Show HN: I mapped US medical prices. Save thousands by driving a few miles • Hacker News Board

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#201

Post by phillmv » Sat, Dec 07, 2013, 9:01 PM UTC

3pt14159 wrote: post #166

thrownaway2424 wrote: post #93

This is cute, but it is based on a flawed premise. There are not "prices" for medical procedures and even the providers don't know what they are going to charge. Anecdata: when my wife was pregnant I asked the hospital what are the basic charges for normal obstetric delivery, since we were paying out of pocket. I got a reply in writing that it was $20k, a suspiciously round number without itemization. The baby comes…

My question is how are they not criminally charged with fraud when this happens? I could understand if this only happens once in a while, that it isn't done intentionally, but it happens all the fucking time, so someone is clearly intentionally doing it. If you hold a man hostage for a month or a year you go to jail for a year or two. If you intentionally overbill a man so that he must work an extra year worst case s…

WELL, if we're talking about INTENTIONALITY then yes the american medical bureaucratic system as evolved obviously singles out the uninsured and proceeds to screw them over.

If we're talking about mens rea, then I doubt it; my wager is tied to how it's in no one's incentive to care that leads to these outcomes. Medical providers are clueless and totally disconnected from administrative functions, hospital billing systems are optimized towards dealing with horrible leviathans that spew sulphur and vomit acid and all of this operates on a scale that makes makes the cost of delivering babies a rounding error.

I'd imagine someone forgot to properly code the procedures/the paperwork isn't set up to give a shit and they were simply charged the default set of procedures.

Blah blah, single payer public systems, blah blah aligning incentives around cost structures, etc. Atul Gawande has a great few articles on this.

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#202

Post by toomuchtodo » Sat, Dec 07, 2013, 9:24 PM UTC

bruceb wrote: post #122

rdtsc wrote: post #112

Earlier quoted context omitted.

Moreover -- ER visits with fake names. I have no moral issues, completely nothing, 0, lying and stealing from the bastards that sell $300 for a bag of saline or $40 for a pill of aspirin. I don't care that nobody pays it, I don't care what complicated laws or accounting tricks are, if that is put on a bill and sent to a person who was just sick or injured, that is wrong. It is criminal. So if you are conscious and ca…

Um this is the reason for Obamacare. People sticking other people with the bill. People will gladly pay $500+ for an iphone but will not spend money on their own health. Yet they expect the hospital to be forced to take them even if the they can pay. Are some hospital charges a ripoff. Oh yes. But they are also open 24 hours a day with highly trained staff ready to try and save your life even if you were doing someth…

Fire fighters. Police. Both do the same job, both paid for by property taxes. Why is a hospital not the same?

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#203

Post by toomuchtodo » Sat, Dec 07, 2013, 9:28 PM UTC

refurb wrote: post #116

toomuchtodo wrote: post #62

Earlier quoted context omitted.

Not a problem My mother is covered by Indiana's medicaid program, as she's at the poverty level but not old enough yet to qualify for Medicare. Her prescription buydown/deductible every month is $550, which I pay for. If you don't mind, I don't want to list specific medications, as it might make it easier to determine her identity. She takes medication for bone mineralization, hormone replacement due to a heart condi…

Ok, I think I understand now. I'm guessing your Mom is slightly above the poverty line? * For people with incomes above 150% FPL, copayments for non-preferred drugs may be as high as 20 percent of the cost of the drug. For people with income at or below 150% FPL, copayments are limited to nominal amounts.[1] * [1] http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By...

They include her husband's income, which is only social security and an extremely small pension that barely covers their food, utilities, mortgage, and property taxes. They don't, of course, take into account his medical expenses in the income calculation.

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#204

Post by potatolicious » Sat, Dec 07, 2013, 9:39 PM UTC

anoncowherd wrote: post #195

rnd33 wrote: post #161

Earlier quoted context omitted.

And people in America stating that healthcare is not free is a rant-trigger for me. Everyone here knows that it's not "free" but subsidised by taxes. That's what "free" means when talking about healthcare, free at the point of service, and free as equally available to everyone. How else would it work? Are the doctors without pay and with no equipment?

It's an important point to make that even "free" healthcare is not actually free - the money has to come from somewhere, and most of it comes from forcefully confiscating it from people. Not only that, but if you're using money, it's much easier to use someone else's money instead of your own, you just won't be too careful about how you spend it. In fact, if you've got a "limitless" supply of other people's money , y…

> "Not only that, but if you're using money, it's much easier to use someone else's money instead of your own, you just won't be too careful about how you spend it."

Sounds logical on paper but doesn't bear out in reality - just about every country where health care is provided via "confiscated funds" pays dramatically less for better outcomes than the USA where people are responsible for spending their own money.

The Parasite(tm) is more bedtime-story boogeyman than observed reality. They exist, but in far fewer numbers than reported, and their effects on the system far less grave than prognosticated.

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#205

Post by mneedham » Sat, Dec 07, 2013, 10:56 PM UTC

clarebear wrote: post #173

thrownaway2424 wrote: post #93

This is cute, but it is based on a flawed premise. There are not "prices" for medical procedures and even the providers don't know what they are going to charge. Anecdata: when my wife was pregnant I asked the hospital what are the basic charges for normal obstetric delivery, since we were paying out of pocket. I got a reply in writing that it was $20k, a suspiciously round number without itemization. The baby comes…

Next time, try a midwife if you and your wife are comfortable with home birth. In the Denver area it runs about $3k for parental care, the birth, and post birth check ups. Also, you don't have to deal with hospitals. I had one of my kids at home with a midwife and I wish it would have been both. If you actually need one, then the midwife will take you to a hospital.

Unless you have one of dozens (hundreds?) of potential complications that can happen during childbirth and you don't make it to the hospital in time. They you've got a dead or severely brain damaged baby and a potentially dead mom. Totally worth it.

And the odds of making it to the hospital in time if you need an emergency c-section or start bleeding out are pretty slim.

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#206

Post by larrys » Sat, Dec 07, 2013, 11:08 PM UTC

thrownaway2424 wrote: post #93

This is cute, but it is based on a flawed premise. There are not "prices" for medical procedures and even the providers don't know what they are going to charge. Anecdata: when my wife was pregnant I asked the hospital what are the basic charges for normal obstetric delivery, since we were paying out of pocket. I got a reply in writing that it was $20k, a suspiciously round number without itemization. The baby comes…

"I got a reply in writing that it was $20k"

What did the reply in writing actually say?

Seems almost as if this was merely a "retainer" paid in advance against the expected cost.

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#207

Post by hotloo » Sat, Dec 07, 2013, 11:14 PM UTC

novalis78 wrote: post #182

hotloo wrote: post #99

Earlier quoted context omitted.

Nice! Me and my friend made this app back in a few weeks ago, and here is the link. http://pricemaps.betterdoctor.com/#/ 1. We used the 'Average Payment' for the actual number shown on the site. 2. Even though it's irrelevant, but it actually goes back to you by your co-pay and other expenses to you. Not 100% sure though. The point in our app is that, we want to compare the price vs quality in the US top hospitals. T…

totally agree! my friend an me started in August on a similar mission http://www.pricepain.com - even tried YCombinator this winter but did not make it. If you checkout our /why section we collected a lot of recent articles and links on the subject

Nice! Looks pretty cool.

How did you get these data? Is there any public source for this? We are using US News Ranking & CMS charge data.

Best, developers behind the BetterDoctor PriceMaps

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#208

Post by 3pt14159 » Sun, Dec 08, 2013, 12:48 AM UTC

phillmv wrote: post #201

3pt14159 wrote: post #166

Earlier quoted context omitted.

My question is how are they not criminally charged with fraud when this happens? I could understand if this only happens once in a while, that it isn't done intentionally, but it happens all the fucking time, so someone is clearly intentionally doing it. If you hold a man hostage for a month or a year you go to jail for a year or two. If you intentionally overbill a man so that he must work an extra year worst case s…

WELL, if we're talking about INTENTIONALITY then yes the american medical bureaucratic system as evolved obviously singles out the uninsured and proceeds to screw them over. If we're talking about mens rea, then I doubt it; my wager is tied to how it's in no one's incentive to care that leads to these outcomes. Medical providers are clueless and totally disconnected from administrative functions, hospital billing sys…

IMO there is a guilty mind somewhere in that hospital. After seeing bill after bill come back wrong and without blowing a whistle / fixing the problem they are obviously accepting that they are lying to a good portion of their client base.

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#209

Post by jgoyette » Sun, Dec 08, 2013, 1:18 AM UTC

jmadsen wrote: post #175

pseingatl wrote: post #150

Earlier quoted context omitted.

It is utterly unfair to complain about errors made by non-native speakers who are making a good faith effort to communicate in English.

Why not? It's not an attack on him personally, but ...why not? Read the rest of his posts. He clearly has a very high level of English, and can state his ideas and opinions clearly. Yet he fell into the same shit-English trap that his friends are all in. My complaint isn't that someone made a mistake. My complaint is that someone who knows better couldn't give a fuck to say it correctly. This is about standards, not…

Why don't we just take this sidebar to Tele's native tongue, Mongolian?

Re: Show HN: I mapped US medical prices. Save thousands by driving a few miles

#210

Post by TaffeyLewis » Sun, Dec 08, 2013, 1:59 AM UTC

potatolicious wrote: post #204

anoncowherd wrote: post #195

Earlier quoted context omitted.

It's an important point to make that even "free" healthcare is not actually free - the money has to come from somewhere, and most of it comes from forcefully confiscating it from people. Not only that, but if you're using money, it's much easier to use someone else's money instead of your own, you just won't be too careful about how you spend it. In fact, if you've got a "limitless" supply of other people's money , y…

> "Not only that, but if you're using money, it's much easier to use someone else's money instead of your own, you just won't be too careful about how you spend it." Sounds logical on paper but doesn't bear out in reality - just about every country where health care is provided via "confiscated funds" pays dramatically less for better outcomes than the USA where people are responsible for spending their own money. Th…

This makes a lot of sense in fact, if for nothing else than the simple reason that most people really don't want to be sick or pretend to be sick so bad that they actually spend a lot of time at a hospital.. They have better things to do.

In Canada, where I'm from, most of the people I know avoid doctors and hospitals unless they really aren't feeling good. They don't want the hassle of waiting and waiting again to see specialists or get a procedure of some kind done.

The canadian socialized system is still really, really slow though for non emergency care but I never believed it was because of parasites wasting hospital resources.