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Trump Signs Executive Order Compelling Disclosure of Prices in Health Care

• inflatableDodo 7y ago
  If this ever translates into reality then it is great, and I really dislike Trump both politically, and as a person. Willing to give credit where it is due, even though I strongly suspect that it is a political stunt that will get lost in committee. Would be delighted to be proved wrong however.
• nwah1 7y ago
  This is a really important goal, but whether simple mandates can solve it, I'm not sure. The real problem is that consumers don't care about the prices, which is how all the various layers of providers and middlemen are able to jack up all the prices without limit. High deductibles are one way that consumers can be made to care, but obviously that has its own problems. Single-payer would not fix the problem by itself, either... although using monopsony power could certainly help, if executed competently. Merging a single-payer approach with a high deductible approach could work, and the deductibles could actually be paid via a government-filled HSA account that one could rollover into a retirement or college savings account, if unspent.
  • yellow_postit 7y ago
    I’m not sure it’s a lack of “care” and more a lack of ability to take action. If I have a broken arm I’m not going to price comparison shop amongst hospitals. Anecdote: I attempted to comparison shop for an mri to diagnosis a potential rotator cuff injury. While I could get the actual scan fees I couldn’t get the fully burdened cost and during the visit it’s entirely opaque what things will be new line items on the bill.
    • PeterisP 7y ago
      While urgent care is a significant part of total medical expenses, it's not that large part - the vast majority of really expensive procedures are scheduled well in advance, and doing price comparison would be quite feasible if the institutions would allow that.
      • craftinator 7y ago
        In practice I've found that to be incorrect. Prices quoted to me are either wildly inaccurate, or end up being the minor percentage of the total cost.
        • PeterisP 7y ago
          That's the "if institutions would allow that" part. Or, more accurately, if institutions would get legally forced to allow that. We didn't get price transparency and limits for ridiculously lying advertising in other consumer markets just by sheer goodwill of merchants, it required legal mandate and enforcement of it.
    • count 7y ago
      And if you're taken in to the ER, you're possibly not even ABLE to consent to charges. You're at the whim of the hospital staff! Did you know they charge for 'chaplain time' for having a chaplain stop by and say hi (you don't get to say yes or no, and this is obviously not medically necessary)?
      • Consultant32452 7y ago
        Emergency care accounts for about 2% of total healthcare expenses. The issue you bring up about consent during an emergency is a real one, but it's not where all the money is going. https://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ https://www.politifact.com/truth-o-meter/statements/2013/oct...
        • sbov 7y ago
          Note that your article cites at least 1 other study that says 5-6% or even as high as 10%. It would be interesting to see a breakdown here - does this include prescription medication? It seems like if you're talking about provider regulation, you shouldn't include that. Unfortunately the article doesn't make it easy to figure this out.
          • filoleg 7y ago
            Even assuming that the 10% number is the right one, it still seems good enough in my book if, in the beginning, only 90% of the expenses get addressed successfully.
        • maxerickson 7y ago
          You don't need that long of a list of things that cost 2% before you've explained quite a lot.
    • jerkstate 7y ago
      From your anecdote you indicate that people will comparison shop among hospitals but are unable to do so. I have a similar story about a broken ankle where I couldn't even get an estimate for an X-ray and a cast.
      • sbov 7y ago
        I got an estimate once. After a total of about 20 hours on the phone. The day I arrived they told me it didn't include a bunch of stuff. They said it didn't matter though because insurance covered it. But they were wrong.
    • mixmastamyk 7y ago
      > If I have a broken arm I’m not going to price comparison shop amongst hospitals. This gets mentioned in every healthcare thread. With transparent pricing we'll soon know which hospital costs 3x of the other, so we (or beforehand or family) can decide which one to go to for treatment.
      • dlp211 7y ago
        This is a very urban/suburban mindset. There is a not insignificant portion of the population that has no choice and the one place they can get medical care is already over an hour away.
        • mixmastamyk 7y ago
          Most folks are moving to cities, the portion you mention is small and getting smaller. Don't let perfect be the enemy of the good. People can make their own decisions. There is no ethical position for keeping pricing information secret. Just because one can imagine a rare scenario where it wouldn't be useful is hardly a reason to continue hiding it.
          • dlp211 7y ago
            While true, 20% of a large number is still a large number. It's easy to disregard these people, but they should not be disregarded. They have suffered directly due to the privatization of hospitals and the requirement to satisfy stockholders. Also, I'm not against price transparency, but I'm highly skeptical that it will improve anything. The reasons should be quite apparent but price setters will settle on or near the highest prices since everyone in the system is incentivized to do so. It also doesn't solve the problem that many people pay a $N copay noatter what the price is due to insurance. And the third issue is the in and out of network problem. When you consider all these, along with the lack of choice for pretty much everyone, it isn't going to change anything.
            • jessaustin 7y ago
              Nobody wants to "disregard" rural patients. Rural patients would also like to know the price they'll be charged after driving 1.5 hours. Often we have a choice among several faraway towns to which we could drive. We've made our peace with the fact that living in the sticks requires driving further. This argument is too dumb to qualify as sophistry.
  • cr1895 7y ago
    >The real problem is that consumers don't care about the prices Forgive my perhaps being out of touch, but isn't the primary complaint that healthcare can be _ruinously expensive_ and unaccountable?
    • conanbatt 7y ago
      People complain about 20U$S copays on doctor visits that bill 400U$S to insurance. Thats the distortion in the market right now. Of course when the insurance doesn't cover the procedure and see the 400U$S bill people flip out.
      • will_brown 7y ago
        >People complain about 20U$S copays on doctor visits that bill 400U$S to insurance. Well if that’s the case...it’s because the $400 bill isn’t the real cost for the service and insurance actually pays $0 of the bilked $400. What happens is the patient pays $20 copay gets billed ~20% of the $400, or $80...then everyone but the patient is happy, Dr. gets his $100 for the visit and gets a $300 tax deduction, the insurance gets its premiums from the patient and gets their 80% waived by the provider effectively shifting 100% of the cost to the patient while still being able to account for the 80/20 split on the books.
        • froindt 7y ago
          Unless there's a weird provision I'm not aware of, you could be over representing the value of the deduction. The best thing for the doctor is to get paid (and pay taxes on) $400. The $300 deduction is of no value to them because they never recognized the $300 as income. The deduction is basically "Hey, sorry you couldn't collect your billed amount. You don't need to pay taxes on money you didn't earn". Sorry if you fully understand this already. The lack of understanding of basic taxes is a pet peeve of mine. People make statements like "Johnny was looking for one more tax deduction, so he donated to my charity". Johnny probably cares about the charity or at least looking good in the community, because he'd have a larger net worth if he just sucked it up and paid taxes rather than donating it.
  • kevin_b_er 7y ago
    The high deductible approach fails because then people have to weigh preventative care and eating or paying rent.
  • Amezarak 7y ago
    HDHPs are rampant now. I have a $6500 deductible. It's absolutely miserable. I dump all the money I can into my HSA every year and inevitably I spend it all. The magic benefits of HSA as an investment vehicle for retirement or college are vastly overstated. Yes, if you basically never go to the doctor, it might work. Go to the ER or urgent care once a year and you're done. (Further, your investment options and the fees thereof are controlled by your employer's HSA servicer, and tend to suck.) Whenever I have a medical issue, I personally try to just suck it up and wait it out, because just to see a nurse practitioner to see is $150, let alone if they have to do anything. Every time my kids get sick I also have to make the same type of decision: is it worth it? This is an absolutely miserable place to be in, but this is exactly what HDHP proponents think is a great idea. Meanwhile, my total annual premium cost is still > 20k. I absolutely do care about prices (which doesn't matter right now, nobody will tell you what they are), and so does everyone I know, most of whom are on these same plans. The only people I know who aren't are unionized. But I have no way of finding out what they are beforehand. I don't even think this mandate will help. Yeah, sure, now the hospital posts the price - but what about the other dozen providers that involve themselves in a single procedure? For example, my wife underwent a routine procedure a few months ago. I am still receiving bills from different providers. So far I'm at 7. Never mind trying to even audit them to see if they really did anything! At the same time, do we really want health care to be under intense price pressures? I'm not so sure. I imagine the medical bureaucracy will continue to expand unimpeded while actual quality of care will go down. That's what I already see happening as a result of cost-cutting.
    • conanbatt 7y ago
      Some cruel reality: you need to ration healthcare to reduce spending significantly. The iron triangle of healthcare: Quality, Access, Cost. That said, there are definite things that increase the cost disproportionately, and the way the government subsidizes insurance through an employer makes a major disconnect between patients and providers. If the subsidy were eliminated and insurance untied to employer you would have a huge step in the direction of unleashing market forces.
      • Amezarak 7y ago
  • jbigelow76 7y ago
    The real problem is that consumers don't care about the prices Just out of curiosity you wouldn't happen to be a twenty-something in relatively good health would you? :)
    • johnwheeler 7y ago
      Yeah, I thought the same thing. I absolutely care about prices and transparency. Wait until op has a baby delivered and sees crap like: * BP/READ $349 * OR/FOO $2090 * OR/BAR $1000 * OR/BAZ $2090 Not real codes, but they might as well be with the current system...
      • nwah1 7y ago
        I have done that and seen all of those. I'm thinking at the systemic level. If everyone had to care about prices, then there would be more demand for transparency, and more competition in pricing, which would help even those who are unable or unwilling to price shop. I also bring up single-payer in a related way because the need to find in-network providers within reasonable distance often is such a limiting factor that price shopping isn't possible. With single-payer, one could actually choose between all of the providers... in addition to other benefits. There are websites like ZocDoc which are like yelp for doctors, but they can only do so much because of the lack of price transparency, and lack of ability of consumers to choose doctors out of network.
      • coldcode 7y ago
        Everything in health care is a code, I think there are something like 10,000 different ones in the latest version.
    • delecti 7y ago
      I think perhaps a better way to phrase it is that people aren't able to meaningfully act on price information.
      • nwah1 7y ago
        There are some markets where price shopping is possible and does happen. For instance, LASIK prices plummeted as a result of competition and price shopping. There could be many more, if not for various policies that impede this.
  • Despegar 7y ago
    >Single-payer would not fix the problem by itself, either... although using monopsony power could certainly help, if executed competently. The other half of this has to be aggressive antitrust enforcement in the healthcare sector.
    • SlowRobotAhead 7y ago
      So that along with the fact that "if executed competently" is outside of the government's ability... Are two reasons this will never happen.
      • Despegar 7y ago
        I wouldn't be so sure. Antitrust is having a renaissance right now.
        • SlowRobotAhead 7y ago
          I agree talk of antitrust is hot right now. We'll see if it's anything more than talk in an election year.
  • dv_dt 7y ago
    > The real problem is that consumers don't care about the prices I think this is a trope in multiple areas trying to pose personal accountability as a solution where one actually needs systematic solutions. You see it with the climate crisis (make sure to buy only 100% organic recycled meat), or student loans (make sure to choose a major that has a 20 year postivive ROI), and medical expenses (make sure to price out and choose the most cost performant cancer chemo cocktail). Really we need working institutions and controls those institutions can impose because the markets for industrial processes, or educational funding, or heathcare are vastly complex products with large capital, time, knowledge commitments needed to adequately check misperformance. The investments needed far exceed most time or money resources that make sense for any one person can put into single transaction. That's why collective institutions are needed to focus on developing the specialized information and policy needed to manage the poorly performing systems.
    • nwah1 7y ago
      The economy is the sum of individual actions, which are all guided by incentives. Set up poor incentives, and each individual poor decision might not matter too much, but the collective result can be awful. The idea that we ought to throw our trust in with bureaucrats is kind of ridiculous, particularly in the age of Trump. But even if this were Scandinavia, incentives would still matter.
      • hn23 7y ago
        But the idea to rely on companies (whose incentive is make more money) is not ridiculous?
    • maxerickson 7y ago
      All meat is just recycled plants and meat.
  • avocado4 7y ago
    This order is about disclosing the prices that consumer pay (co-pays/co-insurance), not the total price with insurance reimbursement. Essentially it would force every clinic to be like Kaiser and MinuteClinic who tell you upfront how much you need to pay for the visit so there's no hidden fees.
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  • cobookman 7y ago
    As someone with an hsa / high deductible plan. I totally care about the cost.
• sparrish 7y ago
  I'm loving this. I shop around for my healthcare needs and it's very difficult to get a quote of any kind for any service. This will increase transparency and competition and that will hopefully lower prices.
• HillaryBriss 7y ago
  It calls for the Department of Health and Human Services to issue a rule within two months that could require hospitals to publicize information on their negotiated rates with insurers for common procedures. and Lawsuits could be likely, meaning any action could be delayed until after the presidential election. a great idea, but it sounds like the EO may not actually change anything for a long, long time, if ever.
• rolltiide 7y ago
  Good first step
• sailfast 7y ago
  > Industry groups are mobilizing to fight back, saying any requirement that hospitals and insurers disclose negotiated rates would go too far. This kind of effort is what is required in order to allow for comparison shopping to occur. Maybe this even enables consumers to shop better for their insurance plans depending on their common needs. That would likely allow folks with certain recurring conditions to shop for the best insurance plan for them (thus also raising the risk level for that insurer and changing prices?) but that's a bit more like how a market is supposed to work. I can't speak specifically to whether the order just increases legal ambiguity or whether it will be enforced, but I'm happy to see any initiative toward price transparency in medicine that will allow the public to start making better decisions. > But the order doesn’t say if hospitals would have to disclose the average of all rates they get from insurers or the specific rate they get from an individual’s insurer. That detail matters: The average rates would have a milder effect on local markets as insurers and hospitals still wouldn’t get clarity on rivals’ specific secret rates. PRECISELY. If everybody understands the negotiated rate, then any size organization can argue for that rate. This would make it easier for smaller-scale companies to get the same rates as larger plans and also reduce some of the incentives for large insurer / care company mergers that seem to be really rent-seeking given the industry comment on this order.
  • dv_dt 7y ago
    I wonder what happens when we create a market where prices are transparent, without disclosure of performance or quality too.
    • justwalt 7y ago
      What do you mean? Aren’t we talking about the price of hospital visits, etc., meaning the performance/quality is expected to be good?
      • ip26 7y ago
        Medical care is not uniformly good. Your parent is alluding to a theoretical race to the bottom on quality.
• rolltiide 7y ago
  Great use of an executive order, the executive branch is so big that having no directives from the CEO is an odd way to run an organization that large Overwhelming even I dont think the constitution envisioned how big of an organization the executive branch is, all with independent sweeping rule making autonomy. Only industry enthusiasts know the specifics of one agency’s depth of rules. Someone elected by the people for totally unrelated reasons has no way of knowing everything these agencies are influencing
  • swalsh 7y ago
    Is it though? I totally support the idea of the action, but it really feels like it should have come from congress. They are supposed to be the law makers. It feels like everytime congress fails, and we have to resort to executive actions to do every day legislation more power is being ceded to the executive branch.
    • rolltiide 7y ago
      The executive order doesn't do what the headline says, it instructs the relevant agencies to create rules within their power I feel like your response is copy pasted for any use of an EO
    • swagasaurus-rex 7y ago
      The consequence for two parties that refuse to cooperate – a shift of power from the squabbling rabble, towards a winner takes all direct leadership. I don't think anybody wins in this event
  • boapnuaput 7y ago
    The president is not a CEO; the executive branch is not a corporation. [0] Moreover, the executive branch does not need to be "run" from the top; instead, it operates in a distributed and semi-autonomous fashion. Think not of the Cartesian brain, but the octopus. The Constitution outlines specific responsibilities of the President in Article Two. [1] Those responsibilities: * Command the armed forces * Have a Cabinet (have the heads of subbranches as direct reports) * Conduct foreign diplomacy * Give State-of-the-Union addresses * Not be bad at carrying out the will of the law; "faithfully execute" whatever the law tells them to do * Get impeached if Congress says so There are some things that the President is enabled to do at a whim, but they are not as broad as you'd think: * Issue pardons * Appoint judges, diplomats, etc. with Congress's approval * Call special sessions of Congress I agree that, in order to be aware of the full nature of the law, the President needs to be surrounded with legal professionals who can advise them on how to not violate the law. But, in Article Two, it's clearly spelled out that the President should have a Cabinet in order to delegate day-to-day responsibilities further. Finally, as a reminder, the President wasn't supposed to be chosen by the people, but by the Electoral College. [2] The Presidency should not be a popularity contest. [0] https://en.wikipedia.org/wiki/Corporatism#Fascist_corporatism https://en.wikipedia.org/wiki/Corporatism#Fascist_corporatis... [1] https://en.wikipedia.org/wiki/Article_Two_of_the_United_States_Constitution https://en.wikipedia.org/wiki/Article_Two_of_the_United_Stat... [2] https://en.wikipedia.org/wiki/United_States_Electoral_College https://en.wikipedia.org/wiki/United_States_Electoral_Colleg...
• conanbatt 7y ago
  Very hesitant that this is the actual problem of healthcare. What you care about is not how much the hospital bills, but how much is leftover after insurance. And that is unknown to all parties.
  • pwinnski 7y ago
    There is no "the" problem of healthcare. There are many, many interlocking issues that combine to drive up prices at every step of the way in every corner of the industry. This might help a little bit, but there is no silver bullet.
    • boapnuaput 7y ago
      In the USA, at least, there is a singular problem: In the early 70s, the HMO Act and similar legislation was passed, bringing in the HMO-oriented system of healthcare. A silver bullet would consist of introducing a single-payer system and winding down the HMOs.
      • conanbatt 7y ago
        HMO's are very successful in terms of providing cost/care solutions. The fact that they are so unpopular reveals the american preference: they want to see any doctor, at any time, with as much access as possible.
      • Dumblydorr 7y ago
        Anecdata: A nuclear family member was the president of an HMO for a few years, as far as I know they successfully pooled Medicare resources and made group-wide decisions that saved a lot of money.
    • wefarrell 7y ago
      The root cause of those interlocking issues is that US society hasn't decided who should foot the bill for an individual's health care costs. Putting that burden on the individual is akin to a reverse lottery, where an unlucky few pay are forced to pay obscene bills in order to survive. Putting that burden on society is "socialism" and is at odds with market economics.
• Waterluvian 7y ago
  The idea of requiring list prices of drugs to be displayed in commercials seems like it might be very effective. Imagine if you were able to do some quick mental math on your couch: "Okay so ask my doctor about Poopathome for my rectal bashfulness... Well let's see first. It says $890/month average dose. My insurance covers 80% so that would cost me something like $180 a month. Yeah sorry Pfizer you'll have to do better."
  • cr1895 7y ago
    >The idea of requiring list prices of drugs to be displayed in commercials It's bizarre that prescription medication is advertised like that in the first place.
    • PeterisP 7y ago
      The obligatory reminder like in similar threads before - in most other first world countries it's not done because it's forbidden; mass media advertisements of prescription medicine is a practice specific to USA and a couple other places.
      • jjoonathan 7y ago
        It used to be forbidden in the USA, too.
        • Rebelgecko 7y ago
          When?
    • arcticbull 7y ago
      Exactly. In Canada you an only advertise either that a drug to treat a certain condition exists, or that a drug with a certain name exists, but not both in the same ad. Why advertise drugs to customers, they're not medical professionals - that's why we have GPs.
      • 7y ago
• PeterisP 7y ago
  That's kind of cool, though the devil is in the details and I'm not sure about the details for this case. Essentially, free market relies on certain assumptions under which the supply/demand 'invisible hand' works properly and the benefits of free market are realized - the key economics 101 assumptions are (1) large amount of both suppliers and buyers; (2) small barriers of entry and exit; and (3) full and truthful information about market conditions. The further we get from these assumptions, the less free (and usually worse for the people) the market becomes, and often we need gov't intervention to ensure that these assumptions stay true and the market behavior stays close to theoretical free market instead of degenerating into an exploitative uncompetitive monopolistic market with hidden information - as the USA medical market is doing, and seems to need such intervention.
  • cheerlessbog 7y ago
    (4) buyers capable of making informed decisions (a) several nearby hospitals (b) enough expertise or impartial advice (c) not in an emergency situation, in pain, unconscious, intoxicated or otherwise unable to make good decisions (d) in a position where the price matters - not too poor, not too rich. Since much of the above is not true in real life, a patient centered market for Healthcare does not work well.
    • dsfyu404ed 7y ago
      The overwhelming majority of healthcare dollars are not spent in emergency situations. If you decide to go to the doctor because of some pain in your neck that's not an emergency decision. If the doctor tells you to get tests that's not an emergency decision, etc, etc. You can go from healthy to cancer to treatment to more cancer (wash rinse repeat until you or the cancer is dead) without a single decision made under any meaningful time pressure.
      • cheerlessbog 7y ago
        And the guy who goes to the ER with a serious heart problem gets admitted and leaves bankrupt? Seems important to avoid that. Even for the cancer - you're in the most stressful situation of your life, you want to evaluate prices? What about your vulnerable grampa? In the UK, where I'm originally from, I've never met anyone who wishes they had a role in evaluating healthcare pricing. In the US, I personally don't either.
• legitster 7y ago
  Pricing transparency was already included in the ACA. What happened to that? Why did it fail?
  • pwinnski 7y ago
    It was somewhat limited. The ACA required hospitals to provide their charge-masters for their services online in “machine readable” format. These charge-master prices have limited relation to the prices faced by insurance companies or people seeking medical care. https://pbghpa.org/blog/aca-price-transparency-results-in-sticker-shock-epidemic/ https://pbghpa.org/blog/aca-price-transparency-results-in-st...
  • cloakandswagger 7y ago
    The ACA had a "chargemaster" rule that required hospitals to post a list of standard charges for treatments, but this doesn't include charges for office visits or elective procedures. More importantly though, these standard fees do not include any negotiated rates between insurance providers and hospitals, making it effectively impossible to comparison shop. A hospital's chargemaster price for procedure X might be $10,000, but might be only $2,000 for a particular insurance provider due to negotiation. That's the difference between the ACA rule and this EO; the EO forces hospitals to post the real prices for each insurance provider.
• jjwhitaker 7y ago
  This may make pricing more transparent but it isn't going to help anyone unless action comes from regulation or something. Martha may check which local hospital has the best pricing for an anticipated upcoming medical need but in the moment the ambulance will take her to the closest and she'll be charged bankruptcy levels for care because the system itself is broken. It'll help further see how broken the system is, but this does nothing to actually change it. It'll be held up by lawsuits for a while then either dropped when politically viable or used to prop up a 2020 plank without anything to actually stand on. If Trump wanted to do something positive he'd bring back the individual mandate and try to reverse the loss of insurance and cost spikes since he signed the 2017 tax bill and other legislation aimed at destabilizing the Us healthcare system. He won't, because the GOP won't, because their goal isn't to help Americans, just the wealthy and corporations like the for profit groups running the detention centers at the border for $750/kid per day sans soap and toothbrushes.
• luckydata 7y ago
  This will do exactly jack squat to control prices, but it MIGHT make enough people that are not paying attention to start thinking about what's going on with healthcare in this country and why it's so expensive. Every time I go to the doctor in the US I wonder WHY they are doing what they are doing, WHY they want to see me two weeks from now even if I have a chronic condition that's perfectly managed already and hasn't changed in years... I never met so many unethical individuals like since I moved to the US and started going to the doctor.
• dclowd9901 7y ago
  There's an unsettling aspect to this story that is being glossed right over: This is, what should have been, a simple bit of congressional legislation that could/should have been drafted in the House or Senate and sent to the president for signing. Yet it had to be drafted as an executive order. Why is the legislative branch so willing to give up the power of the pen to the president? What the hell is going on? This feels like a huge breakdown in the responsibilities of the federal government.
  • ilikehurdles 7y ago
    Outside of funding for the ministry of war, Mitch McConnell will not allow a vote or (when possible) even debate on anything the democratic sides of Congress support, and any bill of this nature would have been supported by both parties.
  • SlowRobotAhead 7y ago
    Excuse me for being a little cynical... But I find the timing a little convenient that only after 2016 are people concerned about Executive Orders and presidential overreach. I'm sure this comment will be followed up with someone saying "nah I've been concerned" and that may be true, but let's look at the common mode here. It's like the people arguing for bigger government are many of the same people arguing against government when it's someone they don't like in power and can't see past their own noses on this.
    • dclowd9901 7y ago
      Oh good, a whataboutism. Not enough of those, lately. I'm not everyone, and it is something that's of deep concern to me, as it should be to you. So feel free to shelve your cynicism and join me in asking our representatives to do better.
      • SlowRobotAhead 7y ago
        A whataboutism would be if the topics weren't directly related. How is this that? Let me help you out. A "whataboutism" would be if I made a post saying "Well, Trump did this one good thing, but Obama passed Credit Card Reforms!" See how those are non-sequitur?
• lanrh1836 7y ago
  It’s crazy that a drug that prevents the spread of HIV (Truvada) is nearly $2000/month. Even if you had insurance with a high deductible plan you’d potentially need to pay $6-7k before having it covered. The government should be giving this away for free.
  • adventured 7y ago
    I agree with your sentiment, and there is a large program doing that right now. In May the current administration got Gilead to agree to give 200,000 uninsured people Truvada per year for free. It's not enough, although it is a start. The Preventive Services Task Force also just put new obligations on insurers in the past two weeks - through an A rating on PrEPs - to provide people with private insurance the drugs at no cost (a mechanism the ACA put into place).
  • SlowRobotAhead 7y ago
    >The government should be giving this away for free. The government has no money. So you're saying the tax payers should be paying $2000/mo/recipient. In this scenario you've made nothing cheaper. You've only externalized the costs on to us. You could argue this is for my/public good, but you didn't ask me, you didn't get a representative vote from me. In your scenario you've just decided how to spend my money. I hope you understand you've only just made the problem worse because nothing has preventing it from being $4000/mo now that they know the gov will buy an unlimited supply. edit: To be clear since posts below don't seem to get it... You're missing a step. You've done nothing to solve the $2000/mo problem, just shifted the costs to everyone. This is the issue with healthcare, the off the cuff solutions don't actually fix the root problems.
    • adrr 7y ago
      It is out of patent, the government could manufacture it. These manufacturers are cutting deals with generic manufacturers to delay the introduction of generic drugs to the market in order to maintain a monopoly. It also cheaper to put people on prep than to pay for their HIV treatment. Who is paying for all the HIV treatment to opiate addicts? Medicaid is which is the government.
• Someone1234 7y ago
  I support this. That being said, does Trump have that power? Executive Orders are very powerful because the executive branch is huge. But this is an EO compelling private companies to do a certain thing. That seems beyond the reach of EOs. I'd be happily wrong here, as I said I do strongly support this. Can anyone explain why I am wrong?
  • jmaygarden 7y ago
    The legislative branch has ceded most regulatory authority to the executive branch. Telling companies what to do is a major part of that. If the Department of Health and Human Services was given this authority, and the President is in charge of that department, then how would an executive order be inappropriate?
  • cloakandswagger 7y ago
    The EO requires health officials to propose a regulation that achieves the proposed price transparency. In that sense, it's an EO compelling the government to create a new regulation, not a law.
  • mi100hael 7y ago
    It's almost guaranteed to get challenged in court, at which point the judiciary will determine whether it is congruent with existing legislation. Worst-case it's not, and congress will probably take up a similar initiative so as not to appear ineffective.
    • amanaplanacanal 7y ago
      > congress will probably take up a similar initiative so as not to appear ineffective. It would be nice if it worked that way, actually.
• deleted 7y ago
  [deleted]
  • Nuzzerino 7y ago
    Been hearing people say that a lot more than twice a day lately.
• dragonwriter 7y ago
  The headline “Trump Signs Executive Order Compelling Disclosure of Prices in Health Care” is a lie [0] and unsupported by the body of the article. Trump did not sign an executive order compelling disclosure of prices in healthcare (nor is that even possible, that's not how EOs work), and the body of the article does not support the claim that he did. He signed an executive order directing various government agencies to propose regulations consistent with existing law which would do that (which seems unlikely to be possible; to be both possible and necessary that would require a federal law to exist permitting the executive to require such disclosure without itself mandating it; if such a law did exist, you'd expect the EO to have cited it, which it didn't presumably because it doesn't) and also directs agencies to do some other, more likely to be possible, things (e.g., write reports identifying who the agencies think we should blame for the absence of price transparency.) It's perhaps worth noting that this EO explicitly described itself as a follow-up of the report produced by the Administration as an outcome of the last EO Trump issued on this issue. Actual EO text appears to be here: https://www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/ https://www.whitehouse.gov/presidential-actions/executive-or... Though the official text will be whatever is published in th Federal Register, not what is on White House public info pages. When it is published, it should show up here: https://www.federalregister.gov/presidential-documents/executive-orders/donald-trump/2019 https://www.federalregister.gov/presidential-documents/execu... [0] propaganda rather than clickbait, I suspect—its a lie to shape opinion of the large number of people who will only see the headline rather than one to get people to click through to read the article.
  • coldcode 7y ago
    Exactly this. Forcing companies to show pricing is not something a EO can do. It could direct Medicare to indicate the prices it is willing to pay for example, but not to require corporations to do the same. That would require actual legislation. That said it's a good topic to wish for.
• metalliqaz 7y ago
  The entire exercise is pointless because the health care market isn't actually a free and open market. There's lots of regulation on health services (obviously, as there should be, because safety is important), but more importantly, when a person is sick or injured, they usually are not able to comparison shop. Emergencies make it impossible, but even a relatively common illness makes comparison shopping unrealistic. What we have is not a market and efforts to help comparison shopping really do almost nothing to fix things. Has anyone else had a doctor or nurse filed the wrong paperwork for a blood test, and then you get stuck footing the bill for an obscenely expensive test you didn't need or want? It's happened to me several times. And you have to pay whatever price the test facility sets, period. The system is broken and until the insurance industry's grip is broken, we are not going to get relief.
  • pdpi 7y ago
    > but more importantly, when a person is sick or injured, they usually are not able to comparison shop You don't need to comparison shop reactively. You can look up some prices preemptively, and choose a preferred hospital that you know to go to when you need it. Obviously not ideal, but it does allow for something.
    • toomuchtodo 7y ago
      “Don’t worry about the burning house, here’s a bucket to save the flower bed”. “Transparent” pricing is meaningless without a functioning market, which healthcare can’t be for anything but the most discretionary procedures.
    • ceejayoz 7y ago
      "Ah, yes, I've self-diagnosed myself as having a heart attack. Now, which local hospital had the lowest charge for that? Oh, but what if it needs a bypass operation? That other hospital was cheaper for that..." The actual thought process during an emergency tends to be more along the lines of "oh fuck it hurts make it stop".
    • metalliqaz 7y ago
      Choosing what you think is generally the cheaper hospital is not a solution. The things they charge you for is varied and you never have a choice as to what they will be. The doctors usually charge you separately, and you can't predict which doctors are on call at any time. But even more fundamentally, the issue is information asymmetry. Consumers don't have anywhere close to adequate information to make intelligent choices about health care costs. 99% of consumers have no applicable medical training.
• ptmcc 7y ago
  If one argues in favor of "free market" solutions for healthcare, then one MUST argue in favor of pricing transparency. A functioning free market requires the open and honest sharing of price information for consumers to make informed choices. Now, whether or not health care should operate under free market principles is a different discussion entirely. But the established powers seem to consistently fall back on the free market argument, but continue to keep pricing as opaque and complicated as possible.
  • dmix 7y ago
    The US has long ago abandoned free market healthcare. I don't know why people keep calling it that. It's some bastard child of socialized medicine where the poor and old are covered mixed with gov mandated private insurance coming from a few very large insurance companies capable of operating within the regulatory environment. Which is basically one step removed from full blown single-payer public health insurance (as we have here in Canada) and about a hundred steps removed from "free market" health care. I hope the US gov decides on single payer soon as I see no path towards going back to an actual market. Which would be better than the current system which features much of the worst of both worlds.
    • tombert 7y ago
      I've been saying this for years. The only way that our healthcare is truly capitalistic is that someone makes a profit. When I got appendicitis a few months ago, it's not like I went on Yelp and searched for the best prices and and reviews; I went to the hospital that was closest, and prayed that it was covered by my insurance.
    • TrevorJ 7y ago
      Yep. It's the worst of both worlds right now. Either take it over fully, or devolve it to a pure free market system, with medicaid backstops.
    • phil248 7y ago
      "The US has long ago abandoned free market healthcare." Not true. Like literally every sector of a mixed economy, there is government interference. And sure, there is a lot more in the healthcare industry than most. But it does operate as a highly regulated market system wherein private enterprises compete and consumers make decisions. And certainly it is not strictly "free market", but then again nothing is.
• novalis78 7y ago
  For someone who worked on price transparency in 2013 - I was personally affected with surprise billing - and spent long hours working on a price discovery / transparency tool called pricepain.com, I completely welcome this move. While it won’t solve all issues at once, shining some light into the medical billing mess can only be a good thing, allow market forces to enter the picture somewhat.
  • subhobroto 7y ago
    I really would love to hear your experience and some details about the work you did on price transparency. Can you share some? I have been beaten by the surprise billing so many times that I now dedicate some of my personal time to researching the root cause and taking action, one of which is sharing my thoughts with other people in a vain hope that things will get better and improve. I wrote a response to this article here: https://news.ycombinator.com/item?id=20281150 https://news.ycombinator.com/item?id=20281150 Would love any input!
    • novalis78 7y ago
      That sounds very familiar. At first I thought it was a mistake. The confusion when you get several bills, one larger than the other. Then the shock, when you get the final picture of what you owe. I went back and forth with the hospital and finally got an itemized bill (I didn’t know such a thing existed nor didn’t understand why all bills would be itemized.) A square gauze priced at the cost of an iPad,... And then the upcoding racket. It all leaves you confused. How is this possible? Why isn’t the media all over this or the state attorney? And why in the world is the insurance company part of the game? Then came the Time magazine front cover story (2013 I believe “Bills are killing us”) about hospital charge masters (why was nobody going after this decades ago?)... Finally I came across Dr. Keith Smith from the Oklahoma Surgery center and finally the puzzle pieces fell into place. So one does what one has to do: roll back the sleeves and get to work. Poured a couple of months into pricepain.com after hours (a friend working at hospitals in Wisconsin helped with some initial price finding), a NYT offspring that had gathered some medical prices send a cease and desist when we copied their ‘transparent prices for medical procedures in NY’ eye-roll. Eventually the government released Medicaid prices - a first big breakthrough. I had discussions on HN with Better Doctor who tried something similar - eventually they pivoted and focused on other things. We pitched to YC and a medical VC fund. Latter said in 2013 ‘there is at least 5 others that are working on this’ hahaha. Then came Obamacare and the future of free market / direct healthcare with price transparency became unclear - a super state nationalized Healthcare would have buried prices in yearly increasing taxes. So eventually I had to move on but always hoped that something like today’s news - more price transparency to allow for competition and improvements of quality/service - would eventually win out.
• supercall 7y ago
  Expecting the general public to comparison shop for their healthcare needs is unrealistic. Healthcare is a human right in the rest of the developed world, it's time for the US to catch up.
  • metalliqaz 7y ago
    The Obamacare push is the most powerful and organized push that we will likely ever get. It failed to reach that mark. Not sure what could possibly do it now.
    • dragonwriter 7y ago
      > The Obamacare push is the most powerful and organized push that we will likely ever get. No, it's not too even the most powerful and organized push we have gotten, so far, but, even assuming it was: > It failed to reach that mark. Yeah, but it moved the starting point quite a lot. Just like the adoption of Medicare and Medicaid before it moved the starting point that it started from. Just like the adoption of Veterans health care before that... We’re not resetting to zero before each push.
      • metalliqaz 7y ago
        I hope you're right.
• bcheung 7y ago
  Is the motivating idea behind this that patients can demand the same price that insurance companies are getting and ultimately lessen the monopoly insurance companies have? Maybe even just get much cheaper insurance for true emergencies and pay out of pocket for everything else?
  • falsedan 7y ago
    Probably not. More like the HMOs can see the deals each other are getting & maybe new entrants in the market can budget accurately before launching. What would be best if this was a way to collect medical cost trends for a couple of years to pave the way for price regulation.
  • assblaster 7y ago
    If I can pay the negotiated rate, I'm leaving the health insurance marketplace altogether and self-insuring. Why pay $20k+ per year in premiums when I can just save and invest that and pay low prices when needed?
    • Aloisius 7y ago
      Because negotiated prices aren't actually low for a good chunk of treatments - especially for the health conditions that someone paying $20k+/year already in premiums is more likely to contract.
      • assblaster 7y ago
        I pay $25k/year for family insurance with high deductible, and no pre-existing conditions. Negotiated prices paid by insurance actually are pretty good, but could be even better with the price transparency that will come about with Trump's executive order.
    • ThrustVectoring 7y ago
      Because you cannot save enough cash to be able to afford every worthwhile treatment through up-front payment. If you don't have $150k in cash and don't have insurance, you can't get chemotherapy and die a preventable death. With insurance, the worst case is paying your out of pocket maximum, getting treatment, and then declaring bankruptcy or otherwise fighting attempts to balance bill you for hundreds of thousands of dollars.
• pkaye 7y ago
  I think there needs to be the concept of $5 generics. Have the common stuff readily available to anyone in any part of the US for $5 or less per month. And if the private industry in any one region doesn't meet this challenge, the government should offer it. Lets put it this way. Being in kidney failure/dialysis. I take around 12 medications a day and I think only 1 is non-generic. I think lots of health needs could be met by affordable access to the basic stuff.
• ilaksh 7y ago
  My sister suddenly needed a few surgeries and seems to now owe an effectively infinite amount of money. I work for a startup without funding. Health care costs was one of the reasons I decided to move to Mexico. Some of the medicine is still kind of expensive to me, but for those ones it's still literally 10X less than across the border.
• m0zg 7y ago
  Mark my words: later this year Trump will allow re-importation of drugs, and Big Pharma won't be able to charge 5-10x for the same thing in the US. The only reason why previous administrations haven't done this is good old fashioned corruption.
• itsaidpens 7y ago
  Quasi-libertarian SV HN idiots: Shop for healthcare! it's easy! Free market!
• beat 7y ago
  In the Japanese health care system, a government panel sets the prices for all medical goods and services. Private providers and private insurers must then manage their business to be profitable against known, fixed prices, and the panel is responsible for setting prices that allow for profitability while preventing gouging and rent-seeking. They have private providers, employer-provided private insurance, and somehow manage to come in at around half the cost of the US system, for universal coverage and some of the best outcomes in the world. If we used fixed prices, as Japan does, this sort of regulated transparency would be unnecessary.
  • nwah1 7y ago
    I'm sure Trump would pick great prices. The best prices.
  • deleted 7y ago
    [deleted]
• undersuit 7y ago
  I know larger cities are the norm but everyone else is acting like everyone has a choice. My town has an urgent care center and a hospital that serves the entire county. The next nearest hospital is two hours away. Even then we still have people Life Flighted out to Spokane on a regular basis from both hospitals. All transparency will do is put a number in front of my single choice.
  • awakeasleep 7y ago
    I agree that it's not a solution to the healthcare nightmare we face in the USA... but do you think it's a step in the right direction?
    • undersuit 7y ago
      Yes, it will help with some procedures, and especially benefit those that don't have health insurance.
  • foota 7y ago
    I don't think this is true for non immediate care though. If you had something that needed to be done in a number of weeks would you be willing to to to a different hospital to save.. a couple hundred? A couple thousand?
    • amanaplanacanal 7y ago
      Exactly. For some things people fly to other countries because the price difference is enough to pay for their mini-vacation.
    • undersuit 7y ago
      Depends. I can travel to another city, but do I go home to recover after a multi-hour car ride or do I recover in that city? If I have an issue post operation does my home city have the resources to handle it? Who's going to drive me if I need a driver?
  • arwineap 7y ago
• anovikov 7y ago
  We saw what happened to airlines when they allowed 'comparison shopping' and internet search engines did that for us. Ugh. I'd much rather not have the same thing happen with hospitals. For that matter, i'd much rather remove it back for airlines too, as would every middle class passenger (someone who isn't bothered by extra $30 in ticket price, but can't yet afford a private jet). I already see people thrown out of ER room handcuffed because someone with a loyalty card of a higher priority level called in :)
  • amanaplanacanal 7y ago
    Extra $30? Prices were a lot more expensive than that. Ticket prices are about half what they were in 1979.
    • anovikov 7y ago
      If you guarantee me 32'' pitch on all flights, 50lb of check in luggage, ability to change and return any ticket, any time, and good food and wine on every flight in economy, i sign to pay 2x. After all, we have more or less this in premium economy when you have it on the flight (unfortunately it's on just a few, and business is, too drying up), and it's MORE than 2x more expensive. What airlines have become is just an insult to the human dignity. No industry should operate that way. If you are concerned with what comparison shopping, price optimized on the Internet, and free competition done to the taxi drivers, turning them into precarious, powerless and poor Uberists, why aren't you concerned with the 'demand side' of the same problem? Much less healthcare. I'd absolutely hate to get any treatment in a system which is 'optimized' in the similar manner.
• oarabbus_ 7y ago
  I don't understand how anyone (of course, besides Big Healthcare/Big Insurance, who is scalping the common man and lining their pockets with cash with these practices) could not see this as a good thing
• WomanCanCode 7y ago
  The government (federal/state) and our legislators (senate and house of representative) don't always work for us or in our favor. Our political system is not strong enough to overcome the strong lobby/interest of few. We can however design our economy around solving these problems. Make it profitable to solve health-care problems. We would willingly pay a 'prime' membership if such an organization/corporation exist. And if we have more subscribers, then we will have more payer into the system.
• williesleg 7y ago
  He's got my vote now!
• Wowl 7y ago
  This should be wildly popular
• systematical 7y ago
  Making a "free" market operate like one? What a novel idea!
• erobbins 7y ago
  This is awesome. I'm sure he will be opposed by congress, as they get a ton of money dumped in their pockets by pharma and insurance companies. Might be the first time I'll be on his side lol.
  • humanrebar 7y ago
    To be fair, this sort of thing should be a law, not an executive order. Not that Congress passes serious bills anymore.
• RocketSyntax 7y ago
  Thank god. I had to go to urgent care once and it cost me $700 for a 5min throat swab.
• flowerlad 7y ago
  I have good health insurance but recently my insurance declined payment for a lab test on grounds it was experimental. Turns out the insurance company was on solid grounds. At this point I was on the hook for the lab fees. But here’s the interesting part: because the insurance declined payment, negotiated rates no longer apply. This means the lab gets to charge me list price. The list price is a random high price that has no relation whatsoever to reality. In my case I was charged 3x the negotiated price! This executive order helps people in my situation—you can argue that the list price is unreasonable and that the negotiated price is all you should have to pay (even though you were not party to the negotiation). This executive order is also useful for uninsured patients because you now have a basis for arguing for a lower bill. And the courts would be sympathetic because everyone knows list prices are random numbers!
  • sbov 7y ago
    I ran into a similarly infuriating issue with a hospital. We have insurance. But we knew the procedure wasn't covered by insurance. So we would get the list price. We asked about the cash price. But they said we couldn't get the cash price because we have insurance. They said that you cannot get the cash price if you have insurance because the hospital requires procedures always go through insurance if you have it. But we could lie and claim we don't have insurance. On the day of the procedure, they said, oh, if we bill it like this, your insurance would cover it! Sounded good to us. They were wrong. So we ended up with the list price.
    • jachee 7y ago
      If you know your insurance won't cover a procedure, couldn't you truthfully tell them that you don't actually have insurance for that procedure?
      • observer12 7y ago
        Most times its not definitive if the insurance will cover a procedure until after. I know for myself there is a fairly "cosmetic" produce I want, but no matter which surgeon or insurance I have I can't get an answer from either that isn't basically, "do the procedure and after it will be determined if its covered". While the procedure isn't life threatening it definitely would be quality of life improving. Unfortunately, its generally considered cosmetic, at least until later in life where the side effects of not having the procedure can become life threatening.
• refurb 7y ago
  I'm kind of shocked that no healthcare providers have offered price guarantees as a selling point - I know I'd be incentivized by them. My guess as to why is that hospitals are just as confused about how insurance pays for things as the general public is. They could never accurately estimate what a patient would pay out of pocket.
  • viraptor 7y ago
    > I'm kind of shocked that no healthcare providers have offered price guarantees as a selling point It would make sense if there was enough competition pressure. Lack of price guarantees pretty much proves lack of real competition / price finding.
    • refurb 7y ago
      Agreed. I always look to things like Lasik surgery or plastic surgery where there is a ton of competition and real price transparency. Sure, those are elective surgeries, but so are most medical procedures people get done. We might not be able to solve it for every medical procedure, but it seems like there is a lot of low hanging fruit. Hell, in Canada, there are private MRI facilities for people who don't want to wait for the public system. Here is one in Vancouver and look, all the prices are listed.[1] Why the hell can't we have that here? Speaking of which, I had an MRI done that a bay area hospital charged $18K for. Insurance discounted it down to $8K, but apparently I could get done in Canada for $1400 out the door. [1]https://www.canmagnetic.com/contact-us/ https://www.canmagnetic.com/contact-us/
  • bduerst 7y ago
    They do for certain diagnostic and lab services. The problem with healthcare service is that it's not some off-the-shelf product - you don't know what level of work you need going in, and the need for more services may be uncovered later. Giving a price guarantee on something that changes based on the service being done isn't as feasible, especially when coverage changes depending on diagnosis codes.
• marcrosoft 7y ago
  This is a huge win for competition in health care.
• guntars 7y ago
  > Industry groups are mobilizing to fight back, saying any requirement that hospitals and insurers disclose negotiated rates would go too far. Can’t wait to hear their arguments how open pricing would only confuse consumers and cause complete destruction of the US healthcare system.
  • observer12 7y ago
    I am more interested to see which side makes those statements.
• RickJWagner 7y ago
  Seems like it can only help consumers. Kudos to Trump on this one.
• m0zg 7y ago
  Requiring explicit written consent to receive each service (after mandatory price disclosure) would also be welcome. I broke my ankle a few years ago, and half the bills sent to me I didn't recognize what they were for. In one particularly egregious example, some doctor literally spent less than 30 seconds near my ER bed, did not even look at the injury or the charts, and billed my insurance $700. And I've never seen him after that, received no prescriptions, no recommendations, and no treatment of any kind.
  • hn23 7y ago
    Well this Dr. probably had to pay for his student loan:P The price tag comes from somewhere...
    • m0zg 7y ago
      Dude was in his late 40s from the looks of it. Definitely too old for a student loan to be an issue. Probably just got used to charging people arbitrary amounts without their consent.
• thorwasdfasdf 7y ago
  Ideally, we need to move to a system that prevents individuals from being liable for predatory pricing. There should be a law that prevents medical providers from charging their victims directly. They should be forced to only deal with the insurance companies and make it illegal to hold victims accountable.
• sonnyblarney 7y ago
  Even though this is one step in the direction of 'free markets' ... they need to go further. With healthcare, we fall into an entirely different domain of economics, especially because the leverage of those who have 'life saving' services over those who don't is basically existential. A better solution would be: 'one price for everyone'. The entire gambit of 'negotiated prices' is a fallacy in the end, it's just a matter of groups having collective power over another, it's not really economically efficient. Either A) all Americans form a 'super powerful buying conglomerate' which is 10x more powerful than any healthcare provider, thereby forcing 'amazingly low prices' (which basically socialized medicine) - or B) we let the 'aggregate market demand' determine price, which is basically 'one price for all'. America should probably follow one of the European examples where they have a public/private mix. I respect that some people just want full control and want to pay for that, it's fine, but there needs to be a socialized component more efficient than Medicare. I'm not sure if Canada or UK are the best examples for America. Germany, Netherlands or Switzerland might be better.
• subhobroto 7y ago
  Price transparency in healthcare sounds great after the first few seconds of thought about the matter, ever - after all with price matching TVs and Google Home at BestBuy, Amazon and the like work so well! It's not just fancy electronics - it works for healthcary stuff too: Look at how cheap plastic surgery is! Free market at its best! However, past the above sarcasm and after a few more minutes of deep reflection, it starts to unravel that price transparency just does not work if there is no free market. And guess what: healthcare in the U.S. is no free market: https://www.quora.com/Is-free-market-healthcare-actually-possible/answer/Subhobroto-Sinha-1 https://www.quora.com/Is-free-market-healthcare-actually-pos... Yes, price transparency works well in a free market No, healthcare is no free market. Definitely not the U.S. market. Healthcare in the U.S. is a pseudo socialized care where private healthcare dollars subsidize social care programs. Employees on employer sponsored health plans, which are only federally regulated and rarely have the additional protections that the states they reside in afford them are nickle, dimed and squeezed for the very last dollar that can be extracted from them. Employees are beholden to the employer choosing good plans for them, keeping those good plans around at affordable prices and continuing to be in business and able to employ these employees. TOO MANY ifs and buts if you ask me but I digress. As long as we have something like the EMTALA or similar where services have to be rendered regardless of ability to pay, the deficit in payment recieved will have to be covered somehow! Here are two scenarios with Price transparency: Base Scenario: ------------- Provider: I charge $100 cash to see a patient Insurance company (InCo) 1: We will pay you $170 if you agree to work with us. You cannot tell our insured that you will accept $100 cash or we will blacklist you. Provider: ok Insurance company (InCo) 2: We will pay you $120 if you agree to work with us. You cannot tell our insured that you will accept $100 cash or we will blacklist you. Provider: ok Medicare: We will pay you $70 if you agree to work with us. Patient 1 (w/ InCo1): Doctor, I want to see you. How much do you charge Provider: I cannot tell you. Depends. Speak with my biller Patient 1 calls biller and they estimate $180 Patient 2 (w/ InCo2) has the same conversation and gets a $150 estimate Patient 1 and 2 are friends and they compare notes. Patient 1 complains to InCo1 that he paid too much money for the same visit that costs his friend, Patient 2, much less. Plus there's this website that shows the Provider accepts on the average, less than $120! InCo 1 calls Provider: Hey! We heard you charged less for someone else! Trump has this website that says you accept on the average, less than $120! You better charge us less too or we will not renew our contract! Medicare patient: Doctor, I would like to see you Cash patient: Doctor, I would like to see you Scenario 1: ---------- Provider: InCo1, Fair enough. I guess I will absorb the cost of your paperwork, cumbersome claims process, 90+ days of payment delays and reduce my reimbursement amounts because I don't have student loans, rent, staff bills to pay. Medicare patient, I will see you even if I lose money because I'm in this business because I love it. Cash patient, I will honor my $100 rate but I will appreciate if you could tip me $20 because I just lost a few hundred InCo1: No, you have to accept $100 now because you're a push over InCo2: Yeah, what they said. It's not fair you charge us more! Cash patient: Do you want this money or not? Scenario 2: ---------- Provider: InCo1, InCo2, not interested. There are few of me compared to the number of insureds you have and I will not absorb the cost of your paperwork, cumbersome claims process, 90+ days of payment delays. Infact, to renew our contract, my reimbursement amount is now $300 because dealing with you is too much of a hassle. Medicare patient, I will not see you because I am losing money on you. Go see someone else in a better position than I. Cash patient, I will honor my $100 rate because I don't have to deal with all the nonsense but only if you keep your mouth absolutely shut. If this $100 ever makes it to a Yelp review, our relationship is over. I almost considered charging you $200 instead because you don't have an insurance company bargaining for you but I have a weak spot for the unrepresented. President Trump, I charge everyone $300! InCo1: Yeah, he charges $300. That's literally what it says in our paperwork. Here, see it! InCo2: Yeah, he charges $300. That's literally what it says in our paperwork. Here, see it! Cash patient: I have no clue what Provider charges. I am on a payment plan and paid $150 or $100. Maybe. I don't know, please keep me out of this I just want to get better OK? Medicare patient: I have some cash but not enough to pay per visit. Maybe I should also go into business with InCo1 or InCo2 as supplements Which is more likely you think? As long as we have something like the EMTLA or similar where services have to be rendered regardless of ability to pay, the solution to sane pricing is to have King Kong fight with Godzilla and keep each other in check. We just have to ensure we can control both King Kong fight and Godzilla - and so far - they both have been very selfish and barely controllable. We must begin with killing employer sponsored health plans and put individual citizens in direct control of their care instead of whatever the distracted HR team puts together or the even more distracted brokerage company that the distracted HR team contracted after googling for "employee health benefits examples" Individual citizens are not even in the game. They have no bargaining power. Time to change that. Let them regain control of which network they want to work with regardless of where they happen to work or not even work at all. The employer might be looking for the cheapest network but the employee might be looking for a network with good coverage or covers certain doctors of their choosing etc Why complicate matters? Keep things simple. Politics, employment and healthcare do not mix. Healthcare is too important. Keep them separate. Break the ties.
• elamje 7y ago
  To say the healthcare system in the US is broken is an understatement, but this is a step in the right direction. Especially, if we cannot get a single payer system passed through Congress in the near term. Who knows, if the policy is actually done right, it might lower costs.
• drawkbox 7y ago
  This will help but until health insurance and healthcare is disconnected from employer provided, and instead consumer focused, the pricing will continue to be shrouded and fixed. Healthcare and health insurance should almost be separate but should not be tied to a workplace. Disconnecting health insurance from work benefits in favor of payment will help the private market and public market pricing, whichever or a combination of both that it eventually goes. Healthcare that is consumer focused and disconnected from employer provided: - will have to be price transparent - will make starting a business easier - will make the US more business competitive as companies in other countries don't have to provide it - will allow people to change jobs more easily - will make ageism less of an issue - will get companies out of your private health - will allow bigger grouping by insurance companies across the nation not at the job level (right now small/medium/family/individual private insurance is seen as more risky because private insurance groups by employer and smaller is more risky) Health insurance is personal and shouldn't be known by your employer, and re-signing up every year and anytime you get a new job is tedious, it needs to be like all other insurance (auto, home, life mostly) that it is a personal consumer choice and private. Unbinding and de-coupling healthcare from the job is pro-business and pro-consumer health and will lead to true market price transparency.
  • IanDrake 7y ago
    Exactly, we really just need to change one tax policy to make this happen. It doesn't get much easier than that.
  • subhobroto 7y ago
    Brilliant insight! Would love to talk more! I wrote a response to this article here: https://news.ycombinator.com/item?id=20281150 https://news.ycombinator.com/item?id=20281150 Specifically echoed your sentiments at the bottom of the long post, if you want to skip it. What can we do to change it? Would love any input!
• mgoetzke 7y ago
  So now they can see each others prices and collude in the open and ensure no one strays or undercuts on certain deals ?
• epr 7y ago
  Do healthcare providers think that consumers would make decisions differently if presented with pricing up front? If so, how does their omission not fit the legal definition of fraud?
• IanDrake 7y ago
  At best this is a bandaid and not a cure. To treat the problem, you have to go straight to the root. And that problem is: The cost of free is too damn high. Most people in the US don't pay for their medical care or their medical insurance. It's "free", at least in terms of money out of pocket. We need to remove the corporate tax deduction for healthcare insurance from the tax law. This in turn will solve most other problems as market forces are brought back into the picture. Once people start selecting and paying for their own policy, they will be more price conscious on their claims, as most people already are on their auto insurance. Once people are more price conscious, medical facilities will begin to complete again on price and insurance companies will focus on individual plans. It all has to start with the consumer though, and currently the consumer doesn't care what the price is. They don't pay for the medical care and they don't the insurance premiums.
• deleted 7y ago
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• DataDrivenMD 7y ago
  Not too long ago I led a team that built data products using a massive dataset comprised of more than 6B medical claims. This included Medicare, Medicaid, and private insurance. Two thoughts: 1) Trump is either bluffing or he doesn't have anyone around him that actually knows how medical billing works. If he were serious, the executive order would mandate that HHS publish the information based on the data that's already included in every claim (i.e. invoice) submitted to CMS for payment. From a policy standpoint there are already rules in the federal register that allow HHS to publicly disclose cost information at the hospital-level. I'm no lawyer but it seems to me that a well-crafted executive order could stand up in court. Even if it were struck down, putting forth such an executive order would be a shrewd political move because it would cast its opponents in a bad light. These would presumably be insurance companies, the medical billing industry, and for-profit healthcare providers. From a technical standpoint: there are already data pipelines in place for this sort of thing. The CMS Open Data initiative already reports hospital-level aggregates. It's not that hard to comment out a few 'GROUP BY' statements in order to get a POC up and running quickly. 2) Even if the current executive order comes to pass, people will continue to receive surprise bills and experience sticker shock. That's because the total (billed) cost is a function of: - professional services (procedures rendered by doctors/therapists, etc) - facility fees (hospital bed, in-house labs, etc) For any given hospital stay or office visit the quantity and types of items in each category can (and does) vary. The current executive order mostly addresses the latter. Furthermore, two patients seeing the exact same doctor for the exact same thing but using different insurance companies will get vastly different bills. That's because different insurance companies require healthcare providers to bundle/group (and sometimes break out/itemize) services in their own way. Because out-of-pocket costs are, in turn, a % of the total negotiated rate patients necessarily end up with the short stick in terms of cost transparency. Given the current medical billing system, there's simply no way for patients to know exactly what they're going to pay ahead of time because the charges won't be finalized until the insurance company decides what they will/won't cover. No executive order will change that. Transparency will require Congress to muster up the will to write laws that put the patient first, not last.