Big Three Health Care Co-op Could Change How You Buy a Car, Get Surgery

I hear this argument from time to time. While it might be true, it conveniently ignores one sector of healthcare in the US where prices have fallen - elective procedures. Funny how the cost of LASIK hasn't been impacted by the massive inflation in healthcare. Funny how when consumers pay for a medical procedure themselves, they can comparison shop and pick which doc works best for them. Prices are up front. US healthcare in its current state is akin to walking into a Honda dealership and seeing that none of the cars have window stickers. No mileage info, no msrp, no list of options, no warranty info. The average consumer would be completely in the dark. Better yet, imagine a grocery store with no prices on anything - you find out what you owe when you're in line to pay.

@jkross22 The cost of lasik eye surgery works out to be about $200 per minute, and it's a procedure that nobody really needs. Yeah, that would be a great price to pay for extended cancer treatment that one needs to survive.

@jkross22 The pricing thing is what pi$$es me off the most. My daughter had tubes put in her ears last September. The only part of that procedure that I could get a price for was the doctor. I happily paid his fee upfront, before even involving my insurance. I could not get a price for the facility fee, anesthesiologist, or other care givers that all billed separately for a surgery that took under 10 minutes. Total cost for the surgery ended up being over $5000. Where else can you buy a service for $5000 without knowing the price beforehand?

@jkross22 "Funny how when consumers pay for a medical procedure themselves, they can comparison shop and pick which doc works best for them. Prices are up front." That does not work for health care: it's a seller's market, not a buyer's one, especially for things like cancer or cardiopulmonary disease. You can't shop around for a cheap oncologist or neurologist, and you really, really don't want to. "Better yet, imagine a grocery store with no prices on anything – you find out what you owe when you’re in line to pay." This is the problem. Healthcare isn't a market, it's a utility. Trying to treat it like a market and incentivize it is why it's ruinously expensive in the US versus elsewhere. To use your analogy, it doesn't matter what the price in the store is when you're starving and can't afford to shop there anyway. Health care is much more complex than food because, frankly, oncology is a **little bit** trickier than chopping vegetables. Other nations, with single payer, tend to just pay doctors for the work they do and buy the equipment and facilities directly. There is no haggling or negotiation (and when it happens, it's usually when costs spiral) there's just services and delivery.

@psarhjinian Someone should still be able to tell me how much it will cost for my daughter to have surgery at their center for a procedure that they perform dozens of times a day with little to no complications.

@bball40dtw "Where else can you buy a service for $5000 without knowing the price beforehand?" Law* And although with lawyers you might know the rate, you certainly won't know the outcome or the time. Medicine is similar, though with medicine the time is generally a known quantity and the capital costs are often astronomically higher. * And possibly accountancy, but I would put that under "Law" most of the time.

@bball40dtw "Someone should still be able to tell me how much it will cost for my daughter to have surgery at their center for a procedure that they perform dozens of times a day with little to no complications." In a civil society, you shouldn't even have to ask the question. You would just get it done.

@bball40dtw It's like buying an airline ticket or a car -- the prices aren't uniform. But the airline uses a predictable algorithm and the car dealer uses predictable tactics, while the pricing of medical procedures is all over the map. The network system drives up prices because medical providers can pick and choose and play the insurers against each other. The medical providers become the customers, instead of those who pay the premiums.

@psarhjinian I would equate the surgery my daughter had to having a lawyer prepare a will or trust. It's a common thing that lawyers straight bill for because they know how long it's going to take. At least, when I had a will set up, I was able to get a flat fee.

@psarhjinian "Healthcare isn't a market, it's a utility." For definitions of "healthcare" that don't include purely elective procedures, this is right, and the nations that recognize it are the ones that manage to have both reasonable healthcare costs and quality outcomes. It doesn't matter if the insurance is provided by the government (Canada) or private companies (Germany/Switzerland); it matters that it's available to everyone at rates that reflect the use of the entire population as the risk pool.

@bball40dtw psar- I agree. Pch- Well they can tell me how much it costs without insurance, or when I give them my insurance info, they know how much they bill that company. They could have just given me any number. I wasn't expecting something legally binding. Anything was better than, "I don't know". They at least have a Godd@mn range.

@bball40dtw Most of their customers have insurance. If you want to pay cash to a doctor, then you are probably best off haggling with him or directly. Their staff is generally not equipped to do that -- they don't have an MSRP to which to refer. Healthcare is not a typical product that works in a free market. Other countries use pooling to create buying power, but the US had done exactly the opposite by dividing everyone into a myriad of pools, some of which are more appealing to insurers and medical providers than others. That is a core problem that ACA did not fix.

@bball40dtw I understand all that. However, we had a HDHP at the time, and I was going to have to eat a significant portion of the bill. The fact that no one at my insurance company or the outpatient facility could provide me with any kind of pricing or cost information. Since a myringotomy is THE MOST COMMON surgical procedure performed on children, the place that does then, and the insurance company that pays for them would have an idea of what the average myringotomy cost. Asking for that info is not unreasonable. Anyone who thinks that is unreasonable is wrong.

@bball40dtw I'm not defending it, just explaining. The healthcare payments system that we have is a horrendous joke. If someone paid me to design a healthcare system that was inherently costly and inefficient and that transferred maximum dollars into the pockets of healthcare providers while not improving care, my answer would be to copy the United States. It would be difficult to do a worse job, and ACA only dealt with small aspects of the problem.

@bball40dtw Oh I understand we have a problem. I just don't like it, and I find the current system infuriating at best. I don't want to spend my time arguing what constitutes a level 1 and level 2 emergency room visit (It changes the bill by $750 if the emergency room gives your kid an oral antibiotic that costs $.0001). This is not an intelligent and civilized way to spend my time and our health care dollars. It is sheer lunacy.

@psarhjinian Not even law is that bad, attorneys are tending more towards flat fee agreements where possible. I work primarily on a flat fee arrangement. Some cases take longer, others are shorter both are the same low price. We bill hourly for the cases that we can't predict the time investment. Even then, I give you an hourly figure and some sort of estimate. Best way to keep the cost down? Don't spend a bunch of time on the phone yacking with your attorney...go to a shrink!

@jkross22 The problem is that you can live without Lasik. Even as prices have dropped, they haven't dropped enough for me to get it done. I'm nearsighted, and get by without glasses just fine day to day. I only wear them in the car, and those are usually my prescription sunglasses. My vision will have to deteriorate way more, and the price for Lasik will have to substantially drop more for me to get it done. Now compare that to the guy who needs open heart surgery. He isn't exactly in a good bargaining position. He can't hold off until he finds a better price.

@MBella If all other healthcare was priced as Lasik is, it would be even more unaffordable. Not many of us could afford to pay $200 per minute for healthcare over an extended period. It may be tolerable for ten minutes of your life and a one-time optional procedure, but few could afford to treat a chronic condition at that price.

@MBella Healthcare also does not lend itself to market forces the way that food, clothing or appliances do. If I need an oven, I can do some research and find one that meets my needs and budget. If that choice doesn't work out, all I'm out is the cost of the oven, and I can replace it again. If I'm having chest pains, I can do some research but I really need more info that I can only get from a doctor, and even if I got the same sort of info I could get about the oven (options and the attendant costs), making the same sort of decision is nearly impossible. Do I watch and wait, or have one of multiple interventions, each more expensive than the last? If I choose wrong, I'm dead or crippled. I can't just eat the expense and make a different choice.

@ClutchCarGo My daughter wasn't going to die from ear tube surgery. I had already selected the Dr and he worked out of two facilities affiliated with the health system nearby. The fact that neither could give me a price is ridiculous. Either one was perfectly reasonable. He worked at both on different days.

@bball40dtw In MA we actually have passed a medical price transparency law to address that. Implementation is...still a work in progress.

@ClutchCarGo bball, you're right that the charge info was known and should have been available to you, but the system simply isn't set up for people like you. We've been in the current insurance model for so long that pricing info in the charge master has absolutely no bearing on reality, and no one at the desk has any experience on giving quotes. As PCH suggested, you might get somewhere with the Dr or an office mgr, but you'll just get blank stares from everyone else. This is also the result of the point I was making about market forces. Altho you just wanted to know what your bill might be, would you have tried to shop around the price, looking for a better deal? Not likely, and therefore, no office has any experience with giving out pricing.

@ClutchCarGo I just want to burn it all to the ground.

@psarhjinian Setting a broken arm can cost between x and y as can heart surgeries, most ER care and many medically necessary procedures. Your point on cancer care makes sense, but does not and should not absolve hospitals, specialists and other clinical care providers from being more transparent with patients and potential patients on the cost of care of procedures and treatments that can be ballparked. Keeping patients in the dark on the cost of medical procedures benefits the providers and insurers.

@MBella True, if he's taken to the ER because he's had a heart attack. If he's told by his doc he's a high risk and he needs stents, of course he can shop around, or at minimum, talk with his doc about paying for the procedure.

@dtremit The price of a Ferrari is transparent. That doesn't make it affordable. One of the problems with healthcare is with the lack of substitutes. If you can't afford steak, then you can eat chicken or canned tuna or whatever. If you can't afford insulin or chemotherapy, then you can't just adjust your tastes and buy a cheap remedy at the drugstore. Knowing the cost of open heart surgery won't make it a bargain. The essence of the problem is that we overpay providers who want to make Wall Street level incomes. We can't afford to pay them what they want.

@ClutchCarGo Clutch, If it's an emergency, I would hope someone with chest pains is getting to the ER. Cost is irrelevant at that moment. Once a problem has been identified and a treatment plan recommended, it's irresponsible to move forward with the thought that cost is irrelevant. For non emergencies, providers ought to be compelled to tell patients the cost and what their insurance will and won't cover. ACA should have required this. Bball, You're spot on with your frustration. There's a price for everything a hospital or surgical center does. It may not be known to the people you spoke with, but it's absurd that no one could have told you the cost of the procedure.

@MBella Maybe that's why hospitals don't share information regarding the cost of care. If they did, people would drop dead on the spot.

@jkross22 "Better yet, imagine a grocery store with no prices on anything – you find out what you owe when you’re in line to pay." More like, you find out what you owe after you've taken it home and finished eating!

@ClutchCarGo bball - I would like to burn it down as well, and med billing is what I do for a living. If a single payer system replaced the ACA, I would have to find another use for my programming skills, and I would do it happily. jcross - It’s irresponsible to you for me to move forward on my chest pain with the thought that cost is irrelevant. You wouldn't think so about your own chest pain. That's why market forces are not very useful in controlling costs. We all want whatever it takes when our own irreplaceable health is on the line, costs be damned.

Fact check: According to the Bureau of Labor Statistics, the average anesthesiologist makes $246,320 per annum. The average automotive service technician makes $39,980. (I'd quote percentile wages, which are a better figure -- but those for anesthesiologists above the 10th percentile are higher than the maximum wage the BLS tracks.) According to the American Society for Anesthesiologists, the average cost for malpractice insurance is about $20k a year, or about half of what it was in 1985, after adjusting for inflation. So I think your colleagues still suffering in the business are maybe doing just a little better than your Honda mechanic.

@dtremit Good luck to those guys. You can "fact check" all your want. That average income may include those supervising large number of other health care provides. Here in L.A. that $90/hour from Medicare won't keep most of us working beyond 65 years of age.(P.S. 40% of American physicians are over 55)

@gasser Check the numbers yourself, if you'd like: http://www.bls.gov/oes/current/oes291061.htm (anesthesiologists) http://www.bls.gov/oes/current/oes493023.htm (mechanics) Medicine isn't all that different from the rest of the economy. The $112/hr you pay at the Honda dealer mostly ends up with the middlemen, too; statistically speaking, the mechanic's likely to clear less than $20/hour. Indeed, the best-paid 10% of mechanics make half as much per hour as the worst-paid 10% of anesthesiologists. As for the looming shortage you elude to, it would probably be more effective to uncap residencies (one of the reasons so many physicians are over 55) than to drastically increase reimbursements. I doubt a whole lot of doctors are going to want to work too many years past 65 at any price, when they can mostly comfortably retire.