At One Hospital, a C-Section Can Cost Anywhere From $6,241 to $60,584

Mish

The cost of standard medical procedures can vary at the same hospital by a factor of 10 or more depending on who pays the bill.

Broken Health Care

How much does a C-Section cost? The answer is complex, but At One Hospital, Anywhere From $6,241 to $60,584.

When a woman gets a caesarean section at the gleaming new Van Ness location of Sutter Health’s California Pacific Medical Center, the price might be $6,241. Or $29,257. Or $38,264. It could even go as high as $60,584.

The rate the hospital charges depends on the insurance plan covering the birth. At the bottom end of the scale is a local health plan that serves largely Medicaid recipients. At the top are prices for women whose plans don’t have the San Francisco hospital in their insurers’ network.

“It is shining a light on the insanity of U.S. healthcare pricing,” said Niall Brennan, chief executive of the Health Care Cost Institute, a nonprofit that analyzes medical costs. “It’s at the center of the affordability crisis in American healthcare.”

Trump Fought Secret Prices

On June 27, 2019, President Trump issued an Executive Order titled “Improving Price and Quality Transparency in American Healthcare to Put Patients First"

Informing Patients About Actual Prices. (a) Within 60 days of the date of this order, the Secretary of Health and Human Services shall propose a regulation, consistent with applicable law, to require hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients' decision making and allow patients to compare prices across hospitals. The regulation should require the posting of standard charge information for services, supplies, or fees billed by the hospital or provided by employees of the hospital. The regulation should also require hospitals to regularly update the posted information and establish a monitoring mechanism for the Secretary to ensure compliance with the posting requirement, as needed.

The American Hospital Association fought the ruling on first amendment rights.

On December 29, the U.S. Circuit Court of Appeals in the District of Columbia  upheld a district court’s ruling that the transparency requirement was legal.

Hospitals are now required to publish the rates they charge specific insurers for 300 common services considered “shoppable” in a way consumers can easily access. 

Trump fought secret pricing and won. It was one of the best things Trump accomplished in his term. 

Shocking Details

Charges to Different Insurance Plans

Depending on Who Pays

  • Heart Procedure: $89,752 to $515,697
  • Spinal Fusion: Under $50,000 to Over $250,000
  • Hip Replacement: $3,264 to $81,617
  • C-Section: $6,241 to $60,584. The cash rate is $38,264.

Those are not rates that vary across the country or based on the skill of a doctor. Those are rates at the same hospital that depend on who is footing the bill.

Problems and Skin in the Game

The penalty for noncompliance is a mere $300 per day. Thus, I am surprised there is any compliance with Trump's executive order at all.

The second problem is many don't care. Once a person has met their deductibles they do not care. 

Those on Medicare or Medicaid do not care. 

Those with no insurance, no job, and no ability to pay do not care either because no one is ever turned away.

Unless and until there is skin in game in the pocket of the consumer including consequences for not buying insurance these problems will not vanish.

No insurance? OK. We will treat your pain and even fix a broken leg, etc. But Chemo? An emergency heart transplant? Where should the line be?

Medicare for All?

The problems with Medicare are obvious. 

  1. There are no cost controls anywhere.
  2. There is unlimited demand for free services 

We need more competition and more transparency. Trump's executive order was a welcome albeit small step in the right direction. 

Mish

Comments (91)
No. 1-34
Doug78
Doug78

Only now you say it?

WarpartySerf
WarpartySerf

What would you expect from a Health Industry that is nothing but criminal racketeering ? Cuba's life expectancy is the same as the US ..... and re children dying in the dirt , infant mortality rate ..... can you guess ?

Infant Mortality

Compared with other OECD countries, the U.S. ranks No. 33 out of 36 countries (Figure 62). Iceland is ranked No. 1 and has the lowest rate with 0.7 deaths per 1,000 live births.

JJKthree
JJKthree

Read "The True Cost of health Care" by Dr. David Belk. He explains in vivid detail the how and why of the scam we call Health care.

FromBrussels
FromBrussels

MY GOWD ! Those prices, I can t believe my fckn eyes...you actually ARE a utterly insane nation ! In september I had a cervical micro operation( a foraminotomy) in one of the best belgian hospitals, the UZ Brussel, as I wanted a single room(3days), fees almost doubled but even then the total price was below 8K Euro, most of which was paid by the state's social insurance and the single room extras covered by a hospitalisation insurance costing me 300 euro /year ...Your situation is definitely OUTRAGEOUS !

TanksAndSpartans
TanksAndSpartans

This was on 60 minutes. I don't recall the details, but I think the gist of it was that they bought up all the competition to create a monopoly. At the point, they could charge whatever they want - no competition. Not in CA, my doctor's practice was also purchased by one of the larger system's a few years ago.

PostCambrian
PostCambrian

You have spotlighted a big problem but come to the wrong conclusion. People on Medicaid and Medicare probably don't care too much about the cost but it actually doesn't matter much because these rates have already been pre-negotiated. Similarly with those who go to a hospital which accepts their insurance. The rate has already been negotiated and most likely the procedure has already been pre-approved. You are asking a lot if you expect the consumer to be fully educated on medical procedures and their costs, especially when the hospital won't tell you. I will agree that there is a huge demand for free services however these are mostly stoked by advertising by a few providers of devices and services. It would be relatively easy to crack down on these few providers. Another way would be to have a nominal deductible. Most seniors and the poor don't want unnecessary medical treatment although some are not knowledgeable enough to fend off unscrupulous providers.

The big problem is either those without insurance or those who have an unexpected procedure (say they are out of town and suddenly need that C-Section) or need to go to the ER. These people will not have time to research which hospital accepts their insurance (if any). Then the people without insurance (most likely the working poor) will run up a huge bill and then be taken to court, have wages garnished, and perhaps file bankruptcy. Those with insurance (but is not accepted by the hospital) will have a huge deductible to pay (and perhaps run into the same problems of garnished wages or bankruptcy) and then the insurance company will pay the rest of the hugely inflated charges. This increases the insurance costs to everyone.

I don't know what the solution is but one idea that I have is that people without insurance should have the right to pay 120% of the Medicare allowed amount in cash. This would at least prevent hospitals from ripping off the poor. And to prevent hospitals from ripping off insurance companies (and ultimately the consumer of this insurance), insurance companies that do not have pre-negotiated rates would have the right to pay 120% of the mean of the hospital's pre-negotiated rates with the insurance companies that the hospital accepts in an out of service area and/or emergency situation.

Greenmountain
Greenmountain

I understand why deductible look attractive, but they are not IMHO. In a system where you have $6K deductibles, most people can not afford that. Sure if you are making over $100K but for the rest of America, the choice is not to go to the doctor unless it is an emergency so all preventive medicine is out the door as well as medications that could make people's lives better. Talk to primary care docs in rural America and they will confirm this. It is just not clear to me why this country feels it is ok for so many people to have no medical insurance. Wouldn't we want people to be healthy? And most of the rest of the world has figured out how to do this. Let American continue to be proud of the most expensive and least effective medical system in the world - unless you are rich.

Sechel
Sechel

The Swiss health care model which the Isaelis have also adopted is the best compromise if one wants some free market discipline and ensure that the bottom rung of the ladder get subsidized health care

AnotherJoe
AnotherJoe

"There is unlimited demand for free services "
Unless you have numbers that prove that, I call fake news. Do you think that if colonoscopies are free there will be a mad rush to get them? The only reason that demand for "free" services may be high is because hospitals push the services to increase revenue.

Tanner D
Tanner D

I have lied and said I don’t have insurance so that I can receive the cash rate. Often cheaper than the amount i would have to pay going through insurance and then paying the “uncovered” portion. This is in part because with work in construction and we get bottom of the barrel insurance.

Frilton Miedman
Frilton Miedman

It nauseates me that the Healthcare debate revolves around insurance with almost no focus on price.

Total cost of healthcare in 2020 was over $4 trillion, that's $12.5K for every person.

For comparison, the UK spends $2500 per person.

The bulk of this difference is in supplies & pharmaceuticals.

Insurance has become a place for suppliers to hide pricing.

Personally, I'd prefer a system where we pay directly, where hospitals are mandated to offer loans for larger procedures....at least as a parallel option to insurance.

The consumer would have direct exposure to pricing, to shop, to ask questions.

It would also push healthcare into a true free market.

Our current system of private providers largely funded by tax money is failing, miserably.

riten
riten

We all have witnessed how slow and poor our gealth system is by it's response to covid crisis. This is the most expensive, non-transparent and inefficient system tolerated by the people on the planet.
Look at many countries in Europe abd Asia where healthcare is affordable and efficient. It us clear that our system needs to be demolished and replaced by a brand new system that is affordable without insurance, transparent and efficient.
This cannot be achieved without looking at tge reasons for such high prices starting with the cost of medical education, medicines, equipments, reagents, and so on. A carefully built new system with eyes on cost at every level is a must. An ideal system is where a oerson earning basic pay should be able to pay hospital bills without insurance. It is possible. I do not see the willigness.

davebarnes2
davebarnes2

I think the "$60,584" is probably close to $100K more than that.
It is all about the codes.
You read "c-section" and think that is the cost of the women having her baby delivered that way.
Nope. that $60K does not include the anesthesiologist, the hospital stay, the Kleenex charge, etc.

TwisterTim
TwisterTim

The solution is to turn our "sick"care system into a health care system....this can be done by changing the tradition medical model of testing ( looking for issues for which to invoice ) to running complete nutritional profiles on each American. Most chronic illness is due to a deficiency of one type or another. Seniors are particularly vulnerable to deficiencies. For instance,Vitamin D has been shown to be protective in all respiratory illness including COVID-19. Other nutrients are protective against heart disease,diabetes,dementia. Currently ,Doctors are not allowed to screen for deficiencies,unless the patient asks for a particular test. The system is a"SICK" care system,not HEALTH care !!!!! Often a drug leads to another drug which leads to another and so on. Loading seniors up on drugs is big "sick" business !! Our Nutritional profiles need to be normalized and maintained; this would be far less expensive than the current approach.

FooFooFed
FooFooFed

Shocking Details... Housing overvalued, Stawks overvalued, Fed pumping 1.5Trillion, why not HealthCare overvalued?? What? its ok for BTC Amazon Tsla to be nosebleed but not when it comes to fixing a knee or c-section?? Follow the leaders. Contractors in Sutter area are charging 700 sq/ft on rebuilds and almost 200$ /hr on general stuff.

Carl_R
Carl_R

First of all, part of this is understandable, that being the huge difference between Medicaid and full-pay. Hospitals are forced to handle Medicaid patients at a huge loss. If Medicaid patients were all they treated, hospitals would go broke, or at least, turn into ramshackle dumps. Basically, it's a way of making everyone pay for the medical care of the poor without having it show up on the government books.

It is also understandable why rates are different between network and non-network payers. What is less understandable is why they are different for different insurers. If I was an insurance company that had a contract with a hospital, and I found out that my price was higher than other insurers using the same hospital, I would be furious.

What this doesn't go into at all is the rate paid by uninsured people. They presumably are charged the out-of-network price. Of course, from that price, the hospital or doctor is willing to negotiate a discount for prompt payments, but how big the discount is varies from doctor to doctor.

Having prices out in the open will be very helpful for everyone. I personally am very well aware of how different the rates are. I went without insurance for the last 20 years or so. As a result, when I needed care, I would price shop, calling various doctors and getting prices. They are very, very different from one doctor to the next. For example, I needed to visit a urologist for a routine visit. The local Doctor group (who essentially has a monopoly) wanted about $650, and would discount it by 10% if I paid at the time of visit, so $585. One 40 miles away would charge $400 and would discount it 50% if i paid at the time of visit, so $200. The less expensive one was my preference anyway, as he had higher ratings online, and I had personal experience with both practices from 25 years ago for another issue.

Yes, prices are crazy. Yes, transparency is at least part of the answer. When you go to buy a TV, you can price shop. As a result, vendors compete on price, and prices keep going down, while quality goes up. When you buy medical treatment, you can price shop, but few do, so prices rise, and quality remains hard to evaluate.

Carl_R
Carl_R

There was a huge change in the 1990's. At the time I was involved in Tuxedo rental. At the start of the 1990's, almost all high school Seniors wore a 27-29 inch waist pant, or a 31-33 waist, with a moderate number of 34-36 pants, and few above that. By the end of the 90s there were few 27-29 waist a moderate number of 31-33, and most were 34-36 or 37-39. So, in a decade the waist size of the average high school student went up about 5 inches.

Eddie_T
Eddie_T

Lots of good comments....I am very aware of the problems here, but I have a hard time seeing any of it getting fixed with Big Insurance calling all the shots....which they are.

I still like single payer. Imho it’s the only way to get rid of this monstrosity the corporate insurance industry has built. One payer, one price. No profits to CEO’s and no bonuses for screwing the public.

Eddie_T
Eddie_T

Once again today the dollar is trending up.....barely, and with lots of dips. The dollar bottomed Wednesday and bounced....then dropped down to touch the same bottom (90.27) yesterday. Made it all the way up to 90.72 this morning but currently falling again.

Gold and silver are spiking when the dollar dips...but I doubt the trend will be much higher unless the dollar daily cycle fails and we drop below the January low....it still looks like the dollar will head higher to me.....but boy is it ever sluggish.

numike
numike

“Disease is the biggest money maker in our economy.”
― John H. Tobe

humna909
humna909

The problem isn't Medicare or Medicaid it is the privately run hospitals and insurance companies and the history about the chargemaster.
While it is a lightweight format, this is actually a good explainer:

I live down under, broke my ankle and required surgery. It cost me $0 out of pocket to have it done by one of the better ankle surgeons in the city if not the country. (This is the case regardless of insurance.) But the notion that there is unlimited demand for ankle surgery because of its low price is pretty absurd. The care and rehab assistance I received was great, but I would not choose it again.

On the flipside, my one experience of medical care in the US was actually good and 'cheap'. This was a clinic on an expensive ski mountain so I expected eye watering prices, but once I asked about pricing and signed the form that I wouldn't be claiming on US medical insurance the price dropped rapidly. I got to see a specialist quickly and cheaply.

Jojo
Jojo

I had some throat surgery back in Dec. Had to have a growth cut off the back of my tongue and inserted a bit of filler into the vocal folds due to apparent atrophy. I think I believe the whole operation took under 1 hour under general.

The MD/hospital (Stanford) billed $69,132.27 via 16 items, many with the same exact codes but different prices. Medicare allowed a total charge of $4,159.13, zero of which was out of my pocket. [lol]

I always wondered what the purpose of bills like this was? The biling people know exactly what Medicare is going to pay them, so why bill a very large number knowing it will be knocked down? Do they use the difference as some sort of tax write-off? Or are they trying to impress someone?

JoeJohnson
JoeJohnson

Case in point at how our government saves money. Florida eliminated infant circumcision as an option under Medicaid because it's arguably considered cosmetic. 5, 10 years later there was a increase in child circumcisions done for therapeutic reasons which involves a urologist and an ansetheologist and costs thousands of dollars more negating the savings.

ToInfinityandBeyond
ToInfinityandBeyond

The problem with healthcare in this country is that it encompasses many types of medical / business services none of which has an incentive to reign in costs. In fact, the opposite is true in that they try to maximize profit at every turn. A relative of mine in Portugal recently required emergency surgery. My relative, who does not have any medical insurance coverage, elected to use the best hospital in the area and was required to pay the €12,000 (Euros) surgery cost up front. A bargain compared to the US where as a retiree I am paying Medicare and supplemental medical insurance costs of almost $10,000 a year for my wife and I.

Realist
Realist

Mish is very thoughtful and analyzes many issues thoroughly before he speaks about them. His conclusions are typically spot on. However, there are two major issues he consistently gets wrong, though I am not sure why he gets so lost on these issues: US Health Care, and Global Warming. Regarding health care, he often ignores that many other developed nations provide pretty good health care (arguably better than the US overall), for 40% to 50% less cost. Yet he rejects their assorted single payer systems. Why you would outright reject these far more efficient systems, is a mystery.

Mish
Mish

Editor

"is unlimited demand for ankle surgery because of its low price is pretty absurd. "

Stop misquoting me. I did not say unlimited demand for every service. It was a generalized and accurate statement.

And a true one especially if one looks at what Democrats want: Free education, free shelter, free living wage, free this, free that and on top of it all unrestricted immigration.

Sheeesh

Yes, on those terms, and it should be damn obvious what I was discussing, there is unlimited demand for free stuff

Mish
Mish

Editor

"many other developed nations provide pretty good health care (arguably better than the US overall), for 40% to 50% less cost. "

I have discussed that at least a dozen times.

Other nations have caps on education costs, doctors costs, time delays to get a surgery (Canada), etc etc, and above all the right to die and not wasting money so someone lives another 3 months in critical care in pain.

The problem is not that easy to fix but it would help to have less expensive education, more doctors, and above all RIGHT TO DIE that I have discussed countless time only to have false claims that I have not gone over this.

Captain Ahab
Captain Ahab

The key to reasonable health costs is the importance of price discovery. It's essential not only for options, futures, and derivatives. ALL MARKETS need price discovery! Until customers can shop medical services by price, there is NO competition. Without price discovery, there is no need to innovate to reduce prices, no need to be an efficient supplier, etc. So yes, Mish is entirely right that Trump's plan was a big step forward.

How long before Biden signs an executive signs an Ex. Order to the contrary?

Cajundoug
Cajundoug

Bust the trusts. It’s racketeering.

GeorgeWP
GeorgeWP

My country has better health outcomes on pretty much any measure than the US at half the cost per capita. And one reason certainly seems to be an anti competive protection racket for health care providers. On a visit to CA. I when to a pharmacist to get a tube of cream for my son. About $10 over the counter at home. In CA. was $60 and I had to get a doctors prescription. All up about 15 times the cost.

Captain Ahab
Captain Ahab

Some reasons why US Health Care costs are high...

#1 Obesity
#2 Related to obesity, poor nutrition and lack of exercise
#3 Non payment of hospital bills
#4 A litigious society

One-armed Economist
One-armed Economist

Take a look at how prescription prices can vary. Online my script is anywhere from $9.90 to $236.98. An order of magnitude of 23 times!
The status que wants to divide and conquer. We don't have a free market b/e that assumes "perfect information" and health care doesn't want you to have that. Nor "substitute goods". We just have a oligopoly of chaos.


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