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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

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.
  - pdpi 7y ago
    The fact that this data has to be published means any one person with medical knowledge and their techie friend can now build a "what's the cheapest hospital near me?" website, which is something we couldn't do yesterday. This is an enormous problem, and the way you eat an elephant is one bite at a time.
    - amanaplanacanal 7y ago
      This exactly. The average joe doesn't need to be an expert in this stuff. Similar to Consumer Reports.
- nostrademons 7y ago
  Also, just having the ability to comparison shop tends to hold down prices, because firms know that you could go elsewhere if they're gouging you and that information tends to escape. It's like how when the wage-fixing cartel among Silicon Valley employers was discovered, everybody at Google got an immediate ~50% pay bump. You didn't need to actively interview at Facebook, because they knew you could and would rather that you not get that idea in your head.
  - inlined 7y ago
    A mild correction: it was an effective 10% bump. Google used to have an individual and company multiplier to the bonus which could top out to 25%. The company had repeatedly hit the 25% company multiplier and had strong feedback that the employees preferred predictability in pay. So, they gave a 35% pay raise and phased out the company multiplier. It also happened in October 2010, which I think was before the wage fixing was discovered (I know the dates because it was after I signed and before I started. Any time I tried to negotiate on salary they countered on stock because they knew salary was going to multiply by a third)
  - metalliqaz 7y ago
    That is not an apples to apples comparison. A gentleman's agreement not to poach engineers with valuable skills is very different from companies charging people with services who are not able to say "no". There is a massive information asymmetry between health care providers and consumers. Doctors take decades of training. Hell, medical billing by itself is a degree. Consumers will never be prepared to properly assess costs. Even if they could, it doesn't matter when you are hurt and can't refuse. It's more like food sales at a hockey game. Anyone in the arena that wants to eat or drink has to buy what is being sold. As such, prices are hugely inflated, even though the nearby gas station is much cheaper.
  - jerf 7y ago
    Heck, even post facto, if you're in an emergency and you end up stuck at a hospital that charges $50K for a procedure, and then while recovering you find a nearby hospital that does it for $10K, you're not necessarily without options. It's not hard to go to the provider who actually gave you service and say "You know, they charge 20% what you do... what's the odds I can cause $40K's worth of stink in the local news if you don't cut my price down now?" (You may want to consult with a lawyer friend a bit before making quite such a naked statement; that may constitute blackmail in your jurisdiction. But there will still be "ways" of phrasing things in your jurisdiction. Talking to a lawyer may not be all bad anyhow, whatever it is you have to say will sound more credible with some lawyer's letterhead on top. Hospitals hear a lot of amateur lawyers expound their novel legal theories every day.) I'm not going to deny the relationship in that situation is still lopsided in the direction of the first hospital, but the situation is not necessarily 100% in their favor.
- Sir_Cmpwn 7y ago
  Let's hope you don't die in the extra 10 minutes it takes for the ambulance to drive you to your preferred hospital.
  - inlined 7y ago
    AFAIK you don’t get to choose where you go in case of an ambulance, but if you are taking yourself to urgent or emergency care you can shop around. Heck, I had four torn ligaments this year and at least checked yelp reviews before going to urgent care.
  - metalliqaz 7y ago
    Even if you made that request, they wouldn't honor it.
  - ceejayoz 7y ago
    Or discover there's a reason for the price difference.
- fzeroracer 7y ago
  Looking up the prices literally doesn't mean anything. This entire exercise is pointless because it is impossible to tell whether or not you will be charged the in-network fees or price gouged by out of network doctors. You do some price shopping around and find a hospital that's cheap. It says the hospital is in network, and you go. While you're receiving treatment the hospital has another doctor treat you who happens to be out of network and now all of your shopping is rendered useless as you get slapped with a huge bill. This is one of many reasons why shopping for healthcare treatment is ultimately useless. What do you do if you go to the hospital and get slapped with treatment that you need, but couldn't shop for until you arrive? What if it's especially critical treatment? You simply cannot shop around for most medical issues like you can other things because information asymmetry is too high. And putting off a medical issue to do this shopping is frankly horrifying because you have zero clue if the issue you have is critical or not! If you're experiencing the symptoms of a stroke for example this is an entirely time critical medical emergency. Any second spent not getting treatment reduces your chances of a fuller recovery.
sigstoat 7y ago
> 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. this is absurd. there's plenty of spending that isn't in any hurry, and doesn't need to be. a couple of things off the top of my head; opthalmalogical checkups, having funny moles inspected/removed, annual exams of all varieties, vaccinations... the list is enormous. > but even a relatively common illness makes comparison shopping unrealistic take your GP's rates for the services you expect to need over the near year or two into consideration in advance when choosing them. > Has anyone else had a doctor or nurse filed the wrong paperwork for a blood test... maybe if you could check the price ahead of time, you could've checked that they wrote down the correct test?
- metalliqaz 7y ago
  > maybe if you could check the price ahead of time, you could've checked that they wrote down the correct test? maybe you could. I couldn't. My knowledge of the difference between various unpronounceable enzymes is not adequate. Even if I had an app that could tell me the exact costs, how would I know what the Doctor actually intended?
coredog64 7y ago
I’ll repeat the same comment I always make in these threads: This is the way the French system (mostly) works for outpatient care. So anyone who suggests it can’t/won’t work is ignoring that it does work. Refresher: Government has a reasonable and customary price list. You pay the doctor out of pocket at time of service and you get reimbursed at some percentage of R&C (IIRC 80%)
brianwawok 7y ago
> when a person is sick or injured, they usually are not able to comparison shop. Strongly disagree. According to NPR today, something like 75% of in-patient and 90% of out-patient events are shoppable. Think something like having strep throat, or having a possible broken arm. Nothing stops you from looking at a few places before treatment. Sure some cases are you got shot or had a heart attack and had to get rushed to the ER. Of your total medical visits in your life, what % of your total visits were like this?
- Johnny555 7y ago
  ...having a possible broken arm...Nothing stops you from looking at a few places before treatment Except that you're laying on the ground writhing in pain, not the easiest time to pull out your phone and pull up pricewatch.com before you call 911 to find out which hospital has the best deal on x-rays today.
  - nightwing 7y ago
    Most people have some family members or friends who would do that. Where i live (admittedly not USA) it's very rare for a person to go to a doctor alone.
  - alistairSH 7y ago
    In the case of a broken shoulder (collarbone), the ER often does some X-rays, puts you in a sling, prescribes painkillers, and sends you home. You find a specialist the next day. And if you require surgery, that's another day or two. There's no reason you couldn't do a cursory sanity-check on pricing in this case (if pricing info was easily accessible).
    - filoleg 7y ago
      yep, sounds correct. Broke hand, went to the closest urgent care, they did xrays, confirmed it was broken, put it in a sling, and referred me to a specialist (by just giving me a note confirming that they referred me with the specialist's phone number) that they thought was good and was close to where I lived. However, they didn't have to pick that specific specialist. In fact, they even asked me if I had a preferred specialist and/or hospital. I called the specialist the same day, had the appointment a few days after.
mattchew 7y ago
I can't agree with this at all. Our family has four people in it. We've spent plenty of time and money on medical care in the past 18 years. Almost everything we've done medically, we could have made use of price transparency, if we had it. Yes, there are scenarios where the most important thing is to get emergency care as soon as possible. These are the exception--the rare exception--not the rule.
- aiisjustanif 7y ago
  > The rare exception Stop. It's not rare, 6% is not rare [1]. 10 states have 10% and above, up to 26%. Emergency room visits happen quite often enough. [1]: https://www.kff.org/other/state-indicator/emergency-room-visits-by-ownership/?activeTab=map&currentTimeframe=0&selectedDistributions=statelocal-government&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D https://www.kff.org/other/state-indicator/emergency-room-vis...
  - EpicEng 7y ago
    rare adjective (of an event, situation, or condition) not occurring very often. I'd say 6% fits that definition. You're also ignoring the fact that, for various reasons, people show up in an ER when they really didn't need to. This helps in the vast majority of cases and you're being needlessly argumentative.
  - bhelkey 7y ago
    If a policy helps 94% of the time and is no better or worse 6% of the time, should we enact it?
  - jjeaff 7y ago
    It's definitely rare. That's 6-10% of medical visits. Which tend to be made by a minority of people visiting very often. In fact, to use that stat per 1000 people is not very useful. Number of people per 1000 visiting a hospital for an emergency would be more helpful. I suspect it would be much less than even 1%.
  - naasking 7y ago
g00s3_caLL_x2 7y ago
This is the argument I have posed toward most closed systems, heck, even open. For instance, our tax system. The only real way you would ever have a true legit overhaul would be to burn the entire thing down. Now, while I'm not even remotely suggesting that, it seems the only feasible way to start from scratch. I just don't see any incremental adjustments working that would not be thwarted in someway. Now that I've typed this out and read it, a big part of the problem has got to be lobbyist. Get that out of our politics 100% and we might be able to see some progress.
Veelox 7y ago
>when a person is sick or injured, they usually are not able to comparison shop You argument seems to be that since this doesn't work in all situations, it is useless. I strongly disagree. On my current commute to work, I drive by at least 2 major hospitals and know that a 3rd is not far out of the way. If I was willing to drive up to 2 hours, I could choose from at least 7 major hospitals. For emergencies I don't have time to shop. If it is something important but planned (fixing a torn ACL) it would be nice to be able to look up the price at the 7 different hospitals. If one is 1/3 the price of the others, I know which one I am picking. Current rules make it impossible to price shop for fixing an ACL this would make it at least possible.
- whatshisface 7y ago
  >For emergencies I don't have time to shop. What if you shop before the emergency?
  - beat 7y ago
    It's not like people plan on a torn ACL. And for most major health care issues, the primary concern of the patient isn't price, but rather outcomes - quality of care. Do we choose the cheapest doctor, or the doctor with the best reputation? My wife, who is a dancer, tore her ACL last year. Not getting it fixed, and fixed right, was the difference between being able to continue dancing, and having to give up the thing she loves the most. So when decisions like "Use transplant tissue, or cadaver tissue?" came up, there was zero thought given to "Which one costs the most?" It was all "Which one is most likely to get her back on her feet and allow her to continue dancing?"
    - mgkimsal 7y ago
      > Do we choose the cheapest doctor, or the doctor with the best reputation? Most people in the US have never had a way of knowing who the 'cheapest' doctor is until after the bill comes.
      - beat 7y ago
mattnewton 7y ago
We can’t pretend that this will solve everything, but I also struggle to see how it could hurt consumers. It seems like a common sense proposal with potential to help consumers.
- noelsusman 7y ago
  Enforcing upfront price transparency in markets with few suppliers and significant geographic restrictions can result in higher prices through "collusion". This isn't theoretical, it has already happened. https://onlinelibrary.wiley.com/doi/full/10.1111/1467-6451.00057 https://onlinelibrary.wiley.com/doi/full/10.1111/1467-6451.0...
  - mattnewton 7y ago
    Huh, TIL, thanks for the link.
hathawsh 7y ago
My wife and I agreed years ago that we would have a discussion before either of us makes a purchase of about $20 or more. (We haven't adhered to that perfectly, but it has been a great guideline.) Oddly, we failed to notice that we never have that discussion when it comes to health care, even though the vast majority of our interactions with the health care system are certainly not emergencies. We routinely go to a doctor, we don't ask what it will cost, we do whatever the doctor asks, and insurance covers only part of the bill. Health care is the only exception to our $20 rule. How odd... We realized we've been bamboozled. Nearly every hospital and clinic uses the same trick: the doctors apparently don't know what anything costs, the office staff say they don't know what anything will cost us because it depends on the insurance, and the insurance company won't reveal the price until the office staff charges the insurance. All the indirection makes it difficult to determine even a ballpark figure. (It no longer surprises me when the hospital charges $4000 per night to merely sleep in a bed with nurses and doctors nearby.) We decided we're no longer going to make an exception for health care (except in emergencies). We're going to require a price ahead of time so we can discuss it like we do everything else. We intend to annoy the office staff and insurance company until they comply and tell us what the prices will be. We think about it this way: heavy expenses can easily cause stress that reduce our quality of life, significantly offsetting whatever we might gain from medical procedures. I'm glad the legislation seems to be working in our favor.
- ryandrake 7y ago
  I've actually tried this. The doctors and office staff will always claim they don't know how much any of their services cost. They will stubbornly stonewall you if you escalate. I've gotten into an actual shouting match with a doctor over this and ended up getting banned from his clinic. Go ahead and threaten to go to another doctor: They don't care because they know every other practice will stonewall you about anything cost-related as well. No clinic will even let you sign up as a new patient anymore unless you sign their form that essentially says "You agree to pay any amount that we decide you owe. If we make a mistake, tough luck. If you can't afford it, tough luck."
  - hathawsh 7y ago
deleted 7y ago
[deleted]
opo 7y ago
>...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. I disagree. Almost all out-patient medical procedures are pre-planned and it would be possible to comparison shop if there was actual pricing info. Even in terms of hospitals, an estimate is that about 1/2 of the patients are admitted through the ER. Obviously there are emergencies and you aren't going to be doing price comparisons if you are in an ambulance after a car crash, but that isn't the majority of medical care. https://www.nytimes.com/2013/05/21/business/half-of-hospital-admissions-from-emergency-rooms.html https://www.nytimes.com/2013/05/21/business/half-of-hospital... >...The system is broken and until the insurance industry's grip is broken, I don't think there is a simple magic bullet that will solve all of the problems with health care in this country.
jlarocco 7y ago
No, this single thing won't magically fix healthcare in the US, but it's a baby step in the right direction. If we have to completely solve the problem and overhaul the system in one giant step then we'll never get anywhere. The insurance companies and hospitals know it, and that's partly why they fight so hard against small changes like this.
mc32 7y ago
If the data were open, couldn’t someone come up with a “health-shop” site/app to comparison shop for well known issues?

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.
- pdpi 7y ago
  The fact that this data has to be published means any one person with medical knowledge and their techie friend can now build a "what's the cheapest hospital near me?" website, which is something we couldn't do yesterday. This is an enormous problem, and the way you eat an elephant is one bite at a time.
  - amanaplanacanal 7y ago
    This exactly. The average joe doesn't need to be an expert in this stuff. Similar to Consumer Reports.
nostrademons 7y ago
Also, just having the ability to comparison shop tends to hold down prices, because firms know that you could go elsewhere if they're gouging you and that information tends to escape. It's like how when the wage-fixing cartel among Silicon Valley employers was discovered, everybody at Google got an immediate ~50% pay bump. You didn't need to actively interview at Facebook, because they knew you could and would rather that you not get that idea in your head.
- inlined 7y ago
  A mild correction: it was an effective 10% bump. Google used to have an individual and company multiplier to the bonus which could top out to 25%. The company had repeatedly hit the 25% company multiplier and had strong feedback that the employees preferred predictability in pay. So, they gave a 35% pay raise and phased out the company multiplier. It also happened in October 2010, which I think was before the wage fixing was discovered (I know the dates because it was after I signed and before I started. Any time I tried to negotiate on salary they countered on stock because they knew salary was going to multiply by a third)
- metalliqaz 7y ago
  That is not an apples to apples comparison. A gentleman's agreement not to poach engineers with valuable skills is very different from companies charging people with services who are not able to say "no". There is a massive information asymmetry between health care providers and consumers. Doctors take decades of training. Hell, medical billing by itself is a degree. Consumers will never be prepared to properly assess costs. Even if they could, it doesn't matter when you are hurt and can't refuse. It's more like food sales at a hockey game. Anyone in the arena that wants to eat or drink has to buy what is being sold. As such, prices are hugely inflated, even though the nearby gas station is much cheaper.
- jerf 7y ago
  Heck, even post facto, if you're in an emergency and you end up stuck at a hospital that charges $50K for a procedure, and then while recovering you find a nearby hospital that does it for $10K, you're not necessarily without options. It's not hard to go to the provider who actually gave you service and say "You know, they charge 20% what you do... what's the odds I can cause $40K's worth of stink in the local news if you don't cut my price down now?" (You may want to consult with a lawyer friend a bit before making quite such a naked statement; that may constitute blackmail in your jurisdiction. But there will still be "ways" of phrasing things in your jurisdiction. Talking to a lawyer may not be all bad anyhow, whatever it is you have to say will sound more credible with some lawyer's letterhead on top. Hospitals hear a lot of amateur lawyers expound their novel legal theories every day.) I'm not going to deny the relationship in that situation is still lopsided in the direction of the first hospital, but the situation is not necessarily 100% in their favor.
Sir_Cmpwn 7y ago
Let's hope you don't die in the extra 10 minutes it takes for the ambulance to drive you to your preferred hospital.
- inlined 7y ago
  AFAIK you don’t get to choose where you go in case of an ambulance, but if you are taking yourself to urgent or emergency care you can shop around. Heck, I had four torn ligaments this year and at least checked yelp reviews before going to urgent care.
- metalliqaz 7y ago
  Even if you made that request, they wouldn't honor it.
- ceejayoz 7y ago
  Or discover there's a reason for the price difference.
fzeroracer 7y ago
Looking up the prices literally doesn't mean anything. This entire exercise is pointless because it is impossible to tell whether or not you will be charged the in-network fees or price gouged by out of network doctors. You do some price shopping around and find a hospital that's cheap. It says the hospital is in network, and you go. While you're receiving treatment the hospital has another doctor treat you who happens to be out of network and now all of your shopping is rendered useless as you get slapped with a huge bill. This is one of many reasons why shopping for healthcare treatment is ultimately useless. What do you do if you go to the hospital and get slapped with treatment that you need, but couldn't shop for until you arrive? What if it's especially critical treatment? You simply cannot shop around for most medical issues like you can other things because information asymmetry is too high. And putting off a medical issue to do this shopping is frankly horrifying because you have zero clue if the issue you have is critical or not! If you're experiencing the symptoms of a stroke for example this is an entirely time critical medical emergency. Any second spent not getting treatment reduces your chances of a fuller recovery.

sigstoat 7y ago

> 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. this is absurd. there's plenty of spending that isn't in any hurry, and doesn't need to be. a couple of things off the top of my head; opthalmalogical checkups, having funny moles inspected/removed, annual exams of all varieties, vaccinations... the list is enormous. > but even a relatively common illness makes comparison shopping unrealistic take your GP's rates for the services you expect to need over the near year or two into consideration in advance when choosing them. > Has anyone else had a doctor or nurse filed the wrong paperwork for a blood test... maybe if you could check the price ahead of time, you could've checked that they wrote down the correct test?

metalliqaz 7y ago
> maybe if you could check the price ahead of time, you could've checked that they wrote down the correct test? maybe you could. I couldn't. My knowledge of the difference between various unpronounceable enzymes is not adequate. Even if I had an app that could tell me the exact costs, how would I know what the Doctor actually intended?

coredog64 7y ago

I’ll repeat the same comment I always make in these threads: This is the way the French system (mostly) works for outpatient care. So anyone who suggests it can’t/won’t work is ignoring that it does work. Refresher: Government has a reasonable and customary price list. You pay the doctor out of pocket at time of service and you get reimbursed at some percentage of R&C (IIRC 80%)

brianwawok 7y ago

> when a person is sick or injured, they usually are not able to comparison shop. Strongly disagree. According to NPR today, something like 75% of in-patient and 90% of out-patient events are shoppable. Think something like having strep throat, or having a possible broken arm. Nothing stops you from looking at a few places before treatment. Sure some cases are you got shot or had a heart attack and had to get rushed to the ER. Of your total medical visits in your life, what % of your total visits were like this?

Johnny555 7y ago
...having a possible broken arm...Nothing stops you from looking at a few places before treatment Except that you're laying on the ground writhing in pain, not the easiest time to pull out your phone and pull up pricewatch.com before you call 911 to find out which hospital has the best deal on x-rays today.
- nightwing 7y ago
  Most people have some family members or friends who would do that. Where i live (admittedly not USA) it's very rare for a person to go to a doctor alone.
- alistairSH 7y ago
  In the case of a broken shoulder (collarbone), the ER often does some X-rays, puts you in a sling, prescribes painkillers, and sends you home. You find a specialist the next day. And if you require surgery, that's another day or two. There's no reason you couldn't do a cursory sanity-check on pricing in this case (if pricing info was easily accessible).
  - filoleg 7y ago
    yep, sounds correct. Broke hand, went to the closest urgent care, they did xrays, confirmed it was broken, put it in a sling, and referred me to a specialist (by just giving me a note confirming that they referred me with the specialist's phone number) that they thought was good and was close to where I lived. However, they didn't have to pick that specific specialist. In fact, they even asked me if I had a preferred specialist and/or hospital. I called the specialist the same day, had the appointment a few days after.

mattchew 7y ago

I can't agree with this at all. Our family has four people in it. We've spent plenty of time and money on medical care in the past 18 years. Almost everything we've done medically, we could have made use of price transparency, if we had it. Yes, there are scenarios where the most important thing is to get emergency care as soon as possible. These are the exception--the rare exception--not the rule.

aiisjustanif 7y ago
> The rare exception Stop. It's not rare, 6% is not rare [1]. 10 states have 10% and above, up to 26%. Emergency room visits happen quite often enough. [1]: https://www.kff.org/other/state-indicator/emergency-room-visits-by-ownership/?activeTab=map&currentTimeframe=0&selectedDistributions=statelocal-government&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D https://www.kff.org/other/state-indicator/emergency-room-vis...
- EpicEng 7y ago
  rare adjective (of an event, situation, or condition) not occurring very often. I'd say 6% fits that definition. You're also ignoring the fact that, for various reasons, people show up in an ER when they really didn't need to. This helps in the vast majority of cases and you're being needlessly argumentative.
- bhelkey 7y ago
  If a policy helps 94% of the time and is no better or worse 6% of the time, should we enact it?
- jjeaff 7y ago
  It's definitely rare. That's 6-10% of medical visits. Which tend to be made by a minority of people visiting very often. In fact, to use that stat per 1000 people is not very useful. Number of people per 1000 visiting a hospital for an emergency would be more helpful. I suspect it would be much less than even 1%.
- naasking 7y ago

g00s3_caLL_x2 7y ago

This is the argument I have posed toward most closed systems, heck, even open. For instance, our tax system. The only real way you would ever have a true legit overhaul would be to burn the entire thing down. Now, while I'm not even remotely suggesting that, it seems the only feasible way to start from scratch. I just don't see any incremental adjustments working that would not be thwarted in someway. Now that I've typed this out and read it, a big part of the problem has got to be lobbyist. Get that out of our politics 100% and we might be able to see some progress.

Veelox 7y ago

>when a person is sick or injured, they usually are not able to comparison shop You argument seems to be that since this doesn't work in all situations, it is useless. I strongly disagree. On my current commute to work, I drive by at least 2 major hospitals and know that a 3rd is not far out of the way. If I was willing to drive up to 2 hours, I could choose from at least 7 major hospitals. For emergencies I don't have time to shop. If it is something important but planned (fixing a torn ACL) it would be nice to be able to look up the price at the 7 different hospitals. If one is 1/3 the price of the others, I know which one I am picking. Current rules make it impossible to price shop for fixing an ACL this would make it at least possible.

whatshisface 7y ago
>For emergencies I don't have time to shop. What if you shop before the emergency?
- beat 7y ago
  It's not like people plan on a torn ACL. And for most major health care issues, the primary concern of the patient isn't price, but rather outcomes - quality of care. Do we choose the cheapest doctor, or the doctor with the best reputation? My wife, who is a dancer, tore her ACL last year. Not getting it fixed, and fixed right, was the difference between being able to continue dancing, and having to give up the thing she loves the most. So when decisions like "Use transplant tissue, or cadaver tissue?" came up, there was zero thought given to "Which one costs the most?" It was all "Which one is most likely to get her back on her feet and allow her to continue dancing?"
  - mgkimsal 7y ago
    > Do we choose the cheapest doctor, or the doctor with the best reputation? Most people in the US have never had a way of knowing who the 'cheapest' doctor is until after the bill comes.
    - beat 7y ago

mattnewton 7y ago

We can’t pretend that this will solve everything, but I also struggle to see how it could hurt consumers. It seems like a common sense proposal with potential to help consumers.

noelsusman 7y ago
Enforcing upfront price transparency in markets with few suppliers and significant geographic restrictions can result in higher prices through "collusion". This isn't theoretical, it has already happened. https://onlinelibrary.wiley.com/doi/full/10.1111/1467-6451.00057 https://onlinelibrary.wiley.com/doi/full/10.1111/1467-6451.0...
- mattnewton 7y ago
  Huh, TIL, thanks for the link.

hathawsh 7y ago

My wife and I agreed years ago that we would have a discussion before either of us makes a purchase of about $20 or more. (We haven't adhered to that perfectly, but it has been a great guideline.) Oddly, we failed to notice that we never have that discussion when it comes to health care, even though the vast majority of our interactions with the health care system are certainly not emergencies. We routinely go to a doctor, we don't ask what it will cost, we do whatever the doctor asks, and insurance covers only part of the bill. Health care is the only exception to our $20 rule. How odd... We realized we've been bamboozled. Nearly every hospital and clinic uses the same trick: the doctors apparently don't know what anything costs, the office staff say they don't know what anything will cost us because it depends on the insurance, and the insurance company won't reveal the price until the office staff charges the insurance. All the indirection makes it difficult to determine even a ballpark figure. (It no longer surprises me when the hospital charges $4000 per night to merely sleep in a bed with nurses and doctors nearby.) We decided we're no longer going to make an exception for health care (except in emergencies). We're going to require a price ahead of time so we can discuss it like we do everything else. We intend to annoy the office staff and insurance company until they comply and tell us what the prices will be. We think about it this way: heavy expenses can easily cause stress that reduce our quality of life, significantly offsetting whatever we might gain from medical procedures. I'm glad the legislation seems to be working in our favor.

ryandrake 7y ago
I've actually tried this. The doctors and office staff will always claim they don't know how much any of their services cost. They will stubbornly stonewall you if you escalate. I've gotten into an actual shouting match with a doctor over this and ended up getting banned from his clinic. Go ahead and threaten to go to another doctor: They don't care because they know every other practice will stonewall you about anything cost-related as well. No clinic will even let you sign up as a new patient anymore unless you sign their form that essentially says "You agree to pay any amount that we decide you owe. If we make a mistake, tough luck. If you can't afford it, tough luck."
- hathawsh 7y ago

deleted 7y ago

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opo 7y ago

>...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. I disagree. Almost all out-patient medical procedures are pre-planned and it would be possible to comparison shop if there was actual pricing info. Even in terms of hospitals, an estimate is that about 1/2 of the patients are admitted through the ER. Obviously there are emergencies and you aren't going to be doing price comparisons if you are in an ambulance after a car crash, but that isn't the majority of medical care. https://www.nytimes.com/2013/05/21/business/half-of-hospital-admissions-from-emergency-rooms.html https://www.nytimes.com/2013/05/21/business/half-of-hospital... >...The system is broken and until the insurance industry's grip is broken, I don't think there is a simple magic bullet that will solve all of the problems with health care in this country.

jlarocco 7y ago

No, this single thing won't magically fix healthcare in the US, but it's a baby step in the right direction. If we have to completely solve the problem and overhaul the system in one giant step then we'll never get anywhere. The insurance companies and hospitals know it, and that's partly why they fight so hard against small changes like this.

mc32 7y ago

If the data were open, couldn’t someone come up with a “health-shop” site/app to comparison shop for well known issues?