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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

> 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.
- conanbatt 8y ago
  > A "Wellness Exam" can certainly be offered with a different levels of service. But you cannot charge two different prices for the same exam. Same doctor, same location, same duration, same scope of care, same supplies, same patient-risk, same market demand, same season, same malpractice liability, etc etc ? A same price requirement pushes the economic adjustment to other variables. A simple example: do you take patients saturdays? All staff is more expensive to work a saturday, but revenue is the same. (adjust access). If anything, the market does not have enough price adjustments, which is why eeryone is so price insensitive, particularly the patient.
  - zaroth 8y ago
    Luckily the law isn't an algorithm. Medicine is not perfectly packaged and shrink-wrapped, but a law can be written saying there must be a material basis for a difference in price. Let's keep in mind where we are today, which is that price is entirely arbitrary and capricious, and they are allowed to do that. I think people seeking medical care deserve much better than "arbitrary and capricious". Substantially similar services should not have two orders of magnitude differences in pricing. That should be illegal. EMR coding already provides the basis for establishing a non-discriminatory pricing regime. The problem is the billing system takes the EMR coding of the procedure performed, and then convolutes it with a pricing matrix which discriminates on what kind of insurance you have. I walk into CVS and try to fill a prescription. - That'll be $78 dollars they say; - OK, I have this benefit card, it is not insurance but it provides a discounted rate, and I paid nothing for the card. It's like a coupon code. That'll be $55. - OK, I have this prescription drug coverage insurance card, which carries a $200 deductible and a $20 copay. I've already exhausted the deductible. That'll be $20 and insurance pays $3.07. CVS is selling the same drug, from the same distributor, to different customers at wildly different prices (before an insurance contribution) based on some sort of shell game. To say nothing of the cases where insurance companies agree to pay more for one drug, like insulin, in exchange for charging less for other totally different and unrelated drugs, just because in their insurance pool it helps them optimize the number of patients which ultimately will pay the annual out-of-pocket maximum.

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.

conanbatt 8y ago
> A "Wellness Exam" can certainly be offered with a different levels of service. But you cannot charge two different prices for the same exam. Same doctor, same location, same duration, same scope of care, same supplies, same patient-risk, same market demand, same season, same malpractice liability, etc etc ? A same price requirement pushes the economic adjustment to other variables. A simple example: do you take patients saturdays? All staff is more expensive to work a saturday, but revenue is the same. (adjust access). If anything, the market does not have enough price adjustments, which is why eeryone is so price insensitive, particularly the patient.
- zaroth 8y ago
  Luckily the law isn't an algorithm. Medicine is not perfectly packaged and shrink-wrapped, but a law can be written saying there must be a material basis for a difference in price. Let's keep in mind where we are today, which is that price is entirely arbitrary and capricious, and they are allowed to do that. I think people seeking medical care deserve much better than "arbitrary and capricious". Substantially similar services should not have two orders of magnitude differences in pricing. That should be illegal. EMR coding already provides the basis for establishing a non-discriminatory pricing regime. The problem is the billing system takes the EMR coding of the procedure performed, and then convolutes it with a pricing matrix which discriminates on what kind of insurance you have. I walk into CVS and try to fill a prescription. - That'll be $78 dollars they say; - OK, I have this benefit card, it is not insurance but it provides a discounted rate, and I paid nothing for the card. It's like a coupon code. That'll be $55. - OK, I have this prescription drug coverage insurance card, which carries a $200 deductible and a $20 copay. I've already exhausted the deductible. That'll be $20 and insurance pays $3.07. CVS is selling the same drug, from the same distributor, to different customers at wildly different prices (before an insurance contribution) based on some sort of shell game. To say nothing of the cases where insurance companies agree to pay more for one drug, like insulin, in exchange for charging less for other totally different and unrelated drugs, just because in their insurance pool it helps them optimize the number of patients which ultimately will pay the annual out-of-pocket maximum.