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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.

#361

Post by Nasrudith »

cheez wrote: post #228
tomohawk wrote: post #226

Earlier quoted context omitted.

If you are a patient in this situation, there are advocates who can help you. One thing to try is to ask the billing department if they will "accept assignment". What that means is that instead of billing you their fake rate, they would instead bill you as if you were an insurer. IMO, it is incredibly unethical and dishonest for these medical corporations to charge different fees depending on who you are. Prices shou…

When you remove the middlemen, what will you replace them with?

Middlemen are not indispensable - they need to justify their existence not others to justify their absence. The whole point of cutting out the middlemen is to force them to go from a parasitic role to offer some sort of actual utility for their price.

If the middlemen have something of value to offer they have little to fear - just someone to buy gasoline by the tanker for instance keeps gas station middle-men safe because they provide both a workable connection between logistics of the very large production and consumer scale amounts - in addition to the distribution.

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

#362

Post by Nasrudith »

antisthenes wrote: post #301
jlebar wrote: post #292

Earlier quoted context omitted.

Serious question: Do you live a perfect life? Do you exercise daily? Do you never eat processed meat (linked to cancer)? Do you never drink soda (linked to metabolic syndrome)? Do you not smoke? Do you not drink any alcohol (linked to cancer)? Do you live close to your work so as to minimize the time spent in a car (car accidents are a major cause of preventable death)? Are you not overweight, even a little? And so o…

> Do you think that someone who follows all but one of those rules still deserves healthcare? All but two? What's the moral difference between someone who smokes and someone who hasn't taken heed of diet/exercise advice after getting heart surgery? Yes. Yes. Moral difference no idea, but neither one should expect to have society foot the entire bill for their bad habits. > Where do you draw the line? Probably around…

The whole point against it is that there are precedents being set regardless of what you think is 'right' it will start to apply to other things in the model that you agree with far less - especially when they go off of assumptions that turn out to be objectively wrong.

It is essentially a bill of rights thing - either you support universal rights for everyone or you support them being taken away whenever convenient a.k.a. no rights at all for anyone.

Just go back as shallowly historically speaking as AIDS in the 80s. "Only gays and drug users get AIDS so why should we pay to help those degenerates?" sounds downright satirically stupid but that was essentially a real viewpoint and sadly still is really. Judging the 'guilt' of patients is a very dangerous thing for a society to do and doesn't help the underlying health problem at all.

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

#363

Post by Nasrudith »

trevyn wrote: post #47
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.

This could also be due to people in the US simply seeking more care than in other countries.

Even if that was true it doesn't necessarily map. Preventative medicine is known to reduce costs considerably for one. Paradoxically healthcare can be expensive because people aren't getting enough care.

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

#364

Post by conanbatt »

PenguinCoder wrote: post #333
conanbatt wrote: post #315

Earlier quoted context omitted.

> The patient shouldn't have to call the insurance provider to see where it is accepted But this is actually the one that provides the service. You dont call the music band to ask about the prices ticketek charges. You should and can ask about the price without insurance and you might get an answer (though you wont like it).

See other comments in this thread about where that question gets you. My experience has not been any different. IE, the answer ranges from "I can't tell you until the procedure is done", to exorbitant quotes. Of course I don't like those answers, who does?

You can find someone that knows the prices. Small practices will know, and in hospitals I'd try someone from staff, not doctors because they are overworked with patient loads and are shielded from the admin burden.

What makes the expectation unreasonable is when you don't know what you will need. Surgery is a great example of that: what if there is a complication? What if a specialist is required, etc etc.

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

#365

Post by conanbatt »

conductr wrote: post #331
conanbatt wrote: post #271

Earlier quoted context omitted.

Medicare reimbursements are below cost of care. If all insurance lowered to Medicare reimbursements, you will reduce supply.

That’s what most providers claim. In my experience (healthcare Corp finance), it’s typically closer to breaking even on Medicare. Especially if you cut out some fluff/unnecessary spending companies like to engage in. I’ve worked with Medicare and they actually try to do a bottoms up, zero based, pricing to determine what something should cost. So when a hospital is built by some award winning architect and has founta…

Considering private pays almost 200% what medicare pays, I doubt it.

Its more like how airlines work: they make money on first class, and coach is something that fills the plane to cover some costs. If planes were made mandatory to only have coach, they would go bankrupt.

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

#366

Post by idontpost »

cm2187 wrote: post #166
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.

It's far worse than that. It's like if Apple didn't have a price for an iPhone, but instead at the register it scanned the package and looked at which factories each part came from and which assembly-line workers in those factories worked on those specific parts, and which mines the minerals came from, etc. and then charged a different line item for every one of those factors.

Sure, the average cost is $1000. But yours might be $5000.

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

#367

Post by bborud »

conanbatt wrote: post #271
bborud wrote: post #139

Earlier quoted context omitted.

What do they mean by "lose money"? Even if I turn up at a private hospital here in Norway, I pay nowhere near what you would pay in the US. Which tells me that either hospitals are run extremely inefficiently in the US (orders of magnitude worse than here) or there are layers of pretty substantial profit margins. I may be a bit peculiar, but I think a healthcare sector that is set up to mainly benefit execs and share…

Medicare reimbursements are below cost of care. If all insurance lowered to Medicare reimbursements, you will reduce supply.

I was referring to private healthcare without reimbursements or insurance. And mind you: Norway has a pretty high cost of living so it isn't like this is a low cost country.

Which suggests to me that prices do not reflect actual cost, but rather inflated profit margins.

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

#368

Post by jimmyrussel »

coredog64 wrote: post #249
thefringthing wrote: post #227

Earlier quoted context omitted.

Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?

There is no single "European" model.

True. In fact it is worth noting that a large portion of the ACA/Obamacare model was based upon Swiss healthcare (specifically the individual mandate in particular) due to its heavy private market presence.

First line in Wikipedia (https://en.wikipedia.org/wiki/Healthcare_in_Switzerland) There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland (within three months of taking up residence or being born in the country).

The difference being their version of the individual mandate was not struck down or watered down to becoming a 'penalty'. Instead it was like what we do with auto insurance.

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

#369

Post by jimmyrussel »

raven105x wrote: post #288
thefringthing wrote: post #227

Earlier quoted context omitted.

Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?

Personally, yes. Like many posters here I am an Engineer not in the medical field, so take my opinion with a grain (read: mound) of salt. Most "free" healthcare systems have either (1) horrible quality of service or (2) impossibly long waits unless your life is in danger or close to it. The latter is a systemic issue I've noticed in that healthcare, regardless of pricing or structure, does not aim to foster optimal h…

Re: quality vs wait period trade off.

We generally call this the 'Iron Triangle' in healthcare policy/management. You basically get a pick at most two out of (1) access, (2) quality, (3) cost.

As to your general sentiment healthcare is a bit 'one size fits all' when in terms of insurance/reimbursement solutions. Note that the needs of the aforementioned triangle are weighted differently based on acuity of care. More generalized simple/low acuity care we are happy to get low cost and ready access as our best solutions (e.g. minute clinics, online/virtual care/telemedicine for getting a vaccine or pinkeye/localized infection without complication).

Meanwhile ER representing the other spectrum we instead have greater need for higher quality and access. You must get to an ER ASAP and get stabilized.

Chronic care quality solutions with long term cost-effectiveness are what are needed. Access to a specialist for longer term condition management (or episode or care like a cancer diagnosis).

Similarly more procedures are becoming outpatient, or recovery at home, or at dialysis centers, or at skilled nursing facilities ... you get the point.

I argue the problem is that the insurers have not adequately fragmented the insurance market/reimbursement model. Healthcare is changing in how it is delivered and insurers are not keeping up with it when it comes to modeling their payouts. For example why does being in-network matter for low cost care at outpatient facilities? The added 'negotiation' of being in a specific network doesn't add much value. One size fits all doesn't work with the modern spectrum of care.

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

#370

Post by conanbatt »

Holybeds wrote: post #358
conanbatt wrote: post #264

Earlier quoted context omitted.

With the difference that a long-cancer treatment might cost hundreds of thousands of dollars in the US and simply bankrupt the hospital. Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.

Not sure if you are joking but the hospitals are paid by the government for the provided services (via tax money). Obviously a life long cancer treatment will cost much more than 30 USD.

If the government has a final say, then it has to restrict supply to keep costs down. It cant say yes to everything.
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