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Congress is set to ban most surprise medical bills

nytimes.com

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Re: Congress is set to ban most surprise medical bills

#191

Post by pbourke »

lacker wrote: post #76
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

We don't have a free market in health care at all. In a free market you would be able to buy a coronavirus vaccine right now, instead of waiting months to get it for free. We haven't had a "free market" in health care in my lifetime.

> In a free market you would be able to buy a coronavirus vaccine right now, instead of waiting months to get it for free.

Give it a few weeks ...

Re: Congress is set to ban most surprise medical bills

#192

Post by gregario »

kstrauser wrote: post #168
iaw wrote: post #100

Earlier quoted context omitted.

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…

I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.

It's the regulations / limitations you are proposing that make it possible/likely that a monopoly will form. See Milton Friedman on this. There's basically no example of a monopoly forming outside of government regulation.

Re: Congress is set to ban most surprise medical bills

#193

Post by leetcrew »

nottorp wrote: post #27
lordnacho wrote: post #11

> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tas…

From what I know about the US even your restaurant example has hidden service fees and mandatory tips and taxes that aren't on the menu?

not really the same. tipping is a custom, but it's not legally required unless the restaurant clearly states that it will be added to the bill.

sales tax is not really a hidden fee. americans usually know the general sales tax for their state. it gets a bit more complicated with specific excise taxes (eg, alcohol), but these rates are publicly available. if you're really concerned, you can always just ask your server or their manager what the after-tax cost of an item on the menu is.

even if you know exactly what medical procedure will be performed, it is still pretty hard to get an exact quote for the cost. it certainly can't be calculated from freely available numbers.

Re: Congress is set to ban most surprise medical bills

#194

Post by danielrhodes »

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

I don't have any opinions about what the perfect system here is, but I think it's safe to safe say that medicine does not work well as a free market. You don't get to access a free market within the confines of hospital walls when there is an emergency. Moreover, your decisions as a rational actor are impaired because you are being asked to put a price on your own life or quality of life. There is almost no way to make this business not predatory under those circumstances.

Re: Congress is set to ban most surprise medical bills

#196

Post by some_random »

zbrozek wrote: post #134
annexrichmond wrote: post #118

Earlier quoted context omitted.

> and prices are hidden I believe the Trump administration is addressing this: https://www.hhs.gov/about/news/2019/11/15/trump-administrati... https://www.hhs.gov/about/news/2020/10/29/trump-administrati... > The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rat…

We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it pos…

Part of the problem is that the coding happens after the doctors do their thing, are incredible complex, and have to be checked/fixed by a specialist before they can be sent onwards.

Re: Congress is set to ban most surprise medical bills

#197

Post by xyzzyz »

tehjoker wrote: post #178
rayiner wrote: post #142

Earlier quoted context omitted.

That's not true. Medicare can and does negotiate the cost of procedures and doctor's services. What the law says is that Medicare can't negotiate prescription drug prices. That's because Medicare doesn't directly pay for drugs, except what's used incidentally in the course of covered hospital stays. Medicare didn't provide coverage for prescription drugs until the adoption of Part D. That is structured differently th…

That's 1/10th of the military budget for drugs that can be often be manufactured for pennies (drugs with biological elements requiring glass column filtration and such are a different story but are far more rarely used). A point in case is the Hep C vaccine: https://www.medicalnewstoday.com/articles/323767#drug-types-...

The manufacturing costs are irrelevant for new drugs. If the drug companies couldn’t sell them at a profit, they would never develop them in the first place.

There is an issue with some old out of patent drugs that costs a lot despite being very cheap to manufacture, but that typically has to do with FDA certification deciding who can be allowed to produce what, which is also expensive to obtain.

Re: Congress is set to ban most surprise medical bills

#198

Post by snarf21 »

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

We just need to mandate reference based pricing. This automatically goes away and also removes other huge parts of the wasted health care spend. Additionally, it doesn't require new taxes at all.

Re: Congress is set to ban most surprise medical bills

#199

Post by cogman10 »

Karunamon wrote: post #144
zbrozek wrote: post #134

Earlier quoted context omitted.

We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it pos…

I want a comprehensible restaurant-like menu. Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it. [1]: https://www.icd10data.com/ICD10PCS/Codes

Yup! And what will you do about it anyways? Like "Oh, you need xyz, it will cost $1000" Ok. Now that I know that, what am I supposed to do? Shop around? What if I'm in the emergency room, what then? Are they supposed to give me a price menu for every single drug or treatment they need to perform against me?

"Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life".

The ala cart method seems like it might work until you start thinking about the logistics. If someone goes to a doctor complaining about chest pain, do we really want them to leave because an EKG and blood test are going to cost $200. No matter how much the doctor explains to them "You might be dying" plenty of people will walk out of the hospital once the bill is presented. In some of those situations, that's going to be deadly.

Re: Congress is set to ban most surprise medical bills

#200

Post by lvs »

gregario wrote: post #192
kstrauser wrote: post #168

Earlier quoted context omitted.

I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.

It's the regulations / limitations you are proposing that make it possible/likely that a monopoly will form. See Milton Friedman on this. There's basically no example of a monopoly forming outside of government regulation.

That is a completely bizarre claim. What is Google? A highly regulated search monopoly? I think not.
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