All Things in Moderation

A WIDGET FOR YOU!

14 Responses

1. 

   Geanie, on May 20, 2013 at 8:03 am said:

   Thanks Mark, fantastic link!

   All I can say is DOWN with the Chargemaster pricing. And THANK GOODNESS for Medicare.

   And NO ONE losses money by accepting Medicare as Medicare, by Federal law, reimburses hospitals for any given service, factoring in not only the direct costs but also allocated expenses such as overhead, capital expenses, executive salaries (which quite often are MUCH more than even executives of corporations such as Exxon, etc), insurance, differences in regional costs of living and even the education of medical students.

   So when a hospital wants to charge a patient (taken from your link) $41,869.55 and Medicare pays $15,372.49, the $26,497.06 difference can only be described as GREED.

   And since MOST hospitals are under the “charitable” umbrella, there is simply NO NEED for such egregious charges. Any hospital that is associated with a religion, such as our St. Francis and St. Johns hospitals, or any associated with a University, such as our OSU Regional hospital, ARE designated NON-profit hospitals. Yet they ALL, report hundreds of millions in profits every year while millions of families suffer with extreme financial struggles solely to healthcare costs.

   Sheesh, healthcare should NOT be an open market commodity, IMHO.

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     ScottC, on May 20, 2013 at 8:10 am said:

     Geanie:

     Sheesh, healthcare should NOT be an open market commodity, IMHO.

     If you eliminate the market for health care services, how is the price for a given service going to be determined?

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       markinaustin, on May 20, 2013 at 8:19 am said:

       Scott –

       The widget’s information reflects that there is not a competitive market for health care services, even within a community like Austin, and that either the buyer or the seller is pegging prices as a monopolist or a monopsonyst, at each individual institution.

       I am guessing monopoly, not monopsony.

       I don’t know why the competitive market fails here, but it does. Considering the market failure, widespread, and over a long time, this is an industry that cries out for regulated pricing akin to utlity regulation.

       Preferably the regulation would be local and not national.

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         ScottC, on May 20, 2013 at 8:34 am said:

         Mark:

         and that either the buyer or the seller is pegging prices as a monopolist or a monopsonyst, at each individual institution.

         Well we know that Medicaid as a buyer does exactly that, do we not?

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         ScottC, on May 20, 2013 at 8:40 am said:

         Mark:

         The widget’s information reflects that there is not a competitive market for health care services,

         Why do you say that?

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         markinaustin, on May 20, 2013 at 9:45 am said:

         Scott –

         The pricing of similar services in a competitive market would be similar.

         As to monoposony purchasing power, yes, Medicaid, medicare, and the larger insurers all attempt it.

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         ScottC, on May 20, 2013 at 11:32 am said:

         Mark:

         The pricing of similar services in a competitive market would be similar.

         We don’t know from that widget that the services are indeed similar in such a way that they ought to produce a similar price in a competitive market. It compares procedures that are similar in name, but not necessarily in all relevant ways. If one compared the prices of, say, “cars” in a given area, and found prices ranging from $15k to $250k, I don’t think it would be reasonable to conclude that there existed no competitive market for cars.

         Besides which, it seems to me that the relevant price of a given product/service in a market is the amount which is actually paid for it, not what is hypothetically “billed”. And in the few procedures that I checked on, the amount paid by Medicare was actually pretty similar in all instances, regardless of what was billed.

         Finally, and perhaps most importantly, I don’t think one can draw conclusions about how a market operates by looking simply at the behavior of just one participant, especially when that participant is the government.

         I had a long discussion some time ago with my cousin (an anesthesiologist) and his wife (an OB-GYN) about pricing methodologies in the health care business. Among the many notable things I learned is that Medicare reimbursements are entirely unrelated to the amount that is billed. Doesn’t matter whether you bill $1,000, or $100,000 for a procedure, if Medicare has decided it is only paying $400 for that procedure, that is all you are getting. Also interesting, a given procedure must by law be billed at the same rate despite the fact that actual reimbursement is negotiated to varying levels depending on who is doing the reimbursing (individual pay, insurance company A, insurance company B, Medicare). This alone is going to make concluding anything from “pricing” data difficult if not impossible. Also of note, insurance companies negotiate different rates for the same procedure from different service providers. Small providers have much less negotiating power, and therefore end up with worse reimbursement rates than do big providers. Lastly, in negotiating with insurance companies and setting their pricing, they are not allowed to know what other providers are billing or getting reimbursed, because that would be “price-fixing”. (so much for expecting a competitive market to produce similar pricing!)

         I am thinking about asking my cousin to write something up that I can post here at ATiM, and maybe have him come around so that he can address questions you all might have and give you the perspective of a real health care provider on how things actually work, and the role that the government plays in driving it that way.

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         ScottC, on May 20, 2013 at 11:41 am said:

         BTW, Mark, I still would like to know why you claimed that my view of Roe was based on the notion that women have no rights.

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         markinaustin, on May 20, 2013 at 12:24 pm said:

         Scott, I claimed that you discounted women’s rights because in your various discussions you only talked about fetal or infant rights. Not once – not once – did you discuss the woman as having a competing right. You may not think the 14th A applies. You may not think the 9th A. applies. You may not believe that privacy rights exist outside the 3rd, 4th and 5th Amendments, you may not think that federal law is supreme, you may not think Rehnquist was right in discussing privacy in terms of liberty, and all that would show is that you think there is no right in pregnant women at a constitutional level to privacy, due process, or liberty in tension with the fetus she carries. You consider only that state law should trump all else and states can give fetuses protection. You think those thoughts. You do not seriously consider womens’ rights to exist in the equation. Whether or not that stems from your notions of federalism and states’ rights, you have made clear your dismissal of womens’ rights in this discussion.

         As to another question you asked, it would have been possible to duck the case at any stage of the debate, but they did not. So when TX argued for personhood at conception and the Weddingtons argued for it at birth the issue was joined. The viability formula was the result. Pure Solomonic cutting the baby into temporal halves.

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         ScottC, on May 20, 2013 at 1:23 pm said:

         Mark:

         I claimed that you discounted women’s rights because in your various discussions you only talked about fetal or infant rights.

         Actually it was you who raised the issue of fetal/infant rights, by claiming that “The strongest constitutional ground [for Roe] is that basic legal rights are granted to persons, and that persons are born, not merely conceived.” I was simply responding to that claim by pointing out that it didn’t really support Roe at all. As I pointed out at the time, even if we agree that constitutional rights are not granted to unborn humans, that tells us nothing about whether or not the state has the legitimate authority to outlaw abortions, which is what Roe was ruling upon.

         In fact, I didn’t even make the case that the states do have the constitutional authority to outlaw abortions, much less did I do so by assuming women have no rights. But even if I had made that case, it still would not justify the overwrought claim that my view derives from the belief that women have no rights, for all that it takes to conclude that states do retain the authority to outlaw abortion is to discount the single right upon which Roe was founded, and that is the right to privacy, a right which is hardly without controversy. To say that the constitution does not grant citizens a certain claimed right does not imply that one believes they possess no rights at all.

         And if you want to broaden your impression as being derived not from just the specific comment which prompted it, but from the “various discussions” that I’ve had on the topic, it makes even less sense given that just one day before your comment I explicitly proclaimed that “Basically I think a baby that can survive outside the womb has a right to do so, and I think a woman who wants to be detached from the baby inside of her (whether for health or other reasons) also has a right to be. And I think these two rights are reconcilable.”

         Your claim was, simply put, outrageous.

         So when TX argued for personhood at conception and the Weddingtons argued for it at birth the issue was joined. The viability formula was the result.

         Yes, but you seem to assert that it was unavoidable. I don’t see why. Regardless of what the participants were arguing, why couldn’t the Court have simply ruled that the point at which a state has an interest in protecting the life of the unborn is, constitutionally speaking, up to the state itself?

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2. 

   Troll McWingnut or George, whichever, on May 20, 2013 at 8:41 am said:

   Geanie, is it immoral to believe that healthcare is not a right?

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3. 

   novahockey, on May 20, 2013 at 10:20 am said:

   opens a PDF: http://www.aha.org/content/12/2012medunderpayment.pdf

   Medicare sets prices and dares providers, who need access to their beneficiaries, to opt out. There is no negotiation. You either accept the deal or try to survive with about 60 % of your patient population gone. Docs can do that. Hospitals cannot.

   Medicare will point to individual payments and say its fine. providers point to the aggregate and say its not. It’s kind of like a casino. the hospitals might win a few hands. but medicare will win in the end, as it has the house edge and sets the rules to play.

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4. 

   Fairlington Blade, on May 20, 2013 at 11:22 am said:

   NoVa –

   Hospitals do something similar. That is to say, form networks and then provide insurers with take it or leave it pricing. As an example, this piece from Forbes about the effect of two hospitals in Boston combining forces (and charges).

   ßß

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5. 

   jnc4p, on May 20, 2013 at 12:49 pm said:

   May I suggest that Roe discussions get their own thread?

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