President Trump Announces Executive Order on Healthcare Price Transparency….

Earlier today President Trump announced a new executive order, constructed to facilitate a regulation change, that will require healthcare providers to inform patients of the cost of their procedures in advance of treatment.  [Lots of Background Here]

The President makes the announcement [Video and Transcript Below]

[Transcript] – 3:17 P.M. EDT – THE PRESIDENT: Thank you very much. (Applause.) Thank you. Thank you. Wow. (Applause.) Wow. That’s very nice. Thank you very much everybody. Wow. We must be doing something right lately. (Laughter.) That’s very nice. I appreciate it very much. And welcome to the White House. Great place. No place like it, actually.

We’re here to announce new groundbreaking actions that we’re taking to dramatically increase quality, affordability, and fairness to our healthcare system. This landmark initiative continues our campaign to put American patients first. This is a truly big action. People have no idea how big it is. Some people say bigger than healthcare itself. This is something that’s going to be very important.

For too long, it’s been virtually impossible for Americans to know the real price and quality of healthcare services and the services they receive. As a result, patients face significant obstacles shopping for the best care at the best price, driving up healthcare costs for everyone.

With today’s historic action, we are fundamentally changing the nature of the healthcare marketplace. This is bigger than anything we’ve done in this particular realm. And probably, Alex, it’s not even close, from what they’re telling me.

We will empower patients with the information they need to search for the lowest costs and the highest-quality care. In other words, they’ll be able to seek out their doctor, seek out the doctor they want, and they’ll be given vast amounts of information about those doctors.

We’re grateful to be joined by Secretary Alex Azar and Administrator Seema Verma. Thank you very much. Alex? Where’s Seema? Hi, Seema. (Applause.)

And I also want to recognize and thank a great senator, Chuck Grassley. Chuck, thank you very much. (Applause.) And, by the way, congratulations on ethanol. E15, right? He fought so hard. Oh, he’s tough. When he goes after you, he’s brutal. (Laughter.) But he gets what he wants and then he likes you, right? Anyway, congratulations to the farmers, frankly, Chuck. Right? Great job. Appreciate it. And that’s all year-round.

And Mike Braun. Mike, thank you. Thank you, Mike. Great job you’re doing.

Representatives Greg Walden — we worked so hard together on Right to Try, Greg. Right? Right to Try. People are loving it. Michael Burgess, Doug Collins, Devin — Devin Nunes. Thank you all. Incredible people.

Lieutenant Governors Geoff Duncan and Dan Forest. Thank you, fellas. Thank you. Thank you. You didn’t get a very good seat. I can’t believe it. (Laughter.) That’s not like you.

And all of our great state legislators. We have a lot of them with us today, and a lot of great medical people and doctors.

For decades, powerful insurance companies, lobbyists, and special interests have denied the public access to the real cost of the healthcare services they provide. It’s that simple. This lack of price transparency has enriched industry giants greatly, costing Americans hundreds of billions of dollars a year.

Patients have been billed nearly $800 for saline; more than $6,000 for a drug test, at the simplest methods used, and $6,000 — I’ve seen them; and over $17,000 for stitches to just stitch up a minor wound. Often, prices differ drastically between providers and hospitals for the exact same services. And there’s no consistency. There’s no predictability. And there’s, frankly, no rhyme or reason to what’s been happening for so many years.

As a result, Americans, such as Erika Jay, who is here today, find themselves in deeply unfair situations. Erika, please, if you would come up and just explain what happened to you. Thank you very much. Thank you very much. (Applause.)

MS. JAY: Thank you. Over the last three and a half years, while fighting a stage-three cancer, we visited many healthcare facilities. We saw price variations that just caught us off-guard and really surprised us — took us by surprise — from one facility to the next. And it caused us financial hardship.

An example of this is when I had two identical bone biopsy procedures only 11 days apart at facilities that were only 17 miles apart from each other. We learned, when we received the bills for the second procedure, that it cost us more than 330 percent than the first time we had it done. Different facility, identical procedure: drastically different pricing.

This is one of many stories our family has. If price transparency had been required, we would have been empowered to find the best pricing for my care, saving thousands of dollars over the last three years.

Mr. President —

THE PRESIDENT: Yes. I’m right here. (Laughter.)

MS. JAY: Thank you for this executive order.

THE PRESIDENT: Thank you.

MS. JAY: And thank you for empowering and helping families like mine all over the nation.

THE PRESIDENT: Thank you very much. That’s very nice. (Applause.) Thank you. Thanks very much, Erika.

We believe the American people have a right to know the price of services before they go to visit the doctor. Therefore, in just a few moments, I will be signing a breakthrough executive order. It will create unprecedented transparency about healthcare prices and provide this information to the American people for the first time ever — first time it’s ever been done. People knew it should have been done years ago, but they never got it done. I wonder why.

With this order, hospitals will be required to publish prices that reflect what people actually pay for services in a way that’s clear, straightforward, and accessible to all. And you’ll be able to price it among many different potential providers, and you’ll get great pricing. Prices will come down by numbers that you won’t even believe. You won’t even believe it. More price transparency will mean more competition, and the cost of healthcare will go way, way down.

Vanderbilt economist — highly respected — Dr. Larry Van Horn is here with us. Larry was introduced to me by a gentleman who is a great gentleman, great economist: Art Laffer. And Art Laffer just got — as you know, Larry — just got the Presidential Medal of Freedom a couple of days ago. And Art was telling me that he’s the head of a hospital, where he comes from. He’s on the board. And they did this. He said it is beyond anything he’s seen, from an economic standpoint and even a health standpoint.

And I said, “Let’s talk about it.” And we discussed it, and it’s something known very well, but a lot of people don’t do it because there won’t be some rich people that will be too happy about this. But the people will be happy about it.

So, Larry, could you — (applause) — so, Larry, if you would — one thing, before Larry gets up: One of the other big beneficiaries are really good doctors. The good doctors. And they should be the beneficiaries — not the bad doctors, but the good doctors. And I think all of the doctors in the audience know exactly what I’m talking about. So thank you for being here, because I guarantee you’re all probably very good doctors.

So, Larry, if you would, please come up and share a little of your wisdom and what this is all about. Thank you. Thank you very much. (Applause.)

DR. VAN HORN: Thank you, Mr. President, for taking this action that will put healthcare information in the hands of the American consumer. This truly will be transformational.

For years, I’ve studied the impact of hidden prices and what that’s had — the impact that’s had on markets — healthcare markets — as well as American consumers.

My analysis suggests that when cash prices are transparent, upfront, in the market, on average, they’re 39 percent cheaper than the amounts that third-party payers pay for like services.

Even when insurance covers the cost, there is, on average, a 300 percent price variation within a market across — for the exact same services. Your healthcare transparency initiative will empower consumers and use free market forces to drive healthcare markets towards lower prices, better outcomes, greater access, and greater value.
But this is bigger than healthcare. Lower prices for healthcare leaves more money in Americans’ wallets and in their paychecks for the purchase of all other goods and services that are important parts of their lives. This will be good for America and good for Americans. (Applause.)

THE PRESIDENT: Thank you very much, Larry.

Today’s action is not just about lower prices. It’s also about helping Americans find excellent care. Currently, patients do not have adequate tools to find the doctors who would deliver better health outcomes at an affordable cost.

And when they used to talk about Obamacare, “You can keep your doctor,” that turned out to be a lie. Twenty-eight different times it turned out to be a lie. Here, you can keep your doctor, but you can also maybe find somebody other than your doctor at your choice, and that would be based on talent and it would also be based on price.

Because of this, you’ll be able to search out for the right doctor. And it really is, in a true sense, the opposite of Obamacare. You get much better pricing, and you’ll get the doctor that you want and maybe you’ll get better than the doctor that you originally thought about. It’s pretty incredible.

Low-quality care often means unnecessary services. For example, a bad doctor may routinely perform an expensive spinal surgery for back pain without first trying physical therapy.
That’s why my order directs agencies to help inform the public about the quality of doctors and hospitals by leveraging all of this data. By making much better use of this new information, we will save money and save lives, and your care will be much better. It’s incredible.

We’re also joined by Dr. Elaina George, a longtime advocate for patients. Elaina, please come up and tell them a little bit about what transparency means. Thank you. (Applause.)

DR. GEORGE: I love being a doctor. However, one of the most challenging things has been the inability to be an effective advocate for my patients. I’ve had patients deny themselves care because they don’t know how much a service will cost, or, worse, be stuck with a costly bill that they didn’t expect.

I have felt powerless at times because of my inability to help them, especially if I have to send them to a hospital and we can’t find out the price of the service.

Price transparency is a solution to this problem. When patients become healthcare consumers, it will drive prices down, quality up, and most importantly, help doctors serve their patients better.

Thank you, President Trump, for this executive order. (Applause.)

THE PRESIDENT: Thank you, Elaina. Thank you very much. Great job. Thank you, Elaina.

As we fight to increase transparency and lower costs for patients, more than 120 Democrats in Congress support Bernie Sanders’s socialist takeover of American healthcare. It’s very dangerous. The Democrat plan would terminate the private health insurance of over 180 million Americans who are really happy with what they have.

Under my administration, we will never let that happen. We believe in giving patients — (applause) — we believe in giving patients choice and freedom in healthcare, ensuring access to the doctors they want, the treatments they need, and the highest standard of medical care anywhere in the world. And this will make it much better than it’s ever been.

This is a truly historic day. I don’t know that it will be covered that way by the fake news. (Laughter.) But this is truly a historic day. This is a very big thing that’s happening right now. And it’s pretty much going to blow everything away, Alex, as we discussed. People never thought they’d see us do this.

We’re making new affordable health options available to millions of American workers through the association health plans, short-term plans, and health reimbursement arrangements.

We’re working with Congress to stop surprise medical billing. And when you hear “surprise” — (applause) — right? And when we hear “surprise medical bill” we’re not talking about a positive surprise. (Laughter.) We’re talking about, you know, not surprise, “Oh, gee. How happy I am.” You’re talking about, like, a disaster.

Because no American should be blindsided by bills for medical service they never agreed to in advance. Because people get sick. They don’t really think in terms of, “Let’s sit down and negotiate for 20 minutes.” You want to get better. And then you get hit, and you get hit really hard. And that stops.

We’re expanding access to tax-free health savings accounts. To give critically ill patients access to lifesaving cures, we passed Right to Try. We were helped so much by these gentlemen in the front row. What a job you all did, and I really appreciate it. And you, too, Senator. I’ll tell you, that was really great. We think in terms of the House — because I know how hard you fought for it, Greg and Doug. You guys were amazing. But — and Devin, I know you worked on this one very, very hard with everything else you do, but I appreciate it. And very few people would’ve done that.

You know, Right to Try is interesting because it’s been — they’ve been trying to get it for 45 years. And they couldn’t do it. And it sounds simple, but it’s not, because everybody had a reason for not wanting it. The insurance companies didn’t want it because of liabilities. The country didn’t want it because they didn’t want to be sued.

But now you have terminally ill patients that used to — if they were rich enough, they’d go Asia. They’d go to Europe. They’d go all over the world looking for a cure. And we have the greatest doctors in the world right here; the greatest lab technicians and labs and medical services. We have everything. But it takes a period of time to get a certain potential cure approved. Sometimes 15 years. And, by the way, we brought that down to probably an average of six.

But you need time because you don’t want to hurt anybody. But these are patients that are terminally ill and they didn’t want to give them a potential cure because they didn’t want to hurt them, but they’re terminally ill. So we agreed that people would sign a waiver. Nobody is going to be held liable. The drug companies, which didn’t want it because they didn’t want it on their record, we made it a much less part of their record. And we set up different standards where it would be in other parts, which was great for them.

And everybody is happy, and many lives have been saved. And I’ll tell you, we had one the other day that was on — so incredible. A young — incredible young woman where they made a medical mistake and it was over for her. They were explaining last rites. And then, all of a sudden, she did this and she’s now healthy. They think she’s going to be actually fine. You might have seen it. It’s been — it was actually an incredible thing.

So I’m really happy. I talk about it a lot. Right to Try — something that sounds so simple, and yet for 45 years they’ve been trying to get it approved. And they got it.

And just so you feel good, Greg and Doug and everybody — tremendous success. Have you been seeing what’s going on? So many people that were definitely not going to make it are now living, and, in many cases, they’re going to be just fine. So it’s something very — you can all be very proud of that.

So for the first time in a long time, we’re doing things that nobody has ever done before, from the standpoint of what we’re here for.

We eliminated the Obamacare individual mandate penalty, which was the most unpopular thing in Obamacare, by far. And I had a decision to make: Do we do a good job with Obamacare — the remnant of Obamacare? Or do we do a bad job? If I do a bad job, well, there you can blame Obama and the Democrats. If we do a good job, they’ll get a little bit more credit. But it’s still very faulty. It doesn’t work, and it’s too expensive. And I told our great Secretary Alex Azar, “Don’t do a good job, do a great job. Do what you have to do. Work with the states. Do whatever you have to do to make it as good as possible.” Once we got rid of the individual mandate, it made it better.

But Obamacare doesn’t work, but it works at least adequately now. And we had that choice to make. And, politically, it’s probably not a good thing that I did, but it’s the right thing to do for a lot of people. So I want to thank you and I want to thank Seema for doing a fantastic job. I appreciate it. (Applause.)

And we spend a lot of time defending Medicare and Social Security, and we’re always going to protect patients with preexisting conditions. People don’t understand that — that we are fighting very, very hard to get it taken care of for preexisting conditions. And if we weren’t, that wouldn’t happen.

But the Republicans are very much behind that. Totally behind that. And if we do anything and if you see anything a little unusual, it doesn’t make it because we’re putting in very, very strong — taking care of patients with preexisting conditions.

And I would say, Alex, that that is, really, a very strong foundation of what we’re doing and what we’re all about. So it’s very important.

Together, we’re taking power away from bureaucrats. We’re taking it away from insurance companies and away from special interests. We’re giving that power back to patients, and we’re giving Americans the right to know. So we have the right to try, and now we have the right to know, and the right to negotiate, and the right to pick your own doctor, and the right to get great prices. And other than that, you know, what can I tell you? (Laughter.) You can’t do better than that.

But we’re taking one more giant step toward a healthcare system and a healthcare system that’s really fantastic, and it’s going to be good, and it’s going to work for the people.

So I just want to thank everybody for being here. I’m going to go and sign the executive order. And if this is half as big as some people are saying it will be, it will be one of the biggest things ever done in this world, in this industry, in this profession.

And I want to especially thank all of the doctors for being here. We have a lot of doctors in this room, and they’re very proud of what they do, and they want to have our system work. And this is something that I think is going to get it to really work efficiently and well.

Thank you very much for being here. I’m going to sign the executive order. Thank you. (Applause.)

(The executive order is signed.) (Applause.)

Transcript END – 3:40 P.M. EDT

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155 Responses to President Trump Announces Executive Order on Healthcare Price Transparency….

  1. Steven Edwards says:

    I applaud his efforts here but there is still one glaring hole: You can’t have market forces in Triage. if I’m unconscious bleeding out from being shot or having a stroke or heart attack I cannot make informed decisions on price and I will still be the victim of being raped by the hospital the ambulance service and whoever else decides to Bill me because free markets are dependent upon consent.

    Until we seperate this notion of an elective market and a socialized triage, we won’t be able to fix the larger problems.

    Liked by 2 people

    • Ambulance services including AIR services and especially Rescue choppers, whose pricing even up front is totally bogus for its real costs including a nice profit, and yes you have zero choice. I have heard that choppers and the authorities will put you on even if you object and you are stuck with a tens of thousands bill for the transport.

      Liked by 1 person

      • Steven Edwards says:

        As Karl Denninger says: the difference between sex and **** is consent. You cannot consent if you are dying and are still liable for all charges. You can’t say: I want this hospital and not that one, this ambulance service or that one. This doctor not that one.

        Yet you are still stuck with the bill.

        That is slavery.

        Like

      • ms doodlebug says:

        My experience was just the opposite. I was taken to the nearest hospital by ambulance, a mile from my home. From there I was taken by CareFlight to a hospital 25 miles from my home for emergency surgery. I was billed for the ambulance, but not for the CareFlight.

        Like

    • Steven that is one small segment of a long, long chain.

      I believe I understand your point having been transported to ER with a shredded – not cut – radial artery and nearly bled out. However elsewhere when I asked how much for a cholecystectomy all I got was dumb looks. Now don’t tell me there can’t be a “flat rate” price for that procedure just like R&R the engine in my car. Some will go well and the mechanic does really well and others go in the tank. Just how it is. Why should a hospital be exempt from the market?

      How is it a local independent imaging company will scan me for $500 (which is way too high) with the exact same machine as “Mega Medical” yet “Mega Medical” will want $3500?

      The gvt/medical/insurance/industrial complex has ABSOLUTELY NO motivation to reduce medical costs and until that changes this insanity will continue.

      I applaud VSGPOTUS for taking the first step on a long journey!

      Liked by 5 people

      • SwampRatTerrier says:

        Spot on!

        RE: “The gvt/medical/insurance/industrial complex has ABSOLUTELY NO motivation to reduce medical costs…..”

        They are just like the educational system addicted to every greater amounts of the taxpayers’ money.

        Like

    • John says:

      This will still greatly help. It will expose the gouging that has been taking place and standardize all fees. The “industry,” will be embarrassed by the extent of their corruption.
      Example:
      in 2011, I diagnosed a mass on my left kidney. (Stage 3 carcinoma). Received preauthorization, completed all paperwork and co-pays, three weeks before surgery. Spent a little over one hour in the operating room, and two nights in the hospital. My excellent surgeon and anesthesiologist submitted and were paid by the insurance company within the first week. One month later I receive a bill from the hospital for about $48,000, ($20,000 for One hour in the OR suite alone) reporting that the insurance refused payment. They claimed that I had “a pre-existing condition.” I fought it and won. Now here’s the kicker: The insurance companies bill, was for a little over $13,000. (That would’ve been a reasonable charge, but would never be available to me.). I am sure that the hospital still made a profit on the $13,000. Just an example of a typical markup in the “industry.”
      I’m sure that they’ll still give the insurance companies a discount, But everyone will see the pricing and This should Stimulate a little competition.

      Liked by 4 people

      • I hope you are doing well now days John.

        I bet every single treeper here has a horror story about themselves or a family member and outrageous medical pricing.

        This gouging has been out of control for a long, long time and I am glad that Pres Trump is trying to do something about it.

        Liked by 5 people

        • John says:

          Thanks coloradochloe! On July 7 it will be eight years. The right kidney has been doing the work of two, without problems. No cancer relapse so far, with only lifestyle changes and a few supplements.
          The insurance companies will need to be dealt with also. I have come to see them as simply being “casino/investment bankers.” They are not managing your care! They are managing “Their Claim.”

          Liked by 1 person

          • Great news John!

            And good luck with the insurance companies.

            They are all sweetness and light when it comes to collecting the premiums but really turn to the dark side when they must pay out.

            We have been there.

            Like

      • Sentient says:

        Similar experience here. Five days in intensive care in 2017 resulted in a bill to me of $116,000. Once insurance processed it, the true bill got cut to $14,000. That’s right – $102,000 of bullshit. I paid $5,900 (my deductible) and insurance (Medica) paid the rest. So Medica paid out a little over $8,000 in a year in which the premiums they received (from me and my employer) for family coverage (for a high deductible policy) were around $19,000. The inflated nominal invoice for $116,000 serves the purpose of terrifying people into paying outrageous insurance premiums. Price transparency – as the president is mandating – is important, but prohibiting providers from billing different amounts (based solely upon method of payment) is also vital. The current scheme is a racket created to benefit the insurance companies.

        Liked by 4 people

        • Rhoda R says:

          A thought here: A lot of the price gouging is to cover the uninsured and illegals who use expensive medical facilities, personnel and drugs with paying a dime.

          Liked by 4 people

    • coltlending says:

      We’ve been ripped of for so long and by so much the point you make as justified as it is is infentesimal in the scheme of things.

      Most medical care can and should have price transparency.

      Ever notice why Dr.’s come in flanked with 2-3 other Dr.’s when they visit your room?

      Professional courtesy. Those other guys just dropping in with the primary Dr. bill.

      But the real money hustle doesn’t go in to the Dr.’s pocket. It goes in to the Insurance Company and corporate Hospital/Real Estate Co.’s pocket.

      I suspect One of many reasons say there is not medical price transparency is because with transparency a brighter light is shown upon the cost of medical care to illegal aliens, alcoholics and drug a users.

      Liked by 2 people

    • The Admiral says:

      This is still a MASSIVE good start!

      If it is combined with genuine oversight and reporting of medical outcomes of facilities and doctors, it will have a massive positive outcome over time.

      BUT… it may be pretty economically disruptive… but even if it is disruptive, after taking a dump because of market disruptions and displacements, the economy will come roaring back to life as hundreds of billions of dollars find somewhere else to go.

      Liked by 1 person

    • chojun says:

      That’s a part of the problem, but not a really big one.

      The biggest problem are people on employer-based PPO health plans where they simply pay a relatively tiny co-pay at the time service is provided. The true cost of their insurance is completely hidden to them. These types of patients or healthcare consumers are far more likely to seek routine care at emergency rooms (where the cost is between 3-10 times more expensive) instead of clinics etc and are far less likely to request generic alternatives for prescriptions.

      The relationship between providers, insurers, and employers has completely short-circuited the free market in healthcare and has artificially removed market forces. I would suggest that there are 4 major reasons why the healthcare market is broken in the United States:

      1) No price transparency due to relationships between providers, insurers, and employers/plan administrators. Price negotiations/contracts between the (sometimes perversely anti-trust) provider-insurer means the provider may charge vastly different prices for the same procedure to different patients with different coverage
      1a) As an aisde to #1, health provider billing typically is lazy in their approach and can be somewhat greedy at times so providers will use billing codes that result in maximum billable amounts when submitted to insurance
      2) Generally no need to ‘shop’ healthcare because the consumer pays very little of the actual cost (outside of premiums which are typically hidden from the consumer via payroll deductions)
      3) Due to #2, lack of desire among the general public to maintain their health early in life to avoid expenses later in life when health declines
      4) Un- or under-insured patients receiving ‘free’ care or otherwise not paying their bills, and medicare/medicaid reimbursement rejections cause care providers to eat the cost of care (in reality passing it off to the paying consumers in the form of sometimes grossly inflated bills)

      High Deductible Health Plans (HDHP) is a huge part of the solution to the problem because it makes the consumer directly responsible for the cost of their care and provides security in case of catastrophic healthcare expenses. These consumers are incentivized via Health Savings Accounts (HSA) where they can save and invest dollars into an account which grows and can be used for retirement after a certain age.

      Anyway, the whole system is broken at the moment but President Trump’s executive order is a big step in the right direction.

      Like

  2. Let the wailing resound inside all the congcritters lobbyists/insurance companies/testing facilities/etc…LOVE OUR PRESIDENT…Looking out for Americans!!! Outstanding Job, Sir!!!

    Liked by 9 people

  3. YEA YEA YEA, this is great news, this is the beginning I hope, but a stupendous start. Here is one other thing they have done this will stop. What they give you is not a price etc. They give you a price and you pay it for like lab tests. Then walk out. Then a few weeks later you get calls and letters saying you owe basically what you have already paid, and in some cases I am told much much more.

    So long story short. It was a NEW BILL after I paid, see the original was an ESTIMATE, and when it got to billing, it just flat out doubled. READ the documents you sign. Even the dentists have it, this is an estimate. As an estimate they can then have “claim” to up it, and the courts would uphold it.

    Car shops give estimates, but you know that up front and you can tell them if something happens its more you have to call me before doing the work. Big difference.

    It is a start and I bet Karl Denniger is jumping and saying FINALLLY. Have a cold on in the bar at Destin Karl, I know you read here also. Karl wrote a book a few years back outlaying how medical costs were going to bring down the country, I had mine signed by him when I bought him lunch. So Karl you know who this is. Bike says I know you had something to do with this, congratulations.

    Liked by 2 people

    • Steven Edwards says:

      Unfortunately it is impossible to get an estimate and give consent or negotiate when you are not conscious…which is where most people are **** by the system we have now.

      Like

      • BobBoxBody says:

        How about you quit whinebagging, troll.

        In mala fide.

        Liked by 1 person

      • Sentient says:

        It is possible, however, to require that the cost be the cost – with no disparity – whether that cost is paid by an insurance company or with cash by an uninsured patient. This executive order does not ensure that …yet… but it is a big step in exposing the fraud in medical billing, and moves us down the path of eliminating it.

        Liked by 1 person

  4. Hoosier_Friend? says:

    So now I can decide if I want to pay $5000 for a bandaid (which I do not). Thank you President Trump!

    Liked by 2 people

  5. L. E. Joiner says:

    This is a good start, but there is still way too much government control, and the constant confusion between medical care and health insurance.

    For a better approach, see my article, The Principles of Freedom and Medical Care, “How to to make free choice and free markets work in the increasingly complex world of contemporary healthcare”:

    https://walkingcreekworld.wordpress.com/2017/01/09/the-principles-of-freedom-and-medical-care/

    Like

    • Kiz says:

      Clearly a free market works. I go to Costa Rica for private medical care and pay cash. World class care and total control of my decisions. The guy giving you a scan shows you what he found in the spot. Copies of scans are handed to you and e-mailed to your doctor. Same with blood tests. There is no “The doctor has to see it first” BS. When I say world class I mean I can Google the doctor and see he/she is world renowned, except I can get in fast

      Like

  6. candyman says:

    $32,712 to diagnose a kidney stone 3 months ago, 2 1/2 hrs in a room getting a IV then left. Anything, anything to bring down costs!

    Liked by 5 people

    • My April Fools prize was a trip to the ER with a kidney stone.

      I feel your pain rhetorically and in fact.

      Liked by 2 people

    • Sentient says:

      If it’s any consolation, the real cost – which only the insurance companies know – is far less. There’s no way on God’s green earth any insurance company is paying $32k to diagnosis a kidney stone. The purpose of the $32,000 invoice is to make people feel lucky that they have insurance – even though the premiums are outrageous and the deductibles are so high most people are effectively self-insured. The biggest company in my state (MN) is United Health Group and they don’t make a goddamn thing!

      Like

    • maggiemoowho says:

      I was just going to post the same thing. I had a stone and a simple CT scan, given fluids and they told me to get used to passing stones because both kidneys were filled with them. That visit was over $40,000. Drink tons of fresh lemon water or lemonade, it really helps, i’ve passed eight stones since December with very little pain at all.

      Liked by 1 person

      • kp says:

        maggie,

        Great information, I was going to share the same… Lemonade has essentially ‘eliminated’ my problems with this too. Sounds too simple? Belief is in results! Acidic liquid works.

        Liked by 1 person

  7. booger71 says:

    This will work for simple procedures…lab work, tests , sutures, doctors visits and the like.. but any thing major like surgeries, no way a doctor or someone at a desk is going to be able to price it until they have you on the table

    Liked by 1 person

    • Horsepucky booger, just plain horsepucky. There is a hospital that already practices this in Oklahoma, the price is the price. Go overseas, the price is much less and they don’t do that.

      Liked by 1 person

      • Steven Edwards says:

        It works for elective procedures, anything you can schedule but cannot work in an emergency because you cannot negotiate if you are unconscious or dying.

        Negotiating requires a level playing field and the ability to walk away.

        Try walking away when you are at the ER with a kidney stone.

        Liked by 1 person

        • Yes, I said it is a start. However now you can walk in and SEE the price before you act. You do know it, you will not be surprised by a bill inflated beyond reason. You will know and can decide if you want to suffer a little and use your cell phone to make other calls for hospitals in the area and perhaps negotiate.

          This will overall have a great effect for many people. Insurance companies are in on the scam, and the hospitals get away with the BS of NON PROFIT and put a Christian label on the building as they steal your funds. Go to your hospital, look at the building. How many for patients and how many for pencil pushers and case managers etc etc etc. Long way to go. Its a start. Do away with current policies and go back to the eighties with pay the doc with your own funds. Watch how many don’t flood the docs office for a cold or sniffles and want an antibiotic no matter what cause they have insurance. That craps jacks it way up. Oh yes DENNINGER (speeeling)

          Liked by 2 people

        • This is the third time you have made your remarks about the problems on being informed of medical prices and needing emergency care Steven Edwards.

          We are more than aware that Pres Trumps executive order does not solve every single problem with our over priced health care and we are also aware of the stress people are under in an emergency situation.

          But just because this executive order does not solve the whole problem in one fell swoop is no reason to keep on harping about the small percentage of problems that arise in some one being cared for in an emergency situation with no family or friends to look after them.

          Yes overly expensive and perhaps unnecessary procedures during emergency care needs to be addressed.

          But what Pres Trump has accomplished here is amazing and a great first step.

          Liked by 6 people

          • bertdilbert says:

            The medical industry is about 18% of GDP and all combined probably has the biggest war chest of lobbying dollars. You can’t expect Trump to be able to walk into that kind of money without resistance. Total reform is going to be a battle. For now, take what you can get.

            Liked by 2 people

          • @ coloradochloe,
            Yes, good first step! However, Steven Edwards is also correct. It’s not just ER procedures. It’s every kind of major operation. I assisted in over 400 surgeries. 75% of them did not go as predicted, aside from a positive outcome. I was working at a Level 1 Trauma hospital. They take the cases most hospitals can’t.

            When you are talking about catastrophic car accidents, transplants, gunshot wounds, cancer, open heart procedures, even major orthopedic injuries, there’s still a lot imaging can’t map out ahead of time. You can’t tell completely what will be required, nor how much it will cost, because there’s also a per hour cost.

            There’s limited time in which to act when a patient is under general anesthesia. The longer they are under, the more other complications arise just from that, which depend on age and a variety of other factors. Too many unknowables.

            Liked by 4 people

            • I understand the “unknown” aspect of healthcare, surgeries, dental practice etc.

              Most of us who deal with people who give estimates know what that is, and estimate based on what the person providing the service thinks the job will cost.

              Often until the job is underway, things “pop up” that have to be dealt with that are not expected precisely but are always a possibility.

              So the base price of the “estimate” changes.

              We also understand the fast pace of emergency medical work where things need to be done that are not cheap but are vitally important.

              Health care is a complicated business we know that but we also know that right now the way things are going has to change.

              And writing the same post three or four times about how this does not fix everything single thing wrong with our out of whack health care system seemed over the top to me.

              Treepers are not unmindful of these problems and we are not stupid.

              Most of us here have a lot of experience with our medical system either as a patient or as a provider and Steven Edwards seemed to be a bit patronizing.

              I appreciate you very well expressed points also, but again I am familiar with everything you post.

              The variety of factors and the “unknowables” that medical providers must deal with are not exactly a secret.

              Again thanks for the post it was helpful.

              Liked by 2 people

            • 3rdday61 says:

              Mikey, in the situations you cite as examples(non ER) the most important limiting factor is indeed known. As you point out, the doc/team is limited by the length of time that particular patient can stay under anesthesia. Almost all of the potential complications are(should be) assessed and factored in before the surgery.
              If your experience is the rule rather than the exception, that only 25% of surgeries go as planned, then you’ve diagnosed an industry failure of way too many inexperienced/incompetent docs. No wonder costs are so high.
              God made us either male or female so, as a mechanic who had to know hundreds of makes,models,engines,etc.(yes, they’re all different), I’m not buying any of this only 25% of operations go as predicted. They’ve been working on the same two models since the first docs thousands of years ago. I hope somebody took some notes. ER/trauma, different story, but different rules also. You can’t be denied ER treatment by law, so the problem lies in just exactly WHAT constitutes an emergency.
              Surgery is of course a little more involved depending on the system being operated on, but there are ‘routine’ surgeries. Experience tends to mitigate complications.
              Anyhow, mechanics deal in potential life and death situations every time they repair a brake system. Just sayin.

              Liked by 1 person

              • Well, I don’t consider it incompetence. There are limits to current medical technology. We would love it if we could know completely what we’re in for before opening a patient’s abdomen. It’s only about 60-70% there so far.

                Like

        • I did just that. That is I walked away with a handful of hillbilly heroin after an IV and a scan. Took a month to pass. I hoarded some HH and next time I’ll try that first.

          Liked by 1 person

        • Yes but there is always due diligence.
          If I have two ERs in my area and they both post prices for XYZ and one is cheaper than the other, then I can basically guess which one might be cheaper for most things. Of course, the old adage you get what you pay for is also in play.
          You can have your preference on a medical bracelet and of course, if family is nearby, make sure they know your preference.

          Liked by 1 person

    • Paula S Daly says:

      Oklahoma Surgery Center has 70% of surgeries, what people need. Up front pricing.

      Liked by 3 people

    • No, booger is correct. Suppose you got authorization for taking out five inches of cancerous colon at a certain price, but once the patient is open they discover more cancer, which is a VERY common situation. If this EO became law, then the doctors would have to sew ‘em back up. Sorry, can’t exceed the contracted price. And it would cost just as much as the first operation to re-open the patient, since you would have to re-book the whole team and do all the prep over again.

      There would have to be exceptions for major procedures, period, or this idea is unworkable.

      Liked by 1 person

      • Sentient says:

        The insurance companies already deal with this via the coding system. Making the prices predetermined based upon code could work.

        Also, a back door way to eliminate pricing disparity (between insured and uninsured patients) is for the IRS to remove the tax-free status of any hospital that issues a fake invoice for $X when they know full well that the insurance industry agreed-upon price is 1/4 of $X. The majority of hospitals in this country are tax-exempt. Losing that status would get them to fly right in a heartbeat and have a ripple effect throughout the rest of the industry. This IRS change could be enacted without additional legislation.

        Liked by 1 person

        • Then all billing would have to be higher, ALL of it, just to factor in the probabilities for having to sometimes spend extra time/supplies/staff in cases which become more complicated during the operations.

          The hospitals that get the tax exemption are the ones that are not allowed to turn anyone away. That’s what the medical lobbies wanted in order to guarantee “no patient left behind”. A deal is a deal. If Congress revoked that, the unionized staff (most are) would walk.

          It also depends on the region whether most hospitals are non or for-profit. There are numerous for-profit hospitals and clinics in the affluent suburbs and enclaves. It was a big upside to working in Los Angeles county. if you wanted to be a saint, you could work at Gardena. If you needed to pay for your kid’s college, there are a hundred “boutique” hospitals. Sometimes a non-profit and a for-profit hospital would be located across the street from each other!

          Like

    • Liz says:

      If so why can they do it in Costa Rica? We get the price up front. My family have had three different surgeries down there. Excellent results and price up front. We are going down in a few months for colonoscopies. $650 set price. Includes delivery of the prep to your hotel and any sedation or no sedation. They give us what we want without hassle. Also they all speak English as medical tourism is big business and people come from all over.

      Like

      • Liz– Short answer is, “Trial Lawyers”. A longer answer involves litigation, malpractice insurance, lifetime earnings of a patient in Costa Rica v. United States, the necessity of maintaining Electronic Computerized Records instead of paper charts, in order to comply with the Affordable Healthcare Act, and these are only a few of the many, many reasons.

        The unbelievable and (very often) unnecessary tests, procedures, imagings, that have to be performed to CYA, here in the USA, aren’t a requisite in Costa Rica (or Mexico or India or Argentina or…)

        Like

  8. CopperTop says:

    “Even when insurance covers the cost, there is, on average, a 300 percent price variation within a market across — for the exact same services.”

    That was a key point.

    Liked by 6 people

    • That increase came from the “estimate” scam. Now all costs should be revealed and across the board. Even if you’re unconscious there should now be upfront costs posted for all procedures they perform.

      By the way another trick doctors and hospitals do with Medicare is this. Medicare only pays a certain amount for procedures. Lots of doctors want more. So they bill the patient in a private bill for what they really want. Medicare has paid what they will pay.

      so they are “post billing” and the medicare recipient gets a bill at their house. Most pay it thinking they have to. hmmm probably not. See once Medicare pays that is it. The doctors should not privately bill, but they do.

      Make that a felony

      Liked by 1 person

      • CopperTop says:

        Not sure on the second part. if you are talking about Medicare Part A –okay. But if Part B– there’s a co-pay. That’s legal.

        For example? A pre-hospital MRI might not be part A and they will see the Radiology group bill for that but think of the entire illness as as one part A covered.

        Second billing (double dipping) for Part A IS illegal.

        Liked by 1 person

  9. Paula S Daly says:

    Insurance never gets paid the amount, they ask for… even Medicare/Medicaid. They get at least, 50% less for every procedure.

    Liked by 1 person

    • How do you figure that Paula if there is no up front pricing. Insurance companies have “coding” for what they pay. ( and another whole industry for the person that work with that coding running up the cost)
      What they want and claim is bafoonery, just like money majik. convert air into dollars and make interest off of nothing given. Why the Constitution forbid it from outside banks, yet here ..we are, giving all that interest to outside actors. sure makes sense. not.

      Like

    • redhotrugmama says:

      Paula this is false. The insurance company pays the negotiated contractual rate to the provider based upon the ICD10 code submitted on the claim. The report you receive that shows what the provider was paid (called MSN or EOB) shows what the provider BILLS (which yes is always much higher), then it shows what the insurance company was CONTRACTUALLY OBLIGATED (this means the provider signed and agreed to this amount for the service) to pay then it shows any amount owed by the patient. The provider writes off the difference in their accounting procedures.

      Liked by 1 person

  10. Dee Paul Deje says:

    Under Bernie’s plan transparency won’t matter because it will all be free, free, free I tell you.

    Like

    • Sentient says:

      As they say, if you think it’s expensive now, just wait til it’s free. That being said, if the medical insurance companies – and to a lesser degree, the providers – don’t allow an end to their conspiratorial, fraudulent pricing schemes, we WILL get Single Payer – which will put them out of business. Unless something changes bigly, it’s just a matter of time. The number of “muh conservatives” who are willing to defend the criminal cluster**** we have now is dwindling as fast as the number who buy John Bolton’s intervention advice. Anyone who doesn’t acknowledge the growing appeal of “Medicare for All” is living in the past. It’s not because Medicare has gotten better. It’s because the rising price of private health insurance (and deductibles) has become intolerable. Erstwhile conservatives have started to whisper their interest in Single Payer in the same way that erstwhile democrats whispered their support for Trump in 2016.

      Like

  11. Paula S Daly says:

    Oklahoma Surgery Center, is built on this concept… We applaud our President for doing this. 70% of surgeries, are based around this… Thank PDJT!!!!

    Liked by 3 people

    • The name of the facility is the Surgery Center of Oklahoma (Oklahoma City), and it isn’t even a hospital! They only do specific procedures, none of which involve cancer (they have no oncologists). Nearly all of their medical staff are either ENTs or Orthopods, so they are performing the simplest operations, which I’m not saying are unimportant. Broken wrists and ankles still need fixing.

      MANY Surgery Centers are able to do package pricing, because they only perform medium to low risk procedures, and yes that covers the majority of operations in number. Low variables lowers cost. But a surgery center is not a hospital. Hospitals have to be prepared to do high-risk procedures and emergencies. It’s an apples vs oranges comparison.

      Liked by 2 people

  12. Yep … yep … yep …

    … but unfortunately for too-many of us, this is just a stopgap solution, meant to compensate (sic) for the fundamental fact that “every one of the available hospitals are … competing with one another … for profits.”

    (I just had a heart attack. Let me now spend the next hour-and-a-half on the Internet, trying to find for myself the least expensive(!) hospital that will … Ge@3$K!!) Oops.

    Fundamentally: As an American Citizen(!), you do not have a Constitutionally recognized right to health care. Nosiree, a government that spends hundreds of millions of dollars each year on the essential business of “blowing people up, half a planet away,” absolutely does not(!) have a farthing to spend on you.

    Always remember: “hospitals, doctors, and so on are for p-r-o-f-i-t businesses.” If they can’t make a profit doing it, they have no obligation whatsoever to you. And, a U.S. Government, that somehow can spend $160 million dollars on a single drone m-i-l-i-t-a-r-y airplane, cannot possibly(!) do one single thing to help … you.

    (After all, “who do you think you are, anyway?”)

    Liked by 1 person

  13. 94corvette says:

    It would be great to see on every bill how much they are adding to cover the costs of those who do not have insurance, the street people and the undocumented.

    Liked by 4 people

    • MAGADJT says:

      AND the overhead attributed to filing, negotiating with, and collecting from insurance. Price transparency would work great if everyone paid cash for their medical expenses. Consumers would pay less, and doctors and hospitals would make more.

      Liked by 2 people

  14. As gvt meddling is the Root Cause of this mess getting gvt out is the most obvious solution.

    Liked by 1 person

  15. Karl would explain it this way if I may. NOW they have to post their prices in advance. Say you to McDonalds they have the prices, they don’t change if its an emergency or your taking your Time, it is the same price.

    So claiming the bills for an emergency is pickin at nits. They can’t jack up the bills higher that is the point. YOu can’t make a conscious choice. Simple. Have your medical necklace bracelet etc (yea go buy one) and note your requests. Then if there was reasonable Time for them to act, you got a lawsuit.

    very interesting how many are trying to ‘pick some nits” to try and destroy an action that subjugates the medical industry into upfront pricing.

    Liked by 1 person

  16. Atawon says:

    Missing the issue. High costs are due to forced services for illegals and those not financially responsible.

    Liked by 2 people

  17. Paul B. says:

    This is huge. Had no idea it was coming. Daylight comes into the medical marketplace. Transparency, accountability, more true freedom of choice. God bless this man. He is doing so much good (with the exception of E15), in the face of powerful nefarious vested interests.

    Like

  18. Piper says:

    Thank God(and President Trump)!
    The only thing in the world that you “buy” and aren’t given a price upfront!
    This has ALWAYS infuriated me.
    Hope the crooked sickcare company’s follow the order.

    Liked by 1 person

  19. Bill says:

    Here is my question: What is the underlying cause for the high prices for medical care? Staff? Products such as bandaids or splints? Demand? Or is it some sort of government intervention/law that hamstrings the health care provider? Until someone can put their finger on the button of what the exact cause of the high costs then nothing will fix the issue.

    I’m very interested in some responses from people in the industry. I audited Cardinal Healthcare several years ago, but the portion of the audit I was involved in didn’t expose me to any of their cost drivers.

    Like

    • For years we have been told medical malpractice insurance and the high cost of doctor training/education. I’d be interested to see if these are the real factors or not.

      I do know a physician after passing the exams and before doing residency, can easily be 300,000 in debt. And t his is not from a top rated school.

      Like

      • Bill says:

        Their personal debt should not factor in to a parent practices costs. I could see how malpractice insurance could be a big factor. Maybe there needs to be a waiver process where patients can’t file frivolous law suits. And only absolutely gross negligence is pursuable.

        I was thinking that licensing fees required by the government could be the factor. Just like being a lawyer or CPA we are constantly paying fees and CPE costs on a personal level and practice level. It’s a non stop grift. I would love to know how much a practice/hospital has to pay in licensing and constant renewal and compliance fees. The CPA in me says we need to have public access to every medical practices financial statements (ie P&L, Balance Sheet, statement of cash flows…everything). Once they have been thoroughly reviewed by CPA’s, Actuaries and CFA’s then and only the will we be able to solve the underlying issue and get costs down.

        Liked by 2 people

        • I agree personal debt shouldn’t come into this but it is one of the excuses I’ve heard. Other fees would be key as well

          Like

        • MAGADJT says:

          Why not? It’s a cost of being able to practice medicine. It takes 8 years beyond an undergraduate degree to get licensed (4 years medical school, 3/4 years residency) and then they have to build their practice. That means they are in their mid 30’s before they start to earn a real income. That is about 10 years behind the rest of us, which is 10 years later in contributing to a 401K or retirement plan, 10 years later in buying a house, etc.

          Government required education is absolutely a factor in what our medical services cost.

          Liked by 2 people

        • Bill– Medical licensing fees vary from state to state, but around $700/year is farily average. That’s the current cost in Arizona. As far as Continuing Medical Education, again, every state is different, but 12-15 hours/ year are generally necessary. Depending on the topic that the physician chooses, as well as the location in which it’s being offered, $2,000-$5,000 will cover CME/year.

          Licensing and Continuing Med Ed are almost non-existent factors with regards to the high cost of Medical care. See my above post, regarding Medical Malpractice Insurance, as the single most expensive recurring cost that a physician must absorb.

          Like

      • redhotrugmama says:

        In 2012 my local OBGYN here in So. Cal paid 275K per year in malpractice insurance alone.

        Liked by 1 person

        • MAGADJT says:

          In FL, OBGYNs can’t get malpractice insurance because the jury awards are so obscene and there are no limitations, so they just don’t own anything personally. The only ones getting paid are the lawyers.

          Liked by 2 people

      • Rhoda R says:

        Reply to Conservativeninny: I don’t know the exact answer to your question but I’ll offer this: My uncle, a neurosurgeon, retired from practice when his malpractice insurance reached $1,000,000 a year. He’d never had a malpractice claim against him. He told me that his patients couldn’t afford what he would have to charge to make ends meet with that kind of insurance cost.

        Liked by 1 person

      • conservativeinny — On average, Medical Malpractice Insurance can cost an Ob/Gyn provider anywhere from $85,000 to as much as $200,000 per year, AVERAGE– So, this amount includes practitioners in Bugtussle, Oklahoma, to Los Angeles, California. The amount for malpractice for cardiovascular surgeons is much more, and malpractice insurance for neurosurgeons is even higher. Radiologists don’t pay near this amount, and pathologists pay even less. And, Medical Malpractice Insurance increases in cost for every year that the physician practices.

        Here’s a surprising fact that many people are unaware: The least amount ANY physician will pay, is for the very first year that they practice–despite that doctor’s inexperience. Why, you might ask? Because there is no “reservoir” of previous patients; there are ‘zero’ patients who would have an opportunity to sue the physician, since the physician has never before treated anyone.

        But here are the frightening stats for physicians who have been in practice for a few years.

        At age 45, for physicians in low-risk specialties, 36% have had at least 1 malpractice claim. For that same age physician who is practicing in a high-risk specialty, 88% have had at least 1 malpractice claim. Keep in mind that a physician is about 32-35 years old, by the time they’ve completed med school, a residency, and any sort internship necessary for extreme specialization. Pediatric Neurosurgeons aren’t turned out after a couple of years…

        At age 65, for physicians in low-risk specialties, 75% have at least 1 malpractice claim. For that same age physician who is practicing in a high-risk specialty, 99% have had at least 1 malpractice claim.

        Personally, as a 54 year old physician, I don’t know one, single practitioner who has never been sued. Sometimes, the physician prevails, but more often, the patient prevails. As a general rule, those physicians who practice in small towns and know their patients as individuals are less likely to be sued than the practitioner in a larger, metropolitan area, who has limited, to no personal knowledge, of their patients.

        (The numerical data for these stats are from a National Medical Malpractice Insurance Provider, Capson, Inc. for 2018. https://www.capson.com/getting-started)

        Like

    • BobBoxBody says:

      Clayton Christensen wrote a book on this several years ago that does a good job exploring these issues and ways of using technological innovation to help drive costs down (him and his students established a medical kiosk called Minute Clinic, look it up). The book is called The Innovator’s Prescription. Well worth the read since he’s getting input from lots of experts in the medical field but approaches the issue from a business perspective. Some of what Trump is doing is similar to what Christensen proposes in the book.

      Like

      • Bill says:

        BBB, our of curiosity, in the book do they go through financial statements in their determination of how to combat the cost drivers? Or did they simply speak with experts without actually analyzing the books of multiple providers?

        Like

        • Bill- Just to provide a bit of ‘behind-the-scene information’, and this pertains to just one specialty, but if an Oral and Maxillofacial Surgeon can keep his overhead cost to less than 76-78%, he is running an extremely cost efficient practice. This includes all OSHA required disposable equipment, all necessary equipment which can be sterilized, sterilization testing and control comparative basis testing, office staff and technicians, computers, software, office space rental/mortgage, CME for themselves and their staff, Medical Malpractice Insurance, electricity, water and other utilities, outsourced assistance (CPAs, payroll suppliers, Radiological Groups, Anesthesiologists, Marketing Professionals, ALCPR training, surgi-suites, janitorial staff, etc.)

          By the time patient ‘no-shows’ who don’t notify the office prior to cancelling their appointments combined with patients whose accounts become delinquent, then become completely-non-paying accounts, that P & L sheet becomes razor thin.

          Like

    • IMO the main cause of out high care cost is having health care under a free-market system. Capitalism works best for most kinds of work, but not for the cost of things that can’t be accurately estimated (in many cases) ahead of time. Each patient has a different reaction to meds and procedures, and different healing rates. Some colds go away in a day. Others progress to serious pneumonias. How you gonna guess which will be which ahead of time?

      Our laws say everyone gets treated somewhere, whether insured or not. So there’s a hospital in every county that can’t turn patients away. The cost for treating the uninsured gets passed to the insured. That drives up insurance premiums. Then public complains about the premiums, so some insurers lower those by covering fewer conditions and raising the out-of-pocket deductibles. Then those with crap insurance complain their out-of-pocket is too high. Rinse and repeat. It’s a never-ending cycle under a free market system.

      Frankly, Medicare was the easiest billing. All private insurers had to be negotiated with case-by-case. TREMENDOUSLY inefficient for the providers, but that’s how the insurers make their profit – by denying coverage and forcing patients to pay more of the cost.

      I’m just damn glad I was always a tech, paid the same as long as I performed the procedures correctly. Never had to guess which patients would do well, and which would fail to thrive.

      Like

      • Bill says:

        In this scenario the law appears to be underlying cost. But if you look closer, the uninsured that come in and are forced to be treated by law pass their costs on to those that have insurance. Insurance is once again the actual problem, not the law.

        Liked by 3 people

  20. Right to reply says:

    The most interesting thing in all this (and I don’t mean to generalize) is the majority of Doctors/Nurses/Care workers, are Bernie voting Socialists. They know THEY would be financially better off under Socialized care, even wealthier than now, and that is why they don’t support transparency. They want taxpayer money to go towards their upkeep, and the many middle and multi tier managers you get in a Socialist cesspit of corruption.

    Those oh so caring carers don’t want you to know a tooth extraction paid for privately in other countries is around $100 while they charge $1200…Those caring, vicious little Socialists!

    Like

    • WRONG!!!!! Totally ignorant, moronic, clueless, idiotic assumptions-based in zero knowledge of the health care industry class-envy driven post. Sorry- you are painfully ignorant.

      And to think you picked a cash business (Dentistry) as your case in point. You are dangerous.

      Healthcare professionals- especially MDs earn 30% less than they did 12 years ago. So much for your idiotic “even wealthier now” slather.

      What you woefully fail to understand is that the insurance/government alliance (Oligarchy to you ma’am) removed the financial relationship between customer (patient) and provider (MD) thus corrupting the free market and ultimately screwing the patient and then the provider.

      Maybe some cigarette smoking $15/hr low level employee in scrubs may like socialized medicine but the highly educated highly specialized doctor is NOT in favor of Bernie care.

      I apologize for my less than gentle bedside manner here but your ignorance is a disease and your ideas are dangerous.

      Liked by 1 person

    • LKAinLA says:

      I can assure you the statement of md’s and nurses wanting socialized healthcare is absurd. I can also assure you the “freebie, everything for free, including medical care” mentality runs cold on licensed professionals who worked for their degrees and work hard running hospital halls for patients. This would be a good time for everyone to brush up on the cost of illegals on healthcare. Also brush up on countries that provide the free medical care. You will find a tax rate of approx 70%, substandard care and not the best md’s. Anyone can go to med school in those countries. Also, you will find the population can’t sue for the poor and rationed care they receive.

      Liked by 4 people

    • MAGADJT says:

      Sorry but you’re an idiot. I know a lot of doctors and none are Bernie supporters or socialists. You may be posting in declarative sentences and an authoritative tone, but you have no clue what you’re talking about.

      Liked by 1 person

    • maggiemoowho says:

      In other countries you don’t have OSHA, malpractice insurance, continuing medical education, license fees and the list goes on. Most doctors and nurses are not for socialized medicine because it would ruin them financially, they would only make a fraction of what they make now.

      Liked by 1 person

  21. Right to reply says:

    The most interesting thing in all this (and I don’t mean to generalize) is the majority of Doctors/Nurses/Care workers, are Bernie voting Socialists. They know THEY would be financially better off under Socialized care, even wealthier than now, and that is why they don’t support transparency. They want taxpayer money to go towards their upkeep, and the many middle and multi tier managers you get in a Socialist cesspit of corruption.

    Those oh so caring carers don’t want you to know a tooth extraction paid for privately in other countries is around $100 (None taxpayer funded) while they charge $1200…Those caring, vicious little Socialists!

    Like

  22. Right to reply says:

    I don’t understand why posts don’t appear, and then they double post!

    Like

    • kp says:

      Right to Reply,

      Either wait longer or reload your page right after the post box closes up. Works for me, anyway. Then you don’t have to hit ‘Post Comment’ again. Hope this helps.

      Like

      • kp says:

        My MD friends also hate Bernie, Obamacare, etc.
        Each and every one, hate, their word.

        But they drive priuses to work and have SJW bumper stickers…until the weekend, then it’s bring out the gas guzzling toys!

        But anecdotal, as are all our experiences. We can undoubtedly find someone out there that still thinks witch ‘doctors’ are the way to go.

        Liked by 1 person

  23. Keep a sharp eye out for ASCs Ambulatory Surgical Centers. They are private for profit ORs (Operating rooms) for walk in walk out surgery. They are WAY less expensive than a regular hospital. This is a direct competitor to hospitals who are by and large big government Oboingo care supporting clepto-parasites. ASC’s are fighting uphill battles because of state sponsored monopoltistic practices known as CON’s (Certificate Of Needs). CONs are issued by the States as “needed providers” but the process is highly political (Democrat) and largely controlled by the big greedy corrupt hospital systems.

    ASCs allow for rational pricing and cannot hide $500 band aids and $5000/d ICU activities. In short they are free market mini hospitals owned largely by doctors who have a high accountability in pricing and services.

    One other thing (and I hope this does not get me deleted by *ahem, *cough* Mrs.) ASCs do not have affirmative action hiring requirements like big institutional hospitals do. They have merit based hires.

    Liked by 1 person

    • Good points! I would also highly recommend the use of Urgent Cares (if there’s one in your neighborhood), where I spent my last six years before retiring. They can address any type of wound or bone injury, including re-attaching fingers and toes and casting breaks. By law they must have imaging on-site. They do IVs and can stabilize a heart attack for transport. The providers have Emergency Medicine credentials. The cost to patients is even less than at surgery centers. As long as you aren’t unconscious, it’s a great source of rapid response. Most are walk-in only, and the wait is far less than at the ER.

      Like

    • Bendix says:

      There is a battle locally over this very issue. A hospital accusing an urgent care center which applied for a license to do ambulatory surgery of poaching the hospital’s patients.
      It’s kind of the doctor’s weapon in the pitched battle of who gets the biggest share of the profits in the health care wars.
      If the hospital hadn’t become a monopoly that treated patients like dirt they wouldn’t have had this problem.
      https://www.timesunion.com/news/article/Is-Albany-Med-poaching-Ellis-surgery-patients-13429416.php

      Like

    • Rhoda R says:

      Do these wonder centers take insurance? Do they take the indigent/illegals for free?

      Liked by 1 person

      • It’s up to each clinic. Mine took Medicare, but not Medicaid so no true indigents. They are exclusive to the local hospital. In northern WA we don’t see many illegals. We contracted with some insurances, but not all. Anyone could come in and pay a cash price as well.

        Like

      • Typically a privately owned for-profit ASC can take or refuse anybody they wish- just like your local nice restaurant. They can give away services for free, refuse service, or close down for the day and go fishin’. It’s a PRIVATE business so there is freedom.

        BTW the “non-profit” hospitals make truckloads of cash. Out local “charity” hospital system netted $215mm last year- all the while screwing over the MDs and the nurses, and begging for donations for the fund raiser scheme of the week. Non-profit my big white a**. They are a racket and a rip off deeply in bed with the corrupt as hell giverment.

        There was a time when a Hospital was an honest charity and a valuable member of the local community and a good corporate citizen. They were often funded by local churches. Those days are long gone.

        Like

      • Fools Gold says:

        Walked in one yesterday here in TN because wife needed relief of COPD. Regular physician couldn’t see her that day. It was fantastic, no wait, excellent care same as physicians office except she seen a PA. They took ATENA and Medicare. She had zero bill because Medicare deductible had already been met. My point is make a phone simple phone call to the urgent clinic and ask.

        Like

  24. Paula S Daly says:

    Best thing we ever did with our HealthCare, bar none. Insurance never pays, what is posted… ever. this will allow for more competition and put, hospitals out of business. I still have my letter to then, candidate Trump, regarding, this very subject…. I’m going to frame it and hang on my wall now. Thank PDJT, for addressing this Yuge issue! I love you for it!

    Liked by 1 person

  25. redhotrugmama says:

    All I have 20 + years in the insurance industry in operations, IT, management then working for the major supplier that processes medical claims. If you pull out your medical ID card and look at the data…I helped design the system that generates that card and pays the medical claims (with the exception of Aetna and Kaiser systems). So I have a bit of background on this topic. I have some thoughts about today’s executive order.

    While price transparency is a very good thing for consumers here are a few of my thoughts:
    1. Pricing is really from the following perspectives/services: Hospitals, Professional Services (doctors fall into this category), durable goods and pharma. There are not many hospitals out there that truly know the cost of their services. Hospitals have what they call a chargemaster. The chargemaster is considered the “cash price” and “negotiation starting point” for talks with insurance companies. They are getting a bit better at understanding costs, but its very complex. There are numerous articles on this topic. This is a good primer: http://truecostofhealthcare.org/hospital_financial_analysis/

    2. For commercial insurance health insurance provider contracting negotiates individual contracts with physicians, hospitals and other types of facilities (i.e. imaging). These contracts are very complex and contract negotiations are constantly ongoing. Contract duration varies, generally 1 to 3 years max. These contracts are based on diagnosis and procedure codes/ICD10 codes of which there are approximately 65k codes!

    3. For Medicare and Medicaid the prices are set by the agencies. These prices are not negotiable and hospitals and providers if they choose to provide services legally agree to accept the prices.

    Simple Example of System Logic to Process:
    Step 1: Doctors Visit for headache (patient has never had before) code=G44.52 the doctors costs is 450.00 and that amount along with the code is on the electronic claims submission to the insurance company
    Step 2: System logic looks to provider contract, looks for code G44.52 and sees that a) service is approved/allowed under the plan and b) their negotiated/contracted price for this code is 125.00 (this is known as the approved amount)
    Step 3: System looks to see if member has met their annual deductible (in this case we will assume they have already paid out their deductible).
    Step 4: System looks to see if member has a copayment (in our example member has no copay) plan designs determine how copays are or are not applied.
    Step 5: System looks to see if there is an annual out of pocket maximum (in this case it has yet to be met)
    Step 5: System looks to see if member has a coinsurance (in this example this member has 20% coinsurance)
    Step 6: Insurance company pays the doctor 100.00 (this is 80% of the contracted/approved amount).
    Step 7: The member is responsible for paying the doctor their 20% coinsurance of 25.00

    Now under the new Executive Order we want consumers to be able to see their costs before they choose where to obtain services. This will pose numerous challenges (that can be accomplished):
    1. Consumers will need to learn ICD10 codes (this wont happen)
    2. Insurance companies (and CMS/Medicare along with state Medicaid programs) will need to translate ICD10 codes to natural English language
    3. Here is where it gets complicated………………………once doctors and hospitals see the commercial insurance contracted rates the *%(#)*(%)# will hit the fan. If doctor A finds out that doctor B next door gets 100.00 per regular office visit and he/she gets 80.00 per visit what do you think he/she is going to do when their contract comes up for renewal? This is where the rubber meets the road. By exposing the prices that insurance companies negotiate……………..expect some prices to increase and some doctors and/or hospitals to cancel network agreement with insurance companies when they dont get what they want. It will happen.

    Developing the online process to show consumers total price transparency based on negotiated amounts paid by insurance companies will be a large undertaking by each insurance company. For CMS/Medicare/Medicaid it will be its own project as well. In my old world I estimated and led large scale projects like this. This will not be an easy undertaking. Best off the cuff guess is with a good solid project team this is a bare minimum of 2 to 3 year project. It also has a major usability component and needs to be carefully designed.

    Hope this helps shed some light on this topic. I could write more, but this post is already way too long:)

    Liked by 4 people

    • redhotrugmama says:

      I forgot to add that the difference between the provider cost of 425.00 and the amount negotiated for the service of 125.00 equates to a 300.00 loss. Usually depending on how the provider has structured his/her business the 300.00 is a write-off.

      Like

    • Bill says:

      This is a great post. And what it tells me is that the healthcare industry is not controlled by normal market forces. The main problem seems to be the insurance companies. They are driving costs up. Whether it’s manufactured or legitimate remains to be seen. It sounds to me just from reading your post that health care insurance should almost be an illegal business. They clearly can’t manage their business model and are seemingly destroying a service that is needed by most and could easily drive their own costs.

      We all pay a ton in premiums monthly for most of our adult lives. And when it comes time to go to the doctor for routine things we usually still have to pay some sort of copay or deductible. What the heck was all the money we paid in premiums for? And the insurance company’s excuse for needing the copay and deductible is that healthcare costs are so high that they need you to pay these expenses on top of premiums. So basically the insurance company is the cause and “solution” to their own problem. That doesn’t add up. Kind of like government when they create a problem and then ask to be voted in again so they can fix it.

      We need to let independent auditors take a deep dive into the health insurance industry and follow all the money wherever it may lead. That includes money that is paid to government officials via lobbying efforts. This whole situation can be solved. We just have to force them to openly look at the underlying costs.

      Liked by 1 person

      • L. E. Joiner says:

        Yes, the problem is that medical care “is not controlled by normal market forces.” The reasons are third-party payment, both government and private insurance, and also the failure to distinguish between insurance (for ‘catastrophic’ problems) versus medical care. We can solve the problem with HSAs (for medical care) and reserve insurance for catastrophic necessity.

        See ”The Principles of Freedom and Medical Care,” here:
        https://walkingcreekworld.wordpress.com/2017/01/09/the-principles-of-freedom-and-medical-care/

        Liked by 1 person

        • Bendix says:

          Yes. Insurance for doctor visits isn’t insurance, and it IS a bad idea.
          “But what am I going to do, I can’t afford a $200.00 visit and a prescription on top of that, out of pocket”, they wail.
          It never occurs to them that if they can afford hundreds of dollars in premiums every month (and a co-pay) they can certainly afford a doctor visit.
          Prescription coverage drives the costs of medicine up.

          Liked by 1 person

      • hypnotique59 says:

        There is an article on Hillsdale College, healthcare archives, titled A Short History of American Medical Insurance. I found it very informative. Unfortunately I do not know how to post a link using this tablet. Happy reading.

        Like

    • John says:

      Dr. Tricks:
      1. Choose the higher ICD code.
      Code for an “exploratory laparotomy,” instead of in “appendectomy.” Same surgery and same result. Higher reimbursement and possibly be able to keep the patient in the hospital, One extra day, if needed.
      2. Add diagnosis.
      Example: if the patient has a smoker, add “smoking cessation.”
      Simply tell the patient that he shouldn’t smoke, then document smoking counseling. You can get away with adding one level higher in your billing.
      3. With the EMR, it’s very easy to increase your billing level, by simply clicking on many more items. Choose many areas that are very obvious with any patient encounter: i.e.: psychological, appearance, neurological (awake, oriented, well-kept, regular gate, appropriate for age, etc.). This can pass As spending more time with patient. I’ve seen doctors bill 22 patients seen within four hours, at a level that would normally be considered approximately 45 minutes with each patient. Their actual Billing would be considered a 16 hour day.

      Like

      • All Too Much says:

        Dang. This was for Redhotrugmama. My bad.

        Like

      • redhotrugmama says:

        John you are 100% correct. The more codes they stack the more they get paid. I have a provider right now that has submitted over 10 claims like this for services they didn’t provide.

        It would go a long way for insurance companies(and government health plans such as Medicare) to offer incentives to patients/members to report billing vs. actual services provided discrepancies.

        Liked by 1 person

        • Bendix says:

          It also seems to me that the lack of a code can contribute to malpractice.
          I know of a woman who presented at an urgent care center in the NYC vicinity with severe abdominal pain. They decided she was ‘pill-seeking’ and kicked her out.
          Later that evening she was rushed to the hospital for an emergency appendectomy.

          In thinking about how this could have happened to a respectable wife and mother of three, with no history of any drug issues, and wondering why no one simply picked up the phone and called her doctor to find out her history, it occurred to me that maybe they wouldn’t get paid for a call so they didn’t do it.

          Like

    • All Too Much says:

      Paul S Daly – Thank you for posting your information.
      Medassets, now nThrive, has been working with large hospitals, nation-wide for well-more than a decade, providing the hospitals with significants cost savings. The system is based, in part, on price transparency, for hard goods, durable and not, as well as overhead and other things such as labor, management, and professional services. Trump’s order will expand the savings across the board. I’ve wondered why, if a private company can do it, what can’t, or won’t, the federal government? The EO is a legacy move for Trump.

      Actually, I began writing, asking you if you were aware of companies such as those in my example, and if you saw any impact on your part in the equations. That’s all.

      Like

    • iForgot says:

      The problem I see here is that all of this is illegal (felony) under long standing antitrust law. The customer is the patient receiving goods and services, not the insurance companies. It is illegal to charge two different customers two different prices for the same good of like kind and quantity. The insurance companies tried to argue an exemption all the way to the Supreme Court and lost. A few well selected prosecutions could put a stop to much of the problem to the point of being able to pay cash for many of the things that scare people into the arms of insurance companies.

      Like

  26. Clown #1 says:

    It amazes me how a specialist doctor can see you for five minutes and ask a few questions that you could have answered over the phone or online, then charged you hundreds of dollars for it and act like they are doing you a favor…

    Like

    • If you diagnose without actually seeing the patient (I’m talking initial diagnosis, not Rx refills), you lose your license. It isn’t allowed. While the doctor may appear to be only asking you a few questions, they are also observing your demeanor to see if you are being truthful, and observing your respiration rate, skin pallor and a dozen other things. Ask for a copy of your chart notes. You’ll find out all the stuff they assessed while you and they were talking. But of course patients do have the right to be listened to and not rushed.

      Some patients lie. They fudge drinking and drug use. They don’t take their meds as directed. There’s too much one can miss that may be vital unless you are in the room together. Plus, I don’t know how to take an x-ray, a blood sample or urine over the phone or online.

      Liked by 1 person

  27. Mel Alvord says:

    I don’t know if Dentists will be included with this EO or not but it certainly would be nice if they were. Dental cost vary for the same procedure to a very large degree.

    Like

  28. redhotrugmama says:

    If our government really wants to do something about healthcare premiums they really need to take a close look at ERISA.

    Over 60% of companies in the US self insure (pay medical claims of their employees). What this means is they contract with an insurance company for whats called Administrative Services Only (ASO). The company places money in escrow to cover claims and the insurance company does all of the administrative functions. The employer usually gets what is known as stop loss insurance to cover claims over a certain dollar amount. What the average person does not understand is that their employer often makes hiring/firing/layoff and benefits decisions based on the employee healthcare cost to the company. Just because your medical insurance ID card says for instance UnitedHealthcare does not mean your employer isn’t self insured. That fine detail is in your HR benefit documents. Employers that have employees and/or dependents of their employees that have high cost claims are most often the first targeted in layoff’s. If you think your employer can’t see your private healthcare data think again! They can and do use that data!

    Here is an article for example of what happened to AOL employees when there was a very expensive birth
    https://slate.com/human-interest/2014/02/tim-armstrong-blames-distressed-babies-for-aol-benefit-cuts-hes-talking-about-my-daughter.html

    https://www.theguardian.com/us-news/2015/jul/04/deanna-fei-aol-distressed-baby-healthcare-privacy

    Like

    • All Too Much says:

      “What the average person does not understand is that their employer often makes hiring/firing/layoff and benefits decisions based on the employee healthcare cost to the company.”

      Other than the average person’s understanding, what is wrong with the second part of you statement? Absolutely business look at the cost of doing business. Success would be difficult if they didn’t.

      Like

      • redhotrugmama says:

        Linking a persons health to conditions of being able to be employed is a major issue in our economy.

        I am of the opinion that healthcare benefits should be separate from employment. Meaning we all go online and select and pay for our own health insurance plan.

        All it takes is a family member to have a high dollar claim and you lose your job. That just isn’t right in my opinion.

        Like

    • L. E. Joiner says:

      There is no reason for medical care/health insurance to be tied to employment, and many reasons for them not to be. See ‘The Principles of Freedom and Medical Care’, here:
      https://walkingcreekworld.wordpress.com/2017/01/09/the-principles-of-freedom-and-medical-care/

      Like

  29. GB Bari says:

    Can’t wait to see how the Pelosicrats and their media buddies spin this negatively.

    Actually I don’t care what they say, it’s a great big first step in reining in the over-the-top medical costs.

    Liked by 1 person

  30. Paula S Daly says:

    I’ve been waiting for this for 20 years or more. Most people don’t even realize, insurance, let alone, Medicare/Medicaid. They only cover anything about 40%. That’s a fact. My husband went thru, Prostrate Cancer, and they only covered about 40%. Medicaid is even less. This opens up, more competition, not less. Been waiting for this! TY PDJT! No one else, had the balls to do it!!!!!

    Liked by 1 person

    • All Too Much says:

      Nice comments, PD. I replied to an earlier of yours, with a question.
      Keep posting. You have the background to educate us (me) about the details.

      Liked by 1 person

      • Paula S Daly says:

        Thank you, All too Much. I worked in the medical field, married a eye surgeon. I know, this shit. It doesn’t cover people with really bad issues, that are dying, but it covers most of the costs of most people. 70% or more. I love this, and been waiting for this. It’s one of my most important issues. TY PDJT for doing this! I love you, and I love you for doing it!

        Like

  31. MAGADJT says:

    I will tell you that my wife is a doctor (OBGYN). She sees a lot of patients. She has no clue what she gets paid. They are paid what the insurance company allows. This varies as different insurance companies pay different rates for the same procedure; what’s more, the same insurance company pays different rates for the same procedure based on the policy.

    The bottom line is doctors don’t set their own prices. They are told what they get paid.

    Liked by 3 people

    • All Too Much says:

      Insurance defense lawyers are under pretty much the same system – the insurer limits what the lawyer can do to defend the client. In my more than several decades of defending clients in civil lawsuits, I only once agreed to be paid by the insurer, at a rate substantially below my normal rate. After two months going back and forth with the insurer about the scope of how I would defend my client, I packed up the file and got the hell out of Dodge. A doctor, and a defense lawyer, should not be told how to practice by business people and geeks riding desks and staring at numbers all day.

      Like

      • MAGADJT says:

        Price transparency would work great if everyone paid out of pocket for medical care, but they don’t. When we go to the store we see the prices clearly. If we walk out with a gallon of milk, we pay 3.99. What if there were 20 different companies that acted as middlemen to pay for the milk on our behalf, and every one of them had 5 different prices they would pay for the milk? How could the store tell us how much the milk cost? It’s crazy.

        Like

    • Paula S Daly says:

      This is about, posting rates, like Surgery Center of Oklahoma…. to bring down costs of 70% of surgeries that people have to pay. This is not for, a baby being born, so stop, it, right now! No one’s not caring about babies being born, just had one myself. This is about, 70% of surgeries, that don’t require extra stays! Stop it people, and Stop, making shit up!

      Like

      • yadent says:

        This should be about posting rates for EVERY medical procedure by EVERY provider. ANY provider that claims not to know the cost of said service does so by CHOICE. They are aiding and abetting the medical industry’s violation of long-standing US antitrust law. This should also be about level billing. Same price regardless of cash or type of insurance. Saying this is only about ‘surgeries’ is like saying an auto mechanic only has to give you a quote/price for an engine repair but the suspension repair cost is going to be given to you AFTER being done.

        Like

  32. kp says:

    Obviously the main topic here is going to be HOT for days, weeks, months…

    There was a 2nd topic in there as well.

    “And, by the way, congratulations on ethanol. E15, right? He fought so hard. Oh, he’s tough. When he goes after you, he’s brutal.”

    1st I’ve heard of this. Did E15 get passed? Are we gonna’ have to use additives for every tank just like in chain saws, generators, etc.? Thought the farmer subsidies might go away and corn could be used for, you know, eating and stuff. It already smells like you’re following a popcorn machine in some traffic areas…

    Like

  33. maggiemoowho says:

    Hospitals should have to pay taxes, so should health insurance companies. Almost all hospitals and health insurance companies are tax exempt.

    Like

  34. Bendix says:

    Back during the run up to Obamacare, when I was studying the issue of “health care reform”, one anecdote I learned was that the walk-in doctor offices were beating the pants off the regular practices, because the consumer was back in charge, and pricing was more up front.
    I also learned that in Taiwan, doctor’s offices had prices posted like a McDonald’s. If you thought theirs were too high, you went somewhere else.
    This change was long overdue, and Obamacare served only to delay it by over a decade.

    As for not being sure of exact costs, as in the case of finding out a procedure entails more than was thought during surgery, my veterinarian manages to do a pretty good job with estimates. People will get used to this pretty quick, I think.

    As for shopping around, we have the problem of only certain hospitals taking some kinds of insurance, and even when patients carefully plan ahead, they are still ending up with outrageous bills from some service provider who doesn’t accept their insurance even though they work in the hospital that does. This will have to be looked at too.

    The horror stories are good, now that we are at long last looking at reform, the people who are doing that need t know what the problems are.

    This is yuge. Think how much more our VSG could have accomplished by now, if the CIA/FBI/MSM/The Evil Pelosi/Uniparty hadn’t fought him tooth and nail.
    Maybe that was the whole idea, they didn’t want this to happen.

    Thanks to Sundance, for providing the forum for our stories, so the president can have real people advising him, instead of those with pecuniary interests that clash with reform.

    Liked by 1 person

  35. Paula S Daly says:

    This is nothing more than bringing cost down, for Americans with 70% of the shit that happens to them, Everything else, is a big lie. Thank you very much… This American Patriot!!!!!

    Like

  36. noswamp says:

    This is a genius move. PERIOD. Those who think it is not needs to study Economics 101 and Macroeconomics 101. It will make a big difference. Just like that Charles Tiebout said indicated: that given the choice of freedom of movement between areas, and complete and total information, people essentially will vote with their feet. Or in this case buy from the cheapest high quality doctor available.

    Like

  37. dallasdan says:

    I enthusiastically support the President on this issue.

    My practice is commonly described as a concierge practice, where we provide fixed charges for specific treatments/surgeries, and the costs include hospital/pharmacy fees and consulting charges from experts outside our practice who are essential to providing the best possible medical/surgical outcomes. Patients know up-front what their care will cost.

    We do not accept any insurance, but will make the initial electronic filing with the patients’ insurance carriers. This process has reduced our administrative costs by 60%, savings we happily pass-on to our patients. We are paid 100% for routine office and rehabilitation treatments as they are delivered, and 50% prior to any surgical procedure with the balance due within 30 days thereafter, unless there are unforeseen complications.

    We have written agreements with the hospitals and consultants we use, and they are not permitted to bill patients in excess of specified, contracted amounts. This ceases the exorbitant over-billing by hospitals in order to fund their state-required “take all non-payers” requirements. Our patients experience no “billing surprises.” Unfortunately, smaller, less reputable practices can’t make these deals, and the President’s EO will help their patients the most.

    We do this successfully because we are one of the very few premier cardiology practices in the region, and our patients greatly favor the process. Yes, we are on the upside of the treatment cost curve, but you pay for and receive exceptionally fine, often life-saving care.

    Ours and the President’s model work for us and our patients because of its honesty or, in his words, transparency.

    Like

    • Liz says:

      I have a concierge GP. We pay cash for most everything and subscribe to a median age for emergency back up. My GP will coordinate with specialists in Costa Rica as needed. I love this system. When we needed something locally he knew who was good and less expensive. I recently learned how to get around not seeing my bloodwork until the doctor did. I found out I can order it online and pay up front. This dropped the price in half. The system I use in Costa Rica is very high end and still way cheaper than here, but the care is so much better that at this point I would pay more to go down there.

      Like

      • Liz says:

        Dang auto correct, we subscribe to a medishare

        Like

      • dallasdan says:

        The concierge model is the successful physician’s solution to oppressive government interference and the intimidation imposed by insurance companies. People are willing to pay a premium, represented by immediate/near immediate payment for services, for high-quality care delivered in a completely transparent transaction.

        Unfortunately, patients must continue to deal with insurance providers who abuse them as often as they do the doctors who must, for myriad reasons, accept their product.

        Like

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