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

#361

Post by avrionov » Tue, Jan 19, 2021, 1:12 AM UTC

11thEarlOfMar wrote: post #204

ogre_codes wrote: post #171

Earlier quoted context omitted.

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 h…

'Most Favored Nation' drug pricing is currently blocked in court. We don't know how this will play, if it works.

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

#362

Post by bhupy » Tue, Jan 19, 2021, 1:14 AM UTC

pvaldes wrote: post #335

bhupy wrote: post #153

Earlier quoted context omitted.

> I am interested to understand what makes the "raw" costs so wildly different. There are a number of reasons. One big one is simply that doctors in the US command a much higher salary than their counterparts elsewhere in the world: https://economix.blogs.nytimes.com/2009/07/15/how-much-do-do... https://www.politico.com/agenda/story/2017/10/25/doctors-sal... Another big reason is that the US is unique in that it's on…

> doctors in the US command a much higher salary than their counterparts elsewhere in the world Yes, but salaries are also linked to huge debts to pay in their first years, a permanent state of fear to be sued by negligence (losing their license and seeing their only possibility of income vanished). It seems that suicide and depression are too common among young students. They also work too many hours in irregular sc…

Now you're starting to follow the thread to the root cause: onerous medical licensure and onerous medical university accreditation.

In the US, the barrier to become a doctor is higher than it is anywhere else. Nowhere else in the developed world are you forced to do 4 years of undergraduate study unrelated to medicine, followed by 4 years of Medical school, followed by 4 years of residency.

Also, one doesn't require huge debts to pursue a PA or NP degree, but many States disallow PAs and NPs from practicing basic medicine.

Not everyone needs to go through the same level of schooling as a brain surgeon.

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

#363

Post by pvaldes » Tue, Jan 19, 2021, 1:28 AM UTC

sib wrote: post #185

rtx wrote: post #101

Earlier quoted context omitted.

Why add additional steps, government should open hospitals and provide healthcare directly.

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?

Maybe. That would have economical benefits also by lowering crimes related with lack of food or shelter (therefore releasing money to spend in other things and contributing to social peace). The plan would deserve a closer look.

The difference between an apple being stolen by a homeless and an apple being given to a homeless, is that you don't need to pay for fixing the broken window.

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

#364

Post by ahepp » Tue, Jan 19, 2021, 1:38 AM UTC

kube-system wrote: post #353

jackson1442 wrote: post #339

Earlier quoted context omitted.

I don't think you can really say that the US has "access" to a drug when it costs $22,000/month, which, given the median household income of $68,700/yr, is nearly 4x more than the average American makes in a month.

Many Americans who use expensive specialty drugs have prescription drug coverage and don’t pay the entire price of the drug. And/or they get a discount through manufacturers programs. That said, my insurance does not cover the above drug.

So practically speaking, many Americans have to wait even longer than those in the UK? Even if they have insurance? And perhaps even a well paying job with good benefits (an assumption of mine based on the setting).

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

#365

Post by lotsofpulp » Tue, Jan 19, 2021, 1:39 AM UTC

aksss wrote: post #359

lotsofpulp wrote: post #343

Earlier quoted context omitted.

My proposal could be done immediately. All the infrastructure already exists. Remove the tax deduction for employers, give it to individuals on healthcare.gov, job done. Or ban employer sponsored health insurance and don’t offer anyone a tax deduction. Either way, it’s all just a matter of changing regulation. The real problem is big business will lobby against it because it gives them an advantage over small busines…

> immediately Theoretically only, perhaps. I feel like you're overestimating the ability of our regulatory bureaucracy to implement change, or assuming that if you (or I) were dictator the proposal could be done immediately. But imagine flushing out that proposal nationally, getting it through the Legislature (with all the conflicting interests of the medical field, employers, etc), President and then implementation.…

Getting it through legislation is the only problem is what I mean. People can already purchase insurance on healthcare.gov. The infrastructure, the sellers, the pricing is all ready to go with no work. The insurance companies already do the same work so it’s not even like they need to hire people. It’s just cutting out a middleman.

Only politics is in the way, and current entrenched interests not wanting to lose their advantages.

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

#366

Post by ahepp » Tue, Jan 19, 2021, 1:44 AM UTC

treeman79 wrote: post #137

Walked into a clinic for a weekly shot. Paid 60 dollar co-pay each week. One day I asked how much go get shot without insurance. It was $15. I was paying 4x to use insurance. And insurance was getting billed on top of that.

My understanding is that the insurance does not actually pay the price they tell you in your explanation of benefits.

So if it's any comfort, I'd guess your insurance wasn't getting billed on top of that. They probably paid $15 and pocketed your copay.

Some might call this "keeping two sets of books", but apparently it's par for the course here in the glorious USA.

Up until recently [0], it was common for insurers to have rules preventing health care providers from telling you when it was cheaper to pay cash.

[0] https://www.aarp.org/health/drugs-supplements/info-2018/gag-...

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

#367

Post by mobilefriendly » Tue, Jan 19, 2021, 1:52 AM UTC

pkaye wrote: post #210

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 w…

To some degree, the EU (and Canada's similar practice) forces US consumers to underwrite the cost of R & D that creates many of these drugs in the first place.

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

#368

Post by three_seagrass » Tue, Jan 19, 2021, 1:53 AM UTC

treeman79 wrote: post #137

Walked into a clinic for a weekly shot. Paid 60 dollar co-pay each week. One day I asked how much go get shot without insurance. It was $15. I was paying 4x to use insurance. And insurance was getting billed on top of that.

If it's any consolation, the insured patient payments are subsidizing the non-insured cash cost.

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

#369

Post by zdragnar » Tue, Jan 19, 2021, 1:56 AM UTC

ahepp wrote: post #364

kube-system wrote: post #353

Earlier quoted context omitted.

Many Americans who use expensive specialty drugs have prescription drug coverage and don’t pay the entire price of the drug. And/or they get a discount through manufacturers programs. That said, my insurance does not cover the above drug.

So practically speaking, many Americans have to wait even longer than those in the UK? Even if they have insurance? And perhaps even a well paying job with good benefits (an assumption of mine based on the setting).

I don't know about that particular drug, but I was on a super spendy drug- the manufacturer had a program that would cover the difference down to $5 / month or $25 if your insurance didn't cover it or you don't have any.

My insurance wouldn't cover it until I tried cheaper alternatives first, but I didn't want to try those given their fair more serious side effect / risk profile. Because of the manufacturer program, I was still able to get it for $25. I dont know if that would be possible in the UK if the programs arent offered there.

Also, no waiting period other than the medicine had to be shipped from a specialty pharmacy that could deal with the temperature storage and handling requirements. There is a bit of a wait to see a specialist to actually prescribe it, but that varies by geographic region and specialty.

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

#370

Post by react_burger38 » Tue, Jan 19, 2021, 1:58 AM UTC

lotsofpulp wrote: post #195

analog31 wrote: post #187

Earlier quoted context omitted.

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.

Increasing supply of doctors by increasing residency funding, decreasing education costs, and decreasing the sacrifice that needs to be made to become a registered doctor. I have no idea why doctors need to sacrifice their entire 22 to 30 year old lives constantly slaving away, working on call, sometimes 24 hours at a time. Relax some of the draconian, outdated hazing rules. Attract more smart people, make it so youn…

100% with you on the idea of increasing the supply of doctors and shortening medical education.

My dad is an ophthalmologist and he does basically 3 surgeries that take up most of his work time: LASIK, cataract surgery, and cornea transplants.

Was it really necessary for him to do 13 years of schooling to learn how to do those 3 surgeries? I really don’t think so. I feel like we could train doctors in about 6 years (2 years of focused medical training + 4 years of residency / apprenticeship with a practicing doctor). If we’re honest about what doctors are learning, they would have about the same amount of time learning about their actual specialty compared to now, without so many hoops to jump through.

The current system is a cartel that must be reformed.

We also should consider international competition. There are competent doctors in India who could do expensive surgeries like hip replacements for 1/10 the cost AND get better results than the average hospital in the US.

At least we could sell health insurance across state lines...