Moderators: richierich, ua900, PanAm_DC10, hOMSaR

 
User avatar
trpmb6
Topic Author
Posts: 3014
Joined: Thu Apr 19, 2018 5:45 pm

New Federal rule on Hospital Pricing Structure

Sat Dec 07, 2019 10:39 pm

https://news.yahoo.com/trumps-big-healt ... 00560.html

Still trying to formulate my own opinion on this but thought I'd bring it up for discussion.

The new rule set to go into force in 2021 would require hospitals and thus insurance companies to release their negotiated rates. No more presenting inflated rates that everyone knows are fake.

I presume this would allow consumers to be more involved in their hospital choices, but in reality, you pretty much go where you have to go when hurt or sick. Perhaps this would help you make a more informed decision on choosing an insurance provider. Assuming you had much of a choice.
 
User avatar
stl07
Posts: 2293
Joined: Mon May 01, 2017 8:57 pm

Re: New Federal rule on Hospital Pricing Structure

Sat Dec 07, 2019 10:49 pm

It's a baby step in the right direction I guess
Instead of typing in "mods", consider using the report function.
Love how every "travel blogger" says they will never fly AA/Ethihad again and then says it again and again on subsequent flights.
 
User avatar
EstherLouise
Posts: 275
Joined: Tue Nov 14, 2017 6:16 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 1:20 am

Just make insurance companies pay the Medicare rate for everything and pass the savings onto the policyholders. What? Too much too soon?
712 722 732 734 737 738 741 742 744 752 762 772 A310 DC91 DC93 DC94 DC1030 DC1040 F100 MD82 MD83
 
User avatar
Tugger
Posts: 10288
Joined: Tue Apr 18, 2006 8:38 am

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 1:53 am

stl07 wrote:
It's a baby step in the right direction I guess

This.

It will create a discussion when people are able to see the "real rates" for hospital care. The hospitals/medical industry won't willingly give up their fake rates but hopefully a strong debate can begin as to what are "real rates".

My simplistic solution to hospital care rates is that no hospital system can charge more than the lowest negotiated rate. Additionally all systems must provided care across multiple markets and not only the same market. And finally they must equally provide in bottom percentage income markets as well as top income markets (this to prevent walled gardens with some systems focused on areas where they can jack up rates.

The idea is to drive competition and limit isolated markets. But this is off the cuff without a deep analysis on my part. So I am sure someone will tear the idea apart and point out all the weakness and stuff I didn't think about. Which is great, then the plan can be adjusted. (And yes the market and industry always adapts, to maximize advantage or profit, which is why things can not be static. Anyone who refuses to adjust things is just trying to impede or assist "their side" instead of working for the national good. But that's just my opinion. :wink2: )

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 4:38 am

I just wonder if this will create surge pricing?

Oh, dear... they found out how much we charge so we have to jack up our rates to keep our profits!

How is keeping people alive (every life is sacred!) now a for-profit endeavor?
You bet I'm pumped!!! I just had a green tea!!!
 
SanDiegoLover
Posts: 431
Joined: Sat Dec 10, 2016 12:24 am

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 4:48 am

When I lived in Singapore all of the health rates / procedures costs were easily accessible online. From sharing a hospital room with 5 other people, to two per room, to your own room. Certain hospitals became “centers of excellence” in say joint replacement, or cardiac surgeries, or plastic surgery. In Singapore everyone is covered at a basic level, with upgrades paid out of your mandatory medical savings account if you chose to have a private room or only one other person in your room. This mandatory savings account was a portion of your paycheck plus an employer paid portion. The average Singaporean citizen has enough savings to cover 8 hospitalization events. The average American? Less than 1.
 
GalaxyFlyer
Posts: 5481
Joined: Fri Jan 01, 2016 4:44 am

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 12:30 pm

seb146 wrote:
I just wonder if this will create surge pricing?

Oh, dear... they found out how much we charge so we have to jack up our rates to keep our profits!

How is keeping people alive (every life is sacred!) now a for-profit endeavor?


Same as any other service or product that keeps us above ground a “for profit” business. For example, food, clothes, shelter.
 
frmrCapCadet
Posts: 4004
Joined: Thu May 29, 2008 8:24 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 3:44 pm

The health industry is plagued with market failure. Prices are not visible. Purchases are not voluntary. Quality evaluations are not available. Intermediaries impose invisible costs. In our area the local religious mafia have bought out all of the hospitals, doctor practices, specialty care, hospice services. All under the alias of non-profit service. What they do would have, in the 1940s and 50s, been labeled criminal and result in prison sentences. But via lobbying it is all legal now. Waiting time for specialty services are often as long as they would be in Canada or the UK. The system somehow works, I will admit, but consuming 18% of our GNP it will bankrupt not just the victims, but the rest of us to boot.
Buffet: the airline business...has eaten up capital...like..no other (business)
 
User avatar
einsteinboricua
Posts: 8252
Joined: Thu Apr 15, 2010 4:11 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 4:24 pm

trpmb6 wrote:
I presume this would allow consumers to be more involved in their hospital choices, but in reality, you pretty much go where you have to go when hurt or sick. Perhaps this would help you make a more informed decision on choosing an insurance provider. Assuming you had much of a choice.

Indeed. However, if I know group A charges more for the same service that group B provides, why wouldn't I try to go with group B?

I think it's a necessary thing. How exactly are rates determined?
"You haven't seen a tree until you've seen its shadow from the sky."
 
hashtagconfused
Posts: 59
Joined: Thu Apr 18, 2019 5:35 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 5:22 pm

seb146 wrote:
How is keeping people alive (every life is sacred!) now a for-profit endeavor?


when was it not?
 
tommy1808
Posts: 12769
Joined: Thu Nov 21, 2013 3:24 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 5:30 pm

hashtagconfused wrote:
seb146 wrote:
How is keeping people alive (every life is sacred!) now a for-profit endeavor?


when was it not?


All the places where healtinsurances are legally banned from making a profit and/or set prices that only allow Profits if you are more efficient, if at all?

Best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 5:35 pm

hashtagconfused wrote:
seb146 wrote:
How is keeping people alive (every life is sacred!) now a for-profit endeavor?


when was it not?


That is my point. In the United States, it is purely run for profit and not for the good of all. Gilead is being sued for the insane profits they have been making off HIV and PReP medications. The research into those medications were publicly funded by us taxpayers. Gilead claims they didn't have to make a generic and so could charge whatever they want.

https://www.biospace.com/article/gilead ... n-lawsuit/

It does not stop with HIV and PReP meds. We have no public option so we have to pay 100% out of pocket for medical expenses. For simple routine check ups. So, if someone gets really sick from whatever, they will find out in the ER and get a huge bill and have to find a way to finance their treatment. All because we can not afford regular doctor visits. For these companies to simply say "here is our pricing structure for hospital stays" does literally zero to help us pay for our routine care. Or anything.
You bet I'm pumped!!! I just had a green tea!!!
 
User avatar
Thunderboltdrgn
Posts: 2028
Joined: Wed Jan 18, 2012 5:39 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 6:20 pm

einsteinboricua wrote:
trpmb6 wrote:
I presume this would allow consumers to be more involved in their hospital choices, but in reality, you pretty much go where you have to go when hurt or sick. Perhaps this would help you make a more informed decision on choosing an insurance provider. Assuming you had much of a choice.

Indeed. However, if I know group A charges more for the same service that group B provides, why wouldn't I try to go with group B?

I think it's a necessary thing. How exactly are rates determined?


We use something called DRG**.In Sweden we use NordDRG

It takes several factors into account, such as gender, age, primary diagnose code (as in main illness (ICD 10)), secondary diagnose codes (other illnesses)*,
in patient care/out patient care,profession for out patient care visit (as in doctors, nurse, Speech and language therapist and etc), in patient care also takes into
account what measures (currently there are about 10500 different measures) that has been takes regardless if they are small or big, as well as how the patient was
discharged (home, another hospital and etc), days/nights admitted... For out patient care only the primary diagnose code is used to determine the cost/DRG category
but for in-patient care all the factors are take in to account. The result will be put into one of the 27 DRG weight categories (MDC (Major Diagnostic Categories)).
In Sweden a DRG weight of 1 is equal to a cost of about 55'000 SEK (about 5800 USD/ 5200 EUR) then all the DRG categories are based on this. DRG weight
1 is based on the average cost of all medical visits and admissions and to get the DRG weight you divide DRG weight 1 (55 000) with the
the cost of the visit/admission. Also the weight of illnesses and measures depends on how severe/advanced/complicated they are.
Photo documentation with a digital camera is obviously very simple compared to brain surgery or appendectomy in the same way as
an acute upper airways infection (common cold, code J06.9) is more simple then metastasised lung cancer.

Sorry is this is a bit unstructural.

*usually only illnesses (or other medical factor) that is relevant to the actual visit/main illness, like things that complicates the care.
Good examples are diabetes or treatment with anticoagulant medicine,

**Other DRG systems: USA: CMS DRG (Centers for Medicare & Medicaid Services DRG), AP-DRG (All Patient DRG), R-DRG(Refined DRG)
and APR-DRG (All Patient Refined DRG). GHM (Groupes Homogènes de Malades) in France and AR-DRG (Australian Refined DRG) in Australia.
Like a thunderbolt of lightning the Dragon roars across the sky. Il Drago Ruggente
 
hashtagconfused
Posts: 59
Joined: Thu Apr 18, 2019 5:35 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 7:00 pm

seb146 wrote:
We have no public option so we have to pay 100% out of pocket for medical expenses.


how does the public option get paid for? the hospitals and doctors will not start giving care for free simply because it is a public option
 
SanDiegoLover
Posts: 431
Joined: Sat Dec 10, 2016 12:24 am

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 8:37 pm

hashtagconfused wrote:
seb146 wrote:
We have no public option so we have to pay 100% out of pocket for medical expenses.


how does the public option get paid for? the hospitals and doctors will not start giving care for free simply because it is a public option


The public option would figure out what Medicare costs, and you would pay the government monthly for your Medicare Insurance premiums. Your Medicare insurance card would be just like regular Medicare and providers reimbursed accordingly. That way the “free market” would have the US federal government as a competitor.
 
frmrCapCadet
Posts: 4004
Joined: Thu May 29, 2008 8:24 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 8:45 pm

NYT has an op-ed today by a Kaiser Foundation person. She says essentially what I said. Hospitals commit what would have been called out and out fraud, particularly in emergency rooms. Patients are billed by person never seen, and who do not for the patient. Overcharges are standard. They have lobbied congress such that fraud is accepted and a standard practice.
Buffet: the airline business...has eaten up capital...like..no other (business)
 
hashtagconfused
Posts: 59
Joined: Thu Apr 18, 2019 5:35 pm

Re: New Federal rule on Hospital Pricing Structure

Sun Dec 08, 2019 9:06 pm

tommy1808 wrote:
hashtagconfused wrote:
seb146 wrote:
How is keeping people alive (every life is sacred!) now a for-profit endeavor?


when was it not?


All the places where healtinsurances are legally banned from making a profit and/or set prices that only allow Profits if you are more efficient, if at all?

Best regards
Thomas


are just the health insurers banned from profits or the are the hospitals, doctors, other various providers, etc also banned? which places are these?
 
User avatar
Tugger
Posts: 10288
Joined: Tue Apr 18, 2006 8:38 am

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 12:08 am

frmrCapCadet wrote:
NYT has an op-ed today by a Kaiser Foundation person. She says essentially what I said. Hospitals commit what would have been called out and out fraud, particularly in emergency rooms. Patients are billed by person never seen, and who do not for the patient. Overcharges are standard. They have lobbied congress such that fraud is accepted and a standard practice.

do you have a link to that? I tried googling "NYT op-ed Kaiser Foundation" but it didn't come up.

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
User avatar
casinterest
Posts: 11058
Joined: Sat Feb 12, 2005 5:30 am

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 12:09 am

I will be glad to give this as a win to the Trump administration should it go into effect. Part of the issue with going to a hospital, doctor , or urgent care is that no one knows the up front costs. An app on a phone would be great for analyzing symptoms , possible outcomes/reviews and best prices at nearby care facilities for non-emergency items. This is well overdue.
Where ever you go, there you are.
 
User avatar
Tugger
Posts: 10288
Joined: Tue Apr 18, 2006 8:38 am

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 12:15 am

SanDiegoLover wrote:
When I lived in Singapore all of the health rates / procedures costs were easily accessible online. From sharing a hospital room with 5 other people, to two per room, to your own room. Certain hospitals became “centers of excellence” in say joint replacement, or cardiac surgeries, or plastic surgery. In Singapore everyone is covered at a basic level, with upgrades paid out of your mandatory medical savings account if you chose to have a private room or only one other person in your room.

The gigantic difference though is that in Singapore you don't have remote hospitals in the middle of the country serving a population of 40,000-100,000 with limited options and any "major care" is done at another hospital more than 100 miles away.

That is a big cost discrepancy problem within the US medical system. There needs to some method to level costs for hospitals if you are going to level the costs to the patients. That is why I was suggesting hospital systems be required to have multiple locations spread across high and low cost regions. So there could be some kind of cost leveling created.

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
Ken777
Posts: 10037
Joined: Thu Mar 11, 2004 5:39 am

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 1:16 am

Before we actually see any reform of US Health we need to understand that the industry will deliver billions to politicians to keep their sweet deal going? Notice that Trump's wonderful reform starts AFTER the 2020 election so he can let it be repealed without political problems for him personally - and maybe some personal profits after he leaves office.

The best information we could get would be CMS publishing their payments for Medicare and Medicaid with insurance companies being required to publish their negotiated rates. Hospitals should face a significant tax on all fees over the core negotiated rate, like 150% on the excess.

We also need to start looking at drug companies who block generic drugs. This is one area where putative measures are needed.
 
frmrCapCadet
Posts: 4004
Joined: Thu May 29, 2008 8:24 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 3:29 am

Tugger wrote:
frmrCapCadet wrote:
NYT has an op-ed today by a Kaiser Foundation person. She says essentially what I said. Hospitals commit what would have been called out and out fraud, particularly in emergency rooms. Patients are billed by person never seen, and who do not for the patient. Overcharges are standard. They have lobbied congress such that fraud is accepted and a standard practice.

do you have a link to that? I tried googling "NYT op-ed Kaiser Foundation" but it didn't come up.

Tugg



https://www.nytimes.com/2019/12/07/opin ... fraud.html

It disappeared from the main front page, but found the link on my history
Buffet: the airline business...has eaten up capital...like..no other (business)
 
User avatar
trpmb6
Topic Author
Posts: 3014
Joined: Thu Apr 19, 2018 5:45 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 4:33 am

On a personal note, this is of particular interest to me recently because I am currently fighting a hospital and my insurance for what amounts to the difference of a private room vs a shared room.

See earlier this summer I had a routine procedure that went wrong. Infection etc. Spent a long time under the care of infectious disease doctors in a private room. Went septic and almost died. But apparently I should be held responsible for the private room rate despite never being told the two were different. (In truth I was under such a concoction of drugs that there is no way I could have made such a decision).

My beef isnt that they may have a pricing difference for different rooms. My beef is I wasn't informed of such.
 
tommy1808
Posts: 12769
Joined: Thu Nov 21, 2013 3:24 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 6:19 am

hashtagconfused wrote:
tommy1808 wrote:
hashtagconfused wrote:

when was it not?


All the places where healtinsurances are legally banned from making a profit and/or set prices that only allow Profits if you are more efficient, if at all?

Best regards
Thomas


are just the health insurers banned from profits or the are the hospitals, doctors, other various providers, etc also banned? which places are these?


Insurances are banned from making profits* in Germany and Switzerland, and probably most of Europe. Hospitals are not, but at least in Germany prices they can charge are regulated in a take it or leave it fashion, so is mediation or what your physician can charge. Many hospitals are however run by non-profit organisations, giving you a healthy competition between for profit and non-profit hospitals. Quality is incentivised by not paying an extra dime for complications and only pay x-day post surgery stay for example. If you want to make a profit, your care has to be quicker and of higher quality. Of course lobbying and the need to set prices in a way to sustain rural medical services keeps it from unfolding the full effect, but the direction is the right one.

best regards
Thomas

*they can sell "upgrades", like insurance to cover single bed rooms, for profit.
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
B777LRF
Posts: 2668
Joined: Sun Nov 02, 2008 4:23 am

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 6:43 am

If I'm sick, I call the doctor and go see him. That costs nothing. If he finds I'm really ill, he'll admit me to a hospital. That costs nothing. At the hospital they'll throw the entire knowledge of modern medicine at me, in an attempt to fix what's wrong. That costs nothing. I'll stay in the hospital until the doctors find I'm ok to go home, which costs nothing. If there's need for after care, a nurse or doctor will visit me at home however often it's needed, and it costs nothing.

I do have to pay for the medicine once I'm out of the hospital (it's free whilst admitted), but that's heavily price controlled. And, if I'm unlucky enough to need a lot of medicine, it becomes almost free of charge once I've spent the equivalent of around 500 USD in a rolling year. That is to say, if my medicine costs 500 USD the first month, it'll be virtually free for the remaining 11 months of the year. And that 500 USD limit is only because I'm working; for pensioner or permanently ill citizens it's virtually free from the get go.

Yes, I know, living in a wealthy social-democratic country is absolutely horrible. Mind you, I do have to pay around 30% of my salary for this benefit. I know, shocking.
Signature. You just read one.
 
tommy1808
Posts: 12769
Joined: Thu Nov 21, 2013 3:24 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 7:07 am

B777LRF wrote:
If I'm sick, I call the doctor and go see him. That costs nothing. If he finds I'm really ill, he'll admit me to a hospital. That costs nothing. At the hospital they'll throw the entire knowledge of modern medicine at me, in an attempt to fix what's wrong. That costs nothing. I'll stay in the hospital until the doctors find I'm ok to go home, which costs nothing. If there's need for after care, a nurse or doctor will visit me at home however often it's needed, and it costs nothing.

I do have to pay for the medicine once I'm out of the hospital (it's free whilst admitted), but that's heavily price controlled. And, if I'm unlucky enough to need a lot of medicine, it becomes almost free of charge once I've spent the equivalent of around 500 USD in a rolling year. That is to say, if my medicine costs 500 USD the first month, it'll be virtually free for the remaining 11 months of the year. And that 500 USD limit is only because I'm working; for pensioner or permanently ill citizens it's virtually free from the get go.

Yes, I know, living in a wealthy social-democratic country is absolutely horrible. Mind you, I do have to pay around 30% of my salary for this benefit. I know, shocking.


Essentially the same for me here, costs 14.6% of my gross income, split about half between me and my employer. I am well beyond the half time point of my live and to the best of my knowledge i have seen two medical bills in my life: One for vaccination i got when traveling to Africa, one for a 30 EUR surcharge because i wanted a better ceramic filling at the dentist.....
Never been hospitalized as an adult, in that case i would have seen a 10 EUR invoice/day, essentially for the food i eat while i am there.

I have several US friends that went through bankruptcy and/or lost house/business over medical bills.... utterly ridiculous system.

best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
JJJ
Posts: 3620
Joined: Wed May 31, 2006 5:12 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 9:12 am

tommy1808 wrote:
hashtagconfused wrote:
tommy1808 wrote:

All the places where healtinsurances are legally banned from making a profit and/or set prices that only allow Profits if you are more efficient, if at all?

Best regards
Thomas


are just the health insurers banned from profits or the are the hospitals, doctors, other various providers, etc also banned? which places are these?


Insurances are banned from making profits* in Germany and Switzerland, and probably most of Europe.


Countries with a central NHS-style system don't usually have any rules banning profits for health care providers.

The key is that those companies are competing with care that's free at the point of delivery, so they mostly focus on patient comfort and amenities rather than actual healthcare.
 
tommy1808
Posts: 12769
Joined: Thu Nov 21, 2013 3:24 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 9:18 am

JJJ wrote:
tommy1808 wrote:
hashtagconfused wrote:

are just the health insurers banned from profits or the are the hospitals, doctors, other various providers, etc also banned? which places are these?


Insurances are banned from making profits* in Germany and Switzerland, and probably most of Europe.


Countries with a central NHS-style system don't usually have any rules banning profits for health care providers.

The key is that those companies are competing with care that's free at the point of delivery, so they mostly focus on patient comfort and amenities rather than actual healthcare.


yup, you need a system in place to prevent that.

best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
Dieuwer
Posts: 2327
Joined: Tue Dec 26, 2017 6:27 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 5:58 pm

Tugger wrote:
My simplistic solution to hospital care rates is that no hospital system can charge more than the lowest negotiated rate. Additionally all systems must provided care across multiple markets and not only the same market. And finally they must equally provide in bottom percentage income markets as well as top income markets (this to prevent walled gardens with some systems focused on areas where they can jack up rates.

The idea is to drive competition and limit isolated markets. But this is off the cuff without a deep analysis on my part. So I am sure someone will tear the idea apart and point out all the weakness and stuff I didn't think about. Which is great, then the plan can be adjusted. (And yes the market and industry always adapts, to maximize advantage or profit, which is why things can not be static. Anyone who refuses to adjust things is just trying to impede or assist "their side" instead of working for the national good. But that's just my opinion. :wink2: )

Tugg


It depends on the profit margin of the hospital, right? Because if a high- or medium-cost hospital has an minuscule profit margin right now, paying the lowest negotiated rate will mean SALARY CUTS for doctors and nurses.

seb146 wrote:

Gilead is being sued for the insane profits they have been making off HIV and PReP medications. The research into those medications were publicly funded by us taxpayers. Gilead claims they didn't have to make a generic and so could charge whatever they want.

https://www.biospace.com/article/gilead ... n-lawsuit/


Perhaps it would be a good idea that patents derived from publicly funded research should contain a clause stating that medications should be made available at the generic rate (<3% profit margin).
 
tommy1808
Posts: 12769
Joined: Thu Nov 21, 2013 3:24 pm

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 7:09 pm

Dieuwer wrote:
Perhaps it would be a good idea that patents derived from publicly funded research should contain a clause stating that medications should be made available at the generic rate (<3% profit margin).


Just GPL the research... you can use this for free, all patents used in the medication using this have to be made available under the same condition. Cost will drop to competitive manufacturing pricing ....

Best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
User avatar
Tugger
Posts: 10288
Joined: Tue Apr 18, 2006 8:38 am

Re: New Federal rule on Hospital Pricing Structure

Mon Dec 09, 2019 9:32 pm

tommy1808 wrote:
Dieuwer wrote:
Perhaps it would be a good idea that patents derived from publicly funded research should contain a clause stating that medications should be made available at the generic rate (<3% profit margin).


Just GPL the research... you can use this for free, all patents used in the medication using this have to be made available under the same condition. Cost will drop to competitive manufacturing pricing ....

Best regards
Thomas

Sure, and then no company will team with any public university for research and the private funding dollars will completely dry up. All research will move to private universities or corporate controlled institutes and the costs will go even higher.

Soooo, I don't think it is a very wise idea overall.

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
tommy1808
Posts: 12769
Joined: Thu Nov 21, 2013 3:24 pm

Re: New Federal rule on Hospital Pricing Structure

Tue Dec 10, 2019 5:47 am

Tugger wrote:
tommy1808 wrote:
Dieuwer wrote:
Perhaps it would be a good idea that patents derived from publicly funded research should contain a clause stating that medications should be made available at the generic rate (<3% profit margin).


Just GPL the research... you can use this for free, all patents used in the medication using this have to be made available under the same condition. Cost will drop to competitive manufacturing pricing ....

Best regards
Thomas

Sure, and then no company will team with any public university for research and the private funding dollars will completely dry up. All research will move to private universities or corporate controlled institutes and the costs will go even higher.

Soooo, I don't think it is a very wise idea overall.

Tugg


Maybe that will happen, exactly like with Software .... oh.. wait.....

The overall Pharma R&D Budget wordwide is a lot less than 200 Billion, sounds much, but since no single company spends much above 10 billion and they are highly secretive about what they do, the over all bang for all those bucks is probably a lot closer to each companies spending than to the world total. Lets be generous and say that handing money out as research grands would get the same result for 100 Billion. I am fairly sure 20-25 would do it in a normal, openly communicating science setting, and since pharmaceuticals set us all back by almost 1.5 trillion each year, that being shrunk down to the cost of approval, manufacturing and quality control will easily reduce that by a trillion.
Saving 900+ billion a year while making pharmaceuticals commodities, and hence accessible, sounds like a perfectly good reason to send an industry over the plank. There will still be money to be made by securing approvals, manufacturing and distribution. They would also be free to set up research institutes.

best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
User avatar
Tugger
Posts: 10288
Joined: Tue Apr 18, 2006 8:38 am

Re: New Federal rule on Hospital Pricing Structure

Tue Dec 10, 2019 7:04 am

tommy1808 wrote:
Maybe that will happen, exactly like with Software .... oh.. wait.....


Except pharma has patents on molecules.... there is no equivalent in software. Yes there are patents on lines of code but they can be often surmounted or written around. Molecules are far more difficult to get around.

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
tommy1808
Posts: 12769
Joined: Thu Nov 21, 2013 3:24 pm

Re: New Federal rule on Hospital Pricing Structure

Tue Dec 10, 2019 7:49 am

Tugger wrote:
tommy1808 wrote:
Maybe that will happen, exactly like with Software .... oh.. wait.....


Except pharma has patents on molecules.... there is no equivalent in software. Yes there are patents on lines of code but they can be often surmounted or written around. Molecules are far more difficult to get around.

Tugg


a) Patents run out rather quickly
b) They could only use them in products not using any "Pharma-GPL" knowledge, so weaponizing them won´t work beyond very short term. Its an embrace or die kinda thing.
c) Under Article 5A.(2) of the Paris Convention they can be compelled to license their patents when they are three to four years old, so best they can hope for is making some licensing money until the patents run out

Other options are also available, since PGPL medication has the scrutiny of the whole scientific community and no commercial interest to play lose with side effects and such, its is essentially by definition safer. So we can make the price difference between getting an proprietary medication and PGPL medication large enough to make the former a bad investments.

best regards
Thomas
Well, there is prophecy in the bible after all: 2 Timothy 3:1-6
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Tue Dec 10, 2019 6:07 pm

I am still not seeing how this will help those of us who can not afford health insurance anyway. Sure, we can see the price (taxes and fees extra, prices may vary) but if we can not even afford to see a regular doctor on a regular basis or if we have to set up internet funding just for one round of chemo, how does seeing a hospital room price help?
You bet I'm pumped!!! I just had a green tea!!!
 
User avatar
trpmb6
Topic Author
Posts: 3014
Joined: Thu Apr 19, 2018 5:45 pm

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 12:44 am

seb146 wrote:
I am still not seeing how this will help those of us who can not afford health insurance anyway. Sure, we can see the price (taxes and fees extra, prices may vary) but if we can not even afford to see a regular doctor on a regular basis or if we have to set up internet funding just for one round of chemo, how does seeing a hospital room price help?


Well.. it wasn't supposed to address that? And it's more than just the price of the room. In theory having all the negotiated rates made public would help drive more competition and drive costs down and drive hospitals to make improvements in care for the same costs.
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 1:10 am

trpmb6 wrote:
seb146 wrote:
I am still not seeing how this will help those of us who can not afford health insurance anyway. Sure, we can see the price (taxes and fees extra, prices may vary) but if we can not even afford to see a regular doctor on a regular basis or if we have to set up internet funding just for one round of chemo, how does seeing a hospital room price help?


Well.. it wasn't supposed to address that? And it's more than just the price of the room. In theory having all the negotiated rates made public would help drive more competition and drive costs down and drive hospitals to make improvements in care for the same costs.


But that is not going to happen. What will happen is some insurance companies will pull out of markets because they will not be able to turn obscene profits like they have been. Other insurance companies will simply cover those rooms they can make a profit from.

As a "Christian" nation, when did this become acceptable? That the sick are to be profited off of? That greed is the greatest commandment? All these righties praising this idea while, at the same time, demanding the United States is a "Christian" nation is just insane.
You bet I'm pumped!!! I just had a green tea!!!
 
User avatar
trpmb6
Topic Author
Posts: 3014
Joined: Thu Apr 19, 2018 5:45 pm

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 2:10 am

seb146 wrote:
trpmb6 wrote:
seb146 wrote:
I am still not seeing how this will help those of us who can not afford health insurance anyway. Sure, we can see the price (taxes and fees extra, prices may vary) but if we can not even afford to see a regular doctor on a regular basis or if we have to set up internet funding just for one round of chemo, how does seeing a hospital room price help?


Well.. it wasn't supposed to address that? And it's more than just the price of the room. In theory having all the negotiated rates made public would help drive more competition and drive costs down and drive hospitals to make improvements in care for the same costs.


But that is not going to happen. What will happen is some insurance companies will pull out of markets because they will not be able to turn obscene profits like they have been. Other insurance companies will simply cover those rooms they can make a profit from.

As a "Christian" nation, when did this become acceptable? That the sick are to be profited off of? That greed is the greatest commandment? All these righties praising this idea while, at the same time, demanding the United States is a "Christian" nation is just insane.


Why do you always resort to that line of discussion or talking points.. "as a christian nation" it's just dumb. Why is everything about identity politics? Why can't we discuss the economics of what this rule change means without that.

So back up why you think insurance companies will back out. Already federal rules that limit profits. Insurance companies bring the hospital rates down really. That's what is at heart here. Hospitals send out Bill's that say billed rate 2000 dollars, negotiated rate, 25 dollars. Seriously. It's that stupid. It's a problem needing to be addressed.
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 6:52 am

trpmb6 wrote:
seb146 wrote:
trpmb6 wrote:

Well.. it wasn't supposed to address that? And it's more than just the price of the room. In theory having all the negotiated rates made public would help drive more competition and drive costs down and drive hospitals to make improvements in care for the same costs.


But that is not going to happen. What will happen is some insurance companies will pull out of markets because they will not be able to turn obscene profits like they have been. Other insurance companies will simply cover those rooms they can make a profit from.

As a "Christian" nation, when did this become acceptable? That the sick are to be profited off of? That greed is the greatest commandment? All these righties praising this idea while, at the same time, demanding the United States is a "Christian" nation is just insane.


Why do you always resort to that line of discussion or talking points.. "as a christian nation" it's just dumb. Why is everything about identity politics? Why can't we discuss the economics of what this rule change means without that.


That is the mindset of the party in charge. The party who believes everyone wants what they want. Republicans. This is what they believe. It is the talking point they use to keep control.

trpmb6 wrote:
So back up why you think insurance companies will back out. Already federal rules that limit profits. Insurance companies bring the hospital rates down really. That's what is at heart here. Hospitals send out Bill's that say billed rate 2000 dollars, negotiated rate, 25 dollars. Seriously. It's that stupid. It's a problem needing to be addressed.


Why would they stay in a market when they are forced to show their hand? When they are forced to be honest?

The biggest problem I see is that people who work can not afford basic care. Showing the cost of something does nothing to address that.
You bet I'm pumped!!! I just had a green tea!!!
 
User avatar
trpmb6
Topic Author
Posts: 3014
Joined: Thu Apr 19, 2018 5:45 pm

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 2:21 pm

seb146 wrote:

trpmb6 wrote:
So back up why you think insurance companies will back out. Already federal rules that limit profits. Insurance companies bring the hospital rates down really. That's what is at heart here. Hospitals send out Bill's that say billed rate 2000 dollars, negotiated rate, 25 dollars. Seriously. It's that stupid. It's a problem needing to be addressed.


Why would they stay in a market when they are forced to show their hand? When they are forced to be honest?

The biggest problem I see is that people who work can not afford basic care. Showing the cost of something does nothing to address that.


The companies that are entrenched in the health insurance market won't go away. They'll fight for their position. Meanwhile, you'll have companies enter the market to try and undercut the existing pricing structures. Stop worrying about the insurance companies. It's the pricing structure at hospitals that needs to be better understood. You go to a McDonald's and you know what you're paying before you order. If you don't like the prices you go to Wendy's where you can get that awesome Double Stack 4 for 4. I mean that is more food than you'll get a mcdonald's and half the price!

You see the biggest problem is people not being able to afford basic care. I see this as one of the pieces of the puzzle of solving that issue.
 
slider
Posts: 7565
Joined: Wed Feb 25, 2004 11:42 pm

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 2:54 pm

This is LONG overdue legislation and a great step forward to trying to get health care costs under control.

Step one: TRANSPARENCY. Why do you think they're fighting this so hard? Because they're close to being the last industry for which consumers get no pricing visibility. If hospitals comprise a third of all health care costs, and you now are mandated to disclose pricing on 400+ shoppable services, this is a great thing.

Now to get a grasp around the formula for how insurance companies negotiate rates with hospitals...

Bad Orange Man did another good.

I'm usually in favor of fewer regulations and less onerous or costly private sector compliance rules, but in this case, when rapacious capitalism has exploited a significant % of the American economy and has distorted actual market forces to this collusive degree, it's a good step in the right direction.
 
slider
Posts: 7565
Joined: Wed Feb 25, 2004 11:42 pm

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 2:58 pm

seb146 wrote:
hashtagconfused wrote:
seb146 wrote:
How is keeping people alive (every life is sacred!) now a for-profit endeavor?


when was it not?


That is my point. In the United States, it is purely run for profit and not for the good of all. Gilead is being sued for the insane profits they have been making off HIV and PReP medications. The research into those medications were publicly funded by us taxpayers. Gilead claims they didn't have to make a generic and so could charge whatever they want.

https://www.biospace.com/article/gilead ... n-lawsuit/

It does not stop with HIV and PReP meds. We have no public option so we have to pay 100% out of pocket for medical expenses. For simple routine check ups. So, if someone gets really sick from whatever, they will find out in the ER and get a huge bill and have to find a way to finance their treatment. All because we can not afford regular doctor visits. For these companies to simply say "here is our pricing structure for hospital stays" does literally zero to help us pay for our routine care. Or anything.


So again, detaching for a moment the concept of exploitative or rapacious capitalism, let me ask you something.... If a pharmaceutical company takes all the risk, bears all the costs of research and development, which is generally enormous for new drugs, why shouldn't they benefit from the fruits of their labor? (Again, forget taxpayer assisted research for a moment, this is in the private sector context)

How is that different from a farmer selling their wares? Or a shoemaker? Or anyone engaging in the free exchange of goods and services?

I'm genuinely curious where you draw that line. Literal life saving drugs that wouldn't exist will of course have a price tag on them.
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Wed Dec 11, 2019 4:54 pm

slider wrote:
seb146 wrote:
hashtagconfused wrote:

when was it not?


That is my point. In the United States, it is purely run for profit and not for the good of all. Gilead is being sued for the insane profits they have been making off HIV and PReP medications. The research into those medications were publicly funded by us taxpayers. Gilead claims they didn't have to make a generic and so could charge whatever they want.

https://www.biospace.com/article/gilead ... n-lawsuit/

It does not stop with HIV and PReP meds. We have no public option so we have to pay 100% out of pocket for medical expenses. For simple routine check ups. So, if someone gets really sick from whatever, they will find out in the ER and get a huge bill and have to find a way to finance their treatment. All because we can not afford regular doctor visits. For these companies to simply say "here is our pricing structure for hospital stays" does literally zero to help us pay for our routine care. Or anything.


So again, detaching for a moment the concept of exploitative or rapacious capitalism, let me ask you something.... If a pharmaceutical company takes all the risk, bears all the costs of research and development, which is generally enormous for new drugs, why shouldn't they benefit from the fruits of their labor? (Again, forget taxpayer assisted research for a moment, this is in the private sector context)

How is that different from a farmer selling their wares? Or a shoemaker? Or anyone engaging in the free exchange of goods and services?

I'm genuinely curious where you draw that line. Literal life saving drugs that wouldn't exist will of course have a price tag on them.


I am not saying that at all. What I am saying is that we working people can not afford health care. I know our only concern should be for multi-national corporations and the very ultra wealthy elites and no one else. I get it. Maybe understand that insane profits are the reason we can not afford health care? Profits ahead of people and the people who need health care the most cheer this on.
You bet I'm pumped!!! I just had a green tea!!!
 
hashtagconfused
Posts: 59
Joined: Thu Apr 18, 2019 5:35 pm

Re: New Federal rule on Hospital Pricing Structure

Fri Dec 13, 2019 3:54 pm

seb146 wrote:
slider wrote:
seb146 wrote:

I am not saying that at all. What I am saying is that we working people can not afford health care. I know our only concern should be for multi-national corporations and the very ultra wealthy elites and no one else. I get it. Maybe understand that insane profits are the reason we can not afford health care? Profits ahead of people and the people who need health care the most cheer this on.


aside from saying zero, what would be an acceptable profit margin for the healthcare industry?
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Fri Dec 13, 2019 5:34 pm

hashtagconfused wrote:
seb146 wrote:
slider wrote:


aside from saying zero, what would be an acceptable profit margin for the healthcare industry?


As long as we all have affordable health care, why does that matter? I see them as two completely separate things.
You bet I'm pumped!!! I just had a green tea!!!
 
User avatar
Tugger
Posts: 10288
Joined: Tue Apr 18, 2006 8:38 am

Re: New Federal rule on Hospital Pricing Structure

Fri Dec 13, 2019 7:28 pm

seb146 wrote:
hashtagconfused wrote:
seb146 wrote:


aside from saying zero, what would be an acceptable profit margin for the healthcare industry?


As long as we all have affordable health care, why does that matter? I see them as two completely separate things.

Well then you have to define what "affordable" means.

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Fri Dec 13, 2019 10:26 pm

Tugger wrote:
seb146 wrote:
hashtagconfused wrote:

aside from saying zero, what would be an acceptable profit margin for the healthcare industry?


As long as we all have affordable health care, why does that matter? I see them as two completely separate things.

Well then you have to define what "affordable" means.

Tugg


I can see the price of the Ritz-Carlton. Some people can afford that. We can not. And we have a dog, so we stay at Motel 6. We get what we would get at the Ritz: A bed and shower and TV. Added bonus that we get to have our four legged girl with us.
You bet I'm pumped!!! I just had a green tea!!!
 
User avatar
Tugger
Posts: 10288
Joined: Tue Apr 18, 2006 8:38 am

Re: New Federal rule on Hospital Pricing Structure

Fri Dec 13, 2019 11:13 pm

seb146 wrote:
Tugger wrote:
seb146 wrote:

As long as we all have affordable health care, why does that matter? I see them as two completely separate things.

Well then you have to define what "affordable" means.

Tugg


I can see the price of the Ritz-Carlton. Some people can afford that. We can not. And we have a dog, so we stay at Motel 6. We get what we would get at the Ritz: A bed and shower and TV. Added bonus that we get to have our four legged girl with us.

OK, so you just want healthcare that offers a bed and someone to diagnose you and allow your friends to visit while you are there. But you don't mind not getting higher cost elements, such as perhaps surgery or medication or at the least a less sterile room and no meals. You are paying for these services and so need to pay for and get what you can afford as per your example.

Do I have that correct? If not, using your example of high level hoteliers versus low cost motels, what elements are you OK with doing without in your affordable healthcare?

Tugg
I don’t know that I am unafraid to be myself, but it is hard to be somebody else. - W. Shatner
There are many kinds of sentences that we think state facts about the world but that are really just expressions of our attitudes. - F. Ramsey
 
User avatar
seb146
Posts: 22188
Joined: Wed Dec 01, 1999 7:19 am

Re: New Federal rule on Hospital Pricing Structure

Sat Dec 14, 2019 12:57 am

Tugger wrote:
seb146 wrote:
Tugger wrote:
Well then you have to define what "affordable" means.

Tugg


I can see the price of the Ritz-Carlton. Some people can afford that. We can not. And we have a dog, so we stay at Motel 6. We get what we would get at the Ritz: A bed and shower and TV. Added bonus that we get to have our four legged girl with us.

OK, so you just want healthcare that offers a bed and someone to diagnose you and allow your friends to visit while you are there. But you don't mind not getting higher cost elements, such as perhaps surgery or medication or at the least a less sterile room and no meals. You are paying for these services and so need to pay for and get what you can afford as per your example.

Do I have that correct? If not, using your example of high level hoteliers versus low cost motels, what elements are you OK with doing without in your affordable healthcare?

Tugg


The Ritz and Motel 6 offer the same basic amenities. Bed, shower, cable. Air travel is the same. A person can fly NK OAK-LAS or charter a G5 for the same route. Both do the exact same thing but one has more to offer than the other.

There should be a minimum for everyone when it comes to health care. Not just a hospital room, but basic care as well. Some people can afford a private room on a private floor with private nurses. That's fine. Many of us can not even afford a regular trip to the doctor. All I am saying is give us all the basic level and, if we can afford it, let us move up to what level of care we want.
You bet I'm pumped!!! I just had a green tea!!!
 
Ken777
Posts: 10037
Joined: Thu Mar 11, 2004 5:39 am

Re: New Federal rule on Hospital Pricing Structure

Sat Dec 14, 2019 5:46 am

seb146 wrote:
The Ritz and Motel 6 offer the same basic amenities. Bed, shower, cable. Air travel is the same. A person can fly NK OAK-LAS or charter a G5 for the same route. Both do the exact same thing but one has more to offer than the other.

There should be a minimum for everyone when it comes to health care. Not just a hospital room, but basic care as well. Some people can afford a private room on a private floor with private nurses. That's fine. Many of us can not even afford a regular trip to the doctor. All I am saying is give us all the basic level and, if we can afford it, let us move up to what level of care we want.



The most efficient approach to hospital care is also the cheapest. It's an 8 - 12 bed ward with the head nurse (sister) sitting at a desk, managing the junior nurses who are treating the patients. That's still in use in a lot of countries and, if you have good staff the patients get a higher (more attentive)care that the private rooms.

Now days we have one or two bed rooms for many reasons - some including medical need.

That costs money to deliver - far more than a Motel 6. Start with the building standards, then add all the installations needed: stuff like Oxygen and Medical Air. Toss in suction (gag), electronic monitoring systems in both the rooms and nurses stations, there various computer systems like electronic patient records, remote viewing of various imaging tests run, let. The hospital beds need to be at a far higher design for obvious reasons - oner Strker bed probably costs more than all the beds at Motel 6. You also have to provide facilities and systems at nurses stations.

All that costs money, and a lot more money than necessary because of Cost Shifting. If you don't understand Cost Shifting let me know and I'll go over it again. :santahat:

Who is online

Users browsing this forum: 1337Delta764, aerlingus747, Badstig, flyguy89, skyservice_330 and 15 guests

Popular Searches On Airliners.net

Top Photos of Last:   24 Hours  •  48 Hours  •  7 Days  •  30 Days  •  180 Days  •  365 Days  •  All Time

Military Aircraft Every type from fighters to helicopters from air forces around the globe

Classic Airliners Props and jets from the good old days

Flight Decks Views from inside the cockpit

Aircraft Cabins Passenger cabin shots showing seat arrangements as well as cargo aircraft interior

Cargo Aircraft Pictures of great freighter aircraft

Government Aircraft Aircraft flying government officials

Helicopters Our large helicopter section. Both military and civil versions

Blimps / Airships Everything from the Goodyear blimp to the Zeppelin

Night Photos Beautiful shots taken while the sun is below the horizon

Accidents Accident, incident and crash related photos

Air to Air Photos taken by airborne photographers of airborne aircraft

Special Paint Schemes Aircraft painted in beautiful and original liveries

Airport Overviews Airport overviews from the air or ground

Tails and Winglets Tail and Winglet closeups with beautiful airline logos