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Hospital prices are about to go public in the U.S.

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Re: Hospital prices are about to go public in the U.S.

#301

Post by antisthenes »

jlebar wrote: post #292
miketery wrote: post #284

Earlier quoted context omitted.

I agree in principal to an extent - however economics need to be tied to the end product somewhat. Otherwise many people would opt for $100k healthcare cost (at the expense of the public) to extend their life for a few more months, this is not reasonable. Resources are finite - therefore we need appropriate allocation. In the end I agree that a basic safety net is necessary and serves a greater good - providing thing…

Serious question: Do you live a perfect life? Do you exercise daily? Do you never eat processed meat (linked to cancer)? Do you never drink soda (linked to metabolic syndrome)? Do you not smoke? Do you not drink any alcohol (linked to cancer)? Do you live close to your work so as to minimize the time spent in a car (car accidents are a major cause of preventable death)? Are you not overweight, even a little? And so o…

> Do you think that someone who follows all but one of those rules still deserves healthcare? All but two? What's the moral difference between someone who smokes and someone who hasn't taken heed of diet/exercise advice after getting heart surgery?

Yes. Yes.

Moral difference no idea, but neither one should expect to have society foot the entire bill for their bad habits.

> Where do you draw the line?

Probably around morbid obesity that's unrelated to genetic/chronic issues.

> Let he who is without sin cast the first stone, right?

By setting an unreasonable standard and saying no one under it has the ability to cast judgment is extremely anti-intellectual. If 2 people were telling you about health habits and one of them was an olympic athlete (who occasionally ate bacon), and the other was a random overweight person from the street, whose advice would you give more weight to?

Re: Hospital prices are about to go public in the U.S.

#302

Post by snowwrestler »

epmaybe wrote: post #211
novalis78 wrote: post #171

For someone who worked on price transparency in 2013 - I was personally affected with surprise billing - and spent long hours working on a price discovery / transparency tool called pricepain.com, this (first step of an) anti cartel measure brings tears of joy. While it won’t solve all issues at once, shining some light into the medical billing mess can only be a good thing, allow market forces to enter the picture s…

Something I worry about, and that maybe you can help shed some light on, is what the ramifications of such a move would be. You mentioned the grading of schools leading to higher quality. Do we know if any metric suffered as a result? One guess I have is that teachers started teaching for the test rather than for the foundation. Take that same question and apply it back to the issue of hospital cost. If there's more…

> You mentioned the grading of schools leading to higher quality. Do we know if any metric suffered as a result?

We don't know. Something might have suffered but if you're not measuring a metric, you can't really know anything about it. That was the reality of the educational system--very little measurement of anything--and hence the baseline of agreement (not just in Florida but in many states) was simply: let's start measuring.

> One guess I have is that teachers started teaching for the test rather than for the foundation.

This is a good guess, and some teachers and parents definitely agree with you. But the reality is that (again) unless you are carefully measuring a metric, you don't know what is really happening. Collecting a few anecdotes and opinions does not necessarily result in good data.

It's also possible that in the absence of performance metrics, some teachers managed their work to maximize throughput and minimize complaints--by passing students through to the next grade whether or not they were ready. This is also supported by anecdotes, like colleges and employers reporting a decline in student readiness.

Re: Hospital prices are about to go public in the U.S.

#303

Post by miketery »

jlebar wrote: post #292
miketery wrote: post #284

Earlier quoted context omitted.

I agree in principal to an extent - however economics need to be tied to the end product somewhat. Otherwise many people would opt for $100k healthcare cost (at the expense of the public) to extend their life for a few more months, this is not reasonable. Resources are finite - therefore we need appropriate allocation. In the end I agree that a basic safety net is necessary and serves a greater good - providing thing…

Serious question: Do you live a perfect life? Do you exercise daily? Do you never eat processed meat (linked to cancer)? Do you never drink soda (linked to metabolic syndrome)? Do you not smoke? Do you not drink any alcohol (linked to cancer)? Do you live close to your work so as to minimize the time spent in a car (car accidents are a major cause of preventable death)? Are you not overweight, even a little? And so o…

No I don't live a perfect life, I try to do better when afforded the opportunity - but that's besides the point. You're right - I over extended the scope with my initial statement. An in no way do I think the individual without sin is the one who should be making the call either.

However, I think if we gather a pool of public funds there needs to be a priority system or some feedback loop or liability included (back to finite resources being at stake).

Those things like sugar may come with a tax so that respective procedures are funded by it. Likewise for driving, insurance is required. For diet and exercise, maybe you can get an income tax credit for following certain things.

Not perfect, but I think we can get better then a simple pool that's support for everything and anything.

Re: Hospital prices are about to go public in the U.S.

#304

Post by munk-a »

raven105x wrote: post #288
thefringthing wrote: post #227

Earlier quoted context omitted.

Would you prefer the Singaporean norm (clearly posted prices) to the Canadian/European one (free at the point of use)?

Personally, yes. Like many posters here I am an Engineer not in the medical field, so take my opinion with a grain (read: mound) of salt. Most "free" healthcare systems have either (1) horrible quality of service or (2) impossibly long waits unless your life is in danger or close to it. The latter is a systemic issue I've noticed in that healthcare, regardless of pricing or structure, does not aim to foster optimal h…

As a soon-to-be Canadian who has only experienced the US and Canadian systems, up here the quality of service isn't horrible and the waits for service tend to be shorter than they are in the US - but they are based on need rather than wealth. So someone in discomfort but no danger will end up waiting longer in Canada then if they were rich and lived in the US, but my relative with cancer was seen to promptly due to a high chance of complications if surgery had been delayed.

So I'm not sure what constitutes "most free healthcare systems" but Canada is apparently different from "most"

Re: Hospital prices are about to go public in the U.S.

#305

Post by spullara »

spullara wrote: post #82
sitkack wrote: post #53

Earlier quoted context omitted.

Please stop using average. Median is a much better measure.

Average can be the median or the mean. Usually the government reports median when they say average.

I don't think I should be downvoted. This is just a fact. Hell, sometimes it can mean the mode.

https://www.google.com/search?q=average+definition

Re: Hospital prices are about to go public in the U.S.

#306

Post by galangalalgol »

tachudda wrote: post #240
epmaybe wrote: post #211

Earlier quoted context omitted.

Something I worry about, and that maybe you can help shed some light on, is what the ramifications of such a move would be. You mentioned the grading of schools leading to higher quality. Do we know if any metric suffered as a result? One guess I have is that teachers started teaching for the test rather than for the foundation. Take that same question and apply it back to the issue of hospital cost. If there's more…

I suspect that with teachers teaching to a test, it improves bad teachers and holds good teachers back a little.

It accomplishes little. The tests are a subset of the things the students should have been learning anyway. The idea was that by measuring performance teaching could be improved where needed. The actual result was that the "help" given to classes with bad scores has been to overtrain some tiny neural nets to respond to very specific stimuli without teaching them anything beyond the specifically measured behavior. Even the students that pass often haven't mastered the material. They just can take the test. We opted to replace accountability with process and reaped the usual results.

Re: Hospital prices are about to go public in the U.S.

#307

Post by vec »

cryptonector wrote: post #295
bookofjoe wrote: post #172

Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the dep…

Doctors don't know the prices, and neither do the customers (not without doing a lot of homework that can't be done during emergencies). Even when you know the list prices, the actual prices your insurance negotiates are almost certainly different, so asking for list prices isn't enough. Basically, in the U.S. the healthcare system is not exactly a free market as pricing signals are unclear, and most consumers have n…

My wife owns and operates a private medical practice (she's an audiologist), and it's insane the way she has to do billing and accounts receivable.

When a patient asks about prices she quotes them her standard price for the necessary services and calls their insurance company to confirm that the patient is covered and check what kind of copay the patient needs to pay. Assuming the patient is satisfied with the results of that call she provides the services, bills the patient for their copay, and files a claim with their insurance company.

Several months later (and no real way to predict when), the insurance company will provide an "offer" for probably somewhere around 60% of the quoted price (though this varies dramatically as well). She can accept the offer, in which case she's inevitably required by the terms to eat the difference instead of attempting to collect the balance from the patient. Or she can reject it and attempt to collect from the patient, in which case they will likely be very confused and angry as to why their insurance isn't being accepted, despite her explicitly confirming that it would be covered before they purchased her services.

To be clear, none of this is negotiated or agreed upon in any meaningful sense. She doesn't have any special relationship with any insurance provider. Instead, the providers use their massive power differential to dictate terms. She wouldn't be able to stay in business if she didn't accept at least some insurance, but they'd be quite happy to never write her another check.

She knows what her price schedule for everything is, but it doesn't end up mattering that much since she doesn't know when or how much she'll ultimately be reimbursed except in an extremely broad aggregate sense. The worst part is that she has to dramatically overprice her services so that she can ultimately get adequately reimbursed to keep the lights on, which just ends up hurting the patients who don't have insurance.

Re: Hospital prices are about to go public in the U.S.

#308

Post by dang »

assblaster wrote: post #189
___alt wrote: post #102

I'm so glad I live in a country with single-payer healthcare.

I'm so glad I live in the United States, arguably the greatest country in the history of the world.

Please don't respond to provocation by taking the thread into full out nationalistic flamewar. That's the last thing we need or want here, and it breaks most of the site guidelines:

https://news.ycombinator.com/newsguidelines.html

Re: Hospital prices are about to go public in the U.S.

#310

Post by dang »

___alt wrote: post #102

I'm so glad I live in a country with single-payer healthcare.

Please don't post unsubstantive provocations to Hacker News. Perhaps you didn't intend nationalistic flamewar but a comment like this is nationalistic fire-starter.

Moreover it's a generic theme that has been picked over countless times. If you're going to comment about those on HN, please make sure you have something new and substantive to say.

https://news.ycombinator.com/newsguidelines.html

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