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Author Topic: Democrats at least pretend to have a spine, it's a Christmas miracle!
scholarette
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On list prices- from the doctor's I have talked to, the 3rd party that pays is the one setting my price. For example, one doctor says when she agreed to take Cigna, Cigna came back and told her you will bill us $200 for this service. We will then negotiate down to $98 and the patient will then pay $15. Not a single price point was set by her (even the initial bill that they then negotiated). She could either take it or leave it. So if you have cigna, that is what she charges. Blue Cross might tell her you charge $209 and then negotiate to $99 and the pateinet pays $20. Her secretary keeps track of the insurance and their billing rate and that is just how it goes. Only when you have no insurance involved at all does she get to set the price.
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MattP
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quote:
Also, I think doctors should have to publish their price lists.
No physician actually charges a single price as the price varies (substantially!) between the negotiated rates of the several insurance networks that any given doctor is a member of. I had a recent surgery and have been privileged to view the statements for a wide variety of different services related to that. The insurance company price has varied 10-80% from the price billed by the physician, depending on the service.

Posting price lists might help some uninsured people shop around, assuming they know which procedures they need, but will have little effect on insurance companies or the insured, which is who the doctors really care about.

[ December 14, 2010, 01:25 PM: Message edited by: MattP ]

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The Rabbit
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quote:
Also, many people not getting health care actually end up increasing the cost when they do need health care. Biggest example- a diabetic patient can be effectively treated for very cheap.
While it seems logical that covering everyone will be more expensive than covering only some people, it isn't that simple. The current US medical care system is so incredibly inefficient from a cost perspective, that it would not be difficulty to cover everyone and reduce the overall cost of health care. In fact, every other developed country in the world is able to cover all their citizens for a per capita cost that is a fraction of what we pay in the US.
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CT
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Yes to [all three] posts above.

[Regarding the top 2 posts on the page:] And there are additional restrictions that are harder to see: e.g., if you accept payment for seeing patients on Medicaid and/or Medicare, there are put into place other restrictions on what you can and cannot charge at least some non-Medicaid, non-Medicare patients.

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katharina
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It would take time - a great deal of time - to get rid of the inefficiencies. In the meantime, 315 million people would be on the inefficient system. That is an enormous amount of money.

------

I'm aware of the way the cost system currently works. It stinks. That's why costs go up. Moving to a published price list would get rid of that tiered system where health care costs wildly different amounts depending on who you are and how much money you have. Getting rid of that system is EXACTLY why I want published cost lists.

Chase away the inefficiences with a little illumation! Transperency is desperately, desperately needed here.

----

Redoing health care means changing EVERYTHING. If you aren't prepared for the amazing immediate costs and you aren't prepared to change everythign about the system, then advocating for change is irresponsible. Changing completely will cost a lot, but changing only the payer and not everything else is a disaster and deserves to be opposed.

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dabbler
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I haven't found useful statistics yet about the cost of a given illness with versus without health insurance (such as diabetes), but I did come across the Agency for Healthcare Research and Quality page for Healthcare cost research. Good place to start browsing if you want to see what epidemiologists, statisticians, and other researchers suggest are the problems and solutions.
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MattP
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quote:
Moving to a published price list would get rid of that tiered system where health care costs wildly different amounts depending on who you are and how much money you have. Getting rid of that system is EXACTLY why I want published cost lists.
So what you are really asking for is that care providers be required to charge one price for a given service. I still don't see how this would help, other than perhaps saving the uninsured some money by getting them access to insurance company rates. As for overall costs though, the insurance companies already know what all the prices are so there would be no improved transparency to them, while the "true cost" of healthcare to us end-users is still hidden in our employer-provided, tax-deductible, benefits package.
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CT
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It is useful sometimes to look at what has and hasn't worked elsewhere. I am not saying there is an equivalency, nor that any given system's experience will tell us what would happen if the same changes were applied in the US.

However, the experience in Canada was that a switchover to universal coverage was feared in many quarters, fraught with problems, and required serious intervention to succeed. The physicians in Saskatchewan, the first province to institute full coverage, went on strike in 1962. The physicians went on strike, and the Prime Minister had to fly in physicians from other provinces to continue healthcare services.

Now all provinces have full coverage programs, and the majority of physicians in Canada (by far) support this. However, Canada was not always on a universal system, nor was it a straightforward process to switch over. Quite the contrary.

I think the necessary discussions have begun in the US. I think there is a lot of conflict ahead. I don't think we will (or could, even if we tried) repeat the Saskatchewan experience, but I'd rather learn from it what we can, even if that is just that there may be more resistance to certain proposed changes than may have been expected. Knowing that may mean different outcomes should be prepared for, and it may guide such things as dissemination of information.

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katharina
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MattP:

Not necessarily only one price. But people deserve to know that their insurance is higher this year because doctors charge more to treat them than their neighbor.

If tiered pricing is okay, shine a light on it.

I bet it won't be as okay with people once they know. Not only do they have to pay into Medicare for health care for other people, but their own health care costs them even more than it would if they were on Medicare. So the people who are actually working are subsidizing Medicare not only with direct taxes, but by paying higher prices at the doctors' offices.

If the system can't tolerate illumination, that's an even bigger reason to provide the illumination.

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dabbler
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As a psychiatrist, I don't have a problem with it. I believe it's currently against the health insurance contract that a physician signs with the health insurance to publish their rates. A patient knows how much their health insurance reimburses the physician, the physician's public rate, and their copay. But a physician currently isn't allowed to tell the patient that Insurance B, which they also take, reimburses them X instead.

Transparency is good. I think the biggest bang for the buck though, is going to be the transparency in service cost. A patient in the hospital yesterday received a comprehensive drug screen because of a possible overdose. A medical student asked if we should repeat it today. It's not medically indicated, so we aren't doing it. What the student, most physicians, and the patient don't know is that the test costs about $1000. Medication A costs $50, medication B costs $300. A physician should have the information easily accessible to talk about the pros and cons of these medical decisions with the patient. I think it's something missing from the informed consent process.

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katharina
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Yes, to everything in your last paragragh. Stick a dollar figure on all of it. No wonder costs outstrip inflation every year - the costs that figure into inflation are transparent, and medical costs are hidden. Of course things get more expensive if the costs are not subject to market forces.

And consumers should be able to know what their costs is compared to what it would be if they got insurance from a competitor.

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scholarette
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Except I do know what my cost would be if I got insurance from a competitor- at least on a vast majority of things. My copay is going to be X at Cigna and y at blue cross. Whether my dr gets $50 or $100 doesn't actually affect that. My copay is still x. I suppose if your insurance does things as 90% versus copay, it would matter but most give copays. Even a hospital stay on my new one is a flat fee. Though I believe that is because it is an HMO while a PPO is different
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CT
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There is some interesting reasearch on what factors seem to consistently make a difference in healthcare consumers' choices. As I recall, some of the findings were counter-intuitive.

A lot of this work was done by large provider organizations (such as Kaiser Permanente, IIRC) to try to figure out how to distinguish between what they thought would help and what actually helped people be more informed.

At a certain point, for example, more information was counter-productive. Information overload. People started making decisions effectively randomly, and when interviewed qualitatively, said things like "it was toomuch information, so I didn't look at any of it. I just did what my colleague did."

Doesn't mean that transparency isn't the best principle, but be aware of possible unintended consequences.

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fugu13
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I realize the conversation has moved on, but there's something that needs correcting.

quote:
As it currently stands, estimates say Social Security is set to be gone by 2042 unless something drastic is done.
This is completely false. The 'trust fund', which is just a long period of small surpluses saved up due to there being a large paying population (the baby boomers), will be gone in 2042-ish, ceteris paribus. That's not anything like the same as social security being gone. Social security is not a savings program. Money is taxed from a broad, employed population base, and immediately distributed to the smaller retired/disabled/etc population in higher concentration. When there's a surplus, that can be used to handle deficits in later years (what will soon be happening). However, if there's no remaining surplus and a deficit comes along, all that means is the benefit formula (eligibility, means testing, et cetera) needs to be adjusted. It would only take a few minor, though politically hazardous adjustments to bring social security again into balance around the time of 2042 (though the adjustments should be pursued gradually, postponing that date).

In other words, you're right on track to having social security benefits in 2048 or a few years after (depending on eligibility adjustments). Social security will not have been gone in 2042, and that is a lie perpetuated by people who find it politically useful, which is the sort of thing you would be well advised to research before repeating.

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katharina
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quote:
My copay is going to be X at Cigna and y at blue cross. Whether my dr gets $50 or $100 doesn't actually affect that.
When your insurance pays your doctor, they aren't taking the money from thin air. It all comes from you eventually. Your copay is your immediate cost, but you pay for the total cost through your premiums.

Insurance companies don't manufacture money. There is no magic health care tree that pays for what you don't see. All those costs do eventually get paid for, and it is either the end customer or else the taxpayer.

-----

Social Security is a Ponzi scheme - there's the lie that it is forced savings, but it isn't. There will be something at that time, but the benefits we are paying for today will NOT be available to us later.

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MattP
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quote:
When your insurance pays your doctor, they aren't taking the money from thin air. It all comes from you eventually. Your copay is your immediate cost, but you pay for the total cost through your premiums.
Well sure, but no one is going to look at the price list and say "Hey! A check-up cost $200 this year and it cost $100 last year, I'm going to leave my free employer-provided healthcare and pay $1500/month to get my own plan."

Alternately you can complain to your HR department, who is going to go with the best package they can get for the money irrespective of how much providers are payed, or the insurance company, who you aren't really a customer of in any meaningful way, or your doctor, who will probably tell you that the price was set by the insurance company in the first place.

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Destineer
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Another suspect line from that Geraine post:

quote:
My 401(k) however has grown over 13% a year for the past 4 years I've been contributing at my current job.
This account made over 13% returns in 2008? The year the S&P had an annual return of -37%?
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scholarette
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MattP responded better than I could. [Smile]
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katharina
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I honestly don't understand why people are DEFENDING hidden pricing. You prefer a system where the true costs are kept under wraps? Why??

--------

A good start, better than expand-the-welfare-state-without-changing-the-fundamentals we got this year:

1. Exchanges where the types of policies are put in categories and there is an easy comparison between policies.

I participate in one of these - companies who want to offer health insurance to federal employees have to put their offerings into the exchange. There are dozens of options, they are easy to compare, and you can switch every year.

It works fantastically. That should absolutely be available to everyone. As soon as possible.

2. Clinics publish their pricing. They can keep it tiered if they want, but why needs to be clear. So people who want just catastrophic insurance (which they can pick off the exchange) because it's cheaper for them to pay for a few doctor's visits per year can actually run the numbers.

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Raymond Arnold
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I certainly think transparency is better. But I think the point they're making is that when the system is as complex as the one we have now, transparency simply isn't going to help much.
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katharina
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Keeping costs hidden certainly makes things worse. Why on earth someone who doesn't have a financial stake (and there are many who do, which is why costs are hidden) prefers a system where their money is spent without oversight to costs , I do not understand.
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dabbler
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And honestly, the payment given to a physician for a check up is such a miniscule part of the health care system. Sure, do it. But its not going to make a big difference numbers-wise. Procedures, yes, you'll find a much bigger impact. Knowing that the opthalmologist will get paid $5000 for that cataract surgery (I made up the number) from Insurance A, versus $3800 from Insurance B could make a big difference if people switched from Insurance A to B. But also there's a LOT more going into the quality of Insurance A versus B besides their reimbursement to doctors. What % is taken in profit? How much overhead for staffing to deny or process claims? How many hoops does your PCP have to go through to get something approved? What number and quality of doctors take your health insurance? Does your hospital? If Insurance B really does reimburse that poorly, that awesome surgeon may just opt out of taking that insurance all together. You get to see a different one, but it may not be the one with the fewest complication rates.
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Raymond Arnold
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I don't think anyone's arguing it's BETTER to keep things hidden. They're just arguing that when the cost/difficulty of switching insurers outweighs the extent to which they screw you over on individual things, knowing exactly how you're getting gouged doesn't help. Because you can't do anything about it.

I'm still on parent's insurance and I don't know enough to really comment on whether that's accurate. But that's what the actual argument is, not "transparency is worse."

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MattP
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I'm not defending hidden pricing. Just pointing out that there's not an obvious substantial benefit to posting price lists. I think it's fine to do it, but like the booklets of nutritional facts available from major fast food chains, most people aren't going to care.

At least with the nutritional data for fast food you can make an immediate choice based on the data. If you are in an employer-provided healthcare plan and your doctor's fee for service X *seems* too high, then what? Do you really care if you've got a $10 copay regardless of the fee. Even a 10% copay would require pretty substantial price differences for me to leave my family doctor for a better deal.

A public price list is only useful when individuals are actually shopping around for treatment based on cost. This means uninsured individuals and, to a lesser extent, people on high deductible HSA plans. (I'm on one of these plans, but it's associated with a major insurance network so the price is the same across providers anyway.)

ETA: I don't know, but suspect, that pricing for basic services like checkups and x-rays are pretty consistent across the board because there is already competition between insurance companies and they are aware of what other companies are paying. Where there is likely to be disparity is in special services related to emergent conditions.

Given that assumption, I don't think there will be a lot of surprises or market effects as a result of posting prices for basic services and it would be impractical to read a complete list of the hundreds of unique services billed by a given doctor or the thousands provided by a hospital. How in the world would a healthy person make a useful distinction between insurance carriers by knowing what they would pay for chemotherapy or angioplasty?

Such a price list, again, only make sense in a world without insurance, or with a dramatically different type of insurance than we have now.

As long as our insurance plans just pay for whatever we need, we won't generally care about the billed cost of a service any more than we worry about wrecking into a Lexus instead of a Ford even though that Lexus wreck is more likely to contribute to higher premiums in the future than the Ford wreck.

[ December 14, 2010, 04:23 PM: Message edited by: MattP ]

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scholarette
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The other problem is health isn't really something you shop around for. If I need surgery, how much I can negotiate is pretty limited by the fact that I need it. this is my life. Price comparison is pretty limited.
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CT
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I'm happy to have transparency, but it wouldn't be a price list. If it were precise enough to be accurate, it would be a snarl of a flow diagram. With special Venn diagram foldout!

Which is okay, but likely not as useful as one might hope. And, as I noted about, too much information can be counterproductive. Just know that you may end up making things worse, depending on how the informaiton is presented.

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katharina
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Neither of those things make sense to me:

1. I certainly do care that a Ford costs less to wreck than a Lexus. How much a car is going to cost in insurance is absolutely a factor in the decision-making car-buying process.

2. I may not be able to negotiate that I need a heart bypass, but if the prices were posted, I could weigh the cost of having it done at which of the three hospitals in town, or the cost of a trip to Houston with its larger number of medical centers versus staying in town. There is a great deal of room to negotiate.

For most people, buying a car isn't particularly negotiable, but that doesn't mean we'd be better off if no one listed car prices.

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MattP
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quote:
Originally posted by scholarette:
The other problem is health isn't really something you shop around for. If I need surgery, how much I can negotiate is pretty limited by the fact that I need it. this is my life. Price comparison is pretty limited.

That and at the moment it's determined that you need surgery your insurance company mobility is zero. The only way to switch to a different company would be to switch from one employer with a group plan to another employer with a group plan with a different carrier. That's impracticable to the point of ridiculousness.

If you're uninsured then price lists may help, but in my experience you can call different providers and get their prices already. We've been doing that just today so we can weigh when and where to get a dental surgery done for one my children which isn't covered (much) by our insurance.

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katharina
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[quote]in my experience you can call different providers and get their prices already.[quote]

Not even remotely in my experience. I called ten different doctors last month trying to get a quote on a simple procedure, and all ten just tried to get my insurance information and get me to come in for an office visit before quoting a price.

Dentistry is different - because lots of people don't have dental insurance. But for medical doctors? They got downright offended when I asked for the price of an office visit off the street, not even to mention the cost of simple procedure. Very irritating. I'm even more advocating for public pricing than I was before.

You have found benefit in being able to comparison shop for dental surgery. Why should gallbladder surgery be different?

And yes - it would change the system. THAT'S THE POINT. What is untenable is changing nothing of the system and trying to convince the government to get someone else to pay for it all. Not going to happen, and it shouldn't. The system absolutely should be changed, and public pricing should be part of it. It would be both a consequence and a driver of change, and that's the point.

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katharina
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quote:
only way to switch to a different company would be to switch from one employer with a group plan to another employer with a group plan with a different carrier.
Did you even read my post above? Set up exchanges where people can switch health care companies without changing employers - it can happen. It happens now. That's what my employer does, and it works great. And then have doctors and hospitals publish pricing.

Those two things alone would go very far to reign in the monstrous inflation connected to health care costs.

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MattP
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kat,

quote:
1. I certainly do care that a Ford costs less to wreck than a Lexus. How much a car is going to cost in insurance is absolutely a factor in the decision-making car-buying process.
The analogy here is to which car you're going to crash *into*, not which car you are driving. The bigger ticket healthcare items are the emergent situations. Not the check-ups and bloodwork.

quote:
2. I may not be able to negotiate that I need a heart bypass, but if the prices were posted, I could weigh the cost of having it done at which of the three hospitals in town, or the cost of a trip to Houston with its larger number of medical centers versus staying in town. There is a great deal of room to negotiate.
This is only the case if you don't have insurance. For everyone else the cost is a non-issue because the most individually cost-effective option is to get the surgery done at one of the in-network providers, all of which will charge the same amount.

I agree that posting price lists could be beneficial to people that don't have insurance. I just don't think those people are market drivers.

ETA: Another complication to the "post a price list" - most physicians that I know will give need-based discounts, which render even their "standard" prices as just rough guidelines.

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katharina
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I disagree with all of that - you keep defending hidden pricing by saying that under the current system, open pricing wouldn't matter. I'm telling you that's because the current system is broken and a single payer is not the only option to fix it. That open pricing doesn't fit with the current system is the exact point.

We ought to at least give the free and open market a shot. It's done a wonderful job of lowering costs for just about everything else.

quote:
most physicians that I know will give need-based discounts, which render even their "standard" prices as just rough guidelines.
Open pricing won't stop doctors from giving need-based discounts. That's not an argument against.
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scholarette
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For price listing to matter, you first need to change the system. Listing prices would not be the way to change the system.
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CT
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quote:
Originally posted by katharina:
... Set up exchanges where people can switch health care companies without changing employers - it can happen. It happens now. That's what my employer does, and it works great. And then have doctors and hospitals publish pricing.

Those two things alone would go very far to reign in the monstrous inflation connected to health care costs.

Where this has been studied and tracked specifically in the actual healthcare market, rather than in theory, the latter has had no significant effect on pricing. To claim it would go very far to rein in matter is, I think, a clear overstatement.

For example, see the California experience. The Assembly Bill 1627.54 from 2003 required most hospitals to make pricing accessible onsite, with average costs of 25 specific Diagnosis Related Groups available online by 2006. There has been no significant price change correlating with that data since then.

In other, smaller tests, sometimes it makes a difference: sometimes lower costs, sometimes not. But most of the data out there is based on extrapolations from outside the healthcare environment. It doesn't necessarily translate, and the best data we have says that it does not.

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MattP
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quote:
you keep defending hidden pricing
Again, I'm not defending anything. Show me one single sentence where I've indicated that hidden pricing is good or stop saying that. All I'm saying is that price lists do not a free market make nor are they likely to have a substantial effect on prices until insurance mobility is ubiquitous - not just available for some people in some places.
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CT
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quote:
Originally posted by MattP:
quote:
you keep defending hidden pricing
Again, I'm not defending anything. Show me one single sentence where I've indicated that hidden pricing is good or stop saying that. All I'm saying is that price lists do not a free market make nor are they likely to have a substantial effect on prices until insurance mobility is ubiquitous - not just available for some people in some places.
Ditto for me. And I worry about unintended consequences as noted above. That isn't a reason to hide pricing, but it is good reason to publish it in a layered way, so that someone who wants more details can find them, and someone who does not want details can still pick out the forest from the trees.
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kmbboots
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Maybe I am just not understanding and a scenario would help.

Let's say that John has insurance through the Smith Insurance company. John works for a company large enough to have some options so he could change to Jones Insurance Company in February.

In July John gets appendicitis. Smith Insurance has an agreement with Hospital A that charges $10,000 for a surgeon to perform an appendectomy, $5,000 for the anesthesiologist, $4500 for the use of the operating room, $4000 each for the operating room nurses, $1600 per day for staying in the hospital, $400 for the various drugs John needs. (Obviously these prices are entirely made up and there are lots of costs I am omitting.)

Hospital B is a little further away and doesn't have an agreement with Smith Insurance. They charge $25,000 for the surgeon, $$9,000 for the room and so forth. The anesthesiologist has a deal with Smith so they only charge $1,000.

Hospital C is even further has agreements with both Smith and Jones and charges $8,000 for the surgeon, $3,000 for the anesthesiologist, $2,000 for the room and so forth.

The cost to John (deductibles and co-pays and so forth) are the same at Hospital A and Hospital C. John can't afford Hospital B at all.

How does knowing the prices help John?

If this scenario isn't what you have in mind, I would be glad to consider a different one.

[ December 14, 2010, 05:23 PM: Message edited by: kmbboots ]

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Orincoro
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quote:
Originally posted by katharina:
This isn't to say that I'm opposed to socialized medicine.

But if it happened, it would be enormously expensive, it would be paid for by the people who have and are generally happy with their health care, and it would require massive tax increases. If we are going to debate the proposition, I'd rather do it with a true idea of the costs. It would cost.

I've been asleep for most of the debate, but I want to come back to this point to make my own. Yes it would cost. I don't want to give the impression that I don't think it would.

*However.* Health care now accounts for some 15%-17% of GDP, and the current system also bears an economic cost in inefficiency (for instance, due to debt and lack of liquidity among the uninsured, as well as lost work due to lack of preventative care) which pushes the total cost above even that figure. In most industrialized countries, the cost is well below 10%. So while I've seen you make this point many, many times, I don't see why you don't pay more attention to that factor. The point really is to lower the overall costs, and shifting the costs from an ineffective private system, one in which freelance working people like me are unable to obtain satisfactory coverage, to a tax based system could achieve that. If your taxes go up 4%, but your health care costs go down just as much, or if the productivity of the overall economy is increased to compensate for that cost, what's the issue? Do you just believe that can't be done? Are the examples of it being done in other countries not good enough?

In all this, you constantly return to the fact that you and others are happy with their current health care situation. Bully for you. But this is a systemic problem- and the fact that you personally are happy already comes at the cost of many people who are not, and who have much reason to worry about their future in this regard.

quote:
People use whatever is available - be it energy, health care, food, everything. If unlimited health care is available for everyone, then it will cost an enormous amount of money and people use what they need and more. There's no getting around that.
It's free to call the cops. Do you call them all the time? If not, why not?

In this country, as an example, extremely nominal fees for service have had an enormous effect on this type of abuse. We have a public-backed option model, where seeing a specialist costs the insured approximately $1.50. In a country where people will go to the doctor at the drop of a hat, the percentage of GDP spending is in line with the industrialized world standard at about 9%. A real life example of your theory not working out. Sometimes I just suspect you think very little of the morality of poor people.

quote:
We ought to at least give the free and open market a shot. It's done a wonderful job of lowering costs for just about everything else.
Health care is unlike any other commodity. Simple explication: the value of an antibiotic course today, for me, is zero dollars. I don't have any infections. The value of an antibiotic course a year from now, when I life threatening pneumonia, is my entire life savings. Is there another commodity that functions that way, that you can think of? That's why we have insurance markets, and insurance markets *require* regulation. That is, if your goal is to make health care available to everyone. Describe to me another commodity that functions in that way, and I'll listen. I can't think of one.

[ December 14, 2010, 05:47 PM: Message edited by: Orincoro ]

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MattP
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Even for those of us who are happy with our current situation, it's not a sustainable situation. As long as health care costs are rising at their current rate even our cushy employer-provided plans aren't going to survive for long. Its notable that wages have been stagnant for quite some time, largely because of rising healthcare costs. So while we may be "happy" with our insurance, we really should be pissed off at what's happened to our take-home pay.

And that's just my selfish view of things. When I start considering the non-salary worker, small business person, self-employed, unemployed, etc. it's much more bleak.

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dabbler
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kmmboots, the problem is that there's also the layer of what the cost will be to the patient.

Insurance 1:
You pay $300 a month, your work pays $300.
Hospital A gets paid $25,500
You get charged $1000 deductible

Hosp B would get paid ~40,000
You would get charged $2000 because it's out of network

Hosp C would get paid $25,500
You get charged $500 deductible because it's preferred network.

Insurance 2:
You pay $250 a month and your work pays $250.
Hosp A gets paid $27,000
You get charged $1200

Hosp B gets paid $45,000
You get charged $2500

Hosp C gets paid $24,000
You get charged $1200

Insurance C:
You pay $350, your work pays $300

Hosp A gets paid $26,000
You pay $500

Hosp B gets paid $32,000
You pay $750

Hosp C gets paid $20,000
You pay $750

If you're deciding based on what the hospital would get paid, you might go for the last option. If you're deciding based on how much you pay, you might pick a different option. Who the hell knows.

Again, I think it's fine to have that information available but I want to stress that it's currently the health insurance companies that are restricting that information, not your physician.

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kmbboots
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Dabbler, right. I was oversimplifying and even then it was too complicated. And even in your scenario, "Hospital A" is generally not one lump sum entity but many charges to different people/groups some of which may be on your insurance and some of which may not.
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katharina
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quote:
Originally posted by Orincoro:
quote:
Originally posted by katharina:
This isn't to say that I'm opposed to socialized medicine.

But if it happened, it would be enormously expensive, it would be paid for by the people who have and are generally happy with their health care, and it would require massive tax increases. If we are going to debate the proposition, I'd rather do it with a true idea of the costs. It would cost.

I've been asleep for most of the debate, but I want to come back to this point to make my own. Yes it would cost. I don't want to give the impression that I don't think it would.

*However.* Health care now accounts for some 15%-17% of GDP, and the current system also bears an economic cost in inefficiency (for instance, due to debt and lack of liquidity among the uninsured, as well as lost work due to lack of preventative care) which pushes the total cost above even that figure. In most industrialized countries, the cost is well below 10%. So while I've seen you make this point many, many times, I don't see why you don't pay more attention to that factor. The point really is to lower the overall costs, and shifting the costs from an ineffective private system, one in which freelance working people like me are unable to obtain satisfactory coverage, to a tax based system could achieve that. If your taxes go up 4%, but your health care costs go down just as much, or if the productivity of the overall economy is increased to compensate for that cost, what's the issue? Do you just believe that can't be done? Are the examples of it being done in other countries not good enough?

In all this, you constantly return to the fact that you and others are happy with their current health care situation. Bully for you. But this is a systemic problem- and the fact that you personally are happy already comes at the cost of many people who are not, and who have much reason to worry about their future in this regard.

quote:
People use whatever is available - be it energy, health care, food, everything. If unlimited health care is available for everyone, then it will cost an enormous amount of money and people use what they need and more. There's no getting around that.
It's free to call the cops. Do you call them all the time? If not, why not?

In this country, as an example, extremely nominal fees for service have had an enormous effect on this type of abuse. We have a public-backed option model, where seeing a specialist costs the insured approximately $1.50. In a country where people will go to the doctor at the drop of a hat, the percentage of GDP spending is in line with the industrialized world standard at about 9%. A real life example of your theory not working out. Sometimes I just suspect you think very little of the morality of poor people.

quote:
We ought to at least give the free and open market a shot. It's done a wonderful job of lowering costs for just about everything else.
Health care is unlike any other commodity. Simple explication: the value of an antibiotic course today, for me, is zero dollars. I don't have any infections. The value of an antibiotic course a year from now, when I life threatening pneumonia, is my entire life savings. Is there another commodity that functions that way, that you can think of? That's why we have insurance markets, and insurance markets *require* regulation. That is, if your goal is to make health care available to everyone. Describe to me another commodity that functions in that way, and I'll listen. I can't think of one.

People who have more coverage use more health care services. The same people on basic Medicare versus Medicare Advantage - the people on Medicare Advantage have more tests, go to the doctor more often, stay longer in hospitals. Health care is more than a course of antibiotics. It's a decision of whether to see a doctor if you pull a muscle running. It's that second opinion. It's another MRI. It's rerunning the tests to make sure. It's going to the doctor on the fourth day of a cough. There are many, many places where, if health care is perecieved to be costless to the consumer, the consumer uses more health care.
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katharina
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What about the people with no insurance? But there are other situations where people might choose to have catastrophic insurance and pay for the regular care out of pocket. True insurance - it's there in case of a disaster, but it isn't meant to be a maintenance thing. Like car insurance, which pays for a fender bender but not for an oil change.

Or if someone has an enormous deductible - if the first $5000 comes out of pocket, I would certainly hope people would care how efficiently that $5000 is spent, so in most years, they don't even have to reach that number.

Open pricing would be such a great thing. When coupled with true exchanges where the insurance company isn't chosen by HR but the consumers get to pick from a selection, it would go far to reign in costs. It would be part of a great solution - why wait to do it last? If you are fixing something, why not do the good, easiest-in-comparison stuff first?

I think it would actually change the system - if people could actually get a good idea of what thigns were costing, then there'd be more honest conversations about the cost of it and it would be miles easier to make comparisons and cost/benefit analyses. Those are nothing but good when you are choosing where to allocate resources.

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CT
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quote:
Originally posted by katharina:
There are many, many places where, if health care is perecieved to be costless to the consumer, the consumer uses more health care.

There is research on this as well. The amount of cost at which people seem to curb their unwarranted usage is quite small, as Orincoro noted. Above that, there is little effect on usage.

dabbler and kmboots, to your rapidly-expanding model, add the factor of outcomes measures. Just knowing the cost (in matters of healthcare) is not enough, and it can be misleading. This isn't like buying a car, where the car you buy from Place A is pretty much like the same make and model you buy from Place B.

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CT
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quote:
Originally posted by katharina:
Open pricing would be such a great thing. When coupled with true exchanges where the insurance company isn't chosen by HR but the consumers get to pick from a selection, it would go far to reign in costs.
...
I think it would actually change the system ...

I know you think it would actually change the system. When it has been tried and evaluated, that doesn't seem to be the case. I think better assessments are made based on what actually seems to happen with a given change, rather than what we believe will or ought to happen, contrary to the facts -- at least, when that information is available.

Again, I'm not arguing that costs should be hidden. I am trying to figure out why you still believe so strongly that something would happen when, in fact, it didn't.

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kmbboots
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If John has no insurance, it would make sense for him (in my scenario) to choose Hospital C if the ambulance will take him there. Unless it is cheaper because it is not as good. Or there isn't enough time to get to the furthest away hospital.

Unless he only thinks he has appendicitis. Hospital A charges $450 test and Hospital C charges $600 for that test. If it is a gall bladder, the surgeon at Hospital B is cheapest but he drinks.

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CT
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katharina, I think I'm pressing too hard and too directly. As you can probably tell, this is an issue that weighs on my mind a lot, and I get chompy at the bit about it. But I do not mean to be uncivil, and I'll drop it for just a bit.

[ December 14, 2010, 07:40 PM: Message edited by: CT ]

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dabbler
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(Ack: to CT's post a couple posts up, not the most recent one) Definitely, CT. It's a very very complicated scenario.
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CT
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quote:
Originally posted by dabbler:
(Ack: to CT's post a couple posts up, not the most recent one) Definitely, CT. It's a very very complicated scenario.

(Billions and billions! [Wink] Which isn't to say that there isn't much to be done, of course.)
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Geraine
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quote:
Originally posted by Destineer:
Another suspect line from that Geraine post:

quote:
My 401(k) however has grown over 13% a year for the past 4 years I've been contributing at my current job.
This account made over 13% returns in 2008? The year the S&P had an annual return of -37%?
Yes, 13% return. Do you know a lot about the stock market? A negative return as a whole =/= everyone lost money. There are people that made millions in profits in 2008. Over 50% of my 401(k) contributions are invested in foreign stocks, which helped my return rate.

The way things are going right now, I'm almost tempted to buy stock exclusively in Chinese owned entities. Maybe I'll buy some US Bonds [Razz]

Fugu, perhaps you should read up on the so called "Social Security Trust Fund" you defend before you post about it. I think you are confused about how it works.

It works like this:

You pay your OASDI tax from your check. Your employer pays his share. The Treasury receives the money and holds onto it until it is paid out as a benefit or otherwise spent by the government.There is no actual account the money is deposited into. The trust fund is in fact nothing but an accounting mechanism. The treasury credits the SS trust fund with the money, and then they deduct the amount paid out. The rest of the money is converted into Treasury Bonds, which are nothing but IOU's. The government then takes that money and spends it on whatever they want. Boats, aircraft, botox for Nancy Pelosi, etc.

For example, in 2003 the Treasury received about $544 billion in taxes and paid out $406 billion in benefits. The rest of that money that was collected isn't sitting in a trust fund somewhere. It was spent by the government , with an IOU in it's place.

The trust fund shows how much the government has BORROWED from Social Security, not how much is available for future benefits. The Office of Management and Budget under Clinton even said that they are not real assets, and that the only way to finance these IOU's will be to raise taxes or cut benefits.

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