Cat Bites Man. Hospital Charges $55k.

January 28, 2013 2:59 PM

Call it the $55,000 cat bite.
posted by Kitty Stardust (205 comments total)

The original Lazarus got much greater care for much lower a price.
posted by Apocryphon at 3:02 PM on January 28 [32 favorites]

The health care system is muffed up, obviously, but this wasn't just a cat bite. This was a serious infection which required 6 days in the hospital and surgery. That's always going to be expensive. The issue isn't that 6 days in a hospital bed plus surgery is expensive, it's that he had to pay roughly $3000 of that out of pocket rather than the government picking up the tab as it does in most other industrialized nations.
posted by Justinian at 3:04 PM on January 28 [13 favorites]

The issue isn't that 6 days in a hospital bed plus surgery is expensive, it's that he had to pay roughly $3000 of that out of pocket rather than the government picking up the tab as it does in most other industrialized nations.

That's an issue. The issue he's talking about is that our ridiculous system of matching price-hikes and discounts, pro-rating uninsured care across the bills that go out to insured patients, and all the other gymnastics that go into calculating a hospital bill means we can't even establish a freaking baseline for what a medical service ought to cost.
posted by Holy Zarquon's Singing Fish at 3:07 PM on January 28 [53 favorites]

If only he'd used AskMe he would have known to go to the doctor immediately instead of waiting for it to get infected!

NB I have no idea if he waited for it to get infected or not

The $16 tylenol bullshit has got to fucking stop.
posted by elizardbits at 3:08 PM on January 28 [15 favorites]

The issue isn't that 6 days in a hospital bed plus surgery is expensive, it's that he had to pay roughly $3000 of that out of pocket

I think a lot of the point is that 6 days in a hospital probably doesn't really cost the hospital more than the average person makes in a year. And that whatever the actual costs are, it's hard to get a handle on them when the billed out line item prices are from Fantasy Island.
posted by tyllwin at 3:09 PM on January 28 [11 favorites]

I agree with the unstated premise of both links: that's one HELL of a cat.
posted by Greg Nog at 3:11 PM on January 28 [11 favorites]

The cat looks like my newest cat, Licorice. It's only a matter of time, isn't it? I'm doomed, aren't I?
posted by infinitywaltz at 3:11 PM on January 28 [9 favorites]

From the article: "My cozy hospital room at UCLA Medical Center in Santa Monica was priced at $4,000 a night. Four thousand. You can book a 1,400-square-foot Premier Suite at the Beverly Hills Hotel for less than that."

What many people (including Mr. Lazarus, apparently) do not realize is that nursing care is bundled into the room charge at the hospital. You are not paying $4000 a night simply to spend the night in a hospital room. You are paying $4000 for 24 hours of nursing care and other related ancillary services while in the hospital. I do not know if $4000 is too much or too little to be paying for 24 hours of nursing care; that would seem to depend on the level of care needed and required. Either way, if nursing care were billed as a separate line item, this one charge at least would be slightly less opaque. It makes little sense to me that skilled care is rolled up into the room charge.
posted by pecanpies at 3:14 PM on January 28 [15 favorites]

pro-rating uninsured care across the bills that go out to insured patients, and all the other gymnastics that go into calculating a hospital bill means we can't even establish a freaking baseline
...
And that whatever the actual costs are, it's hard to get a handle on them when the billed out line item prices are from Fantasy Island.

Yes, but those issues are not going to be solved without a single payer system. They are symptoms, not causes.
posted by Justinian at 3:14 PM on January 28 [6 favorites]

So, he sends the hospital the cat and then he's square, right?

Sorry, it's really hard for us Europeans to understand your American Health Care. For instance, is it true that eagles carry you to hospital? And that these $16 "Tyler Durdens" are giant burger-sized asprins? We know that everything is bigger in the USA, so we won't be offended to hear how great you have it.
posted by The River Ivel at 3:17 PM on January 28 [79 favorites]

The issue isn't that 6 days in a hospital bed plus surgery is expensive, it's that he had to pay roughly $3000 of that out of pocket rather than the government picking up the tab as it does in most other industrialized nations.

Citation please (I don't believe that if you compare actual costs - no matter who pays - that the US is anywhere near the costs of other "industrialized nations").
posted by devnull at 3:17 PM on January 28 [1 favorite]

To be honest, though, I find myself wondering if he's not shirking his own responsibility a little. Why did the cat bite him? Was he rough-housing with the cat? Did the cat just bite him out of nowhere? He totally glosses over WHY the cat -- "Bear" -- bit him. I hate to say he brought this on himself, but in all this talk of money, I find it hard to believe that the cat just bit him with NO provocation. Who's looking into the REAL story here? Not the lamestream media that's for sure please upvote
posted by Greg Nog at 3:18 PM on January 28 [55 favorites]

I heard this on MarketPlace and I am glad that someone is bringing some attention to this, no matter where you fall on the health care debate. A lot of my friends are health care professionals--one complaint I often here is the rise of health care costs due to unnecessary or over-zealous testing. For example, someone will be given an MRI when they probably don't need one, or a simpler test or examination could rule out its need.

And I always ask, "Well, why not just give them the MRI? Is there risk?"

And most will say, "Because it is an unnecessary cost -- it is extremely expensive and if it can be avoided it can help keep the health care costs down."

And then I ask, how much does an MRI cost? And this is where I always get jammed up in this medicine vs. economics debate, and we all end up far from the same page.

Because I always want to know, how much does the MRI really cost? Let's say an MRI machine costs $1 million. And they last 3 years. And you can do 4 MRIs per day. And they require a full time staff person, as well as an hour of a nurse's time and an hour of a doctor's time, etc. Do they really cost $4000 per MRI? My back of the envelope calculations don't really lead to such high prices.

I don't know the actual numbers here, but something always seems off. Many health care providers DO want to do things efficiently and provide the best care without doing needless tests or incurring unnecessary costs for the patient or the system in general. But if these super-inflated arbitrary prices are being factored into their calculus as the true costs of these procedures then that is throwing the whole thing off.
posted by This_Will_Be_Good at 3:18 PM on January 28 [5 favorites]

Either way, if nursing care were billed as a separate line item, this one charge at least would be slightly less opaque

And then we could start to make reasonable choices and optimizations. Also, probably rolled up into that $4k/night: administrative overhead for HIPAA, overhead for dealing with insurance companies, etc, etc. Rolled up into the $16 Tylenol? Large costs about record-keeping and controlled substances. But we can't meaningfully address these costs if we keep hiding them - -we don't know which elements add $0.10 to the cost of the pill and which add $10.00

how much does the MRI really cost?

Hard to say. But going out in town to do it seems to cost much less.
posted by tyllwin at 3:22 PM on January 28 [1 favorite]

I do not know if $4000 is too much or too little to be paying for 24 hours of nursing care; that would seem to depend on the level of care needed and required.

Well, multiply it out. Let's say you are in the hospital for a full year. You would have 365 days at $4000/day. That would be $1,460,000. You could probably buy a small apartment near the hospital and hire 2 nurses and one doctor full time for that price. I don't know if you would have much left over for $16 tylenols though. And that cat might inhibit your medical staff's ability to keep things sterile.
posted by This_Will_Be_Good at 3:23 PM on January 28 [4 favorites]

Actually, I think the point here is the $14,000 of "funny money" that "disappears." So, if you don't have the wherewithall to contest it, you're a sucker, and you go into debt?
posted by roomthreeseventeen at 3:23 PM on January 28 [7 favorites]

Globe and Mail: Cat’s bite can be deadly: “A bite from a small cat can be a big problem,” writes Marie Joyce of The Washington Post. Noting that up to 50 per cent of cat bites become infected, Princy Kumar, head of the infectious-diseases division at MedStar Georgetown University Hospital, said people underestimate the danger. Seek help if the cat has really sunk its teeth in – “if you see a puncture wound and blood coming out of it.” Unlike dogs, which tend to deliver superficial bites that don’t penetrate far into tissue, cats inflict puncture wounds with their long teeth, which inject bacteria from the cat’s mouth deep into tissue..
posted by ovvl at 3:24 PM on January 28 [2 favorites]

I read the headline and thought 'sounds like someone without insurance - definitely one of the things I was terrified of when I was uninsured', and then I read that it still cost him that much even with insurance, and I'm terrified all over again.
posted by codacorolla at 3:25 PM on January 28 [1 favorite]

To be honest, though, I find myself wondering if he's not shirking his own responsibility a little. Why did the cat bite him? Was he rough-housing with the cat? Did the cat just bite him out of nowhere? He totally glosses over WHY the cat -- "Bear" -- bit him.

It's because it's a fucking animal - that's what they do sometimes and is not outside of the realm of normal experience.
posted by KokuRyu at 3:25 PM on January 28 [8 favorites]

Last year I had a really bad tooth ache and went into the dentist. I had been paying for dental insurance, but I had no idea how much things actually cost. I wasn't sure if you could even do this and I felt super awkward, but I told the dentist that I was a bit low on funds and asked if I could see how much things would cost with my insurance. He was fine with that and actually gave me a printed out list of prices. It kinda looked like a menu, and I sat there with my little bib on in the chair and picked the things I wanted to have done (well, actually, I just chose not to do one thing that was optional, and that saved me $300). In an emergency, you obviously wouldn't have this sort of freedom, but the transparency and seeing things ahead of time was kind of nice.
posted by This_Will_Be_Good at 3:26 PM on January 28 [1 favorite]

$4000 for 24 hours of nursing care and other related ancillary services while in the hospital. I do not know if $4000 is too much or too little to be paying for 24 hours of nursing care;

From quick googling, the high side of nurse pay is about $50 per hour. That means, having a nurse dedicated to you and only you, would cost "only" $1200. For $4000, you'd expect to get at least two, but there's room for three too.

I haven't been in an American hospital, but I'm pretty sure they gotta share the nurses there too.
posted by ymgve at 3:27 PM on January 28 [1 favorite]

Well, at least the cat bit him, rather than scratching him. Cat scratches can cause a nasty fever the treatment for which I gather somehow involves listening to Ted Nugent.
posted by koeselitz at 3:28 PM on January 28 [11 favorites]

Not only that, This_Will_Be_Good, but the unstated meaning behind the assertion that we ask for too much expensive testing is that this is a consumer problem. It's the consumers who are all hoity toity and wanting the most expensive tests to be done. Anecdotally, most people I know are loathe to go to the doctor and are at the mercy of the professionals when they are there. We go in when we are sick and are expected to make sure that all the tests are appropriate and cheap and we hope that when we ask for the cheapest treatment that we won't die. Right.
posted by amanda at 3:29 PM on January 28 [4 favorites]

When a cat bites a man, that's not news. But when Ted Nugent bites a man, that's news.
posted by box at 3:30 PM on January 28 [5 favorites]

ymgve: "From quick googling, the high side of nurse pay is about $50 per hour. That means, having a nurse dedicated to you and only you, would cost "only" $1200. For $4000, you'd expect to get at least two, but there's room for three too.
"

I'm not amped up to defend US medical practices, but there's a ton of equipment in those rooms, too. Not just you and your nurse. $4000/night worth of stuff ? Not likely, but I don't even know much how much one of those hospital beds cost.
posted by boo_radley at 3:33 PM on January 28

What's covered in that $4k room charge? Well..

• nursing care for 24 hours
• utilities including television, phone, electricity, water, gas
• janitorial staff
• cafeteria staff to make and deliver his food
• his food, including raw ingredients and the gas, water, electricity that went into making it
• property taxes
• building upkeep
• disinfecting everything
• HIM Staff Salaries and department overhead
• Billing staff salaries and department overhead
• Utilization Review staff salaries and department overhead
• Coding staff salaries and department overhead
• Compliance staff salaries and department overhead
• Hospital administration salaries and department overhead
• laundry expenses

I don't know if lab tests are included, but if they are then in addition to all that it needs to help pay for the lab equipment, running the lab equipment, the reagents used in lab tests, the salaries of the specially trained staff that run the tests and the staff that collect samples and the support staff that help support the lab staff.

Running a hospital is not cheap.
posted by Apoch at 3:34 PM on January 28 [4 favorites]

From the first article:

One little-discussed aspect of President Obama's healthcare reform law is a switch from the current reimbursement system, which rewards hospitals for treating sick people, to a system that provides incentives to hospitals and doctors to keep people from getting sick in the first place.

The basic idea, similar to the way Kaiser operates, is for insurers to give medical providers a fixed amount of money per member — say, $8,000 a year. If your doctor can keep healthcare spending below that amount, he or she pockets the difference. If you require extra treatment, insurance will cover the true costs of care.

This sort of sounds like an incentive for health care providers to deliver less care.
posted by orme at 3:34 PM on January 28 [8 favorites]

" But when Ted Nugent bites a man, that's news." I don't think that Ted Nugent still has teeth.. Which, now that I think of it, may explain his need for all those guns.
posted by HuronBob at 3:36 PM on January 28 [1 favorite]

Because I always want to know, how much does the MRI really cost? Let's say an MRI machine costs $1 million. And they last 3 years. And you can do 4 MRIs per day. And they require a full time staff person, as well as an hour of a nurse's time and an hour of a doctor's time, etc. Do they really cost $4000 per MRI? My back of the envelope calculations don't really lead to such high prices.

In the UK a private MRI scan will cost the equivalent of about $400 per site for a basic non-specialist MRI scan (i.e. most of them). Prices go up for specialist things like brain MRI's and more sophisticated equipment (e.g. Open scanners, standing scanners, high tesla units, etc.) $4000 is completely unjustifiable.
posted by xchmp at 3:38 PM on January 28 [6 favorites]

What many people (including Mr. Lazarus, apparently) do not realize is that nursing care is bundled into the room charge at the hospital. You are not paying $4000 a night simply to spend the night in a hospital room. You are paying $4000 for 24 hours of nursing care and other related ancillary services while in the hospital. I do not know if $4000 is too much or too little to be paying for 24 hours of nursing care; that would seem to depend on the level of care needed and required. Either way, if nursing care were billed as a separate line item, this one charge at least would be slightly less opaque. It makes little sense to me that skilled care is rolled up into the room charge.

I've spent a night in a US hospital (mid-2000s), and was billed for it because I'm insured (well, in the US at least). The cost was $600 for one night. So even in US terms, $4,000 is far too much.
posted by Jehan at 3:39 PM on January 28 [1 favorite]

The take-home to "How a cat bite cost one man $55,000" is "We have no idea because billing is opaque at best, and because there are lots of deals cut between insurers and hospitals and between hospitals and service providers (labs, drug companies, cleaning contractors) to which patients aren't privy."

And that list that Apoch came up with is a start, except that public hospitals may be funded by local, state or federal taxes and bonds, or by a non-profit Foundation, and some of the reason billing is opaque is that the amount for which patients are responsible is only clarified in the institutional annual report, and even that may have fudged humbers.
posted by gingerest at 3:40 PM on January 28

It's because it's a fucking animal - that's what they do sometimes and is not outside of the realm of normal experience.

That's racist.
posted by Greg Nog at 3:45 PM on January 28 [29 favorites]

devnull: Citation please (I don't believe that if you compare actual costs - no matter who pays - that the US is anywhere near the costs of other "industrialized nations").

Is this OECD paper about US health expenditures what you're after?

From the pdf: "Hospital spending is higher than in the five other OECD countries, by over 60%"
posted by sneebler at 3:50 PM on January 28 [3 favorites]

What's covered in that $4k room charge? Well..
nursing care for 24 hours

Oh no it isn't. I've had insurance that actually covered ICU care but specifically excluded nursing care. Nursing care is definitely a separate line item, and it ain't cheap.
posted by headnsouth at 3:52 PM on January 28 [2 favorites]

As for MRI costs (mind you, this was 12 years ago) : I had a problem with my back. I went to see an orthopedist about it. He ordered a MRI. Insurance company said, "Hold on there, skippy. Maybe he doesn't need that MRI. We won't pay for it until we see if physical therapy helps." So he sent me to physical therapy. It didn't help. It did cost me over $1000 out of pocket, because the insurance weaseled out of most of the charges. They paid about $250. After a few weeks of that, the ortho said, "Hey, we tried it your way, and this problem is no better. I need that MRI." Insurance finally agrees. Got the scan, and the doc was able to tell exactly what was wrong - severe disc problems. After all that, the insurance paid all of $700 for the MRI. Both the insurance and myself would have saved money by just getting the scan done first.
posted by azpenguin at 3:54 PM on January 28 [4 favorites]

I would be very happy to pay him $5 for a chance to pet that furry kitty, even at the risk of a bite. If there are other people like me - and the Internet suggests there are - he could end up turning a profit on this situation.
posted by Joey Michaels at 3:57 PM on January 28 [2 favorites]

If I don't get free wifi, I ain't staying in no room. Bed pan service or not!
posted by breadbox at 3:58 PM on January 28

> "What's covered in that $4k room charge? Well ..."

OK, sure.

Now how much does all of that stuff you listed ACTUALLY COST THE HOSPITAL?

$400 per patient per day? $4,000 per patient per day? $4,000,000 per patient per day?

Good luck trying to find out.
posted by kyrademon at 4:02 PM on January 28 [7 favorites]

So how much would Montgomery Burns pay if he wanted to pay for his cat bite out of pocket?
posted by punkfloyd at 4:04 PM on January 28

I read the post as "Cat Bike", which sounded way cuter.
posted by dunkadunc at 4:06 PM on January 28 [1 favorite]

I don't think that Ted Nugent still has teeth.. Which, now that I think of it, may explain his need for all those guns.

"Thanks for the hamburger. Just set it down on the ground outside there. I have to 'chew' it...." (Pulls out semi-automatic, pops in cartridge.)
posted by JHarris at 4:08 PM on January 28 [3 favorites]

>It's because it's a fucking animal - that's what they do sometimes and is not outside >of the realm of normal experience.

That's racist.

huh?
posted by modernnomad at 4:09 PM on January 28 [1 favorite]

"This is the flip side to our exceptional levels of treatment" - see it isn't the flip side of the levels of treatment at all, it's just gouging.

Other countries have fantastic care too - only their healthcare systems aren't there to profit their shareholders.
posted by zeoslap at 4:10 PM on January 28 [9 favorites]

sneebler: "Is this OECD paper about US health expenditures what you're after? "

Ooh, that's a goldmine:

Overall, the evidence suggests that prices for health services and goods are substantially higher in the United States than elsewhere. This is an important cause of higher health spending in the United States.

[...]

Table 2 shows where [the US] does less. It does not have many physicians relative to its population; it does not have a lot of doctor consultations; it does not have a lot of hospital beds, or hospitals stays, when compared with other countries, and when people go to hospital, they do not stay for long. All these data on health care activities suggest that US health spending should be low compared with other countries.

On the other hand, the US health system does do a lot of interventions. Table 3 shows that it has a lot of expensive diagnostic equipment, which it uses a lot. And it does a lot of elective surgery – the sort of activities where it is not always clearcut about whether a particular intervention is necessary or not.

posted by brokkr at 4:15 PM on January 28 [4 favorites]

Who's looking into the REAL story here? Not the lamestream media that's for sure please upvote

Exactly, he’s so busy abusing cats willy-nilly he can’t afford it, and wants us to pay for it? That makes him cat-slut, right? Pay for your own, cat-whore-man.

Seriously, we will have no solution until health care isn’t a for profit business. Every thing else is a band-aid.
posted by bongo_x at 4:15 PM on January 28 [9 favorites]

Now how much does all of that stuff you listed ACTUALLY COST THE HOSPITAL?


If you think hospitals are making money hand over fist, I don't think that's correct.
posted by sweetkid at 4:17 PM on January 28 [2 favorites]

I don't know the actual numbers here, but something always seems off.

Well, that's what the article is talking about, that the numbers are artificially inflated because the doctors aren't sure which of the bills they send out will be paid, and how much they'll get.

I needed some procedure or other, a few years ago, and had to pay for it out of pocket. IIRC, the price was about $2400. I let my fingers do the walking, and found a nearby place that would do it for ~$350, if I paid up front. They explained that I would pay them when I came in, they'd do the procedure and bill me for the full amount, and then I'd call into the accounting division, and they'd take care of it -- it was the way their system worked.

They were telling the truth. They billed me for $2400, I called in, they fixed it, and I never heard from them again. I've never been quite sure why they did it that way. Seemed pretty strange to me.

That also made it exceedingly clear that it didn't really cost them anywhere near $2400. I needed to drink some radioactive stuff, and it was a big machine, so I'm sure there was a very real cost to them, but it wasn't $2400. Possibly $350 was their break-even point?
posted by Malor at 4:20 PM on January 28 [4 favorites]

I'm curious. Why an mri for an infected cat bite? My gator bite infected and I didn't get an mri. Did I get cheated?
posted by notreally at 4:22 PM on January 28

That's racist.

huh?

is joke

for to do the lols
posted by elizardbits at 4:23 PM on January 28 [30 favorites]

Your $16 tylenol also includes the pharmacist salary. Sigh. Everybody always forgets the pharmacist.
posted by selfmedicating at 4:24 PM on January 28 [5 favorites]

My wife just got our insurance charged $180 usd last week for handing our GP's assistant a form with her medical history on it. That alone is more than we have paid for health care in our combined lifetimes until now living in other countries (and I have had major surgery and broken bones).
posted by srboisvert at 4:25 PM on January 28 [2 favorites]

Well, they may have billed the insurance company for that, but the company will probably pay less, possibly zero.

Insurance in the US is deeply strange.
posted by Malor at 4:28 PM on January 28 [1 favorite]

> Sorry, it's really hard for us Europeans to understand your American Health Care.

Canadians*, too. U.S. health care is equal parts baffling and terrifying to me.

* Yes, yes...our system is far from perfect. I'll still take it over the U.S.'s any day.
posted by The Card Cheat at 4:29 PM on January 28 [4 favorites]

My cat bit me once, was a 2 day stay in the hospital (UCSF) and I believe cost me around 20k before insurance came in and went after the charges.

Bit my hand, got one of my fingers at the nuckle, got infected and a day or two after the bite I woke up with a fever and red lines running up my burning hot hand and arm. They had to re-open my hand then clean it out, then sew it back up and then it was 2 days of being in the hospital making sure the infection didn't try to eat me from the inside out.

Cat teeth are like needles, and their mouths host some really nasty bugs, you get bit in the wrong place and an infection takes hold, you can be looking at some serious problems.

This same cat is sitting next to me being harassed by my toddler. Gotta run.
posted by iamabot at 4:30 PM on January 28 [2 favorites]

Clearly the solution is not declawing cats but detoothing them instead. The downside is that you have to spend all day making them salmon mousse.
posted by elizardbits at 4:31 PM on January 28 [7 favorites]

I had outpatient surgery last year to remove my gallbladder, and ended up staying in the hospital 3 nights. No serious infection or anything, but I did have 2 more procedures. When I got the bill, it was for 48,000 dollars, not including various other bills I got with it. My insurance paid something like 18,000 dollars, I paid 500, and that was it. So what is the true cost? What of the other 30,000 dollars?
posted by Eekacat at 4:31 PM on January 28 [1 favorite]

What's covered in a hotel room charge:
utilities including television, phone, electricity, water, gas
janitorial staff
complementary breakfast, including raw ingredients and the gas, water, electricity that went into making it
property taxes
building upkeep
Housekeeping
staff salaries and department overhead
laundry expenses

I know a hospital is more expensive to run that a hotel but, still, if you are going to itemize that you gotta itemize all the things.
posted by Foam Pants at 4:34 PM on January 28 [10 favorites]

So if I'm getting this right, insurance company CEOs should go around deliberately breeding aggressive cats and injecting them with mouthfuls of microorganisms, then release them into major urban areas. Roving bands of poison cats bite dudes, dudes are rushed to hospital, insurance bills for $50k per dude. News media covers massive poison cat biting epidemic. Republican congressmen resist federal funding for anti-poison cat disease prevention programs (due to big government is bad, due to fiscal situation). Insurance company stock prices surge. Profit!
posted by deathpanels at 4:36 PM on January 28 [2 favorites]

When I had my son, the nurses at the hospital were sure to send me home with a goodie bag. Not just the freebies from the formula/diaper companies etc, but every. single. item. in the room. Not only had my insurance paid for it, but if it had been placed in my room - even if it was unopened - they couldn't give it to someone else.

I got a king's ransom in Dermoblast and maxi pads, I tell you what.

(Oh yes, and the billing was highly strange. I paid nothing, no copay, nada. But the bill to my insurance company was $15k+ which is actually pretty reasonable as births go. Still needed to make six phone calls to get it all paid for because oh no, the insurance company and the hospital billing departments can't just call each other. NOOOOO.)
posted by sonika at 4:39 PM on January 28 [2 favorites]

Someone I know had an MRI in Thailand. It cost about $300. For some things, it would be cheaper to fly to Thailand, get the MRI, then fly back. Most people who need an MRI don't have the time, and aren't in the kind of physical health to make the trip. But it does show that an MRI does not really cost $3000, because if it did, the hospital in Thailand would go bankrupt.

The main problem with the health care system is that people who are uninsured, but have some assets wind up going bankrupt when they need hospital care. Take, for example, someone who owns a sole proprietorship. He can't get health insurance for any reasonable amount, because he can't negotiate the rates. Let's say he goes into the hospital with a cat bite. He's now responsible for a $55,000 bill, including the $14,000 that went "poof" in the article.

If he had $35,000 of assets, the hospital is going to try to get it. This is how small business owners and others just making ends meet go bankrupt. People with no assets aren't going to make it worth the hospital's time to try to collect. People with a lot of assets just write a check for the whole amount. People with insurance write a much smaller check.
posted by Xoc at 4:40 PM on January 28 [6 favorites]

Giving birth in a Japanese hospital costs $3000 above what medical insurance covers. Rural cities like where we lived will often reimburse this cost.
posted by KokuRyu at 4:42 PM on January 28

But the bill to my insurance company was $15k+ which is actually pretty reasonable as births go.

Doesn't sound reasonable when, like me, you're from a country where births in a public hospital cost $0.
posted by Jimbob at 4:42 PM on January 28 [2 favorites]

Didn't we already establish hospitals charge 4k a night so they can negotiate with insurance companies to get 1k. If they started at 1k, they might get $250. It is a negotiating tactic. The problem is you or I don't have the negotiating power of an insurance company.

There was a post about it.
posted by Ad hominem at 4:43 PM on January 28 [2 favorites]

how much does the MRI really cost?

$25k, same as in town
posted by potsmokinghippieoverlord at 4:45 PM on January 28 [5 favorites]

How do you people manage to get bitten by your cats, by the way? I've been scratched plenty, but even giving one of our cats a pill daily for months wasn't enough to provoke a bite.
posted by brokkr at 4:46 PM on January 28

But it does show that an MRI does not really cost $3000, because if it did, the hospital in Thailand would go bankrupt.

There are two kinds of MRIs. The "open" MRIs are much, much cheaper, but they're lower resolution. You can often get those procedures for ~$400 in the US, if you call around.

There's also "closed" MRIs, which are enormous machines that cost ungodly amounts of money. Those MRIs are $2K+, because few institutions have them, and they're not inclined to discount much. They scan at much higher resolution, which is sometimes important.
posted by Malor at 4:46 PM on January 28 [2 favorites]

Last June, we had to take my 1.5-year-old to the hospital because he had croup. He was really sick; they couldn't get his breathing under control with two rounds of medical intervention, so they admitted us to see if additional time would do it. It did, thank god, and we were discharged about 8 hours after admission.

Our initial bill was $4500. This covered:

* The ER fee
* The respiratory therapist
* The medications he was given (tylenol, ibuprofen, dexamethasone, racemic epinephrine, O2)
* The room we were admitted into
* The pediatric hospitalist who did the admission, who came from a different hospital
* The doctor he saw in the ER
* The pediatric pulmonologist who rounded on him and decided to discharge him in the AM
* The nursing care in the ER
* The nursing care on the peds ward
* The lab test that confirmed that he didn't have flu

All told, we were in the hospital for about 12 hours. All that happened in the pediatric room is that we got some sleep, tucked up together in the hospital bed under warm blankets, while he had a cold wet O2 blow-by tucked next to his face and an O2 sat monitor taped to his toe. He was not totally stable when they admitted us though, and the O2 sat monitor also monitored his heart rate, and allowed the nurses to monitor us remotely so that we could sleep. Had he gone into more distress, they would have been able to spring into action.

Our insurance then took that bill, and negotiated stuff downwards. Some things, like the "ER fee," disappeared almost completely. The medication and lab test fees fell by 90%, the charge for the peds room fell by 50%. The bill we were left with was about $1700. We were responsible for ALL of that, because we have a $2500 deductible, but without the insurance we pay almost $700 a month for, we would have been on the hook for the whole thing.

This seems. . . suboptimal.
posted by KathrynT at 4:47 PM on January 28 [14 favorites]

I have no idea how these people get their hands in the cat's mouth, or why.
posted by porn in the woods at 4:48 PM on January 28 [9 favorites]

The money shot:

Happily, that system may be coming to an end thanks to Obamacare.
posted by oddman at 4:49 PM on January 28

I know a hospital is more expensive to run that a hotel but, still, if you are going to itemize that you gotta itemize all the things.

Really? No other business has to do that. When I buy a breakfast at a restaurant, I get an itemized bill that lists prices for eggs, hash browns, toast, and orange juice. They don't tell me how much of that goes to paying for condiments, electricity, property tax, the cook's wages, cleaning supplies, fuel, insurance, marketing, or any of their expenses.

The point of an itemized bill is not to provide a detailed picture of the vendor's accounting practices. I think the biggest point of the itemized bill is so you can spot errors ("I didn't actually order or get bacon") and to make it harder to pad the bill. But when the prices aren't publicized in a menu, and the prices on the bill aren't the prices that are paid, and you're not the one paying them anyway, the itemized bill doesn't mean very much any more. I guess it still gives you a chance to notice gross errors ("Nobody took my appendix out, my appendix is fine. Why is that on my bill?"), but mostly it just gives the insurance companies a chance to fight with their customers.
posted by aubilenon at 4:50 PM on January 28 [2 favorites]

My parents' cat is a totally docile sweetness machine, but recently when I went to grab her to put her away before the paramedics came for a (human) medical emergency in our house, she yowled and scratched the hell out of me. I think she felt the human Worry and was Worried Too and also Wanted To See. I wouldn't have been surprised if she bit me too in that state.
posted by sweetkid at 4:50 PM on January 28

That second article IS the first article, rewritten.
posted by ThatCanadianGirl at 4:50 PM on January 28

Next you will be telling me that different people pay different prices for the same airline flight.

The point is trying to establish the "true cost" of something to evaluate the price is something of a fool's errand.
posted by notme at 4:51 PM on January 28 [2 favorites]

In November last year an infected insect bite on my leg turned into cellulitis, and might have turned into blood-poisoning if my wife hadn't insisted that I go to the hospital at 2AM. Unfortunately while the medics were pumping me full of penicillin my body spontaneously developed an unpleasant allergy to it. I was in the hospital for six days, the same amount of time as David Lazarus, with probably about the same number of tests and procedures. Possibly more.

I have no idea what it cost me. Actually I do, it didn't cost me anything. As I checked out I had to pick up some prescriptions, and those run £7.65 per these days, so call it £23. Beyond that, I pay my taxes.

For me, this is the twenty-first century. Any country that doesn't offer its citizens universal healthcare hasn't reached it yet.
posted by Hogshead at 4:52 PM on January 28 [51 favorites]

Doesn't sound reasonable when, like me, you're from a country where births in a public hospital cost $0.

No, they don't. The OB, the nurses, etc. all still get paid. The hospital still charges money for these services. You live in a country where the government, rather than insurance, pays for this. In any case, 15k for an OB, an anaesthesiologist, nursing care, twelve hours of labor, two days postpartum, and a baby in the nursery for two days and all attendant cost is very reasonable. You just live somewhere where this cost is paid in single payer system, but that does not mean it costs $0, which is highly disingenuous.
posted by sonika at 4:52 PM on January 28 [10 favorites]

Whenever I read stuff like this, I often wonder if our lives would be better if we just threw the entire health care system away and went back to leeches or something.
posted by Mitrovarr at 4:54 PM on January 28 [2 favorites]

You just live somewhere where this cost is paid in single payer system, but that does not mean it costs $0, which is highly disingenuous.

I'm happier being disingenuous than having to spring for $15k for the privilege of having a baby.
posted by Jimbob at 4:57 PM on January 28 [18 favorites]

I broke my finger last year and my ER bill (3 hours waiting room, 1 hour waiting to see someone in the ER, 30 minutes for an MRI and a splint) cost my insurance company $1200, minus my $50 copay. There's no justification for that. I'm lucky that since then, a bunch of urgent care places have opened up right near our place.
posted by roomthreeseventeen at 4:58 PM on January 28

I'll share my health care pricing experiences given that I've lived in several countries :

All your hospital expenses are paid for entirely by taxes in almost any first world country. In my experience, there isn't usually any need to show your national health care card at hospitals, although this might differ by country.

In most countries, any preventative care requires some card issued by either the state health service or a mandatory private insurer. An ordinary doctors visit or dentist checkup in France costs about $40 or $50 without this card, respectively.

I've found the health system's taxes or required insurance premiums usually run you roughly $80 per month in western European countries, so roughly $1000. I've found that buys you zero copay and dental coverage.

So most countries support their ordinary health care by taxing each person roughly $1000 per year, although many spend other tax revenues on their emergency services.
posted by jeffburdges at 4:59 PM on January 28 [2 favorites]

Seriously, why can't a law be passed forbidding hospitals from giving discounts to insurers that they don't give to the uninsured? That would go a huge way towards reducing the opacity of those ridiculous bills.
posted by cosmic.osmo at 4:59 PM on January 28 [3 favorites]

You just live somewhere where this cost is paid in single payer system, but that does not mean it costs $0, which is highly disingenuous.

I'm happier being disingenuous than having to spring for $15k for the privilege of having a baby.

You are missing the point like whoa.
posted by sweetkid at 5:00 PM on January 28 [4 favorites]

I broke my finger last year and my ER bill (3 hours waiting room, 1 hour waiting to see someone in the ER, 30 minutes for an MRI and a splint) cost my insurance company $1200, minus my $50 copay. There's no justification for that.

The justification for that is that there was a fully staffed, on-demand emergency department there to help you with any healthcare issue from a broken finger to multi-system organ failure.
posted by shiny blue object at 5:01 PM on January 28 [1 favorite]

In any case, 15k for an OB, an anaesthesiologist, nursing care, twelve hours of labor, two days postpartum, and a baby in the nursery for two days and all attendant cost is very reasonable.

How do you know? I mean, you feel it's reasonable, but is it? I wonder what governments would pay for a similar birth to yours here -- the same? Much less? I have no sense for what medical things should cost, and it's hard to even define "should" in this case.
posted by jeather at 5:03 PM on January 28

shiny blue object, I'm pretty sure I pay taxes to my state for that.
posted by roomthreeseventeen at 5:03 PM on January 28 [2 favorites]

When I see people defend the $55,000 cat bite situation, I get the feeling we might have deeper problems than just the exorbitantly high cost of medical care in the U.S.
posted by JHarris at 5:03 PM on January 28 [32 favorites]

shiny blue object, I'm pretty sure I pay taxes to my state for that.

Wait you think emergency departments are paid out of your taxes? Can you explain this?
posted by sweetkid at 5:05 PM on January 28

Southern Oregon: I was hospitalized for four days for severe upper respiratory distress, hooked up to various things for three of those days, on oxygen all four days (went home with a little machine that kept me from passing out): about $13,000 dollars. (call it $3250/day)

I don't know how the insurance negotiations went, because I was 100% deductable. They kept sending us bills with progressively smaller amounts until the insurance statements and the hospital statements got down to zero. On the other hand, RedBud had to negotiate between the hospital and the insurance company for some of her medical stuff, and, like the other MeFite, RedBud had to call back and forth between the bookkeeping departments of the Insurance company and the hospital, because, for some reason, they don't seem to like to talk to each other, and they just won't do it themselves. I discovered that RedBud has a vocabulary rich in very specific expletives.

My cats don't bite me. Hardly ever. One of them ate a lily and it cost us about $1000.00 to keep his kidneys from falling out. I guess veteranarians use a different pay scale. We had him in their clinic for three or four days, then took him home. I had to put a needle into him a couple of times a day (for a week or so) to keep him hydrated, but for cats, that's easier than for people.
posted by mule98J at 5:05 PM on January 28

I had to go to the ER a while back and I tried to find out how much it was going to cost me. They couldn't tell me. I'm was standing there in screaming pain, but I wasn't sure if I could afford to pay them or not. Eventually I said fuck it, I have good insurance it can't be that bad, and it ended up being about 10x more than I thought it would be. Now I was able to pay it, but it hurt and I know plenty of people who would have been in a mess of hurt had they had to pay that kind of a bill. AND I HAD GOOD INSURANCE.

(In the long run I needed to get real surgery, and that cost me less than a third of the ER visit...)

Now, it turns out that I looked into things later and the hospital I went to is known for being kind of pricey, but it's not some crazy luxury resort hospital or something, and that's the thing about being in pain. You aren't going to stop at 2am in the morning and research which hospital you should go to.
posted by aspo at 5:06 PM on January 28 [2 favorites]

You are missing the point like whoa.

If an uninsured person in the United States is pregnant and is going to give birth, they will have to pay out-of-pocket for this. Right? What point am I missing, exactly?
posted by Jimbob at 5:06 PM on January 28 [1 favorite]

There are some misconceptions in this thread, and I'd like a shot clearing them up. This may run long.

First, the infamous $16 Tylenol.

-You're confusing that $16 bill for you paying $16 for a pill like it was a donut with no liability attached. You also have to pay the Pharmacist who filled out your script correctly and made sure you weren't allergic to it, that it didn't interact with any other medication you're currently on, and you paid a (usually) licensed nurse to make sure that those pills get to your nurses' station with your name on them and that they're still clean and sterile.

I'd be surprised if it wasn't generic, and then not Tylenol at all, then you get the drug companies that are involved with how much hospitals get to pay to get meds, generic or not. I'd also be surprised that you're only paying $16 for it. They're probably covering other stuff involved on another line.

Tell you what, you sign a release, and you can bring in your own meds, but don't be surprised if you die. Hope that $15.75 was worth it.

Preventative care should be the first resort.

-Well, I mostly agree with this. The insurance companies tactic to deny, deny and follow up that with more denials is so stupidly penny wise and pound foolish that it's hard to quantify. It'd be funny if people weren't dying.

The problem is that there are new tests coming out every day. The old tried and true tests are usually cheaper than the new hotness, but maybe you have something difficult to diagnose, you might communicate your symptoms poorly, or your doc might not know what to do, they may try to get you involved with the newer stuff, and unfortunately that isn't cheap.

Hospitals are making tons and tons of money off of the sick and infirm.

-If you've been in or near a hospital you'd understand what lunacy this is. Hospitals are run on a thin edge, and they're either trying to maximize shareholder value, cover charitable cases, are tied to some sort of learning institution, or just pay an outside company outright. Oh, and don't forget HIPPA. Now they have to tack on those costs to every single thing.

Now the insurance companies? They are making money hand over fist over the entire planet. I've seen earnings reports you people wouldn't believe. I've been privy to a glimpse of the day to day life of the "inner circle" of a couple of massive insurance companies, and the sums of money they deal with on a day to day basis is insane.

And I know very little about how the actual Kings of the Castle, the drug companies work. There is truly dark artistry going on up there.
posted by Sphinx at 5:07 PM on January 28 [6 favorites]

sweetkid, no, of course not, but I don't think that hospitals run without government aid, either.
posted by roomthreeseventeen at 5:07 PM on January 28

This is why we can't have cats.

I have a cat. But then I also have universal healthcare.
posted by orange swan at 5:12 PM on January 28 [1 favorite]

Your $16 tylenol also includes the pharmacist salary. Sigh. Everybody always forgets the pharmacist.

You also have to pay the Pharmacist who filled out your script correctly and made sure you weren't allergic to it

Since when are pharmacists called on to dispense tylenol in hospitals? Do you guys think you need a prescription for tylenol?
posted by stavrogin at 5:12 PM on January 28 [3 favorites]

> "If you think hospitals are making money hand over fist, I don't think that's correct."

Of course I don't. That wasn't what I was trying to get at, at all.

The hospital charges an imaginary surcharge because the insurance company has blackmailed them into accepting an agreement with a crippling discount. But the insurance company knows they're going to charge this imaginary surcharge and attempts to negotiate the hospital down further with a counteroffer based on imaginary numbers which translate to "the amount we want to pay". Ah, but it's actually lower than the amount they're willing to pay, because the hospital is going to counter the counteroffer, but bear in mind that the original imaginary amount the hosptial asked for was even higher than it needed to be because they knew the insurance company was going to make a lowball imaginary counteroffer. Eventually this reaches an equilibrium and that is the amount the hospital charges the insurance company, of which you are charged some fraction or deductible.

The final amount, in any individual transaction, does not necessarily screw over the hospital, or make them a bundle. But the level of abstraction from actual costs is about as high as you can get. U.S. hospitals generally have dozens of staff members, if not more, solely employed to deal with this kind of bullshit and other unnecessary hoops imposed by the U.S. insurance system - all the "we'll pay for X but not for Y, and oh we don't believe Z is necessary, and please fill out every box in this form no it has to be our special form the other zillion companies all have their own special forms" stuff. Entire departments exist in U.S. hopsitals for things that are handled by ONE person in many other countries.

The point isn't that hospitals are making tons of money with their imaginary charges. The point is, if they didn't have to make imaginary charges, the final cost would be less for you AND them.
posted by kyrademon at 5:13 PM on January 28 [8 favorites]

JHarris: When I see people defend the $55,000 cat bite situation

But it's a lot more than just a cat bite, it was a major infection. One that required actual hospitalization. It would be much more accurate to say that it was $55,000 to beat an infection that would either have cost him his arm, or his life. The fact that it started with a cat bite is kind of irrelevant.

Yes, it should be cheaper. But saying that 'a cat bite cost $55,000' is no more accurate than saying that these two skiers were killed by snowballs.
posted by Malor at 5:14 PM on January 28 [2 favorites]

Giving birth in a Japanese hospital costs $3000 above what medical insurance covers. Rural cities like where we lived will often reimburse this cost.

KokuRyu, my son was born in Tokyo, and depending on which ward you live in the government will cover a lot of the cost of childbirth. Four years ago, anyway, that may have changed since. The total cost was about $4,000 USD, but we got back about $3,000 of that. So $1,000 out of pocket, which was not bad at all. Also, in my current ward, all basic healthcare for kids is free. Even for medicine.

Japan's health care system is not perfect, but it's a pretty good model for the U.S. to emulate. If the U.S. initiated a government option, after about a decade or so much of health care would resemble that of Japan: many if not most people on the "public option", but the private insurers not doing too shabby, either. It's not single payer like you find in Europe, so maybe the right-wingers in the U.S. would warm to a system like Japan's.
posted by zardoz at 5:15 PM on January 28

Your $16 tylenol also includes the pharmacist salary. Sigh. Everybody always forgets the pharmacist.

You also have to pay the Pharmacist who filled out your script correctly and made sure you weren't allergic to it

Since when are pharmacists called on to dispense tylenol in hospitals? Do you guys think you need a prescription for tylenol?

If you're an inpatient in a hospital, you do. Patients don't get ANY medication without an order from a doctor.
posted by shiny blue object at 5:15 PM on January 28 [2 favorites]

Since when are pharmacists called on to dispense tylenol in hospitals? Do you guys think you need a prescription for tylenol?

Since the mythical "good old days", where if a nurse screwed up giving tylenol or something else to someone allergic resulting in their untimely death, the hospital and everyone involved would have been sued into oblivion. So like, 1974?
posted by Sphinx at 5:16 PM on January 28 [1 favorite]

"most countries support their ordinary health care by taxing each person roughly $1000 per year ..."

And I, as a self-employed person in the U.S., paid $928/mo last year for medical insurance alone. That's just me, no dependents, and I fully expect it to go up again this year.

I pay an additional $1,000/year in co-pays before my $400+ monthly prescription costs begin to be reimbursed at 80%. And I can't move out of the state in which I'm insured or I will not be able to get coverage due to pre-existing conditions. (At least Obamacare will fix that part next year.)

We need a single payer system in the US. Medicare for everyone!
posted by peakcomm at 5:18 PM on January 28 [12 favorites]

Sphinx: Tell you what, you sign a release, and you can bring in your own meds, but don't be surprised if you die. Hope that $15.75 was worth it.

You ignore, of course, the person who didn't go to the hospital because it costs absurd amounts of money, and thus ended up dying of a treatable condition.
posted by Mitrovarr at 5:19 PM on January 28 [11 favorites]

sweetkid, no, of course not, but I don't think that hospitals run without government aid, either.

They do get aid but it seems like you think your taxes should cover emergency room visits. Just that? Not services in the rest of the hospital too? I'm not talking about what should be I'm talking about what it seems like you think is happening now.
posted by sweetkid at 5:22 PM on January 28

You are missing the point like whoa.

The point being that if you work at Aldi in, say, Germany, making a small income and you have a baby, you will not struggle to pay your hospital bills and possibly go broke, because they as a society have decided to spread the cost across the entire population.

In America, not so much.
posted by moonbiter at 5:24 PM on January 28 [6 favorites]

You ignore, of course, the person who didn't go to the hospital because it costs absurd amounts of money, and thus ended up dying of a treatable condition.

I tried to cover it with the preventative care part, maybe I should have been clearer. It's such a huge problem that some people can't even see it.

I've been in situations myself where if I got into a car accident, or fell down the steps or had a heart attack shoveling snow it would cost me what i used to call "All the money I have."

It's terrible.
posted by Sphinx at 5:26 PM on January 28

Since the mythical "good old days", where if a nurse screwed up giving tylenol or something else to someone allergic resulting in their untimely death, the hospital and everyone involved would have been sued into oblivion. So like, 1974?

So, you're saying because the hospital pharmacy is involved in delivering tylenol throughout the hospital, it increases the cost of tylenol to $16 per pill?
posted by stavrogin at 5:26 PM on January 28 [1 favorite]

You are missing the point like whoa.

The point being that if you work at Aldi in, say, Germany, making a small income and you have a baby, you will not struggle to pay your hospital bills and possibly go broke, because they as a society have decided to spread the cost across the entire population.

In America, not so much.

Yes, that is the point. sonika was explaining how the cost of a baby is not $0 and how it is actually that the cost is spread into the community by government healthcare, and Jimbob your response was no, babies are FREE they are.

Missing the point like whoa.
posted by sweetkid at 5:28 PM on January 28 [1 favorite]

Sphinx: I tried to cover it with the preventative care part, maybe I should have been clearer.

It's not just preventative care, though. I've known people who've nearly died of appendicitis because they couldn't afford to go to the hospital, and that's probably one of the reasons that it seems to always be college students who die from meningitis.
posted by Mitrovarr at 5:29 PM on January 28 [3 favorites]

The hospital pharmacy, the PharmD trained pharmacist, the medication dispensing systems (Pyxis and the like), the individually packaged and barcoded pills, the triple-checks that the nurse does before you get your medication ... It's not like we go down to Costco and pick up a bottle of Tylenol and stick it on a shelf.
posted by shiny blue object at 5:30 PM on January 28 [1 favorite]

How do you know? I mean, you feel it's reasonable, but is it? I wonder what governments would pay for a similar birth to yours here -- the same? Much less? I have no sense for what medical things should cost, and it's hard to even define "should" in this case.

There is no doubt that healthcare in the US costs more than in other places, irrespective of whether the patient, the government, or the insurer is paying. For example, this study found that in 2007, price levels for total inpatient hospital services in the United States stood at 163% of the average price level of the group of countries considered in the study, and were nearly 44% higher than in Canada.
posted by His thoughts were red thoughts at 5:33 PM on January 28

So, you're saying because the hospital pharmacy is involved in delivering tylenol throughout the hospital, it increases the cost of tylenol to $16 per pill?

No, what I'm saying and what has been said by others is that due to liability and other concerns, every single drug goes through the pharmacy. All of them.

Sure, some of those drugs cost around a dollar, but some of them cost $15,000 a dose. From what I remember, the middle range is usually in the $65-$200 range. I'm simplifying like crazy. So, in the end, the percentage you're charging ends up being ~$15 for your "Tylenol".

Also, my info is at least three years out of date, the numbers have gotten worse since then.
posted by Sphinx at 5:33 PM on January 28

My wife recently went through some insurance funny-business and we found out that the hospital, clinic, etc. bills the insurance company 3 times the amount that they would quote you if you paid out of pocket. The reason that they over-bill the insurance company is that the insurance company will often only agree to pay a third of the amount.

Its not like the hospital is making a ton of money, rather just trying to stay above water and tread through all the insurance bureaucracy that's thrown their way.
posted by Divest_Abstraction at 5:34 PM on January 28

So, you're saying because the hospital pharmacy is involved in delivering tylenol throughout the hospital, it increases the cost of tylenol to $16 per pill?

So we have pill cost. Then we have related costs, which include things like inventory management and ordering, storage space for the pills, paying for the pharmacists who know what drugs can and cannot interact, etc etc. All these extra costs are real extra costs on top of the price of the pill. If the first charge to insurance was 16$ on a pill that is otherwise all but free to purchase and doesn't have particularly unknown risk factors, it's probably safe to assume that the total cost of these things is spread out over all pills, not entirely based on base cost of a pill, and that it's at least a few dollars for all the various overheads, magically insurance surcharged to 16.
posted by jeather at 5:36 PM on January 28

Don't get me wrong: 16$ is a lot, and it's worse because tylenol is one of the few things on a bill you know what it would cost you to purchase so you can see the overhead costs built in, but it is not the case that the hospital should actually charge you 15 cents for a pill, or whatever it costs when you buy it at Costco.
posted by jeather at 5:38 PM on January 28 [1 favorite]

The hospital pharmacy, the PharmD trained pharmacist, the medication dispensing systems (Pyxis and the like), the individually packaged and barcoded pills, the triple-checks that the nurse does before you get your medication ... It's not like we go down to Costco and pick up a bottle of Tylenol and stick it on a shelf.

So, the the $16 tylenol isn't inflated at all. It's a perfectly reasonable price. Even if some guy who thinks he's the president of UCLA medical center says its "It's totally crazy." It's good to know that we have people on metafilter who are more well informed than that schmuck.

No, what I'm saying and what has been said by others is that due to liability and other concerns, every single drug goes through the pharmacy. All of them.

You said the $16 price tag not only is justified by the expenses, but that it's most likely more expensive and they're just splitting the cost among other lines.
posted by stavrogin at 5:39 PM on January 28 [1 favorite]

What I find interesting with the US system is that what the public spending on healthcare (e.g. medicare, medicaid and veterans) amounts to more on a per-capita basis than the total healthcare spending (public + private, for all ages) does in every other OECD country except Norway and the Netherlands. (source)

The usual reply to this is that the healthcare in the US funds a lot of innovation, but this certainly doesn't show up in the statistics, such as life expectancy or infant mortality.. Even Mexico is set to pass the US in life expectancy some time in the next decade. (Yes, of course there are other factors than healthcare involved, but health care is usually considered pretty important.)

But hey, I guess discussing administrative routines around handing out Tylenol is more important than trying to explain how infant mortality can be twice as high in the US than in countries that spend half as much on health care per capita (even taking GDP into account, and using the CIA numbers).
posted by Baron Humbert von Gikkingen at 5:41 PM on January 28 [17 favorites]

In the 90's, part of my job was to ask school systems to fill out a survey, estimating their insurance costs if the federal government enacted a single payer system as had been proposed in Congress (The Russo Bill) or if the state did (the Gottfried Bill) -- using the exact calculations found in the bills.

A large school district on Long Island would've saved more than $2 million a year (if memory serves) under the federal plan, and a whole bunch (can't remember the exact numbers) under the state plan. And guess what else they would've saved on? Worker's Comp insurance -- because under single payer, workers would get their injury health care the same way they'd get their normal health care -- no need to fight a claim to get Worker's Comp to cover it.

And everyone everywhere would've had health insurance. Everyone. Small business owners, part time workers, poor kids, people who retire before Medicare kicks in, people between jobs, students....Full coverage, for less than companies pay for the current system.

The bottom line is, we pay more in the US for health care to get poorer health outcomes.

In 2007, medical problems caused 62% of personal bankruptcies. IN 2007 -- BEFORE the economic crisis.
posted by vitabellosi at 5:43 PM on January 28 [18 favorites]

I live in Australia. I once reached into a blur of spinning yowling cat fight to separate next door's black one from my orange one, and got bitten right through the web between thumb and first finger. A week later, a golf-ball-sized lump had blown up above my clavicle, and I needed surgery to remove it. I did it all through private hospitals to make it happen fast. I have no private health insurance. And all up it cost me under $500.

There are some things that governments really can do more efficiently than the private sector, and running a health care funding pool is one of them.
posted by flabdablet at 5:45 PM on January 28 [10 favorites]

It's not just preventative care, ...

So have I. I have a close friend who thought he pulled a stomach muscle taking out the garbage and woke up in the emergency room and wound up $25k in the hole. And this was in like 1993. The reason I called it "All the money I have." was to soften the blow of it maybe being "All of the money I have, and I then get to die."

At the end of the day, in the US, you* are the person who gets to decide what percentage of your money on your own healthcare. Countries with more advanced healthcare systems have come to the realization that we can't possibly have people making their own healthcare decisions on a national level. It's just not fiscally feasible.

To exaggerate, why don't we let children manage their own healthcare? Might it be because they're not qualified or mature enough to do so?

*Oh, and when I said you above, I meant your kids as well.

You said the $16 price tag not only is justified by the expenses, but that it's most likely more expensive and they're just splitting the cost among other lines.

Again, what I'm saying is that you can't look at that cost related to your perceived cost of the drug being dispensed, because they're not really related at all.
posted by Sphinx at 5:53 PM on January 28

Again, what I'm saying is that you can't look at that cost related to your perceived cost of the drug being dispensed, because they're not really related at all.

Yes, because the costs are grossly inflated, according to Dr. David Feinberg, president of UCLA Health System, as quoted in the article. But, apparently you have better information than him and think the $16 price is reasonable, if you include the cost of service, expertise, delivery, nursing care, etc.
posted by stavrogin at 5:58 PM on January 28 [6 favorites]

You just live somewhere where this cost is paid in single payer system, but that does not mean it costs $0, which is highly disingenuous.

Except you only say this about healthcare. We pay for all sorts of things that are free at the point of use--roads, public schools, the police, the fire department, postal delivery, the library, plowing of city streets, parks, etc. We think these things are supposed to be free at the point of use. When a fire department starts charging for coverage because the local electorate refuses to fund them, people are up in arms. They don't shrug and say 'Well, it has to be paid for.' Hell, we roll our eyes at Illinois's toll roads because they were supposed to be a temporary thing. Funnily enough, I rate healthcare as a slightly higher priority for a civilised society than I do a lack of tolls on the expressway, given that tolls have never killed anyone.
posted by hoyland at 6:04 PM on January 28 [21 favorites]

It's not single payer like you find in Europe, so maybe the right-wingers in the U.S. would warm to a system like Japan's.

Clearly you have not met our Rightwingers, who truely believe that poor people (defined as anyone earning under $250k per year) do not deserve to have health care. Further, that it's not even a legitimate function of government to be involved in the health industry, in any capacity.
posted by T.D. Strange at 6:06 PM on January 28 [17 favorites]

I agree with everything hoyland said, except the part where he didn't respond to saying "but that does not mean it costs $0, which is highly disingenuous" by adding "so it's not highly anything."
posted by JHarris at 6:14 PM on January 28

If you think that American health care costs are inflated, wait until you find out about the $500 hammers the Pentagon is paying for spending your taxes on.
posted by ceribus peribus at 6:14 PM on January 28 [2 favorites]

I recently visited the ER with heartburn-like symptoms. I never get heartburn, so I went to the ER, because I have a genetic heart condition and didn't want to take any chances. Outcome? It was heartburn.

My insurance covered the $3,600 bill, and I was treated wonderfully, but the bill was something to behold. "GI cocktail, $365." That's basically liquid Rolaids plus an analgesic.

We're so fucked.
posted by Short Attention Sp at 6:16 PM on January 28 [4 favorites]

Lazarus + Cats + Health Care = The Death of Mr. Lazarescu?
posted by ovvl at 6:21 PM on January 28

cats inflict puncture wounds with their long teeth, which inject bacteria from the cat’s mouth deep into tissue

Best thing you can do for any puncture wound is encourage it to bleed freely. That's why poor people should take aspirin on a regular basis. Lots and lots of aspirin.

Of course, if you need emergency surgery, you may be screwed.

Sorry, I'm just not willing to believe that all hospitals are operating on the red line. Small town hospitals here aren't doing so well, but they're steadly getting eaten up by the amoeba megatals, and their costs are spirialing out of the reach of many peope that were originally served well enough or transfered, if need be. I've watched both our local, supposedly non-profits grow over the last 20 years into major state entities. Their investors and doctors are making loads of money--this I've heard from doctors 'affiliated" with these hospitals.
posted by BlueHorse at 6:31 PM on January 28

Apoch: Running a hospital is not cheap.

It most certainly isn't. I'm in the UK, I pay ~10% of my income in tax for all state benefits, including the (marvellous) National Health Service. In the past two years, I have (in hospital only!):

- been pregnant, needing weekly ultrasounds then daily foetal monitoring for three weeks, plus steroid injections for a baby with an idiopathic birth defect (gastroschisis)
- been in a sole-occupancy birthing suite for 48 hours, with midwives solely dedicated to ensuring that me and my baby were ok (on 12 hour shifts)
- had an emergency caesarean, plus prescriptions for antibiotics and painkillers
- had a baby requiring surgery immediately after birth
- had a baby in the NICU for five weeks, requiring painkillers, antibiotics, IV feeding and NGT feeding
- had hospital post-natal care for seven days (for me after the c-section)
- had a baby requiring a week-long admission to the paediatric ward as she wasn't gaining weight, plus a prescription of high-calorie formula for 40 or so weeks
- had a recurrent quinsy, with two hospital admissions plus prescriptions for antibiotics and painkillers
- had a tonsillectomy to ensure no more quinsies, plus prescriptions for antibiotics and painkillers

and the total cost to me was ...?

£22.95, for prescription painkillers after the quinsy and tonsillectomy (quinsy is a bitch). I barely needed the health service, at all, in the nine years I have lived in the UK before this, but my baby and I have needed them in the last two years - and I'm happy I could pay that and have it looked after.

Your system is fucked. up.
posted by goo at 6:36 PM on January 28 [17 favorites]

How do you people manage to get bitten by your cats, by the way? I've been scratched plenty, but even giving one of our cats a pill daily for months wasn't enough to provoke a bite.

I can field this one. The one cat bite I got that got infected happened when a neighbor's cat somehow got onto my apartment balcony and came face-to-face with my one-year-old, 12-lb housecat, and they were about to tear each other's throats out. I tried to grab my cat, freaked him the hell out, and he bit me. He didn't mean to, and in hindsight I would employ another approach. He got the fleshy part of my palm, and it took two courses of antibiotics to get rid of the infection. He lived with me for another 15-1/2 years.

Cats, man. Cats.
posted by mudpuppie at 6:37 PM on January 28 [1 favorite]

Cats, man. Cats.
posted by ovvl at 6:54 PM on January 28

The thing that gets me is that if you have insurance, your insurance company will negotiate a set of lower rates. If you don't have insurance, they bill you for the maximum rates.

Also, one of the consistently most healthy sectors of the stock market is health care. You don't suppose that has anything to do with the costs, do you?
posted by theora55 at 6:58 PM on January 28

The other thing to keep in mind is that US cost are high because they are actually prohibited from negotiating at a national level to keep costs down. It's even illegal to negotiate national rates after Obamacare comes into effect (it also includes rules against importing drugs because free markets and free trade are not that important after all) because drug companies had to be bought off so they wouldn't bribe their pet politicians into opposing the bill.
posted by srboisvert at 7:16 PM on January 28 [2 favorites]

"- had a baby in the NICU for five weeks, requiring painkillers, antibiotics, IV feeding and NGT feeding"

There was an ad that GE ran incessantly in the U.S. during the London Olympics about how GE's innovations enabled poor women in East London to get high-quality NICU care for their babies in GE incubators (second ad, "Homerton", warning: it's tear-inducing) and it first showed right after the NHS bit in the opening ceremonies I could not tell if GE realized it was shilling for nationalized health care? It was bizarre.

----

The weirdest interaction I have had with my American health insurance company was getting pre-authorized for giving birth. I got a form letter from the insurance company with the fields all filled in all-caps, that went something like, "We are pleased to inform you that your procedure, NORMAL VAGINAL BIRTH, has been APPROVED, and that you have permission to continue with NORMAL VAGINAL BIRTH."

I thought this was so hilarious I put it in my kid's baby book. Hey, insurance company, I don't know if you know this, but NORMAL VAGINAL BIRTH is continuing WITH OR WITHOUT your permission! It's not an optional procedure!
posted by Eyebrows McGee at 7:19 PM on January 28 [44 favorites]

It makes me think about systems like Kaiser, where the insurance companies own the hospitals, and are the employers of the doctors. There's none of this attempt by the hospital to scam the insurance companies.

I'm not saying that there are no problems, (certainly there's the incentive to not provide expensive care), but just that a certain set of very expensive problems goes away.

Since Kaiser doesn't play this game, the CEO of Kaiser can talk honestly about it, and has given a number of talks. Here are some charts, and here is an interview.

I can't find the best talk he gave about hospital costs, when Obamacare was first proposed.
posted by eye of newt at 7:27 PM on January 28

Aaaaargh - that advert would never have run here - and I was in a hospital in the poshest part of west London, with the best neo-natal surgical unit and why she was born there (I got to walk the lovely streets of Chelsea for many hours during my looooooong labour) so that is truly bizarre.

My daughter, despite her birthing difficulties, has only my hand-written entries into her "red book" (health record all children get) to attest to her difficulties - she has to rely on my word and the photos of her in the humidicrib with her guts hanging out, wrapped in glad wrap!
posted by goo at 7:31 PM on January 28

Yes, that is the point. sonika was explaining how the cost of a baby is not $0 and how it is actually that the cost is spread into the community by government healthcare, and Jimbob your response was no, babies are FREE they are.

That was my point. There is a cost, depends on how you pay it... but there is nowhere where medicine costs $0. Yes, I agree the single payer system is better, but that just means that the cost is spread around not that it vanishes entirely.

(Also, you seem to have missed that I personally did pay $0, so the "system" "worked?")
posted by sonika at 7:51 PM on January 28 [1 favorite]

In any case, 15k for an OB, an anaesthesiologist, nursing care, twelve hours of labor, two days postpartum, and a baby in the nursery for two days and all attendant cost is very reasonable.

How do you know? I mean, you feel it's reasonable, but is it? I wonder what governments would pay for a similar birth to yours here -- the same? Much less? I have no sense for what medical things should cost, and it's hard to even define "should" in this case.

Look, I'm not defending the US healthcare system. We need universal health insurance yesterday.

But those costs could well be reasonable. Part of the cost of running an emergency room isn't just the per-unit rate for these things. They have to staff the department for whatever their service level is. That means they have to have all the anesthesiologists, ob/gyns, nurses, janitors and whoever, paid and on call waiting for something to happen. They have to stock ALL the stuff that they could possibly need, because there is no tolerance for "oops, we're out of forceps". All that overhead gets ammortized out over how many clients show up in a period of time, and then you get close to your price. So if they have to have three nurses on staff at all times, and you happen to be the only person in that day, you ended up with quite a deal.

Compare it to something like a McDonald's for simplicity. They really only run a profit during rush periods. The rest of the time is running in the red, doing the cleanup, stocking, breaks and just having people ready to go for when the rush happens. (I even worked for a store that ran in the red for 11 months a year. Only during Christmas did they actually make any money, and that was enough to justify staying open.) Sure, you gave them $5 for 30 seconds of work, what a ripoff. But you can't account for it that way.

There are not-insignificant overhead costs in having a service ready and waiting for you when you need it. In medicine, that can often cost more than the service itself.

Again, US healthcare bureaucracy sucks. But "$55,000 for a cat bite" is shockingly disingenuous.
posted by gjc at 7:55 PM on January 28 [1 favorite]

And I should say that I can't imagine women and babies in East London getting worse treatment than in Chelsea - the NHS is ostensibly the same, regardless of where you live (although of course different hospitals have specialisations). Treatment for a regular birth should be the same, regardless - we knew my daughter would need surgery from the first scan, so I had to move to the specialist hospital for west London (45 mins away) to have my daughter. I am ok with that.

Now she's part of a specialist cancer screening program every 12 weeks (retinoblastoma) in Whitechapel, East London, which I totally forgot to include in my summation above but hey, she's had more incidence of general anaesthetic in her life than I have and I'm 36! Better they catch the tumour and can zap it immediately rather than her being a cyclops her whole life - she carries the gene that caused me to lose my eye but so far (22 months) she is a-ok. It is always terrifying when she goes in for the check though, having to sign the waiver saying they can zap any tumour they find with a lazer - argh. But there are children from all over receiving the same excellent screening and treatment at this specialist East London hospital.
posted by goo at 7:57 PM on January 28

In July, I went to an ER because of a miscarriage. I was admitted around 8 PM and out by 1 AM. Total cost: $6000. Cost to my health insurance with "discounts": $3300. Biggest expenses: Ultrasound (charged: $1100/discount: $637) and ER room (charged: $1582/discount: $866). Total cost to me: $100 (paid with my FSA).

Half of the charges on the "Explanation of Benefits" aren't explained. They're mysteries. "Supplies." "Laboratory." "Emergency Room." "General Medical Services." How much did the hydromorphone cost? No idea. I'm sure it's in there, I just don't know what it costs. I could be getting charged for someone else's services, for all I know.

This I do know: if I were uninsured, that bill would have killed me financially. Even if I called the hospital and pleaded for assistance, and let's say I got the same discounts as my health insurance, I'd still be on the hook for about $3300. That would take years for me to pay off.

So reading about the housecat bite, I am not the least bit surprised at the price breakdown. This has just got to change.

A final note: if my Ob/Gyn had prescribed Percoset when he diagnosed the miscarriage, I'd probably have ridden out the worst of it at home (I had already been doing so for five days when we went to the ER). Pain management was all the ER really did for me in this case. And don't get me wrong, it was very helpful and I love modern medicine. But a $20 prescription versus a $3300 stay that ultimately discharged me with a shrug and a "come back if it gets worse"? I know which one I'd have taken.
posted by offalark at 8:11 PM on January 28 [3 favorites]

I pay around $450 a month to cover my wife and son and my work picks up the cost for my coverage. I have $40 co-pays and a $4500 deductible after which my insurance turns into 80-20 co-insurance up to a maximum of $9000 out of my pocket. After a miscarriage last year (September) and a day in the hospital (doctor thought there was potential for a serious complication) we got our first bill for $1700 to cover "blood tests." We have had at least two bills a month since then for other services related to that day ranging from $4 up to $115, totally well over $2000 out of pocket, and that's with the discounts that my insurance provides me. I happen to make decent money and could cover this, but I guarantee 50% of my co-workers would be totally screwed if this happened to them.

Not only are the costs absurd, but it's incredibly emotionally draining to see bills related to something as emotionally taxing as a miscarriage month in and month out. You'd think that a hospital could, at the very least, make sure they're only sending one maybe two bills.

Oh, and give me more than 10-15 days to pay it. They mail the bill out, it takes 2-3 days to get to me and I have 15 days from the day they mailed it to pay before it's considered "past due."

The whole thing is fucked. Health Care should be a right, not a privilege. A healthy society makes a better society for everyone.
posted by Jacob G at 8:32 PM on January 28 [5 favorites]

Again, US healthcare bureaucracy sucks. But "$55,000 for a cat bite" is shockingly disingenuous.

It was the original cause of all the other things. So ultimately it is $55K for a cat bite -- this particular cat bite.
posted by JHarris at 8:35 PM on January 28

I'm self employed, and on Cobra. My yearly health insurance cost is $7300 with co-pays and prescriptions on top of that.

A few weeks back I slipped with an exacto blade and poked / stabbed myself in the fleshy bit between my thumb and index finger. That spot of course won't stop bleeding on it's own and I got light headed. This was about 11pm so my girlfriend and I walked the few blocks to the ER.

It was a few hours of waiting around and I ended up with 3 stitches. No nerve damage, no X-Rays, no complications, no ambulance, no tests, no medicine except some aspirin—just a simple cut that needed to be stitched up.

My insurance company received a bill of $6200. I"m waiting to see how much of that they will be expecting me to pay.
posted by ridogi at 8:48 PM on January 28 [2 favorites]

I've done a lot of work in outpatient clinics as well as hospitals and the amount of brainwashing and cognitive dissonance is truly astounding, both in the workplace and in this thread.

A doctor would pay a ultrasound tech $30 an hour to bring her own machine and then bill women $200-500 for a 15 minute ultrasound. This was a cash-only "self-pay" clinic for immigrants. I tried to get some kind of explanation for that mark-up but had no success.

Similarly, another surgeon who did nothing but place the same kind of pacemaker, all day, every day, for the last decade, couldn't even give me a ballpark figure on how much they cost. Like, he had to take an hour out of his day and hunt down multiple staff members of the hospital administration and even then couldn't make sense out of it. Then we had to define cost. Literally, the staff member asked me "Costs who?".

The point is that anybody attempting to explain how a paracetamol could somehow be worth $16 is purely delusional.

On that note I've been present for debates between medical students, pharmacists and attending physicians about how healthcare is a privilege not a right and that people would be able to afford healthcare if they stopped watching their cable and their McDonalds and their smart phones. The sharp division in realities brought to mind being in India; watching the higher caste doctors talk mad shit amongst themselves in English while the patients looked on patiently, waiting for an explanation in a language they spoke.

In my experience, most hospital administrators and the doctors that compose the hierarchy are truly so out of touch they don't even realize that a top tier cell phone plan would barely touch the cheapest levels of high-deductible, high copay insurance coverage for a healthy, young male. Much less anyone that wasn't a young healthy male, e.g., planned on having kids, or actually had the unfortunate experience of attempting to use their health insurance.

I could go on for thousands of pages about what's so very wrong... there are so very few things the American system gets right. Actually, I can't even think of any off of the top of my head.
posted by hobo gitano de queretaro at 9:00 PM on January 28 [21 favorites]

> There are not-insignificant overhead costs in having a service ready and waiting for you when you need it. In medicine, that can often cost more than the service itself.

Again, US healthcare bureaucracy sucks. But "$55,000 for a cat bite" is shockingly disingenuous.

I don't understand this critique. With the exception of the Tylenol derail, I don't recall where anyone suggested that the only fair way to proceed would be to pass on only the unit cost to the health care consumer. I think we all understand that health care involves both direct costs (the food you eat, the drugs you take) and the hard-to-apportion costs of having a team of specialized service professionals waiting on a bunch of people 24/7.

To use your McDonald's analogy, the complaint in the thread isn't "why does my extra value meal cost $5 when they spend only 30 seconds serving me?" — it's "why does my extra value meal cost $11 here in America when it costs the equivalent of $5 in every other first-world country?"

Because someone who suffers complications from a cat bite would consume roughly the same products and services in most hospitals on earth. Yet ours is the only nation on earth that would expect anyone to pay $55,000 for those products and services.
posted by savetheclocktower at 9:07 PM on January 28 [5 favorites]

It was the original cause of all the other things. So ultimately it is $55K for a cat bite -- this particular cat bite.

Then I might as well say my driver's license cost me $5000 because I got hit by an uninsured driver.
posted by gjc at 9:10 PM on January 28

Seriously, we will have no solution until health care isn’t a for profit business. Every thing else is a band-aid.

I find myself thinking this about more and more things. I just started watching the first half of Food, Inc while exercising, and my main takeaway was "fuck capitalism."
posted by Foosnark at 9:11 PM on January 28 [1 favorite]

But the bill to my insurance company was $15k+ which is actually pretty reasonable as births go.

There were about 4 million births in the US in 2010. I know not all of them were born in hospitals, or received emergency care of any kind, but if they had received the care you describe, which I think should be a goal of a healthcare system (especially one with such a high infant mortality rate), that would be $60 billion in uncomplicated birth costs each year. If you split the cost evenly across all 120 million US households, that comes to about $500 each. Just for having healthy babies. No other health care.
posted by Garm at 9:12 PM on January 28

How do you people manage to get bitten by your cats, by the way? I've been scratched plenty, but even giving one of our cats a pill daily for months wasn't enough to provoke a bite.

Because cats.
Seriously, about 8 years ago my snuggle bunny of a cat bit me in the arm in the middle of the night. Not a love bite, but a four fangs embedded in my bicep bite. It took me screeching "Nuku, what the fuck are you doing?!" for her to unlatch from my arm. I have no idea if I rolled on her, she was having a dream, or was just curious about what human tasted like.

I bled a little, but not very much. After the adrenaline from being a midnight snack wore off, went back to bed with my cat nestled in the same arm and she never did it again.

Incedentally, called my doctor the next day and they had me come in and get antibiotics right away. I was embarrassed to show the nurse because you could barely see anything. But that is sort of the problem as many posters have pointed out - cat teeth are like hypodermic injections of ass licking bacteria.

(God I miss that cat.)
posted by [insert clever name here] at 9:13 PM on January 28

koeselitz: Well, at least the cat bit him, rather than scratching him. Cat scratches can cause a nasty fever

I'm sorry, no. Cat bites can cause horrid infections. Cat scratches are on the tame side. They don't even give antibiotics for scratches.

How do I know this? I spent last Thursday night in the ER getting my eyelid stitched close because my cat scratched me while I was sleeping. No, she's not a horrible wild beast, and no, I didn't provoke her. I was cuddling with her and had my arm over her. She's on the clumsy side* and was twisting around to get out from under my arm, and her (thankfully recently clipped) claws raked my face, cutting me in five places. Four of the scratches were surface scratches and no big deal, although the one across my nose and under my eye bled the most. But one cut along about 2 centimeters of my eyelid, scraping away a layer of skin that hung on by a thread, and oozed blood for a good hour. It was about a millimeter deep, and luckily did not cut all the way through my eyelid or damage my eye in any way.

So I woke up, said ow, looked in the mirror, freaked out, cried, and called my pre-med friend, who told me to wash it and try to sleep, and calmed me down a bit. So I dutifully splashed some water on my face and went back to bed, but the dull throb in my eyelid wasn't very conducive to sleeping. WebMD is a good idea, right? Because it told me I might go blind if there was any damage to the eyeball, which promptly sent me back into hysterics. By the way did I mention I'm not a cryer? I didn't cry for any of my tattoos, including the one on my ribs. I didn't cry when I got my wisdom teeth out. I didn't cry when I sprained my ankle so badly that I was on crutches for two weeks. But a cut to the eyelid, man does that hurt.

So WebMD plus general freakout, plus the person on the emergency line at my school's health clinic
basically telling me she couldn't give me any advice, I called my pre-med friend back and had him drive me to the ER. Driving yourself to the ER when you can't stop crying is a bad thing, I think.

They weren't busy, I got in pretty quick. Basically they washed it out with water (the coldest water ever), put in two stitches, decided I didn't need antibiotics because her shots and my shots were up to date, and sent me home. It healed up well and five days later I went to my GP to get the stitches out.

I haven't received the bill yet; wish me luck.


*case in point: tonight, chasing the laser pointer, she got confused (really for no reason as the laser was still about a yard in front of her), half-somersaulted, and slid feet first into a chair.
posted by DoubleLune at 9:18 PM on January 28

I just started watching the first half of Food, Inc while exercising, and my main takeaway was "fuck capitalism."

Yeah, I get more and more lefty as I get older, but I have to remind myself that there are many good things about Capitalism, like all things in moderation. It just needs to be heavily regulated.
posted by bongo_x at 10:05 PM on January 28 [1 favorite]

Is this the thread where we reply Very Seriously to obvious jokes?
posted by adamdschneider at 10:14 PM on January 28 [8 favorites]

Then I might as well say my driver's license cost me $5000 because I got hit by an uninsured driver.

I'm sorry, what? Your point isn't as obvious as you think it is.
posted by JHarris at 10:30 PM on January 28 [1 favorite]

The sharp division in realities brought to mind being in India; watching the higher caste doctors talk mad shit amongst themselves in English while the patients looked on patiently, waiting for an explanation in a language they spoke.

They speak in English among themselves because they think in English, and probably don't have a common 'link' language among themselves, not necessarily because of caste. There are other grave problems with healthcare in India, but doctors choosing to think/ diagnose in English isn't one of them.

I should add that those who do medicine because of caste - your ayurvedic/ unani folks - would be specifically speaking in their respective vernaculars, and would be entirely untainted by "English" medicine.
posted by the cydonian at 10:33 PM on January 28

Also:
Is this the thread where we reply Very Seriously to obvious jokes?

The problem with threads like this is you have some people making jokes, and you have other people say similar things that aren't jokes, and it gets hard to tell the difference.
posted by JHarris at 10:34 PM on January 28 [1 favorite]

Is this the thread where we reply Very Seriously to obvious jokes?

You mean like the state of heath care in the US?
posted by ODiV at 10:54 PM on January 28 [6 favorites]

No, we just all want to talk about our cat bite war stories.
posted by [insert clever name here] at 11:32 PM on January 28 [1 favorite]

Some data regarding the cost of births in particular: in England the average cost to the NHS for a "normal" delivery is apparently about £750. (Alas I can find nothing specific to cat bites.)

Private patients in NHS-run hospitals may have to pay as much as ten times that out of pocket.
posted by Pre-Taped Call In Show at 11:36 PM on January 28

The late lamented Norman Cousins, editor of the late lamented Saturday Review of Literature, made the same observation as the article mentioned - that he could stay at a first class hotel with room service for less than he could stay in a hospital. His doctor agreed, so I think he did just that, although the doctor kept in touch. Cousins believed that laughter is the best medicine, and when his pain rose, he played Marx Brothers movies. He lived 10 years longer than expected.
posted by Cranberry at 12:05 AM on January 29

I live in high-cost Norway. Here are the prices of my local MRI provider (in Norwegian, natch). Sample:

MRI scan one region: NOK 1950 / USD 352.
MRI scan further regions, per region: NOK 950 / USD 172
MRI scan prostate: NOK 2900 / USD 524
MRI of possibly broken bones: NOK 900 / USD 162

Other prices to compare:

Pint/0.5 liter of beer in a pub (heavily taxed): around NOK 60 / USD 11
Simple men's haircut: around NOK 350 / USD 63
Ikea Billy bookcase: NOK 365 / USD 66
Sony 46" 3D LED smart TV KDL-46HX75G: NOK 7770 / USD 1402
Average nurse pay, before taxes: NOK 350,000 / USD 63,000 / year
posted by Harald74 at 12:08 AM on January 29 [3 favorites]

You can talk about how much is included in those fees all you want, but the simple fact is that no other country on earth charges those extortionate prices for health care.
posted by empath at 12:20 AM on January 29 [8 favorites]

Here's my pet proposal. Screw the federal approach. Too many constitutional issues. If the mandate, as such, is unconstitutional except as a tax, single-payer probably is too.

Instead, the states can handle this. How? Simple. Pass a statute that says something to the effect of "No health care provider shall provide services to any patient, except where necessary to treat serious bodily injury or prevent imminent death, without providing that patient an estimate for the total cost of the services to be provided. This estimate shall include all applicable discounts and payments from all applicable insurance policies. Before treatment is provided, the patient must agree to the estimate by signing it, and must be given the opportunity to question each item on the bill. Where a cheaper alternative to a particular item exists, the patient must be made aware of it and counseled as to the pros and cons of the available options."

The state would probably also need to pass some kind of statute providing a defense to medical malpractice claims where the patient chose an alternate treatment based on cost. The service provider would also need some kind of way of making certain costs mandatory, so people don't try to cut costs past the point of medical necessity. Like, for example, going in for heart surgery but opting out of that ultrasound. Nope. Not gonna do it. This would probably need to be handled administratively, likely by the state's department of health.

The way I see it, this immediately fixes three problems.

First, people have no freaking clue what health care costs, they just have a sneaking suspicion that this shit's going to be expensive. Giving them the cost up front is not only just a sensible thing to do, but would probably encourage people to consume less care, or choose cheaper options, e.g., opting for the tried and true generic which costs $0.25 a pill instead of the latest, greatest combo drug that's about 10% more effective and costs $7 a pill.

Second, the threat of medical malpractice claims is such a problem that we wind up over-treating almost everything. This is the optimal risk management solution for the hospital, because they limit their liability and maximize their revenue. But it's not the optimal solution for patients, because it adds what amounts to an enormous risk management surcharge to every interaction. The hospital should not be the only party that gets to make choices in its own best interest. The patient should also be able to say "Look, I know you want to CYA here, but I don't want to pay $1,500 for a CT scan of my head that is almost certain to be normal. I broke my arm. Cast me up, gimme my meds, and let me go home."

Third, it would force health care providers to be aware of what their services cost. The next time you go to your doctor's office, ask them what this visit is going to cost. Odds are very good that they haven't a clue. I'm not talking about ultimate cost to the patient, I'm talking just what they're going to bill for this visit. No clue. None. The nurse certainly won't, but even the physician, who presumably has some kind of ownership interest in the business, will have only the vaguest idea of how much he's going to charge you for his services. This is lunacy. Health care providers should be fully aware of what their services cost, or at least what they're going to bill for them, so they can assist patients in choosing the most economical course of treatment.

If health care providers and/or the health insurance industry objects that this is impossible, well, fuck 'em. You're the private sector right? Fucking innovate. Health care seems to be the only service where the neither the consumer nor the service provider has any idea what the cost of services is going to be until long after service has been provided. You wouldn't put up with this shit from anyone else. Why should you put up with it from your doctor?
posted by valkyryn at 1:59 AM on January 29

I got a nasty infection not too long ago, here in France, which also spends a lot of money on health care per capita. First I went to my GP, since I wasn't sure what was going on. She sent me to an ER, but since it wasn't urgent-urgent, it meant I was responsible for the transportation costs. (If it's urgently life-threatening, an ambulance is called and reimbursed.)

Here in France, we choose our doctors, hospitals, and so forth. So on top of choosing transportation (I took the bus, it didn't cost me anything out-of-pocket since I have a flat-rate, unlimited travel pass), I chose my ER. First I went to a public hospital, but it was pretty crowded, so I thought, "what the heck, may as well try out the best private clinic in the country," not far from my place, the Clinique Saint George (named after the dude of George and the dragon fame). Hopped on another bus and was there 20 minutes later. I ended up spending several hours in a private room, getting various exams, and was eventually released with a prescription for strong antibiotics.

Total cost out-of-pocket, pharmacy and outside-of-ER doctor visits included: €18.50. Eighteen euros, fifty cents; there are no zeroes missing. Yadda yadda I pay taxes. I pay less in taxes than I would in the US for the same income.

Here's the line-by-line breakdown. By the way, when you have a single-payer system, the government can negotiate things like the prices of medication, and strongly encourage the prescription of generics. Here in France, even if your doctor prescribes you a name brand thing, pharmacists are required to fill it with the equivalent generic, barring any specific circumstances – if there's a medical reason you can't use the generic, then the name you need is indeed reimbursed; otherwise only generics are. This is one of many ways costs are kept down in such a system, while still maintaining variety and choice.
posted by fraula at 2:18 AM on January 29 [4 favorites]

Total cost out-of-pocket, pharmacy and outside-of-ER doctor visits included: €18.50

I went to a pharmacy in Nicaragua to treat a nasty friction burn, waited 15 minutes to see a doctor who cleaned it up and wrapped it and sent me home with an oral antibiotic, cream, gauze, etc, for around $25 total. A friend of mine banged his head on a surfboard in San Juan Del Sur and got stitches from a local clinic for a total cost of exactly 0 dollars. You can just walk into any pharmacy down there and buy a course of anti biotics or anti malarials, etc -- even stuff like ritalin or xanax for a few dollars.
posted by empath at 2:55 AM on January 29

As a Brit I can't believe that a (seemingly) huge number of Americans are in favour of your healthcare system costs because they are lobbyists or directly employed by the industry.

The only other explanation is Stockholm syndrome. This would explain why apparently intelligent people like gjc strenuously defend a bill of $55K when it is clearly established that such charges are a fantasy negotiating tactic that do not reflect the hospital's costs but are about 2-4 times what the hospital actually expects to get from the insurance company.
posted by epo at 3:14 AM on January 29 [4 favorites]

I went to a pharmacy in Nicaragua to treat a nasty friction burn, waited 15 minutes to see a doctor who cleaned it up and wrapped it and sent me home with an oral antibiotic, cream, gauze, etc, for around $25 total. A friend of mine banged his head on a surfboard in San Juan Del Sur and got stitches from a local clinic for a total cost of exactly 0 dollars.

Awesome.

You can just walk into any pharmacy down there and buy a course of anti biotics or anti malarials, etc -- even stuff like ritalin or xanax for a few dollars.

Not awesome. Antibiotics lose their effectiveness when overused, and there are some potentially serious drug-drug interactions. Ritalin is actually pretty nasty--it's an amphetamine, after all--and Xanax interacts both with a common antibiotic and birth control pills. And self-prescribing psycho-active drugs just strikes me as a bad idea anyway.

Should these things be cheaper? Yes. Should you be able to buy any damn drugs you want? No.
posted by valkyryn at 3:22 AM on January 29 [1 favorite]

This is one of many ways costs are kept down in such a system, while still maintaining variety and choice.

No, it isn't. Americans can already choose generics in most cases. Indeed, most health insurance plans strongly incentivize their use, much along the same lines as what you describe, i.e., there's no coverage for name-brand drugs when there is a generic available unless the physician considers it medically necessary.

Single-payer has its advantages, but this isn't one of them.
posted by valkyryn at 3:25 AM on January 29

I was more referring to the price than the lack of controls. Technically you need a prescription for a lot of those things, even in nicaragua, but there is so much competition in pharmacies (and as far as I could tell, so little enforcement), they don't really check.
posted by empath at 3:26 AM on January 29

I paid $200 for an MRI at a clinic in Canada in 2005, so that would have been about $180 US (it was non-critical, if I'd gotten it at the hospital it would have been free for me but I would have had to wait about 10 days).
posted by furtive at 3:52 AM on January 29

But those costs could well be reasonable. Part of the cost of running an emergency room isn't just the per-unit rate for these things. They have to staff the department for whatever their service level is.

Sure, which is part of why I explained that actual amount it costs for the hospital to prescribe Tylenol -- the actual pill itself is essentially free -- is realistically a couple of dollars (not 16).

But we just don't know what it really costs for a labour & delivery (which is what sonika was talking about) -- what do other countries cost? How much goes to salary of doctors (how many doctors, who usually have how many patients at once) or nurses (same), how is overhead spread out over all the patients, how much does that cost?

Something might feel reasonable or unreasonable -- 15k for a birth (paid by insurance) feels reasonable, apparently, while 40k for the surgery needed for an infected hand of someone who also had diabetes (38.5k paid for by insurance) feels unreasonable, and I don't see how we know what is or isn't reasonable in these cases because there's nothing even to compare them with.
posted by jeather at 4:43 AM on January 29

there is so much competition in pharmacies (and as far as I could tell, so little enforcement), they don't really check.

It'd definitely be the lack of enforcement that drives things then, because competition amongst US pharmacies is brutal, and Wal-Mart's introduction of the $4-10 monthly prescription for generics has had a radical effect on that market.

I have a sneaking suspicion that Wal-Mart either aims to break even on its pharmacy or actually run it as a minor loss leader, but I can't confirm that. They really might just make it up on volume, like they do with everything else. But their margins are so slim--and the pharmacy is such a small portion of their overall revenue--that stores like Walgreens and CVS have been put in a difficult spot.

Speaking more to competition generally, there was a spat last year between Walgreens and BCBS wherein Walgreens refused to accept that insurance for a while. BCBS was essentially demanding that Walgreens run those prescriptions at a loss, and Walgreens refused. There were a few months there where Walgreens customers with BCBS had to go elsewhere. It's since been resolved--I don't know who caved--but it does go to show just how stiff the competition is.

Another thing: the IP situation in non-industrialized countries is such that it's anybody's guess whether (1) the drugs you're getting are actually manufactured by the company on the label and (2) whether the government has basically imposed cost controls on drugs which would otherwise be protected by patents. The patent system is broken, and the pharmaceutical patent system especially, but I'm not actually convinced that the real problem is there. Well north of 90% of the latest, greatest, name-brand-only drugs are basically just combinations of other drugs that are available generically. The only real benefit is that you take one pill instead of two.

Example: my physician recently wrote me a prescription for a name brand drug. It was my first time with the drug, and I took it to the pharmacy, which charged me $140 for it. I was unhappy, but part of that had to do with my insurance requiring a pre-approval and me not wanting to wait, so I just paid it. But the next month, they wanted $220. I asked my physician for an alternate prescription, and I got one for the previous generation of the drug. That one only cost me $60. It's not quite as good as the newer one, but the newer one is nowhere near four times as effective. Maybe an extra 10%. I'll stick with the generics, thanks.

So I'm actually in favor of enforcing drug patents, because in the vast majority of cases, the available generic will do the job just fine, thanks. There's no real need to infringe upon patents a lot of the time.*

All of which goes back to my earlier point about requiring health care providers to know and provide information about the costs of the services they render and drugs they prescribe. CME and drug company literature is always telling them about the latest, greatest things. But in the vast majority of cases, the tried and true methods are almost as good but cost a fraction of the price. I believe educating providers about this will go a long way towards controlling health care costs.

*There are a few exceptions here, obviously, but I think they can be handled on a case-by-case basis. The patent system needs to be overhauled, but I don't think drug patents are the main reason why. Software patents, on the other hand...
posted by valkyryn at 5:20 AM on January 29

I believe educating providers about this will go a long way towards controlling health care costs.

How about pharma companies stop rewarding doctors with vacations, golf outings and restaurant gift cards if they switch over to the new (and barely modified) formulation of the same old drug?
posted by surplus at 5:31 AM on January 29 [1 favorite]

Reading fraula's breakdown of the French system makes me weep for the US, all the more so as I read what some of you are paying out of pocket for insurance. I am self-employed and currently get my insurance through my husband's job. Both healthy, no chronic problems.

We would love for him to be able to quit someday and work for my company, but reading all of this has *seriously* put a damper on that little plan unless I manage to get some huge amount of outside investment, much of which would then go to health insurance payments. This annoys the hell out of me, because you then see how the system is set up to stifle small businesses and business creation/innovation. Give me a system like the one in France and I would happily pay the required taxes, because I bet it would be less than the highway robbery we have happening here.

Additionally, her tales of the Carte Vitale make me wonder when we'll wise up and automate more of that information.
posted by bitter-girl.com at 6:53 AM on January 29

I have a sneaking suspicion that Wal-Mart either aims to break even on its pharmacy or actually run it as a minor loss leader, but I can't confirm that. They really might just make it up on volume, like they do with everything else. But their margins are so slim--and the pharmacy is such a small portion of their overall revenue--that stores like Walgreens and CVS have been put in a difficult spot.

Yeah, I believe a great deal of retail pharmacy profits come from the generally overpriced goods in the front of the store. The pharmacy itself is there to bring in the customers.
posted by ndfine at 7:09 AM on January 29

Simple men's haircut: around NOK 350 / USD 63

Holy shit. I would definitely break out the clippers, or maybe considering it's Norway just let my hair grow out to Viking metal god proportions.
posted by adamdschneider at 7:12 AM on January 29

Not one Cat Scratch Fever reference in the bunch. For shame.
posted by stormpooper at 7:13 AM on January 29

I just don't understand how American right-wingers are not screaming at the fact that they're paying roughly the same taxes as the rest of the world (more in some cases) and getting worse healthcare, AND being expected to pay more on top of taxes for healthcare services.

From a purely financial standpoint, single-payer healthercare makes sense!
posted by blue_beetle at 7:27 AM on January 29 [1 favorite]

Also: a moose bit my sister once
posted by blue_beetle at 7:28 AM on January 29 [1 favorite]

I am self-employed and currently get my insurance through my husband's job. Both healthy, no chronic problems. ... We would love for him to be able to quit someday

I am fully employed but with crap insurance options and get my insurance through my nominal husband's job. Both healthy, no chronic problems. We've been separated for nearly 7 years and would love to get divorced someday but I wouldn't be able to afford insurance otherwise.

Having your health coverage dependent on where you work is fundamentally wrong. It locks creative people into non-creative pursuits, it makes employers pay full-time workers for work that could be shared among part-timers, it leaves everyone - employers, employees, hospitals, healthcare workers, governments - EVERYONE beholden to private insurers.
posted by headnsouth at 7:30 AM on January 29 [3 favorites]

As a Brit I can't believe that a (seemingly) huge number of Americans are in favour of your healthcare system costs because they are lobbyists or directly employed by the industry.

The only other explanation is Stockholm syndrome.

and

I just don't understand how American right-wingers are not screaming at the fact that they're paying roughly the same taxes as the rest of the world (more in some cases) and getting worse healthcare, AND being expected to pay more on top of taxes for healthcare services.

I've argued with such people (I know, I know) and they're concerned with getting the best possible care as quickly as possible. They don't care about the average standard of healthcare in the US because it's not relevant to them. They justify the exorbitant cost by saying that doctors will go elsewhere if they're paid more. They point to systems with universal healthcare and say that their health care needs would be taken care of much later (or not at all) under those systems by a doctor who is not the very best, but maybe only in the top 10%.

I'm not joking and they're not joking. I try to point out that the US system has rationing too, but it's dollar based. That most people in the US will not get the care that they themselves are paying for. They argue back that if X happens to them, then they're taken care of in the way they'd prefer which is not possible in countries with universal healthcare.

I just know here in Canada it seems a lot less stressful when money and insurance aren't as big of a worry.
posted by ODiV at 7:46 AM on January 29 [2 favorites]

Not one Cat Scratch Fever reference in the bunch. For shame.

(control-F for "Nugent")
posted by Greg Nog at 8:03 AM on January 29

ODiV: "They justify the exorbitant cost by saying that doctors will go elsewhere if they're paid more."

According to the OECD statistics linked above, even if you concede that high remuneration is a necessary evil for keeping the high standard of US doctors, the US is spending 72% more on health care than the average in five other well-performing OECD countries.
posted by brokkr at 8:09 AM on January 29

I didn't say I believed them.
posted by ODiV at 8:13 AM on January 29

I didn't think you did. I just wanted to point out that it's a red herring at best.
posted by brokkr at 8:15 AM on January 29

Lots of people in the US believe lots of stupid things that no amount of facts will talk them out of.
posted by adamdschneider at 8:37 AM on January 29 [2 favorites]

Nor can you argue with sociopathic levels of selfishness.
posted by adamdschneider at 8:38 AM on January 29

unless I manage to get some huge amount of outside investment, much of which would then go to health insurance payments.

Check out the Freelancers' Union.
posted by valkyryn at 8:43 AM on January 29 [1 favorite]

it leaves everyone - employers, employees, hospitals, healthcare workers, governments - EVERYONE beholden to private insurers.

I was with you until you got to that one. I agree, bundling health insurance with employment is completely non-optimal. If I had my way, we'd end that practice tomorrow, and replace it with state-mandated guaranteed issue, community rating, and mandated coverage. Support that by completely dismantling Medicare, i.e., putting seniors in the same pool as everyone else, and using that money to fund individuals' insurance purchases.

Instant universal coverage.
posted by valkyryn at 8:47 AM on January 29

My health insurance gets deducted from my paycheck just like my taxes. My "choice" of health insurance providers is limited to what my employer chooses to offer, so it is hardly a free market decision. I suppose I am "choosing" to buy it rather than not by it, but that is a decision made under serious duress -- the threat of bankruptcy or early death if I don't buy it. How is that worse than the "duress" (the threat of prison) under which the government forces me to pay taxes? Seriously -- what is the moral difference between employer provided health insurance and taxes anyway? What is the virtue of the former over the latter, even in a libertarian world-view? Expecially given that with the tax-exempt status of health benefits, the government is effectively subsidizing it anyway?

I had (mandatory as a condition of enrollment) health insurance in graduate school too. It was a big chunk of my pay. Still when I went to the emergency room due to a dislocated jaw, I ended up with a $700 bill to pay out of pocket. What did they do for me at the emergency room? They x-rayed my jaw ("Yup, it's dislocated") gave me a shot of morphine, and tried unsuccessfully to tug it back into position. Then they left me alone for a few hours until they could get someone to put me under anesthesia and muscle relaxants and try again. But during that time I managed to tug it back into place myself. That's right, they charged me $700 for me to fix my own damn dislocated jaw. I have no idea what my insurance may have paid on top of that.
posted by OnceUponATime at 8:54 AM on January 29 [2 favorites]

If I had my way, we'd end that practice tomorrow, and replace it with state-mandated guaranteed issue, community rating, and mandated coverage. Support that by completely dismantling Medicare, i.e., putting seniors in the same pool as everyone else, and using that money to fund individuals' insurance purchases.

Is there any reason that would be an ideal end result? It's not bad as a first step, since it's closer to our current confusing, complicated, wildly inequitable system. But not so great as a goal, since it's still confusing and complicated.

I guess it still keeps everyone involved with the insurance industry employed doing useless make-work, so that's something.
posted by asperity at 9:05 AM on January 29

On that note I've been present for debates between medical students, pharmacists and attending physicians about how healthcare is a privilege not a right and that people would be able to afford healthcare if they stopped watching their cable and their McDonalds and their smart phones. The sharp division in realities brought to mind being in India; watching the higher caste doctors talk mad shit amongst themselves in English while the patients looked on patiently, waiting for an explanation in a language they spoke.

I attribute that argument about how people should be eating better as an answer to the health care crisis to the success of insurance companies in controlling the discourse. I remember when the first George Bush, in a presidential speech, first indicated that people had to "take personal responsibility" for their health. Some of us were like "WHAAAT?!"

It is a tribute to the neoliberal "logic" that individuals are individuals and their life experiences are the attributed to the sum total of all of their individual choices. Meanwhile, the insurance industry is acting collectively to screw us as a nation, out of as much money as possible.

"AHIP likes to talk about how insurance profits are a small share of national health spending -- less then one penny of every dollar spent on health care in the U.S. -- but that is an absurd, deceptive and self-serving statistic. Yet even their own chart of this data shows that the share of the health care economy sucked up by health insurance profits has more than tripled over the past decade.

One penny of the health care dollar is worth $347 billion over 10 years ending in 2019. That one penny would pay for more than one-third of the entire cost of the health reform program."
posted by vitabellosi at 9:06 AM on January 29

But not so great as a goal, since it's still confusing and complicated.

Maybe. Less so when combined with my other proposals here. But it's far less complicated than the current system, which involves overlapping private and public insurers and throws employers into the mix. The insurer-insured relationship is fraught enough without throwing employers into the mix. Employers' interests are opposed to both insurers' and employees at this juncture, so having them negotiate with insurers on behalf of employees makes no damned sense whatsoever.
posted by valkyryn at 9:17 AM on January 29

How much do you want to bet he turns into one of those quirky urban superheroes? He'll wear a costume, but he won't have any superpowers except to make his cat bite people he doesn't like.
posted by jonp72 at 9:27 AM on January 29

That's an issue. The issue he's talking about is that our ridiculous system of matching price-hikes and discounts, pro-rating uninsured care across the bills that go out to insured patients, and all the other gymnastics that go into calculating a hospital bill means we can't even establish a freaking baseline for what a medical service ought to cost.

If you're interested in what medical service ought to cost, don't look at the US - it's deliberately obfuscatory. The British NHS prices are all online (although not that easy to understand). The income to the hospital is meant to cover the whole spell (and average out the way insurance is supposed to).

By my back of the envelope calculation in Britain he'd have ended up in Major Hand Procedures without Trauma (Non-elective) or £5049 + a percentage adjustment for regional cost of living. Let's say he lived in London and call it £6000. That's not the cost of the surgery. It's the cost for the whole stay up to five days. He stayed longer than that? It's £231 (plus cost of living percentage) per night. So say £300 per night. We're up to a total of just under £7000 (or about $10,000). Which covers everything. If the hospital can't keep to that budget, too bad - it eats the loss. (And he doesn't himself have to pay a penny of that in Britain)

Of course the British model is much more efficient than the American one for many reasons despite efforts by our current politicians (self link) but the difference shouldn't be as absurd as it is.
posted by Francis at 9:31 AM on January 29 [2 favorites]

The insurer-insured relationship is fraught enough without throwing employers into the mix.

Getting employers out of it would be a great start (and a necessary one), and what you propose is certainly an improvement over our current system.

I'd like for private insurers to be about as necessary to human health care as they are to veterinary care. Asking the general public to weigh the costs and benefits of potentially hundreds of different insurance packages is not optimal, and adds significant overhead.

It might not be so bad if we could force all the insurers to merge their billing and claims requirements, so that we needn't have so many people devoted to nothing but processing it all.

I don't just want universal coverage, I want serious efficiency improvements. Single payer's the best way I can see to achieve that long-term (I recognize that the US mindset is such we may never get it.)
posted by asperity at 9:40 AM on January 29

It might not be so bad if we could force all the insurers to merge their billing and claims requirements, so that we needn't have so many people devoted to nothing but processing it all.

That could easily be part of my suggestion, upthread, that health care providers be required to submit an estimate to patients before providing treatment. In fact, I don't see any way that could be accomplished without some kind of standardized billing protocol.

For the record: I'm opposed to Obamacare, as I think it's an over-reach by the federal government, and I'd definitely be opposed to any kind of federal single-payer system for the same reason. However, that doesn't mean I don't think there are some good ideas in there. I just think they're more properly a matter for the states to handle.

Of course, for the states to handle this, the federal government would need to (1) end the tax distinction between employer-provided and individually-obtained health insurance* and (2) dismantle Medicare and Medicaid in favor of either cutting those taxes entirely or, which is probably a better move, turning the whole thing into a grant to states to fund individual purchases of health insurance. Then basically say "Okay, states. You've got money now. Damned well figure it out." If states wanted to continue the current system, they could. If they wanted to go single-payer, they could. If they wanted to reform the private health care market to bring about my proposed reforms, they could.

But right now, no one can really do anything. The federal government likely lacks the power to create a single-payer system, as Obamacare barely squeaked by the Supreme Court, and not without some damage. The states can't really do much on their own right now, because the feds are so involved that there isn't a lot of room to maneuver.

*I don't care whether they're pre-tax/deductible or not, just so long as they're both treated the same way.
posted by valkyryn at 10:33 AM on January 29

For the record: I'm opposed to Obamacare, as I think it's an over-reach by the federal government, and I'd definitely be opposed to any kind of federal single-payer system for the same reason.

I'd assume that you are similarly opposed to Medicare, and the VA health system?
posted by T.D. Strange at 11:28 AM on January 29 [1 favorite]

Then basically say "Okay, states. You've got money now. Damned well figure it out." If states wanted to continue the current system, they could. If they wanted to go single-payer, they could. If they wanted to reform the private health care market to bring about my proposed reforms, they could.

And if they wanted to just funnel that money into their friends' pockets and let everyone who doesn't matter politically just die when they get sick, why, they could do that too!

But it's like there are a whole bunch of legislators and governors out there who would do that, mercy me no.
posted by ROU_Xenophobe at 12:07 PM on January 29 [2 favorites]

Don't always assume that hospitals cannot be negotiated with if you don't have insurance. In some cases, they will work with you. My hubby has catastrophic health coverage with a $5K deductible. So he rarely uses it. A brief stay in hospital resulted in a bill based on said hospital thinking he had insurance. Once he told them he was uninsured, they cut the bill in half. IN HALF. The ease with which they did this told me it was a pretty common occurrence.
posted by Kokopuff at 12:54 PM on January 29

Here's my pet proposal. Screw the federal approach. Too many constitutional issues.

No, there aren't! If you think the Constitution prohibits federal health care then I suggest to you that you are using a highly idiosyncratic interpretation of that document, and that you could probably use it to forbid anything.
posted by JHarris at 2:09 PM on January 29 [1 favorite]

(What I've learned from this thread: "disingenuous" is the new go-to word to try to discredit your opponent when you don't know what it means.)
posted by JHarris at 4:07 PM on January 29

I just think they're more properly a matter for the states to handle.

Why? What makes a "state" so damned special? Why would you throw away the efficiencies and equality provided by a single national system on what I assume to be purely ideological grounds? Why would you want people in wealthier states to have a better standard of care than those in less-wealthy states? Why do you seek to ignore the evidence, over decades, from countries with single national systems?
posted by Jimbob at 5:07 PM on January 29 [11 favorites]

unless I manage to get some huge amount of outside investment, much of which would then go to health insurance payments.

Check out the Freelancers' Union.

Be aware that their health insurance is for NY only. I had them and moved to Hoboken NJ which is why I am now on Cobra. It didn't even occur to me until after my move when I called to give them my new address.
posted by ridogi at 6:34 PM on January 29

My state has elected to force half of its population to undergo an unwanted, invasive procedure even though the medical profession says such procedure is not medically necessary before a doctor is allowed to schedule a legal, elective procedure for a patient who chooses to have it. And the patient is responsible for covering the cost of the UNWANTED, INVASIVE, MEDICALLY UNNECESSARY procedure.

The feds may not end up with a plan that makes everyone happy, but punting to the states will result in even more inequity than we have now.
posted by headnsouth at 6:57 AM on January 30 [5 favorites]

I'm feeling a lot like I can now justify my previously irrational fear of house cats. Now I'll just point to the potential costs of an infected bite/scratch and claim the moral high ground. Instead of the mildly ridiculous I-Am-Afraid-Of-A-Common-Small-Pet ground, which is rather more embarrassing.
posted by stoneweaver at 8:53 AM on January 30

Just jumping in to say: If a Tylenol actually does cost the hospital $16 to dispense, that's also a huge f--ing problem.

We need better technology, better recordkeeping, and more PAs so that the administration of a relatively safe drug doesn't require the signoff and supervision of 10 people with terminal degrees.

A nurse should be able to administer a Tylenol from the drawer in the cabinet if the computer says it's safe to do so. If the computer raises any red flags, then we can start involving the pharmacists and doctors. The technology to make this a reality already exists.

I remember the medical establishment arguing against restricting the number of hours that residents could work, because hospitals were notoriously terrible about keeping accurate records on their patients. It's astonishing that they take this as a foregone conclusion, rather than attempting to fix the root problem of much of our healthcare system's utter insanity.

Another problem I see (as an outsider) constantly cropping up in Healthcare is the pathological desire for every practice, every doctor, and every hospital to want to reinvent the wheel, and come up with their own set of practices/procedures. While individual patients are indeed "special snowflakes," hospital populations as a whole are not.

A frightening amount of R&D goes into the production of a Big Mac. McDonalds would be completely unsustainable if every franchise had different kitchen equipment, and every regional manager decided to develop their own version of the Big Mac. There was a great article in The New Yorker last year that compared healthcare to the Cheesecake Factory, which definitely rings true from what I've seen of how medicine is practiced in the US. Standardize hospitals, standardize procedures, and start relying a whole lot more on technology.
posted by schmod at 10:03 AM on January 30 [2 favorites]

"A nurse should be able to administer a Tylenol from the drawer in the cabinet if the computer says it's safe to do so. If the computer raises any red flags, then we can start involving the pharmacists and doctors. The technology to make this a reality already exists."

Ontario has a service with 24/7 access to a registered nurse called telehealth.

From their linked page:

"That means quick, easy access to a qualified health professional, who can assess your symptoms and help you decide your best first step. We can help you decide whether to care for yourself, make an appointment with your doctor, go to a clinic, contact a community service or go to a hospital emergency room."
posted by grippycat at 3:55 PM on January 30 [1 favorite]

Yeah we've got a service like that in Australia, grippycat. It operates mostly as at-home triage. The nurse can tell you whether you should get your arse to the emergency room right away, or just wait and get a doctor's appointment tomorrow. We've found it very useful, and, presumably, it saves some money.
posted by Jimbob at 4:01 PM on January 30