What I learned from reading a thousand emergency room bills • Hacker News Board

Re: What I learned from reading a thousand emergency room bills

#121

Post by AmVess » Wed, Dec 19, 2018, 9:47 PM UTC

heavyset_go wrote: post #66

UnpossibleJim wrote: post #26

Earlier quoted context omitted.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

The history of private firefighting is a particularly dirty one. In the past, fire companies would show up and demand payment before putting out fires. If a payment couldn't be made, the company might negotiate the purchase of the burning property at a steep discount. Later, insurance companies hired brigades to only put out fires on insured properties. Fire companies might have fought or sabotaged one another in ord…

I have a vintage fire plaque next to my front door. They were commonly issued long ago to show that insurance has been purchased. No plaque, no service.

Re: What I learned from reading a thousand emergency room bills

#122

Post by Wowfunhappy » Wed, Dec 19, 2018, 9:47 PM UTC

pitaj wrote: post #60

vec wrote: post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

Emergency situations are exactly what insurance is for. Emergencies account for a minority ( Nobody advocating for free market healthcare is expecting people to shop around in emergencies. People are expected to shop around for good insurance plans which will cover emergency situations to their satisfaction. That is why many free market healthcare supporters also support removing the incentives for employer-provided…

> That is why many free market healthcare supporters also support removing the incentives for employer-provided insurance plans

Among people who support "free market healthcare", who specifically is seriously pushing a plan like this? It is not something I've seen before.

Re: What I learned from reading a thousand emergency room bills

#123

Post by cogidub » Wed, Dec 19, 2018, 9:47 PM UTC

tschwimmer wrote: post #84

I'm surprised to see lots of people in the comments talking about line items. Line Items are irrelevant. They could include line items for oxygen and toilet paper if they wanted to. The hospital charges whatever the market (and where applicable, regulations) allow. The configuration of the line item is pretty much a customer service problem: 'how do we show what we've done in a way that will get the customer to pay i…

There is an issue with what I'll call the "consumer-market" theory in emergency healthcare in that there is no transparency in pricing at time of purchase or prior to purchase.

How can markets function without price-transparency?

Re: What I learned from reading a thousand emergency room bills

#124

Post by rhexs » Wed, Dec 19, 2018, 9:47 PM UTC

daniel_iversen wrote: post #77

It makes me sad that there are places in the world where people have to pay to go to an emergency doctor. I know it’s a political hot topic but all that aside doesn’t most people deep down inside think that every fellow human should have the right to free doctor?

Okay, sure, I agree in general, but how far do we go with this?

Does every other human have the right to extraordinarily expensive, often unproven cancer treatments only available at research institutions in the United States? Are we willing to start making cost based decisions on who should die (i.e. should we really be spending hundreds of thousands of dollars keeping those above 90 alive for age related illnesses?)

Everyone will want everything free, but for this to work you have to make uncomfortable decisions. If you put nothing into the system, how much should you get out? Should others with more resources then be able to then buy private insurance for access to better care even though that sounds "unfair"?

Everyone always glosses over these fun questions when they talk about universal health-care systems.

Re: What I learned from reading a thousand emergency room bills

#125

Post by dv_dt » Wed, Dec 19, 2018, 9:48 PM UTC

dragonwriter wrote: post #74

dv_dt wrote: post #69

Earlier quoted context omitted.

It works in 36 out of 37 modern OECD nations, with the US paying the most, and more than double all the other nations which have the government negotiate a better price. Even in our own VA system, their negotiated prices are lower for drugs than the Medicare part D program, barred from negotiating (and with large pieces managed by private companies). I think your skepticism should primarily be directed to wondering i…

> It works in 36 out of 37 modern OECD nations The rest of the OECD has universal healthcare, but not necessarily fully public healthcare (the model vary considerably.) Which just means that there are lots of good proven models that the US could adopt.

There are lots of good models which all have in common a strong gov't negotiated price control somewhere in a system driven by universal healthcare principles instead of profit and market oriented principles.

Re: What I learned from reading a thousand emergency room bills

#126

Post by Verdex_3 » Wed, Dec 19, 2018, 9:48 PM UTC

duxup wrote: post #39

tivert wrote: post #25

Earlier quoted context omitted.

> But it is unfair to have no idea what costs you are facing and whether any of those costs are out of network on your insurance. It's practically impossible to make an informed economic decision about truly emergency medical care without heavy regulation. It's not uncommon to be literally unconscious while all the care decisions for you are being made by others. See this article for an example: some uninsured woman…

Anecdotal illustration time: Both my kids were born early. The medical bills for both totaled (with hospital stays for babies and mom) north of 100k each, the second WAY north. Both involved situations that were "emergency" type situations. We couldn't shop around, we couldn't even sign anything. We trusted the hospitals and doctors and went from there. Fortunately I had good insurance, if for some reason I had to pa…

I think pregnancy and labor is what's going to finally break the camel's back.

Having children is a pretty basic part of being human. And the costs are such that even millionaires are going to feel it. When basically nobody can afford to participate in reproduction, something is going to go sideways.

With my "good" insurance, I still ended up with a multi-thousand dollar deductible. Which I thought was problematic until I started hearing about people who have high deductible plans that only make you pay 20% after hitting your deductible.

For a 100K bill, 20% is still absurd and especially after you've already paid $2-10K out of pocket.

Re: What I learned from reading a thousand emergency room bills

#127

Post by bluGill » Wed, Dec 19, 2018, 9:48 PM UTC

vec wrote: post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere (the same plan I have now for $100/month would cost over $1000/month, but I can't take that $1000/month to anyone else if I don't like my insurance so I accept it). This keeps me from taking a long leave of absence to live off my savings - until I quality for retirement (medicare).

In a true free market you would have more choices: most emergencies are close to home so you are likely to know which hospital is a good deal.

Of course there are still the emergency while on vacation, and the sudden collapse where a bystander brings you somewhere which are harder to handle. Though if there really was a free market there is incentive to handle those well - if only because the system is designed for the majority of cases where they have to handle it well or you would have gone elsewhere.

Re: What I learned from reading a thousand emergency room bills

#128

Post by krupan » Wed, Dec 19, 2018, 9:48 PM UTC

ncallaway wrote: post #117

pitaj wrote: post #60

Earlier quoted context omitted.

Emergency situations are exactly what insurance is for. Emergencies account for a minority ( Nobody advocating for free market healthcare is expecting people to shop around in emergencies. People are expected to shop around for good insurance plans which will cover emergency situations to their satisfaction. That is why many free market healthcare supporters also support removing the incentives for employer-provided…

But, as described in the article that system does not function . Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance. Further, even if the facility you visit does accept the insurance, that's no guarantee that all doctors within that facility accept that insurance. Even further, there's no guarantee you'll be conscious to validate that you go to a facility that accepts yo…

"That system" as described by parent has not been tried, at least not in recent memory. What we see happening now are thousands of unintended consequences from government meddling with the free market.

Re: What I learned from reading a thousand emergency room bills

#129

Post by nradov » Wed, Dec 19, 2018, 9:49 PM UTC

SlowRobotAhead wrote: post #50

Arubis wrote: post #45

Earlier quoted context omitted.

The party responsible for payment (the government, in this case) can tell a billing party "I won't pay you more than ___ for that service, and if you don't like it, you can sue me" without taking on the same risk that an individual would. Lawsuits are a pretty inefficient, high-overhead way to bill out, so billing parties are incentivized to not raise accountants and auditors eyebrows.

I must admit I'm skeptical of the claim that "only government can negotiate a better price"... I think anyone that's worked on government systems knows that is not typically the case. Why wouldn't insurers argue for better prices now?

In most cases it's not a matter of negotiation, it's a matter of law. For many categories of goods and services it's literally illegal to charge any other customer a lower price than you charge the US government. People are in federal prison today for doing that.

Re: What I learned from reading a thousand emergency room bills

#130

Post by PhasmaFelis » Wed, Dec 19, 2018, 9:49 PM UTC

cabaalis wrote: post #57

UnpossibleJim wrote: post #26

Earlier quoted context omitted.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

> You simply don't get to "shop around" for emergency services You do actually, by where you choose to live and also by the services as detailed in [1]. I think there's merit to investigating public health care. That line stops for me in eliminating private care. 1] https://www.theatlantic.com/technology/archive/2018/11/kim-k...

> I think there's merit to investigating public health care. That line stops for me in eliminating private care.

Has anyone proposed that? If not, I'm not sure why you mentioned it.

Anyway, I suppose I can see the benefit to private doctors, but if private emergency response services for individuals are popular, then something is fucked, as your link demonstrates. Not saying they should be banned, but they shouldn't have to exist in a properly-run society.