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

#281

Post by TeMPOraL » Wed, Sep 22, 2021, 7:29 PM UTC

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…

> 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.

Isn't the latter a strict superset of the former? No payouts is an easily predictable number. And for nonzero amount of payouts, the less those payouts sum to, the more money remains for continuous investing.

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

#282

Post by nickff » Wed, Sep 22, 2021, 7:32 PM UTC

programmertote wrote: post #256

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…

I didn't downvote you and in fact, I agreed with the fact that a significant portion of the exorbitant healthcare prices in the US can be traced back to administrative bloat, MBAs who are in the management and to a degree, the significantly-higher-than-OECD-average salaries of the doctors in the US. Having said that, your belief that many hospitals are non-profit might not be as simple as it looks from the outside. I…

I completely agree with that user's statement:

>"The end result is a privately-owned hospital that operates as a non-profit on the books when it is anything but that... American doctors and hospital executives are printing money using the backs of their patients as the die. They take in millions per year in compensation that was given to them by people who worked hard and fell on bad times. It is one of the most shameful forms of exploitation in modern history."

I'm just unsurprised, as that is consistent with my view of many (most?) non-profits. I also think that the executive pay component is a smaller share than that Redditor seems to.

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

#283

Post by good8675309 » Wed, Sep 22, 2021, 7:33 PM UTC

rconti wrote: post #239

rpmisms wrote: post #176

Earlier quoted context omitted.

I'm thankful the concession was made. The lower price of cost-sharing made it possible for my parents to keep eating while providing for the family.

That's great until the church decides your parents are sinners and refuse to cover anything, and have no consequences for stealing their money.

People voluntarily join health sharing groups. They are run by non-profits, some of which have no religious affiliation.

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

#284

Post by jimbokun » Wed, Sep 22, 2021, 7:33 PM UTC

throwthere wrote: post #243

garettmd wrote: post #234

Earlier quoted context omitted.

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.

That needs to be made illegal tomorrow.

Heck, sounds like there could be a Civil Rights Act case, if prices impact people differently based on race or sex or other protected class.

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

#285

Post by mullingitover » Wed, Sep 22, 2021, 7:33 PM UTC

bjt wrote: post #211

mullingitover wrote: post #118

Earlier quoted context omitted.

Price transparency is a pointless shell game designed to keep everyone strung along on the entrenched, failed system. When you're having a heart attack, the last thing you're doing is shopping around for the best prices on heart attack emergency treatment. The free market has no place in health care, because in the hands of the free market the first thing that will happen in a life-threatening emergency is for you to…

Not all health care is heart attacks. "Health care" is a huge bucket containing everything from buying a bottle of cough syrup to the heart attacks you mention. For life threatening emergencies, I'm with you. Let's fund that care through the state. But excluding the market from everything is not the answer. The problem with using insurance for all these non-urgent things is that insurance distorts the market and pric…

We don't have to reinvent the wheel. Other countries have solved these problems. They have better health care than we do. It's measurable, it's been measured, and no surprise, they have flat-out superior outcomes. They are dramatically more efficient. Our market focus is a cargo cult.

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

#286

Post by nradov » Wed, Sep 22, 2021, 7:35 PM UTC

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…

The Affordable Care Act (Obamacare) eliminated lifetime coverage limits. There are also limits of the minimum medical loss ratio.

Unlike property and life insurers, medical insurers generate very little income from investments. Premium revenue comes in at about the same rate as claims are paid out. They don't have large reserves to invest. And most large employers are self insured anyway, so the ”insurance" company just acts as a claims administrator.

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

#287

Post by EForEndeavour » Wed, Sep 22, 2021, 7:36 PM UTC

KarlKemp wrote: post #186

EForEndeavour wrote: post #144

Earlier quoted context omitted.

This is the GDPR cookie popup annoyance equivalent of requiring hospitals to disclose their chargemasters, but not spelling out that the published data should be reasonably human-readabale. Malicious compliance.

Oh but, if you read slightly between the article’s lines, you’ll notice that the law does require both human- and machine-readable publication. The machine-readable part is mandated here: https://www.federalregister.gov/documents/2019/11/27/2019-24... As a taste of how specific this is: (5) The file must use the following naming convention specified by CMS, specifically: _ _standardcharges.[json|xml|csv]. And here’s…

From your second link:

> c) Format. A hospital has discretion to choose a format for making public the information described in paragraph (b) of this section online.

This is how you get Excel files with certain column widths set to zero. All it has to be is searchable, free, public, and updated regularly.

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

#288

Post by luxuryballs » Wed, Sep 22, 2021, 7:36 PM UTC

peterangular wrote: post #35

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.

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…

That last sentence would be a great opener to the explanation of what insurance is, it’s not healthcare, insurance is something you don’t want to have to use. Healthcare is just healthcare, you can buy it from all sorts of places in various forms without billing to insurance.

Just like how car insurance is not a mechanic.

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

#289

Post by kazinator » Wed, Sep 22, 2021, 7:36 PM UTC

BurningFrog wrote: post #266

kazinator wrote: post #212

Earlier quoted context omitted.

> 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.

Yes; basically it's just a classification combined with an accounting strategy.

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

#290

Post by CPLX » Wed, Sep 22, 2021, 7:38 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…

> Where do you think the money is going?

To the millions of people making a living in the health care system that have no actual role (direct or indirect) in improving the health of patients.