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How about a law stating that a medical provider has to charge everyone the same price for the same service? This would eliminate the many-to-many negotiation p

by ericd 8y ago

How about a law stating that a medical provider has to charge everyone the same price for the same service? This would eliminate the many-to-many negotiation problem that contributes to absurdities like Duke University Hospital having 1,300 billing clerks for 900 beds (https://www.pbs.org/newshour/economy/why-does-health-care-cost-so-m https://www.pbs.org/newshour/economy/why-does-health-care-co...). It would also make it much easier to estimate costs before going to a provider, because instead of having 1000 different prices, that service will have one price (albeit with some variability depending on what's actually done). If you paired it with a law that mandated that hospitals publish their prices for services in a simple JSON format, such that companies could use it freely to create price comparison tools, suddenly you'd make it much easier for market forces to push prices down to sane levels. It's insane how difficult it is currently to figure out how much even routine and planned operations like delivering a child will cost, and as a result people don't bother to even try, so there's no incentive for hospitals to keep their list prices anywhere near the realm of sanity.

rsynnott 8y ago
I mean, realistically, probably because the industry lobbyists don’t care for the idea. It is completely obvious as a (partial) solution, and isn’t even really anti-market, so should be acceptable to all sides of the POLITICAL spectrum. But the industry wouldn’t like it very much.
- tonyedgecombe 8y ago
  The industry isn't going to like anything that works.
  - rsynnott 8y ago
    So, ban or severely restrict lobbying and corporate donations. I mean, it’s not like this is some absurd pie-in-the-sky idea; most developed democracies restrict both.
maxerickson 8y ago
So everyone pays Medicaid prices? Medicare prices?
- ericd 8y ago
  If a doctor accepts the Medicare price, then they'd be obligated to charge everyone else the same price. Or they're free to charge more, and not accept Medicare patients (or the patient would be responsible for the amount over the coverage). This would be easy to look up ahead of time, since their prices would be public and easily accessible via a variety of price comparison tools, and it would be easy for tools to let you filter by whether your insurance covered the amount charged by that provider for that service.
  - maxerickson 8y ago
    You make it sound so easy. People on Medicare vote.
    - ericd 8y ago
      I never said it would be easy politically. Healthcare is a morass with a huge number of entrenched and entangled interests. And the dark side of reducing its absurd costs is that much of the reason for the high price is a bunch of pretty unnecessary high paying jobs involved that largely exist to deal with the system's complexity. And while most people can cheer for lower healthcare cost, they might have a harder time cheering for putting all the people out of work. Worse, it's an industry that employs lots of people in every locality. So it's politically very difficult to tackle. I don't think this would be that terrible for Medicare patients, though. Doctors who were fully covered by Medicare would make it known far and wide, and those who didn't but have large numbers of Medicare patients would see large drops in their patient load.
  - ThrustVectoring 8y ago
    Medicare pricing is currently only possible because healthcare providers can cross-subsidize Medicare patients via raising prices on other patient pools. It's not going to work.
sharemywin 8y ago
While were at it lets require health insurance be required to bill as a percentage of income.
- arcticbull 8y ago
  Or maybe, the state determines a fee schedule, each doctor is paid the same amount for each procedure completed by the state, then the state bills everyone as a percentage of their income, via taxes? And everyone's covered. And there's no pre-existing conditions. Or co-pays. Or deductibles. Or out of pocket maximums. If only there were examples to draw from ;)
  - jeremyt 8y ago
    If only "pay for service" wasn't a recognized problem that we're currently trying to solve itself. It's almost as if when doctors are paid per procedure, they do a bunch of unnecessary procedures. The idea that healthcare can be centrally managed comes from people assuming it's way simpler than it is.
    - arcticbull 8y ago
      Here's a good place to start. You know that demand in the US for a transparent fee schedule so people know what things cost at hospitals? Here's the list of every service administered in Ontario and exactly how much it costs: http://www.health.gov.on.ca/en/pro/programs/ohip/sob/ http://www.health.gov.on.ca/en/pro/programs/ohip/sob/ Those are in Canadian dollars by the way; yes, a specialist consult costs the province $100 (and you, $0). It's hard to hear that you're trying to pre-solve cost problems you don't know you'll have if you were to switch to central management when the US is currently the most expensive healthcare system per capita by a lot (like, double), and is ranked 36th by the WHO. Far less expensive systems per capita are ranked dramatically higher even though they have a fixed fee schedule. Sure, there's room to improve, but maybe knock out the low-hanging fruit first. Further, if that's too distasteful, there's other ways to make this work; the Swiss system forbids private insurers from making profit on the basic administration of healthcare, and caps individuals out of pocket expenses. I'm sure the insurers would find a way under such constraints.
deleted 8y ago
[deleted]
IncRnd 8y ago
> It's insane how difficult it is currently to figure out how much even routine and planned operations like delivering a child will cost, and as a result people don't bother to even try In my real-life experience, that is false. When my wife was pregnant we asked the doctor if we could pay upfront. She said yes, gave us a price, and explained what that would cover. We paid her; the delivery was at the hospital, and everything went well.
- deleted 8y ago
  [deleted]
- ericd 8y ago
  Was the doctor's quoted price the same as the all-in price? In our case, the OB's bill was something like 10% of the final total, which was close to 6 figures, despite being bog standard.
  - IncRnd 8y ago
    Your total seems to be one to two orders of magnitude greater than what we paid. We fully prepaid, and there were no complications. However, I wasn't talking about cost but replying to the assertion that one could not forecast costs. I replied to, "It's insane how difficult it is currently to figure out how much even routine and planned operations like delivering a child will cost, and as a result people don't bother to even try". Your post seemed to refute that as well.

by ericd 8y ago

rsynnott 8y ago

I mean, realistically, probably because the industry lobbyists don’t care for the idea. It is completely obvious as a (partial) solution, and isn’t even really anti-market, so should be acceptable to all sides of the POLITICAL spectrum. But the industry wouldn’t like it very much.

tonyedgecombe 8y ago
The industry isn't going to like anything that works.
- rsynnott 8y ago
  So, ban or severely restrict lobbying and corporate donations. I mean, it’s not like this is some absurd pie-in-the-sky idea; most developed democracies restrict both.

maxerickson 8y ago

So everyone pays Medicaid prices? Medicare prices?

ericd 8y ago
If a doctor accepts the Medicare price, then they'd be obligated to charge everyone else the same price. Or they're free to charge more, and not accept Medicare patients (or the patient would be responsible for the amount over the coverage). This would be easy to look up ahead of time, since their prices would be public and easily accessible via a variety of price comparison tools, and it would be easy for tools to let you filter by whether your insurance covered the amount charged by that provider for that service.
- maxerickson 8y ago
  You make it sound so easy. People on Medicare vote.
  - ericd 8y ago
    I never said it would be easy politically. Healthcare is a morass with a huge number of entrenched and entangled interests. And the dark side of reducing its absurd costs is that much of the reason for the high price is a bunch of pretty unnecessary high paying jobs involved that largely exist to deal with the system's complexity. And while most people can cheer for lower healthcare cost, they might have a harder time cheering for putting all the people out of work. Worse, it's an industry that employs lots of people in every locality. So it's politically very difficult to tackle. I don't think this would be that terrible for Medicare patients, though. Doctors who were fully covered by Medicare would make it known far and wide, and those who didn't but have large numbers of Medicare patients would see large drops in their patient load.
- ThrustVectoring 8y ago
  Medicare pricing is currently only possible because healthcare providers can cross-subsidize Medicare patients via raising prices on other patient pools. It's not going to work.

sharemywin 8y ago

While were at it lets require health insurance be required to bill as a percentage of income.

arcticbull 8y ago
Or maybe, the state determines a fee schedule, each doctor is paid the same amount for each procedure completed by the state, then the state bills everyone as a percentage of their income, via taxes? And everyone's covered. And there's no pre-existing conditions. Or co-pays. Or deductibles. Or out of pocket maximums. If only there were examples to draw from ;)
- jeremyt 8y ago
  If only "pay for service" wasn't a recognized problem that we're currently trying to solve itself. It's almost as if when doctors are paid per procedure, they do a bunch of unnecessary procedures. The idea that healthcare can be centrally managed comes from people assuming it's way simpler than it is.
  - arcticbull 8y ago
    Here's a good place to start. You know that demand in the US for a transparent fee schedule so people know what things cost at hospitals? Here's the list of every service administered in Ontario and exactly how much it costs: http://www.health.gov.on.ca/en/pro/programs/ohip/sob/ http://www.health.gov.on.ca/en/pro/programs/ohip/sob/ Those are in Canadian dollars by the way; yes, a specialist consult costs the province $100 (and you, $0). It's hard to hear that you're trying to pre-solve cost problems you don't know you'll have if you were to switch to central management when the US is currently the most expensive healthcare system per capita by a lot (like, double), and is ranked 36th by the WHO. Far less expensive systems per capita are ranked dramatically higher even though they have a fixed fee schedule. Sure, there's room to improve, but maybe knock out the low-hanging fruit first. Further, if that's too distasteful, there's other ways to make this work; the Swiss system forbids private insurers from making profit on the basic administration of healthcare, and caps individuals out of pocket expenses. I'm sure the insurers would find a way under such constraints.

deleted 8y ago

[deleted]

IncRnd 8y ago

> It's insane how difficult it is currently to figure out how much even routine and planned operations like delivering a child will cost, and as a result people don't bother to even try In my real-life experience, that is false. When my wife was pregnant we asked the doctor if we could pay upfront. She said yes, gave us a price, and explained what that would cover. We paid her; the delivery was at the hospital, and everything went well.

deleted 8y ago
[deleted]
ericd 8y ago
Was the doctor's quoted price the same as the all-in price? In our case, the OB's bill was something like 10% of the final total, which was close to 6 figures, despite being bog standard.
- IncRnd 8y ago
  Your total seems to be one to two orders of magnitude greater than what we paid. We fully prepaid, and there were no complications. However, I wasn't talking about cost but replying to the assertion that one could not forecast costs. I replied to, "It's insane how difficult it is currently to figure out how much even routine and planned operations like delivering a child will cost, and as a result people don't bother to even try". Your post seemed to refute that as well.