Hospitals lift curtain on prices, revealing giant swings in pricing by procedure • Hacker News Board

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

#371

Post by MetaWhirledPeas » Wed, Sep 22, 2021, 8:53 PM UTC

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…

> Reimbursement depends on: 1. Insurance 2. Group which you are under the insurance from 3. Contract language whether its a fee/service or bundled 4. Is the visit covered or not 5. how the visit/procedure was coded (most important and opaque factor)

But this list doesn't care why the price was charged. It only needs to know, bottom line, what amount of money changed hands for the procedure?

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

#372

Post by kazinator » Wed, Sep 22, 2021, 8:54 PM UTC

nickff wrote: post #228

kazinator wrote: post #212

Earlier quoted context omitted.

> many hospitals are non-profits. That can't possibly be true of a hospital that charged $3000 for something on Tuesday, and $53000 for the same thing on Friday. (Under reasonable assumptions like that Tuesday wasn't done at a $25K loss relative to breaking even; why would such be the case? And that they are busy with procedures, not simply doing a way overpriced procedure once every few weeks, and then just burning…

Very few hospitals do cost-accounting, so they don't even know how much things cost; this results in the inconsistencies you see in prices. From Wikipedia: > "In 2003, of the roughly 3,900 nonfederal, short-term, acute care general hospitals in the United States, the majority—about 62 percent—were nonprofit. The rest included government hospitals (20 percent) and for-profit hospitals (18 percent)" https://en.wikipedi…

If you don't know how much things cost, how can you say you're doing accounting?

If you're doing accounting you have a ledger which balances down to the penny, and the expenses are spelled out in there with concrete amounts.

This is why that judge, as noted in the article, rejected the argument that the cost of an X-ray can be unknowable.

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

#373

Post by mullingitover » Wed, Sep 22, 2021, 8:54 PM UTC

gfodor wrote: post #357

mullingitover wrote: post #344

Earlier quoted context omitted.

There may be edge cases, but on the whole if people in the US had the health care systems of the UK, France, Germany, Japan, or pretty much any other developed country, they would riot in the streets if the US system were suddenly forced on them.

lol dead people as “edge cases” - frame this one up - own it.

Nothing funny about it. It's grim, but it beats dead people as the default case. We have a lower life expectancy in the US than Cuba, a nation with a GDP per capita of 8,821 USD. A country where the average person's annual wages wouldn't buy them half of a ten year old used Toyota Corolla has better health outcomes. We have people begging bystanders not to call them an ambulance when they're grievously injured, because they can't afford it.

So yeah, there are a handful of people out of thousands where this system works great. We shouldn't optimize the entire system for hundreds of millions of people for these edge cases.

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

#374

Post by learc83 » Wed, Sep 22, 2021, 8:55 PM UTC

danShumway wrote: post #354

sarchertech wrote: post #329

Earlier quoted context omitted.

>But I would also point out that under Capitalism, signing a contract usually involves the terms of that contract being made upfront. There's nothing inherent to Capitalism that prevents variable priced contracts. >Pretty much every other industry in America has figured out how to put a price tag on the products they sell, Maybe for mass produced products they have, but certainly not for custom work. You aren't payin…

> There's nothing inherent to Capitalism that prevents variable priced contracts. Definitely not the norm though, and it is inherent to Capitalism that price transparency is an important part of creating an efficient market. But sure, it's not a rule . A lot of common things in Capitalism aren't rules, but they're still often signals of a healthy market. > You won't even get an upfront price for something as simple r…

>Definitely not the norm though

It most certainly is the norm when purchasing complex custom services.

>A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process.

If a surgeon could keep your chest open on an operating table while they walked you through the process this analogy would work.

>a good explanation of why pricing a surgery or an entire hospital visit may be difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable".

jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront.

As for the price os a single x-ray. I'm sure the average cost of a single x-ray could be calculated. But how much is that worth when the entirety of the hospital visit is going to be a variable cost? If you're only interested in a single x-ray, there are already outpatient imaging clinics that will give you the upfront cost.

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

#375

Post by 93po » Wed, Sep 22, 2021, 8:56 PM UTC

mardifoufs wrote: post #366

SavantIdiot wrote: post #192

Earlier quoted context omitted.

You mean Bill Clinton in the early 90's? It was part of the Clinton health care reform. But maybe you're not that old. ;-) Every president has pushed for this except Bush Jr. Glad it finally happened even if it was under who I consider to be the worst president* in the last 100 years of US history. Doesn't mean I need to thank him. If you were being tortured in a Mexican cartel prison, would you thank the torturer fo…

Thinking that trump is the worst president in the past 100 years just betrays either an insane privilege[1] or just ignorance. You realize the hundreds of thousands of lives lost directly or indirectly in the war on terror, a war almost completely engineered by the Bush administration, are actually real right? They were people with hopes, plans, dreams that were all wiped out, and for a lot of those who are still ali…

I also really hate how much people ignore the actions of other presidents and hyper focus on one mainly because of the massive amount of consent manufacturing by mainstream media. Hundreds of thousands of people are dead as a result of other presidents, and a lot of those were women and children.

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

#376

Post by sarchertech » Wed, Sep 22, 2021, 9:01 PM UTC

nybble41 wrote: post #359

fragmede wrote: post #233

Earlier quoted context omitted.

Under capitalism, a thing's cost to manufacture has nothing to do with the price of that something. Read that again and work through your objections. Ideally something's price is higher than its cost so the company can make a profit, but there are so many obvious exceptions that its nice, but not necessary. Thus, who cares how much the pill coming down line costs to manufacture, unless you start hacking into the free…

Under capitalism, with that kind of price difference, someone else would move in and start manufacturing the same drug and selling it for less to gain market share. That's competition for you. Or if no one else wants to do the job you could just make it yourself. Cost and price are indeed two different things, but competition keeps the prices of goods down to a relatively low multiple of their manufacturing cost. Unf…

>Unfortunately what we actually have, between patents and other monopolies the government has instituted on drug manufacturing and distribution, is nothing like capitalism.

You could replace patents with trade secrets and have many of the same problems (along with some others).

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

#377

Post by OrvalWintermute » Wed, Sep 22, 2021, 9:01 PM UTC

nradov wrote: post #326

OrvalWintermute wrote: post #175

Earlier quoted context omitted.

> There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (and reimburses providers more poorly than Medicare). Or even Tricare. We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care, but so that various classes of people can get healthcare proportional to their political power (which usually sca…

Medicare reimbursement levels are sufficient to support most medical practices. They charge more because they can, not because they have to. If reimbursement levels are cut then they'll find ways to improve efficiency, and then cut salaries. Is there a reason that US doctors should get paid significantly more than their peers in other developed countries? https://www.medscape.com/slideshow/2019-international-compen..…

> Medicare reimbursement levels are sufficient to support most medical practices.

Big Nope.

Most practices have fairly fixed costs:

Medical malpractice

Facilities rent, or mortgage

Front office

IT & EMR

Privileging/Credentialing

Practice

CME/required education

The only highly variable cost is physician compensation, and considering the limited availability, this will merely cause the retirements and limited access to specialists.

Perhaps you have some evidence to support your extraordinary claim?

I'll provide evidence to the contrary, based on Hospitals and practices refusing to accepting Medicaid [1] patients, or, not accepting/limiting medicare patients[2], [3], [4]

The simple fact is, there is a limited supply of physicians, and many of them don't want to practice the higher volume, 5 minutes per patient, 5 minutes for notes x 12 hours a day type of practice. Not only is the higher volume more dangerous for the patient, it is also more risky for the medical provider, both in terms of quality of life, and also, the risk of an error, or inadequate information exchange.

[1] https://www.reliasmedia.com/articles/147019-when-hospitals-r...

[2] https://www.investopedia.com/articles/personal-finance/10021...

[3] https://www.verywellhealth.com/doctors-accept-medicare-insur...

[4] https://www.hlc.org/news/more-physicians-no-longer-seeing-me...

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

#378

Post by r00fus » Wed, Sep 22, 2021, 9:02 PM UTC

codegeek wrote: post #199

r00fus wrote: post #128

Earlier quoted context omitted.

Did you have a HDHP (high deductible plan)? In that case, you have no co-pay or anything until your deductible is used up. Employers typically contribute a good amount towards this deductible (or even more than) using an HSA. It's still crazy that the bills were so completely divergent.

That's not the point. Your explanation is exactly what the issue is. Why is cash price cheaper than insurance price ? And in that case, why do we even need insurance for most of these visits.

Make no mistake, I think the entire health insurance industry is a meat grinder for profits and we should move to single-payer like most other affluent countries.

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

#379

Post by EamonnMR » Wed, Sep 22, 2021, 9:04 PM UTC

jonathan-adly wrote: post #317

mchusma wrote: post #190

Earlier quoted context omitted.

I think if your point is "the system is broken today", basically everyone agrees with you. If your point is "it is not possible to have transparent pricing", that seems also insane. IMO we should pass a law that says if you can't give people transparent upfront pricing, you can't bill them at all. The idea that you can "figure out a price later" seems absurd.

It is not possible to have transparent pricing in the current broken system. It's like trying to put a bandaid on an arm that met a chainsaw. Not really a good first step and a waste of time. The solution is to go to the OR, and give him a new arm. The more bandaids and time you waste, the worse it is.

By demanding transparent pricing (and other aggressive policy, like say not being able to bill patients without them seeing a price and agreeing) might we force the system to replace itself? Because these companies are very good at complying with regulations, but the regulations allow them to use faces to communicate because most of the regulations are designed to keep most of the system compliant.

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

#380

Post by opo » Wed, Sep 22, 2021, 9:04 PM UTC

peterangular wrote: post #268

opo wrote: post #246

Earlier quoted context omitted.

>...the very nature of profit/capitalistic societies means someone has to lose The last time you bought milk did you lose or did the grocery store? The last time you paid money for a hair cut, who lost there? The extreme regulation of all aspects of health care that has developed over the last century has improved some problems and created other problems - the problems specific to healthcare have little to do with th…

> The last time you bought milk did you lose or did the grocery store? There's way more people involved in that supply chain then me and the store. This is an over simplification. Outside of the obvious answer of "the cows" - factory farming has been destroying my home state causing huge problems in rural America. Also - the environment. Big time the loser there is the environment for literally any bovine farming. >…

>Big time the loser there is the environment for literally any bovine farming.

Factory farming probably does cause externalities that aren't addressed. People could choose to buy from grocers who only source from smaller farms but there isn't as much interest in that due to price sensitivity.

>...and since you can't support yourself on minimum wage I see that as her losing.

Even in the case where you didn't tip, she likely would have preferred having the work than there not being a job available at that location.