Re: Name your poison: how ObamaCare will devastate small business
posted at 3/25/2013 3:08 PM EDT
In response to MattyScornD's comment:
In response to FortySixAndTwo's comment:
In response to MattyScornD's comment:
But why should anyone be charged differently for the exact same procedure? Why shouldn't everyone be able to pay the medicare price, for example?
No one is charged differently for same exact procedure. It's the same charge for you or me at say MGH. It's the reimbursement from your insurer that is different
But, if you want hospitals to go out of business then let's adopt the medicare fee schedule. Boston area hospitals lose MILLIONS on Medicare and Medicaid patients. If it wasn't for the Big 3 insurers these hospitals would be closed.
Some hospitals are transparent about their prices. Some are not. There is no consistency throughout the system. Every hospital has their chargemaster, but not all of the info is made public.
Which hospitals aren't transparent about their prices?
These issues were detailed at length in Time a few weeks ago. A person without insurance will pay more for the same procedure than a person with insurance will. And then, insurance plans vary, which means that two people with different insurances will pay two different prices for the same procedure and same result.
Remember, we're talking about people who are uninsured or underinsured and the out-of-pocket expenses incurred as a result of needing health services. Unless a person can estimate their out-of-pocket expenses for a procedure (with or without insurance) and compare among hospitals, there is no real transparency.
One analysis found considerable price variation for common preventive services: 755 percent cost variation for diabetes screenings (from $51 to $437); 264 percent variation for Pap smears (from $131 to $476); and 132 percent cost variation for colonoscopies (from $786 to $1,819) over a 12-month period. Since the Affordable Care Act mandates these preventive screenings come at no cost to individuals, the costs are borne by plan sponsors. Healthcare Transparency Index, "Affording the Affordable Care Act: Engaging Employees in Finding Lower-Cost Preventive Care," March 2012, Change Healthcare. Another analysis found that hospital charges for appendicitis in California hospitals ranged from $1,529 to a high of $182,955. R. Y. Hsia, A. H. Kothari, T. Srebotnjak et al., "Health Care as a "Market Good"? Appendicitis as a Case Study," Archives of Internal Medicine, published online April 23, 2012. One analysis found that U.S. spending on health care could be reduced by $36 billion a year if the 108 million Americans with employer-sponsored coverage comparison shopped for 300 common medical procedures. B. Coluni, "Save $36 Billion in U.S. Healthcare Spending Through Price Transparency," Thomson Reuters, February 2012. Several studies have found that higher costs do not equate with higher quality.
And even if the prices are transparent, that doesn't mean the prices are reasonable. It's absolutely possible that your insurance company negotiates a higher price than skeeter's, or vice versa. So, why should you pay more for the same procedure merely by dint of the carrier you chose...?
If you're talking about uninsured, then yes, they would get what the charge is from the hospitals. However, MANY hospitals give an "uninsured" discount because the thought is that insured people shouldn't be the only ones that get a discounted rate.
Again, bigger insurers can negotiate bigger discounts for their members. That goes for ANY business. Costco can sell you the same product you'd get at a supermarket or CVS for much cheaper. Why is that ok? Same product right?
And which hospitals aren't transparent about their charges?
Another analysis found that hospital charges for appendicitis in California hospitals ranged from $1,529 to a high of $182,955.
Clearly this wasn't a case where the procedures were EXACLTY the same. Obviusly the $182K had some major complications. Can't take everything you read at face value.