The people speak on the cost of care: Comments on the news

Filed Under: Costs, Health plans, Patients

Jama Internal Medicine article on consumer hospital prices
How much does hip arthroplasty cost?

There are fascinating comments on the stream at the Well blog on nytimes.com for the Libby Rosenthal piece about the study seeking the price of a hip replacement, which was the topic of an article by Reuters also (where I was quoted), and an article by Chad Terhune in The Los Angeles Times. Our friend Robert Field, the Drexel health economist, posted on this same topic, “You probably have no idea what your health care costs,” over in The Field Clinic at Philly.com, the Web site of the Philadelphia Inquirer.

The comments are telling. Here’s a sampling:

“A few years ago our kid needed a ‘walking boot.’   The doctor’s office was out of stock at $1,755.00. I asked the technician where to get one.  He gave me the manufacturer and model number.  Said to buy it on eBay. eBay’s price?  $46, including overnight shipping.” The Los Angeles Times

“As a young, healthy person I now see where all my annoyingly high premium payments and medicare tax dollars are going – paying for hip replacements for rich old people so they can go skiing. Talk about a transfer of wealth.” The New York Times

“When discussing Obamacare with my cousin, an orthopedic surgeon, he always maintained that people should take personal responsibility when ‘purchasing’ health care. So I asked him how much a knee

 

replacement costs (his specialty). His answer: ‘What the insurance company pays.’ So I asked him if he could figure out the actual cost, including his fee, operating room, anesthesia, hospital stay, physical therapy, pharmaceuticals, followup visits and anything else he might think of. He could not come up with any of the numbers. So my question is, how can we make any kind of informed decision about our medical care if the person providing it has no clue what the cost is?” The New York Times

“Imagine going into a restaurant and having no prices listed on the menu. When you’re done eating, you get the bill. The expenses are broken down in elaborate detail ($40 for the hamburger bun, $60 for the beef, $15 for a slice of cheese, $60 for the food preparation, a $40 cashier fee, $600 for the booth you sat in…). But you’re not done yet. Now the bill goes to your credit card company, who tells the restaurant, ‘we only pay $10 for a hamburger’ and sends you a bill for $10 (because you haven’t met your food deductible yet). And the guy who ate the same thing at the next table over, who paid in cash, had totally different prices on his initial bill for every single component. He had nobody to negotiate on his behalf and was billed $50. He had to claim financial hardship (because he couldn’t afford to pay $50 for a hamburger) and so the restaurant lowered his bill to $25.You couldn’t make up a system this stupid or unfair. Nobody would believe it. Yet this is actually how health care works in the US.” The New York Times

“I am currently living in a small, poor eastern European country which is not a member of the EU. Every time that you go to a doctor or hospital here the prices for services are all clearly posted on the wall – i.e. $50 for a sonogram, $100 for a CT scan, $35 to see the doctor, etc. When you leave, you automatically get a printed out copy of the doctor’s findings, as well as any test results or images. The posted prices allow you to shop around and always know what you are getting yourself financially into before you see the doctor.It is amazing! If this poor country with limited resources can do this, the USA certainly can.” The New York Times

“Price transparency along with comparison shopping for healthcare is but another buzzword marketing ploy by the insurance companies that is abused to justify stupendous increases in premiums, deductibles and copays. It’s their job to negotiate with area medical facilities, for their subscribers to obtain the best possible care at the most reasonable prices.” The Philadelphia Inquirer

“The point of this article should be that there is little to no ability to compare prices and create competition for consumers, which clearly helps drive up the price. The majority of those with coverage just pay the copay and perhaps the deductible, and call it a day. There is no motivation to keep costs down. Look at the free contraceptives debacle- women now can get the most expensive ones with no copay, so they have no reason to choose the much cheaper proven generics. The only force really controlling the cost is actually the health insurance company, who negotiates with the providers to set the rates.” The Philadelphia Inquirer