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This seems so sensible to me that I’m curious why the hell it wouldn’t work.

by 31835843 4y ago

treis 4y ago
Which price and who determines it?
- CoastalCoder 4y ago
  I would think that hospitals could create price schedules similarly to how other businesses do. Although I imagine this gets really messy when dealing with Medicare and with the mandate to treat everyone regardless of their ability to pay. I'd expect those arrangements would need to change to make this work. I feel a bit silly pontificating about this. Hopefully someone who really understands the topic will weigh in.
  - deleted 4y ago
    [deleted]
- spaetzleesser 4y ago
  The hospital determines a price and offers it to all comers. Most businesses work that way.
  - rootusrootus 4y ago
    I don't think it would work well. Hospitals are not a free market in most of the US. You have to get a Certificate of Need to set up a new one. Given the near monopoly they have in the local area, regulation is probably going to be required if nobody gets to negotiate.
    - spaetzleesser 4y ago
      Why can't a hospital charge the same price for the same procedure? I can see that different hospitals may charge different prices from each other. But a single hospital should charge the same no matter if uninsured, insured or whatever.
      - rootusrootus 4y ago
        What is to stop the local hospital from deciding that an appendectomy costs a million dollars? You pay, insurance pays, no matter, is is a million bucks.
        spaetzleesser 4y ago
        If they want to, they should do it, publish the price and see how things go.
  - treis 4y ago
    The only business that works that way is retail. And even then most will negotiate on bulk orders. Almost everyone else will have a price list they negotiate off of.
    - spaetzleesser 4y ago
      As far as a patient goes, a hospital is retail.
- manquer 4y ago
  Hospital is free to determine their prices, but they cannot give steep discounts to one channel of sales over other. They have to be consistent. Healthcare pricing should be based on cost+plus models for the hospitals rather than on value driven approach you see every else in any sales. We are not questioning their costs whatever they maybe, if the costs logically remain roughly same no matter how a particular patient came to them, then there is no reason for price to be different depending on type/ nature of insurance or lack thereof.
  - happyopossum 4y ago
    > Healthcare pricing should be based on cost+plus models Cost plus models provide a perverse incentive to increase costs, as 5% of $2 is more than 5% of $1.
    - manquer 4y ago
      Only if there is no competition and no free market[1] If you are locked into "choosing" the one in-network service provider in your area who can price very differently for your insurance than for others yes there is room for perverse incentives as is today. If you and I can choose freely from any service provider in the area and everyone has to price the same way( i.e. not change basis who the customer is) then they will have to be competitive, people are very price sensitive and will tend to move towards the ones which are cheaper. See how the airlines all slowly have moved towards the low-cost models: more economy/less first class even if they were full service. Sure you will have some Frontier/Spirit type organizations eventually but if they get the job done(Moving you from A to B) at lowest price then that is all that matters[3], similarly if a hospital is no-frills and gets your cataract operation[2] or do regular checkup faster and cheaper they will do so and plenty of people benefit from that. Force hospitals to compete, not lock into monopolistic preferential contracts with some buyers and force users to now be exhorted crazy premiums to avoid the possibility being charged even more. Price regulation does not mean government fixes the prices, it should just mean that service provider have to charge the same for anyone without knowing their source (which insurance plan/company or self-funded and income level). ---- [1] While there are some cases where two hospitals / doctors are not equivalent and cannot be compared, vast majority of care is fungible, i.e. you can replace one hospital / doctor with another without material impact to outcome of care. [2] I have seen this myself work https://www.gatesfoundation.org/Ideas/Speeches/2008/05/william-h-gates-sr-2008-gates-award-for-global-health https://www.gatesfoundation.org/Ideas/Speeches/2008/05/willi... it is like assembly line, brutal efficiency. [3] This assumes robust regulation, which we already have in healthcare, probably more so than required, there is no systemic regulatory oversight problems in the industry today.
doktorhladnjak 4y ago
Medicare and Medicaid pay some of the lowest rates. Private insurance from employers and individual policy holders subsidizes the cost for the elderly and poor. Charging the same price would disrupt that, creating all kinds of political fallout.

This seems so sensible to me that I’m curious why the hell it wouldn’t work.

treis 4y ago

Which price and who determines it?

CoastalCoder 4y ago
I would think that hospitals could create price schedules similarly to how other businesses do. Although I imagine this gets really messy when dealing with Medicare and with the mandate to treat everyone regardless of their ability to pay. I'd expect those arrangements would need to change to make this work. I feel a bit silly pontificating about this. Hopefully someone who really understands the topic will weigh in.
- deleted 4y ago
  [deleted]
spaetzleesser 4y ago
The hospital determines a price and offers it to all comers. Most businesses work that way.
- rootusrootus 4y ago
  I don't think it would work well. Hospitals are not a free market in most of the US. You have to get a Certificate of Need to set up a new one. Given the near monopoly they have in the local area, regulation is probably going to be required if nobody gets to negotiate.
  - spaetzleesser 4y ago
    Why can't a hospital charge the same price for the same procedure? I can see that different hospitals may charge different prices from each other. But a single hospital should charge the same no matter if uninsured, insured or whatever.
    - rootusrootus 4y ago
      What is to stop the local hospital from deciding that an appendectomy costs a million dollars? You pay, insurance pays, no matter, is is a million bucks.
      - spaetzleesser 4y ago
        If they want to, they should do it, publish the price and see how things go.
- treis 4y ago
  The only business that works that way is retail. And even then most will negotiate on bulk orders. Almost everyone else will have a price list they negotiate off of.
  - spaetzleesser 4y ago
    As far as a patient goes, a hospital is retail.
manquer 4y ago
Hospital is free to determine their prices, but they cannot give steep discounts to one channel of sales over other. They have to be consistent. Healthcare pricing should be based on cost+plus models for the hospitals rather than on value driven approach you see every else in any sales. We are not questioning their costs whatever they maybe, if the costs logically remain roughly same no matter how a particular patient came to them, then there is no reason for price to be different depending on type/ nature of insurance or lack thereof.
- happyopossum 4y ago
  > Healthcare pricing should be based on cost+plus models Cost plus models provide a perverse incentive to increase costs, as 5% of $2 is more than 5% of $1.
  - manquer 4y ago
    Only if there is no competition and no free market[1] If you are locked into "choosing" the one in-network service provider in your area who can price very differently for your insurance than for others yes there is room for perverse incentives as is today. If you and I can choose freely from any service provider in the area and everyone has to price the same way( i.e. not change basis who the customer is) then they will have to be competitive, people are very price sensitive and will tend to move towards the ones which are cheaper. See how the airlines all slowly have moved towards the low-cost models: more economy/less first class even if they were full service. Sure you will have some Frontier/Spirit type organizations eventually but if they get the job done(Moving you from A to B) at lowest price then that is all that matters[3], similarly if a hospital is no-frills and gets your cataract operation[2] or do regular checkup faster and cheaper they will do so and plenty of people benefit from that. Force hospitals to compete, not lock into monopolistic preferential contracts with some buyers and force users to now be exhorted crazy premiums to avoid the possibility being charged even more. Price regulation does not mean government fixes the prices, it should just mean that service provider have to charge the same for anyone without knowing their source (which insurance plan/company or self-funded and income level). ---- [1] While there are some cases where two hospitals / doctors are not equivalent and cannot be compared, vast majority of care is fungible, i.e. you can replace one hospital / doctor with another without material impact to outcome of care. [2] I have seen this myself work https://www.gatesfoundation.org/Ideas/Speeches/2008/05/william-h-gates-sr-2008-gates-award-for-global-health https://www.gatesfoundation.org/Ideas/Speeches/2008/05/willi... it is like assembly line, brutal efficiency. [3] This assumes robust regulation, which we already have in healthcare, probably more so than required, there is no systemic regulatory oversight problems in the industry today.

doktorhladnjak 4y ago

Medicare and Medicaid pay some of the lowest rates. Private insurance from employers and individual policy holders subsidizes the cost for the elderly and poor. Charging the same price would disrupt that, creating all kinds of political fallout.