When a baby is about to arrive, every minute counts. Yet when Jen Villa of Salinas, California, was in labor, she and her partner drove 45 minutes in the middle of the night, bypassing nearby hospitals to reach one they could afford.
For years, the price of hospital care has been hidden from patients, companies and taxpayers who get the bills — and that secrecy has made a hospital visit in some places prohibitively expensive. It has also fostered disparities, forcing people to pay far more depending on where they go.
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Federal rules put in place in 2021 require hospitals to make their prices public so consumers can compare them and know ahead of time how much going to one will cost. While many hospitals have been slow to comply, the emerging picture has revealed imbalances that leave patients like Villa weighing saving money against being seen by a preferred doctor or at facilities closer to home.
A Bloomberg News analysis of data compiled by Rand Corp. found more than 350 hospitals in communities across the US with significantly lower-cost competitors within 5 miles. More than half the time, the less expensive facilities had quality ratings that were similar or superior to their pricier neighbors. If patients are willing to travel as far as Villa did for lower cost care, they’re likely to find it: Almost half of US hospitals are within 30 miles of a significantly less expensive competitor, according to Bloomberg’s analysis of the Rand data.
Such inconsistencies seem to defy the normal market forces that shape prices for most goods and services…
The “normal” market forces here are with almost fully inelastic demand. The system is working exactly as those in charge intend: to maximize profits at the expense of our health.
Speaking from the pharmacy perspective.
Banks wove their way into drug transactions as a middleman called Pharmacy benefits managers. They stand between insurance and pharmacies to prevent collision, but instead, what we see is insurance companies pay a lot for drugs, while pharmacies see very little for that drug. Over 50% is being taken by the PBM because they’re “preventing” collision. Don’t even get me started on the vertically integrated pharmacies like CVS and United who abuse their position to force consumers to use their pharmacies instead of competitors or use “technological advancements” to keep their prices lower than their competitors.
NYC is currently trying to pass legislation to fix this, but that’s only at the state level.
Wall Street needs to get the fuck out of healthcare and healthcare needs to stay the fuck out of Wall Street. Once a healthcare org talks about share holders, we’re no longer talking about patients.
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The vast majority is inelastic.
Our choice of facilities and physicians is limited by insurers, our selection of whom is in turn limited by our employer.
I can choose a different grocery store by simply driving in one direction instead of another; I can select a different brand of pasta by moving my hand a couple feet down on the shelf. Selecting a new care team for my wife involves a solid week of full-time effort, and there’s no guarantee of the level of care she’ll actually receive.
Not to mention that there might be one or two healthcare “systems” in your area. If you live rurally, good luck with that.
Also if it’s anything like my area there’ll be a six month wait before you can get your first appointment so good fucking luck. If it doesn’t work out? Well, better hope you have a workable plan B.
Plan B is to put a paper bag over your head, lie on the ground, and wait for death.
The market itself undermines consumer efforts to plan care. I asked my doctor to screen a skin mark for cancer, fucking prick told me to come back next time and ask again later. Ok doc, just let me have the cancer instead.
Cost for hospital and doctor visits in the last year: $10,000. After negotiations.
Cost if I lived in Canada: $0.
Not a single thing I had done was a rare procedure. I had to have a lot of different procedures, but all of them were common procedures because all but one was diagnostic.
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I lived in Canada for a while (US expat). What you have to factor in is the wait times are sometimes utterly ludicrous in Canada unless your condition is life threatening. It does you no good for a procedure to be free if you can’t get it.
Having said that, the USA system is hot garbage. So much money is spent on profits and useless administration, paying people to deny claims, paying office staff to argue all day with insurance companies, waste, fraud, etc. We are smart enough and wealthy enough to provide quality, timely care to everyone, if only we could get rid of the greedy idiots in charge.
Wait times are are just roughly 10 percent faster in the US than Canada so I’ll take free and waiting a month more than going into crippling debt
True. I’ve never had problems with wait times in the US, but others are sharing horror stories.
You must not have tried to get mental health help or an orthopedist. Soonest anyone can see me is 3 months out so I will just have to continue using our emergency rooms in lieue of real healthcare.
I had to wait six months to see my neurologist when the last one quit. I had to wait over a month for the surgery I just got despite the fact that I haven’t eaten solid food since august and dry heaved every day.
Don’t pretend wait times aren’t ridiculous in the U.S.
Sorry to hear that. These things ought not to be in a society as wealthy as ours
It took me almost a year to get in for a routine colonoscopy. While I was waiting, the doctors I was scheduled to see left my insurance plan. I then had to find another provider and wait months longer.
US or Canada?
I am in the US. My point was that the extreme waits exist here, too, and don’t seem to be tied to whether you have socialized healthcare or not.
I’m pregnant and picked my husband’s insurance because it covers the only hospital within an hours drive where I can give birth. After it was too late for us to change insurance options, they informed everyone who signed up that they may not cover that hospital. We may not hear if they are covering the hospital until February. If they don’t cover the hospital we will need to pay all prior visits out of pocket, and it will be too late for me to find a provider within network because I’ll be too far along, but I’ll also need to go even further to find a hospital.
So much freedom. The wait times are so short, I’ll need to start working part time just to accommodate the drives to want from my appointments. Not too worry, until I pay the deductible of 10k insurance may be willing to cover up to 10% of the necessary appointments. Private insurance costs more with insurance than out of pocket private providers in Canada.
In my province of Alberta, private health insurance was not an option. At all.
You still have a lower chance of dying from lack of healthcare options or going bankrupt from the only option available. Still though, I’ve heard pretty bad stories of things that shouldn’t be pushed off having long wait times because that’s the system in Canada. There has to be a middle ground between death/bankruptcy and healthcare only for those who need it to live tomorrow.
I knew a lady with heart palpitations who was told the first appointment (Alberta) would take six months. She went to Idaho and got seen right away by paying cash. They diagnosed her with a condition that needed surgery. Even with the diagnosis, it was going to be another six months to get the surgery in Alberta. So she went back to Idaho and got the surgery right away. It cost a few thousand dollars. So it’s just a two-toer system with extra steps at that point
Only a few thousand dollars??? I had a tumor taken out, with insurance, paid around $8k. I had a persistent sinus infection and couldn’t breath for most of my life, need surgery, with insurance, paid $4k and got diarrhea for months due to antibiotics that insurance determined I needed before surgery (surgeon didn’t see why it would bee helpful since my physiology was messed up, no air flow isn’t fixed by antibiotics). Each state is different, different parts of each state are different too… Still though, that sounds like it was a really good move for you and I’m glad you had that opportunity…
It was an acquaintance, but yes. Thing is, if you don’t have insurance, your price is usually deeply discounted. A few weeks ago I needed a scan of a vein for a blood clot. My copay was $300 (and who knows how much the total paid by insurance would be), but they said I could just pay cash and not go through insurance and it was only $130. That’s part of the problem with our system.
I’ve used the system pretty regularly. To be fair, I live in a small city (150,000) within the golden horseshoe, so definitely better care compared to many throughout rural areas.
In the past few years I’ve had the birth of a child including all the various follow ups and shots, a stress test, blood work to rule out several heart issues, a halter monitor test, an ultrasound of my heart, three sets of baseline blood work, and four family doctor appointments.
The biggest fee at each was parking.
I don’t disagree we have tons of room for improvement. Our contributions each year (ie personal amount of taxes we pay for healthcare in Ontario) have not been sufficient to keep up with the growing and aging population. We desperately need greater cancer screening and diagnostic services, as prevention and early detection can save billions in future chemo/rad or operations. Rural areas and family doctors need a rework, as many people are without one due to fewer and fewer docs entering that field.
That said, I would never take the US system over Canadas. The enormous stress illness would place on a family doesn’t seem worth it for the meager tax savings, and the low wait times seem to only be avoided in the US system by paying out of pocket, which is not feasible for many.
I was in Alberta, and for the most part the care was great. There were a lot of shortages, though, which IMO could be solved by paying doctors and hospitals more. Premiums were waived so it was literally free – with a small tax I think the problems could be solved. The Canadian system would definitely be easier to fix than the USA’s
That’s overly simplified. Provinces don’t all recieve the same amount of Federal funding for healthcare. Alberta recieved about 6 billion in Federal funding for healthcare, while PEI recieved about 223 million in 2023. Alberta can afford to pay Healthcare professionals more and have been poaching those professionals from Atlantic Canada creating crises in places like Nova Scotia where the population has greatly increased through the pandemic. So, yes of course if you pay those professionals more you’ll solve problems in some places and cause more problems elsewhere.
Now, provinces can up their own taxes to make up for short falls, but guess how popular that will make the ruling parties that chose that.
The solution needs to be a lot more nuanced than just pay them more.
Edit: clarification
A lot of doctors get their degree in Canadian schools and then go work in the USA, so I do think if Canada compensated better they could retain more people
Do you think that running to the ER for a heartburn or tummy aches is something that is acceptable?
We are smart enough and wealthy enough to provide quality, timely care to everyone, if only we could get rid of the greedy idiots in charge.
If not solving a problem makes money…then the problem will not be solved…ever. That’s basically it in a nutshell. Capitalism needs greed to work and that is fine if kept in check. Obviously it’s not kept in check though. The folks that would do that are compensated by the very folks that make money from the dysfunctional system.
Huh? Where did you get the bit about running to the ER from what I said?
having lived under uk and us systems I’m not sure the US has shorter wait times for some things.
and even if it does its because there are people that need the treatment that aren’t getting it because money.
“poor people die so they are reducing queue times!” is not the big win you’re selling it as here.
Yeah, just pointing out that Canada doesn’t have it all figured out yet either. I have a friend from France, and their system sounds a whole lot more functional.
Most everyone I know has to wait long periods of time and gets bounced around from specialist to specialist trying to find someone who gives a damn and isn’t just there to give you the easy answer and bill you for the 30 sec they spent looking at your issue. USA healthcare has all the same flaws as national healthcare, we just also have to pay for it.
Hi, American here. Wait time for me to get into a dentist are 5-6 months near me.
Is that faster than Canada?
Canadian single-prayer healthcare doesn’t include dental; you need a private policy for that. I never visited the dentist when I lived there, but I presume since it’s for profit it’s better. Are you in a small town or something? My big city seems to have a surfeit of dentists
the fact that is “health-care market” is so fucked
Yeah just what I need to do when I’m dying… Let’s use the hospital price compare tool
At least it exists. Not a big win for sure, but a step in the right direction nonetheless.
I feel like I’d rather have that problem than having to drive an hour away to get to a hospital that’s going to treat me correctly in the first place.
My local hospital life-flights people because they can’t even set broken bones.
How are you going to price compare in an emergency situation, especially if you’re life friends on it?
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‘pro-life’ policy at work.
We need a presidential candidate that actually supports Medicare For All and puts and end to this insane for profit death racket
My wife is in labor at the most expensive hospital in the area of this story, thankfully I have good insurance and have already maxed my out of pocket.
There’s a reason why no other country in the world imitates the US healthcare insurance system.
Yet.
Corporations in the UK and Canada are actively spreading propaganda and lobbying to underfund public health.
Sure, but I don’t think a lot of voters in those countries are particularly impressed by how the US healthcare system works. It’s notorious.
The majority of voters in the US agree
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