The stats from BCBS/VTDigger in headline of my original post were misleading so I deleted. Apologies and thanks to the commenter who explained it.
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In a new public awareness campaign, BlueCross BlueShield of Vermont has joined four independent Chittenden County healthcare facilities in urging clients to seek less expensive care outside of Vermont’s large academic medical centers.
The newly launched website, VT Affordable Care, offers a simple cost comparison for common medical procedures in different settings across Vermont. An MRI, for instance, costs the insurer $6,520 at UVM Medical Center in Burlington, while Northwestern Medical Center in St. Albans charges $2,785. At an independent facility that same service would be $1,799. A laboratory test at UVM costs almost $100 more than it would from an independent facility, where a test could be just $18.
I just got an MRI quote for almost the same price. That number is not an exaggeration.
Vermont Open Imaging was awesome when I used the about 15 years ago. 4.9/5.0 with almost 2k reviews.
Thanks for the lead! I will give them a look next go around. I get annual MRIs.
And don’t let your hospital give you the run around about their mri machines being more modern.
If you ever need an MRI, stay away from the hospitals. The markup is insane compared to an independent facility. When you haven't met your deductible yet, every dollar counts!
Make sure the type of MRI (open/closed, telsa etc) is similar when comparing price against independent facilities. For example, an open MRI will not provide the same resolution/quality image that most hospitals can provide.
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Generally it is an independent provider outside of a hospital network. When in doubt google it.
https://www.google.com/search?q=mri+facilities+near+me&client=safari&hs=rg1o&sca_esv=4803eec076037992&channel=iphone_bm&sxsrf=AE3TifNPeQeFqhWjFF4an0h7o_oVBsqCKw%3A1766438970583&source=hp&ei=OrhJadjtIYuxw8cPoMzYYA&oq=mri+fa&gs_lp=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&sclient=mobile-gws-wiz-hp
I mean the obvious here is that we need to get creative and get a single payer up and running despite demographic challenges. If the system is already insolvent then we need a renewed creative effort by Montpelier. There is a nuanced argument here though. I’m not pro-UVM, but they are offering a robust, speciality-ladened academic medical system. That is fucking expensive to run. There is obviously waste and grift (I.e. they should cut admin salaries), but I hope this might also inspire a philosophical conversation about how Vermonters utilize speciality care and utilization cost for a rural state.
Yes to all of this.
Admins make poverty wages at UVMMC. The only reason they have received raises in the last decade is because of unionization.
The commenter meant administrators, not admin assistants.
VTDigger and Reddit commenters are generally allergic to nuance; if it takes effort to understand, it must not be worth it.
My experience is the opposite. Commenters in this sub tend to be very wise/smart and able to consider nuance.
If you aren’t into minutiae why bother coming here?
But Reddit users do know the value of having a banana!
We tried "single payer" in the OneCare experiment that drove up healthcare spending, enriched UVMMC insiders, had no benefit in outcomes but did give free carrots and celery to a lucky few.
We tried not having a single payer and I’d argue it has the same result? Why not continue creative solutions instead of preserving something that doesn’t work.
Because having only one payor is certain to drive up the cost as in any government monopoly. It's the same reason the Pentagon can pay $6,000 for a toilet seat. The experimentation by government in healthcare is what has exacerbated this mess. Obamacare has proved all of its ctritics correct as costs have spiraled out of control, general access to service has declined and healthcare deserts are being created
Costs are spiraling for a lot of reasons, and boiling it down to the ACA is kinda reductive. I'm not convinced the costs would be half as crazy if the ACA had retained the single payer option it originally included.
There are a lot of palms getting greased in healthcare and it's never just one cause of anything. On the other hand, it's not hard to see that healthcare costs went through the roof within a couple of years of the ACA and that options for insurance coverage and providers fell precipitously. It's basic market principles, the fewer options for payment, the less competition and increasing prices. Single payor would have made this worse.
It's easier for insurers to keeps costs down when they're allowed to deny policies for people with pre-existing conditions or enforce lifetime limits for coverage. Would you rather we go back to a system that allowed those things?
The ACA's hedge against the cost increases that came along with the higher risk pool they were now required to insure was the individual mandate, which required healthier people to maintain a minimum level of coverage to help offset the costs, but a certain political party under a certain president repealed said individual mandate in 2019. As a result, healthy people can now go without insurance, which increases premiums for everyone else, which makes healthy people even LESS likely to purchase insurance, and now we're in a death spiral of increasing costs.
Would I prefer to go back in time and have the ACA fail legislatively and never become law? Hell yes! The individual mandate is a cheap scapegoat for the structural defects in the ACA that have crushed choice and driven up costs. The individual mandate was scrapped because it wasn't working and was punishing a small segment of the population. I hear the same thing over and over here: But for the repeal of the individual mandate; if only we had single payer.... Obamacare would have worked. It's nonsense. This is not to say that the healthcare payment system prior to Obamacare did not have problems and you point to valid concerns about preexisting conditions and lifetime caps. Of course, it's an open question whether health insurance companies are not still following those policies by other means, like treatment and medication denials.
Yes healthcare costs increased, but SLOWER after the ACA https://econofact.org/factbrief/fact-check-have-healthcare-costs-risen-faster-since-the-affordable-care-act-was-passed Healthcare is an inherently constrained market. We can't shop for a different emergency room or compare prices for MRIs as easily as in retail or picking a gym. Instead of us as individual customers voting with our wallets, we rely on an insurer to negotiate prices with the hospital on our behalf, and the prices are better when you buy in bulk, so one single insurer can get a better deal than a crowd of small firms. It's a customer monopoly instead of a provider monopoly. I think profits are a bigger danger to our ability to access healthcare than the perils of government corruption at this stage, because for profit insurance seems to be the bill thats going to make a big chunk of us homeless next.
I don't agree with the premise. In Vermont, the population is small and there is not a market that will support many healthcare institutions. However, elsewhere there is a market to support many more providers and the customer has power. Also, it's not true that the ACA reduced the acceleration in healthcare costs.
Wait until you find out that every other country in the world has a public option and they’re paying half of what we pay, and getting the same results
Then why do people come here from all corners of the world for treatment if it's better and cheaper everywhere else?
Lots of people, lots of reasons.
I’d wager top four are: specialty treatments not readily available in their region, urgent need that can’t be met in time by their system, or they have money to pay a private doctor so they don’t have to wait.
You know lots of people leave the US for cheaper medical procedures too, right?
You could have fooled me.
https://www.forbes.com/sites/rogersands/2021/08/06/americans-are-flocking-to-other-countries-for-medical-procedures/
Actually single payer can simply refuse to pay more. Not only that it can increase medical standards. When I first started off in healthcare pressure sores and ventilator acquired pneumonia were being covered by insurance. They were common place. When Medicare joint commission ruled they would no longer pay for hospital acquired conditions things changed rapidly for the better. It’s a win win.
That was just adding one more middleman with an inscrutable function. More middlemen taking cuts means higher costs. The one thing that would work, actual-single-payer universal healthcare that's free at the point of use, is the one thing our leaders won't do on principle.
Universal healthcare is nothing more than an unattainable talking point like "world peace." If only we had "world peace" there would be nothing left for second graders and beauty pageant contestants to wish for. Same goes for Universal healthcare. It won't happen because it's not a real thing. Universal healthcare is not a real thing because it would be an unworkable disaster. Socialized medicine is a failure in small countries like Canada and the UK. Imagine trying that in a country of 320+ million people....
It’s not “socialized.”
It’s one insurance company run by the government. Numerous studies have shown that the per person costs would be about 1/3 to 1/2 of what we pay currently - pay $4000 in extra taxes instead of $10,000 in premiums and copays, and that’s including coverage for those unable to pay anything.
It’s not perfect. My Canadian friend tells me that he had stomach surgery and his one out of pocket expense - he paid $16 for wife Chantal’s parking.
The biggest savings come from lesser paperwork, cutting out middlemen like PBMs and reducing the layers of contractors each taking 20-30% profits at each step.
Winners: doctors get paid slightly less but do not have all the insurance and admin costs, so overall win.
Winners: patients
Losers: HCA and all those intermediary people who leech the system at every level.
I’m good with that.
Serious question: Do you really believe that a government run program will reduce operating costs for a complex undertaking like delivery of healthcare? Where has this ever happened? Why would it be different this time?
Um, Medicare is extremely efficient and delivers excellent care, so, yes. It's happening right here, right now.
Other countries all over the world have single-payer medical care, and all deliver better care at lower cost, resulting in longer life-expectancies and better quality of life. So, it has happened in every developed country except this one (for those of us not on medicare), and is happening right now.
Medicare does not "deliver" care. It's a payment vehicle that pays prices that are artificially low because healthcare paid by Medicare is subsidized by higher amounts paid by private insurance. Life expectancy is decreasing in the US because of obesity and food, nor access to healthcare or quality of care. Some counties have socialized medicine. Not all. It may be cheaper in some places but the care is not as broad or as good.
Medicare essentially provides the healthcare standards affecting every entity which accepts Medicare. It does more than just make payments.
Got to the moon didn’t they. Our NIH is no slouch either. The NIH drives medical breakthroughs through foundational research, leading to advances like CRISPR gene editing, mRNA vaccines (COVID-19, potential cancer treatments), revolutionary tools (Green Fluorescent Protein, advanced imaging), and major therapies (Alzheimer's drugs, stroke treatments, genetics). Recent highlights include brain-computer interfaces for paralysis, robotic exoskeletons for walking, new dementia screening, and discoveries for Long COVID, impacting drug development, diagnostics, and understanding complex diseases.
You don't have to take our word for it. Right-wing thinktanks have been saying for almost 10 years that Medicare for all would be dramatically cheaper, on the order of $300 billion a year. If people ideologically opposed to collective action for the common good think the government would do a better job, the case is very strong.
Or if you'd rather be cynical, the insurance industry is such a malignant parasite dragging everything down that even the government would be a big improvement.
I'll give you credit though: "It's not a real thing" is a brand new talking point. That you'd say that is very encouraging! Your post, and the other rapid goalpost-shifting I've heard on this issue, reflect desperation at the consensus on the right and the left that the current system is evil and unsustainable.
Can you give an example where the government has replaced an entire private market with a government program and costs have gone down?
Healthcare system in England was compared to USA. Comparable care. Half the cost. Everyone covered.
We have massive fraud in this system now. We have shitty care for 20% and we already have all the “death panels”, denied care, and bad outcomes for 70%, and good care for only top 10%, and paying far more for it.
Around 73 to 78 countries, including most developed nations like Canada, UK, Japan, and Australia, offer some form of universal health coverage (UHC), ensuring essential services without financial hardship, though models vary from single-payer to mandated insurance, with the US being a notable exception in the developed world. WE HAVE A LOT OF STUPID PEOPLE HOLDING US BACK.
The UVM health network needs to be broken up.
For profit insurance and healthcare needs to be stopped. I don't care if they form networks after that.
There are no for-profit insurance companies or hospitals in Vermont.
Isn't basically every insurance company for profit. Eg Havard Pilgrim / BCBS / Aetna?
I know VT health Network is non-profit but it's also bloated up by admin staff in a cycle that keeps adding to its costs.
https://www.vhc911.org/vhc911-stat/does-the-uvm-health-network-deliver-on-the-promise-of-value-amp-efficiencies#:~:text=Is%20the%20network%20delivering%20on,patient%20care%20(Figure%203).
Aetna, yes (its owned by CVS). BCBS, no -- all Blue Cross Blue Shield affiliates nationwide are non-profits. Yes, UVMHN is wildly bloated at the senior admin level.
May be listed as non profits, but non profits can also pay its workers
Agreed that the lack of universal health care is the source of almost all these problems. But in Vermont, at least, we have the weird case of our main for-profit insurance company not actually making profits, due to a monopolist exercising control over a small market that's completely dependent on it. UVM health network should be regulated out of existence.
Which insurance company in Vermont do you think is for-profit?
Thanks for the fact check. BCBS Vermont is not even for-profit!
The only for-profit healthcare orgs in the state are places like OpenMRI or Green Mountain Surgical Center, etc.
FWIW, BCBSVT is a much more complete monopoly in Vermont than UVM Health is.
I'm surprised there are even any insurance companies left operating here, given Vermont's aging population and cost to insure. The Medicare Advantage offerings are almost all gone.
Medicare advantage plans are garbage. They are bankrupting local hospitals by nonpayment. They are also costing us billions in tax dollars. They need to go. We need one plan for all. Give everyone in America Medicare straight up Medicare with no gap.
100% agree.
That's more because Medicare Advantage is basically structurally unprofitable now; they are disappearing across the country, not just here.
No it’s largely due to not meeting insurance companies greed that less profitable markets get dropped. Reports and studies estimate that insurance companies have received over $600 billion in overpayments from the government for Medicare Advantage (MA) plans since their inception, through practices like inflated billing and risk selection. This figure represents overpayments (money received above what would have been spent in traditional Medicare.
High Gross Margins: In 2023, MA plans averaged nearly $2,000 in gross margin per enrollee, significantly higher than margins in other health insurance sectors. Government Overpayments: A significant source of profitability stems from the federal government's payment system. The Medicare Payment Advisory Commission (MedPAC) estimated that in 2024, MA plans were paid $83 billion (22%) more than traditional Medicare would have cost for similar beneficiaries, largely due to "upcoding" (making patients appear sicker on paper) and favorable selection. Market Dominance: The market is highly concentrated, with major for-profit insurers like UnitedHealthcare and Humana dominating the landscape and controlling nearly half of all MA enrollees nationwide. Business Decisions: Insurers often make business decisions to exit certain counties or reduce supplemental benefits in "unprofitable" markets to maintain desired profit levels, demonstrating a focus on margins over market share growth. Recent Pressures: In 2024 and 2025, some insurers faced profit pressures due to higher-than-expected use of medical services by enrollees and slight changes in federal payment rates. In response, several major insurers announced they would be reducing plan offerings and exiting certain markets to improve future profitability. Despite recent turbulence, industry executives remain largely confident in the long-term growth and profitability potential of the MA market.
You do realize that this is the product of Obamacare.....
Obamacare was 15 years ago, how long before you find a new thing to blame stuff on?
There is no new thing to blame. Obamacare reworked the entire healthcare payment system and there has been no intervening change. It is very easy to trace the current collapse in healthcare funding and delivery of services to the policy choices made in the implementation of the Affordable Care Act.
There was an intervening change that was guaranteed to drive up costs. The Tax Cuts and Jobs Act of 2017 effectively repealed the individual mandate which was the key for driving down costs.
You seem to forget that in fact Obamacare is actually Romney care, the republican who actually created the system.
Please tell me about the great plans republicans have for us. Don’t tell me that they are going to give us a couple thousand a year. That’s about 2 maybe 3 months of coverage. I really love it when they say we’re giving the money to you instead of insurance companies….who you will hand it over to or maybe just go without insurance to afford some groceries.
The Republicans have failed to muster the will to make meaningful change happen even when they had the capability to pass real reform. This is a different issue than the current debate over what to do about the end of the Covid subsidies for premiums.
Controlling all three branches of government???
Donald Trump has been promising a new, comprehensive healthcare plan to replace the Affordable Care Act (ACA), or "Obamacare," for over 13 years, with these promises dating back to at least 2011, and a broader focus on universal healthcare as early as his 2000 presidential campaign. You just don’t know when you’re getting played.
UVMMC is a monopoly BECAUSE of misguided attempts to solve healthcare cost increases through regulation....
Do you think maintaining 3 ERs in Burlington would be an effective use of resources?
Yes. If the ER's were privately run and in competition with each other and the market would support 3 ER's, that would be very good.
Yeah let's add profit to all of them, surely that will lower prices.
They are a monopoly around here, seemingly unchecked
The VT Digger piece reads like a press release from BCBS.
Because it is, mainly.
BCBS doesn't even provide the insurance to UVM employees, they've switched to Cigna. Sounds like there's bad blood around.
UVMHN had BCBS of South Carolina, not VT. They are self insured so BCBS of South Carolina got their Admin fee not BCBSVT.
Just to be clear, BCBS is keeping the same rates and not lowering them but encouraging people to go to lower cost of care, seems to me it’s still not the patient benefiting from this.
It’s two baddies fighting each other
BCBS has been losing money for years. They have no mechanism to lower rates without costs going down.
Its clear they need to incentivise this.
If you need surgery, fly to Mexico if you can. Even with the cost of the flight, it's still cheaper.
If you need open heart go to India. The Dr Singh there is the same as the one here. There are actually Cleveland Clinic affiliates. For a two week stay, with souvenirs it’s basically a fraction of the cost of it here.
Universal healthcare for America. No other civilized country has these problems. Not only are healthcare costs lower in other countries their care is better.
This is actually very good advice. Stay away from the hospitals that sell Chevrolets at Lamborghini prices.
UVMMC just transferred the employee healthcare from BC/BS to Cigna.
Yup, I'm sure that's going to do wonderful things to BCBS revenue numbers.
UVM Health is self insured.
And an edit, why are we cheering on the insurance company here?
BCBS hiked rates by double digits this year so they could build their cash reserves (depleted from record highs after the pandemic). Meanwhile, in 2026 UVMMC lowered its prices by more than 8%.
All that suggests that BCBS will see excellent profits in 2026 - likely $50+ million. Will they lower their prices after the reserves are built back?
Yes because it's the insurers who need to be saving money
If people move the profitable things away from UVM Health and only do the major things there that no one else can do, the system will collapse. Maintaining the trauma center and advanced medicine services it has costs money that isn't fully covered by reimbursement for major surgical procedures and inpatient day rates. If they can't afford it, that stuff will disappear.
I’m in intensive care RN, who has spent their life in healthcare. I will tell you this, largely I find there is no excuse for some of the fees associated with hospital procedures. I wouldn’t be contributing to the high cost of my insurance or paying expensive co-pays to benefit any system.
Have you worked in senior administrative roles? Otherwise, I imagine you haven't interacted too much in your career with hospital financial management or had direct training / experience with hospital economics. Maybe they should teach that stuff more intensively in nursing or medical school, but they don't. Like any other complex topic, there is a lot of shit that doesn't make too much sense unless it becomes your job / field to understand it completely.
This system is going to collapse and frankly it has to if we hope to clear the forces that are currently arrayed against reform. Hastening the collapse is not a bad thing.
What a waste of insured people’s money. There is absolutely no incentive for someone to go somewhere that is not the most convenient and best care covered by their insurance.
I'd sooner take health advice from a toothless hobo than an insurance company.
Come on Vermonters, Let’s all get together and sacrifice to help maximize profits for the most important people in the American health care system , the insurance executives.
What’s a good place for finding a PCP? I had just booked through UVM health network and might just go ahead and change it
It says we don't feel the cost until premiums go up? I have a $4000 deductible which I have to meet before they pay anything. I've only met it 2xs in 10 years. A friend has a family plan and they have an $8,000 deductible. I've heard other people post even higher deductibles. We have to get profit out of healthcare and those administrators that make outrageous salaries.
The only way to drive down the cost of health insurance is to not go to UVMMC or any UVMHN hospitals if we can avoid it as Vermonters. They've inflated their prices and have been sending money to their NY entities, hence why basically the entire UVMHN exec team all resigned.
The only other option that I have emailed my VT state rep about is to cap commercial prices at 200% of Medicare. If any health care provider/entity can't make a margin at 200% of Medicare for commercial patients, they are a) lying or b) have inflated overhead costs (UVMMC/UVMHN). Coming from a Medical Billing person (not affiliated with a hospital)
Vt has a lot of alcoholism and drug issues that drive up the usage of facilities
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The only one run by qualified staff? Wow. What are the others doing? Spinning a wheel and letting whoever it lands on press the button?
Unfortunately you’re exactly right. UVM has unjustifiably higher prices but the diagnostic quality is not comparable to most smaller facilities.
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My UVMMC doc told me to go to OpenMRI for a brain MRI, and said that the regular enclosed system has just as good accuracy. It's the open system that doesn't have the same resolution.
Not mentioned here, but the wait time at UVM was a bit over 3 months, Open MRI in Williston found me appointment the next week.
Incidentally, was it still your UVMMC doc reading the MRI to give you your results or did OpenMRI have its own radiologist interpreting the imaging?
OpenMRI had their own remote radiologists. It was read and sent back to my doc within a few hours afterwards.
The last time I had an MRI at UVM, they sent it to a radiologist in Florida that took about the same amount of time before they forwarded it to the ordering provider.
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https://www.vtopenimaging.com/ offers a 3 Tesla. Stop speaking when you have no idea what you are spewing
How sure are you that Open MRI doesn't have a 3T as well?
lmao