90 Miles From Tyranny : This Is Called Winning!

Saturday, June 27, 2020

This Is Called Winning!


5 comments:

boron said...

I just don't understand this. If someone/a corporation can negotiate a good/better price, why must this information be made public.

Mike Miles said...

apparently you have never gone to the hospital only to find out that a hospital that was in your plan had a doctor that was not in your plan, and that doctor billed you a hundred thousand dollars for a procedure that was supposed to be covered.and free to you.
Transparency will bring down prices and lead to better care at lower prices.

Anonymous said...

Yeah, I'm not opposed to capitalism, but why shouldn't one want transparency in a marketplace? I mean, making as profit is allowed. Making money by being underhanded and nefarious is undesireable in civil society...

Carol said...

But this won't drive prices down – at least not without sacrificing in other areas...
The rates and negotiations between a hospital and an insurance carrier are not being kept secret because of the public... They are kept secret from the hospital's competition. Each facility or chain negotiates in good faith to allow at least a slim profit, and you may not believe it, but they are already amazingly slim. And after all the point of any business is to make a profit of some kind - what idiot goes into business to lose money? Picture needing the newest and best new radiation machine, or a machine for lab tests that no one else performs within 200 miles. They generally cost millions of dollars, require special facilities in the case of the radiation machine (think proton therapy), require doctors, nurses and techs that know how to run it correctly, and interpret the results well. The lab machine may need special cooling or reagents (think a Vectra DA test) to run, along with the specialists. Healthcare in this county is always evolving (thank God), and we are accustomed to demanding, and receiving, the best and newest there is out there.
Once other facilities know what their competition is getting reimbursed however, they will demand the same rates. This will drive the reimbursement (the actual money the facility receives, NOT what they charge) lower and lower. This will eventually have the effect of lowering the quality of facilities, equipment and supplies, as well as availability of slots for needed care. It may also hurt the lowest income among us because Medicaid, Medi-Cal, or whatever you call welfare in your state are the worst payers in the system, generally followed by Medicare. This means that they need to cost shift to other payers, including the self-pay population. And believe it or not, the rates the hospital gets paid have little to do with what the patient will owe. THAT is determined by your actual coverage – your deductible, your co-pay, and yes, participating physicians are in that mix as well. While I appreciate what our President is trying to do, it is not going to have the effect people think...
Sorry for the long answer, but I have dealt with this for almost 50 years and understand the issue intimately.

Mike Miles said...

This would be true only if you do not believe in free market capitalism. Free market capitalism, drives down prices, and improves quality and performance. The days of the $200.00 Tylenol pill will be gone, billing will be simplified. To argue against transparency is to argue against honesty.