If hotels billed like hospitals

We just had a baby and I got a fully itemized bill, down to the total time spent with a head nurse vs the lower down nurses (billed at different rates).<p>I agree that I would have liked to have known that if my wife buzzed for a refill on her water bottle that we would be billed for the nurses time at $120/hr.<p>But even if I had known that, the total bill was discounted from 10k to 7k due to an agreement my insurance has with the hospital, and then my 80 | 20 kicked in and our out of pocket expense for a delivery, care and 48 hour stay was $1400 + a $300 copay. So many factors involved would have made estimating my final cost pretty difficult.<p>And that may be the point. It's not so much about transparency, it's more about how complicated the billing actually is.

What really troubles me, that I didn't see represented in this video, is not so much the total amount of the bills but the sheer number of them. These days, a hospital visit results in bills from (at the very least)<p>* The hospital * The doctor (or doctors) who may have spent a total of 10 minutes with you * The lab company that did your blood work (if it was done) * The lab company that did you CT scan / MRI / Ultrasound / X-Ray / other expensive diagnostic exam. * The pharmacy that provided any medications you were given while at the hospital.<p>What's worse, is that if you look, most triage areas have a sign stating all the services are independently operated and you'll receive these separate bills. Confusing and obnoxious--but ok. The trouble begins when you discover that, though your insurance is accepted by the hospital, it's not accepted by one of the <i>other</i> people or services (of which you had no real choice but to use the service available on-site) isn't. The hospital might assign you a doctor that doesn't take your insurance and then you're screwed.

Here in the Netherlands every medical procedure has a standardized declaration code. On the site of the NZa (Netherlands Healthcare Authority) you can check the current and historical cost of a procedure for each hospital.<p>For example go to <a href="http://dbc-tarieven.nza.nl/Nzatarieven/zoekSnel.do" rel="nofollow">http://dbc-tarieven.nza.nl/Nzatarieven/zoekSnel.do</a> and fill in declaration code 085090, the code for a MRI. The NZa determines a maximum tariff for many procedures. For other procedures the cost is negotiable between healthcare insurers and providers.

The primary difference, health care is other people's money. We shop where the government policies hide the true cost of our care by minimizing or eliminating out of pocket expenses.<p>Being on a HSA program now at work really brings home the costs of health care. It shows quite quickly that there is no free ride.<p>Long term health care will never be free, there will have to be minimum payments/co-pays and the like. Otherwise people will simply abuse it, showing up for every real and perceived problem. I am not saying we do not offer free care to people who cannot pay, but damn, I see people claiming a need for other to pay all the while having eight dollar a month cell phone plans, high speed internet, and car payments that are in some cases what my rent used to be.

In summary there's no force to drive down health care costs if prices are not made public. If I need an x-ray, I want to be able to shop around with quality and price information made public.

$200 = ($50 space per night to put self + 20 cleaning + 0.2 mint + 1.80 water + 3 air conditioning + other low-tech things)(1+percentage profit)<p>$20,000 = ($2,000 for 50 years of training for 5 docs + $3,000(1 + percentage unnecessary to prevent lawsuit) state of art chemicals &#38; tests + 2,000 admin + whatev other stuff)(1+ percentage profit)<p>if the hotel industry was run like the hospital industry it would still cost $200-400 or so for an ok room. The price size is the big attention grabber in the video. preventing potentially imminent death, and legal responsibility for it, is EXPENSIVE.<p>also, in a hotel you decide whether to eat chocolate. in a hospital, you might be unconscious or have no clue wtf 'vancomycin' is. so doctors decide. video misses this consumption-decision aspect.<p>wishing for a free, transparent market in medicine is naive, at least now. healthcare can't be 'disrupted' as easily as javascript library trends. but we might at least wish for a standardized 'economy' emergency set of options that uses off-patent stuff and restricts procedures. ER docs would hate binding rules but it does make a difference in unexpected ER cost, even choosing cheap vs expensive antibiotics.<p>if you plan 3 months ahead to pay 10k for plastics penis enlargement, that's a somewhat different issue.

Why aren't hospitals and doctors REQUIRED to post prices?

The terrible acting aside, this is a good way of pointing out how pricing models are totally different and specific to certain industries.<p>Some people can really take the piss because its standard in the industry but totally adhear to normal payment standards in another industry.

What law allows hospitals to do this? If they don't tell you the price beforehand, and they don't publicly post the prices, legally, how do you ever owe them any money?<p>How do hospitals collect these bills? Can the hospital sue you to collect on these bills?

It points to the absurdity of those who claim US healthcare is a "free market". It's a cartel whose hooks are WAY deeper in the political system than just about any other industry, including oil, agriculture, or telecom.<p>Don't like it? Then your choices are either go elsewhere or die.<p>It's tempting to advocate a UK-style system, but I'll need more proof that NHS is not a political tool to depopulate the opposition.<p>Yes, some of us septics/savages watch the PM Q-time and never a session goes by without someone in the opposition complaining about hospitals and clinics in their district closing...

The one item missing here is a hot-topic of mine: emergency care. Not only are emergency services as expensive as the rest of medicine, but worse than that is the providers have a legal responsibility to care for the individual, who in turn has zero responsibility to actually pay the bill.<p>The other missing factor is that in a lot of cases, medicare/medicaid don't actually cover the actual cost of the procedure/service being provided; this leads providers and practitioners to charge more for those with better insurance in order to keep their businesses afloat.

The initial bill is written KNOWING that it will be discounted. Prices are obviously jacked up so they get negotiated down to something reasonable, just like any scenario where haggling is normal.<p>I was just in the ER and got the claim forms. Price paid was about 1/10th the initial bill.<p>If hotels billed like hospitals, they'd offer rooms for $1000/night and settle for $100 when you flashed a Hotels Club card, which everyone would have, pay a flat rate for + deductible, and would use to the max to squeeze every penny of value out of that flat rate.

Well it seems to me we are all in the wrong industry!<p>I'm sure none of these healthcare guys have to deal with fierce competition from all over the world, exponentially increasing automation, the constant threat of outsourcing, etc...<p>Someone mentioned how the hospital charged him $125/hour for a nurse and all she did was bring a glass of water to the patient. Try to extrapolate that situation to IT and see what kinds of crazy numbers you get.

So, why is it again that we don't just run hospitals like any other civil service (police, fire, defense), fund them with taxes, and treat the care as something that a civilized government should provide?<p>Having given government a monopoly on force, it would seem that we should expect it to heal as well. This is absurd.

Downvote for problems only Americans have.