Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The cost of two weeks in an pediatric/infant ICU

kingsley.sh

Post reply on HN
Print view View original

281–290 of 294 posts

Re: The cost of two weeks in an pediatric/infant ICU

#281

Post by iammisc »

Jenk wrote: post #273
iammisc wrote: post #265

Earlier quoted context omitted.

> Yes, it goes both ways, but it goes much further one way over the other. That's fair. For gene therapy, I was referring to Zolgensma, which was delayed substantially in Europe and forced many to seek treatment in America. The delay was mainly due to cost savings, and the delay was clinically meaningful (since treatment is time sensitive).

https://www.england.nhs.uk/2021/03/nhs-england-strikes-deal-... That's available too.

I acknowledged this:

> delayed substantially in Europe

In the meantime, between when FDA approved v NHS, children became debilitated.

Re: The cost of two weeks in an pediatric/infant ICU

#282

Post by aksss »

dexterdog wrote: post #115
swashboon wrote: post #77

Earlier quoted context omitted.

availability, coverage, cost

Um, not cost.

People on individual market with no subsidies (making over, say $50k) got absolutely raped by the ACA. It's great that many uninsured got insurance, but many people like myself spent years uninsured post-ACA because the cost was higher than a mortgage payment with absolutely zero realized benefit until the massively high deductible was met. People who couldn't afford this were then charged thousands by the IRS as a penalty with zero benefit. I find myself not a fan of it from a policy perspective. Didn't like the way it was passed, written, or implemented. Some good effects, but truly bad effects as well. Scrapping the mandate was beneficial for people in my position (starting businesses), but still the healthcare system in the US is a train wreck. It's neither a free market system nor a public system. It is fundamentally broken unless you are an employee of a larger corporation that offers benefits.

Re: The cost of two weeks in an pediatric/infant ICU

#283

Post by CountDrewku »

runjake wrote: post #161
CountDrewku wrote: post #127

Earlier quoted context omitted.

Everything was not free, you just didn't pay directly for it while you were at the hospital. I don't understand why the word free always gets thrown around for country's with socialized medicine. You are paying for it.

You don’t need to explain this. Everyone knows how “socialized medicine” works. What they are saying is that it was zero out-of-pocket as opposed to a quarter of a million dollar bill.

Cool well since we're going with that logic I'll just go ahead and say my insurance provide through work is free.

Re: The cost of two weeks in an pediatric/infant ICU

#284

Post by CountDrewku »

Cthulhu_ wrote: post #170
CountDrewku wrote: post #127

Earlier quoted context omitted.

Everything was not free, you just didn't pay directly for it while you were at the hospital. I don't understand why the word free always gets thrown around for country's with socialized medicine. You are paying for it.

True, but that said, rates in US hospitals are massively over-inflated. They get away with it, insurance companies are not pressuring enough to lower cost (they're probably in on it), and there is no real competition.

I don't disagree I just dislike the dishonesty being presented. The word free is used to make it seem much more palatable to put in universal healthcare and they know it. The reality is there are downsides to having universal healthcare.

Re: The cost of two weeks in an pediatric/infant ICU

#285

Post by CountDrewku »

eatplayrove wrote: post #177
CountDrewku wrote: post #127

Earlier quoted context omitted.

Everything was not free, you just didn't pay directly for it while you were at the hospital. I don't understand why the word free always gets thrown around for country's with socialized medicine. You are paying for it.

In addition to the other replies to you: almost nobody pays $960k in taxes, but they still get this benefit.

Almost no one pays 960k in hospital bills either. That's an insurance negotiating price not what the patient sees.

Re: The cost of two weeks in an pediatric/infant ICU

#286

Post by CountDrewku »

xtracto wrote: post #205
CountDrewku wrote: post #127

Earlier quoted context omitted.

Everything was not free, you just didn't pay directly for it while you were at the hospital. I don't understand why the word free always gets thrown around for country's with socialized medicine. You are paying for it.

This American fixation with the word "free" always makes me chuckle. Aa when a bus driver in Las Vegas got angry when I asked them if thag was the "free" bus, and he angrily replied "it's not free, its complimentary " .

Ok then I assume that using the word free for the insurance I receive from my job is just fine?

Re: The cost of two weeks in an pediatric/infant ICU

#287

Post by caeril »

skeletal88 wrote: post #109
jzwinck wrote: post #3

A quarter million US dollars. Of course the hospital never expects to receive this amount of money. Either they will negotiate it down for uninsured patients, or they will accept a lesser amount from the insurance company. Insurance companies like this over representation of costs because: 1. If you have a percentage copay (edit: "coinsurance"), say 10%, they will tell you to pay $25k because it's 10%, but they might…

The obligatory comment about how crazy this is on many levels. 1. You are being charged prices that you are not expected to pay, but need to negotiate on 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying. In normal countries there is A price list, which is THE price list for all hospitals that are part of the national health care system. If they want to have a…

It's worse than this, though.

You pay whether the doctor killed you or not. Roughly a quarter million Americans are murdered annually by preventable medical errors, and nobody cares. Furthermore, your estate gets full billing after they kill you.

Connecting billing to outcomes would go a long way to fixing this disaster of a system. It would help align incentives for these sociopathic quacks to stop murdering their patients en masse.

You pay: $reasonable_amount if your oncologist gets your cancer into remission, but you pay precisely $0 if the attending physician didn't bother reading your chart because they had to tee off at 3pm and then grab dinner at Fleming's with their mistress, so you got the wrong medication/procedure and you're confined to a wheelchair for life, or dead.

I can't think of any other profession, other than attorneys, where outcomes aren't intimately tied with compensation. Doctors and nurses, as modernity's new Gods, need to be brought down a few pegs with regard to this extravagant privilege.

... to say nothing of the fact that they are worse diagnosticians than a buggy Expert System written in Perl by a drunk college student in 1994, but because they are human, we should rely on them to make life or death decisions. But that's a discussion for another day.

Re: The cost of two weeks in an pediatric/infant ICU

#288

Post by banana_giraffe »

skeletal88 wrote: post #109
jzwinck wrote: post #3

A quarter million US dollars. Of course the hospital never expects to receive this amount of money. Either they will negotiate it down for uninsured patients, or they will accept a lesser amount from the insurance company. Insurance companies like this over representation of costs because: 1. If you have a percentage copay (edit: "coinsurance"), say 10%, they will tell you to pay $25k because it's 10%, but they might…

The obligatory comment about how crazy this is on many levels. 1. You are being charged prices that you are not expected to pay, but need to negotiate on 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying. In normal countries there is A price list, which is THE price list for all hospitals that are part of the national health care system. If they want to have a…

> 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying.

Even when it's not an emergency, it's an amazing bucket of crap.

I take a specialized drug that's very expensive (~85k$/yr). I was considering changing jobs. No one in the HR of the new company, or the CSR side of the new insurer would tell me with any certainty that it'd be covered. The best I could get out of anyone is "we think it's covered, but we cannot promise it will be, nor will we pay out of pocket if it isn't". My doctor's office would just say "most of our patients on insurance can get coverage. Not all, but most"

The bit about not covering it out of pocket might be a statement on how much they wanted me, but the first part is just maddening. It's a large part of the reason I didn't switch jobs. At least I know I can get insurance to cover the drug for now.

Re: The cost of two weeks in an pediatric/infant ICU

#289

Post by gwbas1c »

giantg2 wrote: post #211
Cthulhu_ wrote: post #175

Earlier quoted context omitted.

I'm sure they play tons of games so it's not considered an error. That said, the government needs to step in and set prices for health care. The free market has failed, in this case. Nobody can afford to shop around for a cheaper health care provider in an emergency, and even then there's no real competition.

"That said, the government needs to step in and set prices for health care." I don't see this working without other substantial changes. They do this with Medicaid and Medicare already. The reimbursement rate is pretty low and the actual costs of some services actually exceed the payment. Without fully going to a government run system, I don't think setting standard prices will work well due to the quality and cost d…

Plenty of countries have affordable healthcare. I don't think we need to reinvent the wheel, (in the US,) when we can look at how other countries run their healthcare systems and see what works and what doesn't.

The economics of treating rare diseases and is very different than handling a broken leg or a heart attack. Unfortunately, when we talk about healthcare we tend to lump both problems into the same boat, when paying for rare conditions versus common conditions are two very different things with very different solutions.

If you've read this far, you probably realize that I'm beating around the bush, but if you understand how technology development starts with an expensive iPad, and then a decade later there are cheap generic tablets, I think you can understand the gist of what I'm saying.

Re: The cost of two weeks in an pediatric/infant ICU

#290

Post by ceejayoz »

refurb wrote: post #233
_huayra_ wrote: post #2

I don't understand how people can be so anti-universal healthcare in the US. When you have an $8k deductible, your insurance is basically a gift to the CEO's yacht fund.

The reason universal wouldn’t work is cost is an issue. You can’t just say, sure, we’ll pay for everything. Recipe for exploding healthcare costs. So how to reign costs in? Cut physician salaries? Not likely. Limit procedures? Maybe. Stop paying for the latest cancer drugs the day the FDA approves them? Probably. Not exactly easy to accomplish.

You know universal coverage exists, right? Europe, Japan, Australia, New Zealand... you can't claim it's impossible to structure when there are dozens of functional examples out there.

"Universal coverage" is not "we pay for everything without question or approval process". In both systems, there are people who decide what's covered, and for whom. As for "exploding costs", the US is more expensive - in both public and private spending - than the "universal coverage" spots. https://data.oecd.org/healthres/health-spending.htm

Post reply on HN