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How to fix USA healthcare IMHO: 1. Pharma: drugs must be sold to American people at the same price as the other developed countries such as Canada, Germany, et
by patrickg_zill 10y ago
How to fix USA healthcare IMHO:
1. Pharma: drugs must be sold to American people at the same price as the other developed countries such as Canada, Germany, etc.
2. Prices must be published, and, the lowest paid by any insurer must be available as a cash option if you pay at the time of service.
That is, an MRI scan with a retail price of $3k but which the insurer pays only $1100 for, must be available for $1100 if you pay at time of service, that same $1100.
3. Repeal EMTALA.
- Mendenhall 10y agoIts a dissapointing thing (usa) that both republicans and democrats cant simply agree to make them declare prices etc. Its like all these "acts" have no intention of addressing the real issues at all. Then its amazing to see both parties argue over their plans which will never work because none of them address it from bottom up.
- patrickg_zill 10y agoA poster on another forum I frequent made the point that "regarding the political parties, there are no actual ideologies, only, different interests they represent" and that does seem to ring true some of the time...
- greeneggs 10y agoCalifornia publishes Medi-Cal rates [1]. Unfortunately, not all codes are explained, e.g., 99282 (according to the NY Times article, E.R. "examination and treatment of a patient with a finger fracture") and 99283 ("a narcotic painkiller was also prescribed") are both described as just "EMERGENCY DEPT VISIT". California also has a website comparing costs and quality for treatments across hospitals and regions [2]. [1] https://files.medi-cal.ca.gov/pubsdoco/Rates/rates_range_display.asp https://files.medi-cal.ca.gov/pubsdoco/Rates/rates_range_dis... [2] http://www.cahealthcarecompare.org/cost_detail.jsp?region=16&service_id=212&cost_cat=cancer&cost_cat_name=Cancer http://www.cahealthcarecompare.org/cost_detail.jsp?region=16...
- KZeillmann 10y agoIf I recall, EMTALA is the law that states that hospitals must provide emergency medical care to someone regardless of their ability to pay. Do we really want to live in a society where people are refused treatment for medical care just because they can't pay at that time?
- patrickg_zill 10y agoThe problem with EMTALA, is that it is routinely abused to get non emergency care. As a result, some hospitals have found that it is better to close ERs; which of course means less emergency care when it is actually needed.
- maxerickson 10y agoHere's the question though: Why don't ERs have a billing code that is essentially a walk in visit that costs a sane amount? My vague understanding is that the answer is along the lines of "they don't understand economics" and have worked over time to push lower risk care out of the ER, instead of working to handle it at lower cost inside of the ER, making the typical ER visit more and more expensive to handle... The architect of the ACA literally said the same thing about hospitals, moving services out of the hospital where possible to save money. But that just means that either the utilization of the hospital goes down (driving up costs) or the complexity of the care delivered goes up (driving up costs).
- riahi 10y agoBecause paying people to be there 24/7 is not as cheap as paying people to be in an urgent care from 9-5 or even 9-9. Precisely because the facility is designed to handle massive emergencies means that your fixed costs are inherently higher. Just because you intend to use a supercomputer to browse HN doesn't mean the price to buy the supercomputer gets cheaper. If that's your intended use-case, you should buy a cheaper tablet / go to a cheaper level of care. EMTALA's greatest problem is its unfunded mandate where people are required to provide 24/7 emergency care without regard for ability to pay. Since it's effectively "free", people abuse it and show up at all hours for non-emergent issues because they don't want to wait.
- riahi 10y ago#2 is illegal under Medicare/Medicaid rules. We are required by law to charge the same price to all payers, including patients. We can't offer a cash discount at the time of service, as it is Medicare fraud. We can charge you, accept a lower payment, and then write off the rest as a loss. In your example, who is this magic insurer? Which reimbursement rate are we setting as the bar? I hope its not medicare or medicaid, as they often reimburse below cost. Is it the highest negotiated reimbursement a given imaging center has negotiated? Each of these contracts are negotiated individually between the payers and the imaging center. Because of the variable reimbursement and the federal requirement that one price be charged to EVERYONE, you see huge markups lest you undercharge a payer that would have paid the full amount.
- zimzam 10y agoI think you misunderstood. The poster is saying that if the prices are as follows: Sticker price (uninsured people pay this): $5000 Insurance A in-network price: $2100 Insurance B in-network price: $2300 Insurance C in-network price: $1800 Medicare price: $800 That anyone paying without insurance (cash) should be able to pay the $800 Medicare rate since it is the lowest rate. That's not asking for a cash discount but rather forbidding price discrimination.
- riahi 10y agoMedicare and Medicaid often reimburse below cost. Healthcare businesses make up the difference from private insurance. By forcing people to accept the lowest rate (which is not negotiated, but effect by decree), you absolutely destroy the funding for services. Good luck keeping any healthcare facilities open at those reimbursement rates. Medicare is allowed to set prices by fiat for physician and hospital services. It is barred by law from negotiating on medications. Perhaps the ire should be directed there.
- patrickg_zill 10y agoMy personal view is that most people would be OK with the lowest non-Medicare rate, i.e. "the free market rate". Why Medicare reimburses at an unprofitable rate is another discussion.