U.S. health care's widespread overbilling problem • Hacker News Board

Re: U.S. health care's widespread overbilling problem

#41

Post by wlesieutre » Mon, Jul 10, 2017, 3:41 PM UTC

projectramo wrote: post #32

Retric wrote: post #13

Earlier quoted context omitted.

Pricing does not solve the root problem which is everything trying to get someone else to pay.

I agree with you in that this is another problem but I think the two are highly related. Consider: 1. If you don't have insurance, how do you know where to go? 2. If your insurance company wants to reward you for picking lower priced options, how do you comply? 3. If the government wants to lower systematic costs, how do they give you incentives? Without basic pricing information, all the benefits of a free market ar…

Related to 1 and 2, people on high deductible health plans are paying everything out of pocket until they hit their yearly cap (then insurance kicks in). It's not even whether you have insurance or the insurance company wanting to reward you, it's trying to save your own money like any other purchase.

High deductible health plans are becoming more and more common, from what I gather.

Re: U.S. health care's widespread overbilling problem

#42

Post by mfoy_ » Mon, Jul 10, 2017, 3:43 PM UTC

Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?

Re: U.S. health care's widespread overbilling problem

#43

Post by troyvit » Mon, Jul 10, 2017, 3:44 PM UTC

EvanAnderson wrote: post #11

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with bot…

That's hilarious. They are making the health of your wife and daughter a profit center yet they act offended when you want to know the cost.

Re: U.S. health care's widespread overbilling problem

#44

Post by EvanAnderson » Mon, Jul 10, 2017, 3:45 PM UTC

troyvit wrote: post #43

EvanAnderson wrote: post #11

Earlier quoted context omitted.

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with bot…

That's hilarious. They are making the health of your wife and daughter a profit center yet they act offended when you want to know the cost.

Black comedy, indeed.

Re: U.S. health care's widespread overbilling problem

#45

Post by tcj_phx » Mon, Jul 10, 2017, 3:49 PM UTC

sixdimensional wrote: post #30

For more information about the rough guidelines by which pricing works in the US (or doesn't work), check out the often referred to term "usual and customary" (UCR) charges. Read about it and then form your own opinion - I'd rather not bias too much by offering mine. https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...

There was a reform, maybe sometime around 1985, that replaced "usual, customary and reasonable" with 'what should this procedure actually cost'. Your wikipedia links to this page:

Resource-based relative value scale - https://en.wikipedia.org/wiki/Resource-based_relative_value_...

It took the government 20 years to figure out that they couldn't give the medical system a blank check.

/methinks a helpful medical reform would be to get insurance-paid doctors on fixed salaries. Under the present status quo, some doctors bill insurance companies for as much as they can get away with.

Re: U.S. health care's widespread overbilling problem

#46

Post by mfoy_ » Mon, Jul 10, 2017, 3:50 PM UTC

"The United States remains one of the only advanced industrialized democracies in the world without universal coverage.

While this in and of itself is not a problem, the United States also spends more on health care as a percentage of GDP than any other advanced country in the world and has worse health outcomes – with lower life expectancy, higher infant mortality and higher obesity rates than comparable countries like Australia, Canada, the United Kingdom, Germany, France and Japan." - http://theconversation.com/three-reasons-the-us-doesnt-have-...

Re: U.S. health care's widespread overbilling problem

#47

Post by EvanAnderson » Mon, Jul 10, 2017, 3:51 PM UTC

mfoy_ wrote: post #42

Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?

I am an American.

When I'm particularly exasperated with the healthcare system (usually in the weeks/months following some kind of medical engagement) my answer would be "I don't give a damn which we choose. Let's just make a decision to either socialize medicine completely or let people die."

(My mood is unreasonably caustic after dealing with anything medical. The stress of dealing with healthcare billing, health insurance, and the patriarchal attitudes of medical practitioners raises my blood pressure and gives me near panic attacks.)

When I'm in a more calm and normal mental state my answer would lean toward socializing as much of the healthcare system as possible.

Literally nothing is a bigger fear-factor in my life than medical expenses. The fact that the entirety monetary value of my life's work could be destroyed in a moment by a medical issue freaks me out. The fact that I cannot, in any financially viable manner, insure against this kind of event amplifies that fear.

I feel comfortable in saying that, at least in an abstract way, I am less afraid of death than of leaving my family destitute as a result of unforeseen medical expense.

Re: U.S. health care's widespread overbilling problem

#48

Post by pancreas » Mon, Jul 10, 2017, 3:51 PM UTC

rscho wrote: post #23

Moshe_Silnorin wrote: post #2

Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control,…

YES. Salaries are not that high, either, for people in medical academia and now in HMOs as well. One can justify paying a neurosurgeon 430 per year - after 8 years of post-graduate training, and if you count college and medschool, that is 16 years. During all that time a future neurosurgeon mostly acquired debt, while working 120 hours per week.

Re: U.S. health care's widespread overbilling problem

#49

Post by slice_of_life » Mon, Jul 10, 2017, 3:52 PM UTC

EvanAnderson wrote: post #31

wvenable wrote: post #25

Earlier quoted context omitted.

It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.

This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.

>As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine.

Seems a tad callous even by my standards as a staunch classical liberal; may be all other medical services but not emergency services.

Re: U.S. health care's widespread overbilling problem

#50

Post by jayd16 » Mon, Jul 10, 2017, 3:52 PM UTC

alphanumeric0 wrote: post #39

I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care. Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?

Preventative care means less risk of catastrophic care. Its cheaper for insurance to encourage you towards preventative care than pay for the catastrophic care.