Adventures in Headlines

Does the title of this post at Vox bother you as much as it does me?

If John McCain were uninsured, his surgery could have cost $76,000

Why does it bother me? Because unless they’re alleging that Sen. McCain would have received more care if he were not insured which I emphatically do not believe was the claim, whether he was insured or not has no bearing on the cost of his treatment. It could possibly have influenced the price and it almost undeniably has an effect on out of pocket.

By the way comparing out-of-pocket spending in various OECD countries is highly informative. Here’s a selection, via the World Bank:

Country % Out of Pocket
Canada 46.8%
France 29.1%
Germany 57.3%
United Kingdom  57.7%
United States 21.4%

You read right. Americans pay less out of pocket for health care as a percentage of spending than the people of any other OECD country. There are some who interpret as meaning that Americans should pay more for their health care rather than less. I interpret it as meaning that prices should be lower.

I guess it means you should specify what you mean if you say that you think that our health care system should be more like Germany’s.

13 comments… add one
  • steve

    I am not 100% sure what that Worldbank number means since it is the percentage of private expenditures that tis out of pocket. I am guessing it means that there is some private insurance also. However, my first link looks at out of pocket as a percentage of total heath expenditures, which is what I think we really want. (Second link is nice Commonwealth piece that sort of supports my guess.)

    http://www.oecd-ilibrary.org/social-issues-migration-health/out-of-pocket-expenditure-on-health_oopexphtl-table-en

    http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

    Steve

  • steve

    As to the article, it looks like the old common mistake of mixing up charges and costs. I don’t upset about it much anymore. They are probably correct that if he were uninsured, McCain would have been charged $76,000. If you don’t have insurance you get charged the maximum fee.

    Steve

  • Ben Wolf

    Those particular figures don’t reflect what Germans actually pay out-of-pocket for their total health care bill, only what they pay for things their national health system doesn’t cover. Total German out-of-pocket expenses amount to 13% of spending vs. U.S. 11%.

    Once we take into account that health care costs are roughly double in the U.S., that 11% amounts to a much greater burden than the Germans’ 13%.

  • Ben Wolf

    Steve,

    If I may ask, are you a GP or specialist? What are your thoughts on how a national health system would affect your practice?

  • As to the article, it looks like the old common mistake of mixing up charges and costs.

    The point is that someone pays. TANSTAAFL

  • steve

    Specialist. My best guess is that I would earn less, but would also work a lot fewer hours. I would expect more restrictions on which drugs I use. (I am guessing that we would look a bit like Canada since they still have fairly decent salaries.) Fewer fountains and flat screens in our hospitals. Fewer bells and whistles on our tech. Overall, it wouldn’t be that much different in the way we practice, just tighter on the money. Oh, fee for service probably goes, so a lot fewer procedures get done. A lot fewer heroic end of life procedures for sure.

    Steve

  • Modulo Myself

    What happens when somebody without insurance gets a procedure that on paper to the insurance costs 75K? Insurance negotiates with the hospital if you have insurance. Does the hospital or network just charge straight up what all of the negotiation statements say they are charging? I’m assuming yes.

  • Guarneri

    “A lot fewer heroic end of life procedures for sure.”

    I recently watched (and the actions or inactions) the end stage of metastatic lung CA with my mother, who died.

    How do you envision those decisions would be made?

  • Jimbino

    “If John McCain were uninsured, his surgery could have cost $76,000” is only one of the sentences in the post that fails to observe proper English sequence of tenses rules.

    In English, one would say “If John McCain had been uninsured, his surgery could have cost $76,000.” Or, in the present, “If John Doe were uninsured, his surgery would cost $76,000.”

  • TastyBits

    @Modulo Myself

    This is from my personal experience.

    Without insurance, it is a mixed bag. You are charged the non-negotiated price, and this is usually the most expensive. Sometimes, you can negotiate before any tests or procedures, but it usually means cash up-front. In some cases you can negotiate after-the-fact, but again, you must have the cash to pay.

    When a $76,000.00 bill(s) arrive, you stop answering the phone and reading the mail, and you never sign a certified letter.

    I am now paying out the nose for a platinum plan for my wife, and it is a piece of crap. If I go out-of-network for any reason, I am no different than being uninsured.

  • gray shambler

    Spoke today with a fortyish woman, who’s premium has gone to $600/ month with $6000.00 deductible, she’ strongly considering dropping it, come what may, and I don’t blame her. What if tens of millions of younger adults do the same?

  • steve

    Drew- It would greatly motivate networks to resolve end of life issues before the end is reached. When asked, most people don’t really want “everything” done when there is no chance of a good outcome. Yet, we often do that since many don’t talk it over ahead of time. Also, at present, hospitals get paid for doing everything they do, even if it is not merited. I would expect better pre-op evaluations to determine if the benefits merit the risk. Right now, the scale is subtly tilted by the knowledge that there will be payment. On the medical side I would expect earlier offering of hospice care, which has generally been shown to provide a better quality of life w/o hastening death.

    Steve

  • mike shupp

    @Modulo Myself. TastyBits pretty much sums it up.

    About a year ago, I would up in an emergency ward with a protruding umbilical hernia — something the size of a grapefruit, which was still trying to grow. I passed out trying to explain this to a receptionist, and wasn’t really conscious of much for another 4 or 5 days. There were complications. I’ve got COPD, I could stand to lose some weight, they were worried that I might have picked up an infection from transfusions …. It took three weeks for them to release me. And while I was very grateful for the care the hospital and doctors and nurses, etc., had given me, the final bills totaled to over 270 thousand dollars.

    Which was about 270,000 bucks more than I had. However, in the end, Medicare stepped in and paid about 30 thousand, while telling the hospital to forget most of the rest. The part that really got passed along to me was about 2000 dollars. Somewhat affordable on my social security.

    Here’s a game for Republicans: pick the magic point at which I should have discussed surgical procedures and their costs and the likely hospital costs for proceeding in this venture. What should I have held out for? A private room all the way? Daily flowers? Gold trim on my new belly button? More stations on the overhead TV? How should I have made the best possible, most pleasurable decisions while enjoying this shopping experience? How should I have handled this as a True American Consumer?

    I’m a bit cynical about Econ 101 analyses of healthcare these days.

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