Trump administration to mandate more open medical pricing

Trump administration to mandate more open medical pricing
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#17

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).

#18

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.

#19

So back to the OP…

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

#20

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.

#21

That rule requiring pricing on drug ads is a good step. Doesn’t seem the same thing as the OP though.

#22

Looks like the effort is still active in general…

#23

This is huge. It’s really sort of shocking that this hasn’t been done until now. Imagine being able to shop around for where you’d like to have a procedure done and actually know upfront how much it will cost you. Amazing!

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#24

Still in the works, hopefully soon.

President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry, according to people familiar with the discussion.
The administration is also likely to use a coming hospital outpatient rule to require hospitals to disclose their negotiated rates with insurers, two people said. The rule is expected this summer.

Boy the insurers and hospitals really don’t want to disclose their secret pricing deals…

“Transparency for transparency’s sake, and forced disclosure of thousands upon thousands of competitively negotiated rates, will not help consumers,” said Matt Eyles, president of America’s Health Insurance Plans, an association of health insurers. “Instead, it will cause health-care costs to go up for every American. To improve access and affordability, we need to work together to improve competition, choice and collaboration.”

I think that translates as “to make healthcare more affordable, offer more taxpayer subsidies to pay our already sky high insurance premiums, and definitely don’t force us to disclose the shady backroom deals we’ve cut to pay off various counterparties at the expense of the customer.”

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#25

latest on May 29, 2019

White House runs into health-care industry hostility as it plans executive order

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. And what would a WaPo deep state story be without their signature un-named sources

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#26

On a related note, here’s a good few minute long explanation of how drug prices work, and all the kickbacks (err rebates) and how customers don’t get those.

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#27

This one’s kind of understandable. It’s kind of like requiring car dealers to post every sale price for a car. Volume discounts, discounts for guaranteed payments, etc is a thing in many industries, but in this case all it will result in is “they’re only paying $X, so that’s all I should pay too!”

#28

Except here there’s the extra layer where the volume rebates or whatnot is not given to the sales channel, who at least is incentivized to sell more product. Instead, the rebates are given to the insurance company who has adverse interests in paying for the purchase and in any event does not disclose or have to pass on these rebates to their customer, the insured, in the form of lower premiums. And of course this system is very unfair to those paying out of pocket or with higher deductible plans, as they don’t benefit from these rebates, which effectively amount to overcharging a small vulnerable segment of customers by many times the typical price.

Rebates may also be an end-run around the “% of premium spent on care” requirements under Obamacare, since the rebate revenue isn’t premiums so the insurance companies can get more profits from a system with higher drug prices and higher kickbacks, than one where there are low drug prices, no kickbacks where their profits are capped as a percent of actual premiums.

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#29

As someone who used to pay OOP with HDHP, this is valuable knowledge of what goes on behind the scenes. I have an A++ through my employer now and barely pay anything. All the more reason to mandate (even if it doesn’t cut out the middle man (men) why it is so important not just for pharmecuticals but for healthcare in general.

Anyone who isn’t able to cover themselves or their family under a good healthcare plan from their employer should be allowed to have similar entitlements. They may pay 3x as much for their coverage (self employed, retired, etc) but pay way more for care or drugs and other care. I think healthcare is one of the most costly and biggest shams in current America.

Buying and selling a house comes at a high cost because many people on their industry work hard (questionably) to make it happen. Why should drug prescriptions be muddled with so many costs? Show where the money is really going and cut out all the middle men. I support this 100%

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#30

Pharmaceuticals in particular seem like something that pricing transparency could only really end up helping consumers. If I could go to google and search for ‘Humalog’ to get a prescription and then price compare then I can’t see how this wouldn’t lower the net costs of the product in general. Right now you’ve got such a convoluted system that I couldn’t even guess how I can find out how much Humalog would cost me. If I need drugs I just go to Walgreens and cross my fingers that its not ridiculous, they tell me how much it is and then I pay it cause I’m sick and I need it. How do you even shop around? Ask the doctor to send the prescription to different pharmacies one at a time and use trial and error?

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#31

It is hard to say where the industry is more screwed up (for consumers) but medicine is right up there. My wife just bought a prescription. The pharmacist said that even with her insurance card he could not give her a price. We have apretty high deductible so it would most likely be OOP. The only thing he could do is ring up a sale to see how much the charge was but he offered to cancel it if we did not like the price. Of course, it might stay on the insurance company records so they would not pay for the medicine somewhere else!

We took a chance and the price with insurance went from $550 to $46. So we lucked out. But it is still a scam.

#32

Yeah the way that pricing for drugs works they may as well have us spin a wheel. …

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#33

And if you want the long version of why drug prices go up, here’s a great blog that goes into all the details and incentives and kickbacks. Basically, the PBMs are to blame and are getting rich off higher drug prices, impeding competition that would normally lower costs to customers (ie generics), and expanding costs to the uninsured and the government programs who pay for them (and hence taxpayers generally).

in how many other industries does cutting your prices lead to a decrease in competitiveness? If cutting prices reduces your competitiveness, it stands to reason that raising them increases your competitiveness, and if that is the case, should we be surprised that drug price inflation has been rampant? Something appears truly broken. So what is going on here? The answer is that the third-party-payer model in healthcare has resulted in the industry evolving a ‘bribe the distributor’ model.

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#34

It’s crazy. You could ask for a paper Rx and shop it around.

Seems like the wheels fell off of all of this once fairly low-deductible 100% coverage policies became a unicorn.

It makes me crazy that pharmacists can’t easily compare the cash and insurance prices on a hypothetical basis without ringing it up. And they’re under a lot of pressure from insurers not to do so and cancel just as a price quote. Or that, often paying cash or using a GoodRx code is cheaper than insurance.

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#35

This is interesting and infuriating. Do you have any further details by chance?

#36

It’s what the tech at Costco told me.

1 Like