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I agree with all these problems. I'm not disputing any of it. What does this have to do with an extortionate bill from a state-run hospital?

munk-a 7y ago
The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare. If better priced options are available people are going to stop playing in that private healthcare sandbox - it's part of the same reason why the house has been unable to legalize purchasing drugs abroad... that too would weaken the price fixing abilities of pharmaceutical manufacturers and PBMs - also maybe pharmacies, they tend to get squeezed pretty hard by PBMs though so only in the case where a pharmacy is being squeezed by its own PBM (as is the case of CVS) is the pharmacy really embroiled heavily in this mess as a loss leader.
- vonmoltke 7y ago
  > The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare. Do you have evidence of the Virginia legislature meddling with the hospital's charge master? I could certainly believe that, but in the absence of evidence I'm more inclined to think it's just the hospital administrators trying to extract every dollar they can out of patients. For some reason even non-profit and government entities often seem to have a disturbing emphasis on revenue enhancement.
  - munk-a 7y ago
    I don't have any such evidence and I agree with you that it's quite possible that this particular hospital isn't being directly influenced - the fact that the market seems to be dictating that these prices are acceptable could in fact be the sole influence over the charge master - but it's my view that this pricing level would be impossible is surrounding private healthcare facilities had more reasonable prices. This, and the number of bad actors involved with healthcare, is sort of the issue - whenever the PBMs are under attack they claim innocence and say it's the pharma manufacturers - similarly here the hospital did indeed act in a rational way in their pricing, but that way is only made rational by the broken national system - and if, while an aspirin at a hospital normally costs 100$, at this publicly funded hospital that aspirin cost you 3c[1] then there would probably be outcry by the private hospital that the public healthcare offering is unfairly undercutting prices in a manner that private organization couldn't compete with - you can see this happening right now with the wonderful debate on municipal internet. 1. Insert reasonable cost here, 3c seems much less stupid expensive to me, it's probably still like a 100% markup if buying in bulk but Amazon is willing to give me 100 pills of aspirin for $3.08
  - jascii 7y ago
    A large part of the cost of care is driven by the cost of the providers (mallpraction and other) insurance. Who do you think sets the prices of that?

munk-a 7y ago

The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare. If better priced options are available people are going to stop playing in that private healthcare sandbox - it's part of the same reason why the house has been unable to legalize purchasing drugs abroad... that too would weaken the price fixing abilities of pharmaceutical manufacturers and PBMs - also maybe pharmacies, they tend to get squeezed pretty hard by PBMs though so only in the case where a pharmacy is being squeezed by its own PBM (as is the case of CVS) is the pharmacy really embroiled heavily in this mess as a loss leader.

vonmoltke 7y ago
> The existence of that state-run hospital and the illogical size of their bill is a result of a lot of the lobbying done to keep the private industry from being uncompetitive with publicly offered healthcare. Do you have evidence of the Virginia legislature meddling with the hospital's charge master? I could certainly believe that, but in the absence of evidence I'm more inclined to think it's just the hospital administrators trying to extract every dollar they can out of patients. For some reason even non-profit and government entities often seem to have a disturbing emphasis on revenue enhancement.
- munk-a 7y ago
  I don't have any such evidence and I agree with you that it's quite possible that this particular hospital isn't being directly influenced - the fact that the market seems to be dictating that these prices are acceptable could in fact be the sole influence over the charge master - but it's my view that this pricing level would be impossible is surrounding private healthcare facilities had more reasonable prices. This, and the number of bad actors involved with healthcare, is sort of the issue - whenever the PBMs are under attack they claim innocence and say it's the pharma manufacturers - similarly here the hospital did indeed act in a rational way in their pricing, but that way is only made rational by the broken national system - and if, while an aspirin at a hospital normally costs 100$, at this publicly funded hospital that aspirin cost you 3c[1] then there would probably be outcry by the private hospital that the public healthcare offering is unfairly undercutting prices in a manner that private organization couldn't compete with - you can see this happening right now with the wonderful debate on municipal internet. 1. Insert reasonable cost here, 3c seems much less stupid expensive to me, it's probably still like a 100% markup if buying in bulk but Amazon is willing to give me 100 pills of aspirin for $3.08
- jascii 7y ago
  A large part of the cost of care is driven by the cost of the providers (mallpraction and other) insurance. Who do you think sets the prices of that?