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Comment by garettmd | Hacker News Reader

This. It's telling that people working inside this system operate on a totally different set of rules for how to determine basic things like the cost of some input.

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You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient. It's telling how people on the outside have no idea how complex the system is, as if there's one simple way to cost an item (hell, there's not even one simple way to cost an item with GAAP accounting for a widget). These lists are kind of worthless in the current iteration, but they'll hopefully get better with more targeted intervention.

I wouldn’t call it worthless at all, because of the rest of your last sentence. It provides a starting point.

We need to start setting the expectation of transparency for some small subset of info to get further transparency. Change takes time, as much as we’d like it to drastically improve overnight for real life and death situations like medical prices.

How does the cost of a drug change based on who is consuming it? That's like saying the cost of a loaf of bread changes based on who is buying it.

The price you charge for the bread might change, but the cost is the same regardless of who is purchasing it. There's a difference between varying costs of an item based on accounting methods, versus varying costs of an item due to who is buying it. There seems to be huge disconnect here between people working in healthcare, and pretty much everyone else.

The hospital's drug cost is the price the distributor charges it. That price varies for each individual patient. It's turtles all the way down.

That needs to be made illegal tomorrow.

Heck, sounds like there could be a Civil Rights Act case, if prices impact people differently based on race or sex or other protected class.

Why does the distributor know the identity of the patient?

This reads like straight up corruption and extortion. There could be no other reason to do this than to milk as much money as possible out of people who have no alternative.

You should absolutely be testifying before Congress, not before HN.

This is exactly what happens when a monopoly produces extremely price inelastic goods. If it's not illegal, the monopoly will attempt to charge each customer as much as they can afford.

That doesn't change the question though. It just changes who it's posed to.

>You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient.

Why shouldn't it be? How hard is it for a hospital to project their annual aspirin/paracetamol/? usage and budget for it?

Easy.

Now try it at a rural critical access hospital for rattlesnake antivenom with a short shelf life, so it usually expires unused. They are required by law to stock it or they cannot have their emergency room open. Estimate the revenue generated from treating the one patient who needs it every other year, and by the way, you have 9 contracted payers with different rates and you don't know which one, if any, the patient will have. Rinse and repeat for every other drug required to provide "critical care". Maybe layer on infusion of exotic chemotherapy drugs or monoclonal antibodies to treat a new pandemic virus.

It's not easy.

Radioactive pharmacy is another example of insane pricing complexity (and logistics) because of the short half life problem.

So one patient every two years needs one dose of an antivenom. Charge them for the dose of antivenom. Then add up the unused stock as administrative cost and spread that over all emergency care. Simple and effective.

Do the same sort of thing for all other short-half-life things that you must keep on hand.

It doesn’t have to be hard. I get that it is complicated right now, but let’s focus on the idea that simplifying it would help everyone.

Not my area of expertise but I would bet that would get you a substantial fine from Medicare for misrepresenting your cost of care, or at least be prevented by Medicare cost reporting

https://www.cms.gov/Research-Statistics-Data-and-Systems/Dow...

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