> “This stuff is such a black box,” he said. “You never really know how much your drugs cost you.”
I tried a course of allergy injections (I didn't notice any effect). I asked how much it would cost - NO ONE KNOWS. They have to submit it to insurance and then insurance spins a wheel and says a price.
Health care is not designed for any human in the system. Almost everyone is having a terrible time. It's all for the shareholders.
It's the reason why healthcare is so expensive in the U.S. because this is not just true for drugs, but for procedures as well.
IIRC. I worked orthogonally to medical billing, but never did billing directly.
Fee schedules don't get published. Because if providers know insurance is willing to pay $125 for a procedure, they're going to charge $125 rather than what it cost to do it. So if they want to know, they have to be deduced by the providers.
So providers charge out the fucking ass for everything. Then submit that charge to the insurance. The insurance will say, "We'll only pay $75 of that $300 bill, the rest is patient responsibility". And often, what will happen is that the doctor will write off some or all of the remaining $225, because they weren't looking for that anyway. The charge is just to make sure they get the maximum from the insurance.
The price is completely divorced from the value of the services provided. It's become this weird game.
I've been to doctors that refuse to treat you if you don't want to go through insurance and pay cash upfront for this reason. If they name their real price insurance can (apparently) go after them.
I could understand maybe refusing if I don't have insurance to deal with rare but expensive complications but I do, I just know that it'll be a year long fight and I'll have to pay it all at the end anyway.
That doesn’t seem to quite explain it. I went to a non-profit hospital – which shouldn’t really have shareholders IIUC – and still got ripped off by confusing pricing and misleading estimates. My uninsured friend has a “good faith estimate” from a hospital that literally quotes the price as being “between $0 and $50,000”.
From the outside, a hospital seems like one thing; but it's really nothing at all like retail. Some doctors can bill separately, the pharmacy can bill separately, different departments can bill separately, different diagnostics can bill separately. One well-meaning hospital can't fix this; it's baked into everyone's expectations.
When my son was on Accutane a couple years ago it was a 7mo course. His prescription, from the same pharmacy with the same insurance, never cost the same amount twice.
Why is this news worthy? US Healthcare is littered with various middlemen who have control of different parts of system and regions and any national program won't have flat price because of these middlemen.
EDIT: These middlemen have lobbied Congress to prohibit Medicare from using any government power to force this middlemen to cooperate.
It's not new news, but it's certainly worth repeating in the hopes people will eventually listen. Our system costs way too much for the outcomes we receive in return (the whole system, not just the socialized parts). ACA sort of helped, at least with coverage, but not really with prices. And yet people are terrified of "socialized medicine" ignoring the fact that a significant portion of the population is already successfully receiving socialized care through Medicare, Medicaid, veterans benefits, etc. Le Sigh.
Medicaid in particular is managed by states and the service, reimbursement and access varies wildly between different locales.
There is an elephant in the room that rarely gets the attention it deserves is that 17.3% of the US GDP is contained in the healthcare system. This problem has grown so large that if we fixed it suddenly we could see a tenth of our GDP simply vanish overnight and it'd cause economic shockwaves across America. Twenty years ago this problem could have been solved in a relatively smooth manner - at this point I don't even know if my personal dream of a perfect solution would cause more harm to average people's lives than it'd help.
We are up a creek and determinedly throwing every paddle we find as far as we can manage.
medicare.gov has an estimator in its plan comparisons. You put in your prescription drugs and it tells you how much it will cost for the year for different part D (drug coverage) or part C (medicare advantage + prescription drug coverage) plans.
Do no use it. It's always wrong. It can completely mess up your whole year. I once picked the cheapest advantage plan based on that and it was completely incorrect, i ended up paying outrageous prices.
You have to actually look up what each plan says in its terms (what tier is my drug and how much do i pay for that tier) and calculate a cost for the year. You can find negotiated prices for the pharmacy / company pairing at q1medicare.com. Or you can call the sales department of the different advantage or part D plans.
If we allowed a TRUE free market the US drug prices would collapse. If I could buy a drug from an online pharmacy in literally any other country I would be saving 90% of money.
It is absolutely crazy that us Americans accept this broken system.
> It is absolutely crazy that us Americans accept this broken system.
Want to talk about broken systems?
The US government bailed out GM for $51 billion dollars. That's billions that could have been spent on schools, or healthcare or much needed infrastructure.
This month, GM spent billions on stock buybacks and millions on bonuses for execs while firing a ton of regular workers.
I find it staggering Americans are not rioting in the streets. So many systems are utterly and completely broken.
Bankrupting other countries' socialized healthcare programs is an unacceptable solution. Canada already has to contend with frequent medication shortages due to the stress American health tourism puts on the system.
Except there cannot always be a free market for healthcare. That only would works for preventative care assuming that there is enough supply that you can make a decision because there might be shortages of a specialty you need and cannot get an appointment for 6+ months.
If you're significantly injured in a car accident (to use an example that does not weigh on past medical history), you do not have time, nor likely the wherewithal, to be looking up which EDs are going to be cheapest and then comparing it to their most common outcomes to similar injuries to make the informed decision to which hospital the EMTs will haul you. Rather, you will be taken to the closest available ED with availability.
Serious question because maybe I'm ignorant about it: was it ever a free market?
And the follow-up question is: should it even be a free market given that healthcare is not very conducive to shopping around and price matching, it's always possible to allow private clinics while providing a decent level of care to society in general. I simply do not see how a free market healthcare will be any better.
I recently learned that my neighbor works for Partners in Health (pih.org). They have built an open-source EMR, which they use in far-flung regions like Haiti. I suggested that they can maybe sell their software under commercial terms in the US, to subsidize their international work. Her comment was that EMR systems like Epic are actually a billing system, less a medical record system. The whole system has been built to be opaque.
Honestly, at this point, it feels like the whole US insurance system is run by and for the insurance companies. People, of course, never got much out of it - and it would be cheaper for the government to adopt Sweden's system. I did some calculations once, and if you take Sweden, they spend in total per person four times less than the US government (Medicare and Medicaid alone) does per person (at least in 2022).[1][2][3][4].*
It's somewhere on my "things there has to be a super powerful lobbying group for because no one benefits from this" list, along with the continued existence of the penny.
*The government spent 1750 billion dollars on Medicare and Medicaid. It could have spent about 440. That gap of 1.310 trillion dollars is the vast majority of the US deficit[5]
It's not just Medicare, the whole system is confusing, frustrating, and flat-out broken for anybody who relies on prescription drugs to stay alive.
We have several prescriptions in the family that our insurance won't allow to be filled locally, instead passing to some sort of bulk mail pharmacy. Which would be fine, except you don't know which drugs those are until you take the presciption to the local pharmacy only to have them tell you they can't fill it under our plan. But, by that time, they've got the prescription in their system, so now we need to call the doctor and have them figure out which specialist pharmacy to use (for which the doctor charges us an extra fee), creating more overhead, more cost, more annoyance.
Readit News
I tried a course of allergy injections (I didn't notice any effect). I asked how much it would cost - NO ONE KNOWS. They have to submit it to insurance and then insurance spins a wheel and says a price.
Health care is not designed for any human in the system. Almost everyone is having a terrible time. It's all for the shareholders.
IIRC. I worked orthogonally to medical billing, but never did billing directly.
Fee schedules don't get published. Because if providers know insurance is willing to pay $125 for a procedure, they're going to charge $125 rather than what it cost to do it. So if they want to know, they have to be deduced by the providers.
So providers charge out the fucking ass for everything. Then submit that charge to the insurance. The insurance will say, "We'll only pay $75 of that $300 bill, the rest is patient responsibility". And often, what will happen is that the doctor will write off some or all of the remaining $225, because they weren't looking for that anyway. The charge is just to make sure they get the maximum from the insurance.
The price is completely divorced from the value of the services provided. It's become this weird game.
I could understand maybe refusing if I don't have insurance to deal with rare but expensive complications but I do, I just know that it'll be a year long fight and I'll have to pay it all at the end anyway.
EDIT: These middlemen have lobbied Congress to prohibit Medicare from using any government power to force this middlemen to cooperate.
There is an elephant in the room that rarely gets the attention it deserves is that 17.3% of the US GDP is contained in the healthcare system. This problem has grown so large that if we fixed it suddenly we could see a tenth of our GDP simply vanish overnight and it'd cause economic shockwaves across America. Twenty years ago this problem could have been solved in a relatively smooth manner - at this point I don't even know if my personal dream of a perfect solution would cause more harm to average people's lives than it'd help.
We are up a creek and determinedly throwing every paddle we find as far as we can manage.
The root problem is that there's too much fluff and middle men and bureaucracy and paper trail and it all has to be paid for.
Do no use it. It's always wrong. It can completely mess up your whole year. I once picked the cheapest advantage plan based on that and it was completely incorrect, i ended up paying outrageous prices.
You have to actually look up what each plan says in its terms (what tier is my drug and how much do i pay for that tier) and calculate a cost for the year. You can find negotiated prices for the pharmacy / company pairing at q1medicare.com. Or you can call the sales department of the different advantage or part D plans.
It is absolutely crazy that us Americans accept this broken system.
Is something actually stopping you from doing this? I've never tried Rx drugs but I've imported non-FDA approved sunscreen before and it went fine.
I'm allowed to physically travel there, get an Rx, fill it, and take it back home. Does the online nature introduce a different hurdle?
Want to talk about broken systems?
The US government bailed out GM for $51 billion dollars. That's billions that could have been spent on schools, or healthcare or much needed infrastructure. This month, GM spent billions on stock buybacks and millions on bonuses for execs while firing a ton of regular workers.
I find it staggering Americans are not rioting in the streets. So many systems are utterly and completely broken.
If you're significantly injured in a car accident (to use an example that does not weigh on past medical history), you do not have time, nor likely the wherewithal, to be looking up which EDs are going to be cheapest and then comparing it to their most common outcomes to similar injuries to make the informed decision to which hospital the EMTs will haul you. Rather, you will be taken to the closest available ED with availability.
Deleted Comment
And the follow-up question is: should it even be a free market given that healthcare is not very conducive to shopping around and price matching, it's always possible to allow private clinics while providing a decent level of care to society in general. I simply do not see how a free market healthcare will be any better.
It's somewhere on my "things there has to be a super powerful lobbying group for because no one benefits from this" list, along with the continued existence of the penny.
*The government spent 1750 billion dollars on Medicare and Medicaid. It could have spent about 440. That gap of 1.310 trillion dollars is the vast majority of the US deficit[5]
Sources [1]: Swedish government spending: https://sweden.se/life/society/healthcare-in-sweden [2]: US government spending: https://www.cms.gov/data-research/statistics-trends-and-repo... [3]: Currency converter: https://measuringworth.com/datasets/exchangeglobal/ [4]: Population: The graph that pops up when you search on Google for Sweden population and US population. [5]: https://fiscaldata.treasury.gov/americas-finance-guide/natio...
We have several prescriptions in the family that our insurance won't allow to be filled locally, instead passing to some sort of bulk mail pharmacy. Which would be fine, except you don't know which drugs those are until you take the presciption to the local pharmacy only to have them tell you they can't fill it under our plan. But, by that time, they've got the prescription in their system, so now we need to call the doctor and have them figure out which specialist pharmacy to use (for which the doctor charges us an extra fee), creating more overhead, more cost, more annoyance.