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

Re: Congress is set to ban most surprise medical bills

#241

Post by whiddershins » Mon, Dec 21, 2020, 7:04 PM UTC

akiselev wrote: post #219

gregario wrote: post #192

Earlier quoted context omitted.

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 basically no example of a monopoly forming outside of government regulation. That's tautological statement. There is no free market without private property protections which do not exist outside of government regulation either.

Some people view the protection of individual intrinsic rights (freedom from violence, protection of property, the right to move freely about) as a separate thing from regulation.

Government protecting people's rights, vs. government protecting people, or government prohibiting consensual business dealings.

Re: Congress is set to ban most surprise medical bills

#242

Post by r00fus » Mon, Dec 21, 2020, 7:07 PM UTC

SkyPuncher wrote: post #163

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…

> 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. FYI, they weren't checking for your ADHD medication. They were likely checking for marijuana. * Marijuana can introduce side effects that basically make it look like you have ADHD * Most ADHD medications are stimulants, they have counter indications wh…

It's that secondary system that really should be transparent, not just the "stated price" which everyone knows is BS.

Re: Congress is set to ban most surprise medical bills

#243

Post by learc83 » Mon, Dec 21, 2020, 7:08 PM UTC

umvi wrote: post #137

learc83 wrote: post #41

Earlier quoted context omitted.

That's because most common dental procedures are relatively straightforward and the mechanical processes of the mouth are relatively well understood compared to most of the rest of the body. Plus most dental procedures are elective in the sense that you can usually just have an offending tooth pulled if it gets too bad, so for most people there's a price ceiling that is much lower than say a lifesaving heart procedur…

Why can't a hospital tell me how much an xray costs then? If I come in with a broken arm, why can't they tell me how much it will cost to get it xrayed yet the dentist can do the exact same thing with a broken tooth?

A dentist office is more comparable to an urgent care clinic than a hospital. And in many cases an urgent care clinic can tell you what simple procedures will cost. There are imaging services companies that can tell you upfront how much diagnostic tests are going to cost as well.

A broken tooth is a much less complex injury than a broken arm. In many cases you don't even need to be a dentist to diagnose it. Try walking into a dentist office with a more complex injury that could involve multiple different dental specialties and severe underlying complications. You aren't going to get an immediate upfront price.

Re: Congress is set to ban most surprise medical bills

#244

Post by BitwiseFool » Mon, Dec 21, 2020, 7:09 PM UTC

hodgesrm wrote: post #132

kayodelycaon wrote: post #9

> Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees. If this doesn’t describe evil, I don’t know what else would.

It's hard to see how anyone could extol the virtues of a "free market system" where behavior like this exists. It is pervasive in American health care. Just search for "orphan drugs" if you are insufficiently outraged. [1] [1] https://www.washingtonpost.com/news/wonk/wp/2017/12/18/this-...

I have some Libertarian minded friends and the go-to "solution" for just about every shortcoming in the healthcare system is for some other company to come along and "compete". In principle this would work (Libertarians are all about principles, by the way). But in practical terms there's too much money to be made using these dishonorable business practices and there is no viable competition.

Re: Congress is set to ban most surprise medical bills

#245

Post by my_usernam3 » Mon, Dec 21, 2020, 7:11 PM UTC

javier10e6 wrote: post #195

Humana Healthcare CEO Bruce Broussard base salary in 2016 was $1.24 million. No surprise there.

I'm actually ok with that salary as they have over 50B in revenue. However, I'm sure he and all the other execs receive exorbitant bonuses and stocks plans that make that salary look like peanuts.

Re: Congress is set to ban most surprise medical bills

#246

Post by btilly » Mon, Dec 21, 2020, 7:14 PM UTC

iaw wrote: post #100

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

> 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.…

My suspicion is that Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability which is why the US has such excessive healthcare costs without any apparent justification.

I do not believe that is the primary driver of costs, but it definitely does not help.

For those who don't know what we're talking about, private equity looks for companies with stable revenue streams such that if you find days to make lots of cuts, the revenue stream will continue for a long time. They then strike an agreement with the current owner to buy the company by having the company take a large loan (actually issue bonds, but it comes to the same thing) to pay off the current owners. That's called a "leveraged buyout" (in finance debt is often called leverage).

They then make those cuts and use the difference between revenue and costs to pay off the debt. They then try to juice up the corpse in various ways to find someone to sell the company to before the long-term impact of the cuts becomes obvious.

This happens in any industry with stable revenue streams. And healthcare has exactly that characteristic.

See https://ourfuture.org/20120913/sick-money-how-mitt-romneys-b... for an article on this exact phenomena.

Re: Congress is set to ban most surprise medical bills

#247

Post by zentiggr » Mon, Dec 21, 2020, 7:14 PM UTC

cogman10 wrote: post #214

devonbleak wrote: post #165

Earlier quoted context omitted.

This doesn't even begin to address the real problem: emergency care. Sure I can shop around and do a bunch of research for something that I know is coming up, but when the out of network specialist drops into my wife's hospital room as she's having an asthma attack and can't breathe I don't have the temporal luxury of vetting how much that particular specialist is going to cost out of pocket and can I please have one…

I worry that it will lead to much worse treatment on top of that. Even if it's a non-emergency, getting the prices up front will cause a lot of people to chose to either go untreated or to delay treatment until a problem becomes far worse. Just having prices available does nothing to improve the costs. People with type 1 diabetes know the cost of insulin. Has that prevented it's price from moving to levels that many…

Wouldn't that be even more pressure on the pricing system, though?

If statistics about refused services were kept, we could see where the various providers are pricing in-demand services out of reach of those who need them. Or conversely, what services were advised above and beyond actual need.

We could see pressure on providers to bring costs in line with the benefits of each code/procedure, and the ripple effects could help reduce the premium->insurer->provider cost overages for everyone.

Mind you, I still believe single payer will be the eventual end game, but this could be a solid step in the right direction.

Re: Congress is set to ban most surprise medical bills

#248

Post by Brian_K_White » Mon, Dec 21, 2020, 7:15 PM UTC

whiddershins wrote: post #235

npmaile wrote: post #227

Earlier quoted context omitted.

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)

I can't imagine why I am so unmoved by this tale of woe of the horrible government intervention.

Re: Congress is set to ban most surprise medical bills

#249

Post by AdrianB1 » Mon, Dec 21, 2020, 7:17 PM UTC

herbstein wrote: post #121

jsperson wrote: post #48

Earlier quoted context omitted.

> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected si…

> Other countries seem to have solid solutions for "socializing" medicine What baffles me the most is that most "socialized" systems functions much like a tax-paid insurance policy that covers everything and has no profit motive. Even in a normal insurance situation you're "paying for someone else's treatment". That's the whole point of insurance.

Most of these systems works like an extra payroll tax: it is a tax on salary as percentage, as opposed to a car or house insurance that is linked to the value of the risks insured, not the income of the payer. This is why some people are opposing to that system, the tax vs insurance debate.

Re: Congress is set to ban most surprise medical bills

#250

Post by mikem170 » Mon, Dec 21, 2020, 7:18 PM UTC

harperlee wrote: post #162

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.…

> Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability But that is precisely a market effect of PE being able to do this due to lack of effective regulation, isnt it?

Ok, there could be multiple problems.

One problem with health care in the U.S. is that prices are hidden from the customers. That interferes with a free market. Tax regulations incentivized tying health care to employment and Obamacare making it difficult to get catastrophic care both interfere with a free market, etc.

Another set of problems, as you describe, is the ability for private equity funds to collude and impeded free markets. Especially lobbyists getting laws passed in their favor, medical associations limiting the supply of doctors, doctors incentivized to prescribe opioids, etc.

The original post in this thread referred to our current health care system as a free market, and that is not accurate. That's probably just as wrong as saying that we currently have socialized medicine, and its not working.

I would say that our current health care system is a not a free market and is not socialized, it is broken mix of the two.

It won't be reformed any time soon because millions of insurance industry jobs would need to be eliminated to save any money. Good luck with that.