15 ms·

Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

• wdn 6y ago
  Only in US that we don’t know the price of the health service we are redeeming. When I go get my car fix and I would go around to get an estimate for multiple body shop even if it is under insurance. But when it come to health care, you ask them for a cash price, they said they don’t know.
  • darkwizard42 6y ago
    They will outright REFUSE to give you a quote...forget out-of-network, even IN network?! This is so astonishing cause you would assume they have NEGOTIATED the rate given its in network so there is little variability in what can be charged by the doctor and what can be thrust upon the customer. ex. if you charge $100K more than other in-network doctors, good luck, cause the insurance company is only paying the doctor $5,000 no matter what and the customer will be on the hook for X% of that (outside of deductible and other math required to quote a price)...
    • maxerickson 6y ago
      They bill based on the procedures done and might not have that information until after the fact. I'm not saying it's a good way to do things. Opening a price list, it looks like one hospital charges ~$5000 for a knee replacement without major complications, and then the matching price for one with complications is $30000. So how do they quote that when the complications can be unpredictable? Which of course just says that maybe people shouldn't be put in the situation of trying to figure it out for themselves.
      • koolba 6y ago
        > So how do they quote that when the complications can be unpredictable? Then they should be ones buying “price insurance” to compensate them potentially exceeding the quoted costs. That also has the pleasant effect of aligning incentives so they can keep their costs accurate.
      • toast0 6y ago
        > They bill based on the procedures done and might not have that information until after the fact. Quote a menu then. Something like: If everything goes well, we'll do X, Y, and Z; which will cost $5million, plus an extra $200,000 for the Oxford comma. Some potential complications are this and that and they cost even more, etc. All surgeries are risky, and you could require life saving interventions which will cost a stagering amount, and we won't be able to ask for consent. The patient could say; well wait, I don't actually want an Oxford comma, please leave that out; and they could put that on the chart, and if it's added, it doesn't get billed.
      • civilized 6y ago
        I don't buy that, because of the unpredictability of the worst case, we can't ever be told how much anything costs, no matter how routine.
        • Spivak 6y ago
          Because people will be mad if their bill is significantly north of what they were quoted. And also because providers have genuinely zero idea what insurance will pay for and insurance has zero idea what a provider is going to bill for. You can get basically exact costs for specific codes but good luck assuming they’ll bill it that way.
      • prepend 6y ago
        There are many industries that have this issue and deal with it in different ways. I used to do consulting and fixed price estimates were common. Even when requirements were unclear. The way I mitigated this was with multiple clients. Hospitals have lots of customers. They don’t have to perfectly estimate everything, they just have to be good on average. Here’s a podcast from Econtalk with Dr Kieth Smith from Surgery Center of Oklahoma [0] where he explains how his hospital does it. Basically he estimate the cost for an average procedure and charge that, they are good at estimating and adjust each year. Sometimes extra stuff happens, sometimes less stuff happens. If the shit hits the fan during the procedure they have that rare event factored in. It’s such an odd argument because they certainly could if they had to. But they don’t, so they don’t. [0] http://www.econtalk.org/keith-smith-on-free-market-health-care/ http://www.econtalk.org/keith-smith-on-free-market-health-ca...
        • maxerickson 6y ago
          Right, they bill on what Medicare/insurers (apparently) want, and then are unable to quote cash because of that. Not sure why describing what they do is being treated as a defense of it.
      • bcrosby95 6y ago
        Our local hospital tried to quote us for a routine fertility related procedure because we thought insurance wouldn't cover it. It took several hours on the phone before they figured it out. Day of the procedure they told us they forgot to factor something in and they gave us the wrong price. They said it was fine though because insurance would actually cover it. But they were wrong on that account too. In comparison, the actual fertility clinic we went to was upfront and told us the price of everything ahead of time. Everytime I've had to deal with a hospital the billing experience has been a nightmare. Fuck hospitals.
      • PeterisP 6y ago
        Giving out quotes and sticking to them is obviously not an unsolvable problem since the private health industry in so many other countries manages to do that.
      • darkwizard42 6y ago
        Yeah but I didn't ask for a FULL quote. I simply gave them X Y Z procedural codes and then asked what the responsibility to me would be. I also know what the doctor was going to bill and I want to know how much I would be stuck with. Even a car mechanic gives you a detailed quote of what he EXPECTS and then you sign off knowing there is a caveat that more work could be needed.
    • PragmaticPulp 6y ago
      They have to reveal their prices now. It's part of a bill that the Trump administration passed in 2019: https://www.cnbc.com/2019/11/15/trump-releases-rule-requiring-hospitals-and-insurers-to-disclose-negotiated-rates.html https://www.cnbc.com/2019/11/15/trump-releases-rule-requirin... From the article: > As of Jan. 1, hospitals must publicly reveal the negotiated rates reached with insurers for services, a landmark shift in the sector notoriously opaque when it comes to pricing. The data offer a peek behind the curtain, exposing prices long kept a secret. The catch is that they can't guarantee what services you'll receive. If you have complications after your inpatient surgery, the price is going to be higher than the estimate due to additional services.
      • gzer0 6y ago
        The Affordable Care Act laid the framework to allow for this to happen, under the “Sunshine Provisions” [1] https://www.commonwealthfund.org/blog/2014/affordable-care-acts-disclosure-rules-can-they-improve-coverage-raise-care-quality-and https://www.commonwealthfund.org/blog/2014/affordable-care-a...
        • OgAstorga 6y ago
          Please don’t make this political.
          • caslon 6y ago
            How is that political? I found it interesting to see the (long) process to get where we are.
        • spaetzleesser 6y ago
          The Affordable Care Act had some good intentions but they had no courage to make the hard decisions.Trump was terrible for health care in many ways but forcing hospitals to open up their pricing was a very good thing. I am just a little afraid that they will find other ways to obscure things quickly.
        • refurb 6y ago
    • emkoemko 6y ago
      how is that legal? you are telling me you won't know how much sometime costs until you have to pay for the service? is that not illegal? reminds me of Chinese scam of foreigners where women lure men to restaurants on the take and give you a massive bill at the end telling you it does cost that much but since you can't read Chinese its your fault.
      • darkwizard42 6y ago
        I don't know why it is legal but that is entirely how it works. They can't quote you an exact price on any procedure. They always hem and haw about something could change, negotiated rates vary, all sorts of BS even when you have specified the doctor, the procedure codes, the hospital, the jurisdiction and basically removed nearly every variable from the equation.
  • mindslight 6y ago
    I feel like 80% of the healthcare logjam would be fixed if providers were required to 1. charge uniform prices for all payers and 2. present patients with written estimates based on said price schedule ahead of any non-emergency services, thus forming an actual contract. Note that mechanics don't particularly know what they're going to have to do to any given car before they really get into working on it. Yet the market functions perfectly fine with estimates, agreements on hourly rates, phone calls for decisions on surprise situations, etc.
    • dumpsterdiver 6y ago
      I'm not disagreeing at all (I'm not familiar enough with the system to disagree), just curious about your reasoning on uniform pricing for all payers? The reason I'm curious is because using your car analogy, if I was a barely competent mechanic then management would probably be fine letting me perform oil changes, but when a classic Rolls Royce comes in with all original parts, management isn't going to let me touch that, right? They'll need to call in the big guns, whose rates are definitely higher than my "oil change" rate. I know that doesn't directly map with how medical procedures play out. I guess my real question is when and how does that balance out?
      • mindslight 6y ago
        The reasoning is to make pricing transparent and grokkable as in every other industry, end the severity of this in-network out-network divide, and eliminate this ridiculous dance based around providers sending fraudulent bills to patients. In the car analogy, there are natural differentiators between levels of service, namely completely different shops that Rolls Royce owners go to. Even so, the same shop could have a price list specifically for Rolls Royces, using Rolls Royce certified mechanics. And the residual where a shop is willing to pay for damage caused by barely competent mechanics on less expensive cars, but only becomes concerned when that liability grows? It seems like that should fall on the business.
  • BeetleB 6y ago
    > But when it come to health care, you ask them for a cash price, they said they don’t know. As with everything, "it depends". You often can get an idea from your insurance company, who will often provide you with what's called the "usual and customary" rates for a given procedure (in-network). Depending on the procedure, though, it may be hard to pin down. The procedure you want may actually consist of 3 things, and you need to look at all 3 up. Also, if you call some private practices, and if it's a standard procedure (ultrasound, etc), you will often get a quote if you tell them you'll pay cash without involving insurance (some people ask for the "uninsured rate"). Often that will be less than the insurance negotiated rate. The down side is that whatever you pay will not count towards your deductible.
  • hoka-one-one 6y ago
    According to the law they have to provide a price list, you're probably just asking for the wrong thing. No one's going to go through the price list and translate what you're looking for into medical jargon. My experience has been that you can usually find a list of direct-to-consumer prices online.
  • Spooky23 6y ago
    Only in the US among developing countries do you care. My experience getting a COVID vaccination was eye opening. I walked into a large facility, provided ID, was asked screening questions, consulted with a provider about a medical issue and got the shot. I work for an employer with a legacy PPO. I suffered a back injury, had a major surgery and 8 weeks of physical rehab. My out of pocket was a few hundred bucks. I didn’t lose a days pay because of sick leave at half pay and short term disability insurance. The people I was in rehab with were losing jobs, selling cars, facing complete ruin. The lack of ethical standards and focus on profit over the general welfare of the people is gross.
• 1cvmask 6y ago
  In other countries you can see prices before making a decision. Funny that this a (sticker) shocker to us still today.
  • markdown 6y ago
    In many countries you don't see prices when you go to the hospital because there aren't any. Also, in most countries when you go to the supermarket, you see prices on everything that are the prices you'll be paying at checkout. The United States is truly a paradise for the profiteering capitalist. Citizens will bend over and let you blindfold them before transacting.
    • accounted 6y ago
      In many countries, the concept of the hospital is also different from what it is in the US. Where in the US there are clinics, ERs, urgent cares, and specialty practices, elsewhere there's just hospitals and you can go for any kind of treatment big or small.
      • markdown 6y ago
        Nah, there are clinics and specialty practices even in the smallest third world countries. ER/Urgent care is the same whether it has its own physical building or is a department in a hospital. None of this has any impact on pricing.
      • ipaddr 6y ago
        Usually for urgent care you go to a hospital if it is not urgent you go to your doctor or walkin clinic.
      • C19is20 6y ago
        European here: we have all of those.
  • PragmaticPulp 6y ago
    That's what this article is about. The prices must be revealed now: > As of Jan. 1, hospitals must publicly reveal the negotiated rates reached with insurers for services, a landmark shift in the sector notoriously opaque when it comes to pricing. The data offer a peek behind the curtain, exposing prices long kept a secret.
• bootlooped 6y ago
  I was once told by a pharmacy tech that they couldn't tell me the price of a vaccine until after I got it.
  • koolba 6y ago
    Which pharmacy? In my experience with all the majors they have standard price sheets for vaccines.
    • bootlooped 6y ago
      This was maybe 8-10 years ago, but I think it was a Kroger.
  • JoshGlazebrook 6y ago
    "And I can't determine if I can pay you until after I know the cost"
    • bootlooped 6y ago
      Or "I will reveal the price that I pay you for the shot only after you give me the shot"
  • tzs 6y ago
    When I take a prescription from my Kaiser doctor, covered by my Kaiser insurance, to the Kaiser pharmacy, and ask them how much it will cost they cannot tell me. This is completely ridiculous.
• supernova87a 6y ago
  Isn't one of the problems that the price of the total procedures are so different from the component parts / equipment / time, because different providers (and insurers) lump in different categories of cost with different methodologies of billing for overhead items? Or allow different costs to come in? Such that even if you tried to comparison shop across 2 hospitals, you can't really tell whether that is the "all in" cost of what you want to understand? Or is it that even for the same exact procedure, two patients might be billed differently because of what insurance each allows in particular? Or is it even further, price discrimination? Or because the hospital has agreements with the insurer for other costs to be billed for on the side, complicating the issue?
  • lupire 6y ago
    Yes to all of this. That's the problem.
  • benmaraschino 6y ago
    Yes, this is a part of the problem. This is also why it’s hard to interpret the results of studies like this. Without knowing more about the methodology, it’s possible that a lot of the apparent variation in cost arises from different ways of paying for the same thing. Take a joint replacement surgery—the surgery itself will generate claims for both the surgeon and the hospital, and maybe also the anesthesiologist. Each of those claims could be counted as a bill. But there’s also the initial clinic visit before the surgery as well as the aftercare and rehab, which also generate their own bills. What’s more, some payment models bundle all of those costs into one bill for the entire episode of care. (See how there’s no range listed for the procedures performed at Kaiser?) The problem arises when you try try to compare those individual claims to the episode of care bills. You can’t, because they’re basically apples and oranges. But if you’re not aware, that can make it seem like there’s more variation than there really is. Don’t get me wrong, though, there is way too much variation in what we pay for health care, but it’s important we measure it precisely.
• axlee 6y ago
  I thought "free markets" where supposed to facilitate fair value discovery?
  • elevenoh 6y ago
    Look at Canada, we're spending tax $ on health care per capita each year, yet wait times & outcome success has plateued. This is about more than 'free markets', it's arguably more about regulatory capture by the major entities in health care. The health care industry is hand in hand with education as top of the 'scam index' industries. Yet criticism of health care is relatively 'off limits', and there's low competitive incentive to correct/draw attention to this. 'e.g. you're evil for wanting more efficient health care: why? doctors/nurses are already overworked & efficiency will mean jobs cuts of those at the lowest rung'
  • prostoalex 6y ago
    It does for less regulated markets, which is why you get those promotional mailers with promotional prices on LASIC or teeth whitening. Medical lobby benefits from high barriers to entry, suppressed competition (from foreign doctors or medical tourism companies able to fly their customers abroad) and opaque pricing. Uninformed consumer forced to shop locally is rarely able to extract best pricing. You can look at the annual fear-mongering fairs where medical lobby has been attempting to insert itself as a rent-seeker into kidney dialysis services in California. It's not like those industries are run by altruists, but on TV concerned serious faces in white coats would tell you in alarmist tones how those centers are run without professional supervision and people with no medical training, but when you vote properly, some [highly paid] individual with medical credentials would make things so much better [albeit more expensive in the long run].
    • techrat 6y ago
      Funny how it's only when regulation is involved that it begins to pull back the curtain.
      • maerF0x0 6y ago
• avgDev 6y ago
  The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick. We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone. I had a surgery, called insurance and verified it was pre-approved and in-network. After procedure I receive $22k bill. I was young and did not care about my credit back then and never paid. 5 years later I received a new bill, for $300 as the provider sued the insurance company. I hate going to the hospital and AWAITING a shower of bills. This grinds my gears SO hard. Every hospital stay and bills just keep coming for a few months. As someone who likes to budget and plant expenses, I just cannot stand the US medical system. I never know how much a simple wart removal my cost. $100 or $2000? I'm happy to have good insurance, don't require to use the medical system a lot and have enough money. However, if you are extremely ill you seriously need to move to a "FIRST" world nation or have a good insurance with low max out of pocket. However, you still are going to deal with bills like its your full time job.
  • kshacker 6y ago
    It is not a 'broken mess'. It is an 'engineered mess'. The difference is in intent.
    • danaris 6y ago
      Framing it this way is probably inaccurate, and if inaccurate, unhelpful. From decades of observing the system, it seems extremely unlikely to me that it was deliberately engineered to be this way. Rather, different parts of it grew and changed organically and the parts and changes that benefitted moneyed interests in power stayed, while those that did not were discarded. It does not take a deliberate will behind something for it to be pulled toward this sort of inequality, and presenting it as if that's what's happened suggests that if we could only defeat the Evil People who "engineered" it this way, we could make it better. It's a very compelling idea, and it makes for a nice dramatic narrative, and humans love good stories. Unfortunately, it's not the case. In order to make it better, we need to take a good, comprehensive look at many aspects of our systems of economics and government, and redesign them deliberately and with a strong intention to inhibit the flow of money upward from the 99% to the 1%. It's hard, it will take a long time, the people with the most wealth and power will fight us every step of the way, and there's no silver bullet, but there's also very little that's more worth doing.
• davidw 6y ago
  When I lived in Italy, I once went with private care for a thing I wanted taken care of same day. I called, and they told me all the prices. I think I paid something like 120 euros out of pocket for a chest X-ray and consultation with an ENT specialist. The US health care system is so screwed up.
  • iagovar 6y ago
    It's like that in Spain too. If it's complicated you get an appointment, and an estimate afterwards.
  • ArtDev 6y ago
    In Thailand, the hospital lobby has printed brochures with all the prices. It reads like a menu. I can't wait to return there and be a medical tourist again! The facilities and level of care was superior to my local dive of a hospital that is chronically understaffed. The hospital president make $980k while currently the nurses are on strike.
    • 1996 6y ago
      The US healthcare quality is bad, regardless of how much you pay, period. For knee problems, like you I went to SE Asia as a medical tourist. I was provided with a taxi waiting for me at the airport, a translator who stayed with me at all times, a dedicated hospital administrative assistant for more complex issues like obtaining a copy of my exams, having them send to the doctor of my choice, obtaining the CV of the doctors so I could decide on the best one etc. But the best was the fine dining options, as I do not like hospital food. And when I was tired of the hospital and decided an hotel would be better for my mood, the doctor I had selected visited me in my suite, every day - with a nurse. If I wanted anything, I still had the translator the rest of the time. It's not even a question of costs - that quality of service is just not available in the US, except maybe outside of some VIP setting where it may be shiny but the healthcare is mediocre (friends strongly recommended against such options) Years later, I no longer have to care about costs, but I still won't go to a US hospital.
      • 6y ago
• AndrewKemendo 6y ago
  Has anyone aggregated hospital cost data yet or is it something that is only there if you ask for it? Are there hospital APIs for this? Not that they are mutually exclusive, just that I wouldn't imagine a pricing service exists yet if it's just manually gotten.
  • mklauber1 6y ago
    Take a look at this: https://www.dolthub.com/repositories/dolthub/hospital-price-transparency https://www.dolthub.com/repositories/dolthub/hospital-price-... It's not a nice interface, but it's raw pricing data for 1400 hospitals.
    • AndrewKemendo 6y ago
      Awesome thanks!
• BeetleB 6y ago
  A cautionary note: Don't assume that the low price is "what it really costs". It often happens that hospitals lose money on negotiated rates with some insurance companies, and have to find other ways to recover that money (e.g. high prices for other procedures). So the lower rate in the Chicago hospital of $4613? Quite possible the hospital is losing money when they bill that rate.
• zuhayeer 6y ago
  Always thought it'd be cool to have a levels.fyi for different operational costs across various hospitals (obviously insurance and different coverage makes it a bit complicated and tricky but would still bring a lot of transparency across the board)
• cm2012 6y ago
  I've been ignoring surprise medical bills for 10 years, at least $10k worth altogether. None have reported to credit bureaus yet so I will continue to ignore letters.
  • agumonkey 6y ago
    I had a funny interaction with accounting, not for medical services but import. I got billed extra taxes like 100$ (for a 80$ item), even though the seller said price included import fees to my country, so I bounced complaint emails all around to say no. After a while they stopped responding. Then 6 months later, lawyer official letter comes in. Threats of legal action.. I do the same email bouncing to them. After a while I suggested I paid 20$, the guy handling my case asked me to confirm that, a week later they sent me a new bill with 100$ fees and 80$ rebate. There's no ground in their actions, at any point some dude can edit the documents and consider the issue resolved.
• rscho 6y ago
  People here comparing medicine with car mechanics don't have the slightest idea of what they're talking about. The US system is in the hands of the administrators. Not docs, not even the govt: administrators, usually belonging to a behemoth (private) company that has immense and intrinsic lobbying power due to the nature of the industry. There can be no shortage of buyers. Well, admins wanting to earn more just have one thing to do: reproduce by complexifying the system. Private healthcare is a garbage fire.
  • tdeck 6y ago
    That's not entirely true; doctors have massive political and financial power. The AMA is run by doctors and has consistently lobbied against government funded healthcare for more than a century. They killed FDR's and Truman's proposals and lobbied hard against Medicare and Medicaid in the 1970s.
    • rscho 6y ago
      Docs have power over their own turf (losing ground to admin every day that passes). They incidentally absolutely do not have power over the billing scheme in it's entirety, especially since healthcare juggernauts like Kaiser have appeared. Today, docs are really a small part of the problem but people stay fixated on them both because of envy and because docs are used as strawmen by big healthcare, whose stakeholders have every reason to reduce docs into slavery. Docs use the AMA to avoid being converted into Amazon warehouse workers? Big surprise.
  • refurb 6y ago
    No, it’s not private healthcare that’s the issue, it’s the absurd layer of regulations that were developed over the past 70+ years. Typically some inefficiency was addressed with regulation that just created a new inefficiency. To give you a good example - 340b is a govt regulation that requires drug manufacturers to give a 23% discount off drugs to hospitals that treat a lot of low income patients. Great idea right? Well, that just incentivized hospitals to buy up standalone oncology clinics, fold them into the hospital and then capture that sweet 23% margin on drugs without actually using it to help low income patients. As a result there are almost no community oncologists now, they almost all work for hospitals and good luck starting your own clinic now. Good intentions that just made the problem worse.
• narrator 6y ago
  Kaiser is the only non-broken part of the U.S healthcare system. They have never sent me a bill for a surprise out of network anything. Out of network doctors don't work there. All doctors are on salary. You get one bill from one company. No wonder they have been growing like crazy in California.
  • CGamesPlay 6y ago
    They have sent me a bill for non-preventive services which should have been billed as preventive (aka free), but to their credit I was able to get them to refill with a not-too-tedious phone call.
  • dilyevsky 6y ago
    Kaiser is amazing. Other than no surprise bills that you mentioned they also have your full history that is accessible to all doctors and to you. Also no scammy $200 new patient copays etc
  • throw123123123 6y ago
    Kaiser is popular and 'a' model of care, but do note that it is extremely limited in coverage and is one of the most draconian in respect to providers. They hire people right out of medschool with the offer to pay their entire student debt if they stay with them for 8 years. They have massive burn out.
    • wbl 6y ago
      Kaiser promptly volunteered to perform several minor surgeries I would have spent months hunting down preauthorization for other places. It was almost scary how efficiently they bumped me up to the right person with me having to do almost nothing to arrange it.
    • disabled 6y ago
      Yeah, if you have a rare disease, which 7-8% of the general population collectively has (there are about 8,000 or so rare diseases), for example, then you are totally screwed if you have an HMO. Rare diseases are difficult to treat, frequently involve multiple systems of the body, often require many off-label non-FDA approved treatments, and require specialists that are often in niche fields of medicine.
• benlivengood 6y ago
  Healthcare is such an asymmetric market that there will never be enough information for patients to price things accurately. It's like if every road we drove on had a different toll every time we travelled on it, and we didn't quite know what the total would be (or what construction projects you might encounter along the way) at the end. It's made worse by the high value people put on their health and their low knowledge of healthcare in general. I worked in a hospital for 13 years, most of it on the billing and medical records systems. There was a single project I recall that tried to do price estimation for patients up front. It worked best for lab draws because a fixed number of vials were drawn for a finite number of predetermined tests. Anything beyond that involved human judgement at the time of service: A doctor decides which X-ray views they want taken after seeing an injury, and may need to order more after the first results, and the radiology tech has some leeway in how they actually perform the imaging. A choice between X-ray, CT-scan, and MRI is pretty much an order of magnitude difference in costs between each, and determining whether an injury is bone, soft tissue, organs, etc. may require any or all of them. Surgery is wildly unpriceable. The number of shots of anesthesia will differ for weight, metabolism, actual length of a procedure, and individual reactiveness to the medication, and the anesthesiologist may need additional medications to stabilize a patient's vitals. Each surgeon is making similar decisions as they go along; all of it has a cost and some tools/medicines are pretty expensive but no good surgeon will have price in mind during surgery; they'll use the best available method. The article wants to blame insurance companies for price variation but that's a bit of a red herring. Every clinic and hospital does different numbers of various procedures and has different patient demographics so outcomes and severity will vary. ERs and cancer treatment are notorious cost-centers, whereas radiology services and outpatient procedures are the money makers. Hospitals and clinics have no choice but to pick and choose a set of services each year to raise or drop the prices for even before negotiating with insurance companies on actual reimbursement. Medicare and Medicaid also reimburse at (even lower) fixed rates so hospitals are always balancing costs for the number of commercially insured patients against government insured patients. Hospitals can't refuse emergency service to anyone, so they're also forced to eat the costs if they don't play the pricing game to cover ER and subsequent treatment costs. The whole thing is a terrible mess and socialized healthcare is the solution.
  • 6y ago
• datavirtue 6y ago
  This was a key thing that needed to happen for a long time. Insurance companies had no bargaining power with hospitals and price opacity helped secure that leverage for the hospitals. This is the only sensible thing I can recall to emerge from the Trump administration and it is a much bigger deal than most people realize.
  • datavirtue 6y ago
    I mentioned that Trump accidentally did something good and got downvoted to zero. Same comment without Trump mention gets up-voted. Interesting and disturbing.
    • datavirtue 6y ago
      Happened again. What a lovely community.
• torgian 6y ago
  Meanwhile in developing countries, health care is hassle-free and low cost. I spent 24usd for an invasive procedure and meds in Taiwan. I’m honestly happy I left the States years ago because I’d probably be in debt at this point.
  • kelnos 6y ago
    Taiwan isn't a developing country.
    • yhoneycomb 6y ago
      Yea wtf lol Honestly, by many measures Taiwan is more advanced than the US.
• swayvil 6y ago
  There is only one local dentist that will take my broke person's insurance. And they are notorious for messing up people's teeth. And I think I have a cavity. Dang.
• primitivesuave 6y ago
  I'm the technical cofounder of a mid-sized healthcare startup, and when I start explaining hospital administration to people, I start with this - every person working in your hospital or clinic has no incentive whatsoever for you to emerge healthier. The only goal is to maximize the ratio between the amount your insurance is willing to pay, and the amount of care that is provided. In the case of joint replacement, each insurance provider has negotiated a fixed block payment for all costs related to the surgery. If the surgeon makes a mistake, or the patient doesn't follow along with physical therapy, or something goes wrong for whatever reason, the care provider is financially responsible for any corrective actions on the procedure. This means any complaint in a follow-up visit is usually met with some kind of platitude to make you go away, like "here is a prescription for some pain medication, let us know if the problem persists". There is no incentive to do any scans or tests, since this would eat into the profits that the hospital has made on this patient. For certain GI surgeries, patients are instructed not to eat solid food for a week or two after surgery. A certain percentage of people ignore these instructions and end up in the hospital ER requiring another surgery. In the last couple years, providers of these treatments have learned how to bring that percentage down by hammering post-op patients with daily email/SMS messages to ensure they are educated about their procedure. These systems were not put in place by someone at the hospital who wanted patients to be better informed, they were put in place because someone noticed that percentage and calculated how much money the hospital could be saving for each percentage point in reduced readmission. I have heard good arguments against Medicare-for-all, but I have never heard any logical argument to defend the status quo.
  • Spooky23 6y ago
    In helping with a family member struggling with a very serious medical condition, the only incentive I’ve been work is the stick. The Medicare incentives to kick patients out of rehab is very effective, to the point that it’s a cruel game for families operating under the mistaken assumption that healing is a goal. In the hospital, the only urgency outside of acute/intensive care that I saw was when my family member was readmitted due to incompetence on the part of the hospital, and ended up costing them thousands of unremimbursed dollars.
  • RIDDLERTHIS 6y ago
• williesleg 6y ago
  Thank you donald trump!
• bane 6y ago
  The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems. If one were to sit down and try to create the most absurd approach to healthcare that guaranteed high cost and poor outcomes you couldn't come up with the idiocy that our system has become. It's completely untenable, a failure at every single level from medical school to funeral services. The fact that there are so many smart people working in healthcare defies belief in the absolute fucking disaster it is. Even in the interaction between health providers and insurance companies, the billing practices have moved so far beyond fraud and are so widespread that nobody can even comprehend or describe how fucking broken just that one part of it is. Without getting into details, the healthcare industry is absolutely mortified of a law that requires them to provide patients expected costs before care and to publicize those cost for comparison. I can't believe that some startup hasn't glassdoored billing practices yet by patients simply uploading screenshots of their bills when they get them. note we just went through a bizarre medical experience where surgery was billed out at a total of something like $70k, the "negotiated" price was more like $7k, and we payed out of pocket something like $700. At one point the insurance company turned down the bill from the surgeon, who promptly simply submitted a bill from a "surgical assistant" who we never met or knew existed for the exact same dollar amount which was also denied, and then resubmitted the original bill which was approved and promptly "negotiated" to 10% of the original bill amount in the end. In the meanwhile we had absolutely no idea if we owed $30k for this bill, $30, $300, or $300k. No idea at all. It beggars belief that congress, who is mostly made up of people who are obviously experiencing their own medical journeys, can't put together some easily bipartisan approaches to price visibility.
  • zie 6y ago
    Senators and congresspeople get their own very high quality insurance. They have no incentive to fix it, their own health care is world-class.
    • bane 6y ago
      That's too easy an answer. They get basically the same options for health insurance as other federal employees. And that insurance is not materially different from the insurance you'd get from any other major employer.
• deleted 6y ago
  [deleted]
• QuantumGood 6y ago
  I had to check myself out against doctor's wishes after a serious heart incident. They kept sending doctor after doctor in to "consult"—each one adding a huge fee to the final bill. The hospital's "billing assistant" was NEVER available, after days. I became informed on additional tests they considered doing, and eventually arranged for related tests outside the hospital to determine if the tests they were going to do were necessary. They were not. Bill was just under $60,000, ~$8,000 deductible, paid the deducible in one lump sum and negotiated a 25% discount. A partner at a medical firm told me they are only paid 75%, so it made sense to him that I could negotiate a 25% discount.
• BadassFractal 6y ago
  Another example of how bananas the system is: when I go to order prescription refills through my health care provider, it is currently unable to tell me how much it's going to cost me. You're expected to say "Ok, charge me whatever these cost" and then, I suppose, call customer support if you don't agree with the price you were charged that day. I don't know if there's some kind of a "price of the day" marketplace calculation that needs to happen for the provider to find out the current prices, but that's pretty odd. It's like buying stocks or a Dungeness crab dish at a restaurant.
• mattmcknight 6y ago
  A simple change- providers offering the same transparent price to all patients would make things so much simpler. (and by this I mean different providers could charge different prices, but one provider can't charge different patients different prices.) It removes the whole in-network/out-network scam. It removes the whole process of negotiating prices with insurers. Transparent pricing is the baby step in this direction that reveals the problem. The hope was that it would at least provide negotiating power for payers when they see what the other payers are getting. Let's just take the next step and make them commit to pricing ahead of time.
• alexanderdou 6y ago
  I work in the space (specifically, on the Payer/Health Insurance Co side) and this is my current bugaboo From best I can gather, there are a handful of High-Level issues. But for the sake of brevity, I'll highlight what I think is the biggest: The data requisite to make a confident estimate lives in many different parties' databases. To make an estimate, you would need: (1) Full List of Procedures and Services to be done (keywords here: CPT and ICD codes); (2) Contracted Rates between Payer and Provider; (3) Patient's Deductible, OOP Max, and Plan Benefits; (4) List of which services require Pre-auth (1) lives with the Provider (3) and (4) live with the Payer (2) lives in between, but is also a huge problem because it's a many-to-many sort of relationship (many Payers have many contracts (e.g. annually re-negotiated contracts) with many Providers)