6 ms·

Preventing attempts at collections (like this law does), insurance reform, "medicare for all", etc, etc. are nice but they don't address the root problem. Cost

Preventing attempts at collections (like this law does), insurance reform, "medicare for all", etc, etc. are nice but they don't address the root problem. Costs are out of control. Until we find a way to control costs we will still pay way too much. All that changes until then is who pays what amounts and the point at which payment is made. The hospitals are just going to shuffle around who pays what in order to make up for the income they're not getting from surprise bills unless there's something (actual competition, a government payer who won't put up with that crap, etc,) to stop them. Sure this is a step in a good direction but there's only so many band-aids you can apply to a gunshot wound. While unscrupulous practices like this bill takes aim at should be weeded out it strikes me as hopeless in light of the bigger picture.

howard941 8y ago
Do you have any cost control ideas?
- thorwasdfasdf 8y ago
  Set reasonable low Price ceilings on procedures/ per night stays, pills, etc, adjusted on location and make the hospital liable for any costs above those. I don't see why a night in the hospital should cost 8000$ per night or why a pill should cost 100$, or a little ambulance ride should be 2800$ etc.
nradov 8y ago
Yes the systemic cost is the real problem. As our population becomes older, more obese, and more sedentary the costs will keep increasing. Ultimately I think we're going to need some combination of legislated cost controls and care rationing based on QALYs. Otherwise healthcare will collapse the entire economy. This will all be hugely unpopular.
zaroth 8y ago
The problem is two-sided. Yes the costs paid by the hospital, and the cost of the techniques and tools used by the hospital are all too high, because the system does not properly incentivize finding lower cost solutions that may be equally effective and safe. In this case the problem is exacerbated by the way that privately insured patients are being exploited to subsidize publicly insured patients; “A hospital spokesperson initially told Vox that the hospital’s focus is on serving those with public health coverage, even if that means offsetting those costs with high bills for the privately insured.” It should be illegal to charge two different people different prices for the same procedure at the same hospital. At a more granular level, it should be illegal to price discriminate on anything that can be itemized. The middle and upper class patients are exploited to pay for publically insured patients who get service below cost which the hospital can’t legally turn away.
- exabrial 8y ago
  > It should be illegal to charge two different people different prices for the same procedure at the same hospital I think you're close to a solution with minimal regulatory intervention (Which so far has only made things even more expensive: ACA for example). I'm curious how this would be reconciled with insurer networks though. A cost savings to insurers IS to have networks and discounts.
  - larkost 8y ago
    Two comments: 1. The ACA has by all accounts kept the growth of healthcare costs in check. Yes they have gone up, but at not nearly the rate they were going up before it, let alone the increased rate that most expected. If you start getting into the details this makes a lot of sense, but those details often get lost in the conversation about mandatory coverage (and the subsidies to make that possible on the low end). 2. This sort of cost savings to the insurers is more moving the costs to other people, thus negating most of the cost savings incentives.
lykr0n 8y ago
It kinda does. Second, the bill would regulate the prices that the hospital could charge for its care, limiting the fees to 150 percent of the Medicare price or the average contracted rate in the area, whichever is greater.
xoa 8y ago
>Costs are out of control. Until we find a way to control costs we will still pay way too much. But aren't the provider side actors (hospitals, insurance networks, etc) the best placed to figure out how to control costs? It seems like a significant reason therefore for high costs may be because they simply do not feel any significant pressure to reduce them, in part precisely because of abusive behavior like this. If the spigots of inflowing coerced money are tightened, wouldn't that itself be motivation to try to find savings? It is in other industries at least. Same thing with more information and transparency, if providers are required by law to have all the costs laid out upfront and that is all they are ever allowed to collect that itself seems like a reasonable first step towards at the least motivating them to get their own internal systems in order.
- vladgur 8y ago
  Well, part of ACA, I believe was to limit what private insurers can make to 15-20% over their cost. While this had good intentions, this was not fully thought through because this incentivized insurers to cover more treatment and more expensive treatments because that’s how they could grow their profits which were fixed percentage wise.
  - gnopgnip 8y ago
    Is there any evidence of that happening? Is it a bad thing that an insurance company is incentivized to cover an expensive procedure instead of denying it?
  - dsfyu404ed 8y ago
    >this was not fully thought through That's a charitable way of putting it. It turned the insurers into money movers skimming their profit of the top. It somewhat incentivized them to let costs skyrocket. The more money that changes hands through them the better. A fixed % of a big number is more than a fixed % of a small number. The only thing that stops insurers for covering anything at any price and then just passing the cost and letting premiums really go crazy is that there's still some traces of competition left in the market so people (corporate persons or otherwise) will jump ship to other insurers if premiums get too high. You can look at the profit limits as incentivizing them to cover more expensive care (which it does do) but it comes at the expense of removing any reason for insurers to seriously care about cost so long as they're somewhat competitive with whoever their competition is. That's a very big tradeoff.
mikeash 8y ago
This isn’t really the same. Getting rid of massive surprise bills is valuable even if you don’t reduce costs at all. Conversely, it’s possible to cut costs while still having the possibility of financially ruinous surprise bills.

howard941 8y ago

Do you have any cost control ideas?

thorwasdfasdf 8y ago
Set reasonable low Price ceilings on procedures/ per night stays, pills, etc, adjusted on location and make the hospital liable for any costs above those. I don't see why a night in the hospital should cost 8000$ per night or why a pill should cost 100$, or a little ambulance ride should be 2800$ etc.

nradov 8y ago

Yes the systemic cost is the real problem. As our population becomes older, more obese, and more sedentary the costs will keep increasing. Ultimately I think we're going to need some combination of legislated cost controls and care rationing based on QALYs. Otherwise healthcare will collapse the entire economy. This will all be hugely unpopular.

zaroth 8y ago

The problem is two-sided. Yes the costs paid by the hospital, and the cost of the techniques and tools used by the hospital are all too high, because the system does not properly incentivize finding lower cost solutions that may be equally effective and safe. In this case the problem is exacerbated by the way that privately insured patients are being exploited to subsidize publicly insured patients; “A hospital spokesperson initially told Vox that the hospital’s focus is on serving those with public health coverage, even if that means offsetting those costs with high bills for the privately insured.” It should be illegal to charge two different people different prices for the same procedure at the same hospital. At a more granular level, it should be illegal to price discriminate on anything that can be itemized. The middle and upper class patients are exploited to pay for publically insured patients who get service below cost which the hospital can’t legally turn away.

exabrial 8y ago
> It should be illegal to charge two different people different prices for the same procedure at the same hospital I think you're close to a solution with minimal regulatory intervention (Which so far has only made things even more expensive: ACA for example). I'm curious how this would be reconciled with insurer networks though. A cost savings to insurers IS to have networks and discounts.
- larkost 8y ago
  Two comments: 1. The ACA has by all accounts kept the growth of healthcare costs in check. Yes they have gone up, but at not nearly the rate they were going up before it, let alone the increased rate that most expected. If you start getting into the details this makes a lot of sense, but those details often get lost in the conversation about mandatory coverage (and the subsidies to make that possible on the low end). 2. This sort of cost savings to the insurers is more moving the costs to other people, thus negating most of the cost savings incentives.

lykr0n 8y ago

It kinda does. Second, the bill would regulate the prices that the hospital could charge for its care, limiting the fees to 150 percent of the Medicare price or the average contracted rate in the area, whichever is greater.

xoa 8y ago

>Costs are out of control. Until we find a way to control costs we will still pay way too much. But aren't the provider side actors (hospitals, insurance networks, etc) the best placed to figure out how to control costs? It seems like a significant reason therefore for high costs may be because they simply do not feel any significant pressure to reduce them, in part precisely because of abusive behavior like this. If the spigots of inflowing coerced money are tightened, wouldn't that itself be motivation to try to find savings? It is in other industries at least. Same thing with more information and transparency, if providers are required by law to have all the costs laid out upfront and that is all they are ever allowed to collect that itself seems like a reasonable first step towards at the least motivating them to get their own internal systems in order.

vladgur 8y ago
Well, part of ACA, I believe was to limit what private insurers can make to 15-20% over their cost. While this had good intentions, this was not fully thought through because this incentivized insurers to cover more treatment and more expensive treatments because that’s how they could grow their profits which were fixed percentage wise.
- gnopgnip 8y ago
  Is there any evidence of that happening? Is it a bad thing that an insurance company is incentivized to cover an expensive procedure instead of denying it?
- dsfyu404ed 8y ago
  >this was not fully thought through That's a charitable way of putting it. It turned the insurers into money movers skimming their profit of the top. It somewhat incentivized them to let costs skyrocket. The more money that changes hands through them the better. A fixed % of a big number is more than a fixed % of a small number. The only thing that stops insurers for covering anything at any price and then just passing the cost and letting premiums really go crazy is that there's still some traces of competition left in the market so people (corporate persons or otherwise) will jump ship to other insurers if premiums get too high. You can look at the profit limits as incentivizing them to cover more expensive care (which it does do) but it comes at the expense of removing any reason for insurers to seriously care about cost so long as they're somewhat competitive with whoever their competition is. That's a very big tradeoff.

mikeash 8y ago

This isn’t really the same. Getting rid of massive surprise bills is valuable even if you don’t reduce costs at all. Conversely, it’s possible to cut costs while still having the possibility of financially ruinous surprise bills.