Health insurers just published close to a trillion hospital prices • Hacker News Board

Re: Health insurers just published close to a trillion hospital prices

#171

Post by dominotw » Tue, Sep 06, 2022, 11:21 PM UTC

Barrin92 wrote: post #129

mikem170 wrote: post #90

Earlier quoted context omitted.

Across the board price controls seem to be a common to the various European health care systems. It is my understanding that upper limits are set for the cost of medicine. There is quite a bit of variety across Europe - U.K. is 100% government run, France is a public/private mix, Germany is similar to Obamacare in some ways, others are single payer, apparently some are private, also. But I've read that they all have…

beyond Europe as well. Singapore which has exceptionally low healthcare spending (5.9% of GDP) heavily controls prices and purchases down to individual equipment in hospitals.

> Singapore which has exceptionally low healthcare spending

yea because they have healthy population, its not because of some smart govt policy( if only it was that easy).

singapore obesity rate = 10%

usa obesity rate = 42 %

usa obesity healthcare spend = 90%

Re: Health insurers just published close to a trillion hospital prices

#172

Post by throw123123123 » Tue, Sep 06, 2022, 11:22 PM UTC

sl-dolt wrote: post #32

I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?

It's an entire pipeline of billing to extract the tax benefit of insurance.

The real economy has way many more prices than this one - from each store of anything in the country that negotiates from straws to bread. The difference is that these ones happen in a system that has a paper trail from the doctor, to the insurance, and this admin burden is only (apparently) worth it because the vast majority of money in healthcare goes through tax-advantaged insurance.

Cash based payment should suffice for 50~70% of healthcare expenditues and it would have more prices and not have expensive and abusive billing processes.

Re: Health insurers just published close to a trillion hospital prices

#173

Post by javajosh » Tue, Sep 06, 2022, 11:23 PM UTC

This is unacceptable. Perhaps it meets the letter of the law, but certainly not the spirit. This doesn't begin to make healthcare anything like a "free market". It's dishonest in the same way a restaurant might be forced to release a nutritional analysis of their food, and so they release a molecule-by-molecule description. Despicable.

Re: Health insurers just published close to a trillion hospital prices

#174

Post by refurb » Tue, Sep 06, 2022, 11:24 PM UTC

e_i_pi_2 wrote: post #71

duffpkg wrote: post #70

I'm author of Hacking Healthcare for O'Reilly, 20 year health system executive, blah, blah. It's very easy for people to forget the scale of the US "health system", we are talking 1/5, maybe more, of the entire US economy. If US healthcare spending were a country, it would have the third largest GDP in the world. Accidents of history and the massive federal beauracracy created the crazy monster of ICD/CPT codes that…

Do you consider the amount that the US spends per capita on healthcare relative to other countries for the same standard of care a "failure" of the healthcare industry? Or is there some other reason healthcare "just costs more" here? Also wondering what you think a solution is - single-payer for better and simpler price negotiations, or some other approach? My main concern is if we're spending 20% of GDP on something…

Google search for the McKinsey report on US healthcare spending - I think it was around 2009.

I work in the industry as well and it’s one of the few reports that actually breaks down the spending in a logical way.

They basically adjust US spending by GDP (high GDP countries spend more generally) then compare each category to the OECD average (also adjust by GDP), on a price and volume measure.

The answer is - yes, higher price are a factor, but volume is also a major factor. In hospital spending is actually in line with other countries. Drugs costs more but it doesn’t contribute that much to total spending. In terms of durables (equipment) the US spends less.

The biggest driver? Out patient procedures. Not just price, but Americans get way more out patient procedures done compared to other countries and it accounts for like half of the “excess spend” of the US compared to other countries.

Re: Health insurers just published close to a trillion hospital prices

#175

Post by ecommerceguy » Tue, Sep 06, 2022, 11:24 PM UTC

sl-dolt wrote: post #32

I'm the author. A question I have is: how did so many prices ever get negotiated in the first place? What kind of systems are in place to do this kind of micro-negotiation?

There are hundreds of regional networks across the Country. Heck how many Blue Cross Blue Shields are there?

Re: Health insurers just published close to a trillion hospital prices

#176

Post by notsrg » Tue, Sep 06, 2022, 11:26 PM UTC

bhupy wrote: post #154

ggrrhh_ta wrote: post #126

Earlier quoted context omitted.

Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance, with regulated yearly price adjustments and on top of that, publicly funded hospitals and clinics (mostly unprofitable but of high quality and offering treatments that would not be profitable for private hospitals) that issue their bills to the health insurances. And, to put the icing on the cake, there are treatment…

> Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance So does the US: https://www.healthcare.gov/glossary/minimum-essential-covera... > there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. > Switzerland's com…

TIL Blue Cross is a "non-profit"

Re: Health insurers just published close to a trillion hospital prices

#177

Post by ggrrhh_ta » Tue, Sep 06, 2022, 11:27 PM UTC

bhupy wrote: post #154

ggrrhh_ta wrote: post #126

Earlier quoted context omitted.

Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance, with regulated yearly price adjustments and on top of that, publicly funded hospitals and clinics (mostly unprofitable but of high quality and offering treatments that would not be profitable for private hospitals) that issue their bills to the health insurances. And, to put the icing on the cake, there are treatment…

> Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance So does the US: https://www.healthcare.gov/glossary/minimum-essential-covera... > there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. > Switzerland's com…

Social insurance is covered by AHV/SVA/IV (funded by salary deductions and cover congenital defects, invalidity, some rehabilitation therapies and other non profitable coverage) and of course healthcare is not fully privatized as you say: private insurances are private, offering highly regulated compulsory insurance and can offer less regulated additional insurance. Some hospitals/clinics/health and elderly centers (cantonal) are kept with public debt & public donations even if deficitary because private clinics would be unprofitable otherwise.

I don't know if you legitimately do not know that.

I did not talk about federal/cantonal to avoid writing a thesis in a comment. I never said it was centralized.

Re: Health insurers just published close to a trillion hospital prices

#178

Post by bhupy » Tue, Sep 06, 2022, 11:33 PM UTC

ggrrhh_ta wrote: post #177

bhupy wrote: post #154

Earlier quoted context omitted.

> Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance So does the US: https://www.healthcare.gov/glossary/minimum-essential-covera... > there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. > Switzerland's com…

Social insurance is covered by AHV/SVA/IV (funded by salary deductions and cover congenital defects, invalidity, some rehabilitation therapies and other non profitable coverage) and of course healthcare is not fully privatized as you say: private insurances are private, offering highly regulated compulsory insurance and can offer less regulated additional insurance. Some hospitals/clinics/health and elderly centers (…

You're conflating Switzerland's social pension with the Swiss health insurance system. Swiss pensions do not subsidize the cost of healthcare delivery, and are not used to cover health costs at the point of service (for real or alternative medicine). The payment of healthcare at the point of service is facilitated by a fully privatized industry of insurers.

Salary deductions pay for subsidies to lower income beneficiaries to purchase the same private health insurance (KV) as everyone else. This is more or less identical to the US's ACA, and in fact the ACA was modeled after the Swiss healthcare system.

The one big difference between the US's ACA and the Swiss healthcare system is that the ACA also included an employer mandate and stimulated a regime in which the majority of working-age adults receive their private health insurance from their employers as opposed to the individual market, which is not how the Swiss KV works.

Re: Health insurers just published close to a trillion hospital prices

#179

Post by stefan_ » Tue, Sep 06, 2022, 11:34 PM UTC

e_i_pi_2 wrote: post #80

My current assumption is that private healthcare/insurance is to blame, because countries without that or with less generally have better outcomes at less cost. Looking for evidence to the contrary

Last I checked some >30% of the population were already on Medicare/Medicaid. You already have the "socialism" healthcare.

Re: Health insurers just published close to a trillion hospital prices

#180

Post by ggrrhh_ta » Tue, Sep 06, 2022, 11:34 PM UTC

ggrrhh_ta wrote: post #177

bhupy wrote: post #154

Earlier quoted context omitted.

> Switzerland has very strictly and non-deniable obligatory minimum (very broad in coverage) insurance So does the US: https://www.healthcare.gov/glossary/minimum-essential-covera... > there are treatments and operations (e.g. congenital defects and invalidity-related) that are directly billed to the public social insurance (funded by salary deductions) to help health insurances reduce their risk. > Switzerland's com…

Social insurance is covered by AHV/SVA/IV (funded by salary deductions and cover congenital defects, invalidity, some rehabilitation therapies and other non profitable coverage) and of course healthcare is not fully privatized as you say: private insurances are private, offering highly regulated compulsory insurance and can offer less regulated additional insurance. Some hospitals/clinics/health and elderly centers (…

I guess that you don't know that, for example, if you get operated of a congenital defect in Switzerland, the bill goes to the SVA instead of to your private insurance (and so on for specific cases)

I am not conflating anything, you have a superficial understanding that makes you think it is privatized. If you dig into the spending public & private and the actual details you would see that Switzerland is not privatized as people generally think.