Your heart attack bill: $3,300 in Arkansas, $92,000 in California

Mildly apropos of this topic, I've had the same surgery (kidney stone removal, sorry for TMI) performed in both California and Arkansas. Random! Fancy my chances of seeing an article like this.<p>The procedure in AR was much cheaper, involved less invasive and expensive procedures, and was performed every bit as competently, if not more so.<p>When I look back at the experience, I think a lot of it came down to the sheer amount of redundancy and unnecessary procedure baked into the treatment in CA. I could speculate about the reasons why (fear of litigation being much higher in CA, for instance), though the article does a good job accounting for some of them.

How is this surprising? We've completely taken the free-market out of health care. The only way it will ever be solve is if we re-introduce market forces back into the mix. The other problem is all the government regulations that tie the hands of people that would do the innovating. That's one of the big reasons California is at the extreme. They continually add requirements to medical insurance that increase the cost. The solution is simple, let the free-market, ie us, decide what we want.

As an outsider living in a country with socialised healthcare, the US's healthcare system honestly scares me enough to consider not working there.<p>I understand that insurance is almost always provided by jobs and that it can be comprehensive if the job is decent, but I still fear the risk that some set of circumstances may conspire to leave me uncovered for something, or that the insurance situation might be sticky enough that although I am 'covered', I must wear the out-of-pocket costs whilst fighting to get reimbursed. Yes, I'm paying it every year and may never use it but the nature of insurance is that I'm Doing It Right if I never have to use it.<p>I also struggle to align myself with the attitude that 1.5-2.5% of my wage is worth more than the safety net that I and my fellow countrymen can rely on to be mostly protected from most life-threatening health issues if and when they need it. To me, the well-being of all of the people in my society (no matter how poor or rich) is worth 1.5-2.5% of my wage.<p>It's certainly fascinating looking in from the outside as the US wrestles with topics such as universal healthcare, gun laws, etc. It strikes me as stemming from core philosophic viewpoints that seem to be ingrained in the US psyche but absent from many other western nations.<p>In the end, I'm very grateful that I live somewhere with socialised universal healthcare.

The insane part is that the hospital only receives a tiny fraction of the billed amount from the insurance company, yet uninsured people have to pay the full amount.<p>The US healthcare system is broken on many levels, and I don't think anyone has the balls to really fix it.<p>Some ideas:<p>[1] Free basic medicare for everyone, but allow people to pay for faster/better service. This is the way it works in the UK, and it works very well. The basic service is fine for most people, but if you want a room to yourself or you want to jump the queue, you can pay to get US-style service. Overall it works out much cheaper and fairer than the US system.<p>[2] Set up a system that allows uninsured people to get the same rates as the insurance company. It's a bit of a scam at the moment - basically the hospitals seem to be out to screw you if you're not insured.

I just want to clarify a few things, as it would be charitable to say that there are a few misunderstandings in this thread. I am working on a company that is trying to solve some of these issues; this is a complicated industry that I am still learning much about: hopefully some of what I have learned will be of interest to some of you.<p>The PPACA (Obamacare) is seeking to address this very issue by changing medical reimbursement form a fee-for-service model (e.g. $40,000 to remove a splinter and $10,000 for blood tests and $5,000 for aspirin) to a capitated payment model with additional incentives for providing good outcomes (providing good service). This means that a caregiving organization would get $N a year to care for you, as a male patient with a heart disease in your mid fifties, with N varying as demographics and conditions change.<p>This change will necessitate a sea-change in the way doctors and other caregiving organizations will treat their patients. In fact, it will result in the creation of a new type of healthcare organization (accountable care organizations, or ACOs) with the primary purpose of bringing down the costs of healthcare (and improving health outcomes).<p>This is a paradigm shift in medical practice.<p>CMS (Centers for Medicare &#38; Medicaid Services) is spearheading this change; something which would be virtually impossible to do without such a large (read: government) player taking the first move. There are a million problems with CMS and the government in healthcare, but this is one of the greatest things they have ever done.

Want lower prices? Encourage a system where people directly pay their own money.<p>If all cars cost a $1000 co-pay no matter what car you bought, who's gonna buy the Honda Accord? However, throw price into the mix and Honda Accord becomes a very popular choice.<p>There's no huge, magical saving of money by running all medical spending through insurance providers. In the end the doctors are going to get paid. It is a matter of whether you pay them directly or pre-pay an insurance provider and they pay the doctor. Insurance is about mitigating the risk of rare but financially ruinous events (eg, cancer or serious trauma). There isn't any risk to mitigate with a flu shot or a bad cold or a mammogram. You insure your car against accidents, not oil changes and flat tires.<p>As for the poor problem, that can be solved separately by providing the poor a stipend for health care. No need to re-architect the whole system because it doesn't work for 100% of the population.

Health care in the US is the most broken one on this planet (I have been in Hong Kong and China). It is even worse than the communism countries like China. In China at least all the prices are listed before you decide to take the treatment. And the price is the same for everyone. Not to mention it is much lower than in the U.S. (abdomen sonogram is like $30 or less while in the US you can easily get billed $1200).<p>The ultimate solution IMO would be globalized free market just like the IT industry. If doctors and medical professionals from other countries can come to the US as easy as software engineers, I would expect the cost will go down to a level that we don't even need to be insured.

It always surprises me to see to see my state (Arkansas) in a headline.<p>Just wanted to throw out there that Arkansas actually has pretty good hospitals and whatnot. There are a strangely high number of multinational companies (Tyson, Walmart, Axciom, JB Hunt, among others) based here who donate lots of money to various institutions, most notably UAMS (University of Arkansas for Medical Sciences).

A North American friend of mine went to Cuba a few years ago. He had a piece of glass in his elbow that had been there for a few years. He knew it would cost at least $700 to have it removed in the US, so he never did it. When he was in Cuba, he went to the hospital to have it removed. They did it, straightforward, normal hospital. The final bill? $7. That's SEVEN dollars (although he paid Cuban currency, of course).<p>This same friend was in Papua New Guinea a few years before that (he lived there). Similar story - he was cutting wood and hit his toe with an axe. It wouldn't stop bleeding after a long time, so he went in to a local hospital and got stitches. I forgot what the exact bill was, but it was on the order of $5 (five US dollars). Again, it was a normal hospital, not some grass hut or something.<p>I'm not sure what this all means, except that if I need some expensive medical care that I am able to plan ahead for, I plan to look at places like Thailand for reasonable health care costs. Emergencies, of course, are different, so I may have to go to an American emergency room in that case. And I suck it up for my yearly physical (around $150).

It should be no surprise that the more government "regulates" and subsidizes health care, the more expensive it gets. And the answer to high costs is always more regulation!<p>I keep reading more about doctors who are opting out of the medicare system and switching to cash-only services. In the name of providing care to all, the system is breaking down and stratifying. Obamacare is an abomination of payoffs to special interest that will do <i>nothing</i> to reduce health care costs.<p>Health care must be rationed. It is a finite good. The question is how it gets rationed. Market forces? Private insurance? He who can pay? Whoever the government decides gets it? The bottom line is that the more government decides who gets it, the more expensive it becomes. There's gotta be a happy medium, and my intuition informs me that the happy medium is closer to the free-market side than the mega-regulation side.

I'd highly recommend checking out the linked dataset.[1] One quick observation: subtract Average Covered Charges from Average Total Payments and sort to see what procedures are most overcharged: 7 of the top 10 are "207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS". Average overcharge among those top records is 601K. What is going on that they routinely charge 601K more than they collect?<p>I'm excited to see what all everyone else comes up with.<p>[1] <a href="http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html" rel="nofollow">http://www.cms.gov/Research-Statistics-Data-and-Systems/Stat...</a>

Here's a quick and dirty visualization of the distributions for each kind of care across lots of different hospitals: <a href="https://www.statwing.com/open/datasets/c5fc084c00d24cf221c1727fb9e4f179fb32e860#workspaces/3934" rel="nofollow">https://www.statwing.com/open/datasets/c5fc084c00d24cf221c17...</a><p>Other visualizations today:<p>NYTimes -- <a href="http://www.nytimes.com/interactive/2013/05/08/business/how-much-hospitals-charge.html" rel="nofollow">http://www.nytimes.com/interactive/2013/05/08/business/how-m...</a><p>Washington Post (low on the page) -- <a href="http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/one-hospital-charges-8000-another-38000/" rel="nofollow">http://www.washingtonpost.com/blogs/wonkblog/wp/2013/05/08/o...</a>

I went through a cardiac event, and in the end it cost me $12,000.00 to find out I was fine. That was just the cardiac part of the testing. I also spent a grand or two to find out where the problem lie neurologically. Turns out the same nerve that allows you to know you're having a heart attack, can also have totally unrelated issues itself, and basically give false positives.

A picture is worth a thousand words?<p><a href="http://upload.wikimedia.org/wikipedia/commons/f/f8/HC-Graph.jpg" rel="nofollow">http://upload.wikimedia.org/wikipedia/commons/f/f8/HC-Graph....</a><p>Source: <a href="http://en.wikipedia.org/wiki/Health_systems#Cross-country_comparisons" rel="nofollow">http://en.wikipedia.org/wiki/Health_systems#Cross-country_co...</a>

Within smaller areas, too: <a href="https://twitter.com/HuffPostData/status/332244607805050880/photo/1" rel="nofollow">https://twitter.com/HuffPostData/status/332244607805050880/p...</a>.<p>$7,044 vs. $99,690 between New York and New Jersey! Might be worth that drive.

"Health care in the US is idiotic" doesn't really warrant a headline anymore, everybody gets it.

One of the problems when we discuss "healthcare" is the wide variety of price points for healthcare. So at one end of the market you have fully insured people asking for and/or being prescribed an array of drugs. Often quite literally they take a new drug to offset the harsher side effects of another drug so that it builds to the point whereby they'll start their day with 6 - 10 different pills. At this end of the market you could apply market forces and have significant results. If people more fully feel the burden of cost with those drugs they might very well tackle the underlying causes around obesity, diabetes etc. "If you could drop 30 or 40 pounds you'd probably find you're spending $200 less per month on medication" Sign me up!<p>However, at the middle of the market and the most serious end of the market you're looking at procedures and ailments that can cost $10,000 to $250,000. Here, if you have free market forces at play you're asking people (including many parents) to make horrible decisions between what they can afford and what is best for the quality of life for years or decades. Some will be comfortable with that I know but it appears, given the acceptance and re-election of Obama, that the majority of people in America are more open to the government running healthcare. (I wrote a blog post where I said that the fear of being financially and emotionally destroyed by healthcare was now on par with foreign invasion. As such, just as no one wants free market forces in terms of national defense they now don't want free market forces in healthcare - shameless plug and done! <a href="http://jmlite.tumblr.com/post/46257541683/why-healthcare-in-the-us-should-be-thought-of-as" rel="nofollow">http://jmlite.tumblr.com/post/46257541683/why-healthcare-in-...</a><p>I think free market forces can be applied at certain price points but I can't see how it can be the driving principle across the entire spectrum. I think state run pricing and procedures that cover 80% + of the population with a legitimate private option for those with the drive or means to pay is the best possible outcome from a tough position.

I imagine a large difference is the number of patients with health insurance - if Arkansas has significantly more uninsured, then they need to recoup costs on them. If California has enough insured patients, then their "cost" is a figure they expect insurance to bargain down from.

And my heart attack bill in Canada is $0.

I think the only thing relevant about this article is the linked dataset.

The amount of bullshit I've seen in the hospital gives me little faith that any policy change will solve the problem.<p>The real solution lies in producing safe consumer usable technology that moves all diagnostics out of the hospital. When we can get our comp, CBC, liver enzymes all with a drop of blood on a 1$ chip, when everyone and their neighbors own low cost portable MRI machines, when we can all read our EKG right on our cellphones and have it be interpreted for us 24/7 holter monitor style. Then it would only takes a team of engineers to produce software to quickly crunch all the data to produce a picture of our health... and save everyone from that expensive trip to the hospital.

To all the people who think the free market and medical care are compatible:<p>Boom! You just had a heart attack, you'll be dead inside of 15 minutes. Now, go shop around to find the best price for your treatment.

&#62;&#62;&#62;Your heart attack bill: $3,300 in Arkansas, $92,000 in California<p>And: Your rent bill: $600 in Arkansas, $2,500 in California.

Somebody PLEASE do an app with this data. If I have to schedule &#60;expensive-medical-treatment&#62;, I would love to know which of the dozen odd regional medical centers has the lowest price. Or at least which ones have excessively large prices.

healthcare is something that should be like water.

Bonus: you get a second heart attack when you see the bill.

And death, everywhere, if you fail to look after yourself properly. Prevention is free.

Serious question - can you negotiate your hospital bill like insurance companies can?

Perhaps in this market, Arkansas can leverage economies of scale.

A big factor as to why can be explained in two words.. "Illegal Mexicans"