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

healthcaredive.com

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

#251

Post by sk00tmer »

peterangular wrote: post #206
fragmede wrote: post #171

Earlier quoted context omitted.

Inherently? No, just under capitalism.

I know that any anti-capitalism comments get immediately downvoted here but yeah... The privatization of healthcare is a conflict of interest which is a product of our hyper-capitalistic society. You can't make a profit center out of human services without dehumanizing it in the process - the very nature of profit/capitalistic societies means someone has to lose and I see no place for these interests in healthcare or…

I have to agree with you for the most part, as a Canadian, I know our healthcare system is flawed, deep systemic problems, problems I'm not even familiar with. However, we don't have to deal with any of these price lists or copays or pre-approvals or debt (inside the scope of hospitalisation) I've even heard arguements that many of the pitfalls stem from privatised aspects. I'm a fairly capitalist person, but there is something awfully and fundamentally wrong about a society that monetizes well-being and health.

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

#252

Post by jjoonathan »

joshAg wrote: post #221
jjoonathan wrote: post #210

Earlier quoted context omitted.

Yes, in a well-regulated insurance market the winning business model isn't deceit. That's the point of the regulations. Deceit can take many forms, and I'd argue that undercapitalization is actually one of them. "There's a trap clause on page 23 of the telephone book contract" is only the simplest strategy an insurance company can use to lemon-drop. "We ask our customers to do an impossible information wrangling task…

I'm not saying it's not because of regulations. I'm saying it's not just the regulations on payouts and the regulations on payouts probably aren't even the most important, because all the regulation in the world around ensuring the insurer can't skip out on payouts will do nothing for "Oops we invested badly and have literally no money with which to pay your completely valid claim". The payouts regulations are still…

I'm not sure we disagree. We just allocate the benefit of the doubt differently.

> "Oops we invested badly and have literally no money with which to pay your completely valid claim".

It's 100% possible for this to be a genuine mistake. I'm sure that it happened as a genuine mistake more than once! However, it is also possible to do this on purpose: load up a business vehicle with increasing amounts of risk and extract as much of the premiums as one possibly can before it explodes. If this is done intentionally, it is exactly the same hustle as selling policies that one doesn't intend to make good on, it just uses a different mechanism to shirk the obligation.

Every company that does it on purpose will say that it happened by mistake, of course, and just as I am certain that it has happened multiple times as a genuine mistake, I am certain that it has happened multiple times on purpose.

Undercapitalization is the evolved form of the "sell a trash policy" hustle because it provides almost perfect plausible deniability. It makes sense that the greatest legislative effort would be spent heading it off.

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

#253

Post by merpnderp »

satronaut wrote: post #189
jonathan-adly wrote: post #63

I am one of the people responsible for making these lists. The fact that the general public as well as journalists think this data is accurate in anyway is really funny. This an exercise of futility that only increases the overall cost and provides job security for me :) No one working in a hospital knows how much do we acquire things for, or how much we get paid for doing things in advance. And only like 8 people ca…

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,…

You forget that the x-ray is propping up about 50 admin job positions that don't directly generate revenue. The army of compliance, insurance, billing, etc etc etc employees have to get paid somehow.

But hopefully this price transparency helps us ask the question of why does an x-ray have to pay for a ton of positions which have nothing to do with x-rays, and how do we correct this situation.

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

#254

Post by supperburg »

There is debate about healthcare nationalization.

As always, that which lends itself to regulation via market should be private and that which does not should be nationalized. So which one is medicine?

Medical care that is needed suddenly and urgently must be nationalized because the consumer of this care doesn’t shop the market and therefore the market is not capable of regulating its participants in that case.

Medical care that planned ahead of time, not urgently needed or otherwise allows people to shop the market should be private.

But this is not the issue. Whether or not medicine of one kind or another is private or public doesn’t matter as long as the medical establishment is corrupt and inefficient. Corruption and inefficiency are possible in both scenarios. Too few people in the public appreciate that it is the massive corruption and inefficiency of the medical establishment that is the cause of America’s healthcare problem. Doctors are in hundreds of thousands of dollars in debt by the time they wear a stethoscope. Hospitals are charging ten dollars for an aspirin. Patients can sue and cause material damage to medical practitioners even if the medical practitioner did nothing wrong. The system is broken. It doesn’t cost 300k to train a fucking doctor. It never did in the past and it doesn’t now either.

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

#255

Post by callmeal »

throwthere wrote: post #143
garettmd wrote: post #115

Earlier quoted context omitted.

This. It's telling that people working inside this system operate on a totally different set of rules for how to determine basic things like the cost of some input.

You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient. It's telling how people on the outside have no idea how complex the system is, as if there's one simple way to cost an item (hell, there's not even one simple way to cost an item with GAAP accounting for a widget). These lists are kind of worthless in the current iteration, but they…

>You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient.

Why shouldn't it be? How hard is it for a hospital to project their annual aspirin/paracetamol/? usage and budget for it?

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

#256

Post by programmertote »

nickff wrote: post #208
snarf21 wrote: post #155

Earlier quoted context omitted.

This is why we need reference based pricing. You can't charge more than 1.2 * Medicare and if you pay cash, you get the Medicare price. This change alone would remove 25+% of unnecessary bloat from the US system.

> "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 recently read an insider writing something about it on Reddit: https://old.reddit.com/r/SelfAwarewolves/comments/pruk4x/the...

Hope that gives you an additional viewpoint regarding the "non-profit" label of the hospitals.

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

#257

Post by good8675309 »

lowkey_ wrote: post #231
good8675309 wrote: post #204

Earlier quoted context omitted.

Scams? They paid for my $6000 colonoscopy which caught early cancer, my daughters stitches, my wife's allergy specialist, my son's rocky mountain spotted fever, etc. etc. $500/mo for our family of 5 and we've been on it for nearly 10 years. But yes, please tell me more how this service that is way cheaper than insurance, is a community of people helping each other, and covers way more than insurance, is a scam.

Can I ask what service you use? I'd be interested in checking it out.

Sure, I use Samaritan Ministries. I've tried other health sharing groups but Samaritan has been the best experience. They also have the best tech platform with the best user experience that I've seen. Samaritan is for christians but there are other health sharing groups that don't have that requirement.

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

#258

Post by [deleted] »

spaetzleesser wrote: post #2

Full openness is a good first step to make this insane system a little better. Next step would be for hospitals to quote the same price for the same procedure no matter if or where you are insured. I can’t think of another business where prices are different by hundreds of percent for different customer groups. Also get rid of the whole in and out network system.

[deleted]

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

#259

Post by nebula8804 »

vmception wrote: post #55

Great, now mandate that it is viewable via API Can even use the healthcare industry standard for EHR which is JSON and RESTful

In the meantime, since we have the data, this could be a good project for volunteers to glue together all the different documents from the different hospitals into a single system.

These files are provided as excel documents in what I assume to be a (hopefully) mostly unchanging location on each site. A script could download all the files, match up the procedures and then push it to a pretty tool for everybody to use when comparing prices.

Most enterprises have terrible dev/IT talent but when it is a cause as important as this, talented people tend to show up to provide a great solution.

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

#260

Post by lotsofpulp »

monocasa wrote: post #201
joshAg wrote: post #169

Earlier quoted context omitted.

Only to a degree because policies basically always have an upper limit on coverage. If the payouts are dropping because there's a massive reduction in claims, then there's a pretty decent chance that paying the policy maximum on each claim still won't be enough. Plus, profits don't come directly from the premiums anyway. They come from the investments the insurer makes with the premiums. So sure, they can try to conv…

> So sure, they can try to convince policy holders to increase coverage which allows them to charge a higher premium Or they just stone wall and increase premiums anywhere they can until they hit targets. Like at a previous job I had at a 250 employee company where premiums went up $150/m one year because the previous year had two families had a kid get (very different kinds of) cancer out of the blue. You'd think th…

>You'd think that shopping around would've helped in that case, but the word got out somehow to the other insurance companies and they were giving us similar quotes.

Employers are welcome to purchase healthcare.gov plans that are not allowed to price based on pre existing conditions:

https://www.healthcare.gov/how-plans-set-your-premiums/

If an employer wants to self insure and restrict their risk pool to only their employees, then they have to pay for it.

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