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Full openness is a good first step to make this insane system a little better. Next step would be for hospitals to quote the same price for the same procedure n

Full openness is a good first step to make this insane system a little better. Next step would be for hospitals to quote the same price for the same procedure no matter if or where you are insured. I can’t think of another business where prices are different by hundreds of percent for different customer groups. Also get rid of the whole in and out network system.

breckenedge 5y ago
I like the idea of getting rid of in/out of network. Both recent administrations have taken steps in this direction.
- toast0 5y ago
  Networks are a double edged sword. They're a pain to use (especially for things where network facilities have non-network providers or network providers steer you towards non-network accessory care like labs and what not), but network agreements are also a way that insurers control costs. Forcing insurers to cover every provider means insurers can't exclude overpriced providers.
  - bcrosby95 5y ago
    Yep. These agreements cut out some ridiculous fees some might try to charge. E.g. when my wife had surgery, the hospital tried to charge $20k for the surgery room and $20k for the recovery room. Our insurance pointed out that by their agreement they aren't allowed to charge for use like that. Instantly cut the hospital portion of the bill from $49k to $9k.
    - spaetzleesser 5y ago
      That’s the insanity. You are the same person, same procedure, everything same but somehow the hospital can reduce its bill from 49000 to 9000. That is just not normal for a business like a hospital where they have a ton of fixed costs (unlike a software company where delivery of their product often costs close to zero so they can easily give rebates). This seems to indicate that the 49k is an insanely high price with very high profit margin.
- novok 5y ago
  Psychologists want to charge $200-$250/hr, but insurance only reimburses $120-$160/hr. You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough. While a psychologist has gone to school for 10 years and paid for it. It's gaps like that that lead to the entire in/out network split.
  - breckenedge 5y ago
    FWIW I pay mine in cash from my HSA because he doesn’t accept any insurance due to the headaches involved getting reimbursed.
    - minsc__and__boo 5y ago
      That's fair but for people without HSA they should still file a claim against maximum out of pocket.
  - LurkingPenguin 5y ago
    > You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough. Silicon Valley/big tech is not the center of the universe. How is what "typical" engineers at big tech companies make relevant to a discussion of what psychologists and other medical professionals make? Are you suggesting that the medical profession is doing battle with big tech for (future) workers?
    - novok 5y ago
      Any ambitious and smart enough American who wants to make a high income in exchange for working hard at prep has a choice of jobs they can go into. Many people who go into medicine are not necessarily the most passionate about medicine, but want a high paying, prestigious job. So yes, it does effect the supply of future and even current psychologists and doctors. Supply is dictated partly by cost of that supply vs the demand in dollars for it, and the cost and barriers to med school and licensing is a big factor of supply costs.
deleted 5y ago
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aqme28 5y ago
Completely agree with your point, but I want to point out that a lot of businesses (most?) adjust pricing based on the consumer group.
twistedpair 5y ago
Ever heard of coupons, rebates, bundles? All ways of adjusting pricing based on consumer price sensitivity.
gwbrooks 5y ago
It's not as pervasive, but a good deal of consulting work is priced, at least partially, by the size of the problem you're solving rather than the labor required to solve it. That can lead to price discrepancies similar to (although perhaps not quite as severe) as what you see in healthcare.
mullingitover 5y ago
> Next step would be for hospitals to quote the same price for the same procedure no matter if or where you are insured. After that, decouple health care from employment. Finally, fully excise the connection between health care and ability to pay.
deleted 5y ago
[deleted]

breckenedge 5y ago

I like the idea of getting rid of in/out of network. Both recent administrations have taken steps in this direction.

toast0 5y ago
Networks are a double edged sword. They're a pain to use (especially for things where network facilities have non-network providers or network providers steer you towards non-network accessory care like labs and what not), but network agreements are also a way that insurers control costs. Forcing insurers to cover every provider means insurers can't exclude overpriced providers.
- bcrosby95 5y ago
  Yep. These agreements cut out some ridiculous fees some might try to charge. E.g. when my wife had surgery, the hospital tried to charge $20k for the surgery room and $20k for the recovery room. Our insurance pointed out that by their agreement they aren't allowed to charge for use like that. Instantly cut the hospital portion of the bill from $49k to $9k.
  - spaetzleesser 5y ago
    That’s the insanity. You are the same person, same procedure, everything same but somehow the hospital can reduce its bill from 49000 to 9000. That is just not normal for a business like a hospital where they have a ton of fixed costs (unlike a software company where delivery of their product often costs close to zero so they can easily give rebates). This seems to indicate that the 49k is an insanely high price with very high profit margin.
novok 5y ago
Psychologists want to charge $200-$250/hr, but insurance only reimburses $120-$160/hr. You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough. While a psychologist has gone to school for 10 years and paid for it. It's gaps like that that lead to the entire in/out network split.
- breckenedge 5y ago
  FWIW I pay mine in cash from my HSA because he doesn’t accept any insurance due to the headaches involved getting reimbursed.
  - minsc__and__boo 5y ago
    That's fair but for people without HSA they should still file a claim against maximum out of pocket.
- LurkingPenguin 5y ago
  > You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough. Silicon Valley/big tech is not the center of the universe. How is what "typical" engineers at big tech companies make relevant to a discussion of what psychologists and other medical professionals make? Are you suggesting that the medical profession is doing battle with big tech for (future) workers?
  - novok 5y ago
    Any ambitious and smart enough American who wants to make a high income in exchange for working hard at prep has a choice of jobs they can go into. Many people who go into medicine are not necessarily the most passionate about medicine, but want a high paying, prestigious job. So yes, it does effect the supply of future and even current psychologists and doctors. Supply is dictated partly by cost of that supply vs the demand in dollars for it, and the cost and barriers to med school and licensing is a big factor of supply costs.

deleted 5y ago

[deleted]

aqme28 5y ago

Completely agree with your point, but I want to point out that a lot of businesses (most?) adjust pricing based on the consumer group.

twistedpair 5y ago

Ever heard of coupons, rebates, bundles? All ways of adjusting pricing based on consumer price sensitivity.

gwbrooks 5y ago

It's not as pervasive, but a good deal of consulting work is priced, at least partially, by the size of the problem you're solving rather than the labor required to solve it. That can lead to price discrepancies similar to (although perhaps not quite as severe) as what you see in healthcare.

mullingitover 5y ago

> Next step would be for hospitals to quote the same price for the same procedure no matter if or where you are insured. After that, decouple health care from employment. Finally, fully excise the connection between health care and ability to pay.

deleted 5y ago

[deleted]