Congress is set to ban most surprise medical bills • Hacker News Board

Re: Congress is set to ban most surprise medical bills

#261

Post by unishark » Mon, Dec 21, 2020, 7:24 PM UTC

arcticbull wrote: post #232

npmaile wrote: post #227

Earlier quoted context omitted.

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…

Free markets generally work better the less leverage one party has over another. When the negotiation is "pay up or die" then it's de facto not a free market [1] and the government has a responsibility to step in and address it. The minimum viable remediation is a two-tier system in which the government takes the "or die" out of the conversation. The best approach IMO is single-payer where the government takes the "p…

Personally I've never been told to pay up before receiving treatment at a hospital. Especially when I arrive there unconscious. And Herb Cohen would say once you've received the service, you're actually in a great negotiating position. People actually negotiate hospital bills all the time. Especially in those crazy stories you hear about.

And you need a citation for your claim about when free markets do and don't work.

Re: Congress is set to ban most surprise medical bills

#262

Post by OminousWeapons » Mon, Dec 21, 2020, 7:26 PM UTC

wes-k wrote: post #238

OminousWeapons wrote: post #54

I was working on a health insurance related startup for awhile so I would say I know more than the average person about the space, and even I get surprised on a regular basis by the absurdity in this field. For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. Wh…

You can buy short term insurance. It is outside of the healthcare market place and typically does no cover pre-existing conditions (you have to qualify for it). I actually switched to it 100% as the premiums are way cheaper and I just want insurance against million dollar fees on the low chance I get cancer or I'm in an accident.

Would you mind linking to where you did this?

Re: Congress is set to ban most surprise medical bills

#263

Post by bigwavedave » Mon, Dec 21, 2020, 7:28 PM UTC

mindslight wrote: post #240

thowawayyy wrote: post #210

Earlier quoted context omitted.

I didn't mean to suggest that there shouldn't be the option to freely chose alternative treatment options under a free market model, in cases where you're not happy with what a single payer model would cover. Rather my point was that when you need urgent or critical medical care there should be a baseline assurance of a solution to your predicament as you may not be in a position to shop around. Your analogy with res…

The problem is that we've taken on this hidden assumption that "free market" somehow means that a hospital can create an arbitrary bill for urgent care, and you have no choice but to pay it. That's not really intrinsic to the free market paradigm, but rather an orthogonal corruption pushed via the legal system. In a different thread I pushed the lack of a contract argument, and got back a more fitting legal theory th…

> It was also just a more straightforward example than the overall food market still functioning even though we're all just three weeks away from starvation.

Eh, the overall food market doesn't quite fit as an analogy here. I know I'm not alone when I say I have close to a year of food storage; it's not really the same for surprise healthcare bills.

Re: Congress is set to ban most surprise medical bills

#264

Post by unishark » Mon, Dec 21, 2020, 7:29 PM UTC

dragonwriter wrote: post #226

gregario wrote: post #192

Earlier quoted context omitted.

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 evide…

I think they mean government regulations providing protection from competitors specifically. Not just all possible govt protection that everyone gets including competitors, for example from being robbed or invaded by Russia or whatever.

Re: Congress is set to ban most surprise medical bills

#265

Post by lawn » Mon, Dec 21, 2020, 7:29 PM UTC

matsemann wrote: post #59

dandersh wrote: post #37

Earlier quoted context omitted.

When our youngest was born the nurses (incorrectly) thought his blood sugar was low and had him transferred to a different hospital via ambulance. We were able to fight and get the $2000 bill waived on account of the fact that it was a needless trip. Unfortunately my wife spent the night alone as I was with our son. On a somewhat related note in the span of 10 years the cost to us to deliver our kids doubled. Same ho…

In most of the rest of the western world, the cost of childbirth is mainly the parking fee and snacks from a vending machine while waiting.

In Sweden we stayed at the hospital a few nights with both our sons. The parking was the biggest cost and food for me (my girlfriend got the food for free but I didn't).

Re: Congress is set to ban most surprise medical bills

#266

Post by sebastien_b » Mon, Dec 21, 2020, 7:30 PM UTC

Not being in the US, I have to wonder - Why aren't the personnel at a hospital not considered part of 'in-network' while performing their duties at that hospital?

If being "in-network" is an important thing, it seems like having "out-of-network" personnel is rather deceitful (I would almost say fraudulent).

Re: Congress is set to ban most surprise medical bills

#267

Post by AnthonyMouse » Mon, Dec 21, 2020, 7:30 PM UTC

mattnewton wrote: post #237

treeman79 wrote: post #229

Earlier quoted context omitted.

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.

Even then it would not be truly free because you would need to make decisions in a medical emergency with limited options. It would be like shopping for a dentist with an abscess that could kill you tomorrow.

That would only apply to the 10% of medical costs spent on emergency care. It makes little sense to operate the other 90% based on requirements that don't exist in those cases.

Emergency care is also inherently local. You could operate emergency rooms under the same framework as you do fire departments.

Which doesn't require a national fire department to manufacture the fire extinguishers you buy for your house or repair the damage to your car a week after a car accident.

Re: Congress is set to ban most surprise medical bills

#268

Post by AdrianB1 » Mon, Dec 21, 2020, 7:31 PM UTC

mrlala wrote: post #164

HenryKissinger wrote: post #7

Earlier quoted context omitted.

"‘As I was being eaten, I was thinking about my insurance’: Woman who lost face in bear attack on why she’s voting for Bernie Sanders" https://www.independent.co.uk/news/world/americas/us-electio...

How any of you snakes on here can downvote this is beyond me. I mean, I know who you are. People who have a great job and don't really have to worry about insurance. Or maybe at a university where insurance is probably covered well. So f everyone else, right? I am self employed so I have to worry about paying all this shit myself; 11k family deductible with 40% co-insurance for $1200. Every time my young kids have ha…

I have no great job and I am paying more than 50% in taxes, including health care (not an insurance, but a payroll tax) that I get almost nothing from. That great change described in the article is bringing poor services to everyone, that is the end of it - I saw it in Eastern Europe, I saw it in Western Europe, but people don't want to talk about it. I live in Eastern Europe, decades in a socialist country and decades in a capitalist one, but all with socialized healthcare and that dream of free healthcare for all is an impossible utopia, you just need to think about it to realize.

Re: Congress is set to ban most surprise medical bills

#269

Post by hnracer » Mon, Dec 21, 2020, 7:31 PM UTC

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…

It's good to keep in mind that not all medical services are price inelastic in the sense that ambulance costs or emergency hospital visits are.

GP visits/non-emergency general surgeries/general medicines - just like food, are all necessities for survival, and are all locally price elastic, with the exception of medicines that have regulatory capture - not a free market, such as insulin which is many X the cost in the US because of a government-enforced oligopoly.

This means that no single supplier (whether of food or non-emergency medicine) can raise their prices because consumers have time to find a cheaper alternative. Unless they collude, which is illegal, and impractical for many markets such as GP visits.

For these particular goods, does your view differ, when compared to emergency services which we agree are price inelastic? And if not, how do such services differ to the foods market - holding aside regulatory capture of things such as insulin which we both probably agree is not a good thing?

Re: Congress is set to ban most surprise medical bills

#270

Post by SkyPuncher » Mon, Dec 21, 2020, 7:31 PM UTC

r00fus wrote: post #242

SkyPuncher wrote: post #163

Earlier quoted context omitted.

> I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. FYI, they weren't checking for your ADHD medication. They were likely checking for marijuana. * Marijuana can introduce side effects that basically make it look like you have ADHD * Most ADHD medications are stimulants, they have counter indications wh…

It's that secondary system that really should be transparent, not just the "stated price" which everyone knows is BS.

I agree.

I've had some insight on the other side. I understand why it's the way it is, but as a patient/consumer it's impossible to understand what my healthcare costs are going to be.