Most British people have never had to think about paying for medical procedures. But what would happen if they did?
I decided to find out by asking my British colleagues at BuzzFeed UK to guess what different health procedures would cost them if they were in the US. I then revealed the answer to each question based on data from the website Clear Health Costs.
This is how it went down.
1. How much would an "urgent care" walk-in appointment for something like a burn, a sprained wrist, a sore throat, a sinus infection, or a UTI (such as cystitis) cost without insurance?
The Brits' guesses were all over the map:
"Wait, that's not free?"
"Probably very naive, but I'd guess £100 [$156]."
"Well, you shouldn't go to doctors with a sore throat (according to my mum). Hmmm, I'll say around $50?"
"£15 [$23]."
"Probably too much to make it worth going? Like, $50 maybe? Just put some cream on it instead. Whatever's wrong, just put cream on it."
"I would guess, like, $3,000."
The answer: IT DEPENDS. A survey by Clear Health Costs in New York found it could cost you between $75 and $351 (£48 and £226) if you don't have insurance. This is called the “self-pay” or “cash” price.
The Brits thought they'd probably just stay home:
"You could get a lot of cranberry juice for that. Cranberry juice will solve all your ails: UTI, cystitis, sprain. Oh, you broke your leg? Marinade it in some cranberry juice. Who even needs doctors?"
"Jesus! I'd rather find a home remedy than pay that."
"At my school the nurse just gave us a Strepsil for everything, so I would definitely try that first before paying this."
Jeanne Pinder of Clear Health Costs explained to BuzzFeed why there's such a huge variation in the cost of care.
Basically, for the same procedure, there can be multiple prices you're juggling. There's the sticker price, i.e. the price the provider actually attaches to a procedure when billing an insurance company. "The sticker price can be so inflated as to be mind-boggling," Pinder says.
"Then there's the reimbursed rate that the insurance company actually pays the provider. Then you as an individual have a fixed price, or a percentage of the price."
Providers will often offer a marked-down rate for uninsured people paying cash.
2. How much would you pay out of pocket for one month's supply of birth control pills?
The guesses:
"It shouldn't be any more than £2 [$3]."
"Maybe a dollar per pill? So around $30?"
"£2.99 [$4.67]."
"It's got to be cheaper than having a baby, but I don't know what one of them costs either, so I'm going with £50 [$78]."
"$50? I can't remember how much they said it cost in Girls."
The answer: From $9 to $63 (£6 to £40) for one popular brand at clinics in New York, New Jersey, and Connecticut – and from $68 to $112 (£44 to £72) for another.
The Brits decided they'd probably rather give up sex. Or have enough to "make it worth it":
"Wow. It's a good thing that praying is an effective back-up contraception. "
"Cheaper than a baby. Also easier to swallow."
"$112 a month! No sex for me, then."
"I swear I lose, like, 1 in 5 packets of pills. I would not do that so much if I had to pay for them – also I probably wouldn't skip as many periods."
"Nine dollars I could cope with. For $112 I would want to be having a lot of sex to make it worthwhile, tbh."
3. What would you have to pay out of pocket for a chest x-ray if you DID have insurance?
At this point, my colleagues started to get pretty confused. They guessed anyway:
"What, you have to pay even with insurance? That's insane. OK, I'd say £150 [$234]."
"Surely if you have insurance you don't have to pay?"
"£8.99 [$14]."
"Wait, wait, wait, I thought if you had insurance everything was covered. I'm confused, but I'm going to say £200 [$312]."
The answer: $26. Or $36. Or $117. Or $211. Or $402. Or $500. (That is, £17-£320.) These are all recorded cases of what insured people had to pay out of pocket at different hospitals in the San Francisco Bay Area.
This answer only made my colleagues MORE confused:
"I DON'T UNDERSTAND THE PRICE DIFFERENCES."
"I'm so confused. Why would it range from $26 to $500?"
"Who needs an x-ray anyway?"
"You can get those x-ray glasses from the back of a comic book for like, a dollar. Always shop in the back of comic books, kids."
So why the huge discrepancies even when you're insured?
"Once you know the sticker price you don't know what you or your insurance plan is going to pay," Pinder said.
"Making it more complicated is the fact that these reimbursement rates are regarded as trade secrets, or they're hidden by gag clauses in contracts between providers and payers."
A provider may not want different insurance companies to know they're being charged different rates. "That goes against their business model," Pinder said.
Because of this secrecy, Clear Health Costs relies on crowdsourcing its data from people sharing their medical bills, and by calling up providers and asking for their self-pay or cash rates to gradually add to the website's databases.
4. What would a mammogram cost you WITHOUT insurance?
They were totally lost once again in their guesses:
"Oh, Christ...£500 [$780]?"
"Same as chest x-ray? No, maybe a bit more because of the patriarchy. $600."
"THIS IS TOO CONFUSING. £300 [$468]."
"Still a requirement for the laydeez, sooo $100?"
"$800."
"$1,000."
"$2,000."
And the answer is just as all over the place: In a survey of cash prices of mammograms in New York, the figures ranged from $50 to $600 (£32 to £384).
Their reaction:
" :'( "
"Having cancer seems kind of shit already, why you gotta make it even shittier?"
"WUT?"
"Fucking hell."
"This is just silly."
5. What would a colonoscopy cost you if you DIDN'T have insurance?
The idea of paying for a colonoscopy was too much for some. Their guesses:
"Considering the doctor probably doesn't wanna do it, I'd say £200 [$312]."
"It's not a particularly complex procedure, so $100."
"It would be too depressing to pay to have a camera shoved up your arse. £400 [$624]."
"£30 [$46]."
"Shit, like, $600? Imagine paying for that."
"I would say, like, $1,000."
The answer varies from $600 to over $5,600 (£384 to £3,588).
Their reaction:
"You know what, England is great. I might just stay here, thanks."
"That's the price for one colonoscopy? Please tell me you get a DVD of it to take home for free at that price. You know, for family gatherings at Christmas and such."
"Jesus, bend me over a barrel, why don't you? Oh, wait..."
"Why don't y'all move on over?"
6. What would a vaginal childbirth WITHOUT insurance cost you?
The one was particularly baffling for the Brits. Their guesses:
"They charge you to give birth? Blimey. $100?"
"Sorry, I laughed at 'vaginal'. This SHOULD be free, because you're having a fucking baby. Maybe $5,000?"
"Well, free if you did it in the back of the car like they always do on Hollyoaks, but I'm gonna say £1,500. "
"£20 [$31]."
"$0."
"$15,000? I mean, that is RIDICULOUS."
"Maybe $2,000? But what are they going to do if you can't pay? It's not like you can hold it in."
The answer: An estimate given by a hospital in Arizona for a cash or self-pay vaginal birth without complications was $1,850 to $4,376 (£1,185 to £2,803) – and this was if the patient qualified for means-tested financial aid.
Of course, this figure varies by thousands of dollars according to geography and provider.
Their reaction?
"Fuck."
"I don't understand – it's not like you can just cross your legs."
"Christ on a bike."
"This is crazy. I guess I'm never having kids in America, then."
7. What about a childbirth without complications if you delivered via caesarian WITHOUT insurance?
Their guesses:
"It shouldn't be more than a vaginal birth, surely? Around £6,000 [$9,366]?"
"It seems very mean that complications would be extra. £4,000 [$6,244]."
"$10,000."
"I CAN'T BELIEVE YOU HAVE TO PAY FOR YOUR BABIES. $700."
"$35,000."
"A million dollars."
The answer: $3,760 to $8,632 (£2,409 to £5,530) for a self-pay or cash patient qualifying for means-tested financial aid.
Their reaction:
"Fuck my hat."
"I actually expected this to be more, so in that sense, this is OK. But literally only in that sense."
"MERCA Y?"
"WTF?"
"I have so many questions about how this all works."
8. What would it cost if you had to get an STI test and DIDN'T have insurance...or didn't want to go to your usual family doctor because you wanted to keep it a secret?
Their guesses:
"For the secrecy, maybe £30 [$47]."
"$100."
"In the UK they actually give you free stuff, or like, donate to charity on your behalf if you do this. I did three a week in university to raise money to build a school in Nepal or something. £70 [$109]."
"$500."
"I wouldn't want my family to know I'd had an STI test, to be fair. I reckon $60."
The answer: Four different clinics in New York charged $25, $45, $175, and $200 (£16-£128) according to self-reported data collected by Clear Health Costs.
It also shared the story of a man who was charged $600 (£384). Some clinics are free, but most data collected from New York falls around the $100-$200 (£64-£128) mark.
My colleagues were relieved it was less than they thought, but still perplexed:
"Crazy, especially for what's a public health issue."
"Phew, OK. I saved some money there."
"Small price to pay, if you ask me, but it should be free."
"THEY PRACTICALLY PAY YOU TO DO THIS IN ENGLAND."
9. What would a pap smear (aka a smear test) cost if you went to a women's health clinic without insurance?
Their guesses:
"$500. It's pretty basic, right?"
"I am going to say £40 [$62]. Because really it's not that much trouble."
"All of this is making me sad. Imagine if you needed all of these things at once. I reckon $80."
"If you have to pay more than $50 for that I will cry."
The answer: In New York, Clear Health Costs found examples between $150 and $600 (£96 and £384).
Their reaction:
"This thing takes, like, five minutes, right?"
"WE ARE THE HOSPITAL. YOU HAVE NO CHOICE. GIVE US ALL YOUR MONEY."
"Who decides these things?"
"Like, some of these things it would seem cheaper just to fly to the UK and get it done – you could just make up a name, they wouldn't mind."
" 😭 "
10. Looking at the big picture: What do you think the average annual cost of healthcare is for a family of four in 2015?
Their guesses:
"$1,000."
"I have no idea. Like, £2,000 [$3,122]? That's probably what we pay in tax, right?"
"£250 [$390]."
"$10,000, unless you had a baby, in which case more like $20,000."
"$20,000?"
"I'd say around £5,000 [$7,805] a year?"
"Family of four? No more than £2,000 [$3,122]."
"£3,000 [$4,683] a year."
"This is the most morbid game of The Price Is Right I have ever played. I reckon about $10,000."
The answer: The Miliman Medical Index (MMI) reports a yearly cost of $24,671 (£15,805) for a family of four in 2015 – up 5.4%, largely due to increasing prescription drug prices.
Their response:
"Fuck my hat sideways."
"How do people actually afford this, like, howwww??? I don't understand."
"OMG... I'm really upset."
"This is actual money that they have to pay? How do they afford rent and food?"
11. And finally: What percentage of Americans do you think are uninsured in 2015?
Their guesses were high:
"10%."
"20%."
"35%."
"Hmmm. 40%?"
"I dunnoooooo, like, 50%???"
"55%."
"65%. Eat the rich."
"Loads. Probably like 75%, which, in my expert opinion, is a Bad Thing."
The answer: 12.9%.
That rate has dropped about 4% since Obamacare required people to be insured. Even so, being insured doesn't mean you won't still pay some costs out of pocket.
BUT, while it's 12.9% nationwide, the figures vary hugely by demographics. The Hispanic population is 32.4% uninsured, an improvement of 6.3% since 2013. For African-Americans, the rate has dropped from 20.9% to 13.9%, and for low-income Americans – those earning less than $36,000 (£23,000) a year – the uninsured rate is 23.8%, down from 30.7% in 2013.
The responses:
"Relieved it's not much more than I thought – but that's still 30-40 million people, right?"
"How much is insurance? I don't understand, I don't understand, do people just let people die if they can't pay? I am very confused. I love you NHS, don't ever leave me."
"But how do they afford it, though?"
"I think I am more confused now about the American healthcare system than I was before learning all this."
So there you have it: American healthcare is insanely confusing.
