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

healthcaredive.com

341–350 of 463 posts

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

#341
post #324
post #290

Earlier quoted context omitted.

> 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.

I think this is far too facile. It's like saying half your taxes go to government waste. I mean sure, OK, but how do you get rid of government waste? So far no one has been able to do it. So this is really an unwillingness to engage in the problem, which is absolutely endemic in the current discourse. The key problem is that 20% of our GDP goes to healthcare, and similarly 20% of our population is employed in healthc…

> So far no one has been able to do it.

But that's the problem with your argument. Of course people have done it, nearly every developed country has.

> If you want to reduce healthcare costs in half, so that it is only 10% of GDP, then expect to throw 10% of the population out of work. That will include nurses, doctors, EMT personnel as well as administrators.

No, it won't. I'm talking about eliminating the positions that would only exist because of the private insurance system. Which is a massive amount of dead weight loss.

It's not remotely hard to understand conceptually, I mean EVERY dollar that's devoted to arguing over insurance bills is completely wasted. As are all the dollars spent on insurance advertising and marketing, and so on. Every dollar paid back to health care companies as dividends, or used for stock buybacks.

That's a lot of dollars.

Every time this argument comes up people in the US start talking about it like "Oh yeah? Sure but what's YOUR solution then smart guy? Stumped you didn't I?"

Um, no. My solution is the NHS. Like you can go there and look at it I swear it's a real thing, they have buildings and everything, just book a flight to London and see for yourself. Or, in US terms, Medicare for all, which is also a real understandable thing that exists, except for the "for all" part.

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

#342

Earlier quoted context omitted.

> 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'…

If they were not restricting their risk pool, then how would a couple kids with cancer affect the company's premiums? The costs would be distributed across a much larger population. When I was shopping around for health insurance for my businesses, the premiums were the same as what they would have been individually on healthcare.gov. Kaiser has a good report showing the costs are not that different based on firm siz…

Because the premiums even for the larger risk pool can be negotiated with the insurance company. And if you suck at negotiating (like our HR), then you can accept at face value the arguments the insurance company makes about how much you're costing them, and how they'll just drop you if you don't accept higher premiums.

And I'm going to guess that your businesses had very, very few employees? To the point of not being worth negotiating with from the insurance company's perspective?

And Kaiser isn't run like most insurance companies.

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

#343

Earlier quoted context omitted.

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…

But we are just talking about an x ray here. Estimating the price of a radiologist per hour is not hard.

It shouldn’t be this difficult to price x rays at a per hour or per shot basis.

Pretty much every industry has variability in their jobs. Sometimes they eat some money and sometimes they make more based on what actually happens during the job fulfillment.

No one expects (or should expect) hospitals to literally know the amount of parts and labor for every single x ray they could perform. However, like literally every other business, they should know rates and tiers such that on average they make money. Then, disclose that.

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

#344
post #333

Earlier quoted context omitted.

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.

No system is perfect. If the US had a universal healthcare system, it would suck in many ways. People do, after all, travel to the US for medical care. My point is that there is likely a better local optimum out there than the one you suggest, and coming off as if the problem of healthcare is “solved” is news to people under any system who are suffering due to its inefficiencies or inequities. For example, I live in…

There may be edge cases, but on the whole if people in the US had the health care systems of the UK, France, Germany, Japan, or pretty much any other developed country, they would riot in the streets if the US system were suddenly forced on them.

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

#345

Earlier quoted context omitted.

There's police around hospitals constantly and if they get a whiff that you have a fake ID they're going to be talking to law enforcement sooner or later. Also this isn't going down to your corner liquor store and flashing your drivers license... that thing is going to get scanned etc. --- Actual protip: If you're uninsured and need care they legally can't turn you away at an ER. They have to provide the healthcare t…

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…

No, let's "fuck you," instead.

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

#346

Earlier quoted context omitted.

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.

This reads like straight up corruption and extortion. There could be no other reason to do this than to milk as much money as possible out of people who have no alternative. You should absolutely be testifying before Congress, not before HN.

This is exactly what happens when a monopoly produces extremely price inelastic goods. If it's not illegal, the monopoly will attempt to charge each customer as much as they can afford.

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

#347

Earlier quoted context omitted.

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…

I'm not following why any of that matters to the cost of an x-ray. If there's a gunshot wound and there needs to be a nurse attending to the patient while the x-ray is being taken, the nurse is an extra cost, separate from the x-ray and the x-ray tech. The cost of the x-ray itself shouldn't change.

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

#348
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…

>administrative bloat

I'd love to know how much money is spent by hospital admin staff dealing with the insurance industry.

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

#349

Earlier quoted context omitted.

If they were not restricting their risk pool, then how would a couple kids with cancer affect the company's premiums? The costs would be distributed across a much larger population. When I was shopping around for health insurance for my businesses, the premiums were the same as what they would have been individually on healthcare.gov. Kaiser has a good report showing the costs are not that different based on firm siz…

Because the premiums even for the larger risk pool can be negotiated with the insurance company. And if you suck at negotiating (like our HR), then you can accept at face value the arguments the insurance company makes about how much you're costing them, and how they'll just drop you if you don't accept higher premiums. And I'm going to guess that your businesses had very, very few employees? To the point of not bein…

Kaiser is short for Kaiser Family Foundation, which compiles nice reports about healthcare in the US. Using their reports does not have anything to do with Kaiser the company. Although their insurance side is similar to any other health insurer.

>And I'm going to guess that your businesses had very, very few employees? To the point of not being worth negotiating with from the insurance company's perspective?

Yes, but that was my point about businesses being able to just buy the health insurance plans available on healthcare.gov. Earlier you mentioned the healthcare.gov plans were:

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

But the data does not support that. Average annual employer sponsored insurance is $7,675 for single PPO coverage in 2019:

https://www.kff.org/report-section/ehbs-2019-summary-of-find...

And average lowest cost monthly gold premium on healthcare.gov is $516 ($6k annual) in 2019:

https://www.kff.org/health-reform/state-indicator/average-ma...

So employers can probably save money going to the healthcare.gov plans, albeit with higher out of pocket maximums probably. But at least a couple kids with cancer would not throw off the premiums.

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

#350

Earlier quoted context omitted.

> 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.

Alas, this makes sense.
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