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Insured price $2,758, cash price $521

latimes.com

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

#211

Post by zanny »

mrep wrote: post #177
residentfoam wrote: post #160

Earlier quoted context omitted.

I have mixed feelings about this. As society, we seem to be ok with millennials fresh out of college making hundreds of thousands of $$$ a year for a bunch Javascript that allows people to share pictures of their butt with their friends BUT we are not ok with doctors who literally - save lives - getting paid according to their responsibilities? Same goes with football/basketball/etc.. players whose sole purpose in li…

> As society, we seem to be ok with millennials fresh out of college making hundreds of thousands of $$$ a year for a bunch Javascript that allows people to share pictures of their butt with their friends BUT we are not ok with doctors who literally - save lives - getting paid according to their responsibilities? Programmers only make that because the services they build are extremely scalable, profitable, and wanted…

What gets me at the end of the day is that almost the entire institution that makes programming "valuable" is wholly fictitious and socially constructed. Without institutional international copyright and IP protection the vast majority of software produced would not generate nearly as much revenue per developer hour as it does today. The entire industry is basically an accident caused by greedy corporations extending copyright indefinitely for a century before the commoditization of computation happened and suddenly having the correct number could make you impossibly rich while you were given government protections of your exclusive ownership of said number.

When you look at the stock market and you see ludicrous P/E ratios on companies like Google and Amazon it must be acknowledged the only reason money sees them as being so valuable is because governments the world over have awarded them, through employee ingenuity or acquisition, exclusive permanent monopolies to millions of ideas enshrined in copyrights any of which could explode into an infinite money machine on any given Tuesday. Paired with their treasure troves of harvested data on people they are the largest entities in existence not for the actual real world value they produce but for the untenable position they now occupy with the force of the state and international trade standing behind them to preserve their position as the total arbiters of information.

Its really gross, and I have to live every day knowing that I largely do this (the programming, computers, tech, etc) on the back of a power structure enshrined and grown cancerous over centuries with the intent to exploit perpetual monopolies on ideas.

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

#212

Post by cwkoss »

cwkoss wrote: post #131
beebmam wrote: post #90

Earlier quoted context omitted.

That ISN'T cool, that's quite dangerous, because if it was indeed broken, that may cause harm. Rule #1 of being a doctor is violated. X-ray imaging on a finger is virtually harmless. Using a tuning fork to vibrate a potentially broken bone and causing a patient to feel pain is not harmless.

Putting the patient into medical debt also causes harm

All pharmaceuticals should be tested against the control of handing the patient the cost of the medication in cash.

I bet hundreds of dollars a month would provide depression and anxiety relief for a significant portion of the population.

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

#213

Post by zaroth »

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…

IME an uncorrected 103°F fever is really no big deal. If you are already on Tylenol and Ibuprofen and still at 103 that’s a bit more interesting. Parent pro-tip, Ibuprofen has always been way more effective and also longer lasting than Tylenol at reducing fever in my kids.

I have a similar story from when my first child was diagnosed with T1D. The entire treatment consisted of administering 1 unit of subq insulin and a standard blood test. The bill was coded as intensive care and came to $15k. My OOP contribution was billed as $7k, but I fought it successfully and never paid a dime. Insurance unfortunately paid their full share.

This was Stanford Hospital, which is notorious for over billing, and actually I believe one of the most profitable hospitals in the country.

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

#214

Post by lotsofpulp »

nonbel wrote: post #206
crazygringo wrote: post #184

Earlier quoted context omitted.

They didn't have to check that, and certainly didn't. They knew the prices off the top of their head. The doctor had no idea what health plan I had or even if I had one -- they leave that up to their staff to sort out, they couldn't care less personally.

Then they are just quoting you the "insurance price". Think about it, how could it possibly be more expensive to cut out the middle man?

Because you don’t want to deal with the type of person that doesn’t have insurance. They may be more likely to not pay, or otherwise unpleasant to deal with.

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

#215

Post by bspn »

function_seven wrote: post #174
Spooky23 wrote: post #140

Earlier quoted context omitted.

Generally speaking, that’s an example of a fundamentally wasteful ER visit, and why the lack of universal coverage is so dumb. That’s why ERs cost a fortune. If you’re not bleeding, have a broken limb or other trauma or an expectation of being admitted, you don’t belong in the ER. Take a benadryl.

So why doesn't the triage nurse hand out the Benadryl, tell the patient to wait in the lobby for an hour, and see if that resolves it? They could charge $75 for the single pill, and still avoid using a bed or the services of additional staff.

In short, liability. So much behavior within the US medical profession is driven by a fear of getting sued for malpractice. Even though the patient would be sitting in the ER with treatment close at hand, if the situation did worsen and the patient suffered complications there will be the inevitable questions asked as to why the triage nurse didn't admit them in the first instance. For hospitals it's just not worth the risk of potentially expensive and lengthy lawsuits/settlements.

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

#216

Post by zanny »

beachy wrote: post #132
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…

Here's a contrasting story. On holiday in Rarotonga, our 2 year old got a chest infection. We made it way up the hill to the hospital. A stray dog watched from the side of the road as we drive into the parking area. No one in sight. Eventually we saw someone who pointed us to a building wherein sat the duty doctor. Super efficient, trained in new Zealand, she examined the sprog, diagnosed him and gave us the appropri…

To be fair that isn't the whole story and doesn't really make for a convincing argument to the contrary.

Doctors should be paid well, and in the case of the Cook Islands I assume they have public institutions providing doctors and medicine. In which case, tax payers are paying for it. Which is almost always the most ethical way to do it, and the only really right way we have working practicably in the world today, but it isn't some impossible efficiency that $2.50 supports the costs of operating the hospital, the cost of the drugs, training the doctor, and paying them a wage to justify their skill and expertise required.

Its largely where many politicians in the US arguing for fundamental change to the system come from - its really hard to imagine anything much worse than what they US has now. It would actually take considerable effort to design a more inefficient, more obfuscated and incomprehensible, more exploitative and harmful way to organize medicine professionally.

People just don't want to acknowledge that the United States federal government is not acting on the behalf of its citizens in its decisions whatsoever. It hasn't for decades, but coming to terms with the dissolution of democracy and the reality that US citizens don't have a meaningful, statistical say in government anymore is a hard pill to swallow, because the answers to the question "what do we do about it, then?" are all ugly.

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

#217

Post by lotsofpulp »

maerF0x0 wrote: post #158

This adds to my recent thought stream that it ought to be charge 2 people a different price for the same thing (basket of things) ... Why is it that someone who is a new customer for service X gets a sweetheart deal but those of us who have faithfully paid for months/years are charged a premium? Why is it that 2 people in a hospital pay entirely different prices for the exact same thing? on and on the insanity goes.…

Price discrimination yields the most profit for a seller. You want to be able to capture all that each person is willing to pay, because your cost of goods sold remains the same.

Also the new customer doesn’t permanently get a sweetheart deal, it’s always a temporary incentive to join, which doesn’t seem unfair to me at all. However, as a buyer, if you’re not always shopping around, expect to pay more than someone who does. That’s just how the game works.

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

#218

Post by intopieces »

What’s a little tricky here is that the cash price is only $521 because the insured price is $2,758. If the patient were able to choose the cash price or the insured price, the cash price would be much higher.

One of my family members once told me he is against socialized medicine because it subsidizes the bad choices of the poor. True enough, but that’s no different from the current situation (since hospitals can’t refuse to treat) except that the one we have is opaque.

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

#219

Post by mrep »

zanny wrote: post #211
mrep wrote: post #177

Earlier quoted context omitted.

> As society, we seem to be ok with millennials fresh out of college making hundreds of thousands of $$$ a year for a bunch Javascript that allows people to share pictures of their butt with their friends BUT we are not ok with doctors who literally - save lives - getting paid according to their responsibilities? Programmers only make that because the services they build are extremely scalable, profitable, and wanted…

What gets me at the end of the day is that almost the entire institution that makes programming "valuable" is wholly fictitious and socially constructed. Without institutional international copyright and IP protection the vast majority of software produced would not generate nearly as much revenue per developer hour as it does today. The entire industry is basically an accident caused by greedy corporations extending…

If everyone could copy your IP which is essentially free to do these days with computers, how would anyone make money creating IP which is the main driver of GDP growth? Would you prefer to live in a stagnating economy while every other countries citizens gets richer than you everyday?

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

#220

Post by caraffle »

programmertote wrote: post #135
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…

Finally, someone said this. It's very rare to see putting some blame on doctors for such exorbitant medical prices in the US. I have made several comments about that on HN describing similar observation that I found. A recent example was when I went to see a doctor for ear infection. She put a otoscope in my ear, looked at it for one minute, prescribed me some anti-bacterial, and wrote up $250 for the service. The fi…

There's a lot wrong with the medical field, but this is a ridiculous argument. Programming is hard, medicine is hard. But it's in different ways - it's definitely not transposable (obviously- you switched the other way). I say that as someone who worked in FAANG software and is now in medicine.

Equating salary to mental load is also factitious. Manual laborers work harder than all of us, maybe we should switch salaries with them.

I 100% agree with the difficulty of becoming a doctor. I disagree with the gatekeeping however. Ultimately it comes down to residency positions available, and funding is government limited. We're seeing tons of new medical schools opening, acceptance of the DO crowd, and still the system is getting more competitive.

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