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Health insurers just published close to a trillion hospital prices

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

#351

Post by geenew »

refurb wrote: post #239
dj_gitmo wrote: post #60

Earlier quoted context omitted.

The US healthcare system is wildly complicated and inefficient because it is a double-bureaucracy; pubic and private. The government bureaucracy makes a bunch of rules and also provide healthcare through Medicare/Medicaid. The private bureaucracy compete with each other, and hospitals, and pharma companies, ect. Many of the private health providers are for-profit and lobby against rule changes that would reduce compl…

Canada is the only country I know of that has only one system - public. So your claim of public + private being the issue makes no sense when almost every country has that.

The Canadian system is a mix of private and public, with a mix of national and provincial funding, some national standards (tied to funding), and provincial jurisdiction.

For procedures covered by provincial health programs, doctors in private practice (GPs, at least some surgeons) give the service to the patient and then bill the government for that amount. For services that aren't covered by provincial health programs, GPs/surgeons bill the patient.

Provincial health care programs cover anything medically necessary. My general understanding is that you cannot pay to have a service done which is covered by a provincial health program. The intent is to prevent the establishment of a two-tier health care system.

It's probably less complicated than the US system, but it's still complicated.

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

#352

Post by avarun »

kolbe wrote: post #294
pc86 wrote: post #232

Earlier quoted context omitted.

> Doctors often do 2-6 years of excess schooling residencies learning areas of medicine that will never be relevant to them. Where in the world did you hear this? Don't trust anything else that person told you. Aside from some low-income clinic hours for certain specialties (which is objectively a societal good, not to mention typically specific to a given specialty, e.g. OBs have an OB clinic not primary care) no do…

> Don't trust anything else that person told you. You just said what he said, but with emphasis on 100 hour weeks for years on end being good instead of bad. Why did you disagree with me, then go on to list how much doctors work before the get to practice on their own? His point was they get too much training, with much of it being irrelevant (not all). If you're this angry and reactive, you really shouldn't be a doc…

One thing that makes conversations with doctors about regulations around board certifications easier to understand is that anybody who is currently a doctor in the US is heavily disincentivized from improving or changing the system in any way. The absurdly onerous restrictions on becoming a doctor work to the benefit of current doctors by artificially restricting supply and thus keeping wages high. Why would doctors want to get rid of those very regulations?

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

#353

Post by echelon »

opportune wrote: post #277
nradov wrote: post #204

Earlier quoted context omitted.

Should we apply the same sort of "stupid X law" to people who drink alcohol or drive motorcycles or play rugby? This is one of the moral hazards of a socialized medical system. When the rest of society is paying for your medical care it becomes tempting to save money be dictating exactly how you're allowed to live your life. Obesity is a serious public health problem but we won't fix it by calling people stupid or ch…

Yes I think that makes sense, to an extent. Maybe not specifically those because they are too hard to measure. But it would be a great way to have people put skin in the game. As a taxpayer paying for others’ healthcare I’d love if they were incentivized to live healthier lives to reduce costs

There are people genetically predisposed to gain weight or have heart disease. Cancer can be Russian roulette, as is your immune system picking up random autoimmune disorders. Accidents happen.

There are too many stakeholders with too many backgrounds and conditions for anything like your proposed system to work. Everyone would be angry.

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

#354

Post by dnissley »

thewebcount wrote: post #341
narrator wrote: post #85

Earlier quoted context omitted.

What do you think about how Kaiser has handled the whole thing? The insurance company employing the doctors and just paying them a standard salary seems to create all the right incentives.

My experience in talking to people with chronic conditions that aren’t easily treatable is that Kaiser’s model works great until anything that’s slightly out of the ordinary happens, and then it falls apart. If you’re a zebra (as in “when you hear hooves, think horses, not zebras”), their model is pretty horrible.

Isn't it pretty bad to be a zebra in general though? Certainly there isn't any place where zebras have it better than horses.

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

#355

Post by autoexec »

wahnfrieden wrote: post #336
anonymouse008 wrote: post #297

Earlier quoted context omitted.

I'll concede that the comment was vague and relied too heavily on a shared intuition. Though I will admit, the reward became well played dry comedy throughout your sibling comments. So I'll break down my reasoning a bit. It requires a full blog post to get out, so please forgive the abridged version. Healthcare is a catch all for all the other problems of society. The top costly conditions in the US are (in order of…

The workers who are not allowed to sit their entire shifts, a uniquely American cruelty

It is offset at all by all the workers who are forced to sit their entire shifts? It's probably better on our bodies to stand than to sit for 6 hours at a time, but it starts in schools and ends at desk work. Standing desks are nice, and can help, but not everyone has access to them.

One of the nice things about working from home is that it allows people to escape that kind of environment to a point, but it just enables other types of obsessive micromanagement like "Why hasn't your mouse moved for 15 minutes!" or keeping cameras pointed at you all day long.

What we really need is less micromanaging and an expectation that not everyone is going to be at their desk every minute of the day, but that's a very hard sell in some environments.

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

#356

Post by granshaw »

smcl wrote: post #350
chii wrote: post #253

Earlier quoted context omitted.

But looking from another perspective - if healthcare is 20% of GDP, an awful amount of people are therefore paid directly due to this "waste". Any improvement in efficiency would mean those people lose out on jobs. A new use for them must be found, or there will be massive unemployment (at least, short-medium term).

This is a peculiar perspective to see on HN. Isn't the entire business model of startups and YC based on ruthlessly "disrupting" industries using efficiency gains achieved through technology, causing the same sort of unemployment? Why should healthcare billing and administration be any different?

Actual founders are maybe 0.1% of the HN reader base. Most everyone else are tech workers not looking to disrupt anything.

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

#357

Post by diordiderot »

gruez wrote: post #256
seaourfreed wrote: post #242

Earlier quoted context omitted.

...because the healthcare corporations get congress to sell out citizens. $3.5 BILLION flow through lobbyists every year (all industries). Healthcare being a huge part of that. Congress sells out US citizens & corporations fuel it

That's a pretty good deal considering US federal spending alone amounts to 7.3 trillion dollars.

Lobbying American reps has the highest ROI of any investment in human history.

Ted Cruz would probably cosign a bill to 'throw all puppies off a mountain' for an all inclusive trip to Tulum

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

#358

Post by orangepurple »

nardi wrote: post #315
orangepurple wrote: post #57

Earlier quoted context omitted.

import a CSV into Postgres with open(filepath) as fd: first_line = fd.readline() cols = [] for col in first_line.strip().split(','): col2 = f'''"{col.strip('"')}" text''' cols.append(col2) cols2 = ','.join(cols) print(f"create table {table_name} ({cols2});") print(f"\copy {table_name} from '{filepath}' csv header;") this variant will ingest whatever trash is in your CSV fields as-is (cast & cleanup later) run the out…

Do NOT read a CSV file by splitting on commas. Python has a perfect CSV library built right in: https://docs.python.org/3/library/csv.html . If you split on commas, your code will fail for quoted fields with commas in them.

This is obviously a quick and dirty hack. It only splits the header by commas. Postgres has its own read in logic you can adjust by passing arguments to \copy or copy. If you have anything more complex you need to handle it by parsing the header more intelligently than splitting on commas and adding appropriate arguments to copy or \copy

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

#359

Post by wahnfrieden »

autoexec wrote: post #355
wahnfrieden wrote: post #336

Earlier quoted context omitted.

The workers who are not allowed to sit their entire shifts, a uniquely American cruelty

It is offset at all by all the workers who are forced to sit their entire shifts? It's probably better on our bodies to stand than to sit for 6 hours at a time, but it starts in schools and ends at desk work. Standing desks are nice, and can help, but not everyone has access to them. One of the nice things about working from home is that it allows people to escape that kind of environment to a point, but it just enab…

Why job punishes a sitting worker for standing momentarily within a shift? And what do you mean by one cruelty offsetting another?

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

#360

Post by lifeisstillgood »

xyzzy123 wrote: post #198
duffpkg wrote: post #89

Earlier quoted context omitted.

Healthcare is such a base layer of the economy, I find comparisons to be extraordinaly difficult between countries. On the most basic level our pathway to becoming a healthcare provider of all sorts is dramatically more expensive and limited than other countries, what healthcare providers are paid is dramatically more than other countries, we invest many times per capita what other countries put into basic medical re…

It's a confusopoly! They're most obvious with "basic" products like energy and comms - in theory what is delivered is mostly undifferentiated kWh or GB but through the magic of "confusing plans", marketers have succeeded in making comparisons very difficult for regular people. (You can do it, but you need OCD, a year of billing data and a spreadsheet - which greatly exceeds the cognitive effort most people will inves…

Off-topic but "confusopoly" maybe Scott Adams true contribution to human understanding. IIRR he wrote a comic management book and dropped in a throwaway line and invented the term.
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