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

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

#191

Post by tormeh » Wed, Dec 19, 2018, 10:22 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…

My previous Norwegian employer gave me private health care as a perk. You had to get a recommendation from a government general practitioner first, but after that, it was all private, presumably to get employees back to work faster instead of having them wait for months for an operation.

Of course, most people/companies can't be bothered with this, since the government health care is good enough, but paying for private healthcare is definitely a non-theoretical option.

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

#192

Post by vkou » Wed, Dec 19, 2018, 10:22 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 :(

Where is all the money going? Does the ambulance have a solid-gold steering wheel?

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

#193

Post by fitzroy » Wed, Dec 19, 2018, 10:23 PM UTC

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…

With Medicaid (in New York, at least) a provider isn't allowed to bill a beneficiary for treatment. It is such a huge stress reliever. I can't figure out how so many people continually fall for the propaganda against single payer / Medicaid/care-for-all.

Source: https://www.nyacep.org/practice-resources-2/resources/practi...

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

#194

Post by marshf » Wed, Dec 19, 2018, 10:23 PM UTC

dv_dt wrote: post #178

heavyset_go wrote: post #66

Earlier quoted context omitted.

The history of private firefighting is a particularly dirty one. In the past, fire companies would show up and demand payment before putting out fires. If a payment couldn't be made, the company might negotiate the purchase of the burning property at a steep discount. Later, insurance companies hired brigades to only put out fires on insured properties. Fire companies might have fought or sabotaged one another in ord…

With our level of inequality, this is coming back. In the last Southern California wildfire, there were reports again of private firefighting groups operating in the Malibu area.

These private firefighters are generally contracted to government agencies. This is the same thing the US government or CALFIRE will do during any Type 1 incident.

The same as a concert promoter hiring off-duty cops.

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

#195

Post by tcoff91 » Wed, Dec 19, 2018, 10:23 PM UTC

Verdex_3 wrote: post #126

duxup wrote: post #39

Earlier quoted context omitted.

Anecdotal illustration time: Both my kids were born early. The medical bills for both totaled (with hospital stays for babies and mom) north of 100k each, the second WAY north. Both involved situations that were "emergency" type situations. We couldn't shop around, we couldn't even sign anything. We trusted the hospitals and doctors and went from there. Fortunately I had good insurance, if for some reason I had to pa…

I think pregnancy and labor is what's going to finally break the camel's back. Having children is a pretty basic part of being human. And the costs are such that even millionaires are going to feel it. When basically nobody can afford to participate in reproduction, something is going to go sideways. With my "good" insurance, I still ended up with a multi-thousand dollar deductible. Which I thought was problematic un…

Usually coinsurance is limited by an 'out of pocket maximum'. So even if something happens where you end up with like 600k in medical bills the most you will pay will be like 8-20k (depending on in-network vs out of network). Which is still insane but not as scary as six-figure medical bills despite being insured.

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

#196

Post by suresk » Wed, Dec 19, 2018, 10:24 PM UTC

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…

I don't think this argument fully makes sense, because there are already separate charges for the services you describe. The physician who sees you will send you a bill, as will the facility.

> I charge clients similarly. I overbid projects that I don't really want to do. If you want me to setup Wordpress for you, I'll charge you out the nose. Granted, you get to accept my fees before I ever send you a bill. It's not a perfect analogy.

A more apt analogy might be you installing a Wordpress plugin that costs $10 for a client, then sending them a bill that looks like this:

$1,000 - Install fee

$1,000 - Plugin license

=========

$2,000 - Total

Then, when the client complains that you sold them a $10 plugin for $1,000, you say "Yeah, well, you weren't just paying for the plugin, you were paying for my time to install it" even though you had an additional charge for the time you spent installing it.

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

#197

Post by ncallaway » Wed, Dec 19, 2018, 10:24 PM UTC

darawk wrote: post #149

ncallaway wrote: post #117

Earlier quoted context omitted.

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.

Is there any chance that facilities that don't "accept" my credit card would be able to:

* Not inform me they don't accept my credit card

* Provide the goods and/or render the services

* Charge my 10 times the standard price for those goods and/or services because my card was not accepted?

No sane person would agree that this would be an acceptable regime for credit cards. Yet it's the world we live in with health insurance.

A "free market" is only effective with price transparency and discovery mechanisms. This is not possible in the current healthcare and insurance system as it exists today.

---

Aside from that, you failed to even engage or address the following points from my earlier comment.

> 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 your insurance.

I think both of those points address and rebut your "check who accepts it" argument. Do you have any response to those?

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

#198

Post by ceejayoz » Wed, Dec 19, 2018, 10:25 PM UTC

vonmoltke wrote: post #183

josho wrote: post #163

Earlier quoted context omitted.

> 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?

Fancy new buildings, giant endowments, amenities for staff, raising administrator salaries "to retain premium talent", etc.

"Non-profit" doesn't mean "can't make a profit".

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

#199

Post by dv_dt » Wed, Dec 19, 2018, 10:25 PM UTC

marshf wrote: post #194

dv_dt wrote: post #178

Earlier quoted context omitted.

With our level of inequality, this is coming back. In the last Southern California wildfire, there were reports again of private firefighting groups operating in the Malibu area.

These private firefighters are generally contracted to government agencies. This is the same thing the US government or CALFIRE will do during any Type 1 incident. The same as a concert promoter hiring off-duty cops.

Ah, I understand that happens, but that's not what I was referring to. I was referring to private homeowners and insurance companies hiring firefighters.

https://www.latimes.com/local/lanow/la-me-ln-private-firefig...

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

#200

Post by ams6110 » Wed, Dec 19, 2018, 10:25 PM UTC

Wowfunhappy wrote: post #122

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…

> That is why many free market healthcare supporters also support removing the incentives for employer-provided insurance plans Among people who support "free market healthcare", who specifically is seriously pushing a plan like this? It is not something I've seen before.

Well I don't have any legislation on the docket anywhere, but I would fully support the complete separation of health insurance from employment compensation. It's just another layer of obfuscation between the consumer and provider in the marketplace.