What Happens When Doctors Only Take Cash (2017) • Hacker News Board

Re: What Happens When Doctors Only Take Cash (2017)

#41

Post by friedButter » Mon, Jan 15, 2018, 8:57 PM UTC

linsomniac wrote: post #24

My local mechanic is required by law to tell me how much something is going to cost me before they start work. Why is my doctor not held to the same standard. Ever tried calling a provider to find out how much something is going to cost? Sounds like the medical industry had better lobbyists.

>My local mechanic is required by law to tell me how much something is going to cost me before they start work. Why is my doctor not held to the same standard. Ever tried calling a provider to find out how much something is going to cost?

Does that include a situation where say, when emptying out the oil, the nut over the drain breaks off which necessitates changing the oil sump, except they then discover the engine mounts are rusted and now the engine needs to be lifted and the mounts replaced? (I'm not a car guy, but I hope this demonstrates the thought even if inaccurate)

Re: What Happens When Doctors Only Take Cash (2017)

#42

Post by gedy » Mon, Jan 15, 2018, 8:57 PM UTC

killjoywashere wrote: post #23

maxxxxx wrote: post #4

Earlier quoted context omitted.

A price list like this should be mandatory for all doctors.

Should software developers and lawyers also have upfront pricelists for all services? I will gladly develop a cure for cancer, for the low, low price of $20B.

Software folks mostly do: "I will do mgmt's random projects and requests for $xxxxxx a year."

Re: What Happens When Doctors Only Take Cash (2017)

#43

Post by qubex » Mon, Jan 15, 2018, 8:58 PM UTC

Giacomot wrote: post #29

t3rmi wrote: post #27

Earlier quoted context omitted.

How does one break so many bones?

Free healthcare is a great incentive to be careless with your body. /s* edit: I was being sarcastic

I see you're being voted down but you might actually be right... if I feared that kind of monetary consequence I'd never walk out the door.

Re: What Happens When Doctors Only Take Cash (2017)

#44

Post by friedButter » Mon, Jan 15, 2018, 8:59 PM UTC

linsomniac wrote: post #24

My local mechanic is required by law to tell me how much something is going to cost me before they start work. Why is my doctor not held to the same standard. Ever tried calling a provider to find out how much something is going to cost? Sounds like the medical industry had better lobbyists.

Well, you dont use your insurance for maintenance, you use it for accidents.. Compare accidental repair prices to medical prices, since you do use insurance for regular doc visits, comparable with maintenance

Re: What Happens When Doctors Only Take Cash (2017)

#45

Post by crpatino » Mon, Jan 15, 2018, 9:03 PM UTC

conanbatt wrote: post #7

dukoid wrote: post #5

I think it's an important reminder that markets need some level of transparency to function. And perhaps that relatively simple regulation (like a requirement to publish the prices -- or in other areas the first sale doctrine) might be the best regulation where feasible....

This is a very interesting case, but I'd be cautious about it. Its not that the surgery that costs 60k, will cost 16k if you don't have administrative staff. Its true administration is a huge expense, but I doubt it can make medical care cost 1/4. Also healthcare services can never be "all round service" because any complication could mean a million things from scans to medication. Even on primary care you cant reall…

It is not as if the extra $44K goes all to the admin's payroll. Rather, if you have more personnel, it means you are running a bigger, more complex operation. That demands larger facilities, more equipment, a wider range of skills in your workforce, etc, and that all costs money.

Furthermore, given that all those things require heavier capital investments, it makes less likely that the surgeon performing the surgery is a (partial) owner of the hospital itself, but rather a highly compensated employee. There is a double-bite effect there:

1. The doctor's interest is less alligned with that of the hospital, so he will demand higher compensation for the same amount of work, at least of there's enough scarcity of doctors to justify it.

2. The capitalist owner will naturally expect a return of investment. It is subtle, but in this case the expected profit is proportional to the total capital investment, not the number of hours/services provided.

Re: What Happens When Doctors Only Take Cash (2017)

#46

Post by harrisreynolds » Mon, Jan 15, 2018, 9:03 PM UTC

I've been wondering for a while now why health insurance companies exist at all. They introduce a massive bureaucracy and massive costs and provide very little value.

They evolved from a reasonable idea into a monster that just drains our system and do not provide enough value to justify their existence in my opinion.

Re: What Happens When Doctors Only Take Cash (2017)

#47

Post by ed312 » Mon, Jan 15, 2018, 9:05 PM UTC

maxerickson wrote: post #36

Clubber wrote: post #19

Earlier quoted context omitted.

There is an Adam Ruins Everything episode about that. Basically hospitals were reasonable, then insurance companies came along and brought extra business to hospitals. For that, they felt they deserved a cut. Since the hospitals were mostly non-profits, or low profit, they didn't have anywhere to cut, so in response they raised their rates to provide a cut. There is more to it, but that's the origin of the charge mas…

The American Hospital Association tracks uncompensated care (bad debt and forgiven bills): https://www.aha.org/system/files/2018-01/2017-uncompensated-... It's around $40 billion per year in recent years (for all US hospitals). With hospital spending around $1 trillion, it's 4 or 5% across the industry. There are of course individual hospitals that face higher costs.

That's an incredibly revealing document! I've been looking for something like this to explain to my more conservative friends why the ACA is actually a better way to reduce medical costs.

Re: What Happens When Doctors Only Take Cash (2017)

#48

Post by ef4 » Mon, Jan 15, 2018, 9:09 PM UTC

killjoywashere wrote: post #22

DoreenMichele wrote: post #16

Since their surgery center does not employ the army of administrators that is often required to haggle with insurers and follow up on Medicare reimbursements, their overhead is smaller. This is part of why Obamacare is fundamentally broken. Using the existing commercial insurance system to try to provide universal coverage injects unavoidable extra expense and complications. Really happy to hear about the trend the a…

This may work for chronic conditions and non-lethal problems, but creates a problem when you're talking about urgent care: stroke has a 2-3 hour window for administration of TPA. The goal for intervention in a myocardial infarction is under an hour, same for trauma, where people may be in the ICU for days to months (a lot of months). Who covers those costs?

> This may work for chronic conditions

According to the CDC, 75% of healthcare spending in the US is spent on chronic conditions or issues comorbid with chronic conditions.

So system changes that only help with chronic conditions could still be very worthwhile.

Re: What Happens When Doctors Only Take Cash (2017)

#49

Post by expertentipp » Mon, Jan 15, 2018, 9:11 PM UTC

I've seen similar trends in post-Communist EU countries. We are importing the worst patterns from US. Public health insurance is most of the times miserable.

Re: What Happens When Doctors Only Take Cash (2017)

#50

Post by mcny » Mon, Jan 15, 2018, 9:11 PM UTC

IncRnd wrote: post #38

linsomniac wrote: post #24

My local mechanic is required by law to tell me how much something is going to cost me before they start work. Why is my doctor not held to the same standard. Ever tried calling a provider to find out how much something is going to cost? Sounds like the medical industry had better lobbyists.

The problem really isn't the doctors but the structure of insurance and how people treat health care and health insurance similarly. The worst part is that high costs aren't directly the fault of insurance companies but of government having driven the need for insurance. Health care used to be all cash, and people carried catastrophic health insurance policies only. We are moving back towards that. This isn't stating…

> The problem really isn't the doctors but the structure of insurance and how people treat health care and health insurance similarly. The worst part is that high costs aren't directly the fault of insurance companies but of government having driven the need for insurance. Health care used to be all cash, and people carried catastrophic health insurance policies only. We are moving back towards that. This isn't stating my preference, one way or the other, just the historical facts.

> On the back end, there is the cost of lawsuits that also drives up prices systemically.

Here's one example. A (probably not domesticated) cat scratched someone. They went to get shots. Waited a couple of hours and got the shot. Bill in the mail for about $8k. Somehow, I really doubt Humana paid their 80% which is $6,400 but of course the patient has to pay the 20%. I suspect what is happening is that Humana pays close to $0 and the patient picks up the whole tab of $1,600.