
Medicare will require hospitals to post prices online - DoreenMichele
https://www.msn.com/en-us/news/us/medicare-will-require-hospitals-to-post-prices-online/ar-AAwiccI
======
aaavl2821
I really like this push towards transparency but hopefully people who use the
data / develop will make sure to understand the system and the data they're
dealing with. Like list prices are often incredibly far removed from the
actual dollars paid, and the actual amount paid is all dependent on insurer
contracts

I'd imagine hospitals hate this. Many of them are paranoid at what will happen
if there is more transparency -- there's a union fighting Stanford hospital
now and playing radio ads about high infection rates at Stanford. Other
hospitals are worried about whether similar things could happen to them -- and
hold their data tight to make sure no one has ammunition to do similar things.
Hospitals in many cases market based on brand value rather than quality. In a
closed world, hospitals can define quality any way they want. Everyone is #1
in something. If there's an objective standard for quality based on integrated
data from hospitals nationwide, many brands will be tarnished. I'd be
interested to see how hospitals respond to this push towards openness

~~~
themagician
How this isn't already mandated by law is baffling. We like to champion the
"free market" but then completely fail to implement policies that make that
even remotely possible.

When people talk about the free market and today's healthcare in the US I'm
always like, "What are you even talking about?" You've got a situation where
there is typically no competition and little or no information available to
the consumer. Free market economics simply don't apply.

One of the reasons I like Kaiser is because the price for just about
everything is posted. I know an CT scan of stomach area, with dye is $608.
Every healthcare provider should be required by law to give you an estimate
price on the spot. If it's too complicated because of multiple insurance
providers and their contracts they should be forced to renegotiate in a way
that make this possible. "It depends" or "we can't tell you until after we
bill you" is not acceptable. Can you imagine any other market working that
way? How much is this car? Can you imagine if the response was, "Well, it
depends. We can't tell until after you agree to take possession. It's
somewhere between $40 and $40,000. But it might actually be free if you submit
form X, but you have to go back in time and submit it before you walked in the
door and get it approved."

If the option was universal healthcare vs a free market system there would at
least be a discussion. Instead it's universal healthcare vs the roll-of-the-
dice healthcare system we have now.

~~~
dbatten
I'm glad to see someone else shares this view. I've been saying for years that
both a single payer health system _and_ an actual free market system would be
preferable to the heavily-yet-poorly-regulated mess of a "market" we have now.

If we don't go the single payer route, it seems one of the #1 things we could
do is to help move "insurance" back to being actual insurance (i.e., we'll
keep you from being bankrupted by your medical bills) rather than a system
that highly subsidizes your regular medical care but then may not actually be
there for you when the bills really pile up... If consumers had to actually
shop for procedures (as opposed to knowing the out-of-pocket is $250 and who
knows what happens beyond that), I think you'd start to see people screaming
for transparency, and medical providers would have to get their acts together.

Only one of many problems, I know.

~~~
patrickmay
Resetting the expectation that insurance is for unusual procedures, not for
yearly checkups and the common cold would be a great start. It's also
necessary to focus on the supply side. Just two examples: the AMA limits the
number of doctors and new hospitals can't be opened without the approval of
the existing hospitals in the area. There is far from a free market in health
care in the US.

[http://reason.com/archives/2017/10/25/this-one-weird-
trick-c...](http://reason.com/archives/2017/10/25/this-one-weird-trick-could-
improve-medic)

~~~
s73v3r_
Except checkups and preventative care are usually far, far more effective than
emergency care. So it would be to the benefit of all for insurance to cover
it.

~~~
CWuestefeld
This is intuitive, but turns out to be false.

That is, for any one particular patient who's found to have a disease down the
road - say, cancer - it would have been cheaper for him if that problem had
been found very early, so _for his individual case_ the checkups and tests
would have been a big savings.

But when you account for all the people that do not turn out to have the
problem at all, and the cost of checkups and tests, and then especially the
costs of the followups due to false positives that are a risk in every test,
the overall cost of test and prevention is actually worse.

~~~
michaelmrose
Your statement is poorly thought out on several fronts.

Firstly putting a bullet in the head of anyone with non trivial cancer would
probably be a financial savings for the insurer but the real equation is the
human/societal benefit of treatment vs costs to best make use of a finite
resource.

A simple cost of treatment analysis even misses out on the income that a
person would have earned had they not died and the money that could have been
paid in taxes and used to fund more treatment.

Drilling down into just the cost of treatment your statement isn't even wrong
its a category error like saying that adding 2 integers always yields a number
greater than 42.

For any given test and set of circumstances under which it is administered
there can be a cost benefit analysis.

Example if you spend a thousand dollars on each false positive result and save
10k for each and have a 1% false positive rate and test a million people with
a 1 in a million true positive rate. You will find one true positive saving
10k unfortunately you will also find 10k false positives and waste 10 million
dollars.

In actuality you wouldn't do this you would test people whose symptoms or
circumstances suggest they are likely to have it.

It seems fantastic to suggest that preventative medicine is always financially
negative when people who actually study health care say otherwise.

~~~
CWuestefeld
Still, you've got your facts wrong. Consider:

 _Mr. Gruber_ [yes, it's THAT Jonathan Gruber] _found that when retirees in
California began visiting their doctor less often and filling fewer
prescriptions, overall medical spending fell. People did get sick more often,
but treating their illnesses was still less costly than widespread basic care
— in the form of doctors visits and drugs. ... As Dr. Mark R. Chassin, a
former New York state health commissioner, says, preventive care “reduces
costs, yes, for the individual who didn’t get sick.”_ [1]

You go on to state that the additional productivity of the person we saved
also nets us additional savings. But the same article contradicts this notion
as well:

 _The actual savings are also not as large as might at first seem. Even if you
don’t develop diabetes, your lifetime medical costs won’t drop to zero. You
might live longer and better and yet still ultimately run up almost as big a
lifetime medical bill, because you’ll eventually have other problems. That
would be an undeniably better outcome, but it wouldn’t produce a financial
windfall for society._

You go on to suggest that medical professionals would not be wasting money on
doing too many tests: "For any given test and set of circumstances under which
it is administered there can be a cost benefit analysis."

That seems logical, but it's not how the real world works. People get
emotional about the potential risks, and demand the tests even when there's
not a clear indication. You might remember the hubbub a couple of years ago
when it was suggested, based on historical evidence, that regular mammograms
should be delayed a few years later than was currently the practice. But
women's health advocacy groups raised such a hue and cry that the actual
medical guidelines were not changed to follow the evidence.

[1]
[https://www.nytimes.com/2007/08/08/business/08leonhardt.html](https://www.nytimes.com/2007/08/08/business/08leonhardt.html)

~~~
your-nanny
I think that it is very hard to do a proper accounting. It is difficult to
forsee all the consequences of an intervention; if a parent is sick, they do
not work. The other parent may need to stay home too to help out. A double
whammy on productivity. The firm employing them takes a hit too, as well as
the municipalities and other levels of government depending on tax revenue.
Such hits can lead to declines in necessary investment. And this doesn't even
account for possible epidemiological effects, which can be highly nonlinear,
as infection Cascades can be frequency dependant.

------
BurningFrog
One of the biggest problems with US health care is that it's usually
impossible to find out what treatments will cost before having them.

This makes "shopping around" and being an informed consumer near impossible.

If this actually happens in a meaningful way, hospitals will have to be
competitive on price, and I can easily see a 30% cost reduction across the
industry just from that.

...which is why I'd be surprised if that actually happened. Such a big
restructuring of such a politically powerful industry doesn't just happen in
our system.

~~~
djsumdog
Where as other high income/developed countries, citizens don't have to shop
around because everyone is insured by the State and pays the same prices.

The biggest problem with the US health care system is that it's decades behind
every one of our counterparts in Europe, Australia/NZ, Japan, Canada, et. al.

People in other developed nation don't have to worry when they're sick. They
know they can see a doctor and it either won't cost them anything, or it will
always cost the same amount. If they lose their jobs, they don't have to worry
about their health as well. People can chose to quit their jobs, or take long
unpaid periods to work on their own projects, without having to worry about
how they're going to pay for health care. In America, we're required to pay
for private insurance, even if you leave the workforce.

There is a huge cognitive load when health is in the background of your mind.
In America, we have to work. If you don't work, you don't get services; not
until you're old enough to get Medicare. In other words, you don't get medical
services until you're too old to be a working member of society; until the
country bleeds you dry as a resource.

That is America.

~~~
txcwpalpha
> Where as other high income/developed countries, citizens don't have to shop
> around because everyone is insured by the State and pays the same prices.

Exactly. Everyone praising this is doing so because they think it's great that
this will allow Americans to "shop around" when it comes to healthcare, but
they seem to be missing the fact that even the very concept of "shopping
around" for healthcare is _absurd_.

If you're having a heart attack, or just have a broken bone, or even if you
just have a stomach ache, the last thing that you are going to want to have to
spend time doing is "shopping around" before getting your problems fixed.
Being able to shop around isn't something that should be praised, it's
something that should be relentlessly mocked and is evidence of a failing
healthcare system.

~~~
refurb
_very concept of "shopping around" for healthcare is absurd_

No it's not. A very large percentage of medical care is planned, not urgent.
There is no reason why price comparison can't happen for those.

A great example of a highly functional healthcare market is vision correction
laser surgery. Every time I look around some deal is being offered.
Competition is what drove those prices down.

Can you do that with everything? Of course not. But you can do it with a lot
of planned medical care.

~~~
omegaworks
>No it's not. A very large percentage of medical care is planned, not urgent.

And for those procedures, a hybrid system should suffice. All Americans,
should, at minimum, be able to get urgent, surprise medical issues addressed
in a way that doesn't completely destroy them financially.

Of course, nothing is black and white. Issues that could have been treated in
a planned way become urgent if they're left to fester. Obamacare started
shifting the incentives to make preventative measures more palatable, and
healthcare cost growth has come down as a result. ACA is a /conservative/ set
of policies. Even still, it elicits extreme reactions from loud people on the
fringes.

~~~
bobwaycott
I’d suggest a slight addition:

> _All Americans should, at minimum, be able to get routine and urgent,
> surprise medical issues addressed in a way that doesn 't completely destroy
> them financially._

Elective procedures are obviously a thorny issue people will debate over where
to draw the lines. But standard checkups, routine wellness procedures, and
covering the unexpected ought to be the bare minimum—the healthcare floor of
social decency beneath which we do not allow _any_ member of society to fall
without recognizing we are failing as a society.

------
dirtybirdnj
I went to the emergency room with a horrid ear infection because no local
urgent cares were open and after I called the phone # on my insurance card
thats what they told me to do.

The receptionist literally, and I am using this word correctly, LITERALLY
laughed in my face when I asked how much the visit that had just ended would
cost.

For me it's not about "shopping around" before I go to a hospital. Its having
a transparent and up front bill for what services were rendered before I
leave. It's preventing that shock unbelievable bill that shows up in the mail
three months later, and giving the patient a chance to dispute fraudulent or
excessive costs while they are still in the building.

Hospital billing needs to be open and transparent. It's the most manipulative
and predatory industry on the planet. If only the goal was to help people, it
seems like the companies that own hospitals only care about shareholders.

~~~
poulsbohemian
I had a similar situation about 5 years ago. Even though the hospital had my
insurance info, they sent a bill / demand letter for the full amount anyway.
Of course insurance eventually paid for most of it, and I was finally
reimbursed by the hospital about six months later. This was from an "award
winning" hospital in Oregon. Scum suckers.

------
amluto
I would like to see a stronger law:

Hospitals and doctors must post their price list online.

Hospitals and doctors must disclose to each patient before any non-emergency
service how much that service will cost. The disclosed cost must be consistent
with the price list and must not depend on what insurance is involved.

Hospitals and doctors must not give any non-charitable discount to anyone that
lowers the total amount that they charge below the listed price. (With the
possible exception of Medicare.)

Hospitals and doctors must not attempt to collect more than the listed and
disclosed price from any patient for any service.

In other words, if a doctor is willing to see a patient with some particular
insurance plan for $100 (split between the insurer and patient however the
insurer sees fit), then that doctor cannot bill a patient $300 for the same
service becaues they have a different insurer.

Yes, a law like this would thoroughly invalidate the entire way that insurance
contracts work right now in the US.

~~~
eldavido
Interesting that many states have laws mandating this for auto care.

I'm hoping we reach consensus soon that healthcare isn't somehow "special".
It's just an industry, with incumbent interests, fighting to earn as much
profit as possible, just like any other industry.

~~~
hoschicz
What do you mean by „auto care“?

~~~
RightMillennial
In the U.S., "auto care" means automobile (car) maintenance. In other words,
car repair shops must list or quote you a price before service.

------
shaki-dora
People are mocking this policy here, but it’s obviously better than nothing.

A large number of hospital procedures are likely planned, and can therefore be
subject to comparison shopping. Giving birth is an obvious one. But even for
many fractures there is a day or two before the procedure, and you could
transfer.

Maybe more importantly, public price information allows independent research
into price disparities, and public shaming of the worst offenders. That’s data
only insurance companies currently have access to.

~~~
txcwpalpha
I don't really think it is "better than nothing", though.

If we start 'publicly shaming' hospitals for high prices, then that will
encourage hospitals to aim for low prices. That of course sounds _great_ on
its face, but my concern is that this is going to encourage hospitals to
achieve lower prices through cost cutting, (aka cutting corners, in the
industry where corners need to be cut the least: healthcare).

Trying to rein in healthcare costs is great, but I fear that trying to do it
by encouraging focus on narrow metrics like these could do more harm than
good.

Also, these publicly-available prices will be almost meaningless to the
average person, as they are just 'list prices' and won't match what insurance
or any individual actually pays.

~~~
tibbon
Isn't pressuring them to lower prices (at least a bit) what the insurance
companies do themselves?

~~~
root_axis
Not really. It is much more common and much easier from a business operations
perspective to simply increase premiums or deny coverage, especially because a
lack of competition means that consumers will have to pay the premiums no
matter what. If a price hike causes the premiums to become unaffordable the
insurance company actually benefits because they no longer have to endure the
cost of providing benefits but they get to keep all the money that was paid
before raising the rate to a level that the consumer could no longer afford.
This is in contrast to healthcare providers which have a much better
negotiating position because they're the ones actually providing the service
that the consumer actually wants for the money that they're paying, so trying
to get them to lower prices ends up being a much more difficult and risky
negotiation.

------
phkahler
Next step is to make them actually charge those prices to all
patients/insurers. It's not appropriate for insurers to pay less because they
made a deal with the hospital.

From TFA: It may still prove to be confusing to consumers, since standard
rates are like list prices and don't reflect what insurers and government
programs pay.

Just because your insurance doesn't cover something doesn't mean they should
make more money. This is one of the root problems driving healthcare costs. No
deals for government or insurance companies. Post prices. Standard procedures
should end up with lower pricing due to competition.

------
jihoon796
I've worked in medical finance as a consultant, and a huge problem that I've
seen is that although private insurance was originally intended to encourage
competition, it has made prices much more complicated and opaque for the end
consumer (patient).

Generally speaking, each hospital/practice/clinical lab has to negotiate with
individual insurance companies to get reimbursed at a given rate minus
"contractual adjustments" \- this negotiation process is highly inefficient,
given that each payer may do things differently (a contract with BCBS of NC
may be different than one with Florida Blue), and smaller providers simply
don't have the bandwidth or resources to have any leverage in this process.

The complexity of this ecosystem only hurts consumers and providers (and helps
the payers, of course), and although many insurance entities call themselves
"non-profit", I seriously question their motives.

It's almost reminiscent of the era leading up to the financial crisis of 2008,
where complex derivatives, mortgage-backed securities, and other overly
sophisticated financial instruments made those that worked in the industry
fantastically wealthy, while the common people were left holding the bag when
the stock market finally plummeted.

I hope we can find ways to simplify this system - the single payer system, for
all of its flaws, seems like a step forward in the right direction.

~~~
matz1
Why hospital even need to negotiate with insurance company? Can't they just
set the price they deem reasonable and then let the patient and insurance to
work out the payment within themselves .

~~~
djrogers
It works that way for 'out of network' facilities and doctors, and there are
higher deductibles and lower limits on payouts for those as the insurance
copany has no fiscal control.

The negotiations happen for 'in network' systems, and it's in the hospital's
interests to be 'in network' for as many insurance companies as possible, as
most people choose 'in network' care providers.

~~~
jihoon796
Yes, this is also true.

------
koolba
> Hospitals are required to disclose prices publicly, but the latest change
> would put that information online in _machine-readable format_ that can be
> easily processed by computers.

This is great news and step zero on the long road to transparency in the
voodoo that is USA medical billing.

What would be really awesome is if someone can get non-Medicare versions of
these prices and somehow marry that with the co-pay / co-insurance of common
insurance plans to give people an idea of what they'd be on the hook for. At
the moment nothing short of going through with the medical service and then
taking a time machine will get you the true answer. And even then they can
retroactively change it!

~~~
joombaga
This is exactly what my company's solution does! We get prices from multiple
sources, one of them being claims data (which is basically your time machine).

~~~
koolba
What's your company? (Your HN profile is empty).

Shameless self-promotion is encouraged in this type of reply so don't be shy!

------
davidw
Anecdote: along with the public health care system in Italy, there's a
parallel, private system if you want something a bit fancier, or a bit faster
for non-urgent things. One of the things that made me laugh was when I went
through that to see a local ear-nose-throat doctor. I was able to call and ask
for prices on the phone.

In other words, along with covering everyone via the public system, Italy's
private system is a better functioning market than the US system.

------
pkaye
>Hospitals are required to disclose prices publicly, but the latest change
would put that information online in machine-readable format that can be
easily processed by computers.

Apparently the hospitals have already been required to do this but now it will
be online. Also this number will only give the upper bound of the cost since
it is considerably negotiated down. What good does it do if they say mending a
broken bone costs up to $20k when in reality it is somewhere between 0-$20k
depending on insurance and other factors.

------
willart4food
I like this.

Last year I went to my dermatologist for a routine check up and they frooze 1
mole on my leg:

$ 600 for the visit

$ 600 for freezing the mole

~~~
pg_bot
Wow, that would cover 2 years worth membership at the clinic I run. We charge
$49 / month for unlimited visits, freezing the mole would've been around 10
bucks. You likely could have gotten a plane ticket, flown to our clinic,
gotten the procedure, and flown back for less money

~~~
ihodes
I'm curious to learn more about your clinic. Mind sharing any information?

~~~
pg_bot
Sure, my email is in my profile. Send me a message with what you would like to
know and I will get back to you.

~~~
ihodes
I'm unable to see that in your profile (looks blank to me). Do you mind
updating it?

~~~
pg_bot
Whoops, sorry for lying I've updated my about section.

~~~
ihodes
Thank you!

------
ppeetteerr
Who wants to start the Uber for ambulances? It will have a list of prices for
the nearest hospitals and drop you off where the costs are cheapest and the
waiting times the shortest? (I'm a mobile/backend dev B) )

~~~
dragonwriter
Ambulance services are generally extremely tightly regulated, and often
exclusive area contracts. You probably couldn't operate an ambulance company
with the policy you describe in most places, and you certainly couldn't
legally do an Uber-style middleman service with independent ambulances that
used that policy.

And, unlike taxi laws, the laws on operating thingd that pretend to be
legally-mandated emergency vehicles are going to be vigorously enforced.

------
jadedhacker
Useless. Consumers don't care about how much something costs when it's life or
death and they may not even know enough to understand what price they should
be looking for. Medicare must have the power to negotiate prices for the
benefit of the population full stop. Also, medical service must be free at the
point of service for all US residents to ensure everyone gets essential care
and preventative care.

Here's the healthcare plan we should have:
[https://medicareforall.dsausa.org/](https://medicareforall.dsausa.org/)

~~~
conanbatt
Multiple the medicare spending for the amount of population it serves and
rejoice in a 40% GDP spending on healthcare.

~~~
chimeracoder
> Multiple the medicare spending for the amount of population it serves and
> rejoice in a 40% GDP spending on healthcare.

Don't forget to account for the fact that Medicare's reimbursement rates are
not self-sufficient - they're implicitly subsidized by private insurers. So
it's actually much higher than that.

~~~
conanbatt
That effect goes both ways: medicare gets patients that are old and have more
expensive and chronic diseases, thus their spending per service might be very
efficient. Which leans on which is hard to know without some rigorous
analysis.

~~~
chimeracoder
> That effect goes both ways: medicare gets patients that are old and have
> more expensive and chronic diseases, thus their spending per service might
> be very efficient.

It doesn't really matter, if they're reimbursing below COGS (which they are).
If the expected value of a set of numbers is negative, you can't make it
positive by adding a bunch of other numbers which are also negative (even if
they might be closer to zero, which in this case they oftentimes are _not_ ).

~~~
conanbatt
I don't follow your reasoning. Private insurance pays physicians more than
medicare, producing the implied subsidy you mention (as they pay less). But
once patients get onto medicare, they dont go to private insurance anymore so
there is no subsidy: almost all the money is spent by the state at that stage.

This has the incentive that private markets have incentives to do disease
treatment and prevention before the patient goes to medicare, potentially
offloading care onto the later stages.

I would surely like some formal study and analysis on this, i feel this is
very theoretical.

~~~
chimeracoder
> I don't follow your reasoning. Private insurance pays physicians more than
> medicare, producing the implied subsidy you mention (as they pay less). But
> once patients get onto medicare, they dont go to private insurance anymore
> so there is no subsidy: almost all the money is spent by the state at that
> stage.

As a provider, let's say 40% of your patients are on Medicare, and 60% are on
private insurance. On average, you're losing money on a per-patient basis for
40% of your patient base, since Medicare's reimbursement rates are below COGS.
You stay in the black by charging the remaining 60% enough to make up the
difference.

Without the privately-insured patient base to subsidize the Medicare patients,
the provider would go out of business immediately, because they wouldn't even
have enough revenue to cover the direct, marginal costs of supplies for each
treatment, let alone anything to pay for staff wages, office space, overhead,
etc.

> I would surely like some formal study and analysis on this, i feel this is
> very theoretical.

This isn't theoretical at all. It's no secret that Medicare's reimbursement
rates are below sustainable levels. Medicare itself admits as much. For
providers that see a high enough percentage of Medicare patients that they
can't effectively distribute the costs among their privately-insured patients
(because there aren't enough of them), Medicare actually runs special stipend
programs, where they provide you with extra money to stay afloat (separately
from the regular reimbursements).

~~~
conanbatt
I dont agree with this analysis, but Im more than willing to read up on it.

> Medicare does not reimburse below sustainable levels > On average, you're
> losing money on a per-patient basis for 40% of your patient basis..

I disagree with this conception of sustainable: at any point if you have two
suppliers with price differenciation yes, one of them 'subsidizes' the other,
but that doesnt make it so the latter doesnt bring revenue. If by law airlines
could not sell coach anymore, they would all drastically go out of business,
even though they dont make money on coach. Medicare does lower reimbursement
but it only matters in so far they take the spot of a private insurer.

Furthermore, sustainable implies that there would be no providers at medicares
rates but that is not true: there would be less because they pay less, but you
would still have providers.

Second, accepting medicare is a hassle for providers but I assure you they
dont do it out of charity. They give you infinite demand which means you can
fill your non-private insurers slots with medicare and provide lots of
revenue.

~~~
chimeracoder
> Furthermore, sustainable implies that there would be no providers at
> medicares rates but that is not true: there would be less because they pay
> less, but you would still have providers.

In most regions, Medicare reimburses rates that are less than COGS. If you
have to pay $100 wholesale just for the supplies to perform a procedure, and
you're only allowed to charge $93 for the procedure, you're going to go out of
business very quickly.

Your assertion that "there would still be providers" is wrong, because unless
Medicare dramatically raised its reimbursement rates[0], most providers would
go out of business overnight. Even if it _were_ true that there would still be
providers, just fewer of them (which is not true), you're at best arguing for
something which, in your own words, would exacerbate the current shortage of
practicing clinicians, which would drive up prices for self-paying patients
even further and dramatically lower the quality of care for the entire
country.

> Second, accepting medicare is a hassle for providers but I assure you they
> dont do it out of charity. They give you infinite demand which means you can
> fill your non-private insurers slots with medicare and provide lots of
> revenue.

Medicare doesn't give you "infinite" demand. But furthermore, having more
patients doesn't help you if you're literally losing money on a per-patient
basis. You can't lose money on margin but "make it up in volume".

This is exactly why Medicare has to provide separate stipend programs to
providers who aren't able to overcharge privately-insured patients and make up
for their losses on Medicare patients that way.

[0] which is the entire point of the comment that began this whole thread -
Medicare would _have_ to dramatically raise its reimbursement rates if it
covered all patients

------
CoffeeDregs
This is great.

Article in The Atlantic back in 2009:
[https://www.theatlantic.com/magazine/archive/2009/09/how-
ame...](https://www.theatlantic.com/magazine/archive/2009/09/how-american-
health-care-killed-my-father/307617/)

My mother-in-law died of brain cancer over the course of about five days. We
received a "Statement of Benefits". She received ~$130,000 of care. Medicare
paid ~$30,000. That's bullshit. Per James Fallows' article, medical price
transparency is CRITICAL. You can't improve something if you can't see it and
can't measure it until after you experience it.

I'm an anti-Trump (and anti-Republican) Republican but I have to admit that,
with this Medicare transparency action, sometimes this administration takes
surprisingly sensible actions.

~~~
iooi
Were you responsible for that debt? Why did Medicare cover so little?

~~~
CoffeeDregs
Great question. We were not responsible for the difference. The "Statement of
Benefits" is a very confusing US healthcare tradition in which you're told how
much you _should_ have paid before being told what you owe. In our case, there
was a corresponding "Medicare discount" (or something; it's been 8 years) and
the final bill was $0.

The situation is _terribly_ regressive: people with the least money and the
least likely to be able to afford healthcare and are therefore most likely to
suffer high hospital costs. People with the most money get healthcare
"insurance" and so get the lowest prices.

------
brettproctor
Understanding the root cause of how our healthcare system developed is both
crucial and completely lacking from most of these discussions.

It is a tale of federally mandated wage control and specialized tax breaks. A
quick google will show many articles outlining how we got here.

Why is car insurance not tied to employers? In general how much better does
car insurance work than health? Are the prices not much more straightforward
and is it easy to shop around? If you are treated poorly by your car insurance
company, can you easily tell all your friends and change companies?

This is the real problem here. Most folks have no choice and no skin in the
game, which leads to all these crazy stories about zero pricing information
and no ability to change companies.

If the tax breaks simply got removed, and people had to actually pay directly
for their insurance and could switch companies, the vast majority of these
problems would go away.

~~~
custos
Car insurance is not comparable to health insurance. It's apples to oranges.
Car insurance reduces risk, by exchanging the cost of an unpredictable
potentially costly event (an accident) for a regular much reduced cost event
(monthly payment). The benefit is predictable expenses and budget.

Health insurance only works this way for the healthy. For the chronically ill,
it's flat out cost reduction to have it and a profit loss for the insurer.

My insurance pays out more than I pay into it every year. I had one year it
paid out ~$250k.

Unless we stop mandating care for the sick unable to pay for it, healthcare is
socialized; it's just a matter of how efficiently socialized it is.

Insurance companies overcharge the healthy to make up for their losses with
the chronically ill, and hospitals overcharge those who can pay to make up for
their losses with those who can't.

Really just need to cut out the middle men.

------
OliverJones
Medicare reimbursement is generally fixed price based on diagnosis (DRG ==
diagnostic related groups)

Table 5 here shows a "weight" . That's the number of units of reimbursement a
hospital gets for each particular diagnosis / procedure / whatever. (LOS is
length of stay) (CC is complications) (MCC is major complications)

[https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Paymen...](https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/AcuteInpatientPPS/FY2018-IPPS-Final-Rule-Home-Page-Items/FY2018-IPPS-
Final-Rule-Tables.html)

Hospitals negotiate with CMS the number of dollars per unit of weight.
Sometimes aggressively. It would be good to have that number of dollars posted
publicly and explained. Does the hospital hate serving Medicare patients
because they don't make enough?

------
sjg007
Good. They also need to improve the appeal processes for private insurance and
crack down on improper denials.

------
testfoobar
Hospital billing is incredibly murky.

1 - I'd imagine the price they will post is similar to an airline's full fare,
refundable ticket price. The price actually paid is quite different and
related to the negotiated rates with your insurer and your deductible.

2 - Hospital billing is often separated from physician billing. Does price
transparency extend to all physician groups?

3 - Patients care about total out of pocket expense. How much is it going to
cost me? Hospitals can't know this because they are not privy to your health
plan structure/details - they only know their negotiated rates. Your health
plan doesn't know it, because it hasn't received the full details of your
treatment.

------
moistoreos
Still have to change consumers of health care to have a consumer mentality for
health care. Whatever the age, you really should actually shop around for non-
emergency medical procedures. This is one area you can really save money
because a lot of places are severely overcharging for simple procedures.

Call the facility, get a quote (they will probably have to do a bunch of work
on their end), document quoted price (if I were to do this I would probably
have the hospital email me a document), and don't pay more than the agreed
upon price.

Receiving non-emergency medical care should be like shopping for cars, pizza,
iPads, houses, etc. So, yeah, start doing that. Be the change you want to see.

------
throwaway84742
I’m in favor of this, and not just for Medicare. Medicare pricing is extremely
low because doctors can’t turn down Medicare patients. Medicare pays like $8
for a physician visit, which is, quite obviously, not sustainable for the
physician. I want to be able to comparison shop at the very least for routine
stuff that’s not customized patient to patient: yearly physical, blood tests,
chronic disease care, etc. Combined with ratings this should reduce the
current extreme information imbalance and drive the prices down.

------
sharemywin
How much of my money are you willing to spend to save your own life?

Read an article that talked about insurance companies providing tools to
consumers about pricing, turns out they don't use them because people are
price conscience when it comes to their current healthcare needs. And my guess
they're probably too price/time conscience when it comes to preventive care.
Aka, they would need to be compensated to stop eating cheeseburgers.

~~~
xena
Cheeseburgers are cheaper than healthy eating

------
late2part
Hotels are required in most jurisdictions to post their rack rate for hotel
rooms. Look on the inside of your hotel room next time, you'll find the rack
rate is usually 4X what you actually pay.

You'll find they comply with this, just like California Prop 65.

They'll continue to give discounts just like Rockefeller gave rebates and
subsidies.

------
rb808
The next interesting question. Say you needed some surgery, would you choose
the cheapest one or the most expensive one?

------
enknamel
I never understood why doctors, hospitals, etc never do this. They know their
prices but they never want to let you know until too late. Heck doctors have
often told me they take my insurance then say "woops you gotta pay me cash!".
Medical billing needs some serious fixing or consumer protections.

------
intrasight
Great read on this topic

[https://www.theatlantic.com/magazine/archive/2009/09/how-
ame...](https://www.theatlantic.com/magazine/archive/2009/09/how-american-
health-care-killed-my-father/307617/)

And his book of course

------
michaelmrose
How about we take this a step further and require hospitals to have one price
for each service to all comers.

Then we can trivially pick a plan independently of backroom deals that are
impossible to evaluate ahead of time and easily pick the provider that
provides the combination of service and price.

------
49bc
Even if it was just “this is the cash price for item X” this would be a huge
benefit for he consumer.

------
BurningFrog
Here is an article about one of the few US hospitals with a fixed public price
list:

[http://time.com/4649914/why-the-doctor-takes-only-
cash/](http://time.com/4649914/why-the-doctor-takes-only-cash/)

------
wdn
This is a step in the right direction. I hope they push all medical services
and drugs to publilsh their prices. This way, customers can have the option to
pay cash or go through insurance.

------
shmerl
Good! It should have been done a long time ago.

------
maxxxxx
We will have to see how this will be implemented but I like that they
acknowledge that price transparency is a big problem.

------
arca_vorago
I don't want just prices, I want to know actual costs and then the prices, and
breakdown of what goes where.

------
King-Aaron
This discussion makes me appreciate the healthcare system here in Australia
much more.

------
technologia
This would be a halfway decent way to fight back a hospital's insane
chargemaster.

------
doggydogs94
I wonder what will happen when an important hospital opts out of Medicare over
this?

~~~
zavi
It's not going to happen, hospitals mostly get revenue from Medicare/Medicaid.

------
notadoc
Singapore does this. Their health care costs are significantly lower than the
USA.

------
SemiTom
how about taking it one step further and aggregate the database of all
hospital prices so we can filter and compare. better yet, single payer system
overall

------
smilbandit
Will hospitals decide to just not take medicare any longer?

------
notabee
Current U.S. healthcare: NIH syndrome writ large.

------
bwb
The big question is which set of prices IMO...

------
hackerews
This would take effect in 2019 if passed.

------
delinka
Feels like a step in the right direction. But we've already got geographic
monopolies in many cases - you can't just decide to go ten more miles in an
emergency because you know the prices are 15% lower.

However, if a new hospital opens close-ish to an existing one, offers a
temporary discount, then the two just keep an eye on each other's websites to
maintain the status quo in pricing will offering "competition," now we have a
duopoly.

Capitalism will find a way to keep screwing consumers.

------
mey
Removing any of the information asymmetry in health care is useful. Providers
in clinics usually don't know what procedures costs, especially with various
insurance negotiations. This empowers patients and additionally medical
providers themselves. It is a real conversation (in non-emergent situations)
that should be happening with patients and providers about what the patient
can afford.

If you do not like that this exposes publicly the capitalist nature of US
health care, then I encourage you to support a universal/government health
care option, rather than trying to prove this information isn't helpful.

~~~
snuxoll
Honestly the biggest pain in the ass when it comes to trying to price
healthcare comes outside office visits. Want to go in for a surgical
procedure? You think it's going to cost $X but it ends up costing $X+Y because
some complication caused the operation to run 10-15 minutes over the estimated
time and now you have an extra unit of time for the anesthesiologist getting
billed.

Price transparency is great, but office visits are basically the only thing
you can estimate well upfront (there's five CPT codes for the visit,
99211-99215 and it's easy to estimate which one will apply based on whether
it's a new/existing patient and the level of history/examination you
anticipate requiring). I will stand by my belief that the only way to "fix"
healthcare in our country is going full single-payer so citizens don't have to
worry about whether they can afford to get treated or not.

~~~
arethuza
A few years back my son got his tonsils taken out at a private hospital in the
UK (my employer at the time provided it) - after the operation the
anesthesiologist and apologized and said that due to a billing mistake I'd
have to pay an additional amount directly and handed me a bill.

Having read horror stories about medical billing in the US I was prepared for
a shock. However the bill was for something like £4.50... :-)

------
xivzgrev
Finally the first good news from the Trump administration.

------
madengr
As long as they assign a variance to that mean price. Even then it woukdn’t
fit any known distribution.

------
silveira
A delusional wishful thinking that a patient, while in pain and in need to
care, will be shopping and browsing around to see prices, and that would drive
prices down. Even if that was true, it requires that you could predict how
much your treatment or visit would cost, and anyone who have actually used and
paid bills in the health system in US knows how it goes.

~~~
rdl
There are some facilities which already post basically accurate prices online:
[https://surgerycenterok.com/](https://surgerycenterok.com/) is a great
example.

If I needed some kind of elective or non-emergency procedure, they would be
high on my list (along with medical tourism to foreign countries where
procedures are also clearly priced, and even cheaper)

I've recently been having pretty good luck going to medical providers and
offering cash (I have Kaiser insurance now, which I basically treat as
emergency/catastrophic only, since they never cover any providers I'd want to
see, so I basically end up paying cash.). I was able to get a dermatologist to
go from $600+ to $95 because cash.

~~~
vidarh
> (along with medical tourism to foreign countries where procedures are also
> clearly priced, and even cheaper)

The thing that is _really_ bizarre to me is that I've more than once seen
people quite prices for non-emergency procedures in the US that are more
expensive than taking a business class flight to London, checking into a high
end hotel and getting treated at a top private hospital targeting mostly rich
people... Of course it's less convenient than being treated near your home,
but the difference can be significant.

~~~
rsynnott
Do such hospitals actually accept non-resident patients from outside the EU
for elective stuff? I'm not sure about the UK setup, but in Ireland, private
hospitals are able to save costs on the basis that if something goes badly
wrong, they can just shunt the patient over to the larger and generally better
equipped public hospital, which is often literally next door, at which point
the patient become's the state system's problem. For instance, many of them
don't have an ICU.

This works okay if the patient is resident or is an EU citizen, and so is
entitled to be treated by the public system (though it's arguably an effective
subsidy of the private system by the public system), but I wouldn't have
thought it'd be feasible for non-resident foreign citizens.

~~~
DanBC
England has a mix of private hospitals and NHS hospitals. Some private
surgeons work from NHS hospitals - in that case you'd have a private surgeon,
a private anaesthetist, and probably NHS nurses / OD techs, and then a private
room.

The cost to visitors of NHS treatment is 1.5x the NHS rate. Some stuff is
exempt.

Here's the official guidance:
[https://www.gov.uk/government/publications/guidance-on-
overs...](https://www.gov.uk/government/publications/guidance-on-overseas-
visitors-hospital-charging-regulations)

[https://www.gov.uk/government/publications/guidance-on-
overs...](https://www.gov.uk/government/publications/guidance-on-overseas-
visitors-hospital-charging-regulations/summary-of-changes-made-to-the-way-the-
nhs-charges-overseas-visitors-for-nhs-hospital-care)

~~~
rsynnott
Huh, interesting. I wonder if that's allowed here, too; the Irish system is a
dual public-private system fairly similar to the UK one. I just assumed it
wouldn't be allowed because it seems like it'd be an undue burden on the
public system.

------
VikingCoder
This is a terrible idea.

Which is better, a CT Scan for $1000 or one for $10,000?

You probably guessed the cheaper one, right? Thinking "all CT Scans are the
same," right? I happen to know that's not remotely true, but it's easy to
think that saving money on a test would make sense, right?

Okay, now which is better, open-heart surgery for $20,000 or $200,000?

That's a lot harder to answer, isn't it?

You need to know the outcomes of those procedures at that facility, compared
to other facilities, to have any possible way to judge them.

~~~
ictoan
This is free market working correctly. Transparency is important. You should
have information about the price AND outcome. It is not mutually exclusive.

~~~
VikingCoder
Healthcare should not be a market.

If you need a heart transplant, and I know you need a heart transplant, you're
in kind of a lousy position to negotiate, aren't you?

I don't buy some Defense tokens or insurance on some market. I pay taxes for
National Defense.

Don't get me wrong, capitalism is awesome. And I worked in healthcare software
for about 13 years. But applying capitalism to basic, necessary healthcare is
no good.

