Healthcare is not a free market. People don't comparison shop, and couldn't even if they wanted to. Price lists are secret because providers have two prices, one for cash and one for insurance. People with health problems have stress enough dealing with insurance companies and providers, filling out endless paperwork, to deal with it even if the info was available. People in hospitals and emergency rooms CANNOT shop for alternatives since they are a captive audience.
When the social norm hardens around "don't charge what it's worth, charge what you can get" this is the result. I once asked a hospital billing agent how they could justify a $10k ER bill for 4 hours of waiting and 1 hour treatment, and they responded, "How much is your life worth?"
One place that gets it right is Germany: an inexpensive public option that gets you competent medical care almost anywhere. Bring your card, no deductibles, no paperwork, no complex calculation and a minimum of paperwork (which is a rarity in Germany). This is how it should be here.
In Germany, access to health care is becoming a major problem. I have two young kids and I’ve experienced on multiple occasions not being able to get appointments with specialists for them. Sometimes you offer to “self pay” - basically paying full cost with no insurance - and sometimes it works, other times it doesn’t.
Germany has a major doctor shortage and it can’t just attract foreign doctors like Anglo countries due to language requirements. This issue will continue to get worse as the population ages.
People act like there are no wait times in the US.
I remember a few years ago, I noticed a mole on my arm suddenly looking very irregular. I kind of panicked, thinking it was potentially skin cancer. I have decent PPO insurance, no worries, I can go call up and schedule an appointment with a dermatologist directly. I live in one of the largest metro areas in the US, tons of doctors, should be a breeze to get it checked out.
I load up the find a doctor website on my insurance company's website. There's like 30 dermatologists within an hour or so drive from me, awesome. I start calling. Not taking new patients right now. Can't be seen for 6 months, 8 months, we could get you in next year. Next year, when I might have quickly growing skin cancer?
Luckily when I finally talked to my wife about it, she reminded me she had poked my arm with a permanent marker. Some solvent, and my mole looks normal again. I still make sure to keep my dermatologist appointments, just so I don't have to deal with the new patient issues and the "we're not taking anyone new these days".
I had a different issue with extreme nystagmus come upon me. Bedridden for days, I couldn't even open my eyes without having extreme vertigo. Calling ENTs to try and get help, none would be able to see me for weeks. Luckily a friend who works with ENTs managed to get a doctor to see me but if it wasn't for that I probably would have just had to suffer at home with no answers as to what was happening.
I now know that unless I'm practically about to die, seeing a doctor that will do more than run extremely basic labs and very basic healthcare is weeks away in the US even if you have decent insurance.
I paid out of pocket and went directly to a dermatologist in a week, where insurance wanted me to go through my doctor (my local doctor has no appointment times) first. It was skin cancer. I ended up bypassing insurance because I was scared to wait the months navigating their system would take. But also because it was supposed to be cheaper (I price shopped) than my deductible. Guess what, when you price shop, the price they tell you has no relevance to the final price.
You lived out what I had only feared. I'm sorry that happened to you, this kind of thing shouldn't happen to anyone.
> Guess what, when you price shop, the price they tell you has no relevance to the final price.
I've found they often can't realistically give any kind of useful quote. I remember getting a total cost estimate from the hospital when my second child was born, anywhere from $20k to $160k before insurance, please sign here.
I can get an MRI in a few hours for a couple hundred bucks out of pocket. I can go get blood drawn in a half hour and lab results tomorrow morning. Tons of private labs and imaging centers are looking for anyone to fill the machine or get stuck. That's not the problem. The problem is getting an M.D. to read the results and actually tell me what's wrong and a good course of action.
In both examples, just getting an MRI would have told me practically nothing. Maybe for the nystagmus, it would have told me if there was significant brain cancer. Maybe a blood test would have told me something about cancer, but there's a good chance it would have been inconclusive, I needed a biopsy (or, in hindsight, a bit of rubbing alcohol).
I've seen a case of both providers of ACA "marketplace" plans in a state each including only one of the four closest hospitals to me as "in network", with similar extremely-spotty coverage for everything else. And one excluded the massive children's hospital in the city that'd also gobbled up every pediatric care office in 50 miles, so there was, practically, only one insurer you could pick if you had kids (those two providers were the only ones offering individual insurance in that state at all, everyone else had pulled back to only doing group plans in that state; both were also companies I'd never heard of before).
This was in an actual city. Things can be even worse out in the sticks, where hospitals are much farther apart and often offer only some of the services you expect from a big-city hospital.
Lots of these plans also only cover a small geographical area, except for ER visits (which I think they have to cover). So don't get sick in a way that gets you discharged from the ER into a regular hospital bed, but still unable to get home, while traveling within your own country, if you don't want to go bankrupt.
Like it truly wouldn't have been crazy for someone on one of those plans to get some kind of travel insurance while traveling in the US. That's how fucked up our healthcare system is.
I'm sure it depends on where you live and the healthcare provider you have. I have Kaiser and can get seen within a week or so and usually the same with any specialist. Kaiser does everything in house, which helps with reducing delays.
Here in the USA, my wife had an infection in the root of a tooth (long story), and was trying to get in to see an oral surgeon to get proper treatment.
Even with an active infection, that could have cost her her jaw or her life if it had been left unchecked, it took months to get anyone to even make an appointment for an initial consultation. We were very fortunate that the oral surgeon we were finally able to talk to was able to fit her in for surgery within a short time after that, due to a cancellation.
People talk dismissively about the "long wait times" you get with some public healthcare systems, but always oh-so-conveniently ignore the fact that there are long wait times here too. Sometimes catastrophically so.
Almost universally, when you dig into it, the "long wait times" that exist in those systems fall into one of two categories: either they are wait times for elective procedures, where your long-term health is not at risk, or they are caused by shortages that are symptoms of unrelated problems.
Long wait times are not exclusive to public healthcare. My dermatology appointment to examine a concerning mole was scheduled 9 months out. And of course I pay for the privilege.
I'm in the US and I hav regular 6-8 month waits for non-specialists and very hit or miss luck with specialist appointments. What you describe is not solved by the us approach
When I worked in the US I had “Kaiser Permanente” which seemed to be something like an all-in-one system. You have specialists, GPs, labs and pharmacy all in one building covered by one insurance. Could something like that scale to the whole country?
> When I worked in the US I had “Kaiser Permanente” which seemed to be something like an all-in-one system. You have specialists, GPs, labs and pharmacy all in one building covered by one insurance. Could something like that scale to the whole country?
We can't even scale out broadband to the entire US.
It can scale to a whole province of 5 million people.
I had Kaiser Permanente when I was in the US. Now that I'm in BC, Canada, it is very similar. I walk into any hospital in the province and every doctor and specialist in the building are part of the same system (technically they are broken up into three geographic subunits, but to the patient it basically doesn't matter). If I need some sort of treatment that hospital doesn't offer, they can immediately refer me to the correct hospital. For emergency cases the provincial ambulance service will transport you to another hospital by road or air at no cost.
There are still independent specialists and doctors outside of the hospital system, but they have access to the same records systems and the billing is so seamless that I suspect that most people don't realize it is happening since it never involves the patient outside of providing your ID.
Of course the approach works, we can see it work at various scales. I think what prevents it from working is that it works best when it is the only option. I don't think we could support 5 kaiser permanentes. And that feeds into insurance - there are a lot of insurance plans, and each of them would likely only support their specific kaisers
So ideally there is one insurance, with one provider that has vertical integration everywhere and then indies outside the network you can go out of pocket for, and oops I invented single payer
Organizations like this have existed in some places in the US as well. I remember growing up in Houston we would go to the Kelsey-Seybold clinic. They had a lot of GPs but also a ton of specialists all under the same network and sharing the same building.
>can’t just attract foreign doctors like Anglo countries due to language requirements
That is a serious and real obstacle. German has a well-deserved reputation for being difficult to learn. I'm pretty good at learning languages but German is extremely difficult to speak properly unless you are raised in it.
Similar situation in Poland with appointments for specialists in at least 6 months and often much longer.
German public health insurances are concerned right now about their unusually high deficits. Because many millions refugees are not working they only get paid a reduced amount towards the mandatory health insurance but have the same full service. Bringing the already substituted public health insurance into insubstantial deficits and now they are increasing the rates for the working class and probably they will need additional tax money too.
Neoliberal fiscal policy to underfund public goods has slowly crept into non-American western health systems, the undercutting of the UK NHS as a leading example of a regressor. It makes everything in the system less efficient - increases calls for even less efficient privatization of healthcare. It doesn't save money for an economy except at the most superficial narrow view level of accounting.
I price shopped having skin cancer removed from my face because the total was under my high deductible. By the end the total was $2500 more than the 'price shopping' 'yes this will be the price' price even though everything went as perfect and easy as possible. This place is the number 1 clinic for doing this in the nearest city. Their waiting room was full of old guys getting skin cancers removed. And there was nothing I could do but pay the extra $2500.
AIUI, this is very difficult to do: the estimate is going to be based on a superficial (in the literal, physical sense) examination of the problem, and once they are actually in there doing what they need to do, they may very well find that there is more that needs doing than they expected.
They can't exactly pause the surgery and get you to consent to an extra few thousand dollars' worth of work.
This is another example of why healthcare really, genuinely is best left as a single-payer government-funded service. People can get the care they need to be healthy, without ever needing to worry about the uncertainty inherent in the price of such a service.
As someone who has lived in single payer single provider. I couldn't disagree more. Nearly every Canadian I know grumbles about the healthcare system. The patients, the workers...
Something can be well worth grumbling about, and still be better than other systems elsewhere.
There's plenty of actual data on this. Relying on what "nearly every Canadian you know grumbles about" when the topic is "are single-payer systems, on average, better than the clusterfuck the US has", isn't sound reasoning.
and price competition would squeeze the range towards better estimates or even taking a loss on some slice of procedures. Just as insurance does right now.
The indirection for variability of costs basically places a accounting hole that the motivation for "fixed" estimates was attempting to plug. Then it basically becomes a regulatory accounting chasing game that costs even more to administer. Instead of verify, time and materials expended are whats billed, now to verify fair prices, you need a sample size of all the outcomes of all the procedures that started with this code and their relative weighting of occurrence, and verify all the time and materials expended for each. It all costs more for dubious benefit of a privatized multi payer model
I was under the impression there were already laws in place around this signed in first Trump term?? Anyone know what I'm talking about? Now I would not be surprised that the industry flaunts it completely.
They have to provide prices for various billing codes, but you can't really make them commit to which billing codes will apply. This is for both legitimate reasons (stuff might go wrong, they might find something is different than what they thought it was just because that unavoidably happens pretty often in medicine, et c.) and for illegitimate reasons that the legitimate reasons give them cover for (medical billing departments are the organizational embodiment of smarmy, lying assholes who are constantly trying to screw everyone)
I recently found out, after getting a big surprise bill, that you can sort of comparison shop now, at least with my insurer. They have a “Treatment cost estimator”, which I’ve found to be pretty accurate, and the price differences from one place to another are substantial.
When the social norm hardens around "don't charge what it's worth, charge what you can get" this is the result. I once asked a hospital billing agent how they could justify a $10k ER bill for 4 hours of waiting and 1 hour treatment, and they responded, "How much is your life worth?"
One place that gets it right is Germany: an inexpensive public option that gets you competent medical care almost anywhere. Bring your card, no deductibles, no paperwork, no complex calculation and a minimum of paperwork (which is a rarity in Germany). This is how it should be here.