Hospital CEOs defend charging patients more at facilities

yet ask them why an MRI on a 30 year old machine that takes 30 minutes costs $5000+ and they have no answer.  go to japan and you can get a full scan for less than $500 on a machine that is brand new. 

It’s part of the really ugly truth of the nature of the US healthcare system dysfunction. There are multiple factors working (unintentionally) to keep it in this dysfunctional equilibrium, and small changes are very unlikely to dislodge that equilibrium. Larger changes are needed but they’re also much harder to carry out due to the risk of the system being made worse.

This is why I get so annoyed when there's a big deal made of little tweaks, some random drug gets a price cut, or there's some big todo about some improvement on some vagary of the system. It's good there are small improvements but a lot of energy is expended on what amounts to nothing in the grand scheme. Instead, we should be focusing on how the system as a whole needs a massive overhaul, but no one wants to actually kick it off.

My mom manages records at a state hospital. Legally, they have to treat uninsured patients that the private hospitals turn away. Then they have to battle insurance companies for the care they do provide. The system is definitely flawed.

To be fair, when you have for profit medical care, you end up with administrative bloat to pay executives to make business decisions that ensure you have the nicest atrium of any hospital around, advertise services, audit how much a single Tylenol should cost at various areas of the hospital, calculate exactly how few doctors and nurses they can staff before there is a strike, slowdown, or walkout, calculate how to outsource facilities maintenance so that they aren't the one criminally underpaying the janitors at their facilities, and calculate how much money you can charge 4th year medical students to do free work for you.

I didn't watch the whole thing, but this dude was a f*** awful choice to represent his hospital system. I've worked in both the insurance end and the hospital system end of the healthcare industry and there are actual, legitimate reasons facilities charge more than private practice, but this dude seemed wildly unprepared to explain that. The answer should have been a basic: "because running a facility is more expensive than a private practice; how many private practices do you know of that have to keep the lights on in an ER, ICU, and multiple inpatient wards 24/7/365?"

I did medical billing in the mid 2010s. G-code king! F*** yeah we billed the max, be cause the government said nope, here is almost nothing, bill those private insurances to make up the difference. Pay your nurses, support staff more! How??? I was making $15 an hour with an associates degree and couple billing certificates. AND quarterly mandatory trainings that mostly didn't apply to me but I "needed" to be certified in it because government said so.

lol "below the cost of providing care". YOU set the cost of providing care!

> health insurance corrupted cost I want to call out a few things hear that’s going to sound a bit “aktually!” But I think it’s important to note 1) insurance models/companies absolutely drive up costs. But they are likely only to be accountable for say 15-20% of the cost delta over other developed nations. The strongest US counter example to this is Kaiser, running a vertically integrated model to streamline this process. While they provide better outcomes in general, they aren’t massively undercutting on price or taking over the world. 2) this “we are losing money to Medicare” is an actual half truth. They are losing money relative to what they charge for the service. Large hospitals (not the insurance cos) set up the pricing such that: private insurances are charged something like 2x, Medicare are charged 1x, Medicaid is charged 0.8x etc. so yes. They “lose money” on Medicare and Medicaid. But the actual true costs of these services aren’t generally “X” it’s like 0.5x so on paper it looks like they lose money and Medicare/medicaid is unsustainable, but in reality it’s just structurally priced to appear that way 3) the whole issue is that hospitals are against pricing regulations and pricing fixes, where lies probably 60% or so of the US cost increases and diff compared to developed nations. Biting the bait of “we can’t afford it” or “it’s the insurance companies” or “greedy” is actually ignoring where most of the costs are coming from and quite effectively so. Remember the pejorative of “socialized medicine” was coined by the AMA itself to intentionally obfuscate and confuse the American people way back in the 40s in opposition to Truman’s effective “Medicare for all” solution that introduced pricing structures hospitals couldn’t control.

Meanwhile, my out of pocket expenses in EU is about the same amount as my co-pay in the Us for the same doctor’s visit.

You forgot the consultants. The consultants charge exorbitant prices to the hospitals to tell them how to get the most money out of insurance companies. Then the consultants charge exorbitant prices to govt/insurance companies to advise them how to spend less money on care. The resulting mess is an extraordinarily complicated and expensive system where the middle people make massive profits. Companies like Deloitte, McKinsey, and PWC make billions playing both sides of the aisle and they are never held accountable for their role in the results.

I would argue neither is to blame. Corporations sole reason for existing is to maximize profits. That is exactly what they are doing. The fact is, there should be no for profit healthcare. This is a failure of our politicians who would rather sell us out then make a state run healthcare system like most of the rest of the western world.

Quest billed my insurance $1,172 for lab work and my insurance paid them $90...I don't understand why I can't just walk into a lab and order a battery of tests and pay them $90, why does insurance even need to be involved?

It’s getting so absurd that you’re better off financially just letting nature take its course, otherwise we face debt, destitution and we die anyway. 

I was charged $850 for a 3 minute outpatient dermatology appointment to freeze something that turned out to be nothing, lol. Murica

"Healthcare is too expensive. NO don't lower healthcare costs, that's COMMUNISM!!"

Healthcare companies used to be required by law to be nonprofit organizations... Guess which party got rid of that requirement???

article talks about Dems saying this is just to distract from Republicans cutting Medicaid

Not that it isn't a good idea regardless, but you don't even have to tax billionaires. The US spends more on healthcare per capita than any other country in the world. And it's not close. You could easily have good universal healthcare without spending more. You might even save some money (to be used on tax breaks for billionaires, of course). It's not about the amount of money, it's how it's spent.

The truth is that everyone in the healthcare system will have to take a haircut if we are ever going to fix the system as a whole. Insurers are a really inefficient way of paying for healthcare, and have bad incentives, but the problem is that providers are also structured badly, waste too much money, and have bad incentives. And they and insurers feed off each other.

This is really the crux of the issue IMO. Every charge is negotiated like haggling at a flea market AND payors can just say no at which point the medical facility eats a loss and has to compensate elsewhere. Medical care needs actual fixed pricing and payors can only deny paying for cause.

Some campaign ads here in MN are saying how bad 304b is and it’s a waste. From what I see it’s saved money for us and patients.

Ooof. I'm 34. Had Hodgkin's lymphoma when I was 18, very luckily under my parents insurance. I "survived!"... And now I have a tumor in my brain and multiple "side effect" conditions. Raised 50,000$ via go fund me to find out what's going on and can't/don't want to pay to be poked and prodded for my remaining time. Or go through chemo again. Got given a vague timeline til it kills me. My only advice... Hold onto every smile, every shred of laughter, and do the best you can to help others smile. Bad days are bad. Good days are good.

Cancer is crazy expensive. I have an app I wrote to track my medical info and it scrapes the EOBs from my provider website and provides stats and breakdowns. Since late 2024 when I was diagnosed, the total billings are over $500K and that's 99% cancer related charges. I knew it would be expensive when they told me about the free, 24 hour clinic for their cancer patients. Anytime they are offering free care you know they are making it up and way more elsewhere. And yea, I blew through my out of pocket in 30 days in 2024 and within the first 45 days in 2025 while I was still on chemo.

They should lose their careers and be left on the streets. That way they will learn what’s it like to not being able to afford anything.

That is not really how the system works. Hospitals and insurance companies have billing contracts, agreed upon before services are provided. That is a “ in network provider agreement “. Hospitals also are “ out of network “ providers for other insurance providers. These they need to bill at higher rate than in network.

Hospitals are also the problem, because they are permitted to outright scam people into paying vastly inflated prices to make up for all their “losses” elsewhere.