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> and prices are hidden I believe the Trump administration is addressing this: https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-histor

> and prices are hidden I believe the Trump administration is addressing this: https://www.hhs.gov/about/news/2019/11/15/trump-administration-announces-historic-price-transparency-and-lower-healthcare-costs-for-all-americans.html https://www.hhs.gov/about/news/2019/11/15/trump-administrati... https://www.hhs.gov/about/news/2020/10/29/trump-administration-finalizes-rule-requiring-health-insurers-disclose-price-and-cost-sharing.html https://www.hhs.gov/about/news/2020/10/29/trump-administrati... > The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rates they actually pay healthcare providers for specific services. > Through a shopping tool available through their plan or insurance company, consumers will be able to see the negotiated rate between their doctor and their plan or insurer, as well as the most accurate out-of-pocket cost estimate possible based on their health plan for procedures, drugs, durable medical equipment, and any other item or service they may need. > Consumers will also have access to accurate price and plan information that allows them to shop and compare costs between individual doctors before receiving care, so they can choose a healthcare provider that offers the most value and best suits their medical needs. But it'll be another couple years before it's all implemented it seems

zbrozek 6y ago
We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it possible, easy even, to make informed decisions among competitors. But fixing this is increasingly feeling intractable, and this pushes me further and further towards believing a single-payer (maybe not exactly, but that's the buzzword) system is the better fix.
- Karunamon 6y ago
  I want a comprehensible restaurant-like menu. Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it. [1]: https://www.icd10data.com/ICD10PCS/Codes https://www.icd10data.com/ICD10PCS/Codes
  - cogman10 6y ago
    Yup! And what will you do about it anyways? Like "Oh, you need xyz, it will cost $1000" Ok. Now that I know that, what am I supposed to do? Shop around? What if I'm in the emergency room, what then? Are they supposed to give me a price menu for every single drug or treatment they need to perform against me? "Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life". The ala cart method seems like it might work until you start thinking about the logistics. If someone goes to a doctor complaining about chest pain, do we really want them to leave because an EKG and blood test are going to cost $200. No matter how much the doctor explains to them "You might be dying" plenty of people will walk out of the hospital once the bill is presented. In some of those situations, that's going to be deadly.
    - newen 6y ago
      For some perspective, I’m pretty sure there are a lot of non-Americans reading this thread amazed at just how comical current US thinking around healthcare has become.
      - rudnevr 6y ago
        Absolutely. By the way, in most cases you don't have to bill it at all, because the actual cost is negligible.
- Frondo 6y ago
  Yes, we need price transparency, but the last time I had a surgery, it was an emergency surgery, in the sense of "get him to the nearest ER or he'll die." By the time the anesthesiologist came around, I was drifting in and out of consciousness -- no way to ask if they were in-network. (They weren't, by the way.) This isn't an uncommon scenario, and one where price transparency isn't really going to help. Also, what am I supposed to do, decline the services of an anesthesiologist and request an in-network one? What if there isn't an in-network one on duty? What if they're busy? if I need a surgery now, what choice do I have?
- some_random 6y ago
  Part of the problem is that the coding happens after the doctors do their thing, are incredible complex, and have to be checked/fixed by a specialist before they can be sent onwards.
devonbleak 6y ago
This doesn't even begin to address the real problem: emergency care. Sure I can shop around and do a bunch of research for something that I know is coming up, but when the out of network specialist drops into my wife's hospital room as she's having an asthma attack and can't breathe I don't have the temporal luxury of vetting how much that particular specialist is going to cost out of pocket and can I please have one that's in network. And we didn't even take an ambulance to that ER. When I had my motorcycle accident I was definitely not given a choice of which ER I was being hauled to - they stuck me on a back board and away we went. The issue isn't just transparency it's also coverage. We can get the menu of prices from the hospital but the specialists do their own billing so won't be covered on that - you're back to an "MP" on the menu.
- cogman10 6y ago
  I worry that it will lead to much worse treatment on top of that. Even if it's a non-emergency, getting the prices up front will cause a lot of people to chose to either go untreated or to delay treatment until a problem becomes far worse. Just having prices available does nothing to improve the costs. People with type 1 diabetes know the cost of insulin. Has that prevented it's price from moving to levels that many can't afford? It doesn't matter if the costs are known up front when drug manufactures end up with patent help that allows them to gouge. When medical devices are often produced by very few manufactures. When hospitals enjoy local monopolies. The thought that the only thing missing from keeping medical prices down is the price tag is just absurd.
  - zentiggr 6y ago
    Wouldn't that be even more pressure on the pricing system, though? If statistics about refused services were kept, we could see where the various providers are pricing in-demand services out of reach of those who need them. Or conversely, what services were advised above and beyond actual need. We could see pressure on providers to bring costs in line with the benefits of each code/procedure, and the ripple effects could help reduce the premium->insurer->provider cost overages for everyone. Mind you, I still believe single payer will be the eventual end game, but this could be a solid step in the right direction.

zbrozek 6y ago

We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it possible, easy even, to make informed decisions among competitors. But fixing this is increasingly feeling intractable, and this pushes me further and further towards believing a single-payer (maybe not exactly, but that's the buzzword) system is the better fix.

Karunamon 6y ago
I want a comprehensible restaurant-like menu. Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it. [1]: https://www.icd10data.com/ICD10PCS/Codes https://www.icd10data.com/ICD10PCS/Codes
- cogman10 6y ago
  Yup! And what will you do about it anyways? Like "Oh, you need xyz, it will cost $1000" Ok. Now that I know that, what am I supposed to do? Shop around? What if I'm in the emergency room, what then? Are they supposed to give me a price menu for every single drug or treatment they need to perform against me? "Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life". The ala cart method seems like it might work until you start thinking about the logistics. If someone goes to a doctor complaining about chest pain, do we really want them to leave because an EKG and blood test are going to cost $200. No matter how much the doctor explains to them "You might be dying" plenty of people will walk out of the hospital once the bill is presented. In some of those situations, that's going to be deadly.
  - newen 6y ago
    For some perspective, I’m pretty sure there are a lot of non-Americans reading this thread amazed at just how comical current US thinking around healthcare has become.
    - rudnevr 6y ago
      Absolutely. By the way, in most cases you don't have to bill it at all, because the actual cost is negligible.
Frondo 6y ago
Yes, we need price transparency, but the last time I had a surgery, it was an emergency surgery, in the sense of "get him to the nearest ER or he'll die." By the time the anesthesiologist came around, I was drifting in and out of consciousness -- no way to ask if they were in-network. (They weren't, by the way.) This isn't an uncommon scenario, and one where price transparency isn't really going to help. Also, what am I supposed to do, decline the services of an anesthesiologist and request an in-network one? What if there isn't an in-network one on duty? What if they're busy? if I need a surgery now, what choice do I have?
some_random 6y ago
Part of the problem is that the coding happens after the doctors do their thing, are incredible complex, and have to be checked/fixed by a specialist before they can be sent onwards.

devonbleak 6y ago

This doesn't even begin to address the real problem: emergency care. Sure I can shop around and do a bunch of research for something that I know is coming up, but when the out of network specialist drops into my wife's hospital room as she's having an asthma attack and can't breathe I don't have the temporal luxury of vetting how much that particular specialist is going to cost out of pocket and can I please have one that's in network. And we didn't even take an ambulance to that ER. When I had my motorcycle accident I was definitely not given a choice of which ER I was being hauled to - they stuck me on a back board and away we went. The issue isn't just transparency it's also coverage. We can get the menu of prices from the hospital but the specialists do their own billing so won't be covered on that - you're back to an "MP" on the menu.

cogman10 6y ago
I worry that it will lead to much worse treatment on top of that. Even if it's a non-emergency, getting the prices up front will cause a lot of people to chose to either go untreated or to delay treatment until a problem becomes far worse. Just having prices available does nothing to improve the costs. People with type 1 diabetes know the cost of insulin. Has that prevented it's price from moving to levels that many can't afford? It doesn't matter if the costs are known up front when drug manufactures end up with patent help that allows them to gouge. When medical devices are often produced by very few manufactures. When hospitals enjoy local monopolies. The thought that the only thing missing from keeping medical prices down is the price tag is just absurd.
- zentiggr 6y ago
  Wouldn't that be even more pressure on the pricing system, though? If statistics about refused services were kept, we could see where the various providers are pricing in-demand services out of reach of those who need them. Or conversely, what services were advised above and beyond actual need. We could see pressure on providers to bring costs in line with the benefits of each code/procedure, and the ripple effects could help reduce the premium->insurer->provider cost overages for everyone. Mind you, I still believe single payer will be the eventual end game, but this could be a solid step in the right direction.