<story><title>Leaked Scripps records reveal automated mark-ups for hospital care</title><url>https://www.latimes.com/business/story/2021-12-10/column-healthcare-billing-markups</url></story><parent_chain></parent_chain><comment><author>huitzitziltzin</author><text>This is an infuriating but not surprising read.   The only surprising thing to me is to see the number written down.  (And that some part of the system was available to a nurse to see!)&lt;p&gt;I’m a health economist and much of my research is on hospitals.   As much as everyone loves to complain about drug companies and insurers as being responsible for high US health care costs, that &lt;i&gt;is not&lt;/i&gt; where the money goes.  The money goes to doctors and to hospitals.  (Specifically: about half of all national health spending to those two groups.)&lt;p&gt;If you want to save money on health care, you need to talk about paying less to doctors and to hospitals.   If you don’t want to pay less money to those two sets of entities, you aren’t going to save much money.  That’s all there is to it.&lt;p&gt;Yes, we can do better by spending less on drugs, but it’s a small amount compared to the gigantic sums which go to doctors and to hospitals.  (Specifically: &lt;i&gt;all&lt;/i&gt; drug spending is about ten percent of national health spending.)   Yes, we can do better by reducing the administrative burden, but that slice of the pie is less than 10%.  (And you will never have 0 admin expenses.)   The administrative burden of health insurance is even lower than 10%.&lt;p&gt;So… go ahead and share your ideas for paying doctors and hospitals less, because otherwise you’re talking about stuff which doesn’t amount to much!</text></comment>
<story><title>Leaked Scripps records reveal automated mark-ups for hospital care</title><url>https://www.latimes.com/business/story/2021-12-10/column-healthcare-billing-markups</url></story><parent_chain></parent_chain><comment><author>ethbr0</author><text>&amp;gt; &lt;i&gt;I started asking questions,” the nurse said. “I was told that if we didn’t mark things up like this, insurance companies wouldn’t give us what we want.”&lt;/i&gt;&lt;p&gt;&amp;gt; &lt;i&gt;Healthcare providers routinely ignore the actual cost of treatment when calculating bills and instead cook up nonsensical figures to push reimbursement from insurers higher.&lt;/i&gt;&lt;p&gt;This is the real story of health care, in a nutshell.&lt;p&gt;Providers say &amp;quot;A procedure costs $100.&amp;quot; Insurers say &amp;quot;Great, we&amp;#x27;ll reimburse you $50 for it, or you won&amp;#x27;t be in network.&amp;quot; Providers say &amp;quot;But it actually costs $100.&amp;quot; Insurers say &amp;quot;Fine, but cut us a deal in exchange for our business, and charge us $50.&amp;quot; They hammer out a contract that specifies $55 for that procedure.&lt;p&gt;On the next procedure, which costs $200, the providers (and their facility) stops to think. &amp;quot;Wait, insurance is going to ask for a substantial haircut on whatever number we give them.&amp;quot; So providers say &amp;quot;This procedure costs $400.&amp;quot; Insurance says &amp;quot;Fine, we&amp;#x27;ll reimburse you $200.&amp;quot; Providers say &amp;quot;Oh no. Fine, we&amp;#x27;ll take it.&amp;quot;&lt;p&gt;Then a few years later insurance analysts get around to noticing relative cost differences, and the entire dance starts over again.&lt;p&gt;The fundamental problems with US health care are (1) the lack of end-user (patient) visibility into costs &lt;i&gt;before&lt;/i&gt; undertaking a procedure, (2) opaque insurance-facility contracts, &amp;amp; (3) the bullshit dance between facilities, middle people, and insurance companies that end up adding confusion, delay, and costs to what would otherwise be simpler transactions.</text></comment>