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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.

#321

Post by alkonaut »

conanbatt wrote: post #316
alkonaut wrote: post #314

Earlier quoted context omitted.

Yes - it makes private insurance an added luxury product. This is normally how it works where there is a publicly funded universal system. On the other hand the public insurance covers many expensive things very well (e.g cancer treatment) so the private insurance is for things like getting a knee surgery without waiting time where the public system can have 90 days waiting time. Someone like an athlete wouldn’t want…

It makes it inefficient in economic terms. I think you are attempting to frame it in terms of cost-shifting: making the "rich" pay for "the poor" by paying twice. But when the public hospital is 10 miles away, and the private hospital is 1 mile away, paying twice effectively lowers the access of care to the people that can't afford to pay twice. And then, proximity to public hospitals would be so valuable, that housi…

Doesn't that type of inefficiency already exist when a patient may need (or want) to go to a "network hospital", when there are multiple competing networks instead of one enormous one (that has say 95% of the "market")?

> paying twice effectively lowers the access of care to the people that can't afford to pay twice

My private insurance that kicks in if I e.g. need a knee surgery with 14 days wait instead of 90, will often require me to fly to a different city, likely even a different country, to get the procedure performed at a specialist private clinic. This care is something completely different to the regular care I need day-to-day for a child delivery, cancer treatment, appendectomy or whatever. As there is so very little overlap I'm also not paying twice. There isn't a private insurer that will offer me cancer treatment, child delivery etc.

They don't exist because who would want to pay twice for that?

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

#322

Post by jlebar »

antisthenes wrote: post #317
jlebar wrote: post #312

Earlier quoted context omitted.

> Probably around morbid obesity that's unrelated to genetic/chronic issues. The jury is still very much out on how common this is, isn't it? Who is going to make the decision of whether I am "at fault" for my obesity? Also how many people actually choose to be morbidly obese? Like, suppose I am genetically predisposed to like "unhealthy foods" (scare quotes because we don't really know what that means). Does that ex…

> Also how many people actually choose to be morbidly obese? Like, suppose I am genetically predisposed to like "unhealthy foods" (scare quotes because we don't really know what that means). Does that excuse my obesity as genetically caused? How are you going to tell the difference between someone who "selfishly likes" unhealthy foods and someone who can't help themselves? More to the point, is there a difference? I'…

From one of the world's foremost experts on the brain: https://www.wnycstudios.org/story/revising-fault-line

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

#323

Post by jlebar »

antisthenes wrote: post #317
jlebar wrote: post #312

Earlier quoted context omitted.

> Probably around morbid obesity that's unrelated to genetic/chronic issues. The jury is still very much out on how common this is, isn't it? Who is going to make the decision of whether I am "at fault" for my obesity? Also how many people actually choose to be morbidly obese? Like, suppose I am genetically predisposed to like "unhealthy foods" (scare quotes because we don't really know what that means). Does that ex…

> Also how many people actually choose to be morbidly obese? Like, suppose I am genetically predisposed to like "unhealthy foods" (scare quotes because we don't really know what that means). Does that excuse my obesity as genetically caused? How are you going to tell the difference between someone who "selfishly likes" unhealthy foods and someone who can't help themselves? More to the point, is there a difference? I'…

> you should ask an expert on obesity. I'm not one, so if their judgment differs from mine, I'll stand corrected. But until then, I'll be of the opinion that most obesity cases are not genetic.

You're saying you have no expertise in this, haven't spent any time reading the literature or consulting with experts, but you nonetheless are going to continue having a strong opinion on this question? What is the basis for this opinion on a question of fact? Hopefully it's not than the fact that fat people are icky and so must be morally at fault for their failings?

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

#324

Post by antisthenes »

jlebar wrote: post #323
antisthenes wrote: post #317

Earlier quoted context omitted.

> Also how many people actually choose to be morbidly obese? Like, suppose I am genetically predisposed to like "unhealthy foods" (scare quotes because we don't really know what that means). Does that excuse my obesity as genetically caused? How are you going to tell the difference between someone who "selfishly likes" unhealthy foods and someone who can't help themselves? More to the point, is there a difference? I'…

> you should ask an expert on obesity. I'm not one, so if their judgment differs from mine, I'll stand corrected. But until then, I'll be of the opinion that most obesity cases are not genetic. You're saying you have no expertise in this, haven't spent any time reading the literature or consulting with experts, but you nonetheless are going to continue having a strong opinion on this question? What is the basis for t…

I can ask you the same thing, but in reverse. What is your strong opinion on believing that people should have no responsibility for the obesity, when we know it is caused mostly by over-eating?

Why do you presume people are completely hopeless at controlling what they put in their stomach?

How many experts did you consult with to form your opinion?

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

#325

Post by antisthenes »

jlebar wrote: post #322
antisthenes wrote: post #317

Earlier quoted context omitted.

> Also how many people actually choose to be morbidly obese? Like, suppose I am genetically predisposed to like "unhealthy foods" (scare quotes because we don't really know what that means). Does that excuse my obesity as genetically caused? How are you going to tell the difference between someone who "selfishly likes" unhealthy foods and someone who can't help themselves? More to the point, is there a difference? I'…

From one of the world's foremost experts on the brain: https://www.wnycstudios.org/story/revising-fault-line

I'll gladly read that in a textual format. Podcasts tend to be long-winded with a lot of useless fluff.

If you have a link to one of his papers, I'll gladly peruse it.

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

#326

Post by philwelch »

munk-a wrote: post #304
raven105x wrote: post #288

Earlier quoted context omitted.

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…

If you are rich and live in Canada, you can cross the border and pay out of pocket to receive treatment in the United States. I wouldn’t be surprised if Taiwan (the only other country with a Canada-style one-tier single-payer system) has a similar relationship with Singapore. Britain also has the ability to pay out of pocket for private practice care as an alternative to the NHS.

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

#327

Post by [deleted] »

conanbatt wrote: post #315
PenguinCoder wrote: post #252

Earlier quoted context omitted.

The patient shouldn't have to call the insurance provider to see where it is accepted. This is adding to the problem. Do you have insurance, yes or no? Should be a good he only question not add-ons like, what provider, etc. It's stupid as hell that certain doctors are in network at a hospital while others are out of network, at the same damn facility. Ask me how I know this. American Healthcare insurance and billing…

> The patient shouldn't have to call the insurance provider to see where it is accepted But this is actually the one that provides the service. You dont call the music band to ask about the prices ticketek charges. You should and can ask about the price without insurance and you might get an answer (though you wont like it).

[deleted]

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

#328

Post by QuantumGood »

tertius wrote: post #146
QuantumGood wrote: post #110

Earlier quoted context omitted.

Had new insurance and a sore shoulder. Was billed ~$1,400 for a physical therapist to examine it ("evaluation"). No treatment. Very little covered by insurance. The next day had a chiropractor treat it and shoulder was fine. $25 with coupon. Funny part is, as it was new insurance, I spent over 30 minutes with insurance rep in advance on phone going over options and trying to get an idea of likely costs. When I had a…

I wouldn't compare a chiropractor to a physical therapist, but $1400 for a sore shoulder? Was this in the ER?

No. Set up the PT evaluation through regular channels, showed up at scheduled time, etc.

They aren't directly comparable, but I wanted to point out treatment vs. evaluation costs experienced. Chiropractor was evaluation and treatment, PT was evaluation only.

I had to assume there was some kind of error, but contesting didn't help. Probably could have contested harder/smarter, but decided instead not to pay. This provider does not turn non-payers over to collections (no credit impact), and does not refuse later service to non-payers. This was the only item I refused to pay via this provider over years going through them.

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

#329

Post by omegaworks »

AmericanChopper wrote: post #65
lostlogin wrote: post #59

Earlier quoted context omitted.

This weird argument pops up regularly. In relation to New Zealand (where I am) it’s argued that the US is subsidising the cost of drug scripts. It’s beyond me quite how NZs drug buying agency is running roughshod over the rights of drug companies that have multiple insurance companies in the US that are bigger customers. What’s the agenda behind this argument?

There’s no agenda behind it at all. If profits in the US market go down, they either have to go up elsewhere, or investment has to go down to match. This is very basic maths.

This argument does not at all reflect the actual revenue model of pharmaceutical companies here in the US.

In the private sector, far larger amounts of funding are spent on marketing than research[1]. The basic maths shows: investment in research can be maintained or even increased while providing greater access to the fruits of that research.

The money is there. What we lack is the proper incentivisation.

1. https://www.washingtonpost.com/news/wonk/wp/2015/02/11/big-p...

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

#330

Post by QuantumGood »

xzel wrote: post #313
QuantumGood wrote: post #135

Earlier quoted context omitted.

As I noted below ($25 vs. $1400 for my sore shoulder), the range of ways providers can "code" what they charge you for is not sane. And how my inpatient bill in a different situation reached ~$45,000 was clearly because the hospital knew how to pad the bill.

And in fact I'd say medical coding is a boarder line predatory practice. There are a number of companies that specialize in padding / inflating medical codes against insurance companies for hospitals (or fighting them etc). It is just another inefficiency in the current system costing everyone more money.

A friend's brother owned a construction and landscape company. One of their key philosophies was "You have to know how to write a bill." A wide range of equipment types, each with different hourly rates, can be used on any one job. Different procedures can be used. Figuring out the combinations that create the greatest "defensible" profit was a widely acknowledged goal of most companies in the space. I am also aware of training companies that do something similar.

It's a common business mindset, unfortunately.

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