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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.

9 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 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.

    3. 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 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"
    2. 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.

    3. 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)

    4. 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