Congress is set to ban most surprise medical bills • Hacker News Board

Re: Congress is set to ban most surprise medical bills

#231

Post by [deleted] » Mon, Dec 21, 2020, 7:00 PM UTC

javajosh wrote: post #220

iaw wrote: post #100

Earlier quoted context omitted.

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…

Yes, it should be "free markets...until the wolves take over the whole system". It's impressive how quickly those profit maximization ideas have caught on, driven by technology (I blame Excel more than anything), and throughout the entire system. The healthcare cash-cow benefits a LOT of people, workers, suppliers, and (especially) administrators at both hospitals and doctors offices. A poor healthcare system is a gr…

[deleted]

Re: Congress is set to ban most surprise medical bills

#232

Post by arcticbull » Mon, Dec 21, 2020, 7:00 PM UTC

npmaile wrote: post #227

javajosh wrote: post #220

Earlier quoted context omitted.

Yes, it should be "free markets...until the wolves take over the whole system". It's impressive how quickly those profit maximization ideas have caught on, driven by technology (I blame Excel more than anything), and throughout the entire system. The healthcare cash-cow benefits a LOT of people, workers, suppliers, and (especially) administrators at both hospitals and doctors offices. A poor healthcare system is a gr…

I think the argument you are responding to is not the one the previous user presented. This issue isn't that people are trying to maximize profit leading to issues. The problem is that there is undue government interference in the market leading to all of the negatives that come from people selfishly trying to maximize profit in a cynical way with none of the benefits of people trying to maximize profits by providing…

Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it.

The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "pay up" part out too, as it allows the system to be globally optimized.

At the end of the day health insurance isn't insurance, it's at best a structured payments plan. You buy insurance against things that may or may not happen. You will get sick and you will die. That's not insurance.

[1] https://corporatefinanceinstitute.com/resources/knowledge/ec...

Re: Congress is set to ban most surprise medical bills

#233

Post by asimpletune » Mon, Dec 21, 2020, 7:01 PM UTC

gregario wrote: post #192

kstrauser wrote: post #168

Earlier quoted context omitted.

I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.

It's the regulations / limitations you are proposing that make it possible/likely that a monopoly will form. See Milton Friedman on this. There's basically no example of a monopoly forming outside of government regulation.

There’s also no example of a monopoly forming inside the molten core of the earth, but that doesn’t mean sunshine causes monopolies.

Re: Congress is set to ban most surprise medical bills

#234

Post by astura » Mon, Dec 21, 2020, 7:02 PM UTC

mattkrause wrote: post #123

mehrdadn wrote: post #24

Earlier quoted context omitted.

> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)

I asked my new dentist why her recommendations were so different from her predecessor. She said that there's not always one "correct" treatment. Some dentists will try to nip potential problems in the bud, lest they get worse. Others have more of a wait-and-see attitude which can avoid some procedures but make others worse. Doctors, plumbers, builders, and mechanics all do the same thing. Do you replace the brake pad…

Difference being is all break pads eventually wear out and need to be replaced and all decks need regular maintenance. Not all teeth are going to eventually need work.

Plus the huge disparity in recommended treatments is an indication some are just throwing shit at the wall to see what sticks:

https://www.theatlantic.com/magazine/archive/2019/05/the-tro...

>Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.

Re: Congress is set to ban most surprise medical bills

#235

Post by whiddershins » Mon, Dec 21, 2020, 7:02 PM UTC

npmaile wrote: post #227

javajosh wrote: post #220

Earlier quoted context omitted.

Yes, it should be "free markets...until the wolves take over the whole system". It's impressive how quickly those profit maximization ideas have caught on, driven by technology (I blame Excel more than anything), and throughout the entire system. The healthcare cash-cow benefits a LOT of people, workers, suppliers, and (especially) administrators at both hospitals and doctors offices. A poor healthcare system is a gr…

I think the argument you are responding to is not the one the previous user presented. This issue isn't that people are trying to maximize profit leading to issues. The problem is that there is undue government interference in the market leading to all of the negatives that come from people selfishly trying to maximize profit in a cynical way with none of the benefits of people trying to maximize profits by providing…

The thing is, government intervention is probably the biggest way the wolves take over. They distort the market to their benefit using governmental force (aka. regulation)

Re: Congress is set to ban most surprise medical bills

#236

Post by AnthonyMouse » Mon, Dec 21, 2020, 7:03 PM UTC

cogman10 wrote: post #190

pxeboot wrote: post #184

Earlier quoted context omitted.

Emergency care seems to account for less than 10% of healthcare spending in the US [1]. [1] https://www.annemergmed.com/article/S0196-0644(13)00313-2/ab...

To me, that sort of proves a point. Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending. Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere…

> Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending.

Emergency care is not actually uncommon. Heart attacks, car accidents, these are the leading causes of death. It's completely reasonable to expect this to legitimately consume 10% of healthcare resources.

> Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere from $10->$15.

This is just opportunism, but it isn't really the core of the problem.

Emergency care is inherently expensive for a specific reason. You need an emergency heart surgeon on premises in case anybody needs heart surgery regardless of whether anybody does at any given time. You also need a neurosurgeon and one for every other specialty, and all the supporting equipment. It's very expensive, which is why it amounts to 10% of healthcare costs.

They then try to recover some of those costs by massively overcharging for ibuprofen and band-aids, which is silly (charge insurers the actual cost for emergency heart surgery instead), but it's not going to be a source of major net cost savings just to do the accounting differently.

Re: Congress is set to ban most surprise medical bills

#237

Post by mattnewton » Mon, Dec 21, 2020, 7:03 PM UTC

treeman79 wrote: post #229

iaw wrote: post #100

Earlier quoted context omitted.

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…

For actual free market, you would need to get ride of most regulations. Basically like going to the vet. Or dentist or cosmetic surgery. Fairly cheap, fine “most” of the time. Sometimes it’s not.

Even then it would not be truly free because you would need to make decisions in a medical emergency with limited options. It would be like shopping for a dentist with an abscess that could kill you tomorrow.

Re: Congress is set to ban most surprise medical bills

#238

Post by wes-k » Mon, Dec 21, 2020, 7:03 PM UTC

OminousWeapons wrote: post #54

I was working on a health insurance related startup for awhile so I would say I know more than the average person about the space, and even I get surprised on a regular basis by the absurdity in this field. For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. Wh…

You can buy short term insurance. It is outside of the healthcare market place and typically does no cover pre-existing conditions (you have to qualify for it). I actually switched to it 100% as the premiums are way cheaper and I just want insurance against million dollar fees on the low chance I get cancer or I'm in an accident.

Re: Congress is set to ban most surprise medical bills

#239

Post by ApolloFortyNine » Mon, Dec 21, 2020, 7:03 PM UTC

HeyImAlex wrote: post #70

I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. A month later I received an explanation of benefits from my insurance company that said they received a 14k bill and had paid 4k of it, so I was on the hook for the other 10k. Furious I went to my psych. They casually said “we’ve taken care of it, you sh…

This is kinda the scary part of insurance, and it happens in every industry where insurance exists. It's very expensive for insurance companies to fight charges, so generally mechanics know a magic number they can give that is way higher than they'd charge you, but the insurance company wouldn't bother to fight.

Ever have work done on a car/boat and have the mechanic offer to pay your deductible? I've had it happen most of the time.

And this part of insurance is hard to fix simply because of how valuable people's time is, and the cost of the insurance company simply being wrong in the end (reputation hit, possible legal repercussions, and cost of the investigation).

Re: Congress is set to ban most surprise medical bills

#240

Post by mindslight » Mon, Dec 21, 2020, 7:03 PM UTC

thowawayyy wrote: post #210

mindslight wrote: post #181

Earlier quoted context omitted.

The same way you don't get super gouged when choosing a restaurant while hangry - non-urgent shoppers keep prices down across the board, even for urgent participants. I'm not saying this makes for some total solution - just reacting to rejection of the market dynamic having any worth. It's foolish to cast aside entire paradigms of approaches because they don't fully solve every corner case. (The dual would be to ask…

I didn't mean to suggest that there shouldn't be the option to freely chose alternative treatment options under a free market model, in cases where you're not happy with what a single payer model would cover. Rather my point was that when you need urgent or critical medical care there should be a baseline assurance of a solution to your predicament as you may not be in a position to shop around. Your analogy with res…

The problem is that we've taken on this hidden assumption that "free market" somehow means that a hospital can create an arbitrary bill for urgent care, and you have no choice but to pay it. That's not really intrinsic to the free market paradigm, but rather an orthogonal corruption pushed via the legal system.

In a different thread I pushed the lack of a contract argument, and got back a more fitting legal theory that hospitals are allowed to charge you under the idea that you not paying would be "unjust enrichment" - they treated you, incurred expenses doing so, and therefore its your responsibility to compensate them. But that still doesn't support them charging you some arbitrarily high price, rather just expecting to be reimbursed for their costs. And so such bills should actually be constrained by the lowest rate they have with contracted insurances.

As for the analogy, I've been pretty hangry to the point where I wouldn't have been able to form a contract. It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation.