Hospitals lift curtain on prices, reveals giant swings for hips, knees and more • Hacker News Board

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#171

Post by refurb » Sat, Mar 13, 2021, 5:47 AM UTC

narrator wrote: post #84

Kaiser is the only non-broken part of the U.S healthcare system. They have never sent me a bill for a surprise out of network anything. Out of network doctors don't work there. All doctors are on salary. You get one bill from one company. No wonder they have been growing like crazy in California.

Kaiser is an integrated provider - both the medical care and insurance so any billing, approvals are all internal.

The only issue I’ve heard is mental health care which is apparently quite lacking at Kaiser.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#172

Post by refurb » Sat, Mar 13, 2021, 5:47 AM UTC

ironmagma wrote: post #160

narrator wrote: post #84

Kaiser is the only non-broken part of the U.S healthcare system. They have never sent me a bill for a surprise out of network anything. Out of network doctors don't work there. All doctors are on salary. You get one bill from one company. No wonder they have been growing like crazy in California.

To say they work is a bit doubtful. Because they are both the insurance and the doctor, there is an incentive for them to find nothing wrong with you.

The incentive is the opposite. Kaiser gets a fixed premium from its patients no matter how much or how little care they get.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#173

Post by refurb » Sat, Mar 13, 2021, 5:52 AM UTC

rscho wrote: post #68

People here comparing medicine with car mechanics don't have the slightest idea of what they're talking about. The US system is in the hands of the administrators. Not docs, not even the govt: administrators, usually belonging to a behemoth (private) company that has immense and intrinsic lobbying power due to the nature of the industry. There can be no shortage of buyers. Well, admins wanting to earn more just have…

No, it’s not private healthcare that’s the issue, it’s the absurd layer of regulations that were developed over the past 70+ years. Typically some inefficiency was addressed with regulation that just created a new inefficiency.

To give you a good example - 340b is a govt regulation that requires drug manufacturers to give a 23% discount off drugs to hospitals that treat a lot of low income patients. Great idea right?

Well, that just incentivized hospitals to buy up standalone oncology clinics, fold them into the hospital and then capture that sweet 23% margin on drugs without actually using it to help low income patients.

As a result there are almost no community oncologists now, they almost all work for hospitals and good luck starting your own clinic now.

Good intentions that just made the problem worse.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#174

Post by nitwit005 » Sat, Mar 13, 2021, 6:16 AM UTC

bane wrote: post #125

The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems. If one were to sit down and try to create the most absurd approach to healthcare that guar…

> The U.S. healthcare system cannot be fixed. Period. Full-stop. The only solution is to nuke it from orbit, pave it over, and start again. It's very easy to point the finger at the conservative party as the one who's screwed it all up, but the other parties are not really putting forward models for successful healthcare systems.

I wouldn't say the Republicans are fully responsible for the state of things, but they can't seem to agree within the party on a basic concept. I recall John Boehner saying he laughed at Republican promises to swiftly repeal the Affordable Care Act, commenting "Republicans never ever agree on health care". And, well, he was proven right.

If you can't unite your party on a big fix, then the only thing you can pass is some sort of limited fix, which tends to just add more complexity to the whole thing over time.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#175

Post by Fomite » Sat, Mar 13, 2021, 6:18 AM UTC

primitivesuave wrote: post #114

I'm the technical cofounder of a mid-sized healthcare startup, and when I start explaining hospital administration to people, I start with this - every person working in your hospital or clinic has no incentive whatsoever for you to emerge healthier. The only goal is to maximize the ratio between the amount your insurance is willing to pay, and the amount of care that is provided. In the case of joint replacement, ea…

The infection control people do, because those won't be reimbursed.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#176

Post by sumedh » Sat, Mar 13, 2021, 6:23 AM UTC

aantix wrote: post #161

gregsq wrote: post #154

Earlier quoted context omitted.

My mother lives in country australia and had pancreatitis it seemed. Hospital, cat and mri’s, spent a week in hospital, sent home, returned after pain returned. More tests, it was decided she should be sent to a larger regional hospital for biopsy. Flew by Lear jet, drove by road home I guess about three hundred miles. Advise was a Whipple procedure. I wasn’t inclined to agree for reasons I won’t go into. I declined…

“Total cost zero”. The cost is never zero. Doctors, nurses, don’t work for free. Infrastructure isn’t maintained without money. It comes from somewhere.

> The cost is never zero.

I dont understand this argument. You literally dont have to pay anything after you come out of the hospital so yes the cost is zero.

You do pay overall for the cost in taxes but so do Americans yet their hospital costs is non zero.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#177

Post by Fomite » Sat, Mar 13, 2021, 6:46 AM UTC

danaris wrote: post #26

kshacker wrote: post #14

Earlier quoted context omitted.

It is not a 'broken mess'. It is an 'engineered mess'. The difference is in intent.

Framing it this way is probably inaccurate, and if inaccurate, unhelpful. From decades of observing the system, it seems extremely unlikely to me that it was deliberately engineered to be this way. Rather, different parts of it grew and changed organically and the parts and changes that benefitted moneyed interests in power stayed, while those that did not were discarded. It does not take a deliberate will behind som…

The Social Transformation of American Medicine is an illuminating read. Much of how we got here came in the form of, essentially, patches on top of patches, some of which were for good reasons, some of which were not.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#178

Post by rscho » Sat, Mar 13, 2021, 6:51 AM UTC

refurb wrote: post #173

rscho wrote: post #68

People here comparing medicine with car mechanics don't have the slightest idea of what they're talking about. The US system is in the hands of the administrators. Not docs, not even the govt: administrators, usually belonging to a behemoth (private) company that has immense and intrinsic lobbying power due to the nature of the industry. There can be no shortage of buyers. Well, admins wanting to earn more just have…

No, it’s not private healthcare that’s the issue, it’s the absurd layer of regulations that were developed over the past 70+ years. Typically some inefficiency was addressed with regulation that just created a new inefficiency. To give you a good example - 340b is a govt regulation that requires drug manufacturers to give a 23% discount off drugs to hospitals that treat a lot of low income patients. Great idea right?…

In my book, the problems begin as soon as the healthcare system is required to be lucrative. And don't tell me not-for-profit hospitals are not lucrative. It would be even worse without regulations. Care providers would illegally organize into cartels (which is of course already happening) and going to see the doc would then really just be like bringing your car to the garage, with all the 'niceties' that go with that. I don't expect to convince any free market proponent, since to really grasp what I mean by all that those people would have to experience the private system from the inside (as I do). Private interests are very much the problem. Healthcare should be a public service.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#179

Post by heavyset_go » Sat, Mar 13, 2021, 6:57 AM UTC

aantix wrote: post #161

gregsq wrote: post #154

Earlier quoted context omitted.

My mother lives in country australia and had pancreatitis it seemed. Hospital, cat and mri’s, spent a week in hospital, sent home, returned after pain returned. More tests, it was decided she should be sent to a larger regional hospital for biopsy. Flew by Lear jet, drove by road home I guess about three hundred miles. Advise was a Whipple procedure. I wasn’t inclined to agree for reasons I won’t go into. I declined…

“Total cost zero”. The cost is never zero. Doctors, nurses, don’t work for free. Infrastructure isn’t maintained without money. It comes from somewhere.

Nobody is under the impression that there aren't costs to care, so your response feels like you're addressing a strawman argument and isn't really insightful.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#180

Post by rscho » Sat, Mar 13, 2021, 6:59 AM UTC

tdeck wrote: post #148

rscho wrote: post #68

People here comparing medicine with car mechanics don't have the slightest idea of what they're talking about. The US system is in the hands of the administrators. Not docs, not even the govt: administrators, usually belonging to a behemoth (private) company that has immense and intrinsic lobbying power due to the nature of the industry. There can be no shortage of buyers. Well, admins wanting to earn more just have…

That's not entirely true; doctors have massive political and financial power. The AMA is run by doctors and has consistently lobbied against government funded healthcare for more than a century. They killed FDR's and Truman's proposals and lobbied hard against Medicare and Medicaid in the 1970s.

Docs have power over their own turf (losing ground to admin every day that passes). They incidentally absolutely do not have power over the billing scheme in it's entirety, especially since healthcare juggernauts like Kaiser have appeared. Today, docs are really a small part of the problem but people stay fixated on them both because of envy and because docs are used as strawmen by big healthcare, whose stakeholders have every reason to reduce docs into slavery. Docs use the AMA to avoid being converted into Amazon warehouse workers? Big surprise.