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The simplest and most common sense medical reform I can think of would be to make it illegal to charge a different price to two different patients, regardless o

by zaroth 8y ago

The simplest and most common sense medical reform I can think of would be to make it illegal to charge a different price to two different patients, regardless of insurance carrier or self-insured, for the same medicine, procedure, or equipment at the same facility. There should be the Price. The amount that insurance Covers. And the remainder is the Patient Responsibility. Either that, or a cash patient cannot be charged more than the Medicare allowed amount for the same procedure. Insurers should not be horse trading to pay more or less for one procedure or another. And if you happen to be treated by someone who is out of network, you shouldn’t be paying an exhorbinant price on top of that higher copay or deductible. The entire concept of negotiated rates is a fraud IMO, and could be reformed with a simple regulation that would I think be supported by a vast majority of Americans. Price changes should have to go into effect for all patients at once, and be published in some ledger at least some number of days ahead of time.

spockz 8y ago
This is kind of what we have in The Netherlands. Insurers make standard prices in collaboration with a large part of the healthcare providers. Healthcare providers have to bill using the exact code of the treatment and that amount cannot be more than the agreed amount. This leads to funny things like there being Treatment X variant A-E for getting a different price for the same treatment based on some arbitrary thing. It also means that now the insurer knows exactly what has been done because the bill says replaced filling on 3rd upper molar with this and that material etc. Before it was just “filling”. Also if you want to provide better care and need more time or better materials to do that you can only do it within the determined budget and they are quite tight.
- zaroth 8y ago
  I don’t necessarily want to standardize care, I want to standardize pricing. Of course there will always be minute variations in a procedure, but the law is not an algorithm. You can have different levels of materials with different prices, but two people still need to see the same price if they choose the same thing, or substantially the same thing. Of course some people will game the system trying to make infinite variations, but at least that one apply to common blood tests and office visits, MRIs, X-rays, plenty of stuff is standardized. So what you are describing sounds a step beyond what I am thinking, which is just a standard published price list which is actually the price, and not a published book price which is an absurd ripoff, and then a secret price which everyone with insurance x, y, or z pays.
davidjade 8y ago
This, a 1000 times this. We just faced this this week. Recently lost insurance due to a unexpected company closure (with apparently no COBRA responsibility in that case). So I started asking our current providers to find out what it would be to pay out of pocket for some services. Here's an actual item: Provider bills $285 For out of pocket cash price, they will reduce by 25% (so $213 or so) Our insurance however got a bigger discount and only had to pay $100 with no further patient responsibility (beyond deductible) It absolutely should be illegal to price like that.
noisy_boy 8y ago
That's like going to a shop to buy a shirt and the price depends on who is paying for it, you or your dad.
conanbatt 8y ago
> The simplest and most common sense medical reform I can think of would be to make it illegal to charge a different price to two different patients, regardless of insurance carrier or self-insured, for the same medicine, procedure, or equipment at the same facility. That would do great damage to the poor and greatly benefit the well-employed. Just like airtravel, the richer pay for the poorer. This has been so since the 50's. > There should be the Price. The amount that insurance Covers. And the remainder is the Patient Responsibility. Iron triangle of healthcare: Price, Access, Quality. If you control the price, you fiddle with access or quality. > ither that, or a cash patient cannot be charged more than the Medicare allowed amount for the same procedure. Medicare wellness exams pay 90 bucks. Insurance pays 150~200U$S (up to 300U$S). VERY different services can be provided at those levels. Take a OneMedical office with 3 doctors, and 16 1/2 hour appointments a day. 48*300U$S = 14.400 U$S max revenue. At medicare rates, they go down to 4,300U$S. Just having the same facility, same rents etc, to get the same revenue they would need to see 160 patients. So the appointment length they can give would be 7 minutes. Or they could move the office to a much cheaper 3rd floor place many blocks down, sacrificing access, but that might save you only 10k a month. Price, Access, Quality.
- zaroth 8y ago
  But most crucially, I do not propose controlling the price. However, a given service must have a single price for everyone who gets it. A "Wellness Exam" can certainly be offered with a different levels of service. But you cannot charge two different prices for the same exam. And once we've established that it should be illegal to charge two different prices for the same exam, then we can get to the interesting work of making those prices more transparent, and maybe even I want to choose between the $90 and the $300 wellness wellness exam on a litter "Good", "Better", "Best" menu, or maybe my doctor recommends which one would be appropriate, and spends 1 minute explaining that and showing me the price at the start. This happens at my chiropractor, and even at my eye exam (e.g. adding an optional retina scan). If there's only one price for an MRI of a particular part of the body, then when the doctor is ordering it, they can actually tell you what it will cost! To your last point about rich paying for the poor. This is true, but it is accomplished by changing the price of insurance coverage, but it should not be accomplished through changing the price of the billable service based on lack or type of insurance coverage, because those are very poor signals for capability to pay. In fact, the poor are most likely to be overcharged through this type of policy.

by zaroth 8y ago

spockz 8y ago

This is kind of what we have in The Netherlands. Insurers make standard prices in collaboration with a large part of the healthcare providers. Healthcare providers have to bill using the exact code of the treatment and that amount cannot be more than the agreed amount. This leads to funny things like there being Treatment X variant A-E for getting a different price for the same treatment based on some arbitrary thing. It also means that now the insurer knows exactly what has been done because the bill says replaced filling on 3rd upper molar with this and that material etc. Before it was just “filling”. Also if you want to provide better care and need more time or better materials to do that you can only do it within the determined budget and they are quite tight.

zaroth 8y ago
I don’t necessarily want to standardize care, I want to standardize pricing. Of course there will always be minute variations in a procedure, but the law is not an algorithm. You can have different levels of materials with different prices, but two people still need to see the same price if they choose the same thing, or substantially the same thing. Of course some people will game the system trying to make infinite variations, but at least that one apply to common blood tests and office visits, MRIs, X-rays, plenty of stuff is standardized. So what you are describing sounds a step beyond what I am thinking, which is just a standard published price list which is actually the price, and not a published book price which is an absurd ripoff, and then a secret price which everyone with insurance x, y, or z pays.

davidjade 8y ago

This, a 1000 times this. We just faced this this week. Recently lost insurance due to a unexpected company closure (with apparently no COBRA responsibility in that case). So I started asking our current providers to find out what it would be to pay out of pocket for some services. Here's an actual item: Provider bills $285 For out of pocket cash price, they will reduce by 25% (so $213 or so) Our insurance however got a bigger discount and only had to pay $100 with no further patient responsibility (beyond deductible) It absolutely should be illegal to price like that.

noisy_boy 8y ago

That's like going to a shop to buy a shirt and the price depends on who is paying for it, you or your dad.

conanbatt 8y ago

> The simplest and most common sense medical reform I can think of would be to make it illegal to charge a different price to two different patients, regardless of insurance carrier or self-insured, for the same medicine, procedure, or equipment at the same facility. That would do great damage to the poor and greatly benefit the well-employed. Just like airtravel, the richer pay for the poorer. This has been so since the 50's. > There should be the Price. The amount that insurance Covers. And the remainder is the Patient Responsibility. Iron triangle of healthcare: Price, Access, Quality. If you control the price, you fiddle with access or quality. > ither that, or a cash patient cannot be charged more than the Medicare allowed amount for the same procedure. Medicare wellness exams pay 90 bucks. Insurance pays 150~200U$S (up to 300U$S). VERY different services can be provided at those levels. Take a OneMedical office with 3 doctors, and 16 1/2 hour appointments a day. 48*300U$S = 14.400 U$S max revenue. At medicare rates, they go down to 4,300U$S. Just having the same facility, same rents etc, to get the same revenue they would need to see 160 patients. So the appointment length they can give would be 7 minutes. Or they could move the office to a much cheaper 3rd floor place many blocks down, sacrificing access, but that might save you only 10k a month. Price, Access, Quality.

zaroth 8y ago
But most crucially, I do not propose controlling the price. However, a given service must have a single price for everyone who gets it. A "Wellness Exam" can certainly be offered with a different levels of service. But you cannot charge two different prices for the same exam. And once we've established that it should be illegal to charge two different prices for the same exam, then we can get to the interesting work of making those prices more transparent, and maybe even I want to choose between the $90 and the $300 wellness wellness exam on a litter "Good", "Better", "Best" menu, or maybe my doctor recommends which one would be appropriate, and spends 1 minute explaining that and showing me the price at the start. This happens at my chiropractor, and even at my eye exam (e.g. adding an optional retina scan). If there's only one price for an MRI of a particular part of the body, then when the doctor is ordering it, they can actually tell you what it will cost! To your last point about rich paying for the poor. This is true, but it is accomplished by changing the price of insurance coverage, but it should not be accomplished through changing the price of the billable service based on lack or type of insurance coverage, because those are very poor signals for capability to pay. In fact, the poor are most likely to be overcharged through this type of policy.