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The prices hospitals negotiate with private insurers for patient services
- smartbit 5y agohttps://archive.is/6mgnc https://archive.is/6mgnc
- avnigo 5y ago"These prices" being price comparisons between insurers, and "here's why" because prices are sometimes much lower with other plans, or no insurance at all. Aside from the clickbait title, this is interesting information.
- 4e530344963049 5y agohttps://trimread.org/articles/288 https://trimread.org/articles/288
- notjes 5y agoWhat magic is this?
- mensetmanusman 5y agoI wonder how disruptive it would be if we let other countries set up health care centers in the US to compete.
- EliRivers 5y agoPresumably you don't just mean the creation of healthcare companies in the US that are foreign-owned but still subject to the exact same current US system (because that would just be the same as now, essentially); presumably you mean something really innovative (or crazytown, depending on view!) like allowing a section of a US population to outright join a foreign system. For example, Seattle decides to switch to the UK NHS, cuts a deal with the UK whereby everyone in Seattle pays into the UK treasury at the same rate UK citizens do towards the NHS, and the NHS takes on a responsiblity for universal healthcare in Seattle for Seattle citizens. Is this the kind of idea you mean? Certainly would be interesting and as a spitballing conversation piece, fun to discuss.
- philjohn 5y agoThe problem with that is that, when it's an extra cost, the uptake may well skew towards those who are more dependent on healthcare with chronic conditions. Single payer works because the risk pool is spread overy everyone in the entire country - and everyone has to pay (it's part of income taxes). That's why the ACA mandate was a thing.
- EliRivers 5y agoYes. It would have to be everybody in. All of Seattle pays in, no exceptions. You say "the problem with that". Pitched another way, we could say "the benefit of that"... when it's an extra cost Would it necessarily be an extra cost? I understand that the amount typically paid in the US on health insurance, by the individual and employers, compares badly with the amount paid in many other systems that provide better healthcare for less money.
- lotsofpulp 5y agoThen the healthy/richer people move to a suburb of Seattle. The reason nationwide taxpayer funded healthcare works is because it is not easy to move to another country.
- mumblemumble 5y agoIt's not like they would be able to import the legal, regulatory and economic environments that foster their lower prices or better outcomes. I would assume that all they would really be able to bring to the table is brand recognition.
- elliekelly 5y agoLegal, regulatory, and economic environments have been “imported” before. I’m not sure how well they actually work in practice but the Colón Free Trade Zone and the Kazakhstan Astana International Finance Center, come to mind as examples. Even Hong Kong, to some degree, started as an “imported” legal system.
- vsskanth 5y agoYou don't need other countries, just allow US entrepreneurs to setup health care services. Google "certificate of need" and you'll see why these hospitals virtually have monopolies in so many counties. US Healthcare nowhere close to a free market.
- fineIllregister 5y agoCertificates of Need solve a very real problem that "free market" health care had. Having health care exposed to boom and bust cycles was unacceptable to people. You'll have to propose an alternative solution better than "well maybe you die" if you want to change that.
- throw_m239339 5y agoAny "foreign hospital" would have to abide by the same standards as "American ones". Furthermore, if it's for profit, I don't see why "foreign establishments" would have lower costs, they'd try to maximize their profit as much as "American ones". Medical tourism is a more cost effective alternative, for dental care, eyesight, or even some heavy surgeries. The problem is the people who would likely benefit the most from that often don't even have a passport... I made the same point about education cost in the rest of the west VS USA previously. Americans are entitled to travel or study in a lot of foreign countries without any hurdle, most of them don't ever take advantage of it for arbitrage.
- mensetmanusman 5y agoWe could let them import their standards to see if the US standards are better or worse.
- tsjq 5y agonot even mega Joint Venture could make any progress. they shut down . "Haven was a not-for-profit, healthcare-focused entity created through a joint venture by American companies Amazon, Berkshire Hathaway and JPMorgan Chase. The entity's stated goals were to improve healthcare services and lower costs for the three companies' employees, while making primary care easier to access, making prescription drugs more affordable and rendering insurance benefits easier to understand." https://en.wikipedia.org/wiki/Haven_Healthcare https://en.wikipedia.org/wiki/Haven_Healthcare
- elzbardico 5y agoBecause the insurance/hospitals/pharma cartel have their ways to ensure that new entrants that don't play ball suffer some nasty consequences.
- someguydave 5y agoDoctors and nurses are just as complicit in holding out for more cash.
- lotsofpulp 5y agoThere is nothing wrong with people bargaining for what they are worth. Especially for laborious jobs working around sick people. I do not exactly see all my work from home friends who I know are working less than 40 hours a week Mon to Fri 9 to 5 clamoring to go help at the hospital right now even at current nurse's pay.
- coldcode 5y agoUS healthcare is a giant cash making scam, where patient health and open pricing are unimportant. If the Federal government actually cared to force the issue, we might find a preference for a national unified system, in which of course the insurers and healthcare conglomerates would lose their profit. So no doubt they spend a fortune ensuring that no matter what rules appear for political reasons, they are not really enforced, and thus don't matter.
- DennisP 5y agoThe book The Healing of America examines eight different national healthcare systems. Three of the best (France, Germany, Japan), in objective terms like health outcomes and percentage of GDP spent, have a lot in common with the ACA, with one big difference: a national price list for services. Maybe a well-functioning market could accomplish the same thing but we certainly don't have that right now.
- ta988 5y agoThere is no such thing as a well-functioning market (or free market). It is repeated over and over as something that could be true, but it is like communism, nobody was ever able to get that working in reality.
- someguydave 5y agoThis article is literally proof that a free market in healthcare has not been tried.
- ta988 5y agoWas there ever a free market anywhere?
- amanaplanacanal 5y agoIt was pretty much a free market until world war two. So yeah, it has.
- stefan_ 5y agoThat guy actually paid the price of a car for a rabies shot. It was probably cheaper to take a vacation south and pretend to be bitten again.
- mikeodds 5y agoI recently had a (potentially) post exposure rabies series of shots in the US. 3 shots of vaccine on day 1 + 1ml of human rabies immune globulin injected all around the exposed site. Then 1 follow up shot every 7 days for 3 weeks. It’s the human rabies immune globulin that you hear the horror stories of people paying $20k for without insurance. It’s strange that due to US medical billing and the uncertainty around it, I was trying weigh up the likely hood of actual infection from the animals saliva (protip for anyone visiting austin: there is actually a fair amount of rabies around). If you develop symptoms, it’s usually too late and the survival rate is very low. That swung the needle in the direction of better to lose a car than be dead. I’m not aware of any other country in the world - where getting those shots post exposure without insurance would have potentially cost that much.
- elliekelly 5y agoWhenever I read about expensive (human) rabies treatment I wonder what the cost would be if the person had gone to a veterinarian instead. I’m assuming the treatment is more or less the same? But if my dog were bit by a rabid animal I’m certain it wouldn’t cost me $20,000+ for treatment.
- h2odragon 5y agoPre exposure shots are available. Doctors charge mad money for them; I've been told I couldn't afford it. A vet is risking a lot to do that. If you find one, pay well. Single shot isn't enough, 2 or 3 at one or two week intervals is what i've been told.
- foldr 5y agoI had the same experience while living in the US. Fortunately my insurance covered the shots (though there was no way to be sure of this at the time), so I “only” had to pay about $1000. It’s worth noting that the survival rate for symptomatic rabies isn’t just “very low” but basically zero. There are one or two known cases of people who made miraculous recoveries, but there is no treatment protocol known to be even slightly effective once symptoms appear. I was actually about to return to the UK when the incident occurred, and I got the final shots there (100% free, no questions asked).
- zaroth 5y agoI’m convinced that the single best way to improve the current private-insurance based system is that it should be illegal to charge two different patients a different price for the same test, drug, or procedure given at the same hospital. I think implementing such a policy could be trivial for many things like labs and drugs and many procedures, and admittedly tricky to implement for complex / one-off procedures, but that shouldn’t stop us from trying. Price transparency is important but eliminating price discrimination is I think the key way to shut down so much of the bloat and corruption currently in the system. The last step would be to make it illegal to do any kind of rebating where patients are billed more than insurance ultimately pays. Charging less for one procedure taken by Patient A in exchange for charging more for another procedure taken by Patient B similarly should just be banned. You end up with a system where the insurance companies and benefits managers have a lot less that they are able to do. Perhaps they would claim they are “hamstrung” but that’s exactly what they should be in this regard.
- deleted 5y ago[deleted]
- Spivak 5y agoYou can actually be lighter touch than that and still have things work. Just make it so that you can’t “pay with insurance.” You have to send the bill to the patient who files a claim, gets a cash payout, and pays the bill. Offer senior discount, have a 30% off sales, have hot flash summer, whatever. But now pricing will be predictable because there are no back-room negotiations. If you ever pay for medical services without insurance you’ll find that places can suddenly give you a straight price.
- lotsofpulp 5y ago> If you ever pay for medical services without insurance you’ll find that places can suddenly give you a straight price. I have tried many times to get a doctor’s office to give me a price in writing for a completely preventative visit where there could be no possibility of variance in service rendered, and I have always received an answer of no. Edit: so now I just assume any healthcare I get will cost me up to my out of pocket maximum, and budget for that yearly.
- deleted 5y ago[deleted]
- recursivedoubts 5y agoDaily reminder that the US spends vastly more, per capita, in government heath expenditures[1], than any other country. We pay for socialized healthcare, and then some, it's just that most of us don't get it. I view the problem as impossible to solve until there is a collapse. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
- kgermino 5y agoI don’t think that’s what that chart says. It’s combining Government and other compulsory expenses. I haven’t reviewed the report behind the chart but I’d expect the blue bar to include things like employer paid insurance premiums.
- ectopod 5y agoLooking at figures from two years ago, the US government was spending about $3600 per head and the UK government about $3000 per head. For the latter money everybody in the UK got free healthcare.
- calvinmorrison 5y agoAmericans are also the fattest and least active 1st world country.
- nine_zeros 5y agoThis argument is invalid because America is not a real 1st world country. It's only rich due to historical legacy of the dollar after WW2.
- User23 5y agoAmerica is rich for many more reasons than Bretton Woods. For most of the 20th century it had by far the greatest real productive and manufacturing base of any country in the world. The USA has been visibly declining for about 45 years sure, and is no longer the world leader in manufacturing, but it still has a huge and well-diversified economy. Since dollars represent, among other things, claims on a share of that economic output, demand for them is quite real and not just an historical artifact. And since no other country with a huge diversified economy is willing to run external deficits large enough to meet foreign demand for reserves, the dollar is pretty much the only good choice. There just isn’t enough gold to clear trade in a $80+ trillion global economy.
- notjes 5y agoWithout Trump, this would not be possible.
- nickjj 5y agoIt would be neat if there was https://www.levels.fyi/ https://www.levels.fyi/ (anonymously submitted developer salaries) for anonymous hospital / medical bills, complete with line items.
- EForEndeavour 5y agoOr the government could just force health service providers to, you know, reveal the price of said services like every other vendor of goods and services, so that patients -- sorry, customers -- have a fighting chance to shop around or plan for medical bankruptcy.
- meowster 5y agoThey already are required, it's just that the fines are too small (~$100/day IIRC).
- cascom 5y agoI actually had this experience for an MRI, I called billing at the hospital at which my doctor was affiliated/recommended I take my MRI - I was floored to learn that if I paid cash, it was ~$1k and if I ran it through insurance it was $1.5k I actually ended up running it through insurance as I wanted the amount to be applied to my deductible… When I asked the (very nice) woman in billing how this made any sense - she told me (paraphrasing) that it’s basically a super complex optimization problem where several thousand products/services are being simultaneously negotiated, such that the hospital can maximize its gross margin, and the insurer can minimize its payments under insurance.
- leeoniya 5y agogetting anything done at a hospital is 2-3x as expensive as a dedicated clinic. an MRI is typically a ~$500 cash / out of pocket diagnostic without insurance, outside a hospital.
- synergy20 5y agoJust spent 1.85K USD on TMJ(tooth joint) MRI with cash, forgot to negotiate the price. it's truly expensive to me though.
- user-the-name 5y agoI had an MRI a little while ago. Then I ended up having to go in for minor brain surgery, and then a checkup with some high-precision head X-rays later. I paid... about $100 for the hospital bed and food while recovering for two days, and about $15 for the taxi they arranged to take me home. Another $10 or so for some painkillers for the headache while recovering at home.
- ta988 5y agoWhere was that?
- EForEndeavour 5y agoI hope you're doing ok now. Which country did this happen in? If the USA, what sort of insurance was it under?
- dls2016 5y agoI don't have anything to add, but I recently received a $701 bill for each my children's covid tests ($1402 total). We took them to their pediatrician, part of a hospital. Insurance covered $0. If the insurance can decide not to pay, guess who else has that option?!
- unpolloloco 5y agoContest that with your insurance company - they should be free...
- EForEndeavour 5y agoThat's absolutely infuriating. The pandemic has laid bare the massive dysfunction in US healthcare.
- meowster 5y ago> The Families First Coronavirus Response Act ensures that COVID-19 testing is free to anyone in the U.S., including the uninsured. https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html https://www.hhs.gov/coronavirus/community-based-testing-site...
- KoftaBob 5y agoI came across Turquoise Health (https://www.turquoise.health/ https://www.turquoise.health/) recently, they're one of the early players that have built a search tool to look up the prices hospitals have negotiated with different insurance companies for procedures. Many people's first thought will be "how does this help patients if they're rarely paying the cash price, their insurance is the one paying". The effects (in theory) will be more indirect than that. Now that insurance companies can see what prices a hospital has negotiated with other insurances, they'll have hard, transparent data to show that those other insurance providers are getting a better deal, and can negotiate prices down. This alone won't be the magical solution to healthcare costs to patients, but this level of price transparency will no doubt have a big impact. It's a great first step.
- ttamk 5y agoFYI, there is a similar effort going on that requires all health plans to host machine readable files containing negotiated rates by provider and procedure code by 2022-01-01: https://github.com/CMSgov/price-transparency-guide https://github.com/CMSgov/price-transparency-guide
- nikkinana 5y agoThanks Trump for passing that executive order, now we get to see their prices.
- cushychicken 5y agoThis story is revealing an important point about the health care system, but it only tells half the story. The other part of how broken the system is, and why pricing varies so wildly, is due to bad faith negotiations on the insurers' side. Many insurers negotiate with a hospital by saying: "We are only going to pay 25% any bill you send us." If the hospital doesn't play ball, the insurer kicks them out of their network, and effectively denies the hospital customers. The hospitals that can't afford to lose those customers is incentivized to quadruple their prices just to get the insurer to cover their costs. However, if a second insurer comes along and negotiates the same way, but says they'll only pay 50% of the hospital's stated cost, the hospital makes a tidy profit on the insurer's dime. (Remember: quoted price = 4 * cost. If insurer pays (quoted price * 0.5), then the hospital makes a 100% profit on that insurance transaction.) What's been created is effectively an endless positive feedback loop to negotiate prices upwards, fueled by rampant information asymmetry and profit motive. We desperately need some kind of government intervention against this in the US. I'm convinced that single payer would fix this in a fucking jiffy.
- lotsofpulp 5y ago>We desperately need some kind of government intervention against this in the US. I'm convinced that single payer would fix this in a fucking jiffy. The majority of healthcare spending in the US is by the government, and the government is the one negotiating the prices. https://crsreports.congress.gov/product/pdf/IF/IF10830 https://crsreports.congress.gov/product/pdf/IF/IF10830 The "insurers" (better referred to as managed care organizations - MCOs) are simply hired to implement the government's pricing and reimbursement policies, and to take the heat from vendors and the public.
- deleted 5y ago[deleted]
- DangitBobby 5y ago> and the government is the one negotiating the prices Where can I read about this? It runs counter to what you typically hear about how healthcare pricing works. The government also pays costs that I don't think private insurers need to worry about. For example, if you can't pay, you don't have private insurance, so private insurers don't really need to worry about paying for the long term care of people in nursing homes. I also imagine that the elderly and poor are more likely to require expensive care than the population covered by private insurers in general. Especially since private insurers will happily say "no!" to customers that are not profitable. So I'm not convinced that being "the majority of spending" is the same thing as being irresponsible with the money. I will also point out the private insurance on this document is a plurality of spending and makes up most of the administrative cost (complete waste, on other words).
- Ozzie_osman 5y ago> In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all. This is basically a racket
- deleted 5y ago[deleted]
- throwawaygh 5y ago> The agency plans to increase the fines next year to as much as $2 million annually for large hospitals, it announced in July. Mass General's annual revenue was 13.4 billion USD. They'll just not pay the fines. It's literally not even a rounding error in their annual revenue! The US healthcare system needs to be rebuilt from the ground up.
- ransom1538 5y ago1) End all medical law suites. You enter care at your own risk. 2) Create more doctors. Stop the boards from restricting the total counts of doctors created. Flood the system full of doctors and nurses. 3) All practices and procedure costs should be made public and upfront. 4) End all drug patents. Flood university researchers with government money instead. 5) Expand medicare to insure everyone in the united states.
- ransom1538 5y agoDownvoted. lol.
- throwaway189q 5y agoIt is not the Doctors or nurses salaries, but the diagnostics costs are astronomical. People are regularly billed for hundreds or thousands of dollars for something as simple as XRays. Other procedures are also almost 5-10 higher than what one would expect to pay anywhere else in developed world. The emergency room charges are just out of the world. And extraordinarily large portion of the cost is not personnel costs.
- coffeecat 5y agoI think a healthcare system based on the following model could work great: * Federal government provides public health insurance to all taxpayers. * Every healthcare provider submits a list of tests/procedures they offer, and the price that they charge for each test/procedure. The prices are public data. Providers can charge whatever price they want. * When you need a test/procedure, you use a website provided by the public insurance system which looks up all providers within a reasonable distance (search radius would be algorithmically determined so that at least 3-5 providers are included in the comparison). The public insurance program covers the price of the cheapest option. Patients are free to choose any provider they want, but if they don't choose the cheapest, they need to pay the difference out of pocket.
- BrandoElFollito 5y agoWhen going to the US from France, I always take an insurance because even a doctor visit is going to be bat crazy expensive. When an American comes to France and sees a doctor, they will pay 25€. I have the feeling we are being royally screwed. By ourselves. We should have monster prices for people who are not part of the EU, with the understanding that tourists should come insured. (One should always take an insurance because a heart operation is going to be costly in France as well, but my point is that for minor stuff there is z huge imbalance)