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One hospital charges $8,000 — another, $38,000

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Re: One hospital charges $8,000 — another, $38,000

#81

Post by FD3SA »

digitalengineer wrote: post #44

I do not understand why there is no public list online with the basic costs of operations (including all the variables). With price transparency a lot of this unequal treatment and prices would surface. I understand there are a lot of variables, but not like it wouldn't be possible. (I understand a treatment at Hopkins would be more expensive than say at your local hospital, but at the very least it would be clear ho…

There's a much easier way: get Medicaid's reimbursement data. Contrary to popular belief, hospitals do not lose money on Medicaid patients. They just lose a whole lot of profit margin.

Re: One hospital charges $8,000 — another, $38,000

#82

Post by MrUnknown »

jws wrote: post #68
300bps wrote: post #58

Earlier quoted context omitted.

>In my personal experience, the law has made insurance less affordable. Last year I had a PPO insurance plan at work that cost $216 per month for a family plan and had very tiny out of pocket expenses. This year my employer dropped the PPO as being unaffordable and switched to a HDHP that costs the same $216 per month for my family plan. Now the plan pays literally nothing for the first $3,000. And then 80/20 up to t…

$216 sounds like only your part of the payment. Do you know how your employer's contribution (the bulk of the total cost) changed? Sounds like they saved a lot of money.

This is exactly it. The company I work for is fairly open, and I know how much they pay every pay period for my health insurance, and it is about 3x as much as I pay for the plan.

This guy's company sounds like they changed providers, pushed almost all the cost to the employee (under the mask that it costs the employee the same), is saving a ton of money, but tells the employees to blame the ACA.

While I work for a decent company, they even tried to blame some crap on the ACA trying to explain why the premiums went up this year. Except, they went up the same amount the year before, and the one before that also.

Re: One hospital charges $8,000 — another, $38,000

#83

Post by jaynos »

digitalengineer wrote: post #44

I do not understand why there is no public list online with the basic costs of operations (including all the variables). With price transparency a lot of this unequal treatment and prices would surface. I understand there are a lot of variables, but not like it wouldn't be possible. (I understand a treatment at Hopkins would be more expensive than say at your local hospital, but at the very least it would be clear ho…

Price transparency wouldn't help in most cases. If my deductible is the same whether I get the $8,000 procedure or the $38,000 (same) procedure, why should I care? I bet the $38,000 one is better.

That's not my specific take, but I bet the majority of Americans would take that argument.

Re: One hospital charges $8,000 — another, $38,000

#84

Post by digitalengineer »

jaynos wrote: post #83
digitalengineer wrote: post #44

I do not understand why there is no public list online with the basic costs of operations (including all the variables). With price transparency a lot of this unequal treatment and prices would surface. I understand there are a lot of variables, but not like it wouldn't be possible. (I understand a treatment at Hopkins would be more expensive than say at your local hospital, but at the very least it would be clear ho…

Price transparency wouldn't help in most cases. If my deductible is the same whether I get the $8,000 procedure or the $38,000 (same) procedure, why should I care? I bet the $38,000 one is better. That's not my specific take, but I bet the majority of Americans would take that argument.

You're right. User will definitely benefit, but not directly. Perhaps the energy for transparancy should be directed at the insurance companies? Or would they not care as well?

Re: One hospital charges $8,000 — another, $38,000

#86

Post by maxerickson »

mapt wrote: post #35
ck2 wrote: post #7

Always tell them you are paying in cash. Take bill home and sumbit to insurance if you are lucky enough to have insurance. You just saved the system at least 75% of the cost.

This is the precise opposite of how it works for a lot of people in the US. I've been on both sides of this, with two incidents a few days apart on either side of student insurance expiring. Hospitals charge uninsured people a ridiculous amount, then mark it down anywhere from 50-98% (Yes, I had a bill that was adjusted 98%) based on negotiations with insurance companies. Uninsured people get hit with the full, absur…

Any basis for implying North Dakota must be less functional than your locale?

Re: One hospital charges $8,000 — another, $38,000

#87

Post by wdr1 »

reycharles wrote: post #45
cmelbye wrote: post #41

Earlier quoted context omitted.

But then what happens when they need care when they're not near the company hospital? You'd need to set up company run hospitals all around the state and the country to manage the costs. And suddenly, you've reinvented Kaiser.

Kaiser Permanente ( http://en.wikipedia.org/wiki/Kaiser_Permanente ) is a »integrated managed care consortium« (health insurance, I guess). I did not know that.

I would not recommend Kaiser. I herniated a disc in my back, fairly severely, 6 weeks ago. I've seen 5 doctors & a physical therapist so far & have yet to get the treatment several have said I need. For the past 6 weeks I've been able to stand for 5-10 minutes, top and can't sit at all.

Whereas an insurance facility has incentive to try not to pay, because Kaiser is integrated, they incentive not to provide the service at all.

Each time you get a referral to a different department the sequence is 2-3 days to schedule the appointment. The first appointment has to be a consult, the next available being in 1-2 weeks. Then the treatment they want to try (if any), being 2-4 weeks out.

Re: One hospital charges $8,000 — another, $38,000

#88

Post by greedo »

humanrebar wrote: post #77
rdl wrote: post #17

I have to admit I was against ACA for a variety of reasons, but if the first step is increased price transparency and exposing that data, it will do a lot of good. The best reform I can think of would be a combination of individually purchased (vs. employer) HSAs, where poor people get grants of up to the the full deductible per year in some kind of special account IFF they sign up for HSAs, and price transparency. E…

That's not a political reality. Since healthcare bought by an employer counts as an tax-deductible expense and healthcare bought by an individual gets no such breaks, there is a huge incentive (equal to the marginal tax rate) for individuals to have someone else write the checks for the bulk of their healthcare costs. Before market-based healthcare will work, either 1) employer-provided health insurance benefits must…

Individual healthcare purchases (not insurance) can be deducted from your taxes, either explicitly if you're filing a long form, or implicitly if you're claiming the standard deduction.

I don't see why it would be a huge burden to make individual health insurance tax deductible.

Re: One hospital charges $8,000 — another, $38,000

#89

Post by greedo »

spodek wrote: post #71
digitalengineer wrote: post #44

I do not understand why there is no public list online with the basic costs of operations (including all the variables). With price transparency a lot of this unequal treatment and prices would surface. I understand there are a lot of variables, but not like it wouldn't be possible. (I understand a treatment at Hopkins would be more expensive than say at your local hospital, but at the very least it would be clear ho…

Seems like an opportunity for a simple web page for people to report their fees and could search what others paid. Not sure if it would make money, but I bet a lot of people would like it and benefit from it. Anybody up for it? Does it already exist?

I think that healthcare providers would have to start this process. The bills and statements are far too opaque for the end user to properly decipher.

As an anecdote, I was treated for cancer several years ago; trying to wade through the morass of bills, statements, treatments, third/fourth/fifth levels of providers, was simply unfeasible.

And hospitals naturally have a desire for this type of billing info to remain opaque since it dissuades any criticism of fee schedules.

Re: One hospital charges $8,000 — another, $38,000

#90

Post by greedo »

lucian1900 wrote: post #49
rdl wrote: post #21

Earlier quoted context omitted.

The weird thing about having an HSA is that because I pay essentially 75% of a lot of things out of pocket (as long as I'm below my deductible), it often makes sense for me to negotiate and "pay cash" rather than running through my insurance. And yes, the doctors, pharmacies, etc. drop the prices a lot. One of the weird things going on right now is that Doxycycline (a common antibiotic) has gone up in price 10-20x in…

That still sounds like a terrible deal to me. In the UK, I pay around 10% of my salary for national health care and get free care for any problem I might have (and so does my girlfriend, of course). Medication is always exactly £7 (or similar, it might have changed slightly recently) regardless of what it's for.

And that leads to perverse incentives; If you have no incentive to help control costs, then it falls upon the NHS to control costs through delays and denial of service.
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