36 comments on “Because health care is paid for through insurance

  1. And this cross-subsidises all the charitable cases the hospital treats who don’t have insurance / medicare / medicaid and who can’t pay cash.

  2. This is a genuine question, as I’ve never been in this position… If on the Continent, one were to turn up at a hospital and say “I’m about to drop but have no insurance !” Will they turn you away ?

  3. Ghost – puhleeeze – in this country, it’s free of course! Doesn’t cost a penny! And even then the Evil Torees don’t give the NHS enough of our money!

  4. Because in America health care costs are largely determined by you negotiating with a medical service provider in order to spend your insurance company’s money.

    Milton Friedman had something to say about the efficiency of someone spending someone else’s money on themselves.

    I wonder what the cost is in the UK? Ultimately if you insist on keeping the infant mortality figures down by having a well staffed, high tech, expensive hospital near by every time a woman gives birth, it is going to be expensive. No matter who pays. You could just drop it the foetus in the middle of the bush if you like. Our ancestors did and that was dirt cheap.

  5. “The Guardian’s new series, the Mother Load, explores why it’s harder to be a mother in the US than in any other developed country. … This struggle needs more visibility – and you can help. We’re asking our readers to fund a four-month reporting project to build community and inspire activism. Together, we can force change. ”

    The Graun given up on trying to foist socialism on the Brits & reckons it’s a better chance in the States? Or just intent on reducing US healthcare standards to that of the NHS?

  6. “Apo Osae-Cwum was the victim of what is called “surprise billing”. In these cases, patients have no way of knowing whether an ambulance company, emergency room physician, anesthesiologist – or, in her case, a half dozen neonatologists – are members of the patient’s insurance plan.

    Even though Apo Osae-Cwum went to a hospital covered by her insurance, none of the neonatologists who attended to her sons were “in-network”. Therefore the insurance reimbursed far less of their bills.”

    So, it’s bureaucracy at fault?

  7. Also ‘just’ to give birth…?

    I thought it wasn’t a simple process, but s potentially life-threatening one for mother and child, even before one factors in premature triplets?

  8. Some comparisons:

    Some friends of mine had their baby in Hong Kong and it cost their insurance company about US$20k.

    My wife is giving birth to number 2 in a week in the Philippines. The most expensive option in the local hospital is costing me less than £1k for C section and 3 nights in the private room (and we get a few hundred quid back from the government).

  9. The hospital charged her family $877,000 in total.

    “When the bills started coming, to be very honest, I was an emotional wreck,” said Apo Osae-Cwum. “And this is in the midst of trying to take care of three babies who were premature.”

    Well what do you expect? Three premature babies are what is technically known as f**king expensive. That is cribs and 24 hour nursing care. Perhaps for months. Where in the world wouldn’t that be expensive? You know, apart from all those countries that would let them die.

    But one 2013 study by the the advocacy group Childbirth Connection found that, on average, hospitals charged $32,093 for an uncomplicated vaginal birth and newborn care, and $51,125 for a standard caesarean section and newborn care.

    So it is from an advocacy group. Otherwise known as useless puffery.

    Despite these high costs, the US consistently ranks poorly in health outcomes for mothers and infants. The US rate of infant mortality is 6.1 for every 1,000 live births, higher than Slovakia and Hungary, and nearly three times the rate of Japan and Finland. The US also has the worst rate of maternal mortality in the developed world.

    Yes but what is the infant mortality for Slovak-Americans? For Hungarian-Americans? For Japanese-Americans? A lot lower, I am willing to bet, than for Americans as a whole. America has a lot of minorities, the bad sort of minorities, who drive up these figures. When we have as many, we will have similar figures. The US does not lie. The rest of the world often does. The Germans will not even count an infant death as an infant death if it occurs in the first few weeks. They will call it a stillbirth. Keeps the figures low.

    or, in her case, a half dozen neonatologists – are members of the patient’s insurance plan.

    Yes, half a dozen people getting on the order of half a million dollars a year tends to be expensive.

    There are few studies that estimate the number of families who go bankrupt from this type of unexpected expense. One of the best estimates is now outdated – conducted 10 years ago.

    Ahh yes, that would be Senator Pocahontas’ fraudulent research I expect.

    “Why any society should let anyone be bankrupted by medical bills is beyond me, frankly,” said Woolhandler. “It just doesn’t happen in other western democracies.”

    Sure. Europeans go bankrupt through high tax bills. But that is just fine according to the Guardian.

  10. Andrew M – they are not counting the costs of the hospital and the equipment. Just the costs of the doctors and nurses and to rent the room.

    And of course Britain does not yet have America’s legal problems. But Slater and Gordon are working on that.

  11. I’d love to hear the other side of this story.

    Don’t people in the US sort it all out with the hospital months prior to the birth? Making sure what’s covered by their insurance, prenatal stuff with the doctors etc? I know it’s said these triplets were premature but not by how long.

  12. As alluded to by smfs, there’s a damned sight more to this than just comparing raw numbers, especially when you are looking at outliers.

    For a start they need to control for infant and maternal mortality rates, but even that isn’t easy because countries measure them differently, if they are measured at all.

    When Castro died I got in to an argument with a dunderhead who claimed that Cuba was a better place to live than the USA because they had a [marginally] better infant mortality rate than the USA. Except as this paper (interview here) shows, in Cuba infant mortality rates are a target not a measurement and doctors go to jail if they don’t meet them.

    There’s probably another dozen factors that need to be controlled fore as well – age of mother, nationality of mother for recent immigrants, ethnic minority …..

  13. Just a small question. But why does the Graun seem never to be able to find a representative example when it’s using an example to represent? The US has a population of 323 million. The majority of white European descent. Why choose what has to either be a recent African immigrant or one of the vanishingly small number of Afro-Americans who are so up their roots myths they’ve adopted a pretend African name.? Or can they not find a Jane Doe of Smallville, USA who’s had anything like this experience? Or is the representative’s experience a whole lot more connected to their unrepresentative personal circumstances than we’re being told?

  14. SMFS,

    > they are not counting the costs of the hospital and the equipment

    Even if you double the figure to account for fixed costs, the NHS is still far cheaper than the U.S. It would be more interesting to see the costs in other insurance-based systems, e.g. France.

  15. @Andrew M – I seem to recall seeing invoices around the €2500 mark when we had relatively simple deliveries (but not entirely simple) in NL.

  16. The NHS is far cheaper? Hm, that’s surely because staff have their wages centrally controlled. In other words, cost is often passed on to them and so is invisible in the organisation’s own accounts.

  17. Number three, now six, was born at the Portland Hospital elective c-section as the others were more urgent in the NHS. Insurance paid 75% of the £12k. (Watch for me editing this later as my memory is hazy but we spent c£3k) There were some add-ons for my wife to have cream-tea with visitors.

  18. BiND

    I seem to recall an article that started the reason the US infant mortality was so low, was because every live birth was recorded as such. Other countries would adopt a wait and see approach if it looked like it wasn’t going to make it

  19. @Gunker – it’s high that even very late miscarriages or deaths of the baby during childbirth were counted in the infant mortality statistics, whereas in e.g. Sweden even early post-birth deaths were not counted as infant mortality.

    Very much a classic “you’re not measuring quite the same thing” situation.

  20. In any given country, the inputs all have given costs. They can be combined more efficiently, but the state is not about to do it. So the cost is what you see, plus the amount you don’t see. We are comparing apples to oranges. Quality varies from country to country, and the government can’t increase quality at no cost, either. People aren’t rushing to give birth in the Philippines (though some Americans are taking “health care vacations” in Costa Rica).

    I pay cash for dental exams (about $230 last time) and can thus insist on half the recommended care, half as often, which works perfectly for me. On the last visit, technical problems prevented the recording of one of the two bite-wing X-rays on that side, but the dentist said the needed information was all visible on the other. The technician is skilled and precise enough to repeat this feat every time, cutting the required shots in half, and any business in the real world would jump at the chance to reduce costs and prices. Nope; they are selling the ambient of perfection to a world in which someone else always pays. They couldn’t even make change at the till…There is no till. Everything is “covered,” even though most dental needs are caused by the passage of time or personal misbehavior (such as failure to brush timely). There is no need for risk-sharing contracts (insurance); only a desire for someone else to pay.

  21. Yes, the biggest flaw of the US healthcare payment system is they’re using an unexpected events payment system for routine known events payment. Like buying an insurance policy to pay for toilet paper.

  22. Last year I had a rock chip my car windshield. The glass shop quoted me $365.00 and asked who my insurer was. On finding it was me and that it was a cash deal I got the work done for $119.95 +VAT.

  23. Fred Z – Yup, both hospitals around here have an instant, published 20% discount if the patient pays directly. The hospitals cannot refuse insured patients nor Medicare patients, but GPs can, and they are actually competitive. There are anecdotes where cash payment for care is even lower than the “co-payment” due to the insurance company under some policies.

    One of the aspects of Obama-care that no one will spend the political capital to overturn (now that real repeal seems to be off the table) is that any treatment paid for by insurance has to be coded on computer and transmitted to Washington; this means every provider has to hire a rulebook-lawyer to learn the volumes of codes for medical procedures. Has nothing to do with “Patient Protection and Affordable Care.”

  24. Well no. That’s bullshit.

    A) Using ‘insurance’ to pay for births which actually benefit the nation is ridiculous.
    B) Invading Mexicans do not pay that money.
    C) Feckless farm equipment do not pay that money.

    Only real Americans without corporate jobs pay that money.

  25. Because indemnity insurance.
    Because people sue doctors in the US.

    Our first daughter was born in the US paid for by an insurance company. Great service, far better than the NHS.

  26. US$32k seems quite reasonable. My twins were born privately in the UK with an emergency c-section. Cost to us was about £20k all up (including all the scans etc).

    Give it 10 years worth of medical cost inflation; plus higher insurance costs against medical misdemeanors etc and the amount doesn’t look too bad.

    The £20k was well worth not having to use the NHS – I would happily have paid significantly more to avoid the butchery that was Whipp’s Cross hospital at the time (blood and other bodily fluid marks on walls, dirty floors, uncaring staff). I just wish that it was possible to get “fully private” health insurance policies that enabled you to bypass the NHS for everything – from GP visits to major surgery!

  27. James in NZ: Are you pretending that this would have been in the case in the NHS of the 60s, for example, before that other change that occurred in 1948 took effect?

    Homogenous nations can engage in socialism, though it should be argued they shouldn’t. Heterogenous ‘nation states’ without any real uniting principle can’t do anything right.

  28. According to the Beeb:

    “NHS medical blunders dating back more than two decades are still costing millions of pounds a year in compensation, it has emerged.
    The negligence bill for mistakes made before 1995 – mainly maternity failings – has begun to rise for the first time in five years.”

    That’s another cost which needs to be included if we are going to make comparisons.

  29. Re: Paul Rain

    Are you pretending that this would have been in the case in the NHS of the 60s, for example, before that other change that occurred in 1948 took effect?

    I didn’t have any real experience of the NHS prior to having kids (good health and an aversion to doctors so always tried to stay away) so can’t say if it was better or worse in the past. Also can’t say if it is better or worse now as we left the UK shortly after having kids. Hence my “at the time” comment.

    Of course it must have gotten much, much worse by now as blood splattered maternity wards and shitty staff were just after the heyday of billions of pounds worth of “investment” under Labour – whereas now after billions more pounds having been spent on it by the Tories it is significantly worse according to Labour.

  30. In the US system “charges” are not “costs” or even what is eventually paid.

    Charges are something like 5 to 10 times what is actually paid. More in the case of very high/expensive treatments. People also often confuse the charges for what they actually owe, since the system is complicated and not well understood even by most medical staff in the USA.

  31. “Why does it cost $32,093 just to give birth in America?”

    Because we like our newborns and mothers to survive.

    Its also why we do this in a fully equipped hospital and midwives are basically extinct here.

    You want a fully qualified medical professional – a *team* of such medical professionals – on hand along with the equipment needed to handle a wide variety of common and uncommon complications of pregnancy? Then you pay 32 grand.

    You don’t? Then you can give birth in your own bedroom for free.

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