@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.
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.
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.