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

#301

Post by kube-system » Wed, Sep 22, 2021, 7:44 PM UTC

throwaway23438 wrote: post #291

kube-system wrote: post #273

Earlier quoted context omitted.

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…

If I'm dying, I want the best care I can get. I'm not about to argue with someone trying to save my life to make a political point to an ER doctor who didn't have anything to do with it in the first place. And I'm certainly not about to risk my own health outcomes by withholding the insurance that I paid for to help me in that exact scenario.

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

#302

Post by hellbannedguy » Wed, Sep 22, 2021, 7:44 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…

"I realized was that hospitals are largely subsidizing the cost of the uninsured by over-billing the insured folk's insurance companies."

1. You have to back up claims like this.

2. I imagine for-profit Insurance companies would love to blame their prices on the uninsured.

3. Many poor people actually have insurance in the USA. Even if they don't apply for it, insurance can be applied for after the fact.

4. The wealthy, and the poor are usually covered by insurance. It's the middle class that needs attention. They have insurance, but it's not great.

I still don't belive our healthcare costs are due to the uninsured. Oh yea, every hospital has a fierce Billing and Collections department.

They are allowed to go after your assets if you can't pay your bill, and they do. Obamacare gave patients some rights, but hospitals blatantly abuse the regulations.

The right to collect in municipal court was never taken away from hospitals.

In my local newspaper, it's not uncommon for a hospital to sue a patient over a bill, and put a Judgment lien on the patients assets.

They claim they only do this as a last resort, but bankruptcy due to medical bills are still the number 1 reason people end up in federal court (Bankruptcy).

Your protections under a bankruptcy are not great either.

There are many hospitals that forced a former patient to sell their home (homestead exemption needs to be higher. In TX, they can't touch your primary residence.). under a bankruptcy.

In CA, for example, the primary home gets a $250,000 protection. (Look up that last figure. I know it's very low in CA, and needs to be raised to at least a million. You have a $600,000 home. You are only protected by $250,000 of it's worth.

So in America, if you do get sick, and can't pay all your medical bills, you have no protections. These for-profit medical companies will come after you with more zest than an unpaid credit card. I think CC companies are less aggressive.

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

#303

Post by xyzzyz » Wed, Sep 22, 2021, 7:45 PM UTC

karmelapple wrote: post #181

danShumway wrote: post #148

Earlier quoted context omitted.

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…

Drugs typically have a pretty in elastic demand. Whether it costs $16000 or $0.05 for a pill, the end user - whether a doctor or a patient - will simply figure out a way to pay for it to alleviate the pain, symptoms, and perhaps to avoid dying. Seems like 340B (I hadn’t heard of this before, thanks!) may have been created with recognition of this inelasticity. If we can limit prices this way, all it would take are a…

There is much more elasticity than you think. Most medicine is not about “not dying”. Here is an example: I get heartburns pretty often. I take a heartburn medicine omeprazole daily. It’s an over the counter drug, costing something like $0.3/dose. If they bumped the price to $16,000 I would just stop taking it, and started getting regular heartburns again. These suck, but I lived with them before finding this drug, and wouldn’t pay tens of thousands of dollar annually to get rid of them.

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

#304

Post by mullingitover » Wed, Sep 22, 2021, 7:46 PM UTC

gfodor wrote: post #298

mullingitover wrote: post #285

Earlier quoted context omitted.

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.

On the contrary, there is, the problem (for some) is that it is indeed a bullet and the people getting (figuratively) shot are the ones who, under this system, are getting very fat on the inefficiencies. They're able to use their illicit wealth to exploit our very broken system of government to maintain their rent-seeking successes.

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

#305

Post by dougmwne » Wed, Sep 22, 2021, 7:49 PM UTC

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…

At this point, I think your colleagues' nihilistic humor is totally lost on the American Public. Your flippancy is a strong argument for legislative reforms of the healthcare industry.

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

#306

Post by nybble41 » Wed, Sep 22, 2021, 7:49 PM UTC

peterangular wrote: post #278

wuliwong wrote: post #270

Earlier quoted context omitted.

>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

I'm in the Jim Camp school of thought where, in negotiation, there is no "win-win" situation. https://www.forbes.com/sites/jimcamp/2013/03/11/revisiting-w... The reason I am firmly in this school of thought is that I've made the absolute mistake of a decision to try for "win-win" situations in a capitalistic society, specifically in regards to contract negotiations and ultimately pricing/billing. When I'm making sure…

> if both parties "won" then didn't both ultimately lose?

No, because even in a capitalist society "winning" is defined by each party's relative improvement over the state they would be in if they didn't come to an agreement and make the trade—not by some absolute measure of whether they did better than the other party. A "win-win" is simply an agreement where both parties are better off for making the trade. This is the usual state of things when both parties are free to accept or decline and there is no deception (fraud) involved, since both parties need to accept the agreement and they will only do so if they believe that doing so benefits them. In rare cases one or both parties may be mistaken about the benefit, but they know their own business better than anyone else and are best positioned to judge the expected value of making the trade based on the information available at the time.

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

#307

Post by nradov » Wed, Sep 22, 2021, 7:49 PM UTC

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.

Tort reform only helps a little. In fact several US states have already implemented major tort reform and their healthcare costs aren't significantly lower. Doctors still tend to practice defensive medicine and err on the side of doing too much rather than too little.

The current bottleneck in producing more physicians isn't medical schools but rather funded residency program slots. Every year some students graduate from medical school but are unable to actually practice medicine because they don't get matched to a residency program. We need Congress to increase funding.

https://www.ama-assn.org/press-center/press-releases/ama-fun...

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

#308

Post by nickff » Wed, Sep 22, 2021, 7:50 PM UTC

kazinator wrote: post #289

BurningFrog wrote: post #266

Earlier quoted context omitted.

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.

The most famous (infamous?) example of this was the Hughes Medical Foundation.

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

#309

Post by [deleted] » Wed, Sep 22, 2021, 7:50 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…

[deleted]

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

#310

Post by joshAg » Wed, Sep 22, 2021, 7:51 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.

No, it's sourced from the initial capitalization of the firm and then realized returns that are reinvested. You can't offer insurance until you're capitalized enough to handle claims on the same day the policy takes effect.

Ideally the premiums will cover payouts and day-to-day business expenses, so the invested money can just keep being reinvested, hopefully into longer term and more aggressive investments. The premiums and payouts get rolled into underwriting profit/income. And that can eventually get rolled into new investments.

Here, look at state farm for 2019[1].

Their underwriting gain was $777 million on $65.2 billion in total premium. Their investment income was $5 billion with a net worth of over $100 billion, which is more than 6 times larger their underwriting premiums.

Their profit ratio for underwriting is like 1.2% because they're not trying to maximize that profit. A large reason they're not trying to maximize it is that for admitted policies, there's usually an upper limit to how much aggregate premium can go to anything other than paying out claims (eg: [2] and [3]).

So for an insurer, they don't want to set themselves up to depend on premiums to fund the investment arm because 1) there's an upper limit on how much aggregate premium can go towards anything other than claims 2) there's no limit on how much aggregate premium can go towards claims, 3) growing premium haphazardly can result in less money available for investing due to other regulations that limit risk and require a certain amount of liquidity for claims.

[1]: https://newsroom.statefarm.com/2019-state-farm-financial-res... [2]: https://www.law.cornell.edu/regulations/california/10-CCR-Se... [3]: https://consumerfed.org/press_release/auto-insurers-reaped-n...