School sports physical: $150
Blood tests: $80
Minor broken bone: $400
Major broken bone: $1200</code></pre>
Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.
For more information about the rough guidelines by which pricing works in the US (or doesn't work), check out the often referred to term "usual and customary" (UCR) charges. Read about it and then form your own opinion - I'd rather not bias too much by offering mine.<p><a href="https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasonable" rel="nofollow">https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...</a>
I think that people always want to look for the worst in every situation. America's healthcare system may not be up to first world standards for treatment. And it bankrupts hundreds of thousands of people a year. But, it's the most profitable healthcare system in the world, and that's the metric that investors really care about.
I guess it won't hurt to offer my own anecdata point about idiot medical billing.<p>Stanford hospital billed us for an IVF procedure. However, we were in Paris at the time they claimed my wife was undergoing the procedure.<p>It took going down to the billing office with our ticket stubs and pitching a fit to get it zeroed out.<p>I agree there's lots of room for improvement in medical billing.
Generally it is really hard to negotiate fair pricing if one side knows the other side has tons of money. "Oh gee, government contract? That'll be $15,000 more for no good reason." Perhaps anonymizing all billing would help so that negotiations simply cannot know what the other side can afford.
Because there's too much coverage, and effectively no choice (due to excessive standardization), the insurance companies are forced not to operate as insurance companies at all.<p>No choice, no competition, no money left when they're done with you.
This is what happens when you make the health care system capitalist. Despite rumours to the contrary, capitalism doesn't reduce prices, that would make no sense for a company trying to make a profit.
Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?