[random023987]

> There was nothing in the ACA that tackled healthcare costs, it was only concerned with spreading healthcare costs.

That's because it was a political solution. If it tackled healthcare costs, it would have been swiftly killed by the health care industry.

[chimeracoder]

> That's because it was a political solution. If it tackled healthcare costs, it would have been swiftly killed by the health care industry.

Awkwardly, it's the other way around. Providers and private insurers would actually love a transparent pricing system. The entity that benefits the most from the lack of transparency is Medicare, and that's why it's almost certainly never going to happen anytime soon. Implementing a transparent price in the market would make it much more difficult for Medicare to extract money from private insurers via sub-cost reimbursement rates, and so they'd pull out all the stops in preventing it from happening.

That's actually what happened with the ACA itself, and it's why the ACA explicitly didn't tackle pricing transparency at all. It wasn't an accident.

[random023987]

> Awkwardly, it's the other way around. Providers and private insurers would actually love a transparent pricing system.

Incorrect. back room deals and discounts is how providers and insurers jockey for advantage.

> The entity that benefits the most from the lack of transparency is Medicare,

Again, incorrect. Medicare ENFORCES a transparent pricing scheme, see https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... for details.

Unfortunately for most of us, we can't simply pay the medicare rates out of pocket, because... f-you, pay more.

[chimeracoder]

> Unfortunately for most of us, we can't simply pay the medicare rates out of pocket, because... f-you, pay more.

We can't pay Medicare rates because Medicare rates are not high enough to be self-sufficient in the absence of other payers[0].

If everyone could pay Medicare rates, every hospital and practice across the country would close up shop immediately, because they'd be operating at an actual loss.

[0] http://classic.ncmedicaljournal.com/wp-content/uploads/NCMJ/...

[random023987]

> We can't pay Medicare rates because Medicare rates are not high enough to be self-sufficient in the absence of other payers

This is incorrect, and you're going to need a better citation than industry self reporting on how they simply want more money.

Assuming medicare prices are fixed, and assuming that insurance companies negotiate deals on par with medicare, and assuming that most uninsured people don't pay their bills... where are these magic "other payers" that are keeping hospitals open?

In fact the opposite is true. If hospitals could get 100% of their patients to pay their bills at medicare rates, they would save money on defaults, billing overhead, and the people who spend hours on the phone fighting with insurance companies.

This is why so many health care professionals advocate for single-payer; having 100% of bills paid according to a fixed price list means greater efficiency and less waste. (and I mean individuals, as an industry the corporations involved prefer the status quo, as it entrenches insurance companies,creates barriers to entry, and drives consolidation)

== EDIT ==

Just to clarify. I'm talking about a situation where 100% of all services provided by a hospital are covered at medicare rates. If 50% are covered by medicare, and 50% are written off, obviously hospitals would have a problem. But medicare is currently reimbursing at break-even rates, kill the collections and billing and insurance departments, and hospitals make a profit at medicare rates.

[chimeracoder]

> and assuming that insurance companies negotiate deals on par with medicare

They can't. By law, they can't reimburse less than Medicare does. In reality, they end up pegging their reimbursement rates to multiples of what Medicare pays.

> In fact the opposite is true. If hospitals could get 100% of their patients to pay their bills at medicare rates, they would save money on defaults, billing overhead, and the people who spend hours on the phone fighting with insurance companies.

No, and there are multiple links downthread that disprove that claim.

> But medicare is currently reimbursing at break-even rates,

Medicare does not reimburse at break-even rates, or anything close to that.

[Retric]

[Citation needed]

US federal + state + local governments spend an obscene amount of money on healthcare. Including extra funding to keep many rural healthcare facilities open etc.

Other countries spend less government money per person on Universal healthcare than the US spends right now. Considering it's far from a universal system it's already subsidizing healthcare costs.

[chimeracoder]

> US federal + state + local governments spend an obscene amount of money on healthcare. Including extra funding to keep many rural healthcare facilities open etc.

"Extra funding to keep rural healthcare facilities open" is exactly what I'm referring to.

Medicare rates are below what would be needed to sustain practices if they operated solely off of Medicare reimbursement rates. Medicare reimburses about 7% less than the costs of supplies, which means they're already losing money even before they have to pay things like staff wages, building maintenance, etc. The way they stay in business is by charging privately-insured patients much more, in order to cover the difference.

Some providers don't see a lot of privately-insured patients, and for those, Medicare provides two different payment programs (separate from normal reimbursements) in order to keep them in business. Otherwise, they would end up closing shop[0], because there's no way that they could sustain themselves off of Medicare reimbursement rates alone. For various reasons, this is more common in rural areas than it is in urban areas, though the program you're referring to does apply to some non-rural hospitals too.

So yes, when you say "Medicare pays extra funding to keep rural healthcare facilities open", you're actually referring to the exact reason that private insurers would love a transparent pricing system. It's not like Medicare pays this money to any rural facilities - they are forced to pay extra money to facilities that don't see enough privately-insured patients to cover the losses that they're making on Medicare patients. Private insurers (and providers) would love to have a transparent pricing system, because that would mean they wouldn't have to bend over backwards just to break even on their Medicare patients.

This isn't hypothetical; Medicare paying extra to these hospitals is a relatively new practice, and it was passed by Congress after a large number of hospitals were forced to close because they went bankrupt treating mostly or exclusively Medicare patients.

[0] Or just stop seeing Medicare patients, which is what many have done.

[smhenderson]

As mentioned above, citation needed. You're bandying around a lot of statements without any links or stats to back it up. Having watched the health care debate pretty closely in recent years I can honestly say I haven't seen this theory on Medicare being the primary problem. Where are you getting your facts from?

edit: corrected typo

[chimeracoder]

> As mentioned above, citation needed. You're bandying around a lot of statements without any links or stats to back it up.

Citation for what? I'm explaining the context of the subsidies that the parent commenter mentioned (themselves without citation). Of the 49 comments on this thread at the moment, there's only one other that includes any links at all, neither of which I'd really qualify as citations of factual information.

This is part of a broader pattern I see on Hacker News when the topic of health care comes up, where comments that present anecdotal information or reasoning that fits into the narrative of the article are accepted without evidence, but those which provide mitigating contextual information are held to standards which are comically high for an Internet comment.

Even in this case, we're talking about the correction I provided to information that OP mentioned without citation. The information about the critical access program is easily verifiable on Google (or even Wikipedia), so I'd hope that OP would feel comfortable verifying it (and providing a citation) before commenting with the misinformation.

[creaghpatr]

The government literally has an entire class of hospital that receives extra taxpayers subsidies because they have a high proportion of Medicare patients.

They are called Disproportionate Share Hospitals. If every hospital has a disproportionate share of Medicare patients (say 100%) then DSH payments go away and hospitals go under.

More info: https://www.cms.gov/Outreach-and-Education/Medicare-Learning...

Both private payers and taxpayer dollars are required to keep Medicare/Medicaid afloat, as those programs have 40M and 70M people respectively covered. Soon there won't be enough leftover people to fund these programs.

[Retric]

The problem with rural healthcare is rural people can't afford it. https://www.hrsa.gov/rural-health/index.html

Midicare is often providing a disproportionate amount of funding relative to the amount of care being provided. In other words Medicare may be 70% of the fund but < 70% of the costs. But, that's frequently not enough to keep the doors open so the government added some back doors to hand out funding without strings attached.