Mighty pricey, this Prostate Cancer stuff.

The bill for my 28 sessions of proton radiation in April-May 2021 (including scans, consultations, hormone therapy, and bloodwork) was $263,229. But the total negotiated Medicare bill was just $21,254. My share was $0.

I was on the ACA from 2014-2018 while I was on active surveillance (AS). The billed charges during those 5 years on AS was $5,717; the total negotiated ACA bill was $3,388. My share of that was $1,661.

In 2024 - just doing periodic PSA and bloodwork monitoring - the total bill was $1,690. But the total negotiated Medicare bill was just $1,370; my share was $0.

Much goes into why our system is the way it is. If we had a “Medicare for All” across the board, not only would we have significantly higher federal taxes, but there would also be a significant amount of healthcare rationing, neither of which most would find appealing.

I had RALP at age 68. 3 months later, I had a right lower lung lobectomy. Thanks to Kaiser and Medicare, my total out of pocket for all diagnosing, tests, surgery and hospitalization (excluding Kaiser and Medicare premiums which are crazy low), was under $1,000.

@xahnegrey40 You are saying it like it is. Having been in healthcare for over 40 yrs - and having many friends scattered in different parts of it - I finally came to realize that all of our problems are caused by insurance itself.
Without going into all the complex fee systems, middlemen, etc, just close your eyes and imagine this: NO INSURANCE…
Just like everything else, the health market would find its own level. If one store charges $500 for an item, bet your life that there’s another selling the same thing for $400…and another for $300 and so on until they all charge the same lower price. People drive the market and if people are unwilling to pay X, then you have to drop your price. This domino effect would go up the chain from providers to suppliers, labs and hospitals - including exorbitant executive pay packages for those at the top.
If no one can AFFORD to buy your product then you either drop the price or go out of business…no other outcomes are possible!
The very existence of a pot of gold (insurance company $$ or literally someone else’s $$) waiting to be tapped engenders all these side hustlers (middlemen) who drive up the cost of doing business by taking their piece of the action. It’s capitalism gone wrong, twisted into its worst possibility.
And in the US it is basically illegal for a hospital or doctor to refuse to treat a patient who cannot pay; but instead of fixing THAT problem, the insurance companies bang the rest of us who DO pay…totally unfair.
An ER doc told me that a man - recently arrived in NYC and holding a suitcase - showed up in the ER with a letter from his doctor in Guatemala describing what surgical procedures he needed to mend a failing heart.
Of course the man had no $$ and no insurance.
The hospital provided over a Million $$ worth of treatment and received only a pittance from the Emergency Medicaid system…another slush fund funded by the rest of us thru some legislative sleight of hand…
Your statement is not politics - it’s reality - and I certainly offer no solution to the problem, but it seems that common sense has gone out the window.
As I write this I am listening to a congressman arguing with a talking head about the government shut down….every other word is INSURANCE!
It’s like some over arching presence in our lives and our government; everything revolves around it; and now our very legislative system is choked by it.
Our Congress should grow a pair, stop taking PAC $$, and come down hard on this industry. Drive it out of business if need be and reset the true order of things.
Charity is a noble virtue and should be practiced - but reasonably and not to the detriment of the rest of us. Patient dumping on ERs and hospitals - that’s what should be illegal - NOT the act of not treating them. Legislators should get off their butts and FIX the problem, not give insurance company execs seats in Congress…
Best,
Phil

@sandguy
yes...everything is negotiable to a point...insurance WILL eventually pay the hospital a negotiated amt...whereas the individual may or may not pay..usually individuals pay around 40-70% of what they owe...if one is on Medicaire then 80% is paid...( with Medicaire) hospitals will eat what isnt because in most cases, Medicaire pays close 90% of the real cost..with some profit..the rest is fluff-but hospitals and docs, nurses et al- are ok with it cause they do get a nice check every two weeks..maybe not exactly what was billed but good enough...but if you believe everyone will get the same level of care..no. and now going forward, those without money-illegal or just poor- will get stablized and sent home...hospitals simply do not have the beds or man power to treat all who drift into their ER anymore...too many and you gotta make X amt to keep your doors open...and the doors are gonna be more open for those with good insurance or lots of $$$$$. the charitable stuff for the masses cannot be sustained.

@sandguy Yes, once the dust settled, some kind of universal healthcare would save U.S. taxpayers money — pro-rated by population, other G7 countries pay less in tax $$ for universal coverage than the U.S. does just for its limited-coverage public programmes like Medicare, Medicaid, and Veterans' benefits — but the challenge is figuring out how to get from here to there.

It would be one of the biggest economic change- management problems in human history, because so much of the U.S. economy depends on the system being the way it is (it's like Eisenhower's "military-industrial complex," deeply tangled into the fabric of the U.S. economy, and it's hard to pull out the thread without unraveling a lot of the fabric 😢).

Today it does’t really matter what insurance you have, the billing process is something all doctors, pa’s an hospitals follow. I manage benefits for my company for a long time and most people don’t understand the billing, what is actually paid an what happens on the company side and whether one is on a self-insured plan or not. Point is, without being political, healthcare in the US is pathetic. My husband an I are on original medicare and the highest level supplemental plans. We pay a fortune but we have no deductibles. We have a high drug plan that for 2026 says our cost of $107 a month each will go to $0. So obviously the cost per prescription will go up. Healthcare is a business in the US an profitability is key. I can’t even imagine how it can change from where it is now.

@northoftheborder
Agreed 100 % . Besides, in the whole western world medical care costs 10 times less than here and care is at the same level of excellence. In the UK there is universal care that is "free" and they also have private insurance for people who wish to have it and go to private doctors and to private clinics, so if one hates "wait period" , one does not have to wait. BTW, my husband waited for months for every single step in his PC care. All European counties also have influx of both illegal and legal immigrates that need "free care" and they manage it just fine. Where there is a will there is a way.

@sandguy Thank you Tommy Douglas.

The costs you got are typical of insurance, artificially inflated to give you an artificial discount when, in reality, your deductible likely covered it.

I had long discussions with my health providers about this. My urologist told me he makes about $1,200 per surgery, a nice living, but not anywhere close to the over $100K the insurance says the whole thing cost (of course that includes everything, but at scale, surgery cost < $10K).

@survivor5280 Yes, that makes sense. With my spinal lesion, I was on the operating table for at least 10 hours (two shifts of anaesthesiologists), in the ICU for one night, in a critical-care bed for two months, and in the rehab centre for another month and a half. I was seeing specialists almost daily, getting radiation and frequent imaging, and needed full personal care (I was paraplegic), including being mechanically hoisted out of bed during the first month. All my meals and prescription meds were provided by the hospital.

There's no way to know, since no invoice was ever written, but I expect I must have cost the Ontario healthcare system at least several hundred thousand dollars over those 3½ months. In the U.S., perhaps it would have been millions, at least on paper (I note the point about inflated billings and "discounts").

p.s. In my case, at least, no waiting and no rationing. I got all the care I needed as soon as it was ordered. Even my emergency spinal surgery happened less than 12 hours after it became clear what was wrong.