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

turquoise.health

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

#241

Post by coredog64 »

mc10 wrote: post #212
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…

I think this is a bit of an oversimplification; there are places where the out-of-pocket price ends up actually cheaper than the negotiated insurance price, which is mind-boggling to me.

A long time ago, when I was poor and underinsured, I had a medical situation that required imaging. The doctor’s office said they had the machines on prem, but they couldn’t give me any kind of price break. So he sent me to a specialist. Signing in to the specialist, they told me that the cash up front discount was 75%, and that even a hint of having to deal with insurance companies was going to mean a higher effective out of pocket.

Practically any US medical practice is going to have huge staffing overhead for the people who maintain the accurate billing records and wrangle with insurance companies.

I can directly compare with the French system: Doctor has a receptionist, you pay him cash right there on the spot, and he’s very limited in what he can do. E.g. he has to send you to the pharmacy to buy your shots, but he’ll administer them. When it’s all done, you fill out a crapload of forms, staple all the receipts to the stack, and your employer (via insurance) returns somewhere between 60-80% of it.

I have long maintained that moderate reimbursement for outpatient care would be a huge improvement for the US. At the same time, there’s a fairly large entrenched interest that wouldn’t like this at all.

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

#242

Post by coredog64 »

analog31 wrote: post #123
dheera wrote: post #79

Earlier quoted context omitted.

Everything is inflated the whole way in the American system. Universities overcharge in the US. The medical education costs upwards of $800K if you include the cost of lost opportunity had you gone into a different field and worked those years instead. So doctors need higher salaries. That, combined with idiotic market dynamics around medical supplies, means that all medical costs are higher. That in turn means every…

I believe a reform of the healthcare system should include paying for medical school. Let's offer a deal: You go to med school for free, then you work for the government for a decent professional salary.

US medical education length is insane. Get an undergraduate degree (pre-med). Then go to med school. Then a residency. Then you can practice.

Other countries do just fine with much less.

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

#243

Post by hkt »

ageitgey wrote: post #206
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 coun…

It doesn't seem like there's a way to do it without aggressive opposition, really. Divide and rule (taking out one rentier middleman at a time) will take decades I'd imagine.

So yeah, expand and improve existing programs until they're universal and comprehensive like the NHS. Sane approach.

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

#244

Post by arppacket »

bhupy wrote: post #94
btbuildem wrote: post #54

Earlier quoted context omitted.

I imagine it's on account of all the administration and intermediaries.

It's not. There's a good breakdown that compares what drives healthcare spending between the US vs Germany (and others). https://www.healthsystemtracker.org/brief/what-drives-health... The vast majority of the difference comes from just the raw cost of inpatient and outpatient care. Even if you were to completely zero out the administrative costs per capita, you'd hardly make a dent in bridging the gap.

The "administrative costs" in that analysis are misleading. "Administrative costs include spending on running governmental health programs and overhead from insurers but exclude administrative expenditures from healthcare providers." I don't think the blue bar is representative of the "raw cost" of care.

This study says over one-third of all US healthcare costs are administrative.

https://www.reuters.com/article/us-health-costs-administrati...

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

#245

Post by zachmu »

We're running a $10,000 bounty to assemble this information into a queryable database:

https://www.dolthub.com/repositories/dolthub/hospital-price-...

You get paid based on the percentage of rows you contribute to the dataset. So if you fill in 20% of the rows, you get $2,000.

More details here:

https://dolthub.awsdev.ld-corp.com/blog/2021-01-14-hopsital-...

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

#247

Post by mancerayder »

kwhitefoot wrote: post #179
mancerayder wrote: post #163

Earlier quoted context omitted.

This is useful - as a starting point. I want to be able to make a case for a single payer system in the U.S., but I think to be effective it's a comparison of costs and outcomes that needs to be had. In the data linked above, we're told that the 'inpatient and outpatient care' is significantly higher than in 'comparable countries.' I believe it. But isn't 'inpatient and outpatient care' just about .. everything that…

> (the latter two have long waits for essential surgeries compared to the U.S.) References?

"Wait times for cancer treatment -- where timeliness can be a matter of life and death -- are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn't start treatment on time despite an urgent referral by their primary care doctor. That's the worst performance since records began in 2009.

And keep in mind that "on time" for the NHS is already 62 days after referral.

Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America."

(https://www.forbes.com/sites/sallypipes/2019/04/01/britains-...)

Yes, I know Forbes has a bent. And I'm generally in favor of single-payer options and not defending the U.S. However I have seen the Wait Time stat over the years in the context of cancer patients, and this is one data point. Canada is apparently worse.

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

#248

Post by aksss »

jimbob45 wrote: post #151
eldavido wrote: post #58

Earlier quoted context omitted.

Also a fiscal conservative, I completely agree single-payer would be much better than what we have now. What I think would be best though, is to eliminate medicare/medicaid, hand people cash, and get out of the way. The high-order problem with medicine isn't coverage or insurance. It's price. There are only two ways to get price under control: meaningful competition, or government price controls (e.g. single payer).…

You’re advocating for the same system that ruined colleges: guaranteed loans. Also coverage is also a huge deal in the US, although it may not be a problem for you specifically. Obamacare covered millions who otherwise might have stayed home instead of seeing the doctor. The problem with US health is scoping. Insurance companies are effectively “certifying” which hospitals and doctors you can see instead of actual ce…

> Obamacare covered millions

I was one of the people who lost insurance starting a new business - too rich to get subsidized (cutoff was/is >~50k/yr), too poor to pay the equivalent of a second mortgage for individual insurance because of runaway premiums on individual market post-ACA. And penalized a few grand for it come tax season until the mandate was effectively rolled back. Was more than supportive of that rollback.

It’s a risk management game for new business owners, and a big incentive for people to keep working for the man.

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

#249

Post by tomca32 »

mynameismonkey wrote: post #209
chaboud wrote: post #186

Earlier quoted context omitted.

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)

That’s a great piece thanks!

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

#250

Post by eldavido »

ska wrote: post #155
eldavido wrote: post #58

Earlier quoted context omitted.

Also a fiscal conservative, I completely agree single-payer would be much better than what we have now. What I think would be best though, is to eliminate medicare/medicaid, hand people cash, and get out of the way. The high-order problem with medicine isn't coverage or insurance. It's price. There are only two ways to get price under control: meaningful competition, or government price controls (e.g. single payer).…

aside: Singapore is a weird case and probably not a good comparitor for most healthcare systems. > If people can't pay as much, the only thing for them to do is drop prices. Or not offer the product at all. One problem with this entire area is that "healthcare" is really not one service/product area, and it is probably a mistake to treat it as such. To be transparent, I don't share your optimism about market solution…

The main thing I take on faith is that people are different and one-size fits all solutions don't produce good outcomes. We have different car brands, grocery stores, non-health insurance companies, package delivery companies, retailers, and housing options. Some people want fast and cheap. Others want to drive an hour to save a few bucks.

This isn't some technical academic point. Without a range of choices, you actually can't know what people truly want. So things don't get better. People can't signal what's truly important by voting with their wallet.

> If we want to benefit from market forces here, it's probably much more effective to have large (or single) payers who understand what the standard of care should be, and can encourage price competition from providers.

I don't get this at all. There are so many markets where complex, highly-paid specialists do work customers might not understand: estate/trust lawyers, auto repair, even dental care. We don't have nearly the same problems as in medicine due to this culture of treating doctors like God. They aren't. They're just a person doing a service, just like a chef or a guy painting a house.

What actually bothers me most about this whole thing is that nobody is willing to get serious about the tradeoffs their system entails. Health care in the US is failing right now. Companies are trying to stay beneath ACA limits because health insurance would crush them. My premiums are $380/month as a healthy, 36-year old nonsmoker with no rare conditions. That is INSANE. There's ever-more incentive to keep people off of W2 employment because premiums have gotten so out of control. If you take the current system, where bankruptcies are the norm, this monster is devouring almost 20% of our GDP, and every time I go to the doctor it's a major hassle, I'll come out and say that yes, maybe I'd prefer to fix that even if someone can't get a $150,000 drug anymore.

>aside: Singapore is a weird case and probably not a good comparitor for most healthcare systems.

Umm...why not? You can't just hand-wave that away.

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