Leaked hospital data shows built-in massive markups on patient care

Discussion in 'The Red Room' started by NAHTMMM, Dec 18, 2021.

  1. NAHTMMM

    NAHTMMM Perpetually sondering

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    I don't see a thread on this yet?

    Middlemen (e.g. medical "insurance") should make transactions easier or cheaper for one end or the other (patients or providers), preferably both. The medical insurance system in America makes things massively worse for both parties, and has for a long time. It isn't getting any better on its own. It's time to move on. Let people opt in to Medicare regardless of age, as a bare minimum.
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  2. Diacanu

    Diacanu Comicmike. Writer

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    Privatizing things that ought not to have been has caused it rot from greed?
    Whodathunkit?
    Certainly not libertarians.
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  3. MikeH92467

    MikeH92467 RadioNinja

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  4. Elwood

    Elwood I know what I'm about, son.

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    How is this a surprise to anyone? I've talked about how medical billing works on this site for more than a decade. Insurance Company X has a fee schedule that the provider is contractually obligated to follow. Lets pretend for a moment that Insurance Company X says, in their own fee schedule that they dictated, that they will pay $150 for a single-use package of surgical sutures. The hospital has successfully found a suppler that allows the package to have an actual cost of $20. So, in order to show the insurance company and patient that they are following the feel schedule, the hospital marks up the "price" for the single-use package of surgical sutures to $300. That way the bill shows the price ($300), the billable amount ($150 per the contract), and a fictional 50% discount.

    Like so many things in life, it's not deceptive in any way IF you understand how the system works. Because, guess what? Hospitals and Doctors don't really get to negotiate fee schedules. Medicare, Medicaid, and all private insurances dictate their own rates. "We pay this, take it or leave it." The provider's only choice is to accept the plan or refuse the plan. They then turn around and attempt to buy goods and labor as cheaply as possible to maximize profit, like any other business.

    It's no different than a Car Dealership selling you a new car at "invoice" which is no where near what they actually paid for the vehicle. It's no different than any business having separate prices for Retail, Wholesale, Jobber, etc. Every business in every industry does it, you just have to figure out the terms on a per industry basis because, otherwise, it's all the same accounting shell game.

    Edit: Let me give you a real world example of how this works and why cash is, and will always be, king. Back when I was doing this regularly, a certain brand of CPAP, CPAP humidifier, and a mask/tubing/filter kit cost the company $400. Blue Cross/Blue Shield's fee schedule said they would purchase it for $2,700. Medicare would "rent" it at $150 per month for 48 months, at which time title for the machine would be transferred to the patient.

    In both situations, you'd be responsible for any deductibles and co-pays, which worked out to around 20-30%. Or, roughly, $550 for Blue Cross/Blue Shield or $1,440 for a Medicare patient.

    You could buy the machine with cash for $650. So, the Blue Cross/Blue Shield patient would be better off using their insurance IF there wasn't an issue with deductibles and the Medicare patient is getting straight hosed. But, it's by the insurance provider's own policy, not the company suppling the equipment. They have to charge what the fee schedule says.
    Last edited: Dec 19, 2021
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  5. steve2^4

    steve2^4 Aged Meat

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    Yeah, this isn't news.

    The common refrain has always been how much they charge for an aspirin. Ok, it's changed to Tylenol.
  6. steve2^4

    steve2^4 Aged Meat

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    However, it is deceptive. Equally by providers and insurers.

    The customer has no hope of being informed and making wise decisions based on market factors.

    It's up to your insurance company and employer, and they don't have you in mind when they negotiate.
  7. Lanzman

    Lanzman Vast, Cool and Unsympathetic Formerly Important

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    But don’t worry. Universal government run healthcare would totally fix all this, because as we all know, there is NEVER any waste, fraud, or abuse in government acquisition programs.
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  8. MikeH92467

    MikeH92467 RadioNinja

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    Like I said: :lalala:
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  9. NAHTMMM

    NAHTMMM Perpetually sondering

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    This is the problem with the system, and it's not going to go away, because the system has grown beyond the reach of customers and people are too overwhelmed with everything else in life to come together and exert their market forces properly upon the companies anyway.

    Let the governmental system compete with the private system and let the free market decide.
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  10. MikeH92467

    MikeH92467 RadioNinja

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    Yep, government programs being imperfect means that they should never be used. Private program imperfections should be tolerated because they aren't government programs and are superior to government programs even if they cost more and serve fewer people because....reasons.... :spock:
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  11. tafkats

    tafkats scream not working because space make deaf Moderator

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    Well, let's try comparing the administrative overhead of private insurance to the administrative overhead of Medicare, then.
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  12. MikeH92467

    MikeH92467 RadioNinja

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  13. Tuckerfan

    Tuckerfan BMF

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    CEF155A9-2427-4559-940D-3905BE1092F2.jpeg
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  14. Bailey

    Bailey It's always Christmas Eve Super Moderator

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    American Exceptionalism is a hell of a drug.
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  15. Elwood

    Elwood I know what I'm about, son.

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    How? Call the provider's billing department and request two UB-04's. One based on your insurance provider and one based on cash prices. You'll see just how much money your insurance company is wasting.
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  16. Elwood

    Elwood I know what I'm about, son.

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    That's not the only indicator though. Hey, I'm a fan of Medicare. I'm also a fan of a single payer option. Not because healthcare is a human right, but because we as a society can choose to provide things for the members of our society, like roads, public transit, etc.

    That said, Medicare has its problems and in many ways, is inferior to private insurances. But, there is a very old adage in the healthcare industry. Medicare lets you meet payroll and keep the doors open. Private Insurance is where you make your profit to buy new equipment and expand your facility's capabilities. Without private insurance, my local hospital wouldn't have an MRI machine, a Heart Cath Lab, or an Oncology Center because, again, Medicare lets you meet payroll and keep the doors open. That's it.
  17. Ancalagon

    Ancalagon Scalawag Administrator Formerly Important

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    There’s a really good book on this that I’ve recommended before, but since it is more complicated than a bumper sticker has been ignored by the usual suspects.

    Bring Back the Bureaucrats: Why More Federal Workers Will Lead to Better (and Smaller!) Government (New Threats to Freedom Series)
    https://www.amazon.com/dp/1599474670/ref=cm_sw_r_cp_api_glt_fabc_QFW05YD05GHT9YS0GE3M

    3F1057CF-79AE-410A-A680-215B2C737570.jpeg

    In Bring Back the Bureaucrats, John J. DiIulio Jr., one of America’s most respected political scientists and an adviser to presidents in both parties, summons the facts and statistics to show us how America’s big government actually works and why reforms that include adding a million more people to the federal workforce by 2035 might actually help to slow government’s growth while improving its performance.

    Starting from the underreported reality that the size of the federal workforce hasn’t increased since the early 1960s even though the federal budget has skyrocketed and the number of federal programs has ballooned, Bring Back the Bureaucrats tells us what our elected leaders won’t: there simply are not enough federal workers to do work that’s critical to our democracy.

    Government in America, DiIulio reveals, is Leviathan by Proxy, a grotesque form of debt-financed big government that guarantees bad government:

    • Washington relies on state and local governments, for-profit firms, and nonprofit organizations to implement federal policies and programs. Big-city mayors, defense industry contractors, nonprofit executives and other federal proxies lobby incessantly for more federal spending.
    • The proxy system chokes on chores as distinct as cleaning up toxic waste sites, caring for hospitalized veterans, collecting taxes, handling plutonium, and policing more than $100 billion a year in “improper payments.”
    • The lack of enough competent, well-trained federal civil servants figured in the failed federal response to Hurricane Katrina and in the troubled launch of Obamacare “health exchanges,”

    Bring Back the Bureaucrats is further distinguished by the presence of E. J. Dionne Jr. and Charles Murray, two of the most astute voices from the political left and right, respectively, who offer their candid responses to DiIulio at the end of the book.

    Review

    John DiIulio’s Bring Back the Bureaucrats (Templeton Press) is an eye-opening account of the hollowing out of American government. DiIulio, an expert on public administration at the University of Pennsylvania, points out that the US has fewer full-time federal officials than it did in 1960, while the amount of money they dispense has increased fivefold. In their place is a legion of for-profit contractors and non-profit NGOs with highly mixed motives, about which we know very little. In the process, misguided American hostility to government has produced a huge challenge for democratic accountability. —Francis Fukuyama, Senior fellow at Stanford and author of Political Order and Political Decay

    “Recommended for public libraries, universities, and anyone interested in political science.” —Dorothy J. Smith, Southwestern Baptist Theological Seminary, The Christian Librarian

    About the Author

    John J. DiIulio Jr. is the Frederic Fox Leadership Professor of Politics, Religion, and Civil Society at the University of Pennsylvania and the faculty director of Penn’s Robert A. Fox Leadership Program. He taught previously at Princeton University and at Harvard University. An award-winning political science scholar and popular teacher, he has served as a senior fellow and directed research centers at several think tanks including the Brookings Institution and the Manhattan Institute. A member of several government reform commissions, he served as the founding director of the White House Office of Faith-Based Initiatives under President George W. Bush, and he helped to reconstitute that office under President Barack Obama. The author of a leading American government textbook, his most recent research includes an ongoing national study of the implementation of the Patient Protection and Affordable Care Act, better known as Obamacare.
    Last edited: Dec 20, 2021
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  18. Steal Your Face

    Steal Your Face Anti-Federalist

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    While I might agree that the federal government may have less employees than it did in the 60s, that doesn’t account for the private companies that basically work for the government.
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  19. Ancalagon

    Ancalagon Scalawag Administrator Formerly Important

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    Uh. Yeah. That’s the entire point.
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  20. steve2^4

    steve2^4 Aged Meat

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    When I show up at the ED?
  21. Jenee

    Jenee Driver 8

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    This is not news. I've been aware and bitching about this very issue since the 80s when I became and adult and started paying attention.
  22. Fisherman's Worf

    Fisherman's Worf I am the Seaman, I am the Walrus, Qu-Qu-Qapla'!

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    But I thought the reason the bandaid the hospital put on me was $200 was because it was better quality. And that $400 pill of ibuprofen made my headache go away quicker.