Live data from Hacker News

Insured price $2,758, cash price $521

latimes.com

231–240 of 345 posts

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

#231
post #29

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.

As mentioned below, the price doesn't matter when nobody is available to see you. Also, the opportunity cost of sitting around with a broken hip waiting to be seen can be higher than going to a privatized country/province and paying for the surgery, in which case you're a super-sucker who paid extra taxes for decades just to end up paying out of pocket for surgery anyways. Anyways, the US system is probably worse ove…

[deleted]

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

#232
post #208

Earlier quoted context omitted.

The pre-tax portion naturally comes out of the part of your paycheck you otherwise wouldn't be able to use at all. The level of discount would therefore be linked to your marginal income tax level, alongside how much your employer contributes to it. The max a person can contribute to these in 2019 is $3,500 and $7,000 for family. It is a privilege extended by the federal government.

Thanks, what do you mean "otherwise wouldn't be able to use at all"? You mean the government gets it?

Yes correct

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

#233
How long has it been broken like this? By my count, at least 346 years, reckoning from the premiere of The Imaginary Invalid by Molière.

The opening scene features the protagonist iterating over a series of rationalizations for reducing his medical bills to 1/3 of the list price. That this scene was expected to be received by an audience which could relate to the necessity of performing these sorts of arithmetic gymnastics (though perhaps exaggerated for comedic effect) suggests that this was already a well-established norm in 1673:

SCENE I.--ARGAN (_sitting at a table, adding up his apothecary's bill with counters_).

ARG. Three and two make five, and five make ten, and ten make twenty.

"Item, on the 24th, a small, insinuative clyster, preparative and gentle, to soften, moisten, and refresh the bowels of Mr. Argan."

What I like about Mr. Fleurant, my apothecary, is that his bills are always civil. "The bowels of Mr. Argan." All the same, Mr. Fleurant, it is not enough to be civil, you must also be reasonable, and not plunder sick people. Thirty sous for a clyster! I have already told you, with all due respect to you, that elsewhere you have only charged me twenty sous; and twenty sous, in the language of apothecaries, means only ten sous. Here they are, these ten sous.

"Item, on the said day, a good detergent clyster, compounded of double catholicon rhubarb, honey of roses, and other ingredients, according to the prescription, to scour, work, and clear out the bowels of Mr. Argan, thirty sons." With your leave, ten sous.

"Item, on the said day, in the evening, a julep, hepatic, soporiferous, and somniferous, intended to promote the sleep of Mr. Argan, thirty-five sous." I do not complain of that, for it made me sleep very well. Ten, fifteen, sixteen, and seventeen sous six deniers. "Item, on the 25th, a good purgative and corroborative mixture, composed of fresh cassia with Levantine senna and other ingredients, according to the prescription of Mr. Purgon, to expel Mr. Argan's bile, four francs." You are joking, Mr. Fleurant; you must learn to be reasonable with patients; Mr. Purgon never ordered you to put four francs. Tut! put three francs, if you please. Twenty; thirty sous. [Footnote: As usual, Argan only counts half; even after he has reduced the charge.]

"Item, on the said day, a dose, anodyne and astringent, to make Mr. Argan sleep, thirty sous." Ten sous, Mr. Fleurant.

(the above is just the first half of Argan's recitations - they go on for another paragraph or two!)

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

#234

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…

Giving diagnostic tests like that would lead to a lot of false-positives.

With any diagnostic test you need to understand what it tests for, how it tests for it, and when it gives false-positives and negatives.

It's just not possible to understand what's going on without a lot of training and education.

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

#235
post #145

Earlier quoted context omitted.

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 "so…

There better be a $300k+ payday at the end of a doctor’s training, otherwise I don’t see how the gauntlet they get put through is worth sacrificing their best years (20s and early 30s).

Maybe the gauntlet would be less severe if there wasn't such a massive pot of gold at the end of this particular rainbow. Much of it is just hazing and weeding out of the "unworthy".

But that's sort of orthogonal to the problem I'm discussing. The cost structure that enables "low cost" socialized medicine in other countries is just not there, and it's not going to be there in this country in the foreseeable future. Given this, all this talk about "medicare for all" etc, is just electoral pandering and nothing else. It's not doable without turning the whole system into a money black hole that's even worse than what we have now.

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

#236
The opposite also happens, where the uninsured price is a lot more than the insured price.

I was in this sort of situation once. I needed a CT scan, but it was on a late friday afternoon, and the hospital couldn't get prior approval from the insurance company. They quoted one price that they would bill the insurance company if it was approved, and another much larger priced that I would have to pay if the insurance company rejected the claim. (I ended up getting the CT scan the next day at a hospital that charged a lot less. I think it was covered by insurance.)

The thing about this that's bad is that it's over-charging the people least likely to be able to repay, and (if they can come up with the cash) they're effectively subsidizing the insured customers. This is the other side of narrative that poor people are driving up health care costs for everyone else because they don't pay their bills.

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

#237
post #64

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…

One really nice thing about single-payer back in Ontario was public salary disclosure, aka, the sunshine list. Since most physicians essentially work for the government, if they make over 100k/yr, the salary is public knowledge. Hint: Canadian doctors aren't eating dirt, by any means.

Most Canadian doctors don’t work for the government if they have their own practice, which is the most common.

I guess if they worked for a public hospital they would, but that’s not all doctors.

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

#238
post #213

Earlier quoted context omitted.

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…

Stanford Hospital used to turn you over to collections if you didn't pay. And I use the word collections loosely here. The guys who showed up at my house were basically bikers with a license to carry. Scary dudes. I had to call the cops because they wouldn't leave my property. The cops had to pull their guns to get the "collectors" to leave. Oh, and after all the billing was sorted out, I didn't owe any money. They w…

UCSF and SF General aren’t much better. Public institutions are some of the worst offenders among hospitals.

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

#239

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…

> the physicians who treat garden-variety diseases can be trained much less expensively.

So, how do you make sure that only garden variety patients see the medical assistant, while seriously sick ones or those who have only telltale signs of a 1-10k illness see the real doctor? If those rare ones don't get to the doc they die.

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

#240

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 had an unpaid ambulance ride of 5 minutes. Moved and never received the bill.

Never heard about it until the collections agency called. I paid it and they still dinged my credit.

Just a lesson for anyone thinking this is a good idea, most likely you will get your credit slapped for this sort of thing.

Post reply on HN