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Hospital Prices Are About To Go Public in the US (ajc.com)

Posted by msmash on from the up-next dept.

Prices hospitals charge for their services will all go online Jan. 1 under a new federal requirement, but patient advocates say the realities of medical-industry pricing will make it difficult for consumers to get much out of the new data. From a report: A federal rule requires all hospitals to post online a master list of prices for the services they provide so consumers can review them starting Jan. 1. The health care industry nationally has a reputation for having little price transparency, which can make it difficult for consumers to price compare. But the hospital's master list prices, sometimes called a chargemaster, is also not a complete look, consumer advocates say. That's because the final bill a patient receives is almost never the same as the sticker price for the services they received. Insurance companies negotiate discounts on the sticker prices. Co-pays, co-insurance, deductibles also add other layers of complexity that bring discounts or increased costs before a final charge is determined.

22 of 382 comments (clear)

  1. Extra charges by Anonymous Coward · · Score: 5, Funny

    Doc: Do you smoke?
    Me: No.

    $130 smoking consultation charge.

    1. Re:Extra charges by saider · · Score: 5, Insightful

      Hopefully this is the first step in getting rid of insurance companies. The hassle of all this is what the insurance companies use to stay in business.

      1. Billing errors are almost always in their favor. You either spend your valuable time haggling with them to correct it, or it gets paid because you don't notice it or don't have time to deal with it.

      2. The time you spend correcting their mistakes also requires people working in the insurance company to correct them. Insurance companies are regulated by the state, and so they often need to justify their rates. The customer service people serve that purpose. The rates are often negotiated such that they are allowed to make a 10-30% profit on their "service". More expenses means more profit. This behavior, which would normally kill a business, becomes something that strengthens it because of the way government has their fingers in this industry.

      4. Doctors now have full time people who do nothing more than haggle with the insurance companies to get paid. This further drives up the cost of care, which again benefits the insurance companies.

      5. Because we have turned healthcare into an "insurance" product, you decouple a service from its price because everything is handled in aggregate. Remember from Finance 101, insurance products are designed to "make you whole" if an unlikely event occurs. Healthcare is a certainty, so paying for it as an insurance product makes no sense. That'd be like having "food insurance" or "housing insurance" to pay for your groceries and rent/mortgage. It is unnecessary and only adds cost. Then the added cost becomes a barrier and the insurance companies sell themselves as helping to overcome the barrier that they erected.

      6. Healthcare is a giant jobs program. All those people haggling over costs would be out of a job things changed significantly. This is the main reason the system won't change.

      7. Individuals cannot change the market because they do not purchase the insurance. Their employers do. Therefore, health insurance companies' customers are not the people receiving the service. Insurance companies provide just enough service to entice HR directors to choose them. Employers are interested in a healthy workforce, but at the end of the day it is a dollars decision that the employee does not get to make. This serves to distort the market.

      Personally, I think the solution is to eliminate health insurance, and take the premiums that companies pay and just deposit that into the employee's health savings account. Then let the employees buy whatever they need. If they want insurance they can choose the plan that is right for them. Kinda like buying car insurance They can also just save the money and pay providers directly - but they need the up-front pricing information to make those decisions. For those that need assistance, the government or charities can deposit money into people's HSA is they need assistance. Then the market will return to something more normal simply because *** the people making the decisions are the people receiving the service. ***

      --


      Remember, You are unique...just like everyone else.
    2. Re:Extra charges by thegarbz · · Score: 4, Insightful

      Healthcare is a certainty, so paying for it as an insurance product makes no sense. That'd be like having "food insurance" or "housing insurance" to pay for your groceries and rent/mortgage.

      I was with you right up until that. Healthcare is not a universal certainty. When my kid was brought into this world it popped out, cried a bit and we had it home no fuss a short while later.
      When my friend's came into this world it turned blue, straight into open heart surgery due to being born with transposition of the great arteries.

      Now five years later and my kid hasn't had much more than butterfly stitch at a doctor. That same friend of mine had his in the emergency room getting a custom metal plate inserted in her head to replace her shattered skull when she landed face first on a rock after dismounting a trampoline.

      My wife hasn't been to the doctor in 2 years. I have endless back problems and had a hernia done. Healthcare is a perfect example of how one person's life can be completely unburdened while another's can financially bankrupt them. The latter is definitely not a certainty.

      That said I live in a first world country which has socialised healthcare so the concept of using insurance to fix this problem just seems so dumb.

    3. Re: Extra charges by burtosis · · Score: 4, Interesting

      I'm not sure you are following this correctly. First off the people and politicans of the same party are in different boats as the flood of healthcare money goes to politicans and not the people. Even republican voters prefer single payer options at around 60% and democrats around 90% although if you call it single payer it drops republican support about 15 points over Medicare for all. In contrast 0 republican politicans support single payer, and almost 0 democrat politicans do as well because to not do so would erode thier campaign coffers. Republicans continually lose thier shit over single payer again and again - just visit Fox News for an example.

      The real takeaway is that republican voters feel the finnancial inequality and hard times and are afraid of the change because there isn't enough money now and so how do we pay for it. Back in reality corporations have been stealing lying and griftng so much citizens don't have any money and even the Koch brothers bias study showed single payer would be 3 trillion dollars cheaper over the next 10 years despite full participation of the citizens and increased use. with single payer somewhere beteeen 70-80% approval across all people the real reason we don't have single payer is we don't live in a democracy, or even a representative democracy

    4. Re:Extra charges by ShanghaiBill · · Score: 4, Insightful

      Car analogy: Auto insurance covers catastrophic events like collisions. But what would happen if it also included gasoline?

      So every time you refuel, you fill out a form, take it to the insurance department at the gas station, sit in the waiting room for 30 minutes while they negotiate the price with your auto insurance company, and when you are finally approved, you sign more forms indicating that you understand that gasoline is flammable and contains carcinogens and should not be consumed internally or sprayed in anyone's eyes. Then they dispatch a highly trained professional to dispense the gas, which is time consuming because there is a different nozzle specified by each insurance company, and your company requires the use of a low cost nozzle that doesn't quite fit your car. Finally, you receive a binder with all the forms and receipts for your tax records.

      What would this do to the cost and hassle of owning a car?

    5. Re:Extra charges by ShanghaiBill · · Score: 5, Interesting

      Great. Because, there won't be any abuse of the system problems with that.

      You should use evidence based reasoning.

      Plenty of countries have healthcare that is free at point-of-use. They have mechanisms to prevent abuse that work well.

      In many countries, when you "go to the doctor", you see a screening nurse or PA first, when you walk in the clinic door. 80-90% of the time that is as far as you get, because your ailment is something routine, and the nurse just hands you some pills and tells you to go home and get some sleep and drink plenty of fluids. Many times there is ZERO paperwork. There isn't even a record that you were there, and the nurse may not even ask for your name. You just walk in, get some quick advice, maybe some free pills, and then you walk out. The cost to the healthcare system is maybe $5, if that.

      In America, even a sniffle means 30 minutes sitting in the waiting room next to people coughing up phlegm, several insurance forms, and a whole team of people to interface with the insurance companies, prepare and clean the treatment rooms, confer with the malpractice attorneys, etc.

    6. Re:Extra charges by ShanghaiBill · · Score: 5, Interesting

      Cadillac plans are taxed, but most employer provided health insurance is not. This is a problem, because involving employers in the health insurance business adds a whole additional layer to the process that insulates the people receiving care from the people paying for it.

      Having your employer provide heath insurance MAKES NO SENSE WHATSOEVER and you only think it does because you are used to it have been conditioned to think it is normal.

      In Maoist China, each factory ran their own school for the children of their employees. So if you changed jobs, your children had to switch to a new school. That is obviously completely idiotic. But you can only see that because you are outside the system and you have seen a better way.

      Employer provided heath insurance IS JUST AS STUPID. If you work for, say, an auto parts store, and they provide health insurance, then your major healthcare decision is being made by someone who:

      1. Knows nothing about healthcare.
      2. Has zero bargaining power.
      3. Has no particular incentive to care about quality of service

      We should remove all tax benefits of employer provided health insurance and transition to a system that makes sense.

  2. how do you manage? by pereric · · Score: 5, Informative

    As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system. Most other 1:st world countries (in Europe, Japan, South Korea ...) have some variation on a single-payer system, where hospital visits and drugs are in most part paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance.

    In Sweden, a visit to a doctor, district nurse, psychologist or physiotherapist always cost $10-$20 (free for children below 18 years old and the elderly). A hospital visit is $20-$40, regardless of what procedures are administrated. (hospitals also seems to base the procedures applied based on medical need, rather than what can be billed). On top of that, there is a yearly cap so no citizen need paying more than $150 each year in hospital fees, and no more than $150 each year for prescription drugs.

    And, to the point, the average EU citizen pay much less (including paid via taxes) for equal 1:st world class health care than the US citizen.

    For example, the British spend around half the US amount on health care per capita, despite having by several measures higher quality:
    https://www.bbc.com/news/uk-42...

    1. Re:how do you manage? by JaredOfEuropa · · Score: 4, Interesting

      paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance

      We in the Netherlands went with a great combination of public and private health care: the expense of a partly publicly funded health care system combined with expensive commercial care providers and a mandatory private insurance. And costs, while not as high in the USA yet, are perpetually on the rise. The only ones happy with this scheme are the insurance companies, who sell us the insurance while at the same time placing an insane administrative burden on hospitals. By the way, if you think this sounds a little like Obamacare, that's because it is kind of similar. At least, that suffered from the same weakness: the insurance companies (though Obamacare might still have been better than the current system in the US, hard to say)

      --
      If construction was anything like programming, an incorrectly fitted lock would bring down the entire building...
    2. Re:how do you manage? by pereric · · Score: 4, Insightful

      That was not really an answer ...
      I don't think US spending money on inefficient and unequally accessible health care help the security of other countries? Or do you think so?

    3. Re:how do you manage? by CrimsonAvenger · · Score: 5, Interesting

      As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system.

      To make a long story short, it's fallout from WW2.

      Wage/Price controls during WW2 made it difficult for businesses to recruit talent - it wasn't like you can pay them more to get them to leave their current job.

      So, someone had the bright idea of offering Medical Insurance as part of the pay package. Legal, since Medical Insurance wasn't covered by the Wage/Price controls.

      Anyways, by the time the notion of Single-Payer got some momentum, Medical Insurance as a benefit of your job was so embedded in the economy that getting rid of it was next to impossible.

      In the long run, Medicare will probably be gradually extended to cover everyone, which will give us Single-Payer by default. But it's hard to deal with the economic disruption (the Insurance Industry is HUUUUGE! and will pretty much vanish with Single Payer) quickly, so it'll be a while.

      --

      "I do not agree with what you say, but I will defend to the death your right to say it"
    4. Re:how do you manage? by Anonymous Coward · · Score: 5, Interesting

      The meme among American conservatives is that the only reason other countries can afford universal healthcare is because they have weak militaries.

      It's completely bonkers for many different reasons:
      1) Universal healthcare is much more economically effective in relative and absolute terms.
      2) Countries with strong militaries (Sweden during the Cold War, France now) still "afford" healthcare partly because of 1).
      3) Sweden gives 1.4% of its GDP to foreign aid compared to 0.2% of the US and still "affords" healthcare partly because of 1).
      4) The US gets a fuckton of influence and business because of its strong military.

      Once they realize what an utterly stupid argument this makes, they turn to the argument of "diversity". Sweden is a less "diverse" country (read: has fewer mooching n*****s) so therefore it magically somehow works.

    5. Re:how do you manage? by Vanyle · · Score: 5, Interesting

      I have a friend who lives in Denmark, When she was younger she had to have a double mastectomy because she was unable to get the care needed prior to this for breast cancer because of their financial system.

      Just recently her husband had died because he was unable to get into a doctor for breathing trouble for around 4 weeks. Turned out he had a pulmonary embolism. Great health care system there.

      And for those that are wondering, she pays about 50% income tax, plus around 25% VAT (this is from random conversations, so not sure if 100% accurate)

    6. Re:how do you manage? by Anonymous Coward · · Score: 5, Informative

      Well, since you asked...

      The American Health Care System is:

      - Posting this as an anonymous cowards so that Google data whorebots don't match my medical history to my e-mail address.
      - Having a birthday in May and losing my parents health care coverage before my first full-time job with benefits starts in August.
      - Calling an insurance company in April and being offered a decent plan for $85/month until my full-time job starts.
      - Finding out 10 years later that this plan was only a "short-term" plan, and that full-coverage plans were about 4x the cost.
      - Visiting my friend in the hospital after he fell off a roof, and seeing him with a smile on his face. Asking him why he had a smile on his face, and him telling me that the ambulance driver asked him the same question. Asking him why he had a smile on his face after he fell off the roof, and him saying that he had already been to the hospital once this year, that he met his deductible, and that everything now was free.
      - Going to my first union meeting and finding out that the new contract had a 0% raise, "but they'll still covering single-payer health care 100%".
      - Thinking after my first union meeting that I'd rather get a raise.
      - Finding out at my second union meeting that health costs were $405/month, and thinking, "I could earn 40% more a paycheck if it wasn't for health care."
      - Thinking for five years that the old people in our union were holding down my salary.
      - Finding blood in my stool after five years of work and thinking, "What the hell is wrong with me?"
      - Choosing to Google my medical issue rather than going to a doctor, and finding out that I probably have an "Anal Fissure".
      - Going to a doctor anyways, because an anal fissure is literally a pain in the ass, and having the doctor tell me, "Let's schedule a colonoscopy."
      - The doctor justifying that a colonoscopy is necessary at the age of 28, because I may have this unpronounceable disease that affects about one-in-a-million people, and it's better to be safe than sorry.
      - Going to have a colonoscopy done, then having the surgeon telling me post-op that my long intestine was "clean as a whistle", then showing me a photo of an anal fissure he found.
      - Receiving a bill for $850 and saying to myself, "So this is what everyone complains about."
      - Finding out five years later that most hospitals charge far more than $850 for a colonoscopy.
      - Getting sick repeatedly and refusing to go to the doctor to avoid a $200 bill.
      - Reluctantly going to the doctor after being sick for four days, getting x-rayed and three vials of blood drawn, testing negative for pneumonia, mono, the flu, and who knows what else, and getting three different bills (doctor, lab, and x-ray) totaling $600, and saying to myself, "I should have stayed home."
      - Having a baby five years later, and finding that I had to quickly shop for a new health insurance policy for an unborn baby, because the moment he popped out of the womb, he would be billed $12,000 for services rendered.
      - Finding out that the most affordable insurance for the newborn was a high-deductible plan with a $6,000 deductible.
      - Finding out that, between the wife's deductible and the newborn's deductible, I owed $9,000 for a newborn. Thinking, "no wonder people wait later in life to have children."
      - Being told by the hospital that I could pay as little as $50 a month towards the $9,000 bill, because even that was a better deal for the hospital than selling the bill to a collections agency.
      - Finding out that I had cancer at the age of 32 and saying to myself, "Fuck my deductible. I want to live."
      - The doctor telling me during my cancer screening that most doctors graduate from medical school with $250,000 - $350,000 in debt, and that his house payment is lower than his loan payment. And he lived in a $300,000 house.
      - Finding out that my total bill for cancer surgery and radiation treatment cost $24,000, and that I only owed a $500 deductible.
      - Seeing my final bill and understandin

    7. Re:how do you manage? by Shotgun · · Score: 4, Interesting

      The Europeans sacrifice the young and the old. The US sacrifices the poor. What we're saying here is that there really isn't enough for everybody to have all the want all the time.

      At least in the US, we can choose. If I've worked all my life to save a nest-egg, I can choose to spend it on EOL care, or I can choose to take a leisurely swim to Europe. Europe, having leaders that are smarter than the rest of us, makes those decisions for me. (Because, I can't have the nest-egg if they've taxed it out of me beforehand.)

      --
      Aah, change is good. -- Rafiki
      Yeah, but it ain't easy. -- Simba
    8. Re:how do you manage? by liquid_schwartz · · Score: 4, Insightful

      As an outsider (living in Sweden, Europe) I am a bit curious, but mostly alarmed how the US have got such a seemingly malfunctioning health care system. Most other 1:st world countries (in Europe, Japan, South Korea ...) have some variation on a single-payer system, where hospital visits and drugs are in most part paid by everyone via taxes, without what seems like the bureaucracy of private or employer-paid insurance.

      The advantage the EU and Japan have is that they don't have a huge underclass. This is changing as the EU is now committing suicide by importing a huge underclass. In California for example 1/3 of the state, a huge chunk of that illegal or anchor babies, is on free healthcare. Free. No co-pays to visit a doctor, no cost for medicine, no monthly fee. This is supported by virtually all legally working adults paying *lots* in taxes and getting nothing in return. It's unsustainable and will bankrupt the state. Working adults however pay hundreds a month just to have insurance, and the anger grows. To say that illegal immigration is killing the state is spot on. Citation: https://www.sacbee.com/news/lo...

    9. Re:how do you manage? by gawbl · · Score: 4, Informative

      ...To say that illegal immigration is killing the state is spot on. Citation: https://www.sacbee.com/news/lo...

      Excerpted from your link (https://www.sacbee.com/news/local/health-and-medicine/article160786554.html):

      "A large majority – 83 percent – of Medi-Cal enrollees are U.S. citizens, according to data from June 2014. The second largest proportion of enrollees, at 10 percent, are qualified noncitizens, a term for permanent residents, refugees, people granted asylum and others. Both citizens and qualified noncitizens are able to access the full scope of Medi-Cal benefits and services. Another 7 percent are undocumented and can only access emergency and pregnancy-related resources. "

  3. Time to stop by DNS-and-BIND · · Score: 4, Insightful

    All this "oh we can't tell you the real price" bullshit needs to come to a screeching halt. This is just cartelism, or guildism, or whatever you can call it. It's an industry screwing us over because it can, and claiming technical difficulties prevent it from changing. It was bullshit when Microsoft did it with Internet Explorer and it's bullshit with hospitals.

    --
    Shutting down free speech with violence isn't fighting fascism. It IS fascism!
  4. All the same a good government requirement by mysidia · · Score: 4, Interesting

    Now all we need is a Nondiscrimination law --- that is, to say,
      a federal rule against price discrimination or blanket pricing deals in that: A healthcare provider may not charge individuals a higher price than a partner insurance company would pay for the same service.

    1. Re:All the same a good government requirement by 140Mandak262Jamuna · · Score: 4, Insightful
      The most expensive people to care for are the old people. And people older than 65 are already in the government plan, because no private company wants to provide coverage for them.

      Just start gradually reducing medicare eligibility age from 65 to 50. Cover all children below 10, call them unborn Americans and their hosts and give pre natal care and cover child birth for free. Gradually raise it 18.

      Slowly allow people to buy into medicare. Eventually we will have a single payer system.

      --
      sed -e 's/Chuck Norris/Rajnikant/g' joke > fact
  5. Re:how do you manage -- Very Well Overall! by I75BJC · · Score: 4, Interesting

    I have lived under the British (UK) health care system and it Sucks! The reports of wait times for surgery, scans, procedures & treatment are much longer than in the USA. The overall Quality is much poorer than the USA. The overall "out-of-pocket" price may be lower but the human costs are definitely lower. USA Federal Government intervention/take-over of the America health care system is the ruin of both health insurance (a la, Obamacare) and health care (restricted treatments, proscribed treatments, etc.). My Carpal Tunnel Syndrome surgery was performed in Memphis, TN. At the time of my surgery, Memphis had more MRI machines than the entire country of Canada (a 1st World Country with single payer health insurance/care). While I can't speak about Sweden's health insurance/care system, I can address the British and Canadian systems with some sort of personal experience. The reports from the MSM in the USA all seem to note that 1-payer systems are "cheaper" for the consumer but the quality is still inferior to the USA.

  6. Re:how do you manage -- Very Well Overall! by arth1 · · Score: 4, Interesting

    I too have lived in Europe with universal healthcare.
    And my experience is that the European system was way better. No arguing with insurance companies over treatments, and having to accept substandard treatments because they're cheaper.
    No avoiding going to the doctor because the co-pays alone can be a fortune.
    No three-month wait for an appointment to see a cardiologist.

    But most of all, the quality of treatment is superior outside the US, because the US system is tailored to increase profits while reducing the liability for doctors and hospitals, meaning it's test-heavy and risk-averse.
    As an example, I have bilateral total hip replacments, done in Europe. The doctors consulted with me before the procedure and gave me alternatives. I opted for uncemented threaded implants, which allows me to run as much as I want, do yoga, and pretty much function better than with the original hips. They will never have to be replaced, although the ball caps can be replaced with minor surgery. The risk is slightly higher during the initial surgery, but the quality of life afterwards is immensely better. This is not even an option for insurance-paid surgery here in the US. The slightly higher risk and higher cost of a longer surgery prohibits it. US hip replacement patients are always given cemented screwed hips, and told that they must not run or do anything hard, for the rest of their life. And that the hips will last for around 20 years.

    Another example is laser vision correction surgery, which was available in the Soviet Union and then in Europe long before it became available in the US. Yet the average American thinks it's an American invention not available elsewhere...

    And non-NSAID, non-opioid pain medications? There are several whole groups of medicines that have been successfully used in Europe for decades now that aren't available in the US, mostly due to lobbying from the existing drug producers.

    And people here in the US accept that crap? And think they have the best healthcare in the world?

    It sucks. It really does. For anything serious, I book a plane and go back to the country for which I still hold a passport. Because the service is so incredibly much better, focused on quality of life for the patients, and not maximizing profits and minimizing liability for hospitals and their marionettes.
    It's truly a world of difference, and not in favour of my new country.