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This clearly wasn’t an ER/ambulatory emergency I’m guessing, since it’s a little difficult to haggle over pricing or consult the HealthGrades rating when you’re in the midst of a heart attack…
It’s just another reminder though that healthcare in the US is a business. The psychology behind the price point becomes irrelevant in almost all high risk occurrences when the choice is pay whatever X is in terms or cost or die on the other hand. If it’s just a routine check-up, this becomes much more debatable.
To your last point about insurance. I read an interesting paper that a hedge fund credit analyst once sent me of the breakdown behind a lot of the activist/propaganda economics people throw around about the industry. As it turns out, healthcare insurance when totaled amounts to only a 1.1% profitability margin (meaning most healthcare premiums actually go directly to costs). All the regulatory red tape also obscures price signals tremendously. There’s a lot of bad ethics that sits behind the industry as a whole, but it’s also a massive challenge trying to genuinely determine what the price truly is.
It's not about just health insurance, it is about financers and monopolists who own the insurance companies, the hospitals, and their supply chains. (Also a nitpick: the health insurance industry average profit margin in 2020 was 3%.) 34% of health care costs go to pay administrators, so a lot of it is having armies of staff disputing every charge at the insurance company, who in turn pays the hospital to have armies of staff fighting the disputed charges. Insurance companies also can have shared ownership with the hospitals that they pay, as well as with the PBMs and pharmacies where prescription medication is dispensed, and investors can even own the land the hospital is sitting on and rent it back to the hospital at unsustainable rates. Even the suppliers of online after-visit surveys are doing very well indeed. So all along the chain it is monopolies extracting value from the insurance companies, hospitals, and patient, along with a lot of coordinated greasing of palms and inside dealing.
Which is not to mention that the hospital prices are set such that they can cover the costs imposed by freeloaders and insufficient insurance/medicare/medicaid reimbursement. It's the dystopia of Americans being happy to pay more for declining quality of service and inefficient systems, while all the profits go to financiers and all the costs go to the taxpayer/honest payer.
it's worth mentioning how much of the admin is just due to complying with the regulatory burden that comes from being in the health care industry. The typical way we try to control costs is by rolling out complex programs that require more detailed coding, data tracking, etc.
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I don't really have a dog in this adversarial fight; it's a total cluster. I did see an interesting one recently, though. Some folks discovered a "hack" if you have a patient with BCBS who travels across state lines before getting care. They've found it financially viable to contract with third-party vendors to maximize their payout. Sounds like eventually BCBS will shut it down, but yeah, the extent to which this adversarial game is played is wild. They've let the whole thing get so complex that it pays to play the game hard... and there's certainly not anyone out there trying to play these games on behalf of patients' pocketbooks. They just fight each other, and some number of patients randomly get screwed in the process.
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Oh I’m 100% with you on this.
The data my friend sent me was for a different year altogether, but at 3% per your example, that’s still quite consistent to the point that the health insurance industry isn’t sitting on mounds of cash when measured as a percentage of their annual profitability. In dollar terms yes, it’s still a lot; I’m aware.
The fact that that much also goes to the administrative layer is something I’ve suspected and doesn’t surprise me one bit. The growth in that sector is one of the major causes for the neoliberal shift in higher education as well, where a large proportion of that goes directly to. I was shocked years ago when one of my adjunct professors told me how much money (namely how ‘little’) her cohort makes, compared to the upper admins. On the one hand mediocre teachers shouldn’t make substantial salaries. Greater pay that’s untethered to performance causes people to want to go into education that have little interest in it. On the other hand, good teachers should be greatly rewarded for excellent performance. But then you have the problem of avoiding grade inflation.
But back to your point about hospitals specifically. George Halvorson pointed out a number of years ago, one of the largest causes of the growth in hospital costs at every point is just ordinary price inflation. Believe it or not. Cost of labor, cost of supplies, it’s enormous and ever-climbing.
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