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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

#261

Post by eldavido »

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…

I never said anything about loans.

What I'm suggesting is food stamps. Everybody can pay cash. If you can't, you get government assistance in the form of a cash-like subsidy that can be spent anywhere food is sold.

It's a fast, efficient way of ensuring universality of care while benefiting from the market discipline you get from having a (mostly) competitive, cash market. Not to mention, there is no insane "food insurance" bureaucracy. You swipe the card at the checkout line and you're good.

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

#262

Post by aksss »

grey-area wrote: post #68
nugget wrote: post #45

Earlier quoted context omitted.

My takeaway from all that research was the same. Almost everyone benefits from universal coverage but the system has to incentivize patients to shop around for the optimal balance of price, quality, and convenience. This can be accomplished with an annual deductible of a few thousand dollars perhaps capped at a % of income. Without this incentive, costs skyrocket. Price transparency is a pre-requisite without which c…

Almost everyone benefits from universal coverage but the system has to incentivize patients to shop around for the optimal balance of price, quality, and convenience. Universal coverage does not need to incentivise shopping around in a single payer system. Also, the majority of patients are not capable of evaluating quality of healthcare, nor should they be.

Any system should incentivize shopping around unless it wants inflated cost. That or discourage frequent engagement (the US consumes comparatively massive amounts of healthcare product and service with inefficient outcomes). Our present system is _designed_ to prevent price comparison and shopping around via price opacity, network lock-in, state-level artificial supply barriers, etc.

Universal coverage on par with Europe would mean we all start consuming less individually (which isn’t a big deal to outcomes but not part of our culture), or we need to have a far more competitive environment for suppliers. Either would be better than what we have today, whether insurance is public, private, or a mix of both.

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

#263

Post by mancerayder »

DanBC wrote: post #256
mancerayder wrote: post #247

Earlier quoted context omitted.

"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. Unsurprisi…

> live at least five years after diagnosis, Five year survival rates don't give you much information, because the US engages in massive over testing. You need to know all cause mortality, and the US does worse here than the UK. The US over tests people and over treats cancer; that costs a lot of money and isn't pleasant for people but it doesn't make them live longer. If hypothetical Beth dies age 82 does it matter i…

I'm always willing to learn more - do we have a one-stop-shop apples to apples comparison of U.S. vs. UK and other countries' healthcare models with stats and explanations, one that is free from strong biases ? I struggled to find a non-political, but still meaningful comparison data site online via Google.

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

#264

Post by jgeada »

marcinzm wrote: post #67
btbuildem wrote: post #54

Earlier quoted context omitted.

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

Probably some of it but I suspect the lack of limitations on services rendered plays into it as well. If someone in the US wants to see specialists 50 times in a month due to munchausens then they'll just be charged their co-pay each time (in most insurance plans). In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral. Same with expensive drugs that don't help…

> In Germany I suspect they'd not be allowed to book appointments anymore or would require a gatekeeping referral.

This is the kind of comment that immediately classifies the commenter as never having lived outside the US and/or not reading anything but US news sources. And with the wilful blindness to how exactly those gatekeeping referrals are present in most every single healthcare plan in the US.

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

#265

Post by 4ec0755f5522 »

I just read an article about quiet / dream jobs (park ranger etc.) In it, every single person has a side gig(s) or is otherwise making decisions on their careers based on medical coverage. Every one of them! One of the people says most people leave when they turn 26 because they can't stay on their parents' health insurance. What?!

  > And like other dream jobs I learned about, it’s not enough to survive on: During 
  > off-seasons, Krumbholz also works as a substitute teacher and an aquarium dolphin 
  > tank cleaner; since being on university health insurance would mean she’d constantly
  > lose it during the off-season, Krumbholz decided to stay on the state exchange
  > instead.
The idea that health care is tied to your employer, and your employment status, is so unacceptably broken. I've never heard of anything so broken in terms of the obvious social and economic harm a bad policy is creating. Having the freedom from health care costs is more freedom for more people than the "freedom" to not pay health insurance or taxes to cover it.

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

#266

Post by coredog64 »

smachiz wrote: post #65
nugget wrote: post #45

Earlier quoted context omitted.

My takeaway from all that research was the same. Almost everyone benefits from universal coverage but the system has to incentivize patients to shop around for the optimal balance of price, quality, and convenience. This can be accomplished with an annual deductible of a few thousand dollars perhaps capped at a % of income. Without this incentive, costs skyrocket. Price transparency is a pre-requisite without which c…

Do you have any studies or sources to back this up? As I understand it, in most EU markets there's no price component, nor much of a choice component and costs haven't skyrocketed.

I lived under the French system for years, and it’s entirely untrue that there is no cost or choice component. You pick the doctors and you pay them fully out of pocket. Your insurance company reimburses you at ~80% of reasonable and customary rates. If you wind up going for inpatient care it’s different, as is the situation for those in extreme poverty. Also, you can pay extra for 100% coverage if you want, but ISTR it was expensive and not really worth it for us.

Now, when I left, the doctors and insurance companies were setting up an analog of the US system: If you saw certain doctors, they would not charge you at point of delivery and there was no co-insurance requirement. It was still new and inconvenient, so I don’t know how that’s worked out.

I don’t have direct experience with the Swiss system, but from everything I’ve read, conversations, etc., it’s a slightly cheaper version of the US system. You buy leveled insurance, you have to pay some out of pocket, etc.

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

#267

Post by tape_measure »

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…

£9.15 per item [independent of its cost]

That's basically what a copay is.

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

#268

Post by whiddershins »

thatfrenchguy wrote: post #207
dcolkitt wrote: post #178

Earlier quoted context omitted.

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, whic…

Hey there. The comment you are replying to specifically addresses this.

I find reading comment threads containing comments that don’t seem to account for the literal assertions made in the previous comment tend to be difficult to follow and quickly degrade.

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

#270

Post by huitzitziltzin »

travisp wrote: post #63
emteycz wrote: post #48

Earlier quoted context omitted.

I don't believe any medical professional in Germany has wage exceeding 150k EUR yearly after taxes - doctors in the US sometimes have multiples of that, coincidentally 5x to 10x more is not unusual.

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.

>pay for US doctors makes up a fairly small portion of overall US medical expenditures (less than 10%)

That is likely too low.

The Centers for Medicare and Medicaid Services provides a National Health Expenditure estimate annually. [1]

Physician and clinical services represented $772 billion out of about $3.8 trillion, so more like 20%.

Hospital services are the other big one: about $1.2 trillion.

US physicians are paid terrifically relative to their counterparts almost anywhere else, this is especially true for specialists.

In fact, physicians represent about 15% - 16% of the top 1% of income earners in the US. See table 2 from this paper: https://web.williams.edu/Economics/wp/BakijaColeHeimJobsInco... which was written using tax return data, not, e.g., self-reported income data.

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

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