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I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-pocket price would be without insurance. She told me a range! It was $96-$115. This was close to the range that google says was about average for the procedure. So this was not a case of over-charging, or unfair pricing. I really did not know if the test was $10,000 or $100 till this call. If they just made the pricing transparent, I think a lot of the problems would evaporate. (Although I think the profit centers would suddenly become the emergency medicine section of the hospital.) I know this article focuses on fraud, but the non-fraud part of the healthcare is just as broken, and probably costs more.

maxxxxx 9y ago
Totally agree. If people in the US want to have markets for health care there should be price transparency. When I had a high deductible plan I always tried to compare prices but you almost never get a straight answer. If the Republicans want to reform health care that's where they should be starting.
- tanderson92 9y ago
  > If the Republicans want to reform health care that's where they should be starting. They don't.
- deleted 9y ago
  [deleted]
- anigbrowl 9y ago
  If people in the US want to have markets for health care I think only certain 'legal persons' and their executive officers and major shareholders want that. Patients, not so much.
Osiris 9y ago
Health care is the only industry where you only find out how much something costs after you're already bought it. Basic supply and demand theory depends on consumers having perfect information. A free market cannot work when a consumer has no information.
- cptskippy 9y ago
  A lot of trades give you estimates but you don't know the actual cost until the work is complete. Auto repair, construction, plumbing, electrical, etc. There are plenty of fixed costs that can be accounted for easily but there are a lot of unknowns that can't be seen ahead of time. That's why quotes and shopping around so prevalent because it allows for competition in price. However in healthcare that's not an option, there is no competition. The cost of fixed cost procedures (e.g. lab work) are unknown. You can't shop around for surgeries or doctors. Everything is wrapping in mystery even after the fact, there is no final bill. Even if you pay everything you're asked to, you might still get a bill 2 years down the road for reasons no one can suitably explain.
  - Johnny555 9y ago
    One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. And I may very well decide not to do it. They may tell me that I need a $1000 timing belt replacement when I ask for a $200 water pump replacement, and I may decide not to do it. I can even ask them to put everything back together and tow the car somewhere else for repairs. If they tell me I need a $3000 engine replacement, I may decide to just scrap the car. The same is not true with healthcare - you may go in for a $20K stent, but have a serious complication that needs $200K open heart surgery -- you don't really have the option to say "put everything back together and I'll live with it".
    - mikestew 9y ago
      One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. It's not just an expectation, it's the law in many places. When I was a pro mechanic in Indiana, anything over original estimate + 10%, and authorization from the customer is required. Well, not required I guess, since if you show up and the bill is 20% over, you just pay the original estimate. (Yes, in the worst case you might have to sue to get your car back. Personally, I've never known that to have happened, because most shops aren't looking to rip you off.) But, as you point out, me being in the middle of a top end job is a little different than a surgeon who's working on a running engine when it comes to needed extra work.
EvanAnderson 9y ago
An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with both tacit and stated insinuations that we're placing a monetary value on her "health" by asking what procedures or drugs might cost. I don't think price transparency will fix much, though. The average person I know has employer-provided insurance and doesn't think a bit about the costs of procedures. Price transparency combined with individuals having to pay for their healthcare expenses would help, but there's blame enough to go around for every player in the system, too.
- troyvit 9y ago
  That's hilarious. They are making the health of your wife and daughter a profit center yet they act offended when you want to know the cost.
  - EvanAnderson 9y ago
    Black comedy, indeed.
    - mtanski 9y ago
      I'm assuming you're ESL, ... in Polish you also call it literaly "black comedy". The proper term you're looking for is "dark comedy". In the US "black comedies" nowadays is a term referring to for/by African Americans; it's a whole sub genre.
      - ukoki 9y ago
        Can't speak for American English but "black comedy" is standard in British English https://en.wikipedia.org/wiki/Black_comedy https://en.wikipedia.org/wiki/Black_comedy
Retric 9y ago
Pricing does not solve the root problem which is everything trying to get someone else to pay.
- projectramo 9y ago
  I agree with you in that this is another problem but I think the two are highly related. Consider: 1. If you don't have insurance, how do you know where to go? 2. If your insurance company wants to reward you for picking lower priced options, how do you comply? 3. If the government wants to lower systematic costs, how do they give you incentives? Without basic pricing information, all the benefits of a free market are absent, and so are the benefits of any incentive system.
  - wlesieutre 9y ago
    Related to 1 and 2, people on high deductible health plans are paying everything out of pocket until they hit their yearly cap (then insurance kicks in). It's not even whether you have insurance or the insurance company wanting to reward you, it's trying to save your own money like any other purchase. High deductible health plans are becoming more and more common, from what I gather.
    - Retric 9y ago
      'High deductible' is so broad it's almost meaningless. At $1,300 single $2,600 family (2017) in the US many people hit every year making price shopping almost pointless. https://en.wikipedia.org/wiki/High-deductible_health_plan https://en.wikipedia.org/wiki/High-deductible_health_plan now at the high end of that a $13,100 family plan does provide more incentive again unless there is something significant wrong when again the incentive to price shop suddenly goes away. Worse, medical spending tends to mostly be by a few very sick people vs. the healthy making high deducible plans have limited real impact.
      - wlesieutre 9y ago
        Mine's $3000/6000, I've luckily been in good enough health to not hit it. It's been the right choice for me; the amount I've saved into my HSA vs employee contribution to our more expensive health insurance option will more than cover hitting the max for a year. I was looking into sleep studies recently, a quick google suggests a cost range of $600 to $5000. I'd definitely shop that around, and if a place won't give me a price then I wouldn't consider doing it. But like you said, I'm pretty small potatoes compared to sick people.
koolba 9y ago
How much did it actually cost? Was the estimate correct?
- projectramo 9y ago
  You know, that is a great question. I have (excellent) employer provided care and I knew my cost would be low. But I will post this when I find out.
briffle 9y ago
Along with price transparency, everyone should leave a doctors office with a copy of their bill. Sure, it will probably also get sent to insurance, etc. But I have had doctors bills come to me 6 months after the fact, and it is extremely confusing to try to figure out what has been billed, what hasn't, etc.
- drewbuschhorn 9y ago
  I had a hospital decide to restart the entire billing process on me after it was all paid for. Only time I've ever been glad for the insurance company (car, not health). I dropped it in their lap, and 3 mo later got an "our mistake" from the hospital, didn't have to lift a finger to fight it.
  - ashark 9y ago
    One of the more surprising things for me, watching major medical events from a distance and relatively close-up in my family, has been that hospital billing departments are at least as inconsiderate, incompetent, out-to-get-you, and generally shitty as insurance companies. And considering how much trouble I've seen/had with insurance companies that's saying something. The number of times I've seen a bill that made no sense and been told, "oh, yeah, you're not misreading it, it's a bill, but you can ignore it because [reasons]"... WTF are they doing? Seriously, no-one else gets away with being so entirely sloppy. Then there's the wonderful "we sent you one bill for a trivial amount which you probably lost in the pile of 50 other damn bills from 20 different providers, many of which were bills but didn't actually need to be paid (see above), plus twice that many not-bills-but-still-kinda-look-like-them statements of benefits and whatnot, didn't send a followup or call you or anything, but now you're in collections for $90 or whatever and your credit's dinged, sucks to be you". Then if there's a dispute with insurance the hospital/providers will harass you until it's over. And sometimes just try to bill you even though they know it's being disputed. I guess they think you're not already spending enough time on the phone fixing their screw-ups. I'm not necessarily in favor of fully nationalized healthcare exactly (some form of universal health care, yes) but it'd almost be worth having the government directly take it all over just to drink up those sweet, sweet hospital billing/admin and insurance company CEO tears. I truly wish everyone involved all the worst.
CoffeeDregs 9y ago
Amen. There was a great article about this in the The Atlantic a few years ago. https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ https://www.theatlantic.com/magazine/archive/2009/09/how-ame... Anecdote: my mother-in-law was a smoker, felt dizzy one day, went to the ER and died five days later from a brain tumor. Got the Statement of Benefits (or similar): the cost was $140k; Medicare paid $40k...
astrodust 9y ago
This strikes me as absolutely absurd. Here, as an example, dentistry is highly regulated and prices are listed in a book. If you want procedure X done it will cost $Y no matter which dentist you visit. This means it's easier to budget for such things, you never have to price shop, and the insurance companies can also easily predict what the costs will be given statistical trends. This idea of medical procedures having random prices is the sort of thing you have to deal with at veterinarians where a simple procedure can cost anywhere from $75 to $500 depending on the place you're going to.
- ghaff 9y ago
  In the US dentists don't all charge the same thing in my experience although they're probably in the same general ballpark for a given procedure. A quick Google seems to confirm that. There is definitely more transparency in pricing because many/most people don't have insurance and insurance for semi-cosmetic procedures is somewhat limited. (And there are often treatment options that people will reasonably choose from based on price.)
dv_dt 9y ago
Transparency would certainly help but it cant solve everything. But medical care isn't regular and predicable, so at best you can get better transparency about the routine costs. My car was recently hit in the parking lot. The body shop said, here's the cost of the repair of the items we can see, but with the warning that it could go higher if we open things up, and find additional damage. Same with people. The other thing is the you know with a car exactly what you will end up with in the end. And with simpler medical procedures that is true, but as they get more complex - the more you are navigating a mess of interlocking procedures, probabilities, and outcomes.
sixdimensional 9y ago
Actually, one way to attack the problem is something Hacker News folk could help with: Build "open source" coding, grouping and costing schemes and tools to maintain those schemes. It would look something like: 1) a software tool to maintain coding systems, grouping, and related costs (essentially a database front-end); 2) something like Wikipedia/GitHub that maintains version history and controls for coding, grouping and pricing schemes; 3) crowd-sourcing so healthcare professionals and organizations could help maintain the data; and 4) a non-profit, non-governmental organization (maybe something like the Mozilla or Apache foundations) that runs to help govern and provide structured releases of the open coding/grouping/costing data. These are just my ideas, but having worked in this industry on the problem of health insurance/healthcare fraud and "healthcare cost" - there are a bunch of organizations making a small fortune controlling these schemes (ex. the AMA) - something ripe for disruption (I hate using this word, but it's the truth). You need quality coding/grouping/costing schemes and systems for the industry to function, but it should be many, many times more open than it currently is.
sidlls 9y ago
Price transparency is not going to fix much, if anything. It may induce rage increased blood pressure on the front end (prior to receiving service), but ultimately health care is often a "must have." Having a price list in hand doesn't suddenly make the price conscious consumer more of an expert regarding the necessity of various services estimated. Nor does it really encourage competition between competitors.
- softawre 9y ago
  You seem to be missing that people want to compare prices at various firms, as well as deciding whether to have a procedure.
  - sidlls 9y ago
    No, I'm not missing that. It doesn't make as much of a difference as you'd think. There are plenty of companies and organizations in this space who offer "price transparency" services to varying degrees of accuracy.
- froindt 9y ago
  There is significant difference in the price different places charge for services. It's not necessarily deciding whether or not to do the treatment, but can also encompass consumers being cognizant of cost and choosing providers who are cheaper. Here is a planet money podcast which goes through some examples of significant expenses being saved. http://www.npr.org/sections/money/2015/10/02/445371930/episode-655-pay-patients-save-money http://www.npr.org/sections/money/2015/10/02/445371930/episo...
binarymax 9y ago
Surprise! Pricing is "transparent", although massively complicated. There are several systems, but let's take a look at Outpatient procedure pricing... A good outpatient pricing guide is here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HospitalOutpaysysfctsht.pdf https://www.cms.gov/Outreach-and-Education/Medicare-Learning... And coupled with the OPPS dataset here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PCPricer/Outpatient-PPS-Pricer-Code.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... as well as a couple others, along with a quick read of the federal register, you can kinda figure it out on your own (/s). Every bill you get must also have the codes and modifiers on it by law. Its interesting to download the dataset and look them up. --EDIT-- I incorrectly linked to the COBOL PC Pricer code above for OPPS! Here is the pricing data: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...
- projectramo 9y ago
  I suppose this would be helpful if they gave us the pricing before the decision of where (or, for many unfortunate people, if) to have the procedure or test done. You seem to be talking about medicare and medicaid, and not about private hospital services. Is that correct?
  - binarymax 9y ago
    Yes, also sorry for the insensitive sarcasm in the previous post. It's a chicken and egg problem. In many cases you don't know if you need a test unless you've already had it. In the case of a procedure, there may be things that come up while it's happening that may complicate things. The irony is that OPPS/IPPS (inpatient) and APC (ambulatory) are meant to simplify things. Doctors and nurses usually do their best to know ahead of time, but medical procedures are complicated. Fraud does happen most often against medicare/medicaid (as covered in this article with one trick known as "upcoding"), but I believe these codes are used with insurance providers as well. If a hospital or doctor is in your provider network (HMO/PPO) then there is a pre-agreed cost between the two set on these fees. Out of network occurs when there is no agreement, so there is no "trust" between the two and the insurance provider offsets the cost to you because they are legally able to do so. In my opinion - overbilling is really caused not by pricing complexity, but by the control of the hospital and insurance provider duality. If there was no such thing as a network, and you were covered everywhere, then shenanigans with certain hospitals and providers would be more difficult.
fredgrott 9y ago
at least in the US one has to remember that Medicaid pays less than Medicare for the same procedures with private insurance taking the price higher hits
rsync 9y ago
"Let me add my big one: price transparency." Lack of price transparency bothers me as well and I wish we had it. However, I don't know if there will ever be enough pressure to manifest this. Price transparency really only matters to the person paying the bill. Our society is very rapidly evolving to consider any healthcare cost of any kind to be an insurmountable burden that no normal person could ever be expected to pay. I suspect that the incomprehensible, ridiculous healthcare schemes that we are living through currently are just death spasms on the way to fully socialized medicine. I'm sure there are rare people here and there that care how much a mile of highway costs to pave or how much a mile of city sewer line costs to install ... I would expect the same number of people to care about the cost of a medical procedure when their own cost is $0.
- bonzini 9y ago
  > Our society is very rapidly evolving to consider any healthcare cost of any kind to be an insurmountable burden that no normal person could ever be expected to pay On the other hand, if prices are not managed properly, premiums get higher and higher. So even if insurance pays, you should care that prices are reasonable.
  - u801e 9y ago
    Car insurance doesn't cover routine maintenance, for example. So the prices for things like oil changes are relatively reasonable. If we had to go through insurance for things like that, then I'm willing to bet that the price of the service would increase substantially and auto insurance premiums would go up quite a bit as well.
    - bonzini 9y ago
      Thatv may be true but, for healthcare, there is an important difference in favor of you: a car is replaceable, a life isn't. If you don't do routine maintenance, the engine breaks down and _you_ have to pay for it. If you don't do routine checkups, you get sick and insurance has to pay---and also, if you die those sweet premiums stop coming to them. Insurance actually has a vested interest in paying for your checkups and screenings, just like in countries with socialized healthcare.
rrdharan 9y ago
This is exactly what Castlight was originally trying to solve with their transparency tool: https://en.wikipedia.org/wiki/Castlight_Health https://en.wikipedia.org/wiki/Castlight_Health Always thought their approach was quite clever and I think they did end up having some success though I'm not sure the overall impact has been as transformative as was originally hoped.
Dove 9y ago
Colorado has this cool law which, as far as I can gather, requires hospitals to report prices for various conditions. It results in tools like this: https://cha.fhsclearquote.com/ https://cha.fhsclearquote.com/ You put in your zip code, how far you want to go, find the condition, and it gives you a list of hospitals, average charge, case volume, and 5th and 95th percentile costs. I'd love a more nuanced analysis that looked at outcomes, too. Still. It's a great tool for planning purposes ("If I have an emergency, take me to . . . ")
- HarryHirsch 9y ago
  Hey, that's wonderful. Price transparency is always touted as the panacea for the relentless runaway growth in healthcare costs in the States. Here's the natural experiment. Has this law managed to rein in healthcare costs? You'd think it hasn't, and the missing focus on outcomes gives it away.
  - Dove 9y ago
    I don't think most people know about it. It's helped rein in healthcare costs in this household at least, though? ;)
TallGuyShort 9y ago
This has been a concern for me as well. I've had doctors order things and call them one thing in person that sounds like what my insurance covers, but then they're billed as something different and I get stuck with the bill, when I really wasn't willing to pay for what it was. So now when I'm signing the papers accepting responsibility for the financial obligations if my insurance doesn't, I ask what it's going to cost if my insurance doesn't cover it. The nurses have no idea. It has to get "coded" before it's billed, and then after the bill is declined the coding people can tell me what I owe them. It's ridiculous.
DougWebb 9y ago
Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And you won't know the final time until you've actually completed the feature. Doctors have a similar problem: too much uncertainty which can't be eliminated until the treatment is completed. They can't even tell you how much an office visit costs, because of the variability in how much time each patient needs, involvement of nurses and PAs, and any tests that must be performed. Lab tests are a little better: they tend to take a predictable amount of time to perform, and the analysis is pretty standardized, but there's probably still some variability when the results are not routine. That explains the fairly narrow range you were eventually able to get. I think we've got the wrong pricing model in mind for healthcare. Instead of itemizing every little action, test, and pill, we should be aggregating these costs. Pay medical professionals fixed salaries, fund institutions using budgets for fixed costs and consumables costs, and pay for it all via taxation as a common good, like public education, libraries, defense, etc.
- sparky_z 9y ago
  Well, in some sense that's true of most businesses, right? Some customer interactions take up more overhead and resources than others. The trick is to aggregate that uncertainty over your customer base and come up with a price that incorporates your expected average costs. There are a lot of businesses that do this successfully because they have to in order to participate in the market. The reason health care providers don't seems to me because that are isolated from competition by heavy regulation. (I'm not saying the regulation in the health care space is necessarily a bad thing on balance, but it means that change can only come through additional regulation rather than depending on hamstrung market forces.)
- EvanAnderson 9y ago
  I agree that the pricing model is wrong. Fee for service creates perverse incentives. Having said that, though, unlike developing a new piece of software we have vast stores of data about procedures, complications, and outcomes from other patients who have already undergone the procedure. Surely there's a pricing model, if we are bound to fee for service, that could use this trove of existing data to provide more transparency. I'd be happy with knowing pricing within half an order of magnitude.
beat 9y ago
And yet, the idea that health care "consumers" would price-shop for the lowest-cost procedure is a dogmatic core of some American ideas about how to "fix" cost in health care.
- mindslight 9y ago
  It certainly wouldn't fix everything, but there are certain type situations it would help fix, yet the philosophy hasn't been tried (at least as long as employer-sponsored health cartels have been around). True price transparency requires that a given provider charge exactly the same amount, regardless of the customer - prohibit bespoke "negotiated" rates, hidden kickbacks, etc. Just today I went to an major-hospital urgent care clinic that has an upfront $50 fee to "be seen". I normally avoid the system like the plague it is (hence not wanting to pay into its protection rackets), but my girlfriend had gone last week for the same week-long fever and had a good experience, so I figured I'd give it a shot. The person working at the desk told me that there "could" be "extras" that would be beyond that fee. Okay, cool. The physician's assistant recommended a chest x-ray, added it was around $75, then confirmed it was $56, and I quickly agreed. My girlfriend was a bit miffed she had turned down the x-ray without knowing the actual price. When it came time to settle up the bill, they had added on a $130 charge because the PA had added on some billable event for her seeing me, despite that this should have clearly been included in the "$50 to be seen". This is textbook fraud, yet it is allowed to persist. I complained, and was met with the standard "it's nobody's fault" attitude, because these people are really just skinjobs on an opaque computer system. If I had been my normal self (currently dealing with some major life events), I would have only paid for the x-ray and told them to shove their unauthorized charge up their ass. Alas, they dropped the fraudulent charge to $80, but the bad taste remains. If I had been told the higher charge up front, that would have been completely acceptable - and if I thought it too high I could have gone to a competitor, or simply not gone (never before in my adult life have I gone to the hospital for a fever). And that doesn't even address the travesty of the only result coming out of this visit was receiving a prescription for the exact same antibiotic my girlfriend had received a week prior! It would have been much easier for her to buy two simultaneous doses from the pharmacy, but the cartel has that locked down as well.
Shivetya 9y ago
I am always dismayed when I get back "it depends". depends on what? I want a pure cash price. however it has been this way for decades having listened to my grandfather back in the nineties trying to by his wife a wheelchair only to be told he could not buy one and no they would not give him a price. so he did what anyone of his generation did, goodwill, salvation army, and finally found one at a garage sale. he just didn't think it right someone had to pay for what he needed for his wife but damn if the system stymies people at every turn. the new billing fun I have is required visits for prescription refills on some medicines and that to me is just overbilling in a different form. I didn't need to visit other than to get permission to refill; no it does not necessarily need to be a controlled substance
beat 9y ago
The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious effects. First, it gives us the in-network/out-of-network distinction. Second, it introduces complexity in the math sense to pricing - providers aren't charging one price, they're charging a wide array of prices, although those prices don't really vary much. The network thing also has the effect of reducing consumer choice in providers. I can use whatever doctors/facilities my insurance has in-network, unless I'm willing to cough up the difference out of my own pocket. Of course, fixed prices would be that wicked socialist government control we're told is ruining everything.
- tptacek 9y ago
  The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.
  - Spooky23 9y ago
    I've got news for you... you already have government price floors on all hospital procedures.
  - ams6110 9y ago
    Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?
    - tptacek 9y ago
      I think so. My point is, government price ceilings on all health procedures are so noxious to half the polity that nobody will support it, and we'll get single payer by default.
tptacek 9y ago
A few years ago my daughter needed a last-minute CT scan, the results of which would determine whether it was safe for my wife and I to go to a conference (long story). The hospital couldn't get authorization for the CT scan from Blue Cross, due to some glitch. "No problem", they said, "we'll just do the test tomorrow." Big problem for us, though; our flight out was the next day. I ended up negotiating a price for the CT on the spot; none existed. They simply couldn't tell me how much the test cost. I had to extravagantly over pay in order to get the test done at all.
blitmap 9y ago
I would love something like census data on how much a healthcare provider paid, on top of what a procedure or medicine costs. Not just how much they paid for you or your walking cane, but how much every provider pays for a syringe.
- dragonwriter 9y ago
  > I would love something like census data on how much a healthcare provider paid, on top of what a procedure or medicine costs. $0. By definition. But I think you may be confusing a health insurance provider (equivalently, a health care payer) with a health care provider.
pw 9y ago
It sounds like you're talking about something more complicated than a blood test, but in case you didn't know, most blood tests can be purchased online (and completed at a local branch of a national testing service e.g. Quest Diagnostics) with complete price transparency from a variety of competing providers.
gscott 9y ago
It is difficult because each insurance provider will have a different contract with the hospital or care provider. My wife works at a hospital that just upgraded from an all Dos based system to a windows based system. Her job is resolving provider disputes where the provider billed a rate that was different then their contract. Old systems + lots of different rates = confusion!
Consultant32452 9y ago
I had an equal and opposite experience getting an MRI. I also have a high deductible plan. When I was told I needed an MRI I went on my insurance provider's website to find MRI locations that are in network nearby. I called the first 5 on the list. I found that some place that was basically MRI-R-US was several hundred dollars cheaper than going to the local mega-hospital. Pricing isn't transparent because people usually aren't paying with money they perceive as their own. What do you care if your insurance company pays $200 or $2000 for that MRI? Eventually that difference shows up in the form of higher premiums, but that's far too complicated for people to respond to intelligently. Let's go one step further and imagine a world in which we completely replaced Medicare with a catastrophic coverage system. If you have a heart attack or something we'll take care of you, but for your day to day healthcare we'll just cut you a check for however much the government was previously paying. You can choose to use that money on anything you want whether it's healthcare related or not. You want to see price transparency and the power of competition to lower prices? Boom, done.
- mring33621 9y ago
  This will result in many people choosing to spend nothing on 'day to day' healthcare. Subsequently, this 'deferred maintenance' will result in increasing rates of catastrophic events, which will drive up costs for that part of the system. Giving cash (or cash equivalents) to people is probably not a good solution.
  - Consultant32452 9y ago
    Why do you care if someone chooses quality of life over longevity? Why do we get to make that decision for them?

maxxxxx 9y ago

Totally agree. If people in the US want to have markets for health care there should be price transparency. When I had a high deductible plan I always tried to compare prices but you almost never get a straight answer. If the Republicans want to reform health care that's where they should be starting.

tanderson92 9y ago
> If the Republicans want to reform health care that's where they should be starting. They don't.
deleted 9y ago
[deleted]
anigbrowl 9y ago
If people in the US want to have markets for health care I think only certain 'legal persons' and their executive officers and major shareholders want that. Patients, not so much.

Osiris 9y ago

Health care is the only industry where you only find out how much something costs after you're already bought it. Basic supply and demand theory depends on consumers having perfect information. A free market cannot work when a consumer has no information.

cptskippy 9y ago
A lot of trades give you estimates but you don't know the actual cost until the work is complete. Auto repair, construction, plumbing, electrical, etc. There are plenty of fixed costs that can be accounted for easily but there are a lot of unknowns that can't be seen ahead of time. That's why quotes and shopping around so prevalent because it allows for competition in price. However in healthcare that's not an option, there is no competition. The cost of fixed cost procedures (e.g. lab work) are unknown. You can't shop around for surgeries or doctors. Everything is wrapping in mystery even after the fact, there is no final bill. Even if you pay everything you're asked to, you might still get a bill 2 years down the road for reasons no one can suitably explain.
- Johnny555 9y ago
  One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. And I may very well decide not to do it. They may tell me that I need a $1000 timing belt replacement when I ask for a $200 water pump replacement, and I may decide not to do it. I can even ask them to put everything back together and tow the car somewhere else for repairs. If they tell me I need a $3000 engine replacement, I may decide to just scrap the car. The same is not true with healthcare - you may go in for a $20K stent, but have a serious complication that needs $200K open heart surgery -- you don't really have the option to say "put everything back together and I'll live with it".
  - mikestew 9y ago
    One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. It's not just an expectation, it's the law in many places. When I was a pro mechanic in Indiana, anything over original estimate + 10%, and authorization from the customer is required. Well, not required I guess, since if you show up and the bill is 20% over, you just pay the original estimate. (Yes, in the worst case you might have to sue to get your car back. Personally, I've never known that to have happened, because most shops aren't looking to rip you off.) But, as you point out, me being in the middle of a top end job is a little different than a surgeon who's working on a running engine when it comes to needed extra work.

EvanAnderson 9y ago

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with both tacit and stated insinuations that we're placing a monetary value on her "health" by asking what procedures or drugs might cost. I don't think price transparency will fix much, though. The average person I know has employer-provided insurance and doesn't think a bit about the costs of procedures. Price transparency combined with individuals having to pay for their healthcare expenses would help, but there's blame enough to go around for every player in the system, too.

troyvit 9y ago
That's hilarious. They are making the health of your wife and daughter a profit center yet they act offended when you want to know the cost.
- EvanAnderson 9y ago
  Black comedy, indeed.
  - mtanski 9y ago
    I'm assuming you're ESL, ... in Polish you also call it literaly "black comedy". The proper term you're looking for is "dark comedy". In the US "black comedies" nowadays is a term referring to for/by African Americans; it's a whole sub genre.
    - ukoki 9y ago
      Can't speak for American English but "black comedy" is standard in British English https://en.wikipedia.org/wiki/Black_comedy https://en.wikipedia.org/wiki/Black_comedy

Retric 9y ago

Pricing does not solve the root problem which is everything trying to get someone else to pay.

projectramo 9y ago
I agree with you in that this is another problem but I think the two are highly related. Consider: 1. If you don't have insurance, how do you know where to go? 2. If your insurance company wants to reward you for picking lower priced options, how do you comply? 3. If the government wants to lower systematic costs, how do they give you incentives? Without basic pricing information, all the benefits of a free market are absent, and so are the benefits of any incentive system.
- wlesieutre 9y ago
  Related to 1 and 2, people on high deductible health plans are paying everything out of pocket until they hit their yearly cap (then insurance kicks in). It's not even whether you have insurance or the insurance company wanting to reward you, it's trying to save your own money like any other purchase. High deductible health plans are becoming more and more common, from what I gather.
  - Retric 9y ago
    'High deductible' is so broad it's almost meaningless. At $1,300 single $2,600 family (2017) in the US many people hit every year making price shopping almost pointless. https://en.wikipedia.org/wiki/High-deductible_health_plan https://en.wikipedia.org/wiki/High-deductible_health_plan now at the high end of that a $13,100 family plan does provide more incentive again unless there is something significant wrong when again the incentive to price shop suddenly goes away. Worse, medical spending tends to mostly be by a few very sick people vs. the healthy making high deducible plans have limited real impact.
    - wlesieutre 9y ago
      Mine's $3000/6000, I've luckily been in good enough health to not hit it. It's been the right choice for me; the amount I've saved into my HSA vs employee contribution to our more expensive health insurance option will more than cover hitting the max for a year. I was looking into sleep studies recently, a quick google suggests a cost range of $600 to $5000. I'd definitely shop that around, and if a place won't give me a price then I wouldn't consider doing it. But like you said, I'm pretty small potatoes compared to sick people.

koolba 9y ago

How much did it actually cost? Was the estimate correct?

projectramo 9y ago
You know, that is a great question. I have (excellent) employer provided care and I knew my cost would be low. But I will post this when I find out.

briffle 9y ago

Along with price transparency, everyone should leave a doctors office with a copy of their bill. Sure, it will probably also get sent to insurance, etc. But I have had doctors bills come to me 6 months after the fact, and it is extremely confusing to try to figure out what has been billed, what hasn't, etc.

drewbuschhorn 9y ago
I had a hospital decide to restart the entire billing process on me after it was all paid for. Only time I've ever been glad for the insurance company (car, not health). I dropped it in their lap, and 3 mo later got an "our mistake" from the hospital, didn't have to lift a finger to fight it.
- ashark 9y ago
  One of the more surprising things for me, watching major medical events from a distance and relatively close-up in my family, has been that hospital billing departments are at least as inconsiderate, incompetent, out-to-get-you, and generally shitty as insurance companies. And considering how much trouble I've seen/had with insurance companies that's saying something. The number of times I've seen a bill that made no sense and been told, "oh, yeah, you're not misreading it, it's a bill, but you can ignore it because [reasons]"... WTF are they doing? Seriously, no-one else gets away with being so entirely sloppy. Then there's the wonderful "we sent you one bill for a trivial amount which you probably lost in the pile of 50 other damn bills from 20 different providers, many of which were bills but didn't actually need to be paid (see above), plus twice that many not-bills-but-still-kinda-look-like-them statements of benefits and whatnot, didn't send a followup or call you or anything, but now you're in collections for $90 or whatever and your credit's dinged, sucks to be you". Then if there's a dispute with insurance the hospital/providers will harass you until it's over. And sometimes just try to bill you even though they know it's being disputed. I guess they think you're not already spending enough time on the phone fixing their screw-ups. I'm not necessarily in favor of fully nationalized healthcare exactly (some form of universal health care, yes) but it'd almost be worth having the government directly take it all over just to drink up those sweet, sweet hospital billing/admin and insurance company CEO tears. I truly wish everyone involved all the worst.

CoffeeDregs 9y ago

Amen. There was a great article about this in the The Atlantic a few years ago. https://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/ https://www.theatlantic.com/magazine/archive/2009/09/how-ame... Anecdote: my mother-in-law was a smoker, felt dizzy one day, went to the ER and died five days later from a brain tumor. Got the Statement of Benefits (or similar): the cost was $140k; Medicare paid $40k...

astrodust 9y ago

This strikes me as absolutely absurd. Here, as an example, dentistry is highly regulated and prices are listed in a book. If you want procedure X done it will cost $Y no matter which dentist you visit. This means it's easier to budget for such things, you never have to price shop, and the insurance companies can also easily predict what the costs will be given statistical trends. This idea of medical procedures having random prices is the sort of thing you have to deal with at veterinarians where a simple procedure can cost anywhere from $75 to $500 depending on the place you're going to.

ghaff 9y ago
In the US dentists don't all charge the same thing in my experience although they're probably in the same general ballpark for a given procedure. A quick Google seems to confirm that. There is definitely more transparency in pricing because many/most people don't have insurance and insurance for semi-cosmetic procedures is somewhat limited. (And there are often treatment options that people will reasonably choose from based on price.)

dv_dt 9y ago

Transparency would certainly help but it cant solve everything. But medical care isn't regular and predicable, so at best you can get better transparency about the routine costs. My car was recently hit in the parking lot. The body shop said, here's the cost of the repair of the items we can see, but with the warning that it could go higher if we open things up, and find additional damage. Same with people. The other thing is the you know with a car exactly what you will end up with in the end. And with simpler medical procedures that is true, but as they get more complex - the more you are navigating a mess of interlocking procedures, probabilities, and outcomes.

sixdimensional 9y ago

Actually, one way to attack the problem is something Hacker News folk could help with: Build "open source" coding, grouping and costing schemes and tools to maintain those schemes. It would look something like: 1) a software tool to maintain coding systems, grouping, and related costs (essentially a database front-end); 2) something like Wikipedia/GitHub that maintains version history and controls for coding, grouping and pricing schemes; 3) crowd-sourcing so healthcare professionals and organizations could help maintain the data; and 4) a non-profit, non-governmental organization (maybe something like the Mozilla or Apache foundations) that runs to help govern and provide structured releases of the open coding/grouping/costing data. These are just my ideas, but having worked in this industry on the problem of health insurance/healthcare fraud and "healthcare cost" - there are a bunch of organizations making a small fortune controlling these schemes (ex. the AMA) - something ripe for disruption (I hate using this word, but it's the truth). You need quality coding/grouping/costing schemes and systems for the industry to function, but it should be many, many times more open than it currently is.

sidlls 9y ago

Price transparency is not going to fix much, if anything. It may induce rage increased blood pressure on the front end (prior to receiving service), but ultimately health care is often a "must have." Having a price list in hand doesn't suddenly make the price conscious consumer more of an expert regarding the necessity of various services estimated. Nor does it really encourage competition between competitors.

softawre 9y ago
You seem to be missing that people want to compare prices at various firms, as well as deciding whether to have a procedure.
- sidlls 9y ago
  No, I'm not missing that. It doesn't make as much of a difference as you'd think. There are plenty of companies and organizations in this space who offer "price transparency" services to varying degrees of accuracy.
froindt 9y ago
There is significant difference in the price different places charge for services. It's not necessarily deciding whether or not to do the treatment, but can also encompass consumers being cognizant of cost and choosing providers who are cheaper. Here is a planet money podcast which goes through some examples of significant expenses being saved. http://www.npr.org/sections/money/2015/10/02/445371930/episode-655-pay-patients-save-money http://www.npr.org/sections/money/2015/10/02/445371930/episo...

binarymax 9y ago

Surprise! Pricing is "transparent", although massively complicated. There are several systems, but let's take a look at Outpatient procedure pricing... A good outpatient pricing guide is here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HospitalOutpaysysfctsht.pdf https://www.cms.gov/Outreach-and-Education/Medicare-Learning... And coupled with the OPPS dataset here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PCPricer/Outpatient-PPS-Pricer-Code.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... as well as a couple others, along with a quick read of the federal register, you can kinda figure it out on your own (/s). Every bill you get must also have the codes and modifiers on it by law. Its interesting to download the dataset and look them up. --EDIT-- I incorrectly linked to the COBOL PC Pricer code above for OPPS! Here is the pricing data: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...

projectramo 9y ago
I suppose this would be helpful if they gave us the pricing before the decision of where (or, for many unfortunate people, if) to have the procedure or test done. You seem to be talking about medicare and medicaid, and not about private hospital services. Is that correct?
- binarymax 9y ago
  Yes, also sorry for the insensitive sarcasm in the previous post. It's a chicken and egg problem. In many cases you don't know if you need a test unless you've already had it. In the case of a procedure, there may be things that come up while it's happening that may complicate things. The irony is that OPPS/IPPS (inpatient) and APC (ambulatory) are meant to simplify things. Doctors and nurses usually do their best to know ahead of time, but medical procedures are complicated. Fraud does happen most often against medicare/medicaid (as covered in this article with one trick known as "upcoding"), but I believe these codes are used with insurance providers as well. If a hospital or doctor is in your provider network (HMO/PPO) then there is a pre-agreed cost between the two set on these fees. Out of network occurs when there is no agreement, so there is no "trust" between the two and the insurance provider offsets the cost to you because they are legally able to do so. In my opinion - overbilling is really caused not by pricing complexity, but by the control of the hospital and insurance provider duality. If there was no such thing as a network, and you were covered everywhere, then shenanigans with certain hospitals and providers would be more difficult.

fredgrott 9y ago

at least in the US one has to remember that Medicaid pays less than Medicare for the same procedures with private insurance taking the price higher hits

rsync 9y ago

"Let me add my big one: price transparency." Lack of price transparency bothers me as well and I wish we had it. However, I don't know if there will ever be enough pressure to manifest this. Price transparency really only matters to the person paying the bill. Our society is very rapidly evolving to consider any healthcare cost of any kind to be an insurmountable burden that no normal person could ever be expected to pay. I suspect that the incomprehensible, ridiculous healthcare schemes that we are living through currently are just death spasms on the way to fully socialized medicine. I'm sure there are rare people here and there that care how much a mile of highway costs to pave or how much a mile of city sewer line costs to install ... I would expect the same number of people to care about the cost of a medical procedure when their own cost is $0.

bonzini 9y ago
> Our society is very rapidly evolving to consider any healthcare cost of any kind to be an insurmountable burden that no normal person could ever be expected to pay On the other hand, if prices are not managed properly, premiums get higher and higher. So even if insurance pays, you should care that prices are reasonable.
- u801e 9y ago
  Car insurance doesn't cover routine maintenance, for example. So the prices for things like oil changes are relatively reasonable. If we had to go through insurance for things like that, then I'm willing to bet that the price of the service would increase substantially and auto insurance premiums would go up quite a bit as well.
  - bonzini 9y ago
    Thatv may be true but, for healthcare, there is an important difference in favor of you: a car is replaceable, a life isn't. If you don't do routine maintenance, the engine breaks down and _you_ have to pay for it. If you don't do routine checkups, you get sick and insurance has to pay---and also, if you die those sweet premiums stop coming to them. Insurance actually has a vested interest in paying for your checkups and screenings, just like in countries with socialized healthcare.

rrdharan 9y ago

This is exactly what Castlight was originally trying to solve with their transparency tool: https://en.wikipedia.org/wiki/Castlight_Health https://en.wikipedia.org/wiki/Castlight_Health Always thought their approach was quite clever and I think they did end up having some success though I'm not sure the overall impact has been as transformative as was originally hoped.

Dove 9y ago

Colorado has this cool law which, as far as I can gather, requires hospitals to report prices for various conditions. It results in tools like this: https://cha.fhsclearquote.com/ https://cha.fhsclearquote.com/ You put in your zip code, how far you want to go, find the condition, and it gives you a list of hospitals, average charge, case volume, and 5th and 95th percentile costs. I'd love a more nuanced analysis that looked at outcomes, too. Still. It's a great tool for planning purposes ("If I have an emergency, take me to . . . ")

HarryHirsch 9y ago
Hey, that's wonderful. Price transparency is always touted as the panacea for the relentless runaway growth in healthcare costs in the States. Here's the natural experiment. Has this law managed to rein in healthcare costs? You'd think it hasn't, and the missing focus on outcomes gives it away.
- Dove 9y ago
  I don't think most people know about it. It's helped rein in healthcare costs in this household at least, though? ;)

TallGuyShort 9y ago

This has been a concern for me as well. I've had doctors order things and call them one thing in person that sounds like what my insurance covers, but then they're billed as something different and I get stuck with the bill, when I really wasn't willing to pay for what it was. So now when I'm signing the papers accepting responsibility for the financial obligations if my insurance doesn't, I ask what it's going to cost if my insurance doesn't cover it. The nurses have no idea. It has to get "coded" before it's billed, and then after the bill is declined the coding people can tell me what I owe them. It's ridiculous.

DougWebb 9y ago

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And you won't know the final time until you've actually completed the feature. Doctors have a similar problem: too much uncertainty which can't be eliminated until the treatment is completed. They can't even tell you how much an office visit costs, because of the variability in how much time each patient needs, involvement of nurses and PAs, and any tests that must be performed. Lab tests are a little better: they tend to take a predictable amount of time to perform, and the analysis is pretty standardized, but there's probably still some variability when the results are not routine. That explains the fairly narrow range you were eventually able to get. I think we've got the wrong pricing model in mind for healthcare. Instead of itemizing every little action, test, and pill, we should be aggregating these costs. Pay medical professionals fixed salaries, fund institutions using budgets for fixed costs and consumables costs, and pay for it all via taxation as a common good, like public education, libraries, defense, etc.

sparky_z 9y ago
Well, in some sense that's true of most businesses, right? Some customer interactions take up more overhead and resources than others. The trick is to aggregate that uncertainty over your customer base and come up with a price that incorporates your expected average costs. There are a lot of businesses that do this successfully because they have to in order to participate in the market. The reason health care providers don't seems to me because that are isolated from competition by heavy regulation. (I'm not saying the regulation in the health care space is necessarily a bad thing on balance, but it means that change can only come through additional regulation rather than depending on hamstrung market forces.)
EvanAnderson 9y ago
I agree that the pricing model is wrong. Fee for service creates perverse incentives. Having said that, though, unlike developing a new piece of software we have vast stores of data about procedures, complications, and outcomes from other patients who have already undergone the procedure. Surely there's a pricing model, if we are bound to fee for service, that could use this trove of existing data to provide more transparency. I'd be happy with knowing pricing within half an order of magnitude.

beat 9y ago

And yet, the idea that health care "consumers" would price-shop for the lowest-cost procedure is a dogmatic core of some American ideas about how to "fix" cost in health care.

mindslight 9y ago
It certainly wouldn't fix everything, but there are certain type situations it would help fix, yet the philosophy hasn't been tried (at least as long as employer-sponsored health cartels have been around). True price transparency requires that a given provider charge exactly the same amount, regardless of the customer - prohibit bespoke "negotiated" rates, hidden kickbacks, etc. Just today I went to an major-hospital urgent care clinic that has an upfront $50 fee to "be seen". I normally avoid the system like the plague it is (hence not wanting to pay into its protection rackets), but my girlfriend had gone last week for the same week-long fever and had a good experience, so I figured I'd give it a shot. The person working at the desk told me that there "could" be "extras" that would be beyond that fee. Okay, cool. The physician's assistant recommended a chest x-ray, added it was around $75, then confirmed it was $56, and I quickly agreed. My girlfriend was a bit miffed she had turned down the x-ray without knowing the actual price. When it came time to settle up the bill, they had added on a $130 charge because the PA had added on some billable event for her seeing me, despite that this should have clearly been included in the "$50 to be seen". This is textbook fraud, yet it is allowed to persist. I complained, and was met with the standard "it's nobody's fault" attitude, because these people are really just skinjobs on an opaque computer system. If I had been my normal self (currently dealing with some major life events), I would have only paid for the x-ray and told them to shove their unauthorized charge up their ass. Alas, they dropped the fraudulent charge to $80, but the bad taste remains. If I had been told the higher charge up front, that would have been completely acceptable - and if I thought it too high I could have gone to a competitor, or simply not gone (never before in my adult life have I gone to the hospital for a fever). And that doesn't even address the travesty of the only result coming out of this visit was receiving a prescription for the exact same antibiotic my girlfriend had received a week prior! It would have been much easier for her to buy two simultaneous doses from the pharmacy, but the cartel has that locked down as well.

Shivetya 9y ago

I am always dismayed when I get back "it depends". depends on what? I want a pure cash price. however it has been this way for decades having listened to my grandfather back in the nineties trying to by his wife a wheelchair only to be told he could not buy one and no they would not give him a price. so he did what anyone of his generation did, goodwill, salvation army, and finally found one at a garage sale. he just didn't think it right someone had to pay for what he needed for his wife but damn if the system stymies people at every turn. the new billing fun I have is required visits for prescription refills on some medicines and that to me is just overbilling in a different form. I didn't need to visit other than to get permission to refill; no it does not necessarily need to be a controlled substance

beat 9y ago

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious effects. First, it gives us the in-network/out-of-network distinction. Second, it introduces complexity in the math sense to pricing - providers aren't charging one price, they're charging a wide array of prices, although those prices don't really vary much. The network thing also has the effect of reducing consumer choice in providers. I can use whatever doctors/facilities my insurance has in-network, unless I'm willing to cough up the difference out of my own pocket. Of course, fixed prices would be that wicked socialist government control we're told is ruining everything.

tptacek 9y ago
The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.
- Spooky23 9y ago
  I've got news for you... you already have government price floors on all hospital procedures.
- ams6110 9y ago
  Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?
  - tptacek 9y ago
    I think so. My point is, government price ceilings on all health procedures are so noxious to half the polity that nobody will support it, and we'll get single payer by default.

tptacek 9y ago

A few years ago my daughter needed a last-minute CT scan, the results of which would determine whether it was safe for my wife and I to go to a conference (long story). The hospital couldn't get authorization for the CT scan from Blue Cross, due to some glitch. "No problem", they said, "we'll just do the test tomorrow." Big problem for us, though; our flight out was the next day. I ended up negotiating a price for the CT on the spot; none existed. They simply couldn't tell me how much the test cost. I had to extravagantly over pay in order to get the test done at all.

blitmap 9y ago

I would love something like census data on how much a healthcare provider paid, on top of what a procedure or medicine costs. Not just how much they paid for you or your walking cane, but how much every provider pays for a syringe.

dragonwriter 9y ago
> I would love something like census data on how much a healthcare provider paid, on top of what a procedure or medicine costs. $0. By definition. But I think you may be confusing a health insurance provider (equivalently, a health care payer) with a health care provider.

pw 9y ago

It sounds like you're talking about something more complicated than a blood test, but in case you didn't know, most blood tests can be purchased online (and completed at a local branch of a national testing service e.g. Quest Diagnostics) with complete price transparency from a variety of competing providers.

gscott 9y ago

It is difficult because each insurance provider will have a different contract with the hospital or care provider. My wife works at a hospital that just upgraded from an all Dos based system to a windows based system. Her job is resolving provider disputes where the provider billed a rate that was different then their contract. Old systems + lots of different rates = confusion!

Consultant32452 9y ago

I had an equal and opposite experience getting an MRI. I also have a high deductible plan. When I was told I needed an MRI I went on my insurance provider's website to find MRI locations that are in network nearby. I called the first 5 on the list. I found that some place that was basically MRI-R-US was several hundred dollars cheaper than going to the local mega-hospital. Pricing isn't transparent because people usually aren't paying with money they perceive as their own. What do you care if your insurance company pays $200 or $2000 for that MRI? Eventually that difference shows up in the form of higher premiums, but that's far too complicated for people to respond to intelligently. Let's go one step further and imagine a world in which we completely replaced Medicare with a catastrophic coverage system. If you have a heart attack or something we'll take care of you, but for your day to day healthcare we'll just cut you a check for however much the government was previously paying. You can choose to use that money on anything you want whether it's healthcare related or not. You want to see price transparency and the power of competition to lower prices? Boom, done.

mring33621 9y ago
This will result in many people choosing to spend nothing on 'day to day' healthcare. Subsequently, this 'deferred maintenance' will result in increasing rates of catastrophic events, which will drive up costs for that part of the system. Giving cash (or cash equivalents) to people is probably not a good solution.
- Consultant32452 9y ago
  Why do you care if someone chooses quality of life over longevity? Why do we get to make that decision for them?