

Top Hospitals Opt Out of Obamacare - wikiburner
http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

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tptacek
_A few, like No. 1-rated Johns Hopkins in Maryland, are mandated under state
law to accept all insurance companies_

That sounds like a totally sane statutory requirement. Why don't more states
have it? Collusion between hospital chains and insurers is the crux of the
health care cost problem in the US.

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clavalle
If they are required to do business with one another how do they negotiate a
price?

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tptacek
How does it work in Maryland, where this is already the law?

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hyborg787
Heavy regulations & requirements on the insurers.

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coreyh1444
Note this is "authored" by watchdog.org which is a media outlet for the ultra
conservative Koch brothers.

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mjn
I'm sort of confused by how authorship works in the US News & World Report
generally, and clicking around a bit on the site doesn't clarify it. Do they
have professional staff reporters? Is it just reblogging stuff from elsewhere?
Are they buying freelance pieces? Is it like Forbes where there's a "Forbes
proper" and an "anybody can blog on Forbes.com here" section (and if so, how
do I tell which is which)? I can't really sort out what the intended semantics
are for an article published on usnews.com but with a byline of another
website.

Seems confusing, but in any case, letting outside lobbying groups run news
articles in their pages, not marked as either contributed op-eds or paid
messages, is a bit weird.

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clavalle
This is going to precipitate one of two things:

If hospitals get federal money for anything they will be required to accept
insurance offered on the exchange that meet some minimum qualification. At
least the two that were blessed as the national options.

Or insurance companies will be required to put an offering on the
exchange...likely both.

Like the states refusing to expand Medicaid and set up their exchanges, the
hospitals are hastening the transition to a single payer healthcare system by
refusing to play ball.

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tunesmith
Sometimes I wonder if some genius "systems thinkers" in Washington planned
that out as the end game all along. Add in the factor that some states have
almost no hospitals, thus the insurance companies have no leverage to lower
premiums, which leads to why certain states have very high ACA premiums.
Theoretically the free market says that another hospital would pop up to
compete on price, but theory ain't practice...

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glenra
> _Theoretically the free market says that another hospital would pop up to
> compete on price, but theory ain 't practice_

It is _illegal_ to start a new hospital to compete on price with the existing
ones. To open a new hospital, you need permission from the current existing
hospitals. If they don't agree that the community you want to do business in
is "underserved", you can't get licensed.

And yes, that policy _is_ insane, moronic, a source of monopoly rents and
probably one of the many reasons health care costs are so out of control. But
it's the law.

[https://en.wikipedia.org/wiki/Certificate_of_need](https://en.wikipedia.org/wiki/Certificate_of_need)

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clavalle
Wow. That is the best example of regulatory capture I've ever seen.

I love the rationalization: "If there are too many hospitals many hospitals
and doctors my recommend unnecessary hospitalization or overcharge existing
patients to cover their overhead".

Amazing.

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glenra
Check out some of these documents if you want to get angry:

[http://www.tennessee.gov/hsda/con_standards.shtml](http://www.tennessee.gov/hsda/con_standards.shtml)

The standard for "Burn Unit" says there can't be more than one burn unit bed
for every 225,000 persons and you can't build a new unit unless all the
existing ones in the area have >70% annual utilization. So what if your new
unit might be MUCH CHEAPER or merely more competent than the current players?
Nope. The government isn't allowed to take mere PRICE into consideration in
deciding if you can go into business. Or competence, or anything other than
expected "need". And your new unit has to have at least 12 beds - operating at
a smaller scale than that is apparently illegal.

Then the standard for "long term care" facilities says they aren't allowed to
plan on using any spare capacity to provide services such as "advanced
emergency care". Why not? Because that might lead to "unnecessary
duplication". Ugh.

