Banks and hospitals are cashing in when patients can't pay for health care • Hacker News Board

Re: Banks and hospitals are cashing in when patients can't pay for health care

#71

Post by mgkimsal » Thu, Nov 17, 2022, 5:50 PM UTC

digdugdirk wrote: post #59

mistrial9 wrote: post #54

Earlier quoted context omitted.

> that hospitals are the enemy in American healthcare no, not every hospital is run this way. Many are, of course.. how can constructive engagement get past these shrill and urgent criticisms, and make positive change?

In this case, I think that having more people constructively engage with the fact that these "shrill and urgent criticisms" are the reality for the vast majority of Americans would make for a positive change. If the vast majority of bank tellers sucker punch you in the face after completing a transaction, the correct response is to implement a sweeping reform of bank tellers - not to do a deep dive root analysis on t…

Any criticism of banking at all would be met with "we have the best banking system in the world!", ignoring the 40 million 'unbanked' people.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#72

Post by sli » Thu, Nov 17, 2022, 5:54 PM UTC

mistrial9 wrote: post #54

stevebmark wrote: post #44

Great article. It’s important to understand that hospitals are the enemy in American healthcare. (All of its layers are the enemy, but hospitals are often overlooked). Many hospitals are viscous for-profit machines that fraudulently maintain a non-profit status. They employ CFOs and business analysts to maximize profits unrelated to care quality. They hire “medical coders” whose entire job is to find the highest pric…

> that hospitals are the enemy in American healthcare no, not every hospital is run this way. Many are, of course.. how can constructive engagement get past these shrill and urgent criticisms, and make positive change?

Medical debt is at least the plurality if not the majority reason people in the US declare bankruptcy. It doesn't matter if it's "not all" when it's far, far too many. The whole idea of shopping around for a better deal (or just a less awful deal) when you need a hospital is patently and obviously ridiculous.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#73

Post by heywire » Thu, Nov 17, 2022, 5:54 PM UTC

chasd00 wrote: post #24

elzbardico wrote: post #7

What is incredibly amazing is how much health care costs in the US. Government expenditures Per Capita are over twice of the nations like Canada, UK, Australia, and Japan. And most of this for medicare, for which only a fraction of the population is eligible. And yet, this is not enough, and people need private health insurance. Then you look at the prices of common medications, and most of them (mind you, a lot of t…

the "invisible hand" can't work because there is no price list available to consumers. That's the craziest thing to me, you can't get a price list for a procedure ahead of time and compare with competitors to get a better deal. There's no way for price discovery to work without an informed consumer.

My employer recently updated our health insurance offering with a plan from UHC called Surest. They were formerly branded as Bind, but have seemed to pivot after their UHC acquisition (the former Bind program had on-demand coverage, whereas the Surest program is more like a traditional copay plan). Part of this plan is an app where you can type in a procedure, browse a list of providers, and select one based on copay price. They claim that their copay is based on UHC’s evaluation of their efficiency and effectiveness. The copay is supposed to be a singular all-in price covering all services related to the procedure (e.g., no separate bill for anesthesia, etc). Dr visit $10-$65, ER visit $325, etc.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#74

Post by iso1631 » Thu, Nov 17, 2022, 5:58 PM UTC

Mezzie wrote: post #47

iso1631 wrote: post #36

Earlier quoted context omitted.

Healthcare demand seems to be boosted by the profit motive. The healthcare industry has an incentive to increase healthcare usage - by oversubscribing unneeded drugs and procedures and through constant daytime adverts about "talk to your GP about thing which has a list of side effects longer than the commercial break "

Yeah, this is definitely part of the reason for the cost, but overall healthcare is pretty inelastic. (Ads for meds are so odd: I spent a couple of years in Canada and they don't do that there and it was bizarre coming back to the US and hearing them.) Another reason for this is that Americans are so litigious: tests are ordered because otherwise the patient can sue. Which in turn is the case because the only way to…

In the UK we have medical malpractice too (and far to much of it), but we also define what tests are expected. My understanding is the people defining those tests aren't incentivised to overtest (by companies trying to sell the tests) or undertest (through fear of being sued).

Re: Banks and hospitals are cashing in when patients can't pay for health care

#75

Post by mgkimsal » Thu, Nov 17, 2022, 6:00 PM UTC

conductr wrote: post #51

dan_quixote wrote: post #5

Earlier quoted context omitted.

I'd say it's cruel . Paying interest on some medical procedure because you (and likely almost everyone else) cannot afford the eye-watering cost? What else do we need to convince people that this is not sustainable? Maybe a collapse in this medical loan market? One has to assume the major players (hospitals, insurance, etc) have firewalled themselves from this system.

> Maybe a collapse in this medical loan market? That won't properly highlight the issue. It's just a financial shell game of bailouts and buying and selling of paper. It doesn't impact the patients. It's not ideal but the only solution is for the patient to be rejected for insufficient funds/inability to pay. Then, when people finally realize they can't get a doctor appointment because they literally can not afford h…

The US seems to have invented (or at least normalized) medi-begging - the process of posting to gofundme-type sites to help pay medical debt. The very existence of 'medial fundraising' as a thing should be the damning indicator that we need some form of single-payer across the board.

Hundreds of thousands of people publicly begging for help with medical bills should be a national embarrassment.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#76

Post by marcusverus » Thu, Nov 17, 2022, 6:07 PM UTC

HDThoreaun wrote: post #21

elzbardico wrote: post #7

What is incredibly amazing is how much health care costs in the US. Government expenditures Per Capita are over twice of the nations like Canada, UK, Australia, and Japan. And most of this for medicare, for which only a fraction of the population is eligible. And yet, this is not enough, and people need private health insurance. Then you look at the prices of common medications, and most of them (mind you, a lot of t…

It's impossible to have a free market in healthcare because there is a gigantic information asymmetry between patients and providers. The government has responded to that with regulations, making the market even less free. So I agree, the invisible hand doesn't work in healthcare, but the government has also made things worse.

> It's impossible to have a free market in healthcare because there is a gigantic information asymmetry between patients and providers.

Why would information asymmetry prevent a free market? The free market works for all manner of highly specialized goods and services, for which there is (almost as a rule) a large information asymmetry between buyers and sellers.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#77

Post by uni_rule » Thu, Nov 17, 2022, 6:17 PM UTC

AlexTWithBeard wrote: post #58

kelseyfrog wrote: post #49

Earlier quoted context omitted.

A law? How come hospitals and doctors that don't have surprise bills out-compete those that do? Surely if this was a thing that patients cum customers demanded, there would be a provider willing to step in an supply it.

Customers demand it, but customers are not willing to pay for it. With a choice to pay $1k "with a small probability of surprise bill" or $5k all-included most patients will prefer the former.

That's how insurance should work in theory so its not like that's a new idea it's just that modern insurance companies are godawful at that original purpose of not screwing people over.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#78

Post by boplicity » Thu, Nov 17, 2022, 6:21 PM UTC

zdragnar wrote: post #28

elzbardico wrote: post #7

What is incredibly amazing is how much health care costs in the US. Government expenditures Per Capita are over twice of the nations like Canada, UK, Australia, and Japan. And most of this for medicare, for which only a fraction of the population is eligible. And yet, this is not enough, and people need private health insurance. Then you look at the prices of common medications, and most of them (mind you, a lot of t…

An interesting story I heard on the radio: A father got a call from his daughter that she went to the emergency room, because she had a vitamin C pill stuck in her throat and she was scared. In NY, they are required to give an estimate of costs, and estimated $1600 for the exam and the can of ginger ale they gave her to drink so she could swallow it. Fast forward a few weeks, and they got the bill. They ended up char…

It gets even worse than that.

When our first child was born, in the States, it was in a birthing center associated with the local hospital. This was in its own building, but in that building they have a room they call the "ER" -- this is where they decide whether to admit you, in terms of being ready to give birth. The entire function of that room, though, is just to charge exorbitant ER rates for admitting into the birthing center. (A 10 minute dilation exam.) This is completely fraudulent, of course, but they've been getting away with it for many, many years.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#79

Post by conductr » Thu, Nov 17, 2022, 6:24 PM UTC

mgkimsal wrote: post #75

conductr wrote: post #51

Earlier quoted context omitted.

> Maybe a collapse in this medical loan market? That won't properly highlight the issue. It's just a financial shell game of bailouts and buying and selling of paper. It doesn't impact the patients. It's not ideal but the only solution is for the patient to be rejected for insufficient funds/inability to pay. Then, when people finally realize they can't get a doctor appointment because they literally can not afford h…

The US seems to have invented (or at least normalized) medi-begging - the process of posting to gofundme-type sites to help pay medical debt. The very existence of 'medial fundraising' as a thing should be the damning indicator that we need some form of single-payer across the board. Hundreds of thousands of people publicly begging for help with medical bills should be a national embarrassment.

We do a good job ignoring the economic issues of our neighbors, until it impacts our house.

Overall, people are pretty vocal about wanting a living wage, affordable healthcare, affordable education, housing, etc. yet we seem to constantly move in the opposite direction. IMO - our political machine has become too dysfunctional and no longer serves the people, or even make meaningful incremental progress. It's quite a damning time for our country and seems like some large correction would be in order at some point.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#80

Post by HDThoreaun » Thu, Nov 17, 2022, 6:24 PM UTC

marcusverus wrote: post #76

HDThoreaun wrote: post #21

Earlier quoted context omitted.

It's impossible to have a free market in healthcare because there is a gigantic information asymmetry between patients and providers. The government has responded to that with regulations, making the market even less free. So I agree, the invisible hand doesn't work in healthcare, but the government has also made things worse.

> It's impossible to have a free market in healthcare because there is a gigantic information asymmetry between patients and providers. Why would information asymmetry prevent a free market? The free market works for all manner of highly specialized goods and services, for which there is (almost as a rule) a large information asymmetry between buyers and sellers.

Information asymmetry is a classic example of a market failure. Markets with extensive baked in information disadvantages are by definition unfree. Just because other markets are unfree doesn't mean medicine isn't.