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

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

#71

Post by Retric » Mon, Jul 10, 2017, 4:42 PM UTC

wlesieutre wrote: post #41

projectramo wrote: post #32

Earlier quoted context omitted.

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.

'High deductible' is so broad it's almost meaningless. At $1,300 single $2,600 family (2017) in the US many people hit every year making price shopping almost pointless.

https://en.wikipedia.org/wiki/High-deductible_health_plan now at the high end of that a $13,100 family plan does provide more incentive again unless there is something significant wrong when again the incentive to price shop suddenly goes away. Worse, medical spending tends to mostly be by a few very sick people vs. the healthy making high deducible plans have limited real impact.

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

#72

Post by mnm1 » Mon, Jul 10, 2017, 5:33 PM UTC

I think this is a great argument for a single payer system. Let the government and hospitals duke it out. When it's the government's money that is being lost, the government might actually care and start negotiating with these providers. Even if it doesn't, at the very least, patients lives won't be ruined by bills for services that they had no control over or knew the cost of beforehand. Not only that, but the government can afford it. When they're losing trillions of dollars on the defense side, I'm certain they can pay for every medical procedure in the country and still have plenty left over. This whole idea that the government doesn't have money to pay for healthcare and other necessary social services is such fucking bullshit when they have the ability to lose trillions in defense and just shrug it off. That's not even mentioning the money that isn't lost on the defense side. Unfortunately, I don't think people have the capability to push their government to spend that money correctly. But that's a different problem altogether.

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

#73

Post by wlesieutre » Mon, Jul 10, 2017, 5:38 PM UTC

Retric wrote: post #71

wlesieutre wrote: post #41

Earlier quoted context omitted.

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.

'High deductible' is so broad it's almost meaningless. At $1,300 single $2,600 family (2017) in the US many people hit every year making price shopping almost pointless. https://en.wikipedia.org/wiki/High-deductible_health_plan now at the high end of that a $13,100 family plan does provide more incentive again unless there is something significant wrong when again the incentive to price shop suddenly goes away. Worse…

Mine's $3000/6000, I've luckily been in good enough health to not hit it. It's been the right choice for me; the amount I've saved into my HSA vs employee contribution to our more expensive health insurance option will more than cover hitting the max for a year.

I was looking into sleep studies recently, a quick google suggests a cost range of $600 to $5000. I'd definitely shop that around, and if a place won't give me a price then I wouldn't consider doing it.

But like you said, I'm pretty small potatoes compared to sick people.

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

#74

Post by wvenable » Mon, Jul 10, 2017, 6:06 PM UTC

pancreas wrote: post #70

mfoy_ wrote: post #36

Earlier quoted context omitted.

Why not just have proper socialized medicine, such as in Canada? Instead of this perverse system of "shadow" socialized medicine, fraud, and over-billing, why not just make it come out of everyone's taxes? That way everyone pays a very modest amount in tax and no one has to be financially ruined by flukes of nature. Also kills a huge amount of overhead in the billing departments, collection agencies, insurance compan…

It will be nice to have socialized medicine, but please, not as in Canada. Their system is not good. I would prefer Medicare expansion to all, or a VA-like system while medicare and medicaids are phased out. This will happen eventually, but alas not soon.

I'm a Canadian, what's wrong with our system from your perspective?

(No system is perfect; there is always room for improvement and trade offs)

Just two weeks ago, my wife had an emergency appendectomy. She went to the free clinic first thing Sunday morning as she had terrible pains all night. They immediately referred to the local hospital. She had the ultrasound in the afternoon and Surgery at 3:00pm. She's been off work (more or less) for 2 week recovering. The only thing we paid for is parking.

This[1] redditor in the US has the same surgery and it cost $55,000 dollars, which insurance covered a lot of but still left him with an $11,000 bill. That's just one simple surgery and that's not a small amount of money.

[1] http://www.cbsnews.com/news/cost-of-an-appendectomy-reddit-u...

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

#75

Post by tcj_phx » Mon, Jul 10, 2017, 6:50 PM UTC

sixdimensional wrote: post #65

tcj_phx wrote: post #45

Earlier quoted context omitted.

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…

Actually, I used to work in health insurance, so I have a bit more insight into this than most, although I've been out of it for a while (10 years or so). If you look into how the RBRVS are calculated, there is effectively a privately run panel that determines input variables and factors that are used in the RBRVS calculations. At some point, someone has to determine the portion of the calculation that represents "ph…

Thanks for your insights. I have family in the medical field, so I've heard a lot of complaints about the system. It seems like most people don't appreciate how much "complication" in the medical industry derives from third-parties paying for almost everything.

I have a doctor who gives his patients a receipt that they can use to "try" to get reimbursed by insurance. He takes cash or check, has all the patients he wants, and zero employees.

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

#76

Post by LyndsySimon » Mon, Jul 10, 2017, 6:50 PM UTC

skummetmaelk wrote: post #38

EvanAnderson wrote: post #31

Earlier quoted context omitted.

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.

Americans cannot stomach the idea of giving anyone anything for "free", without thinking about longer term benefits.

I don't think this is it at all. The argument is that there is no such thing as "free", there are only transfers of cost. Someone is paying.

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

#77

Post by yequalsx » Mon, Jul 10, 2017, 6:50 PM UTC

opportune wrote: post #16

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.

Yep. The AMA/AAMC is essentially screwing the rest of the US so that they can keep doctors' salaries artificially high. There are tons of medical school applicants who get rejected every year, and not because they can't become doctors, but because medical school sizes have remained constant while the country's population (and demand for healthcare) has increased drastically.

My wife recently completed her residency. She has $370,000 in student loans. In order to pay off the loans she needs a high salary. The high salary doesn't go away once the school loans are paid off. It'd make a whole lot more sense for the country to just pay for higher education upfront. We'd be fine with her making half her salary and have the loans forgiven. It'd be much cheaper for society to do this.

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

#78

Post by sidlls » Mon, Jul 10, 2017, 6:52 PM UTC

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…

Price transparency is not going to fix much, if anything. It may induce rage increased blood pressure on the front end (prior to receiving service), but ultimately health care is often a "must have."

Having a price list in hand doesn't suddenly make the price conscious consumer more of an expert regarding the necessity of various services estimated. Nor does it really encourage competition between competitors.

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

#79

Post by Johnny555 » Mon, Jul 10, 2017, 7:02 PM UTC

cptskippy wrote: post #21

Osiris wrote: post #8

Earlier quoted context omitted.

Health care is the only industry where you only find out how much something costs after you're already bought it. Basic supply and demand theory depends on consumers having perfect information. A free market cannot work when a consumer has no information.

A lot of trades give you estimates but you don't know the actual cost until the work is complete. Auto repair, construction, plumbing, electrical, etc. There are plenty of fixed costs that can be accounted for easily but there are a lot of unknowns that can't be seen ahead of time. That's why quotes and shopping around so prevalent because it allows for competition in price. However in healthcare that's not an option…

One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. And I may very well decide not to do it. They may tell me that I need a $1000 timing belt replacement when I ask for a $200 water pump replacement, and I may decide not to do it. I can even ask them to put everything back together and tow the car somewhere else for repairs. If they tell me I need a $3000 engine replacement, I may decide to just scrap the car.

The same is not true with healthcare - you may go in for a $20K stent, but have a serious complication that needs $200K open heart surgery -- you don't really have the option to say "put everything back together and I'll live with it".

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

#80

Post by binarymax » Mon, Jul 10, 2017, 7:04 PM UTC

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…

Surprise! Pricing is "transparent", although massively complicated.

There are several systems, but let's take a look at Outpatient procedure pricing...

A good outpatient pricing guide is here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning...

And coupled with the OPPS dataset here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... as well as a couple others, along with a quick read of the federal register, you can kinda figure it out on your own (/s).

Every bill you get must also have the codes and modifiers on it by law. Its interesting to download the dataset and look them up.

--EDIT-- I incorrectly linked to the COBOL PC Pricer code above for OPPS! Here is the pricing data: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...