Show HN: Compare prices that US hospitals charge patients, insurance companies • Hacker News Board

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#201

Post by curiousllama » Mon, Jan 18, 2021, 6:05 PM UTC

Great solution. I hope this will make asking about costs at the hospital more normal!

I once went to a doctor for vaccinations before traveling. The nurse said "You need X, I recommend Y, and the CDC recommends Z." I responded "great, let's get X right now. Not sure about Y or Z - how much do they cost?"

The question just didn't compute. No matter how I phrased it ("just want to price compare" ... "there's a bunch of travel clinics and I'm trying to get this cheaply" etc), I couldn't make myself understood.

The NP ended up coming in to give me their "anti-vax" spiel. I had walked in to a hospital wanting a vaccine, and asking about costs was so foreign to them that they thought the only reason I could hesitate to get a vaccine was anti-vax sentiment.

All this to say - this tool is very much needed, and has the potential to do a lot of good!

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#202

Post by knubie » Mon, Jan 18, 2021, 6:06 PM UTC

analog31 wrote: post #187

lotsofpulp wrote: post #180

Earlier quoted context omitted.

Transparent pricing enabling the comparison of pricing between different sellers is only one piece of a functioning marketplace. You also need multiple informed sellers and multiple informed buyers.

So it's a step towards a complete policy. What is the complete policy? Granted we might not see it enacted now, but it would at least clarify where the administration was headed.

The current tax code incentivizes insurance as compensation, which drastically distorts the market. The ACA made things even worse by introducing the individual mandate.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#203

Post by aksss » Mon, Jan 18, 2021, 6:06 PM UTC

tfehring wrote: post #78

travisp wrote: post #63

Earlier quoted context omitted.

It's true that US doctors are paid more (although the gap isn't as big as it used to be). However, pay for US doctors makes up a fairly small portion of overall US medical expenditures (less than 10%). So, you could ask every doctor to work for free and not significantly change costs.

There’s a similar (but smaller) differential for other medical professionals too. But more generally, when I’ve done high-level comparisons of medical spending between the US and Western European countries, it seems like every single cost element is more or less proportionately higher in the US. It seems like basically everyone is spending money in roughly the same proportions, including on things like doctors’ salar…

And doing so more frequently in the US, so cost is higher but so is rate of consumption, particularly of services and products that make us feel like we have more mastery over outcomes but in fact do not result in better outcomes on the whole.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#204

Post by 11thEarlOfMar » Mon, Jan 18, 2021, 6:08 PM UTC

ogre_codes wrote: post #171

lostcolony wrote: post #135

Earlier quoted context omitted.

I mean, we can discuss how much credit and where it's due, but I'm pretty sure "current administration", on a given date, makes it kinda apparent?

I think the idea is that the poster wants people aware that at least once in his administration Trump has done something remotely correct. Of course the fact that he did this after spending 3 years trying his damndest to gut our already mediocre public healthcare system makes it a bit of a eye roller, but you know, even a broken clock is right and all that.

For completeness, a couple of other health related actions by the current administration:

- 'Most Favored Nation' drug pricing. Also as of 1/1, big pharma has to charge US payers the same price as the lowest price they charge to other countries. One example cited is insulin. Apparently, the price of Insulin from the same pharma is 10% the price in Canada as it is in the US. Now that this law is enacted, that pharma has to charge the same in the US as they charge in Canada.

- 'Right to Try'. Greatly reduces restrictions on terminally ill patients' access to experimental treatments.

- Removed the mandate on the affordable care act. People who do not have any health insurance were liable to pay a fine. That fine was removed.

- eHealth across state lines. Doctors were not permitted to see patients via video calls across state lines. During the pandemic, that restriction was removed.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#205

Post by leetcrew » Mon, Jan 18, 2021, 6:08 PM UTC

ews wrote: post #168

Daniel_sk wrote: post #158

Earlier quoted context omitted.

I think a lot of people are missing one key difference. Healthcare in EU is based on solidarity system where every citizen pays a percentage share of his monthly salary to the medical insurance. So if you earn more, then you will also pay more medical insurance - but you will get the same treatment as others (unless you have some fancy private insurance on top of the regular insurance). So basically any medical expen…

This is how progressive taxation works. For some reason, US people happily pay for police, firemen, infrastructure or the military as a necessity of a functioning society but have serious problems considering healthcare in the same group.

one could make the argument than the benefits of police, firemen, and military scale somewhat proportionately with wealth. people with meaningful assets have a lot to lose if the police stop protecting their property or the US navy can't guarantee relatively safe trade by sea. their house is probably worth more too. a homeless person probably gets hassled by police much more often than protected by them. socialized healthcare mostly benefits people who don't have and/or can't easily afford good insurance.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#206

Post by ageitgey » Mon, Jan 18, 2021, 6:10 PM UTC

hkt wrote: post #131

Just came here to remind everyone that free at the point of use healthcare is great. I tried to total the cost of the care my son received when he was born, had we been American. I stopped counting at $1million. Being in the UK, I even got a few meals at the hospital canteen thrown in. Not to mention the time in nICU etc. It is horrifying that people have to compare prices and haggle for care anywhere on earth.

Fun fact - I'm a cofounder of this and a US citizen, but I live in London. I agree completely with this. I spend my days working on US healthcare data and seeing how crazy it is while I use the NHS for my actual care.

But the US system is tricky because while it is an huge mishmash of layers of middlemen and clearing houses taking a slice of the pie, those layers also employ a huge number of Americans across the country. It would be extraordinarily difficult (both logistically and politically) to rip all that out in one fell swoop. I feel like the only possible way to bring in socialized medicine in the US would be a gradual expansion of opt-in 'Medicare for All' or something along those lines.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#207

Post by thatfrenchguy » Mon, Jan 18, 2021, 6:12 PM UTC

dcolkitt wrote: post #178

dr_faustus wrote: post #44

It's always fascinating to see that even compared to prices you pay as a self-paying patient in Germany (which are already 1.5x - 2x higher than what the "public" insurances, ie. 85% of the population, pay for the same procedures), the prices in the US are about 5x to 10x higher. The standard of care seems to be quite comparable if you look at outcomes, so there must be huge inefficiences in the American system (doct…

Before coming to any conclusions on this topic, I highly suggest reading this extremely in-depth analysis on cross-country healthcare spending.[1] The simple answer is that Americans really do consume significantly more healthcare than Europeans. The most straightforward signature of this is the fact that a much higher proportion of Americans work in the healthcare industry than any other large country. The US also t…

> The strongest counterpoint to this is that despite America's high healthcare consumption, that health outcomes are significantly worse than Europe. In particular in terms of life expectancy.

Just look at the life expectancy of France and Germany to disprove your theories.

The big difference between the American healthcare system and the one in these countries is that people don’t have to worry about the bills, which means healthcare providers have a much bigger incentive to learn what cost benefit analysis means.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#208

Post by yding » Mon, Jan 18, 2021, 6:13 PM UTC

ageitgey wrote: post #192

yding wrote: post #183

Very cool! We've been working an app that is looking for this exact type of data. Do you have an API or plans for making an API for this?

We do have plans for an api, but we are currently working out the model for it - feel free to get in touch via the site and let us know you are interested and what you might want to do with it.

Thank you. Just did.

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#209

Post by mynameismonkey » Mon, Jan 18, 2021, 6:14 PM UTC

chaboud wrote: post #186

dr_faustus wrote: post #44

It's always fascinating to see that even compared to prices you pay as a self-paying patient in Germany (which are already 1.5x - 2x higher than what the "public" insurances, ie. 85% of the population, pay for the same procedures), the prices in the US are about 5x to 10x higher. The standard of care seems to be quite comparable if you look at outcomes, so there must be huge inefficiences in the American system (doct…

Chargemaster prices (the non-negotiated price) are ridiculously high in the US. They’re so high that some hospitals will give uninsured patients a break of “half off” without even negotiating. The reason for this is that chargemaster price is a fake dollar price resulting from a broken incentive structure and process. Here’s a setup: A hospital is working out a negotiated rate for aggregate services with an insurance…

I have a go-to piece on chargemasters here https://jaz.co.uk/2015/10/15/hospital-retail-pricing-for-dum...

(Worked on hospital pricing reports since 2001)

Re: Show HN: Compare prices that US hospitals charge patients, insurance companies

#210

Post by pkaye » Mon, Jan 18, 2021, 6:15 PM UTC

azalemeth wrote: post #34

I think something else that would be of interest would be doing this for drug prescriptions: compare the cost that my employer, the NHS, pay for a compound and those that Americans pay for the exact same compound. This is easy on my end at least -- prices and prescription guidance are released in the BNF / British National Formulary annually and are all made available in public. I have never understood the US system…

One of the things that EU countries do is negotiate with the the drug manufacturers. So UK in this case of Lumacaftor, didn't cover the drug until they got a reasonable price. This meant a 4 year delay in access to the drug vs the US.

> It was approved for medical use in the United States in 2015, and in Canada in 2016.[3][5] In the United States it costs more than $US 22,000 a month as of 2018.[6][7] While its use was not recommended in the United Kingdom as of 2018,[4] pricing was agreed upon in 2019 and it is expected to be covered by November of that year.[8]

https://en.wikipedia.org/wiki/Lumacaftor/ivacaftor