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It's worth noting that there is no relationship between a U.S. hospital bill and the actual cost of the service: http://truecostofhealthcare.org/hospital_billi

It's worth noting that there is no relationship between a U.S. hospital bill and the actual cost of the service: http://truecostofhealthcare.org/hospital_billing http://truecostofhealthcare.org/hospital_billing "Hospitals see no problem in sending bills to insurance companies for five to ten times the amount that they actually expect, because they are simply playing the game that the insurance companies fashioned. But remember, they only produce one kind of bill, and it’s designed to send to someone who holds all the cards (an insurance company), and so can just refuse to pay anything they don’t want to pay. That’s their game. But what happens when you have to play the game with the hospital alone (if you don’t have insurance, or if your insurance doesn’t cover that stay for some reason). Then you’re on the hook for the ENTIRE amount. Most hospitals have a policy that allows people to negotiate for a lower amount, but most people don’t know this. And don’t expect the hospital to tell you about it, let alone help out. So even if you can remember to negotiate while you’re convalescing from a long hospital stay, good luck trying to get the deal the insurance company gets. For the average person, this is no small matter. In the first case, a two day hospitalization that the insurance company got for $2,100 (after the insurance adjustment), would cost an uninsured person over $21,000. The adjusted charge ($2,100) would be a pretty nasty kick in the finances for most families, but they could bounce back. The unadjusted charge, which is what you’ll get if you don’t have insurance, is an almost certain trip to bankruptcy."

anigbrowl 14y ago
a two day hospitalization that the insurance company got for $2,100 (after the insurance adjustment), would cost an uninsured person over $21,000 Pooh, I ran up a bill of close to that size in only 12 hours without any serious injuries :-/ In fairness the hospital did tell me about their discount policy and cut it down by about half, but it was still kind of a ripoff. Of course it seemed as if every doctor in the place took it upon themselves to have a quick chat with me, and then billed me for the privilege afterwards. I got copies of all the hospital records afterwards and the amount of duplication was ridiculous, not to mention dangerous; there's so much paperwork floating about that my discharge nurse initially gave me the paperwork for a patient in the adjoining room. I think this is pretty unethical, really; ostensibly they're all there to help (and understandably want to to be able to defend themselves for accusations of poor medical care) but as I was recovering from a near-fatal accident the last thing I wanted was some new person coming around every 45 minutes to ask me the same questions afresh, when I had neither the energy nor the initiative to refuse.
- purplelobster 14y ago
  From my experience, the weirdest thing is that you're rarely informed about something having a cost. It can be something as simple as a one minute chat that later shows up on the bill as a separate item. Not only that, but every time I've tried to ask what something costs, I can never ever get a straight answer out of them, I'll just have to find out when I get the bill and pray it's not too much. It's insanity.
  - chris_mahan 14y ago
    There should be a requirement that doctors post all prices like car mechanics.
    - epoxyhockey 14y ago
      Mechanics post prices? The only reliable way I've found to determine the real cost of car repair is to comparison shop and look online in enthusiast forums. Even then, there is still room for haggling.
      - chris_mahan 14y ago
        Not only do they post prices, they will write an estimate and you have to sign it in order for them to begin work, and they can't exceed estimated costs without your approval. (In California)
  - mgkimsal 14y ago
    My wife was in the ER a couple years ago - I asked multiple people (two nurses and a doctor) how much any of this would cost, and they all said "I don't know".
    - roc 14y ago
      The sad part is that they usually truly don't. Because not only do hospitals have largely-fictional rates they try to pass to insurers, there are also the medicare rates, the medicaid rates, the rates they pass to those trying to pay out-of-pocket, the rates for the generic equivalent they'll switch to after you agree to a drug/procedure due to your coverage, the discounted rates they pass to people who will almost certainly let the bill go to collections if it isn't heavily discounted, etc.
wwosik 14y ago
$21k for 2 days in the hospital? Are the beds made of gold? To me it sound totally outrageous. I'm going to have an ACL operation in a very good European hospital, paying out of my pocket and the estimate is running at 4k EUR (say $5.5k) for the operation and one day in the hospital. I understand health costs can be unbounded, but it exceeds all reason.
- DenisM 14y ago
  The beds may not be gold, but the hearts are made of stone.
JPKab 14y ago
I don't blame you for it, since it's long, but I don't think you read the entire article, let alone the second page. I also don't think you actually understand how hospitals bill insurance companies. I'm not saying insurance companies are great: they are not. But their profit margins are substantially smaller than these "non-profit" hospitals featured in the article. Hospitals don't send a high bill to an insurance company, and then play a game of who pays what. All the rates are pre-negotiated. The second page clearly states that insurance companies, when they pre-negotiate, want to do so from the Medicare price as a starting point. Hospitals want to do so from their exorbitantly inflated "chargemaster" central pricing table. As hospitals and clinics have consolidated, they have increased their leverage over insurers so that they can force the insurers to pay far more than they used to.
- kamaal 14y ago
  >>But their profit margins are substantially smaller than these "non-profit" hospitals featured in the article. Every time you hear non-profit anything, run from it like you run for your life. These days a non-profit organization means, the organizations gets to make no profit but the people who run it, take the profit on the organization's behalf.
barking 14y ago
It's worth noting that there is no relationship between a U.S. hospital bill and the actual cost of the service If this is true (and I don't know that it is) then it sounds to me that the free market is not working in this area in the USA. If it's not working then that may be because of supply restrictions because of limited numbers of places and/or high costs at medical schools and excessive restrictions on foreign trained medical professionals entering the US. On the other hand becoming a doctor requires a high degreee of intelligence, high tuition fees and years of long hours as a junior at low pay while you continue to study and do further exams. When you finally get to the promised land you have large debts and a relatively short career ahead of you. You also have rare skills and are a person who has delayed gratification to an extent that few others would be prepared to. You are also in a highly responsible job and are likely to be subjected several stressful lawsuits during your career. In a society where no limit seems to be placed on the earnings of sports stars and others in their early twenties, why should doctors be expected to restrict themselves to less than their market can bear?
- dietrichepp 14y ago
  I don't see how a correctly-working free market would lead to a different situation here. The market is necessarily inefficient: 1. Consumers don't have the skills required to estimate the value of medical care. 2. Consumers don't have the time to negotiate prices: if you're dying, you can't wait. The question here is not doctor's salaries, that's a red herring. The question is why someone without insurance pays so much more than someone with insurance, if the care received is the same. It's because the insurance companies have the time and skills to negotiate prices, and individual consumers are under duress. It's the same reason that workers in unions earn better wages -- although the numbers are different: Wikipedia puts the gap between union and non-union wages at 21-32% in the US, and the gap between the cost of insured and non-insured care is much higher. I say we have a moral duty to replace the current, broken, free-market system. Evidence from countries other than the US supports the theory that socialized health-care can be more efficient.
- droidist2 14y ago
  It's true the free market isn't functioning in healthcare. You mentioned doctor supply. During the late 1990s the American Medical Association convinced the government there was going to be a "doctor glut" so the American taxpayer subsidized medical schools in exchange for not graduating doctors, $100,000 for each doctor not trained.

anigbrowl 14y ago

a two day hospitalization that the insurance company got for $2,100 (after the insurance adjustment), would cost an uninsured person over $21,000 Pooh, I ran up a bill of close to that size in only 12 hours without any serious injuries :-/ In fairness the hospital did tell me about their discount policy and cut it down by about half, but it was still kind of a ripoff. Of course it seemed as if every doctor in the place took it upon themselves to have a quick chat with me, and then billed me for the privilege afterwards. I got copies of all the hospital records afterwards and the amount of duplication was ridiculous, not to mention dangerous; there's so much paperwork floating about that my discharge nurse initially gave me the paperwork for a patient in the adjoining room. I think this is pretty unethical, really; ostensibly they're all there to help (and understandably want to to be able to defend themselves for accusations of poor medical care) but as I was recovering from a near-fatal accident the last thing I wanted was some new person coming around every 45 minutes to ask me the same questions afresh, when I had neither the energy nor the initiative to refuse.

purplelobster 14y ago
From my experience, the weirdest thing is that you're rarely informed about something having a cost. It can be something as simple as a one minute chat that later shows up on the bill as a separate item. Not only that, but every time I've tried to ask what something costs, I can never ever get a straight answer out of them, I'll just have to find out when I get the bill and pray it's not too much. It's insanity.
- chris_mahan 14y ago
  There should be a requirement that doctors post all prices like car mechanics.
  - epoxyhockey 14y ago
    Mechanics post prices? The only reliable way I've found to determine the real cost of car repair is to comparison shop and look online in enthusiast forums. Even then, there is still room for haggling.
    - chris_mahan 14y ago
      Not only do they post prices, they will write an estimate and you have to sign it in order for them to begin work, and they can't exceed estimated costs without your approval. (In California)
- mgkimsal 14y ago
  My wife was in the ER a couple years ago - I asked multiple people (two nurses and a doctor) how much any of this would cost, and they all said "I don't know".
  - roc 14y ago
    The sad part is that they usually truly don't. Because not only do hospitals have largely-fictional rates they try to pass to insurers, there are also the medicare rates, the medicaid rates, the rates they pass to those trying to pay out-of-pocket, the rates for the generic equivalent they'll switch to after you agree to a drug/procedure due to your coverage, the discounted rates they pass to people who will almost certainly let the bill go to collections if it isn't heavily discounted, etc.

wwosik 14y ago

$21k for 2 days in the hospital? Are the beds made of gold? To me it sound totally outrageous. I'm going to have an ACL operation in a very good European hospital, paying out of my pocket and the estimate is running at 4k EUR (say $5.5k) for the operation and one day in the hospital. I understand health costs can be unbounded, but it exceeds all reason.

DenisM 14y ago
The beds may not be gold, but the hearts are made of stone.

JPKab 14y ago

I don't blame you for it, since it's long, but I don't think you read the entire article, let alone the second page. I also don't think you actually understand how hospitals bill insurance companies. I'm not saying insurance companies are great: they are not. But their profit margins are substantially smaller than these "non-profit" hospitals featured in the article. Hospitals don't send a high bill to an insurance company, and then play a game of who pays what. All the rates are pre-negotiated. The second page clearly states that insurance companies, when they pre-negotiate, want to do so from the Medicare price as a starting point. Hospitals want to do so from their exorbitantly inflated "chargemaster" central pricing table. As hospitals and clinics have consolidated, they have increased their leverage over insurers so that they can force the insurers to pay far more than they used to.

kamaal 14y ago
>>But their profit margins are substantially smaller than these "non-profit" hospitals featured in the article. Every time you hear non-profit anything, run from it like you run for your life. These days a non-profit organization means, the organizations gets to make no profit but the people who run it, take the profit on the organization's behalf.

barking 14y ago

It's worth noting that there is no relationship between a U.S. hospital bill and the actual cost of the service If this is true (and I don't know that it is) then it sounds to me that the free market is not working in this area in the USA. If it's not working then that may be because of supply restrictions because of limited numbers of places and/or high costs at medical schools and excessive restrictions on foreign trained medical professionals entering the US. On the other hand becoming a doctor requires a high degreee of intelligence, high tuition fees and years of long hours as a junior at low pay while you continue to study and do further exams. When you finally get to the promised land you have large debts and a relatively short career ahead of you. You also have rare skills and are a person who has delayed gratification to an extent that few others would be prepared to. You are also in a highly responsible job and are likely to be subjected several stressful lawsuits during your career. In a society where no limit seems to be placed on the earnings of sports stars and others in their early twenties, why should doctors be expected to restrict themselves to less than their market can bear?

dietrichepp 14y ago
I don't see how a correctly-working free market would lead to a different situation here. The market is necessarily inefficient: 1. Consumers don't have the skills required to estimate the value of medical care. 2. Consumers don't have the time to negotiate prices: if you're dying, you can't wait. The question here is not doctor's salaries, that's a red herring. The question is why someone without insurance pays so much more than someone with insurance, if the care received is the same. It's because the insurance companies have the time and skills to negotiate prices, and individual consumers are under duress. It's the same reason that workers in unions earn better wages -- although the numbers are different: Wikipedia puts the gap between union and non-union wages at 21-32% in the US, and the gap between the cost of insured and non-insured care is much higher. I say we have a moral duty to replace the current, broken, free-market system. Evidence from countries other than the US supports the theory that socialized health-care can be more efficient.
droidist2 14y ago
It's true the free market isn't functioning in healthcare. You mentioned doctor supply. During the late 1990s the American Medical Association convinced the government there was going to be a "doctor glut" so the American taxpayer subsidized medical schools in exchange for not graduating doctors, $100,000 for each doctor not trained.