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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 co

• gowld 8y ago
  "150%" smells like a made-up number. Unless providers have some freedom to raise Medicare prices (which they don't), this effectively means that Medicare sets prices for everything. I'd rather see laws that strengthen consumers control over their insurance options (improving the power of the demand side of the market), including price disclosures, than pushing the rope from the back end without any competitive market forces influencing prices.
  • batbomb 8y ago
    Of course it's arbitrary but that doesn't mean it's not reasonable. Sure - they might be close to breaking even or at a slight loss when taking medicare, and that probably gives them the wiggle room they need to be sustainable. Put another way - the government gets a 33% discount compared to private insurers. If the argument is that medicare prices are unreasonably low, that seems like a different issue.
  • heydenberk 8y ago
    Have you ever tried to be a conscious consumer for health care? How about for serious health care for a life-threatening of life-changing issue like cancer or childbirth? I never understood the desire to offload any of this cognitive load to the consumer, many of whom are going through the most difficult times of their lives.
    • lewis500 8y ago
      The weird thing is that, even though a lot of policy is oriented toward making you a conscious consumer (high deductibles, coinsurance) in many cases you just can’t do it,at least not very well. My wife got an allergy test at a local allergy clinic, but she had 20% coinsurance so we tried to figure out how much it would cost. Everyone there treated us like garbage. Even when we called the billing department in advance they told us there was no way to know in advance how much the basic allergy test would cost until she saw the doctor. So we went to the clinic (stupidly), and the nurses just acted like we were crazy. Finally one did tell us what the bill would be:$12k. I had researched these tests online and was floored; that’s way more expensive than it should be, and the doctor who gave her a referral had told us it would be a reasonable price. So we were in the awkward position of just leaving the appointment. The doctor then basically talked to us somberly like we were the poorest people on earth, and said “listen, most of the test is for allergens that don’t exist in northern California.” If I just give u the local ones it’ll be like $1800.” I started laughing. Later on I read an NPR story about a lady who had a$48k allergy test from there. Just a complete scam, much worse than a car dealer because at least there they will tell you a price and they will not sell you ten extra useless cars evenif you don’t explicitly say “don’t give me ten superfluous cars for no reason.” Anyway, we got the limited test, and at the end the doctor said “listen I’m not supposed to do this, but given the financial hardship I’ll make an exception. If I don’t put the results in the system you’ll only be charged for the visit.” And he just wrote the results on a yellow notepad paper and tore it out for us. Tldr we were treated like annoying busybodies for asking the price at an in-network facility, and then treated like indigents when we balked at paying way more than anywhere else charges, for totally bs procedures.
      • ams6110 8y ago
        This is a pretty good anecdote that supports why I don't go to doctors.
    • apacheCamel 8y ago
      It has been in my experience that people who are usually for the same ideology as the parent comment are also the same people who have never had a steep medical bill thrown at them after a hospital/doctor visit. It is unfortunate that it usually takes this awful circumstance for people to see the other side but I can imagine it being hard for people to relate until it happens to them.
  • gnopgnip 8y ago
    Hospitals in CA have had to publish chargemasters for a decade already. This law would set the price at the larger of either the medicare cost, or the insurance negotiated cost
    • gumby 8y ago
      But there's no standard format for the charge master so some hospitals publish JSON, some PDFs, some random mixes of formats, and often there is no path from the home page to the published data -- you have to ask. And this is for emergency rooms where typically you don't have a choice.
  • gumby 8y ago
    > Unless providers have some freedom to raise Medicare prices (which they don't) I assume you mean by "provider" humans like doctors, nurses, aides etc. Drug and device prices are essentially not regulated. Medicare/Medicaid pays a fixed percentage of the price set by the company -- but that price is indeed set by the company! (I used to work in pharma and this dynamic was an important part of our pricing plans) If you ever need a drug with an enormous copay (say, $2000/month) you can often contact the manufacturer and get most of that copay rebated. WTF? Well the manufacturer wants a high list price for the drug so that they get paid a lot by insurance companies and MC/MC. Paying your copay means you won't object to the prescription, the rest of which (which is much larger than the copay) is paid by third parties.
  • mcguire 8y ago
    This is medical treatment; there are no competitive market forces to reduce prices.
• SkyPuncher 8y ago
  The chicken and the egg have already been laid in this case. Hospitals cannot charge less than they charge insurance otherwise it would be constituted as insurance fraud. This ends up meaning that insurance rates almost exclusively dictate the floor at which healthcare providers can charge their customers. This will simply prevent hospitals from taking advantage of consumers that lack group negotiating powers.
  • shhehebehdh 8y ago
    Hospitals cannot charge less than they charge insurance otherwise it would be constituted as insurance fraud. This implies that all insurers pay the same rates, which I think is not true.
  • gamblor956 8y ago
    Hospitals cannot charge less than they charge insurance otherwise it would be constituted as insurance fraud. Not sure where you heard that, but it's simply not true. First and foremost, every insurer negotiates different rates with hospitals and other facilities. Second, where is the insurance fraud when a hospital charges an uninsured patient less than list prices, given that no insurer is involved in the transaction?
    • deleted 8y ago
      [deleted]
• btilly 8y ago
  There is also a perverse incentive here. Per https://www.healthcare.gov/health-care-law-protections/rate-review/ https://www.healthcare.gov/health-care-law-protections/rate-... you can verify that insurers are required to spend a fixed fraction (80-85% depending on the size of the group insured) on premiums. With their own costs, profits, etc taken out of the remaining. Which means that the more they pay, the more profit they can potentially make. Therefore it is in the interests of insurance companies that hospitals be expensive but predictable. A hospital with high premiums that can be negotiated down after the fact at need is both. (Better yet is to have a pool of catchable fraud. You look as hard as you need to to get your numbers where you want them.)
  • lotsofpulp 8y ago
    This would fix itself with a sufficient number of insurance firms competing for business. Unfortunately, the majority of the desirable lives you would want to insure to balance out the sick are already in nice white collar employer healthcare plans, so it's not really profitable for multiple health insurance firms to compete.