General Health Care/Health Cost thread

[bad_teammate 13,132]

Tired of negotiating with the vampires. Just drive stakes through their hearts and move on.

[Nice Guy Eddie 13,414]

2 hours ago, Hugo Stiglitz said:

 

I was curious about the costs of a Texas HSA plan on the marketplace.  $475/mo with 6750 deductible.  Or 494 and 5400.

[XYZ 2,154]

3 hours ago, Anastasis said:

Hospital and facility rates and billing practices are a huge part of why we get $1000 monthly premiums for a high deductible plan.  This is a good development in my opinion.

https://www.nytimes.com/2019/11/15/health/list-hospital-prices-trump.html

 

To Lower Costs, Trump to Force Hospitals to Reveal Price of Care

A proposed federal rule would make hospitals list the prices they negotiate with insurers, allowing consumers to seek better deals for care.

 

The Trump administration on Friday announced it would begin forcing hospitals to publicly disclose the discounted prices they negotiate with insurance companies, a potentially bold move to help people shop for better deals on a range of medical services, from hip replacements to brain scans.

 

  Reveal hidden contents

 

“For decades, hospitals, insurance companies, lobbyists and special interests have hidden prices from consumers, so they could drive up costs for you, and you had no idea what was happening,” President Trump said Friday afternoon in the White House’s Roosevelt Room. “You’d get bills that were unbelievable and you’d have no idea why.”

Patients, he said, have “been ripped off for years.”

The federal rule, which would not take effect until 2021, is part of a broader push by Trump officials to make health care markets more transparent to patients. The administration also unveiled a proposed rule to require insurers to allow patients to get advanced estimates of their out-of-pocket costs before they see a doctor or go to the hospital.

Mr. Trump rolled out the initiative personally, providing some counterprogramming to the second day of impeachment hearings while showing his willingness to take on powerful interest groups like hospitals and insurers.

 

 

 

Mr. Trump was “taking historic action to make health care prices transparent for consumers, yet the coverage on all the cables remains on the impeachment inquiry charade,” his press secretary, Stephanie Grisham, tweeted. “Dems should get back to work — just like our” president.

The hospital industry, which has long kept its negotiations with insurers secret, said it would challenge the rule in federal court. “This is a very radical proposal,” said Tom Nickels, an executive vice president with the American Hospital Association, a trade group.

Hospitals say the administration does not have the authority to compel them to disclose their private negotiations and compared the order to forcing private parties to reveal trade secrets.

But if the rule survives, “it’s a game changer,” said John Barkett, a former Obama administration official who is now a health policy expert at Willis Towers Watson. Knowing the price of a colonoscopy or knee surgery before it takes place “would be hugely helpful,” he said.

The administration’s decision to aggressively tackle the secrecy surrounding hospital prices came amid widespread concern about rising costs for medical care. Democrats have also been campaigning on soaring health care costs, and both parties fear entering the 2020 campaign season with unfulfilled promises to gain control of out-of-pocket health spending.

 

People “are increasingly exposed to the crazy pricing of health care,” said Chas Roades, one of the founders of Gist Healthcare, a consulting firm in Washington. “We are overdue for a public airing of how all of this works.”

While the hospitals’ legal challenge may succeed, they are vulnerable to the increasing public outcry over high prices, Mr. Roades said. “It’s not a good look for the industry to push back on transparency on prices.”

Mr. Trump seemed to relish taking on powerful interest groups. “I don’t know if the hospitals are going to like me too much anymore with this, but that’s O.K., right?” he asked. About health insurers, he quipped, “they’ll be thrilled.”

The new rule requires hospitals to make a range of prices easily available, such as prices negotiated within an insurer's network, what hospitals are paid if their care is out of a patient’s insurance network, and what the hospital would accept for the treatment if paid in cash.

Administration officials, employers and others have criticized hospitals and insurers for keeping the deals they strike a secret, making it challenging for patients to seek less expensive care. They argue that by making it easier for people to find the actual prices that insurers pay — and not just the standard list prices for various services, which the Trump administration started requiring hospitals to post earlier this year — hospitals will be under more pressure to compete on prices.

The rule has the potential to roil the health care industry, which critics argue use the secrecy of their negotiations to keep prices high. A recent study showed that private insurers pay some hospitals two to three times more than the federal Medicare program pays for the same care. Even employers say they have little visibility into the prices being paid by the insurers on behalf of their workers.

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Proponents of the rule say it will create a working health care market in which hospitals compete on price and quality. People will be able to look for hospitals that give them the best value, said Cynthia Fisher, a health care entrepreneur and the founder of the group Patient Rights Advocate. “It will be aggregated and assimilated in a way that people can have ready access to it,” she said.

 

Both the hospitals and health insurers say they should not be required to make public what they consider proprietary information, and they are expected to mount legal challenges to any mandated disclosure. In Ohio, a state law requiring price transparency that was passed two years ago is still waylaid in the courts.

Hospitals say that disclosing prices would lead to higher costs, not reduce them, because each institution would know the prices of its competitors and could be reluctant to settle for less.

Health insurers, which have voiced similar concerns, said they were evaluating the rules.

“Transparency should be achieved in a way that encourages, not undermines, competitive negotiations to lower patients’ and consumers’ costs and premiums,” said Matt Eyles, the chief executive of America’s Health Insurance Plans, which represents insurers, in a statement.

Alex M. Azar II, the health and human services secretary, called that “a canard.”

But the legal challenge ahead is real. When the Trump administration tried to require pharmaceutical companies to disclose the list price of their drugs in their television ads, the courts blocked the regulation. A federal judge ruled last summer that the Department of Health and Human Services exceeded its regulatory authority with the rule, which was seen as largely symbolic since list prices are not what patients typically pay.

“We may face litigation, and we feel we are on a very firm legal footing,” said Mr. Azar, who emphasized the information is already being made public to patients on what is called an explanation of benefits form — but after they go to the doctor or get a medical treatment.

Mr. Nickels from the hospital association said information about all of a hospital’s negotiated prices with individual insurers is not currently available. “That isn’t public information given to everyone, given to competitors,” he said.

 

 

That law has no teeth.

[elfenix 34,171]

Quote

Wearing a revolutionary-era tricorn hat, doctor Mathew Maurer stood at a lectern in front of an audience of fellow cardiologists in Philadelphia, decrying the price of a new medication that had the potential to help many of his heart-failure patients.
The drug, Pfizer Inc.’s tafamidis, cost $651 a day, Maurer told them—equal to a patient’s food budget for a month. Drugs don’t work if people can’t afford to take them, he said, and the pharmaceutical company’s $225,000-a-year price was well out of bounds.
Maurer isn’t just any critic. A professor at Columbia University Irving Medical Center, he worked closely with Pfizer to develop the breakthrough drug. He was the lead author on a pivotal, company-funded scientific study that got tafamidis approved earlier this year.
...
Maurer and collaborators released a cost-effectiveness analysis last week at the American Heart Association’s Scientific Sessions meeting, concluding that tafamidis is only cost-effective with a more than 90% price reduction, or a price tag of $16,563.

At current prices, treating an estimated 120,000 individuals in the U.S. with tafamidis would “increase annual health-care spending by $32.3 billion,” the authors wrote.

https://www.bloomberg.com/news/articles/2019-11-19/heart-failure-drug-from-pfizer-attracts-new-critics-over-price

[Incredulity 11,555]

Quote

Wearing a revolutionary-era tricorn hat, doctor Mathew Maurer stood at a lectern in front of an audience of fellow cardiologists in Philadelphia, decrying the price of a new medication that had the potential to help many of his heart-failure patients.

How the fuck are they going to open the article with that statement and then offer no reason or rationale behind it?

[Nice Guy Eddie 13,414]

Personally I don't think that Medicare or private insurance should be paying hundreds of $1000s for medicine for chronic conditions. Curative pharmaceuticals, sure. A $600/day pill for life.  It's unfair to burden others by having insurance cover that cost. 

Now that may ultimately prevent new medicines from being researched or discovered but unfortunately those costs are bankrupting the entire process faster than anything.

[Incredulity 11,555]

5 minutes ago, Nice Guy Eddie said:

Personally I don't think that Medicare or private insurance should be paying hundreds of $1000s for medicine for chronic conditions. Curative pharmaceuticals, sure. A $600/day pill for life.  It's unfair to burden others by having insurance cover that cost. 

Now that may ultimately prevent new medicines from being researched or discovered but unfortunately those costs are bankrupting the entire process faster than anything.

So death panels.

[XYZ 2,154]

18 minutes ago, Incredulity said:

So death panels.

Straw man fallacy.

[Anastasis 23,394]

1 hour ago, elfenix said:

https://www.bloomberg.com/news/articles/2019-11-19/heart-failure-drug-from-pfizer-attracts-new-critics-over-price

 

17 minutes ago, Nice Guy Eddie said:

Personally I don't think that Medicare or private insurance should be paying hundreds of $1000s for medicine for chronic conditions. Curative pharmaceuticals, sure. A $600/day pill for life.  It's unfair to burden others by having insurance cover that cost. 

Now that may ultimately prevent new medicines from being researched or discovered but unfortunately those costs are bankrupting the entire process faster than anything.

 

*Scratches head and wonders why premiums keep going up*

Specialty drugs are consuming a very disproportionate and increasing amount of our Rx healthcare care dollars. 

 

[CooterBrown 17,913]

That same drug is probably $99 for a month supply at a Mexican/Canadian pharmacy.

[Incredulity 11,555]

2 minutes ago, XYZ said:

Straw man fallacy.

 

 

Where do you draw the line?  Because none of the Medicare for all proponents are discussing it.

[XYZ 2,154]

What do you mean “where do you draw the line”? What line? You mean what’s covered and what’s not?

[Incredulity 11,555]

1 minute ago, XYZ said:

What do you mean “where do you draw the line”? What line? You mean what’s covered and what’s not?

exactly.

wherever the line gets drawn will be portrayed as death panel, and probably in some cases rightly.

[Captainant 27,464]

5 minutes ago, Incredulity said:

Where do you draw the line?  Because none of the Medicare for all proponents are discussing it.

It's more that we are already subject to death panels, except it's shareholders deciding who dies instead of the government. Just ask anastasia, good people die every day thanks to insurance declining their coverage because it's not profitable. No Medicare for all detractors are discussing that. 

[Anastasis 23,394]

The bloomberg piece is interesting, and illustrates the game being played.

PFE develops a drug for an exceedingly rare heart condition. They price the drug as a specialty product, based on the low prevalence.  They then engage in a variety of epidemiological studies that intend to increase surveillance activities and increase diagnosis of the condition. They price it based on rare disease status, then do the epidemiological leg work to move the condition out of a rare disease designation.  And of course they will reprice the medication after then increase the number of cases eligible for treatment with their drug 10x. *wink, wink*

[Incredulity 11,555]

Just now, Captainant said:

It's more that we are already subject to death panels, except it's shareholders deciding who dies instead of the government. Just ask anastasia, good people die every day thanks to insurance declining their coverage because it's not profitable. No Medicare for all detractors are discussing that. 

Board of Directors, Executive Management...sure.   Shareholders....no.

I agree what we have now is pretty fucked up.  I don't believe Medicare for all is the answer.

 

 

[Anastasis 23,394]

9 minutes ago, Captainant said:

It's more that we are already subject to death panels, except it's shareholders deciding who dies instead of the government. Just ask anastasia, good people die every day thanks to insurance declining their coverage because it's not profitable. No Medicare for all detractors are discussing that. 

Medicare would put extremely similar if not the exact same utilization management criteria on tafamidis as private insurers are going to do.  They will require confirmation of the diagnosis of the rare condition for which it is indicated, some level of severity criteria, and cardiologist consultation. It is a delusion to believe that M4A is going to change the nature of coverage policies and prior authorization.   

[Captainant 27,464]

2 minutes ago, Anastasis said:

Medicare would put extremely similar if not the exact same utilization management criteria on tafamidis as private insurers are going to do.  They will require confirmation of the diagnosis of the rare condition for which it is indicated, some level of severity criteria, and cardiologist consultation. It is a delusion to believe that M4A is going to change the nature of coverage policies and prior authorization.   

It's just that with M4A the American people can actually change the policies, rather than hoping for the virtue of wealth to change the minds of people at "insurance" firms who profit off of denying coverage to sick people. 

[Incredulity 11,555]

3 minutes ago, Captainant said:

It's just that with M4A the American people can actually change the policies, rather than hoping for the virtue of wealth to change the minds of people at "insurance" firms who profit off of denying coverage to sick people. 

what?  you think "American people" are going to have a say in M4A policies.

[Anastasis 23,394]

13 minutes ago, Captainant said:

It's just that with M4A the American people can actually change the policies, rather than hoping for the virtue of wealth to change the minds of people at "insurance" firms who profit off of denying coverage to sick people. 

In reality we will be trading a variety of formulary generating bureaucracies for a unified government one.  Here is the relevant language from Sanders' bill.  It establishes utilization management principles under item 1, and favors broadly low cost, older generic drugs under item 2.  Item 3 allows for patients to "petition" the bureaucracy, much as they can do today in both private and Medicare settings.  Item 4 means, at least as I read it, "if it is not on formulary you will be can still access it, you will just be paying the retail price."

If you think that M4A will not be managing utilization in the exact same what that insurance companies do, I think that you are mistaken. I would suggest that government take over of that process will actually result in less choice among beneficiaries, compared to a competitive market. I know that anytime that I think about responsiveness to the unique needs of individuals, I always think first of the federal government.  

 

(b) Prescription Drug Formulary.—

(1) IN GENERAL.—The Secretary shall establish a prescription drug formulary system, which shall encourage best-practices in prescribing and discourage the use of ineffective, dangerous, or excessively costly medications when better alternatives are available.

(2) PROMOTION OF USE OF GENERICS.—The formulary under this subsection shall promote the use of generic medications to the greatest extent possible.

(3) FORMULARY UPDATES AND PETITION RIGHTS.—The formulary under this subsection shall be updated frequently and clinicians and patients may petition the Secretary to add new pharmaceuticals or to remove ineffective or dangerous medications from the formulary.

(4) USE OF OFF-FORMULARY MEDICATIONS.—The Secretary shall promulgate rules regarding the use of off-formulary medications which allow for patient access but do not compromise the formulary.

 

Edited November 19, 2019 by Anastasis

[Incredulity 11,555]

Quote

If you think that M4A will not be managing utilization in the exact same what that insurance companies do, I think that you are mistaken. I would suggest that government take over of that process will actually result in less choice among beneficiaries, compared to a competitive market. I know that anytime that I think about responsiveness to the unique needs of individuals, I always think first of the federal government. 

This

 

This

 

FUCKING THIS!!!!

[TwiceHorn 31,283]

1 hour ago, Incredulity said:

So death panels.

Private health insurers that deny coverage in situations just like this are death panels to the same degree.  It's not even a matter of degree, it's the same damn thing.

[Captainant 27,464]

In what world is the healthcare market a competitive market? Prices and coverage are effectively equivalent between providers because "that's what the market demands", and all of them will kill you if it makes them a buck. There is no access to meaningful healthcare without paying their ransom, and there is not any insurance firm that is meaningfully different from the rest of them. 

[Anastasis 23,394]

26 minutes ago, Captainant said:

In what world is the healthcare market a competitive market? Prices and coverage are effectively equivalent between providers because "that's what the market demands", and all of them will kill you if it makes them a buck. There is no access to meaningful healthcare without paying their ransom, and there is not any insurance firm that is meaningfully different from the rest of them. 

Healthcare definitely lacks a number of important dynamics that underlie a functional market. No doubt about that.  But insurance prices and coverage are not effectively equivalent, and there are meaningful differences between not only different insurance companies but the benefits and benefit structures they provide.  There are for example, very meaningful differences between the narrow network plans (e.g., Centene) which thrive in managed Medicaid and ACA markets.  Those networks manage utilization by signing very narrow networks of providers, thus bottlenecking expensive specialty utilization. Those plans are very different compared to large group self insured plans, or large group fully insured plans, or small group at risk plans, or Medicare supplemental plans, or Medicare Advantage plans.  The benefit models, premiums, cost-sharing structures all vary across this different types of plans, and within each of the plan categories.  The strategies that the different companies use to spread risk across providers and patients are very different.

At some point in the discussion, proponents of M4A will have to move beyond simplistic rhetoric and platitudes.  The realities of implementing a single payer system are going to require some discussion of how things like utilization management, coverage determinations, and risk sharing are conducted, and those discussions will naturally take place with comparison to how such things are handled in the current system. 

Edited November 19, 2019 by Anastasis

[Anastasis 23,394]

It's also telling in a thread that was brought TTT with an article about a $250k pharmaceutical, all you can think about are the evils of the lowest margin operators in the entire system.  Also the only entity in the chain of delivery that has a vested interest in maximizing cost-effectiveness of care.  

[Nice Guy Eddie 13,414]

25 minutes ago, Captainant said:

In what world is the healthcare market a competitive market? Prices and coverage are effectively equivalent between providers because "that's what the market demands", and all of them will kill you if it makes them a buck. There is no access to meaningful healthcare without paying their ransom, and there is not any insurance firm that is meaningfully different from the rest of them. 

It's a competitive market in many areas of the world especially in regards to the highest quality of care. Private doctors and hospitals similar to the entire US system, exist in many countries. It's a false narrative that the US completely stands alone in having a partial capitalistic healthcare system.

[XYZ 2,154]

Forget the $250k medication for a very rare disease. Why does a motherfucking MRI cost 20 times more in the USA than in Japan?

[Nice Guy Eddie 13,414]

1 hour ago, XYZ said:

Forget the $250k medication for a very rare disease. Why does a motherfucking MRI cost 20 times more in the USA than in Japan?

Actually one major reason is that most patients don't care about the price because their insurance picks up the tab. They choose the facility that is most convenient even if that facility is 10x more expensive than another in town.  And the expensive facility can't give a break to the cash payer because the insurance plan won't allow it.

A goal of high deductible plans are to incentivize patients to making both good financial and healthcare decisions.

Also patients don't realize that you can sometimes come out ahead if you DON'T use insurance. I bet there is an adequate MRI facility in any town that will accept cash and it will be cheaper than going to your favorite hospital's MRI facility using your high deductible insurance.  One downside is that it won't count towards your deductible but so what if you're saving $1000.  

[Captainant 27,464]

10 minutes ago, Nice Guy Eddie said:

Also patients don't realize that you can sometimes come out ahead if you DON'T use insurance. I bet there is an adequate MRI facility in any town that will accept cash and it will be cheaper than going to your favorite hospital's MRI facility using your high deductible insurance.  One downside is that it won't count towards your deductible but so what if you're saving $1000.  

Yeah, when my wife had to get an MRI to check for breast cancer we really wanted to shop around and get an unknown time slot at some 3rd party MRI center and really wait as long as we could before getting results. 

That's the key thing you healthcare industry apologists consistently ignore - health care is a very time sensitive matter where you're making literally life or death decisions. That's not exactly when people are interested in searching for the best deal, and that's why healthcare costs are through the roof. 

Shareholders can get better dividends if they gouge sick people worried about their loved ones or their own health. And to make matters even more severe, hospitals intentionally use blind billing to inflate costs further to really deep dick those vulnerable people. 

[Anastasis 23,394]

35 minutes ago, Nice Guy Eddie said:

Actually one major reason is that most patients don't care about the price because their insurance picks up the tab. They choose the facility that is most convenient even if that facility is 10x more expensive than another in town.  And the expensive facility can't give a break to the cash payer because the insurance plan won't allow it.

A goal of high deductible plans are to incentivize patients to making both good financial and healthcare decisions.

This is all correct.  The problem is that most people are simply not capable of engaging in either good financial or good healthcare decisions.  And even those that are get bogged down in the fuckery of the system. For example the ER racket by which the facility is in network, but the physician provider network servicing that ER is allowed to operate outside of the network.  You take your 2 year old to the Dell ER with symptoms largely consistent with meningitis after checking to ensure the Dell is a covered facility in your network. Now, try confirming with the provider as they are coming in to perform a lumbar puncture procedure that their physician billing group is not pulling a fucking racket on you and see what kinda of fucking look they get on their face. You end up getting a spinal tap and an overnight stay. Turns out a few weeks later you get a bill in the mail with all the provider charges being billed at out of network rates. Ask me how I know.  

[TwiceHorn 31,283]

The thing to bear in mind about healthcare, first and foremost, is that demand is almost perfectly inelastic:  consumers of it are not price-sensitive.

That means that consumers are not rational.  So, even if there was no information gap, people would still consume more than they could reasonably pay for.

Some form of rationing is necessary in just about any system.

The reason our costs are high and outcomes poor in comparison to the rest of the world is that there's very little rationing.  And non-universal coverage.  But even universal coverage doesn't mean that the stupid will use it before it's too late.

[Anastasis 23,394]

1 hour ago, TwiceHorn said:

The thing to bear in mind about healthcare, first and foremost, is that demand is almost perfectly inelastic:  consumers of it are not price-sensitive.

Maybe in some cases, but not all.  In many cases consumers are very price sensitive, and rightfully so. When they are exposed to actual cost of goods, they make rational decisions. 

 

Consider the treatment of seasonal allergies for example. Most here can probably relate.

In a hypothetical, but not far from reality, example there are some common first line treatment options for seasonal allergic rhinitis. 

Option 1:  generic sedating antihistamine, $

Option 2: generic non-sedating antihistamine, $$

Option 3: branded enantiomer of non-sedating antihistamine option 2 (:)), $$$$$

Option 4: generic nasal steroid, $$

Option 5: branded nasal steroid, $$$$$

 

Options 2 and 3 are equally effective with similar AE profile. Options 4 and 5 are equally effective with similar AE profile. Option 1 is equally effective as 2/3, maybe marginally more effective, but has a less favorable AE profile. A rational, informed consumer is generally going to pick option 2 and 4 as first line options, and them if the shit really hits the fan, maybe consider the other options (or an unlisted second line option) if necessary.

Consumers are price-sensitive when they have sufficient insight. Nobody wants to pay more than they need to for equivalent care. One problem, alluded to by Eddie earlier is that certain benefit designs creates a cloud over the pricing dynamic.  If you coverage is $15 generic and $25 brand copays, the difference between option 2 and 3 at the consumer level is extremely marginal. If the true cost at $17.50 vs. $175.00 is transparent to the consumer, option 2 wins almost every time, but if clouded behind a copay they may very well choose the more expensive but equally effective option because they do not feel the pinch.  The pinch trickles into the plan paid costs, which only increases the premiums of all beneficiaries. If the benefit is a coinsurance design, say 20% coinsurance, you are looking at 3.50 vs. 35.00, still relatively marginal and the true costs are clouded. If the plan is HDHCP, a very different dynamic in play.

Now if you think that Bernie's M4A is going to cover all of these options equally you are deluded. Now I don't think that anything close to Bernie's M4A plan actually gets implemented, and frankly it is challenging to get a sense as to how it actually would be implemented in the real world, but under the language of the bill, options 1, 2, and 4 are probably covered, the rest are denied coverage. Which isn't a bad thing imo. Totally reasonable utilization management.  But the exact same shit that people complain about with private insurance formularies, except this time they are being implemented by the federal bureaucracy. 

Examples like these account for a significant amount of our health care expenditures. You can extend this example to diabetes, hypertension, other cardiovascular disease, oncology, etc.  Basically all of the major cost therapeutic areas. While the 250k one off drugs make also good examples of dysfunction, this is the real in the trenches shit that has to be worked through. Pretending like cost sharing and utilization management and formularies and these other tools that shape healthcare consumer behavior are not going to be part of a nationalized healthcare system is delusional. 

Edited November 20, 2019 by Anastasis

[Nice Guy Eddie 13,414]

2 hours ago, Captainant said:

Yeah, when my wife had to get an MRI to check for breast cancer we really wanted to shop around and get an unknown time slot at some 3rd party MRI center and really wait as long as we could before getting results. 

That's the key thing you healthcare industry apologists consistently ignore - health care is a very time sensitive matter where you're making literally life or death decisions. That's not exactly when people are interested in searching for the best deal, and that's why healthcare costs are through the roof. 

Shareholders can get better dividends if they gouge sick people worried about their loved ones or their own health. And to make matters even more severe, hospitals intentionally use blind billing to inflate costs further to really deep dick those vulnerable people. 

Agree 100% however in order to have a relatively available mri, with the very latest tech, in a close, well-kept location, the expense will be more than one an older mri across town with a 4 hour wait.

i get wanting the results right now.  I would want that too. I would probably pay for the service. But I believe that from a medical perspective getting the mri results today or tomorrow or next week has zero clinical impact for most cancers. You’re buying a luxury with the peace of mind in finding out faster.  Why shouldn’t that service be more expensive as opposed to another patient that would prefer to wait a few days to save $500.  

[Anastasis 23,394]

25 minutes ago, Nice Guy Eddie said:

Agree 100% however in order to have a relatively available mri, with the very latest tech, in a close, well-kept location, the expense will be more than one an older mri across town with a 4 hour wait.

i get wanting the results right now.  I would want that too. I would probably pay for the service. But I believe that from a medical perspective getting the mri results today or tomorrow or next week has zero clinical impact for most cancers. You’re buying a luxury with the peace of mind in finding out faster.  Why shouldn’t that service be more expensive as opposed to another patient that would prefer to wait a few days to save $500.  

Would be interesting to see the average wait times in US, UK, Canada, France, Germany as a starting point. I know what the first three show, but curious as to the broader trends. 

[Francisco 2.0 32,342]

Checking in.

 

Years and years ago, I dislocated my right shoulder in high school.  It went back in, I continued on.  Over the years, I dislocated it again and again.  Last fall, when I started dislocating it putting on deodorant or washing my hair, I knew I had to get this looked at, for it was becoming a quality of life issue.

Was referred to an orthopedic surgeon by my PCP; he had an xray taken, took a look at it and promptly informed me I could have surgery the following week. It was worse than I expected, and I was just living with it.  Put off the surgery to this fall, due to vacations and other things that would interfere with the rehab.

Surgery day came; I was at hospital at 6 am.  Surgery came and went; after he finished up, he was talking to the missus.  The damage was far greater than he anticipated; I had a tear in a tendon on my shoulder, my labrum was detached and torn, I had bone spurs on my humerus, the rotator cuff was like sea weed (his description) and so forth.  A total of 5 things were fixed, and he said I would recover fine after therapy.  Sent me home, and I was in recliner, on dope, happily snoozing by 11 am.

A few days later, I received the doctor's bill.  My portion after insurance was $408, so I promptly paid it.  A day or so after that, the anesthesiologist bill came in, my part came to $87.  I paid that as well.  These are the only two bills I've received to date.

Yesterday, the hospital called and had a few questions about my insurance (BCBS Federal Govt).  I answered them, and the person told me they needed to call the insurance company to verify a few things, so I was put on hold.  Few minutes later, we had a three-way call going.  The two reps spoke back and forth in their medical billing gibberish, with a random question thrown my way.  After about 10 minutes of this, the rep at the insurance company asked what the total bill was for my "procedure".  The hospital rep said "let me check"  and said:

 

$49,992

 

Um, yeah.  Just under $50 large, and I didn't even get a damned meal out of the place.  Now, I have no idea how much I will pay; I was told on the phone they would send me a bill of my portion in the coming weeks.  And I'm thankful I do have insurance.  But how in the hell is a 1.5 hour surgical procedure on a joint with no overnight stay required worth $50,000?

 

As for physical therapy, that starts in the next few days, and the place doing it will file on insurance as well, so that shouldn't have been factored in on the hospital bill. The damage was so great the doctor put off seeing a rehab place until everything had a chance to heal as much as possible.I did have a rehab chair at the house for the first 3 weeks after the surgery; I sat in it for 3 hours a day doing range of motion exercises.

I'm going to ask for a detailed bill once they stick their hand out, for I'm really at a loss why my procedure cost as much as it did.  For reference, my mom fell and broke her hip 2 years ago.  She spent 3 days in the hospital over this, and she required surgery.  Her bill, including rehab and everything associated, was $35,000.  

 

 

[Dnaguy 11,777]

40 minutes ago, Francisco 2.0 said:

Checking in.

 

Years and years ago, I dislocated my right shoulder in high school.  It went back in, I continued on.  Over the years, I dislocated it again and again.  Last fall, when I started dislocating it putting on deodorant or washing my hair, I knew I had to get this looked at, for it was becoming a quality of life issue.

Was referred to an orthopedic surgeon by my PCP; he had an xray taken, took a look at it and promptly informed me I could have surgery the following week. It was worse than I expected, and I was just living with it.  Put off the surgery to this fall, due to vacations and other things that would interfere with the rehab.

Surgery day came; I was at hospital at 6 am.  Surgery came and went; after he finished up, he was talking to the missus.  The damage was far greater than he anticipated; I had a tear in a tendon on my shoulder, my labrum was detached and torn, I had bone spurs on my humerus, the rotator cuff was like sea weed (his description) and so forth.  A total of 5 things were fixed, and he said I would recover fine after therapy.  Sent me home, and I was in recliner, on dope, happily snoozing by 11 am.

A few days later, I received the doctor's bill.  My portion after insurance was $408, so I promptly paid it.  A day or so after that, the anesthesiologist bill came in, my part came to $87.  I paid that as well.  These are the only two bills I've received to date.

Yesterday, the hospital called and had a few questions about my insurance (BCBS Federal Govt).  I answered them, and the person told me they needed to call the insurance company to verify a few things, so I was put on hold.  Few minutes later, we had a three-way call going.  The two reps spoke back and forth in their medical billing gibberish, with a random question thrown my way.  After about 10 minutes of this, the rep at the insurance company asked what the total bill was for my "procedure".  The hospital rep said "let me check"  and said:

 

$49,992

 

Um, yeah.  Just under $50 large, and I didn't even get a damned meal out of the place.  Now, I have no idea how much I will pay; I was told on the phone they would send me a bill of my portion in the coming weeks.  And I'm thankful I do have insurance.  But how in the hell is a 1.5 hour surgical procedure on a joint with no overnight stay required worth $50,000?

 

As for physical therapy, that starts in the next few days, and the place doing it will file on insurance as well, so that shouldn't have been factored in on the hospital bill. The damage was so great the doctor put off seeing a rehab place until everything had a chance to heal as much as possible.I did have a rehab chair at the house for the first 3 weeks after the surgery; I sat in it for 3 hours a day doing range of motion exercises.

I'm going to ask for a detailed bill once they stick their hand out, for I'm really at a loss why my procedure cost as much as it did.  For reference, my mom fell and broke her hip 2 years ago.  She spent 3 days in the hospital over this, and she required surgery.  Her bill, including rehab and everything associated, was $35,000.  

 

 

 

Never pay any medical bills promptly. EVER.

Time is your friend.

Contest everything. Hospitals always, ALWAYS do something wrong with your stay. I kid you not. Fight them on all codes. Have them review everything. Then when they come back, point out something else and have them review that.

Yeah it’s a pain in the ass. Yes it will consume all of your lunch hours. But man does it save you in the long run.

I’ve had a High deductible HSA for close to 5 years now and after my wife’s pregnancies & 2 kids born using the insurance I can say I’ve saved > $5,000 because I’m an asshole who fights everything.

Genetic testing bill for $900? Fuck that. Settle for $80 some 11 months after the fact.

Hospital bill for false labor for $2500? Settle for $400 18 months later. 

Always call in and ask if there’s a discount if you pay today. If they say no, hang up. Try another day. You literally have nothing to lose except your time.

Medical billing is a total crap shoot. They constantly get it wrong / fraudulently charge you and then mail you the bill (mail fraud anyone?) . It’s purposely opaque. You are at a disadvantage.

So I say fuck’em. You want my $?

Come pry it out of my cold dead hands as I probably put off that life saving treatment I needed due to the cost.

[Nice Guy Eddie 13,414]

interesting video from another thread. Why this video is related to GOP voters who may only be alive because of Obamacare, I'm not posting it for that topic. Go the Republican Party thread for that.   

What I wonder is whether we should have a different insurance cost structure for someone that has bad health because of behavior as opposed to bad luck. Take the poor guy in the video. $6K/mo (paid by the govt) in medicine for black lung disease because he chose to work in the coal mines. And its not like black lung didn't exist when he started. Or the woman has diabetes. While we don't know the cause of her diabetes, we do know for many the source of diabetes is behavior.  

Is it fair that healthy(ier) people subsidize people/industries that lead to future health problems? I'm not saying screw them but should the cost be the same for someone that spent a lifetime of healthy behaviors?  But then again this guy might just die if he didn't receive free healthcare.

I feel for this guy in that he worked his career in an industry that abused him and left him extremely sick and presumably poor. But I also hate that the average American annually pays a total of 10K in taxes and he's burning through that much in less than 2 months. 

 

Edited November 30, 2019 by Nice Guy Eddie

[bad_teammate 13,132]

14 minutes ago, Nice Guy Eddie said:

What I wonder is whether we should have a different insurance cost structure for someone that has bad health because of behavior as opposed to bad luck. Take the poor guy in the video. $6K/mo (paid by the govt) in medicine for black lung disease because he chose to work in the coal mines. And its not like black lung didn't exist when he started. Or the woman has diabetes. While we don't know the cause of her diabetes, we do know for many the source of diabetes is behavior.  

I thought this was parody until..

Quote

Is it fair that healthy(ier) people subsidize people/industries that lead to future health problems?

Yes.

The guy with black lung subsidized the wealth of private capital with his life.
The woman with diabetes, even if we just assume she's been chugging Mt Dew since she was a toddler, has done the same for Pepsi Inc.

Also, we should help people when they need it.

[GSU&UT 1,798]

On 11/26/2019 at 2:20 PM, Dnaguy said:

 

Never pay any medical bills promptly. EVER.

Time is your friend.

Contest everything. Hospitals always, ALWAYS do something wrong with your stay. I kid you not. Fight them on all codes. Have them review everything. Then when they come back, point out something else and have them review that.

Yeah it’s a pain in the ass. Yes it will consume all of your lunch hours. But man does it save you in the long run.

I’ve had a High deductible HSA for close to 5 years now and after my wife’s pregnancies & 2 kids born using the insurance I can say I’ve saved > $5,000 because I’m an asshole who fights everything.

Genetic testing bill for $900? Fuck that. Settle for $80 some 11 months after the fact.

Hospital bill for false labor for $2500? Settle for $400 18 months later. 

Always call in and ask if there’s a discount if you pay today. If they say no, hang up. Try another day. You literally have nothing to lose except your time.

Medical billing is a total crap shoot. They constantly get it wrong / fraudulently charge you and then mail you the bill (mail fraud anyone?) . It’s purposely opaque. You are at a disadvantage.

So I say fuck’em. You want my $?

Come pry it out of my cold dead hands as I probably put off that life saving treatment I needed due to the cost.

Imagine having a system where you didn't have to do this in order to not go bankrupt from an emergency.

There's an NPR story every month (maybe week?) where they go over some ridiculous hospital bill. The latest one was a 3 year old shoved a pair of Polly Pocket shoes up her nose and the Urgent Care the parents went to didn't have long enough forceps. They had to go to the emergency room and got hit with a 2000 dollar bill for something that took less than a minute to remove.

[Dnaguy 11,777]

1 hour ago, GSU&UT said:

Imagine having a system where you didn't have to do this in order to not go bankrupt from an emergency.

There's an NPR story every month (maybe week?) where they go over some ridiculous hospital bill. The latest one was a 3 year old shoved a pair of Polly Pocket shoes up her nose and the Urgent Care the parents went to didn't have long enough forceps. They had to go to the emergency room and got hit with a 2000 dollar bill for something that took less than a minute to remove.

Yeah I heard that one as well.

 

The ER is full retard when it comes to medical billing.

 

Its outright lunacy. 
 

ive never been charged anything less than a level 5 ER visit.

 

There is nothing that regulates how they charge you so it’s sanctioned fraud because nothing stops them from charging you as if you came in with a GSW to the chest

[Nice Guy Eddie 13,414]

3 hours ago, bad_teammate said:

I thought this was parody until..

Yes.

The guy with black lung subsidized the wealth of private capital with his life.
The woman with diabetes, even if we just assume she's been chugging Mt Dew since she was a toddler, has done the same for Pepsi Inc.

Also, we should help people when they need it.

This thread isn’t about socialized medicine. Moose out front should hAve told you.

[Bama Chick 28,596]

Yeah......

[Anastasis 23,394]

On 11/30/2019 at 4:04 PM, Dnaguy said:

There is nothing that regulates how they charge you so it’s sanctioned fraud because nothing stops them from charging you as if you came in with a GSW to the chest

https://www.wsj.com/articles/hospital-groups-sue-to-block-price-transparency-rule-11575460685?

Hospital Groups Sue to Block Price-Transparency Rule

Health-care providers say disclosure requirement pushed by Trump violates First Amendment

By 

Stephanie Armour

Updated Dec. 4, 2019 10:03 am ET

Hospital groups sued to block a Trump administration rule forcing them to disclose secret rates, for the first time laying out the industry’s legal strategy for defeating the president’s central health-policy initiative.

The lawsuit filed Wednesday says the rule compelling the hospitals to publish their negotiated rates with insurers violates the First Amendment and goes beyond the statutory intent of the Affordable Care Act.

“The burden of compliance with the rule is enormous, and way out of line with any projected benefits associated with the rule,” according to the suit, which was filed by the American Hospital Association and other industry groups in U.S. District Court in Washington.

The groups say the disclosure under the rule would be compelled speech in violation of the First Amendment. They are asking for an expedited decision, saying hospitals could otherwise spend needless time and resources preparing for a rule that may be invalidated by the court.

SHARE YOUR THOUGHTS

What consequences do you foresee to hospitals disclosing negotiated rates? Join the conversation below.

“Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it,” said Caitlin Oakley, a spokeswoman for Health and Human Services. “President Trump and Secretary [Alex] Azar are committed to providing patients the information they need to make their own informed health-care decisions and will continue to fight for transparency in America’s health-care system.”

The lawsuit, while expected, highlights the scope of industry concern over the regulatory burden associated with the rule, which was completed last month. The legal standoff could complicate other White House initiatives to expand price disclosure throughout the $3.5 trillion health-care industry.

Administration officials have said they are on solid legal ground and that the rule will drive down prices by making consumers wiser shoppers.

“The rule today will irritate many vested interests in Washington, D.C.,” Joe Grogan, head of the White House Domestic Policy Council, said last month when the rule was announced.

The lawsuit is a public-relations gamble for hospitals. They risk being criticized by the Trump administration as opponents of a transparency push that some health analysts say may benefit patients. White House officials have said lawsuits would be a sign that the industry was protecting its interests at the expense of consumers.

At the same time, hospitals face millions of dollars in estimated compliance costs under the rule, which many in the industry say is misguided.

The administration estimated the rule would cost hospitals more than $23 million annually in 2016 dollars. Annual costs range from $38.7 million to $39.4 million in 2019 dollars.

RELATED COVERAGE

One State’s Effort to Publicize Hospital Prices Brings Mixed Results

Hospital groups say the true cost is far higher. The rule requires hospitals to publicize the rates they negotiate with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility. It is scheduled to take effect in January 2021, with hospitals facing fines up to $300 a day if they don’t disclose negotiated rates.

Complying would require spreadsheets with hundreds of thousands of columns, the groups said in the lawsuit. They say such files could crash most standard computer systems.

“Some members worry about the ability of their websites to function at all with such a large file,” the lawsuit states.

According to the lawsuit, the required disclosure of “highly confidential” rates violates the First Amendment, which protects free speech.

Drugmakers used the same argument in a lawsuit that led a judge in July to block a rule that would have required them to include list prices for prescription medications in television ads.

The hospital groups’ lawsuit also said the rule exceeds the administration’s legal authority. Specifically, it cites a provision in the Affordable Care Act, which was further shaped by administration guidance, that required hospitals to make public their “standard charges.” The new rule, however, essentially expands the definition of standard charges, as well as the definition of hospital services, to include negotiated rates.

The hospitals said that expansion goes beyond what Congress intended when it passed the health-care law in 2010, and forces them to disclose confidential contractual information.

The Trump administration has said disclosure would introduce competition and inject more free-market dynamics into the industry. It has also proposed extending the requirement to insurers.

Hospital-price growth has helped fuel increases in U.S. health-care spending. Inpatient hospital prices grew 42% between 2007 and 2014, according to a study this year in Health Affairs, while prices charged by doctors increased 18%.

Hospital groups argue price disclosure could raise prices. If rates are public, they say, some hospital systems might push for payment rates that match their crosstown rivals’.

They say consumers really just want to know their out-of-pocket costs, which requires data from insurers, rather than negotiated amounts for care.

While White House officials have said they have statutory authority, the administration has lost a number of court challenges over its health-policy actions.

A federal appeals court this year halted an administration plan that would have let almost any company opt out of providing contraception coverage on moral or religious grounds. The administration in October asked the Supreme Court to review the case.

And a federal judge in October said the federal government owed health insurers $1.6 billion after President Trump halted payments to the industry under the ACA that reduce consumers’ out of pocket costs.

The new lawsuit is also brought by the Federation of American Hospitals, which represents investor-owned and managed community hospitals, the Association of American Medical Colleges, the Children’s Hospital Association, and three hospitals in Nebraska, California and Missouri. They also plan to file a motion for summary judgment this week, officials said, which asks the court for an immediate judgment in their favor.

“We are concerned our patient families may confuse these commercial rate disclosures and not seek essential care for their children,” said Mark Wietecha, president and chief executive of the Children’s Hospital Association.

Corrections & Amplifications
The hospitals filed their suit on Wednesday. An earlier version of this article incorrectly said the suit was filed Tuesday. (Dec. 4, 2019)

[LurkingHorn 1,049]

14 minutes ago, Anastasis said:

https://www.wsj.com/articles/hospital-groups-sue-to-block-price-transparency-rule-11575460685?

Hospital Groups Sue to Block Price-Transparency Rule

Health-care providers say disclosure requirement pushed by Trump violates First Amendment

 

  Hide contents

 

By 

Stephanie Armour

Updated Dec. 4, 2019 10:03 am ET

Hospital groups sued to block a Trump administration rule forcing them to disclose secret rates, for the first time laying out the industry’s legal strategy for defeating the president’s central health-policy initiative.

The lawsuit filed Wednesday says the rule compelling the hospitals to publish their negotiated rates with insurers violates the First Amendment and goes beyond the statutory intent of the Affordable Care Act.

“The burden of compliance with the rule is enormous, and way out of line with any projected benefits associated with the rule,” according to the suit, which was filed by the American Hospital Association and other industry groups in U.S. District Court in Washington.

The groups say the disclosure under the rule would be compelled speech in violation of the First Amendment. They are asking for an expedited decision, saying hospitals could otherwise spend needless time and resources preparing for a rule that may be invalidated by the court.

SHARE YOUR THOUGHTS

What consequences do you foresee to hospitals disclosing negotiated rates? Join the conversation below.

“Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it,” said Caitlin Oakley, a spokeswoman for Health and Human Services. “President Trump and Secretary [Alex] Azar are committed to providing patients the information they need to make their own informed health-care decisions and will continue to fight for transparency in America’s health-care system.”

The lawsuit, while expected, highlights the scope of industry concern over the regulatory burden associated with the rule, which was completed last month. The legal standoff could complicate other White House initiatives to expand price disclosure throughout the $3.5 trillion health-care industry.

Administration officials have said they are on solid legal ground and that the rule will drive down prices by making consumers wiser shoppers.

“The rule today will irritate many vested interests in Washington, D.C.,” Joe Grogan, head of the White House Domestic Policy Council, said last month when the rule was announced.

The lawsuit is a public-relations gamble for hospitals. They risk being criticized by the Trump administration as opponents of a transparency push that some health analysts say may benefit patients. White House officials have said lawsuits would be a sign that the industry was protecting its interests at the expense of consumers.

At the same time, hospitals face millions of dollars in estimated compliance costs under the rule, which many in the industry say is misguided.

The administration estimated the rule would cost hospitals more than $23 million annually in 2016 dollars. Annual costs range from $38.7 million to $39.4 million in 2019 dollars.

RELATED COVERAGE

One State’s Effort to Publicize Hospital Prices Brings Mixed Results

Hospital groups say the true cost is far higher. The rule requires hospitals to publicize the rates they negotiate with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility. It is scheduled to take effect in January 2021, with hospitals facing fines up to $300 a day if they don’t disclose negotiated rates.

Complying would require spreadsheets with hundreds of thousands of columns, the groups said in the lawsuit. They say such files could crash most standard computer systems.

“Some members worry about the ability of their websites to function at all with such a large file,” the lawsuit states.

According to the lawsuit, the required disclosure of “highly confidential” rates violates the First Amendment, which protects free speech.

Drugmakers used the same argument in a lawsuit that led a judge in July to block a rule that would have required them to include list prices for prescription medications in television ads.

The hospital groups’ lawsuit also said the rule exceeds the administration’s legal authority. Specifically, it cites a provision in the Affordable Care Act, which was further shaped by administration guidance, that required hospitals to make public their “standard charges.” The new rule, however, essentially expands the definition of standard charges, as well as the definition of hospital services, to include negotiated rates.

The hospitals said that expansion goes beyond what Congress intended when it passed the health-care law in 2010, and forces them to disclose confidential contractual information.

The Trump administration has said disclosure would introduce competition and inject more free-market dynamics into the industry. It has also proposed extending the requirement to insurers.

Hospital-price growth has helped fuel increases in U.S. health-care spending. Inpatient hospital prices grew 42% between 2007 and 2014, according to a study this year in Health Affairs, while prices charged by doctors increased 18%.

Hospital groups argue price disclosure could raise prices. If rates are public, they say, some hospital systems might push for payment rates that match their crosstown rivals’.

They say consumers really just want to know their out-of-pocket costs, which requires data from insurers, rather than negotiated amounts for care.

While White House officials have said they have statutory authority, the administration has lost a number of court challenges over its health-policy actions.

A federal appeals court this year halted an administration plan that would have let almost any company opt out of providing contraception coverage on moral or religious grounds. The administration in October asked the Supreme Court to review the case.

And a federal judge in October said the federal government owed health insurers $1.6 billion after President Trump halted payments to the industry under the ACA that reduce consumers’ out of pocket costs.

The new lawsuit is also brought by the Federation of American Hospitals, which represents investor-owned and managed community hospitals, the Association of American Medical Colleges, the Children’s Hospital Association, and three hospitals in Nebraska, California and Missouri. They also plan to file a motion for summary judgment this week, officials said, which asks the court for an immediate judgment in their favor.

“We are concerned our patient families may confuse these commercial rate disclosures and not seek essential care for their children,” said Mark Wietecha, president and chief executive of the Children’s Hospital Association.

Corrections & Amplifications
The hospitals filed their suit on Wednesday. An earlier version of this article incorrectly said the suit was filed Tuesday. (Dec. 4, 2019)

 

Quote

 

Complying would require spreadsheets with hundreds of thousands of columns, the groups said in the lawsuit. They say such files could crash most standard computer systems.

“Some members worry about the ability of their websites to function at all with such a large file,” the lawsuit states.

 

I'm not an expert but this seems like a load of crock. Maybe don't use an Excel document to do this. The program I work in is SQL based and allows you to view thousands of columns of data in the web-based viewer in a matter of seconds. If they already have this data, which you would assume they do, how on Earth is this going to cost hospitals $30 million+ per year to publish them? That seems way out of whack. 

[Anastasis 23,394]

HUNDREDS OF THOUSANDS OF COLUMNS!!!

[elfenix 34,171]

[Dnaguy 11,777]

Won’t somebody please think of the childr......file sizes?

 

Yeah this is completely bullshit.

Publishing rates will put a downward pressure on prices. The opaque and inelastic nature of their business allows them to rake in $$$$$$.

By adding transparency to the process it threatens a key aspect of their profitability.

Edited December 4, 2019 by Dnaguy

[American Swindle 102]

Here's a free market approach to surgeries.  I know Oklahoma sucks, but this surgery center does not

 

 

 

Also an interesting podcast episode:

https://tomwoods.com/ep-481-how-capitalism-can-fix-health-care/

Dr. Josh Umbehr operates a concierge family practice in Wichita, Kansas, and counsels doctors about making the transition to direct care, bypassing insurance and government, through Atlas.MD. He ran for lieutenant governor of Kansas in 2014 on a ticket with his father, Keen, at the top.

A point made in the episode is that Doctor's, having spent 12years plus learning a specific skill, have little business acumen when it comes to the operational side of their practices so they usually just roll with entrenched system as it is.  

Anastasis, what are your thoughts on the Surgery Center in OK?  You heard of them?

My wife was looking at a hip replacement and they do them for 15K cash. I guess what I'm trying to say is that maybe we should embrace free market capitalism for a change.  Please don't confuse it with crony capitalism or "crapitalism."  

 

 

[bad_teammate 13,132]

Every reform is going to involve a full-on war with the private industry, so just kill every part of the private industry that isn't necessary.

[Incredulity 11,555]

3 hours ago, Dnaguy said:

Won’t somebody please think of the childr......file sizes?

 

Yeah this is completely bullshit.

Publishing rates will put a downward pressure on prices. The opaque and inelastic nature of their business allows them to rake in $$$$$$.

By adding transparency to the process it threatens a key aspect of their profitability.

Groundbreaking