There must be a pony in here somewhere.

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Aresen
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Re: There must be a pony in here somewhere.

Post by Aresen » 26 Jul 2018, 16:13

In a way, medical costs are like the Uber economy: Because your choices are often limited at the time, you have little opportunity to negotiate.

The one advantage insurers ought to have - ability to average demand over many individual purchases - doesn't seem to work in the US. In countries with single payer, the monopsony can dictate prices.
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JD
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Re: There must be a pony in here somewhere.

Post by JD » 26 Jul 2018, 16:18

Aresen wrote:
26 Jul 2018, 16:13
In a way, medical costs are like the Uber economy: Because your choices are often limited at the time, you have little opportunity to negotiate.

The one advantage insurers ought to have - ability to average demand over many individual purchases - doesn't seem to work in the US. In countries with single payer, the monopsony can dictate prices.
From what I understand, the insurers' advantage does work that way, in that the amount an insurer pays the provider is invariably less than the rack rate. The issue is that you, the actual patient, are not the customer of the insurer; your employer is.
"Millennials are lazy. They'd rather have avocado toast than cave in a man's skull with a tire iron!" -FFF

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Jadagul
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Re: There must be a pony in here somewhere.

Post by Jadagul » 26 Jul 2018, 16:37

Jennifer wrote:
26 Jul 2018, 15:52
What would actually have to change about the current legal/social/insurance status quo, to make price transparency a thing? Such incidents as Welch's "This will be 800 bucks -- [procedure is done, so it's now too late for Welch to back out] -- wait, did I say eight hundred? Nope, I actually meant eighty-seven thousand because ha ha fuck you" -- and of course there have been many other examples mentioned/posted on this forum and even this thread, though none involving people any of us actually know -- in most service industries, this would be thoroughly illegal fraud: if you check in to a hotel room for $100 and they try charging you $1,000 or $10,000 at checkout the next morning, they would never get away with that (although, since IANAL, I don't know which specific laws or regulations they'd be violating there). Same thing if you go to a restaurant and then, only after you've finished eating and it's too late to change your mind about accepting their service, they give you a bill orders of magnitude higher than the originally agreed-upon price. But obviously, no such rules apply to the medical field -- or perhaps it is more accurate to say, the medical field is granted exemptions to the rules other industries must face.

What are the actual rules or regs causing this problem, and how intertwined are they with "our medical system" as a whole? Obviously, given the realities of medicine, it is not always possible for hospitals to completely, accurately judge a final bill in advance -- there might genuinely be complications which arise -- but the overbilling medical stories causing the problem are not examples of good-faith wiggle-room where setting prices is concerned.
I'm sure a lot of what's going on is that the actual services being provided can change unpredictably in the middle of a lot of medical care.

Like, if you go under the table for routine surgery and things go very badly and they need to do extreme and expensive things, they're not going to wake you up in the middle to okay the add-on purchase.

Now, the reasonable way to handle this is probably to price it in to the beginning: the average operation is $500 but the price is $2000 because some fraction of them are super crazy expensive.

But the way we actually do it is to bill for the services consumed, rather than the services purchased. In the hotel metaphor, it's like they stock the minibar with drinks way more expensive than the actual room---and sometimes you have to drink them or you'll die.

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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 26 Jul 2018, 16:44

Was playing around and found this pretty good dashboard. Couple of interesting findings including that historically price has been primary driver of total expenditures but now total usage is increasing at rate exceeding cost increases.

https://www.healthsystemtracker.org/dashboard/

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thoreau
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Re: There must be a pony in here somewhere.

Post by thoreau » 26 Jul 2018, 17:52

How much of that is increased usage due to the population aging? I'm curious if patterns have changed within age groups, or if age groups are remaining more or less the same but the age profile of the population is changing.
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