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

I write about America’s health care system, and I got caught up in it

nakedcapitalism.com

Post reply on HN
Print view View original

131–140 of 143 posts

Re: I write about America’s health care system, and I got caught up in it

#131

Post by refurb »

civilized wrote: post #94
lotsofpulp wrote: post #85

Earlier quoted context omitted.

That is ridiculous. I have not had such blatant negligence / corruption happen to me yet.

The worst part is we only got this service because it was represented to us as free. It was a genetic test that was nice to have but not strictly necessary. We would not have gotten it if we'd known we would be billed $6k. Now I feel like I will have to screenshot and archive every digital representation that is made to us about whether X will be covered and be prepared to initiate a lawsuit over it. In the meantime…

If this is NIPT don’t pay the bill. The companies will write it off.

Re: I write about America’s health care system, and I got caught up in it

#132

Post by Abishek_Muthian »

cmmeur01 wrote: post #18

Used to do these “pre-authorizations” for Humana and wanted to kill myself after a week. Seniors write in about how they’re eating dog food to pay for their medicine, I forward the letter to insurance doctors, who deny it because they “have to try these 3 drugs before you can get what works”. Made me realize this whole country is broken and those at the top are morally bankrupt.

Not just your country, Nothing throws spotlight on how wonderful capitalism has become(/s) like checking out health insurance industry in almost every country without a socialized health-care. Okay may be private-prisons would come close second.

I get denied health insurance policy itself due to my physical disabilities against the local laws and regulations in my country[1]. That includes major International brands.

How can I put this gently, capitalism thinks I'm not worth living or saving.

[1] https://abishekmuthian.com/insurers-are-putting-the-lives-of...

Re: I write about America’s health care system, and I got caught up in it

#133

Post by kemiller2002 »

AuthorizedCust wrote: post #41
kemiller2002 wrote: post #38

Earlier quoted context omitted.

It's because a lot of times the doctors know it isn't going to work on the outset. A number of generics don't work exactly the same. You're punishing the patient and questioning the expert simply for the fact that the insurance company (or the government in the case of geriatrics) might save a few dollars.

That’s exaggerated. Generics are well known to be effective, and exceptions are unusual. Here’s some commentary to that effect, talking about research to the contrary: https://www.health.harvard.edu/staying-healthy/do-generic-dr... It’s reasonable to expect people to exhaust lower cost alternatives, that are reasonably expected to work, before stepping up costs.

My bad. You are correct. I misspoke. What I meant to say that at times generics (and similar drugs, but not generics) won't work as well as the original drug. Not always, but sometimes they just aren't effective in certain circumstances. The doctor may know this, but can't immediately prescribe what is effective in the name of "saving money"

Re: I write about America’s health care system, and I got caught up in it

#134

Post by agumonkey »

nine_zeros wrote: post #91
agumonkey wrote: post #83

Earlier quoted context omitted.

All asian countries ? china ? japan ? india ? Any book about their systems ?

Systems and prices vary between countries. No idea if there's a book but my experience in Indonesia, India and Vietnam was stellar. Working with a medical facility was as simple as doing something in a mall. If you are going from America, you can't go wrong in any major Asian country. India has the benefit of having English speaking doctors.

And how do they implement quality control ?

Re: I write about America’s health care system, and I got caught up in it

#135

Post by BobbyJo »

jatone wrote: post #125
BobbyJo wrote: post #121

Earlier quoted context omitted.

> You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated This account, or at least should account, for a very small minority of interactions with healthcare facilities. Saying that's why the whole market is defunct is recklessly reductionist. > markets don't deal with this situation well. They don't deal with it at all. Imagine if some people needed bread or they'd die, w…

> This account, or at least should account, for a very small minority of interactions with healthcare facilities. sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues. there is a reason preventative medicine is cheaper (…

> sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.

I don't see how that is a congruent thought. The 'sadly it's not' doesn't follow from your statement after. If you are in pain without knowing how serious it is, you would likely get opinions from several doctors. You're not going to walk into the first hospital you find and say "I'll pay anything you ask just fix me."

> the capitalists idea of a market simply doesn't apply to healthcare.

You still haven't made a logically coherent argument as to why it doesn't. The vast majority of healthcare transactions are made between two lucid and consenting parties.

> this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.

That backs my point, right? Those hospitals aren't funded by emergency care either, which means the point about costs being a one sided negotiation while the other party is dying is still inaccurate.

> you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.

I don't think recognizing the limits of a given resource is cruel or immoral, it's reality. Us not having perfectly clean energy is killing us all, but it isn't cruel and immoral, it's a problem that needs solving. If a town can't afford a hospital, and you want to live in a town with a hospital, move, right? I don't see any reason why taxpayers should pay so a small mountain town in the middle of nowhere can have a staff of doctors and nurses to support a population of 100 people. If someone wants to live in the mountains of Oregon, I don't see how we have a responsibility to pay for a medical care facility to follow them up.

Re: I write about America’s health care system, and I got caught up in it

#136

Post by chousuke »

lotsofpulp wrote: post #62
chousuke wrote: post #32

Earlier quoted context omitted.

That's not really a good counterpoint if the non-insured prices are patently insane. How on Earth is it justifiable for insulin to cost 300 dollars? Here it seems to be around 20-40 euros before the deduction you will get from our national health bureau (which can vary from 0% to 100% depending on your diagnosis and the medication you need.) On top of the national mandatory health insurance, there's also optional pri…

Is it 20 to 40 euros for any and all insulin or specific insulins?

Didn't look that closely; there seems to be variance depending on how large an individual dose is and how many doses are included. I suppose the "price of insulin" is ill-defined without mentioning the dosage.

Re: I write about America’s health care system, and I got caught up in it

#137

Post by nine_zeros »

agumonkey wrote: post #134
nine_zeros wrote: post #91

Earlier quoted context omitted.

Systems and prices vary between countries. No idea if there's a book but my experience in Indonesia, India and Vietnam was stellar. Working with a medical facility was as simple as doing something in a mall. If you are going from America, you can't go wrong in any major Asian country. India has the benefit of having English speaking doctors.

And how do they implement quality control ?

Who is they? And define quality control.

Re: I write about America’s health care system, and I got caught up in it

#138

Post by agumonkey »

nine_zeros wrote: post #137
agumonkey wrote: post #134

Earlier quoted context omitted.

And how do they implement quality control ?

Who is they? And define quality control.

they, the medical professionals

QC = not dying, not having more side effects ..

when you say pure free market, I'd like to know how you get access to this market and who ensure you're not "selling" bad stuff/practice/ideas

Re: I write about America’s health care system, and I got caught up in it

#139

Post by nine_zeros »

agumonkey wrote: post #138
nine_zeros wrote: post #137

Earlier quoted context omitted.

Who is they? And define quality control.

they, the medical professionals QC = not dying, not having more side effects .. when you say pure free market, I'd like to know how you get access to this market and who ensure you're not "selling" bad stuff/practice/ideas

The medical professionals are bounded by law and medical certifications. That said, the real quality control happens by virtue of the incentive system of free market of millions of patients over many years. Their reputations depend on doing "the right thing" - fix the medical issue, give prevention strategies and keep medical costs as low as possible for the customer.

When a medical professional does "the maybe not completely ethical thing", word spreads and they lose future patients to competition. Business declines. The professional loses standing in the community and current employer would terminate their employment. Future employers need good references. They are socially shunned and have legal proceedings on them.

The doctors there are like chefs in a restaurant. The quality of their work determines their standing and future business. Medical facilities are like restaurants. The quality of their service matters.

One thing to note though is that you want to visit medical professionals in cities and not some rural village doctor. Rural doctors are more likely to have "quality control" issues more as their reputations are not discoverable easily without learning local languages.

Re: I write about America’s health care system, and I got caught up in it

#140

Post by BobbyJo »

syki wrote: post #126
BobbyJo wrote: post #124

Earlier quoted context omitted.

> The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage That last bit is exactly what we're in disagreement about, and I haven't seen a good case for it yet. > In the U.S. system denials of care by insurance companies are not done so another person can get said care True. > They…

Police, most roads, and certain aspects of the legal system are free at the point of usage. It’s bad to have for profit police, court system, and Air Force. Some things ought not be profit driven. It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the…

Ahhh, ok. I see where we are disagreeing. You're assuming some equivalencies in what I'm saying that I do not.

> Police, most roads, and certain aspects of the legal system are free at the point of usage.

Sure, and those generally work well because the overhead is low. The per person cost of all of those services combined is extremely low compared to medical expenses. If giving everyone healthcare cost the same as giving every 911 service, this conversation wouldn't be happening.

> It’s bad to have for profit police, court system, and Air Force.

I think government and the monopoly on violence are generally good so long as the government is democratic, so sure.

> Some things ought not be profit driven

Totally agree. Executions and jails for instance. Anything were the service involves inflicting violence or removing rights is probably better left to a democratically elected organization.

> It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.

You're confusing the role with the action. I think 'being the organization that prioritizes care' can be profitable and ethical. That's different from saying 'an organization should get paid for saying no to someone'. Those are two different things and you're assuming that you can't have the first without the second. The insurance company doesn't make money off 'saying no', it makes money off codifying rules that distribute healthcare and enforcing them on a set of people buying into those rules. When more people are denied they make more money, but they aren't 'denying to make money'. It's a different incentive structure from you're describing. Also, nobody in that scenario is 'denying care' they are denying paying for the care. You're still free to go receive the care and pay for it yourself. You can also find a charity and convince them to pay, or crowd fund. That's actually a benefit of the market driven system: there is no such thing as a 'hard' no.

> I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea.

Totally agree. Having the ability to purchase something is not the same as 'deserving' that something. Two entirely different concepts that live in different systems. One is grounded in the philosophical idea of fairness, and the other in the physical process of voluntary exchange.

> Unfortunately too many Americans embody the Bible’s warning regarding the love of money.

Totally agree here too, as an agnostic, although that's kind of a tangent.

Post reply on HN