patrick.net

rando says

Wow, that is amazing! I have never seen any medical center price list before. Excellent. I hope others follow suit.

If you follow links from the Oklahoma site they are a member of an organization that does this:
http://fmma.org/
You can use that website to find a place near you, if one exists. There is one in York, PA, but it seems to only be an orthopaedic care specialty.

Ironman says

You really have issues, you didn't answer either of my questions, you just went off on another straw man and re-direction, as usual. Why do you always do that?

What straw man it that? If it costs more OUT OF POCKET using insurance than paying cash then what relevance is your question? Are you having trouble with this concept somehow?

bob2356 says

You are better off looking at websites that publish prices for all the providers in your area than looking at a single provider. Here are some https://disputebills.com/the-5-best-websites-for-comparing-medical-costs/

Good link, thanks!

When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront.

When she needed an MRI to investigate further, she was offered a similar choice—she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.

Rather than feel good about the savings, Ms. Surdoval got angry at her carrier, Blue Cross Blue Shield of Arizona. “I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?”

...

Finding the negotiated rates for those same services is tougher, since many insurance contracts bar payers and providers from disclosing them. But individual plan members can see that information on their Explanation of Benefit statements, so ClearHealthCosts has joined with public radio stations in New York, California and Pennsylvania, asking listeners to anonymously post what their health provider charged, what their insurance paid and what they paid out of pocket. Thousands have responded, showing that in many cases, while insurers had negotiated a big discount off the provider’s original charge, the negotiated rates were still higher than the service would have cost in cash at the same place or nearby.

http://clearhealthcosts.com

Clear Health Costs - Bringing transparency to the health care marketplace.Clear Health Costs | Bringing transparency to the health care marketplace.

When we compare prices, there are lot of factors. We should also compare average pay for doctors, and average income with cost of surgery for those countries.
Doctors can live happily with 30K in india but in US that is poverty rate.
e.g. in Japan MRI costs 160 but it is done by technician and doctor is not involved vs US where tech takes MRI but doctor will diagnose based on images.
How big is the rental cost differential for facility? Can client who gets MRI, sue and destroy the MRI facility for an error? so high insurance cost. Are they using same equipment newer and better equipment cost more. US has lots of regulations, each extra step cost more money. Does Japan charge cost thru taxes, hence actual cost is subsidized. indirectly it costs same money to citizen since govt takes and redistributes money.

Malpractice Insurance blamed for Health Costs is the biggest BS there is.

http://truecostofhealthcare.net/malpractice/

KgK one says

Does Japan charge cost thru taxes, hence actual cost is subsidized. indirectly it costs same money to citizen since govt takes and redistributes money.

Japanese government institutes price controls on every medical procedure, down to $/sq. in. Stitch.

Ironman says

bob2356 says

Health insurance is a huge part of increasing the cost of health care, not reducing the cost.

I worked in the medical industry my entire career. Want to hear the most popular comment in the insurance arena??

Here it is, "If my insurance isn't paying for it, I'm not getting it". This even came from people who had zero problems paying cash for it.

How do you fix that, oh great Wizard?

Singapore diverts around 5% of income into a health savings account controlled by the individual. Seems to work very well there.

theoakman says

Singapore diverts around 5% of income into a health savings account controlled by the individual. Seems to work very well there.

Not true. The Singapore system is far from a health savings account. There are multiple levels of health care accounts based on income. There is tight government control of spending of hospitals and providers. The government controls what medical procedures the individual can spend on. The contribution rate is 20% employer and 16% employer. The system certainly works well, but it is complex and very tightly managed by the government at all levels. Read Affordable Excellence by William A. Haseltine of the Brookings Institute. It documents the system very well, but is a very dense 170 or so pages that I found to be a bit of a slog.

Singapore scheme works like this (I live here and participate in this scheme):

37% of salary up to a max of 51,000 USD goes into a special account called CPF (essentially a retirement savings account).
Employees contribute 20% and Employers contribute 17%. 21% of 37% goes in to medical account. That means about 7.77% of the first 51,000 USD of salary.
Money goes in pre-tax and it earns approx 4% interest compounded monthly. Money in the fund gets divided into: savings and medical. You can take money out of the medical account and pay for large procedures and medical check ups.

Singaporeans does not receive much additional government support. The government is also fiscally very tight. In the past ten years, the government budget had surplus each year except for 2009 and 2015. In 2016, surplus was 1.3% of GDP. http://www.tradingeconomics.com/singapore/government-budget

The money going into CPF is managed by an entity called GIC. They have bought a lot of commercial real estate around the world, including USA. They are a big player for hard assets around the world. There's another government entity called Temasek. They invest in higher-risk situation and their investments goes toward generating the government budget surplus. Temasek got it's money from listing government owned assets, like telecom, port, subway systems and etc. Then they invested abroad and pioneered the concept of sovereign wealth fund.

It's a fascinating government design. Very corporate: efficient and profit focused.

Republicans will love it here. There's no capital gains tax and very very minimal social welfare, almost none. Corporate tax is low. However, there is a huge tax on car ownership. This is done in the name of reducing traffic jams. But the public transport is so good that you don't need a car. I have gone 11 years without having a car.

The CPF system is not important to this discussion.

The important thing to report from Singapore is the excellent medical services that can be purchased at reasonable prices (relative to USA, Singaporeans bitch and moan about the high cost of living in Singapore). Btw: Singaporeans also mostly hate the CPF. They don't like having so much money being restricted by the government.

Back on track:
For example: Cost of a non-ceasarian delivery: approx 6000 dollars for high end stuff: private rooms, etc...
Cost of GP visit - 40 dollars
Knee Surgery: 15,000 USD (how much in USA?)

My daughter broke her arm and got x-rays and series of consultations. Total cost was about 750 USD.

All of this has to be paid out of pocket, so "the market" found ways to adjust. Part of the problem in USA must be because of:

1. Medicare and Medicaid. patients don't pay.
2. Cost of drugs are ridiculous
3. Lawsuits

bob2356 says

Read Affordable Excellence by William A. Haseltine of the Brookings Institute. It documents the system very well, but is a very dense 170 or so pages that I found to be a bit of a slog.

Interesting!!

xyliang says

It's a fascinating government design. Very corporate: efficient and profit focused.

Republicans will love it here.

Republicans would love a 37% tax rate for a medical system totally controlled by the government? Really? As in the koch brothers republicans? I don't think so.

xyliang says

Back on track:

For example: Cost of a non-ceasarian delivery: approx 6000 dollars for high end stuff: private rooms, etc...

Cost of GP visit - 40 dollars

Knee Surgery: 15,000 USD (how much in USA?)

My daughter broke her arm and got x-rays and series of consultations. Total cost was about 750 USD.

All of this has to be paid out of pocket, so "the market" found ways to adjust.

There are very successful public health care systems out there. There are also some continually underfunded disasters like NIH in Britain.

Of the 5 health systems I've had experience with I like NZ best. You get good care for the money with the least hassle. All are far from perfect. In NZ the top income tax rate is 33% and I paid about 24-26% nominal. That was total income tax for all government services. Health care, low cost college, roads, police, military, legal system, retirement, etc.,etc.. That's vs 23-24% nominal income tax I pay in the US plus 7.65% fica, plus 5-6% state (which through the miracle of AMT I can't write off) with no health care at all.

NZ cost of gp 25-30 USD.
Everything else cost is 0.
No there aren't endless waits or death panels. Drugs are evaluated for cost vs effectiveness then bought in bulk by the government at a low negotiated rate. Expensive procedures are done on a regional basis so there isn't tons of expensive equipment sitting around underutilized. You might have to travel for a complex procedure. When I had a heart mapping and ablation the health system paid for my airfare (sitting in the copilots seat of a cessna 172, I was in a very rural area), hotel, taxi's, and even airport parking.

What is missing is:
the cost insurance companies selling and billing for policies (since taxes are collected anyway there is no additional cost for collecting health care taxes)
the cost of and inherent conflict of interest in pay by procedure (gp's get capitation, specialists are employees of the health system)
the huge cost of doctors negotiating with, billing, and getting paid by the insurance companies (doctors offices don't have any billing staff at all, just a receptionist and nurse(s))
the cascading profit markup on every single procedure or item
profits to insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.,
lawsuits (there are no lawsuits in NZ, lawyers have to actually practice law)
the amount of money spent lobbying politicians by insurance companies/hospitals/labs/drug companies/hmo's/etc./etc./etc.
the list goes on and on.

All of this adds directly to the cost of health care. The vast majority of Americans have no idea were the money is going because they don't know the difference between the cost of health care and the cost of health care insurance. They only know the political talking points of whatever party they follow.

The US health system and political system are both a disaster that can't be fixed. For the same reason. The ever increasing ability of wealthy people and corporations to spend large amounts of money to influence the process to their advantage. Parliamentary systems are messy, but it's difficult to have a large political influence financially since you don't know what the majority coalition will be.

bob2356 says

Republicans would love a 37% tax rate for a medical system totally controlled by the government?

Did you actually read what xyliang wrote? The part that goes into the medical fund is only 7.7% (of the first 50K salary).

As Patrick has said, full price transparency by every provider would do miracles in bringing down the price of healthcare. Focusing on the payer side is stupid...that will naturally follow as provider prices plummet. I believe Rand Paul's plan comes closest to accomplishing this.

bob2356 says

The US health system and political system are both a disaster that can't be fixed. For the same reason. The ever increasing ability of wealthy people and corporations to spend large amounts of money to influence the process to their advantage.

So true.

Your entire post - one of the best/most informative I've read on PatNet.

FP says

bob2356 says

Republicans would love a 37% tax rate for a medical system totally controlled by the government?

Did you actually read what xyliang wrote? The part that goes into the medical fund is only 7.7% (of the first 50K salary).

True, I meant to type system not medical system. However It is all intertwined. I still don't think the republicans would go for 7.7% and total government control. He also didn't discuss what happens if someone doesn't have enough in the account to cover a major medical event. Read Affordable Excellence if you want to know how the whole system works in detail.

just any guy says

As Patrick has said, full price transparency by every provider would do miracles in bringing down the price of healthcare.

Feel free explain how this miracle will happen in detail since the vast majority of people have their medical bills paid by a third party. The information is out there on the internet already and I don't see any miraculous bringing down of the price of healthcare.

bob2356 says

The information is out there on the internet

Actually price agreements between insurers and providers are highly confidential.

You can sort-of find out some prices that insurers pay and some prices that the uninsured public pay, but it's a very long way from transparency.

The miracle will happen if people can shop around.

rando says

Actually price agreements between insurers and providers are highly confidential.

You can sort-of find out some prices that insurers pay and some prices that the uninsured public pay, but it's a very long way from transparency.

The miracle will happen,if people shop around

if people shop around

So what is going to inspire huge numbers of people to shop around when the insurance company is paying anyway? A question that never is addressed by the price transparency cult. Just the chanted mantra of price transparency, price transparency.

Most people choose a doctor by recommendation of someone they know or the closest doctor to them off the insurance company list of doctors. If people did somehow miraculously find the inspiration to shop around the odds are very high are the cheaper doctor won't be on the same insurance plan. What then?

I;m not against price transparency, but it's not going to save much if it happens. Unless human nature changes also.