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> I've always wondered what's stopping someone from creating a non-profit and just having people join it in order to give the non-profit ability to negotiate lo
by SkyPuncher 9y ago
> I've always wondered what's stopping someone from creating a non-profit and just having people join it in order to give the non-profit ability to negotiate lower prices.
Likely the fact that many of these prices are basically standardized because of CMS. Providers basically look to what the Medicare/Medicaid standard is as a benchmark for pricing.
As a provider why accept a lower price from insurance when the gov't is providing a backlog of people at predetermined prices?
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Unless these companies are also looking to enter the provider space, they will likely only competing on marginally better insurance rates.
- chimeracoder 9y ago> As a provider why accept a lower price from insurance when the gov't is providing a backlog of people at predetermined prices? This isn't even an option on the table. Private insurers are generally required by law to pay more than Medicare does. And besides, Medicare reimburses rates that are below COGS, so providers charge private insurers more in order to make up the difference. Otherwise, they wouldn't be able to accept Medicare patients at all; they'd literally lose money on a per patient basis.
- shanusmagnus 9y agoThis is so important and so little understood: Medicare can demand the prices that it does because other payers will be making up for it. Their low prices create externalities in the rest of the insured market.
- qaq 9y agoHave you seen rates Medicare/Medicaid pays? It's generally way lower vs what private insurance providers can negotiate
- dannyw 9y agoAmazon is basically about vertical integration. I'd be surprised if they do not enter the provider space. Don't forget the rumors that Amazon is planning to offer its own branded generics.