Hospitals lift curtain on prices, revealing giant swings in pricing by procedure • Hacker News Board

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

#241

Post by Notanothertoo » Wed, Sep 22, 2021, 7:09 PM UTC

EForEndeavour wrote: post #164

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.

The more I read about US healthcare, the more confused I am about how it's grown this perverse for this long. Prices are hidden (until the government forces them into the open), but they're badly distorted anyway by perverse incentives, which all seem to ladder up to the root cause of providing healthcare for profit.

Thank the private free market.. /s it goes this way because the government involvement. If anyone else in another industry attempted the same thing they would be sued for fraud.

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

#242

Post by garettmd » Wed, Sep 22, 2021, 7:09 PM UTC

karmelapple wrote: post #200

garettmd wrote: post #108

Earlier quoted context omitted.

I think the issue here is that the system that has been setup is so dysfunctional that there is some validity to the phrase "the cost is unknowable". But prior to this regulation, it was extremely difficult to even ascertain just how dysfunctional it all was. Putting it out in the open means more accountability for providers and insurers. Which in due time means more regulation :) Which is how it goes when an industr…

Exactly this, though I’d like to point out that word “misbehaves.” Many people may not see the medical cost world as misbehaving at all. It sounds like healthcare companies, from drug manufacturers to hospitals, are charging what the market will bare. The inelasticity of the products and services for sale are what allows this market to become so out of whack. I don’t need an iPad that badly, but I do need to have the…

I see what you're saying, but much of the factors driving the "misbehavior" is due to companies being in-cahoots with each other on creating convoluted pricing schemes, kickbacks with various parties, and muscling through legislation that favors healthcare providers and insurers, to the detriment of patients.

It's true that this can all be explained in economic terms, but it's true in the same sense that the behavior of warlords can be described by economics.

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

#243

Post by throwthere » Wed, Sep 22, 2021, 7:09 PM UTC

garettmd wrote: post #234

throwthere wrote: post #143

Earlier quoted context omitted.

You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient. It's telling how people on the outside have no idea how complex the system is, as if there's one simple way to cost an item (hell, there's not even one simple way to cost an item with GAAP accounting for a widget). These lists are kind of worthless in the current iteration, but they…

How does the cost of a drug change based on who is consuming it? That's like saying the cost of a loaf of bread changes based on who is buying it. The price you charge for the bread might change, but the cost is the same regardless of who is purchasing it. There's a difference between varying costs of an item based on accounting methods, versus varying costs of an item due to who is buying it. There seems to be huge…

The hospital's drug cost is the price the distributor charges it. That price varies for each individual patient. It's turtles all the way down.

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

#244

Post by lotsofpulp » Wed, Sep 22, 2021, 7:10 PM UTC

kube-system wrote: post #232

haliskerbas wrote: post #136

Earlier quoted context omitted.

Reminds me when my dentist charged me $50 for a cup of fluoride (nothing too special about this fluoride). I asked why they said it would be covered. They said when they checked with insurance it says it’s covered, but for my age or whatever it’s not actually covered. So then I said why is it my fault that you gave me something you said was free but actually wasn’t because your check wasn’t thorough enough? They said…

Just take all of the money you'd otherwise spend on dental care and put it into a savings account or FSA. I've never seen a dental insurance plan that actually makes financial sense. Most of them place significant limits on expensive and unlikely care, and cover routine care with little or no cost sharing. Insurance is a highly inefficient way to pay for expected expenses.

Dental insurance via employer is mostly just a way to pay for dental healthcare via pre tax dollars.

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

#245

Post by silverlake » Wed, Sep 22, 2021, 7:11 PM UTC

satronaut wrote: post #189

jonathan-adly wrote: post #63

I am one of the people responsible for making these lists. The fact that the general public as well as journalists think this data is accurate in anyway is really funny. This an exercise of futility that only increases the overall cost and provides job security for me :) No one working in a hospital knows how much do we acquire things for, or how much we get paid for doing things in advance. And only like 8 people ca…

You're in charge of literally saving lives but you can't handle something as standard as cost estimation? How can you joke about that? Figuring out the cost to the hospital in terms of materials and labor should be standard. Example, an x-ray. You know you need to pay an x-ray tech X$/Hour and after doing 1,000's of x-rays, a hospital should have it down that somebody with a broken leg will require N hours (maybe .5,…

To be fair Boeing doesn’t know how much an airplane cost.

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

#246

Post by opo » Wed, Sep 22, 2021, 7:11 PM UTC

peterangular wrote: post #206

fragmede wrote: post #171

Earlier quoted context omitted.

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…

>...the very nature of profit/capitalistic societies means someone has to lose

The last time you bought milk did you lose or did the grocery store? The last time you paid money for a hair cut, who lost there?

The extreme regulation of all aspects of health care that has developed over the last century has improved some problems and created other problems - the problems specific to healthcare have little to do with the "the very nature of profit/capitalistic societies"

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

#247

Post by svmegatron » Wed, Sep 22, 2021, 7:13 PM UTC

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).

Can you elaborate on this? My gut agrees with you 100%, but I can't puzzle it out.

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

#248

Post by throwaway23438 » Wed, Sep 22, 2021, 7:13 PM UTC

kube-system wrote: post #240

throwaway23438 wrote: post #129

Earlier quoted context omitted.

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…

People show up at hospitals physically unable to identify theirselves all of the time. https://www.npr.org/sections/health-shots/2019/05/07/7207022... Hospitals that accept medicare do have a legal obligation to stabilize patients. But we're talking 'stabilize' as in 'you're not dying'. If you're alert and capable enough to be arguing with people and you're not a psych danger, you're likely stable enough to legally b…

I'm aware of that. That's different from refusing to identify yourself to avoid paying money to the healthcare racket.

The discussion here is whether there is a legal obligation to identify yourself. If there is such a requirement, it would apply to someone who is fully capacitated but refusing to identify themselves. It would not apply to someone who is unable to identify themselves due to incapacity, because such a person obviously lacks any criminal intent.

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

#249

Post by snarf21 » Wed, Sep 22, 2021, 7:13 PM UTC

nickff wrote: post #208

snarf21 wrote: post #155

Earlier quoted context omitted.

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…

You are forgetting about all the brokers and all the staff at the insurance companies whose jobs is to negotiate different prices for procedures with different doctors. Most brokers charge 5%. Additionally, this change would cause a loss of some clinical jobs. A lot of the urgent cares would no longer be profitable and would have to get shutdown. Additionally, all these changes would ripple in other ways. Some providers may start offering sub Medicare cash prices to attract business. There is no reason healthcare costs needed to go up 6% per year and the main reason it does is that it can.

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

#250

Post by [deleted] » Wed, Sep 22, 2021, 7:14 PM UTC

monocasa wrote: post #203

joshAg wrote: post #141

Earlier quoted context omitted.

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.

[deleted]