[HN Gopher] White House wins ruling on disclosing health care pr...
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White House wins ruling on disclosing health care prices
Author : gscott
Score : 171 points
Date : 2021-01-01 11:49 UTC (11 hours ago)
(HTM) web link (apnews.com)
(TXT) w3m dump (apnews.com)
| rblatz wrote:
| I suspect that we will find out that insurance isn't paying much
| at all for most health care procedures, and the bulk of the cost
| is payed by the patient.
| paledot wrote:
| This is true. My wife paid out of pocket for a procedure that
| should have been covered, and when she finally made it through
| the labyrinthine process to seek reimbursement, they only
| wanted to reimburse her for half of the cost, because that's
| the negotiated price the provider would have paid the hospital.
|
| In case you were still a bit unsure if the entire American
| health care system is irreparably broken or not.
| wasdfff wrote:
| Few people incur north of their 10k deductible in medical fees
| a year, but nearly everyone pays for something every year out
| of pocket.
| coredog64 wrote:
| As someone else has already pointed out, ACA imposes an 80%
| medical loss ratio on insurers. That means 80% of premiums have
| to go towards medical expenses.
|
| Insurance is a financial product, and there will be winners and
| losers. I pay my auto insurance bill on time and without a
| complaint even though I haven't had an accident in 20+ years.
| maxerickson wrote:
| My billing statements always include the insurance portion and
| the patient portion. Could be a Michigan law. The bills also
| include the billed price and the covered price (so the portion
| that they 'negotiate' is also on there).
|
| It would be big news if the amounts they said they paid weren't
| actual payments.
| jtbayly wrote:
| That's after the fact, though. You don't get to see any of
| those numbers until it's too late to matter.
| maxerickson wrote:
| It matters in the sense that the payments made by the
| insurance company are already transparent; the other poster
| is speculating that it will be revealed that the patient
| portion is larger than the insurance portion, which people
| in (at least) Michigan already know isn't the case.
| jtbayly wrote:
| I didn't read the grandparent the same way, but that
| makes sense.
|
| Still, I don't think it's accurate to say that the prices
| are transparent when you can't find them out without
| first signing away an unknown amount of your own money.
| maxerickson wrote:
| Sure, it's not price transparency, it's payment
| transparency (which I don't think is a redefinition of
| anything I've said above).
| nerdponx wrote:
| This I believe is standard practice at major insurers. It's
| called an "explanation of benefits" (EOB), and I have always
| been able to see them easily on my insurer's website.
| MeinBlutIstBlau wrote:
| The one that stands out most to me is having to disclose what we
| need to pay in cash if we choose. Not that any of this is really
| going to change any pricing, but hopefully it's just another step
| towards single payer.
| zoomablemind wrote:
| > "... A separate regulation that applies to insurers has not
| been finalized."
|
| This part of the puzzle is still missing. IIRC the providers are
| required to use patient's insurance (and the associated prices),
| when patient does have an insurance. So, for example, if cash
| price is lower, than the effective negotiated price (factoring in
| the deductible and copay), one would still be required to pay the
| insurance-based price. Granted, in most cases patient would have
| no idea about what are those prices are until getting the bill.
| Hopefully, this part will get more transparent.
|
| This is especially noticeable with the high-deductible plans
| available under ACA.
|
| It's getting harder and harder to clearly see the interests of
| providers and those of insurers separately from each other.
| Especially with the recent consolidation in the healthcare
| sector.
| nojito wrote:
| It's a clever success of the insurer lobbying effort. They have
| successfully convinced the US that it's the hospitals that are
| the problem not the insurers who control the revenue streams of
| hospitals.
| [deleted]
| maxerickson wrote:
| For most insured, payments that go towards the deductible make
| more sense than payments that don't, even with a fairly large
| difference in price.
| jesterpm wrote:
| That really depends on the individual/family. Most years our
| costs are much closer to zero than to our deductible.
|
| In our case, specificly, the only exceptions have been things
| know significantly in advance where it would really be
| practical to be able to shop around.
| maxerickson wrote:
| Yes of course it depends on the size of the deductible and
| predictability of spending.
|
| Average deductible is ~$1700, at that point the differences
| either need to be huge, or additional spending needs to be
| very predictable.
|
| Source for $1700: https://www.kff.org/health-costs/press-
| release/benchmark-emp...
| someguydave wrote:
| Indeed, I think insurance and health providers collude to jack
| up prices. "Saving" a heavily inflated price makes the
| insurance look good. The provider can use the high prices as a
| bludgeon against the uninsured.
| jb775 wrote:
| Probably more-so collusion between health providers and
| medical equipment companies.
|
| As long as the insurance company isn't losing money between
| total paid premiums minus total claims, they don't have any
| incentive to care about overcharging. Artificially high
| medical prices do however work to their advantage during
| claim negotiations with health providers (e.g. "We know that
| piece of plastic you charged $1000 for only cost you $10, how
| about we give you $200").
| eyeball wrote:
| n=1, but I've sat in the room in contract renewal
| negotiations between a big insurer and a hospital.
|
| There was no collusion, it was two sides that nearly hate
| each other arguing over rates. Hospital wanted more, insurer
| wanted to pay less.
| chadash wrote:
| I can imagine this being true at a micro level. But at a
| macro level, Obamacare has a rule that insurers can have a
| maximum profit margin of 20%. So you have two ways to
| increase profits in the long run:
|
| 1) Increase number of subscribers. Possible to do, but the
| market is pretty saturated.
|
| 2) Raise prices of healthcare overall. 20% of larger costs
| is more than 20% of smaller costs.
|
| Intuitively, lowering costs would seem to be a money-making
| proposition, but if you are already at the 20% margin, it
| doesn't actually help you.
| matwood wrote:
| Correct. I received a refund check from my insurance
| company this year because they did not spend 80% of
| premiums on healthcare.
| m16ghost wrote:
| >Obamacare has a rule that insurers can have a maximum
| profit margin of 20%. So you have two ways to increase
| profits in the long run:
|
| >1) Increase number of subscribers. Possible to do, but
| the market is pretty saturated.
|
| >2) Raise prices of healthcare overall. 20% of larger
| costs is more than 20% of smaller costs.
|
| The 20% profit margin also has to cover the insurer's
| operating expenses. After covering the costs, an insurer
| typically makes 2-3% in profit. Also, the insurance
| industry in aggregate is typically paying 85%-86% of
| premiums as medical services, so they still have
| incentive to negotiate prices with hospitals[0].
|
| The insurance industry is likely to make a greater profit
| in 2020 due to the pandemic. Consumers have deferred a
| lot of their medical procedures, but their premiums have
| stayed the same.
|
| [0]https://content.naic.org/sites/default/files/inline-
| files/20...
| macinjosh wrote:
| > The provider can use the high prices as a bludgeon against
| the uninsured.
|
| While I am sure that happens, my experiences in that past of
| being without insurance most places gave me a discount for
| paying in cash. Up to 30% at some clinics. This is especially
| true for smaller providers as dealing with insurance
| companies was a huge time and resource suck so they preferred
| cash patients.
| r1b wrote:
| There's a lot of detail here
| https://www.federalregister.gov/documents/2019/11/27/2019-24...
| williesleg wrote:
| Why not? They know their prices, hospitals are in business to
| take as much as they can, and by having insurance pay they'll
| gouge as much as they can, and now their true prices are coming
| out. To competition and freedom!
| rtkaratekid wrote:
| This was not in my radar, but strikes me as really good news for
| American healthcare. Are there any substantial downsides? I was
| not even close to being convinced by the arguments given by
| insurance companies in the article.
| parsimo2010 wrote:
| It isn't a bad thing, but it won't affect many Americans. Most
| of the country has insurance coverage, and even a high copay is
| probably cheaper than paying cash for most things. However, it
| will hopefully lower prices for people that have no coverage
| for some procedures by exposing any gross differences between
| the negotiated rates with big insurance payers and the cash
| rates offered to individuals. It will benefit people that are
| uninsured or undercovered, if they do their homework.
|
| I have a feeling that while this is a step in the right
| direction, people can still be taken advantage of. Like,
| hospitals may offer a reasonable cash price for a baby delivery
| but still tack on all sorts of extra fees. Similar to the
| "underbody rust protection" scheme with car dealers. It's
| supposed to be illegal but somehow the hospitals will figure it
| out.
| svieira wrote:
| Having gone without insurance coverage, I have heard phrases
| like "our standard 85% discount" when notifying that I am
| paying cash instead of using insurance. (That said, I've also
| only received 30% discounts, so don't immediately jump ship
| :-) )
| ahelwer wrote:
| I'm a young healthy dude and have a high-deductible
| healthcare plan, so I absolutely care about finding low
| prices for things (since I don't hit my deductible). I got
| strep throat in 2019 and had a hell of a time comparing
| prices for test + antibiotics between different clinics. I
| usually had to physically show up at the location before
| they'd give me a price. Prices varied between $20 and $250!!!
| Hopefully this will help.
| SOLAR_FIELDS wrote:
| There is a fabulous place in OKC called the surgery center
| that does not take insurance and lists the upfront cost for
| all of their procedures on their website. I live about 6
| hours drive away from it but just having that resource
| available makes it worthwhile to check if it's worth it to
| drive 6 hours if I need something done:
| https://surgerycenterok.com/
| Zanni wrote:
| I disagree. Even with insurance, it can be impossible to know
| how much you're going to pay in advance. I had a surgery a
| few years ago, and my insurer sat me down in advance and told
| me what was covered and what wasn't--the upshot of which was
| that I was told I'd only owe a $25 co-pay for the entire
| thing. And then after the procedure--wham--I was hit with
| hundreds of dollars of bills for things like an ultrasound,
| mandated as part of the procedure, performed in the same
| building by the ultrasound tech they sent me to ... who
| happened to be an independent contractor. WTF. The additional
| cost was mostly irrelevant to me, but the surprise billing,
| _after_ the consultation, was maddening.
| credit_guy wrote:
| I generally think this is a very good step in the right
| direction. The only negative that I've heard voiced by some
| people (here on HN) was that the penalty for non-compliance is
| negligible (if I remember correctly, something like a few
| hundred dollars; I don't remember if a few hundred dollars in
| all, or per day, but for a hospital both are a rounding error).
|
| Edit: The penalty is $300/day [1]
|
| [1] https://www.hhs.gov/about/news/2019/11/15/trump-
| administrati...
| jerry1979 wrote:
| Do we know if this will expose physician fees? If not, I
| imagine physicians could charge the patients, then physicians
| and hospitals could settle the difference on the backend.
|
| In other words, a potential downside of partial sunlight
| could come from the fact that providers may want to move
| costs/charges around to obscure prices therefore making the
| system even more inefficient.
| IG_Semmelweiss wrote:
| that's not possible. At least not possible on a large
| scale.
|
| there are strict regulations (AKS and Stark) governing
| hospital <> Provider pay payments.
|
| Any pay in excess of medical services FMV will be toxic to
| pay out and could land both hospitals and providers in big
| trouble.
| paul_f wrote:
| There are no downsides to the consumer. Hope the Biden
| administration doesn't reverse this.
| [deleted]
| apta_ wrote:
| What motives would they have to reverse it? Don't they claim
| they're "for the people"?
| ormaba wrote:
| > What motives would they have to reverse it?
|
| What part of "Orange Man Bad" did you not understand? Isn't
| it enough that Trump supported it?
| musingsole wrote:
| Are you aware that this statement _cannot_ be true? It 's
| like potheads holding marijuana up as a panacea. This will
| reduce income for some number of hospitals, and hospital
| administration gets a turn at the table too. If you make the
| business feel pain, they'll pass it on to their customers
| with some new policy of their own.
| RickJWagner wrote:
| If those hospitals are relying on hidden prices to protect
| their profitability, they are not well run. Period.
|
| It is time. There is no good reason for hiding the true
| costs. This is the beginning of a much-needed revival in
| the health-care industry.
| pmiller2 wrote:
| It's a good thing, and one of the very few things I will
| happily stand up and commend the Trump administration for.
| Unfortunately, the impact on private individuals is likely to
| be very low, because those negotiated rates are extracted from
| hospitals by insurance companies by sheer weight of the number
| of policyholders they have. You and I won't be paying those
| rates, nor will we be able to negotiate anywhere near them. Our
| starting point as individuals is something called the
| "chargemaster rate," which is, theoretically, what the hospital
| might charge Joe Schmoe who's uninsured.
|
| In practice, even chargemaster rates aren't the _real_ rates.
| Despite not being a huge insurance company, it is possible to
| negotiate with hospitals if you 're either quite rich or quite
| poor.
|
| On the rich side, oftentimes just saying you're going to pay
| cash up front will get you a substantial discount. On the other
| end, hospitals frequently have entire departments theoretically
| devoted to helping poor and indigent patients afford medical
| care. What those departments actually do is sign people up for
| government benefits, or, sometimes, just writing off entire
| bills.
|
| Anyway, yes, it's a good thing. No, it probably won't make a
| difference to you.
| jtbayly wrote:
| > it is possible to negotiate with hospitals if you're either
| quite rich or quite poor.
|
| It is possible to negotiate, no matter who you are. I can
| literally be described as both quite rich and quite poor
| using your criteria. Simply saying you don't have insurance
| at one major hospital near us immediately reduces the bill by
| 49% (from the charge master rate, presumably).
| stevespang wrote:
| Now let's do the same for lawyers . . . .
| paulgb wrote:
| > The rule mandating that hospitals disclose their privately
| negotiated charges with commercial health insurers is scheduled
| to take effect Jan. 1, 2021.
|
| So, today. Does anyone know how/where the data will be published?
| xyst wrote:
| likely, each hospital system will be publishing their own data
| rather than having it centralized.
| donarb wrote:
| The law also specifies that publishers must provide data in
| easily accessible formats so that web developers can make
| price comparison tools for the public.
| to11mtm wrote:
| > easily accessible formats
|
| Anyone want to guess the ratio of CSV/XML/JSON we'll get
| out of this?
| zuzzurro wrote:
| ""This transformative hospital price transparency rule has been
| fought at every step by the swamp and defenders of the status
| quote," White House press secretary Kayleigh McEnany said in a
| statement."
|
| Is "the status QUOTE" actually a thing now?
| seibelj wrote:
| Second only to quid pro quote
| spaetzleesser wrote:
| Good! Let's hope Biden will have the courage to do even more
| about price transparency. If we can't have something like
| Medicare for All they should at least make sure the "free market"
| works like an actual market. The minimum requirement for a market
| should be that the participants know at least how much goods
| cost. The current situation is just ridiculous where hospitals
| and insurance can do pretty much whatever they feel like and the
| patient has no way to know if they are being overcharged or not.
| roamerz wrote:
| Let's hope! But honestly that probably won't happen if he gets
| into office. Transparency is the enemy of socialism.
| zrail wrote:
| > if he gets into office
|
| What do you mean by this?
| entropea wrote:
| Biden's entire career has been center right policy. There
| will absolutely be no socialism under Biden. People were sure
| Obama was a socialist too, but he left calling his actual
| policies closer to a moderate Republican[1] and I strongly
| agree with him there.
|
| https://www.youtube.com/watch?v=677elaGIsKU
| nerdponx wrote:
| You do know that actual socialists hate Biden, and that he
| has openly walked back anything remotely socialist in his
| platform, and that none of his policies were anything more
| than a glance at socialism to begin with... right?
| leesalminen wrote:
| You do know that nearly everyone expects Biden to die
| shortly, leaving us with President Harris, the most left-
| leaning Senator in American history. Now, Mrs. Harris also
| likes to put poor people in prison for marijuana charges,
| so "left-leaning" isn't saying _too_ much, but by American
| standards...
| spaetzleesser wrote:
| " most left-leaning Senator in American history."
|
| That's just propaganda nonsense. It seems everybody who
| is only slightly left to the current administration is
| labeled as "RINO" or "far left" who wants to create a
| second Venezuela or Cuba.
| zrail wrote:
| "nearly everyone" is doing a lot of work there. I for one
| don't expect him to die in his term. I do expect him to
| decline running for a second term and set up Harris for a
| strong campaign in 2024, but four years is a long time.
| nerdponx wrote:
| Lest we forget that Biden, Sanders, and Trump are all
| around the same age.
| roamerz wrote:
| No I did not realize that but that said I don't believe he
| is anything but a puppet to the left and to the big
| corporations that gave billions and manipulated what
| American people were allowed to see so him walking anything
| back is about as credible as Obama's if you liked your
| health insurance plan, you could keep it.
| nerdponx wrote:
| I mean, that's exactly the same criticism he gets from
| the far left. Words like "neolib" and "centrist" and
| "corporatist" are common slurs in that millieu, many of
| them directed at Biden, Pelosi, Schumer, et alia.
| spaetzleesser wrote:
| Who in the two ruling parties don't sell out to big
| corporations? The Democrats have failed producing a
| decent health policy. And so have republicans. Do you
| remember "repeal and replace"? Repealing they did as much
| as they could but they forgot about replacing.
| m16ghost wrote:
| This will be a good thing initially for consumers as it will
| allow people to comparison shop for the less complicated, non-
| life threatening medical treatments. It puts into place the other
| piece of consumer-driven healthcare[0], which is meant to put
| market pressure on medical services.
|
| Note the new transparency rule only affects hospitals, so the new
| rule won't cover services performed at local doctor's offices or
| clinics.
|
| There will be several knock-on effects where the overall impact
| is unknown:
|
| 1. The transparency rule not only reveals prices to consumers,
| but also to other insurance companies and other hospitals. Since
| these price arrangements were typically conducted in private,
| this will impact negotiations between insurers and hospitals in
| competitive markets, which are typically in major cities. This is
| likely to force outliers on both the cheap end and expensive end
| to bring their rates closer to market. To the extent that either
| the hospital or the insurer cannot bring their rates closer to
| market, this may accelerate consolidation of hospitals into
| larger networks to improve negotiating power, and/or cause
| smaller insurers to drop hospitals from their network.
|
| 2. Since the transparency list is not comprehensive, and not all
| medical services are shoppable (i.e. scheduled in advanced,
| typically non life-threatening), this may cause hospitals to
| shift costs to services that consumers have no control over,
| meaning the emergency and unlisted procedures. It will take a few
| years for hospitals to understand the impact the rule has on
| their bottom line.
|
| [0]https://en.wikipedia.org/wiki/Consumer-driven_healthcare
| loceng wrote:
| I'd like to see the costs/invoice from each doctor you see or
| service billed for in the Canadian system as well.
| ausbah wrote:
| a small piece of good news coming from the Trump administration,
| but still far too little to be meaningful
| sho wrote:
| Even a stopped clock is right twice a day
| donarb wrote:
| They has also put through a rule that drug companies were
| required to show the cost of a 30-day supply of the drug in
| their TV commercials. They did it for a few months before that
| pharmaceutical companies went to court and got a judge to rule
| in their favor.
| gotoeleven wrote:
| Actually according to the headline the White House did it.
| Trump only does bad things so something else must be
| responsible. In this case the house he lives in did it.
| krapp wrote:
| > Actually according to the headline the White House did it.
| Trump only does bad things so something else must be
| responsible. In this case the house he lives in did it.
|
| FFS it's always been common practice to refer to the current
| administration as the White House.
| jtbayly wrote:
| It would be interesting to compare what percent of the time
| criticism of President Trump's official actions used his
| name, vs what percent of the time praise of his official
| actions said "White House". I suspect that there would be a
| vast discrepancy within publications.
| hedora wrote:
| Somewhat related: There are now services that negotiate or shop
| around your local pharmacies for cheap prescriptions. They claim
| they often are able to find the prescription drugs that retail
| for less money than insurance co-pays.
|
| I'm not sure if these services are a scam or not, but
| anecdotally, the one time I needed medical care without insurance
| (due to a short inadvertent coverage gap), the out of pocket
| price was significantly lower than my co-pay would have been.
|
| In fairness to the insurance companies, the doctor made it clear
| she charges people without insurance less money. This bill will
| prevent hospitals from subsidizing uninsured people with money
| from the insured; that's a potential downside. We really need
| universal single-payer health care in this country.
| ThrustVectoring wrote:
| Uninsured people are cheaper to provide service to, too. Don't
| underestimate the effort it takes to code things up for
| insurance consumption and navigate their bureaucracy and any
| routine denials of payment.
| omneity wrote:
| Could you mention / link one of these services?
|
| I'm quite curious.
| macinjosh wrote:
| IMO the healthcare market should be restructured into 3 sub
| markets where a payment scheme that make the most sense for the
| type of care can be applied:
|
| - Routine/Preventative Care [Self or Employer paid in cash]
|
| - Emergency & Acute Care [Self or Employer paid insurance]
|
| - Chronic/Disabled/Elder Care [Socialized Medicine]
|
| However, that is far too logical and efficient for our current
| system of crony capitalism.
| nerdponx wrote:
| There are a few problems with this setup.
|
| 1) Part of the reason why Americans are so sick is that they
| don't have access to preventative care in the first place. Just
| getting a check up at the doctor should not be a financial
| burden.
|
| 2) It breaks the basic model of insurance, wherein risk is
| spread among many parties and the premiums that come in can pay
| for the losses paid out.
|
| 3) Employer sponsored insurance just handcuffs people to their
| jobs. This is bad for all kinds of reasons.
| macinjosh wrote:
| Not sure you've fully thought this through...
|
| Regarding your first point, in a system as I've described
| pricing for preventative care will be driven down by market
| forces. Especially with market pressures like price
| comparisons made available. This kind of care is fairly fixed
| in cost and has predictable demand so the business risks are
| much lower. Additionally government could provide tax
| incentives for things like getting an annual exam for
| example.
|
| For point #2 you have this backwards. Insurance is meant to
| guard against risk. When you have situation like the current
| one where insurance is used to pay for routine or predictable
| care that whole idea of spreading the risk around with
| insurance is moot as the risk of costing the plan money is
| 100% for everyone.
|
| Finally, fully single payer medicine is bad for all kinds of
| reasons as well. We need balanced solutions not ideologies.
| ahelwer wrote:
| Canadian here! Socialized medicine is, in fact, good. I
| think the US has gone about as far as it can go with
| crowbarring healthcare into an insurance model. Moving from
| Canada to the states as an adult I can sincerely tell you
| that healthcare here is an utterly terrible experience on
| every level, from check-ups to clinic visits to overnight
| emergency room stays. At a certain point it becomes more
| ideological _not_ to have socialized healthcare. And that
| point was passed long, long ago. Twisting a few dials &
| pulling some levers on a machine that is fundamentally
| profiting off of people being sick will just never cut it.
| Nothing can overcome that underlying incentive.
| nerdponx wrote:
| I'd encourage you to take a look at some health economics
| literature, instead of accusing me of being an ideologue.
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