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

The Man Who Was Treated for $17,000 Less

online.wsj.com

Post reply on HN
Print view View original

51–60 of 121 posts

Re: The Man Who Was Treated for $17,000 Less

#51

Post by alex-g »

Ensorceled wrote: post #43
munificent wrote: post #33

God, what a terrible article. So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a "self-pay" (or uninsured) patient. Yeah, how well does that strategy work when you're having a heart attack and are moments from death? I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasona…

How does that make the article terrible? He's not saying that this is a good thing he's using this as an example of how broken the medical system is. Did you read to the end? Or did you just get annoyed after the first few paragraphs and write this screed?

No, the author's argument is that this kind of negotiation is what ought to happen all the time; his example of brokenness is that insurance rules distort the marketplace and drive up prices. Far from objecting to haggling, he thinks it should happen more often. This is a fairly typical free-market argument. The parent post by munificent advances the counter-argument that patients are not always in a position to haggle over prices.

Re: The Man Who Was Treated for $17,000 Less

#52

Post by rprospero »

jusben1369 wrote: post #44
munificent wrote: post #33

God, what a terrible article. So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a "self-pay" (or uninsured) patient. Yeah, how well does that strategy work when you're having a heart attack and are moments from death? I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasona…

I see this argument a lot. It's really unhelpful if you're trying to resolve the big challenges. The reality is that around about 90% of all healthcare spend can be done in a normal, thought out manner. The car accident/heart attack/ambulance can I negotiate my surgery dialogue is such a small part that using it really distracts away from the main issues. This was an incredibly disturbing story. It's a pity that it t…

The reason that it comes up a lot is because it's not that small of a part.

Before I met her, my wife went to the hospital with severe pneumonia. She was there for over a week, partially due to a surgical error by the hospital. During this time she was fired because she ran out of sick days. This cancelled her insurance. The hospital then charged her $30,000 for a bunch of procedures that she never had the chance to see a price for on account of being unconscious most of the time. She went to the billing department and mentioned that she was now unemployed and without insurance. She offered to pay what she could, but they calculated that they could make more selling the debt to a collection agency, who is still asking us for the full $30k.

Now that I've calmed down a little, I want to say that you are right that 90% of healthcare spending can be handled in a reasonable way. Prescription drugs, birth control, check-ups, and routine treatments could certainly be handled better. However, the reason that the other scenario comes up so often is that the remaining 10% can be completely catastrophic.

Re: The Man Who Was Treated for $17,000 Less

#53

Post by neltnerb »

AlisdairSH wrote: post #50
jbooth wrote: post #38

Earlier quoted context omitted.

Of course healthcare is special, it's not a normal market because of extreme demand inelasticity. Food is special too, but it manages to function as a market because we have a food surplus, a plethora of replacement goods within the food category and it's much less specialized to produce. This doesn't mean that people don't deserve to earn a living. The doctor in the article managed to find a way to make the man's pr…

Emergency medicine is inelastic and not conducive to price shopping and other research. But, what percentage of medicine falls into that category? For example, I currently have a shoulder injury. I'm meeting with an ortho specialist next week. And it will likely require surgery to correct. So, while I "need" the surgery, there's no real hurry. I could take an extra week to meet with several providers and ask about pr…

As another example, I'm very likely going to be switching to a medication that costs $60,000/year for a variety of reasons.

It's slightly elective (my mother has the same issue, but has been okay) but highly probabilistic (my situation could be much worse if I don't take it). There are alternative medications, but they involve injections weekly or daily (which I've been doing), don't cost much less, and produce side effects that make it very difficult to work.

The kicker? The active ingredient is DMF, which I can buy in bulk for 1000x less. I've looked up the pricing, so I feel like I am applying some amount of analysis in determining that it's worth the cost. But it does feel like, even accounting for need to recover expenses of doing medical trials, this is a bit ridiculous.

Re: The Man Who Was Treated for $17,000 Less

#54

Post by to3m »

nether wrote: post #36
zellyn wrote: post #7

Earlier quoted context omitted.

Every time I hear how much Lasik surgery has improved , I'm gladder I haven't let those damned lasers anywhere near my eyes. :-) For the hackernews spin, this trick works for software too - I learned it at my first job, where each client had a different stack and we had to evaluate lots of enterprisey vendors: look at the improvements. The same thing that makes vendors tell you their software will make you toast and…

I'm glad I bit the bullet and got lasik last year. It beats the nonzero risk of eye infection every time I touch my eyes with contact lenses. These problems can cause vision loss and sometimes require eye removal: http://www.webmd.com/eye-health/news/20061010/lasik-surgery-...

I have some solid lenses made out of plastic, held in front of my eyes. "Non-contact Lenses", I suppose you'd call them. Or perhaps, "binocularettes"? Anyway, they're sort of like monocles, but attached to a little frame that fits around my ears and above my nose, keeping the lenses in place. A minor hassle but you soon get used to it.

Ask me on my death bed to be sure - but I'm pretty sure that the risk of eye removal from my non-contact lenses is pretty low. I much prefer it to the creaky old technology of actually putting things in your eye. Progress!

(I used to have some fashioned from pure glass, and they were pretty decent - much more resistant to scratches - but obviously glass comes with a risk of breakage and therefore shards of glass in your eyes. I have to admit that such a thing never actually happened while I had them, though.)

Re: The Man Who Was Treated for $17,000 Less

#55

Post by TDL »

rayiner wrote: post #30

So what do you do if you don't have $3,000 to pay for what can be a life-threatening operation (a hernia)? The Cato Institute answer, let the person die, is economically nonsensical. The economic value of that person's lost labor is almost certainly worth way more than $3,000.

Could you provide the link to where the Cato Institute says that letting the person die is an acceptable option?

Re: The Man Who Was Treated for $17,000 Less

#56

Post by jbooth »

AlisdairSH wrote: post #50
jbooth wrote: post #38

Earlier quoted context omitted.

Of course healthcare is special, it's not a normal market because of extreme demand inelasticity. Food is special too, but it manages to function as a market because we have a food surplus, a plethora of replacement goods within the food category and it's much less specialized to produce. This doesn't mean that people don't deserve to earn a living. The doctor in the article managed to find a way to make the man's pr…

Emergency medicine is inelastic and not conducive to price shopping and other research. But, what percentage of medicine falls into that category? For example, I currently have a shoulder injury. I'm meeting with an ortho specialist next week. And it will likely require surgery to correct. So, while I "need" the surgery, there's no real hurry. I could take an extra week to meet with several providers and ask about pr…

Non-emergency medicine, also inelastic.

There's no hurry on your shoulder surgery, but there's also no point at which you say "Geez, at that price I'd rather not", like it's iMax tickets for Iron Man 3. Maybe there's a point at which you literally can't make it happen and are forced to live with it but it is not a Normal Good with Econ 101 supply/demand curves.

I guess that one could contend that our current f'd up situation is a random historical accident rather than a somewhat predictable outcome from treating an essential good as a market good. But you certainly can't claim it's a functioning market, for any definition of functioning or market.

Re: The Man Who Was Treated for $17,000 Less

#57

Post by alanh »

baddox wrote: post #31
JohnTHaller wrote: post #29

Earlier quoted context omitted.

His affiliation means his facts and actual investigation of the full story are suspect. His motivation is clear in that it was designed to be an anti-'ObamaCare' piece, which fits right in with the Wall Street Journal/Fox News/Murdoch's mission. Just as the facts and full story would be suspect in a pro-ObamaCare piece on MSNBC or Daily Kos.

> His affiliation means his facts and actual investigation of the full story are suspect. That is one of the most blatant statements of a textbook fallacy I've seen in a while. The affiliations and motivations of the arguer do not affect the trueness of facts or the validity of arguments.

I knew I’d see this comment before I opened the HN discussion. Yes, it is fallacious to reject arguments to do the source. No, it is not unreasonable to use known facts about a speaker to weight the trust placed into their statements!

Re: The Man Who Was Treated for $17,000 Less

#58

Post by millstone »

JohnTHaller wrote: post #37
bmmayer1 wrote: post #22

Earlier quoted context omitted.

Just because he is allied with the Koch brothers doesn't mean he's wrong.

But it does mean his facts are more likely to be wrong. Or lacking the full story and the other facts that disprove his point and are conveniently left out. Remember, the Cato Institute (Koch brothers) and News Corporation (Murdoch) are intentionally biased organizations that design studies and stories to make specific points that further their agenda. This anti-'ObamaCare' piece in the WSJ carries about as much weig…

It carries no weight. The article casts aspersions on Obamacare, but does not give a single example of how Obamacare has or will affect this patient.

We are told that this patient chose a low-cost health insurance policy due to his financial situation. He is exactly the sort of person who is likely to benefit from Obamacare when the subsidies kick in.

Re: The Man Who Was Treated for $17,000 Less

#59

Post by turar »

baddox wrote: post #16
bmmayer1 wrote: post #4

"Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care." Sadly, most people forget this. They think that healthcare is somehow immune from the laws of economics, that it is "special."

Many people will unabashedly say that they believe healthcare to be special. It's not uncommon to hear people say that they don't believe profit motive has any place in healthcare. I don't buy it. I don't see how healthcare is any more special than, say, food production (both are obviously vital to health), yet I think most people have come around to recognizing that profit motive is a spectacular way to organize the…

Many people will unabashedly say that they believe fire fighting to be special. It's not uncommon to hear people say that they don't believe profit motive has any place in fire fighting. I don't buy it. I don't see how fire fighting is any more special than, say, food production (both are obviously vital to health), yet I think most people have come around to recognizing that profit motive is a spectacular way to organize the production and distribution of food.

Re: The Man Who Was Treated for $17,000 Less

#60

Post by Ensorceled »

alex-g wrote: post #51
Ensorceled wrote: post #43

Earlier quoted context omitted.

How does that make the article terrible? He's not saying that this is a good thing he's using this as an example of how broken the medical system is. Did you read to the end? Or did you just get annoyed after the first few paragraphs and write this screed?

No, the author's argument is that this kind of negotiation is what ought to happen all the time; his example of brokenness is that insurance rules distort the marketplace and drive up prices. Far from objecting to haggling, he thinks it should happen more often. This is a fairly typical free-market argument. The parent post by munificent advances the counter-argument that patients are not always in a position to hagg…

Ah, I thought of the surgeon wanting a free market similar to car pricing. There's the MRSP that is high but not crazy; you can haggle but, overall, prices would go down so you wouldn't have to haggle in order not to die or go bankrupt ...
Post reply on HN