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

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

#211

Post by krupan » Wed, Dec 19, 2018, 10:30 PM UTC

vec wrote: post #181

bluGill wrote: post #127

Earlier quoted context omitted.

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…

"Employers, quite rationally and of their own free will, choose to offer health insurance as a benefit"

Sorry, it's because of tax breaks, not pure rational free market. All the rest of what you describe are unintended consequences of that non-free-market tax break that seems like such a good idea on the surface.

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

#212

Post by CWuestefeld » Wed, Dec 19, 2018, 10:30 PM UTC

vec wrote: post #116

SlowRobotAhead wrote: post #30

Earlier quoted context omitted.

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?

Because it's not everyone paying for everyone's health care, it's one entity paying for everyone's health care (using funds they get from everyone). That one entity can unilaterally refuse to do business with abusive vendors. They can negotiate for lower prices. They can notice and investigate discrepancies in pricing between similar cases. They are in a position to judge which types of care are and are not cost effe…

They are in a position to judge which types of care are and are not cost effective and can refuse to cover the latter.

That doesn't always work out as well as you might think. A number of years back Medicare told hospitals they'd no longer pay for UTI treatment, unless the provider could prove that the patient had the UTI when they were admitted. This made sense, because hospital-acquired UTI is a big thing.

The thing is, what hospitals had to do to defend against this was to test everybody being admitted to prove that they already had the UTI. So from Medicare's point of view they were saving, but from a broader perspective they were pushing unnecessary costs (unnecessary tests) onto providers which increased the total amount being spent on healthcare.

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

#213

Post by bluGill » Wed, Dec 19, 2018, 10:30 PM UTC

vec wrote: post #181

bluGill wrote: post #127

Earlier quoted context omitted.

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…

You are missing one critical point though: If I through my own free will decide that I want a different plan I need to come up with that $1000 difference that my employer is kicking in for me. If I could get that $1000 back to spend on my own I'd have the ability to choose a $1300 plan instead of the $1200 plan (for $1100 because of the factors you sight), that extra $200 out of pocket is much more affordable than the extra $1200 I have to come up with now. Or maybe I don't want all the perks of my work plan would want a $1000 plan that doesn't cover something in the work plan.

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

#214

Post by pjc50 » Wed, Dec 19, 2018, 10:31 PM UTC

cabaalis wrote: post #57

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…

> 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...

I don't think there are many places outside repressive states where private healthcare is actually banned? Even the UK's extremely centralized NHS runs alongside a private system. It actually has the effect of making the private system cheaper since they don't have to cover everything or everyone.

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

#215

Post by pitaj » Wed, Dec 19, 2018, 10:31 PM UTC

vec wrote: post #181

bluGill wrote: post #127

Earlier quoted context omitted.

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…

> 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.

This is false. Offering insurance as compensation started during WWII when wages were frozen by the government. Employers found other ways of attracting workers.

There is also the fact that employer-provided insurance is almost entirely untaxed. A dollar in direct employer insurance is essentially a dollar directly to healthcare spending. If it goes through to the employee, that's reduced to at most $0.70 due to payroll taxes, and often much lower. This provides and incentive for both employers and employees to prefer employer-provided insurance.

Compared to these, the effects you described are negligible.

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

#216

Post by pjc50 » Wed, Dec 19, 2018, 10:32 PM UTC

ams6110 wrote: post #206

PhasmaFelis wrote: post #130

Earlier quoted context omitted.

> I think there's merit to investigating public health care. That line stops for me in eliminating private care. Has anyone proposed that? If not, I'm not sure why you mentioned it. Anyway, I suppose I can see the benefit to private doctors, but if private emergency response services for individuals are popular, then something is fucked, as your link demonstrates. Not saying they should be banned, but they shouldn't…

Yes, many people who advocate for "single payer" intend that to mean eliminating any private-pay option.

Do they? Are you sure? Who? The UK's single payer system coexsists OK with private care. It's not a necessary part of the process.

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

#217

Post by otikik » Wed, Dec 19, 2018, 10:32 PM UTC

thatswrong0 wrote: post #82

tgsovlerkhgsel wrote: post #62

Want to do something about it? Regulate it. Like literally, have some government body write a table: 1 pill of 400 mg paracetamol ............ $0.50 1 pill of 800 mg paracetamol ............ $0.60 prescribing medicine (once per day) ..... $4.32 base fee for an ER visit .............. $200.00 5 minutes of work by an ER physician ... $27.43 etc. and impose that as the maximum price that can be charged. It's not going t…

Shouldn't the max price of services (not things like RX of course) be different depending on the cost of living in that area? You'd need different prices in different areas otherwise the prices might be too expensive in some areas and too cheap in others. If the prices set are too cheap, you might see more people using the ER for non-emergency purposes, which would be bad for the people that need to use the ER for ac…

Universal-Care citizen here. Let me explain how it works. It's definitively not "first in, first served": when you reach the place, you get "pre-examined" by a doctor, who estimates the urgency of your case. Fast, like, in minutes. He assigns you an "urgency level". You then have to wait more or less depending on that. I don't know the exact algorithm they use, but I would assume it's some kind of weighted queue. If you go to ER with a headache, you will have to wait for a long time.

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

#218

Post by vkou » Wed, Dec 19, 2018, 10:32 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.

> Hospitals are required to treat the uninsured, but the government doesn't actually compensate them for that.

What percentage of hospital budgets is lost to this?

If it's anything less then 95%, I don't see how the assistance of an out-of-network nurse could possibly cost $5,000.

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

#219

Post by ncallaway » Wed, Dec 19, 2018, 10:32 PM UTC

ams6110 wrote: post #206

PhasmaFelis wrote: post #130

Earlier quoted context omitted.

> I think there's merit to investigating public health care. That line stops for me in eliminating private care. Has anyone proposed that? If not, I'm not sure why you mentioned it. Anyway, I suppose I can see the benefit to private doctors, but if private emergency response services for individuals are popular, then something is fucked, as your link demonstrates. Not saying they should be banned, but they shouldn't…

Yes, many people who advocate for "single payer" intend that to mean eliminating any private-pay option.

I don't believe that's true.

What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care?

I've never seen one.

In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada.

I've never once spoken with an advocate of single payer who wants to eliminate private pay, private insurance, or private care.

I am also an advocate of single payer, and I wouldn't advocate eliminating any of those things.

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

#220

Post by mulmen » Wed, Dec 19, 2018, 10:33 PM UTC

krupan wrote: post #201

mulmen wrote: post #151

Earlier quoted context omitted.

"Move to a better market" seems like an argument that some local marketplaces have failed. The whole value proposition of the free market is that it improves the available services and prices through competition. If I have to move somewhere else to find a market where this is true then the local market is clearly failing and the free market idea doesn't work. Said another way: Should I then also move when I want to f…

I mean, I know people that moved away from Hawaii precisely because they couldn't afford the milk there. Believe it or not there are people who move into cities because of better fire departments, police departments, etc.

Did they leave Hawaii only because of the price of milk or because staple goods in general were more expensive than other places? In this case the market is working but it is a market where cities compete on cost of living, not milk. In that case moving makes sense.