An MRI scan costs $1,420 in America. It runs $450 in the UK.

[Uncle Joe]

Link to tweet

(snip)


The International Federation of Health Plans, a group representing the C.E.O.s of health insurers worldwide, publishes a guide every few years on the international cost for common medical services. Its newest report, on 2017 prices, came out this month. Every time, the upshot is vivid and similar: For almost everything on the list, there is a large divergence between the United States and everyone else.

Patients and insurance companies in the United States pay higher prices for medications, imaging tests, basic health visits and common operations. Those high prices make health care in the U.S. extremely expensive, and they also finance a robust and politically powerful health care industry, which means lowering prices will always be hard.

For a typical angioplasty, a procedure that opens a blocked blood vessel to the heart, the average U.S. price is $32,200, compared with $6,400 in the Netherlands, or $7,400 in Switzerland, the survey finds. A typical M.R.I. scan costs $1,420 in the United States, but around $450 in Britain. An injection of Herceptin, an important breast cancer treatment, costs $211 in the United States, compared with $44 in South Africa. These examples aren’t outliers.

(snip)

The international survey focuses on prices paid by private insurance companies; in many countries, public health programs pay less, meaning the gap in prices for many countries may be even larger if it took account of every patient. The survey doesn’t have information from every country, nor detailed prices for every medical procedure. Drug prices do not include rebates. But the report’s overall message is clear. Prices in the United States are higher for nearly everything — by a lot.

(snip)

https://www.nytimes.com/2019/12/27/upshot/expensive-health-care-world-comparison.html

[MineralMan]

1. Well, a big part of the difference is how much the people and places that

do the procedures earn. Here, we take a free market approach to that, with every provider setting his or her own goals. Add to that the profit motive for clinics and other places where procedures are done, and you have the explanation of the higher costs.

Until a single payer system dictates the amounts paid for each procedure, medication, or other service provided, we will not get close to the lower prices in some systems.

The profit motive, over all, determines the price level. That's why there is so much professional opposition to single payer. That and the fact that every clinic has to have its own MRI, Cat Scan, and other equipment, which increases costs to the patient. That stuff is very expensive.

Overcoming that price-setting by individual providers, clinics, labs, hospitals, and drug manufacturers is the biggest challenge. Until the profit motive is removed, it's going to be very, very difficult to implement a plan that duplicates what we see in many countries.

Just saying "Medicare for All" doesn't do that, you see. Not even close. Without price controls, there will be no equity.

[George II]

2. How much do the British pay in taxes to get that cost down? Add the taxes AND the $450 and.....

.....you'll probably wind up about the same as in the US.

Once again, people aren't looking at the big picture, just selective "facts".

[Uncle Joe]

3. Well if you want to consider the "big picture" don't forget to add

the tens of thousands of Americans that die every year for being uninsured or underinsured along with the hundreds of thousands of Americans that go bankrupt for medical reasons on an annual basis.

How much are those American lives worth not just from a humanitarian level but how much does that lost production and write-offs adversely affect our U.S. GDP?

[George II]

4. There's also this:

“Why aren’t we incorporating the cost of all the funeral expenses of those who die because they can’t afford access to health care. That is part of the cost of our system.”

[Doodley]

36. Good point.

[TexasTowelie]

8. It probably doesn't cost as much as you think it does.

If you can't find any data to support your point, then it is just casting fuel into the fire to see the reaction.

[Uncle Joe]

14. Tens of thousands of early American deaths combined with hundreds of thousands of bankruptcies

every year has little or no effect on U.S. GDP?

All one needs is logic and common sense to know this isn't true.

[Hav]

5. I don't think you need to add taxes to the 450

As this is what's paid by your insurance and therefore already covered by your monthly rates.
The comparison is already about what the procedure costs.

[George II]

9. But the $450 is that low because of government support (or subsidy) that is funded by taxes.

[progressoid]

22. And that's a bad thing?

[George II]

24. Didn't say it was, but the cost is being misrepresented by leaving out a HUGE chunk of it.....

....and where that chunk came from.

[progressoid]

28. So it's a GOOD THING!

[Doodley]

37. No that is not true. The ENTIRE $450 cost is paid by the government-funded health care system.

[TheFarseer]

53. It's low because they negotiate prices

$450 is the total price paid by the government, NOT the price paid by the individual and the government pays the rest.

[MineralMan]

6. Really, though, those numbers are not what most people pay.

Their insurance pays most of it. If I get a diagnostic MRI, I will pay almost nothing for it out of my pocket. I'm on a Medicare Advantage plan that will pay virtually all of the bill, at a price Aetna has set that it pays providers for the MRI. For that, they take my Medicare Part B premium and $46/month. I have some small co-pays for most services.

The point is that I don't know what an MRI costs, until my EOB arrives and I find out what Aetna paid for the service. That's very different from what the MRI provider charges a self-pay patient. It's much lower, because Aetna has set the prices it will pay, and its network providers have agreed to accept that amount.

Same thing with my medications. Since all of my meds are Tier 1 drugs, I have zero copay for them. Again, Aetna has negotiated prices with its preferred pharmacies for each medication. Prices are set, and I don't pay any of it directly.

I know what those meds cost without coverage. It's about $250 for a 90-day supply, because I used to self-pay, rather than use a Part D plan. When I went with an Advantage plan, Part D is included. I pay a penalty each month for not having used Part D before, but in aggregate is is less than I have saved in the past.

The one thing that single-payer can do is set pricing across the board. If it does that, there can be big savings. However, if that is done by for-profit insurers, the costs will still be too high, since there is a profit that must be made. Until we get rid of that element, we will not be able to achieve the lowest possible costs. Since we're a capitalist nation, though, that's going to be a tough nut to crack.

[George II]

10. Coincidentally this morning I received a bill from a lab for blood work I had done....

....a few weeks ago for my annual physical.

The original bill had two separate line items.

First was $40.00, adjusted by $33.10 to $6.90 by United Healthcare (Medicare supplement)
Second was $35.00, adjusted by 31.90 to $3.10 by United Healthcare (Medicare supplement)

My cost is $10.00.

There was no charge for the physical exam itself, which included an EKG.

Back in the summer I had some medical issues that needed blood work of about $550. Again, I paid only $10.00.

[MineralMan]

12. Yup. That sounds typical.

I have my annual wellness checkup next month. I won't have to pay anything for it, not even a co-pay, and they do a complete blood test series. Normally, that visit is the only time I see my primary care doctor each year. He writes prescriptions for the entire year at that visit. Really, it's just to see whether anything has changed that needs an adjustment to my BP meds.

[progressoid]

23. And who pays the insurance company?

[Doodley]

38. This is the cost that the providers charge regardless of who pays.

[Ohiogal]

7. I would rather pay more in taxes

If I could rid myself of sky high monthly premiums, deductibles, and co-pays. And also ensuring that every American has access to affordable health care.

I’d rather my taxes went towards this than towards Trump’s golf outings, endless wars, and propping up his other insane or destructive policies.

[TexasTowelie]

11. I think that all of us would like to have our own a la carte menu

for which items we are willing to pay for.

For example, I've only been on a boat once in my life, so I certainly don't want to pay for the Coast Guard. I also don't have any children so I would certainly want to reduce how much I pay for public education and the subsidies I contribute to children's health insurance programs. Nix the free tuition programs too.

The point is that we don't get to pick and choose which items we pay for.

[Ohiogal]

19. I have no problem with paying higher taxes

that go for the common good. As I previously said, if we could ensure that every American could have great health care, that to me is worth it. A healthy population benefits everyone. As does an educated population. My house has never burned down but I gladly pay for fire protection. I am willing to pay taxes for food stamps for those who struggle or for a mom to have affordable day care so she can work.

Of course you cannot realistically expect an a la carte menu for where your taxes go. But when some people argue that those countries with great low cost health care pay much higher taxes than we do, I say it’s worth it. Many people forget that people in those countries who pay higher taxes don’t have to pay ridiculous monthly premiums, co-pays, and deductions like you do when you have private for profit health insurance.And, in my case, it’s especially worth it because my healthcare plan’s deductible is almost ten thousand dollars which is absurd. I have no prescription coverage until my deductible is met. I’d rather that my monthly premium was used for healthcare that pays for things like Medicare pays for.

Elizabeth Warren says that a higher “healthcare tax” would still be less than what we pay for private health insurance, and you get so much more. To me, it would be worth it.

[TheFarseer]

55. Also

If employers don’t have to pay for health insurance, wouldn’t they in turn pay higher wages?

[Doodley]

39. Exactly! But you would not have to pay more taxes. As much taxes go to

healthcare in USA as in UK, but there is no insurance scam to pay in UK. The people in the UK live longer, health outcomes are better, and infant mortality is better.

[Perseus]

16. I Canadian friend of mine explained to me how we pay much more for healthcare

even though they pay high taxes to pay for healthcare. Unfortunately this was years ago and I din't have the numbers with me anymore, which I know makes a weak argument for me. The fact is that although Canadians pay higher taxes, it is more than offset for what they don't pay on healthcare.

In the USA we pay taxes, and on top of that we pay when we go to the Dr., when we buy medicines. Procedures and medicines cost four or more times in the USA than what they cost in most other countries.

And no, we would not wind up with the same in the USA, universal healthcare would have cost controls and the taxes would pay for them.

One more thing, FREE EDUCATION. I just met a Canadian Dr. whose career cost him $750.00, that is all it cost him to become a Dr. in Canada, while in the USA most people who graduate in Medicine are left with a $500,000.00+- student debt. Those doctors have to pay for the student debt thus rising the costs on healthcare.

[George II]

20. That $500K+ is pretty high. Here are tuition in the US for all medical schools. The HIGHEST....

...per year is $99K for out of state students, $52K for in-state students. That's the highest. The second highest is $91/$47K

Most are much lower than that.

https://www.shemmassianconsulting.com/blog/medical-school-tuition

BTW, average starting salary after medical school is $138K for physicians, $145K for internists, $162K for pediatricians and $200K for gynecologists.

[FunkyLeprechaun]

29. I live in the UK

While the taxes are a little bit higher than the US, it’s no where near prohibitive than the US. I had a two month stay in the hospital where I had xrays, dialysis etc etc.

I didn’t pay anything.

[Doodley]

35. Try zero. It costs nothing more than the taxes. By the way, I'm British and

I never saw a medical bill in my life until I moved to America. The whole idea of the NHS is free healthcare.

[mitch96]

13. Back when I was doing CT scans, the administration want a breakdown of actual costs...

They were negotiating with companies to buy new machines. We were tasked to determine the ACTUAL cost of a non contrast CT scan of the brain. A very quick and simple test.. We had to include the electricity used, technologist time, time to schedule the patient and time to register the patient when they came in. Service contract costs were included also.
After the scan, time to get the images to the radiologist but not the radiologist time..
different charge... For a 15 min scan the actual cost was ......... $45. This was about 10 years ago...
We would normally receive what insurance allowed, usually $450. Out of pocket charges were around $1100... The reason we were told that the prices were so high b/c other departments did not generate income like housekeeping for instance.. A needed department but would not generate income... Radiology and Laboratory made money for the hospital to offset departments that did not make money.
m

[George II]

25. The "actual" cost of the scan, as you detailed, does not include the cost to train the radiologist..

...or the cost to purchase and maintain the scanner, or the cost to heat the room in which the procedure takes place, or the cost of the electricity used to light up the room, etc.

There is a lot more involved than simply the individual costs directly related to the procedure.

[mitch96]

33. No the Rad training cost was not included as the radiologist charge is separate.

I did mention maintenance and purchase price was included but I did not mention them. Building costs are factored into plant costs. Need lights everyplace in a hospital. They do not make the hospital money. That is also why a asprin cost over two bucks in a hospital..
m

[TreasonousBastard]

51. Whoa! All businesses have non-production expenses like taxes, heat, insurance...

profit centers charged "proportionately" for these services (usually meaning the manger missing from the meeting gets hit with the whole thing)

[MineralMan]

15. Until the entire health care system is moved to a government-run system

the profit motive will continue to keep prices high. For me, the ideal is a completely socialized healthcare system, with everything being government run and every provider receiving a government salary. However, such a system will never exist in the United States. That would be the lowest-cost system possible. If pharmaceutical manufacturing and research were also government-owned, prices for healthcare would go down even more.

See, I'm a socialist by philosophy. However, I am forced to be a realist in real life. What I described above will not ever be implemented here. Still, it is the lowest-cost system that is possible. It would also be very, very unpopular in this society. That's why it will never happen.

So, we have to come up with something else that simulates such a system. The Medicare plus supplement system works pretty damned well. Add subsidized care for low-income people and pay for it with employer taxes and self-employment taxes and it would be pretty simple. It would have to allow for price controls on procedures, hospitalization and, yes, pharmaceuticals, but it would then be able to compare favorably with the systems in most capitalist societies, none of which have a pure socialistic healthcare system. Cuba does, but we're not going to implement that style of healthcare.

However, there is not enough popularity for either concept that either will be adopted right now. There is no support for fully-socialized healthcare, but there is not enough support for the hybrid system, either. Some sort of compromise system will have to serve in the interim, until support for a better system is available.

Making any major change will probably take a couple more decades, I think. Meanwhile, we have to keep plugging away with an expansion of the ACA, I think. Nothing else could get through Congress, and that's not an optional thing.

[Doodley]

40. A socialized system will never happen in America until Democrats:

- Unite on a viable and proven system.
- Convince Americans that they are currently being scammed.
- Convince Americans that a better system would cost far less, give better outcomes and lead to longer life-expectancy (as in other Western nations).
- Show that we have a moral duty to provide healthcare for all.

[Recursion]

43. You forgot #5

- Find a way to get white voters to accept social spending that visibly helps minorities

[Doodley]

44. True. I have never seen such anger as from my in-laws with Medicare who object to "other people"

getting healthcare.

[Recursion]

17. UK physicians make GBP60K

Last edited Sun Dec 29, 2019, 04:59 AM - Edit history (1)

Convince American doctors to take that pay cut, and we could have healthcare that cheap too

[MichMan]

21. I imagine Nurses make much less than that

[Recursion]

60. We underpay nurses and medical techs compared to the rest of the OECD

If you look at the giant pie chart of where our health care spending goes compared to other developed countries, it's not to pharma (we're pretty much average there) or even to insurance companies (we're pretty much average there, too): it's paying for outpatient procedures, and most of that is going to physicians. Nurses, med techs, home health aids, public health professionals, dentists: we pay all of them less than the OECD average. It really is the doctors.

[George II]

26. Actually doctors in the UK earn 60,000 to 100,000 pounds, which is about $80,000 to $130,000.

[Blue_true]

45. Sheee. Don't ruin a good story with currency exchange considerations. nt

[Recursion]

58. There was a pound sign in the title which DU apparently doesn't render

I don't think any Unicode works in comment titles, irritatingly

A GP in a council surgery starts at £60K, which is about $78K. They max out at £100K or so, which is about $130K. The average US physician salary is $150K.

[George II]

61. It takes out all symbols other than " and '

[David__77]

30. I don't think that Medicare for all should be implemented as a cost saving measure.

Rather, I think it should be implemented to improve the health and well-being of the populace. Personally, I think that aggregate health care costs would rise along with the scope of health care services.

[Humanist_Activist]

57. They don't have 5 or 6 figure student debt to contend with. In addition, that's in pounds. n/t

[Recursion]

59. I forgot DU comment titles strip Unicode

But, yeah: £60K, which is less than half the average US physician salary. And NHS doctors are capped at IIRC £110K, except for some hard to fill specialties.

[bucolic_frolic]

18. My 1997 MRI? $500 cash

Half the normal price.

Procedure was ill-advised and made me ill. They found nothing. Doctors were just reducing liability if you ask me.

[David__77]

27. A big question here, in my opinion is: should health care without debt be a right?

I think that it should be made to be a right that is guaranteed by the federal government. If it causes more taxes? Yes.

I believe that it will save lives and heighten health and make for a better and more productive and well society.

[guillaumeb]

32. Well said.

When we have a system that puts profits above patients, that system will only be a good system for those who profit.

[mitch96]

34. +1 too much of a profit motive in the mix.. I've seen it up close and personal

Surgeon to radiologist. "find someting, I need to cut today, got to make a boat payment" ....
he was not kidding.
m

[guillaumeb]

31. Medicare for All is very scary Joe.

For the insurance profiteers.

For the rest of us, it would be a huge improvement.

[sheshe2]

41. Beg to differ.

guillaumeb
31. Medicare for All is very scary Joe.

For the insurance profiteers.

For the rest of us, it would be a huge improvement.

Without a cost analysis. A time frame when this change would come about and what people will fall back on in the interim...just have no healthcare for a couple of years while politicians duke it out? As for Gov. controlled health care, see what they are trying to do with Medicare and Medicaid. ACA.

[Uncle Joe]

42. It's sucks for all those lobbyists as well guillaumeb.

They might have to start lobbying for beneficial to society industries for a change.

[George II]

46. Profit margin for healthcare insurers is 3-5%. Even the corner grocery store couldn't handle that.

[guillaumeb]

49. A common insurance industry meme.

One that is often cited here. If this meme were true, the insurance industry would have disappeared when the ACA was passed.

[Hoyt]

52. It is fairly accurate. But, there is a ton of volume to make 6% or so

on premium revenue quite substantial.

Cutting out insurance companies will save money, other factors equal.

But it’s not going to save so much that we won’t still be paying a lot for healthcare, and that will likely make it difficult to increase taxes for other purposes. In any event, everyone deserves affordable coverage.

[bullwinkle428]

47. Where is Bernie finding these cut-rate MRIs? Mine cost over $2500,

and this wasn’t some crazy internal organ targeting. It was the forearm and elbow area.

[myohmy2]

48. unconscionable...

…I don't see how we'll ever get a handle on the cost of healthcare when the insurance companies and healthcare providers can charge whatever they want...my entire life we've been babbling about controlling the cost of healthcare...have we?

...IMO, without Medicare being the financial gate-keeper for the American people (like they are today for Seniors) I don't see a way to force insurance companies and healthcare providers to restrain their greed...

...Bernie's the only candidate that has championed Medicare For All and hasn't fudge from his position...in the political environment we're now in, to proclaim a position then back-slide, is the certain kiss of political death...even trump clearly understands that...

...Bernie's Medicare For All will set us free from the wall-street casinos so we can put that money directly into healthcare...

...voters have lost all patience with bullshit lies and half-hearted promises...

...Bernie's the way forward...

[Uncle Joe]

50. Well said myohmy.

[myohmy2]

56. thank you...

...Uncle Joe...

[NYMinute]

54. blah blah blah blah blah