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Hard to Get Mileage from Hospital Price List in Limited Rural Market

My family had a health emergency recently. In the first 72 hours, we didn’t have a chance to check the price lists. Even if we had, I don’t think the paramedics or the ER docs or the ICU team were going to pause in their ministrations to ask if we wanted to order out for IV solution or drive across town to the other shop for the EKG. As NPR noted this afternoon, health care doesn’t work like a normal market.

Donald Trump’s latest signature-show-off, ordering the Department of Health and Human Services to write some price transparency rules, won’t “fundamentally chang[e]” the non-market nature of the healthcare marketplace. It’s certainly not “bigger than anything else we’ve done in this particular realm.” Prices will not “come down by numbers that you won’t even believe” (good grief—does the mindless extemporizing never end? Trump had an actual economist in the room who could give him a number; could the President of the United States not read a simple brief and give actual data instead of gratuitous hyperbole?); it’s possible that, absent bigger reforms acknowledging the non-market nature of healthcare, Trump’s order, if turned into actual action (and given his poor batting average, transformation of this healthcare theater into actual price-transparency policy is a longshot) will raise prices:

The Federation of American Hospitals, the American Hospital Association and America’s Health Insurance Plans have argued that disclosing contracted prices won’t help consumers know what they’d actually be on the hook to pay.

The trade groups also have said that revealing the process could reduce competition, because no doctor or hospital would want to be paid the lowest rate and would ask for the higher payments neighboring facilities receive.

“We also agree that patients should have accurate, real-time information about costs so they can make the best, most informed decisions about their care,” Matt Eyles, AHIP president and CEO, said in a statement. “But publicly disclosing competitively negotiated, proprietary rates will reduce competition and push prices higher — not lower— for consumers, patients and taxpayers” [Rachel Roubein, “Trump Aims at Health Cost Transparency with Executive Order,” Politico, 2019.06.24].

But maybe Trump figures he’s got to make it look like he’s doing something on healthcare, since his numbers on that issue offer Democrats a foothold for 2020 gains:

American Bridge polled voters in small towns and rural areas, screening out self-identified liberal Democrats, to find out what they thought of the president. The group gave Trump a positive job approval rating overall, and it backed a generic Republican for Congress by 29 points over a generic Democrat. But the Republican-leaning pool of voters also gave Trump unfavorable ratings on several key issues, highlighting potential avenues of attack for American Bridge: 50 percent rated Trump negatively on “cutting taxes for people like me.”

Several health care questions were worse for the president. Just 25 percent of respondents gave Trump a positive rating for “reducing health care costs,” compared to 67 percent who rated him negatively, while they split against Trump 39-51 on “taking on the drug and pharmaceutical companies” [Scott Bland, “Democratic Group’s Poll Shows Trump Vulnerable with His Base on Health Care,” Politico, 2019.06.24].

Trump’s promised price list might not move those low ratings much in rural America. After all, what good is a hospital price list here in Aberdeen when the Avera doctor (Dr. Armstrong, who led his team with clear-eyed confidence and saved a life) tells you you’re going to Sanford because Sanford is the only shop in the state with the machine we need to have the best chance of going home happy and whole someday?


  1. Cory Allen Heidelberger Post author | 2019-06-24 19:00

    (Reminder: while I mention my personal example, I am disinclined to offer further details in this venue. The thrust of the comment section should be analysis of policy. Share your own examples of the difficulty of making informed and rational economic choices in the rural health care market as you see fit.)

  2. Porter Lansing 2019-06-24 19:24

    The Brookings Institute recommends two Democratic House Bills to mitigate surprise emergency room bills. It’s a beginning but has much more benefit than Trump’s newest attempt to end Obamacare.
    – Each of these federal actions can lessen the risk or mitigate the impact of surprise medical bills for insured Americans, a problem that has long plagued private health insurance beneficiaries in America, but individually will not completely protect consumers. As we have recommended before, a more comprehensive federal solution is necessary to protect consumers from balance billing.

  3. Joe Nelson 2019-06-24 19:39

    I am pro-transparency. Too much of healthcare is decided behind closed doors, with patients paying more and more while drug companies and health insurance companies profit. Get it out in the open. As an aside, NPR’s On Point had a great hour program today looking at Germany’s healthcare system, specifically their pharmaceutical system.

    One of the key things was making the prices as well as the negotiations between insurance companies and pharmaceutical companies public. Another key thing was an independent panel which reviewed new drugs, comparing effectiveness to drugs already on the market (something that does not happen in the U.S.).

  4. mike from iowa 2019-06-24 20:14

    Rural hospitals as well as city hospitals in South Dakota already have a price list from Medicare, agreed to in advance, and not subject to change.

  5. Debbo 2019-06-24 20:34

    Elizabeth Warren has a plan for that. 😁 In 2018 she wrote a bill called the Consumer Health Insurance Protection Act. (Some called it ACA 2.0) Here are the basic highlights, but not all of it, from The Fiscal Times:

    Limit insurance premiums to no more than 8.5 percent of income

    Cap out-of-pocket prescription drug costs for those on private plans at $250 a month, or $500 per family

    Require insurers who sell Medicare Advantage or Medicaid managed care plans to offer coverage on ACA exchanges that have limited competition

    Require private insurance plans to spend 85 percent of the premiums they receive on paying out claims, up from 80 percent under the ACA currently

    Set limits on insurance company profits to match what those private insurers can earn from Medicare and Medicaid

    Provide more money for ACA outreach and enrollment efforts

    I think the only way to stop the insane and cruel prescription drug price gouging by Big Pharma and rein in the absurd greed of the insurance industry is a Medicare for All option at any age and removal of any restrictions on Medicare/Medicaid negotiating drug prices. I think buying medications from Canada ought to be legal too. After all, competition is the best thing for capitalism, right?

  6. Porter Lansing 2019-06-24 20:45

    As NPR noted, German’s have a more streamlined and efficient government than USA. German healthcare isn’t their only benefit.
    ~ Germans pay just slightly more (brackets begin at 14% – top bracket is 42-45%) income tax than Americans but have twice the spending money left at the end of the month. Nice!
    They arrange this because their taxes pre-pay many things that their citizens have chosen. German’s get pre-paid four weeks paid vacation. Pre-paid one year sick leave (with a medical waiver). Pre-paid retirement income. Pre-paid disability insurance. Pre-paid maternity leave. Pre-paid childcare. Pre-paid college education and pre-paid trade school. (If you pass the entrance exam.) As mentioned, pre-paid healthcare. Pre-paid unemployment insurance for a year, if you’re laid off. And more …
    ~ With all the extra spending money, Germans travel, live very well, and are much more satisfied with their lives than we Americans.
    It’s, true. Buying as a group saves big bucks. Just ask a COSTCO member. Just ask a CO-OP member. Ask an REA member.

  7. Porter Lansing 2019-06-24 20:48

    PS … There’s something else about Germany. Contrary to South Dakota it was those poor in school who moved away not the best and brightest. And, guess where they moved? North and South Dakota. ツ

  8. Certain Inflatable Recreational Devices 2019-06-24 20:53

    The rate of inflation in the cost of medical services increased at four times the rate of general inflation after passage of Medicare. That figure comes from a 1995 study. I think it has accelerated since.

    The rate of inflation of the cost to get a college degree increased at about four times the general inflation rate after the feds guaranteed college loans. That was also from about 1995, and I believe that rate may have increased.

    I’m not opposed to using some of the fruits of folks’ labors to offset the costs of all the conveniences the moneymaking class (and I include myself in that group, for the moment) enjoys in the pursuit of its frenetic, but fairly comfortable, life.

    I’m not opposed to using some of that fruit to pay some medical expenses of some people. I am not sure there are enough bananas being cultivated to totally finance socialized medicine. Therefore I am firmly astride the fence on single-payer or just about any taxpayer-financed medical program.

    NOBODY understands the options available under Medicare. NOBODY understands a medical insurance policy.

    Nobody understands me.

  9. Maxine Rasmussen 2019-06-24 20:56

    Econ 101: Supply and demand drive free market. When people can make a rational decision they buy what they can afford. How can healthcare, whether emergency or not, be thrown into the same category as material goods or other services? How can a patient or the patient’s family or.other decision maker make a.rational decision based only on cost of the service? And I mean “rational” as in weighing any decisions based only on cold $ facts. Parents do not place a dollar on their children’s worth. Individuals do not place a dollar value or limit on themselves. As an EMT, I have never experienced one patient or their representative ever ask, Wait how much is Life Flight? (Depending on the company and distance: up to $35,000) As an EMT, if a patient is non responsive and alone, we call for Life flight (we are 2 hours away from an ER by ambulance) for that patient, because we assume he/she want to live. People don’t ask what the ambulance ride will cost. The will to live or keep your loved one living transcends simple rationale used when you decide what vehicle or boat to buy. It is irrational to assume people will choose the lowest cost to their finances when making health decisions. Econ 101 just doesn’t cut it for healthcare.

  10. Certain Inflatable Recreational Devices 2019-06-24 20:59

    In recognition of Porter’s talk about Germans in ND and SD, I highly recommend Louise Erdrich’s “The Master Butcher’s Singing Club.”

    You won’t go wrong with Louise Erdrich, but “…Master Butchers Singing Club…” is, I think my favorite of seven or eight of her books I’ve read or listened to.

    My own life as a child on the streets of Belle Fourche exposed me to the elder stages of the characters she puts in Scranton ND in the years shortly after WWI. Exquisite insight.

  11. grudznick 2019-06-24 21:14

    I have heard my good friend Bob’s thoughts on this before, and I think he is swaying grudznick over to his side. I don’t know about the Germans and such that Mr. Lansing is fixated on, but golly about the singing club and insights by Bob, I put my hat on the line for their veracity.

  12. Debbo 2019-06-24 21:17

    CIRD, Master Butcher is an outstanding book and Erdrich is simply a great writer. I’ve read about a half dozen of hers. She’s just superb.

  13. Debbo 2019-06-24 21:19

    This is one thing the crony capitalists never have a real answer to– Why is it that the most successful nations in the world today have a government health care system, yet the USA doesn’t?

  14. Certain Inflatable Recreational Devices 2019-06-24 21:33

    If there’s anything I want in life, it’s for a POS like grudzwhack to be “on my side.”

  15. grudznick 2019-06-24 21:46

    Congratulations, Bob!!! I’m on your side like the boil on the birthmark on your right thigh.

  16. Kurt Evans 2019-06-24 22:49

    “grudznick” writes:

    Congratulations, Bob!!! I’m on your side like the boil on the birthmark on your right thigh.

    I think several of us see you that way, “grudznick” … and this blog would probably be a much better place if Cory lanced you.

  17. Porter Lansing 2019-06-24 23:56

    grudznick, you Irish balooba. I’m fixated on exposing why SDak’ers are the way they are. The two biggest factors for the obsessive, deviant behavior are German heritage and the oppressive Catholic Church.

  18. Jenny 2019-06-25 08:14

    Health insurance should be less expensive for people that exercise and eat healthy. A healthier body can prevent people from getting such health conditions as obesity, diabetes, hyperlipidemia, hypertension heart problems, etc.
    This could motivate people for wanting to live a healthier lifestyle, and Maxine, I work in healthcare and people ask their doctors all the time how much a procedure is going to cost, how much a RX med will be.
    Your views are simply false. Of course, in life and death situations, that is different, but the majority of the time, healthcare consumers WANT and NEED to know the price when it can be a matter of going into bankruptcy or putting food on the table.

  19. Jenny 2019-06-25 08:17

    Why does the conversation always have to turn to stupid stuff? Cut it out you guys.

  20. Jenny 2019-06-25 08:28

    So CIRD is blaming the high costs of medical services on Medicare?
    The astronomical corrupt prices of Big Insurance and Big Pharma has nothing to do with it? Or the fact that people are living longer than ever before with chronic diseases?
    It is not really a free market when when one can’t even afford to get into the Free Market.
    Don’t knock Medicare, people love their Medicare.

  21. W R Old Guy 2019-06-25 08:59

    I saw an ad this morning on CBS by a group called “One Nation” ( I think I got the name right) opposing MEDICARE for all. It claims you will have care rationed and have to wait for medical care. One person is shown saying that she had to wait 30 days for an ultrasound. She did not say if it was urgent or routine of course. A 30 day wait for a routine test is not unusual but we tend to want things to happen immediately.

    I think the ad is a harbinger of things to come over the next election cycle.

  22. Jenny 2019-06-25 09:15

    People should really take a lot at Elizabeth Warrens healthcare protection plan that Debbo pointed out. Out of all the candidates, Warrens plan is the only one that is constructed to sets limits on health insurance company profits.
    But oh no we can’t have the richest one percent that run these racketeering companies making less profit. That would go against the (fake) free market that the republicans try to say that it is.

  23. Maxine Rasmussen 2019-06-25 09:24

    Jenny, I find you confusing. You respond to me that “Healthcare consumers WANT and NEED to know what prices are…” Then in the next post you respond to CIRD: “Don’t mess with Medicare. people love their Medicare.” I can only assume you like to argue for the sake of argument. If I didn’t find it a waste of my time, I would ask then why is the cause of bankruptcy in this country catastrophic medical costs?

  24. Jenny 2019-06-25 10:08

    Maxine, read ElizabethWarren’s plan then you will understand what I mean.

  25. Jenny 2019-06-25 10:31

    Maxine if I didn’t find it such a waste of time, I would ask why you are only focusing on emergencies. You say parents don’t place a dollar on their children’s worth but unless they’re in the upper class income range, they are sure going to worry about being able to afford it once they start getting the bills afterwards

  26. Jenny 2019-06-25 10:41

    The “you can’t put a price on healthcare “i sounds like something Trump would say to appease big insurance.

  27. RJ 2019-06-25 23:13

    To a large extent, Maxine makes a very true point. When a person is in a life- threatening situation, first responders and the medical staff just want to save your life, a price comparison isn’t on the table. The cost of healthcare and health insurance in the US is ridiculous. I was able to go back to nursing school and afford insurance because of the ACA and have subsequently
    Worked with many patients who have been able to access preventative care and care for diabetes, cancer, pre-natal care etc because of the ACA. The US can provide affordable, quality healthcare…Many counties have done a better job. It’s about priorities. Healthcare over military spending. Cory, I totally agree that people should be aware of health care costs up front and be able to compare prices. I hope someday that is not necessary. It will take systemic change.

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