Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls • Hacker News Board

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#231

Post by germinalphrase » Wed, Feb 27, 2019, 6:12 PM UTC

sbov wrote: post #203

tmaly wrote: post #181

Earlier quoted context omitted.

We still cannot get a price list of medical procedures in the US thanks to the antitrust exemption provided in McCarran-Ferguson Antitrust Act of 1945. I think repealing this would be a good start. All other industries are required to provide price lists. My friend went to the ER recently for a sprained thumb. They wrapped it in some bandage and he got a bill for $14,000. His insurance is covering 80% but he is still…

Don't go to the ER for a sprained thumb. Unless its an actual emergency, go to urgent care. I live in a pretty expensive area of California and they still only charge $95 per person they see. And our insurance covers it completely. And rightly so, they would much prefer a $95 bill to a $14,000 one. With kids we go a couple times per year. They definitely have saved us a lot of money and time.

Urgent care also closest. My closes urgent care is open from 8 am - 6 on. The rest close by 8.

Deep cut at 9pm... emergency room is only option.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#232

Post by lotsofpulp » Wed, Feb 27, 2019, 6:13 PM UTC

dragonwriter wrote: post #226

lotsofpulp wrote: post #96

Earlier quoted context omitted.

The unofficial doctors union restricts funding for residency spots, thereby restricting supply of doctors, and keeping their prices high. You can be a doctor in the UK at 24, and in the US, you're at least 30. Insurance companies' profit margins are capped by law, so only reason they would be making more money is if the providers are charging more money.

> The unofficial doctors union restricts funding for residency spots No, they don't, unless “unofficial doctors union” is a misleading way of referring to the US Congress (which has way more lawyers than doctors) which funds many of those spots through Medicare (but also some through the VA.) > You can be a doctor in the UK at 24, and in the US, you're at least 30. You can have an MD, having graduated from high schoo…

I was referring to the Accreditation Council for Graudate Medical Examination being staffed by doctors:

https://www.aafp.org/news/education-professional-development...

https://www.washingtonexaminer.com/thanks-to-doctors-there-a...

You don't need to be at least 30, but since most new doctors are that old, I assume there's a reason that's stopping them from becoming doctors earlier, therefore also restricting supply:

https://www.kaptest.com/study/mcat/how-long-does-it-take-to-...

>One of the greatest concerns for students considering a career in medicine is how much additional education is needed—along with the associated time, effort, and medical school debt.

The timeline can seem daunting. Four years for medical school, a minimum of three years for residency, and a few more if you want to specialize with a fellowship. Combine that with an average starting age of 24 (or 26 for DO—doctor of osteopathic—applicants), and this means the vast majority of medical students don’t become independent physicians until their early 30s.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#233

Post by throwaway5752 » Wed, Feb 27, 2019, 6:15 PM UTC

torpfactory wrote: post #220

throwaway5752 wrote: post #196

Earlier quoted context omitted.

Why did he go to the ER?

Thumb injuries are actually treated very seriously (at least more seriously than you might think) by medical professionals because thumb injuries can have very high consequences for quality of life. You can live a totally normal life without an index finger but a missing or disabled thumb is a much more significant impact.

I know. To elaborate (and reply indirectly to will_brown) I think it's impossible to say how egregious $14k is for billing without knowing how severe a sprain it is and how much they had to do to diagnose it. Maybe he walked out with a bandage, but maybe he got an x-ray or mri? And ERs are expensive because they have to handle anything from a MI, stroke, poisoning, massive trauma, or ID case. If you go to one, you have to pay for use of that very complex facility. Then you pay for diagnostics that they deem necessary. Then you pay for the attending/specialist(s)'s time. A thumb trauma could be super severe and it was probably a good call, and it's great he walked out with a bandage. But I don't think that a $14K er bill is that out of bounds given what they are intended for, nor do I think that a bill needs to be commensurate with treatment rendered.

edit: since this thread is about cancer, I will not reply more because it's OT in pretty fundamental ways. The US healthcare system has massive issues, but I am not sure this particular case relates to the thread or is a great example of the dysfunction in general. A price sheet is not possible for "my thumb really hurts" ... it will depend on a lot of situationally appropriate decisions being made by the attending that cannot be predicted.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#234

Post by justwalt » Wed, Feb 27, 2019, 6:15 PM UTC

rayiner wrote: post #105

This came up last year when it was discovered that Leon Lederman had to sell his Nobel Prize to pay for cancer treatments. But there is more moral complexity to this issue than people appreciate. Cancer treatment is inherently expensive; it just doesn't seem that way in some other countries because the government pays from the outset. But I don't think that's necessarily moral, compared to something like Medicaid, wh…

I would think the average person would feel slimy/predatory buying someone else’s Nobel prize. Unless it’s the case of a friend offering to help out, but then why not just lend the money without the collateral?

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#235

Post by madeofpalk » Wed, Feb 27, 2019, 6:20 PM UTC

throwaway5752 wrote: post #233

torpfactory wrote: post #220

Earlier quoted context omitted.

Thumb injuries are actually treated very seriously (at least more seriously than you might think) by medical professionals because thumb injuries can have very high consequences for quality of life. You can live a totally normal life without an index finger but a missing or disabled thumb is a much more significant impact.

I know. To elaborate (and reply indirectly to will_brown) I think it's impossible to say how egregious $14k is for billing without knowing how severe a sprain it is and how much they had to do to diagnose it. Maybe he walked out with a bandage, but maybe he got an x-ray or mri? And ERs are expensive because they have to handle anything from a MI, stroke, poisoning, massive trauma, or ID case. If you go to one, you ha…

> I think it's impossible to say how egregious $14k is

I live (well, lived. currently in the UK) in Australia, and the concept of a $14k bill for a sprained thumb is so out of my world. I cannot fathom how anyone would find that even remotely acceptable.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#236

Post by mancerayder » Wed, Feb 27, 2019, 6:21 PM UTC

chimeracoder wrote: post #178

cletus wrote: post #138

Earlier quoted context omitted.

Pharmaceutical companies spend way more on marketing than research. If drug companies are willing to sell the exact same drug in Canada or the UK or Germany or France for less than a percent (in some cases) of what they sell it here for then why can't US insurance companies, hospitals and consumers buy it for that price? There's no reason other than an artificial monopoly. You'll note that I didn't say "anywhere" and…

> If drug companies are willing to sell the exact same drug in Canada or the UK or Germany or France for less than a percent (in some cases) of what they sell it here for then why can't US insurance companies, hospitals and consumers buy it for that price? There's no reason other than an artificial monopoly. They're willing to do that because the US is a much larger market than any of those countries. Most pharmaceut…

They're willing to do that because the US is a much larger market than any of those countries. Most pharmaceutical companies - including European companies - make the lion's share of their profits from the US market. If they couldn't, you'd certainly see the costs for essential medicines increase in European countries.

"Willing" is a broken way to look at it. The drug prices are negotiated by the government in the single-payer systems.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#237

Post by lotsofpulp » Wed, Feb 27, 2019, 6:26 PM UTC

nradov wrote: post #208

lotsofpulp wrote: post #96

Earlier quoted context omitted.

The unofficial doctors union restricts funding for residency spots, thereby restricting supply of doctors, and keeping their prices high. You can be a doctor in the UK at 24, and in the US, you're at least 30. Insurance companies' profit margins are capped by law, so only reason they would be making more money is if the providers are charging more money.

There's nothing stopping the government and individual hospitals from boosting funding for residency spots. The AMA isn't doing anything to prevent it.

I assume there's at least some lobbying going on between healthcare industry and keeping the funding limits in place.

https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html

I can't think of any other reason Congress would be restricting this if they were really serious about the bringing down the cost of healthcare. Yes, I don't have concrete evidence, but the setup of the situation provides a very nice plausible deniability angle to all parties.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#238

Post by madeofpalk » Wed, Feb 27, 2019, 6:26 PM UTC

kibwen wrote: post #141

chaosbutters wrote: post #61

Earlier quoted context omitted.

doesn't matter who is president in 2020, if the senate isn't blue. And right now, it doesn't look like the senate will even hit 50/50.

Fortunately (ironically, sardonically), thanks to the precedents being set by the sitting president, future presidents will be free to declare healthcare a national emergency and divert funds away from, say, the defense department in order to pay for it. A slim majority in the senate and a minority in the house won't be near enough to stop them. The current senate dissolves the checks and balances at their own instit…

> future presidents will be free to declare healthcare a national emergency

Well, actually, maybe it is a national emergency? Definitely seems more of an emergency than some wall.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#239

Post by ticviking » Wed, Feb 27, 2019, 6:27 PM UTC

tmaly wrote: post #181

cletus wrote: post #34

In Australia the Leftist government of Gough Whitlam introduced health-coverage-for-all in 1975 with a scheme called Medibank. In 1984 after a couple of governments, Bob Hawke's Leftist government created the Medicare scheme (Medibank became a government provider of private health insurance), which exists to this day. The most interesting stat I ever heard about Medicare was this: prior to Medicare the number one cau…

We still cannot get a price list of medical procedures in the US thanks to the antitrust exemption provided in McCarran-Ferguson Antitrust Act of 1945. I think repealing this would be a good start. All other industries are required to provide price lists. My friend went to the ER recently for a sprained thumb. They wrapped it in some bandage and he got a bill for $14,000. His insurance is covering 80% but he is still…

This!

I've got family in health management and THEY can't reliably figure out what a procedure costs(not even something like a simple statistical characterization) much less what they should charge for it.

Re: Cancer Complications: Confusing Bills, Maddening Errors And Endless Phone Calls

#240

Post by rarecoil » Wed, Feb 27, 2019, 6:28 PM UTC

nradov wrote: post #179

shereadsthenews wrote: post #43

I'd like to know where the patient with the $870 MRI bill was seen. My last MRI was billed at over $7500. Before I started treatment for my brain tumor I got divorced for purely financial reasons and gave all my remaining money to my children. USA is so fucked.

For non-emergency imaging studies it's worth shopping around. Prices really can vary by a factor of 10× between facilities in the same area. For those with private insurance, most major insurance companies offer some sort of cost estimator on their web sites which allow members to see which radiology centers are cheaper. (I do appreciate that this is a bad experience for patients.)

I needed an MRI a few years ago, and my insurance provider actually called me to tell me about insurance-preferred imaging centers, and how much the out-of-pocket cost would be at those centers vs. the one my MRI was initially scheduled at.