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Hospital prices are about to go public in the U.S.

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Re: Hospital prices are about to go public in the U.S.

#161

Post by tertius »

onetimemanytime wrote: post #156
tertius wrote: post #143

Earlier quoted context omitted.

Ambulance staff are incentivized by pretty nurses and free food/snacks. Ask any paramedic in a city with enough choice of hospitals and they'll tell you. What is the best answer to the "emergency care competition" that you've found? And what proportion of medical spending is on emergency vs. not?

>> What is the best answer to the "emergency care competition" that you've found? Pay what the insurance or medicare pays, plus a capped xx% because they got a volume discount. By law hospitals have to stabilize you, can't let you die, money or no money. (I know they have been cases of trying to dump patients but...) So you saved me, but how did you come up with the $455,000 bill? We entered into a contract without p…

I meant the best answer to the "there is no competition in emergency care" objection.

Is there a current good answer to a consumer having the ability to competitively (without too much work) receive emergency care?

Re: Hospital prices are about to go public in the U.S.

#162

Post by cm2187 »

setr wrote: post #98
feanaro wrote: post #71

Earlier quoted context omitted.

That still doesn't explain how prices of medical services in many other countries turn out several order of magnitudes smaller than commonly encountered prices in the US.

I've discussed this before, but I think there's quite a bit of funny money in hospital bills -- a 10k bill rarely actually materializes in 10k transferred across all parties involved. Doctors bill $10k to your insurance, the insurance decides its too much, lawyers are on-hire to negotiate and take a 30% cut of the outcome, and finally 2k is paid out; the absurd bill naturally accounts for the absurd process, and I do…

I'd be curious to know how much of that is caused by malpractice insurance. I mean if hospitals were overcharging so much, then surely we should see lines of rolls royce in the hospital parking lot. Doctors are well paid in the US but they are typically not rich.

Re: Hospital prices are about to go public in the U.S.

#163

Post by tertius »

kristopolous wrote: post #150
tertius wrote: post #143

Earlier quoted context omitted.

Ambulance staff are incentivized by pretty nurses and free food/snacks. Ask any paramedic in a city with enough choice of hospitals and they'll tell you. What is the best answer to the "emergency care competition" that you've found? And what proportion of medical spending is on emergency vs. not?

Even in non-emergency care, perfect competition requires perfect knowledge (the consumer to know medical knowledge), perfect information (knowing the exact quality of care from all competitors beforehand), rational buyers (having no preexisting biases based on irrational cognition), no barriers to entry or exit (ie, being able to switch hospitals mid stream), no network effect (the previous state...eg who does the la…

Perfect competition? There is no such thing in practice. Also potentially a way to outsource this to a group with better knowledge.

Dentistry is a good example of competitive service, eye care is as well. And negotiation is normal.

You're moving the goal posts in the right direction, but to the edge.

Re: Hospital prices are about to go public in the U.S.

#165

Post by kristopolous »

tertius wrote: post #161
onetimemanytime wrote: post #156

Earlier quoted context omitted.

>> What is the best answer to the "emergency care competition" that you've found? Pay what the insurance or medicare pays, plus a capped xx% because they got a volume discount. By law hospitals have to stabilize you, can't let you die, money or no money. (I know they have been cases of trying to dump patients but...) So you saved me, but how did you come up with the $455,000 bill? We entered into a contract without p…

I meant the best answer to the "there is no competition in emergency care" objection. Is there a current good answer to a consumer having the ability to competitively (without too much work) receive emergency care?

You could do limited supply side bidding and some of that already happens, but proximity to care matters so much that I think structuring it like all the other emergency services (such as police and fire) is probably the right way to go. Urgency is the only maximizing function.

Re: Hospital prices are about to go public in the U.S.

#166

Post by cm2187 »

mwerd wrote: post #133

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type…

In a way it's like if Apple was advertising the price of its individual electronic components rather than the all-in price.

Re: Hospital prices are about to go public in the U.S.

#167

Post by kristopolous »

tertius wrote: post #163
kristopolous wrote: post #150

Earlier quoted context omitted.

Even in non-emergency care, perfect competition requires perfect knowledge (the consumer to know medical knowledge), perfect information (knowing the exact quality of care from all competitors beforehand), rational buyers (having no preexisting biases based on irrational cognition), no barriers to entry or exit (ie, being able to switch hospitals mid stream), no network effect (the previous state...eg who does the la…

Perfect competition? There is no such thing in practice. Also potentially a way to outsource this to a group with better knowledge. Dentistry is a good example of competitive service, eye care is as well. And negotiation is normal. You're moving the goal posts in the right direction, but to the edge.

Plenty of things are pretty close to perfect competition

Grocery stores, sandwich shops, coffee houses, clothing stores, coin laundromats, circuit design, postal carriers, kitchen utensils and serving equipment, rental cars, housekeeping things like brooms and dustpans, bouquets and flowers, nuts bolts and fasteners, airlines...

Essentially anything where the brands are fairly indistinguishable and you have a hard time separating them. That's competition working.

Eyeglasses are probably one of the closest in medical. Common medicines like lactase, dextromethorphan and acetaminophen also score high.

Re: Hospital prices are about to go public in the U.S.

#168

Post by ascar »

telotortium wrote: post #45
pkaye wrote: post #10

Earlier quoted context omitted.

If you look at healthcare vs GDP, the US is way above the line compared to comparable countries. https://www.healthsystemtracker.org/chart-collection/health-... I think scaling the average costs from other countries accounting for GDP would be a good way to set the rates.

If you look at the actual household income in various countries, as opposed to the GDP, which doesn't always track household income as well for many OECD countries, it turns out that the US has pretty much the healthcare consumption expected for its average household income: https://randomcriticalanalysis.com/2018/11/19/why-everything... . Based on this analysis, I think the primary issue with US healthcare is the fa…

The graph is already adjusted for PPP, so this difference in income should be largely mitigated, shouldn't it? Thus the US still spends about double of other countries.

Re: Hospital prices are about to go public in the U.S.

#169

Post by ashelmire »

cm2187 wrote: post #162
setr wrote: post #98

Earlier quoted context omitted.

I've discussed this before, but I think there's quite a bit of funny money in hospital bills -- a 10k bill rarely actually materializes in 10k transferred across all parties involved. Doctors bill $10k to your insurance, the insurance decides its too much, lawyers are on-hire to negotiate and take a 30% cut of the outcome, and finally 2k is paid out; the absurd bill naturally accounts for the absurd process, and I do…

I'd be curious to know how much of that is caused by malpractice insurance. I mean if hospitals were overcharging so much, then surely we should see lines of rolls royce in the hospital parking lot. Doctors are well paid in the US but they are typically not rich.

> Doctors are well paid in the US but they are typically not rich.

What doctors do you know? My friends who are just getting out of residency and such are making a few hundred thousand a year. My college roommate’s father was an anesthesiologist making $800k/year.

Just because they don’t draw attention to themselves with ostentatious vehicles doesn’t mean they couldn’t afford to (the anesthesiologist only had a Porsche for each of his kids).

Re: Hospital prices are about to go public in the U.S.

#170

Post by cm2187 »

ashelmire wrote: post #169
cm2187 wrote: post #162

Earlier quoted context omitted.

I'd be curious to know how much of that is caused by malpractice insurance. I mean if hospitals were overcharging so much, then surely we should see lines of rolls royce in the hospital parking lot. Doctors are well paid in the US but they are typically not rich.

> Doctors are well paid in the US but they are typically not rich. What doctors do you know? My friends who are just getting out of residency and such are making a few hundred thousand a year. My college roommate’s father was an anesthesiologist making $800k/year. Just because they don’t draw attention to themselves with ostentatious vehicles doesn’t mean they couldn’t afford to (the anesthesiologist only had a Porsc…

The first result on google (that I don't particularly vouch for) seems more in line with what I would expect:

https://www.sokanu.com/careers/doctor/salary/

So between $200k-400k depending on seniority and speciality. It's not really outrageous compared to other, highly educated professions.

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