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Why Medical Bills In The US Are So Expensive

Why Medical Bills In The US Are So Expensive

They billed our insurance company over $3 million for the cost of transplant. Then I have another EOB right after it was it was another $1 million.So you’re looking at a $4 million transplant. I don’t know what people do without insurance. How could you even begin to pay that? We hear so much about how expensive medical bills are, we’ve almost become numb to it. In 2017, 1/3 of the money raised on GoFundMe went towards medical campaigns. And the site raises $650,000 a year for more than 250,000 medical campaigns. Luca was born with Alveolar Capillary Dysplasia and Hirschsprung’s Disease. At three weeks old, he had surgery to remove part of his colon. At two months, he went into cardiac arrest. And at five months, he had a lung transplant. His parents had to turn to fundraising almost immediately just to keep up with the medical bills. They did a clamshell approach and he has several scars from all of the other surgeries. So when did the U.S. health care system go from a philanthropic program to a multi-billion dollar industry? And where do the funds go once the bills are paid? Today, the U.S. health care system is in a sort of tug of war between physicians, hospitals, pharmaceutical companies, shareholders and insurance companies. The list goes on. But for this video we’ll just focus on these entities. Caught in the center of it all are the patients. We’re often not able to provide the type of care that we want because of the cost of care. Most Those costs are now forcing a growing number of uninsured or underinsured Americans into traveling abroad for medical treatment. Everyone started thinking of health care as a business where the metrics were profit, return on investment, efficiency, and those aren’t the metrics of health but that’s how we judge hospitals today. You would think that they would be looking out for your chronically ill children and you know all of the medications and and things like parking at the hospital. No. No that’s not covered. But before we get to all of this, let’s rewind to understand how we got here. This chart is a pretty good place to start. The data shows health care spending versus life expectancy. The rest of the world pretty much stays the same course. But around 1980, the U.S. veers off. I like to say it’s kind of the, the road to hell is paved in good intentions because everything we’ve done was in the name of better health. To be clear, growth in U.S. health care spending has slowed over the past few years but it’s still way higher than in other wealthy countries. Before government programs like Medicare and Medicaid, Blue Cross and Blue Shield were the main providers of health insurance in the U.S. At the time they were nonprofits and accepted everyone who wanted to sign up. But at this point, it wasn’t to control costs. It was really insurance in a worst case scenario. And after World War II, employers started offering health insurance. Suddenly demand was booming. From 1940 to 1955, Americans with health insurance went from 10% to more than 60%. That demand created a business opportunity, and for profit companies started rolling in. Insurance was the first sector because it’s in some ways the original sin, in the sense of it separated the consumer from payment right. So it felt like nobody was paying. By 1951, Aetna in Cigna were major players in the for profit health insurance market. And in 1965, President Johnson established Medicare and Medicaid. This medical insurance for those over 65 will become effective July 1st. Even so, the for profit insurance market continued to gain steam through the 70s and the 80s, capturing more and more of the health insurance market. Meanwhile the first for profit hospitals started popping up around the country. When Medicare and Medicaid started, there were none. But by 1983, one in seven U.S. hospitals belonged to an investor-owned multi-hospital system. By the 90s, Blue Cross and Blue Shield had merged but they were losing money, fast. And in 1994, they let their local companies turn to Wall Street to stay afloat. Hospitals I think were the first to realize, well we can charge whatever we want for these things because it feels like no one’s paying. But then you know there are all these doctors in the hospitals. They see all these business consultants coming in. They see the hospital’s CEO making two million dollars a year and they’re feeling like wow we’re suckers. You know we’re working our tails off here, and we want in too. Essentially hospitals went from being run as a philanthropy to being run as a corporation. But these corporations aren’t selling just another widget. They’re putting a price on human health. The health care industry is now the country’s biggest employer. And those employees need to get paid. Throughout all of this is private capital, and lots of it. You would think that if hospitals are becoming more efficient the cost to consumers should go down too. But that hasn’t necessarily been the case. And a lot of that has to do with the billing system. Of course doctors need to get paid. There are admin costs and medical supplies and technology. But instead of this three page bill you’d get in Belgium, medical bills in the U.S. look more like this. I am my son’s secretary and I spent a lot of time taking care of just just medical bills ,and phone calls, and that type of thing. We talk a lot about the billers and the coders and the consultants who really are removed from health care. They’re not there because they care about health, they’re there because they see a business opportunity. And you know you can’t blame them in the sense that that’s what their companies are supposed to do. They’re looking for business, so a collection agency that does health care, you know to them a bill is a bill is a bill. They don’t care if it’s for somebody’s heart transplant or someone who was not very judicious and spent a lot more money on a Rolex watch that they couldn’t afford. It’s a bill. But how come those bills are so long? It has to do with something doctors call unbundling. Think of it like buying a plane ticket. You pay for the ticket itself, but there are a lot of extra charges squeezed into your final bill. $30 for a checked bag. $50 for a few extra inches of leg room and another $3 for water. You get the gist. People get irate about it in an airline ticket but in healthcare we’ve kind of come to accept it as, oh that’s just normal. And part of the reason I wrote the book is to say that’s not normal in other countries. Hospitals do this through a complex system of codes. New patient visit: 99201-05. Emergency room visit: 99281-85. Burn due to water skis on fire: V9107. Yeah there really is a code in case your water skis burst into flames, you know, as they do. Different codes mean different prices. Just take the codes for a laceration. You’ll be charged a different amount depending on the size of the cut, where it’s at on your body and how complex the suture is. Coding historically was about tracking diseases., right. But in the U.S., pretty much alone, how you code a patient interaction is a billing construct. Again something that would had scientific and medical purpose gets translated into a business asset. Every day we spend hours going through check boxes, typing notes, documenting things that we’re supposed to document for billing purposes, that we really don’t think improves patient care. The more that you spend time with computers, the more that we spend time billing, that means a lot less time for face to face interaction with our patients. And that’s why most of us got into medicine in the first place. There are benefits to taking down all that data. In theory, it can lead to better results in the long run. Doctors may find things later that they didn’t catch in the moment. But at the end of the day, it’s just not working in the U.S. Some doctors say they’re concerned about malpractice lawsuits, so they order more tests to protect themselves. Bills keep getting longer, and health outcomes aren’t always getting better. The American Hospital Association declined to comment on criticisms of the current hospital system. But they do have a fact sheet explaining that hospitals often don’t get paid the full amount that the bill. The AHA claims two-thirds of community hospitals lose money when the government pays Medicare and Medicaid bills. And that “the hospital payment system itself is broken.” And of course a big part of that health care spending is on drugs and supplies, both of which can be hard to get insurance to fully cover. Oh, thank you Luca. Can you show us what’s in that box? Are these your ostomy bags? So we get 10 per box and that lasts me about two and a half days. What they’re currently charging me is one $1,178 this month for those boxes. Thank you! Let’s talk about one of the biggest issues weighing on the pharma industry right now and that is drug prices. From $18 a tablet jumping to $750 a tablet a 4000 percentage just 24 hours. Do you feel badly about what’s happening? No in fact we’re increasing access to patients, Meg. We’ve all heard about Martin Shkreli raising the price of Daraprim. But what about Colchicine or Epinephrine? The prices of those drugs have both skyrocketed because one company has control over it. The response is usually the same, the companies need to raise prices to fund the research and development for the next drug. For the most part high priced drugs have patent protection from the government. They pretty much have a monopoly in a market so very often you have someone who needs a specific cancer drug. One company makes it, they’re the only company that makes it, no one else can make it. And since it might be absolutely necessary for your life, they’re in a position where they could charge anything they want. How is that possible? Well there’s not really anyone stopping it. Once people realized you can get away with this stuff it became a race to the top. It’s also important to remember that many of these costs are adding up during a very stressful time. Sometimes the people paying the bills aren’t even conscious. The analogy I often make is firefighters when they come to a burning house. So when your house is on fire, your family’s inside, you don’t want to be sitting there negotiating with firefighters. Oh you know I’m going to pay you $300,000 they want $400,000. That’s not how you want to do this. And often health care does have that character. Medical emergencies are chaotic. And health insurance is confusing. There are HMOs, PPOs, deductibles, copays and premiums to try and make sense of. You’d think that if people are insured, they shouldn’t have to pay that much out of pocket. But that’s not always the case. Not every doctor accepts every insurance plan. And some hospitals have staff employed by multiple third party companies. So one trip to the E.R. could get you five different bills and your insurance might only cover one. I actually stopped taking ambulances. Really. We had one really really close call where Luca was pretty unstable. We knew things were going south and we drove him to the hospital instead. I sat in the back and slowly increased the oxygen the entire ride and my husband was driving 120 mpg down 95 because it was faster and cheaper for us to do it that way. When you’re being slammed with those type of bills like you just can’t incur any extra costs. And I’m a nurse so I figured I was in the backseat and if I had to do chest compressions I was going to do chest compressions. Today nearly 30 million Americans are uninsured. That’s down from roughly 55 million in 2010 before the Affordable Care Act. But it’s still a higher percentage than countries like France, Japan and Israel. The insurance companies are supposed to be negotiating their prices lower because in a lot of cases they’re ultimately the ones footing the bill. But as we’ve seen over the last few decades, those costs can still get passed onto consumers. Health costs and contribute to all sorts of inequalities in society. So people who are poor or middle class even, they’re just one serious illness away from bankruptcy. So where do we go from here? Once there’s all this money sloshing around in the system there’s this kind of pile on effect where everyone wants to grab their bit of this huge pot of money. And now what we have as we’re trying to take it back and reduce costs is everyone is desperately clinging to their piece of the pie. Of course, health care costs have the potential to impact your personal budget if you’re paying for insurance or when you get sick. But it also impacts the country’s bottom line. The government currently spends more than $1 trillion on health care. And the CBO expects spending on Medicare and Medicaid to double in the next 10 years. That’s not just because the population is getting older. A large part of that spending will come from health care getting more expensive. There’s no magic solution as to what to do next. But people are at least starting to think about the steps it will take to turn things around. One is having a lot more transparency. Both doctors and patients and their families should have an understanding of roughly what it’s going to cost. Alternative route, having some sort of government manufacturing facility so that you could say to Shkreli’s: “OK you want to do that, guess what? Next week, we’re going to be on the market and we’re going be selling this stuff for a dollar two dollars a pill.” Peekaboo. (laugh) Ready. Peekaboo. There is a very very strong possibility that Luca will need a second lung transplant before he’s ten years old. He’s already had one and they will list him for a second. And right now the policies in our health care system is they do not list him for a third. So I do not know if I will see my child ever hit his teens or early 20s. It’s pretty scary. Like I don’t know if I’ll ever see him get married. It’s just so unknown.

  • Proud of my italian universal heathcare system, one of the best in the world. Americans won't pay taxes for other people's cancer but they don't think they could have cancer or other diseases in life. It's about being supportive. If all are paying, everyone pays less. That's what a country it's really about.

  • My medication for Narcolepsy and Cataplexy is $3,600 a month and every four or so months my insurance sends me a letter saying they don't want want to pay for it anymore with some new excuse. In my state of Massachusetts Elizabeth Warren has an agency to help people in my case and supply them with a free well seasoned lawyer to fight back against the insurance company. So far been to court over it twice and have won thankfully. Without this medication I cant even leave the house or function. Its really scary and I just want to stop worrying about if they're going to take my coverage away leaving me to pay something I can't. (At one point I did out of pocket by two months worth and it put me in debt.)

    It is scary. (Rooting for Bernie)

  • The system is working perfectly. It's meant to eliminate ethnic minorities who tend to be poorer. The few poor whites are just collateral damage. The idea of a health care system that works well for everyone is so dreaded, whoever is able to get legislators to pass it would get assasinated.

  • 1000 dollars just for a ambulance to the hospital. I’d rather drive my dying self there then call the police.

  • I visited a doctor 2 months ago for a preventive exam which should be covered by my insurance. But since it was my first visit she wanted to ask me some questions about my health conditions and medical history etc, so I told her about my chronic skin problem, she collected the information and gave me a referral for the skin problem because she cannot treat it, and she didn't give me any treatments or prescriptions whatsoever, nor did she even do the preventive exam I wanted because she didn't want to do it for a new patient. At the end she scheduled another appointment a few months later for the preventive exam. The whole visit took about 15 minutes.

    A few weeks later I received a $183 bill, so I called the insurance and I was told the doctor filed a regular visit code instead of preventive exam code, and so it's not covered. Then I called the doctor and she doesn't want to admit her fault but insisted that it became a regular visit instead of a preventive one because I mentioned the chronic issue. It's really ridiculous that all the doctor did was spending 15 minutes collecting my data, and now I need to pay $183 for that! Of course I can afford $183, but I'm just so sad and angry to be ripped off like this…

  • I wonder if doctors are benevolent figures like the ones in my country ,that give free healthcare or even free surgery to people with no inssurance?

  • In simpler words the health care system in america is hand in glove with politicians and congress who are actually blackmailing patients into either you pay so much or we do not care…shame on America…I know hospitals in other parts of the globe were treatment is as good or better than america with fraction of the cost Americans are paying…

  • I have a $2,000 deductible so the insurance co. will not pay anything until I meet $2,000. I need to have a xray, ultrasound, and see a specialist which will cost me about $200 or $300.

  • Dear America, our alliance… Please get yourself universal healthcare, these insurance companies are only there to make money it's business for them, don't listen to politicians against universal healthcare it's proven to work and be the best option, politicians against universal healthcare are most likely paid large sums by these insurance companies to feed you with lies and propaganda, if universal healthcare was so bad as some of these idiot politicians say why is there no one in any of the scandinavian countries, multiple european countries and Canada that are against it? You don't see any politicians in any of those countries fighting for private health insurance, or any citzen calling for a rework of the healthcare system, i would recommend voting for Bernie Sanders as he seems the most honest one, he not only kept his policies for years, but he also has proven he is for the people with his wrapsheet and accomplishments, i pray for you guys and hope the propaganda is unsuccesfull and that you all do your own research before taking a decision, and remember to vote for the policies you feel will better your country and not by popularity this is real life politics, not a reality tv show you don't want another George Bush or Donald Trump. With love from Denmark.

  • List the costs of the procedures creating Market free enterprise competition. Medical is fighting it tooth and nail because it will reduce prices

  • I went to the ER for dehydration. I spent 2 hours there, got an xray of my chest and an IV to rehydrate. Even with my insurance I still ended up with a $300 bill! American healthcare is a joke.

  • I took the bus across town to the hospital after an asthma attack ($2 for the bus fare) rather than an ambulance ($1k for the trip). Other than Medicaid, I am uninsured.

  • What´s the name of the health insurrance in USA ? GoFundMe. But wait: There are others who help you. Rep will cry: Thats socialism… POOR America

  • Solutions:
    1. Doctors should not have to do an undergrad. A music degree does not help one become a doctor!

    2. Make patents for drugs last only 1 – 5 years. OR limit Price to Cost ratio (businesses can inflate costs though).
    3. Make it easier for doctors to do their work so they do not have to fear malpractice or these law suits
    4. Along with 3, make it easier for doctors to start their own businesses (hospitals)

  • There is EXTREME overcharging taking place.. I've seen things like 2 Aspirin tablets at a hospital cost $70 on someone's bill. It's utter insanity.
    Why is there no control or regulation for how much they can charge. Someone else had a simple Urine test costing $5,000 and the test itself should be $100 or less.

    This is Mafia style extortion prices. It's fraudulent.. Most other countries do not have it like that. Not to that extreme.
    Ironically it's the universal healthcare countries, because the government has oversight in that because that is how it's all paid, via taxes.
    Don't get me wrong there is other crap in those systems as well. But clearly a little more control.

  • Hospitals are a business of making money not losing money, they milk you for every cent! If your in need of severe care that uses a lot of resources and staff? Expect the bill to be ridiculous! This problem not exclusive to the United States. You know how much some of their equipment cost like MRI? $1,000,000 or possible more, some do rent, cost per month for electricity and water? All this are some of the things that are passed on to the patients. If you have insurance? Mines pays 10%-20% of the total bill, which hospitals considered paid in full, they should do the same for people who don't have insurance or problem paying the deductible?

  • Extremely expensive I had a deep cut on my nose went had 3 stitches put on the bridge of my nose I was in the medical clinic at not the hospital but the little ones for 1 hour $20,000 my out-of-pocket was 2,000 and the Bill said stitches 10.00 but didn't have anyting else listed on what it cost I try to get that information for my insurance company that didn't happen how can I take him to court I don't care if I had to spend another $80,000 to prove my point if that's what it takes Healthcare is terrible the service is good for us but the price is ridiculous do not see what they come up with that we all know the government should pay for that that's what it garments for did that guy rich people they don't do that we pay taxes and everything else and we still have to pay for insurance you're spending billions of dollars on climate control and I can't change that nobody can billions and billions and billions and billions and billions on war supplies tanks Planes Trains in a Yachts whatever but we can't afford healthcare for everybody now I'm integrate country I love America but that's the one thing is going to change I'll even pay more tax put it up to 20% but I want the same healthcare for free Target set 8.25% it'll be 20% sign me up as do it

  • Its actually smart,they put healthcare so high so americans can just go to other countries and destroy their healthcare system by healing there so the other country has to pay

  • Stop the annoying, silly background noise that overshadows and competes with the person speaking. It's far too loud. Turn it off and fire the idiot that suggested it.

  • Us health care is a joke!!! Thai needs to be taken care of so people don’t have to stress over a medical bill. I’ve been there I have health insurance went to the hospital for Week and still put a dent in my pocket.

  • Oh my god… that's crazy… for the very reason to understand why insurance is important and how it is used when is New Year's but if you never use it but never has any value but if you have it and then use when it's absolutely necessary then you understand the value…

  • Simple answer, and the video mentions it… government intervention, if the government is involved its more expensive, eliminating government involvement and letting health insurance become a free market will create competition, lowering the prices of coverage.

  • it's because america subsidizes the world's healthcare. all of the new medical treatments and drugs cost billions to develop and pass medical trials it takes teams of doctors, scientists and the lives of sick patients for these drugs to make it to the world. without the financial incentive that america provides the world's overall output of innovations in drug/medical treatments would collapse.

  • Americans think they have the best healthcare system in the world (best treatments and tech) and that the European systems are somehow dingy and crude.

    It's cultist thinking, as literally the opposite is true. Hell, a Norwegian prison is better than the majority of US hospitals. French doctors don't do unnecessary heart surgery like the scandals in the US.

    These people remind me of communist propagandists from the Soviet Union that used to paint Western Europe and its social democratic model as degenerative, decrepit, debauched, decadent and profligate. As though high living standards was a bad thing.

    American capitalism is a religious belief akin to the sort of thing the Mayans used to believe.

  • As an American living and working in South Korea, I am continuously shocked by how affordable and cheap healthcare is here. My government regulated health insurance costs only about 80 dollars a month and every doctor visit I've had has costed less than 10 dollars! And health care is the same quality in the states. 🤔

  • So could the American go to other countries and buy the cheaper drugs which have the same effects back home for their personal use ???

  • 8:41 – "AHA declined to comment": Lack of transparency is a sure sign of trying to hide corruption, as if it isn't already obvious without their defense.

  • I have always lived in Canada and all my healthcare is free and this lady is getting a bill For &4M dollars

  • Gotta love how this doesn't even acknowledge government's role in this! I bet if you go to one of these wonderful countries and ask them if breast implants and other electives are covered they would laugh in your face.
    The American government wants every little thing covered, even if employees don't want it, and the government tells the health providers that there is an unlimited amount of "free" money for whatever they want to try and charge..and that they will get paid whatever they want. Excess ensues…

  • There is NO WAY a hospital in America should be allowed to charge 100x more than what the same procedure would cost in Canada or France. There are more parts in the car industry than there are components in the medical industry, this should not be so difficult to manage. "For Profit" hospitals need to be taken OUT of the Fed / State Backed Medi-cad providers. Government should create a medical supplies branch for consumables to eliminate price gauging. That's how you get prices to drop. The cost of procedures should be identical across successful countries (USA, Canada, France, Germany, Japan, etc). High cost to cover malpractice lawsuits… abolish that BS. People in the military can't sue military doctors. It should be the same for Fed/State backed Medi-cad providers. How do I know if they gave me a generic drug vs high-dollar name brand in the hospital? Only the nurse knows for sure. If the Federal Government mandates that I must have health insurance, than it needs to be regulated. Imagine if Department of Transportation became a "For Profit" company.

  • Wake up America… Universal health care with government keeping a level playing field on prices in the only way…

  • America best country on earth-lies and propaganda. Kind of like what N Korea tells its people.. and I'm American…

  • There was recent case of man with employer supplied insurance that was away from "network" and had kidney failure and was billed $11,000 per dialysis for total of $540883 total bill. The medicare system pays $250 per treatment for this. The hospitals bill because there is no law to stop them. The truth is they expect uninsured to negotiate the bill down. Don't ever "sell the family farm" to attempt to pay off these obscene bills. If you are unemployed and have no medical insurance they are not allowed in most states to sue you and will take a small monthly payment of as small as $20 dollars. I have two neighbors who had emergency heart procedures and they told me they were paying $20 a month and they were 55+ years old(thats $240 a year and they ain't gonna live that long). Most hospitals have been playing this over bill game for years now and some admit its attempt to recoup loss from uninsured who pay nothing at all .

  • I think what's worse is that my dad took over my assets when I got injured at work.

    Only to see him spend 100k on two brand new trucks that just sit in his garage, I'm still paying my own medical bills and I'm denied assistance even though I'm making less he did as a business owner.

    Btw, he kept the money from the house I owned, I bought a foreclosure and he made an excess of $30k.

    Some father

  • I got some pills today from the pharmacy here in denmark, 7 $, i looked it up, the same pills cost 591 $, im glad i do not live in the US, we pay TAX to run our health care…

  • For a burn that thay didn't even cover up. Just cream. 21,000 lean on me becouse no med insurance. 5 hours sitting in the er. I don't even make that much in a year.

  • Imagine you to work 3 jobs and 30% of your total income allocated for health premium and you need to satisfy such high deductible. And some needs to wait to reach age 65 just to get 20% coinsurance and let Medicare cover 80%. You pay for parking fee everytime you visit a provider, pay upfront and get refunded after claims are processed and EOBS genrated. The individuals ability to get healthcare coverage is such a pain. But good thing is got limits on copay until negotiated rate. Insurance is literally a huge business. Less people insured the higher the premium to cover medical cost spent by insurance.

  • Shout out to all the other people like me who’ve been paying $10/month to medical bills to placate them 😂🙄
    “Healthcare” bill collectors are the devil

  • I overheated and needed to get my temperature down so I went to the hospital got a IV drip and some ibuprofen for a couple hours and it costed over $4,000 just for that wtf

  • We now spend $3.5 trillion each year to give healthcare to 248 million, leaving 82 million with little to no healthcare. With Medicare for all, every citizen or visitor in the U.S. would receive free healthcare.  And if a restriction required patients to have a healthy 10% fat diet and no addictions, yearly healthcare costs would drop to $1.5 trillion or less.

  • I am Canadian, and I am horrified at the U.S. healthcare system. In Las Vegas, they even advertise hospitals on billboards.

  • Ban all health insurance…you pay out of pocket for all your health care needs. Never going to happen but there is no other way to lower costs.

  • I tried relying on the free health service we get in europe to help fix my bad back. they kept giving me the run around. I set up go fund me, and went private, now my back is fine.

  • I guess that there always needs to have a good balance between “chasing $" and social benefits. Was told that FDR fought for making electricity available to all American and American becomes stronger that way. We can draw parallel lines for internet access and medical benefits as they are basic needs for modern society.

    The funny fact is that China one time tried to imitate American medical system and quickly concluded that it is not going to work, same as for "chock therapy" that poisoned several ex Soviet block countries.

  • A lady I knew needed a procedure formerly $2000 and overnight in the hospital. Now, 2 weeks and $20,000. She got it in South America, overnight and $2000 by a doctor from the U S

  • My ex-husband's father, once shared with us that he had the actual medical bill from the hospital for his birth, from 1945, one week stay in hospital for baby and mother…49.00. Even adjusting for inflation, that's dirt cheap!

  • I read some of the comments. It’s like the U.S vs Europe – two extremes. I’m from Singapore. The healthcare system here is somewhere in between. Public hospitals are heavily subsidised by government but not free. If you are rich and want better healthcare, you can always visit private hospitals. It’s your own choice.

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