I analyzed hospital price lists so you didn't have to • Hacker News Board

Re: I analyzed hospital price lists so you didn't have to

#371

Post by throwaway0a5e » Thu, Jul 07, 2022, 7:40 PM UTC

ClumsyPilot wrote: post #369

throwaway0a5e wrote: post #317

Earlier quoted context omitted.

>But in reality, good regulation is good, and bad regulation is bad. No one brick in the road to hell is bad. But you can definitely pave a road to hell with the accumulation of "positive" changes. People tend to define positive over too short a timeline or too narrowly.

No one square meter of nature is bad. But you can definitely doom people to horribly die because there is a natural swamp between them and the hospital. People tend to define 'natural' too narrowly, forgetting that 'things that are natural' includes cocaine, tapeworms, rape, birth defects, the Plague and cancer

Are you implying that individual regulations all have some inherent goodness on their own?

They're just rules we make for ourselves. There's nothing special about them. Opinions like that are why we can't fix messes like this.

Re: I analyzed hospital price lists so you didn't have to

#372

Post by ClumsyPilot » Thu, Jul 07, 2022, 7:42 PM UTC

loonster wrote: post #277

GoOnThenDoTell wrote: post #193

Earlier quoted context omitted.

Effective regulation is somewhat of an organisational skill. Perhaps its just low pay attracting low talent

No. It's the high profit attracting high incentive to capture the regulation. The goal of the regulation is to increase prices (profit) while preventing other parties from competing on prices

I am always amazed by these "no-regulation" arguers - how are you doing to resolve disputes?

Suppose I want to sell my product, and find a company willing to buy, a middle manager signs the contract. When the company recieved my product, it refuses to pay, says this person was not authorised to sign the contract on behalf of the company.

Must the company prove the purchase was unauthorised, or must I prove the employee was authorised? Suppose employee was unauthorised, is it my or the company's problem if this guy 'took initiative', who eats the loss?

What if they already used my product and only realised after the bill came due? What if the deal was overpriced like 10x from market average? What if the guy's title says 'Head of procurement' but the company swears their bylaws don't allow him to authorise purchases?

Re: I analyzed hospital price lists so you didn't have to

#373

Post by wefarrell » Thu, Jul 07, 2022, 8:25 PM UTC

coredog64 wrote: post #309

wefarrell wrote: post #295

Earlier quoted context omitted.

"There are some bad actors, absolutely true. However 'Hanlons Razor' -- never attribute to malice that which is adequately explained by stupidity -- definitely applies." In healthcare especially incompetence opens the door for bad actors to exploit weaknesses in the system which amount to huge amounts of money being wasted. Medical fraud, for example, is one of the most sophisticated organized criminal activities in…

$1000/month insulin is not 100 years old. Your comment is like complaining that because penicillin was isolated in 1928, nobody should have a patent on any antibiotic. Humalog insulin was patented in the 90s, and IIRC, is what Walmart sells for $25/vial. Novo Nordisk (among others) continually improves the product. Those improved products are where you see the $1k/month prices.

From the Mayo Clinic:

The 3 main reasons cited by pharmaceutical companies for the high cost of new prescription drugs do not apply to insulin. First, the “high cost of development” is not relevant for a drug that is more than 100 years old; even the latest and most commonly used analog insulin products are all over 20 years old.8 Second, the pricing is not the product of a free market economy. Free market forces are clearly not operational; there is limited competition on price, the person who needs the product is not in a position to negotiate the price, and there is no relationship of price increases over time compared with overall market inflation. The price of insulin has risen inexplicably over the past 20 years at a rate far higher than the rate of inflation.9 One vial of Humalog (insulin lispro), which used to cost $21 in 1999, costs $332 in 2019, reflecting a price increase of more than 1000%.10, 11, 12 In contrast, insulin prices in other developed countries, including neighboring Canada, have stayed the same. Insulin pricing in the United States is the consequence of the exact opposite of a free market: extended monopoly on a lifesaving product in which prices can be increased at will, taking advantage of regulatory and legal restrictions on market entry and importation. Third, the arguments that high costs are needed for continued innovation and that attempts to lower or regulate the prices will hamper innovation are not a valid excuse.13 There is limited innovation when it comes to insulin; the more pressing need is affordability.

https://www.mayoclinicproceedings.org/article/S0025-6196(19)...

Re: I analyzed hospital price lists so you didn't have to

#374

Post by sl-dolt » Thu, Jul 07, 2022, 9:05 PM UTC

pc86 wrote: post #356

sl-dolt wrote: post #164

I'm as surprised as anyone to see this #1 on HN. Glad y'all like it. AMA. Feedback, criticism, comments, directions to go, whatever.

Might be a dumb question, but if I joint hospitals and prices, and filter to the couple nearby hospitals that I care about, and I get 0 rows, that means they're violating the transparency law, correct?

It's not quite that simple. Remember that this database was built collaboratively, and it's possible that our bounty hunters just didn't get to that hospital. We have fairly good coverage, but it's impossible to say if 1) they didn't find the chargemaster, but it exists or 2) they didn't look for it.

We'll probably run another price bounty in the future to capture the rest of the chargemasters.

Re: I analyzed hospital price lists so you didn't have to

#375

Post by cyanydeez » Thu, Jul 07, 2022, 10:15 PM UTC

bitcharmer wrote: post #208

cyanydeez wrote: post #45

Earlier quoted context omitted.

Or don't be racist and rebuild the social safety net Americans desocialized because of equal rights.

What does racism has to do with broken medical health care system in the US?

Privatization since the 60s is a reaction to equal rights and "welfare queens"

Re: I analyzed hospital price lists so you didn't have to

#376

Post by Abishek_Muthian » Fri, Jul 08, 2022, 2:03 AM UTC

tunap wrote: post #331

IG_Semmelweiss wrote: post #322

Earlier quoted context omitted.

While what you are saying is all true, in general terms, but the key story seems missing: The "top of the funnel" system is very much fighting to preserve itself. - Insurance companies are in bed with hospitals to collaborate swindling money from the govt: read about kickbacks sent by the US Govt to hospitals as Disproportionate Share Hospital payments. - Hospitals have a PR arm moving profits to defend their monopol…

All valid, but you forgot another big story, for another day: "medical billing". This, in my minimally-informed opinion, is the syndicate keeping the fence running. I've had dealings with 4 owners of separate small-to-moderately sized billers and their top-brass all owned > 1 multi-million dollar homes around the world. Also, their toy boxes contained millions in cars, boats & flying machines. It must be nice, but in…

Don't forget the doctors who are part of that syndicate.

I'm a professional patient, 99.9% of the doctors I've took treatment from(not U.S.) for major ailments are businessmen masquerading as doctors and I'm not talking about some scrappy hospitals; These are world renowned hospital chains.

What happens when you optimize for profit, instead of medical science? Wrong diagnosis and prognosis; I'm a victim of one and it has ruined my life.

On the other hand, There are doctors who risk their lives every day to serve people in need e.g. Doctors without borders, Doctors who rushed to serve during pandemic(Many of them loosing their life to it) etc.

Re: I analyzed hospital price lists so you didn't have to

#377

Post by caramelcustard » Fri, Jul 08, 2022, 3:53 AM UTC

lotsofpulp wrote: post #312

caramelcustard wrote: post #66

Correct me if i'm wrong, but aren't some hospital bills/prices considered to be negotiable estimates? If so, wouldn't that skew the data? And yes, prices should be set in stone and be easily accessible, unless it's something that is hard to evaluate due to one reason or another.

Starting Jan 1, 2022, a healthcare provider has to provide an estimate and you are only liable for that estimate plus $400 in case of overage. https://www.cms.gov/nosurprises/consumers/understanding-cost...

Thanks for clarifying!

Re: I analyzed hospital price lists so you didn't have to

#378

Post by IG_Semmelweiss » Fri, Jul 08, 2022, 4:03 AM UTC

nradov wrote: post #360

IG_Semmelweiss wrote: post #335

Earlier quoted context omitted.

Medical billing is by a product of government mandates on insurance to cover everything + medicare and medicaid. Make those programs go away, and CPT codes would eventually die. It is not going to go away so unfortunately we need to learn to live life with it, and instead make it irrelevant, or niche, just like a ferrari is niche. The best way to cope is to have an alternative to CPT coding, which means, alternative…

The best way to cope is to shift provider compensation from a fee-for-service model to a value-based care model. That reduces the need to code individual procedures using CPT for billing purposes. This industry shift is already underway, but moving slowly.

hard disagree.

value based care is another iteration of "pray for alternative" to non FFS model, aka the APM.

This is the road of the HMO, the RVU, the QCCS...and i could go on and on. Its the road that we have traveled on since the late 80s. Its the road of the wanderer in the desert.

It doesn't lead anywhere but more profits for the road-builders.

40 years of history with 0 decreases in healthcare costs is all the evidence you need to put this one to bed.

Re: I analyzed hospital price lists so you didn't have to

#379

Post by someoneFromWeb » Fri, Jul 08, 2022, 8:04 AM UTC

russnewcomer wrote: post #313

someoneFromWeb wrote: post #257

Earlier quoted context omitted.

Have you ever heard about OpenEHR? https://www.openehr.org/

FWIW, pretty sure duffpkg was involved in the creation of OpenEHR, and therefore probably has heard of it.

but doesn't it solve problems he wrote about (Epic and vendor locking of data?)

Re: I analyzed hospital price lists so you didn't have to

#380

Post by robertlagrant » Fri, Jul 08, 2022, 8:21 AM UTC

IG_Semmelweiss wrote: post #335

tunap wrote: post #331

Earlier quoted context omitted.

All valid, but you forgot another big story, for another day: "medical billing". This, in my minimally-informed opinion, is the syndicate keeping the fence running. I've had dealings with 4 owners of separate small-to-moderately sized billers and their top-brass all owned > 1 multi-million dollar homes around the world. Also, their toy boxes contained millions in cars, boats & flying machines. It must be nice, but in…

Medical billing is by a product of government mandates on insurance to cover everything + medicare and medicaid. Make those programs go away, and CPT codes would eventually die. It is not going to go away so unfortunately we need to learn to live life with it, and instead make it irrelevant, or niche, just like a ferrari is niche. The best way to cope is to have an alternative to CPT coding, which means, alternative…

> Hospitals create monopolies, independent doctors break monopolies with competition.

The question might be: can we create an Uber-like business that has gives doctors the tech infrastructure to consult with patients without it feeling like a mom and pop shop?