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

291–300 of 463 posts

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

#291

Post by throwaway23438 »

kube-system wrote: post #273
throwaway23438 wrote: post #248

Earlier quoted context omitted.

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…

There is no legal obligation for you to identify yourself to any businesses that I'm aware of. Most businesses will refuse you services if you refuse to cooperate in paying, to the extent that they are legally able to do so. I think you can expect that a hospital met with this scenario will complete their obligations under the EMTALA and nothing more.

Even with identification, healthcare systems usually will not do more than they're required to under EMTALA. The hospital will provide intensive care to the uninsured DKA patient, since they're obligated to do so under EMTALA, but they will not provide that patient the insulin and other care necessary to prevent them from needing ICU in the first place, since it's not yet an emergent condition.

If there's no risk of criminal exposure, even insured people should start doing this. Hitting hospitals with uncompensated care under EMTALA is one of the few points of leverage we have to fight back against these murderers. Hospitals are, by and large, not innocent parties in this -- several hospital groups are even members of the Partnership for America's Health Care Future terrorist group, which bribes politicians to fight Medicare for All.

It would bring me great pleasure to get to tell a hospital to go fuck themselves and to quit bribing politicians to fight M4A if they want to get paid next time.

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

#292

Post by iratewizard »

eganist wrote: post #218
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…

> increase the numbers of doctors and nurses and tort reform to manage the lawsuits to enable lower malpractice insurance costs. and a scheme to drive down med school pricing. Maybe more competition? Enabling more MD and DO schools? There are <200 medical schools (both MD and DO schools) in the US.

Medical errors cause an estimated 250,000 deaths in the United States annually.

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

#293

Post by nybble41 »

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…

Private health care is adversarial (so you have to look out for your own interests) but this does not automatically imply a conflict of interest. It may become a conflict of interest if you get your advice about which tests or treatments to undergo from the same health care provider who profits from you taking that advice, but this is something which you have control over: Get your advice from one place and have the work done somewhere else, just as you would for e.g. home inspections.

It's not as if public health care doesn't have moral hazards of its own, including conflict of interest. The system may officially be non-profit but the interests of its workers and administrators (profit-oriented or otherwise) do not necessarily align with those of the patient.

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

#294

Post by 0xcde4c3db »

hartleybrody wrote: post #196
loeg wrote: post #83

Earlier quoted context omitted.

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

> (they’re scams). citation or story?

https://www.buzzfeednews.com/article/lauraturner/christian-h...

They're not inherently scams, but a major reason that the "premiums" are lower is that they have hardly any legal mandate to actually provide anything, which comes as a surprise to some members who are denied reimbursement. Their authority to deny "coverage" (scare quotes because that's not, technically, what they provide) is huge. In particular, HCSMs frequently deny reimbursement on the basis of conservative religious morality. Got an STD while unmarried, or cheating on your spouse, or just in an open marriage? You can't ask your good Christian neighbors to pay for that. Drug addiction or mental illness? The cure is more Jesus. Abortion? Not even to save your life. You get the idea.

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

#295

Post by munk-a »

saalweachter wrote: post #111
ipaddr wrote: post #99

Earlier quoted context omitted.

Aren't insurance rates regulated meaning if they payout a smaller amount than expected the rates will go down next year?

Now; I think the "medical loss ratio" requirements were one of the most important features of the ACA. One of the worst offenders from the before-times was an insurance plan targeted at college students that had a 10% MLR.

I wonder how MLRs interact with subsidies, backroom deals and manufacturer rebates - if an payer can inflate their MLR by double paying for a medication - but then they get a rebate back for half the cost they paid will MLR tracking catch that?

Payers often get incentivized to promote certain drugs via manufacturer kickbacks and I wonder if this system is also used to run around MLR requirements.

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

#296

Post by pc86 »

Why is it that insurers in the US are seemingly the only industry where the person paying the bill can a) negotiate it after services are received; and, b) just decide not to pay it if they don't want to?

Hospitals should set a price for a procedure. There will be some variability of course as people need more or less anesthesia, identical surgeries can take longer to perform (=== more OR/surgeon time === more money), etc. But a $22-102k like in the article is absurd. Insurance companies should be required to pay whatever the hospital price is provided it can be justified. There should be specific courts to handle these disputes until the industry realizes it isn't special. Regardless, the onus shouldn't fall on the patient. Outcomes should be limited to: 1) Insurance company pays without complaint; 2) Insurance company doesn't pay, is sued by hospital, and is ordered to pay by the court; 3) Insurance company doesn't pay, is sued by the hospital, prevails in court, and hospital adjusts accordingly, eating 100% of that loss.

But, we'll likely just stay where we are now where people pay $100 for Tylenol PM and insurance companies get out of paying claims because one person out of 12 in the OR were out of network and they're all contractors.

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

#297

Post by weberer »

mullingitover wrote: post #285
bjt wrote: post #211

Earlier quoted context omitted.

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.

What market focus? Prices were completely opaque until just a few months ago. Any economist on the planet will tell you that would lead to awful outcomes for everyone except the powerful healthcare lobby.

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

#298

Post by gfodor »

mullingitover wrote: post #285
bjt wrote: post #211

Earlier quoted context omitted.

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.

There is no silver bullet. Your absolutist perspective undermines your argument.

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

#299

Post by jonathan-adly »

earksiinni wrote: post #188
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…

> Take the simple exercise of figuring out cost/revenue of an aspirin administration. [...] In your opinion, is this something that could be exhaustively modeled in software? What would the bottlenecks be? I'm guessing probably the biggest is the fact that the necessary data isn't digitized, or if it is, it's not easily accessible.

Yes. It could be. The bottleneck is selling it. Healthcare has lots of problems that can be solved with software. The bottleneck is always making a business case and selling to hospitals which is a nightmare.

So long as a shitty excel sheet with inaccurate data fulfills the regulatory requirement, you will find a lot of trouble getting people to pay money for it.

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

#300

Post by thesimon »

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.

Why does the distributor know the identity of the patient?
Post reply on HN