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> Industry groups are mobilizing to fight back, saying any requirement that hospitals and insurers disclose negotiated rates would go too far. This kind of eff

> 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.
    - Fjolsvith 7y ago
      There is a standard of quality one can expect that is defined by malpractice law.
- thayne 7y ago
  Well I'd say it's better than a market where both are pretty opaque
- fucking_tragedy 7y ago
  There's too many points of negotiation between many, many entities for there to be transparent pricing in our current system. A single payer system would eliminate those points and drive costs to their equilibrium point.
snarf21 7y ago
This is easier to solve by just passing a law that insurance companies move to reference pricing. Meaning that private insurance cost is always Medicare + 30%. This is what most private insurance negotiates anyway. It is completely unnecessary bloat to have all this maneuvering on price for no benefit. The insurers (payors) will push back because they see themselves as gatekeepers and this as their differentiation. They need to go back to only making their money on their float against premiums. Additionally, we should also add that paying cash means you get the Medicare price.
- linuxftw 7y ago
  Price controls don't work. This will only lead to a shortage of doctors that take an insurance plan. > we should also add that paying cash means you get the Medicare price. Medicare doesn't pay enough. What if the doctor doesn't accept medicare?
  - Aloisius 7y ago
    Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Of course, reimbursement rates are hardly our only problem. We also use more expensive treatment options for the same conditions, give doctors (and thus patients) a level of flexibility unheard of elsewhere that allows to spend money on unnecessary medicine just to make a patient happy and have ridiculous administrative overhead costs.
    - coredog64 7y ago
      We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo.
      - subhobroto 7y ago
        Not really. You tell the working parents that they can deliver the baby in the shared room for no additional cost or upgrade to the private suite for $100k.
mempko 7y ago
Nah, let's just replace the whole thing with Medicare for all. The federal government can then negotiate prices which will be far lower than any smaller org can do. Works in Japan where prices are super low and the system is very good (far more private doctors per capita than in USA).
- sailfast 7y ago
  I'm interested to know why you think the government is incentivized to negotiate the best pricing for citizens. They would fill the same role as existing insurers, but instead of multiple black boxes there would be one. There is no way to tell if the price we are paying is at all good value for money compared to what it could cost. I'm not sure this solves our health care cost escalation problem, and the government would still be fighting against providers that would continue to grow and merge together so they would be able to negotiate with the government. This reduces overall service and competition.
  - mempko 7y ago
    I think that because it happened in Japan and other places. Japan has a single payer health insurance system called NHS. The government pays 70 percent of the cost of all health procedures, if you’re a low-income or elderly resident, it pays as much as 90 percent. The remaining 30 percent is covered by private health insurance. The government is EXTREMELY good at negotiating prices. In other words, there are already examples of it working really well, so it's pretty clear it can work well here too with enough care. Japan is known for really high-quality care that is insanely cheap and has more doctors per capita than in the USA. So the worry that overall service and competition would decline is unfounded. So let's take really good working examples and try them here. The USA can do so much better, it's not even funny. https://www.bloomberg.com/opinion/articles/2017-09-19/want-a-better-health-care-system-check-out-japan https://www.bloomberg.com/opinion/articles/2017-09-19/want-a...
    - ekianjo 7y ago
      High quality care in Japan? this claim is debunked when you see doctors dont spend more than 5 minutes with patients, barely do any tests before giving out medications by the dozen for most medical conditions. If that is high quality care it is seriously laughable.
subhobroto 7y ago
> 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. The fallacy is assuming large insurer / care companies are interested in paying more to providers or keeping a lot for themselves. Insurers work on margins, floats and risk pools. More the better. They would rather have more insured to have a larger float, a more diverse risk pool and lesser margins but more volume. Also, why would a large insurer be OK with a smaller-scale company getting the same rate? No market I know of works that way - a larger negotiating body always gets an advantage over a smaller negotiating body. Which is WHY smaller companies want to become larger companies. Otherwise it would not make sense - it's way easier and cheaper to run a smaller company than a larger company for example. You and I can't start NewCo and demand the State of Alaska give us tax credits. Alaska will bend over backwards for Amazon. That's how it works. 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!

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.
  - Fjolsvith 7y ago
    There is a standard of quality one can expect that is defined by malpractice law.
thayne 7y ago
Well I'd say it's better than a market where both are pretty opaque
fucking_tragedy 7y ago
There's too many points of negotiation between many, many entities for there to be transparent pricing in our current system. A single payer system would eliminate those points and drive costs to their equilibrium point.

snarf21 7y ago

This is easier to solve by just passing a law that insurance companies move to reference pricing. Meaning that private insurance cost is always Medicare + 30%. This is what most private insurance negotiates anyway. It is completely unnecessary bloat to have all this maneuvering on price for no benefit. The insurers (payors) will push back because they see themselves as gatekeepers and this as their differentiation. They need to go back to only making their money on their float against premiums. Additionally, we should also add that paying cash means you get the Medicare price.

linuxftw 7y ago
Price controls don't work. This will only lead to a shortage of doctors that take an insurance plan. > we should also add that paying cash means you get the Medicare price. Medicare doesn't pay enough. What if the doctor doesn't accept medicare?
- Aloisius 7y ago
  Medicare's reimbursement rates are already higher than every other developed nation. The idea that it doesn't pay enough is, frankly, bs. Of course, reimbursement rates are hardly our only problem. We also use more expensive treatment options for the same conditions, give doctors (and thus patients) a level of flexibility unheard of elsewhere that allows to spend money on unnecessary medicine just to make a patient happy and have ridiculous administrative overhead costs.
  - coredog64 7y ago
    We overtrain docs and we’ve built hospitals that focus on private rooms instead of wards. Both of those hugely increase the labor cost and will take a long time to undo.
    - subhobroto 7y ago
      Not really. You tell the working parents that they can deliver the baby in the shared room for no additional cost or upgrade to the private suite for $100k.

mempko 7y ago

Nah, let's just replace the whole thing with Medicare for all. The federal government can then negotiate prices which will be far lower than any smaller org can do. Works in Japan where prices are super low and the system is very good (far more private doctors per capita than in USA).

sailfast 7y ago
I'm interested to know why you think the government is incentivized to negotiate the best pricing for citizens. They would fill the same role as existing insurers, but instead of multiple black boxes there would be one. There is no way to tell if the price we are paying is at all good value for money compared to what it could cost. I'm not sure this solves our health care cost escalation problem, and the government would still be fighting against providers that would continue to grow and merge together so they would be able to negotiate with the government. This reduces overall service and competition.
- mempko 7y ago
  I think that because it happened in Japan and other places. Japan has a single payer health insurance system called NHS. The government pays 70 percent of the cost of all health procedures, if you’re a low-income or elderly resident, it pays as much as 90 percent. The remaining 30 percent is covered by private health insurance. The government is EXTREMELY good at negotiating prices. In other words, there are already examples of it working really well, so it's pretty clear it can work well here too with enough care. Japan is known for really high-quality care that is insanely cheap and has more doctors per capita than in the USA. So the worry that overall service and competition would decline is unfounded. So let's take really good working examples and try them here. The USA can do so much better, it's not even funny. https://www.bloomberg.com/opinion/articles/2017-09-19/want-a-better-health-care-system-check-out-japan https://www.bloomberg.com/opinion/articles/2017-09-19/want-a...
  - ekianjo 7y ago
    High quality care in Japan? this claim is debunked when you see doctors dont spend more than 5 minutes with patients, barely do any tests before giving out medications by the dozen for most medical conditions. If that is high quality care it is seriously laughable.

subhobroto 7y ago

> 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. The fallacy is assuming large insurer / care companies are interested in paying more to providers or keeping a lot for themselves. Insurers work on margins, floats and risk pools. More the better. They would rather have more insured to have a larger float, a more diverse risk pool and lesser margins but more volume. Also, why would a large insurer be OK with a smaller-scale company getting the same rate? No market I know of works that way - a larger negotiating body always gets an advantage over a smaller negotiating body. Which is WHY smaller companies want to become larger companies. Otherwise it would not make sense - it's way easier and cheaper to run a smaller company than a larger company for example. You and I can't start NewCo and demand the State of Alaska give us tax credits. Alaska will bend over backwards for Amazon. That's how it works. 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!