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

#271

Post by eightysixfour » Mon, Jan 18, 2021, 7:12 PM UTC

huitzitziltzin wrote: post #236

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…

This is not that plausible as an analysis of the role of chargemasters. I agree that the chargemaster prices are fake, but what you are proposing is: Hospital: "Our insurance partners pay us a fraction x of Chargemaster charge X, so let's make C larger ." The insurer understands the game being played here, just like you do. It's not like the insurer doesn't also realize just like you do that the chargemaster price is…

My understanding is the insurance companies are incented for C to increase as well - under the ACA insurance companies can only have a certain profit margin, so the only way to increase profit is to increase revenue and payouts.

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

#272

Post by aksss » Mon, Jan 18, 2021, 7:13 PM UTC

lotsofpulp wrote: post #238

sib wrote: post #185

Earlier quoted context omitted.

Why? (Seriously - you seem to be assuming the answer here.) Would the same statement be true for food and shelter (also necessary for life)? Should the government be the provider for all food and shelter in order to avoid additional steps?

Because a person is capable of determining good produce from bad produce and make informed decisions when purchasing groceries. The same is not true for healthcare. Even when purchasing shelter, people are not sufficiently informed to be able to make a good decision, hence the existence of electrical, plumbing, and structural codes and inspections. With healthcare, people are extremely uninformed. The costs are extre…

This is a bit chicken-and-egg. People are uninformed about cost and quality of healthcare because the third-party payer system obscures detail (often intentionally).

Spend some time uninsured and you become a very discerning consumer.

Further, for every service that requires healthcare advocacy (often provided by family members, btw, not professionals even in existing system) there are probably >five that are commodity services (labs, prescriptions, diagnosis, imaging, etc.)

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

#273

Post by batrat » Mon, Jan 18, 2021, 7:13 PM UTC

11thEarlOfMar wrote: post #85

Even I am surprised: Appendectomy: MSDRG 343: at Kaiser in Santa Clara: $56,000 Appendectomy: MSDRG 343: at Holston Valley Medical Center, TN: $4,700 Our healthcare system is even more broken than I ever imagined.

What the ..... My wife paid non evasive extraction of appendix 600 euros in a private hospital (and was an emergency) in East EU and is considered luxury by some. It's free in public hospitals.

You guys are swimming in cash.

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

#274

Post by whiddershins » Mon, Jan 18, 2021, 7:13 PM UTC

Daniel_sk wrote: post #230

leetcrew wrote: post #205

Earlier quoted context omitted.

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 h…

That's a very American way of thinking. I am totally fine that I contribute with a bigger part and it's used for people that would not be able to afford it.

I don’t know if you realize this, but when you write it this way it seems that you are implying an ‘American way of thinking’ is a morally inferior one.

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

#275

Post by huitzitziltzin » Mon, Jan 18, 2021, 7:13 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…

The Health Care Cost Institute has something like what you want - see Figure 2 about halfway down this page:

https://healthcostinstitute.org/hcci-research/international-...

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

#276

Post by nabilhat » Mon, Jan 18, 2021, 7:14 PM UTC

mancerayder wrote: post #163

bhupy wrote: post #94

Earlier quoted context omitted.

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.

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…

Given that inpatient + outpatient = 100% of the category, I have to agree. Lumping the cost of "Medical Care" into a single metric in a breakdown of spending on, well, medical care, doesn't offer much insight. Showing exactly the same data in 4 different graphing methods doesn't add anything but clutter. The lack of effort honestly makes me question this organization's mission.

I think the most useful bit is the reference to the OECD data source. For those not already aware, OECD has far more detailed data available to browse [0], and heaps of more informative and competent presentations [1].

[0] https://stats.oecd.org/

[1] http://www.oecd.org/health/health-expenditure.htm

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

#277

Post by peytn » Mon, Jan 18, 2021, 7:15 PM UTC

4ec0755f5522 wrote: post #265

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 > o…

That sounds extreme. Without taking sides, I suggest another possibility is that the author may have a bias, agenda, or angle to the story.

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

#278

Post by xyzelement » Mon, Jan 18, 2021, 7:20 PM UTC

4ec0755f5522 wrote: post #265

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 > o…

// 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.

This is not how freedom works. Your argument is akin to saying "freedom from hearing uncomfortable opinions" benefits more people than "freedom of expression" does.

On the broader level, I got to experience healthcare in the US both as a broke-ass immigrant child and as a working adult. It ranged from good to amazing in terms of availability of appointments, treatments, quality and comfort. Night and day beyond what I experienced in the USSR as a kid. So while people are shitting on the system we have, many people find it excellent and amazing and we like the freedom to continue enjoying it.

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

#279

Post by whiddershins » Mon, Jan 18, 2021, 7:21 PM UTC

aaronblohowiak wrote: post #116

bhupy wrote: post #94

Earlier quoted context omitted.

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.

>raw cost of inpatient and outpatient care I am interested to understand what makes the "raw" costs so wildly different. When my son had an infection in germany, we went to the equivalent of pediatric urgent care and after seeing the nurse, having bloodwork done and a few different 15 minute sessions with the physician we came to the end of the visit with the doctor, they apologized that we had to be charged the full…

If you think about it, you just weren’t actually charged for what you used.

If what you did were reflective of the doctor’s hourly rate, that doctor would be making around $150,000 usd/year.

And that’s ignoring the costs of every other aspect of the overhead.

The cost is being born some other way.

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

#280

Post by peytn » Mon, Jan 18, 2021, 7:21 PM UTC

JohnCohorn wrote: post #259

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 wonder how much truth there is in the theory that insurers are incentivized to let costs go way up and may be complicit in it. Basically the theory I’ve heard is that Obamacare limited by law the percentage margin that insurers can make as their piece of the pie. So then one of the only easy ways left for them to grow their profits in an absolute sense is to increase the amount of money flowing through the system.

The other factor is that hospitals have wised up over the years and started merging, which turns them into local monopolies and makes insurance companies price-takers.