Retiredat63:
You may have noticed that all the angsty posts and threads on the forums about retirement and health care are from Americans. Think of the peace of mind public health care would bring to your fellow Americans. And it is not "free", we all know we are paying for it through our taxes. There is no reason your individual states couldn't run it just like our individual provinces do.
High taxes up there. Gas costs a lot. However, facts and figures show that health care is less expensive per capita and more complete. Given the fact that some people have NO health care, it certainly does seem like it would be an improvement for the common welfare.
Abe:
However, unlike most cartels, physicians do not “fix” their prices, they are very aggressively negotiated by insurance companies.
I guess because the prices are not "fixed" is one reason you can never get a clean answer as to what something will cost when you visit a clinic. They tell me, "Why do you ask? You have insurance." Right. I have premiums too.
They usually can give a list price if you pay out of pocket, which tells you at least the high end of the cost (since insurance companies always negotiate lower prices) but that doesn't really answer what an insured person is going to be billed.
The main reason a lot of places don't give clear prices on routine things is usually due to a non-disclosure agreement with insurance companies. For example, if my hospital has a contract with Insurance A, they will agree that X lab costs $Y for those patients with Z diagnosis, and the patients will owe W% of the cost. Generally patients will know what the W% is, but not the other numbers.
The contract almost always says you cannot disclose the cost because then:
1) people from Insurance B will find out and say "hey, why is Anthem paying $Y+5 ?!" and potentially switch to Insurance A
2) people from Insurance A through Z will realize they are paying significantly more in premiums than they are getting back
3) people at that hospital may go to a different one with a cheaper negotiated payment if they care how much the insurance company is paying (above their out of pocket expenses)
It's nuts, but the only other option is for the hospital to not take those patients' insurance, because, in general, the hospital system is usually a much smaller corporate entity than the insurance company. Generally what happens if the hospital balks and wants to be paid more is the insurance company no longer will pay for anything at that hospital (make them out-of-network). There are usually more hospitals than insurance companies in a given area.
Now, this generally matters to you if the insurance company refuses to pay because they didn't think that the test was necessary for a given disease / diagnosis. This happens a lot, and then there's much arguing back and forth. A good example I have is with patients who have high-risk cancers. Sometimes I will want to get a CT. If national guidelines indicate a CT is necessary, almost all the companies will pay without question and the patient only has the co-pay. They may specify it has to be done with a contracted imaging company, the cancer diagnosis confirmed by their physicians, etc. However, if these steps aren't followed exactly, they may refuse to pay any portion and the patient gets the whole bill (often without the physician even knowing). Even worse, if the guidelines say "consider a CT" or don't mention it at all, almost no insurance company will pay without an argument (called a "face-to-face" in the jargon - apparently people talked in person before computers). They may then agree to pay with certain stipulations like above, or just refuse entirely. Then the patient either pays all of it or forgoes the test. Either way only the insurance company wins.
Now, there are fraudulent practices by physicians and hospitals that the insurance companies are doing all of the above to prevent, so it goes both ways with the paperwork. This would be fixed in large part of physicians were salaried and hospitals were nationalized (like in a lot of other countries).