Health
Health care costs up to 300% higher for privately insured patients than those with Medicare, report reveals
Most Americans — more than 65% — have private health insurance, but a new report has revealed a potentially very expensive drawback.
Patients who have private (commercial) coverage may end up paying significantly more for their medical care compared to those who have public health insurance, such as Medicare, according to recent data from RAND Corp. in Washington, D.C.
As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid.
HEALTH CARE COSTS UP TO 300% HIGHER FOR PRIVATELY INSURED PATIENTS THAN THOSE WITH MEDICARE
Several states — California, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin — had medical costs that were more than 300% higher than Medicare prices, the report stated.
The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at over 4,000 hospitals across the country between 2020 and 2022.
Patients who have private coverage may end up paying significantly more for their medical care compared to those who have public health insurance, such as Medicare. (iStock)
The report also included the names and prices of each hospital.
“Calculating 4,000-plus U.S. hospitals’ overall relative prices has never been done before this study, because it’s so difficult to collect the requisite data and to get permissions to publish the hospital and health system names associated with each relative price,” said Brian Briscombe, a health care analyst at RAND and one of the study authors, to Fox News Digital.
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“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”
The report gives employers a tool they can use to become “better-informed purchasers” of health care services, Peter Hussey, director of RAND Health Care in Santa Monica, California, noted in a news release.
“Hospitals account for the largest share of health care spending in the U.S., so this report also provides valuable information that may aid policymakers interested in curbing health care costs,” Hussey also said in the release.
The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at more than 4,000 hospitals across the country between 2020 and 2022. (iStock)
The wide variance of prices across hospitals is the most important takeaway, according to Briscombe.
“Within a single city, you can find a hospital that (on average across all its services) charges privately insured patients about twice as much as Medicare charges for those same services — but down the street, another hospital charges three times what Medicare charges,” he told Fox News Digital.
The difference in prices cannot be explained by differences in quality, he added.
“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”
Dr. Brett Osborn, a Florida neurologist and longevity expert, was not involved in the RAND study but said the findings are “concerning.”
“Hospitals bill private insurers multiples of the Medicare allowable,” he told Fox News Digital.
“The elevated costs are passed onto patients, resulting in higher premiums and out-of-pocket expenses.”
As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid, according to a new study. (iStock)
And these costs are on the rise, Osborn warned.
“People accept job offers because the employer offers health insurance — otherwise, for many, the premiums would be unaffordable,” he added.
Osborn emphasized the significant price variations among states.
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“Hospitals in some states charge less than 200% of Medicare rates, while others exceed 300%,” he said.
“Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”
“This discrepancy is due to some hospitals’ market power, making it hard for employers to avoid them. Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”
The doctor also called for greater price transparency from hospitals.
The new report published the names and pricing models of more than 4,000 U.S. hospitals. (iStock)
“Despite a federal rule for price transparency, only 24.5% of hospitals comply — highlighting the need for informed health care purchasing and policy changes to manage costs,” he said.
“The system is fundamentally flawed, designed to profit from illness rather than promote health,” Osborn continued.
“It clearly favors hospital systems, not the patients, reinforcing the harsh reality: There is money in the sick.”
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Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, said the issue of price variations is complex.
“Sometimes these are hidden costs, and sometimes hospitals and other health organizations know they can get away with charging private insurers more while obscuring prices from both the insurer and the patient to help compensate for the shrinking reimbursements from public insurances,” Siegel told Fox News Digital.
“At the same time, more out-of-pocket costs are transferred to the consumer in terms of copays and deductibles, as middlemen take the profits.”
“The system is fundamentally flawed, designed to profit from illness rather than promote health.”
With the lack of price transparency, there is no way to introduce competition, Siegel said, as the true costs and prices are hidden.
The study did have some limitations, the researchers acknowledged.
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“We didn’t have sufficient claims data to publish all U.S. hospitals’ relative prices,” Briscombe told Fox News Digital.
“Some states in the U.S. don’t have All Payor Claims Databases (APCDs), so we have to collect claims from one data contributor at a time – usually from employers that operate in that location and whose employees and dependents use those hospitals.”
“Despite a federal rule for price transparency, only 24.5% of hospitals comply, highlighting the need for informed health care purchasing and policy changes to manage costs,” according to a doctor who spoke with Fox News Digital. (iStock)
Overall, he said, the researchers had a “sufficiently large sample of data” to estimate the overall relative price of each hospital and health system included in the report, Briscombe said, “but it would be nice to have even more claims data in order to publish the relative prices for all U.S. hospitals.”
Fox News Digital reached out to the Centers for Medicare & Medicaid Services and the American Hospital Association requesting comment.
For more Health articles, visit www.foxnews.com/health.
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Nearly 20% of American adults reported having an anxiety disorder in the past year, data shows — and many are more likely to feel uneasy and anxious as the sun sets.
While “sunset anxiety” isn’t an official medical diagnosis and does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), some mental health experts agree that it’s a very real phenomenon.
The symptoms aren’t limited to just anxiety, according to Andrea D. Guastello, PhD, a licensed psychologist at the University of Florida Department of Psychiatry.
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“It can be any psychiatric symptom that increases in frequency or intensity as the sun goes down or at night,” Guastello told Fox News Digital.
Symptoms may include feelings of depression, isolation and hopelessness that tend to increase at night, the expert said.
While “sunset anxiety” isn’t an official medical diagnosis and does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), some mental health experts agree that it’s a very real phenomenon. (iStock)
What is sunset anxiety, exactly?
Sunset anxiety occurs when a person starts to feel anxious as the sun goes down at the end of the day, Beena Persaud, PsyD, clinical psychologist with Cleveland Clinic Akron General in Akron, Ohio, told Fox News Digital.
“The lack of natural light can cause people to have less energy and motivation, restless discomfort, worry and nervousness about accomplishing tasks,” she said.
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People who have previously experienced episodes of anxiety and are generally more on the anxious side are more susceptible, Persaud said, as are people who have a heightened sensitivity to light changes and those who consider themselves to be “night owls.”
“Adults are more likely to feel it than teens or children, and this may be due to adults’ sense of responsibility for daily activities,” one expert said. (iStock)
There are no specific gender or racial tendencies for sunset anxiety, the expert noted.
“Adults are more likely to feel it than teens or children, and this may be due to adults’ sense of responsibility for daily activities,” she added.
Common triggers
The onset of sunset anxiety could be related to the circadian rhythm, which is the body’s internal clock that regulates many functions, according to experts. The circadian rhythm is influenced by the production of melatonin, Persaud said.
“We know there can be hormonal changes with winter and daylight saving time,” she told Fox News Digital.
“Since our production of melatonin is easily affected by light, early darkness can cause symptoms of both anxiety and depression. The body believes it should be getting ready for bed because of the darkness.”
“The lack of natural light can cause people to have less energy and motivation, restless discomfort, worry and nervousness about accomplishing tasks.”
Experts report an increase in seasonal anxiety from October to late March.
“The changing of the seasons and earlier darkness make it a prime time for people to experience both sunset anxiety and seasonal depression,” Persaud said.
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Anxiety can also occur if someone is carrying a heavy mental load of activities and responsibilities and struggling to complete them all by the evening.
“Darkness occurring earlier makes us physically and emotionally tired, and we feel as if the day is ending before we can achieve our daily goals,” said Persaud.
Tips to alleviate sunset anxiety
Guastello at the University of Florida offered the following tips to help curb anxiety around sunset.
If you experience worsening or persistent symptoms of sunset anxiety that don’t improve with the above lifestyle changes, experts recommend consulting with a mental health provider. (iStock)
Set reasonable goals for yourself.
Plan enjoyable activities around the time your anxiety usually kicks up.
Fox News’ Health newsletter brings you stories on the latest developments in health care, wellness, diseases, mental health and more.
TOP 3:
– Stem cell therapy could correct heart failure in children, say doctors and specialists at the Murdoch Children’s Research Institute in Melbourne, Australia.
– Doctors saved a pregnant woman and her baby after discovering a grapefruit-sized tumor in her chest cavity.
– A second-grade boy saved his friend from choking by doing the Heimlich maneuver in the school cafeteria – and it was caught on camera.
Researchers at MCRI are studying and reprogramming the potential of the blood to treat disease, specifically heart failure in children. (iStock)
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A Chicago woman was just weeks away from giving birth when a nagging cough led to a shocking medical discovery.
MaKenna Lauterbach, then 26 years old, began experiencing severe coughing fits in the last three months of her pregnancy.
“They would be so severe that I would become winded and nauseous to the point of vomiting,” she told Fox News Digital.
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Lauterbach, who lives on a farm in Washburn, Illinois, also began noticing shortness of breath while tending to her horses and goats.
“I give hay to the horses every morning and noticed how winded I was becoming with a dry cough,” she said. “My body felt like I just ran two miles, when, in reality, I had only walked to the barn and back.”
MaKenna Lauterbach, pictured with her husband, Parker, and new baby, Colter, was diagnosed with stage 3 melanoma. (Northwestern Medicine)
Some doctors dismissed Lauterbach’s symptoms, she said, repeatedly telling her, “It’s because you are pregnant.”
Eventually, though, when the coughing led to vomiting, doctors performed scans and detected a large, grapefruit-sized tumor in her middle chest cavity and right lung, which was completely blocking the artery to the right lung.
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“It’s extremely rare to see this type of tumor invading into the major blood vessels of the heart,” said Chris Mehta, M.D. — a cardiac surgeon with the Northwestern Medicine Bluhm Cardiovascular Institute who specializes in complex heart reconstruction — in a press release.
“It’s extremely rare to see this type of tumor invading into the major blood vessels of the heart.”
“We may see something like this once every few years.”
The tumor had put Lauterbach — and her baby — into respiratory distress.
‘In real trouble’
Lauterbach was flown to Northwestern Memorial Hospital in Chicago, where a large medical team was waiting for her.
“MaKenna was in real trouble, and we had to act quickly – this wasn’t something that could wait for Monday morning,” said Lynn Yee, M.D., maternal-fetal medicine specialist at Northwestern Medicine, in the release.
Though he was born three weeks early, little Colter is a thriving, happy baby boy today. “As for myself, I am still healing, emotionally and physically,” said Lauterbach. (MaKenna Lauterbach)
“When you’re pregnant with a baby that’s nearly full term, your lungs already aren’t functioning at full capacity, and when you add a huge tumor on top of it, you run the risk of having respiratory collapse and cardiac arrest.”
The baby was not tolerating the contractions well and Lauterbach’s blood pressure was plummeting.
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The team performed an emergency cesarean section — and on Easter Sunday, a healthy baby boy, Colten, was born.
‘Blindsiding news’
After the delivery, it was time to address the tumor.
“The tumor was sitting on top of MaKenna’s heart and extended into the right lung, impacting all three lobes and the entire main trunk of the pulmonary artery,” said Kalvin Lung, M.D., a thoracic surgeon with the Northwestern Medicine Canning Thoracic Institute, in the release.
Doctors performed a biopsy and diagnosed Lauterbach with stage 3 melanoma.
The Lauterbach family lives on a farm in Washburn, Illinois. MaKenna Lauterbach first experienced severe coughing fits and shortness of breath when tending to the horses and goats. (MaKenna Lauterbach)
The doctors believe she may have had a melanoma on her skin at some point, and that “a cell or two escaped” and began growing inside her body.
“It was truly blindsiding news,” Lauterbach told Fox News Digital. “When I first got the diagnosis, I went through a roller coaster of emotions.”
“I was grieving the birth plan I had spent months preparing, while also dealing with the news of my unexpected diagnosis.”
After first feeling relief at having an answer, she said she felt some anger that her symptoms had been dismissed earlier. Then there was the fear of the cancer itself.
“Because of the tumor, the delivery happened so quickly. I was grieving the birth plan I had spent months preparing, while also dealing with the news of my unexpected diagnosis,” she said.
“My situation was serious, and while my clinical team was working on a plan to treat my cancer, it was comforting to know that the NICU nurses [at Northwestern] were taking such wonderful care of our son.”
Taking life-saving action
The team at Northwestern recommended that Lauterbach undergo three cycles of immunotherapy before surgery, which helped shrink her tumor by 30%.
Dr. Lung and Dr. Mehta removed Lauterbach’s entire right lung, parts of the main pulmonary artery and her lymph nodes.
The Lauterbach family is pictured with, left to right, Dr. Kalvin Lung, registered nurse Mary Schuessler and Dr. Lynn Yee. (Northwestern Medicine)
“The surgery was risky relative to other cancer surgeries due to the need for cardiopulmonary bypass, and the need to repair the main artery going to both lungs, but it was done under very safe conditions with well-proven techniques,” Dr. Lung told Fox News Digital.
“We were concerned that even with the extent of surgery, we would not be able to completely remove the tumor,” he went on.
If the tumor had grown just slightly more into the main artery going to the lungs, or if it had involved the heart, it would have been a different outcome.
But the surgery was a success, and Lauterbach’s latest scans showed no evidence of metastatic melanoma.
Colter Lauterbach is pictured with Santa ahead of his first Christmas. (MaKenna Lauterbach)
“Her outcome was very good,” Dr. Lung told Fox News Digital. “She has recovered from surgery almost entirely, and her main issue is shortness of breath, which is a consequence of only having one lung.”
“In terms of cancer prognosis, we expect it to be quite good, given that the entire tumor responded to the immunotherapy treatment she received.”
‘New normal’
Today, though he was born three weeks early, little Colter Lauterbach is a thriving, happy baby boy.
“As for myself, I am still healing, emotionally and physically,” said MaKenna Lauterbach. “My lung capacity is getting close to ‘the new normal’ for me and I’m finally starting to return to some sort of normal routine.”
“There are some days when the bad memories and the unknowns haunt my thoughts.”
Looking ahead, Lauterbach will continue immunotherapy treatments for one year, and the doctors will continue to monitor CT scans to ensure the cancer doesn’t come back.
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Her cancer is currently considered a “stable disease,” doctors say, which means no new tumors have appeared.
The new mother, who turned 27 in October, said she is looking forward to her son’s first Christmas on the farm.
MaKenna and Parker Lauterbach are pictured with their son, Colter, after he was born by emergency cesarean section. (MaKenna Lauterbach)
“Emotionally, I try my best not to let reality weigh on me, but there are some days when the bad memories and the unknowns haunt my thoughts,” she said.
“Colter and my wonderful husband, Parker, are what have given me the strength to make it through everything.”
For more Health articles, visit www.foxnews.com/health
For other women, Lauterbach emphasized the importance of “knowing your body.”
She advised, “If you know something isn’t right, don’t take ‘I don’t know’ for an answer. Find someone who will take your concerns seriously and would rather do extra testing just in case, as opposed to missing something life-threatening.”
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