Price of a hospital circumcision in the US: $23,000

Mark_Frauenfelder

Please don’t turn this into a discussion about why or why not males should be circumcised. This isn’t what this post is about.

tylerkaraszewski

That’s going to work about as well as posting about how much it costs to kill an Iraqi civilian with a Predator drone and telling people not to talk about wether we should kill Iraqi civilians, only about how much it is reasonable for that to cost.
- http://grumer.org/ Avram Grumer
  
  If someone would program Predator drones to perform circumcisions, then we’d have a thread!
  - Lobster
    
    Oh, they can. In fact they can take off far more foreskin, far faster than a human doctor, and on multiple targets at once.
  - bobk
    
    Aren’t those targets already circumcised? Now, if you could get the Predators to sew it back on, you might have something there.
http://twitter.com/perizade Perizade

Well, if that extraordinary price is supposed to be a deterrent, I think it might be good to talk about that. Does the hospital have the right to deter circumcision, as it’s an unnecessary procedure, by attaching such a fee?
- oasisob1
  
  I like your use of the word ‘attach’.
http://www.facebook.com/profile.php?id=692271352 Rob O’Daniel

But it IS. This is about an utterly needless procedure. And it’s being performed in a hospital facility per a physician’s recommendation (or more often, outright insistence).

Now sure, the charges on this are beyond reason, but that wouldn’t even be an issue if this mutilatory & unnecessary operation was not being performed.
Frank W

Srsly, Mark? Sending the bill is the only point of the whole operation.
DewiMorgan

If you didn’t want people to discuss your hot button topic, why on earth did you post about it?
anneymarie

Well, the reason the price is probably so high is that it’s an elective surgery so it is related to the necessity of circumcision.

P.S. Breast implants are pretty pricey too!
- jerwin
  
  Breast augmentation apparently costs between five and ten thousand dollars. The procedure involves general anesthesia.

http://ordinarystrangeness.com/ holladown

My son’s was done at home, cost 500 bucks, from a moil. Great job, yet a horrible experience.

Guest

How’s that for-profit medical system working for ya now?

http://www.facebook.com/russingram Russ Ingram

heavily-regulated for-profit…
- fnarf
  
  “Heavily regulated” doesn’t have anything at all to do with why health care is more than twice as expensive in the US than anywhere else. It’s systemic. The system is designed to produce absurdly high prices that rise 10-15% a year forever.
grimc

What makes you think it’s working at all?

jon_anon

Ah but does that cost include the potential penile amputation that this gentleman awoke to discover after his own (adult) circumcision? http://preview.tinyurl.com/3mz5hzg

OldBrownSquirrel

My son’s was done at home, cost $700, from a mohel. The catering was extra. There weren’t any problems.

A few days later, he had a supernumerary thumb excised, in a clinic. That cost significantly less than $23,000.

RJ

Sounds like an antisemitic pricing strategy.

http://twitter.com/perizade Perizade

That doesn’t make much sense- hospital =/= mohel.

cservant

How much is it just to stay in a bed and just get your temperature checked?

xunker

I enjoy how no one read the VERY FIRST COMMENT from Mark about this not becoming a pissing match (pun intended) about male circumcision. (edit: moderators are on this now in force.)

That being said, some states have statutes on the books where you can challenge each charge and ask for a billing breakdown about why things cost what they did. Some times you are also allowed to ask for a comparative survey with other operations done at the same facility to see if your charges are vastly out of line. It does vary from state to state but I would guess that MA is the one that may give you options.

Marktech

I enjoy how no one read the VERY FIRST COMMENT from Mark about this not becoming a pissing match (pun intended) about male circumcision. (edit: moderators are on this now in force.)

I read it, which is why I didn’t comment: those who respected the request presumably self-selected themselves out of the thread. Besides, I expected that somebody else would be along to say what I would have said, and say it better; I was right.

I think it’s unwise to ask for comments to go, or not to go, in any particular direction; but it’s Boing Boing’s bat and ball, as I said when Disqus came in.

http://www.facebook.com/profile.php?id=19225587 Jeff Dailey

I’ll leave this here.

fnarf

It costs that much because no one pays. Your insurance pays, and your insurance is paid by your employer (in America, if you don’t have an employer, you don’t have insurance, and you get your medical treatment, if any, in the ER). There’s no incentive for anyone to charge less. Your employers would love to pay less, but health insurance is operated by cartels; there is no negotiating, only taking it, and taking it, and taking it.

Nice exotic hardwood paneling at the doctor’s office, though.

Lobster

Nice exotic hardwood paneling on your soap box, too.
- fnarf
  
  That’s funny, I thought there’d be some substantive criticism here, but instead, this. My analysis is correct. Health care is majorly borken. You can’t possibly have not noticed this, unless maybe you’re twenty and have never been to a doctor before.
  - Lobster
    
    If you’re looking for substantive criticism here, maybe your point should be more substantive than, “I am right.”
    
    Healthcare is broken. It’s just not as simple as you say it is. Think that maybe that’s possible? That maybe a system with generations of history, involving millions and millions of people, with billions of different treatments, billions of different problems and billions of different bills, designed specifically to be difficult to understand, might POSSIBLY be a LITTLE harder to fix than your little one-paragraph summation of what you perceive to be THE problem, without any offer for the beginnings of an answer beyond, “hey let’s not do that?” Do you think that just MAYBE it’s not so simple? Maybe? That maybe it’s even so complex that no one human on the face of the earth could truly understand each and every facet to a point where they could know, clearly and without any experimentation or speculation, how to fix things for everyone? Maybe?
    
    How’s that for substantive criticism?
    - fnarf
      
      Better than nothing, but still piss-poor. Condescending, uncomprehending, and dim.
      
      Actually it is quite simple to solve, and yet impossible at the same time. Single-payer is your answer, but it will never happen. Not until health care is 75% of GDP, and not even then.
Alan

Um, that’s not exactly true. My employer pays a lot of my premiums, but I pay a portion, too. And that’s getting to be more and more. And it’s those expensive premiums that pay for the outrageous bills like the one being cited here. And, because the premiums are so expensive, small employers with low overheard or the self-employed are dropping health insurance as a benefit, meaning more people in the ER, which is often tax supported, which means either more taxes, which everyone pays, or fewer services elsewhere, which everyone pays for and don’t receive.
I do agree with you, though – the system is way broken. And keeping insurance companies in the game isn’t going to help.

Private Private

Never pay full price for circumcision. Always wait for a ‘Ten Percent Off’ sale.

http://profiles.google.com/james.m.aaron James Aaron

That includes anesthesia, because the person waited too long to have it done. Doctors will routinely do circumcisions on newborns without anesthesia and it costs very little money and is done outpatient (meaning you don’t have to pay for the hospital side of things). When you wait 14 months, that’s what happens. It’s also usually not covered by insurance, because it’s cosmetic.

phisrow

I’d be curious to know what type of anesthesia it covers.

Topical gels and/or local injected stuff should, in a sane world, add fairly minimally to the cost. General, on the other hand, is both much more complex, and something you don’t exactly want to skimp on quality with…
http://twitter.com/perizade Perizade

Mystery solved! :)
PrettyBoyTim

Wait… they circumcise little boys without anaesthesia? Seriously? In the 21st century?

How can that *possibly* not be child abuse?
- http://about.me/rosemwelch Rose M. Welch
  
  Because they’re too young to sue over it. :(
http://about.me/rosemwelch Rose M. Welch

No. No, it doesn’t. The need for anesthesia is the same a day after birth or a year after birth. Further, full anesthesia isn’t necessary. Most physicians use a little numbing cream and a plastic ring thing-y. My doctor offered to do it for $300, which he called his ‘golf money’. We declined.

VerySincerely

Oh that’s just the invisible hand of the market magically making everything wonderful and fair for everyone. Hooray for unfettered capitalism!

Kludgegrrl

In Ontario (in Canada) circumcision is deemed to be an elective cosmetic surgery, and so it is not covered by OHIP… you have to pay for it. that said, it only cost about $150 (by a pediatrician, in a hospital, with local anesthetic). I suspect that, in those instances when it is not deemed elective (which do occur, some boys have medical problems that require the removal of their foreskin), there would be no fee.

IMHO, as someone whose son *was* circumcised, the practice here seems pretty equitable. The prices for most medical procedures in the states are a bit insane.

factswonthurtyou2

It does cost money in Canada because it is considered ‘cosmetic surgery’ hence not covered under the Health Care Plan.

But the cost is puny compared to the mentioned quote ………..

Circumcision

Newborn $ 150

Other $ 900

What does the fee cover?

Answer: The fee covers the cost of the use of the equipment, medical/surgical supplies, drugs, staff time and other supplies and expenses incurred during the procedure

http://www.cvh.on.ca/admin/about_procedure_fees.php
- jerwin
  
  The fee covers the cost of the use of the equipment, medical/surgical supplies, drugs, staff time and other supplies and expenses incurred during the procedure
  
  But neither the physician nor the anesthesiologist are employed by the hospital; and they will charge for their time.

weendex

I’m pretty sure elective surgery in a hospital is always very costly. It is a terrible waste of hospital resources. I’m sure there are tons of private practices that would do this for a more reasonable cost. You don’t get nose jobs or lasik at the hospital either.

mtdna

The next issue of Make Magazine has an article on how to do it yourself.

irksome

Popular Mechanics already did it. Also, Modern Crafting. I had my foreskin tanned and made it into an attractive and practical coin purse.

When I rub it, it’ll hold $11.37.

http://twitter.com/Skepgineer skepgineer

The prices are bullshit because there is no prior price information given to customers. They generally refuse to tell you the exact price until after you’ve become obligated to pay it, and certainly won’t provide that info over the phone, so there is no way for customers to shop around for the cheapest provider of the same service.

http://twitter.com/jhritz jhritz

Seems strange that someone would wait 14 months. I suspect that has something to do with the need for anesthesia. Frequently its done to newborns without any pain relief. When they do, its a local. The 23k quote sounds like an outlier.

http://glitch.tl/ Michael Smith

Frequently its done to newborns without any pain relief.

Yeah my mother told me that this was the reason I wasn’t circumcised in 1965. She was put in a room adjacent to the room where they circumcised the newborn boys. The sound was horrible. Thanks Mum!

jerwin

How does this compare to the prices charged by plastic surgeons, for say, elective rhinoplasty, or breast augmentation? IIRC, those are not covered by insurance.

Mister44

Tort reform. That’s all I’m saying.

grimc

Just curious: What do you think a reasonable price for your primary hand would be?
- Mister44
  
  Sorry man – you can’t sell organs and body parts in the US. I wouldn’t ask such questions, you could get in trouble.
  - grimc
    
    Nice dodge. But if you’re going to promote tort reform as the answer to medical costs, you should have some ballpark figures about what the limits should be for an arm, or an eye, or a lung. That’s what we’re really talking about when it comes to ‘tort reform’.
    - Mister44
      
      Why should *I*. I am hardly an expert. I think something like a “blue book value” would be prudent. Why should one person get $X for a missing hand, and another person $Y – the difference being who had the better lawyer.
      
      I see a lot of Drs for my issues. I have friends who are Drs, and then there are Drs the kiddo has seen. I have asked over a dozen of them what they thought would be the one thing to effect health costs the most. Everyone one of them said tort reform. My wife who is a layer and works in health and retirement plan law has said tort reform. I am inclined to listen to these people. You can look at the states with the worst tort laws and see how they are losing Drs to other, friendly states.
      
      Not wanting to only rely on the fallacy of appealing to authority, they saw two big cost that tort reform would rein in. First was malpractice insurance. It is a jaw dropping number what a general practitioner has to pay for malpractice. For small, on Dr offices, this puts a huge strain on their business. These people are not performing surgery or anything like that, but they still pay a very large number in case they get sued for missing a disease that only Dr. House would be able to diagnose.
      
      The other thing was because of their fear of being sued, drs order a ton more tests than what would be prudent otherwise. Needless MRIs and other expensive tests rack up the insurance company costs, raising your premiums etc
Beth Gibson

What’s tort got to do with this all? I woulda thought it contract law

Michael Schade

anesthesie is definitely driving up the cost here, at 14 months those kids feel enough anxiety to not hold still, always bad for a surgical procedure. Your option are regional anesthesie (research caudal block and penis block) but if the little one squirms the anesthesised parts move with it. The other option is a general anesthesia which is the procedure with the highest risk ( for death mind you) amd the Mayo Clinic found that anesthesia in children under 4 could lead to learning disabilities, so i’d advise against this elective surgery

Glenn Fleishman

This was a problem in Seattle, too, with hospital treatment of routine things. A woman went into a clinic associated with a hospital for a “blemish” removal. She was charged $900 hospital fee, even though another clinic run by the hospital nearby wouldn’t have levied that fee. She sued and won, but that was about disclosure, not about charging the fee.

When my podiatrist moved his practice from the same hospital’s specialty clinic (no hospital fee) to the hospital proper, I had to find another practitioner as a result. The extra fee is related to profit and overhead across the hospital, rather than anything to do with an individual patient’s costs.

http://profiles.yahoo.com/u/TGZ75URQ6DKTCNXV3RV36ZKALQ Matthew

I wonder if a single-payer healthcare system would solve this type of problem. Too bad we’ll never find out. Even when democrats had full control of congress and the white house, the senate filibuster kept them from getting the healthcare bill they truly wanted. I’m hoping the changes that will force everybody to buy insurance, and keep the insurance companies from denying coverage will cause healthcare costs to go down for people.

http://www.facebook.com/profile.php?id=687197532 Teddy Hotdogs

Imagine the cost of foreskin replacement!

Moe Hong

A mohel would have done a better job for $50.

http://twitter.com/Skepgineer skepgineer

Two policy recommendations, which should break the confusopoly and restore competition enough to drive prices down considerably:

1. Ban price discrimination in healthcare. The same hospital must
charge everyone the same price for the same procedure, less what their
insurance pays.2. Those exact prices for common services must be publicly posted in
the hospital and on the web, and be available to anyone who calls
them, without wishy-washy evasion. If certain complications may alter
the amount of services that need to be rendered during a procedure, the
probability and cost of that should be amortized into the posted price.

Layne

A good start, at least. Better than the usual tired, misdirected “GREEDY CORPORATE OVERLORD$” argument that springs up whenever a crazy story like this gets some attention.

The medical system today is very far from operating similar to anything resembling a typical unfettered business. Federal health payouts, laws regarding care, rampant lawsuits, employment based insurance, restrictions on inter-state insurance, and the opportunities for fraud are just a few of the factors combining to turn your average doctor/hospital visit into a payment nightmare.

Attempting to force even more controls and price fixes on the market isn’t going to result in better, accessible care. Instead, we seem to be doubling down that a bunch of bureaucrats (who can’t understand the internet, technology, copyright etc.) are going to shake off their big money influences and solve the complex systems of healthcare market.
Good luck with that.
Lobster

And how would this drive prices down instead of up?

You seem to be forgetting something here. The competitive marketplace only works when someone has a choice. When your choices are, “pay my price” or “die,” you don’t always have time to price match and clip coupons. It’s also not reasonable to ask a patient – one whom is unsure whether a procedure is going to change their life forever or end it – to go to Kilroy’s House of Discount Cardiology if they can’t afford a real hospital.

bill sargeant

The nursing staff kept asking my wife if she wanted pain killers, finally she took two pills and did not take them. The bill indicated $12,000 for pain killers. Also, they did not do the boy’s circumcision, days of calls and two trips to the children’s hospital and I just said F*#k this. He will be keeping his forskin. I later ate the pain pills for fun.

atimoshenko

Unbelievable.

But also relevant to ask who is making all the money then? As far as I know, hospital budgets are quite tight and doctors, especially subtracting for medical school loans, are comfortably off, but not swimming in money.

With technological progress and whatnot, there is no way that something that was performed routinely and effectively for free 2000 years ago should now cost FIFTEEN TIMES THE ANNUAL INCOME of the median-earning human being alive today.

hab

They are quoting full price, as the family does not have the leverage of the government or insurance companies to negotiate price. Medicaid patients are not profitable to doctors and hospitals. They are lucky to break even on their expenses. Cash-paying patients, in part, subsidize those who are “insured” by government price-fixing.

It will be interesting to see what will happen when everyone is “insured”…

Brainspore

(Obligatory:) “Does that include the tip?”

Rtarara

It’s cosmetic surgery. I’d be outraged if we were talking out of pocket expense for repairing a cleft palate or something, then I might be outraged about the cost of a cosmetic procedure. We aren’t. It’s quite unnecessary medically, so I’m not going to get upset at the cost. It’s like complaining about the cost of a boob job.

zombienietzsche

Medically unnecessary procedures, with only aesthetic benefits are a waste of resources and time.

http://halfbakedmaker.org Robert Baruch

I suppose that’s why the British have snaggle-teeth.

I kid, I kid!
hab

Not if the cost of these procedures is subsidizing the free care of uninsured patients seen in the ER (required by EMTALA) who either cannot or will not pay for their own care.
- Lobster
  
  I’m sure that most of them are just lazy illegal immigrants who could totally afford to pay but would rather buy tacos and sombreros and burros with their money. Our society would be MUCH better if we refused to subsidize a little humanity and instead let those people die for their greed or failure to have money. After all, they aren’t like us, and they can’t speak our language so it’s not like any white people would even understand it when they beg for someone to please stop the pain.
  
  That’s how the line goes these days, right?
http://johnmc.net/ johnmc

What aesthetic benefits?

awjt

Are you sure it’s a boy?

scatterfingers

Strange. It’s free in my country, though I don’t think I’ll ever need those services.

http://www.facebook.com/people/Laura-Mezoff-Christy/693434773 Laura Mezoff Christy

I recently had to have the same blood test performed twice– two days apart. Because of my travel schedule, I had the tests done @ two different hospitals. One hospital charged over 6 times as much for the same (extremely simple) blood test! I’m supposed to get “negotiated rates” via my insurance company. When I called my insurance company to ask how it is a “negotiated rate” when it varies by SO much, they basically said I was out of luck and I had to pay it.

I have a very high insurance deductible, so I often try to find out the cost of procedures prior to getting them. I am generally unable to get the information and/or am treated like a low-life, or an idiot for asking how big a bill I am about to incur. (Apparently it is a crime in the US to try to keep your healthcare costs under control). The system is broken, and serves nobody well– except the insurance & drug companies.

http://www.aquaticape.org/ anthrosciguy

3 words: Trip to Thailand. For far less than the Mass Gen price you’ve got first class tickets and a long stay.

Guest

There is a sin tax on booze, weed, and tobacco. I’m all for a sin tax on elective plastic surguries, perfumes, makeup and fancy cars.

Anything you do just to fit in should be expensive.

Debbie Segal Williamson

Wow. I just gave birth 2 months ago here in Honduras at a private hospital. I still havent gotten the total bill yet but expect no more than $1000 US dollars. That includes c-section, total hospital stay of 3 nights, my OB, the pediatrician and most of all the pediatric surgeon who did my son’s circumcision. My care was excellent and nobody was rushing me out of the hospital. Eat your heart out first world…the 3rd world really came through for me on this one.

Tzctplus -

Here in the UK I believe it would be all for free.

Alanwordguy

Still, it’s not something you want to leave to the lowest bidder.

surreality

So… I can see the “it’s cosmetic” argument here, but I also think that doesn’t *really* excuse the price. I know more reasonable prices for non-necessary surgeries isn’t exactly the most glamorous cause, but I still think that price is ridiculous and unfair, cosmetic surgery or no cosmetic surgery. It shouldn’t be okay to charge someone *that much* either way.

l337n00b

The fact that it is cosmetic matters a lot. You don’t have any more right to cosmetic surgery than you do to a Louis Vuitton handbag. If you don’t like the price, don’t pay it.

That being said, it’s actually really hard for me to believe that this is the price of a circumcision. I believe that it is the price that someone was quoted for a circumcision, but I am quite certain there are others who will do it for less, and I am also fairly confident that no one (or at least very close to no one) is actually paying that price.
- jerwin
  
  You don’t have any more right to cosmetic surgery than you do to a Louis Vuitton handbag.
  
  Be sure to keep that sentiment in mind should you ever need reconstructive surgery.
  - l337n00b
    
    “Be sure to keep that sentiment in mind should you ever need reconstructive surgery.”
    
    I considered posting again to clarify my comments – since some surgeries that are labelled “cosmetic” are actually quite important to the health and well-being of the patients, but thought it would be needlessly taking up space.
    
    Here’s the thing: I’m pretty sure you know what I meant when I said that you don’t have a right to cosmetic surgery. All you’ve done is pointed out that you can choose to interpret my statement in a way that makes me seem foolish. Giving uncharitable readings to other people’s words in order to seem smarter than them is not a great accomplishment.
    If you take the view that circumcision is more like a critical cosmetic surgery (akin to, say, having your face reconstructed after being mauled by a dog and losing most of your lower jaw) than it is like more colloquially cosmetic surgery (such as nose jobs) then I think you should state that outright.
  - zombienietzsche
    
    PRO TIP: Cosmetic Surgery =/= Reconstructive Surgery
    - jerwin
      
      Because it’s billed differently?
  - Martin Harley
    
    Reconstructive and elective cosmetic surgery are not the same thing
    - jerwin
      
      Technically, surgeries that are neither emergency surgeries (initiated immediately) nor urgent (initiated within 48 hours) are elective. Such surgeries may still be medically necessary, but the doctor and patient can still choose when the surgery is to occur.
      
      Since so many of the plastic surgeon’s repertoire is not covered by insurance, their fee structure appeals to consumers, rather than to insurance companies. Boston General’s prices are designed around the insurance company’s expectations, not the average consumer.
  - Tzctplus -
    
    You know what he means…. he didn’t mean surgery that is necessary.

Paul Bryden

In Alberta (Canada), newborn circumcision is not covered under Alberta Health Care, and most doctors’ charge between $100 and $200 to do the procedure.

Lobster

In America (‘Murica) it costs $350 to spay or neuter a dog.

hinten

So, a post about the cost of circumcision but we are not supposed to talk about circumcision?
Why not make it easier on the moderators and post the cost of any other arbitrary medical procedure.
Tooth extraction, removal of an ingrown nail, fixing of a broken small toe, etc.

What makes this procedure and dollar figure post worthy vs. others?

http://www.facebook.com/people/Cynthia-Bonville/100000861934243 Cynthia Bonville

The price sounds about right for something that is very easy with a newborn but not at all with a toddler. The tools for the job are built for newborns, from the board where they are strapped down to the cap that goes over the glans head. Toddlers who have an understanding of cause and effect, they are surprising strong and bendy, and accessing airways are tricky never mind you don’t have proper bell size to getting to the foreskin without touching the glans which means you want a still patient so you need a pediatric anesthesiologist, pediatric urologist, a surgical suite and then there is the insurance to cover liability. Oh, and newborns heal rapidly and have good clotting in comparison to toddlers as well so that is another concern.

I don’t think healthcare is broken as much as it is a technically trickier procedure because of age, for my sons who were circumcised before 3 weeks – one in hospital at 2 days, one at 3 days in the office and the 3rd in the office again at 3 days, each procedure was billed at ~$400 but it was local anesthetic done by the pediatrician who was not specialized beyond that with only my husband at the first two and the medical tech at the 3rd (some moms had fainted in the clinic so they no longer allowed parents to attend). Each one, being newborns, healed within 5 days or less. The price of circumcision depends on circumstances and complexity, newborns are easy, toddlers and children in general are not. There is a reason why circumcision is done around at 8 days or earlier or not at all until “adulthood” (13 years).

Donald Petersen

I believe there’s your answer. I have no doubt that the procedure is an order of magnitude easier on a newborn than on a 14-month-old. I wonder how much my parents had to pay for mine? Unnecessary as it was, I certainly don’t hold anything against them for having it done, nor have I ever wished it hadn’t taken place. Still, I wasn’t about to have it done to my own son. If we can’t learn from one generation to the next, why bother reproducing at all?

librtee_dot_com

I just went in to get an x-ray at an American hospital. Paying cash.

The price came out to $21.75! I was astounded. My jaw literally dropped. It was the first time I had ever heard of a reasonable bill from an American medical facility.

A couple days later, I went to get a checkup for my daughter. They said it would be $150. Then, aftewards, they handed me a bill for $210 – ‘$286 minus a 25% cash discount.’ I made a fuss, and they dropped the total to only $60. Again! Reasonable. I was amazed.

So, don’t be afraid to haggle, and shop around aggressively. Even in our totally broken medical system, it is possible.

I still remember the time I got a $2500 bill for three lousy stitches on my chin, which my insurance refused. I didn’t even need them, but when I showed up to my uncle’s funeral covered in blood my family insisted in me going off to a hospital. It’s all imaginary anyway, I simply didn’t pay it – six years ago now. They can take a long walk off a short pier, as far as I’m concerned.

The other solution, of course, is to just DYI ;)

http://www.wikihow.com/Home-Circumcision

jerwin

Here some interesting, if old breakdowns of the cost to insurers, medicaid, and the uninsured of a relatively simple, medically necessary procedure: a diagnostic bilateral mammogram.

HOSPITAL/LOCATION: UCLA Medical Center/Los Angeles
OFFICIAL CHARGE: $460
MEDICAID*: $127
MEDICARE*: $90
HMOs, HEALTH PLANS*: Up to $242
POLICY ON UNINSURED: Gives discounts based on individual’s
ability to pay, says CFO Sergio Melgar

HOSPITAL/LOCATION: Oregon Health & Science University/Portland
OFFICIAL CHARGE: $240
MEDICAID*: $65
MEDICARE*: $59
HMOs, HEALTH PLANS*: Average $128
POLICY ON UNINSURED: Works with uninsured patients to help
them find financial aid; offers sliding scales, payment plans

HOSPITAL/LOCATION: Jamaica Hospital/Queens, N.Y.
OFFICIAL CHARGE: $351
MEDICAID*: $50
MEDICARE*: $96
HMOs, HEALTH PLANS*: $40 to $78
POLICY ON UNINSURED: Has sliding fee scales for uninsured,
says CEO David Rosen

HOSPITAL/LOCATION: Johns Hopkins Hospital & Health System/Baltimore
OFFICIAL CHARGE: $261
MEDICAID*: $156
MEDICARE*: $173
HMOs, HEALTH PLANS*: $186
POLICY ON UNINSURED: State regulation of charges reduces disparity
between bills to insured and uninsured

HOSPITAL/LOCATION: Grinnell Regional Medical Center/Grinnell, Iowa
OFFICIAL CHARGE: $285
MEDICAID*: $73
MEDICARE*: $79
HMOs, HEALTH PLANS*: $119 to $190
POLICY ON UNINSURED: Works with uninsured to set a payment schedule
*actual payment from Medicaid, Medicare and/or HMOs, health plans
Note: Charge includes hospital and physician fees.sourceNow, if it actually costs $90 to perform the procedure, but the insurance will only pay a fourth of the cost (out of habit/policy/avarice), then it makes financial sense to charge $360. But in order to support the $360 costs, the accounting methods used by the hospital must distribute the padding accordingly. Rooms must be billed at a padded rate, operating theatres must be billed at another padded rate, the services of physicians at yet another, and so on.And when all of these calculations are put together, the hospital comes up with$23,000 in charges– which would result in a $6000 reimbursement from the insurance company. If the insurance company is reluctant to cover the cost of the procedure, you’re obliged to deal with a $23,000 bill.

Nicholas Tuzzio

Yeah, sorry, I just can’t get all that worked up over the price of an optional cosmetic procedure.

elix

As far as pointless procedures go (barring legitimate medical problems), that’s a hell of a lot to charge for a pointless procedure.

bjohndook

If you have to pay for any medical expenses out of pocket, ask for an itemized list, and haggle with them over every single thing.

It’s seriously not fun, but you’ll quickly find out why these prices are so inflated – they’ll try to charge you ~$100+ for “administering” a single tylenol pill.

rhinoman

I had chest pains and had a CAT scan done on my chest to check for calcifications in my cardiac arteries. Cost? $180 at the really nice hospital, $120 at the crappy one in a lousy part of town. Why so cheap? It’s NEVER covered by insurance, so the hospitals charge a market rate.
You might also look into why auto body work has become so bloody expensive – it’s always covered by insurance.

If you insure something, the hospital has no incentive to reduce the price. Quoted medical procedure costs are more like an opening bid than a reflection of the true cost of the procedure. I suspect if you shopped around and pushed a bit, you could get different prices.

Also, you’re going for an elective procedure on a child, probably with general anesthesia, to Mass General, the bloody Cadillac of hospitals. Ask around, go rural – it’s not hard to do in Boston. Yes, you will have to shop around a bit. But it can be done.

jerwin

Massachusetts General confirms that the cost would be in the $9K — $17K range, prior to any discussion of an uninsured patient discount.

DewiMorgan

UK: An ambulance is free and is the right of every person.
US: Ambulances cost $1,000, or considerably more. Anyone can call one, or have one called for them, and get stiffed with this bill – and in fact, an elderly lady fell behind me in the cinema the other day, and an ambulance was called: I imagine she’ll be getting the bill, though I doubt she can pay.

UK: You pick up the phone, call emergency services, and get those services, for free, whoever you are.
US: You pick up the phone, call emergency services, and phrase things very carefully indeed so that you are calling only fire and police, never ambulance.

UK: NHS dental treatment for me, consultation, X-Ray, cleaning, fillings, specialist referral for extraction: £35 (~$50).
US: Similar dental treatment for my wife: ~$3,000.

UK: You get hurt, you go to the ER and get it seen to, albeit after a bit of a wait.
US: You get hurt, you tough it out and try home remedies unless you are fairly sure that you are dying, because you can’t afford the bill. My wife got sent home with painkillers and a $5k bill.

UK: About 20% of my income went in tax, healthcare, etc.
US: About 20% of my income goes in tax, about 30% of the remainder in health insurance. I am considerably worse off financially.

UK: Health care cost per capita $2508/year
US: Health care cost per capita $6102/year
(2004 figures, from 2007 CRS report for congress: other sources and years give similar proportions)

UK: infant mortality 0.51%
US: infant mortality 0.68%

UK: life expectancy 79 years (if you escape kettling).
US: life expectancy 77 years

There’s some REALLY good reading on the problem, and where the money goes, in a 2009 report to Congress, “U.S. Health Care Spending: Comparison with Other OECD Countries” by Chris L. Peterson and Rachel Burton. some great and rather surprising graphs. Also, congratulations to them on managing to tell Congress “It’s the prices, Stupid” and get away with it :P

All that said, I for one heartily approve of cosmetic, elective procedures being charged through the nose, if that goes to fund stuff that really needs doing. However, I don’t think that’s actually the case here.

aeon

Same comparisons pretty much apply here in New Zealand. Except life Expectancy (2009 data) is 80 years and Infant Mortality is 0.48%. You’ll wait a bit longer than the UK for some elective procedures though, and have to pay a little per visit to see a General Practitioner and a lot to see a Dental Surgeon. Still nowhere near as much as you’d get stiffed for in the US.

davidasposted

“There is compelling evidence that male circumcision reduces the risk of
heterosexually acquired HIV infection in men by approximately 60%.” – World Health Organization

http://www.who.int/hiv/topics/malecircumcision/en/index.html

Just so you know.

anneymarie

Not really as relevant in the U.S. and not as useful as a condom.
- davidasposted
  
  Absolutely. Nevertheless, circumcision does have health benefits, contrary to most of the claims otherwise in this thread.
  - Tzctplus -
    
    So what you and others are saying is that circumcision has health benefits for males that can’t be bothered to wear a condom? Golly, I am changing my mind about this pointless procedure.
Joe Sixpack

Setting aside the idiocy of having unprotected sexual intercourse with an HIV-positive partner, various other methods also reduce the risk of contracting HIV. Such as wearing a condom. Or abstinence. These methods don’t require boys to undergo a torturous experience to which they cannot consent. They also don’t deprive boys of thousands of important nerve endings, nor do they introduce a risk of botching the procedure altogether (which leads to serious complications, and occurs with nontrivial frequency – the NSFW wiki on this topic has more information).
- davidasposted
  
  Children are by legal definition unable to give consent; this is one of the chief responsibilities of parents in Western societies. Why is the cut/uncut debate in North America so intense?
  - t3kna2007
    
    > Why is the cut/uncut debate in North America so intense?
    
    Because as is too often true, it reveals that North Americans have for the most part lost the facility/desire for moderate discourse?
    
    “The argument .. is to da det.” /T’Pau
  - Joe Sixpack
    
    There are limits to what parents can consent to on behalf of their children. For example parents of a 11-year-old girl cannot force her to have sex with a 55 year old man just by “consenting” on her behalf (and thank lawyers for that, because there exist cultures that would have a field day with that loophole).
    
    I’m not sure if the circumcision debate is any more intense in North America than it is in Western Europe. I’d venture that the debate has been more or less resolved in Western & Northern Europe, given their low rates of circumcision. Accusations of racism or religious intolerance also inevitable appear in any European debate due to their demographics of circumcision. As for other parts of the world, the practice is rare in China, and practiced in India only by the country’s Muslim population.
  - Hugh x
    
    You answered your own question. “Children are by legal definition unable to give consent” and circumcision is the removal, lacking medical need, of a normal, healthy, functional, irreplacable body part – that it would be illegal to remove it if were any other such part of a non-consenting human of any age, or the most nearly corresponding part of a girl baby. In brief, circumcision is anomalous.
http://twitter.com/nategri DJ Cat Gif

Experimental method for this sounds.. iffy. From a HuffPo article (http://www.huffingtonpost.com/ali-a-rizvi/male-circumcision-and-the_b_249728.html):

“… to be included in the study, men had to be HIV-negative and uncircumcised. The men also had to consent to ‘avoid sexual contact (except with condom protection) during the 6 weeks following the medicalized circumcision.’ ”

Also:

“… males in the study that underwent circumcision were not only told to abstain from sex for a significant time period after the operation — reducing their exposure time by six weeks compared to the uncircumcised (control) group — but told to use condoms, taught how to use them, and educated about their benefits. During this six week period, the men in the uncircumcised group did not have the same restrictions.”
Marktech

Whenever I hear the words “compelling evidence”, I immediately suspect somebody’s trying to sell me something!

The WHO page uses the headline-friendly relative risk reduction (“by approximately 60%”) rather than the absolute risk reduction; that’s bad practice, and means – understandably enough – that they’re in the business of marketing, not science.

I can’t find the primary sources anywhere on the WHO site (they may be there, but my time is limited; they’re not linked to on the page you cited, and they don’t seem to appear on the “Data and statistics” page) but the studies I’m aware of which report this sort of benefit return absolute risk reduction of under 2%; they have all been small-scale and flawed in various ways [details available, if you're interested], and population studies of HIV rates and circumcision don’t as yet support their conclusions. Time may tell, but I wouldn’t accept either the WHO’s word or the studies I’ve seen as evidence of any health benefit from circumcision.
- davidasposted
  
  So what you’re saying is that you doubt the accuracy of the claim, but do not have the time to investigate further, so you’re just going to go with your hunch?
  - Marktech
    
    So what you’re saying is that you doubt the accuracy of the claim, but
    do not have the time to investigate further, so you’re just going to go
    with your hunch?
    
    If you substitute for “your hunch” the words “proper scientific scepticism”, that’s not far off; but don’t forget, the onus is on the people making the claim to substantiate it. It’s their job, not mine, to provide robust supporting evidence for what they believe. Otherwise there’s no reason to believe it, is there?
  - Hugh x
    
    Rather than accept a hyped-up conclusion as “compelling” yes, that’s a reasonable thing to do.

DewiMorgan

Yes – discussing the health care issues in the US is a really great topic.

Unfortunately, posting it with an example that’s as incredibly hot-button topic, and then asking that the example chosen not be discussed, does seem to be really rather poorly thought out, when there are SO many other examples of the medical industry’s excesses that wouldn’t have evoked such a powerful feeling of disgust in most readers.

And by requiring administrative action to censor those posts, it frames the whole site, and their support staff, as supporting the unfortunately-chosen example as a cultural norm.

I feel that this is pretty clearly NOT a global BB policy at all, and that Mark was just unfortunately short sighted in his selection of an example, and didn’t realise until he’d posted that this particular aspect of his own cultural norms could be so intensely repugnant to so many people.

In BB’s defense, it has previously hosted posts against at least the wilder excesses of this specific issue, such as Cory’s post about a practitioner using his teeth, killing one child with his herpes, and infecting another: http://boingboing.net/2005/02/02/herpes-rabbi-used-mo.html

Guest

Hot button… (snicker)…

jerwin

In the US, male circumcision (neonatally) is very common. In Europe, not so much.

traalfaz

My brother recently needed an MRI scan and had no insurance. For the scan he needed, the charge for JUST that procedure (in and out, about 30 minutes in the room total) was about $3000.
A friend who works in medical imaging in the UK said that the SAME scan, if done in a private, non-NHS sponsored facility in the UK, using the SAME equipment and people with the same training, would be about $700.
He also does international consulting, and he said that the same scan on the same equipment with people with the same equipment in India would be about $80.

Again, exact same equipment, same procedure.

jerwin

Medical bills are like phone bills. The entire cost is outrageous, but it’s broken down into many pieces, each of which seems arguably justifiable.

foxtails

Don’t forget to include the child’s future cost of foreskin replacement surgery, and also the emotional cost he will bear once he’s old enough to understand what a circumcision is.

jerwin

Don’t worry. The Net Nanny will block circumcision activism sites. Hopefully, by the time he learns to mourn for something he never knew, he’ll have his own insurance.
Donald Petersen

Don’t forget to include the child’s future cost of foreskin replacement surgery, and also the emotional cost he will bear once he’s old enough to understand what a circumcision is.

Don’t overestimate the emotional cost. The procedure isn’t all that uncommon at this point (though not as prevalent as it was in my youth), so there won’t be a hell of a lot of stigma attached to having a cut penis when he gets older… and as Jerwin points out, by the time he finds out what it all means, he’ll be pretty danged used to the penis he’s had all his life. He’s not apt to bemoan his fate unless someone puts the idea in his head that he ought to, for one reason or another.

It’s not quite the same as female circumcision, in my opinion. Circumcised penises work just fine. I reiterate my opposition to the practice of circumcision in general, but once the deed’s done, there’s no benefit to making a huge deal of pain and regret over it.

Unless, y’know, it’s botched or something.
- Steven Olsen
  
  It’s not comparable to FGM. No one said it was in the discussion that I’ve seen. And yes, the claim that it will scar you emotionally for life is BS. But it’s still a stupid, meaningless procedure. Cosmetic surgery without the consent of the person receiving it.
  - Joe Sixpack
    
    And yes, the claim that it will scar you emotionally for life is BS.
    
    Not quite. Operations that go without a hitch (as well as can be said for such a procedure) probably don’t scar boys emotionally for life, but the botched instances certainly do. It’s hard to imagine a victim who has had part of his glans removed, or lost other parts due to penile necrosis, not experiencing psychological problems relating to sex.
  - catherinecc
    
    It fucks over trans women down the line. I know we’re only a minorty and aren’t exactly viewed as human, but there have been a lot of people who are really, really angry at their parents over this as it introduces an annoying surgical complication.
    - Mister44
      
      You’re talking about circumcision, correct? If so, in all seriousness, – in what way does it “fuck [them] over”?
    - catherinecc
      
      Affects depth and sensation in surgical outcomes. Sometimes quite negatively.
    - Mister44
      
      Really. I learned something new today. Thanks for the reply.
    - Mister44
      
      I am thinking about this more than I probably should be ;o) But if a foreskin is something that is desirable for this operation, can/do people try to “regrow” it? That isn’t the right word, but during WWII some Jews would do procedures that would give them a foreskin so they could try to pass as Christians. I don’t recall the specifics, something like string and weight to pull on the skin to elongate it. Sort of like how people use those big disks in their ear lobes, or the tribal Africans with the large disks in their lip.
    - Hugh x
      
      There are dozens of DIY devices for foreskin restoration, and tens or hundreds of thousands of men are doing it – which should tell you something about whether cutting if off is such a good idea.

http://www.facebook.com/vladcole Vladimir Cole

It feels wrong to host a blog that free-ranges over all sorts of topics with intellectual fearlessness but that suddenly tells its readership that one particular religious topic is off limits. If you cultivate an intellectually curious, engaged readership, don’t be surprised when clumsy censorship attempts make them bristle.

Anyways, it seems $23,000 is not very much to pay if you’re relatively certain your son will be travelling to Africa once he’s come of age and will be having lots of unprotected sex while he’s there. That’s the one scenario where circumcision makes sense.

jerwin

Religious? Hah! It’s part of being a Red Blooded American Male.™

http://twitter.com/jparismd Jason Paris

are we really having a discussion on one man’s “price quote” I find it is exorbitant but I also find it unbelievable. their is no general anesthesia for this procedure. just a bit of local lidocaine and likely costs 500 dollars. please check your facts before you publish anecdotal evidence.

gigasquid

Your US health system is completely and utterly fuc*ed up. What a racket!

http://whimsicalacious.tumblr.com/ Patrick McGorrill

Is this wrong? It’s a popular cosmetic surgery and hospitals are raking in some profits. No one gets hurt if getting a child circumcised is cost prohibitive for a family. Paediatric anaesthetists might end up a bit overvalued by hospitals, but aside from little market foibles what’s the issue?

Steven Olsen

Sounds reasonable to charge that much for an unnecessary operation that confers no serious benefit. Do the post again with something that you have to have done, like an appendectomy.

http://www.facebook.com/RedBoots Juta Stokes

If we can’t discuss the way we feel about circumcision, maybe we can just call it “spraytanning”. I have a twelve year old son, and if anyone had tried to “spraytan” his baby penis they’d have had to pry him out of my cold, dead arms to do it. And then his father’s. But I’m Australian and I think my country is advanced enough that “spraytanning” is pretty rare these days.

I also think that having to pay $23 000 is not enough punishment for “spraytanning” a child. As my grandfather would say, “Some people have more money than sense”.

professor

I would have assumed that the procedures, equipment, anesthesia etc in Canada and the US would have been pretty much the same, however seeing the price-difference I can only assume that in the US the foreskin is gently gnawed off by Paris Hilton personally, while in Canada they just bash it off with a rock

秀平月

I say, what’s the rush? Let kids decide whether they want to be spraytanned (thank you Juta Stokes) when they can talk and consent to it (the, ahem, “benefits” mentioned here are quite unlikely to be important in the first ten years). If the high cost discourages people from spraytanning their babies, I’m all for it.

Having said that, this is an unnecessary though common and simple procedure, so there’s bound to be better offers if you shop around. I just thank my lucky stars I wasn’t born into a spraytanning culture.

http://www.facebook.com/people/Vincent-Maldia/100001023048460 Vincent Maldia

thats too expensive. In the philippines we can do it for 300 dollars in a nice hospital and with general anesthesia. We can do it for less than $10 if its done under local anesthesia in the doctor’s office

so just take a vacation in my country and save a lot of money

http://twitter.com/bethmorgan Beth Morgan

I work at a company that helps people understand and track their health care expenses (www.simplee.com), and this was an actual comment we got yesterday from a medical professional:

“The number that is stated as Total Health Care Costs is wrong. You are summing up all retail prices charged to insurance, and not what insurance actually paid. As any healthcare professional knows, the retail price charged is arbitrary and does not show anything about real costs. This is never a price that is paid unless you are uninsured.”Uh… yeah, okay. Glad to see someone on the inside of the system admitting how flawed it is, I guess.

elix

Glad that at least someone’s being honest that the pricing scheme is entirely arbitrary. And, apparently, is designed to leech off the insurance system and any poor suckers who’re unfortunate enough to get sick/injured when they don’t have insurance. Refreshing. I don’t know how the bean counters responsible for the billing can sleep at night.

chumpmeat

Well that does it, I’m definitely not going to circumcise my hospital.

http://twitter.com/mariogilre Mario Gil

My wife got breast implants two years ago and she got billed $2,500. This year she underwent a small 30 mins surgery to extract a little mass from one breast and she got billed $29,800. The awkward part is that the plastic surgeon charged exactly what he quoted for the whole procedure, including followup visits. But despite we repeatedly asked for a quote on even a rough approximate before the mass extraction, it was practically impossible to get any amount from anyone at the hospital or at the doctor’s office. Between the outrageously expensive things they billed there was a $850 disposable support bra!

http://www.facebook.com/people/Kimberly-McKinnis/513369752 Kimberly McKinnis

Hospital visits are ridiculous. When I was in the ER for several dehydration and food poisoning, I received a bill full of charges for co-pays, down to the PILLOW on my bed. It was the most ridiculous bill i have ever seen and fighting it with my insurance company was a nitemare.

Ianmac

Perhaps the hospital was trying to discourage such child abuse, without having the guts to refuse outright.

gwailo_joe

Why has no one discussed the real issue here? If you DON’T circumsize your sons, they will almost certainly never become famous and world renowned porn stars.

Cut dicks sell flicks! Think of the poor childs’ future! In these troubled times you would limit his chances of making a living wage in his later years? For Shame!

(and of course THE COVENANT WITH Y#WEH for crying out loud) heh heh…

Hugh x

As Russell Crowe said, if you can’t spell it, don’t do it.

DewiMorgan

Erm… all you people are spelling it “tort reform”.

But cosmetic surgery on young boys… that’s clearly “tot reform”.

Hugh x

There are men who would pay $23,000 to get their foreskin back. Put the money in a trust for his education, and your son (the doctor) will thank you twice.

donovan acree

It works like this.
Hospitals need to ensure patients visit so they contract with insurance companies to send business their way. In return the insurance companies get a HUGE discount on services. The amount of discount or write off depends on the hospitals bargaining power. A lone hospital in a city can demand better compensation than one that must compete. For example, I’ve seen Cigna contracts that only pay $300 per day for inpatient services no matter how much work is done.
Medicare and Medicaide usually only pay 20% or less to the hospital. The rest is adjustment. Our government has made it illegal to charge differently for cash, insurance, and medicare so the price structure has to stay the same. The hospital has to charge $1000 to get $200. This gives us grossly inflated prices. That $23,000 is so the hospital can actually bring in the $4,600 it will actually cost them to do the work. Remember, at a hospital you are paying for doctors, nurses, techs, admissions, and all of the related overhead.
The problem here is how the feds have gamed the system with medicare and insurance.

modusoperandi00

I got circumcised. A bunch of times. The doctors gave up. They were just making it angry. You wouldn’t like it when it’s angry.

eyebeam

I think you need to check out the link about the guy with the rotten cauliflower penis…

irksome

And it’s 12 million, not 25.

Price of a hospital circumcision in the US: $23,000

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