> Hospitals don't even know what a given service costs,
That's not really true. We're talking about the costs of goods sold, which means it's pretty easy to place a lower bound on the marginal costs. For example, if the lab supplies for running a certain test cost $100/unit from the vendor and Medicare pays $93, you know that the hospital is losing money off of it. We're not taking into account the overhead, infrastructure, or any of that stuff, since it doesn't factor into COGS.
Anyway, this number comes straight from Medicare's own figures, astonishingly. I can't dig it up right now, but it's in the public record, somewhere within a ~100 page PDF. I have the PDF at home and have linked to it on HN before. Medicare literally acknowledges that they reimburse less than 100% of the direct costs that they incur (in 2012 it was 93%, IIRC.)
> In 2012, beneficiaries of Medicare and Medicaid received nearly 60% of the clinical services provided by
Florida Hospital (as measured by charges)vi. However, payments from these government programs
represented just 40% of Florida Hospital’s total net revenuevi
. In comparison, private payers received 30% of
the care provided by Florida Hospital and represented 56% of its total net revenuevi
And the next paragraph:
> hospitals such as Florida Hospital have no ability to negotiate the payments from the public payers –
Medicare and Medicaid – that pay for the majority of the clinical services provided. This poses a tremendous
financial challenge for hospitals because these payments do not cover costs. In order to overcome these
shortfalls, hospitals negotiate higher rates from private insurance groups. For this reason, continuing cuts to
Medicare and Medicaid payments create an unsustainable business environment and put undue financial
pressure on private payers
(The common response to this is that we need to increase funding to Medicare. While it's true that Medicare happens to be underfunded, that doesn't actually address the structural problem. Because Medicare has the ability to change their reimbursement unilaterally[0] while it has to request additional funding from Congress, these two will always be out of sync).
[0] the word 'negotiate' is often used here, but since hospitals are essentially legally required to accept Medicare patients, it's no more a fair negotiation than the negotiation you have with Comcast over your bill. You can squeeze a few extra dollars out of them if you fight, but at the end of the day, Comcast has all the power, so they can - and do! - price-gouge.
That's not really true. We're talking about the costs of goods sold, which means it's pretty easy to place a lower bound on the marginal costs. For example, if the lab supplies for running a certain test cost $100/unit from the vendor and Medicare pays $93, you know that the hospital is losing money off of it. We're not taking into account the overhead, infrastructure, or any of that stuff, since it doesn't factor into COGS.
Anyway, this number comes straight from Medicare's own figures, astonishingly. I can't dig it up right now, but it's in the public record, somewhere within a ~100 page PDF. I have the PDF at home and have linked to it on HN before. Medicare literally acknowledges that they reimburse less than 100% of the direct costs that they incur (in 2012 it was 93%, IIRC.)