
'Legitimate' US healthcare pricing could reduce costs by a third - forrestbrazeal
http://www.modernhealthcare.com/article/20161014/news/161019940
======
niftich
It's hard to overstate how bizarrely opaque healthcare pricing is in the US.
Despite the quality of the care ranking favorably worldwide, medical bills are
an after-the-fact surprise.

In the diplomatic, foreign exchange, and expat communities living in the US, a
common advice is "don't get sick". Those who can afford to travel often get
care "back home" or elsewhere in Europe or Asia, because the costs can be
determined in advance -- not to mention almost always cheaper.

Meanwhile, Americans are subject to surprise pricing, supposedly-helpful
"Explanation of Benefits" forms that itemize procedures into miniscule sub-
steps costing several hundreds of dollars each, a complete inability to
reconcile a bill with the corresponding insurance claim -- to say nothing
about trying to correct a paperwork mistake should it occur, or even being
able to detect it in the first place.

~~~
WalterBright
Few people ask what the price will be in advance. I do know people that do,
and they can and do shop around. You can get quite a bit better prices that
way.

Few procedures are an emergency.

~~~
soccerdave
When I needed an MRI, I called five different places and only one of them
would actually tell me a price. All of the others said "we don't know the
price until we submit the claim to insurance". Not sure if they were telling
the truth or just being lazy at their jobs. Either way, getting a price in
advance is not as simple as just asking.

~~~
ethbro
In fact, they know two exact prices: (1) the price they will bill your
particular insurance company & (2) the lowest price in actual total they can
accept

Unfortunately, there's no benefit to them to tell you (2). And without
verifying your exact insurance coverage (i.e. submitting a claim) they have no
idea how (1) relates to your eventual out-of-pocket costs (and they're
disincentivized from telling you the billed rate in case you're actually
another insurer trying to negotiate lower rates).

~~~
mirimir
Actually, as pmorici notes, there are three relevant prices. Without
insurance, you will be charged the "cash price", which is always far greater
(maybe 3-4 times) the price that they have negotiated with your insurance
company. For large insurance companies, that price can be close to the lowest
price that they will accept.

Even if you have insurance, they may be able to bill you for the difference
between the cash and negotiated prices. It depends on relevant law and terms
negotiated with your insurance provider. It's prudent to ask. Also, providers
will sometimes "accidentally" bill you for that difference, even if they're
not permitted to.

~~~
tehlike
it's actually a little more nuanced than that. Hospitals/providers have what
they call charge master. it is probably the cash price you are mentioning.

Even uninsured can end up negotiating the bill, albeit after the fact.

Sometimes, insurance might negotiate lower prices than what a certain
procedure/treatment costs, i believe that's not uncommon. They make up for it
from other procedures in general.

1\. The lack of health care cost transparency reduces price competition. 2\.
people not asking for price in advance, or not caring because the are already
past their 1. deductible 2. out of pocket maximum makes healthcare
expensive[a]. Similar to reference pricing, high-deductible health plans (with
added HSA benefit) makes people think twice before going to doctors. I also
felt a lot of people are not price conscious about healthcare - just yesterday
a friend mentioned "i picked the most expensive plan so i don't have to think
about it". Completely reasonable, but one reason why prices get higher each
year.

[a: reference pricing] [http://www.nytimes.com/2016/08/09/upshot/how-common-
procedur...](http://www.nytimes.com/2016/08/09/upshot/how-common-procedures-
got-20-percent-cheaper-for-many-californians.html)

~~~
mirimir
> Even uninsured can end up negotiating the bill, albeit after the fact.

Yes. One could say something like "I know that you're billing me three times
what you get from insurance companies, and I know that you'd pay at least 50%
to a collection agency, so will you accept 40% now?"

> Sometimes, insurance might negotiate lower prices than what a certain
> procedure/treatment costs, i believe that's not uncommon. They make up for
> it from other procedures in general.

True. Also from payers with less negotiating strength.

~~~
FireBeyond
"Yes. One could say something like "I know that you're billing me three times
what you get from insurance companies, and I know that you'd pay at least 50%
to a collection agency, so will you accept 40% now?""

Unfortunately, this misses another pertinent point, that the provider/facility
will be able to charge off and deduct as a loss either that 50% of the
original amount they're going to charge you, as well as getting 50% from
collections, or 100% if they're... 'creative'. This can often reduce incentive
to negotiate.

~~~
mirimir
Maybe so. But wouldn't that _increase_ the incentive to negotiate?

------
stuckagain
This idea is based on healthcare not being a scam. You can ask for a price and
then will tell you a price but even if you pay that price, up front, in cash,
you will later get bills for more "services", received or perceived. In any
other industry people would go to prison.

~~~
erentz
Yes. My wife recently went for a physical, something covered fully under our
plan. We were surprised to see a bill follow and a separate consultation
charge (not covered) alongside the physical charge (covered and zero rated).
It turns out because she asked the doctor a question the doctor decided that
was outside the scope of the physical and constituted a separate consultation.
Of course how you're supposed to know what is or isn't in scope I have no
idea.

~~~
eh78ssxv2f
I had the same experience. As a part of small talk at annual physical, I asked
a question to the Doctor to which they gave an answer which I already knew
("You do not need to worry about this"), and I got charged for that.

My workplace pays me incentive money for getting an annual physical. So, now I
just go to physicals, stay quiet just so that I get the incentive money.

I wonder how doctors feel that their patients are scared of asking them any
questions.

~~~
tgokh
This is a little sketch - if the question you asked didn't required any
additional work (specialized physical exam, detailed history taking,
additional medical decision making), billing for it as a separate evaluation
and management visit (as opposed to a preventative visit) isn't kosher. Often
people come into their preventative visit wanting to discuss their insulin
regimen, blood pressure history or a new acute problem, and this is the
situation where the second charge is appropriate.

~~~
forgottenpass
_if the question you asked didn 't required any additional work [such as]
medical decision making_

That effectively of reduces the scope of meaningful _questions_ I can a
_doctor_ to near-zero, right?

------
crispytx
My wife's wheelchair that the insurance company is paying for costs $6,000.
The "loaner" wheelchair she's using now costs $400. The $6,000 chair being
built is essentially the same as the $400 chair. Fraud like this is the reason
we have the most expensive per capita healthcare in the world.

~~~
orionblastar
My mother needed a wheelchair, we went to Amazon and bought a $300 one instead
of the $6000 one the insurance company wanted us to buy. No difference that we
can tell.

~~~
tehlike
good thing is those are the things you can shop around -easier-. when you are
in a hospital getting care, you have very little idea about how much it's
going to cost you.

~~~
orionblastar
Also don't throw stuff away. I had injured my knee and has surgery to correct
it. I bought a walker until I got better. When my father got sick he borrowed
my walker instead of buying a new one.

If you look in thrift stores you can find canes and walkers as well sometimes.

It is just like OTC aspirin, bring in your own bottle to save money as if a
nurse gives it to you, you are charged $50 a pill. Buy one for $1 at a Dollar
Store and use that.

------
samirillian
I've often heard/personally espoused the belief that health shouldn't be
treated like a commodity. Interesting argument here that if health were only
"truly" treated like a commodity, we'd have much fairer pricing. Capitalism
has many faces, of which the free market is only one aspect. The healthcare
industry in the US functions a lot more like other examples of what Naomi
Klein might call "disaster capitalism": preying on the fact that health is by
its very nature un-commodity-like to extort the sick.

The problem with this whole line of reasoning may be that health just can't be
fairly priced according to free market principles, and that acting like it can
be will just continue to enable the status quo.

~~~
djsumdog
I worked for a health care insurance company during the 2008 debates on the
cost and quality web applications.

Like people have mentioned, they only gave a range, and a useless one at that.
This was during the big push to HSAs and how healthy people could save using
them and roll that money over to an IRA later in life to aid in retirement, or
kept in the HSA for medicare costs.

We read Redefining Health care at work and there was a lot of talk, but always
with the for-profit ends (even through we were a non-for-profit, not to be
confused with a non-profit).

I left the US for a while and I found it interesting that in other countries,
doctors could always tell me a price. An office visit was never more than $70
and when I got better work visas, the doctors offices even worked with me to
get a better rate (even though I didn't have a full residence visa needed for
Medicare).

Every lab I went to for imagination told me the price on the phone.

The Affordable Care Act is terrible. I does help the very poor, but everyone
in the middle still struggles between many terrible options. Contractors often
get the worst plans that have little to no substantiation.

I have not seen a doctor for a year and only have minimal effective coverage
($17). Full plans from my employer start at $400/month. I've open enrolled in
an ACA plan for next year, but it's still $200 a month and I plan on quitting
my job and travelling. Because it's based on last year's income, I can't
switch to a low income plan until the following year.

Employers should have been banned from offering plans at all, or at the very
least, giving any discounts. But really, we should have a single payer system.
The current state of health care under the ACA is still not good, and far from
our European counterparts.

------
cmurf
I'm convinced employer paid insurance is the single biggest problem. Very few
people buy plans in the healthcare marketplace, most get it from their
employer, and most of those have no idea what that plan costs compared to
other plans.

With employer paid care, the employer is the primary customer. A level playing
field would be everyone having to go direct to insurer/broker or healthcare
market. And people would be so irritated with that process, which also
requires annually reevaluating to get the best price, as a society we'd either
go back to bartering chickens or go single payer.

~~~
lobster_johnson
Part of the original plan for the Affordable Care Act was, as I recall, to
require members of Congress to use the government-run marketplaces. Congress
refused. Not surprising -- they probably have the best health insurance in the
US.

If Congress were forced to "dogfood" the health system the way ordinary people
experience it, I suspect Republicans would be falling over themselves to enact
a single payer system.

~~~
jack9
Ridiculous healthcare is one of the perks for govt officials. Any one of the
Congress people or Executive administrators can get a full body scan on a whim
(e.g. it was all the rage in washington during the first bush administration
through the second bush terms). You get a clean bill of health for your
campaign, or you get whatever you find, treated and maybe get well enough for
the next campaign cycle.

------
kumarski
I think the pricing is an implicit way the cog in the engine works.

I don't necessarily agree with it, but I see it and always think about it when
anybody points out how expensive medical care is here in the USA.

Biotech R&D advances in the USA are funded by monstrously price gouging
insurance companies.

Are you a biotech innovator? Your best bet is to start in the USA because you
can charge a lot of money and nobody will lift a finger that influences your
market potential like what happens in other countries.

Hopefully a large pharma company will buy your small pharma or medical device
company because they have 2 things you don't:

1\. Distribution - 1 sales rep for every doctor

2\. Synthetic Scaling Insight - They have deep insights and grandfathered
advantages in this arena, lest you can double down on putting in 40M-100M to
make it happen.

\---Or so this was the way it was explained to me through hundreds of
interactions trying to build a genetics company in the USA. ---

The hunt for drug targets is the elusive hunt for the black swan. There's 8-10
new genetic tests that come out each day but very few if any of them can be
tied to something specific, because it's tough.

Data doesn't necessarily make it easier, despite the notion of big-data
optimization.

As such, prices will get higher, before they get lower. That or drug dev.
stagnates.

The elephant in the room anytime we talk about US healthcare is our flawed
food environment - Sugar. It's creeping up on other countries fast.....

------
Steeeve
> They can continue to set their own rates, but a different rate for each
> patient must be prohibited.

This is a terrible idea. That means no discounts for people in need, and no
doctors saying "don't charge her for that aspirin" as both would become
illegal.

I'm all for transparency in pricing, but the lack of flexibility in charging
customers is already a big problem. When you go to the hospital, everything is
charged at max-price, then insurance companies pay out their negotiated rates.
People without insurance don't have the ability to negotiate and end up with
ludicrous bills that even the most generous insurance company wouldn't pay.

~~~
Veratyr
Instead of subsidising those in need through price changes, the government can
simply subsidise those in need directly, paying part of the bill itself. This
is how it works in many other countries.

~~~
finiter
The 46% of the country that gets to decide who runs the country hates doing
that.

------
adjkant
This is the tip of a really trashy iceberg when it comes to general healthcare
costs.

Not only is consistent prices by patient a problem, but prices by procedure
and by hospital has a huge range as well, as documented many times. An
operation can cost $10K at one place and $100K at another. This isn't news
though.

[http://www.huffingtonpost.com/2013/05/08/hospital-prices-
cos...](http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-
differences_n_3232678.html)

What isn't talked about is this: when you want to get a procedure done, and
your insurance will cover it the same at each place, how do you choose your
hospital? Location is usually a big factor. You'd also probably want to go to
the place with the best facilities. What ends up happening is that hospitals
will build these expensive facilities in good locations to attract, for lack
of a better term in this story, customers. Billion dollar construction
projects. Do you think their prices went up or down during this build?

That all is raw cost. Now throw in what you pay. If your insurance covers the
95K of the 100K, but won't cover any of the 10K, you're going to choose the
100K procedure. The health care insurer eats that 95K and then raises their
prices across the board. Everyone nationally loses, except for that hospital,
which is now closer to paying off its new facility.

This situation in reality is much murkier, and I skated over plenty of details
I'm sure, some I didn't even realize I skated over.

Now, state of the art medical facilities are a good thing on their own, but
there's a game being played here with the prices of the facilities themselves
and how they are paid for. With the lack of transparency, we aren't really
able to determine much.

All of these dynamics come from the complexities of a system that badly needs
to be simplified, regardless of if you think it should be done by the
government or privately. You can probably already see here how a single payer
system or some sort of direct proportionality costs could make a big
difference. I can't say I have the solution, but I think this part of the
narrative is often missing.

------
throwaway2016a
The other day I went to the doctor and had a minor procedure done (I had two
moles I wanted removed) and asked "How much will this cost if insurance
doesn't cover it?"

The answer: "I don't know"

How can you not know what the cost of a routine procedure like that is? If a
simple thing like that can't be give a cost what hope do we have?

Edit: If anyone is curious, $580 but my insurance covered it.

~~~
hkmurakami
How big was the medical facility? Might be the case that the doctor genuinely
doesn't know since the hospital operations folks determine the price?

~~~
MBCook
That's quite possible. And let's ignore insurance for a moment.

How is the doctor supposed to responsibly recommend treatment if they don't
have the faintest idea of what it costs? If you need some kind of drug in the
doctor can think of to that would probably work just fine, would it be really
useful if the doctor knew that one was $1/pill in the other was $45/pill? If
the difference in the price for the patient ends up being significant maybe
that should be something to take into account.

However if you set up the system so that the doctors never actually know what
it costs…

------
seranwrap400
One reason for the bizarro healthcare pricing situation is that hospitals can
claim the writedown (difference between huge fake price and actual price) as a
loss when filing taxes. A few changes to the Internal Revenue Code would help
put a stop to this.

~~~
MBCook
IRS code is the same way we got in to the nonsense of almost everyone getting
their insurance through their employer, which led to the situation where there
was almost no market for individual policies. That meant they were insanely
expensive and the cost effective only way to get healthcare was to be employed
by a big company. And that meant switching jobs could be insanely expensive.
And that meant you could pay people less because you had a form of lock-in.
Don't want to lose that pre-existing condition coverage.

One little text change, design to either give companies more compensation
options or promote health insurance (I'm not sure which) had a really huge
unintended effect on the way the entire employment system runs.

~~~
tehlike
a little context on the healthcare insurance by employer system: During WW2,
the US banned increasing employee compensation, so employers looked for
alternatives and they figured insurance would be one area. That's how the US
got into the mess of "employer takes up the bill" :)

ref:
[http://www.nber.org/papers/w14839.pdf?new_window=1](http://www.nber.org/papers/w14839.pdf?new_window=1)

So wars have long lasting impacts on the society, taxes and insurance are some
important examples.

~~~
MBCook
I didn't realize it was a war thing. Thanks.

------
costcopizza
I know this is reference pricing rather than legitimate, but it seems likes a
start:

[https://www.mdsave.com](https://www.mdsave.com)

------
johng
Truth in billing, which is required of telephone carriers would be huge by
itself in the medical field. Also, being able to opt out of a $600 gown,
etc...

~~~
chimeracoder
> Truth in billing, which is required of telephone carriers would be huge by
> itself in the medical field.

It would be, but Medicare would never let that happen, because opaque billing
is how they ensure they can reimburse below cost and get private insurers to
essentially subsidize Medicare patients.

~~~
FireBeyond
This is a claim often stated, but rarely actually demonstrated - ways in which
Medicare doesn't cover costs, that is.

------
fixxer
If the ACA had sought to create a competitive market between the consumer and
the provider instead of between the consumer and the insurer, it would have
been a truly revolutionary leap forward.

Instead, we got entitlement expansion.

~~~
MBCook
It got A LOT more people covered. It made it so you don't have to worry about
losing coverage when you switch jobs due to pre-existing conditions.

No, it wasn't real reform. They could've allowed you to shop for plans offered
in other states for example. But it was a truly useful step forward for TONS
of people.

------
niels_olson
The methods of Medicare pricing were established by DeBakey's subordinates
when Johnson pushed Medicare through. It's backroom deals all the way down.

------
maxlybbert
It's like he's never heard of "price discrimination" (
[https://www.joelonsoftware.com/2004/12/15/camels-and-
rubber-...](https://www.joelonsoftware.com/2004/12/15/camels-and-rubber-
duckies/) ). Yes, medical care in the US is priced to basically be as
expensive as you (or your insurer) can afford. That isn't uncommon, as Spolsky
points out. Airline tickets are priced the same way. But so is everything that
has a premium model and a basic model, etc.

~~~
rubidium
Ok, that article linked was brilliant. It points out all the hypocrisy of
being too analytical about pricing.

The real question is how can your customers pay for it.

------
tkiley
> Healthcare providers must likewise be required to publish their rates in a
> uniform format such as industry standard CPT codes or a percentage of
> Medicare rates.

This proposal does not address the primary reason that price transparency is
really goddamn hard: Even if you know exactly what a provider will charge for
each CPT code, you don't know which CPT codes are going to be billed for a
particular patient care event.

Inconsistent cost per line item is not the key problem with transparency.
Tools like Castlight actually do a pretty decent job of guessing how much each
item on a provider's CPT "menu" is going to cost a patient. In many (most?)
situations, it is simply not possible to predict which CPT codes are going to
be billed for a particular patient's care. This is the key reason price
transparency tools tend to give a range rather than a specific price for a
particular procedure.

(Also: Big picture, the idea that this would decrease costs by 33% is absurd.
If healthcare providers had to publish real legit price sheets that were used
by real consumers, prices would converge within a market, but they would not
converge that low. Published pricing is not going to cause these businesses to
collectively roll over and give up 33% of their revenue.)

~~~
tehlike
There are many factors contributing to this actually.

1\. Doctors overprescribe because they are afraid of mistakenly
underprescribing (we are a litigious country after all). This end up costing
patients more tests/procedures, and cost doctors malpractice insurance
premiums. 2\. Procedures are billed differently per insurance policy. There
are millions of variations of anthem PPO, and what they cover and how much
they pay differs.

3\. You, as the policy beneficiary, only care about your out of pocket cost.
You don't really care about the price unless 1) you pay some percent of the
money (reference pricing), 2) you are below your deductible.

So you are right, price transparency alone is not enough, but it is indeed a
big step. If you knew in advance the price of thing, you probably wouldn't pay
400$ for a bag of saline solution [1]

[1] [http://www.nytimes.com/2013/08/27/health/exploring-
salines-s...](http://www.nytimes.com/2013/08/27/health/exploring-salines-
secret-costs.html)

~~~
tkiley
> you probably wouldn't pay 400$ for a bag of saline solution

Hey, this is a great example: I might very well pay $400 for a bag of saline
solution even if I knew the price in advance, because I don't care about the
price of the bag. I care about the all-in cost of my treatment. If that total
cost happens to include a $400 bag, I don't really care.

The "$30 Asprin" narrative sometimes misses the big picture of healthcare
costs. The price of an apsrin or bag of saline solution is inflated to cover
the enormous fixed costs of running a hospital with an ER. Could the ER charge
$4 per bag or $0.25 per asprin? Of course, but if they lose their per-unit
margin on the saline and asprin, they're going to jack up the price of some
other CPT code because they have to cover their fixed costs somewhere.

~~~
tehlike
that's a great point, and something that is actually telling about the us
healthcare.

The 400$ saline bag is probably an illustrative example, but i believe it's a
pretty common line item for most surgeries. I don't know enough about medical
procedures, but i assume it's not one of the rare items/prescriptions where
the high cost is somewhat justified.

I care about "all-in" cost of treatment. I don't see that. I don't see that
until it's too late. I don't get charged for "all-in", i get charged per
individual item in that "all-in" care i got.

------
cassieramen
I constantly feel like my doctors are hamstrung in providing me with the best
medical care because of this. It's hard to recommend the best medical option
for your patient when you have no idea at what point in time they will be able
to afford it. It's fine to say a simple surgery will fix a problem for me but
if you don't know how long I'll have to save to afford it it could snowball
into a larger/more difficult surgery.

~~~
mikepurvis
This week my wife and I went to the hospital here in Waterloo and delivered
our third child. Total cost was $16... to park our car overnight in the
garage.

Now, our delivery was as close to perfect as you can get. We were only there
overnight, but there are a million unknowns with a baby, and I'm just so
thankful knowing that no matter what might have happened, we would have
received what we needed, when we needed it, and if it wasn't available at our
local hospital, we would be transferred to where we needed to go— all at no
charge.

There isn't really a message here, just grateful to live in a country where my
medical professionals can recommend me the care I need without having to have
a conversation about costs. And most importantly, that that same care is
available to everyone in my country, not just those who happen to work a
salaried white collar job.

~~~
ArtDev
What was the out of pocket? Thousands of dollars, correct?

How many bills did they send you and for how long? How many billing errors
were made?

This is not normal in a developed country.

My favorite part is when they bill the baby for the cost of its own birth
against its own seperate deductible.

~~~
tehlike
hah - that's news to me. It could have been more interesting where they charge
half of the delivery to the mother, and half (where the baby is out in the
world) to the baby :)

Make that baby pay for it, America... oh wait!

------
Animats
California's assembly passed a law requiring hospitals to charge Medicare's
rates to self-pay patients. Schwarzenegger vetoed it.

------
mooneater
It seems like a similar price inflation affects anything sold to the military.
Every time I hear comparisons involving the size of the US military budget, I
always think "yeah but everything they buy (including hammers + toilets) are
5x-10x the price, so their effective budget is only 10%-20% of that"

------
dzink
To get a closer-to-real cost of healthcare, especially surgical procedures
look at veterinary care in the US. Similar tools and equipment, similar
medicines, similar training, except pricing is not defused by third party
payers and padded by liability insurance costs.

------
dd36
If Thailand can do it, why can't we?

[https://www.bumrungrad.com/en/realcost-thailand-
surgery](https://www.bumrungrad.com/en/realcost-thailand-surgery)

------
sethev
The problem with this thinking is you don't know what services you'll require
(apart from routine checkups and specific treatments for already diagnosed
problems). It does me no good to have a list of all the thousands of possible
things a hospital might do along with a price for each one.

~~~
rgbrenner
That's definitely part of the problem too.. but that exists because of the
pricing structure hospitals use.

If I go into a store and buy a part, they don't say, well let me call the
factory, and they'll get a list of all the things that were done to create
this particular part, and a price for each. The store comes back with a list:
Raw materials: $ Packing materials: $ Surcharge for production delay caused by
spill: $ Resurfacing of part because of material defect: $

If a manufacturer tried that, they would be out of business immediately. Yet
that's exactly what hospitals do, even down to a charge for the 2 cents worth
of aspirin.

In normal businesses, they charge a price for the product that covers the
details, the mistakes, the extras required to delivery the product. The
mistakes, etc are averaged out over all of the items produced, along with the
cost of the misc supplies, equipment, etc.

~~~
sethev
The current system sucks but I have trouble picturing your alternative. If a
person has abdominal pain it could be caused any number of things - some of
which could have no cure at all and some of which will just go away on their
own. What price list could they possibly consult?

------
em3rgent0rdr
> "Congress need only mandate that all hospitals, physicians and labs publish
> legitimate prices—like all other businesses"

Is that true for _ALL_ other businesses? I know some businesses are under
control of price fixing legislation, but is that true for all?

~~~
mcguire
As others have pointed out, it's not true for some industries: auto repair,
enterprise software and college tuition. Also, cell phone and Internet service
"bundles".

All of these industries have at least one thing in common: they're kind of
scammy.

~~~
rconti
Sure it is. Auto shops have a labor rate. Say, $150/hr. That's the price. For
parts, you'll pay the same markup as the next guy. You can negotiate, but you
can negotiate ANYTHING.

~~~
mcguire
They also have a big book of how long each individual repair should take.

If your insurance company has preferred repair shops, do you think the
insurance company is paying the standard rate? They do have a better
negotiating position than you do.

Of course, this isn't as big of a problem as it used to be, back when they
didn't post an hourly rate.

------
squozzer
Here's a similar take -- [http://www.huffingtonpost.com/david-belk/hospital-
bills_b_42...](http://www.huffingtonpost.com/david-belk/hospital-
bills_b_4257433.html)

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hardtke
Error in the article: auto insurers also have negotiated rates with service
providers, including body shops and auto glass repairers.

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tehlike
but there is less variance in prices, more flexibility in shopping, and less
variance between estimated and final cost.

