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This is the kind of data that is needed for true transparency, and true medical reform. Prices will be gouged so long as you can't compare; Realistically, this

This is the kind of data that is needed for true transparency, and true medical reform. Prices will be gouged so long as you can't compare; Realistically, this still has a long way to go (Because I'm certain that a lot of these differences are in part due to one procedure being billed as many different codes under the current US regulatory mess), but it's a good step up from what we've had available in the past.

cookiecaper 13y ago
The only thing that's going to matter in effectively reforming medical cost structures in the U.S. is getting a critical mass of people who are shut out from medicine due to the insurance scam. While there are presently some people who are in a bad position, it's not enough people to really mount a meaningful united front. Sure, people are upset, but not enough people are upset in the right way to really make policymakers fear for their careers and/or lives. Huge swaths of "money" in the medical industry are the result of paper pushing, pure and simple. No one is spending their own money, or even really "real" money: the doctor's bill will say something outrageous for the cash price, because they know the insurers will demand a large reduction, and even though they write "$40,000" for something, they don't actually expect anyone to pay that directly. They expect you to either call and get a "cash payment discount", i.e., something close to what they charge insurance companies (which is still really high, because insurance companies aren't spending "real" money either), or to use your insurer to "pay" the bill. Remove the lecherous middle-men who do nothing but shuffle numbers around and we can start making progress on medical pricing. This is not the ONLY cause of high costs, but it is easily the largest and most perverse problem point, because this type of billing completely destroys all conventional rules of supply and demand. Interestingly, the Affordable Care Act does the opposite of this, and strengthens the lecherous middle-men to the point that it will be illegal not to give them money (the government will forcibly take the money from you in the form of a "tax penalty" if you do not voluntary sign up for "medical insurance").
- 001sky 13y ago
  This is a generalized problem with insurance, tho. Ie, if you had a likely expense, you would plan for it (house, college, etc). You buy insurance precisely because you don't think you'll need it. So, the people that need to use it are always going to be a small group. The people that don't have it, another group. The people getting screwed (on the sharp end) are the subset of those where there is overlap. This will always be a small number (by math). That being said, for everyone is paying into the system but its more death by thousand cuts. As long as pricing is opaque and uncorrleated with out-of-pocket marginal payments, there will be a problem. The cleaner solution is simply to remove the facade of pricing a-la-carte services. The problem there, is two fold: (1) how to control the inevitable buracracy with a huge budget making life or death decisions; and (2) how to incentivise research and science/product development without the cash cow of monopoly pricing (patents are useless if selling is illegal). While these problems seem to be solvable, they are daunting and not simple. In a world where the NSA is spying on every electronic communication over the internet, perhaps even more so. Ie, a world where privacy and trust is being undermined by those seeking to entrench their own power. Its harder poltically to delegate more responsibility to the "government".
  - cookiecaper 13y ago
    I agree that this is how insurance works. Normal insurance is a hedge against anamolous disaster. Medical care is something that practically everyone will need at one point or another, i.e., it is not an anamolous disaster, and therefore insurance is a problematic billing model from the get-go. We should start by saying that insurance is often considered a perverse industry because their incentives are inverted. Normal businesses make money by providing a product or service to clients, and the incentives are therefore aligned. Insurance makes money by explicitly NOT providing a product or service in exchange for your money; if they have to give you the thing you've paid for, they are less profitable. The more frequent claims against a particular insurer are, the more incentive they have to make things difficult, because some people will ultimately give up and that'll be one less (or lessened) payout that the company must supply. As medical insurance policies will likely have several claims per policy per year, they have an incentive to be the worst type of insurance. Most people with home insurance will never use it, because their house is not likely to get robbed, or catch on fire, or encounter even more esoteric occurrences. Considering the multi-hundred-thousand dollar investment most people have in their homes, a nominal fee of a few hundred bucks per year is entirely reasonable to protect that asset. The opposite is true of medicine. Most people will get medicine sometime, and it's not uncommon to need access to medicine several times per year (even excluding the chronically ill). Even car insurance will often go several years without being used, but not medical, especially not if you have a policy that covers multiple people (policy holder + spouse + dependents). Insurance simply does not work for services that are commonly required, and that's what it boils down. There is a major feeding frenzy operating on the backs of the nation's health, and everyone is pointing the finger at the other entity, and again, there's more to it than just insurance, but insurance is now and always will be the most major cause of problems in this industry. The only way to bring it back to sanity is to expose it to true market forces; the clientele must spend their own money to receive medical services, and therefore medical providers must set prices within an affordable range or go out of business. The leeches who do nothing but sit there and push paper must be removed, plain and simple. No amount of whining about how it will put some people out of work, etc., can be tolerated on this. The fact is that insurance is a very, very bad thing to have so deeply ingrained in our medical system, and we won't see major improvement until those people go away. Other countries have band-aided it by saying "OK, I see meidicine 'costs' inordinate amounts of money, we'll just write what is effectively a blank check to the industry", but that's not how we should do it in America. We must accept that market forces must dictate the prices, that hospitals the size of universities are probably not plausible, and that the whole industry must be brought back down to earth. The industry is obviously not going to like that, but it must be done. We need some ballsy politicians who can make it happen.

cookiecaper 13y ago

The only thing that's going to matter in effectively reforming medical cost structures in the U.S. is getting a critical mass of people who are shut out from medicine due to the insurance scam. While there are presently some people who are in a bad position, it's not enough people to really mount a meaningful united front. Sure, people are upset, but not enough people are upset in the right way to really make policymakers fear for their careers and/or lives. Huge swaths of "money" in the medical industry are the result of paper pushing, pure and simple. No one is spending their own money, or even really "real" money: the doctor's bill will say something outrageous for the cash price, because they know the insurers will demand a large reduction, and even though they write "$40,000" for something, they don't actually expect anyone to pay that directly. They expect you to either call and get a "cash payment discount", i.e., something close to what they charge insurance companies (which is still really high, because insurance companies aren't spending "real" money either), or to use your insurer to "pay" the bill. Remove the lecherous middle-men who do nothing but shuffle numbers around and we can start making progress on medical pricing. This is not the ONLY cause of high costs, but it is easily the largest and most perverse problem point, because this type of billing completely destroys all conventional rules of supply and demand. Interestingly, the Affordable Care Act does the opposite of this, and strengthens the lecherous middle-men to the point that it will be illegal not to give them money (the government will forcibly take the money from you in the form of a "tax penalty" if you do not voluntary sign up for "medical insurance").

001sky 13y ago
This is a generalized problem with insurance, tho. Ie, if you had a likely expense, you would plan for it (house, college, etc). You buy insurance precisely because you don't think you'll need it. So, the people that need to use it are always going to be a small group. The people that don't have it, another group. The people getting screwed (on the sharp end) are the subset of those where there is overlap. This will always be a small number (by math). That being said, for everyone is paying into the system but its more death by thousand cuts. As long as pricing is opaque and uncorrleated with out-of-pocket marginal payments, there will be a problem. The cleaner solution is simply to remove the facade of pricing a-la-carte services. The problem there, is two fold: (1) how to control the inevitable buracracy with a huge budget making life or death decisions; and (2) how to incentivise research and science/product development without the cash cow of monopoly pricing (patents are useless if selling is illegal). While these problems seem to be solvable, they are daunting and not simple. In a world where the NSA is spying on every electronic communication over the internet, perhaps even more so. Ie, a world where privacy and trust is being undermined by those seeking to entrench their own power. Its harder poltically to delegate more responsibility to the "government".
- cookiecaper 13y ago
  I agree that this is how insurance works. Normal insurance is a hedge against anamolous disaster. Medical care is something that practically everyone will need at one point or another, i.e., it is not an anamolous disaster, and therefore insurance is a problematic billing model from the get-go. We should start by saying that insurance is often considered a perverse industry because their incentives are inverted. Normal businesses make money by providing a product or service to clients, and the incentives are therefore aligned. Insurance makes money by explicitly NOT providing a product or service in exchange for your money; if they have to give you the thing you've paid for, they are less profitable. The more frequent claims against a particular insurer are, the more incentive they have to make things difficult, because some people will ultimately give up and that'll be one less (or lessened) payout that the company must supply. As medical insurance policies will likely have several claims per policy per year, they have an incentive to be the worst type of insurance. Most people with home insurance will never use it, because their house is not likely to get robbed, or catch on fire, or encounter even more esoteric occurrences. Considering the multi-hundred-thousand dollar investment most people have in their homes, a nominal fee of a few hundred bucks per year is entirely reasonable to protect that asset. The opposite is true of medicine. Most people will get medicine sometime, and it's not uncommon to need access to medicine several times per year (even excluding the chronically ill). Even car insurance will often go several years without being used, but not medical, especially not if you have a policy that covers multiple people (policy holder + spouse + dependents). Insurance simply does not work for services that are commonly required, and that's what it boils down. There is a major feeding frenzy operating on the backs of the nation's health, and everyone is pointing the finger at the other entity, and again, there's more to it than just insurance, but insurance is now and always will be the most major cause of problems in this industry. The only way to bring it back to sanity is to expose it to true market forces; the clientele must spend their own money to receive medical services, and therefore medical providers must set prices within an affordable range or go out of business. The leeches who do nothing but sit there and push paper must be removed, plain and simple. No amount of whining about how it will put some people out of work, etc., can be tolerated on this. The fact is that insurance is a very, very bad thing to have so deeply ingrained in our medical system, and we won't see major improvement until those people go away. Other countries have band-aided it by saying "OK, I see meidicine 'costs' inordinate amounts of money, we'll just write what is effectively a blank check to the industry", but that's not how we should do it in America. We must accept that market forces must dictate the prices, that hospitals the size of universities are probably not plausible, and that the whole industry must be brought back down to earth. The industry is obviously not going to like that, but it must be done. We need some ballsy politicians who can make it happen.