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Comment by ceeplusplus | Hacker News Reader

It really is a toothless law, the hospital probably makes more surplus profit from price discrimination in a single week than their entire fine for the year. The damages should be increased 100x.

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In my fantasy world there's a full-on constitutional amendment demanding that any monetary fine must meet or esceed the profits gained by breaking the law.

I've long advocated for a few variations of this: 1. fines must conform to a percentage of the targets earning wealth (e.g. someone who makes 30K a year gets fined $3000, someone who makes 300K gets a 30K fine etc) 2. flat out just as you said, fine must EXCEED by a multiple, the amount they gained (however, determining the gain is in many situations, requiring a lot of forensic accounting to sort out).

...now I'm amused by which Ayn Rand sycophant is downvoting me because I propose proportionality so the efficacy of punishment affects evenly across the board. Y'all are the Scientology of pop-econ.

I would advocate a more direct form of damages: a hospital that does not comply may not charge more than the minimum over all hospitals in a 500 mile radius for any procedure. A hospital that does charge more and is caught must refund double the difference. Furthermore, no contractual provision may penalize patients for attempting to seek that double refund, and a class action lawsuit to recover the difference that actually goes to trial recovers triple instead.

Hospitals will comply immediately :)

How about if you can’t post the prices, you simply aren’t allowed to bill for any services?

This is the one that's simple to enforce. No price, no bill.

Y'all are leaving out the no service part that would come with that.

No service = no bonus for whatever exec decided not to publish the list.

In general, I’d love to see the same consumer protection required from auto shops applied to a hospital. An auto shop must give an estimate in advance.

Wut? The service has already been rendered at that point. Without an upfront price, no contract has been formed, so there's no basis for the hospital to bill an unjustifiable amount. At best they could request reimbursement for cost incurred. eg $0.01 for an aspirin and not $60.

At which point? The hospital would stop providing services shortly after it was informed that it would not be able to bill for them.

Also, I'm pretty sure you can write a contract that doesn't have an upfront price.

Informed by who? Hospital performs services, sends out a "bill" 30 days later, patient responds "due to the lack of published pricing as per federal reguation, no contract was formed and thus this bill is invalid". Are you saying the hospital would then react by stopping providing care to all patients from then on? Why wouldn't they react by you know, complying with the law to stay in business?

A contract has to have defined consideration, otherwise it is not a contract. Time and materials (hourly rate + cost/plus) is another standard form of financial consideration, but "we'll charge you whatever we feel like at some later time" is not.

The only reason these laws have any teeth is medicare/medicaid reimbursements.

If you make working with the govt on reimbursements too painful, many hospitals in well-off insured areas (good payer mix which is like gold to medicine) will just stop treating medicare/medicaid.

Not only that, but it costs money for the hospital to make the chargemaster available, deal with people asking about it, etc. If the fine is really just $900K, if I was a hospital CFO I'd pay that every year without a second thought, or even work up a service charge to add to all hospital billing a la the "Federal Access Charge" AT&T puts on phone bills so I can get people to blame the government for $15 Motrin tablets in the hospital.

An interesting game. The govt could then raise the fine, but would they risk bankrupting the hospitals by pushing too far?

It costs money for the hospital to do payroll for the CEO too but that never gets dropped somehow!

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