Trump Signs Executive Order Compelling Disclosure of Prices in Health Care

Absurd list prices were used to screw Medicaid and Medicate. Because they often paid at 85% of list price. When commercial payers had negotiated as much as 90% discounts. But that doesn't work anymore, I think.

Of course, reimbursement rates are hardly our only problem. We also use more expensive treatment options for the same conditions, give doctors (and thus patients) a level of flexibility unheard of elsewhere that allows to spend money on unnecessary medicine just to make a patient happy and have ridiculous administrative overhead costs.

The government is EXTREMELY good at negotiating prices. In other words, there are already examples of it working really well, so it's pretty clear it can work well here too with enough care.

Japan is known for really high-quality care that is insanely cheap and has more doctors per capita than in the USA. So the worry that overall service and competition would decline is unfounded.

So let's take really good working examples and try them here. The USA can do so much better, it's not even funny.

https://www.bloomberg.com/opinion/articles/2017-09-19/want-a...

Because larger purchasers have more leverage to negotiate better discounts/bulk rates. When your choice is, "take the offer or you don't get any payment", you take the offer.

I can think of two. First, so they can spend the money on other things they want (military, social security, education, etc.). Second, is so they can get re-elected by those same citizens.

==There is no way to tell if the price we are paying is at all good value for money compared to what it could cost.

We could look at the dozens of other developed countries who work like this, should give us some clues.

Here are three good ones: the UK, Japan and Canada. All different systems, all providing medical care for much less cost than we do in the US.

Additionally, your reasoning is flawed at best. The government can legislate that providers can only charge $x for y service, which private actors cannot. 300 million+ people is a very large market to leave just because you are slipping on profits. There are many other levers a single payer who is the government can pull as well.

We need some price setting regulation to protect consumers from getting fleeced. When the hospital knows that I'm going to say yes, why not price every surgery at $100k?

We've tried letting the insurance companies regulate the price, but they've proven themselves incapable either because there are so many secrets making the market not fair or because they don't have an incentive. It is time to try something else. The government is our mechanism for regulation. Let's use it.

https://www.statista.com/statistics/268826/health-expenditur...

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

The US is an outlier, because the US system is broken.

IMO the US healthcare market either needs to be properly regulated, or it should be converted to single-payer (a system which many other countries use with great success) - other developed countries are spending significantly less per capita for better outcomes while still allowing private healthcare for those who want it and can afford it.

If you can’t provide a better alternative then it’s still an improvement.

The much larger UK NHS system where even hospitals are publicly run would be even harder to pull off in America. So single payer insurance is basically the lowest hurdle. Plus the simpler the better.

At some point the right in the US has to concede on healthcare because it’s already been gutted and killed by a thousand cuts. And I say that as a libertarian leaning person. You can’t honestly believe they can solve this problem by writing a thousand more small reform bills.

Plus if you give the mob public healthcare they will be much more tolerant of pro-economy policies and take a strong argument away from the people who want to gut even more industries so they function just as poorly as the pseudo healthcare market in the name of “fairness” and “equity” (mediocrity for all!). Lesser of evils.

That's not public information. Even if that was available, that's useless.

Realistic price does not matter at all unless we are talking millions of dollars. Being in network or not does.

Let me explain why:

Have you been to court on this matter? I am interested in what your experience was.

Here is mine: the judge was tired from the previous case and really did not care what I nor the ambulance provider thought.

To her we were just sqabbling over prices: The ambulance provider wanted way more ($6k vs $600) than I thought was reasonable and I felt I had been taken advantage of when I was most vulnerable and it was not a honest way to make a living and we should not encourage it.

The judge had no interest in how I felt: it was all a matter of how to get us out both quickly and have the next hearing.

The ambulance provider said their 2 mile trip to the ER was worth $6k because blah blah blah.

Then I presented.

I had printouts that showed that ambulance providers that were in network with my plan typically charged $550 for the same exact service with the same level of staff in the ambulance.

I was hopeful that showing this and that there was no in network ambulance providers within a reasonable distance where I was injured would help me.

Nope.

I also said it was pretty unethical for the ambulance provider to have a business plan where they would be out of network by design with all insurance companies as way to extract as much as they could from people in distress.

I was with Anthem Blue Cross - they are a pretty big company, no small fish.

This ambulance provider clearly puts it on their website and all paperwork that they explicitly don't work with insurance companies because they don't get paid a fair price.

The judge asked me if I had signed the paperwork that said I would bear all expenses before I got into the ambulance.

I said yes.

Then she asked how much money I made and what payment plan I would be able to afford.

Maybe if the ambulance charged me a million dollars, then I could try with the "bill is not fair or reasonable" story, but I had the feeling the ambulance could have charged me $10k and I would have had to pay it because I'm a highly compensated individual in the top 1% income bracket in the country so I deserve to pay more.

I now always carry blankets and bags in my car so I can cover myself if I am bleeding and get into a taxi or Uber/Lyft/etc, without getting blood on the seat, to the nearest hospital if I can.

In the UK, where I'm originally from, I've never met anyone who wishes they had a role in evaluating healthcare pricing. In the US, I personally don't either.

The whole union's representative model is bent over backwards to keep consensus with the south eastern US for reasons that have little relevance this century, but are impossible to change.

The electoral college is from when there were 800,000 free white males in all the original states (US 1790 census), and the union still felt like it needed Georgia and South Carolina to agree to be a part of this contract for strategic reasons. I wonder how many of them were literate land owners!

Is that relevant today? Is ANY of that relevant today? Many other countries looked at the electoral college over the last 250 years and saw how it was a strategic compromise masqueraded as a feature. They decided not to do it and stick with popularity contests.

In the time when the Constitution was framed, and in many times since, there is the meme of "checks and balances". [0] The overall idea is that no one branch of the Federal powers may be unilaterally or universally unabridged in its ability to act; other branches have powers which may check, veto, review, or otherwise neutralize certain actions.

So, why is the President sometimes called "chief"? Because, as Article Two also states, they are the "Commander in Chief" of the armed forces. When it comes to military decisions, yes, there is no office above the President's; however, note that the President's military powers are neither unilateral nor unlimited. Crucially, the President isn't able to declare war or allocate funds for military use without Congress' approval.

Hope this was informative. The USA's Constitution is a fascinating document worth reading, even for those not from the USA.

[0] https://en.wikipedia.org/wiki/Separation_of_powers#Checks_an...

Negotiated prices paid by insurance actually are pretty good, but could be even better with the price transparency that will come about with Trump's executive order.

$25k/year over ten years is $250,000, and compounded at 6% is $319,000.

So yeah, I'd easily be able to self insure for anything.

https://www.politifact.com/truth-o-meter/statements/2013/oct...

They said it didn't matter though because insurance covered it. But they were wrong.

Well if that’s the case...it’s because the $400 bill isn’t the real cost for the service and insurance actually pays $0 of the bilked $400.

What happens is the patient pays $20 copay gets billed ~20% of the $400, or $80...then everyone but the patient is happy, Dr. gets his $100 for the visit and gets a $300 tax deduction, the insurance gets its premiums from the patient and gets their 80% waived by the provider effectively shifting 100% of the cost to the patient while still being able to account for the 80/20 split on the books.

Untying insurance from employment is a great idea, but it won't solve this. With HDHPs being so common the 'disconnect' between providers and patients is already not a real thing. Neither will single payer fix the underlying problem, although at least individuals will be better off.

At any rate, entrusting laymen to understand when they should and should not seek emergency medical attention means that people will die through entirely preventable causes in an attempt to ration their health care spending. Your cure sounds worse than the disease.

There are no effective market forces you can 'unleash' in the case of health care. It wouldn't matter if you removed all government regulation and subsidies tomorrow. Even in a world where it all somehow works out, do you want medical providers in a race to the bottom? In the absence of meaningful quality of care information (impossible), consumers are incredibly sensitive to one thing: price. What you will end up with is cheap(ish) providers providing incredibly substandard care by cutting corners and killing people.

It should be possible to reopen those negotiations and reach a fair conclusion, but there's going to be a lot of fighting on a case-by-case basis (with a lot of cases). I believe it would ultimately work out better for everybody, but the "ultimate" would be years -- if not decades -- away.

That's exactly how things were in the 1930s. Healthcare was unaffordable to the degree of public outcry, which is why universal healthcare legislation was introduced repeatedly and stifled by the AMA every time. In fact, early health insurance programs were designed to bypass pay-as-you-go medical fees because they weren't meeting the needs of the hospital or patients. It wasn't a tenable system.

It seems we're regressing.

I also bring up single-payer in a related way because the need to find in-network providers within reasonable distance often is such a limiting factor that price shopping isn't possible.

With single-payer, one could actually choose between all of the providers... in addition to other benefits.

There are websites like ZocDoc which are like yelp for doctors, but they can only do so much because of the lack of price transparency, and lack of ability of consumers to choose doctors out of network.

There could be many more, if not for various policies that impede this.

You could drop the cost of care just de-regulating. But Milton Friedman failed, who would succeed today on that path?

I think you are technically correct that Truvada is a life saving drug but I feel you are being dishonest. If you exclude occupations where you could be exposed to HIV, most of the US users of Truvada could choose to change their behaviors and reduce their chance of contracting HIV to <1%.

There is also the general trend that US companies pay large amounts of money to develop drugs, charge US customers enough to cover R&D costs and then sell the drugs at cost internationally. Does that suck for us? Yes, but it helps the rest of the world significantly.

No. I earned mine. And now here you want to come along and have it spent on something we all agree is a scam at $2000/mo/user.

I reject the premise that any money spent on the social good is money well spent by default. I argue that money spent wisely the goal, GP had no plan for wisely, just spend to spend. That is why ACA failed, it did nothing to adjust costs, just signed everyone up into a broken system.

At the same time most people here are just saying "it's been invented, patent expired and should be free now!" which is another way to say "I want remove incentives for new drug research by making it very high risk and low reward". So I disagree with that too. I wonder how many people understand why the USA is the center of pharmaceutical research and in general healthcare research?

Feel free to attack me for just not caring about people selfishly, surely I'm a greedy monster. That seems ineffective to me, but what do I know!?

Maybe those free doses are being distributed to clinics for people who are not capable of initially paying for or even filling out forms for reimbursement.

in rich countries it s subsidized by generous healthcare contributions

I believe its use is for pre-exposure? Anyway its not about passing judgements about lifestyles, but since there is a much cheaper alternative, people won't be persuaded to subsidize the expensive stuff.

This is an enormous problem, and the way you eat an elephant is one bite at a time.

It also happened in October 2010, which I think was before the wage fixing was discovered (I know the dates because it was after I signed and before I started. Any time I tried to negotiate on salary they countered on stock because they knew salary was going to multiply by a third)

There is a massive information asymmetry between health care providers and consumers. Doctors take decades of training. Hell, medical billing by itself is a degree. Consumers will never be prepared to properly assess costs. Even if they could, it doesn't matter when you are hurt and can't refuse.

It's more like food sales at a hockey game. Anyone in the arena that wants to eat or drink has to buy what is being sold. As such, prices are hugely inflated, even though the nearby gas station is much cheaper.

(You may want to consult with a lawyer friend a bit before making quite such a naked statement; that may constitute blackmail in your jurisdiction. But there will still be "ways" of phrasing things in your jurisdiction. Talking to a lawyer may not be all bad anyhow, whatever it is you have to say will sound more credible with some lawyer's letterhead on top. Hospitals hear a lot of amateur lawyers expound their novel legal theories every day.)

I'm not going to deny the relationship in that situation is still lopsided in the direction of the first hospital, but the situation is not necessarily 100% in their favor.

You find a specialist the next day. And if you require surgery, that's another day or two. There's no reason you couldn't do a cursory sanity-check on pricing in this case (if pricing info was easily accessible).

I've even broken bones on vacation and only had x-rays after I've arrived home. Does it hurt? Yes. Am I incapacitated? No.

It's very doable. When I broke my arm in highschool, I was in mind bending agony for a few minutes. Then I put some ice on it and went to work the next day. Didn't get a cast on it until after work.

When I broke two fingers a year later, I took my own x-rays at a dental clinic for which I did some maintenance work. Yep, they were broken. No, I didn't pay anyone to tell me to stop using them for a while.

Sure, lots of broken arms need a cast, but this idea that you can't shop if you're in pain is goofy.

Edit: To clarify I am an American myself and this irritates me.

But most expenses are pretty predictable, like the colonoscopies that I have to get periodically (and which I do shop around for, altho it's damn difficult). Yeah, if there's a bowel perforation all bets are off, but that happens 1/1000 times.

adjective

(of an event, situation, or condition) not occurring very often.

I'd say 6% fits that definition. You're also ignoring the fact that, for various reasons, people show up in an ER when they really didn't need to.

This helps in the vast majority of cases and you're being needlessly argumentative.

In fact, to use that stat per 1000 people is not very useful.

Number of people per 1000 visiting a hospital for an emergency would be more helpful.

I suspect it would be much less than even 1%.

Many ER visits often happen because people can't afford insurance and preventative care. If this alleviates some of that by permitting more competition due to price transparency, then it will become even more rare.

And for most major health care issues, the primary concern of the patient isn't price, but rather outcomes - quality of care. Do we choose the cheapest doctor, or the doctor with the best reputation?

My wife, who is a dancer, tore her ACL last year. Not getting it fixed, and fixed right, was the difference between being able to continue dancing, and having to give up the thing she loves the most. So when decisions like "Use transplant tissue, or cadaver tissue?" came up, there was zero thought given to "Which one costs the most?" It was all "Which one is most likely to get her back on her feet and allow her to continue dancing?"

That's called buying health insurance.

Most of us either choose the lowest cost option on the public market that suits our needs for emergency care or take our employers options, of which there are one or two. Even if you had previously made a choice, which again is not something most people can or want to do, when an emergency happens, it’s an emergency! You will have to be taken somewhere.

There are many times when an ER is full, you are outside of your home area, maybe just traffic, that would push you to another hospital in an emergency. Your argument is not only poorly made, I find it hysterically obtuse. Most people don’t want to get to or even have to choose their damned emergency care. To assert otherwise is disingenuous

Things are changing... very slowly.

Dental insurance firms would probably like to engage in all the price-fixing and patient confusion that other health insurance firms enjoy, but they can't possibly employ enough people to arrange their dastardly schemes with tens of thousands of different dentists. Instead, they have to publish (to dentists, not to the public) lists of reimbursement limits by procedure code. Dentists decide whether they'll accept any particular insurance plan largely based on reimbursement, and many of them are willing to discuss those decisions with their patients. At the same time, most dental patients don't have insurance at all [EDIT: and many are fine with that, since they can afford the care they need].

Single physicians in family practice would be in largely the same position as the typical general dentist, but the work they do is a relatively smaller portion of the overall industry. After all the real screwing from medical costs takes place via hospital visits and high-tech imaging. Even a smaller hospital will start getting calls from insurance executives after they generate a few expensive cardiac procedures in any particular quarter.

Don't take this as a defense of dental insurance. It's fine if you get it from an employer, but after working in a dental clinic I don't think anyone should get it privately. If you need a lot of dental work they don't pay for much of it (this is also true of many employer-provided plans). If you don't need a lot of work you end up paying them more than you'd pay the dentist. Most people who need lots of dental work but can't afford it should get loans for that work, from e.g. Care Credit or one of its competitors. Yes, that sucks, but it sucks less than private dental insurance.

Let me help you out. A "whataboutism" would be if I made a post saying "Well, Trump did this one good thing, but Obama passed Credit Card Reforms!" See how those are non-sequitur?

Frankly (and maybe it's different in Canada), but I feel like people will have better health outcomes if they are aware of the options and consult, work with, and even challenge if need be, their GP.

GPs (or Primary Care Physicians, PCPs in the U.S.) share some goals with their patients, but many goals are not shared:

* Spending less money / good drug success / less side effects vs. using only tests/drugs they GP is comfortable with * Avoiding lawsuits vs. candid discussion * Taking time to research medical hypotheses vs. needing to get to the next patient

Come to think of it, if one is willing to invest the time, have an inquisitive mind, and demand a partnership relationship with most service providers, perhaps that person will generally have better outcomes in many areas (home repairs, dental, car service, etc.).

This should be your doctor's job when you go for annual checkups. If you don't go for annual checkups, you shouldn't be surprised that your health choices are falling out of date.

I also have a hard time believing that the reason prices haven't gone down is due to some overall lack of awareness of the problem.