I don’t know how many times I or someone I know has gone to a provider and told my portion of the bill and then been bill a much, much higher amount. Then the provider backs out of their quote and tell you it’s your responsibility. It is the biggest misrepresentation I’ve ever seen. You have no recourse; pay or be turned over to collection. Something needs to be done. Something specific, binding and permanent to hold the providers and insurance companies accountable.
I never thought I would say this: thanks Trump
This may provide a slice of justice before we can elect in people who will work towards healthcare access for all (not free to patients, but affordable)
The lack of transparency is borderline scammish from my experience. Currently, I am organizing my paperwork in a fight against Advocate Health in IL due to misleading -- that is the nicest I can label it -- billing practices. They had given me a worksheet that said my occupational therapy services would cost 45 dollars an appointment and 0 for deductibles. Since I have a high deductible plan, I asked -- really, I begged -- the staff to tell me what the actual price will be. Two office workers assured me it would cost $45 an appointment, nothing more. After two appointments, I received a bill for $554. I was told it was for a doctor; I never saw or agreed to meet with a doctor during these appointments. Since then, I decided to look into a mystery bill I did pay to Advocate: $1000 charge that came over a year after the date of service with no explanation. When I wrote my insurer about it, they replied that it was my responsibility and the payment included: "the cost containment penalty for late notification on the inpatient stay." What even is that?? The hospital notified the insurer late so I pay the penalty?
Unless consumers are actually going to comparison shop for health care (unlikely) this will have no effect, or possibly a negative effect. Hospital A posts $2000 for an MRI, clinic B posts $1200 for an MRI. If people flock to clinic B, mission accomplished. If they don't, then clinic B might as well just raise their price to $2000. Mission NOT accomplished. At that point it just becomes a legally mandated vehicle for price fixing.
As my public health economics prof used to say, market forces are distorted in health care because of information asymmetry. Even if prices are made transparent to consumers, so what? For most people, they do not pay for their own care out-of-pocket, they're covered to a large degree by their insurance plan and they pay the insurance directly with prices set by the insurer. Providers do not directly control what they charge most of the time, barring concierge type practices. Secondly, past experiments show professionals much less the public have a hard time judging quality of care. Medical care is not like buying a coat or a car where buying a cheaper, lower quality product can be done with minimal risk. This is just Trump's distraction from Medicare for all. Medicare for all skips the confusing negotiation of prices, weighing of quality for consumers: prices are negotiated instead by the government. Works for almost all 1st world countries, why not the US?
5
1) The legality of doing this by executive order, instead of a law passed by Congress, is going to take months of litigation to resolve.
2) Knowing prices is a first step, but how much comparison shopping can you do when lying on a gurney in an ER, while in extreme pain?
3
On the one hand, what difference does it make if you can't afford even basic healthcare? On the other hand, I believe healthcare is the one area where, for people with insurance, cost is irrelevant.
The payment rates by insurance companies are available when you sign so this will make no difference to people with insurance. Again, it will not matter to people who can't even afford basic healthcare.
While the effort is laudable I believe it will be as useful as requiring pharma companies to include in their TV commercials any drug cost over $35. Drug companies don't advertise generic drugs (brand name drugs are never that cheap). Without health insurance brand name drugs are prohibitive and with insurance high deductible plans are almost equally as useless. Pharma companies, who don't face any competition (patent-protected drugs) have no incentive nor do they care to lower prices; the care for patients is pure spin. People who rely on drugs to survive, such as insulin, don't have any influence because a) they do not have a choice of which company the pharmacy makes their purchases and b) only legislation will fix that.
Health insurance and drug coverage will never be affordable as long as the system remains a for-profit system.
4
As a recently retired physician, I believe that this is a good idea that has been discussed far too long. While I am no supporter of Trump, he should be given credit for this one action if it actually comes to pass. However, everyone must understand that similar proposals by Dems have been opposed by PHARMA, Insurers and Hospitals and blocked by Senate Republicans. I fear that the complexity of pricing may make the proposed policy un-workable. Doing this via an Executive Order avoids the need for Trump to exercise true leadership and work with Congress to come to some sort of consensus to create a law that would accomplish this and additional needed reforms. Insurers and pharmaceutical companies have kept their prices from public scrutiny far too long, and hospitals have been complicit in this action. Enthusiasm for this one action must be tempered by the failure of Trump & Congressional Republicans to articulate specifics of their plan for a new "beautiful" health care plan. The weakness of Obamacare was that it started with necessary buy-in from PHARMA, Insurers and Hospitals rather than an understanding in Congress that all Americans deserved an affordable comprehensive system. Consequently, too much power in crafting the plan was given to these suppliers of healthcare services. Obamacare is not perfect, but it is an acceptable start and certainly better than the invisible, make believe plan offered by Trump and the Republicans.
3
@Bob Parker As a Physician, if you post $150 for an office visit, and the M.D. down the street posts $125, do you really think your patients are going to move? Unless they are willing to move it is not a free market and price transparency is irrelevant. If face, seeing those prices, The guy down the street might just RAISE his prices to match yours !
Moving overseas and getting genuine healthcare, I giggle watching this cacophony of caring, compassionate voices of Western Civilization espouse platitudes of care and concern while they condemn their fellow man.
Americans are getting what they deserve; ever since Reagan destroyed the future of African Americans in the USA have I not been more certain of a reckoning. I just won’t be there with you all when it comes.
7
Ya know, say what you want about Trump but I have to give him credit for something that Democrats should have done a long time ago.
2
Is it possible that our president is bumbling, stumbling his way into a sensible path on an issue of this magnitude?
1
So when people see the cost of their medical bill in advance they will freak out and not get the help they need. Brilliant idea Trump.
2
Nice article, particularly mentioning the apparent contradiction on health care with the appeal attempt on the whole ACA through the courts this summer.
Someone correct me if I'm wrong, but, to my understanding, the court could decide to stop Obamacare effective the date of its decision.
That is, not giving the states the necessary few years to even re-establish the old high-risk pools, and other mechanisms, to try to get some coverage for people with pre-existing conditions.
The old system pre-Obamacare was quite problematic, with humongous eligibility gaps and affordable problems, especially for people with pre-existing conditions. Exactly how problematic depending on the particular state.
(See, for instance, CT high-risk pool rates from 2012:
$7500 stop-loss: $2077.18 a month for a male 60-64
https://web.archive.org/web/20120330094653/http://www.hract.org/hra/Rates/2012/Individual/IndPPORates.htm ;
$1000 stop-loss: $3908.02 a month for a male 60-64
https://web.archive.org/web/20120329050351/http://www.hract.org/hra/Rates/2012/Individual/IndSHCPRates.htm
)
A court destruction of Obamacare effective immediately on its decision would be even worse than that old system!
2
The more distance between a patient receiving needed care a Doctor provides and being paid, the more actual cost effective medical care suffers. Government paid Doctors working on an assembly line basis isn't sustainable if quality and advanced procedures are desired too. Cackling,do good, value projecting politicians standing between patient and Doctor is folly.
1
Regardless of whether price-transparency would drive price up or down, “it is the right way for providers to compete based on price and quality to win consumers, who deserve the dignity to be informed prior to the choice of service”, which is why I have founded the transparency-driven healthcare navigation platform, MediBookr -
Wow, Donald Trump is doing something good for a change.
I've long been shocked that we Americans tolerate the blatant price gouging, hidden costs, covert fees, padding, and other chicanery foisted on us by doctors, hospitals and others in the health care industry.
When I was run over by a car while bicycling, instead of working about my broken leg and hip, I had to worry about how much the health care providers would do an end run around my insurance, forcing me to pay for services and materials I didn't need and had no chance to consent to.
I was in a "teaching hospital." A doctor would lead his flock of students into my room, spend a few minutes using me as a guinea pig, and then leave without ever speaking to me.
He billed $575 for each visit to my room is what I was told when I asked my health insurance company about it and only 60% of it was covered by insurance.
The next time he came, I told him to leave and asked him why he was billing me. He denied billing me.
If Trump can do something to force the greedy clowns in the health care industry to tell me up front what they're charging me and why, I applaud Trump, for once.
1
I can't help but think the Trump administration is doing this in concert with the healthcare industry. Instead of meaningful, widespread healthcare reform, throw the populace a bone or two. The industry pretends to fight it but really they're happy that it's a distraction from the endemic problems with their profiteering. And the president gets to look "tough" with a mild reform or two.
Trump is full of (pleasant) surprises.
If this works, it will be another win for ordinary Americans.
Trump wants to neutralize democrats on healthcare.
He knows medicare for all is not realistic. He knows conservatives will never agree to it. He knows even the democrats are divided on it, and some are offering public option as a more realistic alternative.
Trump's hands are tied. But Americans notice that he is fighting and coming up with creative and tangible ideas to counter the democrats.
Isn't that what one wants from their president?
Isn't that what makes Trump almost unbeatable in 2020?
Permitting insurers to conceal their pricing information has damaged the health care market, and harmed individual health outcomes.
The current regime of industry protectionism must be ended.
Though I share many reader's thoughts looking at this as "a broken clock is right twice a day", we should all at least appreciate how the market mechanism can work, when it does.
I like to bring up Zenni optical, where, if you avoid the upsells, you can get progressives for $40. Compared to $250 to $500 at the optician or opthomologist's office.
It would take a lot of market magic, though, to have this kind of thing work for people with medical emergencies, where there are patents on pharmaceuticals, and numerous barriers to free information. As well as some costs are inherently and unavoidably high -- so we need insurance, and the problems from that cost insulation inevitibly assert themselves.
It will be interesting to see how this turns out.
I might recommend the brief discussion by physician/reporter Elizabeth Rosenthal on the PBS Newshour tonight:
https://www.pbs.org/newshour/show/trump-pushes-for-new-transparency-with-health-care-prices-but-will-it-lower-them
where she finds the effect unclear.
1
All of the First World civilized nations have access to quality affordable healthcare as a human right for the many. America is not one of them.
The notion that consumers have the ability or desire or need to make medical healthcare choices based upon economics is delusional and ludicrously contrary to human nature.
Americans are not economists nor medical doctors. Health care is sui generis.
5
Going to the doctor or hospital should be as easy as going to the grocery store or home depot; you choose between similar items among competing brands with prices posted on the shelves.
Many liberal experts hope that this initiative does not succeed. It would show that Trump wants to reduce medical costs and make people wonder why Obama chose instead to follow the wishes of his big campaign contributors in the medical business.
Generally price transparency benefits consumers but how will it give "power back to patients" under our current health care system? To compare health care costs, one needs to know the drugs and medical services covered by an insurer, what percentage the insurer will pay, and the negotiated price for each drug and medical service code (and there are thousands upon thousands of codes). Even if an insurer has negotiated the lowest price for a drug or medical service code, one does not know until the time comes whether the insurer will agree to pay for it based on the particular situation. One may not be able to control whether the needed doctor/facility is in or out of network. And on and on.
One can't plan ahead for the drugs one's doctors will prescribe or the codes doctors will choose to use until these become a routine part of one's health care regimen. Perhaps one can shop around and make informed choices when planning for elective and preventative medical services, but we do not chose or time our illnesses. There are so many variables involved in determining the cost of health care, it is virtually impossible to comparison shop. Knowing the prices up front won't help consumers choose more cost-effective options when they can't foretell or control their diagnoses and may have limited control over treatment options. It is doubtful price transparency will lower costs. The only way to control the costs and quality of drugs and medical services is under universal health care.
4
Elephant in the room: Look at it another way ...if prices were posted for procedures, some people wouldn't get the care they needed thinking they didn't need the service and end up sicker and/or either expiring or requiring more expensive care later. hmmmm....
The public's right to know the price they will pay for a service - in advance of them paying it, so it can influence where to purchase that service - far outweighs any insurance or hospital's right to keep their prices a secret.
How is this even up for debate?
9
What about the academic institutions which are manned day and night by healthcare providers which take on complicated cases that no one wants to touch. Whee the next generation of healthcare providers is getting trained. Where patients are treated regardless of whether they can pay or not. These hospitals rely on creative accounting to continue their impossible missions. Wait till they all shut down because of stuff like this and then there is nowhere to go...
5
Sounds good on the surface but I suspect it will not result in much useful or bankable information to healthcare "shoppers." Instead it will probably end up being one of those "bureaucratic government regulations" that require providers to do more paperwork and drives up costs. What it really is is a president who got elected on repeal-and-replace Obamacare now running for re-election with zero improvements to healthcare. It's just more tinkering with a broken system driven by greed. Medicare for All.
3
I'm a salaried physician and would love to know what my employer is charging patients I treat. In point of fact, as little more than a glorified assembly line worker myself, I would argue that even Henry Ford's employees know more than I do about what the price of our product is.
16
Transparency could mean higher prices when rural areas see the higher cost in non rural areas and decides to up their cost to match.
I am a clinician in private practice. The dark side of healthcare is that it is proprietary. Unless a patient advocates for their needs, clinical and financial, it will be business as usual.
2
This is why I love getting medical care in Mexico. For anything routine and planable, you literally signs contract with the hospital before the procedure that outlines the exact amount you will owe. When you leave you go to a window and can pay with a major credit card. Contrast this to the downtown Brooklyn Mt. Sinai medical center: I spent hours trying to determine how much I'd pay with my high deductible health plan for a non-urgent check-up my son needed. Nobody could tell me, not the hospital and not my health plan. Without the exact billing codes nobody could say and nobody could guess what billing codes the doctor would write until after the exam. Some guessed hundreds, some said fifty dollars. Some said it may be included as a preventative exam.
18
@cpf Yes, you can't get a billing code until you have a procedure and you can't figure out the cost of a procedure until you have a billing code. It took me 10 phone calls to figure out the cost of a ROUTINE MAMMOGRAM.
12
How about we see Trumps taxes, Ivanka and Jared’s taxes, Eric and Con Don Jrs’ taxes to start. After we claw back the billions they owe us and put them all in jail and save the millions from shuttling them around everyday then we can get to posting prices at Trump properties next to what they got away with.
14
I will go to my grave knowing that private sector corporate health care, for profit, is unethical, immoral, illogical, usurious, indefensible, vile, loathsome, dishonorable and that its existence reveals the Achilles Heel of Capitalism, greed.
Make no mistake, I love capitalism and free markets, innovation and competition but only if an independent government, elected of the people and for the people distributes profits in such a way that nurtures and enables its society at all levels.
In our country Greed has penetrated our government to the extant that it has become dysfunctional. Capitalism in America has become predatory and even cannibalistic on the body public. That's it and that's all.
29
@HoodooVoodooBlood. Whoa! Right on. Capitalism is a very good system/ideology but left alone, it trends into excessive greed/driven behavior. Smart regulation is required.
1
Oh no, ... I like something Trump proposed.
13
It's a complicated world!
@clifton.yopp
Don't worry, Trump very existence is built on deceit and lies. This is not what it seems.
2
The president now legislates? By himself? Can't wait for the courts to look into that...
The big medical problem - one that most affects medical prices for all of us - is the explosion in obesity and, especially, childhood obesity. Yet politicians will not discuss that.
Of all the problems we face, from climate change, to war, to election financing, to the schools, to government spying on citizens, only the explosion in obesity is something people can do something about as individuals and get results.
We are becoming the fattest, the sickest (Metabolic Syndrome) nation on the planet. Life expectancy for this generation has gone down - a first in 50,000 years. Dare to speak about it, and one is accused of "fat-shaming." We are dying because of the way we eat and drink. If a president can indeed legislate via fiat, tax sugary soft drinks 2¢ per gram of sugar. That will save lives. There is no doubt about it. If that is not "national security," what is? But people refuse to see the very real immediate threat right under our shirts.
https://emcphd.wordpress.com
3
@Rev. E. M. Camarena, PhD
Agree with your comments on the obesity epidemic, although the decline in physical activity is equally to blame, and the opiate related deaths and suicides probably have more to do with the decline in life expectancy. Deaths at a young age have far more effect on life expectancy than the old dying a few years sooner.
2
@Ohio MD: Yet that comment on the death rate is not my personal assessment. A three month drop in life expectancy, so far, has been documented by pediatric endocrinologist Robert H. Lustig and attributed to childhood obesity, now at a staggering 18.5% in America.
https://emcphd.wordpress.com
1
@Rev. E. M. Camarena, PhD Michelle Obama tried to do that by making school lunches healthier. She was "roundly" criticized and bullied by nearly every Republican in America.
2
This is long overdue. I happen to think Trump is an utter incompetent, but as the saying goes, even a broken clock is right twice a day.
6
I can see Trump's future plan. Pay up front healthcare or solvent green.
This is not the way medicine or the real world work. People don't diagnose themselves. They don't decide what is wrong with them, find a cheap place to get the work done, and then hunt for a doctor.
People visit a doctor who decides what test/surgery is appropriate for their problem. People then go to the hospital where that doctor has admitting privileges. This is how it works. Except in extremely rare situations, knowing prices doesn't help at all.
9
@gesneri Except of course in the rest of the developed world where it does.
Health care pricing reminds me of the sale of photographic equipment in New York 40 years ago. There were list prices suggested by the wholesale distributors, but nobody paid them. But at least you could visit the camera store and find out the retail price before you laid down your money.
In health care, there are no posted prices, and you often don't know what a procedure will cost until you have received it. Everyone pays a different price, not disclosed to the public at large. It creates a necessity to buy health insurance, if you can afford it.
And this is the system that some people are concerned will be overturned?
10
Republicans tried to improve Obamacare but Democrats insisted it was great just as it is. They also scared people by saying they would lose coverage although that was explicitly denied by Republicans. But now almost all Democrat Presidential candidates want to end Obamacare. Some propose Medicare. My wife and I each pay over $4000 a year for Medicare and insurance supplements. There are copays and deductibles. (Oh, did you think Medicare was free?) The Democrats need to back off ending Obamacare or they will see their political careers ended.
2
There was no Republican plan to improve medical care in the US. Only to end the ACA.
Trump pretended to have a plan, but healthcare is far too complicated for his weak mind to do anything useful.
We do not have to start from scratch. Developed nations around the world provide better care for less money. Studying how and crafting our new system is the first step.
Let’s get rid of the claims handlers, salespeople, marketers, managers and executives at health insurance companies, and put them to work doing something useful. Picking tomatoes, perhaps.
Only one way might have a chance to work. Politicians outlaw taking drug and healthcare lobby $. Big pharma can make a congressman a millionaire over and over.
The times Trump tackled drugs cost the cost rose. I bet the same happens to his new healthcare initiative.
2
"But both insurers and hospitals have objected to having what they describe as proprietary information made public"
The amount I will be billed for health care services is "proprietary"?!? So proprietary that no one can tell me what my bill will be until after I've bought the service? This goes a long way towards explaining what's wrong with health insurance in America today.
13
Transparency does not necessary mean cheap. Dr and Hospitals can meet to set prices high.
There are so many way drug companies manipulate drugs. They meet and determine who sells what to keep the prices high. Big pharma even pay generic companies billions not to make and sell cheaper generics.
2
@Bill Some states' attorney generals have decided to sue Big Pharma for price fixing. It will be an interesting case. 60 Minutes did an episode on it.
2
I heard Trump cooing about how this would send the price of health care "way, way, down".
Anyone here dumb enough to believe Trump? Or crooked enough to try to convince others to believe Trump?
8
Why not do the same for pharmaceuticals? That’s where the healthcare money is spent!
5
@Michelle Hill
Actually only about 10% of total healthcare spending is on drugs.
https://www.actuary.org/content/prescription-drug-spending-us-health-care-system
The goal of any healthcare reform should continue to be on service providers and value-based performance measurement. The balance between protecting proprietary contracts and ensuring a competitive marketplace should be the focus of reform measures.
1
Just what we did not need: fake transparency.
If there is something worse than no data, that’s the pretension of data and this is what this is. We need all costs of all medical procedures and all discounts and all copays disclosed. Let sun shine and disinfect!
5
More executive “orders.” How presidential, in a dictatorial way. US democracy is non-functioning at this point.
4
As soon as Trump unleashes his hyperbole “ really fantastic”, my interest shuts down. That phrase means another empty promise and no follow through. I guess we are used to his imagination ‘gun’ not having any bullets. Trump is an empty headed demagogue.
4
This whole Republican viewpoint of using the "marketplace" to adjudicate costs in BOGUS. As a consumer I have almost no choice in doctors, facilities, or the test that re run on me. Doctors practice under the aegis of an overarching hospital system, which owe their practice. They refer me for tests to the hospital's laboratories and facilities. I need a specialist, guess what, the specialist operates under he hospital umbrella.
The only way to get market power is have a single payer, or multiple regulated payers, who has/have market power against the entrenched provider half of the equation.
4
@Howard
The simple fact is that while it may appear otherwise to some, hospital systems are very far from cash machines Theres no reason “marketplace” has to be a dirty word. A well regulated market should provide consumer choice at market-determined prices. There’s absolutely nothing anyone should disagree with on that (unless you are a member of an interest group receiving above-market prices due to market distortions). In the case of health care, the focus has to remain on better evaluating and reporting outcomes. This is a better way to ensure provider accountability rather than bluntly forcing prices down via a single payer.
3
We don’t need information, we need caps on prices. Particularly the insurance companies are protection rackets. Go single payer administrated with disclosed prices and let these companies sell policies for luxuries, frills and heroic technology. The pharm carrion can charge unitary prices that most of the world enjoys.
5
Amazing to watch the knots people will tie themselves into to attack anything that is associated with Trump. Even the write up itself is all focused on possible pitfalls and the push back by insurance companies and big HCP’s. So here we are, knowing costs of services upfront and before one incurs them is actually bad. Any other industry this economic concept applies to? Any examples? Did not see any concerns about people avoiding needed healthcare because of being scared that unknown bills to come could ruin them either.
9
@Just Saying
We have all learned the hard way not to trust anything Trump promises.
Just sayin'.
9
@Just Saying The problem is that Trump is incredibly naive. Example: someone asks how much is a surgeon's bill for appendectomy. Hospital A says $8,000. Nearby Hospital Bsays $6000. Hospital A says ok, we lower price to $6000 BUT then hospital A increases cost of anesthesiologist by .... $2000 (no consumer would think to ask about that, or post-op nurse etc.)
2
Healthcare is the only place where you don't get a receipt immediately after your purchase.
Healthcare is the only place where you can't get a straight answer on the price or even an estimate.
This may not bring down costs but at least it will improve the experience and likely patient satisfaction
13
I know many people, including myself, are not fans of the president Trump. However, as the old idiom goes: “Even a stopped clock is right twice a day”.
This is a good move, and long overdue.
13
@Sam
Agreed!
Many dentists in Mexico cater to English-speaking clients and advertise their procedures with costs online. A simple web search for American dental rates is not available. Care is generally good and safe. Many locals here without insurance go across the border for care that costs a third of the going rate in the United States.
The high cost of insulin finds many Southern Californians going across the border to get their prescriptions filled because the three pharmaceutical companies has raised prices so high.
15
Note that this is just an executive order. It has no teeth under force of law. It's not even completely fleshed out.
This is typical Trump: make a big announcement, sign it with a big, black pen, and hope uninformed Americans will believe it's actually going to happen.
By the time the lobbyists get through with it, and the courts, there won't be anything left to enact.
11
Yawn & distraction. This will do zero to curtail costs. No way can any hospital make a list of prices that would have any value to patients with insurance being the determinant of a patient’s out of pocket cost. Medical decisions are not market driven. Who needing hospitalization is going to cost shop while ill enough to need it? It’s much ado about nada.
3
Something is always rotten in Trumpland (I don't want to insult the Danes). Conveniently, the order has no force and will quietly disappear as Peter pays Paul. This is not even sleight of hand. It is pure posturing and absolute buffoonery with 2020 in mind.
3
Yes, yes, and yes.
2
Give it a shot. Thank god I had insurance. One night, I ended up in the emergency room and stayed for 2 days. It cost my insurance company $17,000. I said are you kidding?
7
There is no story here. Where is the legislation?
5
Another worthless executive order. The trouble with politicians is that they are politicians and not healthcare experts. \
3
This is kind of smart and stupid at the same time. Stupid in that when your having a heart attack- you have time to price shop?
Smart in that we can see how the medical industry knows that health has no price. FYI the ENTIRE rest of the world provides health care to it's citizens. Imagine if our president was as good at health policy as he is a lying and name calling!!!
5
The only "really fantastic" order Americans want to see is Trump in hand cuffs and put behind bars.
I'm surprised NYT still publishes what garbage this criminal spews on a daily basis.
9
Universal health care for all! Now!
This Republican hogwash is not acceptable.
4
Don should ask his HUD Secretary what he'd think about more transparency in healthcare period. He'd probably choke on his OREOs.
3
So Trump’s going to come up with some cheap plans. That’s what he has up his sleeve. People will get sucked into it, and then find out how little the plans pay. This will backfire, but the patient will feel the ramifications, no one else.
Donald Trump is the major convincer for things that have no value. The healthcare policies will be worthless, or next to it.
I am a registered nurse who handled hundreds, probably thousands of cases in my case management career, hospital and insurer. This country is being led by a big fraud in the Oval Office.
Alex Azar should be for the people. No way. He’s another Trump puppet.
6
No properly educated economist would ever be opposed to transparency around prices. In fact free markets only really work when pricing information is immediately and universally available.
Give Mr X a new hip for $15k because he is an employee of large company Y but won’t give me the same deal when I walk in as a patient? Up to you, I’ll look elsewhere.
This sort of transparency is long overdue. Charging the uninsured rates only an Arabian Prince would countenance just because they are not members of the ‘in group’ is legal but not sustainable in a free and transparent market.
11
That sounds just fantastic.
Or you could simply let people have universal access to health care whatever the necessary costs.
You know, let me tell you my Canadian health care story this year. Just between us.
I asked my doctor about a recurring pain that had been around for a few years and he gave me a a sheet of paper that I took to the medical lab in the same building where I booked an appointment for sonar imaging of my abdomen.
The result of that was sent to a specialist who determined from imaging that I likely had a Spigelian hernia, and me seeing my GP again to discuss the ramifications.
I could either live with the episodic pain and discomfort and fear, or there was a surgical option.
I met with the surgeon and first had to have a colonoscopy to rule out other possible surprises.
That got done, and I elected to have surgery.
That got done laporoscopically in an operating theatre in a city hospital with at least four people assisting. It took about an hour and a half I was later told. Five little holes that didn't even need stitches.
I was released from hospital that same day and await follow-up in a week or two to confirm what appears to be a successful repair with mesh.
I did not have to pay one penny of any of the costs incurred along the way.
I only had to show my OHIP health card to be read at every single step of the above medical care.
It took from about February to May to play out.
That is how a health care system should work in a great nation.
17
Having spent 33 years in private health insurance, I can tell you that trying to compare prices for a procedure is like spinning the Wheel of Fortune. One person's simple gall bladder removal is way different than another person's. It varies by hospital, buy surgeon, by radiologist, pathologist, medical complications, co-morbidities of the patient, and more. Every insurer has negotiated its unique pricing based on everything from diagnosis to total outcomes to quality. You can no more tell someone what their gall bladder removal will cost than you can tell what a flight will cost from New York to Los Angeles. First class or coach? Day of the week? On Thanksgiving Wednesday or a normal Tuesday in October? With or without luggage? Non-stop or multi-leg? The effect of publishing prices is that no one will know anything but everyone's expectations will be raised.
8
Frankly your argument is 100 percent baloney. I am a US expat living in South Africa. I received an estimate for my knee scope before I agreed to the procedure. it was pretty accurate.
5
I have asked, "but what will that cost me?", and been given a range. But is my insurance coverage on the high end or the low end? Single payer, the rest is too complicated and corruptible.
10
I know when I go purchase a car how much each "extra" costs, such as power seats, high quality stereo systems and high performance tires. When I head in for surgery I don't know what to ask about. Who is going to tell me, in advance, how much more my surgery will cost if complications arise? Who will tell me how much my stay will cost me if a non-network doctor is called in midway through my surgery because the network physician is called to an emergency case?
This all sounds great but my surgery stay doesn't come with the sticker price affixed to the operating room door. I can't renegotiate when when I am under general anesthesia. Someone in the White House will need to come back with something better than this if they want to lower health care costs.
5
More lip service from the man without a plan.
And this country really needs to make up its mind. Private insurance or government controlled.
And I'd like to know what many other things "really" cost.
What was the mark-up on that hi-fi receiver I just purchased ?
Perhaps an executive order to disclose that?
1
More transparency can help lead to solutions. The insurance companies hate the idea. That’s good enough for me.
4
@Martin I'm more concerned about the cost of our military equipment and technology.
Healthcare is a very large “for profit” enterprise with mega-hospital chains, big pharmaceutical companies with locks on patented medicines, large health profitable insurance companies, and even large physician owned medical practice businesses. Not to mention the super profitable medical suppliers of specialty medical equipment. None of these groups will support a reduction in their profits. And they have highly paid lobbyists to keep those profits coming.
9
I used to get prices for medical visits and procedures. But those prices are retail. Insurers, including Medicare, get big discounts. Plus the hospitals and surgeons add the caveat that actual rates could differ based on complexity, time and other stuff. Anyhow, as others have pointed out, the healthcare decisions you make shouldn't be based on price. Instead, ask about experience and outcomes. Much of this is already on the web.
3
This could be a small step in the right direction. However, if the lobbyists get their way and tell tRump they won't stand for it, he might back away or give these very same doctors and hospitals the right to 'opt out', or, they may be able to hide some of the costs, or post them with so much gibberish, it won't make sense to someone without a medical degree.
We need a system that is fair to all. Let hospitals, insurers, drug makers, and doctors make a profit, but not a skyrocketing one. Let a doctor have to give a patient a written description, along with side effects, and a valid reason if they want a patient to undergo surgery, tests, x rays, and other procedures. They need to be totally transparent with the patient and the patient should be able to decide for themselves if they want to under go it. If a patient comes in with a copy of an x-ray, mri, etc. the doctor should use that and not tell the patient they are going to do the same procedure.
Let hospitals have to account for every procedure that is performed as well as everyone who stops by a patient's room with a 'how do you do' and then, bills the patient hundreds of dollars... actually, make that medical fraud. No one should have to pay for someone who pokes their head in the door.
We need an affordable health care system instead of giving people stipends so they can afford sky rocketing costs.
2
This is pure populism. Virtually any other politician would be too beholden to the healthcare lobby to do something like this. This is where Trump’s billionaire status helps average Americans.
7
@James Tulp Mississippi.
It is good that prices, once shrouded in secrecy, will be disclosed. But please note: patients should not be forced to treat medical care like any other consumer product. Doctors are not easily interchangeable like cars, and even if they were, patients should not be forced to shop around for good prices when they are sick, hurting, and scared. On the other hand, disclosure of prices will alert lawmakers to outrageous price gouging which might inspire them to regulate prices, instead of allowing hospitals to hang the burden of high prices around vulnerable patients' necks, and then to se them if they don't pay.
3
@Sherry But I could see hospitals saying, 30% of all of our patients don't pay their bills. Then what?
1
No fan of Trump, as in I despise him. But I am willing to applaud the man if the policy is good. If the insurance companies are fighting this policy, then I am for it.
41
"a truly disruptive change that could lower health care prices and reorder the health care system by wresting power away from industry and putting it in the hands of patients."
This is hyperbolic hogwash. Most patients have no choice over which providers they use; HMOs and PPOs have already wrested that away from them. Further, health care is now so concentrated/near monopolistic in many localities that there are few alternatives. Further, the truly sick aren't going to be interested in spending hours in researching opaque and arcane databases to find the cheapest (and not necessarily the best) care. They've got better things to do with their lives.
6
I called providers to get a cash price for a PET scan a couple months ago. The prices varied greatly.
If I wanted to get the insurance negotiated rate for a covered test, i had to get the test scheduled and negotiated before the price could be told. And it was made clear that the REAL price wouldn’t be known until after the test was done.
How is that for transparency?
Clearly some people care about their care and cost of care.
This should not be shrouded in ‘can’t know’
The providers know the cost codes and the pricing is known.
Cough it up.
7
I’m in the emergency room with a ruptured appendix. A nurse brings me a menu and under A I locate appendectomy. Hmmmm, that seems a bit overpriced. Honey, call that other hospital and see what they charge for a ruptured appendix. With a simpleton in the White House, everything sounds good if you don’t know anything.
20
Of course in an emergency, you do what’s needed. But that’s a very small piece of the medical cost puzzle.
Opening cost books to allow patients to more easily shop for covered procedures/tests is a good thing.
4
You are missing the point. There are tests that have to be done that can be scheduled. It is exactly those tests where you could look at a price list and see in advance what the cost is. Same holds for scheduled surgeries. I have a high deductible health plan and I always ask because I rarely meet the maximum out of pocket amount and want to minimize my costs.
I occasionally have seizures and after a recent one my doctor ordered an extended EEG. I asked the front desk staff what the cost was and was given a range from $1000 to $2400. We need a new system.
The lobbyists will come out of the woodwork on this one. There is no way this will ever happen.
4
The one thing hospitals, doctors, and insurance companies don’t want is negotiation on prices. That’s why US medical costs are almost 2X that of most EU nations, where government is permitted that intermediary public interest role. Here, Trump wants patients to do the negotiation. While they are sick and dying, our people must now fight about money?
Sounds like the makings of a deeply chaotic and undisciplined administrative mess. It’s another sloppy Trump half baked specialty. In a real way, his proposal is an attack on the R defended status quo, packaged as a populist medical rights movement. Well, it’s an election year, so fasten your seatbelts.
4
ANYTHING that has to be done in “secret” smells like a rat to me. Why do they have to “negotiate” prices in secret? There’s something wrong with this system as it stands. It stinks to high heaven. I also smell the fear of these insurance companies being forced to finally show us exactly how much they rip us off.
Universal healthcare for ALL! Put these insurance companies out of business!
10
All other “First World” countries pay far less for their citizens healthcare than what Americans must pay.
The reason for that is that they all have universal care.
The U.S., at $7,960, has the highest total expenditure on health care per capita in the world.
The U.S. expenditure is $2,500 more than most civilized countries with national healthcare systems, including Norway ($5,352), Switzerland ($5,344), Netherlands ($4,914), Luxembourg ($4,808), Canada ($4,478), Denmark ($4,348), Austria ($4,298), Germany ($4,218) and France ($3,978).
In the U.S., healthcare expenditure as a per cent of GDP is 17.4%. This compares to expenditures per capita in the other nine listed countries of 11.8% and less.
The U.S. spends by far the highest amount on pharmaceuticals and other medical nondurables of the nations cited. These industries pay GOP politicians vast sums to keep their excessive profits coming.
In spite of this, the U.S. life expectancy, at 78.2 years, & lags behind all the other countries studied.
5
@Joe Miksis
Maybe there are some additional factors for less healthcare costs: in the US we live on highly processed food — regularly eat fast food which is very high in salt, sugar and fat —just like Trump; we do very little exercise — just like Trump: and are obese — just like Trump.
Citizens in many First world eat healthier diets, regularly exercise and are physically fit. Contrast Melania with Trump — whose healthcare costs are likely higher even accounting for the big age difference?
Finally, some sanity from Trump.
3
Let it rip! This might be the first thing I agree with Trump on so far. Any time more transparency is met with threats of impending doom and gloom I immediately feel like there's plenty that the secretive entity wants to hide. Show all prices ASAP regardless of discrepancies. If prices start to actually go up as a result the public outrage might finally be enough to make nationalized health care a priority.
Imagine a world where medicines weren't advertised! Where profit wouldn't drive the medical field! To all who say that research would stop or wait times for procedures would kill old people I say PHOOEY!
9
Who looks for the cheapest doctor when shopping for healthcare?
8
@Dan B When the government pays for your healthcare that is what you'll get.
2
@Jeff When Aetna pays for my healthcare, the cheapest doctor is all I can afford.
This goes against everything I’ve been taught since I was a kid:
Oh, no, grandma is on life support and it’s a sin to even think what this will cost. If I’m lucky she’ll survive and the bill will be through the roof and now I can finally prove to her how much I love her when I pay it without a peep.
What Trump is going might mean I have to start being nice to her sooner.
5
Price transparency would obviously be a good thing; honesty is always better than secrecy. If people realized the physical therapy sessions for which they paid $150 while uninsured were billed to their insurance later on at $900 (true story!), they’d be outraged — and maybe eventually, force systemic change.
However, price transparency is not a panacea for what ails our healthcare system. As many have pointed out, people don’t shop for healthcare the way they shop for widely available, identical products like milk, or a particular model of printer. Availability of appointments, geographical convenience, reputation of the particular center or specialist, and often just plain urgency of the situation — all make comparison shopping impractical.
Even for non-urgent, apples-to-apples expenditures like an MRI: Do you really want to invest hours to make a project of price shopping for every little medical thing? In other parts of the world, people just go get it done and move on with their day. We should be able to, too.
22
@Jaclyn. You give the example of MRI shopping as difficult. I was in Chicago and needed an MRI (that I had to pay out of pocket). Within 15 minutes I had 5 quotes. The recommended location (hospital) was $1475. I had three others under $500. Even if I was covered under my insurance, why would I want to waste this money that could ultimately go towards lower premiums?
6
@Jaclyn "Do you really want to invest hours to make a project of price shopping for every little medical thing?"
It's not just a simple price comparison either. You would also want to know, comparatively, how many complications there are, how many infections occur, how long your stay will be, how treatment results vary, how many re-admissions there are, and on and on.
After all that, do average consumers even have the knowledge and skill set to evaluate whatever little information might be available?
Get real about medical care costs--the most costly events involve situations where time is of the essence and cost comparisons are not taken into consideration. In addition, the way medicine is practiced now many primary care practices feed you into specialists related to to them --example: in my small town all the primary care doctors belong/own the Springfield Clinic. They then refer you to a specialist at Springfield Clinic. How often does anyone say "well, gee. I'm gonna search for a specialist who does the work I need at the cheapest hospital.
Every medical group, hospital and insurance company will fight this to the death with unlimited funds---
6
@James T ONeill As you describe, I have a primary care and specialist doctors belonging to the same loose network affiliated with a hospital chain. This has the added advantage of medical records that can be directly accessed by all four doctors; i.e., my primary care doctor can immediately see visits, diagnoses, prescriptions generated by specialists I see.
I think you underestimate the number of tests that are ordered.
Certainly some medical needs are acute. But for the non-acute needs, why make it pats or impossible to determine the cost ahead of having the test/procedure done?
1
The biggest abusers of secret pricing are the buying groups and pharmacy benefits managers (PBM's). That is one of the main reasons why drugs and medical devices cost far, far more in the United States than in other developed countries. Make THOSE prices transparent and you will do more to drive down health care costs than simply making hospital and physician rates public.
13
The government should be careful what is wishes for, because one thing that will rapidly become clear is how little government payers, particularly Medicaid, actually pay physicians and hospitals. That is the biggest driver of cost shifting to commercially insured and private pay patients.
7
I was a nurse for 30 years, the fact is when people are sick they don’t have the energy where with all or focus to price shop!
There is nothing wrong with having prices public it’s already known that prices vary widely.
I just don’t see how this will help, we need for our populace to have medical coverage universally. Prices often vary because hospitals, clinics, and medical groups take care of people who are not covered and they raise prices to offset their loss.
29
This is pointless nonsense, people cannot make informed purchasing decisions from the back of an ambulance.
26
@Fran Taylor You're right, people don't make purchasing decisions from the back of an ambulance. But not everything is an emergency. I called several local hospitals early in my pregnancy, asking what I thought was a basic question - what would it cost me to deliver there, assuming, of course, a smooth delivery (what is the base price?). Nobody could tell me. Nobody even seemed to know who would know the answer to such a question. That shouldn't be acceptable.
13
@SS And if you had the answers, would you have picked the cheapest one? C-section gets a free side dish?
But the spouse can
Costs are out of control, healthcare has become the new mortgage payment and this does nothing really to address problems that call for fundamental change to the system.
7
So what if a $400 test is $300 across town? You still need to come up with $300. No $400 test is going to be an affordable $10 anywhere else.
5
Who can trust either this president, the insurance companies, or the hospitals? Every one of those entities is out to fleece sick people.
6
Face it. The ACA, ("ObamaCare"), stinks.
The Republican plan is non-existent.
Here is MikeCare. It almost doesn't stink:
You know how the government pays to provide us with universal necessities like cops, education, libraries, road construction and repair, fire departments, snow removal, defense, garbage removal and the like? That's what we need in regard to medical care to make sure that everyone in the country, regardless of wealth or income, is covered. Just like with the other services medical services should be paid for using the taxes which we pay.
You go to whatever doctor you want, you pay a deductible to discourage frivolous medical visits, and the medical providers get paid according to a reasonable government schedule that is tailored to region. Medical providers who do not want to accept what the government is paying can do so by posting a notice in their offices to that effect. You either pay the difference or go elsewhere. In any event you get the best possible care which is what we all deserve. What is the argument in favor of letting people get sick and die just because they are financially distressed?
And that's the end of it. Welcome to the 21st Century!
If it makes the prez feel any better call it "TrumpCare".
Do it!
9
Sounds like Medicare for all
5
@MIKEinNYC
I’m pretty sure that’s what the ACA was was working before trump and his republicans started killing it. Instead of killing it with no replacement plan in place they should have worked on fixing/improving it but they wouldn’t do that because it had Obama’s name on it..So sad to see all the distraction of some really positive programs but they had to go because Obama created them
6
This doesn't matter. People need the healthcare. Competition is good, but it can't fall on the patient.
3
"Forcing the hospitals and insurers to disclose their agreements 'has a chilling effect on negotiation — it could create a race to the top,' [Tom Nickels, an executive vice president at the American Hospital Association] said.
Really? The American Hospital Association thinks that cost transparency leads to HIGHER prices? I've got as book for Mr. Nickels. It's written opaquely and thus almost impossible to read, but he'd probably be used to that. It's called "The Wealth of Nations."
4
@RR Yes, it's possible, and even probable. There are places in our economy where price is seen as an indicator of quality. This is particularly true when evaluating quality is either subjective or difficult, such as medical care.
One of the reasons CEO pay became sky-high starting in the 1990s is because full executive pay packages had to be disclosed. Boards of Directors charged with filling C-suite positions were not willing to risk hiring the cheapest available executive. So pay packages have soared.
@RR
People need to ask themselves: How many healthcare providers would be against the implementation of price transparency if they believe that transparency will INCREASE the prices that they could charge? None, of course.
1
Or we could just have some kind of universal healthcare plan, like other civilized countries.
30
You want 'pricing disclosure', America.
The Great American 17% of GDP Healthcare Rip-Off costs about 5% to 7% of GDP more than the cost of healthcare in civilized countries.
That's about $1 TRILLION more per year each year every year that goes to corporate insurers, hospital corporations, PhRMA, medical device suppliers, CEOs and other members of the medical racketeering community vs. what happens in civilized countries.
The solution is not better 'health care shopping' after your near-fatal car accident, heart attack, broken bone or other near-death experience.
The solution is single-payer healthcare or heavily regulated universal healthcare that regulates corporate blood profits out of a public utility and tells Greed Over People to go take a hike.
None of it will be possible until we first get single-payer campaign financing so Congress can stop being purchased.
This fake Trumpian half-solution will do nothing meaningful.
79
@Socrates
The claim that Medicare for all doesn't work because it'd be government run is a big fat lie.
Medicare for seniors works beautifully. Especially with an inexpensive supplemental insurance.
My aunt and uncle have Medicare and United Health care supplemental. They pay $134 each and $26 each for United. Coverage is excellent. Reasonable copays for quartetly pcp checkups and yearly specialist exams. Plus wellness care benefits.
If this can work for 50 million seniors then why not for ebetuone?
134+26= $160 a month. Not bad huh?
2
For the first time he is doing something I can support. As it is now one emergency room visit leads to bill, after bill, after bill for all kinds of procedures and services I have no idea what for or who performed them. It takes months for some of them to be added to the related bill. My new method for dealing with them is to simply throw them away for the first 6 months. Once the total becomes consistent for a few months I pay.
11
The dirty little secret of U.S. healthcare is that payers (insurers) lackadaisically negotiate with providers (docs/hospitals/pharma). With enough hard nosed negotiating the savvy patient can settle at ten cents on the dollar.
4
For insurance companies and healthcare providers, Up is down, black is white and transparency is evil.
6
Well, yes the public should have this information. But how will it help someone in the emergency room? Even if you tell them, "by the way the anesthesia assistant that is on call is not in your insurance provider's network so you will have to pay his full cost of $3000 even though you will only have to pay $300 for the surgeon because she is in the network." At that point can you actually say "No I don't want that anesthesia assistant?" I cannot see how this could eliminate those "surprise" bills.
6
I'm not a Trump supporter, but I do support more required transparency around pricing. I've been blindsided a couple of times in the past few years with unexpectedly exorbitant prices for basic lab work ($3,500 out of pocket to see if my teenage daughter had an obscure serious reason for erratic menstrual cycles) and for a second mammogram ($2,000) to take another look at something suspicious looking on a first one. I'm not saying these tests shouldn't have been prescribed or even priced differently, but I should have had easy access to that price information - and the ability to discuss the needs for those tests vs. costs - before I was surprised with a budget-busting bill. In both cases, I might add, the referring MDs were surprised by the prices as well. Something is not quite right with the surprise approach to health care prescribing and billing when so many people are covered by high deductible health plans and pay high OOP costs these days. I also find it funny that general citizens would oppose price transparency. Cost may not equal quality in healthcare, but that's no reason to keep cost a secret.
23
I am a health insurance professional, and I hate Donald Trump. But this is a very good tactic to reduce the total cost of care - both for the patient and for the country in general. The public already has access to anonymous price estimates from vendors that use large databases of cost information. What we really need is real-time, patient specific cost estimates prior to care delivery. The AHA will say that’s not possible. But look at market disruptiors like One Medical that are already doing so today. If the AHA drags their feet long enough, they will go the way of the dinosaurs.
34
@Erik Goodfriend One Medical is based on a concierge model, which has pros and cons, but to compare it to employer-based or government-based insurance is not a good analogy.
Concierge means people pay extra $$ on top of what insurance pays, co-pays, etc. I actually worked at a concierge practice part-time when I was younger. While I like the idea of providing individualized care at my and the patients' own pace and my colleagues were smart people, it is like a charter school in that it violated some of my personal principles about assuring the general public -- and not just a privileged few -- get quality care.
Price transparency may be fine when we're talking about elective, non-urgent procedures like cosmetic surgery but I don't think it helps with urgent/ chronic medical issues. In a prior life, I was part of a team putting together transparent quality data on nursing homes aimed at the public: what I learned is people have a very hard time making medical decisions. Not unexpected given the complexity of medicine.
Not to mention, choosing the cheapest option in medicine is not like choosing the cheapest coat or computer option: you can die or get maimed because of your wrong choice.
This is yet another one of Trump’s decisions that makes me wonder why this hasn’t been done before. Absolutely yes- and thank you!
5
Prices of insurers are hardly secret. People get hundreds of thousands of documents a day that your doctor billed $300, was paid $100, or your hospital billed $10,000, was paid $3000. It’s diffuse, but all the info is there - that’s different than literally bring secret. It’s not secret. If you want to know what Blue Cross of NJ pays St Mary’s for an MRI there are probably 50 or 100 copies of that mailed out yesterday.
I would like more critique of what this order will “say.” The President can’t just declare this - unless it’s some emergency war power. He can, however, ask health agencies to start making regulations in this direction over the next year. That’s different than ordering all the hospitals and docs to do something Monday, or ordering all the plumbers or all the architects in the US to do some act suddenly on Monday.
6
Here’s the truth of this horror: “Consumers typically know the price of something before they make a purchase.” Why typically? Always. Nobody pays for anything in America—home, gas, milk, car—without knowing the price BUT healthcare. It is illegal under consumer protection laws and antitrust laws to charge AFTER a service is given. No business man, home or auto buyer can walk into a bank and apply for a loan to buy a car, home, or start a business and say, “I don’t know how much I need, so can you write me a blank check.”
8
@Not Pierre
Student loans aren't like that. You don't know how much you're signing up for when you sign your loan documents.
2
@Not Pierre Yeah, that way, if you think its too expensive, you can decide not to give your kid that surgery that he needs.
3
@Dan B
Your kid's surgery may not be optional, but many healthcare needs are. I am on Medicare, but I was without health insurance for several years. You can bet that I shopped for the best prices for lab tests and other "normal" medical services, including negotiating with my dermatologist on the cost of treatment in advance. These simple steps saved thousands of dollars then and still do.
Just because I now have Medicare is not a reason to quit trying to manage costs. Some medical care is not covered by Medicare and, of course, dental care isn't covered. I still shop around or, in the case of my wonderful dentist, negotiate fees for service in advance.
Couple of things concern me here.
1 - 45 is governing through executive order and he vilified the prior administration for doing the same.
2 - When cash strapped, cost is often looked at however this is not a consumable good, it is healthcare. In this scenario, cost is a poor indicator as to quality of care, hospital mortality rates, etc.. Consumers are poorly educated on health care costs and may choose the cheaper option thinking they will receive the same level of service.
I believe there should be more transparency in hospital/healthcare costs but cost is only part of the equation.
3
I live in Italy and am covered by the national health care system. It's not fancy but all of my fellow Italians and I can go to the doctor when we need to. Something Americans will never learn is that there are better systems than theirs. Sure, you can have a luxury room with a TV and constant attention by the staff, but health care should be about the treatment, not the "marketing." Even if you knew the price for treatments and procedures, do you really believe you would have a choice about your coverage? The U.S. health care system is a scam, plain and simple.
Recently, one of my American colleagues was admitted to the hospital here in my town and required surgery. All he did was worry about paying for the hospital, the surgery, etc. He ended up paying a couple of hundred euro for a surgery that would have cost thousands in the U.S. for his out-of-pocket coverage.
When will you all ever learn that the hospitals, insurance companies physicans and big pharma only care about making money. Your health is nothing but a profit center for them.
114
@mrfreeze6
We will never learn mrfreeze6, never.
Basic information is over most peoples' heads because that is the way they want it. Don't bother them with 'a plan' or such nonsense as details or even a rough outline of how mismanaged our medical insurance is.
That is on purpose as well as I found out recently with an outpatient knee surgery.
Health care itself should not be for profit, and it is that care that was deliberately turned into an 'industry' and made a 'product' Well, the customer, oh I mean the patient,seems to be at least offered a complaint department.
Or an opportunity to see a realistic bill, instead of these works of fiction masquerading as such.
8
@mrfreeze6 Dude we know believe me. The problems run very deep in this country. When nationwide polls are conducted about people's beliefs they tend to lean heavily towards social programs and overall fairness. However the form of democracy the USA employs doesn't allow for each person to have a fair vote. Each vote is translated through the shadowy Electoral College where representatives who are constantly lobbied and donated to are supposed to cast votes in their favor. Just look at Bernie Sanders treatment by the DNC in 2016
10
Shopping for health care is not like shopping for a gallon of milk!
1. You may need a special type of milk that isn't sold in a store close to you.
2. Depending on the quality of the milk (which is not obvious just by looking at it), you could get charged a lot more.
3. The store may only have one kind of milk, and it will charge what it wants for it, if the store knows they're the only store in town.
4. If there is another store close by, and they find out that they're losing money by charging less for their milk than the store across the street does, they'll increase the milk's price to match their competitor's (think gas stations' price maneuverings).
Long story short, I'm all about transparency. It won't help with emergency room costs, since you're not likely to spend precious time scanning various ERs' prices when your loved one is having a heart attack. But it may help with certain elective procedures and specialist care. But I can still imagine a situation where regional prices can be quite high, simply because there are so many regions with only one or two specialists in any given field, and they will not want to lowball themselves, particularly if they're in a field that does not have a lot of patients to fight for.
6
@Liz
To add to your analogy:
5. You may be told a price for milk without realizing that such price does not include separate charges you will be billed for the milk carton, the glue holding the carton together, and then may get a separate bill (or bills) from an entirely separate entity that delivered the milk to the store.
28
A little more transparency is great, but this proposal ignores the fact that people do not always "shop" for healthcare as they do other goods and services. If I go to an ER with severe chest pains, I'm not likely to walk out and find a competitor offering a better price. One of the biggest problems of our for-profit system.
29
Maybe part of the reason why people don't shop around now is because of a lack of price transparency.
3
@Jeff Baskin
This describes how price transparency can prevent you from being massively overcharged even in the case of emergencies:
With health care price transparency, if you have an emergency, and hospital X charges much more than other prices that could be found nearby, you're very mad after you see the other prices. So, you post on Facebook or elsewhere the comparisons of what the same services would have cost at hospitals Y and Z. This leads to people quickly learning that hospital X is an excessively expensive place to get medical care, and they start going to hospital Y or Z whenever possible, so hospital X suffers from lack of business. However, the people who run medical providers are smart enough to recognize upfront that such bad publicity would be very bad for them, and they therefore have to avoid charging such out-of-line prices at any point.
4
As a sole practitioner in private practice, I am not allowed to negotiate prices with any insurance companies. The insurance networks decide on the fees all by themselves. I am TOLD what THEIR fees are. It's called "the fee schedule" and I openly give my patients a copy of the fee schedule that I am given by the insurance company.
If a patient has no insurance, then I am happy to negotiate with them directly, but if they want to use insurance, we are both stuck with whatever that insurance company says is the price and the coverage.
If groups of providers able to do negotiating have secret deals then yes, let's hear about it. Just know that for some providers, there's no secret deals. It's already all out in the open for my practice....
50
@sfdphd
Ah yes, the 'fee schedule'. As I found out in some incidents with insurance representatives on the phone, they pull some of these numbers out of thin air on a whim, if you persist, and you must with documentation, they will eventually back down or come to reality.
How the elderly can cope with this on their own is daunting to me. This cannot continue.
8
The price outcome of such a policy is debatable, so a MUCH better policy prescription would be to require hospitals to accept Medicare prices as payment in full, regardless of which insurance company (or patient) is paying.
Medicare Prices For All is a string first step to getting health costs under control -- and to eliminate the exploitation of monopolies by hospitals and hospital systems when they're the only game in town, which is increasingly the case in many markets.
Medicare Prices for All.
It's simple and transparent.
10
Medicare prices barely doesn’t cover the cost of overhead and a reasonable physician salary.
1
@Alex who is to say that if all the health care dollars wasted on private insurer's overhead (around 30%) were eliminated, that medicare reimbursement could not be better? Also remember that medicare runs at a 3% overhead and it's administrators make public servant salaries not multimillion bonuses every year. As a former US based family physician who now works in a medicare for all system in Australia, I know it can work.
3
Of course the hospitals and the insurance companies are against this order. Making the cost of healthcare transparent will NOT reduce cost or increase competition. I consider this as a baby step towards public's understanding of cost of healthcare overall. We should not walk into an ER and pay $25 copay and think that is all that costs us. The unintended benefit of shouldering greater deductible is that patients are becoming more aware of the cost. The public should know why Stanford Hospital or Memorial Sloan Kettering gets paid better for doing the same thing as another community hospital that is less well known but offer same great care.
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@Sadie Do you really think your average community hospital has the same level of expertise, measured outcomes, and care plans for advanced cancer as Memorial Sloan Kettering? Conversely, would you go to Sloan Kettering for a broken leg?
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Even a broken clock is right twice a day!
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big deal- NOT! most people couldn't afford a $10,000 medical cost out of pocket whether they knew the price or not, so who cares?
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@JA, But if they wanted to live, they'd probably find a way to find the money. So it would come down to, e.g., being $10,000 in debt versus being $5,000 in debt. I CARE A LOT.
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@RR,
Not how it works now. Either a person has insurance or Medicare or Medicaid that pick up the cost or the hospital has to treat the poor who are never going to pay the bill (who’s going to lend them money?), which gets passed on to everyone else. Just a vicious circle, unless we can achieve “healthcare for all”, I don’t care how we get there.
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@RR: Not necessarily. Trying to raise $5000 is not like scrounging for spare change among the sofa cushions. It may be impossible for some people to gather that much money, regardless of how hard they try, and if they're really sick, trying to raise $5000 for treatment may be beyond what they're physically capable of. The assumption that everyone should be able to find $5000 is absurd, especially when so many households in this country couldn't raise $400 for an emergency.
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Part of the beauty of markets with transparent pricing is that consumers can be more confident of reasonable pricing without as much of a need to shop around. The benefit that you would get from price transparency, even if you're a non-shopper, is that whatever provider you're using would have been previously embarrassed/driven into reducing any exceptionally-high prices for care. Providers which might like to charge dramatically-high prices would recognize that the transparency into any such high prices would be great fodder for news reports (and social media posts, etc) revealing just how out-of-line are their prices. So, such providers would also recognize that their business would be seriously damaged by the widespread exposure of their highly out-of-line pricing due to the corresponding reluctance of potential patients to use that provider. Perform a web search for "We, not me: how healthy markets really work", to read an article from the organization "BrokenHealthcare", which further clarifies how price transparency would reduce medical costs.
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This is great news. I work with Seniors and Medicare. A BIG problem is that many seniors today are on Medicare Advantage plans, which often have great benefits as long as you stay in network. Most know that their primary care physician is in-network, but are unaware that he/she is sending them to out-of-network facilities for lab work, etc. If you get services out out-of-network, the charge is often a percentage, which can run in the thousands of dollars. Many seniors have no idea that they are getting out of network services (lab work, specialists, etc.), much less how much it will cost. They simply remember that their Medicare Advantage plan said a particular procedure would be $40 in-network. It's only AFTER they get the bill that they discover that they owe $1500. If they were made aware BEFORE the service, most would immediately demand an in-network provider. It's a no-brainer.
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@Michael
This is precisely why I stay on original Medicare with a supplement rather than switching to a Medicare Advantage plan. With my plans, I know what will be covered and what it will cost. Even though the upfront costs of Medicare Advantage plans appear less expensive, the end result is not. A better idea would be for more seniors to stick with original Medicare and a supplemental plan than to be gouged by the private industry Medicare Advantage plans.
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@Sue Great point, and it gives a much broader network of providers, more choice is a wonderful thing.
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@Michael ~
I graduated from MIT in technology based management based, and stayed abreast of the internet and financial markets for decades.
And it took me a year to figure out that there were very few "advantages" in a Medicare Advantage program, at least for the consumer.
So many GOP'ers scream that "Medicare for all" would cost trillions, but for me, with the social security deductions and the supplement plan and the Part D for scripts, it isn't free.
But indeed a clean and simple package.
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at first i though this would be a good idea stating prices for Meds. on TV ads. i then realized if one company is charging 80$ and another only 60$ there is no way the 80$ charge will come down. the 60$ would go up. charge what the market will bare.
or, price gouge. Competition between corporations is an illusion. they price fix amongst themselves all the time.
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@scootter1956
We will not be oversold: if you can find a higher price somewhere, bring it in and we'll top it!
I got that from a satirical Pentagon procurement handbook (remember the $2,495 toliet seat?) I bought in the 80s.
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It is not exactly true. There is reason why one company charge 60$ while other charge 80$, right? Maybe, they want more business, so for them it will be good to keep prices at 60$.
The results of this Trump order, so far, have been just computer dumps of long listings of obscure, unintelligible cost entries, and nominal prices. It's a first step in a journey of a thousand miles before this becomes useful to customers. Maybe, after a hundred more regulations, this will be of value some day; at present, it's useless noise. If a Trumpolyte wants to dispute this point, the best counterargument would be to link to a useful hospital price list.
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Where can I find the raw data dumps?
@GKR You have to start somewhere. Many groups are working to create usable comparisons --- and none of those would be possible without this first step. I hate Trump -- and so can you -- but still applaud this move.
@GKR The "computer dumps of long listings of obscure, unintelligible cost entries" are actually the price lists ("charge masters") kept by hospitals. They may be difficult to interpret but I'm not sure how that's Trump's fault (and I despise Trump) - its because the pricing and charging system is super complicated and so is medical care in general (one of the drivers of the complexity is simply that there are hundreds of thousands of possible products and procedures that a typical hospital might perform). You need to understand them in context, however - they're the "list prices" which exist almost entirely as a starting point to apply "discounts" which yield "allowed amounts" for the various payers that negotiate with the hospitals.
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So what? You go to a doc and he/she orders a test at their hospital. How many are going to check prices? How many care if their insurance pays? Then the few that are uninsured and have to pay gouged prices (overcharged so they can get Insurers to pay more) are expected to shop around? Remember all of this is for profit not health care. Until we get a single payer system thees gimmicks will not help. The health care industry must have its primary mission health care not profits. Most insurers and hospitals and health care providers made many billions last year. This is their purpose.
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Trump knows little about health care and what he does know is dangerous for us all. Always looking for an easy solution to complex matters(he noted health care's complexity) he listens to Fox and the UN-vetted members of his administration. Trump is the worst president this country has ever had and yet he gets more media coverage than any other president has. So his random, chaotic, narcissistic thoughts are ever present. Most new and very expensive drugs have no alternatives so knowing the price doesn't really help much. Where there is competition, knowing the prices may help or backfire by causing a leveling of high prices.
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@Paul Raffeld Trump is horrible, but transparency is way overdue. There is no possible way that consumers knowing the price before, rather than after, is a net negative. Hating Trump doesn't mean you have to oppose this good idea.
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Although knowing prices may not help, it is definitely will not hurt.
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Alex Azar is the last person that should be head of HHS.His years working as a lobbyist for drug companies should have made him an "untouchable" for this important position.There are so many ex lobbyists working in trump's administration that they have created their own swamp.There is no way to get a fair shake from anyone that worked as a lobbyist.
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