231–240 of 276 posts
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It's like measuring your penis in millimeters instead of inches to make it longer. Zimbabwe is printing trillion-dollar bills, so everybody there must be rich....
I got to hold one of these Zimbabwean bills the other day. One hundred trillion dollars, IIRC. Pretty cool.
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I am in Bangalore and don't have medical insurance. Paid Rs 300 fee to General Physician for a consultation another 1500 Rs. for a bunch of tests. In my hometown in Bihar the same thing costs Rs 150+500 with excellent doctors. It's not all rosy but it's not that bad.
The only thing I can tell you is to go and get health insurance ASAP. Both for yourself and your dependents. Get one and be safe, one serious illness can bankrupt you these days(actually it always has). But my point is even a week of hospitalization can be pretty expensive. And don't be under an impression you will be able to travel to Bihar or wherever when the need arises. During cases of emergency those are not pr…
The first supposed fact thrown around in the medical costs argument like this is, "Well in India their cost of living is lower, so they charge considerably less, yadda yadda..." but it's obvious the price difference goes way beyond any cost of living gap. That's over $100,000 in price difference, while it is true the cost of living (salary, prices of every day items) in India is considerably less than that of the US,…
I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades , bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home…
I'm glad you're well. How much would it be worth if you'd had to sell your house and/or declare bankruptcy, while knowing that similar-quality treatment was available for 1/20th the price in India and elsewhere?
Not just being snarky. Since leaving corporate America (and the healthcare plan) to start my own thing, I think about healthcare costs a lot. For starters, the lack of transparency or price-competitive marketplace, for such an expensive purchase, is mind-blowing.
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The only thing I can tell you is to go and get health insurance ASAP. Both for yourself and your dependents. Get one and be safe, one serious illness can bankrupt you these days(actually it always has). But my point is even a week of hospitalization can be pretty expensive. And don't be under an impression you will be able to travel to Bihar or wherever when the need arises. During cases of emergency those are not pr…
Agree. The last time I bought health insurance in India, it cost me Rs 2600 ~ $50 for a year for $10000 worth of coverage.
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This is exactly what is wrong with health care in a free market. if you had an operation with a 10% chance of failure for $5000, would you take it? What if you could spend twice the money and cut your risk down to 5% if you quadrupled the expense? $20000, even I'd take that option for you, as an objective observer. what if you could cut it down to 4% for $50000? Ok now it's getting a little silly, but it's still your…
choosing that expense you doom the ones who can not afford it. Do I? Elsewhere in this thread is a post about a surgeon greatly improving the lives of those who cannot afford it by buying a used laparoscopic tool and creatively applying it. I've had laparoscopic surgery; thanks to the high price I & others pay, the laparoscopic instruments used may have replaced the very same one that Indian doctor is using. Far from…
The healthcare market cannot chose to capture deadweight losses. People would view health care professionals treating rich and poor with different medical standards as an abomination. There is no Healthcare basic edition, Home basic, Home premium, Professional, Ultimate. If you raise the general cost of a heart surgery from $50K to $55K, and lower the mortatilty rate from 5% to 4.5%. Does the amount of people you save with that 0.5% worth the amount of people who can't make it to 55K, but could make it to 50K?
Are you sure these numbers are in your favor? Well, I mean, yes of course they're in your favor, I mean everyone, as a whole.
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I've had heart surgery, costing very close to that six-figure the article gives. Every dollar was well spent. Tearing my chest open with a car jack, rendering me dead for most practical purposes, replacing body parts with cyborg components meant to last for decades , bringing me back to life, repairing the extensive damage caused, continuous monitoring for anything that could go wrong for a week, and sending me home…
They brought me back from the dead, how much is that worth? I'm glad you're well. How much would it be worth if you'd had to sell your house and/or declare bankruptcy, while knowing that similar-quality treatment was available for 1/20th the price in India and elsewhere? Not just being snarky. Since leaving corporate America (and the healthcare plan) to start my own thing, I think about healthcare costs a lot. For st…
Yes, health care costs a lot. Miracles are expensive.
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But, in those routine cases, fee-per-service-rendered is pretty much exactly the same as fee-per-outcome, no? I mean, barring malpractice, which already has its own (litigious) path of remediation.
It brings the financial incentives inline with what everyone says the goal is. Fee-for-service incentivizes volume, even if it comes with the consequence of worse outcomes; we simply depend on doctor’s morals to not push it too far, with malpractice and licensing handling truly outrageous abuses. Fee-for-outcome explicitly incentivizes better quality control in a much more fine-grained manner. More on point, fee-for-…
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Not sure what you're trying to say here. You seem to be trying to defend the cost of a $100,000 operation by making a snarky comparison with outsourcing an IT project. Is that actually what you meant?
No, I'm suggesting that HN commenters here are likely far less competent to speculate about the cost structure of heart operations than believe themselves to be. In an analogous situation which they actually understand, the tenor of this comment thread would reverse in a hurry. (Which we could ascribe partly to self interest but in major degree to "Deliver X for the US market in America" and "Deliver X for the Indian…
In my case: U.S. cost structures, sure, I don't know them, though I do speculate and guess, and asked if someone knows of a hospital with transparent enough data.
Uruguay cost structures are a different bag altogether, since they're mostly government-run and they have to make numbers somewhat public. Add to that one of my brothers working in a hospital (he's a few years from graduating as a doctor) and other sources, and I can get an estimate that I hope is correct to an order of magnitude. A relative has been a customer of the Cleveland clinic, so I know the exact number he paid. I also know the exact number another person paid for the exact same surgery here in Uruguay - it was close to one-tenth, and he chose to pay private rather to go through the public institutions (which have huge delays).
Below is a PDF in Spanish, on an investigative piece from a weekly that goes into great detail on the costs of surgery in Uruguay. I'll just quote some basic numbers:
- Fixed fee per major surgery (medical act) UY$ 27.500 / U$ 1300
- Monthly Head Heart Surgeon salary (per hospital) UY$ 263.000 / U$ 12500
- Other heart surgeons, between UY$ 162.500 and 243.000 depending on seniority and other factors - U$ 8.000 to 12.000 range, per month. Those are close to the best salaries anywhere in Uruguay, usually as well trained as any doctor in the U.S.
- Cost to the hospital per major operation (heart surgery), UY$ 206.000 / U$ 10.000
Smaller operations like angioplasty cost UY$ 60.000 / U$ 3.000
The most expensive surgery is heart transplant, which costs UY$ 684.000 / U$ 32000
All those are set by the government, so those ARE the actual costs (well, actually they were in 2008, I didn't adjust by inflation and exchange rate), no insurance or strange stuff involved. The patient is not billed a cent, but there is a huge delay (months usually), and doctors don't really schedule surgery unless it's critical for the person's health (almost no quality of life procedures through the public system).
http://www.semanario-alternativas.info/archivos/2008/5)mayo/...
PD: Surgeons and Anesthesists have tremendous power, and managed to get paid close to ten times the rate of other doctors.
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It's like measuring your penis in millimeters instead of inches to make it longer. Zimbabwe is printing trillion-dollar bills, so everybody there must be rich....
I got to hold one of these Zimbabwean bills the other day. One hundred trillion dollars, IIRC. Pretty cool.
It's not greed, it's a consequence of health insurance. Get rid of health insurance and prices would drop 10x.
"Get rid of health insurance" ... and people would start up health insurance again because it's absolutely needed. Silliest thing read on HN in weeks.
My country has a system that, while bad, sounds absolutely awesome compared to the U.S. . It's a socialist system that is called Mutualism.
The best explanation I could come up with after some Googling is: http://www.hmg.gov.uk/media/60217/mutuals.pdf "Mutual organisations do not have external shareholders - they are controlled by their members. Members may be users of the mutual, employees, other stakeholders or a combination of these Mutual organisations are either owned by and run in the interests of existing members, as is the case in building societies, cooperatives and friendly societies, or, as in many public services, owned on behalf of the wider community and run in the interests of the wider community"
http://en.wikipedia.org/wiki/Mutualism_(economic_theory)
It does have several downsides - mutual healthcare institutions are strongly discouraged from doing any healthcare on non life-threatening situations, waiting lists for surgeries are way too long, there's corruption and doctor bribing and queue-jumping and strikes... but it "works", most people have good healthcare and don't get bankrupt if they need surgery, for just about U$ 100 per month, and their families have coverage too.
PD: see also
http://books.google.com.uy/books/about/Mutualism_and_Health_...