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

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

#141

Post by maxlybbert » Wed, Dec 19, 2018, 9:54 PM UTC

cronix wrote: post #20

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…

If they told me it would cost $60 for a simple Ibuprofen, I'd get out of bed and walk myself down the pharmacy on the first floor where they are regularly priced (in the SAME building), or send a family member down for that 10 minute walk to save $50 times how many you need to take. The pharmacists know the drugs I'm taking and interactions, yet the Ibuprofen isn't marked up a couple hundred percent.

While my wife was recovering from surgery in Nevada, the surgeon literally said “I can have the hospital give her these pills I’m prescribing her (OxyContin or something similar), but it will cost you a lot less to get them from the pharmacy across the street and give them to her when you go home.”

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

#142

Post by bluGill » Wed, Dec 19, 2018, 9:54 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…

True to an extent, but in any city (100,000 or more people) there will be two hospitals and so the poor can choose which of the two to use. Note that by poor choosing only a small number need to have the practical ability (which is to say the almost middle class) to choose since a hospital will want to attract them and that ups service for everyone even thoose who couldn't reasonably get to the other hospital.

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

#143

Post by briandear » Wed, Dec 19, 2018, 9:55 PM UTC

rootusrootus wrote: post #80

ttcbj wrote: post #24

Earlier quoted context omitted.

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc. My wife is a doctor, and at this point, I think single-payer is the least bad option.

I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have…

The problem with single payer is that it results in shortages. Look at waiting lists for the NHS, especially for mental health or routine surgery. That is a direct consequence of single payer. An unpopular view, but it is a fact.

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

#144

Post by wymy » Wed, Dec 19, 2018, 9:55 PM UTC

mondo9000 wrote: post #118

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…

Meanwhile the EMTs make $12/hr :(

I'm one and make $11/hr.

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

#145

Post by nradov » Wed, Dec 19, 2018, 9:56 PM UTC

drak0n1c wrote: post #48

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

For non-life-threatening ER visits an app that has your insurance info and lists the Doctor prescribed treatments with their itemized cost would be ideal to see before you consent or choose what to do. For those without smartphones, the software can also be in the hospital computers ready to give a print-out. Wouldn't presenting it beforehand drive down costs? I'd be in favor of legislation requiring up-front costs t…

For any ER visit it's generally impossible to predict exactly what treatments will be needed. Minor differences in treatment can cause large price variations. And the hospital won't be able to reliably predict how much the patient has to pay without actually submitting a claim to the insurer.

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

#146

Post by commandlinefan » Wed, Dec 19, 2018, 9:56 PM UTC

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

> if they don't become more transparent it's going to be forced upon them.

Semi-tinfoil-hat conspiracy incoming: I think doctors and hospitals actually want government funded medical care, and are doing some of this to speed that up. Think about it. No more dealing with 100 different insurance companies or sometimes trying to bill uninsured patients: just develop expertise in handling one single government agency, and rake in essentially as much money as you care to have.

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

#147

Post by josho » Wed, Dec 19, 2018, 9:57 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…

Mixing a public option with a private option isn’t that ideal either.

The wealthy with their ability to influence politics will lobby to undermine/weaken the public system to save their tax dollars.

You are better off with one system so that everyone is entitled to the same level of care. We do this with fire/police, same applies to health.

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

#148

Post by mattkrause » Wed, Dec 19, 2018, 9:57 PM UTC

drak0n1c wrote: post #48

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

For non-life-threatening ER visits an app that has your insurance info and lists the Doctor prescribed treatments with their itemized cost would be ideal to see before you consent or choose what to do. For those without smartphones, the software can also be in the hospital computers ready to give a print-out. Wouldn't presenting it beforehand drive down costs? I'd be in favor of legislation requiring up-front costs t…

Ugh, no thank you.

There are a few procedures where a layperson could probably make meaningful decisions. How much anesthesia do you want for a procedure: cheap but uncomfortable, or pricy and painless? Should a specialist go all out to minimize scarring, or are you fine with a mark on your arm.

But for most other things, would you actually be comfortable analyzing the risks, costs, and benefits of treatments on your own? Diagnostic tests too? You're really going to say "I hear what you're saying about a possible stroke. Still, I think the CT is overpriced--and don't even get me started on the MRI—so I'll either pay for a regular old x-ray or we can just see how this numb face/slurred speech thing plays out...."

Also, how is this going to work for malpractice? The first person who opts out of the "expensive" stuff and doesn't make a full recovery is going to raise merry hell. "I KNOW I SAID NOT TO DO IT, BUT YOU EXPLAINED IT BADLY. If only I had known..."

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

#149

Post by darawk » Wed, Dec 19, 2018, 9:58 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…

> Acquiring insurance does nothing to ensure that the facility you visit will accept that insurance.

Does acquiring a credit card ensure that businesses will accept it? When you select your insurance plan, check who accepts it. Problem solved.

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

#150

Post by manfredo » Wed, Dec 19, 2018, 9:58 PM UTC

aidenn0 wrote: post #97

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.

In that article he specifically laid out the scenario of a vaginal birth with no complications.

But the hospital doesn't know if the birth is going to be uncomplicated until it actually happens. If the hospital gives out only a projected price, then it could lure people into false sense of security. A non binding price is effectively ad worthless a no price.