Practical Patriot 🇺🇸 @InternetCPA

FAH says hospitals, plans, employers, and policymakers must “work together” before patients can get an accurate estimate. Amazing. Hospitals can generate a final bill down to the IV, contrast dye, radiologist, facility fee, and aspirin but apparently cannot estimate those same charges until after the patient is trapped in the parking lot. For scheduled care: send the CPT bundle and expected hospital charges to the plan; the plan returns deductible, coinsurance, and patient liability. One estimate. Before service. You do not need Congress to discover email.

Federation of American Hospitals @FAHhospitals

16 hours ago

Our members share the goal of advancing meaningful price transparency policies. But for transparency to truly work for patients, hospitals, health plans, employers, and policymakers must work together to provide timely, accurate information about expected out-of-pocket costs

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FAH says hospitals, plans, employers, and policymakers must “work together” before patients can get an accurate estimate. Amazing. Hospitals can generate a final bill down to the IV, contrast dye, radiologist, facility fee, and aspirin but apparently cannot estimate those same charges until after the patient is trapped in the parking lot. For scheduled care: send the CPT bundle and expected hospital charges to the plan; the plan returns deductible, coinsurance, and patient liability. One estimate. Before service. You do not need Congress to discover email.

@neoavatara When you cast the first stone, make sure you don't live in a glass house.

@BleedBlueCasey If you don't have an outside threat, moving the ball around the perimeter is for not. UK found this to be true last year.

After we announced our investigation and subpoena into CVS yesterday, one of the independent pharmacists from the press conference received a late-night “audit” from CVS. This has the appearance of intimidation for speaking out, and it will be addressed.

When one company owns the PBM, retail pharmacies, and more, patients pay the price through higher costs, restricted access, and fewer choices. Thank you Florida AG Uthmeier for investigating CVS/Caremark. Exactly the kind of scrutiny needed to break the stranglehold on prescription drugs. fox35orlando.com/video/fmc-284b…

Doctors don’t need AI to replace them. They need AI to help them do what they trained to do. When AI handles information overload and administrative work, clinicians can spend more time listening, examining, educating, and caring for patients. AI should help doctors be doctors.

@DrDiGiorgio @tylerblack32 Nothing says “consumer choice” like choosing an MRI without knowing it costs $400 or $4,000.

But the real choice is not simply “drive 20 minutes or pay $200 more.” A good employer plan should make high-value care affordable and force providers to compete on transparent prices and quality. Otherwise “100% covered” can become another way to hide the cost from the employee while the employer pays an inflated negotiated rate.

@JoinCrowdHealth The most impressive part of UH is how a company can own so many pieces of the system and still explain that “everyone else” is the reason costs are rising.

@mcuban Indiana is effectively saying: “If hospitals behave like regulated utilities, do not be surprised when government regulates them like utilities.”

You are confusing uniform transparency with uniform pricing. Nobody expects a scheduled MRI and an ICU admission to have the same quote. But every hospital and insurer already uses standardized identifiers for outpatient services or episode groupings for inpatient care. Require all of them to report actual cash prices, negotiated allowed amounts, facility and professional fees, and patient liability in one auditable schema. Elective care can show upfront prices; emergency care can show ranges, benchmarks, and historical episode costs. Complexity is a reason for better displays, not a license for secrecy.

If all healthcare were paid for out of pocket, with catastrophic coverage serving as a backstop, healthcare services and products would become far less expensive. The common objection is that no one could afford it. That might be true if prices remained unchanged, but today's prices are heavily shaped by an opaque third-party payment system in which patients rarely know the true cost of care and providers compete only indirectly on price. Even today, the average household contributes more than $20,000 annually toward health insurance premiums, yet many families still face substantial deductibles, copays, coinsurance, and unexpected medical bills. Insurance often feels less like comprehensive coverage and more like prepaid access to a complex financing system.

Surely you just forgot to comparison-shop. Go to every hospital website, download the machine-readable file, identify the correct CPT code, determine whether the $886 includes the technical component, verify the radiologist’s separate professional fee, match it to your exact insurance plan, decode the payer-name variation, and compare all nearby facilities. Then get the chest X-ray somewhere cheaper. That is what “price transparency” means in American healthcare. Totally normal market.

Anthony DiGiorgio, DO, MHA @DrDiGiorgio

a week ago

I got a chest X Ray a few weeks ago. Got the bill today. To read the X-ray, the physican got paid $31.00 To shoot the X-ray, the hospital charges $886.16 I also got lab work. Hospital charge: $784.19 Hospitals are the reason for high healthcare costs.

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Surely you just forgot to comparison-shop. Go to every hospital website, download the machine-readable file, identify the correct CPT code, determine whether the $886 includes the technical component, verify the radiologist’s separate professional fee, match it to your exact insurance plan, decode the payer-name variation, and compare all nearby facilities. Then get the chest X-ray somewhere cheaper. That is what “price transparency” means in American healthcare. Totally normal market.

The false choice is “Medicare for All” or “Canadian-style waits.” America has a third option: universal basic coverage with private providers competing on price, quality, access, and outcomes. Government can finance the floor. Doctors, hospitals, surgery centers, labs, pharmacies, and direct-care models can compete to deliver the care. But the money has to be visible. Publish prices. Audit claims. Show denial rates. Expose PBM rebates and spreads. Build capacity where shortages exist. Coverage without capacity fails. Capacity without transparency gets captured.

Lowering Medicare eligibility is not a healthcare strategy unless Congress explains the economics, transition, incentives, taxes, and administration. But the first bipartisan step does not require rebuilding healthcare overnight. Trump can direct HHS, Treasury, and Labor to turn existing hospital and insurer transparency rules into usable data infrastructure. One national schema. One public repository. Every hospital and insurer reporting clean, downloadable, plan-level prices: cash price, negotiated rate, provider IDs, plan IDs, facility/professional split, bundled services, quality data, and update dates. You cannot design a national healthcare plan when nobody can see the machine you are trying to reform. @RoKhanna

I agree baby steps are more likely than a perfect redesign. So start with the baby step that changes the most incentives: make price transparency real. Every hospital and insurer should submit clean, standardized, downloadable pricing data to one public repository. Same format, fields, provider IDs, plan IDs, cash prices, negotiated rates, facility/professional split, total episode indicators. Not scattered websiteswith giant “good luck decoding this” files. Then employers, patients, doctors, auditors, researchers, cities, and startups can compare prices and expose waste. That does not fix everything, but it turns the lights on.

To be clear, I am not arguing for government-run healthcare. I am arguing for universal basic financing inside a transparent market where doctors, hospitals, surgery centers, labs, pharmacies, and direct-care models compete to deliver care. The insurer or administrator should not own the maze. It should process claims for a disclosed fee. And yes, fraud will exist in any system this large. That is not an argument for keeping the black box. It is an argument for stronger audits, visible claims, traceable payments, and real penalties.

Exactly, that is the entire point. If universal healthcare is handed to the same big insurers inside the same black box, then we did not reform healthcare. We just gave the current maze a taxpayer-funded engine. That is why the operating rules matter. Any administrator should be a fee-only processor, not a hidden toll booth. The issue is not whether a contractor touches the claim. The issue is whether the contractor can hide the money. The problem is not that big insurers exist. The problem is letting them operate in the dark.