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

#321

Post by 5cents » Mon, Jan 18, 2021, 8:58 PM UTC

xyzelement wrote: post #308

Falling3 wrote: post #303

Earlier quoted context omitted.

> However I recall the night my son was born - the facilities, staff and resources of the hospital were unmatched - the mother and baby would not have the same experience anywhere else in the world. We had a wonderful experience with the birth of our daughter, but I have no idea how I could claim it was better than anywhere in the world. I'm asking because you seem to be making a low-hyperbole claim here: what is you…

// but I have no idea how I could claim it was better than anywhere in the world. I'm asking because you seem to be making a low-hyperbole claim here: what is your basis for saying that? Conversations with friends and family abroad. // Particularly, when the US has some of the worst metrics for infant mortality, birth weights, and mother mortality rates in the developed world. Not an expert but I understand there's a…

All countries do their best, and Sweden seems to be the most successful country at the moment [0]. Neonatal mortality rate in Sweden was 1.38 per thousand in 2019, compared to 1.4 in Norwy, 2.77 in the UK and 3.7 in the US [1]. But you are right that the rate of premature births is higher in the US than most European countries (10-15% in the Us compared to The rate of still birth in 2009 in the US was 2.95/1000 compared to 2.74 in Sweden and 2.2 in Norwy [4]

That the statistics of neonatal deaths are manipulated is also a bold claim, it deserves some references?

[0] https://news.ki.se/sweden-leads-the-world-in-saving-extremel...

[1] https://www.who.int/data/gho/data/indicators/indicator-detai...

[2] https://www.reddbarna.no/born-too-soon-the-global-action-rep...

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346062/

[4] http://chartsbin.com/view/1445

Edit: spelling

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

#322

Post by stjohnswarts » Mon, Jan 18, 2021, 8:58 PM UTC

xyzelement wrote: post #278

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 w…

You're being single minded here. You should compare it to what is available in Europe, Cuba, Canada, etc not what's going on in Russia. We want everyone to have good health care, not just people in silicon valley and the tech industry who by and large to get good insurance.

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

#323

Post by stjohnswarts » Mon, Jan 18, 2021, 9:01 PM UTC

xyzelement wrote: post #310

CoolGuySteve wrote: post #306

Earlier quoted context omitted.

That may be true but the USSR is a collapsed state, we should be comparing wealthy countries. According to this the US is mostly in the high top 10 for outcomes in cancer and cardiovascular disease treatment outcomes: https://en.wikipedia.org/wiki/List_of_countries_by_quality_o... But the US spends more than double the OECD average per capita to achieve those marginal gains: https://upload.wikimedia.org/wikipedia/com…

I didn't make this clear - I agree with you about the USSR, but the point I meant to make is that on metrics like cost and availability of care, it would look "better" than the US.

No one who is legit just compares cost and availability they are going to also include the health levels of the nation, time to actually getting an appointment, time to get a surgery for a condition, etc. You can't just pick out two variables and say "see I'm right!" . There are a ton of European health markets that are superior to the US market when comparing multiple variables. We need to copy them or do something very similar rather than being stubborn assholes and think everything has to be home grown.

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

#324

Post by dghlsakjg » Mon, Jan 18, 2021, 9:04 PM UTC

xyzelement wrote: post #294

bcrosby95 wrote: post #291

Earlier quoted context omitted.

My experience as a child was great. As a working adult I spend hours fighting with insurance, hospitals, and doctors to get my bills properly covered. It feels like a bunch of wolves arguing over whose gonna eat the sheep (me). For this privilege I get to pay insurance a minor fee of 3k/month for my family of 5.

There definitely had been a few snags with insurance that we had to work through - not claiming it's perfect. However I recall the night my son was born - the facilities, staff and resources of the hospital were unmatched - the mother and baby would not have the same experience anywhere else in the world. My wife works in the ER - they constantly use procedures and deploy resources in ways that would be considered im…

There is a huge Caviat in your scenario. A lot of people won't come in because they can't afford it, or they won't get the test because they can't afford it. Your wife can order the imaging test, but she doesn't have to deal with the debt, and/or months of arguing on the phone with administrators that her patient sees.

I live in Canada where I am enrolled in the provincial health plan. If a doctor recommends a test or treatment I get it. Cost isn't a consideration. My age isn't a consideration. Please don't spread lies about how universal healthcare works. Unlike insurance in the US, if the doctor orders it, it is covered by the healthcare system here.

Truth: I may have to wait based on a triage system.

If the doctor doesn't recommend a test as necessary or I don't want to wait for my place in line, I can go to a medical clinic that offers these tests privately and pay/have my employer provided secondary coverage pay.

In that way it turns out that we don't have to make the tradeoff.

I've had the best insurance I could buy in the US, and now I have the standard health care that every person in my Canadian province gets. My experience, which is backed up by studies, is that I am healthier, and the population in general is healthier under the Canadian system.

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

#325

Post by technics256 » Mon, Jan 18, 2021, 9:05 PM UTC

egillie wrote: post #315

technics256 wrote: post #311

Earlier quoted context omitted.

Are you scraping this or just visiting each site manually and getting the machine readable data? Cool stuff!!

California collected all of their hospitals' data at https://oshpd.ca.gov/data-and-reports/cost-transparency/hosp... The average prices for common procedures is on the 1045 sheet I have my gripes with California but I love that they did this

Woah, I'm a CA resident and also surprised and happy. Are you seeing a lot of non-compliance?

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

#326

Post by TheOsiris » Mon, Jan 18, 2021, 9:05 PM UTC

spaetzleesser wrote: post #313

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…

Employer based health insurance should be abolished. There should be one risk pool either nation or state wide and within that everybody can get insurance for the same price. It would reduce a lot of administrative effort in companies (why does my employer have to worry about my health insurance but not my car insurance?) and allow people to change jobs without worrying about health care. Religious employers also cou…

it should be, and it needs to be if we ever want to fix this problem, but it'll be political suicide for anyone that even says this out loud. corporations would be all for it to.

(majority of) people with jobs have no idea how bad/expensive healthcare really is. they have excellent insurance coverage and they pay very little for it. if we make them responsible for buying their own it'll be impossibly expensive. but this is exactly what they need to realize so that we can have the political movement to overhaul the entire system

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

#327

Post by dghlsakjg » Mon, Jan 18, 2021, 9:11 PM UTC

Trill-I-Am wrote: post #282

xyzelement wrote: post #278

Earlier quoted context omitted.

// 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 w…

Would the general public of other developed nations be happier if their healthcare systems were more like the US's?

I've lived in the US, and now live in Canada.

Despite right-wing propaganda that we're all flocking to the states for care (never met a single person who has even considered that), or that we're all dying on years long wait lists (there is an element of truth to that, but it's a triage system. So cancer patients get priority for surgery before the skier who blew his ACL).

I still have yet to meet a single person who doesn't think the US system is batshit crazy.

Canadians recognize that their system has problems, and can be improved (which is true of ANY complex system). But they also don't think that the US system is functional or desirable.

I know that the nearest border crossing to me regularly has ambulances waiting for people that preferred to travel sick or injured than seek healthcare in the US. In other words, people literally flee the country to avoid being treated in the US.

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

#328

Post by y-c-o-m-b » Mon, Jan 18, 2021, 9:23 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…

My first question to a potential new employer has become "what are your health insurance benefits and how much do you cover?" rather than "what's the salary range you're hiring for?" (although this still comes second). If it's anything less than 80% employer-paid coverage or they don't offer traditional PPO plans, it's an automatic withdrawal of my application.

I've recently found I now need to add another filter to this: "WHO is your insurance through?" because apparently even 90% employer paid health insurance through UnitedHealthcare still sucks compared to inferior coverage through BlueCross or Aetna. I had to switch primary care doctors for everyone in my family (me, wife, kids all had different docs) because none of them were in network with United. Confused by this, I called around. I found out doctors offices loathe dealing with UHC due to UHC's reluctance to pay or the generally obnoxious claims process. Their "in-network" providers is contained to a much smaller list of providers that put up with their bullshit. I'm seriously considering leaving my current employer (which I'm very happy with) for this reason alone.

Lack of reliable (or any) health insurance is the #1 reason I don't take contract jobs even though they're more attractive to me.

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

#329

Post by ketanmaheshwari » Mon, Jan 18, 2021, 10:12 PM UTC

originalvichy wrote: post #176

ketanmaheshwari wrote: post #159

Looking at some of the prices, I can't help but think how great an incentive it is to be healthy in the US. "Health is wealth" if it applies anywhere it is in the US. I have taken extra measures to ensure that myself and my family are healthy in the last year and with a tax-free HSA account that is invested into ETFs, I am literally printing dollars just by following basic principles of being healthy.

Health privilege becomes a thing when access to healthcare becomes a barrier. I know the word ”privilege” is quite radioactive. I was sick often as a kid and after finding a diagnosis I’ve been performing well among my age peers. Thank you Finnish healthcare. Couldn’t imagine how much it sets you back cognitively to have health issues as well as financial issues burdening your mind 24/7. Completely avoidable pain and…

Agreed. I was just looking at the positive aspect of it.

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

#330

Post by vinay427 » Mon, Jan 18, 2021, 10:15 PM UTC

coredog64 wrote: post #266

smachiz wrote: post #65

Earlier quoted context omitted.

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…

> 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.

I moved from the US to Switzerland so maybe I can offer some anecdotes here. You're basically right in that it's a slightly cheaper version of the US system. However, some things that I didn't have to pay for in the US such as calling am ambulance without riding in it or seasonal flu shots do cost money here ($500+ for an ambulance to show up in the middle of a large city...), but I think these small lapses are overshadowed by expensive inpatient treatment being essentially completely covered minus some reasonable deductibles as well as outpatient treatment that is usually partially covered depending on the insurance plan.

The positives compared to the US largely revolve around necessary and typically expensive treatment being far more likely to be covered under insurance with relatively low copays and deductibles. The downsides in common with the US are the administrative hassles of dealing with an insurance company and its own billing middlemen (e.g. a COVID test was improperly billed to me which needed to be sorted out), the large monthly premiums for most people (~$250 is typical except for those who qualify for subsidies), and the lack of clarity over what and how much of anything is covered even when the billing is done correctly.

Do I call an ambulance? Do I go in to see a doctor? Will I end up with a massive charge? I'd prefer a single-payer or completely comprehensive system for this last point alone.