the more I read about health care pricing, the more it seems like they're basically just making up shit as they go along
I agree. Its because they know they're basically untouchable. You don't have options. You need healthcare
I work in radiology. Even being exposed to this one slice of the medical world, I can tell you they ARE making up shit.
Here in California, insurance companies pay anywhere from roughly $400 to $550 for an MRI without contrast. Add another $100 or so for "with contrast." The type type of MRI is actually the first two done one after the other, "without and then with contrast." But it's considered a third type because MRI providers provide this option as a cheap package to get people to order it. It has its own CPT code. The price of this is about another $100 on top of the MRI with contrast.
So in CA expect insurance companies to pay like 500/600/700 (price of without/with/without and then with contrast) on average.
Over in Oregon, insurance companies are paying something like 800/900/1000 on average.
Why the discrepancy? MRI machines cost more in Oregon? MRI techs, radiologists, and other medical staff paid way more in Oregon? Medical companies taxed way more?
No. It's supply and demand.
On top of that, search the internet for stories about people getting charged thousands of dollars for an MRI. Even on NeoGAF I remember someone saying something like they were charged $8000 for one. At a bar here in LA a guy I met told me he was charged $5k for a CT scan. (CT scans are actually CHEAPER than MRI scans. Here in CA on average the insurance companies are paying like, 275/325/375 or so for a CT scan for without/with/without and then with contrast). My barber told me an MRI costs $15000, based on the fact that he was charged that much for one. I didn't have the heart to inform him of what insurance companies are paying.
You will also notice that the high prices people are paying are not consistent. My barber was charged $15k while other people are charged $8k or sometimes $1k. When charging the patient, the medical providers make that number up based on their individual thinking. When charging insurance companies, they have to deal with a market value, because insurance companies have the luxury of having some leverage in negotiating. Insurance companies negotiate rates from the comfort of their desk, before they send any patients over to the medical providers. Patients standing at the receptionist counter of an MRI provider are not in the same position.
If that was too long to read, just read this: Medical providers charge you thousands of dollars for radiology scans that insurance companies pay hundreds of dollars for.
If you want some proof that MRIs and CTs don't cost as much as people are getting charged, go to look up Medicare rates. It shows you how much the government pays for an MRI, a CT, or any other operation covered in Medicare. I just happen to work in radiology and can tell you that insurance companies pay a couple hundred more for an MRI than what the government pays. Individual people often pay thousands more.
Well, kind of. Liberals (a chunk of them anyway) argue for Universal Healthcare. That's not just "Who's going to pay the bill?" Effectively Universal Healthcare is arguing that the bill can go down quite a bit. With UHC you get a monopsony and all the power then goes to the overriding insurance that everyone has. Prices have to go down in that case, because then the hospitals and drug companies are competing for the right to do their services. I would say the farce is coming from the conservatives moreso. They're the ones saying we can't afford UHC and that it lowers quality, etc. UHC lowers prices and has been proven to not lower quality.
The prices will not go down if the industry remains for-profit. That's why the only type of UHC that will work is the single payor. UHC in the form of making everyone buy insurance from for-profit companies (like the ACA does) will do nothing to lower costs.
