
Hospitals pledge to fight admin price transparency plan in court - howard941
https://www.healthcaredive.com/news/hospitals-pledge-to-fight-trump-admin-price-transparency-plan-in-court/567474/
======
istjohn
I spent 45 minutes at the hospital where I was to get a lab test done, trying
to get a quote for said test.

Prescribing doctor didn't know the cost. Lab tech didn't know. Billing
department told me I needed a procedure code. Lab tech who was ready to draw
blood couldn't tell me the needed code even after spending five minutes at a
computer looking for it. Prescribing doctor gave me the code. Called back
billing. They will call me back in 2 to 5 days with a quote. Weeks later, I've
yet to hear from anyone.

This was at The Ohio State University Wexner Medical Center.

~~~
Berobero
I was in Japan two years ago; got pneumonia and needed antibiotics.

Went to a hospital with no insurance and no appointment. I was being seen by a
doctor within 30 minutes. Doctor wanted to do some additional labs just to
rule other things out, but _he_ was worried that it would be expensive for me
given the lack of insurance. He called up billing with me still in the room
and had a price within a couple minutes: ~$70 USD.

Ultimately I left the hospital after being seen, getting chest xrays, the
additional labs, and antibiotics in hand. No insurance and I paid less than
~$160 USD.

~~~
programmertote
Exactly the way it works in a SE Asian country I grew up. The private and
public hospitals have price quotes on different procedures and it's for
everyone to see. The comments above using Boglehead's quote as a justification
of why medical pricing has a lot of variance is mostly a lie. My wife, who is
a doctor trained in our home (SE Asian) country and is doing her residency in
the US, and I were just laughing at the fact that it's much, much more
expensive to get an X-ray here in the US than it is in our country (which
costs ~$4 at most). Here, there's no price list for procedure as simple as
taking an X-ray.

Hospitals, doctors, insurance companies and pharma companies are all scamming
the US population. Every evening, my wife and I watch TV (WNBC to be exact)
and we see many commercials from hospital networks, insurance companies and
drug companies. This reminds us everyday that medicine and healthcare is
commercialized to the max in this country and the only way from here is
downhill. We both don't hope to retire in the US; when we grow old, we will go
back to our home country and live there in the hope of getting much more
affordable (and yet, of more or less similar quality) medical treatments.

~~~
AtlasBarfed
Have you seen radiologist salaries?

It's a scam, Jim.

There are four pigs at the trough of US health care:

Insurance Device/Drug Lawyers Doctors

Everyone points the finger at other people and desperately fight to maintain
their bloated share of the bloating pie.

Unfortunately doctors are not your friends in hospitals. They are trying to
get billing.

~~~
programmertote
Indeed! As she was applying for residency programs, my wife briefly
entertained the thought of becoming a radiologist because boy, they made a
load of money for 8am-2pm work! We both are 100% self-aware that healthcare
industry has a lot of bad actors including doctors, pharma companies, hospital
admins, lawyers and pretty much everyone involved.

If residents cry about 60+ hours/week of work during the first year residency,
I don't pity them much. First of all, the hours aren't really that bad even
for a hospital in metro NY area (speaking from my wife's residency experience
so far). In our home country, residents have it worse; my wife had night float
EVERY THREE DAYS over there. In the US, it's at most four times a month!
Second of all, the "grueling hours" are for the first year of residency (in
fact, during those hours, there's not much happening especially in night
floats, so you can get decent sleep) and after that, things got much, much
better. Sacrificing just one year and paying exorbitant exam/school fees--in
the region of ~$250K total--to make $250K as starting salary is TOTALLY WORTH
it. If any of the doctors complain that they are debt-laden, they are either
fiscally irresponsible or are simply exaggerating. They can repay $250K debt +
interest in less than 5 years if they really want to. Of course, it's much
easier to use these (debt and hours/years sacrificed) as excuses to justify
their pay.

If the doctors are true and honest, they should be advocating AMA to relax the
residency and medical school requirements. No more than five years total (no
undergrad necessary) is needed to treat garden variety problems. Then each
specialty/fellowship can take however long it needs to take. But AMA and its
leechers (KAPLAN, ECFMG, USMLE, FSMB, etc.) won't allow that because they make
loads of money from exam and preparation fees. Everything about healthcare is
business now and whether it is good or bad depends on one's moral compass (and
how strongly one feels about capitalism).

~~~
perl4ever
"advocating AMA to relax the residency and medical school requirements"

People talk about the constriction of supply of doctors, but aren't NPs and
PAs doing everything these days anyway?

------
bloopernova
I'm being offered $550 by my insurance in "gift cards" if I use certain
facilities for any MRIs or other diagnostics. I think that shows just how
wildly variable different locations charge, and how much they get away with.

I'd love to see a published price list for standard procedures, because I
think hospitals have become too used to being cash cows for administrators and
CEOs. This isn't to say I think nurses or doctors are overpaid or underworked,
or don't deliver good care. I just wish that people in the USA could get good
healthcare without having to claim bankruptcy.

I really miss the NHS and Bupa private insurance in the UK. NHS was great for
so much stuff, but when I needed multiple surgeries on my leg metalwork, I
chose to use private health insurance. This let me have the same consultant as
the NHS hospital, same surgeons, but in a smaller "fancier" hospital that took
really good care of me. What's funny to me is that extra private insurance was
just a few pounds a month, and nothing at all like the thousands we spend here
in the USA.

~~~
mywittyname
> This isn't to say I think nurses or doctors are overpaid

The probably are. Clearly hospital executives and administrators are raking in
most of the money, but we can't sit here and pretend that caregivers don't
directly benefit from such an arrangement as well.

There's a reason urgent care centers and small clinics pay their doctors less
than most of us make, or skip employing doctors at all in favor of nurse
practitioners, and their nursing staff makes ~1/3 what they would be earning
in a hospital setting. Labor is expensive; specialized labor is even more so.

~~~
devicetray0
> skip employing doctors at all in favor of nurse practitioners

Hold up. I hope you're not being negative on hiring NPs. As someone who is in
favor of NPs (and knows many NPs), they provide excellent primary care and
hiring them can help bring down the overall cost of healthcare. I say we
should teach and hire MORE NPs to provide cheaper primary and preventative
care, not blame clinics for hiring them.

~~~
Broken_Hippo
This, and exactly this. NP's are great for the run-of-the-mill sicknesses and
minor injuries that most adults and children get. In conjunction with a PCP,
they provide excellent primary care even for more complicated patients.

In addition, specialist nurses are a great addition to a specialist's team. I
don't see a neurologist all that often, but I have checkups with one of the
team of wonderful nurses at the office, some of which specialize in the
disease I have. It works out wonderfully and allows the specialist to take
care of more patients and still provide pretty wonderful service.

------
legitster
The previous administration had a similar effort that failed. I hope that this
effort is successful.

>"For instance, it could allow one provider to follow and match the prices of
the other provider (like two gas stations across the street from one another
who face no other competition)," Garmon said.

I understand this argument, but I think they underrate how much people are
willing to shop around when they actually have prices to use as a metric. I
would be willing to travel to get a cheaper hip replacement if I actually know
what the local price is, rather than being surprised by it every time.

~~~
bluGill
I'd pay more for quality. If I knew hospital X is better at hip replacement
I'd pay extra to go there. Of course how much extra I'm not sure, and I'm also
not sure how you compare hip replacement quality like that.

It is only emergency rooms where I don't get a choice - if you need an
emergency room close is important.

~~~
sigstoat
> It is only emergency rooms where I don't get a choice - if you need an
> emergency room close is important.

i feel like the folks on here peddling this line have not ever spent any time
watching who comes through an ER.

most of the people who go into an ER aren't dying, or screaming in pain.
they've just got a problem that can't wait until urgent care opens up again in
the morning. or they need something done that urgent cares aren't equipped to
do (fancier diagnostic equipment; whatever). they've got plenty of time to
consult with a hypothetical "find a cheap/good ER near me" app.

~~~
mc32
I think lots of people say “ER” for trauma center.

~~~
soapboxrocket
I think lots of people say "ER" for "ED" Emergency Department became the most
common term about a decade ago and Emergency Room faded from building guides
and hospital documents.

~~~
mc32
Either way most don’t have trauma centers, in SF I think only SF General is
the only level 1 trauma center although some of the people also rotate through
UCSF’s ED.

~~~
soapboxrocket
Yea, very true. Up here in Seattle I believe we are in the same boat, a single
level 1 trauma center.

------
XG6
Of course doctors and hospitals don't want price transparency. That would
create pricing competition, which would drive down consumer prices, lower
profit margins, and force them to become more efficient. Price transparency is
one of the key elements of the highly successful Singapore healthcare system.
Add in universal tax-free (or tax-deferred) Health Savings Accounts, and we
could not only improve the US healthcare system but also help more Americans
save for retirement and build wealth. There's no excuse not to try simple
regulatory solutions before committing to a massive government takeover. I
hope we get bipartisan support for price transparency.

~~~
commandlinefan
> doctors and hospitals don't want price transparency

Well, I do want price transparency - IF it works the way they promise. It’s
hard for me, as a programmer, not to draw parallels to every employer’s
expectation that I should be able to listen to them describe a software
problem and quote them a timeframe on the spot (which, of course, they’ll then
try to “negotiate” down). On the one hand, as a non-medical-professional
outsider looking in, it seems to me that _of course_ they should be able to
say ahead of time how much a cataract removal surgery should cost, they’ve
done it hundreds of times (I hope). On the other hand, I know how much
variability occurs in software projects and how little of that is trivially
predictable.

On the other other hand, I can’t for the life of me imagine any possible
reason why they can’t say EXACTLY how much an MRI will cost before they do it.

~~~
umvi
Yeah but come on. It's one thing to program something with nebulous
requirements.

The cost of the X-ray machine is known. The cost of collecting X-rays can be
calculated deterministically.

The only thing similar to programming is trying to diagnose a rare disease or
tricky condition. But for run-of-the-mill deterministic procedures, the cost
should absolutely be known.

~~~
commandlinefan
Well, I think so too, but - just to play devil’s advocate - many of my former
bosses would almost certainly say something like, “the cost of the web server
is known. The cost of collecting the web traffic can be calculated
deterministically. We’re just talking about a website here, the cost should
absolutely be known.”

~~~
carapace
The prices don't change in a supermarket if you edit your shopping list, eh?

A hospital can't predict everything a patient will need (their shopping list),
but they should be able to account for the cost of each
procedure/drug/test/bandage/etc... eh?

~~~
Fomite
The problem is a lot of that isn't deterministic. There's a lot of "If Then"
statements that aren't easy to price ahead of time.

Like, your procedure is very different if your doctor decides they could use a
specialist consult.

~~~
carapace
> your procedure is very different if your doctor decides they could use a
> specialist consult.

The necessity of the specialist consult may be unexpected, but it doesn't
follow that the cost of it should be secret or obscure, eh?

The intrinsic unpredictability of health care isn't an excuse for additional
unpredictability of cost.

~~~
Fomite
Agreed, but a lot of people interpret "transparency" as "Your knee surgery
will cost $4500", not a flow chart of possible costs.

~~~
carapace
Sure, but that's their problem, eh?

------
KukicAdnan
We need price transparency!

Went to a quick care the other day because of a flu that would not go away,
was seen and diagnosed with bronchitis in less than 5 minutes. The quick care
billed my insurance $1,840, which they talked down to $300, and had me pay
$115. What?

~~~
topicseed
From the UK. Health care cost stories in the US seem incredibly dreadful. Hard
to grasp how a huge power like the US can't get itself around decently-priced
healthcare.

~~~
bluGill
It is incentives. Most people get their heath care from insurance, which is
subsidized by their job. I can legally buy my own insurance, but it will cost
a lot more than what I pay through work so of course I don't. My boss wants me
to keep working, and so high medical costs keep me from quiting to start my on
competitive business. I can live for a couple years on cheap food and little
else, but I need at least emergency health coverage as a just in case.

Lack of transparent prices is one tool the system has to ensure I don't have
any other option.

~~~
TheSoftwareGuy
> I can legally buy my own insurance, but it will cost a lot more than what I
> pay through work so of course I don't.

Which is entirely frustrating too. This only happens because employers only
subsidize specific health plans, instead of letting the employee spend that
money on the health plan that they deem best for themselves. Isn't that
ridiculous? Why would my employer care what health insurance I get anyways,
they don't know my health situation. I should be able to use the money they
spend on my health insurance however I want!

~~~
lotsofpulp
> Why would my employer care what health insurance I get anyways,

Two reasons.

One is that it gives people pause before leaving for another job, as they
might have to figure out new healthcare providers.

Second is that it gives larger employers the benefit of paying less for
insurance, especially if their employee group consists of younger healthier
white collar workers. It also helps them because businesses can pay for health
insurance with pre tax dollars, which helps compete against small businesses
that can’t afford to pay for health insurance for employees, whose employees
have to pay for their own health insurance with after tax money.

------
soneca
The Econtalk podcast latest episode is about a surgery clinic in Oklahoma that
has full price-transparency policy. I am outsider to US healthcare system, but
after listening to it, it seems hardly controversial what would be the right
thing to do here:

[https://www.econtalk.org/keith-smith-on-free-market-
health-c...](https://www.econtalk.org/keith-smith-on-free-market-health-care/)

~~~
wswope
Texas Free Market Surgery offers a near identical business model based out of
Austin.

Green Imaging (who I used to work for) offers cash-pay imaging services for
all modalities across Texas, and are in the process of expanding nationally.
Because they contract with existing imaging facilities, they don't post prices
publicly to avoid poaching patients, but if you call in or message them
through the website, they'll give you an up-front price for any service they
offer.

For family practice/general medicine, there's a business model called "Direct
Primary Care" that offers you unlimited primary care services, usually for a
cost of $50-80/month, and most big cities will have a few providers following
this model.

A lot of progress is being made in terms of transparent/affordable outpatient
and day surgery services, but it's hard to get spread the word because the
current healthcare model is so entrenched.

~~~
AtlasBarfed
The South is almost a total loss when it comes to medical fraud. Combined with
the more unhealthy population, it is just a boondoggle.

There's a reason the Tricare South contract is so coveted.

------
glofish
This is IMO the "simple solution" to healthcare - nothing will bring down
healthcare costs faster than the following

\- be allowed to choose

\- know how much something costs

\- pay some of the cost themselves (co-pay, health savings account) etc.

~~~
triceratops
Americans already have co-pays, deductibles, coinsurance and whatever other
terms the insurance industry has cooked up, with no visible effects on costs.
In addition to your other changes the following would also help:

\- Allow competition. Don't give hospitals the power to veto new hospitals in
their area.

\- Disallow regional consolidation of hospital systems and medical practices.
Regional monopolies are bad.

\- Increase resident slots and supply of doctors. Make foreign degrees easier
to transfer to the US.

\- Outright ban pharmaceutical advertising. Nothing whatsoever of importance
would be lost and all the pharma companies would save millions every year.

~~~
eutropia
There's an argument to be made with respect to advertising to physicians, but
not the general public. Doctors have limited time and they ought to know what
meds are available somehow..

~~~
triceratops
I thought that was called pharma marketing, not advertising. That too has had
corruption and perverse incentives in the past. However, I did mean banning
advertising to the general public.

Doctors have the knowledge and expertise to critically evaluate statements
presented to them by marketing materials (whether they do so or not is a
different story). The general public, modulo the odd autodidactic genius,
largely does not. If someone from the general public wants this information,
they are free to find it on the Internet. In fact maybe we could make it
mandatory that any materials presented to doctors are also posted on the
company's website for anyone to see.

------
braythwayt
Here in Canada, there is no price transparency whatsoever. Just when people
are facing the stress and uncertainty of fighting a crisis like Cancer, they
are given absolutely no inkling what their treatment will cost.

When a physician makes an appointment for you with a plastic surgeon to
discuss reconstructive surgery... No transparency about the cost.

When they prescribe chemotherapy... No transparency about what the doses
cost.*

When they schedule surgery... You don't have any idea if they'll pull in
another nurse or surgeon during the procedure, and again... No transparency
about cost.

\---

I feel icky making jokes about this. But seriously, price transparency is a
perfect example of the "XY Problem."

America asks, "How do we make paying for health care an efficient and
transparent marketplace," but the correct answer is, "If what you want is a
functioning, civilized country, stop trying to make healthcare a marketplace."

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

\---

* Prescription drugs are still a quagmire in Canada. Basic chemotherapy is somewhat covered by various provincial drug plans, but if you're employed you usually rely on your employment benefits for prescription drugs much as Americans do.

Many of the things covered by employment plans are more convenient than those
covered by the public plans. For example, the public plan may require a dose a
day, while the product that only requires a dose a week is only covered by an
employment plan.

But the bottom line is that if you aren't employed and can't afford
chemotherapy, you will get treated.

~~~
bcrosby95
There are shades of bad. The US health care system with price transparency is
better than the US health care system without it.

The same procedure can cost 1,000x more if you go across town. It's been long
reported that Hospitals mostly pull prices out of their asses. The health care
problem in the US is not just a health insurance problem, it is also a health
care provider problem. Even if you had a single payer system, pricing like
this is insane.

~~~
braythwayt
What you say is true, but does not negate or discount what I said in any way.

Again, with the XY problem...

If someone asks for X, but really needs Y and there is a better way to get Y
than to help them with X... Of course X is better than no X and no Y.

But that doesn't change the fact that Y is much, much better than X. And in
the case of health care, it is not even close. Price transparency may lead to
each person paying a little less, or at least being less stressed, but it
still won't fix the fact that America has the most expensive system, with the
worst outcomes, in the developed world.

So yeah, X is better than --X, and ++X even better than X, but that doesn't
change the fact that Y is still the correct solution when you focus on the
problem you really want to solve rather than making the incorrect solution
slightly less incorrect.

\---

Also, IANAE, but I do not believe that in Canada, hospitals are permitted to
have a 1000x variance in pricing. I think that for those things we socialize,
the government sets the price.

~~~
carapace
I think you're right (profit motive and health care don't mix) but then how do
you cut the Gordian Knot? I'm cautiously hopeful that price transparency might
be a start.

~~~
mrguyorama
Honestly? Stop electing people who scream that public health is a communist
devil plot?

~~~
carapace
I'll see what I can do.

------
sam36
My uncle wrecked his motorcycle once. He ended up in a ditch unconscious.

Someone called 911. For what ever reason a life flight helicopter was then
called and picked him up and took him to a local county hospital. He woke up
there a few hours later. After they had already ran all kinds of tests. They
had a large list of all the problems from busted spleen, broken bones, head
concussion, etc.

After a day of rest in the bed, the only thing wrong was a sore ankle and some
deep scratches on his face. He checked himself out and we went and drove him
home. They sent a bill of $16,000 the next month to him. He asked why it was
so high since the only thing they did was give him a helicopter ride and a bed
to sleep in (none of which he consented to but of course hard to consent when
you are unconscious).

He sent them a check for $16 which was the minimum amount required. He fully
expected to pay $16 per month for the rest of his life, but they never sent
another bill and he never asked... That was 15 years ago.

~~~
mehrdadn
Confused, so they flat out lied about broken bones? Something doesn't seem
right.

~~~
sam36
I think the term they used was "fractured"

~~~
mehrdadn
Yeah, and my dictionary lists "bone break" as the 1st definition of that. I
don't think it means anything else?

------
maerF0x0
> Transparency is not going to work where there is no competition, Emily Gee,
> a health economist at the left-leaning Center for American Progress, told
> Healthcare Dive.

That's bs. I will drive to a further away hospital if it saves me $75 an hour
of time spent...

(edit: clearly I'm talking about non-emergency here)

~~~
bluGill
But it won't. Your insurance will pay for it either way, so you are spending
an hour of your time to save your insurance $75 - which won't even be given
back to you in form of lower premium.

~~~
maerF0x0
> Your insurance will pay for it either way

This is an assumption based on a very good insurance package. Most have out of
pocket co-pays . So yes, we have to gross it up by the co-pay percent and
discount it by the Annual deductible limitt, but generally the point stands.
If I can save enough money I might travel away from the monopoly. Until that
data is transparently available I can't optimize that scenario w/ my own
choices.

> which won't even be given back to you in form of lower premium

Systemically it will eventually if insurance companies are competing with
eachother for your business

~~~
jonlucc
Sort of; in my experience, even with a high deductible health insurance plan,
the insurance company's negotiated rates are still in effect. In other words,
if a visit would be billed to an uninsured person at $200, but my insurance
caps it at $100, then $100 is the price accepted by the doctor's office no
matter if I'm paying because I haven't reached my high deductible or insurance
is paying because I have a regular, not high deductible plan.

~~~
maerF0x0
right, but now you're talking about in-network vs out-of-network rates. I
believe should disappear with price transparency...

------
rhacker
We have obviously routed out a LOT of fraud by forcing the auto repair
industry to change its practices to inspect -> quote -> customer decision.

I guess the question becomes this - is there so much fraud in this industry
that we need to do this change?

Even if it's NOT fraud, have hospitals simply become used to charging anything
they want because they have no competition?

~~~
AlexandrB
The problem is you can't inspect -> quote -> customer decision with someone
who's having a heart attack. Even if the person is lucid, they are unlikely to
say no to any price if they're at death's door. No amount of competition
changes the simple fact that health care is not a fungible service. CPR at
facility A can't be exchanged for CPR at facility B if B is even a few minutes
away.

Combined with the emotional state most patients are in (something other
industries, like mortuaries, prey on as well) and you have a recipe for
gouging even under ideal competitive regulations.

~~~
rhacker
I don't see a problem with ambulance coming in -> charge them to the moon
because if we don't do what we're going to do, they are going to die.

There's a problem with applying that logic to - hey I have a pain in my hand
because I was rowing a boat today without warming up. Take this 800mg
Ibuprofen. 3 months later $800. (So that's a true experience with my wife and
rowing a boat)

------
devinhelton
While publishing the negotiated prices for each procedure code would be
interesting, I don't see how it would change much since it wouldn't
necessarily be the price they would actually charge me, and it wouldn't help
me know beforehand what sort of add-on procedure codes/bills were going to be
part of my care.

The policy I would like to see is that patients should only be legally liable
for costs that they sign off on up front (at least for most elective care). It
never ceases to bother me that every time I go to the doctor I have no option
but to give the hospital a blank check and have to cross fingers that they
will not hit me a month later with ridiculous charges.

~~~
cmiles74
Eventually the published price will be close to the amount you are being
charged. I would expect health care providers to stick with their promise to
post the highest possible cost but as people being to use these prices to shop
around (both these numbers are exorbitant, but this one is less so, etc.), I
am confident they will abandon this gambit.

IMHO, it's kind of nuts they are even starting out with this argument.

------
selimnairb
This is why we need single payer and to abolish/greatly diminish private
insurance. Hospitals and insurance companies continuously demonstrate the
failed state of the healthcare market. Market-based healthcare will always be
unworkable due to impossible to reconcile conflicting incentives.

------
greggman2
An interesting interview this week on Econtalk about price transparency. The
interview happened before Trump's price transparency plan was announced but
the podcast just made it up this week.

[https://www.econtalk.org/keith-smith-on-free-market-
health-c...](https://www.econtalk.org/keith-smith-on-free-market-health-care/)

Some guy has been running a non-insurance based surgery center for years, the
surgeons make more and patients pay less or so he claims. All prices are
listed on their website. They claimed they don't change prices. If a doctor
misses something and needs to do extra work their policy is that's the doctors
fault for not doing enough due diligence beforehand.

He also claimed there are some perverse incentives like he claimed a hospital
might bill an $100k but only receive $13k. But, they can claim a $87k loss
which the government will partly reimburse. He further claimed that insurance
companies often have contracts with employers where the employer is supposed
to pay a percentage of the amount the insurance company saved for them. In
other words, the insurance company will say "we managed to save you $87k on
your $100k bill, pay us 20% of the savings" so they have an incentive to ask
the hospital to charge more.

Note: I have no idea how backed up this is. Just passing on the podcast,
hoping to see more knowledgeable feedback.

------
jimbob45
The most salient issue is insurance providers being able to proclaim arbitrary
hospitals as "in-network" and "out-of-network". My significant other claims
that hospitals are now hiring contractors, who are always by definition "out-
of-network". This hurts the career prospects of the contractor and lowers the
level of care received.

And for nothing! Insurance should not be certifying which doctors you can and
cannot see. That's for the medical boards to decide.

~~~
jonlucc
Yeah, if I go to an in-network facility, then they have an out-of-network
provider walk into my room, how am I supposed to know? The same is true of
labs. My wife had her blood drawn and sent to a lab every couple of years
without issue until one year they sent it to a different lab unbeknownst to
her. It was out-of-network and cost $800.

~~~
AnimalMuppet
I've had good luck arguing with the insurance company on that kind of thing.
It's worth a phone call.

~~~
jonlucc
It's been way too long now, but thanks for the tip. We called insurance and
the doctor's office several times each to no avail. Insurance's answer was
that we should sit in the exam room with an insurance representative on the
phone to ask where each vial of blood is going and what for, then relay that
to the insurance representative to give a verdict.

------
mc32
Yes, hospitals, that’s the way to win hearts and minds.

Fortunately both parties seem to welcome this idea, to lesser and greater
degrees...

~~~
avocado4
Hospitals don't care about hearts, minds, or patient wellbeing for that
matter.

You will be brought there and they will extract $8000 for a simple procedure.
That's all that matters for them.

------
mullingitover
There should be a basic law of health care: no person is liable for a debt
they incurred before they were presented with the price and had an opportunity
to refuse. I'd give some amount of leeway for unconscious patients, but aside
from that every single penny of expense should be agreed to up front. The
absence of this policy explains a lot about how things have become so
perversely broken.

~~~
Miner49er
Or we could just make healthcare a human right. No debt at all.

~~~
AlexTWithBeard
It's an interesting question. Health care is a human right. Therefore it must
be free.

A prompt and fair trial is also a human right. Therefore legal help must be
free.

Moving around, staying warm and basic hygiene - a lot of stuff sound like
basic human rights, but very few argue that transportation, heating and sewer
draining services should be free.

I think most people around don't mind paying for the service. They just want
the prices to be reasonable and predictable.

~~~
wetpaws
I don't see any contradiction in what you are saying. Yes, they are rights and
should be free.

They are not right now, but that's because we are operating in a world of a
limited resources, but not because it is a right state of thing.

------
fzeroracer
Price transparency is a losing battle.

Let's say they make prices transparent. You ask them about the cost of getting
an X-ray done and they quote you $Number. You go and get an x-ray done and
you're billed for $number plus a few extra thousand for any number of unknown
costs.

Hospital billing is a lot like getting billed for internet/phone/cable etc.
They'll throw all kinds of bullshit charges, ding you for not using certain
things and more. Then you have to waste energy calling them up to talk with
someone whose job is to get you off the line.

That's assuming you can even shop for your needs. If it's an emergency then
you're screwed either way. The only change this would cause is that insurers
and hospitals would adapt and figure out other ways to sneak in charges.

If you want to fix this problem at the core, then trying to make it more of a
free market won't work. You need stronger oversight and control to keep things
in check.

------
mriguy
Plug for Econtalk episode on exactly this topic - transparency in prices for
healthcare:
[http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare...](http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare.mp3)

------
soapboxrocket
I think the bigger scam is how they break apart the hospital/doctors offices
into separate companies. Now I'm not complaining how I go from one building to
get blood drawn and a different building for the emergency department.

I'm complaining how I walk across the hallway in my doctors walled garden
inside the building but when I enter that room, in his area, and get an x-ray
that is a completely different company that bills me separately and I have to
pay a different co-pay to.

------
burke_holland
> Instead of helping patients know their out-of-pocket costs, this rule will
> introduce widespread confusion, accelerate anticompetitive behavior among
> health insurers, and stymie innovations in value-based care.

So people are too dumb to understand prices, and unlike any other economic
system to ever succeed, knowing the value of a thing will DECREASE pricing
competition.

I was waiting for the good argument on why this is a bad idea. Instead we got
_that_.

------
fbanks
Additional anecdata: Enjoyed an extended honeymoon through Thailand,
Singapore, and Malaysia in 2016 and my wife was bitten by a stray dog in rural
Thailand early on -> 7 medical interactions involving post-exposure
prophylaxis and rabies shots in all 3 countries over that next month. (She's
fine BTW!). Price transparency was really amazing in all these places and I
think it might be a single reform that's broadly ameliorative of the max-
friction / painful experience of US healthcare. In each country, we basically
called around, asked "do you have this shot and how much is it" and got a more
or less straight answer, despite having some language issues everywhere but
Singapore. Whole experience cost ~ $1k, including some visits for 2nd opinions
to high-end private clinic in Singapore and we just gave up bothering with it
on our US insurance b/c of deductibles and hassle.

------
greenimg
Doctors' wages have grown minimally ocer the last 20 years. Increased costs go
to big pharma, 'not for profit' hospitals, and insurance companies, the
"cartel". Meanwhile, the expense and number of years of training for high end
docs increases. I am 57 and still did 4 years undergrad, 4 years med school,
and 5 years postgrad. I did not do the 1 or 2 year fellowship now required for
many radiology positions. Read the Proscan law suit about what happens when
undertrained folks read imaging exams. It is not the shortcut needed to save
healthcare. We can pay docs fairly if we get 80 percent of care away from
hospitals where it costs 3 times more than it does elsewhere. Because
hospitals employ or subsidize 70 percent of docs, most care happens there.
That is really a huge part of the problem.

------
xrd
I'm surprised there is no startup that sells you membership in offshore
healthcare. If you want to do anything, you just jump on a short hop flight to
a man made island in international waters and get healthcare. Or, coupled with
a trip to Thailand. It would be disruptive and cheaper.

My wife is a doctor and last night she tried to renew her credentials at a
major hospital network here. She could not, despite clear instructions, open
the PDF locally to add her signature. I inspected the web view in chrome tools
and see it is an awful Microsoft product behind the scenes.

This is the reason this attempt by Trump will never happen (I'm supportive
even though I despise Trump). My wife's incentives and the hospital incentives
are aligned, even though no one will admit it. Even if hospitals are forced to
give price transparency, they will just go and buy a shitty solution from
Microsoft (I'm using Microsoft as a placeholder, but it can be any large tech
company who wants in on the action), who will be happy to certify it for the
law. It won't work and the hospitals can blame Microsoft. Microsoft will lobby
politicians to water down the law so they won't pay anything but a pittance if
things don't work. Consumers will get continually screwed. The doctors and the
hospitals will continue to make great money because they will still not have
to admit pricing this way, with zero transparency, is the golden goose of
healthcare and why costs are insane in the US.

------
_bxg1
Right now healthcare in the U.S. is the worst of capitalism (basic health is
tied to income/employment, perverse profit-incentives) _and_ the worst of
anti-capitalism (anti-competitive monopolies/cartels) at the same time. I
don't think improving its ability to function as a free market will ever be a
real solution, but it certainly can't hurt.

------
greenimg
The problem with transparency at the hospital level is the CPT coding system,
for which all medical entities including the govt pay the AMA millions of
dollars to use, which splits up exams and procedures into components. So even
though the knee MRI might cost $1600 (ridiculous but typical), that does not
include the radiologist's interp, billed separately by the rad group, or the
$300 orbit xray to screen for metal. Also anesthesia is paid based on time,
cannot predict that. It is all a sham. And, they can get out of it for a $300
a day fine....well worth it to most of them.

------
TurkishPoptart
My dad, who is in his late 60s, has about $200k to live off of in his
retirement. Provided I outlive him, I have a sneaking suspicion that his
savings will not only be siphoned out by whatever hospital system inevitably
treats him, but that _I_ will have to cough up the remainder! Granted, this
isn't a discussion he and I have had. Just goes to show that if you have some
terminal condition in this broken country, it's better to just be hit by a bus
or drown, than be "treated" comfortably in a hospital bed for $5k+ a night.

------
carapace
(EXPLETIVE DELETED! I try to avoid low-content comments, i do, but goddmnit it
pisses me off to hear them say, "Oh the poor patients will be so confused!")

------
sharemywin
I would be awesome to see more sites like this:

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

Wish it worked with insurance

------
mriguy
Plug for an Econtalk episode on exactly the topic of transparency in
healthcare prices.
[http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare...](http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare.mp3)

------
throw1234651234
This is purely anecdotal, but I had a 15 minute (literally) ultrasound.
Hospital "facility use" fee: $800. 15 minutes of technician's time: $250. Bill
came down to $650 after adjustments.

This is messed up.

I imagine people with serious health problems just kill themselves or ruin
their lives forever.

~~~
daveslash
I got 1 stitch at the ER (before I was aware that Urgent Care was a a thing).
First hospital visit in my adult life. Some saline solution, an alcohol wipe,
a shot of Novocaine, and 1 stitch. $3,200. I now avoid the hospital like the
plague (ironically).

~~~
maxk42
I got the same procedure at a cash-only walk-in clinic. (Eight stitches,
actually -- a chunk of flesh was literally dangling from my finger.) $200.

We will never get control of the insane cost of health care until we force
medical facilities to actually _compete_ with each other.

~~~
HarryHirsch
Normal countries do this by imposing price controls, and it works remarkably
well to contain costs. Why can't the US do the same?

~~~
maxk42
Unfortunately, central planning stifles innovation. We have the best cutting-
edge medical technology in the world for the few who would like it and can
afford it. But by eliminating pricing transparency we've also eliminated the
incentive to make those technologies cheaper and more accessible to the common
man.

~~~
HarryHirsch
You don't need innovation for the usual complaints that you see a primary care
physician for - broken arm, throat infection &c. That stuff lends itself to
standardization and following of protocols.

~~~
Emergently
Except when your broken arm needs to be reduced or you have an open fracture
and you require moderate sedation to have a physician perform those
procedures. Not so standardized and not to protocolized.

------
imgabe
What an excellent way for hospitals to help convince everyone to switch to a
single-payer system.

------
naveen99
Insurers must have data on pricing. You can call up some already before having
imaging procedures for some guidance on cost. Maybe they can expand price
transparency as a differentiator to their competitors.

------
TurkishPoptart
This, IMO, is the best thing to happen under the Trump administration.
Hospitals will have a hard time arguing on behalf of price-shrouding.

------
dantheman
I really hope this goes through - this one item will allow people to actually
have educated discussions about care and ROI. It will allow people to compete,
to specialize, to better serve those who are ill.

------
7532yahoogmail
I dislike the Trump admin a lot. But I like this a lot. The federal government
ought to make this step 1 in a strategic effort to make a consumer report
campaign for patients. 100pct consumer driven all about where the money goes,
why, by whom, how prices are assessed, how they differ geographically, and
outcomes to money spent. Put the consumer in charge of their money

------
perseusprime11
You cannot do any good in this industry.

------
egdod
This is one thing Trump is doing that _should_ get broad support. It probably
won’t though, because some people are physically incapable of agreeing with
him.

~~~
sakopov
I honestly didn't even know this was in the works. It's amazing how much
effort is put towards blocking out any positive news about this
administration.

~~~
legitster
It was actually one of his campaign promises:
[https://www.politifact.com/truth-o-
meter/promises/trumpomete...](https://www.politifact.com/truth-o-
meter/promises/trumpometer/promise/1393/require-price-transparency-health-
care-providers/)

------
bootlooped
I called a pharmacy once and asked how much a vaccination would be. I had
insurance. They told me they couldn't tell me how much it would be until after
I got the shot.

~~~
frankharv
PBS has an excellent report about flu vaccinations and the widely varying
prices. Millions of shots given every year and prices from free to $85.

I wonder what the actual vaccination vile costs in this whole scheme compared
to the overhead.

[https://www.pbs.org/newshour/health/the-hidden-costs-of-
free...](https://www.pbs.org/newshour/health/the-hidden-costs-of-free-flu-
shots)

------
aphextim
I don't think anyone who has had to pay hospital bills would agree with the
hospital lobby's decision to fight this. The article's title makes it give the
impression this is okay because, orange man bad, however regardless of the
party pushing for transparency it is something everyone would benefit from
(other than the heal care industry/insurance company's profits).

~~~
daveslash
I _thoroughly_ dislike the bad orange man, but I will save my strongest words
for a more appropriate forum. That said, just because you may dislike someone
doesn't mean that you have to opposed _everything_ they do. I do agree with
this push for price transparency.

~~~
olliej
Right? I always find myself wondering why antitrust isn’t applicable?

The hospitals clearly work together to ensure that consumers don’t have
accurate or correct pricing information, which has always seemed like it
should be classified as anticompetitive behavior.

~~~
bluGill
I don't think they are working together so much as the system is setup to
reward their anti competitive behavior so they all have followed the rewards
to the same end.

------
Wh1skey
Surprise, state monopoly wants to keep their monopoly.

------
arcticbull
Obligatory reminder socialized medicine exists, is cheaper [1], controls costs
better [2] has better health outcomes [3], complete price transparency (for
instance [4]) and no surprise billing. Also, a reminder that a majority of
Americans want it [5].

And yet here we are, once again.

[1]
[https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita)

[2]
[https://www.healthaffairs.org/do/10.1377/hblog20110920.01339...](https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/)

[3] [https://www.oecd.org/unitedstates/Health-at-a-
Glance-2017-Ke...](https://www.oecd.org/unitedstates/Health-at-a-
Glance-2017-Key-Findings-UNITED-STATES.pdf)

[4]
[http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser...](http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20191001.pdf)

[5] [https://www.commondreams.org/news/2019/07/02/people-dont-
ins...](https://www.commondreams.org/news/2019/07/02/people-dont-insurance-
companies-they-their-doctors-poll-shows-majority-voters)

