Straightforward healthcare reform would start with eliminating this unprecedented and nonsensical ability for hospitals to engage in arbitrary post facto billing, require well-defined contracts for non-emergency care, and require providers to publish a uniform all-payer rate schedule for emergency/urgent care. Any deviation should result in a non-enforceable invalid bill, with easily claimable punitive damages if such fraudulent charges end up being mistakenly paid.
When I walk into a grocery store, buy some items, and leave there is absolutely no chance that I will later get a bill in the mail from the cashier for their bagging services. If I were to, it would be laughably unenforceable. And yet, this is precisely what the medical establishment feels entitled to do when they refuse to answer basic questions about prices or "network" status of providers, and then send you multiple bills for a single engagement!
While this would do little to help healthcare affordability for those who truly cannot pay, it is a necessary step to creating a functioning market regardless of who is paying. The point we're at now, where even people with the ability to pay have no clue how exactly the system will attempt to screw them, is utterly untenable.
For what it's worth, this is the kind of reform the Republican party could be loudly and persistently pushing if weren't primarily interested in dysfunction. As it stands the only popular avenue for reform I've seen is to punt the whole thing to the government, which I'm forced to reluctantly support even though it feels like giving up on actually solving the problem and letting the organizational cancer metastasize and feed on taxpayer money.
This. Something I've come across is that most of my friends who have ended up in better insuring (and often paying) jobs are somewhat blind to the thievery happening in plain sight because the monthly premiums are conveniently out of sight.
As a thought experiment, congress should simply ban and outlaw employer provided healthcare and force everyone who desires to be insured to make contract directly with Kaiser, Blueshield etc. When you pay north of $2k / month (for a family of four) out of your own pocket for the pleasure of being able to make an appointment in hospital, that just might draw enough ire to effect change.
Of course that should also make employing someone equally cheaper, or allow for equally large salary increase.
So as you fly through the air after being ejected in a car crash, make sure to pull out your phone and negotiate upfront pricing with your providers before you hit the ground and are rendered unconscious.
While I agree after the fact billing is stupid, your scheme implies people choose their hospital based on rates as they are flying through the air after being ejected from a car in a crash. Make sure to choose wisely before you black out!
Or, every doctor visit has an attending billing assistant to explain costs of care to both the doctor and the patient.
Because the doctors don't know and don't have time to know.
In the end this is all Republican laissez faire fantasies. We need socialized medicine, like ever other civilized and (by our standards) uncivilized country has.
I have no clue when the Republican party would have been able to push any coherent reform to the health care system. 50 years ago? The modern Republican party exists solely to defend entrenched oligarchies and anticompetitive cartel dominated markets. That's what campaign finance rules reward.
The Democrats also perform the same function, but at least with some attempts at reform around the edges, because that's what their voting block demands.
I expect the main difficulty this presents to hospitals isn't that their customers will be informed, or even that their competitors will be advantaged, but that they will be unable to engage in price discrimination (charging different amounts to different customers, based on their willingness and ability to pay). Or at least, they'll need to do so transparently.
I don't agree that hospitals charge based on ability to pay. I believe that they generally charge the max and then, maybe, negotiate the price based on your ability to pay (more likely they put you on a payment plan).
I had an accident in late 2010 where I needed to stay in the NICU for 14 days. In January 2011 I had major neck surgery and spent another week in the hospital. SFGH charged me $100K for the NICU stay and $200K for the surgery (plus a separate bill for $1K from SFFD for my initial ambulance ride).
I had no job or insurance at the time and was in the process of moving out of my apartment.
Luckily, it was a slip and fall type accident and I immediately hired a lawyer when I saw the bills. I was also approved for MediCal after my surgery and they initially covered the bill. But they put a lien on my lawsuit. I learned a lot during all of this, but my biggest takeaway was that MediCal paid $20K for a bill that was charging me $300K! Less than 10% of what I was being charged!
My kid recently needed a script. We had to go through a specialty pharmacy that ships directly to home because it apparently wasn't carried in the pharmacies like CVS. The script was over $400.
Insurance denied the claim.
They "applied a coupon" and the price magically became $35.
In this one transaction there's multiple layers of corruption most likely starting with the prescribing doctor.
The main difficulty is that the penalty is laughable.
$300/day doesn't even begin to cover a single well-paid IT professional who can handle this project, let alone a team with resources.
It may seem trivial to HN audience to comply (hey, just do a SQL query and post the resulting CSV!), but hospital IT systems are oftentimes legacy dinosaurs, so a transparency project like this could cost millions of $ to undertake.
Why pay millions, when you can simply pay a measly penalty of ~$109,000 year after year?
Many, many medical bills go unpaid. Calculation of likelihood of payment based on customer attributes is being used to consider offering discounts to pay quickly.
I don’t know how this wouldn’t act as de facto price discrimination but it is happening.
Unfortunately hospitals are in the same category as banks that allows them to get away with breaking rules and criminal behavior with a slap on the wrist.
If there ever has been as sector that needs price transparency it's hospital and medical in general. It's really hard to understand that people are putting up with insanity.
There’s one difference, and that’s Medicare/Medicaid. The government could easily decide that they will stop paying hospitals for Medicare/Medicaid patients until this gets implemented. I bet it would happen pretty fast.
This seems like an area where the federal government could take a leaf out of Texas' new found love for citizen-driven lawsuits: allow individuals rather than CMS to sue hospitals for the damages (up to US$2M starting tomorrow).
My guess is that you'd see the hospital IT and pricing infrastructure do a reasonable impression of faster-than-light travel and the information would be available by January 3rd.
A post about price transparency wouldn't be complete without the "Surgery Center of Oklahoma"[0]. If one for profit hospital can figure out how to publish prices in advance of surgery (for a lower price), than all hospitals should be able to do so too.
this seems like something that should actually be able to be handled in bipartisan fashion, you need price transparency for a free market to function properly so Republicans should support because lower costs would stunt demands for universal healthcare.
This seems like something that shouldn't be handled by the "free market" at all, because human health is at stake. And because of that, it isn't left to "the free market" in most of europe.
First off, law/rule is passed. So who is in charge of enforcement.
Second, came into existence 01/2021. That was under Trump and Republicans, so ostensibly they support it.
Third, the only concern I have is being able to ensure that the procedures are the same and also outcome statistics. There are a couple different hip replacement surgeries that you can have. One is trickier to perform but has better outcome and recovery time, if both are listed as hip replacement and customers don't know there are differences then you create a race to the bottom.
Maybe it’s time to get a proper publicly funded universal healthcare system. Then these problems would go away. My hypothesis is it could be funded if we increased federal taxes by 100-200 basis points.
I believe a functional universal healthcare system can only be created without interference from the existing insurance companies and healthcare networks, but they have a strong lobbying engine that cultivates both sides of the political spectrum.
If we make a universal healthcare system now, it could be a slight improvement for us, but it can only be written and passed in a way that will funnel an even larger portion of GDP to health insurance companies and hospital networks.
> Texas-based Christus Health early this year said on its website it planned to defy the rules because its comprehensive list of prices “will only be useful for our competitors.”
Because publishing prices leads to actual competition.
It's disingenuous, patronizing and offensively cynical, but it's no defense. It reminds me of people naming bills the opposite of what they are meant to do. The "Patriot Act" was touted to among other things "defend freedom" and then enabled a surveillance state. That kind of thing. The hospitals will have to be sued into compliance by the Attorney General's office if it's important enough to Mr. Garland.
I had a hospital call me recently and inform me that the cash price for an upcoming procedure would be much lower than the price they would bill the insurance company. Since I wasn't going to meet my deductible this year, they suggested I accepted the cash price to save money.
I asked them if the insurance price was the price billed to the insurance company or the negotiated price that actually gets paid. They could not give me a straight answer. I had them stay on the line while I added my insurance company to the call. The agent at the hospital communicated the necessary information to the insurance company (there's a ton of stuff that effects the price, down to which radiologist happens to be scheduled that day). And of course, the negotiated price for the insurance company was lower than the cash price the hospital was offering.
I really don't think this attempt at getting me to pay the cash price was some accidental mix up. I think someone at the business side has figured out not only can they convince people to pay a higher rate, but that then they don't need to deal with billing the insurance. A double savings. I wonder what percentage of people they successfully scam with these calls.
To anyone outside the US reading this who is really confused, I'll see if I can start a GoFundMe to explain the US healthcare system to foreigners
Meanwhile in Canada I have had multiple trips to my doctor, multiple tests, x-rays, ct-scan, blood work, and probably a couple others I am forgetting and my bill has been zero dollars. There is no such thing as a bill. I guess I pay taxes but that is it. As a non American it is so hard to see this and understand how it is allowed to happen. You guys must have to choose between doctors or financial uncertainty and I can't understand how a country as good as USA has allowed this to happen for so long.
The thing to understand about the US healthcare system is that it's all based around corruption and waste (where waste to you is profit to someone else). The inefficiency is the point. It's a racket.
There are many known better systems and obvious improvements, where "improvement" means you get the same quality of care for less money. But then you get the same quality of care and the providers make less money.
Even if you're going to have a market-based system, things like price transparency would make it more efficient. Which is why they fight it so hard.
If all we did was replace the existing insurance system with single payer, it would solve nothing, because all the same lobbyists would just make sure that the government continues to overpay them. Single payer advocates like to point out that Medicare pays a bit less than private insurance in the US, but Medicare pays a lot more than single payer systems do in other countries. And if it was the only payer in the US then the lobbying pressure to increase what it pays them would be even higher.
Regardless of who is doing the paying, the problem that actually needs to be solved is the corruption.
American healthcare is fantastic for the wealthy. Get what you want when you want with almost no wait. We also get treatments you can't get in Canada, if you have enough money.
The wealthy in the US have some of the best health outcomes in the world. It's only when you average with the middle class and the poor that our average outcomes drop.
The system stays the way it does because it's great for the people with power -- the wealthy.
There's a lot of reasons behind it I think as a complete history/politics deletant; damage from cold war anticommunism, side effect of post world war 2 success, and the general story the US and it's citizens tell about themselves as individualistic.
The US came out of WW2 immensely wealthy (overall of course not everyone was allowed to participate in the boom) which buried a lot of the impetus that pushed other European countries to create their national health systems.
Then we were fighting against communism which took so many forms of social programs into the area of forbidden ideology that could spell the doom of the US and the rest of the world.
And then there's just the individualistic streak that seems to have been endemic to the US since it's founding. Religiously as well as economically there's a lot of focus on individual effort and rewards.
[+] [-] neonate|4 years ago|reply
[+] [-] mindslight|4 years ago|reply
When I walk into a grocery store, buy some items, and leave there is absolutely no chance that I will later get a bill in the mail from the cashier for their bagging services. If I were to, it would be laughably unenforceable. And yet, this is precisely what the medical establishment feels entitled to do when they refuse to answer basic questions about prices or "network" status of providers, and then send you multiple bills for a single engagement!
While this would do little to help healthcare affordability for those who truly cannot pay, it is a necessary step to creating a functioning market regardless of who is paying. The point we're at now, where even people with the ability to pay have no clue how exactly the system will attempt to screw them, is utterly untenable.
For what it's worth, this is the kind of reform the Republican party could be loudly and persistently pushing if weren't primarily interested in dysfunction. As it stands the only popular avenue for reform I've seen is to punt the whole thing to the government, which I'm forced to reluctantly support even though it feels like giving up on actually solving the problem and letting the organizational cancer metastasize and feed on taxpayer money.
[+] [-] rixrax|4 years ago|reply
As a thought experiment, congress should simply ban and outlaw employer provided healthcare and force everyone who desires to be insured to make contract directly with Kaiser, Blueshield etc. When you pay north of $2k / month (for a family of four) out of your own pocket for the pleasure of being able to make an appointment in hospital, that just might draw enough ire to effect change.
Of course that should also make employing someone equally cheaper, or allow for equally large salary increase.
[+] [-] AtlasBarfed|4 years ago|reply
While I agree after the fact billing is stupid, your scheme implies people choose their hospital based on rates as they are flying through the air after being ejected from a car in a crash. Make sure to choose wisely before you black out!
Or, every doctor visit has an attending billing assistant to explain costs of care to both the doctor and the patient.
Because the doctors don't know and don't have time to know.
In the end this is all Republican laissez faire fantasies. We need socialized medicine, like ever other civilized and (by our standards) uncivilized country has.
I have no clue when the Republican party would have been able to push any coherent reform to the health care system. 50 years ago? The modern Republican party exists solely to defend entrenched oligarchies and anticompetitive cartel dominated markets. That's what campaign finance rules reward.
The Democrats also perform the same function, but at least with some attempts at reform around the edges, because that's what their voting block demands.
[+] [-] tempestn|4 years ago|reply
[+] [-] clsec|4 years ago|reply
I had an accident in late 2010 where I needed to stay in the NICU for 14 days. In January 2011 I had major neck surgery and spent another week in the hospital. SFGH charged me $100K for the NICU stay and $200K for the surgery (plus a separate bill for $1K from SFFD for my initial ambulance ride).
I had no job or insurance at the time and was in the process of moving out of my apartment.
Luckily, it was a slip and fall type accident and I immediately hired a lawyer when I saw the bills. I was also approved for MediCal after my surgery and they initially covered the bill. But they put a lien on my lawsuit. I learned a lot during all of this, but my biggest takeaway was that MediCal paid $20K for a bill that was charging me $300K! Less than 10% of what I was being charged!
[+] [-] Consultant32452|4 years ago|reply
Insurance denied the claim.
They "applied a coupon" and the price magically became $35.
In this one transaction there's multiple layers of corruption most likely starting with the prescribing doctor.
[+] [-] antisthenes|4 years ago|reply
$300/day doesn't even begin to cover a single well-paid IT professional who can handle this project, let alone a team with resources.
It may seem trivial to HN audience to comply (hey, just do a SQL query and post the resulting CSV!), but hospital IT systems are oftentimes legacy dinosaurs, so a transparency project like this could cost millions of $ to undertake.
Why pay millions, when you can simply pay a measly penalty of ~$109,000 year after year?
[+] [-] bredren|4 years ago|reply
I don’t know how this wouldn’t act as de facto price discrimination but it is happening.
[+] [-] daniel-cussen|4 years ago|reply
I haven't had that experience. That would be like a health dealership.
[+] [-] EamonnMR|4 years ago|reply
[+] [-] spaetzleesser|4 years ago|reply
If there ever has been as sector that needs price transparency it's hospital and medical in general. It's really hard to understand that people are putting up with insanity.
[+] [-] MBCook|4 years ago|reply
There isn’t something quite as direct on banks.
[+] [-] stevesearer|4 years ago|reply
Or maybe it could be where you get discounts at participating local businesses when you upload.
Kind of like a weird proof of work concept.
[+] [-] maxwell|4 years ago|reply
[+] [-] PaulDavisThe1st|4 years ago|reply
My guess is that you'd see the hospital IT and pricing infrastructure do a reasonable impression of faster-than-light travel and the information would be available by January 3rd.
[+] [-] pg_1234|4 years ago|reply
[+] [-] loonster|4 years ago|reply
[0] https://surgerycenterok.com/pricing/
[+] [-] ren_engineer|4 years ago|reply
this seems like something that should actually be able to be handled in bipartisan fashion, you need price transparency for a free market to function properly so Republicans should support because lower costs would stunt demands for universal healthcare.
[+] [-] usrbinbash|4 years ago|reply
[+] [-] themaninthedark|4 years ago|reply
Second, came into existence 01/2021. That was under Trump and Republicans, so ostensibly they support it.
Third, the only concern I have is being able to ensure that the procedures are the same and also outcome statistics. There are a couple different hip replacement surgeries that you can have. One is trickier to perform but has better outcome and recovery time, if both are listed as hip replacement and customers don't know there are differences then you create a race to the bottom.
[+] [-] abeyer|4 years ago|reply
That seems to be making the assumption that any politician is willing to listen to something that the "wrong" side says.
[+] [-] ghufran_syed|4 years ago|reply
[+] [-] felipellrocha|4 years ago|reply
Oh, my sweat summer child...!
[+] [-] hestefisk|4 years ago|reply
[+] [-] droopyEyelids|4 years ago|reply
If we make a universal healthcare system now, it could be a slight improvement for us, but it can only be written and passed in a way that will funnel an even larger portion of GDP to health insurance companies and hospital networks.
[+] [-] arwhatever|4 years ago|reply
[+] [-] redis_mlc|4 years ago|reply
[deleted]
[+] [-] spaetzleesser|4 years ago|reply
[+] [-] Day1|4 years ago|reply
Is saying that consumers are too stupid to understand the benefits of price transparency an adequate defense?
[+] [-] b9a2cab5|4 years ago|reply
> Texas-based Christus Health early this year said on its website it planned to defy the rules because its comprehensive list of prices “will only be useful for our competitors.”
Because publishing prices leads to actual competition.
[+] [-] technofiend|4 years ago|reply
[+] [-] shmerl|4 years ago|reply
[+] [-] outside1234|4 years ago|reply
[+] [-] jedberg|4 years ago|reply
[+] [-] onetimemanytime|4 years ago|reply
or will they be able to list dozens of other charges that may or may not be added to the procedure?
[+] [-] torbTurret|4 years ago|reply
The worst bit is that this is often learned during trying times in ones life, when stress makes it easier to overlook.
[+] [-] russdill|4 years ago|reply
I asked them if the insurance price was the price billed to the insurance company or the negotiated price that actually gets paid. They could not give me a straight answer. I had them stay on the line while I added my insurance company to the call. The agent at the hospital communicated the necessary information to the insurance company (there's a ton of stuff that effects the price, down to which radiologist happens to be scheduled that day). And of course, the negotiated price for the insurance company was lower than the cash price the hospital was offering.
I really don't think this attempt at getting me to pay the cash price was some accidental mix up. I think someone at the business side has figured out not only can they convince people to pay a higher rate, but that then they don't need to deal with billing the insurance. A double savings. I wonder what percentage of people they successfully scam with these calls.
To anyone outside the US reading this who is really confused, I'll see if I can start a GoFundMe to explain the US healthcare system to foreigners
[+] [-] unknown|4 years ago|reply
[deleted]
[+] [-] 14|4 years ago|reply
[+] [-] AnthonyMouse|4 years ago|reply
There are many known better systems and obvious improvements, where "improvement" means you get the same quality of care for less money. But then you get the same quality of care and the providers make less money.
Even if you're going to have a market-based system, things like price transparency would make it more efficient. Which is why they fight it so hard.
If all we did was replace the existing insurance system with single payer, it would solve nothing, because all the same lobbyists would just make sure that the government continues to overpay them. Single payer advocates like to point out that Medicare pays a bit less than private insurance in the US, but Medicare pays a lot more than single payer systems do in other countries. And if it was the only payer in the US then the lobbying pressure to increase what it pays them would be even higher.
Regardless of who is doing the paying, the problem that actually needs to be solved is the corruption.
[+] [-] refurb|4 years ago|reply
While my coworker in the Bay Area got her a choice of surgery slots less than a month out.
There are trade offs.
[+] [-] jedberg|4 years ago|reply
The wealthy in the US have some of the best health outcomes in the world. It's only when you average with the middle class and the poor that our average outcomes drop.
The system stays the way it does because it's great for the people with power -- the wealthy.
[+] [-] rubyist5eva|4 years ago|reply
There are plenty of private healthcare services in Canada. Ever been to the dentist?
[+] [-] rtkwe|4 years ago|reply
The US came out of WW2 immensely wealthy (overall of course not everyone was allowed to participate in the boom) which buried a lot of the impetus that pushed other European countries to create their national health systems.
Then we were fighting against communism which took so many forms of social programs into the area of forbidden ideology that could spell the doom of the US and the rest of the world.
And then there's just the individualistic streak that seems to have been endemic to the US since it's founding. Religiously as well as economically there's a lot of focus on individual effort and rewards.
[+] [-] eagsalazar2|4 years ago|reply
[deleted]
[+] [-] trembonator|4 years ago|reply
[deleted]