Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Congress is set to ban most surprise medical bills

nytimes.com

Post reply on HN
Print view View original

221–230 of 440 posts

Re: Congress is set to ban most surprise medical bills

#221

Post by vkou »

schoolornot wrote: post #216
bfieidhbrjr wrote: post #57

Earlier quoted context omitted.

There's no "market" in healthcare in the US. Long ago, it became illegal to open a hospital without a 'certificate of need' from the State. That's why so many towns have only one hospital - it's a government granted monopoly like cable companies in the 80s. Differential pricing is also illegal. You fly cheap on Sunday at 3am, expensive on Monday at 9am. Healthcare providers are not allowed to charge less when it's ch…

Are most of the costs even accumulated in hospitals? I'd imagine the price gouging certainly is. We arbitrarily restrict the number of MD students so why shouldn't we expect $1000/hr. bills for care?

Every country in the world restricts the number of MD students, bit only the US has truly mind-blowing billing practices, and care costs, and puts the average freshly minted doctor half a million dollars in student debt.

Re: Congress is set to ban most surprise medical bills

#223

Post by darkwizard42 »

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

As someone who is now figuring out how to deal with a 20K charge because one of the surgeons consulted was out-of-network (and EVERYTHING including the anesthesiologist, primary surgeon, hospital care was all in-network)... that last part is the most insane for me...

Before my last surgery they offered me crutches and I asked if that was all covered by my insurance and specifically was it in-network with my provider. Imagine if it wasn't and some poor sap thinks... yes I should take crutches after a leg surgery and gets stacked with a massive upcharge

Re: Congress is set to ban most surprise medical bills

#224

Post by raunakdag »

AlexandrB wrote: post #93
lacker wrote: post #76

Earlier quoted context omitted.

We don't have a free market in health care at all. In a free market you would be able to buy a coronavirus vaccine right now, instead of waiting months to get it for free. We haven't had a "free market" in health care in my lifetime.

Are you suggesting that it's better to distribute the vaccine in a way that keeps those most likely to get it vulnerable for longer (i.e. inefficiently)? What's exactly is the benefit of a free market in a situation where it's less efficient at allocating resources than central planning?

I don’t think he’s suggesting it insomuch as providing an example.

Re: Congress is set to ban most surprise medical bills

#225

Post by ApolloFortyNine »

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

15k for an airlift honestly sounds cheap all things considered, but the surprise out of network doctor is such bullshit it should have been fixed ages ago. It's one thing when you had to go to the ER, but even when your visit was planned they can spring you with that.

Re: Congress is set to ban most surprise medical bills

#226

Post by dragonwriter »

gregario wrote: post #192
kstrauser wrote: post #168

Earlier quoted context omitted.

I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.

It's the regulations / limitations you are proposing that make it possible/likely that a monopoly will form. See Milton Friedman on this. There's basically no example of a monopoly forming outside of government regulation.

> There’s basically no example of a monopoly forming outside of government regulation.

The monopoly on force which defines the state must first form before there can be any government regulation, and thus must inherently form outside of government regulation.

Once that forms, of course, there is virtually no example of anything in human society forming outside of government regulation.

But taking the absence of evidence of how things behave “outside of government regulation” for evidence of ones preferred view of the difference between life under government regulation and without it is rather unwarranted.

Re: Congress is set to ban most surprise medical bills

#227

Post by npmaile »

javajosh wrote: post #220
iaw wrote: post #100

Earlier quoted context omitted.

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…

Yes, it should be "free markets...until the wolves take over the whole system". It's impressive how quickly those profit maximization ideas have caught on, driven by technology (I blame Excel more than anything), and throughout the entire system. The healthcare cash-cow benefits a LOT of people, workers, suppliers, and (especially) administrators at both hospitals and doctors offices. A poor healthcare system is a gr…

I think the argument you are responding to is not the one the previous user presented. This issue isn't that people are trying to maximize profit leading to issues. The problem is that there is undue government interference in the market leading to all of the negatives that come from people selfishly trying to maximize profit in a cynical way with none of the benefits of people trying to maximize profits by providing a product that people will prefer over the competition.

Re: Congress is set to ban most surprise medical bills

#228

Post by lostapathy »

cogman10 wrote: post #190
pxeboot wrote: post #184

Earlier quoted context omitted.

Emergency care seems to account for less than 10% of healthcare spending in the US [1]. [1] https://www.annemergmed.com/article/S0196-0644(13)00313-2/ab...

To me, that sort of proves a point. Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending. Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere…

It also doesn't help how insurance handles ER visits.

I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible.

I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all falls to my deductible. (Insurance paid nothing)

So it cost me almost 3x as much to go during the day than it costs during the ER - but my insurance paid out about 6x as much for the ER visit. I wonder how many "ER Abusers" have figured out it's actually cheaper for THEM to go to the ER than "normal doctors"?

Re: Congress is set to ban most surprise medical bills

#229

Post by treeman79 »

iaw wrote: post #100
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…

For actual free market, you would need to get ride of most regulations.

Basically like going to the vet. Or dentist or cosmetic surgery.

Fairly cheap, fine “most” of the time. Sometimes it’s not.

Re: Congress is set to ban most surprise medical bills

#230

Post by throwaway201103 »

cogman10 wrote: post #190
pxeboot wrote: post #184

Earlier quoted context omitted.

Emergency care seems to account for less than 10% of healthcare spending in the US [1]. [1] https://www.annemergmed.com/article/S0196-0644(13)00313-2/ab...

To me, that sort of proves a point. Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending. Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere…

There is a lot of overhead in a hospital ER. You need medical equipment to handle all types of injury/trauma. You need advanced and very expensive diagnostic equipment (e.g. MRI, CT scanners). You need treatment/operating rooms and all the supplies. You need physicians and nurses and supporting staff. You need lab services. All of your patients arrive more more or less at random, unscheduled, so you can't really optimize any of it. It's probably the most expensive way to deliver medical care that you could think of. Even if it's only a minority of the care delivered, it's very expensive to deliver it.
Post reply on HN