211–220 of 305 posts
Can't you pay directly for private insurance in the US? I pay directly to the insurance company. It costs me about 145 usd/month and includes health insurance (with urgent care), long term care insurance, life insurance (about 500k usd) and some more. I could have done it through my employer, but when I leave for another place I'll have to renegotiate the price with the insurance company, and also this option has les…
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Insurance should be used for what it is — an financial instrument to protect against unforeseen and catastrophic financial loss. Car insurance doesn’t pay for tires or oil while it could be argued that bad tires increase the risk of accident. However tires and oil are an inextricable requirements to owning a car. This idea that health care should be paid for by someone else has always puzzled me. It’s the equivalent…
It’s simply not true. In the 4 countries I have lived in, the US was the only one with very expensive heathcare, and in the other 3, which all have what Anericans call socialized medicine, healthcare was even more detached, but much cheaper.
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Why not? You also can't live without food but there is a market for that. Even when you don't have time to cook and need food on short notice, there are plenty of fast food and delivery options available. There is nothing impossible about a situation where a hospital has a reputation for being cheap but having long wait times while another hospital is more expensive but has shorter wait times. Then in an urgency you…
You can live for weeks without food, it can be stored easily (unlike services which aren't stored at all), and the barrier to entry is low... Many people even have their own food gardens. It's also very amenable to nearly complete automation. Therefore food is super cheap.
At the moment the only thing I can think of that are expensive services are also luxury services. Most people consider health care to be a basic service that should be open to those who need it, regardless of wealth.
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>attending your annual checkups reduces your risk of needing expensive treatment Btw, there's no evidence of this. Zero...zip...zilch...none. http://www.bmj.com/content/352/bmj.h6080
So, you're claiming that since certain cancer screenings are ineffective it therefore means that managing issues such as hypercholesterolemia, hypertension, and diabetes are also ineffective? That seems like a stretcher to me, and I'm not buying it.
diabetes usually shows itself, hypertension is a silent killer though.
i'm not arguing against check ups, but I could imagine why they are not as effective as you might think.
i myself do not get checkups, i have insurance, but going to the doctors is a miserable experience.
First is trying to schedule a visit. Usually the earliest they can see me is 3-6 weeks away. when I have free time to see a doctor, thats when I need to do it. I dont know whats going to happen in my schedule a month from now?!
next, if I actually get the appointment, I am punctual and show up 15 - 30 minutes before the appointment. However, I dont get seen for 30-45 minutes after the scheduled appointment. This isn't just one time, this is E[X]. thats 45 minutes waiting with people who are coughing , sneezing, etc. after I see a nurse for 2 minutes and get sent to a room, usually thats another 5-10 minutes waiting in an empty room.
when I finally see a doctor, I am only allowed to talk about one thing. if its multiple things, I have to schedule another appointment. usually the doctor cant help with any of my ailments, I need to schedule an appointment with a specialist. usually another facility. unfortunately, I am not allowed to schedule an appointment with a specialist directly, I have to see my primary care first.
I'm curious, this article spins the whole "lower rates of ambulance usage" as a positive thing, but is there enough evidence to say that? From the article: _______ With demand for ambulances decreased by available Uber drivers, emergency personnel have been able reach critical patients faster while also applying necessary treatment on the way to the hospital, according to a new economic study from the University of K…
Well, they could ask Uber for all the rides they made to the ER and see if - roughly - the numbers match with the claimed 7% reduction of ambulance calls.
I mean, a lot of people may have - coincidentally in the same period Uber came to the cities - become aware of the high cost of ambulance, or lost their insurance or whatever other reason and used taxis or some other means.
After all the study takes into account what happened over very roughly 3 years 2012-2015, how many people read (say):
http://articles.latimes.com/2013/aug/23/business/la-fi-healt...
http://www.nytimes.com/2013/12/05/health/think-the-er-was-ex...
If there was a "penetration rate" (which is not the same thing as "establishing the service") and a direct correlation with roughly the same number of UberX rides to the ER and of less ambulance calls then it would IMHO sound much more credible.
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The system works fairly well if you are poor too. I know several people who have walked into and out of the hospital without paying a dime. It really seems like the middle class gets the raw end of the deal.
Well, not if you need treatment. If you're poor, yes you won't pay anything because the hospital won't bother to bill anyone. But if you need surgery and have no insurance or medicade, there are cases of doctors sending you home, waiting for sepsis and then amputating, because it's cheaper and takes less resources. Extremely poor people may not pay for care, but be assured that in America, they get no where near the…
Cancer is probably the worst example you could pick to prove your point. It turns out that the US system is highly-optimized for specialized care (which happens to include cancer), as opposed to routine care. That's one of the reasons it ends up being more expensive.
In fact, even when including poor and uninsured people in the mix, the US has dramatically better outcomes when it comes to cancer treatment than the UK, Canada, Denmark, France, the Netherlands, etc.
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The system works fairly well if you are poor too. I know several people who have walked into and out of the hospital without paying a dime. It really seems like the middle class gets the raw end of the deal.
Well, not if you need treatment. If you're poor, yes you won't pay anything because the hospital won't bother to bill anyone. But if you need surgery and have no insurance or medicade, there are cases of doctors sending you home, waiting for sepsis and then amputating, because it's cheaper and takes less resources. Extremely poor people may not pay for care, but be assured that in America, they get no where near the…
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> Health care costs have spiraled out of control because of the detachment of who is paying from who is receiving the service — much like higher education. No, they have spiralled out of control because health care is something where no real market can exists, so you need good regulation (which the USA doesn't have). If you have an urgent and life-threatening health problem you can't shop around for a cheaper hospita…
Why not? You also can't live without food but there is a market for that. Even when you don't have time to cook and need food on short notice, there are plenty of fast food and delivery options available. There is nothing impossible about a situation where a hospital has a reputation for being cheap but having long wait times while another hospital is more expensive but has shorter wait times. Then in an urgency you…
How many people on HN have done the reading to know when a fecal occult blood test can and can't be substituted for a colonoscopy? And those are generally tests that don't have urgency. When you're in the hospital because you've been vomiting for 6 hours and are passing out, are you going to say yes to the abdominal CT? This recently came up with a friend, who called me for advice. I was with a doctor in the moment, who said that he didn't see why it was indicated (for a host of reasons). The doc got on the phone with friend who handed the phone to the physician's assistant who was going to bring him to the CT, and argued the guy out of the CT. This took knowledge, effort, and persuasion. Who here is going to be able to self-diagnose and say, "Skip the CT -- I'll have it if X has not improved in 24 hours and Y continues to decline."
For many reasons, in the US there is a lot of "defensive medicine" practiced. The doc would rather order the CT than defend against a lawsuit, and for him/her it takes less time to order the CT when the patient rolls in than wait 24 hours while observing the patient in the hospital. But it's not actually in the patient's best interest. Our incentives are not aligned, and patients do not have the time or baseline knowledge to evaluate individual treatments.
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You can live for weeks without food, it can be stored easily (unlike services which aren't stored at all), and the barrier to entry is low... Many people even have their own food gardens. It's also very amenable to nearly complete automation. Therefore food is super cheap.
>I understand that healthcare is more expensive than food for all those reasons. What I don't understand is why there can't be a market for it. Expensive services can have markets too. At the moment the only thing I can think of that are expensive services are also luxury services. Most people consider health care to be a basic service that should be open to those who need it, regardless of wealth.
Why exactly can't I know ahead of time how much will each hospital in my area charge if I have a heart attack and have to go to their ER? Why can't I know which hospital has better survival rates, or the shortest wait times?
That information is all that is needed to have a healthcare market. It should not be impossible.
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Why not? You also can't live without food but there is a market for that. Even when you don't have time to cook and need food on short notice, there are plenty of fast food and delivery options available. There is nothing impossible about a situation where a hospital has a reputation for being cheap but having long wait times while another hospital is more expensive but has shorter wait times. Then in an urgency you…
You can live for weeks without food, it can be stored easily (unlike services which aren't stored at all), and the barrier to entry is low... Many people even have their own food gardens. It's also very amenable to nearly complete automation. Therefore food is super cheap.