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

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

#131

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

Wowfunhappy wrote: post #102

manfredo wrote: post #83

Earlier quoted context omitted.

Realistically, no hospital is going to give out a price. They don't know what unexpected complication may arise that requires additional services.

Realistically, how am I supposed to act in a financially responsible manner when I don't even know the order of magnitude a service will cost? Unforeseen complications are not exclusive to the healthcare industry. Imagine if you were trying to build a house, but had no idea how much it would cost. "Realistically, no construction company will give out a price; they don't know what unexpected complications may arise."…

With respect to financial responsibility, if the cost of the delivery is a concern I don't think the couple in question is financially stable enough to start a family anyway. Even if this proposed change does occur there's a good chance it actually makes the procedure in question more expensive. If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an ucomplicated birth in order to subsidize those that do experience complications.

Not to mention, your analogy to construction works is a good one - but perhaps not in the way you intended. Plenty of construction projects run into complications and experience cost overruns. The only situation in which I can see hospitals giving out prices is in the same context as construction projects. Non-binding estimates that are projections based on prior assumptions, which will change if unexpected situations occur.

In fact the best analogy I've come across is with car mechanics. Fixing a person is like fixing a car. The shop can charge a set rate for labor, and will provide an invoice for parts. In that sense, price is perfect transparent. But even the best mechanics can't predict with certainty what it'll take to fix a car without seeing it first. Who knows when they'll pop open the hood expecting to do a standard operation only to find that the car is messed up way harder than was originally predicted.

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

#132

Post by TheOtherHobbes » Wed, Dec 19, 2018, 9:50 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…

These scams were happening at least as far back as Roman times.

Supposedly Crassus, the richest Roman of his day, made rather a lot of money like this.

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

#133

Post by btilly » Wed, Dec 19, 2018, 9:50 PM UTC

Arubis wrote: post #93

heavyset_go wrote: post #66

Earlier quoted context omitted.

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…

Indeed, this is the origin of the term "fire sale".

I'm pretty sure not. The term "fire sale" refers to selling merchandise that survived a fire and therefore would have associated damage.

However the policy of negotiating for property at bargain basement prices while there was a fire next door was very notably one of the ways that Marcus Licinius Crassus (a political ally of Julius Caesar) enriched his fortune.

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

#134

Post by maxlybbert » Wed, Dec 19, 2018, 9:50 PM UTC

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

As I understand it, the inflated prices are to cover price breaks given to other groups (especially Medicaid, but also Medicare): https://johnhcochrane.blogspot.com/2018/11/cross-subsidies-a... .

Insurance companies generally get “most favored nation” clauses so that they all pay the same price as each other. EOBs show the list price for a service, and the much smaller amount actually paid. The people who really get the short end of the stick are uninsured: they only see the list price and maybe an offer to negotiate.

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

#135

Post by AlexandrB » Wed, Dec 19, 2018, 9:51 PM UTC

thatswrong0 wrote: post #82

tgsovlerkhgsel wrote: post #62

Want to do something about it? Regulate it. Like literally, have some government body write a table: 1 pill of 400 mg paracetamol ............ $0.50 1 pill of 800 mg paracetamol ............ $0.60 prescribing medicine (once per day) ..... $4.32 base fee for an ER visit .............. $200.00 5 minutes of work by an ER physician ... $27.43 etc. and impose that as the maximum price that can be charged. It's not going t…

Shouldn't the max price of services (not things like RX of course) be different depending on the cost of living in that area? You'd need different prices in different areas otherwise the prices might be too expensive in some areas and too cheap in others. If the prices set are too cheap, you might see more people using the ER for non-emergency purposes, which would be bad for the people that need to use the ER for ac…

> If the prices set are too cheap, you might see more people using the ER for non-emergency purposes, which would be bad for the people that need to use the ER for actual emergencies.

The "long wait times" that Canadians sometimes complain about actually address this problem within public healthcare. If you come into the ER for a non-emergency, fine, but prepare to wait 4-6 hours. Every emergency case coming in the door will get placement ahead of you.

Some provinces (e.g. Ontario) address this with phone triage hotlines that help you make a decision about whether to go to the ER, a walk-in clinic, or wait for a doctor's appointment.

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

#136

Post by StreamBright » Wed, Dec 19, 2018, 9:51 PM UTC

ben_jones wrote: post #112

wycy wrote: post #46

Earlier quoted context omitted.

From what I understand (which is honestly not much), I think in cases like this you can contact the hospital and just insist on paying the same amount your insurance would have paid, and they'll often take it. That's just what I hear, though.

My last visit to a hospital it was requested I arrive 30 minutes early to "fill out paperwork". After arriving at the radiology department an office assistant took me into a nearby room and had me sign consent forms and make payment on the spot. Anxious for my exam I signed everything and handed over my debit card. Later on I realized one of the forms cemented acceptance of the debt and guaranteed my full payment of…

Yes it is, there are several factors jacking up the price in the US. There are some good videos on it on Youtube. I was always wondering why people think that it is a free market there. In Europe there are several countries that let you use private and public health insurance (even at the same time) and you can go to any healthcare provider and still get a reasonable price. In my country the private provider "industry" is booming and most lab work can be done in a private manner, usually for a very reasonable price. Most of this is accessible in a week ahead booking time.

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

#137

Post by TheOtherHobbes » Wed, Dec 19, 2018, 9:53 PM UTC

krupan wrote: post #128

ncallaway wrote: post #117

Earlier quoted context omitted.

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.

I think you mean from the "free market" - which is neither free, nor genuinely a market - usurping the good-citizen responsibilities of mature and sane government.

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

#138

Post by vec » Wed, Dec 19, 2018, 9:53 PM UTC

ademup wrote: post #103

cabaalis wrote: post #57

Earlier quoted context omitted.

> 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...

Although most humans are perfectly ambulatory, there are innumerable reasons why they don't get to "choose where to live". Income levels, employment availability, schooling, racial pressure, and many more factors come in to play. Not everyone can physically fit into the best areas. The best areas for emergency services don't necessarily align with the best education (although very high income levels tends to align wi…

> If the private system provides value, it will likely survive.

And if it doesn't survive, good! Industries don't have an inherent right to keep existing if they don't fill some useful function. Refusing to implement an otherwise desirable social program because it might cause an existing industry to become obsolete is far and away the most anti-capitalist argument I see self avowed capitalists make.

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

#139

Post by ddebernardy » Wed, Dec 19, 2018, 9:53 PM UTC

y-c-o-m-b wrote: post #28

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad tim…

I'm at a loss as to why the US is still dead set to have no meaningful health coverage.

I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday.

Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from my local social security.

Adding insult to injury I had a very expensive international health insurance policy owing to my traveling around the world back then. And they didn't cover dental with my plan. I knew they wouldn't. But it was still mind boggling to me in that I never expected a casual procedure that would have cost me €150 at most anywhere in Europe - most of which would have gotten refunded at that - to cost me a whopping $4,500 in the US.

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

#140

Post by kbutler » Wed, Dec 19, 2018, 9:53 PM UTC

Arubis wrote: post #93

heavyset_go wrote: post #66

Earlier quoted context omitted.

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…

Indeed, this is the origin of the term "fire sale".

This appears to be incorrect, and the usual interpretation of "sale of goods damaged in a fire" is the original.

https://www.merriam-webster.com/dictionary/fire-sale