[Reedx]

I just learned, to my surprise, that pricing and transparency changes may go into effect next year.

Forcing hospitals to disclose prices:

https://www.nytimes.com/2019/11/15/health/list-hospital-pric...

Though the hospital industry is fighting it, so we'll have to see if the rule survives.

[ceejayoz]

I'm completely onboard with price transparency, but am skeptical as to the utility of it to the consumer. I suspect a lot of people will get "oh, we thought it'd be X, but it turned out to be Y, which is 3x the price" sort of scenarios.

I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.

[unishark]

The pricing game in the medical field is not that though, it's just a ridiculous tradition. They give hugely inflated prices then accept a fraction of that from insurance companies because it was their real price anyway. If any uninsured individual (e.g. with good credit they want to protect) gets ensnared by this and ends up paying their 3x number it's totally unfair.

when they are selling similar procedures for elective or cosmetic surgery, like plastic surgery patients, the prices they ask are much more competitive.

[albeebe1]

i wonder if they inflate the prices to inflate their write offs come tax time.

[pkaye]

No they can only write off actual costs.

[Gibbon1]

I'm pretty sure a good accountant can drive semi-truck full of large bills through that.

[devonkim]

I dunno, the reality is that we have mark to market accounting https://en.m.wikipedia.org/wiki/Mark-to-market_accounting

[SkyPuncher]

Some how automotive repair, general contracting, and many other industries have been able to solve this problem.

It's baffling how medicine can't produce accurate estimates. Sure, there are edge cases and differences between patients. However, every surgeon has a rough idea of how they're planning to do a procedure. They've been trained and practiced on it many, many times.

I have a torn meniscus. The doctor can happily tell me how easy it is to clean up and exactly what he'll do to fix it. He certainly knows what the risks are and potential complications.

Why he can't document that prior to surgery, I have no clue.

[ajford]

Shit... my vet can do that. They saw my cat, estimated the surgery necessary, the length of care in an ideal and not-ideal situation, cost of potential extras based on possible complications or additional needs such as full sedation.

I was given three estimated prices that ranged from $800 to almost $1800, with an expected final cost of $1000 being the most likely outcome. Surgery came out to $975.

And this is with a non-communicative and uncooperative animal, not a human.

Not to belittle what a doctor does, but I totally agree that a doctor should be able to estimate the most likely and most extreme situations and gauge the range.

[joquarky]

When one of my pets had surgery a few years ago, the surgeon's office actually sent us back a bit over $500 a few weeks afterward since it went smoother than expected.

[ceejayoz]

The extremes are much wider in human medicine, though.

No one's going to spend a million bucks on a severely premature puppy, but we will for a human, regularly.

"This might be $500, or $250,000" isn't super helpful.

[ajford]

True, but it should be possible to say the average cost is $10,000 according to the last N similar operations. In the event of something abnormal occurring, you might require an extra $25,000 for this and that, and if the shit hits the fan, expect $250,000 for extreme lifesaving effort.

[bonzini]

That's why private healthcare makes no sense. You just cannot attach a price tag to human life no matter if it's premature birth or a child with leukemia or routine surgery like an appendicitis. The only sensible way to run healthcare is by socializing it.

[aesthesia]

Socializing healthcare doesn't eliminate the cost calculus, it just shifts it to a different group of deciders. It feels icky to attach a price tag to human life, but in a world where resources are not infinite, and healthcare requires resources, those decisions have to be made somehow.

[xylophone]

I agree. I would say the only reason providers are not cost estimating is because they don't need to in order to get business.

For automotive I'm typically getting a problem diagnosed first, then after diagnosis, I'm agreeing to a price for a fix. This is the norm for that industry.

For a walk in appointment for a rash, I'm agreeing to a fixed visit fee, PLUS signing that I agree to pay any charges my insurance does not agree to pay. The true costs can (and should) be computed by the provider, so the only true unknown in that equation is what Insurance will cover. THEN the provider (wanting to cover their bases) is putting that risk of not getting paid by insurance, back onto the patient.

I like to think we're 1 killer app away from a shift in consumer behavior here to change the expectations

[pkaye]

I'm in the Kaiser Permanente system in California where the hospital and insurance are one entity. Since everything is pre-negotiated, most times its just the copay. So under my plan, for example $20 for primary physician visit, $40 for specialist visit, $20 for blood test visit and $100 for emergency visit. Having one entity involved simplifies things.

[pblcprvscrt]

Kaiser utilizes the Experian program.

[blaser-waffle]

They can totally do it. It's only a problem because they want it to be a problem.

I worked in Australia for a little and had a couple of doctors visits (mole removal, fractured rib). They were able to tell me, on the phone, cost for a consult, removal, xray, check-up, etc. I was able to pay for the mole removal + biopsy with cash...

I'd love to see something like this in the US:

"Assuming a standard hernia surgery, you're looking at $3000 base for the procedure, with another $300-900 for consumables. 91% of surgeries are at or under $3500, 99% are under $4100. Though patients can go home the same day, 24 hour of hospital bed are covered under the fee; additional days in hospital beds are available at [X] rate. In the event of serious complications, consumables, beds, and misc. are billed at [Y]."

[fjp]

The very existence of insurance allows this insane inflation to occur. It completely obscures the need to to price things accurately.

[bonzini]

Not really, insurance must exist because healthcare expenses aree simply too unpredictable. And anyway places with single-payer healthcare spend much less than the US even though they are effectively a state-run insurance. Heck, the same applies to Medicare.

[sharadov]

Only in the US, in India, every medical procedure has a cost attached. 90% of the transactions are cash, and it would not work otherwise.

[gshulegaard]

While I understand your healthy skepticism, I would be a bit more bullish given this example from 2013:

https://kfor.com/news/okc-hospital-posting-surgery-prices-on...

One thing is for sure, any improvement to price transparency is a boon to competition.

[therealdrag0]

Thought provoking chat with owner: https://www.econtalk.org/keith-smith-on-free-market-health-c...

[ceejayoz]

> Some Hospital administrators accuse the surgery center of cherry-picking the healthiest and wealthiest patients.

You probably won’t see this place put a fixed cost on a 26 week preemie like my twins.

[dsfyu404ed]

>I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.

Considering that colonoscopies are not urgent you'll likely elect to have your butt probed at the clinic that doesn't have a massive price discrepancy between removing something and not.

I really hope the price transparency rule works as alleged. I'd be totally unsurprising if the entrenched industry finds some way to neuter it but I'm hopeful.

[ivalm]

> Considering that colonoscopies are not urgent you'll likely elect to have your butt probed at the clinic that doesn't have a massive price discrepancy between removing something and not.

For most people they have insurance and for them to get any kind of help paying they need to be working with an in-network provider. There is no meaningful market here even for elective/non-acute procedures.

[TYPE_FASTER]

> am skeptical as to the utility of it to the consumer.

Yeah, me too. It definitely seems like more of a way to look like the industry is doing something without actually reducing costs to the end patient.

Our daughter went to the ER and was administered ibuprofen. We got an itemized invoice. Insurance paid $9 for one pill.

So going forward, I guess I'll be able to ask how much the pill will cost, then...haggle? Tell them not to give my daughter medicine?

Just seems like we're going backward...

[thiagomgd]

> I'm sure "colonoscopy, clear" and "colonoscopy, with removal of polyp and pathology on it" will have different prices, but you won't know which it is until after the procedure.

Which is expected, and kinda ok. At least, if you do a colonoscopy and there's nothing else, no complications, it would be that price.