Catching up: Medical clinic pricing and geopolitical concerns for ports

June 22, 2014 

Here is some stuff I know, the “midyear clearance of leftovers, random items and follow-ups” edition:

 • We’ve been harping in this space regularly on the shake-up coming in health care, in terms of where and how services are delivered and who pays how much for it.

So here’s one more, albeit small, contribution to that trend, a news item that got lost in the bigger wave of health care news including the VA scandal and various Obamacare debacles.

The Everett Clinic, which operates nine locations in Snohomish County, has begun posting prices for certain medical procedures, detailing what patients will self-pay.

This isn’t a hugely revolutionary move, for three reasons. First, as noted previously, some medical providers have been posting prices. Urgent care clinics often list on their websites the cost of many routine procedures and treatments. So do some specialty practices.

And the chart that the clinic now posts is limited in scope — just six items, under the category of imaging services.

Further, medical pricing gets incredibly complex once arrangements with insurers, group plans and multiple providers are figured in. So if you’re trying to price what an entire set of services might cost for a hospital stay or even a day surgery, you’re not going to know what the hit is until the indecipherable and often uncoordinated and unconsolidated bills start coming in — and maybe not then either.

Still, the fact that a chest X-ray with two views will set you back $74.75 — $56.06 with a 25 percent prompt-pay discount — is more information than patients had before. The Everett Clinic promises to add more through the year, and invites patients to call for a quote on services not listed on the website.

“Transparency,” a crowd-favorite buzzword of the moment, doesn’t mean much on its own; what counts is what’s done with that transparency once it’s achieved. When it comes to health care transparency, however, consumers have had as much transparency as trying to read one X-ray in the middle of a stack of a dozen of them — and through the box containing all those sheets of X-rays as well.

Neither of the two large Pierce County-based health care systems, MultiCare and Franciscan, are posting prices for services on their website. A Franciscan spokesman says the issue is “certainly one we are thinking about” as health care reform continues.

 • A dominant dark cloud looming over conjecture about the fates and futures of the ports of Tacoma and Seattle has been what happens when the Panama Canal widening project is finished. The prevailing scenario of doom is that, with the canal able to accommodate larger vessels, container ships will bypass the West Coast ports and head directly to the Gulf and East coasts.

There are multiple arguments supporting and refuting the likelihood of that outcome, but the ports are already trying to come up with countermoves — cooperation with each other, shifting to other types of cargos (as Tacoma is considering with the proposed gas-to-methanol plant and export terminal) and facilities to handle ships that won’t fit through the canal even after it’s expanded.

What happens when there’s not one but two canals through Central America? What happens when that new canal is bigger than Panama’s?

What if that canal is developed by China, with participation by Russia, and runs through Nicaragua (a country with its own history of less than amicable relations with the U.S.)?

There is such a project contemplated, with a construction start possible by the end of this year and a partial opening as soon as 2019, as detailed by a story in Russia Beyond the Headlines, an insert in the Wall Street Journal.

Just the players involved raise geopolitical implications, few of them good. The RBTH story notes that a major motivation for building the canal is to counter what is seen as American control over major trade routes; an agreement with the Nicaraguan government allows Russia to have warships and aircraft in its territory.

Backers of the new canal are banking on growth in cargo volumes to support the venture — but when did a feasibility study ever say there was insufficient demand for a massive construction project? Freight volume growth has been tepid at best lately, and if the new canal has to grab market share by price slashing, the effects will be felt from Panama City to Prince Rupert, B.C., and all points in between.

The RBTH quotes one analyst as saying Russia is more interested in a northern sea route, which carries its own potential geopolitical unpleasantness.

The projected cost of the project (including ports, an airport and an oil pipeline) is $40 billion. Unless massive cost overruns on a massive construction project are a purely American phenomenon, a canal that isn’t expected to be fully done by 2029 will be vastly more expensive than that. And even $40 billion, even for China and Russia, is a lot of money to spend just to poke a finger in the American eye, no matter how enjoyable that might be for those giving the finger to the U.S.

Bill Virgin is editor and publisher of Washington Manufacturing Alert and Pacific Northwest Rail News. He can be reached at bill.virgin@yahoo.com.

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