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How this isn't already mandated by law is baffling. We like to champion the "free market" but then completely fail to implement policies that make that even rem

How this isn't already mandated by law is baffling. We like to champion the "free market" but then completely fail to implement policies that make that even remotely possible. When people talk about the free market and today's healthcare in the US I'm always like, "What are you even talking about?" You've got a situation where there is typically no competition and little or no information available to the consumer. Free market economics simply don't apply. One of the reasons I like Kaiser is because the price for just about everything is posted. I know an CT scan of stomach area, with dye is $608. Every healthcare provider should be required by law to give you an estimate price on the spot. If it's too complicated because of multiple insurance providers and their contracts they should be forced to renegotiate in a way that make this possible. "It depends" or "we can't tell you until after we bill you" is not acceptable. Can you imagine any other market working that way? How much is this car? Can you imagine if the response was, "Well, it depends. We can't tell until after you agree to take possession. It's somewhere between $40 and $40,000. But it might actually be free if you submit form X, but you have to go back in time and submit it before you walked in the door and get it approved." If the option was universal healthcare vs a free market system there would at least be a discussion. Instead it's universal healthcare vs the roll-of-the-dice healthcare system we have now.

chimeracoder 9y ago
> How this isn't already mandated by law is baffling. It's not baffling if you look at the way the medical billing system actually works. In short, Medicare is able to use existing laws (the requirement that Medicare receive the lowest price, along with the lack of mandate to reimburse COGS) to force providers to use funds from privately-insured patients to cover the costs of treating Medicare patients. From a financial point of view, the biggest adversary of price transparency (for privately-insured patients) is Medicare itself. In that light, it's not surprising that an administration which has been very clear it wants to defund Medicare (without actually admitting as much in those words) is establishing rules that will essentially restrict the effective operating budget that Medicare will work with, long-term.
dbatten 9y ago
I'm glad to see someone else shares this view. I've been saying for years that both a single payer health system and an actual free market system would be preferable to the heavily-yet-poorly-regulated mess of a "market" we have now. If we don't go the single payer route, it seems one of the #1 things we could do is to help move "insurance" back to being actual insurance (i.e., we'll keep you from being bankrupted by your medical bills) rather than a system that highly subsidizes your regular medical care but then may not actually be there for you when the bills really pile up... If consumers had to actually shop for procedures (as opposed to knowing the out-of-pocket is $250 and who knows what happens beyond that), I think you'd start to see people screaming for transparency, and medical providers would have to get their acts together. Only one of many problems, I know.
- acidtrucks 9y ago
  I agree with this, and I would also like to see more welfare programs separate from the insurance role. Insurance companies like to trick you into thinking you're getting a better deal because of them. That's not what insurance means. Keep those roles separate and straightforward.
- cookiecaper 9y ago
  Yes! Political chicanery and tribalism is exploited to make sure that the leeches stay in place, with neither side realizing that what we have now is just the worst of all worlds for everyone else. I'm pretty conservative and I'd love to see a solution to the healthcare marketplace that doesn't amount to nationalization, but at this point, the market is so distorted and fundamentally unworkable that even a nationalized healthcare industry would be preferable. There is no definition that fits better than "FUBAR" [0]. The only solution is going to be tear down the industry that we have and build something more sustainable in its place, whether that new thing is a nationalized health system or just very serious regulations to ensure healthy and functioning competition and free-market ideals (Obamacare does the opposite of this, literally making it illegal to not pay a health insurer; good policy would make non-catastrophic medical coverage illegal). Whatever the answer is, there's going to be a lot of people who are unhappy about it, but we have to fix this. That other conservatives are just slamming their heads into the sand and saying "free market" when it's impossible to know how much a given medical procedure will actually cost until 3-6 months after the fact is just utterly and fundamentally embarrassing for everyone. Pricing is the most fundamental element in a functioning market. You can't pretend to be making rational choices if you can't even find out the cost. The whole thing shows how very little anyone is paying attention to anything other than virtue signaling. The government is a big bad powerful thing, but it exists for a reason, and reducing every argument down to "just let those nice men in the Hamptons handle it, they wouldn't be rich if they weren't real smart" gets really tiresome. [0] https://www.urbandictionary.com/define.php?term=fubar https://www.urbandictionary.com/define.php?term=fubar
dfee 9y ago
There is something quite interesting in this - you claim that “free markets” are inhibited by a lack of information. I’m not sure information is requisite in “free markets”; is it? I like the idea that a free market requires some information liquidity but I’m unfamiliar with any economic theories / philosophy on the subject. Anyone here have some information that can be explored alongside that idea?
- mox1 9y ago
  Access to information is a pretty big requirement to a free market. In fact models of the free market assume "perfect information". https://en.wikipedia.org/wiki/Perfect_information https://en.wikipedia.org/wiki/Perfect_information
  - dfee 9y ago
    I can’t find anything on there that supports the idea that free markets are modeled on “perfect information”. I wouldn’t think that’s the case, anyway. Because marketing/advertising/awareness is a cost with diminishing returns, meaning it’s be prohibitively expensive to inform everyone of your product in the market, much less make accessible ALL products in a category for comparison shopping for any customer at any given time (aside from a singularity event). I do think markets require some information liquidity to be maintainable, and I generally understand free markets to be free of coercion. This sounds more like an “transparent market” though I’m not sure that’s a defined concept.
    - dfee 9y ago
      So after some light reading, theoretical free markets are predicated on complete information, and known to be impossible to achieve for the reason I mentioned. Interesting.
      - themagician 9y ago
        We assume "perfect information" because that's what lets us create simply supply and demand functions. Obviously in the real world you rarely (if ever) have perfect information—and we have models to deal with that—but healthcare has almost zero information. You either can't make a choice because you literally can't (only one provider in your area) or you can't make a choice because you don't have pricing information. So you can't maximize your own utility, because you don't know what options lead to that outcome. Just about the ONLY assumption that holds true in healthcare is that firms maximize profits. And, in a twist of irony, the only healthcare provider to provide information on pricing is Kaiser Permanente—which is a non-profit. Yeah, they still do maximize profits, but not for shareholders. So you could make the argument that healthcare as a whole meets exactly zero of the assumptions necessary for any kind of free market model to apply.
aaavl2821 9y ago
I like to think about it less as free market vs universal healthcare, and more in terms of incentives of incumbents and political power of incumbents to protect those incentives through regulation. If your regulatory regime doesn't adequately deal with incentives, then the companies you regulate will just find a new way to abuse the system to suit their needs Right now, lack of public understanding of healthcare quality and lack of transparency is a big weapon for providers. Providers have a lot of political clout, as hospitals are huge employers at local levels and thus have lots of local political influence, plus they are powerful on a national scale bc its a huge industry. There could theoretically be a large scale political movement against hospitals, though it would probably have to be grassroots, as again, hospitals have lots of control over the political incumbency because hospitals employ so many people and are important to communities. However, it is hard for grassroots movements to propose effective policy recommendations. Healthcare is complicated, and presenting simplistic solutions that sound good but probably won't work gets more grassroots support than complex solutions that may be more effective (i personally think that single payer is one of those solutions that sounds good but prob wont work, but i know thats controversial). In many cases, its probably possible for hospitals to push legislation that sounds like it is decreasing costs, but actually helps powerful hospitals make more money (one could argue that ACOs and ACA in general are an example of this). Making the issue worse is that hospitals control data, so they are able to cherry pick data that makes them look good and get public support based on these factors, but grassroots organizations cant access data to counter those claims So hospitals have tons of political cover to protect their interests through 1) control of information and 2) influence on politicians through their roles as large employers
gameswithgo 9y ago
free market health care is innately impossible (simple example: you can't pick your hospital if you are knocked unconscious in an accident) , all the first world countries save one have figured that out, and get better health for less money because of it.
slantedview 9y ago
> We like to champion the "free market" but then completely fail to implement policies that make that even remotely possible We like to talk about free markets, but we don't really want them, at least our elected representatives don't. This is the reason why Medicare is _legally prohibited_ from negotiating drug prices (something that blows the mind of pretty much everyone the first time they hear it).
- refurb 9y ago
  Saying Medicare can't negotiate drug prices is an over simplification. For physician administered drugs, the gov't has said "we will pay an average of what everyone else pays". No negotiation, just defacto proclamation of what Medicare will pay. For prescription drugs, Medicare pushes negotiation to private insurers who actually provide the coverage. They do negotiate with drug companies, often getting very steep discounts. Also, Medicare has said to drug companies "once a patient hit the donut hole, you need to give a 50% discount". Again, no negotiation, just a "if you want to do business with Medicare, deal with it". So yes, they don't negotiate drug prices, they just tell the drug companies what they are willing to pay.
- 8bitsrule 9y ago
  The word 'free' ... like the words 'nature','organic','improved','good', and 'god' ... means what you want it to. You may, of course, try to convince people that you mean something else entirely. Of all such words, the word 'democracy' is possibly the most-abused.
reaperducer 9y ago
> "It depends" or "we can't tell you until after we bill you" is not acceptable. Can you imagine any other market working that way? Auto repair. Computer repair. Probably most kinds of repair. Even when prices are posted, there's always a ton of wiggle room, and by the time you find out the work is already done.
- wyldfire 9y ago
  > Auto repair. I walk in and sign a form that states I agree to pay diagnosis fee not to exceed ~$120. Diagnosis happens, I get an estimate of the work required to execute the repair. I can't recall a time when I paid anything other than precisely the amount of the quote offered ahead of time. Maybe it happens but it's vanishingly rare. Best part is that the repair center will triage and rank the problems and often offer more than one treatment which will vary on endurance/cost/etc. Would that medicine could offer the same!
  - optimuspaul 9y ago
    But can you then pick up your phone and do a quick price comparison with nearby shops without taking your car to each one and potentially paying a diagnosis fee at each one?
    - themagician 9y ago
      Yes.
      - optimuspaul 9y ago
        How if they don't publishing pricing information?
- HarryHirsch 9y ago
  At least in auto repair you have a pretty good idea how much repair is going to cost you, and when you've been in a major wreck you get one bill that you can turn in to your insurance, not ten from the tow truck, the body shop, the paint shop, the several master mechanics &c, and none of them is out of network for insurance purposes. And the bill is usually honest. The pregnancy test for males isn't a joke, it really happened to a physician colleague of mine.
rdiddly 9y ago
Two things complicate the realization of a free market in this sector: 1) It's standard practice to proclaim one's love for free markets when one is trying to enter a market. "Competition is good!" (for me) But then as soon as one's company is entrenched in said market, one mysteriously starts doing everything possible to make it less free. "Competition is bad!" (for me) The one consistent part here is, of course, the "for me" part. 2) In most of the healthcare industry you are not the customer; your insurance company is. So the incentives are perverted accordingly. Higher prices for providers means more revenue for them, obviously; that part is straightforward. Higher prices paid by insurers, you would think, means it's harder for them, but just like any business, they adjust their prices (premiums, rates) accordingly, so they can pass costs on to the consumer and still make a profit. So higher prices from providers just means the insurer is essentially insuring a higher "volume" of claim dollars and collecting a higher volume of premiums; in other words they're doing more business and making proportionately more profit.
- nradov 9y ago
  In practice that's not really how it works any more. Most "insurance" companies don't provide much actual insurance. Instead they act as third-party administrators for self-insured employers and other group buyers. Those customers are very price sensitive, so insurers have a lot of incentive to drive down provider prices in order to maintain market share. What's increasingly breaking the free market is provider consolidation. In many areas most of the small medical practices have been bought up by larger organizations. So those large providers control so much of the market that insurers have to pay whatever they charge. For example, in Northern California if an insurer (other than Kaiser Permanente) doesn't have Sutter Health in their network then their plans aren't viable.
VeronicaJJ123 9y ago
No one claims US healthcare is free market. Not the libertarians nor the left. US healthcare resembles the Nazi model where government dictates all the parameters while the private industry acts like government's bitch. FDA, Patents Office and AMA are all in cahoots with the pharma companies instead of focusing on increasing competition and given choice to patients.
wyldfire 9y ago
> Can you imagine any other market working that way? How much is this car? Can you imagine if the response was, "Well, it depends. We can't tell until after you agree to take possession. I was livid when I couldn't find out how much it would cost for a medical procedure for my wife. All I got were excuses about how they couldn't do it. So many of us have high deductible insurance now. How can they not be setup to do this yet? How is it that we're not all demanding it? Let's be clear: there's no real problem that couldn't possibly be solved here. All the other industries do it, medicine is no different. If unpredictable problems cause new expenses, then you can either disclaim those from upfront quotes and/or try to predict likely events that would cause additional charges.
- BadCookie 9y ago
  There's a business called ZoomCare where I live that posts their prices for uninsured patients. I am quite annoyed that I, someone who has private insurance with ZoomCare as an in-network provider, was charged almost twice as much as the posted price. That money comes out of my pocket because I have one of these high deductible plans. So even places that are decent enough to post prices pull some b.s. when insurance is involved.
  - jessaustin 9y ago
    It's a bit of a gray area, but theoretically the provider has a contractual obligation to your insurer, to charge what your insurer requires. Also, they have to do more work for you than for an uninsured patient. By bringing your insurer into this, you've also made more work for them. You could have made it easier for everyone by simply telling the provider that you are uninsured.
- kmonsen 9y ago
  I got some fancy new experimental equipment when I was recovering from a broken arm. I had to sign a paper that if I lost it I could be responsible so I asked how much it was and no one could answer and I was the first to ask. In the end I signed and was never asked to return the item.
sixdimensional 9y ago
I used to work in health insurance business, and actually a lot of this information is available via CMS: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... It's mandated in a sense because all Medicare data has to be sent to and aggregated by CMS and then reported on. So I think this already happens. California also has some mandates about hospital "chargemaster" data, and the data is publicly available here: https://www.oshpd.ca.gov/chargemaster/ https://www.oshpd.ca.gov/chargemaster/
s73v3r_ 9y ago
"How this isn't already mandated by law is baffling." Cause people get in a huff about mandating things by law, complaining about "freedom".
fouc 9y ago
Good point, a free market requires a transparent market.
paranoidrobot 9y ago
> You've got a situation where there is typically no competition and little or no information available to the consumer. Free market economics simply don't apply. I think a bigger issue is that during an emergency, even in the case where you are conscious and cogent, you will often have no ability to determine if you should get treatment at that hospital, or another. I think it's utterly insane that life-critical procedures could result in someone being in massive debt (or bankrupted) through no fault of their own. This insanity is one reason why when people ask "Would you be interested in working in the US?" my immediate answer is "hell no". Even if employers were offering gold-plated top of the line insurance (doubtful), the insurers have so much wiggle room with bullshit about lifetime limits and whether they will cover X treatments, and whether specific hospitals are covered.
systematical 9y ago
I've been saying this for years. Try asking your dentist or doctor how much something will cost. Most of the time they just tell you well we bill your insurance and then your insurance figures out your cost. Once in a while I can get a cost within 10 minutes, but that makes it impossible to shop around. It should take them a few moments 90% of the time to give me a quote with only exotic procedures being the exception. Is it so hard to provide a real-time cost? It might not be easy now, but we have the damn technology. System is broken. Mandate this, give them a deadline to implement. They have deep pockets, the engineers and tech exists, delivering it within 3 years should be mandated. Let me shop around cuz capitalism... You want to cut healthcare costs? This is something 100% of congress can back, even with a hefty lobby against it. Cruz and Sanders could co-sponsor this for Christ-sake, thats how non-partisan this is.
- zentiggr 9y ago
  > System is broken. Mandate this, give them a deadline to implement. They have deep pockets, the engineers and tech exists, delivering it within 3 years should be mandated. Have you ever looked at the language specs for MUMPS? That's what a lot of medical software started out in, or is still written in. Compared to anything but Intercal, it's amazing that it works at all... 3 years indeed.
  - deleted 9y ago
    [deleted]
test6554 9y ago
lol, the free market doesn't mean free as in money. Not that I agree with this, but in a free market, information is a good to be purchased just like everything else. In other words, no matter how nervous hospitals are about transparency, there is some dollar amount that would make them willingly provide all of their pricing data. A company could buy all the data, analyze it and create a paid service that ranked hospitals by affordability, quality, etc. They could then sell access to governments, universities, and insurance companies who would then be able to make informed decisions about society, career-planning, and coverage networks.

chimeracoder 9y ago

> How this isn't already mandated by law is baffling. It's not baffling if you look at the way the medical billing system actually works. In short, Medicare is able to use existing laws (the requirement that Medicare receive the lowest price, along with the lack of mandate to reimburse COGS) to force providers to use funds from privately-insured patients to cover the costs of treating Medicare patients. From a financial point of view, the biggest adversary of price transparency (for privately-insured patients) is Medicare itself. In that light, it's not surprising that an administration which has been very clear it wants to defund Medicare (without actually admitting as much in those words) is establishing rules that will essentially restrict the effective operating budget that Medicare will work with, long-term.

dbatten 9y ago

I'm glad to see someone else shares this view. I've been saying for years that both a single payer health system and an actual free market system would be preferable to the heavily-yet-poorly-regulated mess of a "market" we have now. If we don't go the single payer route, it seems one of the #1 things we could do is to help move "insurance" back to being actual insurance (i.e., we'll keep you from being bankrupted by your medical bills) rather than a system that highly subsidizes your regular medical care but then may not actually be there for you when the bills really pile up... If consumers had to actually shop for procedures (as opposed to knowing the out-of-pocket is $250 and who knows what happens beyond that), I think you'd start to see people screaming for transparency, and medical providers would have to get their acts together. Only one of many problems, I know.

acidtrucks 9y ago
I agree with this, and I would also like to see more welfare programs separate from the insurance role. Insurance companies like to trick you into thinking you're getting a better deal because of them. That's not what insurance means. Keep those roles separate and straightforward.
cookiecaper 9y ago
Yes! Political chicanery and tribalism is exploited to make sure that the leeches stay in place, with neither side realizing that what we have now is just the worst of all worlds for everyone else. I'm pretty conservative and I'd love to see a solution to the healthcare marketplace that doesn't amount to nationalization, but at this point, the market is so distorted and fundamentally unworkable that even a nationalized healthcare industry would be preferable. There is no definition that fits better than "FUBAR" [0]. The only solution is going to be tear down the industry that we have and build something more sustainable in its place, whether that new thing is a nationalized health system or just very serious regulations to ensure healthy and functioning competition and free-market ideals (Obamacare does the opposite of this, literally making it illegal to not pay a health insurer; good policy would make non-catastrophic medical coverage illegal). Whatever the answer is, there's going to be a lot of people who are unhappy about it, but we have to fix this. That other conservatives are just slamming their heads into the sand and saying "free market" when it's impossible to know how much a given medical procedure will actually cost until 3-6 months after the fact is just utterly and fundamentally embarrassing for everyone. Pricing is the most fundamental element in a functioning market. You can't pretend to be making rational choices if you can't even find out the cost. The whole thing shows how very little anyone is paying attention to anything other than virtue signaling. The government is a big bad powerful thing, but it exists for a reason, and reducing every argument down to "just let those nice men in the Hamptons handle it, they wouldn't be rich if they weren't real smart" gets really tiresome. [0] https://www.urbandictionary.com/define.php?term=fubar https://www.urbandictionary.com/define.php?term=fubar

dfee 9y ago

There is something quite interesting in this - you claim that “free markets” are inhibited by a lack of information. I’m not sure information is requisite in “free markets”; is it? I like the idea that a free market requires some information liquidity but I’m unfamiliar with any economic theories / philosophy on the subject. Anyone here have some information that can be explored alongside that idea?

mox1 9y ago
Access to information is a pretty big requirement to a free market. In fact models of the free market assume "perfect information". https://en.wikipedia.org/wiki/Perfect_information https://en.wikipedia.org/wiki/Perfect_information
- dfee 9y ago
  I can’t find anything on there that supports the idea that free markets are modeled on “perfect information”. I wouldn’t think that’s the case, anyway. Because marketing/advertising/awareness is a cost with diminishing returns, meaning it’s be prohibitively expensive to inform everyone of your product in the market, much less make accessible ALL products in a category for comparison shopping for any customer at any given time (aside from a singularity event). I do think markets require some information liquidity to be maintainable, and I generally understand free markets to be free of coercion. This sounds more like an “transparent market” though I’m not sure that’s a defined concept.
  - dfee 9y ago
    So after some light reading, theoretical free markets are predicated on complete information, and known to be impossible to achieve for the reason I mentioned. Interesting.
    - themagician 9y ago
      We assume "perfect information" because that's what lets us create simply supply and demand functions. Obviously in the real world you rarely (if ever) have perfect information—and we have models to deal with that—but healthcare has almost zero information. You either can't make a choice because you literally can't (only one provider in your area) or you can't make a choice because you don't have pricing information. So you can't maximize your own utility, because you don't know what options lead to that outcome. Just about the ONLY assumption that holds true in healthcare is that firms maximize profits. And, in a twist of irony, the only healthcare provider to provide information on pricing is Kaiser Permanente—which is a non-profit. Yeah, they still do maximize profits, but not for shareholders. So you could make the argument that healthcare as a whole meets exactly zero of the assumptions necessary for any kind of free market model to apply.

aaavl2821 9y ago

I like to think about it less as free market vs universal healthcare, and more in terms of incentives of incumbents and political power of incumbents to protect those incentives through regulation. If your regulatory regime doesn't adequately deal with incentives, then the companies you regulate will just find a new way to abuse the system to suit their needs Right now, lack of public understanding of healthcare quality and lack of transparency is a big weapon for providers. Providers have a lot of political clout, as hospitals are huge employers at local levels and thus have lots of local political influence, plus they are powerful on a national scale bc its a huge industry. There could theoretically be a large scale political movement against hospitals, though it would probably have to be grassroots, as again, hospitals have lots of control over the political incumbency because hospitals employ so many people and are important to communities. However, it is hard for grassroots movements to propose effective policy recommendations. Healthcare is complicated, and presenting simplistic solutions that sound good but probably won't work gets more grassroots support than complex solutions that may be more effective (i personally think that single payer is one of those solutions that sounds good but prob wont work, but i know thats controversial). In many cases, its probably possible for hospitals to push legislation that sounds like it is decreasing costs, but actually helps powerful hospitals make more money (one could argue that ACOs and ACA in general are an example of this). Making the issue worse is that hospitals control data, so they are able to cherry pick data that makes them look good and get public support based on these factors, but grassroots organizations cant access data to counter those claims So hospitals have tons of political cover to protect their interests through 1) control of information and 2) influence on politicians through their roles as large employers

gameswithgo 9y ago

free market health care is innately impossible (simple example: you can't pick your hospital if you are knocked unconscious in an accident) , all the first world countries save one have figured that out, and get better health for less money because of it.

slantedview 9y ago

> We like to champion the "free market" but then completely fail to implement policies that make that even remotely possible We like to talk about free markets, but we don't really want them, at least our elected representatives don't. This is the reason why Medicare is _legally prohibited_ from negotiating drug prices (something that blows the mind of pretty much everyone the first time they hear it).

refurb 9y ago
Saying Medicare can't negotiate drug prices is an over simplification. For physician administered drugs, the gov't has said "we will pay an average of what everyone else pays". No negotiation, just defacto proclamation of what Medicare will pay. For prescription drugs, Medicare pushes negotiation to private insurers who actually provide the coverage. They do negotiate with drug companies, often getting very steep discounts. Also, Medicare has said to drug companies "once a patient hit the donut hole, you need to give a 50% discount". Again, no negotiation, just a "if you want to do business with Medicare, deal with it". So yes, they don't negotiate drug prices, they just tell the drug companies what they are willing to pay.
8bitsrule 9y ago
The word 'free' ... like the words 'nature','organic','improved','good', and 'god' ... means what you want it to. You may, of course, try to convince people that you mean something else entirely. Of all such words, the word 'democracy' is possibly the most-abused.

reaperducer 9y ago

> "It depends" or "we can't tell you until after we bill you" is not acceptable. Can you imagine any other market working that way? Auto repair. Computer repair. Probably most kinds of repair. Even when prices are posted, there's always a ton of wiggle room, and by the time you find out the work is already done.

wyldfire 9y ago
> Auto repair. I walk in and sign a form that states I agree to pay diagnosis fee not to exceed ~$120. Diagnosis happens, I get an estimate of the work required to execute the repair. I can't recall a time when I paid anything other than precisely the amount of the quote offered ahead of time. Maybe it happens but it's vanishingly rare. Best part is that the repair center will triage and rank the problems and often offer more than one treatment which will vary on endurance/cost/etc. Would that medicine could offer the same!
- optimuspaul 9y ago
  But can you then pick up your phone and do a quick price comparison with nearby shops without taking your car to each one and potentially paying a diagnosis fee at each one?
  - themagician 9y ago
    Yes.
    - optimuspaul 9y ago
      How if they don't publishing pricing information?
HarryHirsch 9y ago
At least in auto repair you have a pretty good idea how much repair is going to cost you, and when you've been in a major wreck you get one bill that you can turn in to your insurance, not ten from the tow truck, the body shop, the paint shop, the several master mechanics &c, and none of them is out of network for insurance purposes. And the bill is usually honest. The pregnancy test for males isn't a joke, it really happened to a physician colleague of mine.

rdiddly 9y ago

Two things complicate the realization of a free market in this sector: 1) It's standard practice to proclaim one's love for free markets when one is trying to enter a market. "Competition is good!" (for me) But then as soon as one's company is entrenched in said market, one mysteriously starts doing everything possible to make it less free. "Competition is bad!" (for me) The one consistent part here is, of course, the "for me" part. 2) In most of the healthcare industry you are not the customer; your insurance company is. So the incentives are perverted accordingly. Higher prices for providers means more revenue for them, obviously; that part is straightforward. Higher prices paid by insurers, you would think, means it's harder for them, but just like any business, they adjust their prices (premiums, rates) accordingly, so they can pass costs on to the consumer and still make a profit. So higher prices from providers just means the insurer is essentially insuring a higher "volume" of claim dollars and collecting a higher volume of premiums; in other words they're doing more business and making proportionately more profit.

nradov 9y ago
In practice that's not really how it works any more. Most "insurance" companies don't provide much actual insurance. Instead they act as third-party administrators for self-insured employers and other group buyers. Those customers are very price sensitive, so insurers have a lot of incentive to drive down provider prices in order to maintain market share. What's increasingly breaking the free market is provider consolidation. In many areas most of the small medical practices have been bought up by larger organizations. So those large providers control so much of the market that insurers have to pay whatever they charge. For example, in Northern California if an insurer (other than Kaiser Permanente) doesn't have Sutter Health in their network then their plans aren't viable.

VeronicaJJ123 9y ago

No one claims US healthcare is free market. Not the libertarians nor the left. US healthcare resembles the Nazi model where government dictates all the parameters while the private industry acts like government's bitch. FDA, Patents Office and AMA are all in cahoots with the pharma companies instead of focusing on increasing competition and given choice to patients.

wyldfire 9y ago

> Can you imagine any other market working that way? How much is this car? Can you imagine if the response was, "Well, it depends. We can't tell until after you agree to take possession. I was livid when I couldn't find out how much it would cost for a medical procedure for my wife. All I got were excuses about how they couldn't do it. So many of us have high deductible insurance now. How can they not be setup to do this yet? How is it that we're not all demanding it? Let's be clear: there's no real problem that couldn't possibly be solved here. All the other industries do it, medicine is no different. If unpredictable problems cause new expenses, then you can either disclaim those from upfront quotes and/or try to predict likely events that would cause additional charges.

BadCookie 9y ago
There's a business called ZoomCare where I live that posts their prices for uninsured patients. I am quite annoyed that I, someone who has private insurance with ZoomCare as an in-network provider, was charged almost twice as much as the posted price. That money comes out of my pocket because I have one of these high deductible plans. So even places that are decent enough to post prices pull some b.s. when insurance is involved.
- jessaustin 9y ago
  It's a bit of a gray area, but theoretically the provider has a contractual obligation to your insurer, to charge what your insurer requires. Also, they have to do more work for you than for an uninsured patient. By bringing your insurer into this, you've also made more work for them. You could have made it easier for everyone by simply telling the provider that you are uninsured.
kmonsen 9y ago
I got some fancy new experimental equipment when I was recovering from a broken arm. I had to sign a paper that if I lost it I could be responsible so I asked how much it was and no one could answer and I was the first to ask. In the end I signed and was never asked to return the item.

sixdimensional 9y ago

I used to work in health insurance business, and actually a lot of this information is available via CMS: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... It's mandated in a sense because all Medicare data has to be sent to and aggregated by CMS and then reported on. So I think this already happens. California also has some mandates about hospital "chargemaster" data, and the data is publicly available here: https://www.oshpd.ca.gov/chargemaster/ https://www.oshpd.ca.gov/chargemaster/

s73v3r_ 9y ago

"How this isn't already mandated by law is baffling." Cause people get in a huff about mandating things by law, complaining about "freedom".

fouc 9y ago

Good point, a free market requires a transparent market.

paranoidrobot 9y ago

> You've got a situation where there is typically no competition and little or no information available to the consumer. Free market economics simply don't apply. I think a bigger issue is that during an emergency, even in the case where you are conscious and cogent, you will often have no ability to determine if you should get treatment at that hospital, or another. I think it's utterly insane that life-critical procedures could result in someone being in massive debt (or bankrupted) through no fault of their own. This insanity is one reason why when people ask "Would you be interested in working in the US?" my immediate answer is "hell no". Even if employers were offering gold-plated top of the line insurance (doubtful), the insurers have so much wiggle room with bullshit about lifetime limits and whether they will cover X treatments, and whether specific hospitals are covered.

systematical 9y ago

I've been saying this for years. Try asking your dentist or doctor how much something will cost. Most of the time they just tell you well we bill your insurance and then your insurance figures out your cost. Once in a while I can get a cost within 10 minutes, but that makes it impossible to shop around. It should take them a few moments 90% of the time to give me a quote with only exotic procedures being the exception. Is it so hard to provide a real-time cost? It might not be easy now, but we have the damn technology. System is broken. Mandate this, give them a deadline to implement. They have deep pockets, the engineers and tech exists, delivering it within 3 years should be mandated. Let me shop around cuz capitalism... You want to cut healthcare costs? This is something 100% of congress can back, even with a hefty lobby against it. Cruz and Sanders could co-sponsor this for Christ-sake, thats how non-partisan this is.

zentiggr 9y ago
> System is broken. Mandate this, give them a deadline to implement. They have deep pockets, the engineers and tech exists, delivering it within 3 years should be mandated. Have you ever looked at the language specs for MUMPS? That's what a lot of medical software started out in, or is still written in. Compared to anything but Intercal, it's amazing that it works at all... 3 years indeed.
- deleted 9y ago
  [deleted]

test6554 9y ago

lol, the free market doesn't mean free as in money. Not that I agree with this, but in a free market, information is a good to be purchased just like everything else. In other words, no matter how nervous hospitals are about transparency, there is some dollar amount that would make them willingly provide all of their pricing data. A company could buy all the data, analyze it and create a paid service that ranked hospitals by affordability, quality, etc. They could then sell access to governments, universities, and insurance companies who would then be able to make informed decisions about society, career-planning, and coverage networks.