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Comment by killjoywashere | Hacker News Reader

This may work for chronic conditions and non-lethal problems, but creates a problem when you're talking about urgent care: stroke has a 2-3 hour window for administration of TPA. The goal for intervention in a myocardial infarction is under an hour, same for trauma, where people may be in the ICU for days to months (a lot of months). Who covers those costs?

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Ideally, a single payer system.

I am not advocating for this cash only option to be the entire system. I am merely saying that Obamacare is broken and I am glad to see alternatives emerging, given that Trump has so far failed to provide a real solution at the federal level.

Every insurance company in the United States, along with Medicare and Medicaid, already has a fixed amount that they will pay the caregiver for administration of TPA. I guarantee it, even without bothering to look up what TPA is. If the procedure is covered by insurance at all, there's a pre-approved reimbursement amount for doing it.

Outside of an expensive, time-consuming, and almost always useless appeals process, that flat rate is all the doctors are going to get. They can take it or leave it.

There are medical codes for every imaginable procedure, and essentially every medical code has a fixed, preset amount that the insurance company will pay to have it performed.

I get that. Do you know the history of the CMS billing schedules? They called Dr. DeBakey and he sent a couple of his fellows to Washinton and they priced out every single thing. That has been revised, amended, and addended many times since, but yes, I'm well aware.

The point is that there's no shopping around in the emergent cases. You can't say "Well, in my incapacitated, mid-stroke state, let me check the menu of the 3 nearest hospitals for the cost of a stroke admission." It ranges from "nothing to do here, looks like it was a TIA, patient demands to go home" to "We need to take your wife to the OR for an emergent craniotomy and clot removal to decompress the foramen of Monroe. Right now. Because minutes are brain cells."

Your point is irrelevant to whether or not pricing transparency has value for customers. It's like saying that it doesn't matter at all if mechanics provide pricing transparency because you could break down in the middle of nowhere in the desert somewhere, and then what good does that do you?

"The point is that there's no shopping around in the emergent cases."

Why would "shopping around" matter if the amount the doctor was going to get paid was fixed (and published) in advance?

I don't understand why you think that pre-published fees would make this (alleged) problem worse rather than better.

In the (unlikely, IMO) scenario where one hospital really was massively more expensive than another, patients will almost certainly know that in advance, just as they know that they're going to pay more at Wolfgang Puck's restaurant than McDonalds.

The rates generally are published, via CMS. This whole thing is barking up the wrong tree. The rates are one thing. Coding is the real art. Making sure you captured every RVU, CPT code (do you have any idea how many arterial lines might be started on a patient dying of diffuse intravascular coagulopathy?) How do you capture all that?

> This may work for chronic conditions

According to the CDC, 75% of healthcare spending in the US is spent on chronic conditions or issues comorbid with chronic conditions.

So system changes that only help with chronic conditions could still be very worthwhile.

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