The Cost of an ACL Injury • Hacker News Board

Re: The Cost of an ACL Injury

#121

Post by jonknee » Tue, Jun 04, 2013, 1:25 AM UTC

angersock wrote: post #101

dragonwriter wrote: post #86

Earlier quoted context omitted.

> The machine shops I know will buy new tools as needed, but reuse them on large job runs--and throw them out once they lose tolerance. Hospitals aren't machine shops, though, so it would be a significant additional cost to equip and staff them to evaluate tools for reuse. There's also particular costs around requiring additional handling of used surgical tools rather than disposing of them that may not exist to the…

Right, right--but the point here is that economies of scale have driven the cost of machine tools low enough that they can treat them as disposable for the type of work they're doing. This whole thing seems more a collection of specialized widgets that offer only marginal utility over a stock scalpel, and which aren't priced to reflect the sheer triviality of their manufacture. Maybe somebody finally needs to be enou…

How special are we talking about? There are 100,000 of these surgeries in the US every year (and then tons more globally). It's not like this is a part for the space station.

Re: The Cost of an ACL Injury

#122

Post by dragonwriter » Tue, Jun 04, 2013, 1:28 AM UTC

dclowd9901 wrote: post #114

rayiner wrote: post #82

Earlier quoted context omitted.

Medical liability costs are about $55 billion in the U.S., or about 2.4% of overall costs: http://www.hsph.harvard.edu/news/press-releases/medical-liab... . There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.

Overall costs: 2.291 Trillion $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going?

> $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going?

Even if the people you know were somehow a representative sample, that's not all that surprising. A significant health event can easily cost orders of magnitude more than $7,638, so even if 90% didn't have one in a period of several years, the average cost could still easily be $7,638 per person per year.

Re: The Cost of an ACL Injury

#123

Post by dragonwriter » Tue, Jun 04, 2013, 1:30 AM UTC

apendleton wrote: post #12

dbuxton wrote: post #9

This is absolutely shocking to me. Had my ACL replaced in the UK privately about 8 years ago (no health insurance, paid out of pocket). Total cost was £3000 (+ £600 for initial scan). I could have got it done for free on the NHS but it would have messed up my term time at university. Like the OP I had meniscal tearing too so more or less directly comparable. (Although obviously 8 years is probably a long time in medi…

We hear about medical tourism from the US to India, Thailand, etc., but with these kinds of price discrepancies between the US and UK private practices, I wonder why there aren't more Americans who go to the UK for surgery?

> I wonder why there aren't more Americans who go to the UK for surgery?

Because a sizable share of the Americans who could afford even the UK surgery prices plus travel and accommodations to/in the UK also have health insurance which covers the procedure in the US, and makes it cheaper for the patient to have the procedure done in the US even if the total cost is more expensive.

Re: The Cost of an ACL Injury

#124

Post by coryrc » Tue, Jun 04, 2013, 1:33 AM UTC

dclowd9901 wrote: post #114

rayiner wrote: post #82

Earlier quoted context omitted.

Medical liability costs are about $55 billion in the U.S., or about 2.4% of overall costs: http://www.hsph.harvard.edu/news/press-releases/medical-liab... . There are debates about how much "defensive medicine" adds to the cost, but those aren't all that relevant here since the costs presented are exclusive of additional tests, etc.

Overall costs: 2.291 Trillion $7,638 per person per year. That just can't be right. I and 90% of the people I know haven't made a significant trip to the dr or hospital in years. Where the fuck is that money going?

Nursing homes warehousing the elderly past mental decline while waiting for the body to catch up.

Re: The Cost of an ACL Injury

#125

Post by tsycho » Tue, Jun 04, 2013, 1:38 AM UTC

(I am slightly hesitant to publicly share info like this, but what the heck...for science!)

I tore my ACL 1.5 years ago playing soccer, and went through a similar surgery as the OP at NYU Langone Medical Center in New York. Interestingly, my final bill for the surgery (including the same things as the OP) was almost the same - $67k and change.

However, more importantly, the actual amount paid to the doctor/hospital etc. was $18k, of which I think I had to pay around $2k, insurance covered the rest. So while the sticker price might be $67k, the actual cost is significantly lesser. In the bills that I saw from my insurance company (BCBS), for each line item, they would have a column for "Allowed Amount" or something like that which generally varied between 20-30% of the billed amount.

On a different note, I don't whether the cost would have been the whole $67k if I was uninsured. I hope not. But if yes, that's really punitive to the people who can least afford it. For that matte, even a 18k cost is prohibitively expensive for someone who cannot afford insurance.

Re: The Cost of an ACL Injury

#126

Post by yummyfajitas » Tue, Jun 04, 2013, 1:39 AM UTC

larrys wrote: post #81

dr_ wrote: post #37

Interesting read, and a valid criticism of the costs associated with ACL repair in the US. It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there. My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including ph…

"with insurance only for real medical emergencies" You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line. I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. T…

You pay $100 for preventative care now to avoid paying the $5,000 deductible down the line.

Re: The Cost of an ACL Injury

#127

Post by dragonwriter » Tue, Jun 04, 2013, 1:39 AM UTC

angersock wrote: post #100

drdoc wrote: post #96

Earlier quoted context omitted.

As an anesthesiologist, this is a bad idea for various different reasons. There are a numerous reasons why a physician needs the tools that he needs. The type of procedure, the type of patient and the familiarity of the equipment. I routinely intubate patients with a particular type of tool because that is what I feel most comfortable with and I have trained with. Yes, I can intubate with the myriad of other devices…

If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint. If I dropped a plumber off at a job site and she didn't have a particular type of ergonomic monkey wrench she'd grown accustomed to and said she couldn't do the job, she'd be mocked endlessly. If I dropped a line chef off at a ki…

> If I dropped a Linux admin off at a shop which didn't have emacs on their boxen and he refused to work because he might accidentally screw up a config file, he'd be laughed out of the joint.

The kind of errors made by a Linux admin who is more familiar with emacs using vi don't have as much likelihood of ending up with dead customers and massive liability for the Linux admin and/or his employer as the kind of errors that could be expected from a surgeon being forced to use non-preferred equipment.

So the situations aren't exactly parallel.

> In a system which costs as much as ours does to people who simply can't afford it, we (as a society) cannot afford to cater to the whims of overspecialized professionals.

In a system which costs as much as ours does compared to every other advanced country, while providing worse access and not producing better outcomes, we certainly can't afford to not do some research to figure out what everyone else is doing right and we aren't.

But somehow I don't think letting surgeons choose the tools used for a particular surgery based on their own expertise and understanding of the needs of the particular surgery, rather than having one standard kit used for all surgeries regardless of the specific details of surgeon and patient, is the difference.

Re: The Cost of an ACL Injury

#128

Post by smartician » Tue, Jun 04, 2013, 1:52 AM UTC

tsycho wrote: post #125

(I am slightly hesitant to publicly share info like this, but what the heck...for science!) I tore my ACL 1.5 years ago playing soccer, and went through a similar surgery as the OP at NYU Langone Medical Center in New York. Interestingly, my final bill for the surgery (including the same things as the OP) was almost the same - $67k and change. However, more importantly, the actual amount paid to the doctor/hospital e…

The way understand it, yes, the uninsured person would receive the $67k bill, but can then go and negotiate to lower the amount payable. Insurance companies just did that negotiation beforehand and have a standing agreement with the provider. All of this reeks of huge inefficiencies to me. There are people at both the insurance companies as well as at every health care service provider whose full time job is to negotiate rates with each other?

Re: The Cost of an ACL Injury

#129

Post by [deleted] » Tue, Jun 04, 2013, 2:08 AM UTC

pyre wrote: post #64

chudi wrote: post #39

Earlier quoted context omitted.

I got my ACL replaced in Argentina and the cost including rehab was about U$S 3000 having one of the best insurance companies (about 120 U$S a month). If I wanted to use the public care, it could probably cost almost nothing. It always amazed me that in the US the health of a person is not a right and if you get hurt doing anything you have to pay huge fees.

That's because in Libertarian Utopia everyone of importance will be independently wealthy, and those who aren't, deserve to be trampled by the others. /sarcasm

[deleted]

Re: The Cost of an ACL Injury

#130

Post by rexreed » Tue, Jun 04, 2013, 2:10 AM UTC

pyre wrote: post #112

jacoblyles wrote: post #97

Earlier quoted context omitted.

Libertarians have been complaining about the USA's complicated health bureaucracy for decades. Hell, they've written dozens of books about it. It doesn't take a genius to find perverse incentives in US medical pricing schemes. But don't let me get in the way of your 30 seconds of hate...

I've met plenty of people whose political views on health care were along the lines of: Person 1: "You should pay for your own care" Person 2: "What if you are poor and can't?" Person 1: "Sucks to be you." With the possible addendum of: Person 1: "But charity organizations will cover the costs for those that can't pay, because then I can choose of my own will to put money towards the cause." Person 2: "What if not en…

Can the issue of who pays for healthcare be adequately separated from the issue of its cost? I think so -- given how wide the disparity in health COSTS (put aside the payer) are between not only countries, but even counties in the US [1].

It would be great if we can talk about the origin of these health costs without getting entangled into who should be paying them. But maybe that's an impossible task.

The Libertarian-in-Chief Ron Paul himself a Physician who claims that the exhorbitant costs in health care are a more recent phenomenon. He quotes how much his costs were to do house-visits (remarkably small), and compares that with the ballooning in costs more recently. While one can argue that Libertarianism is a Utopic view, the rapidly escalating prices of healthcare are not something that is espoused by Libertarian philosophy. I.e. Low health costs and individual responsibility for health paying are not incompatible. Then again, neither are low health costs and universal health coverage. Right now, we have the worst of both worlds: high health costs and individual responsibility for payment.

[1] http://big.assets.huffingtonpost.com/hospital-procedure-cost...