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Comment by jseliger | Hacker News Reader

It has long puzzled me that we don't have strong political constituencies for price transparency in medicine. Every medical provider ought to have a website that lists every fee and cost; this is not hard to do, yet when I call providers for cash prices, the answer is often, "I don't know" or "I can't tell you."

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It's downright barbaric. You have a service for which you basically can't get a quote, can be collected into oblivion if you don't pay, you don't even know WHO will bill you (or even how many bills you'll get!), and you very well might be unconscious or in no position to make this kind of decision. Your life might be on the line!

It only gets some level of sanity (though not to reasonable level) if you involve insurance companies, who have some of the information necessary and the leverage to negotiate.

Also don't forget that the thought of even asking for a refund on prescription medication will get you laughed at.

Right, so I'm supposed to pay $700 for some medication that has a chance of either making my heart stop or cure my condition and if it doesn't cure it, too bad.

Agreed, it's so opaque. I feel like I've called a specialist asking what they think my copay will be given my insurance plan and they said they don't know, talk with my insurance firm. I call my insurance firm and they say they don't know, I have to submit the claim first.

Any marketplace where the buyer isn't informed of the price until after the transaction is ripe for disruption.

Frankly, I don't see how it should be possible to buy something you're not entitled to know the price of; or rather, I don't think it should be possible to bill more for something than the quote.

It is complicated ( don't want to excuse it), but I am not sure I would expect the doctor to know your insurance arrangement (or even how much you would expect to pay because you would need to know how much of your deductible you have already gone through.)

And how would the Insurance company know until they are billed for the procedure?

This is what's so strange about the system. There is no "price sheet" because it's all funny money until the consumer gets billed. Perhaps the doctor would not know, but the hospital should have a price sheet for every routine service rendered.

Those edge cases that are not routine procedures should have estimates provided in advance.

For those edge cases that are so time sensitive that an estimate cannot be provided to the consumer in advance... well, that's what insurance is for.

I think it was a huge mistake that this didn't get tackled during the Obamacare discussions. Price transparency and the removal of preexisting conditions would be a big step for some sanity in the US medical system. It's also pretty sad that the Republicans who are supposedly for markets don't push for price transparency.

Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked (assisted by now-deceased McCain) any non-taxation-related changes to Obamacare.

Reference: https://www.politifact.com/truth-o-meter/promises/trumpomete...

Your claims are simply erroneous and your link doesn't support them. From your own link:

> The House GOP bill that has emerged as the leading option to repeal and replace the Affordable Care Act includes no added price transparency provision.

So the bill that McCain helped defeat didn't contain improved transparency according to your own source. And the GOP hasn't introduced significant legislation since to address the problem, therefore Democrats supporting (or not supporting) it is all hypotheticals based on no actual legislation.

The link I provided documents the 2016 Republican platform of full price transparency in healthcare.

You quibble about how they failed to repeal ACA and follow up with new regulation. Factually, Trump and the Rs failed with their 3-step plan, right after step 1 -- hence we remain stuck with the lack of price transparency under the Democrats' Obamacare.

So, blaming Republicans is not factual.

> Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked (assisted by now-deceased McCain) any non-taxation-related changes to Obamacare

This is a bizarre summary of the failed repeal of the ACA with a bill that wouldn't have even included the proposal they supposedly wanted.

Reference: the article you linked to

It's a fact that Trump and Republicans ran on a platform of free-market healthcare and full price transparency, unlike their opponents.

The article I linked points out that this price transparency could not be achieved in the very first legislative step -- by the nature of that first bill, related exclusively to tax and revenue since it originated in the House.

Politics is an art of compromises, to achieve what is doable with sufficient majorities, as well as taking into account popular support in view of the next round of elections.

In this case, the only change that could pass was to remove the tax-shaped penalty so that people are allowed to ignore Obamacare plans. Next would have been a basic repeal of Obamacare (blocked by Senate Democrats and McCain). Finally would have been new and very different regulation, including price transparency (which could not even be attempted since step two was blocked, the consensus was that new regulations should only be passed after repealing Obamacare, and Republicans failed to build a majority around that approach).

But they didn't do that when they got power.

You're right, the Democrats did not require full price transparency when they had overwhelming majorities in the House and Senate, plus the Presidency. Also, the Democrats later managed to block the repeal of Obamacare, which would have been a prelude to passing new regulations including full price transparency in healthcare, thus defeating the plans of the Republicans.

You are completely wrong, the democrats didn't have an overwhelming majority in the senate. They had the minimum they needed to pass obamacare, 66. Remember that they wanted to have a single payer option and the damn democratic senator from nebraska didn't want that, and he thought if "he single-handedly stopped single payer" he'd be re-elected. So that one senator stopped single payer from being in the bill - he did vote for it after that. And that guy wasn't re-elected. Sen. Ben Nelson of Nebraska. Anywhoo, you are completely and utterly incorrect about the dems have an overwhelming majority to do whatever they wanted. In the senate they had the bare minimum, and anyone who felt they wanted a change could get it.

http://www.nbcnews.com/id/34446325/ns/politics-health_care_r...

Down-voting won't erase the fact that this was the Republican platform in 2016: "Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals." [1]

[1] Scroll down to point #5 in https://web.archive.org/web/20161110004206/https://www.donal...

The Republicans control all three branches (inc. both houses of congress) of the federal government. If they wanted to bring forward legislation that addressed this issue they've had at least two years to do so (arguably more since Obama would have happily signed a pro-price transparently bill, it is an issue he spoke on).

Where is the link to the GOP's actions rather than their empty promises?

Bah, I'm not interested in your goalposts.

I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".

We all know that Democrats are the party entirely responsible for Obamacare and its lack of price transparency.

[Added for emphasis] Democrats created Obamacare without the full price transparency several people here seem to care about. Yet, you all choose to denounce Republicans -- who demonstrated in their attempt that they don't have a sufficient majority to repeal Obamacare, let alone introduce better healthcare regulation once it has been repealed.

They're your own goalposts:

> Actually Trump and the Republicans ran on a platform of price transparency, but Senate Democrats can block and have effectively blocked

The Democrats cannot block a piece of legislation that doesn't exist. You yourself set up the criteria and you've failed to meet it.

> I replied to someone who falsely claimed that "Republicans who are supposedly for markets don't push for price transparency".

Quite correctly. You cannot link to the Republican legislation that supposedly tackles this issue while they continue to control all three branches (inc. both houses of congress) because there is no legislation. They're tried nothing and accomplished even less.

  Obama would have happily signed a pro-price transparently bill

Really? Then why didn't his Democrat colleagues in full, filibuster-proof control of the House and Senate send him one?

Obama never had a congress that was filibuster-proof. The 110th, 111th, 112th, or 113th congress weren't. The 110th was the most favorable but wasn't filibuster proof, least of all under the filibuster rules of the time.

Plus the poster I was responding to specifically made claims about the Republican's policies and what they claimed the Republicans had tried. If the Republicans don't bring up legislation the Democrats cannot be blamed for not voting for it (or Obama for not signing it).

The 110th Congress was during the presidency of George W. Bush.

During the 111th Congress, from the appointment of Al Franken until the death of Ted Kennedy, as well as during the term of his appointed successor Paul G. Kirk, the Democratic party held 58 seats in the Senate and caucused together with 2 more senators.

https://en.wikipedia.org/wiki/111th_United_States_Congress "gave the Senate Democratic caucus sixty votes, enough to defeat a filibuster in a party-line vote."

https://www.nytimes.com/2009/07/01/us/politics/01minnesota.h... "providing Democrats with something they had long hoped for: 60 votes, and thus at least the symbolic ability to overcome filibusters."

> the removal of preexisting conditions

That happened under ACA, didn’t it?

It did.

The Republicans would argue that forcing price transparency is regulation and government intervention, just like net neutrality.

Strange, in 2016 the Republicans ran on a platform of full price transparency in healthcare.

I don't recall this at all. The only thing I remember is that they wanted to repeal (and less so, replace) Obamacare. I don't remember anything about price transparency.

It was a major element.

See point 5: "Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure."

https://web.archive.org/web/20161110004206/https://www.donal...

Why aren't they doing this now?

Because they didn't and don't have a sufficient majority in the Senate to repeal and replace Obamacare. And my understanding is that they would no longer have sufficient popular support to do it, either.

Huh. And they can't pass point 5 without repealing the ACA?

This is so incredibly stupid. You and a bunch of down-voters are so ideologically fixated that you can't handle a simple, factual description or chronicle without launching into sophistry.

I'm not a politician. I don't work for nor run any part of the legislative branch. I'm not a Republican, I've never even voted for them. I have zero interest in speculating about what one or another party might do in the future. But I do care about facts. Now do your worst with this.

OK, two points:

1. That point 5 seems to me to be something that in a rational universe, could get enough votes from both sides of the aisle to pass. Of course we live in a universe where neither party wants to give the other party anything they could call "a win". An the Republicans will explicitly not allow anything to come to a vote unless it has the support of the majority of republicans. They could write a bill and bring it to a vote if they wanted to.

2. It appears the real hold up is that they don't want to do anything that would make health care better unless they can first repeal the ACA. You can think about that however you like, I certainly have my opinion.

They didn't find a sufficient majority for any of their plans they voted on that night. Not AHCA. Not BCRA. Not for straight repeal nor some skinny repeal. [0]

And that's exactly the problem with politics. They don't vote for improvements, if that makes the more radical changes they want less necessary and thus appear less necessary. Especially under the shitty US election system allowing only two parties. The one who looses in the end is the citizen who just wants better healthcare.

[0] this yt channel is where I get my US healthcare news from: https://youtu.be/tMsSF2vDf6k

ps: Its funny the republicans only managed to pass repeal back when they knew obama would veto it.

They have also historically called for a balanced budget and deceit reduction... at least when the other party is in power.

As you can very well see, I answered one very specific false claim about price transparency in healthcare.

I did not intend to suggest I am interested in otherwise discussing your personal interests in the political deceits and failures of either American party.

California requires hospitals to publish chargemasters (price sheets for most common procedures) and makes them available https://oshpd.ca.gov/data-and-reports/cost-transparency/hosp...

Perhaps they should be taxed on their MSRP and not be given a tax rebate on discounts. That would encourage them to keep their published prices matched to what they actually charge.

They aren’t taxed at all because they register as non-profits even though they act as partnerships.

> Perhaps they should be taxed on their MSRP and not be given a tax rebate on discounts. That would encourage them to keep their published prices matched to what they actually charge.

The problem is that as there's no mandatory insurance in the US like there is in Germany, there is a very high chance that the patient may not be able to pay the bill, and so the hospital (or practice) is stuck with the costs. Which may go into six, sometimes seven digit sums. And this loss has to be eaten somewhere... in the form of everyone else having to pay way overinflated sums.

The only way to fix the US health system is to provide a national mandatory insurance for everyone which covers everything of basic healthcare, and then for the private industry they can offer insurance packages for higher-quality care (single rooms instead of shared ones, for example). Or, if that is not possible due to the insurance companies having bought off half of Congress, at the very least introduce a nationwide pricing list for medical procedures, with as few possibilities for deviation as it can be done (for example, services in the center of Manhattan can be more expensive than somewhere out in the woods because rent and staff are more expensive).

> a nationwide pricing list for medical procedures, with as few possibilities for deviation

This already exists with Medicare.

  mandatory insurance in the US like there is in Germany

In Germany, what happens when an uninsured person shows up at an emergency room (say, a refugee claimant or illegal entry?)

Refugee/Asylum claimants are "insured" in the sense that such services are payed for under the Asylbewerberleistungsgesetz. Otherwise uninsured people will have to pay themselves or receive help from social services.

The idea is that you are always insured for essentials, so the question is to find out under whom at that time. No idea what specifically determines the insurer for someone entering the country. But coverage will begin back on entry and they will request membership payments for the entire time, even if you did not "use" that coverage.

As for refugees specifically, I'd expect that to be mostly a question of whom they sign on with first. The public insurance has the same rate regardless of provider, so it wouldn't make much of a difference, and governmental support will probably pay that bill anyway.

> In Germany, what happens when an uninsured person shows up at an emergency room (say, a refugee claimant or illegal entry?)

They get treated first, payment is worked out later.

Sounds like there just hasn’t been enough money and support to create a committed movement, not when pharmaceutical companies have the means to push the narrative that it’s an intractable problem.

From the article:

> Another reason Mr. Arnold got involved: Drug pricing was an issue no other philanthropist had claimed.

This makes some intuitive sense. America’s healthcare system manages to hide its costs so well while providing modern treatment that it may not seem like the most compelling humanitarian problem for a billionaire, i.e. a first-world problem compared to providing mosquito nets to prevent malaria.

I couldnt even get cvs to tell me the price of something with my insurance. They said it would take a few days.

I saw this with my girlfriend. She needed a procedure where the provider refused to even give a ballpark number, the insurance refused to tell if they would cover it or to what extent. So if you really need it, your only way forward is to get the procedure and hope for the best without even a basic idea about the costs.

"insurance refused to tell if they would cover it"

'Hey boss, I saw the schedule. Not sure I I will be able to cover any of those shifts you gave me. By the way, pay me the same weather I do my job or not. Thanks'

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