[HN Gopher] Health insurers just published close to a trillion h... ___________________________________________________________________ Health insurers just published close to a trillion hospital prices Author : sl-dolt Score : 325 points Date : 2022-09-06 15:49 UTC (7 hours ago) (HTM) web link (www.dolthub.com) (TXT) w3m dump (www.dolthub.com) | gigatexal wrote: | Price transparency is an essential part of a healthy market. Or | so says the theory. I hope they release it. I wonder what I can | do to help? I'm capable in db design, sql, etc being a data | engineer by day perhaps I can help this effort. | flowersjeff wrote: | From my understanding though, these 'prices' are outdated nearly | as quickly as they are published. I.e. sure you have a set, but | everything is dynamic and changing. Seems like it would require a | ML approach to 'understand' such a dataset going forward. | MichaelZuo wrote: | 6000 hospitals x say around 10000 priced items, on average, per | hospital x 100 different negotiated pricing formulas = 6 trillion | unique prices. | | Of course many hospitals negotiate en bloc as part of a | healthcare network, and there probably are more than 100 | different organizations that negotiated unique healthcare pricing | but the ballpark number seems to make sense. | sl-dolt wrote: | I'm the author. A question I have is: how did so many prices ever | get negotiated in the first place? What kind of systems are in | place to do this kind of micro-negotiation? | gmarx wrote: | The next question would be 'how long did the average | negotiation take' followed by 'how much were the average people | on each side of the negotiation paid?" (or are most of these | negotiations the result of computers talking to each other? | Either way with a few assumptions one could make an estimate of | the smallest amount these different prices cost the system. | Might be huge | balderdash wrote: | I would assume these get negotiated as a large list with each | payer so if you have 500 services, and 4 payers, you probably | and up with 1k-2k unique prices? | bawana wrote: | Today in Massachusetts, physicians cannot get paid unless they | belong to an organization that negotiates their rates with the | insurers. These negotiating entities are like unions but not | really. If the insurer and the organization disagree, the | insurer simply goes to a different organization to make a | contract. Prices were not publicly available so each | negotiation resulted in a different fee schedule. On top of | that, insurers invent different 'products' with different | amounts of 'coverage' for different premiums. Each of these | 'products' had their own negotiation, their contracts, and | their own subset of physicians who chose to participate. So | what do these organizations do for the cut that they take? They | reduce the burden of the insurers so they dont have to | negotiate with each individual provider. | | Hospitals are an entirely different system. They have much more | negotiating power and if an insurer has a customer that goes to | a hospital emergency room outside of their contract, the | insurer has to pay outlandish rates. So it is in the insurer's | interest to make a deal. They achieve this by inventing | different 'products' with different amounts of 'coverage' for | different premiums. Each of these 'products' had their own | negotiation and their contracts. | | Price transparency is the first good thing that has been | mandated. However, this misses the mark. The focus is the | patient, not the insurer, the hospital or the physician. | Accordingly, patients should be allowed to submit their | explanation of benefits and their bills-this is the data that | reflects the true cost of healthcare. All of the numbers | provided by hospitals, insurers and physicians has been | massaged and buried in a forest of minutiae. | dj_gitmo wrote: | The US healthcare system is wildly complicated and inefficient | because it is a double-bureaucracy; pubic and private. The | government bureaucracy makes a bunch of rules and also provide | healthcare through Medicare/Medicaid. The private bureaucracy | compete with each other, and hospitals, and pharma companies, | ect. | | Many of the private health providers are for-profit and lobby | against rule changes that would reduce complexity and save the | system money. It know this may sound glib, but if you are | trying to understand the US healthcare system and something | seems strange, usually it's because it makes someone money and | they'll fight hard to keep it that way. | spaetzleesser wrote: | "usually it's because it makes someone money and they'll | fight hard to keep it that way" | | And it's not just some money but very BIG money they make. | KennyBlanken wrote: | > Many of the private health providers are for-profit and | lobby against rule changes that would reduce complexity and | save the system money. | | This is almost certainly an anti-competitive move. By keeping | many rules and regulations, you need more staff to deal with | them - and smaller insurers have fewer patients to amortize | those salaries over. | ChrisMarshallNY wrote: | _> pubic and private_ | | Eek. | | Just. Eeek. | | :P | e_i_pi_2 wrote: | My understanding (not an expert by any means) is that we | basically have two tiers of negotiation - the fed. govt. has | way more leverage but also some amount of corruption that goes | into pricing, then afterwards individual hospitals and | "networks" of providers will negotiate with the insurer - | sometimes after the procedure has already happened - to figure | out the final price. | | The end result is that you might end up with an individual | doctor having to work with the insurance company for pricing, | so the same procedure can cost vastly different amounts at | hospitals down the road from each other providing the same | level of care. To make it worse we also have laws preventing | healthcare providers from providing prices upfront, out of a | fear that people will forego necessary care they can't afford. | | Edit: seems like this changed 01-01-2021, now we do have some | price transparency laws - https://www.cms.gov/hospital-price- | transparency | celestialcheese wrote: | > To make it worse we also have laws preventing healthcare | providers from providing prices upfront, out of a fear that | people will forego necessary care they can't afford. | | What are these laws? This seems so backwards - I know | personally I have put off medical care in my past because I | had high deductible insurance, and no guarantee that the bill | I'd get wouldn't wipe me out, and no way to price shop. | Paralysis of unknown. | e_i_pi_2 wrote: | Ah thanks for making me look this up! Seems like it did | change recently (Jan 1, 2021) | | https://www.cms.gov/hospital-price-transparency | | Now assuming the hospital is compliant the information | should be available. To be fair my understanding of the | argument for the old law was that you didn't want a | hospital with a big sign out front saying "Broken arm | repair: $10k" and having people not go in for it when there | might be some financial aid they could get afterwards | willcipriano wrote: | I'm sure the real reason is that the hospital up the road | will set up a sign "Broken arm repair: $9k" to compete | and that isn't something the lobbyists want. | elliekelly wrote: | It's not the case. The No Surprises Act requires a good | faith estimation for most procedures. Although IIRC it | _doesn't_ apply to people who don't have insurance, which | seems kind of backwards as those people would likely be the | most price-sensitive and have the least amount of | bargaining power in the market. I guess they also tend to | have the least amount of political power, too... | woobar wrote: | Are we sure they negotiated unique prices with each provider? I | wouldn't be surprised if they have a dozen of templates that | get replicated every time a new entity accept preexisting price | sheet. Basically they have dumped a denormalized data set. | tyingq wrote: | What was negotiated was probably more blanket style discounts | like "10% off your published medicare rate for procedures in | categories a/b/c" for one customer and "15% off retail price | for all categories other than x/y/z but only in these | geographic areas" for another customer, and so on. | | But, when publishing, they omit the context and just dump every | negotiated rate. Because it's technically compliant, but keeps | things opaque. | gffrd wrote: | Super curious about this, too. | | Also! What did they do before they could store 100TB of pricing | data? How has pricing (and care quality) changed as a result of | being able to do this type of thing? | yojo wrote: | Possibly the original data is logically compressed. E.g. | payer A pays 110% of our standard rates, payer B pays 85% of | our standard rates. Those two rows could translate into | thousands of CSV lines depending on the number of procedures. | | Maybe you have a couple one off negotiations for high volume | procedures, but even still the source data could be several | orders of magnitude smaller than the dumps. | kderbyma wrote: | this would be a great social study. cases where technology | has enabled the racketeering and price gouging by | corporations with almost no gains in efficiency or output or | quality or any metric of value. | acchow wrote: | They are obviously not computing pricing this way. Their | pricing system applies rules. But they are dumping every | possible combination. | thechao wrote: | Any time you can convert a problem from an `N x K` problem to | an `N + K` problem, there's some asshole administrator trying | to turn an `N + K` problem into an `N x K` problem. It wouldn't | surprise me if there's huge amounts of redundant information in | there. | acchow wrote: | > In the newly-released data, each "negotiated rate" (or | simply "price") is associated with a lot of metadata, but it | boils down to: who's paying, who's getting paid, what they're | getting paid for, plus some extra fluff to keep track of | versioning. The hundreds of billions of prices in the dataset | (probably over a trillion) result from all the possible | combinations of these things. | | They basically denormalized all the dimensions. | | Imagine you have a function which takes 5 arguments and | returns one value. You could give me the source code and let | me run this function. Or you could give me a mapping of every | possible combination of the 5 inputs to the returned value. | The former could be quite small, but the latter would be a | massive number of rows. | imoverclocked wrote: | > You could give me the source code and let me run this | function | | If I understand correctly, in this case, that function's | source is highly distributed in wetware. It's about as | closed-source as it gets; nobody has anywhere near the full | source. Each hospital is its own fiefdom! | acchow wrote: | Yeah this is part of the problem. | | But even if you had like 10M rows of pricing and then | gave a 2% discount to entity A, 3% discount to entity B, | 4% discount to C, etc. | | You could publish these discount rules. | | Or you could just multiply the 10M rows by the number of | different entities giving 10*n M rows. | | And then let the consumer of the data try to figure out | the rules from the output...? | huslage wrote: | They aren't negotiated individually. They are negotiated | categorically. They generate individual prices based on some | discount rate off of a negotiated max. | coding123 wrote: | Maybe good, maybe bad. I suspect the good will be lower prices as | we resolve major conflicting prices for the same service. Maybe | bad as we find that nurse Jackie is spending too much time taking | care of your sick husband and that needs to cut back as the | prices the hospital is negotiating drops. The service will become | more standardized and robotic. | jamestimmins wrote: | Seems like every week there's a new massive scale DB project or | company getting announced on HN. | | If they're looking for projects that create public value and | demonstrate the power of their products at scale, digitizing this | and making it searchable may be a good marketing project that's | appealing to certain kinds of customers. | sl-dolt wrote: | Figuring out the size of this data was part of the research | phase for doing just that: building out that database. I'm | curious to know if other people are already working on it | (maybe Turquoise Health?) | ageitgey wrote: | Yep, we have built this database at Turquoise Health. I | agree, the data is massive - and don't forget that it is all | refreshed monthly! | JackFr wrote: | Is that from the hospital side or the insurer side? | ageitgey wrote: | We have built databases for both and can compare between | them. | withinboredom wrote: | It's my understanding these prices are negotiated to some | degree, so it's probably both sides at various times. | jamestimmins wrote: | It's cool seeing that Turqoise Health exists. One of my | first programming projects back in the day (when I was | trying to get a jr role in 2014) involved building a simple | version based on data.gov medicare data. The inputs were | terrible and tiny (e.g. chest pain at hospital X costs | ~$60k on average across 5 patients), so I was always | curious what a real world version might look like. | | edit: As I reflect, I'm amused to recall that this was | early enough in my path that I didn't know about DB | indexes, so I was very proud that I figured out how to | basically roll my own indexes by pre-sorting the columns by | lat and lon. I don't remember whether my solution | _actually_ prevented a full-table scan, but it felt like a | major breakthrough at the time. | jamestimmins wrote: | Very cool. Who do you see as the likely users of that | database? Is it primarily for researchers/data journalists, | or is there a commercial value to it? | | I'd be very curious to read more about the data cleaning | phase when you get there. Specifically, how hard it is to | combine this data and construct good schemas. | atourgates wrote: | As someone who's worked on the provider side in different | capacities, I can tell you that there could be tremendous | value on the provider side. | | It's entirely possible that two surgeons with offices next | to each other could be getting reimbursed at wildly | different rates for their most common procedures for their | most common procedures by the same provider. | | If you're that provider, you ABSOLUTELY want to know what | the surgeon next door is getting paid the next time your | group is negotiating with the insurance provider. | bob1029 wrote: | It would appear us SQLite zealots have encountered the final | boss. | | Petabytes uncompressed would be tricky if you need to slice | those columns. SQLite caps out at ~281 terabytes of storage | before it can't track any additional pages. | | None of this is to say you couldn't partition the data across a | lot of SQLite instances in varying ways. I will probably take a | shot at it this weekend. Looking to see just how unlimited my | AT&T fiber connection is anyways. | salawat wrote: | >It would appear us SQLite zealots have encountered the final | boss. | | Just wait. It's actually a multi-boss fight, since you have | to wrangle the Pharmacy Benefits Management datasets, plus | Medispan, plus Medicare, plus all the MedicAid datasets, plus | VA. | | Are you and all your mightiest boxen bad enough dudes to make | sense of the entire U.S. Healthcare industry? | | <Actuary Stormrage in the background> | | _You are not prepared!_ | topspin wrote: | > It would appear us SQLite zealots have encountered the | final boss. | | That's cute. :) | | There isn't much value in feeding it all into a conventional | RDBMS. OLAPs and columnar stores are what is needed here. But | first it will need a great deal of grooming and ETL work. | gizmodo59 wrote: | Yeah.. It would be much easier to copy the data to S3/any | object storage (better to convert it into a columnar format | like parquet) and query it directly using a SQL on lake | engine like Dremio or Athena or S3Select would work too. | mskar wrote: | I work in data at https://www.carrumhealth.com/, and I've been | parsing this data for weeks. The transparency prices allow us to | meaningfully negotiate with providers, and make tangible, | incremental progress toward cheaper health care. Providers and | existing insurance carriers leverage information asymmetry to | control the market otherwise. | | For context, we bundle the 100's of itemized costs into a single, | static bill per surgery type. In doing so, we've built a custom | virtual-network with the most efficient surgeons. These surgeons | are able to meet the volume and quality requirements to allow for | lower margins. We're able to get negotiated rates that are 10-40% | cheaper than traditional insurance contracts when we have data | that we trust. | | Unfortunately, this data alone isn't enough to properly determine | prices because organizations will spread costs across procedure | and billing codes that often occur in aggregate groups. For | example, in a joint replacement surgery, some organizations may | dump the cost into the billing for the implant itself, while | others may put it under the procedure code. You have to gather | billing data en masse to see which charges occur together, then | combine this pricing data to determine what costs will actually | look like for someone experiencing a procedure. | | It's a nightmare! | riskable wrote: | How much do you think it costs to maintain all these negotiated | contracts VS just having a single payer system with the same | price for all procedures? | hayst4ck wrote: | PBS put out a documentary ages ago comparing America to other | countries. At the time our administrative overhead was 25% | while Taiwan's overhead was 2%. | mskar wrote: | It's very expensive, carriers have an economic incentive to | simplify it and this is still where they end up. There are a | long tail of provider circumstances that the single-payer | model will need to figure out. Some examples: | | * Small hospitals in low-density, underserved areas have to | make up for underutilized equipment and personnel costs. They | raise prices on unrelated, common procedures to break even | (This is very common) | | * CMS (medicare/medicaid) sets a low price for a procedure | that's overly common in a particular facility, now that | facility loses money for each occurrence. They choose other | procedures to raise the price to try to break even. | | * Larger hospitals have higher administrative and operations | costs (for things like training and research) that benefit | society, but need to be averaged out across all procedure | costs. This differs from hospital to hospital. | | * Smaller professional facilities or physicians groups (like | Ambulatory Surgery Centers) have much lower administrative | costs and a smaller staff, so they have lower overhead per | procedure. They are designed to be efficient, and can handle | lower prices. However if there are any major complications, | they won't be able to service the patient, and have to send | to a hospital. This then pushes all the highest-cost, ICU- | type procedures into hospitals, where there is already a | higher overhead, causing hospitals to need separate pricing | to cover more complex patients. | | A large single payer price set will probably force | efficiencies into the healthcare system. It'll be great for | folk's costs, but we may see many facilities close, and lines | of care will be consolidated into specialty centers. (more | travel to get imaging, procedures, or to see a specialist) | narrator wrote: | What do you think about how Kaiser has handled the whole | thing? The insurance company employing the doctors and just | paying them a standard salary seems to create all the right | incentives. | drak0n1c wrote: | Sounds like an application for ML, to determine which codes | frequently coincide per-patient at each provider and then | assign those groupings to cross-provider "Treatment XYZ" | buckets to enable apples-to-apples comparisons. | mskar wrote: | Great call, many orgs in health tech use billing/procedure | code embeddings to group, just like you're suggesting. | didgetmaster wrote: | Is the data unique or has it been duplicated for multiple | formats? In other words is there a CSV file right alongside a | Json file and an XML file that contains the exact same data, | just in different formats? | | Is the data partitioned at all (e.g. by state) so that you can | just download the data for California without downloading all | the data; loading it into a huge database table; and then | querying it (e.g. SELECT * from <table> WHERE state = | 'California')? | mskar wrote: | There is some duplication, where different networks under the | same carrier could benefit from normalization, but in-general | duplication isn't the primary issue. | | The data is partitioned for some carriers at the network | level, but unless that carrier has networks that are unique | to a given state it's difficult to partition by location. | | The majority of the data is lumped into very large, single | JSON (not newline delimited), so an initial parsing step is | required to break out substructures for parallel processing | via warehousing technologies. I think Aetna has a 300Gb | compressed (single) json file. | | After breaking the json to a single array entry per | provider/network, parsing is still a bit tricky because there | are some very "hot" keys. Some provider array entries may | only have 1000 code and cost entries, others may have 100k. | We've seen array entries >50Mb for a single | provider/network/carrier. | planetsprite wrote: | I wonder what percentage of work in the US healthcare system is | completely unnecessary from a general perspective but made | necessary deliberately to justify the unethical system that | allows millions to die unnecessarily. | suoduandao2 wrote: | Judging by the US's price/outcome ratio compared to other | developed nations, a little over half[1]. | | [1]https://www.pgpf.org/blog/2022/07/how-does-the-us- | healthcare... | ChrisLomont wrote: | Why that article points out the US spends $12k/capita on | healthcare the singles out administrative costs at $1k/capita | while ignoring all the other relevant factors is beyond me. | They then use the misleading infant mortality stat, ignoring | that the US considers vastly more babies viable than any | other country, meaning we try to save infants that other | countries write off, thus they count against the US when it | fails, but not against the other countries that don't count | them as viable. It's a really poor article ignoring important | nuance in what it presents. | | The US pays about twice per nurse or doctor in the system, | and part of that is because the US pays nearly twice for most | skilled work. So, to get prices like most other developed | nations, we would be forced to cut nurse and doctor salaries, | which would likely lower quality of workers as future workers | went to more lucrative fields, which would likely lower | outcomes. | | The US can have higher cost or lower quality. How would you | make this tradeoff? | kaesar14 wrote: | Which part of this equation is contributing to hospitals | charging 50 dollars for a bag of IV fluid? I'd cut that | part out. Whatever it is. | geraldwhen wrote: | That price pays for the parking deck, security, janitors, | nurses to administer the bag, needle disposal, IT, admin | salaries, the hospital building itself, etc etc. | | An urgent care can probably administer an IV. If that's | all you need, go there. They are far cheaper and not as | lavish (or equipped) as hospitals. | Judgmentality wrote: | > So, to get prices like most other developed nations, we | would be forced to cut nurse and doctor salaries, which | would likely lower quality of workers as future workers | went to more lucrative fields, which would likely lower | outcomes. | | Why are you ignoring all of the costs that go to people | besides nurses and doctors? I know very rich people whose | entire careers are built around selling overpriced products | to hospitals. These people are leeches that provide no | value other than profiting off of dumb compliance laws. If | you can buy the same product at any store for 1/10 the | price, there is no benefit to requiring it be gatekept by | people whose sole incentive is squeezing blood from a | stone. | | Get rid of graft. The problem is the system and the | incentives it creates. US healthcare is dictated primarily | by insurance companies who care more about maximizing | profit than providing healthcare. | | To fix the system you start with increased transparency, | then you focus on accountability. Why do we allow such | blatant corruption? Let's get rid of all the leeches first, | since they provide no actual value while jacking up prices. | There are so many areas we can improve results and cut | costs before we address the salaries of doctors and nurses. | paulmd wrote: | > The US pays about twice per nurse or doctor in the | system, and part of that is because the US pays nearly | twice for most skilled work. | | which is in turn because in the US an average GP comes out | of medical school with $200k-300k of student debt that has | to have interest serviced and paid off within some 10-20 | year timespan. That cost ultimately ends up being borne by | the patient and their insurance. | | unfortunately the US is very resistant to the idea of | education reform in general, very very resistant to student | debt relief, and very very very resistant to student debt | relief for "high earners" like doctors and lawyers, even | when a huge chunk of that earn is going to debt service. | But there is a shortage of doctors and we're doing | everything in our power to make the path unattractive for | new students. And this time the problem isn't even the AMA | - the AMA agrees there is a problem and is onboard with | expanding the pipeline... it's just not all that attractive | a profession anymore when you can make equal/higher | compensation (after considering the debt) in software or | other fields. | | doctors are still extremely well-paid professionals in | other countries, but if we tackle the cost of education we | can get our numbers down much closer to theirs. conversely | if you push salaries too low then servicing $200-300k of | student debt won't be realistic and the path becomes even | less attractive. | | medical care is probably the single most complex political | problem in the US because it's basically at the nexus of | every single social and political problem we have. doctors | are too expensive... because they're trucking around a | quarter million of student loan debt from our shitty | education system. we spend way too much on end-of-life care | and not enough on earlier care... because seniors vote. we | have way too much overhead due to the multi-payer insurance | system and the market-driven pricing system's overheads... | and all those insurance companies are huge lobbyists too. | Drug and device costs are out of control... because the US | doesn't allow conditioning of regulatory approval on price | negotiations, or reimportation from other countries, etc. | It's just every single political problem in the US in a | single field all at once and every hand is dipping into the | till as much as they can get away with, and it's | politically infeasible to slap the hands that are necessary | to slap to actually get costs reduced. | jahewson wrote: | A debt of 1 to 1.5 years salary does not go very far to | explain why US doctors are paid double what they would be | in other countries. | | The US brought this problem upon itself by cutting | medical school funding in the 1980s to reduce the number | of doctors and keep salaries high. That situation | remained until 2005. Now we have too few doctors, too few | schools, and a generation that grabbed all the money for | themselves and is now retiring. | ChrisLomont wrote: | > to justify the unethical system that allows millions to die | unnecessarily | | Which people are those millions? | | The system saves millions of lives that would have died in | generations past. How do you factor that into your claim? | spaetzleesser wrote: | There are lot of people who don't go to a doctor when they | should. Even taking an ambulance after an accident is a | gamble a lot of people can't afford. | fishtockos wrote: | Anyone knows if this dump contains drug insurance coverage? | duffpkg wrote: | I'm author of Hacking Healthcare for O'Reilly, 20 year health | system executive, blah, blah. | | It's very easy for people to forget the scale of the US "health | system", we are talking 1/5, maybe more, of the entire US | economy. If US healthcare spending were a country, it would have | the third largest GDP in the world. Accidents of history and the | massive federal beauracracy created the crazy monster of ICD/CPT | codes that results in the very clumsy way of pricing healthcare | services that results in this massive matrix of data. | | As pointed out elsewhere there is a tremendous amount of cost | distribution that goes into the code matrix and this plays a | large role in negotiations with health insurers as well. Ground | is given in one set of procedures and lost in others. | | This is a big step in shining light into areas that need it to | improve the system overall. | esotericimpl wrote: | e_i_pi_2 wrote: | Do you consider the amount that the US spends per capita on | healthcare relative to other countries for the same standard of | care a "failure" of the healthcare industry? Or is there some | other reason healthcare "just costs more" here? | | Also wondering what you think a solution is - single-payer for | better and simpler price negotiations, or some other approach? | | My main concern is if we're spending 20% of GDP on something | other countries accomplish with 10%, then that's a huge waste, | especially in a country with a larger total GDP pool. | medlazik wrote: | As with everything it touches, it's the intrinsic failure of | capitalism (ofc success for the capitalists / bourgeoisie). | It's the amount of capitalism that defines prices. In every | other country the more healthcare is a public matter, the | cheaper it is for the people. | gwright wrote: | Healthcare in the US is definitely _not_ driven by the free | market. It is probably one of the _most_ regulated | industries. Whatever disfunction you want to call out in US | healthcare it is going to be difficult to pin that on the | free market. | medlazik wrote: | Free market? Capitalism. I know we're on HN but, say the | word? Capitalists take a cut. Shareholders of big pharma, | insurance companies and hospitals are why healthcare in | the US is expensive. Public sector not being monopolistic | is why healthcare in the US is expensive. In France, | social security reimburses about 70% of most costs. Cheap | private insurance reimburses the rest. About 75% of | public hospitals and not for profit. Generic medicine | being prescribed is the norm. The state _naturally_ fixes | healthcare prices because it 's monopolistic on | healthcare. Same as all public services. | a-user-you-like wrote: | Non free market? Communism. I know we're on HN but, say | the word? | | Of course the US market is highly regulated and so the | market is not free to lower prices. Of course the AMA is | a racket. Of course needs of certificate are abhorrent. | | Given the customer non--coerced access to his preferred | provider, and not taking his money and slapping a bunch | of regulations on him will of course lower prices and | give him better care. | | I don't see why the other side can't see it. | medlazik wrote: | That's right, communism. Social security in France is | _literally_ a communist system, founded by a communist | minister. Hence why neoliberals want to destroy it. | brightball wrote: | I've heard a lot of complaints about Medicare/Medicaid. It | does not inspire confidence in single payer. | duffpkg wrote: | Healthcare is such a base layer of the economy, I find | comparisons to be extraordinaly difficult between countries. | On the most basic level our pathway to becoming a healthcare | provider of all sorts is dramatically more expensive and | limited than other countries, what healthcare providers are | paid is dramatically more than other countries, we invest | many times per capita what other countries put into basic | medical research, the way are population is taxed is very | different than other countries, our patient population is | very different from other countries, our expectations are | very different from other countries, our scale is | dramatically different than other countries, and so on. The | US is a singular animal politically in that it is a compact | of individual states that especially in regards to | healthcare, the federal goverments powers (though it may not | seem so at times) are actually quite limited. It's all but | impossible to come up with reasonable numerators and | denominators for comparison. | anonymouse008 wrote: | > Healthcare is such a base layer of the economy | | Academically this sounds enlightening, but it only takes | one cursory walk around a supermarket in the US to see this | is unequivocally false. Healthcare is an externality, not a | base of anything. From the average customer to the product | in the aisle to the marketing - everything is 100% not a | direct cost benefit function in terms of healthcare. | skybrian wrote: | I'm not sure what that proves, given that you went to a | grocery store instead of a pharmacy. | tbihl wrote: | I'm guessing parent was saying that most medical spending | is payback for terrible US American eating habits? | rgrieselhuber wrote: | And add on top the oft-repeated that "health insurance is | healthcare." That's how you obfuscate a whole of things. | e_i_pi_2 wrote: | My current assumption is that private healthcare/insurance is | to blame, because countries without that or with less | generally have better outcomes at less cost. Looking for | evidence to the contrary | coredog64 wrote: | As two quick examples, both Switzerland and France have | private healthcare providers and insurers. I think that's | enough to falsify your assumption :) | simonw wrote: | Those countries both have "less generally" than the USA. | e_i_pi_2 wrote: | I don't think that disproves a general trend that | increased socialization in healthcare costs leads to | better outcomes and less per-capita spending. | | Also FWIW France and Switzerland both have universal | healthcare, under different systems where France splits | payments 3 ways and covers more with the govt[1], and | Switzerland seems to have a system like the ACA in the US | where it's compulsory, but they also set caps on the | deductibles and maximum price. | | [1]: https://en.wikipedia.org/wiki/Health_care_in_France | | [2]: | https://en.wikipedia.org/wiki/Healthcare_in_Switzerland | bhupy wrote: | It's not just Switzerland and France; the Netherlands | also has a private-only health insurance system. It's | also very difficult to draw decisive conclusions since, | across countries, there are hundreds of confounding | variables -- it's not just public vs private, but it's | also which regulations exist in each country, whether | it's employer-sponsored vs individual, general | willingness to pay, etc. You're correct that Switzerland | has a system like the ACA in the US, but the biggest | difference is that it's not common for the Swiss to get | their private insurance from their employers; it's all on | the individual market. The US is actually unique in that | regard, and is probably the most significant difference | -- the vast majority of working age adults in the US get | their insurance from their employers, and as a result the | ACA's individual market has been in a dire state since | the program's inception. | | Also "socialization" is very different from | "nationalization". The general trend you're talking about | is more to do with the fact that having society | _subsidize_ healthcare for the poor can lead to better | outcomes. As it relates to who actually does the | insuring, underwriting, and payment (public vs private), | one isn 't necessarily better than the other; each has | its trade-offs. It's just that the US (in particular) has | chosen the worst of both worlds. | | I work in this industry, and from where I sit, the | closest thing we have to a clean A/B test that controls | for all of those confounding variables is actually being | run in the US right now, with Medicare. When you turn 65, | you have the option to enroll either in "Original | Medicare", which is what we usually think of when we talk | about "single payer healthcare in America", or you can | enroll in Medicare Advantage (aka Medicare "Part C"), | where the premiums that would go to the CMS instead go to | private insurers like Humana, United, Oscar Health, | Aetna, Clover, etc. These plans replace Original | Medicare. | | - 48% of Medicare beneficiaries are on private Medicare | Advantage plans instead of the public "Original | Medicare". Because everyone is entitled to "Original | Medicare", this is purely voluntary. This number has been | growing so rapidly that the CBO projects that by 2023, | the majority of beneficiaries with choose the private | over the public option. The CBO further projects this | proportion to increase to 61%(!!) by 2032. | (https://www.kff.org/medicare/issue-brief/medicare- | advantage-...) | | - For most beneficiaries, Medicare Advantage costs about | 40% less than Original Medicare and are, on average, of | higher quality than Original Medicare | (https://healthpayerintelligence.com/news/medicare- | advantage-...) | | - In Urban areas, Medicare Advantage costs less per | capita to administer than Medicare -- and that's not | including the extra Medicare Part D insurance that you | would have to buy if you're on the Original Medicare plan | (https://www.commonwealthfund.org/publications/issue- | briefs/2...) | | So no, you cannot look the cost difference between the US | and other countries and simply conclude that it's because | of private insurance, because the actual data tells a | different story. And "universal healthcare" is not the | same as "public" healthcare. It might help to think about | it this way: universal access to food can be achieved | without nationalizing the food industry, or the food | payment industry. | PaulDavisThe1st wrote: | From medicare.gov: | | > Medicare Advantage Plans are another way to get your | Medicare Part A and Part B coverage. Medicare Advantage | Plans, sometimes called "Part C" or "MA Plans," are | offered by Medicare-approved private companies that _must | follow rules set by Medicare._ (emphasis added) | | Those rules are, IIUC, substantively different than the | ones that cover the non-medicare private insurance | industry, and as a result I'm not sure what any of the | (true) facts that you've quoted really mean in the | context of the questions being asked here. | | Also, from reading up about MA, it would seem that MA is | operating on the "HMO" (health maintainance organization) | model that started to be touted in the 1990s. AFAIK, the | HMO model has not done much to contain consts in the | broader US private health insurance world. It would be | interesting to know if it is specifically the combination | of the HMO model and Medicare rules that has allowed MA | to apparently work better than OM. | bhupy wrote: | I actually work in this industry and adjust claims myself | from time to time, so I love talking about this stuff! | | > that must follow rules set by Medicare. (emphasis | added) | | Yeah, I'm not sure that anyone seriously believes that | insurance companies should operate in a 100% unregulated | fashion. Even the US's food industry (which is | predominately privatized) is regulated in some capacity. | The argument is whether _regulated private insurance_ can | deliver good outcomes. That is very much the case, as | evidenced by Switzerland, the Netherlands, and Medicare | Advantage. | | > Those rules are, IIUC, substantively different than the | ones that cover the non-medicare private insurance | industry, and as a result I'm not sure what any of the | (true) facts that you've quoted really mean in the | context of the questions being asked here. | | First of all, the non-Medicare private insurance industry | is _heavily regulated_ , often more so than Medicare | Advantage private insurers. In fact, you raise an | important point: it's important to consider _which | specific regulations_ are helping and which are hurting. | Outside of Medicare Advantage, there are regulations that | strictly control insurance company 's profit margins, how | much of premiums can be spent on collecting medical | claims (see: the 80/20 rule and Medical Loss Ratio | rules), the fact that every beneficiary must be treated | exactly the same (ERISA, parts of ACA), a minimum amount | of coverage required (the ACA added this), the employer | mandate (ACA), etc. | | To give you a sense for some of the unintended | consequences that have been created by regulations on | non-Medicare Advantage health insurance plans, due to | Federal mandates and tax incentives, health insurance is | predominately provided by employers rather than the | individual market (unlike Switzerland, Germany, or the | Netherlands). What we're seeing in healthcare costs is | analogous to what you might see happen to airline ticket | costs if we all got our air tickets through our | employers: the vast majority of us would fly business | class, while the unemployed would be simply unable to pay | for business class fares out of pocket. A big reason for | this is that employers (especially medium-to-large | businesses) have a much higher purchasing power (and | hence, willingness to pay) than individuals. If you take | this behavior and combine it with the fact that health | insurers' profit margins are capped by law, insurers pay | more absolute dollars for treatments (which doctors | happily accept), charge more to employers (who are | generally less price conscious vs individuals), thus | bring in more absolute revenue, and therefore more profit | because a capped profit percentage of a higher revenue is | higher than a capped percentage of lower revenue. It's | somewhat counter-intuitive, but the policy combination of | an employer mandate and insurance profit cap results in | increased prices. | | This cocktail of regulations does not exist for Medicare | Advantage insurers -- even though they are still | regulated in different ways. That's a very important | distinction. Currently, Medicare Advantage insurers are | allowed to return 50 percent to 70 percent of any cost | savings to beneficiaries in the form of reduced premiums | or expanded benefits -- whereas with employer-sponsored | insurance, even if such cost savings existed, they would | accrue to employers (unbeknownst to worker beneficiaries) | -- and that's assuming there are cost savings for | employers; there aren't, due to the aforementioned | regulatory concoction. A big part of why Medicare | Advantage actually works really well is because it's | effectively a basic income for health insurance, it's | just that individuals are empowered to use those dollars | to buy whichever healthcare plan meets their needs | (including a public option), as opposed to being forced | to choose among a small selection of plans curated by an | employer. | | > Also, from reading up about MA, it would seem that MA | is operating on the "HMO" (health maintainance | organization) model that started to be touted in the | 1990s. AFAIK, the HMO model has not done much to contain | consts in the broader US private health insurance world. | It would be interesting to know if it is specifically the | combination of the HMO model and Medicare rules that has | allowed MA to apparently work better than OM. | | Medicare Advantage plans can both be HMOs as well as PPOs | (https://www.medicare.gov/types-of-medicare-health- | plans/pref...), it's just that _there happen to be_ many | MA plans that are HMOs. HMOs can have very good outcomes | with significant cost savings (think of the pre-2010 UK | NHS as a public HMO), but can also have bad outcomes if | managed poorly (think of the 2022 NHS or US 's VA as | poorly managed public HMOs). With Medicare Advantage, | seniors have the option to choose. | nicoburns wrote: | The obvious regulation which almost every other country | has is direct price controls on medicines, treatments | etc. Not profit percentage controls. A dead simple "this | is how much you're allowed to charge". | | I don't really understand why anybody would be against | introducing this in the US. | bhupy wrote: | It is not so obvious at all. Medicare Advantage does not | have price controls, and it still costs less per capita | than Original Medicare. | | > A dead simple "this is how much you're allowed to | charge". | | This has its own set of unintended consequences, | including physician rationing (it's a huge crisis of the | NHS right now), and a reduction of investment in new | medical research. There are _many good reasons_ to be | against introducing this in the US. | | Switzerland does not have price controls on medicines, | treatments, etc. and the reason why it is so often cited | is because it enjoys a comparable level of healthcare | innovation to the US while still ensuring universal | access (through its ACA-like subsidies). It also costs a | lot per capita (among the highest in the OECD), but it | actually gets what it pays for | (https://pubmed.ncbi.nlm.nih.gov/26766626/) | (https://www.theweek.in/news/world/2022/05/07/7-reasons- | why-s...) | | In fact, of the countries that usually make up the global | leaders in health/medical innovators, all but 1 (the UK) | engage in price controls | (https://immigrantinvest.com/insider/the-best-healthcare- | coun...), and the UK's NHS is suffering from a rationing | crisis, and (ironically) a cost crisis. | JumpCrisscross wrote: | > _France and Switzerland both have universal healthcare_ | | You said private healthcare/insurance were to blame. | Switzerland has private health insurance. | | Universal healthcare is a separate goal post. For what | it's worth, I'm unclear its comprehensive iteration is | compatible with America's immigration model. (It | absolutely is for life-saving measures.) | ggrrhh_ta wrote: | Switzerland has very strictly and non-deniable obligatory | minimum (very broad in coverage) insurance, with | regulated yearly price adjustments and on top of that, | publicly funded hospitals and clinics (mostly | unprofitable but of high quality and offering treatments | that would not be profitable for private hospitals) that | issue their bills to the health insurances. And, to put | the icing on the cake, there are treatments and | operations (e.g. congenital defects and invalidity- | related) that are directly billed to the public social | insurance (funded by salary deductions) to help health | insurances reduce their risk. | | Switzerland's compulsory private health insurance is | nothing comparable to other countries' private insurance. | There is "additional private insurance" in Switzerland | (covering alternative medicine treatments, access to | single bed rooms in hospitals, etc.) which do operate as | private insurances elsewhere. | PaulDavisThe1st wrote: | What aspect of America's immigration model do you think | intersects with this? | | > You said private healthcare/insurance were to blame. | Switzerland has private health insurance. | | Private business in all western countries operates within | the regulations and laws that cover them. The health | insurance industry in Switzerland operates under a very | different set of regulations and laws than the same | industry in the USA. If you want to blame the OP for not | being more explicit - "private healthcare/insurance and | the regulatory framework are to blame" - then fine, but | ... this is actually the crux of the issue. | JumpCrisscross wrote: | > _but ... this is actually the crux of the issue_ | | I'm not sure it is. Universal healthcare is orthogonal to | private health insurance. That's the lesson of | Switzerland's example. I don't believe this is commonly | known or accepted in American politics. Instead, any | attempt at reform is pitched and vilified as an attempt | to end private health insurance.e | bhupy wrote: | Not sure why you're getting downvoted, but this is | exactly correct. Universal healthcare != public | healthcare. | e_i_pi_2 wrote: | Ah good catch I was moving the goalposts there - I think | in my head public and universal and basically | interchangeable - if everyone has it is it a public good | regardless of if it's provided by a collection of | "private" companies | pessimizer wrote: | > countries without that or with less generally have better | outcomes at less cost. | | This isn't necessarily a great metric, because almost all | countries have better outcomes and all countries have lower | per capita cost, whether their systems are public, private, | or mixed. The US spends more _public_ funds on healthcare | than countries with universal socialized health care | systems. The fact that we 're also personally bankrupted | after spending the same tax proportion on healthcare is | just a bonus. | | It's not specifically private healthcare or insurance | that's the problem, it's the specific corruption of the | people who own the healthcare industry and their | legislators. | mikem170 wrote: | Across the board price controls seem to be a common to the | various European health care systems. It is my | understanding that upper limits are set for the cost of | medicine. | | There is quite a bit of variety across Europe - U.K. is | 100% government run, France is a public/private mix, | Germany is similar to Obamacare in some ways, others are | single payer, apparently some are private, also. But I've | read that they all have cost controls. | Barrin92 wrote: | beyond Europe as well. Singapore which has exceptionally | low healthcare spending (5.9% of GDP) heavily controls | prices and purchases down to individual equipment in | hospitals. | rayiner wrote: | Most countries have private healthcare (meaning private | providers). Many others have a mix of for profit and non | profit insurance companies. There's not a whole lot of | difference between Obamacare and say the system in say the | Netherlands, Switzerland, or Japan. Those are also | "individual mandate" systems. | spaetzleesser wrote: | Number one is full price transparency of the whole chain. I | work for a medical device company and even the marketing | people can't really tell what our stuff costs. There are a | ton of middlemen with obscure contracts and very high | markups. My ex got one of our devices and I was told by our | people that the hospital should have received the device for | between 20k-30k (nobody seems to really know) and the | hospital charged 80k for the device alone. They also charged | another 200k for a one hour surgery with a total hospital | stay of six hours. | | It's also hard to explain that US patients pay a multiple of | the drug price people in other parts of the world pay for the | something. | | The problem is that if the US wastes 10% of GDP on health | care inefficiencies this creates a huge lobby that will fight | tooth and mail to keep that money. | linkdink wrote: | In your opinion, what would be the lowest hanging fruit that | could be changed to have the largest positive impact? | duffpkg wrote: | People are rarely satisfied with this answer but its | demonstrably true and was proven time and time again at the | facilities ClearHealth managed. | | 1) Feverent, almost religious, adherence to hand washing. 2) | No neck ties or dangly sleves whatsoever in buildings that | house patients. 3) Change from stainless steel hardware for | doors and travel touch surfaces back to "brass/copper". | | Those are simple, virtually free, things that have a very | meaningful impact on outcomes. Some of the most viscous | fights I've had with hospital boards were over what amounted | to the "uglier look" of copper/brass. | | It is an extremely unpopular topic in healthcare but the area | that takes a lot of effort to solve but also has a | tremendously out-weighted benefit is reducing preventable | medical errors. My opinion after being in healthcare ~20 | years is that preventable medical error is absolutely in the | top 3 causes of death in the US. The easiest subset of it to | resolve is prescription related errors, we have all the tools | to resolve those but not the will. | linkdink wrote: | Well, I'm satisfied with that answer. But maybe that's | because I think brass and copper look better than stainless | steel. | BitwiseFool wrote: | >"3) Change from stainless steel hardware for doors and | travel touch surfaces back to "brass/copper". | | Because of the pandemic I started encountering doors that | have a shoe pull, where you can use your foot to open the | door instead of having to touch the handle. I really hope | these catch on, but they are still quite rare. | snuxoll wrote: | Also stop getting rid of paper towels if you still have | manual faucets. Nothing grosses me out more than going to | a public restroom with only air dryers, but manually | operated faucets that now require you use clean hands to | turn off after you turned them on with presumably dirty | hands. | hyperbole wrote: | This seems very much like the episode of Veep'Boxes of lies' | where they try to hide their nefarious deeds alongside the real | day to day inter-workings of the vice presidents office but | inundating the public with data. | anigbrowl wrote: | This is a common strategy in litigation as well - if someone | complains that you have pricked them with a needle, dump | haystacks on your opponent's doorstep while also insisting on | your right to a speedy trial. | Titan2189 wrote: | Someone with the right connections should call up Google Cloud | and ask them to ingest the data into BigQuery as an example | dataset like the NY taxi trips. It would be a great way for them | to show off the capabilities of the engine and helpful for | everyone wanting to do analysis on it. | | https://cloud.google.com/bigquery/public-data | inetknght wrote: | You want to _encourage_ Google to own more health data? | | Sorry, I think that idea is bonkers. Google already "owns" way | too much data. | franga2000 wrote: | Who said anything about owning it? Just making it available | for processing through their platform too. | CobrastanJorji wrote: | Sometimes people do a thing where they see certain keywords | in combination and reflexively respond without regard to the | meaning those words are expressing. For example, it's what | happens if I use a word like "welfare" near that one uncle at | Thanksgiving. The signature feature is a very strong negative | reaction but with content that doesn't seem related to what | the previous person was saying, except that it involves | certain keywords. | | I think that's maybe what happened here. You saw "Google," | "data," and "ingest," and your sentiment analysis report came | back positive, and it triggered a response. | nojito wrote: | This data is already available cleaned here. | | https://turquoise.health/ | JackFr wrote: | I think that's hospitals not insurers. | sl-dolt wrote: | I know it's not in the business interest of Turquoise Health, | but I'd like to see that data be downloadable. There's a lot of | insight sitting in the data. | | This blog was a feasibility analysis to see what kind of work | it would take to get that data. If we do get it, we plan on | making it free to download. | metadat wrote: | Where is the raw 50-100TB of compressed data available for | download? | | Is it fully public or does it require registration to access? | sl-dolt wrote: | It's all fully public. Here are some tools that will get you | the negotiated rates links along with the sizes of all the | files: https://github.com/alecstein/transparency-in-coverage- | filesi... | | This won't get you all of the insurers, but it'll get you a a | few of the major ones. | | If you want links to the files of more insurers, here's a | project from one of my friends at Postman: | https://github.com/postman-open-technologies/us-cms-price-tr... | thelastgallon wrote: | I wonder what their egress bill will be if a large number of | people are interesting in parsing this data. | daniel-cussen wrote: | Yeah the whole SaaS breaks expectations as far as using a | server. | cwillu wrote: | Unrelated: "dolt" vs "doIt" is one of my standard font competence | tests | salawat wrote: | dolt vs do<capital>I<\capital>t you mean? | cwillu wrote: | No, do<lowercase>l</lowercase>t vs doIt. | RhodesianHunter wrote: | Anyone else get the feeling this is malicious compliance on | behalf of the insurance companies? | | "Oh, they're going to force us to publish our prices are they? | Well we'll publish so much data it'll take a herculean effort to | make it readable to anyone that doesn't work in data engineering" | spaetzleesser wrote: | They may have that thought but crunching large amounts of data | is not exactly hard these days. Better too much than too little | data. | geraldwhen wrote: | There are a lot of billing codes. It's not as simple as you | hope. A giant csv export is easy enough to process and | synthesize for normies. | outside1234 wrote: | Oh totally. It also probably is the formats they already had -- | so they just dumped them into a file -- versus making something | more orthogonal and ergonomic. | sl-dolt wrote: | I'm not sure what format they store their records in, but I | have a hunch it's a lot more structured than what we see in | the CSV files. The data dumps have to comply with some CMS | guidelines set out here: https://github.com/CMSgov/price- | transparency-guide | kube-system wrote: | They use relational databases. Then a zillion ETLs to | massage that data into every format they need it in, of | which this is one of them. | teeray wrote: | Just be glad the lawyers didn't make the prices exclusively | available via the traditional UHaul full of Banker's Boxes. | axus wrote: | The article mentioned CSV files, it seems more like a | reflection of what a huge bureaucracy the US healthcare system | is. I liked their suggestion that the government should have | created the database as part of the law, done the processing on | the raw data, and made it more accessible. | orangepurple wrote: | import a CSV into Postgres with | open(filepath) as fd: first_line = fd.readline() | cols = [] for col in | first_line.strip().split(','): col2 = | f'''"{col.strip('"')}" text''' | cols.append(col2) cols2 = ','.join(cols) | print(f"create table {table_name} ({cols2});") | print(f"\copy {table_name} from '{filepath}' csv header;") | | this variant will ingest whatever trash is in your CSV fields | as-is (cast & cleanup later) | | run the output in a psql instance connected to your db | | (important note: \copy is a psql client command and it is | critical to use \copy instead of COPY in many cases where the | server process may not have the permission to read your CSV | file. with \copy you can read any file the user that launched | psql client has permission to read. to make things more | confusing it is indeed possible to stream stdin through psql | but you use the regular COPY for that instead of \copy) | [deleted] | lumost wrote: | meh, I'd prefer the raw data. We can always create DBs out of | the raw data, we can always link data. Handling this after | the fact would be impossible. | | Linking a few trillion records doesn't seem that difficult. | It should be doable with a good data warehouse and a | reasonable entity linking model. I suspect that we'll find | more than a few instances of fraudulent behavior once the | data is linked. | | My father was nearly pushed into ~2 Million dollars worth of | brain surgery that was unnecessary. Not only was the | procedure unnecessary, the price for it was >5X what a top-3 | hospital would have charged. I only became privy to this once | I pushed him to come to Mass General Hospital (MGH) for a | second opinion. The surgeon we saw at MGH also believed the | suggested procedure to be dangerous. | | I wonder if it's possible to cross-reference | mortality/complication rates with prices... | daniel-cussen wrote: | jjulius wrote: | ... what in the blue hell...? | vxNsr wrote: | Most likely a poor ai attempt. | 1MachineElf wrote: | From the user's "about" section: | | _Perhaps you 'll think my comments are unthinkable. My | only response to that is that they were legibly written, | not by a machine, but by a writer with a soul._ | jjulius wrote: | Yeah, it's unclear to me. A lot of the more personal | things that are mentioned throughout the account's posts | seem to match up with some of the quickly-googleable | details that can be found just via their username. I | suppose that it could be baked into the AI, but... /shrug | secondcoming wrote: | So I should never visit a doctor in Chile? | A4ET8a8uTh0 wrote: | In their defense, if it was anything but CSV files, they | would be accused of making it too complicated/locking into | proprietary formats and so on. I can't say CSV would be my | first choice, but I don't really want to think what the | alternative would be. | Victerius wrote: | Millions of .xlsx files | easrng wrote: | NDJSON? Sqlite? | carabiner wrote: | lol, have you ever worked with data from a non-tech company? | This is probably the best they have, even inside the company. | watwut wrote: | Can confirm. Also, it is not better in tech companies, they | just have the same data in higher variety of formats and | storage systems. | mesozoic wrote: | Say someone ingests this data and clean it up make it usable, | who's the customer for that service? What would they want to know | from it? | dvaun wrote: | I think that there is opportunity for some neat visualizations | with map overlays, average costs of various categories of | procedures, etc. As for the customer, I wouldn't know. | 55555 wrote: | I want to be able to visit a website, select my hospital, the | procedure, and my insurance, and see what it will cost. Next to | the result, please show me how much the same procedure would | cost with the same insurance at other hospitals near my | location. | | You will literally save American lives. | muhammadusman wrote: | Turqoise health kinda does this now, not as robust yet but I | have been using it to check out prices. Hopefully, your use | case becomes a reality soon. | llanowarelves wrote: | Restoring sanity and making it like any other product or | service. | sp332 wrote: | A patient wants to know how much a procedure will cost. Now the | hospital can look up that data, since apparently (from | experience, not hyperbole) no one who works there actually | knows. | bravura wrote: | Could we rename the title to: "Health insurers just published | close to a trillion hospital prices" | | This post is lot more interesting and important than the current | short title would suggest. | anigbrowl wrote: | Seconded | dang wrote: | Sure. | intrasight wrote: | Seems crazy that SEC rules require structured data but these | health accounting rules did not. I guess health care has better | lobbyists. | nimbius wrote: | this disclosure was spurned by recent federal legislation that | required it. Im a full cynic on the disclosure, so be warned. | | - these prices, as negotiated between insurers and providers, | were already well known inside the industry. so much so that many | procedures could be declined coverage well in advance of a | customer ever needing one. this insider knowledge formed the core | of many earnings reports for insurers and hospitals alike, | | - Disclosure is meaningless if the customer has no alternative. | most health services that bankrupt are emergency medicine, and as | such youll pay anything to save your own life. thrusting a stack | of price sheets at a faceless national healthcare monopoly and | demanding a fair price is a laughable if not sad idea. Healthcare | is not something capitalism is equipped to competently support. | | - hospitals have zero incentive to work with you on any price for | any service, and no federal state or local law will compel them | to do so by virtue of a combination of bureaucratic deadlock and | regulatory capture. is it, for them, more profitable to sell your | arbitrary debt to a credit collection agency? shove you into a | debt counseling service they get kickbacks from? work a long and | grueling payment plan through their own financial services | division to bolster quarterly profit long-term in a recession? or | just ignore your pleas entirely? what they charge is not up for | debate by _you._ | xtracto wrote: | For profit Health insurance is a scam. | | It's like if you signed a contract to pay Netflix a monthly fee | to _eventually_ watch a movie, and for some reason Netflix | profit would be based on _you watching as little as possible_. | They would do all in their power to minimize the amount of | content you could really watch. Unaligned objectives. And the | problem is that unlike Netflix, Health Insurance (at least in | the USA) is inelastic: You MUST pay for it. | TimTheTinker wrote: | I would _love_ to hear from an insider on what the difference is | between these published files and the internal databases - I 'm | sure the difference between the two is striking. Malicious | compliance, indeed. | bottlepalm wrote: | This is the real solution to healthcare costs and quality. | Instead of the government handing hospitals a blank check for low | quality services in a single payer scenario, we allow price | transparency, competition and the free market to drive down costs | and increase quality. Hate him if you want, but this was a huge | accomplishment by Trump that has just started to take effect. | | If you think the government can bring down the cost of anything | please see education and NASA for great examples. ___________________________________________________________________ (page generated 2022-09-06 23:00 UTC)