The anatomy of a ripoff • Hacker News Board

Re: The anatomy of a ripoff

#101

Post by jellicle » Tue, Jan 10, 2012, 5:07 PM UTC

saucetenuto wrote: post #51

CWuestefeld wrote: post #21

Earlier quoted context omitted.

You make it sound like one follows from the other in an obvious way. I think it does follow logically. I'm assuming that the regulations were intended to serve some purpose. If the system was working as the regulators/legislators wanted, there would have been no point in regulation. The regulations were created for the purpose of altering the way things would normally work out. By analogy, if we see a canal, it's pro…

Speaking as someone who doesn't know much about this stuff, your analogy reads more like, "the canal diverted the waterway, so tigers devoured the Pope". It may well be true, but you need to flesh it out more: explain how the new course flooded the tigers' habitat, forcing them to migrate to Rome.

The person you're responding to believes that if medical charges are vastly different between providers it must be due to evil government regulation, because after all in other sorts of stores we never see wildly varying prices for the same item and healthcare, where people have plenty of time to comparison shop (even if you're choking on turkey, you still have a few minutes to contact the various local hospitals and determine which provides cheaper ER service before you pass out) is a perfect example of a transparent market.

Re: The anatomy of a ripoff

#102

Post by Lagged2Death » Tue, Jan 10, 2012, 5:13 PM UTC

CWuestefeld wrote: post #3

My wife is the manager of budget and reimbursement at a hospital, and from many conversations with her, I can imagine that this article is accurate. However, if I were writing this, I would have given greater emphasis to the effect that Medicare has on these problems. The article does mention that Medicare typically pays fees that are below actual cost for the procedures, and that hospitals must therefore increase ch…

Medical care is the most highly regulated industry in the economy...

Uh huh. Talk to the (quite profitable) utility companies about that.

Re: The anatomy of a ripoff

#103

Post by arethuza » Tue, Jan 10, 2012, 5:14 PM UTC

Symmetry wrote: post #66

sp332 wrote: post #45

Earlier quoted context omitted.

How do the doctors get paid if the patient is only paying $17 per visit?

That's heavily subsidized, of course, but part of it is also that doctors are only paid about half as much in Europe, on average, as in the US.

You also need to take into account how much it costs to become a doctor in the EU and the fact that in places like the UK doctors trained and employed by the NHS are free to go and augment their income by doing work on private paying patients.

Re: The anatomy of a ripoff

#104

Post by yummyfajitas » Tue, Jan 10, 2012, 5:15 PM UTC

jellicle wrote: post #99

yummyfajitas wrote: post #63

Earlier quoted context omitted.

...when you measure things like life expectancy, Britons are as healthy as Americans. That gives you an idea of how much money is going down the tubes due to administrative inefficiency. It's hardly clear the money is going down the tubes due to administrative inefficiency. It might just be spent on unnecessary medicine, and costs might be higher in the US. According to one fairly decent source, administrative ineffi…

Well, yeah, if you ignore all the studies and only read libertarian blogs, then it's hardly clear. Administration accounts for 31% of healthcare costs in the U.S., and 16% in Canada, for example.

The views of the bloggers at the incidental economist tend to be moderate liberal. Seriously, go read the blog, and find me a single post indicating libertarian views.

I'm sorry that data driven liberalism conflicts with mainstream ideology and your favored talking points.

Re: The anatomy of a ripoff

#105

Post by gcp » Tue, Jan 10, 2012, 5:17 PM UTC

viandante wrote: post #13

moozeek wrote: post #5

As far as I can tell from the facts given in the EU you would have paid about the same amount the author had to pay out of his own pocket (~ 700 USD). If you had no health insurance at all.

As far as I know in EU public insurance is mandatory, so you would never pay such ammount.

In Germany its optional starting from a certain income level. (At least it was x years ago)

Re: The anatomy of a ripoff

#106

Post by goatforce5 » Tue, Jan 10, 2012, 5:18 PM UTC

wildmXranat wrote: post #86

goatforce5 wrote: post #53

Earlier quoted context omitted.

Due to my own stupidity I fell off my bike on the weekend. A few minutes later I realised my little finger was swelling up and hurting a whole lot. Universal healthcare let me go to a hospital get 3 x-rays and a doctor to tell me nothing was broken. Took 3 hours, but multiple people apologised for it taking so long while I was there (to be honest, I thought it was quick. A sore finger must just about be last on the l…

Huh ? I'm glad that your finger is better, but you procedure was not 'out-of-pocket' $0. Here in Canada, where the similar treatment would be $0 at the time of treatment, I would've paid in thousands already into the health care system in federal/provincial pay deductions. I consider, the money lost to be a continuous out of pocket expenditure. I still like this system more tbh.

The out-of-pocket was 0 in the sense that my tax is already paid and there was no additional expense in me choosing to go to hospital to be checked out.

So, yes, I pay for it. A big chunk of my pay packet goes to tax, but i'm happy knowing I can receiving good treatment without having to work out if I can afford it.

I'm also happy it means those less fortunate than myself (re: current income levels) will receive the same level of treatment.

After hitting the road and dusting myself off, it meant I didn't have to do a cost/benefit analysis of going to hospital vs. walking it off.

Re: The anatomy of a ripoff

#107

Post by jiggy2011 » Tue, Jan 10, 2012, 5:21 PM UTC

jiggy2011 wrote: post #9

Wow , I'm glad I don't have to expend mental energy on stuff like this. Universal Healthcare, get it. It's really good. Honest.

I love how this comment is getting up and downvoted all over the place, it has been as low as -1 and as high as 13. Currently on 9

Re: The anatomy of a ripoff

#108

Post by yummyfajitas » Tue, Jan 10, 2012, 5:21 PM UTC

astrodust wrote: post #95

yummyfajitas wrote: post #65

Earlier quoted context omitted.

It creates a downward pressure on health care costs.

In what hypothetical world? It sounds like the hospitals in the US couldn't care less how much they charge people since they'll just sue you into oblivion if you don't pay. What's the difference between a $1K deductible and a $10K one? How's that going to make one bit of difference? Consumers have no say in how much the procedures cost. There's no "price pressure" from anyone but the group buyers, those being the ins…

In what hypothetical world?

In the world joezydeco lives in. Apparently high deductible plans have already caused hospitals to change their procedures.

Consumers have no say in how much the procedures cost.

Consumers now have an incentive to shop around or try alternate treatments.

With a low deductible plan, their only incentive is to find the doctor they like the best or the hospital closest to their house.

Re: The anatomy of a ripoff

#109

Post by adolph » Tue, Jan 10, 2012, 5:21 PM UTC

dbcfd wrote: post #22

CaptainZapp wrote: post #7

Sorry, but isn't it just outright fraud to charge > 400$ for a medication, which has a "retail price" of a few $?

Nope, that's capitalism. Someone (the insurance) is willing to pay that price. It'd only be fraud if the government was paying for it. [Edit]Some hate against my comment. For those that fail to understand... It isn't fraud if you go to a gas station that is charging $0.10 more a gallon, and fill up there. It's fraud if you pay for that gas, and its water. The insurance is still buying the same drug, they have just ch…

Taking advantage of the predicament of others is not capitalism; it is price gouging. It would be one thing if the consumer were able to compare prices and other aspects of the product and make a choice based on the consumer's values (of which price may not be the most important thing). This is a bit more like a gas station charging 10x more during a hurricane evacuation.

Re: The anatomy of a ripoff

#110

Post by droithomme » Tue, Jan 10, 2012, 5:22 PM UTC

Mc_Big_G wrote: post #90

The real scam perpetrated by hospitals and doctor's offices is rebilling. It works like this: 1) They send a bill with no information about the services performed. 2a) You waste your time tracking down what it was and then pay it. OR 2b) You pay the bill without wasting your time to verify. 3) They wait somewhere between a month and 6 months. 4) After receiving payment, they bill you again for the same services. 5a)…

Yes. There is extensive intentional fraud and corruption in the system, along with rampant profiteering that exists regardless of whether an entity has been granted "non-profit" status. (Non-profit doesn't mean you can't pay everyone on the board of directions millions in compensation.)

Each time I've dealt with it (mostly helping relatives with their confusing bills) there's been double and triple billing, and billing for procedures not performed, and for work done by people that weren't present, or on days the patient wasn't even present. The more complex the treatment, the more entities jump in to the feeding trough for a share. You have to keep extensive records of everything actually done, which is not always possible if you are not with the patient 24/7. Then when the bills come they are full of hundreds of cryptic codes. You might have some procedure done that takes 30 minutes, and get 20 different bills from 10 different entities, sent over a period of 18 months following the procedure, which apparently now lasted days and involved dozens of people, medicines, tools, and tests, some done multiple times.

The primary reason medicine costs crazy amounts in the US is because of corruption and fraud. Sending a lot of these people to prison could do a lot to reduce costs and straighten things out. That and single payer.