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Stethescope on top of pile of money
Say you're on Medicare, and you get pneumonia that requires hospitalization, and say you live in Boise, Idaho. You have a choice of two hospitals. In one, treatment is going to cost $26,932. In the other, $16,239. In Bakersfield, California, the treatment would range from $55,277 to $77,562 among that city's four hospitals. In Boston, one hospital would treat you for $16,952, but the total bill could end up being $54,405 at another hospital.

We know this because the Obama administration, for the first time ever, has compiled national data on what hospitals charged Medicare in 2011 for the 100 most common impatient services. They're making that data available (the database information is here) to the public, and hope it will provide impetus for further reforms.

Administration officials said they offered up the data with hopes that its release would administer a market corrective, forcing hospitals to take greater heed of competitors while arming ordinary people with information they could use to seek a better deal. The data could also spur health insurance companies to negotiate with hospitals to seek lower prices.

"Our purpose for posting this information is to shine a much stronger light on these practices," said Jonathan Blum, director of the Center for Medicare. "What drives some hospitals to have significantly higher charges than their geographic peers? I don't think anyone here has come up with a good economic argument."

The very fact that prices are now public may bring change, he added. "Hopefully, it will cause hospitals themselves to take a hard look at their charge-master practices and to ask hard questions of themselves as an industry why there is so much variation," he said.

The amounts hospitals charge Medicare are not the amounts that actually end up being reimbursed by the program, and in fact, are sometimes as much as six times the actual reimbursement rate. A New York Times analysis of the data shows that the charges are generally three to five times greater than reimbursements. The Times also got a partial explanation from Blum as to why their might be so much variation. Medicare does pay slightly higher rates to teaching hospitals and facilities in cities with high labor costs.

The public release of this data, Blum said, was partly inspired by the blockbuster TIME magazine story by Stephen Brill, which exposed the unfathomable and completely arbitrary price-setting "system" used by health care providers. It's a bizarre game that providers and insurance companies play—we'll charge, oh what the hell, this amount, and you can pay whatever!—that has no oversight, no rhyme, no reason. But at least this new transparency might do exactly what the administration hopes: create some competition that forces both providers and insurance companies to negotiate lower prices, and to save all of us some money.

Originally posted to Joan McCarter on Wed May 08, 2013 at 03:35 PM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Free marketeers ought to be appalled... (20+ / 0-) the current state of charging for health care in this country, because it's not just opaque, it's practically designed to keep patients from being informed enough to know what they're going to be charged for goods and services (the same way they are when, for example, they go to buy food or a set of tires).  But that's because the free marketeers don't really care about free markets; they care about free profits for providers.  They don't care that health care charging in this country is basically a scam.

    True Progressives understand that a single-payer system would short-circuit all of this by establishing only one means of reimbursement.  No room to game the system there (or at least substantially less).

    The road to Hell is paved with pragmatism.

    by TheOrchid on Wed May 08, 2013 at 03:43:09 PM PDT

    •  but that is how the free market works (6+ / 0-)

      I don't know why anyone would be surprised.

      After all, nature's evolution produced fleas, ebola, and the cockroach. (Although, you can't blame nature for the Brussels sprout.)

      "Survival of the fittest" isn't always nice for the victims of the fittest parasites.

      •  The key word in this comment... (3+ / 0-)
        Recommended by:
        kefauver, second gen, Creosote

        ... is "parasites."

        Good for the Obama administration for doing this.

        "Enlightened statesmen will not always be at the helm." --James Madison, Federalist 10

        by mrhelper on Wed May 08, 2013 at 06:23:55 PM PDT

        [ Parent ]

      •  It certainly is not. (1+ / 0-)
        Recommended by:

        For one thing, it is nearly impossible to get prices in the current "system".  I have been through that process and have wanted to inflict bodily harm on more than a few people.

        For another, the care-givers have an enormous amount of market power (think monopoly).

        Limited choice of hospitals, supply of doctors/caregivers artifically constrained by licensing practices and requirements.

        Unbalanced information -- that's always a problem when lay people deal with professionals, but I challenge you to get the information you actually need to make significant decisions from most doctors.  

        And, finally, lack of rational action.  When the condition we face is life-threatening, we tend to go all whack-a-doodle between the ears AND the doctors turn into the worst kind of vultures.

        None of that is consistent with the information flows or competitive forces required for a free market.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sat May 11, 2013 at 08:24:06 PM PDT

        [ Parent ]

    •  It's just insane (9+ / 0-)

      And it's all just a bizarre game, everyone basically just seeing how much they can get away with.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Wed May 08, 2013 at 03:59:03 PM PDT

      [ Parent ]

    •  They are appalled and they figure (2+ / 0-)
      Recommended by:
      kefauver, JerryNA

      if we'd just eliminate all govt regulations and let the free market work, everything would be just peachy.

      Or something like that.

      Want a progressive global warming novel, not a right wing rant? Go to and check out New World Orders

      by eparrot on Wed May 08, 2013 at 06:09:42 PM PDT

      [ Parent ]

      •  They should be careful what they wish for, (1+ / 0-)
        Recommended by:

        remember that it's government regulations that prevent them from losing their heads via guillotine (or even just being lined up against a wall and shot).  I don't think they would survive very long in a war of everyone against everyone though neither would anyone else.

        You have watched Faux News, now lose 2d10 SAN.

        by Throw The Bums Out on Sat May 11, 2013 at 08:12:20 PM PDT

        [ Parent ]

    •  Real free marketeers ARE appalled. (1+ / 0-)
      Recommended by:

      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

      by dinotrac on Sat May 11, 2013 at 08:18:52 PM PDT

      [ Parent ]

    •  Depends on what you mean by "free marketers." (0+ / 0-)

      The laissez-faire types are much more concerned about methods than effectiveness. They just tout effectiveness to sell it to others.

      I consider myself a big fan of markets though. Markets that actually function as close to the pure mathematics of perfect competition as possible. But those kinds of markets require transparency and availability of information to consumers that often don't freely exist in natural markets. The solution? Legislate transparency through open books and legislate availability of information through public awareness campaigns and direct disclosure. This still won't get you to a perfect market, because even with full availability people will never have enough time to learn everything (if I knew everything my doctor knew, I'd have his job), but it's a best approximation.

  •  health insurance (22+ / 0-)

    is more like a protection racket than even a business, and it's relationship to the actual health care that people receive is even more tenuous.

    Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

    by a gilas girl on Wed May 08, 2013 at 03:46:35 PM PDT

    •  Health Insurance (1+ / 0-)
      Recommended by:

      I've mostly been self-employed all my life, sometimes insured, sometimes not. I was uninsured from about 2001 until I turned 65 in 2005 and went on Medicare.

      When my Cobra expired in 2001 I sat down and made a conscious decision that went like this.

      I'm betting everything I have in my retirement account that I'll stay healthy or at least be able to pay for my care until Medicare kicks in. I'm not going to buy individual medical insurance.
      I won my bet, but I knew I was all in.

      I suddenly started a blog.

      by JG in MD on Wed May 08, 2013 at 07:59:18 PM PDT

      [ Parent ]

      •  A lot of people (2+ / 0-)
        Recommended by:
        Creosote, JG in MD

        1)  Don't have that luck - things happen that are out of our control - cancer, auto accidents, a slip on the bathroom floor; or

         2)  Are already too ill or have a chronic condition or need regular expensive medication, etc, and cannot ever make that bet to begin with.

        You're a very lucky person.

        It is a national shame that millions of people aren't cared for and/or cared for very poorly by this sham of a "health care" system which is really just an insurance racket and for-profit pillaging.

        People across Europe (and elsewhere) are appalled when they learn that people go bankrupt for medical conditions in the USA.  We have the worst healthcare system in the developed world.

        "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

        by YucatanMan on Wed May 08, 2013 at 08:55:55 PM PDT

        [ Parent ]

      •  I did the same thing. (1+ / 0-)
        Recommended by:
        JG in MD

        Had some initially relatively inexpensive insurance for the self-empoyed for a few years in the mid-nineties, then with the Net was able to check out the Texas-based company and learn how spotty and sharp-practice-like other insureds had found the company to be and dropped it.

        Thank heavens we have been fortunate.

      •  You pay your premiums every month and (3+ / 0-)
        Recommended by:
        JerryNA, mrsgoo, eps62

        then the insurance company fucks you around for 18 months after your doctor recommends a biopsy, sending you to specialist after specialist as a stalling tactic.

        By the time it's finally authorized, the shits' metastasized.  Oh, and you've been sick for so long you're on disability and just about to land on Medicaid, and which point the taxpayer picks up all the radiation and chemo.

        This model hasn't been changed a bit.

        The real "gamble" is whether you'll get the care you need even if you pay the beasts who have now been even further empowered to profit from misery.

        Wash. Judge Tells Cops To Return Man’s Marijuana Or Be Found In Contempt

        by JesseCW on Sat May 11, 2013 at 06:18:51 PM PDT

        [ Parent ]

  •  Medicare is the only system that pegs (21+ / 0-)

    what it pays medical providers to what it costs those providers to provide services.  In other words, the only sensible system out there.

    The chargemaster or list prices have no basis in any reality whatsoever.  It is complete nonsense and why medical care costs so much more.  Plus the chargemasters and negotiations they cause give the insurance companies a basis for their purely administrative existence. Using medicare as chargemaster and list price not only assures a proper price is paid, but also that administrative costs are minimized.

    "To recognize error, to cut losses, to alter course, is the most repugnant option in government." Historian Barbara Tuchman

    by Publius2008 on Wed May 08, 2013 at 03:50:05 PM PDT

    •  yep (8+ / 0-)

      A lot of factors go into calculating a provider's rate per Relative Value Unit, but once you have it, the reimbursement is straightforward. Yes, the RBRVS can always stand adjustment and tweaking as technology changes, but the concept is plain.

      But, as you note, if it worked that way then what "value" would insurance companies provide? And what profit could they extort?

      Labor is prior to, and independent of, capital. Capital is only the fruit of labor, and could never have existed if labor had not first existed. Labor is the superior of capital, and deserves much the higher consideration. -- K.Marx A.Lincoln

      by N in Seattle on Wed May 08, 2013 at 04:31:20 PM PDT

      [ Parent ]

  •  pity, because now (3+ / 0-)
    Recommended by:
    elwior, ColoTim, Barton Funk

    they will all raise prices and price fix.

  •  A bit off topic... (6+ / 0-)

    And I don't mean to make fun of your typo, but I rather like the idea of "impatient services".  (Not intended to be an attack or a criticism of making typos - it happens, I just found this one amusing)

  •  The sad thing is... (17+ / 0-)

    If you do not have health insurance, you get charged that higher amount.

    The least amongst us pay the most.  As  Yakov Smirnoff  used to say, "What a country".

    "Perhaps the sentiments contained in the following pages, are not YET sufficiently fashionable to procure them general favour..."

    by Buckeye Nut Schell on Wed May 08, 2013 at 04:55:59 PM PDT

    •  That's the incredible, callous injustice of this (4+ / 0-)

      shameful "system."

      The poorest, most desperate are penalized by these fake pricing schemes and driven into bankruptcy.  How the hell is that right?  How can any doctor, clinic or hospital justify these insanely cruel practices?

      "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

      by YucatanMan on Wed May 08, 2013 at 08:58:22 PM PDT

      [ Parent ]

      •  They do it because they expect the uninsured will (5+ / 0-)

        never pay.

        Partly---remember all those years of "The uninsured cost **!! This is why your medical bills are so high, you insured middle class twits!  Blame these broke "freeloaders" refusing to forgo food in order to enrich us!"??

        Yeah, that shit was based on cost inflation of four or five hundred percent.

        Additionally, when they sell the unpaid bill to a collection agency for 20 cents on the dollar, they'll actually recoup most of their real costs.

        It also allows for-profit ventures to pretend to be NPO's, thereby avoiding taxes.  We didn't make a dime!  We "lost" 30 million treating the uninsured last year!

        Wash. Judge Tells Cops To Return Man’s Marijuana Or Be Found In Contempt

        by JesseCW on Sat May 11, 2013 at 06:22:50 PM PDT

        [ Parent ]

  •  You know it's bad when you call the hospital (10+ / 0-)

    after getting a bill for a 24 hospital stay with no procedures for $15,000, and you somehow end up feeling bad for the administrator you're talking to when you give them a massive dressing-down about how no other industry in the US is allowed to get away with the BS they pull in hospitals.

    "Well, we're going to do this and this to your car, but we can't tell you how much it will cost.  Here's this paper saying that you'll agree to pay whatever we decide to charge you."  Can you imagine?

    After a while he just didn't know what to say.  The guy (this was a higher level administrator in the hospital) just basically agreed and sounded very defeated and a little depressed.

    I ended up paying the bill, after the insurance paid their share, it was still a large chunk of our monthly income.

    I blog about my daughter with autism at her website

    by coquiero on Wed May 08, 2013 at 04:58:56 PM PDT

  •  well, you know (7+ / 0-)

    i'm stunned.

    But at least this new transparency might do exactly what the administration hopes: create some competition that forces both providers and insurance companies to negotiate lower prices, and to save all of us some money.
    c'mon... a real reform of health care would have addressed this... because it would have looked in depth at the pressures driving costs and everything else. i mean, is this info all that new or surprising??????

    too many of us have been saying that this reform didn't address the real deep issues.

    it doesn't get any easier. honestly. how much more data does this site need to consider using its sway and presence to apply power and ideas outside of brand politics? issues... and local and regional politics.

    as Jeff Sachs stated recently:

    "We have a corrupt politics to the core, I am afraid to say, and . . . both parties are up to their neck in this. This has nothing to do with Democrats or Republicans."
    meaning it's not one or the other... but I don't have to explain what he means, do I?
  •  In an emergency, though, you generally aren't (8+ / 0-)

    given a choice for where to go for services.  The ambulance will take you to the nearest choice.  I realize there are lots of services that aren't emergencies, but that's what I've had the most personal experience with.

    I believe Colorado is one of the states to make public some of the information on outcomes from care so that you can also determine if that hospital that charges more actually has a better chance of curing you without a side helping of annoying flesh-eating bacteria (for example).  That is also an important part of the choice for where you get treated in non-emergency situations.

  •  Other prices are going down (3+ / 0-)
    Recommended by:
    N in Seattle, elwior, Creosote

    A friend of mine is a hearing healthcare worker. He gets reimbursed $22 for a complete hearing eval. 20 years ago he was getting 30% more.

    The price of everything has increased over the last 20 years. He and his group must not have good lobbyists.

    Be ashamed to die until you have won some victory for humanity. Horace Mann (and btw, the bike in kayakbiker is a bicycle)

    by Kayakbiker on Wed May 08, 2013 at 05:07:06 PM PDT

  •  Transparency doesn't do jack s. (6+ / 0-)

    Posting the data publicly won't do a damn thing to change price levels.  Prices aren't determined by information but by power, the leverage hospitals have over patients.  Patients are sick, injured, near death persons who don't have the ability say to the ambulance driver, "hey, can I check the website first?"

    Only if this information leads to popular mobilization around the issue will we see anything change.  Like a successful push for socialized insurance.

  •  Recent family experience with acute medical care (5+ / 0-)
    Recommended by:
    nchristine, FG, JerryNA, Creosote, Barton Funk

    and its costs has given me a personal insight into how crazy this system can be. Facilities and providers overcharge, insurers agree to pay only part of it, some back room negotiation takes place, and they settle on a price that works for both. Most of the EOBs haven't come in yet so I don't yet know what our costs will be, but obvious what you see isn't what you get, or pay. This is medieval trade bazaar price negotiation in a 21st century industry. Perhaps it actually make sense to insiders, but it just seems bizarre to me.

    Also, NEVER accept what any of these parties insist is the final, set in stone, non-negotiatable word. It almost never is. They're just hoping you believe it is and accept their terms. You're as much in on these negotiations as they are. Stand your ground and make them work for you too. You won't always get what you want, but you'll probably get better terms than initially offered. The "sucker" factor is part of how they make their money. Don't be one.

    "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

    by kovie on Wed May 08, 2013 at 06:39:38 PM PDT

  •  During the Obamacare (3+ / 0-)
    Recommended by:
    JerryNA, YucatanMan, Barton Funk

    negotiations Diane Rehm had on a republican strategist who claimed conservatives don't mind having costs dumped onto them by hospitals due to non-payers. He said this is a better system than universal healthcare.

    I support the two-state solution: for the USA.

    by plok on Wed May 08, 2013 at 07:04:16 PM PDT

    •  They prove themselves to be idiots everyday, (2+ / 0-)
      Recommended by:
      Creosote, Barton Funk

      yet people keep voting for them.

      I guess idiots deserve representation like all the rest of us. . .   I just never knew there were so many.  

      (I realize this is a departure from my usual "hey, we've got to talk nice to try to convince them not to vote Republican," but how much can a person take? How long will this crap go on?)

      Basically - I heard that show too - the Con was saying, "Yes, we prefer a wasteful, inefficient, expensive and frequently ruinous system because GOBMINT Bad." Paranoid loser freaks, seriously.  That's what they are.

      "The law is meant to be my servant and not my master, still less my torturer and my murderer." -- James Baldwin. July 11, 1966.

      by YucatanMan on Wed May 08, 2013 at 09:03:47 PM PDT

      [ Parent ]

    •  The entire fraud that "non payers" were ever (2+ / 0-)
      Recommended by:
      JerryNA, eps62

      responsible for skyrocketing health care costs in the first place was laughable.

      Hospitals make profits, pharma makes profits, executives make obscene bonuses, but we're supposed to believe that the uninsured (who hospitals massively overcharge) were the reason?

      That's like the Gap trying to blame shoplifters for their labor practices.

      Wash. Judge Tells Cops To Return Man’s Marijuana Or Be Found In Contempt

      by JesseCW on Sat May 11, 2013 at 06:27:35 PM PDT

      [ Parent ]

  •  Negotiating cut rates with insurance companies (6+ / 0-)

    is price fixing and it's anti-competitive.

    It ought to be completely illegal to charge people different rates based on whether or not they've got insurance, or who they're insured by.

    Wash. Judge Tells Cops To Return Man’s Marijuana Or Be Found In Contempt

    by JesseCW on Sat May 11, 2013 at 06:04:50 PM PDT

    •  Agree. I have been blessed to have good (2+ / 0-)
      Recommended by:
      JesseCW, eps62

      health insurance through my employer, but I never thought it was fair that I got a "discount" because my employer was big enough to strong arm providers into accepting a lower price.

      I can't walk into a department store and get 70% off any item because I work for Company X.  Why should I get special prices for medical services based on my employer's clout?

      Extreme, but true example.  At a recent office visit, I was given a shot.  The provider billed my insurance $12.00.  The insurer "allowed" $0.52 (yes, 52 cents) and paid $0.46.  I owe $0.06.  What king of a racket is that?

      “The future depends entirely on what each of us does every day.” Gloria Steinem

      by ahumbleopinion on Sat May 11, 2013 at 08:52:28 PM PDT

      [ Parent ]

  •  Market based competition? (1+ / 0-)
    Recommended by:

    What a concept.

    "Do what you can with what you have where you are." - Teddy Roosevelt

    by Andrew C White on Sat May 11, 2013 at 06:21:05 PM PDT

  •  $100,000 For Two Stents In My Dad's Leg (2+ / 0-)
    Recommended by:
    Mote Dai, eps62

    The hospital sent him the bill instead of to his insurance company.  Obviously, nobody is paying anyone 100 large.

    There’s always free cheddar in a mousetrap, baby

    by bernardpliers on Sat May 11, 2013 at 06:27:48 PM PDT

  •  Also (3+ / 0-)
    Recommended by:
    JerryNA, DSPS owl, eps62

    I suspect that they inflate the charges to be in a position to claim that the un-reimbursed amount constitutes charity or possibly a tax deduction.

    "Mr. President, I'm not saying we wouldn't get our hair mussed. But I do say no more than ten to twenty million killed, tops." General Buck Turgidson

    by muledriver on Sat May 11, 2013 at 06:46:19 PM PDT

  •  Free market (3+ / 0-)
    Recommended by:
    JerryNA, susanala, eps62

    would require not merely general competition, but also an end to healthcare corporations' immunity from antitrust prosecution (and we should do the same for MLB, as long as we're tinkering).

  •  Another great example... (3+ / 0-)
    Recommended by:
    Slightly Wobbly, JerryNA, eps62

    ...of why "health care" isn't just another "product" the consumer can shop around for to get a competitive price.  I remember when I needed lithotripsy to break up a kidney stone...I rather naively called around to multiple hospitals to inquire just how much the procedure was.  My insurance was to pay 80% "of the cost" but I had no clue what the total cost was and how much my 20% would be.  $500? $1000? $2000?  I had no idea and no one would answer the question.  I would get transferred to billing departments who had no clue.  I would say, "OK, you routinely do these procedures, what does it cost?"  The answer would be invariably, "We don't know how much it will cost you."  And I would clarify that I am asking a different kind of question.  It was soooo frustrating.  It isn't like you can shop around to get the best price.  It isn't a car or some other good or service.  

    The sequester is the new Republican immigration reform plan. Make things so bad here in the US that no one will want to live here.

    by Mote Dai on Sat May 11, 2013 at 06:49:20 PM PDT

  •  Insurance companies "negotiate" with physicians, (4+ / 0-)
    Recommended by:
    JerryNA, DSPS owl, susanala, eps62

    too, if that's what you want to call it. For expensive procedures that require pre-authorizations, the insurance company will call and "offer" to pay less. The implication is that the pre-authorization depends on the price. What's a physician supposed to do in a situation like that. (Nice patient you've got there. It'd be a shame if anything bad happened to him.)

    Several years ago, a disabled friend of ours who lives on SSI and  Medicaid was referred to a pain specialist for back pain. The pain specialist required a spinal MRI to treat. The hospital where the MRI was to be preformed obtained a pre-authorization from Medicaid and notified our friend in writing, but when the bill came, Medicaid had refused to pay any of it. The charge for the MRI was 2.5 times his total monthly income. There was no way he could pay it. He was so upset about, he asked me to call the hospital about it. I made several phone calls over a couple of months trying to get the hospital to discount the price and accept really low monthly payments, when suddenly they informed me that they had a "fund" for situations like his and had decided to absorb the full cost. I was pleasantly surprised, but also aggravated that our friend had to go through so much anxiety over it.

    The whole situation is Kafkaesque.

  •  Cost to patient of all procedures listed here in (2+ / 0-)
    Recommended by:
    susanala, eps62

    B.C. is ZERO. Would guess they'd be similarly priced in the whole country.  No co-pay, no deductible, no lifetime limit, no pre-existing conditions, (no invoices).

    B.C. Government health care spending 2012 - $3,690 per capita (CAD approx at par with USD currently).

    If the figures seem low, check out Ezra Klein's graph in January, 2013 (which use PPP to compare Canada/US spending).

    “The data show government health-care spending per capita in the United States and Canada. The United States spends more. And that’s not more per person who gets government health insurance, it’s more per resident. And yet Canada covers all its citizens, and we don’t. That should be considered shocking stuff, and yet I rarely hear it mentioned.”
  •  Speaking as a Canadian... (4+ / 0-)
    Recommended by:
    ahumbleopinion, mzinformed, eps62, acnetj

    ...and therefore a resident of a country with a universal health/single payer system, I feel the need to ask the following question after having reviewed some of that data.

    WHAT THE FLYING FUCK IS WRONG WITH YOU PEOPLE?! How in the name of the god I don't happen to believe in, but there you are, do you let them get away with that bullshit? Why, for heaven's sake, haven't you descended on your politicians with pitchforks and torches and told them to fix this shitstorm of incompetence, stupidity, and plain, old-fashioned highway robbery?

    Medical care isn't cheap, but back in 2008 a study of the Canadian system found that an average hospital stay (defined as being seven days long) for general sickness cost $7000, and that included nursing care, diagnostics, and surgery.  People injured in accidents averaged $9400. Average for heart attacks and strokes were $11,200. Again, that includes the room, nursing, whatever diagnostics you need, surgery, the whole bit.

    Even if government wasn't paying for almost all of it (you pay if you want a TV in your room, for instance) and the patient+insurance was covering the entire cost, that's still massively cheaper than in the US. In that whole chart, I only found a handful of instances where the average claimed cost for a specific treatment was less than the Canadian average for all treatments.

    And remember, the Canadian average is based on a 7 day stay: most treatments wouldn't require that long, and you guys are still getting charged more!

    I don't like using the phrase "pathologically stupid" when referring to an entire country, but man...

  •  Try being an individual who just wants to find (1+ / 0-)
    Recommended by:

    out what it will cost to get something done.

    Nearly impossible.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Sat May 11, 2013 at 08:18:32 PM PDT

  •  No one at hospitals can inform a patient about (0+ / 0-)

    charges because no one knows what test, exams, procedures were finally done until discharge. They could estimate, but no one knows for sure until the chart/medical record was reviewed.

    No one knows what true pricing should be because no one understands hospital costs except those costs captured via the Institutional Cost Report which is an inexact measure. Hospitals, (maybe a handful do) do not do actual cost accounting.

  •  Has Anyone Heard of DRGs? (1+ / 0-)
    Recommended by:

    Medicare has been paying hospitals by DRGs for over thirty years. DRGs stands for Diagnostic Related Groupings. This means that Medicare pays the hospital a flat rate based on the diagnosis, not what the hospital charges.

    The hospital writes off what is left over on the bill after Medicare pays its share. The hospital is forbidden by law to bill the patient for the overage. The patient pays the Medicare deductible, whatever that is, but that is all.

    As I said, this has been the Medicare payment method to hospitals for over thirty years.

  •  Does this mean... (0+ / 0-)

    ...the government's coming for the hospitals as well?

  •  for the first time ever (2+ / 0-)
    Recommended by:
    eps62, paradise50

    Billions of tax dollars spent on this monopoly and this has never been done before?

    Why do I feel republicans are to blame for this waste fraud and abuse?

    •  ...I doubt you can pin the differences... (0+ / 0-)

      ...charged by different hospitals across the land on Republicans. Plus their price fees are not what most pay. The only ones that pay the highest possible fee are those with no insurance...meaning we all pay. The fees paid to hospitals and medical practitioners is contracted.

      Case in wife recently has a needle biopsy of her breast (it was benign). The fee was $17,000. The contracted fee was actually $2000 (what Anthem Blue Cross was going to pay the hospital)...

      Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

      Ignorance is bliss only for the ignorant. The rest of us must suffer the consequences.

      by paradise50 on Sun May 12, 2013 at 03:55:38 PM PDT

      [ Parent ]

  •  This entire diary is based on a false premise (0+ / 0-)

    As I said in my earlier comment, Medicare has had a payment system to hospitals in place for thirty years. They pay a predetermined fee to hospitals for care of Medicare patients, REGARDLESS OF WHAT THE HOSPITAL HAS CHARGED. Those charges are just on paper.

    Called Diagnostic Related Groupings, hospital clerical staff known as coders use a telephone book sized resource to code diagnoses when billing Medicare.

    Medicare reimburses the hospitals for the authorized amount for the diagnosis or diagnoses. How many tests or procedures are done on the patient, how much the hospital charges for all of this, how long the patient stays in the hospital. All of this is TOTALLY IRRELEVANT to the reimbursement that the hospital gets from Medicare. The hospital has to write off any overage.

    Other groups also use DRG payments. Medicaid, Champus, and some private insurances as well.

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