What I learned from reading a thousand emergency room bills • Hacker News Board

Re: What I learned from reading a thousand emergency room bills

#431

Post by conanbatt » Thu, Dec 20, 2018, 7:40 AM UTC

smileysteve wrote: post #35

SlowRobotAhead wrote: post #30

Earlier quoted context omitted.

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?

Because, then the single payer, can say "your policies/prices don't work with our system", fix it, or we won't cover any patients, effectively shutting you down.

Or it can tell the patient "this is the treatment that the state will afford" and then they shut you down.

Re: What I learned from reading a thousand emergency room bills

#432

Post by Gibbon1 » Thu, Dec 20, 2018, 7:40 AM UTC

tokyodude wrote: post #403

Gibbon1 wrote: post #337

Earlier quoted context omitted.

The US has lots services that are provided by regulated monopolies. My garbage company, power company are all regulated monopolies. A key thing is you're required to have garbage and power service but the rates are negotiated by a public utilities commission or the city or county. However Healthcare in the US isn't a regulated monopoly like that.

And there was an entire thread about how those regulated monopolies are not working well. In particular PG&E in California. I think it was this one https://news.ycombinator.com/item?id=18690916

My point was just we do have regulated monopolies in the US. But healthcare in the US isn't a fully regulated monopoly.

I'll argue whatever PG&E problems are they don't rise at all to the level of healthcare. And their problems are due to poor regulation and the US's current terrible management culture.

Re: What I learned from reading a thousand emergency room bills

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Post by conanbatt » Thu, Dec 20, 2018, 7:41 AM UTC

commandlinefan wrote: post #146

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

> if they don't become more transparent it's going to be forced upon them. Semi-tinfoil-hat conspiracy incoming: I think doctors and hospitals actually want government funded medical care, and are doing some of this to speed that up. Think about it. No more dealing with 100 different insurance companies or sometimes trying to bill uninsured patients: just develop expertise in handling one single government agency, an…

Someone will get fleeced for sure, what is guaranteed with government provided care, is that it wont be the politicians.

Re: What I learned from reading a thousand emergency room bills

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Post by conanbatt » Thu, Dec 20, 2018, 7:42 AM UTC

tgsovlerkhgsel wrote: post #78

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

Doesn't have to be government _paid_, just regulated. Literally saying "you can't charge more than X for service Y". It isn't unprecedented either, see taxi tariffs in some areas.

Price controls never work. Its bad economics.

Re: What I learned from reading a thousand emergency room bills

#435

Post by conanbatt » Thu, Dec 20, 2018, 7:47 AM UTC

ncallaway wrote: post #219

ams6110 wrote: post #206

Earlier quoted context omitted.

Yes, many people who advocate for "single payer" intend that to mean eliminating any private-pay option.

I don't believe that's true. What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care? I've never seen one. In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada. I've never once spoken with an…

It most definitely means banning private insurance (not private care). Thats why its "single". IT has to, because otherwise it would have to compete on the market as any other plan, and it would fail because all private insurance would dump the expensive patients on to medicare, which will need to either increase prices or increase taxes to survive.

Plus the whole point is to eliminate dealing with the adminsitrative burden of claims and billing. IF you just add another insurance, you just make it worse.

Re: What I learned from reading a thousand emergency room bills

#436

Post by bemurphy » Thu, Dec 20, 2018, 8:08 AM UTC

ceejayoz wrote: post #106

noja wrote: post #64

Earlier quoted context omitted.

Today is "don't believe the comments day" it seems. How is an unconscious person meant to be stop an "out of network" nurse assisting? Is there a tattoo that you can get?

> How is an unconscious person meant to be stop an "out of network" nurse assisting? They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it. https://www.npr.org/sections/health-shots/2018/08/27/6408918... > Surprise bills occur when a patient goes to a hospital in his insurance network but receives…

> The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.

I got this one, it was mindblowing. For ER work, they'd bill through one practice, for scheduled appointments, another.

I got balance billed for $11k. My father, who worked in employee benefits for over 30 years, couldn't even figure out what was up at first. Then they filed to send me to collections because I kept refusing to pay (note, I'm in California and this billing is illegal for life-threatening emergency visits matching the situation I was in). Finally, the insurance company stepped in and covered me, but we were only able to achieve this because my family knew people personally at the insurer.

All kinds of messed up.

Re: What I learned from reading a thousand emergency room bills

#437

Post by JamesBarney » Thu, Dec 20, 2018, 8:13 AM UTC

noelsusman wrote: post #380

dbt00 wrote: post #17

Earlier quoted context omitted.

> I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffi…

You also have to cover uncompensated care, which is a significant chunk of change at any hospital in a major metro area. Besides, nobody actually pays the charges. Insurance companies don't, CMS doesn't, and even the uninsured can typically negotiate a bill down with a quick phone call. That's why the charges are all made up bullshit. It doesn't matter so why bother? Most hospitals in the US are non-profits. You can…

This just isn't true. The costs of the uninsured are not driving ibuprofen up to $60.

The % of people who are uninsured has halved in the last decade, and this hasn't changed a thing for insurance billing.

Re: What I learned from reading a thousand emergency room bills

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Post by geezerjay » Thu, Dec 20, 2018, 8:39 AM UTC

minikites wrote: post #349

nordsieck wrote: post #319

Earlier quoted context omitted.

> Price discovery requires pricing some people out of the market. Period. There is no "free market" healthcare system that can or ever will deliver required health services to everyone. There is no economic system that can deliver all of the health care to everyone who wants it. Fundamentally, health care resources are limited: doctors, beds, MRI machines, etc. Desire for health care is much less limited. The questio…

Are you saying that the richest country in the world can't accomplish something that already exists in plain view in some of the poorest countries in the world?

You really should get the facts on how those systems actually operate.

I'm currently living in an european country that has a national health service that supposedly ticks all the socialist talking points, including free (in theory) access to emergency care, but not only is the service largely inoperational with year-long waiting periods for surgeries, including cancer treatments, but also has a disgruntle workforce who systematically complains they are underpaid and overworked.

The situation is so appalingly bad that the national health service even routes patients to private hospitals and clinics, ending up paying a hefty bill for the services they were supposed to provide in-house but are largely unable to provide.

Re: What I learned from reading a thousand emergency room bills

#439

Post by dragonwriter » Thu, Dec 20, 2018, 8:43 AM UTC

conanbatt wrote: post #430

rootusrootus wrote: post #205

Earlier quoted context omitted.

I've heard the 2/3 number (sometimes a little less, most recently slightly over, 68%) from a few reputable sources recently. At the same time, I generally consider Kaiser pretty reliable. I think the discrepancy comes from what is being included in the total -- all costs, direct payments only, tax subsidies, etc. At least from what research I've done. Even if we take the value to be 50%, my point stands -- the gov't…

You should look into what Kaiser does to its providers. Its pretty grim.

Henry J. Kaiser Family Foundation, not the Kaiser Permanente managed care consortium. Same founder, but very different organizations.

Re: What I learned from reading a thousand emergency room bills

#440

Post by jackkinsella » Thu, Dec 20, 2018, 8:47 AM UTC

I often find in these discussions that Americans look with undue admiration over to Europe and imagine that the same stuff doesn't happen here.

But it does.

I recently got my wisdom teeth pulled out in Germany, and without my asking, the doctor sent me a pack of 12 Ibuprofen and billed me 24 euro, i.e. €2/pill. I didn't want them because I had 500 of the same at home, which I bought for 25 euro — i.e. €0.05/pill. That's a markup of 40x.