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

#261

Post by alex_smart » Wed, Sep 22, 2021, 7:19 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…

>the only way to do it sustainably is to increase the numbers of doctors and nurses, so as to drive down their salaries

Getting the hospitals to accept a price ceiling which forces the issue is another way to do it.

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

#262

Post by wswope » Wed, Sep 22, 2021, 7:19 PM UTC

jrochkind1 wrote: post #222

peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because if an insurance company decides not to cover something (very very common, even in-network) then the inflated price is what you end up getting billed for. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

>> They have a column called "Uninsured cash price." These prices are > And this can really cause issues for people who are insured because if an insurance company decides not to cover something (very very common, even in-network) then the inflated price is what you end up getting billed for. That doesn't sound like an "inflated" price? 25% of what insurance companies are billed for? I'm confused. I'm not sure y'all…

He’s saying if you go in as an insured patient and get denied for a procedure by the insurance company after it’s been performed, you’ll get a bill from the hospital for the insurance-negotiated rate, not the uninsured cash pay rate. You can generally talk the billing department down to the cash pay rate, but that requires having a lot of meta-knowledge of how American healthcare works.

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

#263

Post by jonathan-adly » Wed, Sep 22, 2021, 7:20 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,…

Because the broken leg could be a gun shot wound, or an alcoholic who fell down and now is withdrawing, or a geriatric patients who is abused at home or a person who fell due to side effects of drugs with alternatives, or a cancer patient with bone metastases.

No one gets an x-ray for a broken leg then leaves with their foot broken. Even assuming that you are just trying to figure out the cost of an x-ray - there is a radiologist involved (unless you want to read it the x-ray on your own) and how they bill is a whole total beast!

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

#264

Post by kingsloi » Wed, Sep 22, 2021, 7:20 PM UTC

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.

I'd love to look up uninsured prices and compare them 1-1 to what I was charged for my little girl's 2 week ICU stay https://kingsley.sh/posts/2021/two-weeks-in-the-icu-as-a-bab...

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

#265

Post by city41 » Wed, Sep 22, 2021, 7:20 PM UTC

codegeek wrote: post #199

r00fus wrote: post #128

Earlier quoted context omitted.

Did you have a HDHP (high deductible plan)? In that case, you have no co-pay or anything until your deductible is used up. Employers typically contribute a good amount towards this deductible (or even more than) using an HSA. It's still crazy that the bills were so completely divergent.

That's not the point. Your explanation is exactly what the issue is. Why is cash price cheaper than insurance price ? And in that case, why do we even need insurance for most of these visits.

I think the problem is, it's insurance. I pay $1200/month for my ACA insurance as I am a freelancer. Those with full time jobs pay a similar amount, just indirectly. In a given year, if I am healthy and need minimal medical care, then my insurance puts me way behind financially. If I have a sudden medical emergency, it can really save me. That is of course, assuming the insurance company will honor their end of the bargain which is another matter altogether.

I don't want health insurance. I want health care.

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

#266

Post by BurningFrog » Wed, Sep 22, 2021, 7:21 PM UTC

kazinator wrote: post #212

nickff wrote: post #208

Earlier quoted context omitted.

> "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…

> many hospitals are non-profits. That can't possibly be true of a hospital that charged $3000 for something on Tuesday, and $53000 for the same thing on Friday. (Under reasonable assumptions like that Tuesday wasn't done at a $25K loss relative to breaking even; why would such be the case? And that they are busy with procedures, not simply doing a way overpriced procedure once every few weeks, and then just burning…

PSA:

Non profits can be as greedy as any other organization.

Typically the money goes to wages for the leadership rather than profits to the owners.

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

#267

Post by lotsofpulp » Wed, Sep 22, 2021, 7:21 PM UTC

peterangular wrote: post #237

monocasa wrote: post #201

Earlier quoted context omitted.

> 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 th…

> 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. It's bad enough that I've heard office gossips complain about other employees leveraging their healthcare turning into higher premiums the year after. Like, as evil as complaining their coworker's kid got cancer. When…

>It's bad enough that I've heard office gossips complain about other employees leveraging their healthcare turning into higher premiums the year after. Like, as evil as complaining their coworker's kid got cancer.

That is how it would have to work if the employer wants to restrict the risk pool to the company's employees. After all, money has to come from somewhere.

But employers are welcome to participate in healthcare.gov plans where the risk pool is much larger (across the whole state), and where individuals in the company cannot be solely blamed for increases in healthcare costs:

It's bad enough that I've heard office gossips complain about other employees leveraging their healthcare turning into higher premiums the year after. Like, as evil as complaining their coworker's kid got cancer.

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

#268

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

opo wrote: post #246

peterangular wrote: post #206

Earlier quoted context omitted.

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 th…

> The last time you bought milk did you lose or did the grocery store?

There's way more people involved in that supply chain then me and the store. This is an over simplification.

Outside of the obvious answer of "the cows" - factory farming has been destroying my home state causing huge problems in rural America. Also - the environment. Big time the loser there is the environment for literally any bovine farming.

> The last time you paid money for a hair cut

When I was getting my hair cut professionally I tipped a $20 because I knew the gal cutting my hair working at the midwestern mall Regis Salon was making jack-all. I knew this because I worked at Geeksquad with her boyfriend, eventually husband. If I were not to tip well she would be at-risk for making minimum wage for that hour - and since you can't support yourself on minimum wage I see that as her losing.

I've always tipped my butt off because I know without that they lose.

---

So yeah - sorry... I anecdotally do see losers in the situations you described. I don't have to look hard to see them.

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

#269

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

lotsofpulp wrote: post #260

monocasa wrote: post #201

Earlier quoted context omitted.

> 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 th…

>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. Employers are welcome to purchase healthcare.gov plans that are not allowed to price based on pre existing conditions: https://www.healthcare.gov/how-plans-set-your-premiums/ If an employer wants to self insure and restrict their risk pool to only their…

> Employers are welcome to purchase healthcare.gov plans that are not allowed to price based on pre existing conditions:

Which are stupid expensive for anyone much above the poverty level.

> If an employer wants to self insure and restrict their risk pool to only their employees, then they have to pay for it

A 250 person company wasn't self insuring or restricting their risk pool to only their employees. They wouldn't be negotiating premiums with an insurance company if they were self insuring.

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

#270

Post by wuliwong » Wed, Sep 22, 2021, 7:23 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

If by 'profit/capitalistic societies' you mean those allowing for voluntary exchanges between its people, I would disagree. As an adherent to the subjective theory of value, I think it is common that both parties in an exchange would consider themselves 'winners.' [0]

[0] https://en.wikipedia.org/wiki/Subjective_theory_of_value