4 ms·

It is not possible in the current setup, yes. But if there was no insurance company to deal with for little things like X-Ray, that's the question. Why is trans

It is not possible in the current setup, yes. But if there was no insurance company to deal with for little things like X-Ray, that's the question. Why is transparent pricing so difficult for a hospital management to come up with if they don't have to answer to an insurance company OR even the Govt. for that matter ? Private Hospitals are mostly run like a business anyway so why not this part ? The status quo is not good enough and that is the point I am making.

rayiner 10y ago
Are we going to allow doctors and hospitals to turn away anyone who can't pay the advertised rates? Like we allow every other business to do? And will we require Medicare and Medicaid to pay those advertised rates, without the discounts they currently get? Jose are the things that force cross-subsidization.
- bradleyjg 10y ago
  The hospitals that are covered by EMTALA (duty to treat) are those that "receive federal assistance, maintain charitable nonprofit tax status, or participate in Medicare". A hospital is free to get off the federal government gravy train if it thinks it can make more money that way.
  - rayiner 10y ago
    You can't have the government distorting the market by bringing half of all potential customers under a single taxpayer-funded system then pretend that hospitals have a real choice in whether to participate in those programs.
    - Retric 10y ago
      Many are not part of the system, so they really do have a choice. Granted, location is a big part of this, and it's much simpler to operate this way when population density is high and there are other hospitals in the area.
      - cmdrfred 10y ago
        I work for a medical group that does just this. It is indeed possible and profitable. You just have to pay taxes on earnings.
      - riahi 10y ago
        All ERs are bound by EMTALA. It's hard in this modern era to have a hospital that doesn't have an ER.
- mindslight 10y ago
  Those hospitals' standard rates should be paid by direct reimbursement from the government at their set rate. In the event they're out of line with the expected market (no idea what that distribution looks like, but obviously there would be one), then the hospital would be investigated for price gouging all their customers (as customers of this industry are less able to shop around). The problem we have here is the exact same problem as with taxis/Uber (and telcos somewhat. and actually that public code thread we argued about the other day, too). Rather than just directly subsidizing infrastructure for poor people, governments enticed businesses to provide some service at a loss by giving them special privileges across the board. As the market finds more efficient solutions, the reality disconnect becomes painfully apparent. Market consumers grow sick of the incumbents' overhead, while simultaneously the businesses gradually renege on their unprofitable obligations.
  - harryh 10y ago
    I wonder if it might be possible to start some kind of group buying organization to negotiate insurance like rates without the actual insurance. I would seriously consider going without insurance except for the highest cost goods & services (say over 100k) except for the fact that it will cost me more to go to the doctor for a check then my insurance company currently pays. The group discount without the risk sharing would be a very interesting product for me. I wonder how many other people would be interested in such a thing.
    - mindslight 10y ago
      This would be pretty great, but so would real healthcare reform where businesses were simply required to publicly post uniform prices. I think a fundamental problem of trying to privately implement this idea is that medical businesses have an extreme amount of overhead simply to deal with insurance companies, but they don't precisely ascribe it to insurance as payment. From a doctors' office's perspective, the "actual cost" of providing you cash service still includes paying all their back office rather than just actual services rendered. Coming from the other direction, you have high-deductible plans that effectively do this in many more words. Plus that whole tax subsidy that fueled the growth of this institutional cancer in the first place.

rayiner 10y ago

Are we going to allow doctors and hospitals to turn away anyone who can't pay the advertised rates? Like we allow every other business to do? And will we require Medicare and Medicaid to pay those advertised rates, without the discounts they currently get? Jose are the things that force cross-subsidization.

bradleyjg 10y ago
The hospitals that are covered by EMTALA (duty to treat) are those that "receive federal assistance, maintain charitable nonprofit tax status, or participate in Medicare". A hospital is free to get off the federal government gravy train if it thinks it can make more money that way.
- rayiner 10y ago
  You can't have the government distorting the market by bringing half of all potential customers under a single taxpayer-funded system then pretend that hospitals have a real choice in whether to participate in those programs.
  - Retric 10y ago
    Many are not part of the system, so they really do have a choice. Granted, location is a big part of this, and it's much simpler to operate this way when population density is high and there are other hospitals in the area.
    - cmdrfred 10y ago
      I work for a medical group that does just this. It is indeed possible and profitable. You just have to pay taxes on earnings.
    - riahi 10y ago
      All ERs are bound by EMTALA. It's hard in this modern era to have a hospital that doesn't have an ER.
mindslight 10y ago
Those hospitals' standard rates should be paid by direct reimbursement from the government at their set rate. In the event they're out of line with the expected market (no idea what that distribution looks like, but obviously there would be one), then the hospital would be investigated for price gouging all their customers (as customers of this industry are less able to shop around). The problem we have here is the exact same problem as with taxis/Uber (and telcos somewhat. and actually that public code thread we argued about the other day, too). Rather than just directly subsidizing infrastructure for poor people, governments enticed businesses to provide some service at a loss by giving them special privileges across the board. As the market finds more efficient solutions, the reality disconnect becomes painfully apparent. Market consumers grow sick of the incumbents' overhead, while simultaneously the businesses gradually renege on their unprofitable obligations.
- harryh 10y ago
  I wonder if it might be possible to start some kind of group buying organization to negotiate insurance like rates without the actual insurance. I would seriously consider going without insurance except for the highest cost goods & services (say over 100k) except for the fact that it will cost me more to go to the doctor for a check then my insurance company currently pays. The group discount without the risk sharing would be a very interesting product for me. I wonder how many other people would be interested in such a thing.
  - mindslight 10y ago
    This would be pretty great, but so would real healthcare reform where businesses were simply required to publicly post uniform prices. I think a fundamental problem of trying to privately implement this idea is that medical businesses have an extreme amount of overhead simply to deal with insurance companies, but they don't precisely ascribe it to insurance as payment. From a doctors' office's perspective, the "actual cost" of providing you cash service still includes paying all their back office rather than just actual services rendered. Coming from the other direction, you have high-deductible plans that effectively do this in many more words. Plus that whole tax subsidy that fueled the growth of this institutional cancer in the first place.