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

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

#181

Post by vec » Wed, Dec 19, 2018, 10:16 PM UTC

bluGill wrote: post #127

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.

We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere (the same plan I have now for $100/month would cost over $1000/month, but I can't take that $1000/month to anyone else if I don't like my insurance so I accept it). This keeps me from taking a long leave of absence to live off my savings - until I quality for retirement (medicare).…

> We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere

What you are describing are in fact the freest parts of the health insurance market.

Employers, quite rationally and of their own free will, choose to offer health insurance as a benefit because it attracts and retains talent better than other similarly priced incentives. The fact that you're hesitant to take a leave reveals that it's working.

Insurance companies, quite rationally and of their own free will, choose to offer steep discounts to purchasers who buy for a large group of people instead of just one or two. It reduces their marketing costs and gets them a better balance between sick and healthy clients.

You, quite rationally and of your own free will, choose to both accept your employer's offer of discounted insurance and to remain at your position longer than you would otherwise prefer to maintain that insurance coverage. In fact, the only thing you foresee changing the status quo and allowing you to retire at all is when you become entitled to benefits from the state in the form of Medicare.

Nothing in the phrase "free market" implies the resulting equilibrium won't conspire to limit an individual consumer's choices.

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

#182

Post by xixixao » Wed, Dec 19, 2018, 10:17 PM UTC

ThomPete wrote: post #165

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 ill…

Agreeable until the last sentence:

> 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.

US Population: 325 million

US Immigration: 1.5 million (2016)

EU Population: 512 million

EU Immigration: 2 million (2016)

(taken from top Google results)

It's fairly accurate to say that, compared to the US, the whole of EU has a "Scandinavian" model of health-care (ie, states guarantee good health-care services to everyone).

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

#183

Post by vonmoltke » Wed, Dec 19, 2018, 10:18 PM UTC

josho wrote: post #163

wmil wrote: post #109

Earlier quoted context omitted.

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.

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

Including all the non-profit hospitals? What's their motivation?

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

#184

Post by bluGill » Wed, Dec 19, 2018, 10:18 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…

Not enough people actually tried to do what you did, so the high deductible plans didn't provide the desired result.

I think they could, but more people would need to be in them and try to do what you did. It needs to be enough people to eliminate the problem where insurance companies like the system being too complex because then you use them instead of paying for it our of pocket.

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

#185

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

ddebernardy wrote: post #139

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…

The US healthcare system is the equivalent of xkcd's TornadoGuard app.

https://xkcd.com/937/

You only find out just how badly it works when you need it the most.

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

#186

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

newyankee wrote: post #162

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.

IIUC, much of healthcare billing in the US is governed by discrete codes for services performed. I suspect this allows big customers like Federal Gov't & insurers to audit bills easier. In order to either be more specific about the bills or allow less wiggle room, they made these codes remarkably more specific recently (ICD-10 [1]). IMO the descriptions of the items in these codes are humorously specific. Imagine if your auto mechanic got $650/hr for labor, I suppose you would get much more specific invoices for their work too.

[1] https://en.wikipedia.org/wiki/ICD-10

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

#187

Post by berberous » Wed, Dec 19, 2018, 10:21 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.

I think everyone acknowledges the current system is the worst of all worlds. _Both_ the left and the right are correct in my view: (1) single payer universal healthcare or (2) removing a ton of the existing government regulations and forcing healthcare to behave more like a free market, would each be better than the existing system.

I don't think "free market healthcare" is oxymoronic though. It does not seem to me impossible (logically...maybe it's impossible politically) to remove the current incentives that prohibit price discovery and/or enact laws and regulations that incentivize it.

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

#188

Post by james_s_tayler » Wed, Dec 19, 2018, 10:22 PM UTC

newyankee wrote: post #168

quickthrower2 wrote: post #114

Earlier quoted context omitted.

+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 ?

It's fantastic here too. I had a scare recently and called the ambulance, was at the hospital pretty quickly, got an x-ray, stayed overnight, turned out not to be a serious thing but finally figured out what was causing it. No drama and no crazy $100,000 bills. Just healthcare of an acceptable quality when you need it.

There is just no way that any perceived marginal improvement in the quality of care on an individual basis warrants an off chance of maybe being bankrupted. I can't say I've ever found the quality of care of be poor or unacceptable. It's always been available and served me well.

I kind of liken it to being forced to drive an $80,000 BMW as opposed to being provided with a reasonable Toyota that does the job.

The economic experiment has been tried and the US is on the wrong side of it.

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

#189

Post by tangent128 » Wed, Dec 19, 2018, 10:22 PM UTC

manfredo wrote: post #131

Wowfunhappy wrote: post #102

Earlier quoted context omitted.

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…

> With respect to financial responsibility, if the cost of the delivery is a concern...

As the GP noted, if you don't even know the order of magnitude to expect, the cost will always be a concern. The upper bound on the price is in the trillions, after all.

> If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an uncomplicated birth in order to subsidize those that do experience complications.

This function is currently performed by insurance companies; a frequent criticism is that insurance should limit itself to true emergency situations, but when any routine operation can balloon in price unexpectedly, it's not irrational to want its purchase mediated through the insurance provider.

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

#190

Post by krupan » Wed, Dec 19, 2018, 10:22 PM UTC

Let's be careful to not look at one type of health care, emergency care, and generalize to all types of health care. Right now we all (Americans at least) don't really have insurance. We are part of pre-paid health clubs and we try to use the health club membership to pay for everything. For true time-sensitive emergencies we should all have traditional insurance, and yes, the services should probably be supplied, like fire fighting, by non-profit organizations.

Health care that is not time critical should not work like the fire department. In fact, emergency rooms, once they diagnose something as not being an emergency should be able to say, "sorry, this isn't the right place for this, go to a doctors office."

With non-emergency care we should all be able to get price quotes up front, we should be completely aware of our choices and the be able to shop around. We could maybe outsource that to health care clubs like Aetna and UHC if we choose to (knowing that we are getting less choice and that we'll have to deal with those bureaucracies as a trade-off), but there shouldn't be any tax breaks or employee incentives for using those health clubs.

I recently had surgery to have my vision corrected with no "insurance" (or health care club) involved and it was so nice. I shopped around, the doctors all competed for my business and treated me like royalty, there was absolutely no confusion over price, there were financing options available, the technology was cutting edge (or I could have chosen to go less cutting edge and paid less), it was incredibly refreshing. I'd love if most of my health care could be like that.