Hospitals 1, Patients 0

by James C. Sherlock

Since January 1 of this year, after a court battle won in late December 2020 by the Trump Justice Department, the Centers for Medicare/Medicaid Services (CMS) has required hospitals to post median payer-specific negotiated rates.

I figured the fix was in when most hospitals in Virginia still haven’t complied. The Virginia Department of Health’s data contractor could have done it for all of them with data it already collects.

Sure enough, on April 27, the Biden administration’s CMS proposed repealing the transparency requirement. The elimination of this rule will be the latest casualty of the political power of the hospitals, especially with Democratic politicians.

Price transparency is wildly unpopular with hospitals because it exposes their huge rate differentials for the same procedure in the same hospital by the same medical team depending upon who is paying. These internal prices often vary by a factor of three.

Armed with that information, consumers can not only negotiate prices with their nearest hospital and shop prices among hospitals, but also compare them to other competitors like ambulatory surgical centers and independent medical imagery and testing centers.

These data are particularly useful to insurance brokers in serving their clients, businesses shopping for both insurance and providers and insurers negotiating rates. For insured patients, lower payments to hospitals mean stabilized or lower premiums and lower co-pays.

It won’t be the last hospital-friendly/patients-be damned-rule change coming out of the Biden Department of Health and Human Services. (They will be matched by the teachers-union friendly/students and parents be damned rules out of the Biden Department of Education.)

The hospitals and the politicians they dominate, most but not all of whom are Democrats:

  1. either hope the people who are disadvantaged — the rest of us — won’t notice; or
  2. they don’t care if we notice, because they think few will understand the costs to consumers; or
  3. they have political or health care monopolies in their districts; or
  4. all three.

I pick choice 4.

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4 responses to “Hospitals 1, Patients 0”

  1. CITIGROUP Joe to the rescue of business — those business leaders headquartered in Delaware are sitting fat and happy in their wood paneled country club cigar bars.

  2. DJRippert Avatar

    “Hey, Donald. Thanks for taking my call.”
    “No problem, Joe. What can I do for you?”
    “A little birdie told me that you ordered hospitals to post their rates. Is that right?”
    “Yeah, Joe. I thought people should know what hospitals charge insurers so they can shop around.”
    “Holy Mackerel! If hospitals run around posting rates there will be papers taped to the walls all over the place. It will make our hospitals look junky, don’t you think? I don’t want junky looking hospitals. No siree.”
    “The intention was that the rates would be posted on the internet, Joe”
    “How the hell are you going to tape something to the internet, Donald? I wasn’t born yesterday.”
    “Isn’t it time for you afternoon bowl of pudding, Joe?”
    “Yes it is. Pudding keeps me as fit as a butcher’s dog.”

  3. Publius Avatar

    Walmart, Target, Kroger, Food Lion, Publix, Aldi, Lidl, Whole Wallet, Fresh Market, Trader Joes, which ones have I left out?
    Richmond needs government help to lower the cost of groceries!
    What has happened to the cost of education and medical care ever since the government “helped?”
    How about illegitimate births?
    How much of the “disparities” can be attributed to kids being in single parent households?
    Transparency and competition in healthcare would be a good thing, so of course the Dems are against it.

  4. Nancy Naive Avatar
    Nancy Naive

    Sucks not to be King. Oh well, ain’t the first time you got the shaft.

    Of course, the ounter argument was two-fold; 1) nobody shops for medical care, and even if they did, the average American equates cost with quality in small choices, and 2) it forced hospitals to reveal costs breaks given the insurers. So Aetna, not getting as sweet a deal as Anthem threatens to take patients elsewhere, so the provider raises costs to Anthem.

    The fact that you even think a system like healthcare could operate like a free market puts you in the severely disadvantaged category

    You can’t win; you can’t break even; you can’t leave the game until it’s over.

    Also, not to nitpick, but have you ever shopped for a healthcare policy? Ever been denied coverage for a preexisting condition? Ever COBRA’ed with a former employer to keep coverage while you moved your family across country? Been on vacation and tried to find a doctor for your daughter who accepted your insurance, only to go to the ER? Of course not. 30 years in the military right into Tricare, right into Medicare with Tricare as a supplemental, which costs, what $400 per year?

    And one more question on your “other” subject of expertise. Have you ever read one paper on CRT that didn’t have the word “Marxist” in it?

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