Trump administration to mandate more open medical pricing

Craig Gotwals is all over this potentially good news for the supporters of free enterprise:
Post on Gotwals blog

This proposed regulation has the potential to do more for healthcare price containment and transparency than the 40,000 pages of statues and regulations spawned by the Patient Protection and Affordable Care Act (“PPACA” or “Obamacare”). The Trump Administration is considering a regulation to compel doctors, hospitals and other healthcare providers to make the “secret” agreements on pricing they have in place with the insurance industry publicly available. For the first time in the history of modern insured healthcare in America, the public would actually know the real prices and the free market would begin to be unleashed.

Obviously there will be tremendous pushback by the medical oligopoly and the Democrats who want the current system to totally fail so they can ram through socialized medicine.


How would you utilize price information if it were available?

We can all think of ways the medicos will try to avoid getting nailed down on the price such as with the creative coding used by some MDs I have consulted where if I even mention some topic they code it as a billable event.


Let’s post the latest news on this topic here:

May 29, 2019

The most far-reaching element favored by the White House aides developing the order would require insurers and hospitals to disclose for the first time the discounted rates they negotiate for services, according to health-care lobbyists and policy experts familiar with the deliberations.
The idea has stirred such intense industry opposition, however, that it may be dropped from the final version, the sources said.
From the WaPo.

I don’t know if it would necessarily make me go to a different hospital or clinic. There is a certain amount of trust, etc. that gets built up with a doctor if you visit regularly. However, it would be useful in making an informed decision when a choice is given. I use the analogy of a restaurant, when they ask me if I would like chicken on my salad. What they don’t tell you is that it changes your $7 salad into a $15 ‘entree’ by adding chicken.
Often you are presented with decisions like, for an injury would you get an xray or an MRI. The MRI would give us a better view, but if I knew how much it was going to cost, that would be nice to know in the decision.

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A transparent list of actual cash prices instead of theoretical rack rate (chargemaster?) prices for cash payers would be nice.


That would great if you could whip out your phone and try and price match, but who would actually do that? especially during an emergency

This is a strawman. I have never needed emergency medical services. Have you? But I would have saved a lot of money if I could have price shopped for the colonoscopies, CT scan, lab tests and most other services I have paid through the nose for since I was self-employed and had a high deductible HSA policy.


Agreed. the vast majority of medical costs are non emergency, and even so, if you see one hospital has crazy ER rates, you can pick a health plan that covers a different one or tell your family so they know that one is your preferred hospital, etc.

More disclosure is a good thing for the customer, pretty much always.


You’re right that overall most expenses aren’t emergencies and we’d all potentially save a lot if we could easily price shop.


I don’t know if its necessarily / technically a strawman. Emergency medical needs happen daily. Yes I’ve paid them. Good for you if you haven’t. Some people might perceive that emergency spending is higher than it really is vs the non emergency costs. I bet 90% of my dads lifetime healthcare is for emergency spending. But he’s not the norm.

(edit : and then I read the whole thread and see xerty already made the next point…)
Also, we could potentially save money even for emergencies. If theres any choice in emergency room then you could find out which is cheaper in advance and ask to only go to that emergency room. A lot of emergencies don’t mean you’re unconscious and unable to pick Hospital A vs Hospital B.

Do you have a choice if you’re picked up by an ambulance? I thought dispatch tells them where to go. That said, many “emergencies” don’t require an ambulance, so your comment still holds.

I assume the specific rules depends on where you live. I’d also assume they take you to the nearest hospital or the designated hospital in a zone or city limits.

yeah I don’t think I’d take one unless I had no choice. I mean as long as were talking about saving money those glorified taxi rides cost $500-2000

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You lead an unexciting life :slight_smile:

Yes, in my experience. The ambulance charges by the mile.

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Ref to abulance rides. Last i knew 10 years ago. Florida was required to take you to the hosoital of choice. I did an ems shift. In 12 hours i visted 4 different hospials. So if you are a bit south of orlando u do have choices.


And you could see mobile apps like GoodRx but for typical procedure costs at various hospitals around you. In most cases, you could look that up quickly or even find out in advance which ER you’d want to go to if you have the choice and time.

Bottom line, it’s hard to know the practical impact but having cash prices upfront could not possibly be a bad thing. Maybe it would also get rid of the inflated charges you see on your bills. It’s typical to see something billed $300-400, and then see the network discount for 75% of that. Such BS.

Whether more transparency would solve all issues, that’s very hard to say. I doubt it personally but it’d be a much needed move in the right direction IMO.

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But how much does adding X extra minutes to the trip in cases where an ambulance is necessary reduce survivability?

It would obviously depend. But a lot of situations, even where an ambulance is necessary, still allow them to drive with traffic. Even if the ambulance arrives with lights and sirens, it’s not uncommon to leave with traffic. The purpose of the ambulance in many situations is really just to serve as a vehicle for EMS and/or the apparatus to reach the scene, not necessarily with urgency.

Depending on the area, lights and sirens may not actually save that much time. Of course, 30 seconds could matter a lot for some things, but it won’t always matter.

I was referring more to “choosing” hospitals further away than ambulance vs no ambulance.

Yeah, I’m just saying that in a lot of cases, adding minutes doesn’t increase risks.

But this is not my area at all. I wasn’t aware you could choose, but I only know about a couple cities’ rules, and mostly only have heard about rules in passing. The emergency services for the cities I’m aware of don’t let you choose (due to traffic, requirements to get the responders to other locations, ER conditions, and some teams wanting to give business to certain ERs so they personally get benefits there).

Oh, you were serious. I’d think if the patient makes the choice, then it’s probably not a life-or-death situation. I would also guess the ambulance crew has some discretion, and saving the patient’s life would have priority over their choice of hospital.

So back to the OP…

Is this change actually happening or are they still just ‘considering’ it?

Appears to be implemented now. I’m not going to watch any TV ads to find out, but if you do, let us know.

Edit: this is more drug transparency, but not yet medical cost transparency.