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Part of it is because consumers are completely detached from the price aspect of medical care. Getting an estimate, shopping around? Forget it. It’s a black

by xienze 8y ago

Part of it is because consumers are completely detached from the price aspect of medical care. Getting an estimate, shopping around? Forget it. It’s a black box. And, frankly, part of it is because hospitals can’t refuse care to anyone and if they can’t pay, someone else has to.

darkerside 8y ago
It's crazy because the initial idea was, insurers would be more educated buyers and thus better able to negotiate with medical providers. As it turns out, with no skin in the game, they hardly seem to care to negotiate prices at all!
- olliej 8y ago
  They do negotiate - the prices they’re charged are vastly less than what you would be as an individual. As far as I can tell the problem is really the big HMOs seem to be essentially managing another companies money, rather than their own, and they essentially get a cut of money going in and out of them.
iwiririwo 8y ago
That's what mandatory insurance is for. Everyone pays what they can, and gets what they need. Doesn't work perfectly, but allows me to go to a hospital anytime without being broke after. There's benefit for everybody, which is risk reduction. You actually blame poor people for going to the ER in case of emergency.
maxxxxx 8y ago
"And, frankly, part of it is because hospitals can’t refuse care to anyone and if they can’t pay, someone else has to. " I think that's a cheap excuse they have to rip off everybody else. I would like to see the actual numbers of people who aren't paying and what losses they incur.
- maxerickson 8y ago
  It's substantial but doesn't come anywhere near explaining prices. The PDF here has some numbers: https://www.aha.org/data-insights/2018-01-03-uncompensated-hospital-care-cost-fact-sheet-december-2017-update https://www.aha.org/data-insights/2018-01-03-uncompensated-h... Somewhere in the ballpark of $40 billion dollars a year vs total revenues in the ballpark of $3 trillion. Various aspects of Obamacare had the effect of leveling them off. There is likely additional underpayment due to Medicaid and Medicare (to the extent those programs are underfunded and operate by mandating care, they are a hidden tax).

by xienze 8y ago

darkerside 8y ago

It's crazy because the initial idea was, insurers would be more educated buyers and thus better able to negotiate with medical providers. As it turns out, with no skin in the game, they hardly seem to care to negotiate prices at all!

olliej 8y ago
They do negotiate - the prices they’re charged are vastly less than what you would be as an individual. As far as I can tell the problem is really the big HMOs seem to be essentially managing another companies money, rather than their own, and they essentially get a cut of money going in and out of them.

iwiririwo 8y ago

That's what mandatory insurance is for. Everyone pays what they can, and gets what they need. Doesn't work perfectly, but allows me to go to a hospital anytime without being broke after. There's benefit for everybody, which is risk reduction. You actually blame poor people for going to the ER in case of emergency.

maxxxxx 8y ago

"And, frankly, part of it is because hospitals can’t refuse care to anyone and if they can’t pay, someone else has to. " I think that's a cheap excuse they have to rip off everybody else. I would like to see the actual numbers of people who aren't paying and what losses they incur.

maxerickson 8y ago
It's substantial but doesn't come anywhere near explaining prices. The PDF here has some numbers: https://www.aha.org/data-insights/2018-01-03-uncompensated-hospital-care-cost-fact-sheet-december-2017-update https://www.aha.org/data-insights/2018-01-03-uncompensated-h... Somewhere in the ballpark of $40 billion dollars a year vs total revenues in the ballpark of $3 trillion. Various aspects of Obamacare had the effect of leveling them off. There is likely additional underpayment due to Medicaid and Medicare (to the extent those programs are underfunded and operate by mandating care, they are a hidden tax).