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How to Charge $546 for Six Liters of Saltwater

nytimes.com

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Re: How to Charge $546 for Six Liters of Saltwater

#31

Post by jes »

smokinn wrote: post #29
refurb wrote: post #16

One of the big reasons for this problem is Medicare. The reimbursement that Medicare offers is often far less than it costs the hospital. Why does Medicare not cover the cost of a procedure? Usually because it did cover it in the past (to the point of generosity) and providers reacted by shifting their services to maximize the profits. A good example is the infusion of drugs. Medicare pays ASP+4% (just cut from +6% d…

Sounds like the problem isn't actually medicare, sounds more like it's adding a capitalistic, profit-maximizing middleman into the system.

With respect, what does capitalism mean to you? Lassiez-Faire or something different?

Re: How to Charge $546 for Six Liters of Saltwater

#32

Post by microcolonel »

They don't clarify though, the costs of running a sufficiently-advanced multiple-effect distiller, dealing with the FDA, WHO and whomever else forces them to... these costs could definitely add up, no?

What do you think the bar is for entering the market of providing water for injection? Who's there to make it costlier, maybe the insurance oligopoly can hold some of the blame for this as well...

Re: How to Charge $546 for Six Liters of Saltwater

#33

Post by uptown »

kumarski wrote: post #2

I keep getting that feeling that something must be done. Any suggestions HN readers?

I'm nowhere near having an answer, but pricing transparency needs to be a major part of the solution. I realize OPEC isn't exactly a popular entity, but I wonder whether a similar model might have some benefits here. Form a group comprised of representatives from interested parties tasked with establishing pricing for services rendered that is consistent across the entire nation. Perhaps allow regional adjustments based on cost-of-living deviations, or some other relevant metric - but cap how much those deviations can actually influence the price of care.

End the idiotic "billed rate" vs. the "negotiated rate" nonsense.

Include patient transportation in the equation. If singular pricing isn't attainable, a local hospital's care is too expensive, and the patient can receive similar care at an alternate location in a cost-effective way - cover the transportation cost under their insurance.

Tort reform. Liability insurance premiums for health care professionals is as crazy as the price for the care they provide. This is as big a problem as the price of a bag of saline.

I know these aren't the answers - but pricing of services is key to the problem, and the Affordable Care Act did little to get that under control beyond attempting to move more individuals under the umbrella of insurance and outside of emergency care.

Re: How to Charge $546 for Six Liters of Saltwater

#34

Post by lifeformed »

kumarski wrote: post #2

I keep getting that feeling that something must be done. Any suggestions HN readers?

What would happen if a hospital opened up that just had reasonable rates? It wouldn't make any deals with insurance companies other than to take payments. It posts all it's prices online and transparently for everyone to see. You can shop for treatments on their website. Could they make money this way?

Re: How to Charge $546 for Six Liters of Saltwater

#35

Post by derleth »

csense wrote: post #3
kumarski wrote: post #2

I keep getting that feeling that something must be done. Any suggestions HN readers?

Turn healthcare into a government bureaucracy. Because that's an effective way to combat waste, inefficiency, and overcharging

Only fools and ideologues argue against systems which have been demonstrated to work.

Re: How to Charge $546 for Six Liters of Saltwater

#36

Post by nikatwork »

Many in this thread are claiming that price fixing wouldn't occur in a "truly free" market. This is misty-eyed naivety.

In a completely deregulated free market, it is even more in the hospitals' interest to form a price-fixing cartel. Any new player in the market trying to set reasonable market prices could be excluded through market pressure tactics (eg, tell distributors don't sell to them or our cartel will no longer use you).

It seems to me that the parlous state of the US healthcare system is in fact a perfect demonstration of the dangers of a completely free market, and claims that "oh no it's not actually free enough" are merely handwaving.

Re: How to Charge $546 for Six Liters of Saltwater

#37

Post by tapp »

thrownaway2424 wrote: post #21
dopamean wrote: post #15

Earlier quoted context omitted.

> This is why free markets aren't the answer to everything. Perhaps I've misunderstood you here but in my opinion the way healthcare works is sort of the opposite of a free market and if a free marketplace for health services were allowed to exist then things like $500 bags of saline solution wouldn't exist.

It is not possible to have a "free market" in health care because the "customers" are often on the brink of death, or not even conscious.

I've heard this statement used frequently to shut down debates re using market dynamics to improve the healthcare system in this country.

However, the substantial majority of healthcare services provisioned are non-emergency.

It is absolutely possible for us to have a freer market in those services (Lasik procedures are just one frequently cited example) and IMO that would be a huge improvement over the current Frankenstein system we have today.

Re: How to Charge $546 for Six Liters of Saltwater

#38

Post by socialized »

After spending six months in the hospital for orthopedic care for my news it became very apparent that unless you had a negotiated rate with your HMO or were on Medicare, pricing was the wild west. If you could discern what the bills were for via the medical codes, you would become outraged by the overhead. The best part is that hospitals get to hide behind HIPAA as they gouge and steal.
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