3 ms·

I don't really think the make or break is from a $100 spread on wellness visits. It's going to be the acute illnesses and injury that you do not have time to pl

by Klinky 4y ago

I don't really think the make or break is from a $100 spread on wellness visits. It's going to be the acute illnesses and injury that you do not have time to plan for that are the killer. Also chronic illness often can be difficult to manage, with acute flare-ups requiring unexpected hospitalizations. If you're on immuno/biologic therapy, more of the cost is in your drugs than in the doctor or facility. As GP pointed out there are a myriad of medical/diagnostic codes, and variety of scenarios that could turn something like a baby delivery from a $5,000 affair into a $500,000 affair. Do we really expect that patient to accurately compare all the medical/diagnostic codes between providers to determine if they're getting gouged or not? Would it even be ethical to take a baby out of a NICU to try to save $50,000? We need to stop acting like healthcare is like buying a car or buying Fruity Pebbles from the store. People aren't going bankrupt because they spent an extra $100 on a wellness visit. They're going bankrupt because of needed care that was very expensive, and even cutting the price in half or by 2/3rds would've still resulted in them going bankrupt. I guess with pricing transparency they can more confidently find out they can't afford it anywhere.

thephyber 4y ago
Ugh. I feel like defeatism like this comment is what causes the paralysis against fixing all of our medical cost issues. > Do we really expect that patient to accurately compare all the medical/diagnostic codes between providers Forest for the trees. The end user doesn't need to micromanage medical codes when deciding which provider to use. They need a cost "grade" for each provider (maybe based on averages or select common procedures). Apps like Google Maps would be able to help us decide the cost versus distance equation. Price transparency bends the cost curve down. It doesn't matter whether it is wellness or Urgent Care. So long as you are conscious, you should have information+tools to help you decide where to go. Obviously if you are arguing single-payer, that would be a different situation but since most Americans don't have that, we need to address the issues that apply to us. Facilities mark up the drugs they provide. Pharmacies have mark-up. Price transparency helps those transactions as well. > acute illnesses and injury that you do not have time to plan for that are the killer Perhaps, but not for everyone. Kidney dialysis is an example of a predictable, frequent, necessary for 500,000 Americans) and expensive ($3k - $15k per month) and represents about 6% of all American healthcare spending.[1] Working price transparency for a few of the large cost drivers like dialysis would increase competition on price and reduce the total paid by patients and insurers (and thus, all insured). > even cutting the price in half or by 2/3rds would've still resulted in them going bankrupt. Price transparency won't fix all of the price distortions. Nobody is saying it will. But it's a necessary component of bringing prices down, along with like 80 other changes. [1] https://healthpolicy.usc.edu/brookings-schaeffer/congress-should-end-dialysis-companies-third-party-games-with-insurance-coverage/ https://healthpolicy.usc.edu/brookings-schaeffer/congress-sh...
- Klinky 4y ago
  I think it's realist, not defeatist. More information can be good, but this doesn't mean it brings with it lower costs. It will require significant investment in aggregating & analyzing the data to make it useful. I think it is useful, but for professionals who understand the system. Alternatively it will put even more burden on the patient to coordinate their care, which is already a challenge. I assure you that you can still be incapacitated by pain or discomfort while conscious, and going line by line through medical bills to haggle over price is just not patient friendly. Even if you get an idea of the price ahead of time, the price when you arrive might end up different because of your unique circumstances or maybe even just shady behavior. Yes, maybe the pricing transparency gives the patient more ammo to haggle with, but relying on sick patients to become market watchdogs just seems like the wrong horse to hitch our wagon too. We have grocery stores with 200% markup on some goods, yet they're still in business. Price being posted doesn't mean it's affordable. Then you add in sales, coupons, rebates, discount clubs, "add to cart" pricing, SKU variations, "convenience" fees, etc... And the price listed is now no longer "the price listed". It gets even more complicated with medical systems.
  - thephyber 4y ago
    > but this doesn't mean it brings with it lower costs It's not a certainty, but the odds are far higher than having 0 chance of shopping by phone/website, which is the way the US medical industry currently exists. > grocery stores Have accurate prices on every item. They calculate most of the variables at the display and all of the variables at the time of the transaction. They are a great example of somewhat complex pricing being transparent. Grocery profit margins are tiny (usually in the 1-3% range). Sure, the occasional store and the occasional item right before a special event may bring in a larger margin, but grocery stores are an example of effective price transparency working. Like you, I'm not hopeful that price transparency would fix much, but at least it would distinguish the "Shop-n-Save" medical center from the "Lunardi's" (premium grocers in affluent Silicon Valley suburbs) of medical centers. Right now we can't even distinguish those classes of prices across medical providers.

by Klinky 4y ago

thephyber 4y ago

Ugh. I feel like defeatism like this comment is what causes the paralysis against fixing all of our medical cost issues. > Do we really expect that patient to accurately compare all the medical/diagnostic codes between providers Forest for the trees. The end user doesn't need to micromanage medical codes when deciding which provider to use. They need a cost "grade" for each provider (maybe based on averages or select common procedures). Apps like Google Maps would be able to help us decide the cost versus distance equation. Price transparency bends the cost curve down. It doesn't matter whether it is wellness or Urgent Care. So long as you are conscious, you should have information+tools to help you decide where to go. Obviously if you are arguing single-payer, that would be a different situation but since most Americans don't have that, we need to address the issues that apply to us. Facilities mark up the drugs they provide. Pharmacies have mark-up. Price transparency helps those transactions as well. > acute illnesses and injury that you do not have time to plan for that are the killer Perhaps, but not for everyone. Kidney dialysis is an example of a predictable, frequent, necessary for 500,000 Americans) and expensive ($3k - $15k per month) and represents about 6% of all American healthcare spending.[1] Working price transparency for a few of the large cost drivers like dialysis would increase competition on price and reduce the total paid by patients and insurers (and thus, all insured). > even cutting the price in half or by 2/3rds would've still resulted in them going bankrupt. Price transparency won't fix all of the price distortions. Nobody is saying it will. But it's a necessary component of bringing prices down, along with like 80 other changes. [1] https://healthpolicy.usc.edu/brookings-schaeffer/congress-should-end-dialysis-companies-third-party-games-with-insurance-coverage/ https://healthpolicy.usc.edu/brookings-schaeffer/congress-sh...

Klinky 4y ago
I think it's realist, not defeatist. More information can be good, but this doesn't mean it brings with it lower costs. It will require significant investment in aggregating & analyzing the data to make it useful. I think it is useful, but for professionals who understand the system. Alternatively it will put even more burden on the patient to coordinate their care, which is already a challenge. I assure you that you can still be incapacitated by pain or discomfort while conscious, and going line by line through medical bills to haggle over price is just not patient friendly. Even if you get an idea of the price ahead of time, the price when you arrive might end up different because of your unique circumstances or maybe even just shady behavior. Yes, maybe the pricing transparency gives the patient more ammo to haggle with, but relying on sick patients to become market watchdogs just seems like the wrong horse to hitch our wagon too. We have grocery stores with 200% markup on some goods, yet they're still in business. Price being posted doesn't mean it's affordable. Then you add in sales, coupons, rebates, discount clubs, "add to cart" pricing, SKU variations, "convenience" fees, etc... And the price listed is now no longer "the price listed". It gets even more complicated with medical systems.
- thephyber 4y ago
  > but this doesn't mean it brings with it lower costs It's not a certainty, but the odds are far higher than having 0 chance of shopping by phone/website, which is the way the US medical industry currently exists. > grocery stores Have accurate prices on every item. They calculate most of the variables at the display and all of the variables at the time of the transaction. They are a great example of somewhat complex pricing being transparent. Grocery profit margins are tiny (usually in the 1-3% range). Sure, the occasional store and the occasional item right before a special event may bring in a larger margin, but grocery stores are an example of effective price transparency working. Like you, I'm not hopeful that price transparency would fix much, but at least it would distinguish the "Shop-n-Save" medical center from the "Lunardi's" (premium grocers in affluent Silicon Valley suburbs) of medical centers. Right now we can't even distinguish those classes of prices across medical providers.