I am looking at this as an endodontist (retired 12 years). I would like to approach your suggestions stanza by stanza.
"All providers must post, in their offices and on a public web site without any requirement to sign in or otherwise identify oneself to access it, a full and complete price list which shall apply to every person."
My price today (should I still be in active practice) for root canal therapy (tooth #3/#14), not inclusive of diagnosis, not inclusive of radiographs (diagnostic/in treatment), not inclusive of gingival surgery or possible future apical surgery, not inclusive of number of visits, not inclusive of anesthesia: local, nitrous oxide, or general induced by anesthetist/anesthesiologist of patient's choice (and hired by and paid by patient for the procedure) would range anywhere from $0.00 to $250,000.00.
Just as each tooth is different and each patient's medical/emotional/dental requirements are different, each short/long term outcome may be different.
As the treating endodontist, my only problem regarding fee is that I must offer the patient my services at a somewhat reasonable fee stated prior to beginning the procedure after speaking with the patient for a period of five to twenty minutes.
Have I ever been surprised! More than once.
Please remember: I can always lower my fee after explaining that I found the situation less complicated than it appeared at first: I cannot raise my fee!

@Boron - $0.00 to $250k? Bullshit.

PS: You just made the argument for being fed to sharks.

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Good thing s/he's retired.

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The learning curve for being dead is steep, but everyone gets it down pat on the first go usually.--Thystra, March 28, 2023

@ Tickerguy
no matter insurance coverage from which I never requested any benefits for the following:
1. I always charged Catholic (I am not) clergy $0.00
2. I always charged the immediate family of any practicing/retired dentist $0.00
3. I always charged my physician's immediate family $0.00
4. I always charged several families whom I knew to be poor as church mice $0.00
for my services

@Boron -- Your example is why you, and every other medical professional who refuses to charge the same price for the same service to all comers should go to prison -- and that's when I'm feeling charitable.

Quote:

no matter insurance coverage from which I never requested any benefits for the following:
1. I always charged Catholic (I am not) clergy $0.00

You stole the cost of that procedure from another customer.

Quote:

2. I always charged the immediate family of any practicing/retired dentist $0.00

You stole the cost of that procedure from another customer.

Quote:

3. I always charged my physician's immediate family $0.00

You stole the cost of that procedure from another customer.

Quote:

4. I always charged several families whom I knew to be poor as church mice $0.00
for my services

You stole the cost of that procedure from another customer.

AND, you did so by fixing prices, which is a 10 year federal felony for each instance under 15 USC Chapter 1, and you did so because you, and the other endodontists in the area, all refused to post a level price which everyone paid. This allowed you to tell the NEXT customer that HIS root canal cost $1,200 when in fact what you really did was make him pay the $600 for the member of the clergy along with this own $600, and you did it through deliberate subterfuge.

In short you arrogated to yourself the right to force someone else to pay for a procedure that any person who you "deemed worthy" at your sole whim.

You believe by dint of your dental "license" you have the right to steal unlimited amounts of money from other people, subject only to your particular determination that some person "deserves" to be the beneficiary of theft from someone else.

You should be in prison for the rest of your life and you, along with your entire blood line, should also be asset-stripped to your underwear as EVERY BIT of what you took from others and your bloodline enjoyed as a result during your career with this outrageous scheme was in fact THEFT.

You have in fact illustrated EXACTLY why the bill I put forward must become law and why the ENFORCEMENT of said 100+ year old anti-trust law in regard to EVERY practitioner in the medical field is so important. Were such law to have been enforced your ass would have gone to prison YEARS AGO and given the TEN YEAR prison term for EACH offense, consecutively, worms would get fed by your corpse before you'd ever see the outside of said prison again.

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@ Tickerguy
My goodness gracious! In order to be in contravention of 15 USC Chapter 1, I'd have to get together with every other endodontist in my area and make certain that we were all following these same charitable impulses. Sorry - this never happened.
I charged each patient (that would be "individual patient", not plural, not "customers") on the basis of the amount of work and time I projected I would have to perform in order to properly (and painlessly) complete the root canal work.
You make the unfortunate leap assuming that I "stole the cost of that procedure from another patient." If I "stole" any profit, I took it from the mouths of my family which I shall be more than happy to explain to those that guard the gates as the worms are feeding on my earthly remains.

Oh fuck you, you disingenuous robber!

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The learning curve for being dead is steep, but everyone gets it down pat on the first go usually.--Thystra, March 28, 2023

@Boron -- if you don't want to go "tit-for-tat" how about starting with answering the question I originally posed and you dodged. You can find that at the "------" mark -- just scroll down.

Quote:

My goodness gracious! In order to be in contravention of 15 USC Chapter 1, I'd have to get together with every other endodontist in my area and make certain that we were all following these same charitable impulses. Sorry - this never happened

Uh, no you don't @Boron. There you be wrong.

Quote:

I charged each patient (that would be "individual patient", not "plural, not customers") on the basis of the amount of work and time I projected I would have to perform in order to properly (and painlessly) complete the root canal work.
You make the unfortunate leap assuming that I "stole the cost of that procedure from another patient." If I "stole" any profit, I took it from the mouths of my family which I shall be more than happy to explain to those that guard the gates as the worms are feeding on my earthly remains.

You admitted, up above, that there are plenty of people who you charged zero. It would be nice if you could actually operate a business charging someone zero without forcing someone else to pay that fee, but its dishonest to claim so. As a former CEO I'm well-aware of this. Never mind the indirect costs that are allocated across every customer (e.g. rent, etc.) in YOUR business (and most others) there are direct allocable costs that are inescapable. While they were quite a bit fewer in my line of work than yours they were not zero -- they never are.

MCSNet had a transparent, published price and discount list. Nobody got a better deal than anyone else on the same terms. If you wanted to buy 20 of something you got the same price as anyone else who bought 20. Why? Because if I didn't do that I had to fuck someone else in order to give the "preferred" person that discount, and to do that in a competitive market I have to collude with other people OR THE OTHER GUY WHO DOESN'T DO IT TAKES ALL THE CUSTOMERS I SCREW AWAY FROM ME AND I GO BANKRUPT SINCE ALL I HAVE LEFT ARE THE PEOPLE I'M GIVING SERVICE AWAY TO.

(Incidentally when it comes to goods as opposed to services that too is covered by FEDERAL LAW. Robinson-Patman says that it is illegal to discriminate for or against buyers of goods in like kind and quantity that travel or are produced and sold in interstate commerce. In the case of Robinson-Patman no collusion is required, mere discrimination is sufficient. Again, FEDERAL LAW that has stood for a LONG time, and when running MCSNet I shoved that up a couple of vendor's backsides who tried to pull that crap too.)

There is no evading this fact; if I sell something at a loss (and zero, where I have costs and I always do, is always a loss) someone else has to get screwed. If the other party who I screw figures out I'm screwing them I'm fucked as they will go somewhere else. The only way to prevent them from figuring it out is to hide that fact and I can't do it unless everyone else is doing it too which is hard proof that collusion is taking place because it only takes ONE competitor who doesn't and the scheme collapses.

General economic theory states that these schemes always collapse for that reason; five dudes selling carpeting who try to collude will always have one who defects and screws the other four. Three decades of hard proof in the medical business proves that this is not true in that field of work and the reason is that you don't have to publish a price NOR CHARGE EVERYONE THE SAME PRICE FOR THE SAME SERVICE, and you can DELIBERATELY hide this from the customer through insurance company contracts and other similar schemes making it impossible for the consumer to choose between providers on the basis of price for comparable services from different individuals and firms. This has been the ENTIRE MODEL of medicine for the last three-plus decades.

It is not just MY opinion that this is illegal IT IS THE SUPREME COURT'S opinion that it is illegal. Twice. Royal Drug and Maricopa County, dating to the late 1970s and early 1980s. The very same conduct that led to those cases goes on EVERY DAY right here and now for the last FORTY YEARS and yet it was ruled ILLEGAL under 100 year old law by the highest court in the land.

You seem to think that by hiding this its ok. It's not. And without collusion OF SOME SORT in a market with competitors its also impossible to sustain if the differentials are meaningful simply because all you will have left as soon as the veneer of obfuscation is stripped away is the customer who gets charged zero because some OTHER competitor will serve that customer WITHOUT shifting the zero-price dude's cost onto the guy who's paying for it.

CAN you privilege a few people on a small basis (e.g. a modest "senior" discount) without that happening? Sometimes. But you sure as hell cannot GIVE AWAY service that has a real, no-bullshit per-unit-to-supply cost without someone else paying for it and remain in business, and you can't shove it down someone else's throat if you are forced to disclose your pricing up front, along with your competitors doing so as well or you will VERY reliably go bankrupt unless you and the competitors collude to privilege people in the same way such that the competitors cannot ruin you by taking all the customers onto whom you cost-shift away from you by undercutting the comparable service for a lower price.

Designing a structure that does this, no matter how you do it and how many layers of the onion you put around it, is a violation of said law. So ruled the USSC in Royal Drug where they determined that the business of insurance does not include price-setting for goods and services between providers and customers, which was the refuge claimed (McCarren-Ferguson, to be specific.)

The ENTIRE medical system has operated on this basis of collusion, price-hiding and cost-shifting FOR DECADES. It's illegal to do that and has been for over 100 years. If I so much as met with ONE of my competitors and discussed such a scheme as a CEO, or implemented it between us, I'd STILL be sitting in a federal prison.

Never mind that so-called "medical insurance" is in fact nothing of the sort. Insurance is a pooled risk scheme under which you pay in a premium until there is a loss and then the loss is paid. The loss occurs when the event happens. Exactly zero so-called "medical insurance" today operates on this basis; get cancer, stop paying the monthly premium upon diagnosis and you will find out real fast that you did not actually buy what meets the legal definition of INSURANCE. What you bought was a price-fixed scheme intentionally obscured to prevent you from choosing between goods, services and providers on a transparent basis and by devising and operating that scheme everyone involved in it makes a windfall profit they would otherwise not be able to extract from you.

It is quite-simple really: If this was not true you should be able to walk in and pay the Medicaid price for any good, service or drug. You can't and it has nothing to do with a volume discount as each PERSON is, as you noted, an individual with individual circumstance and condition. Yet today ICD codes in fact differentiate between same, do they not? Yes, they do and they form the HARD PRICE upon which CERTAIN people are "costed" while others get THE REST of their bill.

That can ONLY happen through collusion and deliberately burying the price for those getting screwed where they can't find it and act on it because otherwise everyone not on Medicaid doesn't go to said place and the guy giving the "discount" for Medicaid goes out of business.

That I can hire someone for a price (another insurance company) to try to screw someone else instead of me not only doesn't change the character of the scheme it underlines same in bold ink.

Tell me why The Surgery Center of Oklahoma can price procedures on an "all-in" basis at costs typically around one fifth (and basically never more than half) of a local hospital -- and publish them on their web page? Note that those prices include everything and that includes fixing their own fuckups such as a hospital-acquired infection, which the local hospital will actually BILL YOU FOR when THEY caused it. By the way that incentive results in their infection rate being WILDLY better than the local hospital's too -- gee, I wonder why when they have to EAT their mistakes? Why are they that tiny of a fraction of the other guy's price? Because the local hospital forces you to pay for the guy who pays nothing, they won't give you a price until they have a scalpel buried in your body, they're not responsible to fix their own mistakes -- they get to BILL YOU for them instead and they have you over a barrel when you need it done, that's why. The common word for that is extortion.

Can you charge me 2-5x the price of a gallon of gas if a hurricane is coming? The law says you cannot; that's illegal. So why can you do it when I'm having a heart attack .vs. when I'm not? Are not both life-threatening emergencies? Would I pay $20,000+ to have a fractured bone repaired and casted when I could pay $6,000 for the same thing at Oklahoma? Not unless its broken NOW and I need it set NOW, right? Well? Why can't I charge $20/gallon for gas under exigent circumstance but its perfectly ok to do it when the dude just broke his arm, which is also an exigent circumstance? They're BOTH illegal yet only one gets prosecuted and the other is considered "ordinary business."

The same is true, by the way, of international price-fixing when it comes to drugs and medical devices. 15 USC Chapter 1 specifically includes international trade yet exactly NOBODY has been prosecuted for selling drugs "over there" for ONE TENTH or even ONE HUNDREDTH of what they are charged for here. Absent restraint of trade this is impossible since I could hop on a plane, fly to "X", fill a suitcase with said drug and come home and sell it. If I try that I'll go to jail yet without that restraint of trade said differential pricing schemes would not last 24 hours.

It is WAY past the time where these laws, which have stood on the books for over a hundred years, were enforced against EVERY aspect of the medical industry.

--------------------

The entire POINT of the proposed bill is to strip away the HIDDEN cost-shifting and put it all on the table. Competition will do the rest.

Why do you object to insisting that just as I cannot charge YOU $20/gal for gas based on YOUR car insurance company but the other guy $4.00/gal because of HIS you must follow the same law AND CHARGE EVERYONE THE SAME PRICE FOR THE SAME THING?

At the same time there IS a legitimate argument about "what do we do with the people who currently pay little or nothing because they have no money?"

It deals with THAT as well in a way that is transparent, screws nobody, and if that person becomes capable of paying down the road they will and do eat the bill. If not the the taxpayer eats it exactly as we eat it now, but transparently so and without the medical system using it to screw everyone who ISN'T indigent.

And oh, by the way, have a look at the Monthly Treasury Statement and what has happened with Medicare and Medicaid over the last 20 or so years. If we don't enact the above proposal, and continue to allow the scheme to continue, it will collapse the federal government because it has continued to expand in both scope and depth over the last 30 years and is expanding at an exponential rate which cannot be continued.

So either we fix it, which incidentally also fixes the FEDERAL BUDGET at the same time, or we suffer not just a medical system collapse but a full-on federal government budget collapse as well -- and at present trends THAT IS ONLY A COUPLE OF YEARS AWAY.

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@ Tickerguy
I tried to underline the point that my "customers" are patients and, in point of fact, no two are alike.
I am not selling goods which can be manufactured by machine that two of them are like twins: I am selling my training, my expertise, my time; a service, an art if you wish, to correct a problem, perhaps a defect, in a situation where no two are alike. If I treated patients in that manner, I don't know that I could ever sleep at night.
That's one of the joys of treating a human being: no two are ever alike: even twins.
BTW: if you're ever in the area, I'll be happy to buy you a drink and we can discuss this faccia a faccia over several hours. Right now I'm displacing my daughter who's visiting us: the "computer room" doubles as a guest room.
OTOH when I get it back, I'll continue to discuss why medical care cannot be placed on the same level as manufactured goods.

Oh c'mon @Boron.

The entire fucking medical system works on exactly the model you claim doesn't exist:

Quote:

That's one of the joys of treating a human being: no two are ever alike: even twins.

Guess what -- that was not true when my daughter was two seconds old, when she was four years old, five, six, ten, and now. Nor me. When I go into the dental office to have my teeth worked on everything does have a price, and this time .vs. last, if its the same procedure and same complexity its priced the same way.

If you deal with any insurance companies at all or keep records and bill on an ICD basis you're blowing bullshit and you know it. You can't convince me of what I know factually is false because I know how the system works from one end to the other. Never mind my personal experience with it having only a Cat policy until Obamacare showed up for both of us and seeing first-hand the sort of RAPE that was served up to drive prices higher while paying a LOT less for the same fucking service.

You talking to a guy who was ALSO on the other side of the desk with the health insurance companies and had to deal with them for a decade as the man who negotiated the deals and wrote the checks for his employees and -- when they tried to fuck people, I stepped in and stopped it. Not because I had to, but because I wanted to and I was not going to let people get screwed.

Since I've had a root canal (and have the cap and nice image on X-rays of that tooth to prove it) I know bit about that too, on the business end of the drill-n-file operation, so spare me that crap as well.

Have a nice time with your family.

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@boron you really sound like a condescending prick who is used to being the smartest guy in the room who just ran into someone above you on the intellectual food chain.

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The learning curve for being dead is steep, but everyone gets it down pat on the first go usually.--Thystra, March 28, 2023

Why is it that every root canal I've had at 3 different dentists has always cost the same?

One was much higher rent space than the others, one was a podunk burb town in a shitty office park. Yet coincidentally the prices were all the same? How could that be?!?!?!

HCVA and ICD9/10 Codes don't tend to result with a magic 0.00 for the assigned services. Haven't experienced that override feature before.

A Licensed Practitioner performing off the record services that could in theory cause a serious medical complication or death. Seems legit.

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"We have resolution authority under Frank/Dodd... How about we USE IT?" Karl Denninger, 10/07/10 on the Dylan Ratigan Show, MSNBC.

I should probably schedule a dentist appointment. Been 11 years now.

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@Krz et al, since switching to Xylitol paste, I'm starting to reconsider even the 6 month. Shit's amazing.

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"We have resolution authority under Frank/Dodd... How about we USE IT?" Karl Denninger, 10/07/10 on the Dylan Ratigan Show, MSNBC.

You can get real cheap and fancy. But bulk xylitol granules (1/2 cup) + baking soda (1/4cup) + peppermint oil + bentonite clay if you like.

Put it all in a food storage container & shake to mix. Lasts the better part of a year.

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I want to see teeth flying as someone is beaten with a cast iron dildo hidden in a sock.

But... but... but then you wouldn't have the honor of a crook like @Boron working on your teeth.

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Molon Labe
Where is Henry Bowman when you need him?
How many are willing to pledge this? We mutually pledge to each other our Lives, our Fortunes, and our Sacred Honor

I found some xylitol mouthwash that I've been brushing with for a while. Stuff is much thicker than regular mouthwash and works great.

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All I know is that I am a senior citizen that refuses health insurance, and can attribute my lack of need for medical care primarily to God, but also to positive dietary and lifestyle changes over the year. When the ACA was enacted, and I saw the one year premium for me, it was more that what I spend out of pocket for medical care in 20 years. So I agree with Karl that subsidized insurance should not pay the bills of diabetics that continue to drink sodapop, lung cancer bills of smokers, and liver transplant bills of alcoholics.

Mentos gum uses Xylitol as he the sweetener.
Brush at night, two pieces of Mentos gum before bed.

No cavities for 10 years now.
No candy and soda pop helps a lot too.

This is delusional. People eat like shit, Don't realize that our food systems are poisoned. To buy straight from a farmer, "that' to expensive" meanwhile they get their starbucks, have their boats etc. They sit around on their fat ass get sick, watch TV dont do anything about their health then get sick and blame the medical system. You cant price what you charge duh.. everyone is different, a quick check up will run minimal 5 min, and detailed exam could last hours. Furthermore if a Dr. is contracted by any insurance company. They have to abide by the rules, they cant give you discount because thats fraud and you'll get jail time.. And because everyone wants their insurance to cover it.. you now have corporate healthcare. Yes, you people brought this on. So now you get timed visits, and if the Dr. is not productive enough doesnt write enough scripts guess what they get fired. The systems in place are because of you people. Take responsibility. Here is a simple fix, you ready.... Get rid of insurance. Refuse to pay it. Take that money save it use if for medical emergency. Meanwhile find a good Functional medicine Dr. who specializes in preventable disease, and learn how to fucking take care of yourself. Then if something happens you have that cash to pay for your emergency visit. There is your solution. The rest of that BS you were rambling on about upstream, is to fucking long and boring to read or comprehend, but it sounds like the rest of the finger pointing BS i have heard 1000 times. You are responsible for your own health. Don't want to work or pay for health care.. guess your gonna die. No one is responsible for you.

Well well probably works for a hospital. And admits it didn't read it. Probably can't manage more than 30 seconds at once.

Bye

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Damn! Two days in a row of the wonderous splatter of the Ban Hammer to go with my Community Coffee.

What the actual fuck.


Why is it that people like to drop trou in the living room and shit all over the furniture?

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Father forgive me for the times I craved a place at a table that you would have flipped.

Dang, is that a record? Registered and banned on FIRST post?