Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

healthcaredive.com

Post reply on HN
Print view View original

201–210 of 463 posts

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#201

Post by monocasa »

joshAg wrote: post #169
monocasa wrote: post #134

Earlier quoted context omitted.

So that encourages greater payouts more or less synced with greater premiums in order to increase year over year real profits. And given that the payouts are very nearly a function of how hard the insurance company can negotiate, they can simply choose to call off the negotiations when they reach their target amount.

Only to a degree because policies basically always have an upper limit on coverage. If the payouts are dropping because there's a massive reduction in claims, then there's a pretty decent chance that paying the policy maximum on each claim still won't be enough. Plus, profits don't come directly from the premiums anyway. They come from the investments the insurer makes with the premiums. So sure, they can try to conv…

> So sure, they can try to convince policy holders to increase coverage which allows them to charge a higher premium

Or they just stone wall and increase premiums anywhere they can until they hit targets. Like at a previous job I had at a 250 employee company where premiums went up $150/m one year because the previous year had two families had a kid get (very different kinds of) cancer out of the blue. You'd think that shopping around would've helped in that case, but the word got out somehow to the other insurance companies and they were giving us similar quotes.

The power relationship is very very tilted in the insurance company's favor and they can more or less dictate terms.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#202

Post by [deleted] »

danShumway wrote: post #148
jonathan-adly wrote: post #123

Earlier quoted context omitted.

The cost of the aspirin depends on these things lol. Look up 340B. There is a drug called Oncaspar. It's >$16,000 for one patient, and 5 cents for another (acquisition cost). Same drug, widely different acquisition cost.

When two pills coming from the same company are being made at the same time on the same machines, then they both cost the same. It's pretty obvious that the patient status changes nothing about that. However, the hospital's acquisition cost is variable because you're further down the supply chain and you're seeing the exact same kinds of arbitrary behind-the-scenes price swings that this article is talking about. It…

[deleted]

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#203

Post by monocasa »

joshAg wrote: post #141
jjoonathan wrote: post #80

Earlier quoted context omitted.

Insurance has the worst moral hazard: the winning strategy is to sell a product that pretends to cover your customers but actually doesn't. Your customers give you money for nothing and they will only realize it once in a blue moon. You can probably buy off the few who are capable of causing actual blowback, and if that doesn't work just rebrand. Until everyone becomes a contract lawyer capable of devoting weeks to i…

Payouts and premiums aren't where the money is in insurance. It's in the return on investments the insurer makes with the money they hold in trust. From an insurer's point of view, the best market isn't one with no payouts, but one where there is a highly predictable amount of payouts, because the better they can predict how much they need to payout, the more aggressive they can be with their investments. Yeah, there…

> It's in the return on investments the insurer makes with the money they hold in trust

...sourced from the premiums. When they pull in more premiums, they have more money to invest.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#204

Post by good8675309 »

loeg wrote: post #83
mullingitover wrote: post #73

Earlier quoted context omitted.

> These prices are There are some clever insurance companies whose entire model is "tell the hospital you don't have insurance, get the cash price, pay it with this debit card we give you."

You’re probably thinking of “healthcare ministries,” which are not insurance (they’re scams).

Scams? They paid for my $6000 colonoscopy which caught early cancer, my daughters stitches, my wife's allergy specialist, my son's rocky mountain spotted fever, etc. etc. $500/mo for our family of 5 and we've been on it for nearly 10 years. But yes, please tell me more how this service that is way cheaper than insurance, is a community of people helping each other, and covers way more than insurance, is a scam.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#205

Post by texasbigdata »

throwaway23438 wrote: post #129
peterangular wrote: post #60

Earlier quoted context omitted.

There's police around hospitals constantly and if they get a whiff that you have a fake ID they're going to be talking to law enforcement sooner or later. Also this isn't going down to your corner liquor store and flashing your drivers license... that thing is going to get scanned etc. --- Actual protip: If you're uninsured and need care they legally can't turn you away at an ER. They have to provide the healthcare t…

I've often wondered what would happen if you went to the ER, carried no identifying documents, and just refused to identify yourself. Just hope nobody recognizes you there. Giving a fake name is fraud, and people have been arrested for doing that at the ER. (Fuck America.) But I don't know that there's any legal obligation to give any name at all. If you don't give them a name, you're not lying to them, and oops, loo…

I believe legally they have a duty to provide care.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#206

Post by peterangular »

fragmede wrote: post #171
wuliwong wrote: post #159

Earlier quoted context omitted.

Insurance isn't inherently a moral hazard.

Inherently? No, just under capitalism.

I know that any anti-capitalism comments get immediately downvoted here but yeah...

The privatization of healthcare is a conflict of interest which is a product of our hyper-capitalistic society. You can't make a profit center out of human services without dehumanizing it in the process - the very nature of profit/capitalistic societies means someone has to lose and I see no place for these interests in healthcare or education.

Edit: yep - expected that. Maybe someone argue as to why privatization (which is a product of capitalism) isn't a conflict of interest in regards to healthcare?

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#207

Post by karmelapple »

donatj wrote: post #122
deadmutex wrote: post #113

Earlier quoted context omitted.

Was there any difference in ability to sue the provider in case things went wrong? I heard that sometimes they ask the uninsured to sign away the ability to sue the doctor and get lower prices in return. I am not too sure about details, this is just hearsay.

I remember she did have to sign a lot of paperwork. I have no idea what it contained however.

And that’s because the product you were buying had a completely inelastic demand. You might have died if you didn’t get treatment.

Perhaps allowing healthcare providers to incentivize things like this is… not great? Because we’ll sign pretty much anything if we’re sick enough.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#208

Post by nickff »

snarf21 wrote: post #155
Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

This is why we need reference based pricing. You can't charge more than 1.2 * Medicare and if you pay cash, you get the Medicare price. This change alone would remove 25+% of unnecessary bloat from the US system.

>"This change alone would remove 25+% of unnecessary bloat from the US system."

Where do you think the money is going? Insurance companies are not as profitable as you might think, drugs are not a massive burden on healthcare expenditures, and many hospitals are non-profits. The truth is that most of the money is going to staff wages; if you want to reduce healthcare spending, the only way to do it sustainably is to increase the numbers of doctors and nurses, so as to drive down their salaries (but this is not a popular option).

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#209

Post by batty_alex »

jonathan-adly wrote: post #167
IMTDb wrote: post #140

Earlier quoted context omitted.

The spirit is here is that you should fully open all those factors and fully open how they influence the cost paid by the patient. Make an excel sheet, a web app, an API, whatever. But let people know and simulate the cost - include all required factors. If the prices you charge differ from the prices provided by your open data platform, or if some factors are omitted from the open platform, you should get a lawsuit…

There is no internal reliable system. Healthcare in the US uses faxes. People here thinks that their local hospital is Google, while in reality it's a badly managed/badly funded 100 year old non-profit organization full of middle managers who just learned how to use their email.

> 100 year old non-profit organization full of middle managers who just learned how to use their email.

As someone who works in the industry, you gave me a hearty chuckle - well done, too true

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#210

Post by jjoonathan »

joshAg wrote: post #141
jjoonathan wrote: post #80

Earlier quoted context omitted.

Insurance has the worst moral hazard: the winning strategy is to sell a product that pretends to cover your customers but actually doesn't. Your customers give you money for nothing and they will only realize it once in a blue moon. You can probably buy off the few who are capable of causing actual blowback, and if that doesn't work just rebrand. Until everyone becomes a contract lawyer capable of devoting weeks to i…

Payouts and premiums aren't where the money is in insurance. It's in the return on investments the insurer makes with the money they hold in trust. From an insurer's point of view, the best market isn't one with no payouts, but one where there is a highly predictable amount of payouts, because the better they can predict how much they need to payout, the more aggressive they can be with their investments. Yeah, there…

Yes, in a well-regulated insurance market the winning business model isn't deceit. That's the point of the regulations.

Deceit can take many forms, and I'd argue that undercapitalization is actually one of them. "There's a trap clause on page 23 of the telephone book contract" is only the simplest strategy an insurance company can use to lemon-drop. "We ask our customers to do an impossible information wrangling task and only review the paperwork if they get cancer, so that we have an excuse to drop them" is a slightly more evolved form. Loading up sacrificial business vehicles with risk and using bankruptcy to discharge obligations is the most advanced form of deceit-based insurance business models, because it provides plausible deniability. "We just tried to compete a bit too hard!" they can claim, even if they knew in their hearts exactly what they were doing: the age old practice of selling insurance that you had no intent of making good on.

Fortunately, we have a long record of historical evil tricks to draw on when crafting legislation, because I absolutely stand by my claim that the natural incentives (the ones that happen without careful legislation) in the insurance industry are overwhelmingly bleak, both on an absolute scale and relative to other industries.

Post reply on HN