Hospitals and Insurers Didn’t Want You to See These Prices. Here’s Why.

Discussion in 'Health Care' started by Lil Mike, Aug 25, 2021.

  1. Lil Mike

    Lil Mike Well-Known Member

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    Fascinating article from The New York Times on hospital pricing.

    Hospitals and Insurers Didn’t Want You to See These Prices. Here’s Why.

    This year, the federal government ordered hospitals to begin publishing a prized secret: a complete list of the prices they negotiate with private insurers.

    The insurers’ trade association had called the rule unconstitutional and said it would “undermine competitive negotiations.” Four hospital associations jointly sued the government to block it, and appealed when they lost.

    They lost again, and seven months later, many hospitals are simply ignoring the requirement and posting nothing.

    But data from the hospitals that have complied hints at why the powerful industries wanted this information to remain hidden.

    It shows hospitals are charging patients wildly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test.

    And it provides numerous examples of major health insurers — some of the world’s largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.

    To me, that was the surprising part, not that differing insurance plans negotiate differing rates with hospitals, but that sometimes it's cheaper if you have NO insurance at all!

    upload_2021-8-25_18-26-53.png
     
  2. Mircea

    Mircea Well-Known Member

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    So what?

    I already proved that.

    Wills v Foster 229 Ill. 2d 393 (2008).

    Plaintiff owed $80,163 in medical bills but the hospital accepted an insurance company negotiated settlement of $19,005 in full satisfaction.

    Was $80,163 a just debt? Not if the hospital settled for $19,005, because the hospital's profit margin is still 250%-500%. Note that $80,163 is 4x more $19,005.

    I can post several 100,000 cases just like that and it wouldn't even count the Millions that never go to trial in the first place.

    So, again, how do you know the bill you allegedly owe is legitimate? Why hasn't anyone started a thread on that? What if you went to Kroger's and at the checkout they say you owe $800 for your groceries? What do you say? "Hey, I'll settle for $190" and off you go?

    Is that a good way of doing business?

    Liberals keep screaming, "We want a healthcare system like Europe!"

    Well, so do I, because to have a healthcare system like Europe, we'd have to shut down 90% of the hospitals.

    It would take all of 90 days to cut everyone's health plan costs by 60%. Just have to repeal 3 federal laws, amend another and correct a mistake by the Supreme Court.

    It would take another 90 days for an additional 10% to 30% reduction in health plan coverage.That's because I'd have to withhold Medicaid and CHIPS funding from the States to coerce them into repealing all the harmful laws they've enacted at the behest of the American Hospital Association and to pursue anti-trust actions against the hospital monopolies and monopolistic cartels.

    At that point, we'd go from exactly ZERO Americans having health insurance to 100% of Americans having health insurance, unless they refused it.

    That's right. ZERO Americans currently have health insurance. Should you end up in court, you'll find out what you have is fee-for-service, which is not the same thing as insurance. Those are two totally different concepts, even though people continually and mistakenly call it "insurance."

    Even the "homeless" (snicker) could afford health insurance. True, they'd have to give up 2 or 3 40-ounce missiles each month, but at least they could afford it.

    All you have to do is fix the mistakes that your federal and State governments and a special interest group called the American Hospital Association made and your problems are solved.
     
  3. kazenatsu

    kazenatsu Well-Known Member Past Donor

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    Trump tried to implement a plan to impose price transparency.

    This is very cynical but some people think the Democrats don't really want to try to solve this problem or implement price transparency until they can get the issue solved their way. As long as these blatant problems exist, it will just help create further impetus for a socialist or national heathcare plan. Also the Democrats will be able to hold this over the insurers head, telling them they better be willing to support a national healthcare plan or they will lose their special privileged status. (We saw some of this in the compromises under the ObamaCare plan too) It may have more to do about ideological considerations than actual care about the consumer. If we instituted price transparency right now, then Democrats would have nothing to hold over the head of big insurers and coerce them with. It's all political strategy.
     
    Last edited: Aug 28, 2021
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  4. Greenbeard

    Greenbeard Well-Known Member

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    Obamacare (the Affordable Care Act) is what gives the federal government the authority to require these price disclosures. It started under the Obama administration with required chargemaster disclosures, expanded to negotiated prices under the Trump administration, and now finally has teeth (substantial monetary penalties for noncompliance) under rules proposed and implemented under the Biden administration.
     
  5. Mircea

    Mircea Well-Known Member

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    That is a patently false statement that only a shill would make.

    This is a primary source:

    https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdf

    Show us the applicable section, paragraph/sub-paragraph to support your baseless claim.

    It is not cynical. It is reality.

    It is an undisputed irrefutable fact that the federal and State governments, along with an entity known as the American Hospital Association ("AHA"), are the sole architects of the nightmarish healthcare system in place in the US today.

    As a matter of honor, integrity, morality and ethics, no person should be permitted to engage in discussions about the US healthcare system unless and until they are fully acquainted to the facts as to how this system evolved from the period 1919 to the present.

    Any person who is so uninformed cannot present an opinion. They can only offer a belief based on gross misunderstandings, biases and prejudices.

    Everyone's education can begin by accepting the irrefutable fact that the Physicians for National Healthcare is the political arm of the AHA and that Senator Warren was a board member and director of Physicians for National Healthcare and that Physicians for National Healthcare wrote the PPACA (colloquially "Obamacare") and passed it off to their good friend and colleague Chuckie Rangel to be introduced in the House (since Senator Warren is, well, a Senator.)

    It is also an irrefutable fact that the AHA created the very first health "insurance" company in America, called the Blue Cross.

    Let's start small.

    The AHA, with the eager help of your federal and State governments, disenfranchised Millions of Americans so that they could not obtain health plan coverage, or could not afford health plan coverage, and those Millions were largely the retired and elderly.

    Having created a problem, the AHA the disingenuously offers up a solution for the problem the AHA and your governments created.

    Don't believe it?

    Read and weep:

    "Introduced by various House and Senate sponsors and subject to extensive hearings, the basic framework of part A began to reflect accommodations between the sponsors, the Administration and the American Hospital Association (AHA). It ranged all the way from principles of institutional reimbursement, which has been pretty thoroughly already worked out in a general way for their own purposes between Blue Cross and the Hospital Association over a period of several years The American Hospital Association has already nominated the Blue Cross organization for its membership, although some member hospitals will undoubtedly elect out of this arrangement. We have proceeded very far in the development of working arrangements with Blue Cross, although no formal approval as a fiscal intermediary has yet been given them."

    [emphasis added]

    Primary Source: Report to Social Security Administration Staff on the Implementation of the Social Security Amendments of 1965, Robert M. Ball Commissioner, November 15, 1965

    Y'all been letting the AHA -- who you do not elect and who are not accountable to you -- manipulate and ruin your healthcare system for nearly 100 years.
     
  6. kazenatsu

    kazenatsu Well-Known Member Past Donor

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    One question: How was the AHA able to disenfranchise persons so they could not obtain coverage? Surely there were other alternative health insurance companies. Excuse my ignorance but is the AHA in control over large hospital systems and what type of insurance they will accept? Do Medicare rules somehow factor into this?
     
  7. Greenbeard

    Greenbeard Well-Known Member

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    SEC. 2718(e) of the PHS, as added by the ACA (on p. 19 of your link).

    Which, lo and behold, is the statutory basis cited in the Trump HHS's rule on this

    It even notes that their rule is building on the initial Obama-era rules implementing the rule to require hospital chargemaster disclosures. Which Biden has now added real teeth to (see: U.S. Proposes Raising Penalty for Hospitals That Don’t Publish Prices)
     
    Last edited: Oct 6, 2021
  8. Mircea

    Mircea Well-Known Member

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    There's nothing on page 19 that says what you claim it says.

    Did you read 1886(d)(4) of the Social Security Act?

    We should probably go to Social Security's website to read that:

    https://www.ssa.gov/OP_Home/ssact/title18/1886.htm

    Here is § 1886 §(d) and sub-paragraph (4)

    (4)(A) The Secretary shall establish a classification of inpatient hospital discharges by diagnosis-related groups and a methodology for classifying specific hospital discharges within these groups.


    (B) For each such diagnosis-related group the Secretary shall assign an appropriate weighting factor which reflects the relative hospital resources used with respect to discharges classified within that group compared to discharges classified within other groups.


    (C)(i) The Secretary shall adjust the classifications and weighting factors established under subparagraphs (A) and (B), for discharges in fiscal year 1988 and at least annually thereafter, to reflect changes in treatment patterns, technology (including a new medical service or technology under paragraph (5)(K)), and other factors which may change the relative use of hospital resources.


    (ii) For discharges in fiscal year 1990, the Secretary shall reduce the weighting factor for each diagnosis-related group by 1.22 percent.


    Any such adjustment under clause (i) for discharges in a fiscal year (beginning with fiscal year 1991) or payments under paragraph (5)(M) (beginning with fiscal year 2021) or payments under paragraph (5)(M) (beginning with fiscal year 2021) shall be made in a manner that assures that the aggregate payments under this subsection for discharges in the fiscal year are not greater or less than those that would have been made for discharges in the year without such adjustment or payments under paragraph (5)(M).


    (D)(i) For discharges occurring on or after October 1, 2008, the diagnosis-related group to be assigned under this paragraph for a discharge described in clause (ii) shall be a diagnosis-related group that does not result in higher payment based on the presence of a secondary diagnosis code described in clause (iv).


    (ii) A discharge described in this clause is a discharge which meets the following requirements:


    (I) The discharge includes a condition identified by a diagnosis code selected under clause (iv) as a secondary diagnosis.

    (II) But for clause (i), the discharge would have been classified to a diagnosis-related group that results in a higher payment based on the presence of a secondary diagnosis code selected under clause (iv).

    (III) At the time of admission, no code selected under clause (iv) was present.


    (iii) As part of the information required to be reported by a hospital with respect to a discharge of an individual in order for payment to be made under this subsection, for discharges occurring on or after October 1, 2007, the information shall include the secondary diagnosis of the individual at admission.


    (iv) By not later than October 1, 2007, the Secretary shall select diagnosis codes associated with at least two conditions, each of which codes meets all of the following requirements (as determined by the Secretary):


    (I) Cases described by such code have a high cost or high volume, or both, under this title.

    (II) The code results in the assignment of a case to a diagnosis-related group that has a higher payment when the code is present as a secondary diagnosis.

    (III) The code describes such conditions that could reasonably have been prevented through the application of evidence-based guidelines.


    The Secretary may from time to time revise (through addition or deletion of codes) the diagnosis codes selected under this clause so long as there are diagnosis codes associated with at least two conditions selected for discharges occurring during any fiscal year.


    (v) In selecting and revising diagnosis codes under clause (iv), the Secretary shall consult with the Centers for Disease Control and Prevention and other appropriate entities.


    (vi) Any change resulting from the application of this subparagraph shall not be taken into account in adjusting the weighting factors under subparagraph (C)(i) or in applying budget neutrality under subparagraph (C)(iii).


    Very clearly, that is discussing discharges and not what you claim it is discussing.

    Alright, so I followed up on that.

    You claim it was amended in 2011, yet it took the Obama Administration 4 years -- 2015 -- to propose rules and those rules didn't even go into effect until January 1, 2019.

    On top of that, the rules proposed only demonstrate the incompetence of the Obama Administration.

    Patients are not medical billing coders. Because they're not, they won't have a clue what they're reading because the terms are difficult for any patient who doesn't already work in the medical field to understand, and that would only confuse patients.

    The rules created by the Obama Administration do not compel hospitals to explain what a patient's out-of-pocket costs might be, makes no attempt to show how negotiated discounts with health plan providers might apply, and lacks any relevant contextual information that a patient would need to make an informed decision.

    And, on top of that, both the ACA and the rules are so poorly written, it doesn't take into account that both State and federal courts have ruled that pricing info -- whether in the hospital industry, steel industry, auto industry, insurance industry and any other business -- may be of a proprietary or otherwise confidential nature.

    And, no matter what you or Trump or Hiden say, there's nothing in Section 1886(d)(4) that backs them up.

    The ACA does not solve the root problem in your healthcare system, which is your hospitals operating as legal monopolies and monopolistic cartels because the predecessors of Senator Pocahontas bribed and swindled State legislatures into giving hospitals monopoly power (under the guise that the negative consequences of monopoly would be offset by all the free healthcare hospitals would give away to the poor.)

    If Obama wanted to fix your nightmare healthcare system, then he should have invoked the Supremacy Clause and went after hospitals using the Sherman Anti-Trust Act.
     
  9. Greenbeard

    Greenbeard Well-Known Member

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    Yes, there is. The legal requirement, established by the ACA, that every hospital make public a list of its standard charges. Literally what's being discussed in this thread. The statutory basis for the entirety of the federal government's price transparency push.

    DRGs are the unit for inpatient hospital services paid for by Medicare and most other payers in the U.S. If you're talking about the price of an inpatient stay, you're talking about the price of a DRG. The rule just clarifies that DRGs are included in the list of things for which the ACA requires public price disclosures.

    What are you even trying to dispute at this point? This thread is about the implementation of the ACA's price transparency requirements for hospitals. You incorrectly claimed this is "patently false" because you were apparently unaware of this basic fact. Now you know.
     
  10. Melb_muser

    Melb_muser Well-Known Member

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    Huge, shocking - and completely unsurprising at the same time.
     
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