Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The profit-obsessed monster destroying American emergency rooms

vox.com

Post reply on HN
Print view View original

91–100 of 163 posts

Re: The profit-obsessed monster destroying American emergency rooms

#91

Post by agentcoops »

404mm wrote: post #18

I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons: 1. Anytime one of my family members gets sick, it’s rather…

It's funny, my first job out of college was machine learning for a company processing medical bills to detect fraud on the part of hospitals. It was a very eye-opening process for me as to how American health care is perhaps the worst designed system conceivable by man -- as in, it's genuinely difficult to imagine how the various regulations, incentives etc could be made worse from any perspective (left or right) or measure (human care, cost, equality, whatever). Medical diagnoses are systematized in a rigorous manner through a series of codes (ICD9s, CPTs, DRGs etc), but there is no real set or expected pricing for each code apart from Medicare and these strange agreements between particular insurance providers and particular hospitals (i.e. what defines "in-network" or "out-of-network", where pricing is more or less random). Bills also have an explicit location type (Inpatient, Outpatient, Emergency room, Ambulance etc) and Urgent/Emergency Room care is significantly and consistently the most expensive to the insurer (most American insurance is, after all, high deductible emergency insurance) and thus one of the major vectors of fraud was passing bills off as such. One of the real aspects of madness in the whole system is the pricing disconnect and lack of transparency between all participants: hospitals ask an agreed upon price to insurers who pay it with few questions asked, as hospital pricing drifts up insurers raise premium prices, employers keep paying premiums, and individuals either pay something contractually determined by their insurance company or an essentially random price if uninsured.

TLDR; it isn't at all surprising to me that yet another vulture on American health care expenditure has discovered how profitable emergency rooms can be and that we see such a mad proliferation of urgent care facilities on every corner.

Re: The profit-obsessed monster destroying American emergency rooms

#92

Post by JamesBarney »

skhunted wrote: post #41
VancouverMan wrote: post #34

Earlier quoted context omitted.

The widespread need for medical insurance only exists because regulation has introduced many artificial inefficiencies within the health care sector that in turn severely distort the pricing of medical services and medical products. We'd see far more reasonable pricing, and much less need for something like medical insurance, without the regulations that artificially limit the supply of practitioners and clinics, tha…

The fact that healthcare is far cheaper in every European country that has universal healthcare suggests that you are wrong.

I think the causality runs the other direction. Europe has an efficient system so they can easily afford to give everyone health care. We have a very expensive system so we don't.

Medicare costs do not look like the rest of the world. Medicare has slightly lower costs than private insurance but that's mostly bargaining power not any increases in efficiency. They free ride a little off money made off private insurance.

Re: The profit-obsessed monster destroying American emergency rooms

#93

Post by AnthonyMouse »

skhunted wrote: post #88
AnthonyMouse wrote: post #81

Earlier quoted context omitted.

"Regulatory capture" is the regulations the people complaining about regulations are complaining about. "Lack of government oversight" almost never leads to high consumer prices. It can lead to externalities , but if there are no regulations preventing anyone else from competing with the incumbents, it's very hard to sustain monopoly rents.

Most people in the U.S. think regulations are bad in and of themselves. Regulations as a concept are the wrong target. Lack of government oversight and regulations almost always leads, eventually, to cartel pricing and/or monopolistic type pricing.

> Most people in the U.S. think regulations are bad in and of themselves. Regulations as a concept are the wrong target.

Regulations as a concept are the category of thing which is causing the problem. You then have to look into which specific regulations are contributing to the problem, but there are 10,000 of them. You can name some of them, like Certificate of Need laws, but that's just a representative example rather than an exhaustive list of every problematic regulation. So people say "regulations" or "inefficient regulations" because what else are they supposed to call them?

Hardly anybody thinks the ban on leaded gasoline is a bad regulation.

> Lack of government oversight and regulations almost always leads, eventually, to cartel pricing and/or monopolistic type pricing.

Only if you're specifically talking about lack of antitrust regulations, which is the exception rather than the rule in the overall category of regulations.

Most regulations simply increase costs. This is true whether they're good or bad. The ban on leaded gasoline increases the price of gasoline; lead is a cheaper stabilizer than what they use now. The ban on circumventing DRM increases the price of playback devices (or reduces quality at the same price); device makers have to pay to license the stupid DRM and it impairs competition by preventing anyone from making a device with features Hollywood doesn't like. But the ban on leaded gasoline is a good regulation because it's preventing a major externality, whereas the ban on circumventing DRM is a bad regulation because it doesn't do what it was sold as doing and instead is used by the studios to capture the market for playback devices.

Getting rid of bad regulations improves efficiency and lowers prices.

Re: The profit-obsessed monster destroying American emergency rooms

#95

Post by JamesBarney »

namdnay wrote: post #8
giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

Regulations for healthcare exist are complex in every developed country, but in most everything works fine for a fraction of the cost, so I don’t think that’s the main issue

Measuring burdensomeness of regulation by number of laws is an incredibly poor measure. Though I'd still be surprised if many countries healthcare laws were as complex as our own.

For example

All doctors require 1 year of schooling 2 year 5 years 10 years 20 years.

Each is 1 law but has each also has very different level of burdensomeness.

Re: The profit-obsessed monster destroying American emergency rooms

#96

Post by ninalanyon »

JamesBarney wrote: post #84
jaco6 wrote: post #68

The problem with American healthcare is the attempt to compromise between healthcare as a universally available public utility and healthcare as a commodity on the private market. (Arguably this is a legacy of pre-modern healthcare, where hospitals were operated by charities run by nuns and funded by aristocrats and royal families, hence all the “Saint” names in hospitals nowadays). There’s a variety of weird example…

> It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily. I don't think this is true. Some countries with public healthcare are far more efficient than our system. But there are countries that have systems similar to ours that are far more efficient as well. We just have a really shitty system, and who pays f…

> But there are countries that have systems similar to ours

Really? Which ones are they?

Re: The profit-obsessed monster destroying American emergency rooms

#97

Post by JamesBarney »

ninalanyon wrote: post #96
JamesBarney wrote: post #84

Earlier quoted context omitted.

> It would be more efficient to pay for it using taxes, both income and sales taxes, rather than letting some groups—the poor and the elderly—off the hook arbitrarily. I don't think this is true. Some countries with public healthcare are far more efficient than our system. But there are countries that have systems similar to ours that are far more efficient as well. We just have a really shitty system, and who pays f…

> But there are countries that have systems similar to ours Really? Which ones are they?

Israel, Switzerland, and the Netherlands all rely on private insurance as well and still have vastly better systems than our own.

Re: The profit-obsessed monster destroying American emergency rooms

#98

Post by kevin_thibedeau »

404mm wrote: post #18

I live in north Texas, and the situation here is pretty much on par with the article. Urgent Care & Emergency Room combos are here on every corner. It’s a lucrative business, so it makes sense that private equity firms are gobbling it up. But I think the more interesting problem here is one level up. Why are there so many of them? I see two possible reasons: 1. Anytime one of my family members gets sick, it’s rather…

The FTC really should put a stop to labeling community ERs as Urgent Care when they aren't subject to the same billing regulations and are just an excuse for a predatory money grab.

Re: The profit-obsessed monster destroying American emergency rooms

#99

Post by analog31 »

giantg2 wrote: post #7

The thing that doesn't get mentioned much in these conversations that I've personally seen play a big role is the regulation. When you have highly complex regulations, you end up consolidating practices. As regulations increase, the number of distinct providers/owners decrease. Many individuals don't want to run their own practice due to the complexities (insurance, etc) that exist beyond the work (treating people).…

Healthcare is essentially a creature of regulation. It owes its beginnings to the requirement that care must be effective.

Re: The profit-obsessed monster destroying American emergency rooms

#100

Post by VancouverMan »

skhunted wrote: post #41
VancouverMan wrote: post #34

Earlier quoted context omitted.

The widespread need for medical insurance only exists because regulation has introduced many artificial inefficiencies within the health care sector that in turn severely distort the pricing of medical services and medical products. We'd see far more reasonable pricing, and much less need for something like medical insurance, without the regulations that artificially limit the supply of practitioners and clinics, tha…

The fact that healthcare is far cheaper in every European country that has universal healthcare suggests that you are wrong.

High costs are certainly present in socialist medical systems, they're just somewhat obscured.

I'm more familiar with Canada's taxpayer-funded, "universal" provincial health care systems than the European ones, so I'll describe the costs we typically see with them.

Government health care spending makes up a huge portion of the provincial budgets each year. This results in costs like high tax rates, and significant government debt. (Those, in turn, introduce other costs, such as the stifling of business development and employment, among others.)

Another significant cost is the poor quality of service. Long delays are the norm. This can mean single-digit hours-long waits for emergency service, double-digit hours-long waits for semi-emergency situations, and weeks to months for routine diagnostics and specialist appointments.

A lot of Canadians don't have a family doctor, and walk-in clinics are typically quite busy and have relatively short hours, so people end up going to emergency rooms even for relatively minor health issues. That only exacerbates the problems there.

Even once you're finally seen by a practitioner, there is little incentive for them to do a good job because there's pretty much no competition, and no punishment for providing poor service. Don't expect a favourable outcome, especially for anything requiring in-depth investigation or long-term treatment.

Common dental, vision, and pharmaceutical costs often aren't covered by the provincial systems, which results in many Canadians paying even more money for costly private medical coverage on top of the "universal" coverage they've already paid for via taxation and public debt.

It's very revealing that despite paying a lot for the local health care systems, Canadians with the means to do so will often seek treatment in the US anyways. Even if they have to travel and pay a lot more money to do that, at least it tends to result in much faster, and much higher quality, service than they would ever have received in Canada.

Post reply on HN