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Medical Care Bargain Hunting With Bret Stephens

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Excellent comment thread here, but I especially recommend this from LosGatosCA:

I think I’m starting to see the brilliance of the conservative Republican market driven, outsourced delivery model. For example, consider a massive heart attack strikes a 55 year old man without a health insurance policy but a HSA with 6 month’s of contributions.

Step 1 – call Uber, not 911. Pay the peak pricing gladly – it still beats a fully loaded EMT response . Plus, if they don’t show up you get a $5 credit, should you survive

Step 2 – remember to not go comatose. Such lack of discipline at this critical pricing decision point could adversely impact your ability to make a rational decision on the services you may be willing to pay for and which supplier in your particular market you may want to utilize. You can ignore this if you live in a rural market and the nearest regional hospital with an ICU is 25 miles away.

Step 3 – direct the Uber driver to the nearest accredited hospital while you use your iPhone to solicit quotes from alternative medical retail establishments (hospitals, clinics, etc) don’t forget to read the reviews. At these times it’s also especially helpful to bring up your pre-defined Excel template that you cribbed from Consumer Reports to plug in the quotes as you are making your way to the first medical retail establishment in your itinerary for this medical emergency. Be glad you aren’t a rape victim so you can be sure that whatever fully informed facility and treatment path you decide on, the hospital won’t refuse to treat you according to your wishes. OTOH, the medical retail establishment might not treat you unless you can produce a current liquid net worth and credit score that meets their patient treatment scoring index. Subprime can lead to restricted options.

Step 4 – If your are alive and still conscious when you reach the first medical retail establishment remember ‘you don’t get what you deserve, you get what you negotiate.’ Just think of the ER staff and attending physicians as Turkish rug merchants. They need your business, keep in mind that you may need to just walk away if they refuse to bargain in good faith. Beware of hardball negotiation and scare tactics like:

You should have called 911 instead of Uber, now it’s going to cost you an extra week in ICU.

If you had been getting regular checkups and lowered your cholesterol from 525 you wouldn’t need the bypass and the stent.

You should take our offer because you won’t make it to the next medical retail establishment.

Don’t let these medical financial predators stampede you in to making rash split second decisions that they claim are life or death. Take your time, gather all the data, read all the reviews and make a carefully considered, rational decision. Don’t treat this like that impulse buy when you bought that overpriced, red convertible that had that incredibly hot model in the magazine ad.

Good luck, with a solid plan and the patience to not panic under pressure you’ll be able to get a great deal. Should you die, it’s not your problem anyway. If you have severe brain damage, you might still have gotten a bargain by not paying for services you didn’t get. Plus using Uber is a major savings opportunity. Not everybody needs trained medical technicians administering CPR, oxygen, or other stabilizing procedures.

Next week: how to determine if you really even need Uber to reach your local medical retail establishment.

Previous articles: How to have physicians bid for your business when your appendix has burst

Thinking of selling your blood, plasma, organs – read this first!

Hard to see any flaws in this plan. I mean, would you like to be “shunted” to mere insurance, like you lived in any other liberal democracy or something?

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  • Warren Terra

    I’ve taken a Lyft once, and an Uber never. The Lyft driver was a really nice guy, almost comically eager, and very kindly offered me a water bottle from a cooler he kept handy. Nice enough, I suppose, but now the driver seeking that perfect rating and a maximum tip will have to add a few things to that cooler. Ampules of clot-busting drugs, for stroke victims. Maybe some opiates, for those needing pain relief on the way to the hospital. And some Narcan, for opiate overdoses.

  • Hells Littlest Angel

    I see a way here to help both the patient and Uber. The patient is looking for bargain-rate medical care, and Uber has no path to profitability. But if the driver could just stock the trunk of his car with nearly everything an EMT might need … and they could call it UbeRx!

    • econoclast

      You are wasted on this comment section. You need to head to Silicon Valley and set up some meetings with the VCs on Sand Hill Road.

    • TimJ

      Alreay posted but yours is better. UbeRx!

  • e.a. foster

    Yesterday was Canada Day, in Canada, sort of like your 4th of July. Same type of anniversary only we were celebrating 150 years of being a country and all the tens of thousands of years prior when the First nations were the country. In the mist of this the Canadian Broadcasting Corporations, sort of like P.B.S. except with commercials, ran a whole lot of comedy routines about Canada from American, Canadian, British comedians. So they get to the American comedian explaining Canadians to his American friends. Well the look the same as Americans except they don’t carry guns. They carry medical cards. (they’re provided free in 9 out of the 10 provinces. the 10th charges $150 per month for a couple. then the American comedian explained: In Canada cigarettes are 9 bucks, heart transplants 9 bucks.
    Now that was a few years ago so smokes are $12 and the heart transplants 12 bucks.
    In British Columbia we don’t need Uber, you dial 999 and ask for an ambulance which is part of the medical system and operated by the provincial government all over the province with trained paramedics. The trip $80. If they need to helicopter you some where, its $80.
    With that little medical card which all Canadians pretty much carry like Americans carry guns, we can go to the doctor, a specialist, exrays, scans, lab tests, hospital E.R.s, have any type of surgery you will ever need, including pace makers, transplants, cancer treatments, etc. Just keep showing that little card. The only transplant they don’t pay for is a hair transplant.
    Our country has done very well with this medical system as has many other countries. Why Americans can’t get with the program is beyond me. Citizens save a lot of money. of course you don’t get to deduct the interest on your mortgage but we still think we have a great deal.
    Canada spends less per capita on health care than the U.S.A. with better results and more coverage.
    Why Americans would want their fellow citizens to die from a lack of health care is beyond me. Why the leaders in the country would want the same thing is beyond the pale.
    Of course some Americans do argue you sometimes have to wait for some surgeries in Canada and that is true. However, you will get the surgery, unlike the American system where you may never get the surgery because you can’t afford insurance or the operation. However broken bones get done when you come into the E.R. and its free.
    So forget Uber and use a real ambulance. They even give you the lights and sirens

    • kaydenpat

      “Canada spends less per capita on health care than the U.S.A. with better results and more coverage.”

      I sincerely don’t believe that Republicans care about their fellow citizens getting access to healthcare. If they did, we wouldn’t even be discussing this issue as if it were some huge controversy right now.

      I grew up in Canada and much of my family and friends are still there. They crinkle their foreheads whenever the issue of American healthcare is brought up. Before I became a citizen here, I had a massive asthma attack and was hospitalized for 4 days. The costs were astronomic but thankfully the Canadian government paid most of it and my Dad’s workplace paid the rest. If I recall correctly, it was a couple of thousands of dollars just for the ambulance.

      I applaud the Democrats for standing firm and demanding that the ACA be made better while making it clear that they will have no hand in passing Trump Care.

      • Jon Hendry

        Republicans think of health insurance the same way they think of Grace. People who have insurance deserve it because they’re fine upstanding people. People who don’t have, or lose insurance, do so because they are sinners who don’t deserve to have healthcare.

    • keta

      The answer is very, very simple. It’s the little symbol above the “4” on your keyboard, and it’s what most animates the tortuous torture America insists on inflicting on its citizenship via health care.

      • D. C. Sessions

        Actually for the difference in what medical care here costs in countries like Canada we could readily pay for everyone to have coverage. The difference in pricing is to a large degree “waste, fraud, and abuse.” Which is, apparently, not always a bad thing.

        • Steve LaBonne

          But that waste, fraud, and abuse keeps lots of doctors and healthcare / insurance executive in yacht payments, and they will fight like hell to keep the $$ flowing to them.

        • BigHank53

          If a rich white man is pocketing the money, it obviously can’t be waste, fraud, or abuse, can it? It’s just the way the world is supposed to work.

          • N__B

            Profit, by definition, cannot be waste, fraud, or abuse, any more than a Republican can increase the deficit.

            • DAS

              Maybe I’m making the wrong analogy from thermo (and anyway I see you’re snarking), but isn’t profit, by definition, an inefficiency?

              • N__B

                Here’s a serious answer: it depends on your perspective. If your interest is in the overall efficiency of the organization, than profit is an inefficiency. If your interest is in taking a profit, then everything else is, to some degree, an inefficiency.

                Subjectivity rulez, objectivism droolz!

                • Linnaeus

                  Indeed, it’s all about how you define the system.

              • D. C. Sessions

                Depends on whose definition you mean. Adam Smith? Yes, or at least past the modest profits necessary to keep the proprietor out of bankruptcy.

                Ayn Rand’s? Need I really say more?

    • D. C. Sessions

      Our country has done very well with this medical system as has many
      other countries. Why Americans can’t get with the program is beyond me.

      In short, because then people who don’t deserve medical care would be able to take advantage of Job Creators to get appendectomies just for jollies. Cheaper than a ticket to a hockey game.

    • N__B

      Breaking Bad: Canada

      Walter White is diagnosed with cancer. It’s treated. He continues being a high-school teacher with an unexpressed low opinion of humanity. The end.

      • wjts

        His former student,

        • N__B

          By the end of BB, Mike was the only character I really liked.

          • wjts

            What about Badger and Skinny Pete? (And I always liked Skyler.)

            • N__B

              Skyler was fine, but they didn’t give her character much to do other than react to Walt’s assholishness, so I found it difficult to be actively pro-Skyler. Also, she misspells her name.

              Every episode Badger and Skinny Pete were in, I was hoping that one of the violent types would kill them, but it never happened.

              • wjts

                She wasn’t my favorite, in the sense that I wasn’t tuning in each week to learn what she was up to, but her line about how “Someone needs to keep this family safe from the man who’s trying to keep this family safe” was a high point of the series. Also, she gets points for her enemies, i.e. Internet morons who hated her for being mean to Walter.

                • N__B

                  I would have liked her more if we got any sense that she was attempting to reconcile her husband’s secret with her brother’s position. If she did, I missed it.

                  Re your last point: I like Anna Gunn much more than I like Skyler.

                  ETA: One can easily argue that Skyler helped get Hank killed. She obviously doesn’t bear full responsibility, but it’s another reason my overall opinion of her is not great.

                • wjts

                  I seem to remember that tension cropping up, particularly towards the end. I can see an argument that it should have weighed more heavily in her decisions about what to do, though.

                  And I’ll agree that Anna Gunn is more likable than Skyler White.

                • N__B

                  Reply the ETA > ETA: A not-morally-good-but-dramatically-good character is a good description of how I feel about Mike. I never got enough of Skyer dealing with the contradictions (wanting to be better than Walt but pretending that laundering the money in the car wash was okay, keeping Walt’s secret when she could have at any time gone to Hank and asked for immunity, her issues with her boss at the steel fabricator’s) to feel like the character was fully developed. To be very clear, I am certain that Gunn could have done this as an actor; I place the blame on the writing and so on Vince Gilligan.

                • wjts

                  Yes, Skyler was not as well-served by the writing as she could have been. But I think the character who was worst-served in terms of never really grappling with the overall plot was Marie.

                • N__B

                  As far as I can tell, Marie’s character existed because Gilligan didn’t want Hank single.

                  As may be obvious, I’m not actually a huge fan of BB, mostly because of what I see as problems with the scripts. It was well acted and well directed, but rudderless at times. It was not the experience for me that The Wire was, or Orphan Black is.

                • wjts

                  I’ll be charitable and assume that at one point in the writing process there was a reason for her kleptomania.

                  And I did like Breaking Bad an awful lot for two reasons. More than any other TV show I’ve seen, it took the Classical definition of Tragedy and ran with it. Second, it was a great thriller – “Crawlspace” is the single tensest episode of TV I’ve ever seen.

                • njorl

                  I didn’t understand it at the time, but Marie’s kleptomania was a foreshadowing and a contrast for Walt’s uncontrolled ambition. He was a meth kingpin for the same reason that Marie stole things. Once he got a taste for it, he needed to keep doing it.

                • fearandloathing

                  Mike was the egoless flipside to Walter White. They were both super competent at their respective aspects of the business. The only difference was that Walt, driven by his ego, felt a need to be in charge of everything and insist that everything be done his way and everybody recognize his genius (an obsession with having your genius recognized is a major drawback if you are involved in a criminal enterprise, not to mention the fact that such people are just pains in the asses to coworkers in any enterprise, criminal or not, actual genius or not. And being a pain in the ass in a business where people are accustomed to solving organizational conflicts violently is also problematic)

                • N__B

                  Nice analysis. Early on, when Mrs__B and I couldn’t remember Mike’s name, we called him “the professional.”

              • njorl

                It was originally Badger, Skinny Pete and Combo. Combo got killed by an 11-year old. Killing off the other two would have been gratuitous. If this were “Game of Meth”, the 11-year old would have had a list – Combo, Skinny Pete, Badger, Pinkman, Heisenberg…

      • fearandloathing

        You are probably not looking to get into a serious debate about the psyche of Walter White, but it was always my opinion that the cancer was just a plot gimmick to make Walter more sympathetic and to give him a sympathetic reason for Breaking Bad (plus a handy way to eventually end the show). What was really driving Walter was that he resented the fact that not only was he wasting his efforts trying to teach a class of students who couldn’t care less, but these kids were driving better cars than he was. It was all driven by his ego. Not fair!! My genius deserves to be recognized. Why are these ignorant little *(& driving fancy new sports cars and I’m not. In America, the only recognition that counts is in dollars. You could very easily have the same character in the same show without the cancer. Matter of fact, if it was really only about the dollars for the cancer treatment and to make sure his family was provided for, Walter would have probably got along fine with Gus.

        • N__B

          We got a hint of what had gone wrong at Gray Matter, but not the whole tale. I personally would have loved some more back story there. But yeah, WW resented his students and everyone else.

          • BiloSagdiyev

            Ass fearandloathing has said before (er, to me), Hey, Walt, if yer such a danged genius, how did Gray Matter –> years of teaching h.s. chem happen? That’s a big gulf. It’s mostly a script device, but it makes his whiny obsession even more pathetic.

    • ringtail

      I don’t keep track of the right wing fever swamp, but wasn’t the stock reply (at least in the 90s through the debate on the ACA) that “sure, health care in Canada is free but it’s terrible and the wait is so long that anyone who can afford it comes to the US when they need anything serious”?

      During the ACA debates I remember substantially the same argument but substituting Britain/NHS for Canada.

      • Cheap Wino

        The stock reply is to lie.

    • Why Americans can’t get with the program is beyond me.

      The serious answer is that while Canadian-style health care would work very well here in America if we’d implemented it 60 years ago like you did.

      But we didn’t, And now, in order to implement it, we’d have to force EVERYBODY in the health care industry to take a massive pay cut. Not just the insurance industry. Canadian doctors and nurses get paid substantially less, Canadian hospitals get paid less, Canadian pharmacies get paid less.

      The ACA passed because it largely affected *only* the insurance industry, which few folks like. If you tried to pass a Canadian-style health care bill, you’d have doctors calling all their patients saying “this will force me out of business and you will have to find another doctor.” (In truth, the doctor’s costs would drop along with their revenue, but most will only notice the revenue drop.) And the same would happen with every other contact people have with the health care system. EVERYBODY would be against it.

      This is why we can’t “just get with the program”. It’s too late for that. Or at least too late to do it all at once. A more gradual set of reforms that ends up there may be possible, and the ACA was a very good first step at that. A public option – advocated by notorious corporate shill Hillary Clinton – would have been the next step. But now even that will never happen.

    • rm_rm_rm

      When I’ve visited Canada and needed health care, I’ve always had to remind them on my way out that I should pay. They often have trouble remembering which back office has the person who can accept payment from Americans.

      • fearandloathing

        Thomas Haden Church did a funny skit on this on Funny or Die (looks to still be up there and on Youtube) as Gus Porter: American Legend, a rugged mountain man who accidentally stumbles across the border, is mauled by a bear, but dies rather than accept any free Commie Canadian care. Although technically, I suppose payment is accepted from Americans or their insurance.

        • rm

          In my experience, they cannot trust insurance from the States to pay, so you pay in cash and file for reimbursement at home. I’ve had to remind them about money during small office visits.

          Once in the ’90s my grandmother broke her arm, had surgery to install a metal plate, with several days in recovery. That time they made sure to send us to the billing office (across the street, a room on the fifth floor). The billing people were afraid to tell us how much it would cost, since the price was so high . . . $750. For everything. We laughed and told them we expected to hear $15,000.

  • This is written as snark, but there actually is a large swath of conservatives who really believe this kind of thing would work for nearly every medical emergency/condition. People really should be forced to “shop around” for medical treatment.
    One of my brother-in-laws is a firm believer in this. It’s the magic of the market, he says, and we should just let it work. He lives in Massachusetts and has been forced to buy health insurance. So if he ever needs to go to a doctor or hospital, his incentive to shop has been destroyed by big government. (Mind you, he’s in his early 60s and hasn’t been to a doctor in decades because they’re just trying to sell him stuff.)
    But if he ever needs treatment, he’d totally be prepared to do the research needed to understand his condition, understand the entire range of treatment options, then find the best practitioners in the field and obtain a basket of price quote before undertaking treatment.

    • I often wonder what the Wingnuts buy
      One half so worthless as the Swill they sell.

    • sam

      Just for a lark, the next time you see him, you should dare him to call up the 3 closest hospitals to just *try* to get a price list.

      • Cassiodorus

        He’ll just say we need to mandate that the hospital engage in “price transparency” and share their list.

    • kaydenpat

      I could definitely see Libertarians taking LosGatosCA’s comment seriously. Not sure if Conservatives actually believe that it could work versus not caring whether it worked or not.

    • Dr. Ronnie James, DO

      It’s worse than that: these viewpoints are pretty common among doctors (esp surprise surprise, older white males, who know everything about health policy donchaknow).

      I interviewed for a residency position at a hospital/ clinic in a very poor section of Long Island near the border with Queens. At the end, the director asked me what I thought about Obamacare. I gave a pretty anodyne, even-handed answer, during which he interrupted, “it’s a disaster! We need more free market in healthcare!” End of discussion. Bear in mind that nearly all residency positions (and hence this man’s salary) are paid by Medicare funds.

      6 hours of driving (LI, NYC, NJ and Philly traffic) wasted. I didn’t even rank the program, and later heard from someone who’d transferred out it was a horrible program (as I had suspected).

      • caphilldcne

        As a poli sci/JD bleeding heart type who works on HIV issues I’m always amazed by this as well. I sort of thought docs were all in it to cure people and money was a side benefit (which does actually describe some docs I know). And the dentists are an even tougher sell. See today’s Post.

        • caphilldcne
        • efgoldman

          I sort of thought docs were all in it to cure people and money was a side benefit

          Look at the docs in politics (congress, senate, state houses). Almost every one is an ob-gyn who objectively hates women and is rabidly anti-choice, usually anti-birth control, and most definitely a hard-core RWNJ.

        • Dr. Ronnie James, DO

          Older docs saw it as a path to money/ respectability (the jokes about doctors on the golf course have deep roots). As the field opened up to women and POC, it’s changed a bit. But certain fields (surgery, orthopedics, cardiology) are still havens for that outlook. And from what I’m seeing of a lot of my newly-minted colleagues, a lot of them value medicine mostly as a path to the Instagram-worthy “baller lifestyle.” Med schools still favor people with this mindset.

          Interestingly, there’s a stark difference in OB, between OBs over ~50-55 who trained when medicine was still predominantly white and male (a lot are embittered would-be surgeons who had to settle for matching in OB so they could still operate doing C sections and hysterectomies), and newer generations of OB who are much more diverse. The world changes, slowly.

    • Lot_49

      Hope your brother-in-law is one of the lucky few with a genetic disposition towards low cholesterol.

      • Only time will tell. But I’m sure he’ll start shopping for cardiac response teams just as soon as the clot hits his heart.

        • Jon Hendry

          Dare him to drive a nail through his palm and then do the price shopping.

          • BigHank53

            He should drive the nail through his tongue. Have fun navigating the phone tree!

            • N__B

              If he’s an alum of James Buchanan High School he knows how to insert the bullets nail manually.

          • Jesus would have thought ahead and bargain shopped.
            I was going to say he would just heal himself but he didn’t do that that one time he really needs to. Maybe his superpowers only work on others.

  • DAS

    I thought conservatives accepted that emergency medicine was the one exception to “the market always works better”. And they were happy letting the ER be how “those people” got all their medical care. I.e. in the conservative’s ideal world, if you have an unfortunate accident or a heart attack or stroke or something, you’ll come out of the hospital with not only a medical bill but also a communicable disease you caught from someone using the ER as a primary care center.

    Perhaps this is how we can get conservatives on board with universal health care? “If alas you should have a medical emergency, you don’t want to be stuck in an ER filled with a bunch of those people with communicable diseases … make sure those people have good health coverage so they don’t get stuck in the ER interfering with your emergency care”.

    • kaydenpat

      Hmmmm. This could work with poorer/middle class conservatives but not with the Republicans in Congress, many of whom don’t care about healthcare access unless it’s their own. I don’t see any scenario in which Republicans in Congress back universal healthcare when all they really want to do is pass a bill which will give a huge tax cut to their rich buddies and benefactors.

    • Adam Short

      Actually, the least-discussed part of the GOP plan for our medical system is that once they’ve driven the nonprofit hospitals out of business, poor people won’t be able to go to the ER anymore, which will solve that problem.

      Republicans aren’t confused about this stuff. Their plan is to reduce costs by making it so most people cannot afford to go to the doctor.

      • ArchTeryx

        Yep. It ultimately comes down to their idea that health care should be like perfect teeth – a class marker. The poor should just be allowed to die and be done with it, because they never deserved to live in the first place except as servants to the 1%.

        They used to put sick slaves to death, after all.

      • SFAW

        >Their plan is to reduce costs by making it so most people cannot afford to go to the doctor.<

        To paraphrase the late Gert Frobe:
        "No, Mr. 99-Percenter, I expect you to die."

  • Jon_H11

    I honestly wish that they thought this. At least then evidence or facts could change their minds. Really it comes down to nothing more than “I have it very, very good. To make everything systematically much much better, my individual situation may have to be made marginally worse. Maybe not even worse in terms of actual care quality or even cost, but simply in terms of my football team (the Republican party) having to take a loss.”

    Even for people who don’t have it very good and would massively benefit from the new system, the idea having their “team” lose weighs enough in their personal cost-benefit analysis to make them foam at the mouth against it. This is where we’re at. This is why Trump won the Rep primary on a platform of “We lose! Lose feel bad! Pick me! I make we win again!”

    People will suffer because of this idiocy.

  • efgoldman

    Obviously, the Next Big Thing in web services is MEDLINE, the discount hospital and medical service version of Priceline. You won’t know what hospital you’re going to, or who the service provider is, or where they’re located, until you give them your card number, but you’ll get the VERY BEST price for that cast, or appendectomy, or cardiac ICU.

    • N__B

      I’ve been joking, at this point for decades, about retiring by setting up a 900 number called “Dial a Beam.” Call up, spend $9.99 per minute, get answers to your structural design questions. There’s no reason doctors can’t use the same business model.

      • BiloSagdiyev

        “Ooh, baby! You drive those rivets sooo hard!”

        • N__B

          It takes six men on a crew to drive rivets.

          Just sayin…

    • postmodulator

      That name’s taken. My best friend works for a company called Medline. I don’t like to beat him up about it but it sounds like they’re just middlemen jacking up the price.

      • efgoldman

        That name’s taken. My best friend works for a company called Medline.

        It’s OK, I don’t know where to get the startup money anyway.
        Anyway, that’s the best I can do at 700-ish on a Sunday morning.

      • Warren Terra

        There’s seriously a company named Medline?

        Medline was for decades the most important database in medicine and (some of) biology, created by the NCBI (National Center for Biotechnology Information), or maybe by what later became it (so:not a company). It still is,except that now the same database is known as Pubmed. All in all, it’d be strange for “Medline” to be used as a company name.

        • https://www.medline.com/

          I’m not sure if they’re actually middlemen, though. It looks like they cut out one of the usual middle tiers (distributor) by doing their own distribution for the products they manufacture.

          ETA: Although if postmodulator’s friend works in the distribution part of the company, it probably does seem like they’re middlemen.

    • the actual Bajmahal

      GoodRx … an actual online service for locating the lowest cost medications in your area.

  • Adam Short

    What is especially weird about this “shop-around” bullshit is that it’s already happened. It’s well-known in health policy circles that if your deductible is higher than a certain percentage of your income, you become price-sensitive – that is, you will decline to go to the doctor when you think you need to because you feel like you can’t afford it.

    I think at this point more than half the country has such plans, though I forget the specific numbers.

    God, these idiots.

    • Jon_H11

      I had a high deductible ($6000) Obama care plan a few years ago. I didn’t use much care, but I had to get another polio vaccine since I didn’t have records and was going to grad school. When I asked for the price all I got was a look of confused shock and annoyance, borderline anger. I eventually figured out it was $40 using my phone. The blood tilde they presented as an equivalent option since I already had had the vaccine was $700! No one there had any clue.

      In terms of their annoyance at me asking for the price the only thing I can compare their reaction to was when a guy on the street in DC trying to hustle me saw that I actually was reading the “literature” he gave me– it was actually an old lottery number scan form. At least he offered to sell me pot after I figured out the ruse.

      • postmodulator

        I have a relatively generous health care plan, but have often had to ask about what my out-of-pocket costs will be. I am invariably met with at least mild surprise. I just explain patiently that while I make a comfortable living, an expenditure of several hundred dollars must be budgeted for.

        I don’t know where hospitals and clinics find people who have trouble wrapping their heads around this concept. Maybe there’s a brainwashing portion of their training, and at the end of it, you see everyone as a millionaire. (Honestly, even that’s not realistic. Most mere millionaires would have to change their lifestyle if confronted with an uninsured two-week hospital stay.)

        • anonotwit

          A woman I know recently had an overnight stay in a Florida hospital after what she was afraid was a heart attack (which fortunately it wasn’t, although her doctor up here in Toronto hasn’t diagnosed it yet). Her bill: $28,000.

        • efgoldman

          My diabetes clinician bought an A1C tester machine for the office, since she wants one for every patient, every time. It looks and sounds like a tabletop R2D2. Take an extra drop of blood, insert it, machine does its thing for 90 seconds or so, voila.
          Except United Healthcare, which runs one of the two Medicare supplement plans (AARP) and also insures a number of large businesses and offers exchange plans, will only reimburse her $8/test for using her machine, which means she loses money on every one.
          So she ends up writing a lab slip and sending the patient to a lab. I KNOW even at the reduced fees that insurance/Medicare/Medicaid pays, it costs them significantly more for patients to do that.
          Small $$ amounts, but still stupid beyond belief.

    • Cassiodorus

      I remember trying to comparison shop when I had my wisdom teeth removed without insurance. Most providers wouldn’t give evens a rough estimate of price.

  • busker type

    On a few occasions during the 12 years that I was uninsured before the ACA took effect I tried to ask healthcare providers or staff how much things would cost. They have absolutely no idea, and some of them are hostile to the question. But I doubt that Bret Stephens, or anybody advocating this approach has actually tried it.

  • Taylor

    I was hearing about “shopping around for healthcare” from people in the medical supplies industry in ten years ago, and more recently I’ve heard this being advocated by a health insurance broker. My counterargument in the latter case was, isn’t this what I pay a health insurance company for?

    I definitely get a sense that it’s a policy idea looking for an opportunity.

  • gyrfalcon

    I have to express my disappointment to the extent that this blog’s snarking is focusing on the limits of free-market principles and venture-capitalist disruption to address just the immediate problems of healthcare pricing and traumatic costs. There are larger long-term concerns that can be addressed, like those pesky regulations impeding the use of new nimble technologies from entering our hospitals and driving down costs! I hear they’re already doing extraordinary things with blood tests.

    • D. C. Sessions

      I see what you did there.

    • N__B

      After the leeches have debraded your wounds, they can be sold to the poor as sausages. Synergy!

      • the actual Bajmahal

        Johnsonville Leaches.

    • stepped pyramids

      I knew that was going to be about Theranos. I was just saying to a friend the other day how much it sucks that Theranos turned out to be vaporware. What they claimed to have really would have been worth the hype and the billions.

      • gyrfalcon

        Well, yes, if the product Theranos had been hyping had actually been possible it would have been worth a lot. But if any of the patent medicines of the 18th and 19th century had lived up to their marketing they would’ve been worth a lot too. If Silicon Valley actually manages to listen to medical professionals and builds something that works outside their engineering textbooks, they’ll have all my praise. But the notion that there is some sort of revolution waiting to happen, but none of the doctors or hospitals want to change, is shortsighted and ultimately poisonous. I’d much rather see the same sums of financing invested in surer incremental change.

        • efgoldman

          But the notion that there is some sort of revolution waiting to happen, but none of the doctors or hospitals want to change, is shortsighted and ultimately poisonous.

          Back in the 70s, I took a marketing course. There was actually a student who claimed to know that Gillette had designed a razor that lasted a lifetime and never needed replacing, but they put it in a guarded vault so nobody could get at it, so they could keep selling blades.

          In the 80s, when American cars started rusting before they left the plant and were otherwise totally unreliable and crappy, stories kept surfacing that GM had a 150 mpg car that they wouldn’t manufacture, to protect the gas companies. My late brother in law absolutely knew that to be the truth.

        • ColBatGuano

          The idea that the founder of Theranos had discovered some entirely new technology that would completely destroy the diagnostics industry was ludicrous from the start. She wasn’t Newton and this isn’t the 17th century.

  • biz5th

    Actually, you need to add a few extra steps to the price shopping process. It’s not just the hospital pricing you have to check out, but also the ER doctors, cardiologists, radiologists, pathologists, anaesthesiologists, labs. The hospital cost is only the beginning, so make sure you have a really big spreadsheet.

  • randomworker

    That was an excellent comment.

    I’ve tried this. My deductible is $7200. First, if you want any amount you pay to go against the deductible you have to confine your shopping to the network.

    Ok so you priced out your “initial consultation” with your ENT specialist. In the middle of it she suggests a minor procedure to get a better look. Oops. Now what? Do you say no, and then start the shopping process all over again? But now you have to include another office visit in your calculations. Wait! No ENT specialist is just going to sit you down and poke that thing up your nose without the “initial consultation.”

    So I just asked her “how much?”
    “$200”
    “Ok”
    She performs 30 second procedure.

    The bill comes. $425. I call. “She doesn’t know, don’t listen to her. If you need to know, the prices are on the website.”

    “Oh, yes, here they are. It says $375.”

    “Those are last year’s prices, you dummy. See, it says 2016 right there, at the top!”

    Yeah, no. Not gonna work.

    • BigHank53

      And how is the magical invisible hand of the free market supposed to punish them for not keeping their retail price list up-to-date, anyway?

      Customer: “I’ll show you assholes and take my business elsewhere!”

      Provider #2: “Our price list hasn’t been updated since 2015.”

      Provider #3: “Fuck you. Your name isn’t Anthem or Cigna or Kaiser, is it?”

      Provider #4: “What? You’ll just have to wait until you get the bill.”

      • N__B

        I know people who would happily change their name to Kaiser C. Anthem if it would get them better health care.

    • Rob in CT

      Holy shit, they had a price list at all.

  • howard

    i have spent years looking for a conservative response to ken arrow and i have yet to find one.

    it’s amazing how loose the conservative definition of a “market” is….

    • Jon_H11

      The thing about leaning on abstract terms like “market” and “regulation” is that they have no specific content. I’m willing to discuss the specific benefits and costs of any particular regulation or market structure.

      But it’s never about that. It’s “markets good, regulation bad!”. And by “markets” they mean whatever Republicans do, and by “regulation” whatever Dems do. It’s just a one step removed cover to assert what is in actuality pure tribal partisanship. And the party’s purpose is to dupe voters so they can keep money flowing to the donors.

      • Bizarro Mike

        I think there’s a shift –conscious or otherwise — in the use of “good” when talking about the market. For parts of conservative utterance, they mean good in a technical way: delivering better values of some metric than another form of economic organization. But it slides quickly to mean morally good, the opposite of evil. At that point, any notion of measurement and comparison are gone.

        It’s nuts. People don’t attach this sort of thinking to gravity. Is gravity good or bad? Well, it’s good when you want to make hydro power and bad when you fall down the stairs.

        • BigHank53

          It’s the Church of the Free Market, home of St. Rand and Supply-Side Jesus, and it makes as much sense as any other evangelical faith. The whole point is repetitive praise and adulation as tribal affirmation. Who cares about the real world and how it works?

          • Linnaeus

            The Church of the Free Market is the closest thing the United States has to a national religion. Which is why someone misusing the term “neoliberal” doesn’t bother me quite so much.

            • bs

              Well, there’s the Church of Mammon, but i think they’re just different sects of the same pelf-worshipping greedheads.

      • Cheap Wino

        “Markets” means whatever way somebody can find to profit. Bullying, gaming the system, legal intimidation, usury, scam, grift, etc., all part of markets.

        • Jon_H11

          “Bullying, gaming the system, legal intimidation, usury, scam, grift, etc.”

          This seems to circumscribe “whatever Republicans do” pretty well.

    • BiloSagdiyev

      Anything that justifies what they want, or denying things to people they don’t want to get things?

  • stepped pyramids

    OT: people should check out Peter Beinart’s very, very compelling argument that Democrats should shift right on immigration over at The Atlantic. Nut graf:

    In 2014, the University of California listed melting pot as a term it considered a “microaggression.” What if Hillary Clinton had traveled to one of its campuses and called that absurd? What if she had challenged elite universities to celebrate not merely multiculturalism and globalization but Americanness? What if she had said more boldly that the slowing rate of English-language acquisition was a problem she was determined to solve?

    Some on the left would have howled. But I suspect that Clinton would be president today.

    That’s the kind of penetrating insight I expect from the author of “The Good Fight: Why Liberals—and Only Liberals—Can Win the War on Terror and Make America Great Again”. Hey, that last bit’s kind of catchy! Maybe we can adopt his great ideas about immigration, draft a charismatic outsider to run for president, and use that as a campaign slogan! We can even make hats!

    • Scott Lemieux

      This is the centrist equivalent to “Clinton lost because Lena Dunham appeared on a panel at Duke.”

    • DAS

      As I have mentioned here previously, know many people who vote Democratic and who would agree with Peter Beinart here. If Clinton would have punched some hippies, it would have made them all tingly. The thing is that all those people (at least the ones I know) live in blue states, and enough of them voted for Clinton that she won those states. I think that if Clinton embraced hippies a bit too warmly she may have struggled in some “safe states” with large FIRE sectors. However, I don’t think Clinton lost any states because she didn’t punch hippies enough …

      Does any voter in PA, MI or WI who would even consider voting Democratic care about hippy punching? I think the voters in those states who would care about punching hippies already are committed to voting Republican anyway.

      • PhoenixRising

        every time you mention this, you are still correct

      • Hob

        Upvoted for using “hippie punching” in its original and useful sense (a symbolic gesture that serves no purpose other than to get conservative brownie points), instead of

        As for the rest of your comment, I suspect you’re right, although I think Beinart is still being totally ridiculous to think that criticizing a phrase in an internal communication at a university in 2014 would be an effective form of signaling to anyone; it takes too long just to explain what the hell that’s about and why someone should be offended by it.

        (I mean, Beinart’s premise is also just grossly dishonest in the first place— the UC document didn’t say that “melting pot” was offensive in and of itself, it said that that was one of many phrases that someone with a “race doesn’t matter, I’m color-blind” mindset might be likely to lean on, hence maybe you should think twice about it. But I’m sure he doesn’t give a shit.)

    • efgoldman

      people should check out Peter Beinart

      Is he Mr McMegan, or do I have him confused with somebody else?

      • gyrfalcon

        IIRC, Mr. McMegan is actually Peter Suderman. Writes for Reason most of the time; and like nearly all libertarians, isn’t nearly as smart as he thinks he is, but also doesn’t generally pretend to Beinart’s dungpile style of tossing out conservative boilerplate in a way that might confuse a permanent somnambulist into thinking he’s writing “from the Left”, then patting himself so hard on the back his elbow dislocates.

  • Jon Hendry

    Just wait until the High Frequency Trading shops find a way to insert themselves into healthcare market transactions.

    “We have a new server room set up across the street from Mass General. When a stricken healthcare shopper buys at the market rate, our time advantage lets us slip in, buy low, and sell to the sick person at a slightly higher price.”

    • busker type

      Healthcare scalping. Mind blown. Praise free-market Jeebus.

    • Hogan

      Markets were up today on news of a major cholera outbreak in Michigan.

  • BiloSagdiyev

    Hmm, what can we learn from “Boogie Nights”? Maybe you’ll be able to find a big paper sack full of money in the aftermath of a a robbers vs. vigilantes shootout in a late night doughnut shop! Medical bills paid!!

    The odds of this happening to any of us aren’t bad at all. I remain optimistic about America!

  • postpartisandepression

    Excellent analysis but it stopped short because since he had only been contributing for 6 months he only had $6000 in his HSA and when the hospital ran their credit check which now includes the info on how much you have in your HSA they knew he would not be able to pay for a basic emergency visit which is typically $6000+ unless your insurance company has negotiated a $5000 discount. The bypass is way out of reach.

    When hospitals and ambulances do not have to pick up and care for people with insurance then I will support tRumpcare.

  • TimJ

    Great post, thanks! I’m thinking that an app for ios and android is in order here, maybe it can be tied to the service that takes you to the hospital. Uber can compare the prices and take you to the cheapest option. Health care is just another commodity after all.

  • LosGatosCA

    Hey, late to the party. Had to cash my Soros bonus check.

    Also, too, running a new healthcare proposal for that Stephens brat to tout – if you’re so concerned about your health, why haven’t you become a Christian Scientist?

    Happy 4th of July. Only 10 days until the tumbrels!!

  • fearandloathing

    Blah, blah, blah, blah. This is a ridiculous over analysis of what ought to be a fairly simple straightforward economic decision. Just die and it won’t cost you a dime.

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