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

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

#161

Post by dragonwriter » Wed, Dec 19, 2018, 10:03 PM UTC

rootusrootus wrote: post #154

briandear wrote: post #143

Earlier quoted context omitted.

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.

I am skeptical of a causal relationship there. In the United States, approximately 2/3 of healthcare costs are already borne by the government. My parents are both enrolled in Medicare and they are very satisfied. Why would it not work if we just dropped the eligible age for Medicare to zero? Hasn't this been extensively studied recently?

> In the United States, approximately 2/3 of healthcare costs are already borne by the government.

Less than half; US healthcare spending was around 8.5% GDP public, 8.8% GDP private in 2016.

https://www.healthsystemtracker.org/chart-collection/health-...

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

#162

Post by newyankee » Wed, Dec 19, 2018, 10:04 PM UTC

lolsal wrote: post #18

I wonder what healthcare bills would look like if they were itemized so that things like Ibuprofen were literally billed at cost ($0.25 per?) and there were line items for services/labor that captured the real cost of being a medical professional: - Emergency room wait: $0.10 for lights - OTC eyedrops (4 drops): $0.20 - Triage by on-duty nurse: $100 (@ $300/hr) - Consult by on-duty physician: $220 (@ $600/hr) - Late-…

Isn't there something like generally accepted accounting principles in healthcare ? Genuine question if anyone knows the answer.

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

#163

Post by josho » Wed, Dec 19, 2018, 10:05 PM UTC

wmil wrote: post #109

andrei_says_ wrote: post #101

Earlier quoted context omitted.

What blows my mind is how a nurse costs $5k for the duration of a surgery. Surely the nurse did not make $5k. Where does this money go?

Hospitals are required to treat the uninsured, but the government doesn't actually compensate them for that. So they jack up everyone else's bills in the hopes that enough people will pay that they'll make a profit. Insurance companies will usually push back, so (sometimes partially) uninsured people with decent credit hit with huge charges.

> So they jack up everyone else’s bills

No. That’s the justification given so that people get angry at the wrong thing.

Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit.

Don’t get angry at the uninsured get angry at the politicians for enabling a broken system.

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

#164

Post by im_cynical » Wed, Dec 19, 2018, 10:05 PM UTC

rhexs wrote: post #124

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?…

We gloss over them because:

1. Your first point about "unproven cancer treatment" has an overly narrow focus on the edge of medical research. These cases are yes something that needs to be addressed, but they are far from the norm of normal medical care.

2. I've never heard anyone ask for anything free related to healthcare. There is very little truly free care in the US. The conversation here is about price transparency and what is considered reasonable.

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

#165

Post by ThomPete » Wed, Dec 19, 2018, 10:05 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.

The problem is that neither models work and both have shortcomings.

In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help.

In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various illnesses and procedures are limited to x amount a year.

Healthcare is a wicked problem cause it's a good thing that it's a profit center in the sense that it provides budgets to do more research and it's a a bad thing because it makes it unreasonable expensive to to not have healthcare.

In the scandinavian model it's a good thing that everyone gets treated (more or less) the same but a bad thing that they don't have as much capital to work with invest in new machines and that there are budgets which limit how much the government will spend on various procedures.

Personally I would like the system to be so that you pay to get normal check-ups, there is no limit to how many doctors are allowed in different parts of the healtcare sector and no one goes bankrupt from getting seriously ill.

That would at least help with some sort of a balance I think.

Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare.

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

#166

Post by darawk » Wed, Dec 19, 2018, 10:05 PM UTC

tclancy wrote: post #158

darawk wrote: post #149

Earlier quoted context omitted.

> 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.

And only have emergencies around there and don't lose consciousness! It's simple math people!

Buy insurance that has good coverage for the places you are likely to be. Why is that a problem?

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

#167

Post by manfredo » Wed, Dec 19, 2018, 10:07 PM UTC

SilasX wrote: post #159

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, no airline is going to give you a price for transit to a destination. They don't know if there will be a terrorist attack or if the baggage handlers on the other end will jack up their rates.

A terrorist attack is an extremely low frequency event to the point is being nearly non-existent. The same cannot be said of birth complications. Baggage handler rates don't change on a dime. Labor rates do affect ticket prices, but they're drastically more predictable.

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

#168

Post by newyankee » Wed, Dec 19, 2018, 10:07 PM UTC

quickthrower2 wrote: post #114

amriksohata wrote: post #44

Brit here, thank God for the NHS

+1. Moved from UK to Australia and it is very similar here too in that most medical care is free. One difference is that the ambulance service charges for residents, and usually it is reasonable priced (but not cheap) but if it turns out you need a helicopter the bill can be quite large! But insurance covers it. For most professionals insurance is very cheap because of the tax saving you get.

any idea how is it in NZ ?

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

#169

Post by MichaelApproved » Wed, Dec 19, 2018, 10:07 PM UTC

wycy wrote: post #46

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…

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.

This is horrible advice. Do not agree to pay a penny of that fraudulent bill. If you didn't agree to the service, you should not be liable to pay.

Call the hospital and demand it be removed from your bill. That's what others[1] (including myself) have done and the fraudulent charge was eventually removed.

The absurd part is that you would even need to do this. How many people don't understand you can fight healthcare charges and get them removed? How many have the free time that it takes to call the billing department over and over?

The whole health insurance system is trash and needs to be replaced.

[1] https://news.ycombinator.com/item?id=18719725

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

#170

Post by jwr » Wed, Dec 19, 2018, 10:07 PM UTC

phyller wrote: post #104

Great article. I think the narrative around health care is often around who has access to good insurance and who doesn't, and as the cost has skyrocketed we have doubled down on that debate. The real problem is that health care providers won't or even can't tell you how much something costs. This has set up this situation where, since money is not part of the decision making process, they just keep raising costs. Ima…

> If we can find a way to bring market forces to bear

I think the problem (also outlined in other comments) is that there are no market forces in the US health services market. There is no pressure to provide less expensive services, no pressure to reorganize, and no reason not to do what is being done now: build a non-transparent system where people get charged arbitrary amounts and prices are not known beforehand.