New health insurance “transparency data” looks suspiciously wrong
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That’s because their negotiating power is mainly due to the size of their buying power, not special knowledge or skills. Health “insurance” is basically the lamest, most economically perverted form of collective bargaining ever.
Brokers, medical billing staff, and other middlemen serve no purpose other than increasing cost (in order for an inefficient, openly colluding private cabal to invest premiums, deny claims, and collect profit) because everybody needs access to medical treatment.
On the other side my child's healthcare is amazing and all free. We get instant access to great services.
It’s not whether the cost is socialised or not that decides how long the wait will be.
It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn.
If care is free, aren’t you more likely to go than if you had to pay even a minimal cost?
New Zealand has an accident compensation system which pays for accidents (though there may be a small surcharge) but not most medical events. They split the hair finer that is sane. Swallow a foreign body? Medical problem. Swallow a foreign body as say ‘it feels scratched’? Accident. Insect bite? Medical. Mosquito bite? Accident (it’s a distant memory from when I billed these things but I’m fairly confident I’m right).
It’s all to do with cause and effect, and each must be identified.
The accident compensation scheme covers a portion of wages too. Medical problems cost, not US style but not free.
By competing on ... what? Can't be price (because "free" wins). The only other option is competing on quality.
Your statement doesn't sound correct.
I already asked what the ways are; why are you replying saying there are ways?
I literally asked "In what ways?" and you are replying "handwaving There Are Ways" ...
In case you really can't imagine alternatives: what if the private system spreads lies about the non-private system? What if they use their influence to change laws and regulations to prefer their system? What if they use their influence to make others with influence treat those using the non-private system worse?
None of these are competition in the sense you're asking for, and yet they are a natural consequence of private incentives.
It's hard to compare apples to oranges but with high doctors per capita, low wait times for speciality services, long lived citizens and a far lower percentage of GDP spent on health, I wonder if there are any serious holes to poke in Italy's system when compared to the U.S. or if they simply just beat us on every metric.
https://www.oecd-ilibrary.org//sites/242e3c8c-en/1/3/2/index...
https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?location...
$1500 on my HSA plan, which btw right now is returning 4.6% in a money market. How awesome is that?
Great deal. Worst pain ever.
The point is, the entire thing is broken nearly everywhere you look. I don’t know what a better alternative is, but we sure need one.
So you millage may vary.
Also, where I live there are five (?) Hospitals with ER within a ten minute drive... in suburbia. There just can't be that many people getting deathly ill sick.
I thought they do, in fact, and the bill expires if not sent out in time.
If you have a chainsaw accident and its serious, you arent going to wait 8 hours
US, and he's insured, and it's supposedly a pretty-good hospital.
I've been to the same ER within months of that, and it was empty and I was back in a room (well, cubby) within 15 minutes, with something just barely severe enough to merit an ER visit. Quick. Fucking expensive (think it was almost $3k by the time they were done sending bills, for 5 stitches and an x-ray—and that's with insurance), but quick.
It was mostly just timing and luck.
> My father's cancer treatment was not covered so the last year of his life cost him everything.
Sucks that it happens to anyone, but the final year(s) of healthcare finding a way to soak up every cent, before the end, is basically the norm here in the US. Everyone's retirement savings is just money the healthcare industry's lettings us hold temporarily.
The same dynamics play out with pension schemes. Declining birth rates play havoc with proposals that rely on a large, young employed base who's work supports a small, retired set of pensioners.
My own perspective is that healthcare is extremely limited on the provider side. Professional organizations have been limiting the supply of doctors / doctor equivalents for decades. Not to minimize the work a family medicine or general practitioner puts in, but many important health services/early interventiona can be safely and reliably provided by a nurse practitioner or physicians assistant (what a horrible name) on a much larger and affordable scale then exists today.
It's a perverted cross between escrow and welfare in which the population basically pays their own way in the long run plus supports all the people who make their living by being "administrative overhead" along the way.
There is enough (potential) money and incentive here that almost any system will be perverted eventually.
NHS is not known for speedy treatment, for instance.
It’s about ongoing oversight and a willingness and ability to cut through bullshit to fix things. That’s in short supply here and everywhere else.
The stories (first hand from relatives who use it) of blatant profiteering and abuse of the system in Medicare is mind boggling.
From what I understand (I am not a UK citizen, but me mum's mum spoke Scouse. My mother, on the other hand, spoke The Queen's English), everyone loves to hate on the NHS, but no politician in their right mind will touch it. It's a "third rail."
In the UK, it's from the voters.
In the US, it's from the Healthcare Industry.
They are allowed to spend as much as they want for votes due to their freedom of speech. Sure they can't directly vote but ever since like 2010 have a lot of human rights and I'm sure would love more. I would not be surprised if one day they could directly vote considering due to their rights. I hope though we can push back before then and change things.
https://www.brennancenter.org/our-work/research-reports/citi...
Most of Medicare is administered by middlemen and private companies.
t. licensed broker / agency owner
Now can you make a cogent argument for why more than one federal / national union should exist? Why does Europe allow multiple unions?
As someone familiar with insurer, provider, and facility IT systems, I'd offer an alternate explanation -- the data is bad because healthcare IT is understaffed (and often incompetent).
These are businesses that have squeezed most costs out, and IT is definitely a cost.
Imagine banking... if there were much less competitive pressure and an inability to offer services across state lines without substantial additional effort.
They received a mandate.
They tried to respond in the way that required the least amount of effort.
From someone in the industry, it's entirely plausible this is the best they can do.
Which usually means it takes CMS threatening to drop them for them to launch a multi-year project to finally fix the issue (somewhat).
Dealing with them right now feels like dealing with the government might as well just have the government run it
This is the best they can do when all their incentives align so that being as opaque and disingenuous as possible about costs (and understaffing and often screwing it up helps with that!) helps them.
IMHO, best of both worlds would be the federal government taking over and centralizing the most core services (rates, interchange, data systems, etc) and allowing private insurance companies to build offerings on top of that (customer service, servicing, product mix, etc).
They are certainly very creative in making the system as expensive as possible. See Medicare Advantage.
"IMHO, best of both worlds would be the federal government taking over and centralizing the most core services (rates, interchange, data systems, etc) and allowing private insurance companies to build offerings on top of that (customer service, servicing, product mix, etc)."
This would be best. There is so much unnecessary bureaucracy at providers and insurers because the insurers have different setups. The medicare setup would be a good foundation .
In what way?
> especially on the operations side
If the US had national, universal health insurance, the operations would be much simpler.
(My qualifications to make this statement: 15 years in healthcare IT, including UHG/Optum, and 8 years as CTO of a large clinical organization that included primary through tertiary care, research, and an insurance operation.)
I certainly don’t have your credentials, but my experience in being an insured person doesn’t match this. I’m willing to believe you, but having filled out forms for UHC to get reimbursed for an out-of-network doctor, it sure feels like they kind of make it up based on how they feel that day. I’ve submitted what appear to me to be identical forms for reimbursement (like the super bill the doctor gives me has the same codes, duration, etc.), and the reimbursement differs for no reason I can discern (had long blown past my deductible, etc.). It feels like sometimes you get lucky and the person evaluating your form gives you a break, and sometimes you’re unlucky and they don’t.
On the other hand, malicious compliance does seem par for the course for these assholes. So what you say makes sense.
Sure, insurance companies ultimately know what they paid, but consider that these MRFs are almost certainly not being prepared by the people responsible for that knowledge. They were probably tasked to one or two data analysts who quickly banged them out in whatever BI/reporting tool they use and did nothing to verify correctness. It's not like they had an accountant audit these if they weren't absolutely required to (they weren't). Most healthcare analytics tools are complete junk drawers of data from numerous systems and getting these MRFs right was probably never a priority for anyone. Just a total "I have no idea if these are right but they sure are numbers" exercise.
I mean, how many times have you seen some Tableau report that's all screwed up because some of the MRNs aren't actually MRNs (even though someone named the model field community_mrn) but file numbers from the scheduling system, and now you've got duplicate patients? BI systems just breed that kind of problem unless you are extremely careful about managing them, and since they're "not systems of record" (these are scare quotes) few people are.
Maybe the problem IS the line items. You know the labor cost of tracking the fact a person was given Tylenol is way more than the cost of the pill? Just give people the incidentals and stop billing for them. Half your overhead might vanish.
BTW, yes every medication need to go on their chart. But it does not need to go through the entire finance system and to insurance.
> Sure, insurance companies ultimately know what they paid
It came to mind reading the above that a more accurate/useful perspective might be "The insurance companies' system knows what they are paid," but those system may comprise multiple software systems, none of which have data in compatible formats.
Ergo, even though the insurance company "knows" operationally (it can generate a number on request), it might be unable to generate a list of all numbers (effectively: every path through the system).
But that's why mandates work in insurance: if CMS pushes hard enough, eventually the insurers will develop the functionality.
Assuming this is true for the sake of argument, saying that this sort of thing isn't malicious compliance is a sad kind apologistics for bad behavior that seems to regularly appear on HN.
How can these kinds of companies optimize their charge codes to get the max for the procedures, optimize their taxes to pay the minimum possible, and then do a poor job on these existential crisis kinds of things? I think they know what they're doing in all cases.
It's not rocket science! But it is decades of code on top of decades of code. There's a reason they still pay COBOL programmers...
What's the cost of an X-ray? Did you know they used to do a FREE X-ray at the shoe store back in the day to check fit? Yeah, don't tell me they squeezed out most of the cost.
American healthcare not a free market.
You should be able to go back to the hospital and say - based on the hospital public fee schedule , total FFS for CPT should be (very low number) . Therefore, my deductible payment is overstated, please reduce my bill dramatically.
A lawsuit would follow, which would make it very interesting. Chief argument:
The customer can clearly say its fraud - he/she looked at the public rate schedule and believed the charges would be based off the public rate schedule.
Ultimately, the disconnect between published rates and the EOB is going to come back to bite hospitals, once people shop around using the data.
So, not an entity which by its very nature spends other people's money and can never run out? I agree, sounds like a great idea, but someone will have to invent such an entity first. The ones we have would not meet the requirement.
... what's that? The entire OECD has more centralized government control of healthcare than the US, ranging from extensive price controls, to de-facto or de-jure monopsony, to outright direct control of the healthcare system, and nowhere is there a strong populist movement to ditch that for a heavily free-market-based solution? And literally all of them are way cheaper per-capita than our system? And outcomes remain between pretty-good and great? And instead of the bureaucratic billing mess we have, that's all nice & simple and takes up almost none of the time of sick people and their families? This makes no sense, I read several columns on mises.org proving from first principles that this is impossible!
Yes, and let's also imagine all of the existing single-payer systems (de facto or otherwise) work as advertised and didn't have elites-with-means flee to other nations for quality care.
Let's also imagine these systems provide stellar quality care and more importantly, timely care.
We can daydream all we want - but the reality isn't so obvious or absolute.
For those who are really in the know... the US already is a socialized medicine nation. Look at how much of the US annual budget is blown on medical care. Hint... it's larger than the military budget.
You mean the US...?
It's a quaint idea... but nobody likes the reality once it's implemented. Evidenced by the fact that the US is already the largest public health system in the world, and people do not even realize it.
I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand.
These are exactly the ones I had in mind.
> universal public health care with costs covered by the government.
To be pedantic, this doesn't exist anywhere in the world. The taxpayers foot the bill universally. You may not personally care, but it matters when we're discussing spending other people's money.
In the US, we already have universal public health care. If you cannot afford to pay a portion of your premium, you can be eligible for healthcare at zero expense to you.
The US government spends more on healthcare than any other nation. The US is already socialized healthcare. It's just not the utopia people thought it would be so they continue to complain...
It gets way more complicated than we can discuss here - things like private premiums are so expensive because the socialized system does not pay it's entire bill, etc. The entire thing is a massive C.F. but speeding further down that same tunnel is not going to suddenly magically make it better. It's very much-so the "but we can do it better" mentality, despite however many previous attempts there has been.
Those countries citizens rate their happiness with the healthcare system in their country ~2x higher than US citizens do. So that line of thinking doesn’t hold.
>> it matters when we're discussing spending other people's money
That’s not how money works and until that fundamental misunderstanding is eliminated, learned helplessness will prevail. A country that issues its own currency cannot save money in its own currency.
The hard limitation a government faces is resources, not capital.
Ah, the so-called "Modern Monetary Theory"... the same one that told us governments can spend infinitely without consequences... and then runaway inflation and looming recession happened. Of course, not MMT's fault...
In case my sarcasm wasn't thick enough - it is indeed how money works. The attempts to "1984" economics thankfully are failing spectacularly enough to put it to rest.
> Those countries citizens rate their happiness with the healthcare system in their country ~2x higher than US citizens do. So that line of thinking doesn’t hold.
This is a false statistic designed to mislead people into thinking some other system is objectively better.
you’re making a strawman argument. You’ve mischaracterised then proceeded to knock it down.
Here’s Randall Wray, a leading MMT scholar on this topic in early 2020: https://www.levyinstitute.org/publications/covid-relief-and-...
“The inflation worriers’ objection seems to be largely over the “stimulus checks.” While we prefer targeted spending in normal times (and prefer pay for work over transfer payments), these are not normal times. The extra $1,400 (above the $600 already approved) will and should go to most families to help cover those bills. The propensity to consume out of these checks will not be high, as most people will use them to pay down debts or replen- ish savings (only 29 percent of the first round of checks was spent on consumption, while 34 percent was used to pay down debt and the rest was saved). What little boost to consumption they will provide can be handled without inflation, as production around the world has rebounded sufficiently.”
Before we dive into the relief part, note the “While we prefer targeted spending in normal times (and prefer pay for work over transfer payments)”. This refutes your argument as being a strawman. MMT doesn’t say what you said it does.
That doesn’t refute that stimulus is mostly inflationary though, so let’s look under that rock.
All spending, private or public inescapably contains inflation risk, however we saw something else for the most part.
Building on Randall’s reference to what the first relief was spent on (mostly non inflationary - but with some inflation where checks were issued to those without need for relief), we then went on to see supply side shocks (it’s still a pain to source some cars). There were demand shocks very early on - toilet paper predated stim checks so something else caused that demand side shock…
To this day We still see the predictable bullwhip in some markets.
We also see evidence of suppliers opportunistically increasing prices - some of our largest corporations are currently enjoying record profits.
So let’s be more direct in knocking this argument down - what are the cases of inflation that can’t be completely explained with one of:
1. increased profits in the supplier
2. global supply shock (oil, gas, manufactured goods etc)
So what exactly is the argument around inflation if it is limited to a few asset classes that are ripe for obvious taxation solutions to eliminate said inflation?
>> it is indeed how money works
but going back to this bit, ignoring bs macro fairy tales and looking specifically at the system itself (which most macro theories rarely do, the stated assumptions in most macro bs are laughably absurd).
So how do things work in practice?
Ignoring that the fed has bought treasuries and thus literally means the government created money from nothing on a whim - ignoring this case because while it does sink the argument that taxes come before spending, it is a complex case with lots of gotchas that mean it’s not fair to characterise it as govt create money regardless of circumstance in all cases.
So instead let’s look at the policy that gives exactly this operation:
Step 1: The fed finances the primary dealer banks that participate in treasuries auctions - it accepts treasuries as collateral for repos.
https://www.newyorkfed.org/markets/domestic-market-operation...
Step 2: The primary dealer banks are obligated to stand ready to purchase treasuries
https://www.newyorkfed.org/markets/counterparties/policy-on-...
Step 3: and the Federal Reserve ensures there are sufficient reserves to do so by supplying them through temporary repos (a matched purchase of Treasury debt with a requirement that the seller must repurchase later). While the Federal Reserve is not in that case directly buying the new issue directly from the Treasury, it uses the open market purchase to buy an existing bond in order to provide reserves needed for a private bank to buy the new security. The end result is exactly the same as if the central bank had bought directly from the Treasury.
https://www.newyorkfed.org/markets/domestic-market-operation...
>> In case my sarcasm wasn't thick enough - it is indeed how money works.
I won’t be sarcastic, but you have been overconfident and mistaken.
NB: Great rebuttals include links to authoritative sources.
>> This is a false statistic
People’s opinions are invalidated only if they feel a different way than you? Come on… behave!
Sorry... these are borderline crackpot theories. The devastation left in the wake of only a taste of MMT implemented is enough to drive MMT to bed, thankfully.
It's also rather interesting how one can tell a MMT'er is in their midst without much even being said.
I flee the U.S. to have all my medical related tests and work, out of pocket, in the E.U. And it is cheaper and much much better experience. (And I don't get different treatment compared to any members of my family that are insured in Europe for paying out of pocket.)
First of all: I speak with a doctor. Not a nurse, an administrator to size me up, to see if I am in actual need of an appointment, but a doctor. (Yes, this has happened to me in the U.S. I find it unacceptable, especially given that I was apparently in much more dire situation than I even thought, and was lucky to be seen by a doctor, otherwise I would have joined the disabled group of individuals.)
I am not sure why people in the U.S. keep bringing up the UK [Edit: -- not sure if that is what you are implying but most people are in other comments]. Pick any EU country. Sure, you might not have a 5 star doctor's office, but you are going to be treated by a doctor efficiently. And that is what matters. Don't waste money on administrative tasks and fees.
Wow. Imagine a world where one entity received all the peoples medical bills instead. Too bad the EU can't achieve that.
Also looking at a primary care wait time is fine, but what is broken in most single player systems is specialists and "non-emergency surgery"... which is often stuff that significantly affects your quality of life.
https://worldpopulationreview.com/country-rankings/health-ca...
(the colors represent a primary care, but actually hover over each country...)
-
I ruptured a ligament in my knee and since it wasn't a traumatic injury, the surgery to repair it was considered a non-emergency and I was sent home from the ER.
My uncle is an orthopedic surgeon in Norway and was shocked to hear I was already scheduled for surgery to repair within a week. He said in Norway that would easily have been a month or two wait, which is alarming to me.
At the end of the day the US system is broken, but I think this illusion that single player is some strictly better concept that the US is just rejecting is also wrong. Care is noticeably worse in many EU countries when you look past the singular measure of "Time to see your primary care"
Do you have a suggestion where in the US that is? The US has many doctors but essentially all of them are gated behind insurances and especially hospitals.
You can see your doctor pretty much freely within the US for nearly any reason. This idea you cannot see your doctor in the US, or that you receive treatment from nurses or administrators is simply not true.
> insurances and especially hospitals
You may be confused, because some doctors operate private practices, while others choose to work for large hospital organizations. Private practices may be more akin to what some people's idea of a doctor should be. Most insurance plans offer a selection of hospitals and doctor networks, allowing you to chose the style and type that works best for you.
In all cases, you can see your doctor if needed, with very little lead time if any.
I think this is pretty uneven across the country but it is definitely far from guaranteed that you can see a doctor on demand with a short lead time. I have heard of similar problems pretty much throughout the central region of the country. In an attempt to alleviate the situation a number of states have programs where they pay subsidies to providers in areas with longer wait times, but this turns into a complex billing system and states often can't afford enough to really make a big difference.
In some ways the private insurers are doing some good here, as several offer "patient concierges" that will do things like try to find a provider for you that's accepting new patients. But in a recent experience that involves calling every two weeks and being told they still can't find any availability, for a couple of months.
Sorry, as someone who knows multiple people in various parts of the US healthcare system, this is pretty laughable. At the very least, we have different definitions of 'freely'.
Most of the urgent care clinics near me, for example, no longer accept patients without appointments. ER wait time is several hours, and you will owe hundreds if not thousands of dollars after unless you have _very_ good insurance.
> This idea you cannot see your doctor in the US, or that you receive treatment from nurses or administrators is simply not true.
Not from administrators, but nurses yes. Many clinics will only have a RN on duty large parts of the time. There are also systems where you can set up telehealth appointments, but a lot of the time they will be with a nurse and not a doctor.
> In all cases, you can see your doctor if needed, with very little lead time if any.
My parents have been trying to address some conditions they've developed, in one case, pretty serious. There's a several month lead time on their appointments to deal with this.
Although actually re-reading your post, it sounds like you're really just trying to take a dig at Nurse Practitioners, most of which hold doctorates.
I guess if you're too good for a DNP, the primary care must in fact seem like an impossible thing, in which case I do wish you good luck on the 8 hour flight for "all my medical tests".
They just suck in different manners, different countries have different degrees of "suckness" and so on.
And then there's the big problem beyond the question of who is paying: How much is being paid.
Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK.
If you don't solve this issue, a single payer system would probably become more similar to the terrible situation in most Latin American countries, where you have terrible supposedly universal public healthcare systems, but where in practice if you can pay for private insurance, you will do it.
Must be that law of economics that says the more you make of something the more expensive it gets.
https://www.investopedia.com/terms/l/lawofdiminishingmargina...
Would a free market be better? Probably overall, but the bar is very, very low. Instead of running another decades-long experiment, perhaps just use a model proven to work? There are many to choose from.
It truely was impressive how these forum members unearthed massive savings and really, once you knew what to do, didn't seem all that invasive or difficult.
We are writing more groups using Referenced Based Pricing. Good idea.
I’m not trying to excuse the other bad behavior, but within the data itself, he’s experiencing a combination of health insurers’ incompetence, the kludged up data models they’ve had to build to represent the output of the multiple generations of claims processing systems and other administrative processes, and the general mess that provider identifiers are. Every payor calculates values differently. Every payor uses different codes (beyond the standard CMS and CPTs). Every payor has different arrangements that are difficult to represent in standard schema, eg capitation in Florida, delegation in California, or the oddness that are Taft-Hartley plan.
There is a link in the article to a discussion with CMS. Another participant in the discussion works for IQVIA, a long-time claims data aggregator (and CRO and a bunch of other things), and clearly understands what’s going on. It would be extremely difficult to do this work at all without significant experience working with multiple payors’ data, which requires time and access, and pays well once you do have that specialized experience.
When you get an x-ray, you would expect to see 3 claims (again, simplifying).
—— One is the x-ray tech taking the picture. That gets a professional claim with a CPT code and is straightforward.
—- One is the interpretation by a radiologist of the imaging. That is a professional claim with a CPT and a modifier.
—- The last depends on the place of service. If it’s in a hospital, or at an outpatient facility, or at an ASC, then you get a facility claim to go with it.
Next, under what circumstances did the x-ray occur? Was it during an inpatient stay? If so, the payor might pay based on a DRG, which is basically a bundle of all the services that occur during the stay. How do you decide how much of the cost to allocate to the various parts of the x-ray? There are more variations on this.
Next, how are the providers contracted? Are they participating providers? Par vs non-par have different payment rates.
Next, was the service in-network or out-of-network, defined by the patient’s insurance benefits?
Does the patient’s PCP participate in a capitated arrangement (fixed fee to the PCP’s office per month)? If so, what is the allocated cost for the service based on the submitted encounter?
What about fees for network rental? Sorry, this one is esoteric, but it’s another factor.
And so forth and so on. It’s a mess.
Please take a look at the CMS Price Transparency Guide https://github.com/CMSgov/price-transparency-guide and familiarize yourself with the schema. You can also take a look at the federal ruling: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-...
The metadata you're talking about is specified in the files themselves. I've limited my search to fee-for-service (non-capitated, non-derived, non-bundled) institutional claims.
You can write to me if you have more questions. alec@dolthub.com
Riiiiiight…
I've worked within the health insurance industry (workers' comp, specifically); I know what a shitshow it is. As a fairly green programmer, I was tasked with creating a flat file export from our IBM mainframe's database for a new/changed regulatory requirement, and within just a few weeks (including a bunch of time spent waiting for return files from overnight batches), my export complied with the stated spec better than the agency's own files did.
But the health insurance industry makes absolutely jaw-dropping profits. The only reasons they can't harmonize their systems and produce something at least resembling standard outputs are because it would cost them slightly (on their scales) more money than just continuing to do what they're doing now, and because the higher-ups are (as with many industries) chronically unwilling to commit to one particular standard if it will make it even a little bit harder for them to change their minds whenever they want.
I absolutely don't believe this complexity is inherent in the problem space, because it very much looks like it is not. I'd believe that one or more actors in our healthcare system really like for it to be this way, though.
If the meaning of these prices is only decipherable by an elite priesthood that is too busy to work on the problem, there is no real public transparency.
This data should be verified by matching it against claims data.
Take an example like this https://github.com/CMSgov/price-transparency-guide/discussio...
I don't know how closely you've worked with this data -- you clearly have some kind of expertise -- but how do you explain this?
The insurance companies had 18 months to talk to the CMS and ask for a better data model. If they're not able to explain how much things cost with 5 different negotiated types -- negotiated, percentage, derived, fee schedule, and capitation -- then they should have asked for another one.
The hospital and insurance rates are both fee-for-service base rates for items billed individually. If there's some nuance in interpreting how "fee for service" "dollar amount negotiated" goes, definitely write to me and let me know. I talked with experts in healthcare pricing before I published this.
You can write to me at alec@dolthub.com if you wanna hit me with more questions.
Fine, "you don't know" how much things will cost. We can figure it out for you. No thoughts, head empty, just post and sign every bill you generate as it comes.
At DoltHub, where we build databases like codebases, we're running a data bounty, collecting rates for popular medical procedures for all US hospitals. Then we'll release the data under CC. Find out more here.
The health insurance industry is quietly and uniquely one of the darkest markets in the world.
His nominal role is to assist with Medicare-related matters, but given that the ostensible goal here is to compare rates (and most payors define rates as a percent of Medicare), I think the request wouldn’t be too much of a stretch.
Similarly, might be possible to get some congressional offices to lend their weight. Happy to personally lend a hand with the outreach if there’s interest.
There should be fine a 1% of annual revenue for every day these companies are in non compliance with prison for the ceo if they are non compliant for over thirty days.
Due to the cost I was curious, and found out that I could literally purchase all of the FDA-approved* lab equipment for my house and run tests on myself for less cost than it was to go to a physicians office. The physician (i.e. expertise) is irrelevant here (almost always are) as the most input I've ever seen provided by one amounts to 'take an Aleve if you're hurting'.
Home labs are likely where the future is headed, and it's the fault of the medical industry being so utterly useless. I've been through most medschool (neurology-focused) courses, and most physicians or any medical professional uses essentially zero of that knowledge.
(In fact, my local hospital has pretty great lab prices for this exact reason, so I'd assume this kind of price competition for simple tasks might already be a thing in some urban areas.)
It's lives on the line. In a somewhat realistic ideal world, any monies that exchange hands at that level should be to cover costs plus a moderated profit.
The lack of moderation and accountable oversight on the profit centers of healthcare is a real issue that we could solve, but too many people would rather have a 0.00000001% greater chance of becoming a millionaire in their lifetimes rather than put checks on unchecked capitalism.
Insurance companies are a problem, and they've grown fat skimming a fair fraction of this nation's GDP for no observable value provided. Our healthcare system is more expensive and has on average worse outcomes than other first world economies.
none of my colleagues believe it (they also don't believe in human caused climate change or that ectopic pregnancies are unviable, all sorts of nonsense)
I'm waiting until we meet that great filter in the sky
The second big problem is that they are being forced to buy it.
So you have something that isn't what people want, but that they are legally obligated to "purchase"... Is it any wonder most people are dissatisfied with it?
I am not sure why this is even a divisive topic. Sure discuss how a doctor decorates their office. Who cares. When you are dying or are in pain, nothing but treatment at any cost matters.
Oh, sure, in a crisis you need care immediately. What about all the other circumstances? What about the possibility of making pre-arrangements in event of crisis, some sort of “insurance” even? Not to be confused with the comprehensive health care delivery product called “insurance” in the US (which, hey, also exists as a model and could persist in a market.) Maybe some markets are still monopsonies, but surely not all. I can surely find a variety of GPs, allergists, physical therapists, …
A sound argument for or against a market health system recognizes that emergency care is only one circumstance of many, a minority of health care costs, and it’s possible we might be better off if it does not drive the overall design of healthcare.
If you want to get a sense of what a correct, properly labeled example might look like, you should visit the CMS's guidance [1]. Health insurers should be providing documents that follow the format described there, and most importantly, reporting values that are accurate.
> No one can produce the corrected/missing rates but the insurance companies themselves. All we can do is point out when we’ve found rates/patterns that don’t make sense. E.g. https://github.com/CMSgov/price-transparency-guide/discussio...
https://github.com/CMSgov/price-transparency-guide/tree/mast...
Along with this fantastic guide:
https://github.com/CMSgov/price-transparency-guide
I recommend them to anyone who wants to see good examples of price transparency.