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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

#11

Post by gwgarry »

DanBC wrote: post #6
mitmads wrote: post #2

"a health system that can set prices with impunity because consumers rarely see them — and rarely shop for discounts"

Why aren't the insurance companies working to drive prices down? I understand the theory: People buy insurance; the insurance companies 'police' medical providers and regulate (through the market) the pricing of services. From the outside it doesn't look like that works. From the outside it looks like very many more (often unneeded) tests are conducted. And it looks like the insurance companies are not squeezing the…

The insurance companies are going to "negotiate" with the hospitals in which the hospital's bargaining position will be to offer fewer services, or the reduce the level of service provided. That's what it looks like from the inside. The insurers put as much money in their pockets. And the hospitals do the same. The patient gets hit with a large bill and fewer sub-par services. Everyone wins. Except the patient.

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

#12

Post by drawkbox »

girvo wrote: post #3
mitmads wrote: post #2

"a health system that can set prices with impunity because consumers rarely see them — and rarely shop for discounts"

Kind of defeats the whole "free market" thing, doesn't it?

It isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem.

Not sure how you fix it, maybe by temporarily making it illegal to allow a company to provide health benefits through insurers to fix this. Employers should only be allowed to give you the money for an individual plan (most startups sometimes do this instead). Employers don't pay your auto insurance, home insurance or other insurance. Maybe a one time convert of employer groups to individual groups managed for risk, then, for privacy, for business, for better health care the individual has that (also probably a back up plan for those in need).

Why should employers know about your health? This is ancient thinking where you stayed with a company forever. It's also a privacy thing. I think it would also combat ageism. It will also make starting companies and competing much easier with less friction. It would also allow employees to more easily go from job to job, when you have an employer plan it is a scary predicament sometimes.

Cost can only be competitive if they are seen, they will be seen if it is moved away from employer provided.

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

#14

Post by cmircea »

drawkbox wrote: post #12
girvo wrote: post #3

Earlier quoted context omitted.

Kind of defeats the whole "free market" thing, doesn't it?

It isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem. Not sure how you fix it, maybe by temporarily making it i…

Or how about have national healthcare? Like every other decent country on this planet?

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

#15

Post by drawkbox »

cmircea wrote: post #14
drawkbox wrote: post #12

Earlier quoted context omitted.

It isn't really a free market though, it is a fixed market. If it was true free market it would be individual to service, that is why prices are all over the place. We just need to return to individual health care plans, paid for by employees individually (or give them cash health benefits). If your employer paid your auto insurance we'd have the same problem. Not sure how you fix it, maybe by temporarily making it i…

Or how about have national healthcare? Like every other decent country on this planet?

Possibly, but you can't make that leap directly, people/industries don't move that fast. First step is move away from company provided, I am sure there would be renewed interest for it in many against it now, or some workable private and public system where prices are known, more direct.

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

#16

Post by Jayschwa »

epistasis wrote: post #9

This is why the ACA is such a boon for people that thonk health care should be a free market. It takes the free market ideals and embraces them; the accusations of socialism are more telling of the accuser than the accused. That's not to say that I think health care should be a free market, just that its the goal of the ACA, and the current situation in the US is much less free a market, and due to employer provided…

One good aspect doesn't make it a boon. In my personal experience, the law has made insurance less affordable. I'm in between jobs and bought an inexpensive short-term, high-deductible plan. However, the plan has been deprecated (no renewals after a certain date) because it does not meet all provisions of the ACA.

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

#17

Post by rdl »

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. Employers who currency pay for your entire insurance could give you an equivalent amount (plus deductible) which goes into your Health Savings Account.

You're then effectively paying an army of 300 million to constantly search for the best prices (or rather, to find third party organizations to search for the best prices for them). $3-5k/person is actually not that unreasonable for the poorest 30mm people and those covered by medicare/va/medicare-for-kids/etc.

I'm confident this could drop the prices of procedures by >10x, comparable to other countries. Americans are really good at driving down costs when they know the costs and are paying them out of pocket; look at how much cheaper it is to buy an iPhone in the USA vs. where it's made.

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

#18

Post by yitchelle »

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.

"if you are lucky enough to have insurance."

This is one of the many sad points about the health system. Luck should have absolutely NO relation to whether you can afford reasonable health care. Reasonable health care should be available to Joe Blow who is earning minimum wage at your local city council and to Mr. Burns who is earning 20x more than Joe Blow.

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

#19

Post by ck2 »

yitchelle wrote: post #18
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.

"if you are lucky enough to have insurance." This is one of the many sad points about the health system. Luck should have absolutely NO relation to whether you can afford reasonable health care. Reasonable health care should be available to Joe Blow who is earning minimum wage at your local city council and to Mr. Burns who is earning 20x more than Joe Blow.

Great news, they solved this in a very profitable way.

In a few years it will literally be a crime to not have insurance. So cannot afford it? Not their problem - YOUR problem.

Yay 'murica.

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

#20

Post by rdl »

Jayschwa wrote: post #16
epistasis wrote: post #9

This is why the ACA is such a boon for people that thonk health care should be a free market. It takes the free market ideals and embraces them; the accusations of socialism are more telling of the accuser than the accused. That's not to say that I think health care should be a free market, just that its the goal of the ACA, and the current situation in the US is much less free a market, and due to employer provided…

One good aspect doesn't make it a boon. In my personal experience, the law has made insurance less affordable. I'm in between jobs and bought an inexpensive short-term, high-deductible plan. However, the plan has been deprecated (no renewals after a certain date) because it does not meet all provisions of the ACA.

My long-term HDHP went from $80/mo to $118/mo, which is high in percentage terms, but still not a big deal IMO. In the process they gave me unlimited lifetime coverage, added free preventive care, etc. -- which IMO seems actuarially impossible, but I'm on the buy side of this transaction.
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