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Thanks for bringing those specific citations up Aestu...while not all of them make sense (how is talking about the "chargemaster" a propaganda argument for insurance companies?)...most of them do.
Does that make the article worthless, though?



Let's talk about the issues the article raises....

Hospital Executive compensation...Aestu, these are businessmen with no medical knowledge...do you think they ought to be paid millions?

Companies that sell the healthcare equipment, their executives and employees are paid quite handsomely, do you think this is correct?

Aestu, do you agree with Jubber...that hospitals just use their chargemasters to make up for the losses they incur as a result of free healthcare and low cost public options?


This isn't a blame game...we all know the insurance companies have entrenched interests that are screwing us all over. Do you feel the hospitals are blameless in this? They are making quite a bit of money off of it...more than hospitals and clinics in other countries.

Does this seem right to you?

The question is....why is medical care in this country so expensive in the first place?

You say insurance companies are the sole reason? Can you explain how insurance companies cause hospitals to charge 6 times the actual cost of aspirin?



Honestly, I just want to understand the system as you see it...if you think the healthcare clinics are blameless. Or maybe you don't...we got so caught up in the "is this article propoganda for insurance companies" that we completely ignored any valid questions it posed.

While you complain that I'm treating all the players as monolithic, you have treat all providers as monolithic to make the argument that there is, or would be, no competition in the "ultimate seller's market." In large metropolitan areas, there generally exists more than one large healthcare provider--and they would be competitors. That means that they'd be capable of undercutting one another, which they might be able to do for one type of service/treatment, but probably wouldn't be able to do for all services. That would mean that while you might go to the Catholic-run system for thyroid treatments, you'd be better off going to a corporate entity for cancer treatment, or a non-profit with no religious affiliations for treatment of problems with the digestive system. Rural areas might only have one large provider, but if the prices they set aren't competitive other providers might enter their region. There is also going to competition between the smaller private-practice doctors who provide service as they compete for customers. What should end up happening is what happens in other businesses, like retail, where you'll have "bargain" providers--like Wal*Mart or Dollar General--that would provide a broad range of services most everyone will be able to afford who compete with varying grades of providers of a higher quality--everything from Target to Tiffany--that wold cater to special needs/requests or provide more specialized treatment.

Holding all payers to the same pricing avoids the problem addressed in the article Azelma linked, which is that certain payers subsidize the services bought by other payers.

Your Pal,
Jubber

AKA "The Gun"
AKA "ROFeraL"

World Renowned Mexican Forklift Artiste

What you are proposing is the same logic behind airline food. Profit goes up exclusively by cutting the quality of a product with guaranteed price and delivery, then marketing it to people who have no choice.

You're giving a tortured rationalization for dysfunctional mechanics for the sole reason of preserving the pretense of a free market and ideological sacred cows like "competition", "savings", and class distinctions.



Faulty premise. It isn't a problem at all. It's how society works.

It isn't a problem that some people subsidize other people's medical care any more than it's a problem that some people subsidize other people's roads, mail service, telecom, education or whatever else may have you.



Hospitals are blameless in the same sense universities are blameless. They are actors playing a game conceived by someone else, and they are being controlled by money flowing in from private interests determined to keep the government out.



The same way banks and the education industry drive up the cost of textbooks. If schools were fully funded and brought under the control of democratic authorities, they wouldn't try to mark everything up and balance it on the backs of students.

Why do you think trustee boards choose to play the game? How do you think they get their jobs?
Same with medical administrators.

Why are corporations so determined to prevent quorum-based public campaign funding? Because they know that if that were to come to pass and candidates got their money from the state, their game would end overnight. The democracy would rein the abuses in, appoint professional directors, and that would be that.

Aestu of Bleeding Hollow...

Nihilism is a copout.

Yes. Insurance companies will only pay a percentage (if any) of the cost of care. So if a treatment truly costs the hospital $100, the insurance company might pay none, or $25, or $75. This causes a problem for the hospital, obviously. So for someone with insurance, they may charge $500+ for that treatment, hoping to at least get the actual cost of the treatment covered. Anything else is extra.

There are, of course, a number of things that hospitals don't charge for that need to be covered too, so I understand charging a bit more than what a treatment actually costs (though not as much as they do, honestly. it's exorbitant). When a patient asks for a juice or a soda, we just grab it out of the fridge. It's not documented anywhere, or assigned to a room. They just drink it. There are other things like this too. Gauze, tape, bandages. I mean for something like an IV or a catheter, that would be documented so a few items might be accounted for that way, like a catheter strap or a canister for measuring urine. Most places now have you document how many tries it took. It could take someone 2+ times to get a catheter or IV in, and that requires more needles/catheters because once they're contaminated, they're tossed.

I absolutely agree that the executives of the hospitals shouldn't make nearly as much as they do. It's ridiculous. For example, the CEO of the hospital I have a rotation through makes $575,000, which is 26% less than the median salary for hospital CEOs. Some of the neurosurgeons make nearly $2 mil because they have "incentives" to refer clients to the hospital. I mean granted, they went through a ton of schooling. Took out hundreds of thousands in loans. I get that. Still seems to be a bit much though.

But an RN with a bachelors degree at this same hospital starts at $19/hr. Around $36k a year. And anyone who's been to or in a hospital knows it's the nurses and the techs (who make $9/hr, just btw - to put that in perspective, they're wiping up piss, shit, blood, and vomit for less than my bf made at walmart) that take care of them. When my mom was in the hospital in December, she saw her doctor once in the four days she was there. The stupid fuck didn't even put in an order for an analgesic, after they withheld the medication in the ER because they were sending her upstairs. I could hear her screaming when they transferred her from the stretcher to the bed from 200 yards away in the waiting room, through the door, clear as day. It took an hour to get ahold of him, and another two until the damn thing was put in the system.

s^ | Kay

What do you know about the "chargemasters" this article references?

It talks about there being little rhyme or reason to them...some hospitals might charge $2,000 for something another hospital might charge $4,000 for....

It's just what the hospitals set their rates at. It usually goes through procedures, supplies, things like that. So at one hospital, they may have decided to charge $400 for this one diagnostic test, so every time they bill under that code, the patient/insurance company is charged $400. Another hospital may decide to charge $600. I think California is the only state that requires hospitals to disclose the costs publicly. You can kind of get an idea here. You can just put in a surgery, all commonly done, and see what different hospitals charged for the same thing. They're unadjusted for government/insurance discounts as well. It's the bill you'd get in the mail if you were uninsured.

s^ | Kay

I looked up Coronary Artery Bypass Graft and saw $324,000. HAHAHAHAH nice joke.

Although I've heard that if you are uninsured you basically just have to reach a compromise with them for a percentage of the cost although still even if they give you a 90% discount on that it's over 30 grand. I guess that is a little more reasonable than over 300 grand though -_-

This is where the strength of the article is, I believe. Regardless of it's "pro insurance company" agenda.....why are we okay with hospitals not disclosing their costs and listing out everything you're paying with the fullest transparency?

Why should one hospital be able to charge some absurd amount for a procedure or medical item, and another hospital can charge something completely different?


If you want a new pair of shoes...you could go to multiple shoe stores, compare rates, and make your purchase decision based on that. You have all the power because you can decide to not get the shoes at all.

It's a little different if you absolutely need an angioplasty or something to live....yet you can't compare rates, or really dig into the costs at all. Looking at medical bills is hilarious...the way they list things is to be intentionally misleading. If it's gauze, they won't use layman's terms...so you're getting charged $100 for something that's $3 on Amazon....it's just so...wrong.

Most of the "chargemasters" are seldom referred to and just accepted as "it is what it is"

That's what makes me go "WTF"

You are contrasting two things that are exactly identical. This is the "free market". Arbitrary pricing. The difference is, you can choose not to get shoes, and you can't choose to not get medical care. That's why a free market approach is fine for sundries and not fine for medical care.



Do you know exactly how much your power or telecom or gas bill are? Do you know how much you are charged for those services versus the cost of creating them?

It's the same with any product or service. All firms have a CFO or deputy thereof that decide how much the product costs. The article is manipulating you by making the common seem ominous via innuendo.

Aestu of Bleeding Hollow...

Nihilism is a copout.

Selling a pair of shoes for 30 dollars because your competitor is selling shoes for 35 dollars is free market pricing.

Meeting with your competitors and deciding an MRI machine costs $200,000 and not disclosing the manufacturing costs is not.

Nothing in the free market, by any definition, requires me to tell you how much my product costs to make. How much do you think your shoes cost to make? Is it possible for you to have any real idea?

Collusion is a an inevitable reality of the unobstructed free market.

Aestu of Bleeding Hollow...

Nihilism is a copout.

That's what I was saying!



It makes the fact that they don't clearly show costs to you all that more offensive when you have absolutely zero choice in the matter.

This is what Medicare does so well...forces hospitals to only charge what something costs. The problem is, because of private insurance company deals and crony capitalism, these hospitals can gouge the crap out of everyone else



You're correct...but I feel there are certain services/goods that shouldn't be profit ventures able to be exploited because of inelastic demand. Energy and Healthcare fall into that category. At the very least...we should get clear expense reports...which tell us why something costs what it does.

And there you go.

See, even lies can be truthful. The utility of the article, as with many such things, isn't looking for truth, it's looking for lies. If the article's deception hadn't been uncovered, you'd have taken the lies at face value, believing it was the hospitals, and not those controlling the system.

This is also why I read John Birch Society magazines.

Aestu of Bleeding Hollow...

Nihilism is a copout.