4 ms·

> tmaly 10 minutes ago [-] I echoed this idea in a comment yesterday. The medical industry is the only industry with a broad anti-trust exemption. What this

> tmaly 10 minutes ago [-] I echoed this idea in a comment yesterday. The medical industry is the only industry with a broad anti-trust exemption. What this means is that they do not have to publish prices like all other industries. Could you elaborate on this? I don't see what publishing prices has to do with anti-trust, and certainly I have encountered "call for prices" elsewhere.

mikeash 10y ago
I don't know about the anti-trust aspect, but the situation in medicine goes far beyond "call for prices." It's often impossible, no matter what you do, to find out what a procedure will cost. Billing systems are so complicated that the hospitals themselves barely understand it, and the only way they can find the cost for many things is to go ahead and do it and see how it comes out.
- ArtDev 10y ago
  They provider may not even be allowed to tell you due to contracts with insurance companies. This kind of thing is outright criminal. We need transparent pricing regulation!
  - prostoalex 10y ago
    Would be hard to enforce legislatively, as you're essentially forcing private companies to disclose the previously confidential pricing agreements between them and insurance companies. What will end up happening is the equivalent of MSRP in car sales - here's the list price, but since you're such a good guy, and we're running a promotion, you can get 5% off if you act today.
    - beambot 10y ago
      So instead you sign a contract to purchase a car (with no take backs!) and only then do you get told the must-pay MSRP? That's about how medical pricing works today.
      - prostoalex 10y ago
        Some states do require chargemaster transparency, e.g. https://www.oshpd.ca.gov/chargemaster/ https://www.oshpd.ca.gov/chargemaster/
    - mikeash 10y ago
      Why would that be hard? I thought law takes precedence over contracts. Even having the equivalent of car MSRPs would be a huge improvement. As it stands today, you often cannot get any price for a procedure beforehand, not even a "forget about insurance, I'm just going to pull out a wad of benjamins and start counting until you tell me it's enough" price. Plus, car prices don't vary that much from MSRP. I can look up a car's MSRP and know that this is approximately what I'll pay. If I get a really good deal I might get away with paying 10-20% less. If the car is in extremely high demand, I might have to pay 10-20% more. But I can get a pretty decent idea. Medical pricing often varies by a factor of ten depending on whether you have insurance, and which provider it is.
      - prostoalex 10y ago
        I posted a link below, but some states already mandate chargemaster transparency. It's close to useless, as one quickly discovers that (a) pretty much any procedure costs a trillion dollars, but discounts apply and (b) the consumer's view of "procedure" and hospital system's view of "services provided" differ radically, as every gauze used up, every vital measurement, and every painkiller is a billing item in hospital's book (cost of goods and labor), but are integral part of the "procedure" the way the consumer sees it.
        mikeash 10y ago
        That some current laws are useless doesn't mean better laws couldn't be made. Mandate a final, guaranteed, all-inclusive price, or require disclosing every single discount made available to anybody, or even require charging the same price to everybody. I think the real problem is that Americans mostly aren't willing to have their government going around telling businesses to cut out their shit or else.
        prostoalex 10y ago
        I don't know if there are simple one-step solutions. > Mandate a final, guaranteed, all-inclusive price How would that work for something like birth? Depending on the amount of time spent in labor and a host of potential complications (some requiring presence of additional doctors like anesthesiologists or surgeons to perform a C-section) the costs will vary greatly. > require disclosing every single discount made available to anybody, or even require charging the same price to everybody That could work, as long as discounts don't evolve into kickbacks or rebates, but then why should an insurance company that signed up 10 customers receive the same discount as an insurance company that sent 100,000 people? The latter loses their leverage, which typically sends the prices up, not down.
dv_dt 10y ago
The ACA required hospitals to publish prices in some contexts. http://thehill.com/policy/healthcare/204868-new-price-transparency-rules-for-hospitals-under-o-care http://thehill.com/policy/healthcare/204868-new-price-transp... https://www.bna.com/hospitals-required-price-n17179910723/ https://www.bna.com/hospitals-required-price-n17179910723/
tmaly 10y ago
Karl provides more detail in his write up than I could cover, and he links to two US Supreme Court cases in regards to the price issue https://market-ticker.org/akcs-www?post=231949 https://market-ticker.org/akcs-www?post=231949
- dllthomas 10y ago
  Interesting, if ranty, hard to follow, and possibly overstated. For one, there seems a distinction to be made between "publishing" prices and individually receiving a quote in advance of work. If there's a technical sense in which the two are equivalent, I would recommend clarifying in casual conversation. Those requirements also don't seem (though I could've missed something) to be a part of anti-trust law, per se. The requirement that prices be consistent is, in the cited Robinson-Patman Act (although that seems to only apply if you're crossing state lines?)

mikeash 10y ago

I don't know about the anti-trust aspect, but the situation in medicine goes far beyond "call for prices." It's often impossible, no matter what you do, to find out what a procedure will cost. Billing systems are so complicated that the hospitals themselves barely understand it, and the only way they can find the cost for many things is to go ahead and do it and see how it comes out.

ArtDev 10y ago
They provider may not even be allowed to tell you due to contracts with insurance companies. This kind of thing is outright criminal. We need transparent pricing regulation!
- prostoalex 10y ago
  Would be hard to enforce legislatively, as you're essentially forcing private companies to disclose the previously confidential pricing agreements between them and insurance companies. What will end up happening is the equivalent of MSRP in car sales - here's the list price, but since you're such a good guy, and we're running a promotion, you can get 5% off if you act today.
  - beambot 10y ago
    So instead you sign a contract to purchase a car (with no take backs!) and only then do you get told the must-pay MSRP? That's about how medical pricing works today.
    - prostoalex 10y ago
      Some states do require chargemaster transparency, e.g. https://www.oshpd.ca.gov/chargemaster/ https://www.oshpd.ca.gov/chargemaster/
  - mikeash 10y ago
    Why would that be hard? I thought law takes precedence over contracts. Even having the equivalent of car MSRPs would be a huge improvement. As it stands today, you often cannot get any price for a procedure beforehand, not even a "forget about insurance, I'm just going to pull out a wad of benjamins and start counting until you tell me it's enough" price. Plus, car prices don't vary that much from MSRP. I can look up a car's MSRP and know that this is approximately what I'll pay. If I get a really good deal I might get away with paying 10-20% less. If the car is in extremely high demand, I might have to pay 10-20% more. But I can get a pretty decent idea. Medical pricing often varies by a factor of ten depending on whether you have insurance, and which provider it is.
    - prostoalex 10y ago
      I posted a link below, but some states already mandate chargemaster transparency. It's close to useless, as one quickly discovers that (a) pretty much any procedure costs a trillion dollars, but discounts apply and (b) the consumer's view of "procedure" and hospital system's view of "services provided" differ radically, as every gauze used up, every vital measurement, and every painkiller is a billing item in hospital's book (cost of goods and labor), but are integral part of the "procedure" the way the consumer sees it.
      - mikeash 10y ago
        That some current laws are useless doesn't mean better laws couldn't be made. Mandate a final, guaranteed, all-inclusive price, or require disclosing every single discount made available to anybody, or even require charging the same price to everybody. I think the real problem is that Americans mostly aren't willing to have their government going around telling businesses to cut out their shit or else.
        prostoalex 10y ago
        I don't know if there are simple one-step solutions. > Mandate a final, guaranteed, all-inclusive price How would that work for something like birth? Depending on the amount of time spent in labor and a host of potential complications (some requiring presence of additional doctors like anesthesiologists or surgeons to perform a C-section) the costs will vary greatly. > require disclosing every single discount made available to anybody, or even require charging the same price to everybody That could work, as long as discounts don't evolve into kickbacks or rebates, but then why should an insurance company that signed up 10 customers receive the same discount as an insurance company that sent 100,000 people? The latter loses their leverage, which typically sends the prices up, not down.

dv_dt 10y ago

The ACA required hospitals to publish prices in some contexts. http://thehill.com/policy/healthcare/204868-new-price-transparency-rules-for-hospitals-under-o-care http://thehill.com/policy/healthcare/204868-new-price-transp... https://www.bna.com/hospitals-required-price-n17179910723/ https://www.bna.com/hospitals-required-price-n17179910723/

tmaly 10y ago

Karl provides more detail in his write up than I could cover, and he links to two US Supreme Court cases in regards to the price issue https://market-ticker.org/akcs-www?post=231949 https://market-ticker.org/akcs-www?post=231949

dllthomas 10y ago
Interesting, if ranty, hard to follow, and possibly overstated. For one, there seems a distinction to be made between "publishing" prices and individually receiving a quote in advance of work. If there's a technical sense in which the two are equivalent, I would recommend clarifying in casual conversation. Those requirements also don't seem (though I could've missed something) to be a part of anti-trust law, per se. The requirement that prices be consistent is, in the cited Robinson-Patman Act (although that seems to only apply if you're crossing state lines?)