Healthcare is expensive - Gee I wonder why

"HammerheadFistpunch" (hammerheadfistpunch) 01/17/2019 at 13:13 • Filed to: healthcare

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Just got my bill from my daughters surgery over the holidays. it wasn’t a small bill. Insurance paid for most of it because we had met our deductible and hit our out of pocket max...which we would have anyway...but it is still a shock to see it itemized.

I wasn’t surprised to see the OR fees, anaesthetists fees, or anything like that, there was one line item that was half the bill.

1ML [special solution only provided by one pharma company] - $9570

1...Mililiter.

The best part? It’s basically just sugar gel. Seriously.

This 1 ML

cost 2x as much as the OR fees. TWICE! I only needed 1ml, most need 2-3 and some need 2-3 two or more times!

I realize that the FDA makes bringing new drugs to market expensive but cmon! Like I said they probably sell 20,000 units of this stuff annually. You’re telling me that it cost 191 MILLION dollars to bring to market sugar gel?

Speaking of improbably numbers, !!!error: Indecipherable SUB-paragraph formatting!!! is well over 300 likes, which...why? I mean I meant to be funny but it wasn’t THAT funny.

dogisbadob > HammerheadFistpunch 01/17/2019 at 13:20

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Why is that gif a video? Videos take up too much space and are too slow. Gifs are better!

HFV has no HFV. But somehow has 2 motorcycles > HammerheadFistpunch 01/17/2019 at 13:21

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this is why health care shouldn’t be a privately owned business. far too many companies are making billions of dollars off of allowing people to continue to live.

H ealth care should be a non profit government run program.

HammerheadFistpunch > dogisbadob 01/17/2019 at 13:21

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maybe its a metaphor. 

CB > HammerheadFistpunch 01/17/2019 at 13:21

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“The free market always dictates the best prices!”

Spaceball-Two > HammerheadFistpunch 01/17/2019 at 13:23

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When my son was born my wife was given two regular old tablets of Advil for some post birth discomfort. $90

We’re taking half the medicine cabinet with us for the next one.

HammerheadFistpunch > HFV has no HFV. But somehow has 2 motorcycles 01/17/2019 at 13:23

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Government run is NO way to improve efficiencies. no, pharmaceutical companies just need to be tightly regulated so as not to allow gouging. Even if it took 10 years of paying 15 doctor, chemist and researchers to bring it to market ...191 million PER YEAR?! That’s unreasonable.  It probably cost the company 10 million MAX to bring it to market and produce it.

Dr. Zoidberg - RIP Oppo > HammerheadFistpunch 01/17/2019 at 13:24

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It’s basically a national scam. And they got us by the balls.

shop-teacher > HammerheadFistpunch 01/17/2019 at 13:25

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I’m not one bit surprised. The bill for the birth of my oldest was about $100k. Luckily we’re on a high quality HMO, so our out of pocket was one co-pay.

jimz > HammerheadFistpunch 01/17/2019 at 13:27

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the sad(der) part is nothing on that bill is what the insurance will actually pay.  They’ll end up paying whatever negotiated rates they have with the network.  One of the guys in my R/C boat club is an ER physician, he actually contracts a service to do his billing and receivables.  He said “I literally don’t know what I get paid for any given procedure.” 

Spanfeller is a twat > HammerheadFistpunch 01/17/2019 at 13:27

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Healthcare is expensive - Gee I wonder why

Because healthcare is a very popular product that also has a very high barrier to entry, meaning that competition is often minimal.

This without including government subsides and private insurers that keep the private market artifically expensive in order to pressure people into getting health insurance.

But BOOM! Since there’s little competition, and the government isn’t exactly consistent with the subsides, insurance companies raise costs saying they fear “uncertainty.” Which means that less people get insured (and those who have special conditions are sometimes sent to higher risk pools with higher costs) which means insurers have less money to cover the hospital costs (which keep rising artificially) which also means less people get insured.

The moral of this story is that somehow this messy system grew to represent 1/5th of the US economy which means that reforming it in order to protect consumers is incredibly complex and/or impossible if you ask moderate politicians .

HammerheadFistpunch > Spaceball-Two 01/17/2019 at 13:27

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T his is very common. And sad. What really honks me off is that the reason is because insurance “pays” for the difference (i.e. pays the real price and passing the artificial savings on to you on your bill so you feel good about paying your premiums) but the company I WORK FOR is an integrated system - the insurance arm and the hospitals are working under the same management. The insurance knows that advil doesn’t cost $90...because the same company sets the prices yet it will still happily “charge” you the full price. and heaven help you if you are paying cash. You are STILL going to pay the $90 even if that was only a fake number for the insurance agency to knock down on paper.

facw > HammerheadFistpunch 01/17/2019 at 13:29

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Things are a bit absurd, I take a drug that costs ~$1000/week, 50mg dose, in a 0.98mL solution. I was in constant pain and pretty non-functional without it though. Ultimately, consumers almost invariably lack the knowledge (and often time) to make good decisions about treatments, which means consumer-based market cost controls won’t work effectively. Insurers tried to clamp down on rising costs in the ‘90s, and got hammered for it so for the most part, so they backed off for the most part, and just passed the costs on. And as we’ve seen, government attempts to control costs get hammered as “Death Panels”.

Increasing competition in the space may help (especially with generics), but the high barriers to entry make that difficult. On top of that, you have anti-competitive instances where companies have paid off people interested in making a generic to avoid that. And even if the high costs justify the setup costs, you have the problem that current producers can likely just slash their costs to do you in, which in the short term is good for consumers, but creates a strong disincentive for companies to invest it starting up production.

HammerheadFistpunch > jimz 01/17/2019 at 13:29

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Exactly.  Its even harder to know that if I was paying cash I would be asked to pay the fake rate, even though its not remotely related to the actual costs.

fintail > HammerheadFistpunch 01/17/2019 at 13:29

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If only it could work in Murka like it does in the rest of the first world.

Spanfeller is a twat > CB 01/17/2019 at 13:29

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"free"

HammerheadFistpunch > Spanfeller is a twat 01/17/2019 at 13:31

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The company I work for is starting their own generic pharma company expressly with the purpose of providing cheap generics (specialized drugs with expired pat ents) that still cost a lot because of minimal competition to cover basically the cost of making the medicine plus enough to keep the company viable. its supposed to be lowering generic prices substantially . We’ll see.

davesaddiction @ opposite-lock.com > HammerheadFistpunch 01/17/2019 at 13:33

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That’s a good GIF. 

gettingoldercarguy > jimz 01/17/2019 at 13:33

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Al most all ER physicians are contract. That group got screwed long ago.

Rusty Vandura - www.tinyurl.com/keepoppo > HammerheadFistpunch 01/17/2019 at 13:34

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Is your daughter well?

HammerheadFistpunch > shop-teacher 01/17/2019 at 13:35

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For something that the actual payments to the hospital was probably closer to 30 grand.

HammerheadFistpunch > davesaddiction @ opposite-lock.com 01/17/2019 at 13:35

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apparently it’ s a video, but yes.

HammerheadFistpunch > Rusty Vandura - www.tinyurl.com/keepoppo 01/17/2019 at 13:35

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Oh she’s great.  Already back to gymnastics class.

gettingoldercarguy > HammerheadFistpunch 01/17/2019 at 13:36

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That’s the price listed because it’s based off of what the government pays (Medicare/Medicaid) . They cannot negotiate prices on that. Insurance companies can and do pay a lower negotiated rate that isn’t shown.

Once we get the political will to negotiate with pharmaceutical companies, that price will tumble down.

Spanfeller is a twat > HammerheadFistpunch 01/17/2019 at 13:38

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The interesting thing about the US is that, it is an absolute market failure...

Every country in the world (even those with government owned healthcare) have private health options, and those are significantly cheaper than in the US... But they still make bucketloads of money. I believe in public healthcare, but I do recognize than 1/5 of the US economy can’t disapear inmediately and the private sector could be working a lot better.

Somewhat related;

Textured Soy Protein > HammerheadFistpunch 01/17/2019 at 13:38

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I had an outpatient surgery in fall 2017. The top line cost was about $15k before insurance discounts and payments. I still ended up paying about $3k out of pocket even though our insurance at the time was provided by her job at a goddamn hospital/HMO/insurer company.

Textured Soy Protein > jimz 01/17/2019 at 13:40

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The really sad thing is we're paying out the ass for high deductible plans and unless we meet those deductibles the only nominal benefit we see is access to those prices negotiated by the insurer rather than the rack rate that you'd have to pay with no insurance. 

SPAMBot - Horse Doctor > HammerheadFistpunch 01/17/2019 at 13:41

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Watch the dirty money episode on the pharmaceutical company. They basically just buy companies for their drugs and jack the price way high. Spend almost nothing on R&D and make a killing scamming the insurance companies which in turn raise pricing to consumers.

You can throw around free market, etc. but I think pharmaceutical companies need some type of regulation to prevent this. Maybe a minimum % of income to R&D? I don’t know, but something has to give.

Spamfeller Loves Nazi Clicks > HammerheadFistpunch 01/17/2019 at 13:41

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That’ll last for a week till they realize “wait, we can literally print money by charging the same as the other guy and only knocking $5 off.” Guaranteed. I don’t care how ethical you are or you think the people in charge are. Anything short of that will get everyone removed from the board and blacklisted in the name of ‘SHAREHOLDER VALUE.’

random001 > HammerheadFistpunch 01/17/2019 at 13:42

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Good news is best news.

Tristan > CB 01/17/2019 at 13:46

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The healthcare market hasn’t been a free market since 1965.

TheRealBicycleBuck > HammerheadFistpunch 01/17/2019 at 13:50

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That same dose will cost substantially less in another country .

Even though prescription use is similar per capita per country, the cost is rising in the U.S. because the pharmaceutical industry is charging more. How much more? Here are the trends:

HFV has no HFV. But somehow has 2 motorcycles > HammerheadFistpunch 01/17/2019 at 13:55

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My suggestion could only work in a perfect world where the government is efficient and honest. so yeah, nah .

yeah the profit margin is ridiculous. I go in once a week for a shot that is supposed to help my body overcome it’s allergies. without insurance it would cost over a grand PER VISIT. for a nurse to spend 5 minutes with me a one give me one shot. I wish I could make a grand in 5 minutes.

facw > jimz 01/17/2019 at 13:57

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I have a friend who is an anesthesiologist, and says he’s happily be paid half as much if it meant he didn’t have to deal with all the paperwork and overhead associated with insurance. It wastes an inordinate  amount of his time.

facw > dogisbadob 01/17/2019 at 14:02

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Gifs are extremely inefficient because they are using ancient compression. The video (mp4) version is 64KB, while the gif version (kinja stores both for compatibility reasons) is 576KB, so almost an order of magnitude larger. Granted kinja does sometimes re-encode gifs without paying attention to whether the new versions  are  actually smaller, but the mp4 would still be vastly more efficient.

dumpsterfire! > HammerheadFistpunch 01/17/2019 at 14:09

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Sou nds like she came out in good shape. Would y ou mind telling me what drug wa s billed at$10k/ml? you can tell me none of my business if you like, but maybe I won’t use that drug in the future on my patients if I don’t have to.

benjrblant > HammerheadFistpunch 01/17/2019 at 14:12

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99PI has a cool and recent podcast on the orphan drug act, essentially the act that allows pharma companies the right to patent and exclusively sell certain drugs for a year. the intent was good, however companies have grown to exploit the living snot out of this law and healthcare has become incredibly expensive because of it.

https://99percentinvisible.org/episode/orphan-drugs/

bshappy > HammerheadFistpunch 01/17/2019 at 14:23

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Not that I’m a fan of Pharma companies but you’re not paying for the drugs you’re using, your’re paying for 100 drugs that failed before they got to the drug you’re using. 

Svend > HammerheadFistpunch 01/17/2019 at 14:32

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Bloody hell.

I hope your daughter is better. 

Just over 19 years ago my step-father was given 18 months to live unless he lost a lot of weight quickly. He was put on the waiting list.

He was in a high stress job and his position on the list would fluctuate due to someone leaving the list and/or someone needing it more urgently.

He went private to have the gastric bypass done to get it over and done with and move on. The whole cost of private care in Leeds including pre and post op care, assessments, follow up care such as a further operation to remove the ‘apron’ of skin from his lower abdomen, etc...

The whole cost was £11,000. The thing was at the time there was very few surgeons who did that op in the U.K. and the guy who did it, was the guy who would of done it on the NHS system.

Everything since has been NHS, would he of got the op done, yes, but would of taken longer and he wanted it out of the way to move on.

So when I see stuff from the U.S. in todays climate, it drives me crazy.  

VajazzleMcDildertits - read carefully, respond politely > HammerheadFistpunch 01/17/2019 at 14:36

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It’s got 300 likes for the same reason that America’s Funniest Videos keeps getting watched, no matter how many times in a row a kid falls into a pool or a guy gets a football in the groin.

The bulk of the US isn’t clever enough for better jokes.

shop-teacher > HammerheadFistpunch 01/17/2019 at 14:43

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No, that was the amount they actually paid the hospital. It was an 8-day nightmare, and at a couple of points it looked like my wife not be coming home with us. In an effort to save the insurance company the expense of a C-section, the hospital screwed up big time, and ultimately cost the insurance company a lot more money on top of damn near killing my wife .  We used a different hospital the second time around.  It was delightfully uneventful in the best way possible.

If only EssExTee could be so grossly incandescent > HammerheadFistpunch 01/17/2019 at 15:02

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One of my sister’s drugs (that she will be on for life) is about $30k per month. That’s $250/pill. She’s also on two other inhaled meds  that are $10k/mo each.

This cocktail of drugs is proven to extend the lifespan of people with cystic fibrosis by a good 20 years. We try not to think about what happens if insurance decides to stop covering them.

If only EssExTee could be so grossly incandescent > HammerheadFistpunch 01/17/2019 at 15:09

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Ever look at what hospital CEOs make? Even a small tertiary care facility can pay their CEO $2 million/yr. Tell me why that person NEEDS that much money. They could half  their salary, still live obscenely comfortably, and hire like 20 nurses with the rest.

His Stigness > HammerheadFistpunch 01/17/2019 at 15:47

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I think my hip replacement was some stupid amount like $200,000. My mom didn’t have to pay anything. It was so nice being on her insurance because as soon as a doctor said “surgery,” all co-payments stopped. I didn’t even have to pay co-pays for office visits.

I didn’t look at the itemized bill because I’d get mad. But now I’m curious how much the actual implant was. 

DipodomysDeserti > shop-teacher 01/17/2019 at 16:30

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Holy hell. I’m gues sing there were complications? My wife had our kids at home, and we mostly paid the midwife in work trade (she was a legit midwife, but needed a bunch of work done that I could help with).

HammerheadFistpunch > If only EssExTee could be so grossly incandescent 01/17/2019 at 16:42

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Our last CEO took a big pay cut, his compensation package was still huge but it was well below average for his position . Our new ceo takes a relatively high salary but still far less than average. Granted our system is a not for profit so we have some responsibility to keep costs down. We just dumped a whole level of middle management to increase clinical hires.  

HammerheadFistpunch > bshappy 01/17/2019 at 16:45

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I took that into consideration in my 10 mil estimate.  I mean it should NOT cost more than 10 million dollars to develop a sugar gel.  

HammerheadFistpunch > benjrblant 01/17/2019 at 16:45

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correct.

HammerheadFistpunch > dumpsterfire! 01/17/2019 at 16:48

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Unless you’re in Urology you won’ t have to worry about it. Its called Deflux. Though im sure you’ve seen plenty of this kind of thing in your practice. Something we did a little while ago for the heart program was instead of choosing tools for the entire system extensive research was conducted on several choices in varying range in prices.  One surg kit would be $1500, one would be $600.  We were using the $1500 on the assumption that it was the better one but when we conducted the study the results shows they performed the same.  We (the hospital system) presented the data to the heart docs and said that it was their choice...the bulk chose the cheaper kit and outcomes haven’t been any worse.  

shop-teacher > DipodomysDeserti 01/17/2019 at 16:48

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Yeah, lots of complications. I’ll give you the short version:

-My wife became pre c lamp s ic, so she was immediately checked into the hosp ital

-They were afraid the insurance company would refuse to pay for a C-section, so put her on pi to c in to induce labor. B ecause my wife had uncontrolled high blood pressure, they also put her on potass ium to keep her from having a stroke ... potassium counteracts pitocin

-They did this for FOUR. FUCKING. DAYS. My wife spent four days in that bed, stuck full of IVs, unable to eat.

-Speaking of the IVs, my wife had become very badly swollen. So swollen they couldn’t get a proper IV going. They probably stabbed her 3-4 dozen times to get a total of eight IVs going, including a pick line.

-Towards the end of day 4, with ZERO progress made towards inducing (Zero, she hadn’t dilated one little bit), the baby’s vitals started getting wonky, so they finally started prepping for a C-section

-The anesthesiologist screwed up the spinal block and had to redo it

-The baby was born healthy, but mom was in pretty bad shape

Crap, this is the short version ... bloody hell

Over the next four days we had to deal with my wife trying to breast feed with no food or water in her own system, still with 8 IVs stuck in her, or maybe we were down to 6 by then, the details are fuzzy. A pediatrician who woke us all up at 5am to yell at my wife for not doing a good enough job breas t feeding. My wife developed a spinal fluid leak, which causes you to vomit the instant one sits up. My wife never did produce enough to fully feed the baby, so we had to start formula feeding . Oh yeah, somewhere in there the bed broke, and we had a couple really bitchy nurses just to top it all off.

I swear, that’s the short version!

bubblestheturtle > HammerheadFistpunch 01/17/2019 at 19:20

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Good old Charge Master.

https://www.healthcarefinancenews.com/news/study-hospitals-still-using-chargemaster-markups-maximize-revenue

gogmorgo - rowing gears in a Grand Cherokee > HammerheadFistpunch 01/17/2019 at 22:11

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Good thing you have a proper medical system in your country that is accessible to everyone and regulates drug prices so they don’t get out of hand.

gmporschenut also a fan of hondas > HammerheadFistpunch 01/17/2019 at 22:26

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(somewhat in the healthcare field) yes it took them 10mil to bring to market, but they also spent 5 mill 10 times that failed halfway through and a $ 1 million a 100 times that went nowhere.

gmporschenut also a fan of hondas > Tristan 01/17/2019 at 22:31

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I would role that back even further to 1943 .

HammerheadFistpunch > gmporschenut also a fan of hondas 01/18/2019 at 01:36

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I’ve seen the healthcare dollars come and go...I KNOW it doesn’t take 200 million to develop an fda approved gel. 

duurtlang > fintail 01/18/2019 at 03:14

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Seriously. Reading through all these comments almost makes one believe the US is some kind of anarchist third world country. And it's not like they have to reinvent the wheel. There are so many better examples to be found globally

fintail > duurtlang 01/18/2019 at 09:21

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That’s maybe the worst part - nothing new needs to be invented. If a country the size of Germany can make it work, that model can be used as a basis on the other side of the pond. However, in few other places does the pharma industry and the advertising and graft related to it have as much hold on public policy than in Murka.

In some quality of life areas, the US isn’t exactly first world.  There’s no defending the current healthcare model.  Anyone who tries to do so is either deceptive or simply dumb.

MontegoMan562 is a Capri RS Owner > HammerheadFistpunch 01/18/2019 at 10:21

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My god the healthcare costs are insane. The problem is people like me are blessed with crazy good insurance and I never see these costs. So the hospitals and pharma companies pass it along to insurance, insurance pays it, slowly raises insurance rates to cover the gap and it’s “all good. ”

One of the things that gets me is when we had our kids it was billed out $1,300 a night for the baby to go to the nursery so we could actua lly sleep. To a room staffed with 2 nurses watching 6-8 babies. Say there are 7 babies in there , that’s $9,100 billed just by them entering the room. You know damn well those 2 nurses weren’t taking home $4,550 each for the night, they certainly weren’t even taking home 1,000 for that night. Even if they DID take home 1,000 each, that means 7,100 in profit off the nursery. That’s insane. It doesn’t cost that much to run the damn nursery. B ut most people never see that because the insurance covers it so the hospital just keeps charging it.