Insured price $2,758, cash price $521 • Hacker News Board

Re: Insured price $2,758, cash price $521

#141

Post by kickopotomus » Fri, Aug 02, 2019, 10:02 PM UTC

alexhutcheson wrote: post #119

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

ER bills are always shockingly expensive. If you don't think your condition is life-threatening, it's normally both faster and much cheaper to go to an urgent care clinic if one is open. However, for potentially very serious problems (possible heart attack, stroke, serious injuries, etc.) you have no choice - you need to go to the ER and deal with the bill afterwards.

> 4 year old to the ER because he had a 103 fever

I think most parents would react similarly. Then to turn around and bill $756 is predatory.

Re: Insured price $2,758, cash price $521

#142

Post by tyfon » Fri, Aug 02, 2019, 10:02 PM UTC

astrodust wrote: post #8

Wouldn't it be nice to have an ultrasound and not know the price, nor care? That's what countries with single-payer are like. America needs to give up on this nonsense. There should be riots.

I'm having an ultrasound (at a private clinic) in about two weeks to check for a gall bladder stone.

I have no idea what it costs but I guess out of pocket it would be about $20 "co payment", same as when I had a MR scan for my neck earlier this year. If you're out more than $200ish a year you don't have to pay the "co payments" anymore either, but that's only happened once for me.

If you need to go to hospital it's free regardless.

Norway here, guess we have a tax funded "single payer" system. Wouldn't have it any other way.

Re: Insured price $2,758, cash price $521

#143

Post by cosmie » Fri, Aug 02, 2019, 10:04 PM UTC

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

> I never received a ding on my credit report.

Non-medical and medical collections tend to get different treatment nowadays[1][2]. It may have ended up on your credit but after a super long delay, or it'd disappear entirely if they were able to get something out of your insurance instead. And even if it shows up on your credit report, depending on the specific scoring model being used, it still may not have had much if any impact. [2] details how some of the scoring models treat medical collections.

[1] https://www.experian.com/blogs/ask-experian/can-medical-bill...

[2] https://www.creditkarma.com/advice/i/how-to-remove-medical-c...

Re: Insured price $2,758, cash price $521

#144

Post by tasty_freeze » Fri, Aug 02, 2019, 10:10 PM UTC

tandem_bike wrote: post #124

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

Everything you say is true. Modern healthcare is so expensive and inefficient because its built around the demands and capabilities of the past. Usually I hate it when people say something is fundamentally broken, but healthcare really is. The time has come for a complete overhaul of the system. No more primary care doctors. They can be replaced by software and patient service representatives. Diagnostic services sho…

> You should be able to get whatever diagnostic test you want, whenever you want.

Tests may be less expensive than what we are getting billed, but they aren't free. There are hypochondriacs who I'm sure would order hundreds of tests a year if allowed. There are many people who have hard to diagnose problems, and out of desperation, would order tests which have no possible bearing on their condition, just in case it finds something.

Let's say that you routinely screen everyone for everything, because why not, it's free. What is the burden of not only performing all those tests, but following up on the flood of false positives? It would probably swamp the healthcare system, allocating resources to the wrong places.

Re: Insured price $2,758, cash price $521

#145

Post by m0zg » Fri, Aug 02, 2019, 10:10 PM UTC

evrydayhustling wrote: post #71

avocado4 wrote: post #41

Earlier quoted context omitted.

https://www.politico.com/agenda/story/2017/10/25/doctors-sal... Providers are the core problem. Various doctor associations (AMA et al) have strangled supply side of healthcare through State licensure and scope of practice laws. Just read medical forums to get an idea of what an average doctor thinks about competition in the form of midlevels: https://www.auntminnie.com/Forum/tm.aspx?m=581583 "Don’t teach your mid le…

That forum is amazing! Thanks for the primary source! That said, two quibbles/questions: Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping a…

It's not just the cost of training. In the US there's implicit expectation that becoming a doctor is a way to become wealthy, similar in earning potential to becoming a lawyer. There's no such expectation in most other countries which are often used in arguments for how socialized medicine "costs less". Their doctors make a fraction of what US doctors do, so of course it "costs less".

Right now in the US you'd be "socializing" the expectation that a doctor should make $300K+ a year, with a very weak upper bound. Which I'm not going to say real good ones shouldn't, but good ones, in my personal experience, are few and far between.

This is something we'd need to deal with before forcing taxpayers to pay for these inflated expectations at gunpoint, _if_ we decide to go the "single payer" route. ACA, ironically, did nothing at all to address the _affordability_ side of things. If I'm forced to give up a good chunk of my income for "free" healthcare, I'd be categorically not interested in paying for yet another beach house some surgeon wants to buy.

Just like all problems involving human motivations, this is a tough one to solve. It's so tough, in fact, that I think the most realistic path forward is gradual automation of everything that can be automated, though technological means, such that we only use doctors where a robot or a computer can't do the job. Someone needs to start another Theranos, but do it for real this time.

Re: Insured price $2,758, cash price $521

#146

Post by rabidrat » Fri, Aug 02, 2019, 10:13 PM UTC

drblast wrote: post #107

Insurance is not supposed to make routine things more affordable. It's supposed to spread the risk of catastrophic loss from unlikely events around to a large group of people so you don't have to worry about losing your house if you get struck by lightning. Everyone needs routine medical care at some point so an insurance model doesn't work there. You don't have gas or grocery insurance, do you? If that were a thing…

Agreed, calling it health 'insurance' is a horrible misnomer. But, I don't think that your solution (stipend + insurance) is good, since there are conditions that increase the frequency of 'routine' care. So, for instance, a diabetic with no income/wealth, who has to rely solely on their stipend for healthcare, would still be screwed with one of these conditions.

You might say that insurance should cover this kind of condition and not consider it 'routine care', but we see how well this works in the current for-profit medical insurance system. Insurance providers seem to be okay paying out low-frequency high-cost events, since that's the risk profile they model, but they hate paying out recurring care costs. Once you become a recurring cost, it is in their profit interest to reduce your care, or get you off their rolls.

Re: Insured price $2,758, cash price $521

#147

Post by slg » Fri, Aug 02, 2019, 10:15 PM UTC

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

>I worked at Vanderbilt on their payroll system, and I would regularly see general practitioners making $350,000 a year, and this was 15 years ago! It wasn’t uncommon to see teaching doctors getting paid a million dollars.

It isn't uncommon for software developers to make $350,000 a year or even over a million if they get equity in the right company. Maybe the Googles of the world wouldn't have to spy on their users to the same extent if software developers weren't so greedy and taking such a huge slice of the value of their own labor.

Would anyone here agree with that statement? If not, how is it fair to apply that same logic to doctors?

It is also worth noting that doctors have other costs that don't apply to people in the tech industry such as the high cost of the extra schooling they must receive and malpractice insurance which can cost anywhere from a low 5 digits to $150,000+ a year deepening on their specialty.

Re: Insured price $2,758, cash price $521

#148

Post by lxe » Fri, Aug 02, 2019, 10:18 PM UTC

Are "cash" prices always cheaper than what's billed to insurers? What if one starts an "alt-isurance" company that just gives people cash for their medical bills that operates completely outside the medical industry network?

Re: Insured price $2,758, cash price $521

#149

Post by rayiner » Fri, Aug 02, 2019, 10:20 PM UTC

evrydayhustling wrote: post #71

avocado4 wrote: post #41

Earlier quoted context omitted.

https://www.politico.com/agenda/story/2017/10/25/doctors-sal... Providers are the core problem. Various doctor associations (AMA et al) have strangled supply side of healthcare through State licensure and scope of practice laws. Just read medical forums to get an idea of what an average doctor thinks about competition in the form of midlevels: https://www.auntminnie.com/Forum/tm.aspx?m=581583 "Don’t teach your mid le…

That forum is amazing! Thanks for the primary source! That said, two quibbles/questions: Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping a…

US drug spending accounts for about 11% of total healthcare spending.

Re: Insured price $2,758, cash price $521

#150

Post by chiph » Fri, Aug 02, 2019, 10:20 PM UTC

It really helps to be a shrewd negotiator when it comes time to pay your bill.

https://youtu.be/pY-BGNjI2Rg?t=281

Should you have to do this? No.

No one in American healthcare knows how much it costs to deliver care. And as a result, the bills are more like: "They look rich. Let's see if they'll just pay it."