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Price transparency would help, but it wouldn’t solve the duress problem. After a car crash we all want to go to the nearest hospital rather than the most price

Price transparency would help, but it wouldn’t solve the duress problem. After a car crash we all want to go to the nearest hospital rather than the most price efficient one.

calvinmorrison 6y ago
That's probably true but a lot of medical cost is scheduled like follow up or specialist visits, surgery and things of the less urgent nature.
- thowawayyy 6y ago
  How is that solving the car crash situation?
  - octopoc 6y ago
    It's not, but if 50% of your business cares about prices and 50% doesn't, that's still a lot of pressure to have competitive prices.
    - t-writescode 6y ago
      It sounds like this conversation needs a usage breakdown to see where most bills come from from a total price experienced perspective. It seems like most people's greatest fear around hospitals is a surprise ER visit that blows through their savings.
  - mindslight 6y ago
    The same way you don't get super gouged when choosing a restaurant while hangry - non-urgent shoppers keep prices down across the board, even for urgent participants. I'm not saying this makes for some total solution - just reacting to rejection of the market dynamic having any worth. It's foolish to cast aside entire paradigms of approaches because they don't fully solve every corner case. (The dual would be to ask how single payer healthcare solves purely elective procedures like cosmetic surgery. It doesn't.) Obviously any market dynamic for urgent care needs to recognize that no contract has been formed, and so hospitals can't unilaterally set charges under a fallacious idea of contract. For instance when your car gets towed under duress (accident on the highway, expired papers, etc), the state sets the rates they're allowed to charge. They're still inflated, but at least within a factor of 2-3x the usual market. (FWIW I think single payer is a good pragmatic way forward)
    - thowawayyy 6y ago
      I didn't mean to suggest that there shouldn't be the option to freely chose alternative treatment options under a free market model, in cases where you're not happy with what a single payer model would cover. Rather my point was that when you need urgent or critical medical care there should be a baseline assurance of a solution to your predicament as you may not be in a position to shop around. Your analogy with restaurants is not a good one, since you are unlikely to be in a situation where you're about to starve to death, and the only restaurant in town has 3 Michelin stars, grocery stores don't exist, and passers-by are not qualified to give you food :)
      - mindslight 6y ago
        The problem is that we've taken on this hidden assumption that "free market" somehow means that a hospital can create an arbitrary bill for urgent care, and you have no choice but to pay it. That's not really intrinsic to the free market paradigm, but rather an orthogonal corruption pushed via the legal system. In a different thread I pushed the lack of a contract argument, and got back a more fitting legal theory that hospitals are allowed to charge you under the idea that you not paying would be "unjust enrichment" - they treated you, incurred expenses doing so, and therefore its your responsibility to compensate them. But that still doesn't support them charging you some arbitrarily high price, rather just expecting to be reimbursed for their costs. And so such bills should actually be constrained by the lowest rate they have with contracted insurances. As for the analogy, I've been pretty hangry to the point where I wouldn't have been able to form a contract. It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation.
        bigwavedave 6y ago
        > It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation. Eh, the overall food market doesn't quite fit as an analogy here. I know I'm not alone when I say I have close to a year of food storage; it's not really the same for surprise healthcare bills.
pxeboot 6y ago
Emergency care seems to account for less than 10% of healthcare spending in the US [1]. [1] https://www.annemergmed.com/article/S0196-0644(13)00313-2/abstract https://www.annemergmed.com/article/S0196-0644(13)00313-2/ab...
- cogman10 6y ago
  To me, that sort of proves a point. Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending. Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere from $10->$15.
  - lostapathy 6y ago
    It also doesn't help how insurance handles ER visits. I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible. I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all falls to my deductible. (Insurance paid nothing) So it cost me almost 3x as much to go during the day than it costs during the ER - but my insurance paid out about 6x as much for the ER visit. I wonder how many "ER Abusers" have figured out it's actually cheaper for THEM to go to the ER than "normal doctors"?
    - lotsofpulp 6y ago
      That makes perfect sense, assuming your annual deductible was met after you paid your $500 copay. Deductible means you pay for the first $x in a year. After that, your insurer starts paying some portion (your portion is called copay). Then you hit your out of pocket maximum (for in network services), after which insurer pays 100%.
      - 6y ago
pmart123 6y ago
Pricing transparency through a public ally available database would at least help with more competitive or uniform drug/scheduled treatment costs?
- fencepost 6y ago
  Some level of price transparency becomes law in under 2 weeks on 1/1/2021. https://www.foley.com/en/insights/publications/2019/12/price-transparency-fed-government-final-rule https://www.foley.com/en/insights/publications/2019/12/price... I believe this was fought out in court this past summer and upheld.

Price transparency would help, but it wouldn’t solve the duress problem. After a car crash we all want to go to the nearest hospital rather than the most price efficient one.

calvinmorrison 6y ago

That's probably true but a lot of medical cost is scheduled like follow up or specialist visits, surgery and things of the less urgent nature.

thowawayyy 6y ago
How is that solving the car crash situation?
- octopoc 6y ago
  It's not, but if 50% of your business cares about prices and 50% doesn't, that's still a lot of pressure to have competitive prices.
  - t-writescode 6y ago
    It sounds like this conversation needs a usage breakdown to see where most bills come from from a total price experienced perspective. It seems like most people's greatest fear around hospitals is a surprise ER visit that blows through their savings.
- mindslight 6y ago
  The same way you don't get super gouged when choosing a restaurant while hangry - non-urgent shoppers keep prices down across the board, even for urgent participants. I'm not saying this makes for some total solution - just reacting to rejection of the market dynamic having any worth. It's foolish to cast aside entire paradigms of approaches because they don't fully solve every corner case. (The dual would be to ask how single payer healthcare solves purely elective procedures like cosmetic surgery. It doesn't.) Obviously any market dynamic for urgent care needs to recognize that no contract has been formed, and so hospitals can't unilaterally set charges under a fallacious idea of contract. For instance when your car gets towed under duress (accident on the highway, expired papers, etc), the state sets the rates they're allowed to charge. They're still inflated, but at least within a factor of 2-3x the usual market. (FWIW I think single payer is a good pragmatic way forward)
  - thowawayyy 6y ago
    I didn't mean to suggest that there shouldn't be the option to freely chose alternative treatment options under a free market model, in cases where you're not happy with what a single payer model would cover. Rather my point was that when you need urgent or critical medical care there should be a baseline assurance of a solution to your predicament as you may not be in a position to shop around. Your analogy with restaurants is not a good one, since you are unlikely to be in a situation where you're about to starve to death, and the only restaurant in town has 3 Michelin stars, grocery stores don't exist, and passers-by are not qualified to give you food :)
    - mindslight 6y ago
      The problem is that we've taken on this hidden assumption that "free market" somehow means that a hospital can create an arbitrary bill for urgent care, and you have no choice but to pay it. That's not really intrinsic to the free market paradigm, but rather an orthogonal corruption pushed via the legal system. In a different thread I pushed the lack of a contract argument, and got back a more fitting legal theory that hospitals are allowed to charge you under the idea that you not paying would be "unjust enrichment" - they treated you, incurred expenses doing so, and therefore its your responsibility to compensate them. But that still doesn't support them charging you some arbitrarily high price, rather just expecting to be reimbursed for their costs. And so such bills should actually be constrained by the lowest rate they have with contracted insurances. As for the analogy, I've been pretty hangry to the point where I wouldn't have been able to form a contract. It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation.
      - bigwavedave 6y ago
        > It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation. Eh, the overall food market doesn't quite fit as an analogy here. I know I'm not alone when I say I have close to a year of food storage; it's not really the same for surprise healthcare bills.

pxeboot 6y ago

Emergency care seems to account for less than 10% of healthcare spending in the US [1]. [1] https://www.annemergmed.com/article/S0196-0644(13)00313-2/abstract https://www.annemergmed.com/article/S0196-0644(13)00313-2/ab...

cogman10 6y ago
To me, that sort of proves a point. Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending. Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere from $10->$15.
- lostapathy 6y ago
  It also doesn't help how insurance handles ER visits. I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible. I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all falls to my deductible. (Insurance paid nothing) So it cost me almost 3x as much to go during the day than it costs during the ER - but my insurance paid out about 6x as much for the ER visit. I wonder how many "ER Abusers" have figured out it's actually cheaper for THEM to go to the ER than "normal doctors"?
  - lotsofpulp 6y ago
    That makes perfect sense, assuming your annual deductible was met after you paid your $500 copay. Deductible means you pay for the first $x in a year. After that, your insurer starts paying some portion (your portion is called copay). Then you hit your out of pocket maximum (for in network services), after which insurer pays 100%.
    - 6y ago

pmart123 6y ago

Pricing transparency through a public ally available database would at least help with more competitive or uniform drug/scheduled treatment costs?

fencepost 6y ago
Some level of price transparency becomes law in under 2 weeks on 1/1/2021. https://www.foley.com/en/insights/publications/2019/12/price-transparency-fed-government-final-rule https://www.foley.com/en/insights/publications/2019/12/price... I believe this was fought out in court this past summer and upheld.