9/16/2013 8:30 PM ET|
Debate rages over Obamacare, medical costs
Newly public data has shed light on wild disparities in the cost of common medical procedures and treatments, which in itself could put pressure on doctors, hospitals and other providers.
When Dr. Jeffrey Rice needed to schedule outpatient foot surgery for his son three years ago, he called the recommended facility to find out what it would cost. The estimate was so high -- $15,000 to $25,000 -- that Rice asked the surgeon for a second option. The cost for the same one-hour procedure at an outpatient surgery center in a slightly more convenient location: $1,500.
Rice's experience isn't an anomaly. Costs for identical medical procedures can vary by thousands of dollars from clinic to clinic, city to city and state to state, according to federal data and other sources.
With the next phase of the Affordable Care Act kicking in Oct. 1, when individuals can begin enrolling in state-run health exchanges, debate rages over whether health care reform will do anything to rectify such pricing disparities or help lower costs.
The 2010 law, widely known as Obamacare, is meant to address the availability and cost of health insurance, not necessarily the cost of specific services. Still, supporters believe that because it paves the way for universal health care coverage, the resulting larger pool of insured patients should lower costs in the long run. Supporters also believe the high-deductible health plans that health exchanges and a growing number of employers are offering will make consumers more cost-conscious and put downward pressure on health care prices.
Detractors say the number of uninsured who will get coverage under Obamacare is not large enough to affect the cost of health care and that expanded coverage of preventive care and other services will contribute to higher prices.
"Anybody who says they know how it's going to affect costs is smarter than me, or they're guessing," says Dr. Peter Ubel, a medical doctor, author and a professor of business public policy and medicine at Duke University. "This is the kind of stuff that will unfold over the next few years."
Making health care costs more transparent
The uncertainties over what could happen haven't slowed a movement to make health care costs more transparent, and some argue that holding doctors, hospitals and other providers more accountable for what they charge will on its own help drive down costs.
Today, what hospitals or doctors charge isn't determined by quality of care but by market power, says Rice, who is chief executive at Healthcare Blue Book, a medical care cost-comparison website. "If you're an academic medical center with a good brand name you'll be paid more than an imaging center. If you're a hospital chain you might be paid more than an individual hospital," he says.
Last May, the federal government's Center for Medicare and Medicaid Services helped shine a light on costs by publishing for the first time Medicare charges for the 100 most frequently billed discharges at 3,000 U.S. hospitals. For example, bills for treatment of chest pain at 10 Bay Area hospitals in 2011 ranged from an average $21,044 at Chinese Hospital in San Francisco to $53,408 at Seton Medical Center in Daly City. The average Medicare reimbursement for the treatment ranged from $4,575 to $7,795.
Since May, websites such as NerdWallet and OpsCost have created user-friendly services that make it easy to browse the government data. One Oklahoma mom used OpsCost to contest a bill for her daughter's emergency room visit that included a $260 charge for acetaminophen, the pain reliever better known by the brand name Tylenol, says OpsCost co-founder George Kalogeropoulos. A Tampa man whose family doesn't have insurance used it to find a hospital for his wife to deliver their baby.
"It's also been very surprising how many hospital CFOs and billing experts have been asking us for data about their competitors, other hospitals near them," Kalogeropoulos says. "Generally speaking, there is a lot of unease in those circles as prices have been set in a fairly irrational and arbitrary way for so long, and these folks know that a storm is brewing with the push for transparency."
Other tools have popped up to help people pick low-cost health care providers. Healthcare Blue Book supplies pricing information found in the health care section of Angie's List, a subscription-based consumer review website. Healthcare Blue Book also licenses its database, which is compiled from commercial and private insurance data, to insurance carriers to share with their corporate clients' employees who can use it to choose providers.
But prices can vary widely even within an insurer's network of approved providers, Rice says. "Patients have to shop the network, that's the biggest message that I can get out," he says. "Otherwise, you don't find out until after, and pay several thousand dollars too much."
Hospitals sharing prices
In another sign of transparency, some hospitals are starting to advertise their fees. In August, the Surgery Center of Oklahoma posted prices for common procedures, including $1,925 for putting a cast on a broken arm and $6,990 to repair a knee ligament. North Carolina Gov. Pat McCrory recently signed a bill requiring hospitals to disclose prices for 140 common medical procedures.
"More states are starting to put requirements out there for hospitals to post prices," says Ubel, the Duke University professor. "That's going to change the culture of medicine almost as much as anything else. That's not from Obamacare, it's more just everyone realizing they have to look at why they're spending so much money on health care."
One way that Obamacare could eventually help drive down health care costs is if hospitals are motivated by it to join accountable care organizations, or ACOs, groups of service providers who band together to offer coordinated care at lower prices. "Obamacare gives (providers) incentives to do this, and if that has a big effect on how medical practice works, it could lower costs," Ubel says.
According to Kaiser Health News, more than 428 hospitals have joined ACOs, serving an estimated 4 million Medicare recipients and about 14% of the U.S. population.
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all this is for 13% of the population.
I read some where if you had a Medicare supplement plan nothing would change. Scratch that. I got my explanation of benefits today and somebody screwed the dog. Everything went up by a ton. I don't know where these so called experts on the cost of health care get their info. Obamacare is a big hoax. The insurance companies already have found loop-holes by raising deductables and drug copays. They won't suffer, but the common folk will.
The post office is always broke.
Amtrack gets bailed out regularly.
Homeland security is a money eating joke, and they think that another amnesty is going to help.
Social security, medicare, and medicaid are all broke or real close to it.
The government isn't supposed to be able force you to buy anything, especially from them.
This socialism BS doesn't work. And neither do most people anymore.
The ACA, aka, ObamaCare will do nothing to control costs. It still relies upon a fragmented and inherently inefficient system of private insurance plans that negotiate pricing according to market clout. You could not design a less cost effective system if you tried! This will be an epic disaster for consumers, but I'm not entirely convinced that tha wasn't the plan all along.
And for those of you that missed his first term, obama sucks too. What a surprise.
"This will be an epic disaster for consumers, but I'm not entirely convinced that the wasn't the plan all along."
no kiddin?? where the phuck were you azzwipes 5yrs ago??? all this has been said, looks like Lilmbaugh, Hannity, Savage, Levin, Crowley, etc, etc were right all along oh yea and Sarah Palin about the 'death panels' it was that pig sebiilious or whatver the hell her name is that almost let an 11yr old girl die that needed a double-lung transplant! had it not been for bad publicity that little girl would be dead. PROOF that 'death panels' do exist! LIVING PROOF in fact!! you vermin that voted for that muslim bastard really should have a nice deep place in HELL for you to exist in for all the damage you've done to the nation, at least you WILL BE IN THE SAME BOAT AS WE ALL ARE, you're not exempt but lo' and behold the politicians are!! always a different road for those cksuckers naturally!! GAAAAAWD I hate to say but this country makes me sick! just sick!
"wow, I see all the conspiracy crackers are out in force on this one"
"The best healthcare system on the planet, according to the World Health Organization, is France"
"Just base our coverage along the lines of how it is done in places like England and Norway and we will be fine. If they can do it, so can we."
Question: Isn't that fraud?
Doesn't someone who intentionally takes you and I through obamacare with its cost and its dividing America IN TWO - just to get to nationalized health care - belong in jail?
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