Cheyenne: Thank you for joining us for this episode of What the Finance. There are a few things we like to mention at the top of each episode.
Rachel: First, if you want to get in touch with us, you can email What_the_finance@protonmail.com or join the What the Finance Discord Server.
Cheyenne: Second, it would mean a lot to us if you could support our show through Patreon. Starting at $3 a month, you can get episode shoutouts access to topic polls, and get to listen to some pretty hilarious outtakes.
Rachel: And, uh, third, as we seek to be a more inclusive show, we want to acknowledge that colonialism is an ongoing process, and capitalism, which we regularly decry, is part of this process. We are recording this episode on the ancestral land of the Dakota and Ojibew people, and we recognize our sovereignty and express our gratitude of being here. All right, well, welcome to another episode of What the Finance where we get to talk about hospital pricing transparency.
Cheyenne: This episode came from quite a few things, one of which was Amazon buying a healthcare system.
Rachel: Wait, yeah, I had honest to goodness, completely forgotten about that. Could you refresh me and everybody else?
Cheyenne: Yeah, there was a lot happening at that time. Um, so this was, I want to say, what, like, three, uh, four months ago at this point, I think, and Amazon bought a company called One Medical is, I think, what it's called. That's the high-level overview of kind of what sparked part of this thought process. For me, at least. Um, one of many conversations that came out of that acquisition was pricing. Because something that Amazon is known for is typically being one of the better prices for most items. That's very purposeful for them. Because while you may have to wait a week to get it, you're saving two or $3. And so people are willing to do that. Now, we all have talked about before. One of the reasons that Amazon does can, quote unquote, afford to do that is because they cut expenses. Other places used to be that it was efficiencies that they focused on. They had a lot of warehouses in a lot of different places, and so it was cheaper for them to get goods to people. And now, while that's still partially true, a piece of it is also that they don't pay their workers as well as they should.
Rachel: Right.
Cheyenne: I should rephrase that, because I don't think that the two or $3 that they are cutting off of the product, like the price of product goods is so much why they can't afford to pay their employees liberal wages and are scared of them unionizing. I think that has more to do with the leadership, uh, making significantly more money than any one person or group of people needs. That's just a guess, though.
Rachel: Yeah, well, I mean, I think it's a guess that we both agree.
Cheyenne: So anyway, many concerns came out of this one, what is pricing going to be like right now? And another focus came from there is a trying to remember for sure. I'm pretty sure it's a law that hospitals have to have their prices for common, uh, procedures. There we go. Could not think of that word. They, uh, have to have that pricing on their website, and if they don't, you can report them. And I should have prepared and grabbed the website, but I thought, I'll never forget that website.
Rachel: I have it up and I could include it in the show notes.
Cheyenne: Thank you!
Rachel: You’re welcome!
Cheyenne: It's like we've been friends for a while, and we've been doing this thing for a little bit, and our brains go to similar places.
Rachel: Yes. So I actually have a little bit of a beef with that. Not with the price transparency. There's no beef there. It's not a law. It's a rule from the Centers for Medicaid and Medicare Services.
Cheyenne: Uh, that's why there's no adherence.
Rachel: All ah, you all who want, like, smaller government and fewer interventions in the government. The reason that this isn't being enforced is because regulatory agencies like the Centers for Medicare and Medicaid Services don't have any teeth to enforce their own rules. So, yes, it's a rule, and they can assess you, but pretty hefty fine for not posting your prices. They also have to be reactive to regular citizens like us reporting, like, hey, my hospital doesn't have these prices on their website. Instead of proactive and going, hey, hey, you don't have prices posted on your website. Here's a giant fine. So they're kind of playing a number.
Cheyenne: And the thing that bugs me is that it's putting the responsibility on consumers this is not my responsibility to do some of that ground level work for you, but that's what they're doing. They're crowdsourcing. The thing is that there are people like you and I who won know that this even exists, that this is even a, uh, rule. Right.
Rachel: It's a thing.
Cheyenne: Then, yeah, we have the means and the access to one nowhere to report that to, and then be able to actually follow through and report that. If we find that it's not those three things are pretty big deals, because if you don't know, you don't know. If you don't have time, you can't go report that. And if you don't have access to technology and let's be real here. I mean, I don't know that everybody has the access to technology that everyone thinks that they do. That's just mine, because I've tried to access some things on a website, and I know that it's getting better. I know that sites are being designed for, um, mobile design, more so than they ever have been, but that still doesn't mean that they're easy. And again, it comes up with an accessibility thing, because that's small. That's a small screen.
Rachel: Right. Well, I mean, and the fact of the matter is, most of the United States is rural and doesn't, uh, have great Internet access.
Cheyenne: Right.
Rachel: So even if you have, like, a smartphone or, um, a computer in your house that can access the Internet, the infrastructure isn't there for you to maybe necessarily have reliable access. So you can't, like it's not reasonable to say to somebody living in, like, the middle of Wyoming, oh, yeah, just go to our website, probably. Yes, but also no.
Cheyenne: Right. Well, and we've talked about differences in where we live in the state. You live in the more populated area. I live in a rural area, which is most of the state. I have service issues with my cell phone coverage. It's a thing. I mean, so I lost my what point I was trying to make. Oh, okay. There we go. The point that I was trying to make there was that, like, I live in a relatively common rural area in the state, but also it's a place that it's not out of the realm of possibilities that multiple people are in. And so for us in this space to have service issues, I mean, I cannot imagine what it's like in places where it's not as I'm trying to.
Rachel: Like, where the infrastructure isn't really built.
Cheyenne: Up in a way that I was trying to figure out how to say that, because I was like, I don't want to give away exactly where I live. I know that we've kind of alluded to it, but I don't want to be like, well, the CEOs and such of companies that come up here probably have a lot to do with why we have great service.
Rachel: Right. Yeah. Nothing to do with the government providing a public good.
Cheyenne: Exactly.
Rachel: Right.
Cheyenne: My realism is showing. Right.
Rachel: That's the charm of the show.
Cheyenne: Uh, I think it's like the one time that capitalism helped me probably, um, not the one time, but, uh, the one time I'm willing to make mention.
Rachel: Of, admit it, we've been kind of taking on the price transparency. So I want to just be very clear. I think it's a good thing. It's a good idea. Where it's frustrating to me is, like, we just said, it's putting the responsibility on regular consumers who. Right. Like, we talk about all the time. We're all busy getting screwed over by capitalism, so we don't maybe have the energy to be, like, reporting. The other intent behind it is right. To allow consumers to price shop and negotiate. And in an area, uh, like in the area that I live, where there are multiple hospitals in my area that I could choose from.
Well, cool. Most people don't live in an area where there are multiple hospitals for you to choose from. So your ability to negotiate is then really limited. And let's be real honest. If you're in a situation, if you're in an emergency situation, you're going to go where the ambulance takes you, and you're going to be stuck with the bill.
Cheyenne: Right.
Rachel: Like, you can't say to the ambulance driver, wait, what's going to be the cost of this, uh, possible emergency procedure? Like, quick, let me pull out my cell phone and make sure that you don't want to take me to another hospital. Like, no, that's not how any of that works. So it's frustrating to me that all of this burden is being placed on regular citizens. It should be the place of the corporations, who, by the way, in the United States, most healthcare systems are nonprofits.
Right. Which, I mean, I could go off on that. I won't. Right now. It should be their responsibility to watch out for the people that they are that are under their care.
Cheyenne: It shouldn't be our responsibility. Something that I feel like I want to just make mention of is that I understand that the cost for certain common procedures is going to be higher because of many factors. So m, one of the more common procedures that I can think of that would probably be listed on a website would be like a colonoscopy ,mammograms. Those types of procedures and those types of procedures, very common, are still going to be expensive because one, you're always paying off equipment, and then you're always putting money aside for future equipment improvements. You're paying for the expertise of not just doctors, but surgical techs, rad, text, those types of people who actually perform that. But then you're also paying for the time of the people who sterilize the room, the equipment. I mean, there's so much rolled on then, not to mention the building itself, the electrical, uh, there's so much that goes into it. So I understand why those things are always going to be expensive. I don't love it, but I understand it. I do think that there is still room to have some of that pricing information available so that people can look at it and go, okay, it's more expensive for me to get my mammogram at this hospital than at, uh, this clinic. But if I go to the place that's a little bit cheaper, the technology isn't quite updated yet, so I'm going to go with a slightly more expensive because the technology is better, right. Giving people those options. But again, that's assuming the one you have the time and the access to do that. That's just one of the other points that I wanted to make with, um, regards to the earlier conversation and Amazon acquiring a health care entity, uh, were privacy issues. Amazon already has so much information on people now adding into that. We may have to do a follow-up on this because I have some thoughts about significantly more thoughts about the, uh, privacy concerns and that acquisition. Maybe we should probably do yeah, we.
Rachel: Should do another on that.
Cheyenne: It's a pretty big piece, and I have some thoughts. Um, so I guess it's a good time for us to wrap it up and say, hey, come join us. On our discord server. Check out our socials.
Rachel: For our wonderful listeners, we’ll see you next week.
