Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

U.S. health care's widespread overbilling problem

axios.com

Post reply on HN
Print view View original

251–260 of 273 posts

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

#251

Post by craigvn »

coredog64 wrote: post #211
craigvn wrote: post #209

This is what happens when you make the health care system capitalist. Despite rumours to the contrary, capitalism doesn't reduce prices, that would make no sense for a company trying to make a profit.

French outpatient care runs in a capitalist manner. You pay full price at the office, and your insurance reimburses you at 80% of "reasonable and customary". You are free to choose any Doctor, and it is up to you to decide how much any conveniences or perceived quality is worth.

Can't say I am an expert on the French system, but a quick Google says that the insurance is pretty tightly regulated by government.

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

#252

Post by mring33621 »

Consultant32452 wrote: post #240
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…

I had an equal and opposite experience getting an MRI. I also have a high deductible plan. When I was told I needed an MRI I went on my insurance provider's website to find MRI locations that are in network nearby. I called the first 5 on the list. I found that some place that was basically MRI-R-US was several hundred dollars cheaper than going to the local mega-hospital. Pricing isn't transparent because people usu…

This will result in many people choosing to spend nothing on 'day to day' healthcare. Subsequently, this 'deferred maintenance' will result in increasing rates of catastrophic events, which will drive up costs for that part of the system.

Giving cash (or cash equivalents) to people is probably not a good solution.

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

#254

Post by Mouse47 »

dingo_bat wrote: post #239
beat wrote: post #149

Earlier quoted context omitted.

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

> tuning the prices to insure profitability Highly offtopic, but thanks to anyone who helps me with this: wouldn't ensure be a better fit here?

Yes, unless he was making an insurance joke

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

#255

Post by EvanAnderson »

passivepinetree wrote: post #193
EvanAnderson wrote: post #29

Earlier quoted context omitted.

Another anecdote to this point: I had an experience in which a doctor accepted me as a patient (knowing what insurance I had and what reimbursement rates the insurer would pay), performed a procedure for me, then subsequently found out my insurance would not cover the procedure (because of a preexisting condition waiver I did not know was still in force). The doctor then demanded full payment for his non-discounted r…

What ended up happening in this case?

I met with the doctor face-to-face. He felt that he needed to stand-by his policy of demanding the non-discounted fee. He did not believe the rate for the service was set when he accepted my insurance (with a known reimbursement rate), but rather was based on his billing staff finding the highest amount to bill after the procedure was complete.

He made an argument (that I considered specious) about "fairness" to other patients and problems he'd had in the past with patients mistreating the office staff because of perceived "unfairness" in his offering discounts.

My attorney advised me that I'd likely spend more money fighting the doctor than just paying him. Because I care (probably more deeply than I should) about my credit rating I opted to pay the doctor and put the whole mess behind me. I also ditched my pre-ACA insurance that carried this never-expiring pre-existing condition waiver and moved to an ACA plan with no such waivers.

The surgery center that was involved in the ordeal was much more reasonable, BTW. They charged me the amount my insurance company would have reimbursed them. When I brought this up to the doctor (who is also a partner in the surgery center business) he simply stated that his office's policies differed from those of the surgery center, and that his policy was to receive his full fee.

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

#256

Post by mtanski »

EvanAnderson wrote: post #44
troyvit wrote: post #43

Earlier quoted context omitted.

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.

I'm assuming you're ESL, ... in Polish you also call it literaly "black comedy". The proper term you're looking for is "dark comedy". In the US "black comedies" nowadays is a term referring to for/by African Americans; it's a whole sub genre.

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

#257

Post by mtanski »

beat wrote: post #149
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…

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

Yeah, based on my experience living here I don't think this kind of price control is ever going to happen in the U.S.

In the majority of the 1st world where the goverment and general population accepted the fact that healthcare is a special case outside normal economic rules. That's why get things like single payer, price controls.

That's not the prevailing belief in the US. The majority of people in power (not sure about general population) believe that healcare is like any other business subject to the same rules. Single payer is government interference into the market; price controls are definitely out of the question. Price controls might even be unconditional (if challenged, depending on context).

Also, the various lobby groups representing doctors are very powerful much like unions used to be. However unlike labor unions these groups have broader cross party relationships. These groups tent to oppose any kind of limits on pay that could directly impact their constituents.

When you put that in perspective it's obvious to understand why we end up which such convoluted solutions as the ACHA in order to expand/guarantee medical coverage to people.

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

#258

Post by beat »

tptacek wrote: post #163
beat wrote: post #149

Earlier quoted context omitted.

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

It's not a government takeover of health care - only of pricing. The Japanese model is largely private providers, and private, employer-provided insurance.

Standardized pricing gets rid of the problem of charging different customers (slightly) different pricing, and having massive negotiations on a per-carrier basis. This sort of thing isn't a matter of "competition drives down cost". It's just stupid and inefficient.

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

#259

Post by beat »

int_19h wrote: post #233
ams6110 wrote: post #170

Earlier quoted context omitted.

Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?

Fun fact: Medicare is prohibited from negotiating drug prices with suppliers, by law.

Ah, yes, Medicare Part D. That's what happened the last time the GOP got to write a health care bill.

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

#260

Post by Dove »

HarryHirsch wrote: post #196
Dove wrote: post #123

Earlier quoted context omitted.

Colorado has this cool law which, as far as I can gather, requires hospitals to report prices for various conditions. It results in tools like this: https://cha.fhsclearquote.com/ You put in your zip code, how far you want to go, find the condition, and it gives you a list of hospitals, average charge, case volume, and 5th and 95th percentile costs. I'd love a more nuanced analysis that looked at outcomes, too. Still…

Hey, that's wonderful. Price transparency is always touted as the panacea for the relentless runaway growth in healthcare costs in the States. Here's the natural experiment. Has this law managed to rein in healthcare costs? You'd think it hasn't, and the missing focus on outcomes gives it away.

I don't think most people know about it. It's helped rein in healthcare costs in this household at least, though? ;)
Post reply on HN