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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 i

• 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.