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Health insurers just published close to a trillion hospital prices

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Re: Health insurers just published close to a trillion hospital prices

#131

Post by tyingq »

sl-dolt wrote: post #32

I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?

What was negotiated was probably more blanket style discounts like "10% off your published medicare rate for procedures in categories a/b/c" for one customer and "15% off retail price for all categories other than x/y/z but only in these geographic areas" for another customer, and so on.

But, when publishing, they omit the context and just dump every negotiated rate. Because it's technically compliant, but keeps things opaque.

Re: Health insurers just published close to a trillion hospital prices

#132

Post by nicoburns »

bhupy wrote: post #127
PaulDavisThe1st wrote: post #118

Earlier quoted context omitted.

From medicare.gov: > Medicare Advantage Plans are another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by Medicare-approved private companies that must follow rules set by Medicare. (emphasis added) Those rules are, IIUC, substantively different than the ones that cover the non-medicare private insurance industry, and as a result I…

I actually work in this industry and adjust claims myself from time to time, so I love talking about this stuff! > that must follow rules set by Medicare. (emphasis added) Yeah, I'm not sure that anyone seriously believes that insurance companies should operate in a 100% unregulated fashion. Even the US's food industry (which is predominately privatized) is regulated in some capacity. The argument is whether regulate…

The obvious regulation which almost every other country has is direct price controls on medicines, treatments etc. Not profit percentage controls. A dead simple “this is how much you’re allowed to charge”.

I don’t really understand why anybody would be against introducing this in the US.

Re: Health insurers just published close to a trillion hospital prices

#133

Post by 1MachineElf »

vxNsr wrote: post #116
jjulius wrote: post #96

Earlier quoted context omitted.

... what in the blue hell...?

Most likely a poor ai attempt.

From the user's "about" section:

Perhaps you'll think my comments are unthinkable. My only response to that is that they were legibly written, not by a machine, but by a writer with a soul.

Re: Health insurers just published close to a trillion hospital prices

#134

Post by [deleted] »

dj_gitmo wrote: post #60
sl-dolt wrote: post #32

I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?

The US healthcare system is wildly complicated and inefficient because it is a double-bureaucracy; pubic and private. The government bureaucracy makes a bunch of rules and also provide healthcare through Medicare/Medicaid. The private bureaucracy compete with each other, and hospitals, and pharma companies, ect. Many of the private health providers are for-profit and lobby against rule changes that would reduce compl…

[deleted]

Re: Health insurers just published close to a trillion hospital prices

#135

Post by e_i_pi_2 »

JumpCrisscross wrote: post #101
e_i_pi_2 wrote: post #98

Earlier quoted context omitted.

I don't think that disproves a general trend that increased socialization in healthcare costs leads to better outcomes and less per-capita spending. Also FWIW France and Switzerland both have universal healthcare, under different systems where France splits payments 3 ways and covers more with the govt[1], and Switzerland seems to have a system like the ACA in the US where it's compulsory, but they also set caps on t…

> France and Switzerland both have universal healthcare You said private healthcare/insurance were to blame. Switzerland has private health insurance. Universal healthcare is a separate goal post. For what it’s worth, I’m unclear its comprehensive iteration is compatible with America’s immigration model. (It absolutely is for life-saving measures.)

Ah good catch I was moving the goalposts there - I think in my head public and universal and basically interchangeable - if everyone has it is it a public good regardless of if it's provided by a collection of "private" companies

Re: Health insurers just published close to a trillion hospital prices

#136

Post by bhupy »

nicoburns wrote: post #132
bhupy wrote: post #127

Earlier quoted context omitted.

I actually work in this industry and adjust claims myself from time to time, so I love talking about this stuff! > that must follow rules set by Medicare. (emphasis added) Yeah, I'm not sure that anyone seriously believes that insurance companies should operate in a 100% unregulated fashion. Even the US's food industry (which is predominately privatized) is regulated in some capacity. The argument is whether regulate…

The obvious regulation which almost every other country has is direct price controls on medicines, treatments etc. Not profit percentage controls. A dead simple “this is how much you’re allowed to charge”. I don’t really understand why anybody would be against introducing this in the US.

It is not so obvious at all. Medicare Advantage does not have price controls, and it still costs less per capita than Original Medicare.

> A dead simple “this is how much you’re allowed to charge”.

This has its own set of unintended consequences, including physician rationing (it's a huge crisis of the NHS right now), and a reduction of investment in new medical research. There are many good reasons to be against introducing this in the US.

Switzerland does not have price controls on medicines, treatments, etc. and the reason why it is so often cited is because it enjoys a comparable level of healthcare innovation to the US while still ensuring universal access (through its ACA-like subsidies). It also costs a lot per capita (among the highest in the OECD), but it actually gets what it pays for (https://pubmed.ncbi.nlm.nih.gov/26766626/) (https://www.theweek.in/news/world/2022/05/07/7-reasons-why-s...)

In fact, of the countries that usually make up the global leaders in health/medical innovators, all but 1 (the UK) engage in price controls (https://immigrantinvest.com/insider/the-best-healthcare-coun...), and the UK's NHS is suffering from a rationing crisis, and (ironically) a cost crisis.

Re: Health insurers just published close to a trillion hospital prices

#137

Post by snuxoll »

BitwiseFool wrote: post #120
duffpkg wrote: post #99

Earlier quoted context omitted.

People are rarely satisfied with this answer but its demonstrably true and was proven time and time again at the facilities ClearHealth managed. 1) Feverent, almost religious, adherence to hand washing. 2) No neck ties or dangly sleves whatsoever in buildings that house patients. 3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Those are simple, virtually free, thing…

>"3) Change from stainless steel hardware for doors and travel touch surfaces back to "brass/copper". Because of the pandemic I started encountering doors that have a shoe pull, where you can use your foot to open the door instead of having to touch the handle. I really hope these catch on, but they are still quite rare.

Also stop getting rid of paper towels if you still have manual faucets. Nothing grosses me out more than going to a public restroom with only air dryers, but manually operated faucets that now require you use clean hands to turn off after you turned them on with presumably dirty hands.

Re: Health insurers just published close to a trillion hospital prices

#138

Post by skybrian »

anonymouse008 wrote: post #121
duffpkg wrote: post #89

Earlier quoted context omitted.

Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical re…

> Healthcare is such a base layer of the economy Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.

I'm not sure what that proves, given that you went to a grocery store instead of a pharmacy.

Re: Health insurers just published close to a trillion hospital prices

#139

Post by rayiner »

e_i_pi_2 wrote: post #80

My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary

Most countries have private healthcare (meaning private providers). Many others have a mix of for profit and non profit insurance companies. There’s not a whole lot of difference between Obamacare and say the system in say the Netherlands, Switzerland, or Japan. Those are also “individual mandate” systems.

Re: Health insurers just published close to a trillion hospital prices

#140

Post by spaetzleesser »

e_i_pi_2 wrote: post #71
duffpkg wrote: post #70

I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that…

Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something…

Number one is full price transparency of the whole chain. I work for a medical device company and even the marketing people can't really tell what our stuff costs. There are a ton of middlemen with obscure contracts and very high markups. My ex got one of our devices and I was told by our people that the hospital should have received the device for between 20k-30k (nobody seems to really know) and the hospital charged 80k for the device alone. They also charged another 200k for a one hour surgery with a total hospital stay of six hours.

It's also hard to explain that US patients pay a multiple of the drug price people in other parts of the world pay for the something.

The problem is that if the US wastes 10% of GDP on health care inefficiencies this creates a huge lobby that will fight tooth and mail to keep that money.

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