500 per stitch . Consider this how do hospitals th will it get better or worse with obamacare . Also, an al jazeera exclusive brings new questions to light over irans influentialing program. Plus the Energy Drink Business is exploding with little regulation. We will hear from a doctor whose new study is adding to growing concerns safety. Can you live your life paying for everything by only using online currency . We will be joined by a couple who live in or who lived in banking. Hello. I am antonio mora. We begin with outrageous hospital bills. The mysterious methods hospitals use often puzzle experts. How can it cost one person in california 1,500 to get stitches when the person next to them is charged 500 more and the same treatment in florida could cost over 3,000 . As al jazeeras janet tuboni reports, higher costs do not necessarily equal better care. Renewing a longstanding debate prices. Hospital costs have americans fed up with the system. I think Insurance Companies and hospitals and healthcare in general are really over the top reporter some even say they paying. If you were going to get one stitch, would you pay 500 tore stitch yourself . I would try to stitch myself. Shocking. I am not surprised. There is a thing in america about like having competitiveness and an open capitalization. The disparity in costs on this map represent the same procedures in different hospitals. Some well a gap of over 90,000. You can go to one hospital, get a procedure that costs 7,000. You can go to another hospital, exact same procedure, 100,000. You can go to europe or asia and get it for a third of that. Patients here at the nyu Medical Center will pay the high cost of treatment and Services Look so many other americans but what they want to know is what exactly are they paying for . Some hospital administrators say the cost is due to highly trained professionals available at all times, upgraded equipment and building standards that meet expectations. I think that there shutted be more oversight probably in terms calculated. With a difference in opinion, one question is clear where is the money going . Giana york. New york times core en respond event has been writing about this all year. Her fifth article, paying until it hurts on the high cost of American Healthcare appears in tuesdays edition of the new york times. Elizabeth. Thanks. Its been said you need a ph. D. In economics to understand how hospitals and hospital bills. You are a doctor in addition to being a journalist. But still, i dont know if you can explain this to me because i dont think anybody can. How in the world can you have a hospital charge 137 for a bag of saline for an iv when the thing costs a buck . The truth is hospitals charge what they can get away with charging in our system. There is no reason for them to do otherwise because we are the one country in the world that doesnt control prices. But how in the world can that make sense . Lets look at some more of theseprises. Example. You looked at a hospital in california, california pacific. Some of these inflated prices. Tylenol with codeine, the hospital price was 36. 78. The market price, 5s 0. 00. We talked about the iv fluid back, neck brace costs 20 bucks on the regular market. A knee orthro scopic hospital price 14,110. The market price, barely over 2,000. How in the world does a hospital get away with that . Who would go to a hospital and pay 14,000 if you could go 2,000 . The problem is in most of the u. S. , you cant go to someplace else and do it for 2,000. The star of part 3 of our series went to belgium because he didnt want to get his hip replaced in the u. S. Or he couldnt afford it. So i think if you shop around, you can get somewhat better prices, but our prices are universally inflated. But why can they get away with it, i guess is my question . Because there are so many people involved in the process. Well, because we dont pay those bills directly. I mean when you look at your hospital bill, you get your hip replaced, you get your explanation of benefits and you see that 99,000 and you think, whoa, what could cost that much . But your insurance is paying most of it. You may have a 2,000 dollar deductible. Beyond that, you are like it problem. There is a Ripple Effect in the end that avenge affirmative all of us. Sure but not one we see directly. We cant respond to prices. We dont experience them directly and, you know, i challenge anyone to call around to hospitals and say, whats it going to cost to get my hip replacedd you cant get the consumer . You cant do that in most places. California is an example. They have to put these prices online. So you use, again, the example of california pacific. Lets look at some of those prices. They put the stuff online. 33,000 for an xray study of the hearts arteries, more than two 5 grand for gallbladder removal. That doesnt include the doctors fees, 5,500 for a simple delivery of a baby. That doesnt include 731 bucks extra for every hour of labor. So, oh, my god, if you have them in labor, you are in big trouble. They add on all sorts of other things. Are those actual costs for the hospital, real prices, or are they just putting these inflated numbers out there as a beginning point, as a starting point for negotiations . Well, they are they are Cost Shifting when they come up with those numbers because they will say, they have all of these services but they arent paid for, like nurses salaries, like heating, cooling, you know, whatever. But basically, they pull numbers out of thin air. They say, what do we need to make . And then they adjust their prices for this, that, and the other to make that. Now, you know, someone would say to me, well, look, your iphone doesnt cost 650. Everyone marks things up. But there are no actually, this is healthcare. This is about peoples survival, having a baby, kids getting immunizations. So the question is, do we really want that prices the way we have our cell phones priced . You end up paying the 650 bucks unless you are getting it through a provider with a contract. In this case, does everybody end up paying those 32,000 for the heart xray . Well, you know, most of the insurers will negotiate rates. The poor the unfortunate people who actually are hit with those bills are people who dont have insurance, who dont have an insurer to argue on their behalf. But, you know, in a way, we all pay because its people say, why is my premium going up . This is why. Why we have so many bankruptcy connected to it. Right. Then you see a doctor at that hospital talked about how medicaid only pays 10 to 20 of the costs. Medicare, 70 of the costs. Insurance Companies Often get about half of what those list prices are. Right. So again, it just seems like played. Its a crazy system. Its a completely crazy system. We dont do anything else like this. If someone said do you see, you had someone come in to do your kitchen and they said the price is going to be 20 draws in br we will take 200,000 but we will take 30,000, how could you possibly have a system like that . And yet thats what we are doing with healthcare. And one thing that i really didnt understand, i guess i dont understand most of tin th but in california, again, you have to publish prices online, put the prices out there. But their emergency room costs are the highest in the country 50 higher than in the northeast. You would think if you were actually putting those prices out there, it would lower prices. So how do they end up here . Well, the thing is, putting prices on there is not making them accessible to actual human beings. The state, to its credit, said to hospitals, we want to see your charge masters. Now, i use that as a list price, but its not like a restaurant menu where there are five pages. Its 400 pages of medical coding terms. So, i trained as a doctor so i know what those codes mean. So i can tell you what they are charging for most things. I mean there were a lot of things like, you know, fiveinch screw platinum, blah, blah, blah, that i dont know what it is and its 7,000. So you can imagine if you say to your hospital, i want an itemized bill and you get this list of stuff, its kind of meaningless. So california, to its credit has taken this first step. Most states havent even done that but in terms of being actually useful for patients, not really. You talk about all sorts of other things including how Emergency Rooms from gone from being money pits to money makers. There, they jack up the costs. Elizabeth. Thank you. I hope everyone looks at prices a lot more it would be a fairer market. Thats for sure if we knew what was out there. He liz Beth Rosenthal with the new york times. Great to have you here . Thank you. For more on healthcare costs and whattrition to obamacare, we are joined by james robinson, professor of health economics. He joins us from our stud studio. Great to have you with us, james. I think you do some things up nicely and asked an important question about healthcare and the new york times. You said, quote, hospitals are selffueling, everexpanding machines. There is an infin ite amount of stuff to buy, am ebbities, new wings, higher salaries, more nurses. But to deliver good healthcare, what do you need . What do we need . And should they be charging what they are charging for those things we need . Well, i think that there is really three interconnected aspects of the problem. The first is that the consumer doesnt have any way of knowing what the price ofhy is and the prices structured, as elizabeth was saying, thats so obscure, nobody can understand it. Thats the first problem. The second one is that the prices, themselves are so there is not a single price for anything that you would actually want to buy. It comes out as these bits and pieces of, as she put it, screws and bolts and bandages and aspirins when what you really care about is whats my care going to cost me . Whats that whole doctor visit going to cost me . Whats the whole admission to the hospital going to cost me thats not prized that way . The third is that the consumers often dont care because somebody else is paying for it. We dont care what something costs if someone else is paying. All three of those need to be addressed if we are going to have any rationality in the healthcare pricing system. In many ways, it really is completely anticapitalistic because you end up not knowing what you are buying. So, it really is an aberration to the rest of of our economic system. Its a peek youll yar world because it is a market system but because of insurance and the wait insurance is structured, we are all like we are drugged. We dont care, we dont know. Through higher premiums and taxes. At the time we are receiving care, we have this illusion that someone else is paying for t even if we try, do a diligent job of trying to understand what things cost, we get these incomprehensible. You have been out spoken on how it is the biggest driver of rising healthcareh Health Insurance premiums but the outrageous costs have been known for years. So why hasnt the outrage over this taken us anywhere . Its hard to understand. We used to we used to say that healthcare costs couldnt rise above 10 of gdp. People would be outraged. Now, its about 18 and seems like its just going higher. I really think that the fundamental issue is that really, people have believed that someone else is paying for their healthcare raernling themselves. This is the great illusion of healthcare, that we are not paying for it. Is that illusion going to get worse under alabamacare . The president is making a renewed push and stressing costs. Say. The website is working for the vast majority of people. We need to make sure that folks refocus on whats at stake here, which is the capacity for you or your families to be able to have the security of decent Health Insurance at a reasonable cost. So in the short and longterm, what do you think obamacare will mean for the cost of care . I think that it will have the two different effects. It will have some costreducing effects because it will help consumers make more apples to apples comparesons across health plans and, hopefully, across doctors and hospitals. Thats a little bit more to be seen. Thats very important so the consumer is making their choices. On the other hand, i think we have to admit that the administrative costs of this whole system are high. And really, unfortunately, obamacare is layering another layer of complexity on a Healthcare System which is already groaning under the plex complexity of our system, which expensive. What about that . You said in the recent article that the average stay around the world is about 6,000. In the u. S. , its over 18,000. What if the quality what is the quality of care here compared nations . I think all of the studies are pretty clear on this that the quality of care in the United States is about comparable to the other industrialized nations such as canada or the european nations or australia. So we spend more, gu we dont get more. We just have this unbelievably convoluted system and we need to make it more simple. We need to have the consumer, the patient, more engaged in understanding and caring about what it costs, and then we need the Healthcare System, the hospitals, the doctors, the pharmaceutical companies, to respond to a consumer, an interested and informed consumer by making their prices more understandable. Frankly to compete on the basis of price, which will drive prices down over time. James robinson, really appreciate you joining us to try to make some sense out of this, this big mess. We appreciate you joining us. Thank you. My pleasure. Coming up, an al jazeera exclusive minister with irans Foreign Ministers raises more concerns about the countrys nuclear ambitions. We will have analysis next. Lets going back to hermela. The night against low wages is taking on the banking industry. I will tell you more coming up. What do you think . Join the conversation on twitter ajconsiderthis and on our faceboo our facebook and ogolog google pages. Every sunday night Al Jazeera America brings you controversial. Both parties are owned by the corporations. Entertaining its fun to play with ideas. Thought provoking get your damn education. Surprising oh, absolutely . Exclusive oneonone interviews with the most interesting people of our time. Youre listening because you want to see whats going to happen. I want to know what works what do you know works . Conversations you wont find anywhere else. Talk to al jazeera. Only on Al Jazeera America. Oh my power of the people until we restore our free from debt to america to lets make a deal. Jamar zarif has wrapped up a diplomatic Charm Offensive after wrapping up an interim deal on Irans Nuclear program. Zarif gave an exclusive interview to Al Jazeera English where he emphasized again that Irans Nuclear program will go on at least partly on irans terms. Iran will continue its enrichment at 5 . And iran will continue construction work at iraq. For more here in new york is nadir sh ar mi at the joseph corevel at the university of denver. Also, the coof a new book, the syria dilemma. You heard zarif speaking. He insisted they dont want nuclear bombs. As you heard, he is insisting on continuing work at the plant that the nuclear re actor at iraq which would be able to produce bombs. He said they continue to have the right to enrich. You have this conflict between what the ir ranians are saying and what john kerry is saying. Both sides are trying to spin it for domestic audiences. We have to judge iran not by what the foreign minister is saying but what iran has committed itself to by virtue of the general eva agreement, what its doing on the ground. I think what we are hearing is iran wants to show it has not capitulated to the international community. When you look at the general eva agreement, iran has made a an almost 180 degree turn. It had to accept the dmrandz of the international community. Capitulation by iran that it had to make in the case of very concerted western efforts. Lets look at some more of what zarif said. Is it all spin . Most of us think the economic sanctions are what led iran to the negotiating table, but he had this to say when sanctions started, iran had less than two 00 centrifuges. Today, 19,000. So the product, the net product of sanctions has been about 18800 centrifuges added today irans stock of centrifuges. On the other hand, the people of iran blame the west for instructions that have been imposed on their livelihood, on their ability to buy medicine, on their ability to finance and purchase food items from abroad. So does he have a point . That, in fact, the saifrpingsz have led to iran getting more and more centrifuges and developing their own Nuclear Program creating some sort of resentment . He is saying that for domestic constituents. One has to ask why did it come to an agreement that it previously had rejected in previous years . He is saying its not because of the sanctions. I think most reasonable people know the sanctions has devastated the iranian economy. The reason why iran has made this aboutface, signed the geneva agreement, because it realized its economy, the future of its regime was headed toward disaster. It had to make a compromise. Thats whats going on. Zarif said and insisted that Irans Nuclear program is for peaceful purposes and transparent. We have nothing to hide. They have been searching iran up and down, in and out, for the past 10 years probably more than they have searched any other country on the face of this earth. And they have not found a single evidence of diversion of our Nuclear Program into anything other than peaceful purposes. If you watch him. Is he as netanyahu said on, a wolfe in sheeps clothing . I am a reminded of a diplomat who says an ambassador is someone who is a nice gentleman who is sent abroad to lie for the good of his country. We are seeing that in his statements, that he is a very likeable statements but these statements have to be deciphered and interpreted. Is clear, they hit the Nuclear Facility and they have things. Right, or ask the question why werent International Inspectors given full access to iran before . Why do we have to wait until this agreement if iran really had nothing to hid