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Comment by rtkaratekid | Hacker News Reader

This was not in my radar, but strikes me as really good news for American healthcare. Are there any substantial downsides? I was not even close to being convinced by the arguments given by insurance companies in the article.

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I generally think this is a very good step in the right direction. The only negative that I've heard voiced by some people (here on HN) was that the penalty for non-compliance is negligible (if I remember correctly, something like a few hundred dollars; I don't remember if a few hundred dollars in all, or per day, but for a hospital both are a rounding error).

Edit: The penalty is $300/day [1]

[1] https://www.hhs.gov/about/news/2019/11/15/trump-administrati...

Do we know if this will expose physician fees? If not, I imagine physicians could charge the patients, then physicians and hospitals could settle the difference on the backend.

In other words, a potential downside of partial sunlight could come from the fact that providers may want to move costs/charges around to obscure prices therefore making the system even more inefficient.

that's not possible. At least not possible on a large scale.

there are strict regulations (AKS and Stark) governing hospital <> Provider pay payments.

Any pay in excess of medical services FMV will be toxic to pay out and could land both hospitals and providers in big trouble.

It isn’t a bad thing, but it won’t affect many Americans. Most of the country has insurance coverage, and even a high copay is probably cheaper than paying cash for most things. However, it will hopefully lower prices for people that have no coverage for some procedures by exposing any gross differences between the negotiated rates with big insurance payers and the cash rates offered to individuals. It will benefit people that are uninsured or undercovered, if they do their homework.

I have a feeling that while this is a step in the right direction, people can still be taken advantage of. Like, hospitals may offer a reasonable cash price for a baby delivery but still tack on all sorts of extra fees. Similar to the “underbody rust protection” scheme with car dealers. It’s supposed to be illegal but somehow the hospitals will figure it out.

I'm a young healthy dude and have a high-deductible healthcare plan, so I absolutely care about finding low prices for things (since I don't hit my deductible). I got strep throat in 2019 and had a hell of a time comparing prices for test + antibiotics between different clinics. I usually had to physically show up at the location before they'd give me a price. Prices varied between $20 and $250!!! Hopefully this will help.

There is a fabulous place in OKC called the surgery center that does not take insurance and lists the upfront cost for all of their procedures on their website. I live about 6 hours drive away from it but just having that resource available makes it worthwhile to check if it’s worth it to drive 6 hours if I need something done: https://surgerycenterok.com/

I disagree. Even with insurance, it can be impossible to know how much you're going to pay in advance. I had a surgery a few years ago, and my insurer sat me down in advance and told me what was covered and what wasn't--the upshot of which was that I was told I'd only owe a $25 co-pay for the entire thing. And then after the procedure--wham--I was hit with hundreds of dollars of bills for things like an ultrasound, mandated as part of the procedure, performed in the same building by the ultrasound tech they sent me to ... who happened to be an independent contractor. WTF. The additional cost was mostly irrelevant to me, but the surprise billing, after the consultation, was maddening.

Having gone without insurance coverage, I have heard phrases like "our standard 85% discount" when notifying that I am paying cash instead of using insurance. (That said, I've also only received 30% discounts, so don't immediately jump ship :-) )

It's a good thing, and one of the very few things I will happily stand up and commend the Trump administration for. Unfortunately, the impact on private individuals is likely to be very low, because those negotiated rates are extracted from hospitals by insurance companies by sheer weight of the number of policyholders they have. You and I won't be paying those rates, nor will we be able to negotiate anywhere near them. Our starting point as individuals is something called the "chargemaster rate," which is, theoretically, what the hospital might charge Joe Schmoe who's uninsured.

In practice, even chargemaster rates aren't the real rates. Despite not being a huge insurance company, it is possible to negotiate with hospitals if you're either quite rich or quite poor.

On the rich side, oftentimes just saying you're going to pay cash up front will get you a substantial discount. On the other end, hospitals frequently have entire departments theoretically devoted to helping poor and indigent patients afford medical care. What those departments actually do is sign people up for government benefits, or, sometimes, just writing off entire bills.

Anyway, yes, it's a good thing. No, it probably won't make a difference to you.

> it is possible to negotiate with hospitals if you're either quite rich or quite poor.

It is possible to negotiate, no matter who you are. I can literally be described as both quite rich and quite poor using your criteria. Simply saying you don’t have insurance at one major hospital near us immediately reduces the bill by 49% (from the charge master rate, presumably).

There are no downsides to the consumer. Hope the Biden administration doesn't reverse this.

Are you aware that this statement cannot be true? It's like potheads holding marijuana up as a panacea. This will reduce income for some number of hospitals, and hospital administration gets a turn at the table too. If you make the business feel pain, they'll pass it on to their customers with some new policy of their own.

If those hospitals are relying on hidden prices to protect their profitability, they are not well run. Period.

It is time. There is no good reason for hiding the true costs. This is the beginning of a much-needed revival in the health-care industry.

I hope they make the penalties prohibitively high.

What motives would they have to reverse it? Don't they claim they're "for the people"?

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