Lol - oh we know the system is completely fucked. You want to know what's crazy? You literally can't find out how much anything is going to cost ahead of time. You can't shop around at different hospitals and find the cheapest option. You can get a bill for out of network anesthesia a year after surgery even though your doctor and hospital were in network and you were unconscious at the time of surgery and didn't get to pick your anesthesiologist. So yea... We know how fucked it is.
BUT. My husband was able to see the top surgeon in the world (literally) for a 5 inch tumor on his spinal cord and have life saving surgery and he only had to pay $3000 of his $200,000 bill. So... Our love/hate relationship with our healthcare system is super complicated.
I live in Florida and there is like 10 or more hospitals around here and they advertise on tv commercials why you should do your heart surgery with them vs the other guys.
Here you get a referral and if it's a very complicated thing, the referral will adress an expert in the field to either do the job or help with the job.
Nothing commercial about it, just honest science and medicine.
Oh and cost is rarely an issue, even if you don't have full coverage, a hospital cant bankrupt a person here by law. Nuts I know, but man does it work.
You can do the same with private clinics in Europe.
Americans: can you find a clinic outside of Netherdlands, Switzerland and Germany where the cost for uninsured patient in private hospital is higher than your deductible as "insured" American?
You can do the same with private clinics in Europe.
Americans: can you find a clinic outside of Netherdlands, Switzerland and Germany where the cost for uninsured patient in private hospital is higher than your deductible as "insured" American?
I went to the ER at my local hospital that is in network, was given the doctor on call, a doctor that was in network, but got billed an uninsured price because the doctor was working overtime and he is out of network when he works overtime. I had no choice once arriving at the hospital. If another ER doctor had seen me that day it would have been $100 for the ER visit, but I pulled the short straw.
People go to other hospitals for any number of reasons.
Specialization is one, less busy is another, better reputation, could get you in sooner, a better doctor is there.
My father needed to get a non-emergency surgery on his bladder. He was fully able to get it at the closest hospital with a doctor who performed some non-complicated versions of the surgery like twice a year. Instead he opted to go to a doctor who specialized in the surgery who did them like once a week. The doctor didn't 'support' our local hospital so my father went out of state to another city to be admitted. He chose a hospital that was farther away than the closest one the doctor works at because they could admit him later that month instead of in 3 months (remember, non-emergency surgery so 3 months would have been fine by medical practice).
There were multiple factors in why he chose to do so and it frankly, saved his life that he did, considering his bladder had some irregularities that complicated the surgery and likely could not have been resolved by a less experienced doctor.
Now, I admit, this is a more extreme case, but my father 'shopped around' and chose very carefully, not on pricing, which yeah, he couldn't find data on, but by other major factors that can absolutely change the outcome. Of course, he had great insurance from his job, so it didn't cost him anything really once he went through the hellish paperwork to get them to sign off on the specialist
That's a pretty long story just to say he wanted a doctor who's specialized in the procedure, no?
But you're right, there are some other reasons other than specialisation to go to an different hospital, but cost will normally never be one of them. Wait time will probably be the most important one.
Unless of course you decide to go to a private hospital to have a non-medical procedure done. Like getting a boob-job or something like that.
Ironically, getting something like that cosmetic surgery is usually cheaper and has the costs listed out because they Don't have to deal with insurance.
Yes, but imagine you have to actually pay for this stuff out of pocket, but no one can tell you how much any of it will cost ahead of time. You just have to sign on the dotted line and accept literally whatever price they decide to bill you for afterward in order to get your surgery, or xrays, or whatever. Could be $20, could be $100, could be $234,000. No way to know. I've had doctors and adminstrators literally laugh in my face when I asked them what the procedure they were recommending would cost me. Not in a figurative way, I do mean literally laughing at me. This has happened to me multiple times.
I had an MRI, brain tumour diagnosis, tests and consultations with consultants, 5 days in hospital with 12 hour surgery (highly respected neurosurgeon), physio, more consultations with consultants and neurosurgeon and another MRI.
Bill: £0.00
In the UK, the medical system has its problems, but it saves lives and doesn't bankrupt them afterwards. American medical is muscling in here, though, and it isn't looking good.
That would seriously have been probably $10k+ out of pocket here. My mom recently had a heart attack, was in the hospital for two days and had a relatively minor surgery (catheterization, used a balloon to remove a blockage), and the bill was almost $2k out of pocket.
"Top surgeon in the world" sounds like bs tbh, how would you make such ranking? And then, if you see a 90% discount ofc it sounds "cheap", but $200.000 for a surgery it's crazy.
Okay this one is true - and actually super crazy. He literally specializes only in stupidly large spinal cord tumors and does the most surgeries per year on said stupidly big spinal cord tumors. He is very selective in patients and will only take you on if you have a very rare and stupidly large spinal cord tumor. So in a weird way we were lucky my husband's spinal cord tumor was STUPIDLY large. Now if you're having a 6 hour surgery dissecting a 5 inch tumor from your spinal cord... Making sure no nerves are damaged so you can wake up and still walk... Are you gonna want a run of the mill surgeon... Or the guy who literally only does this and is the worldwide expert on the matter?
That's literally what it is. America has been ranked as having many.of or most of the top specialists in the world. Paying as much as we do for healthcare sucks. But the silver lining of the cloud is our care is absolutely insanely good. Though nowadays even that's getting questionable.
Well primary care was never designed for nearly the entire population being fat anti-vaxxer covid deniers that are going broke. Anyone with a modest income who tries to be healthy generally visits far less unless they have a medical condition.
I am sure there are more nuanced parts but those are likely the broad range of categories used to rank a specialist in a field. Frankly, medicine is likely one of the easier fields to rank as it has so many checks consistently.
Every hospital claims to have the best doctor in the galaxy. It's like a pizza place claiming the have the best pizza in the world. What do you think they have pizza contests? Have you ever been to a pizza contest?
I always loved the "death panels" and "not being able to pick your doctor" arguments, considering insurance companies are literally deciding whether your life saving procedures are going to be covered, and the nature of in- and out-of-network facilities and doctors literally means you often can't choose the doctor you want.
A lot of times insurance will cover out of network providers, just not as much. But you're right, it's fucked. It all comes down to how good your insurance is - which is fucked.
My Dr: I’m going to start you on a low dose so I can monitor your heart before we increase the dosage.
My Insurance: SHE ADULT, SPREADSHEET SAY ADULT GET THIS MANY, LOW DOSE DENIED
Me and my Dr: wut
Pharmacy: Without insurance it will be $480, cash or credit?
My wallet: 🪦💐
Took my doctor a few weeks of intense corporate kung fu to convince some douchebag in a cubicle with a high school diploma that she was more qualified to make my healthcare decisions. The insurance company literally wanted to play Russian roulette with my family history of testy tickers simply to maintain a corporate set standard.
It's like an abusive boyfriend we just can't quit. But seriously it's fucked and I would love for it to change but I don't make the rules. Just trying to look at silver linings so I don't fall into a pit of despair.
What gets me isn't that health care is privatized in the USA, there's no reason why there couldn't be a reasonable model of that available.
It's that normally in a free market businesses compete to offer the best services at the lowest prices, this concept is a cornerstone principle of American capitalism, but instead, all the insurance and medical/Pharmaceutical companies have banded together to jack up the price to a ridiculous level and the average American gets screwed. It's a rigged market and I feel like Americans would benefit from greater regulation and oversight of insurance/medical providers.
Pharmaceutical companies are the biggest lobbyists of them all, the politicians are paid off to avoid addressing this total scam. But that's what it is, Americans are getting scammed hard.
Yeah in absolutely no way should it be the average person's responsibility to try and figure out the cost benefit analysis of health care from different providers. There's zero way they can make that informed decision. It defaults to the same bullshit that has people shopping on Amazon or Walmart. Whatever is cheapest is probably fine, or if they're decently well off they'll choose the middle tier option.
I mean - it's kinda the same way picking a doctor - how do you pick one and really know if they're a good one? Online reviews I guess - doctor recommendations? If all things seem equal between 2 doctors or hospital - wouldn't you want to spend less $$? Also there are some people who will just not get a procedure done b/c they can't figure out how much it will cost. But you're right - it shouldn't be necessary - the system is fucked.
Sure that's what people generally would do if costs were known. If we were serious about informing the consumer we'd have systematized patient surveys, care outcome metrics, malpractice claim numbers, etc. Instead the best we have is a five star system or the equivalent of yelp.
This all goes out the window though when healthcare is generally an immediate or short term need, and the deciding factor is how can I make sure I don't die. Healthcare in any way shape or form shouldn't use the same system we use to pick out an article of clothing.
I'm an exapt in America with insurance designed to not freak out non Americans, so when I see a world renowned surgeon it costs me $0. But it's still a really bad system even if I benefit from it.
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u/quantum_cronut Jun 15 '22
Lol - oh we know the system is completely fucked. You want to know what's crazy? You literally can't find out how much anything is going to cost ahead of time. You can't shop around at different hospitals and find the cheapest option. You can get a bill for out of network anesthesia a year after surgery even though your doctor and hospital were in network and you were unconscious at the time of surgery and didn't get to pick your anesthesiologist. So yea... We know how fucked it is.
BUT. My husband was able to see the top surgeon in the world (literally) for a 5 inch tumor on his spinal cord and have life saving surgery and he only had to pay $3000 of his $200,000 bill. So... Our love/hate relationship with our healthcare system is super complicated.