The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER • Hacker News Board

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#261

Post by DFHippie » Sat, Nov 20, 2021, 2:17 PM UTC

rsj_hn wrote: post #181

LightG wrote: post #149

Earlier quoted context omitted.

Ok, I'll take all of that at face value and as given. It just sounds completely broken over there and I'm not sure I will manage to wrap my head around it. All I know is simpler systems around the world exist and work such that those 10 middle class families would never get stiffed like that, whilst also looking after the needy. I can't fathom it.

> It just sounds completely broken over there and I'm not sure I will manage to wrap my head around it. Agreed. But that's the way it is, and it's important to understand why it's this way. When Europe and Australia adopted national healthcare systems, the industry was ~3-5% of GDP. So at that point it wasn't politically strong enough to resist either nationalization or strict controls. Then healthcare mushroomed in…

Yes, the healthcare system is politically powerful in the US, but also we have a culture war that has existed since the founding of the country such that half the country considers is highest political priority avenging slights and punishing the other half. Any sufficiently powerful minority can leverage this state of low level war to prevent any legislation that might harm them. Someone wants to prevent hog waste runoff from CAFOs? Inflame the culture war! Medical pricing is out of control? Inflame the culture war! People are being destroyed by payday lending and someone wants to address this? Inflame the culture war! Someone wants to reduce our profits by forcing us to internalize the costs of methane leaks? Inflame the culture war! There are a bunch of people itching to beat up their neighbors. Tell them that the people who want to fix something are their enemies and away they go. That is why the Land of the Free is such a shitshow.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#262

Post by refurb » Sat, Nov 20, 2021, 2:20 PM UTC

boplicity wrote: post #216

refurb wrote: post #51

Earlier quoted context omitted.

Well UCSF charged my brother in law $20,000 for an MRI a private standalone MRI clinic charges $3,000 for. Insurance paid UCSF $16,000 after discount. So I’d say the hospitals definitely are a part of the problem. You can imagine what he did with a fund raising letter he got from UCSF asking for a donation so they could continue to help the community…

> Insurance paid UCSF $16,000 after discount. There you go. The insurance company is actually incentivized to not negotiate a lower price. What if they refuse a ludicrous price? Their customers will complain -- what, what? go without MRIs? Worse -- the insurance company gets to keep 20% of the costs as profit. For a $16,000 bill, that's $3,200. For a $3,000 bill, that's just $600. So why, again, would they fight for…

Not really accurate.

The insurer did negotiate the price down - from $20,000, so a 20% discount.

But yes, UCSF just leverages their name and the desire for insurers to have them in network. Their attitude is basically “no, I won’t go lower, and you’ll pay anyways”.

No, insurance companies don’t keep 20% as profit. They can keep 20% in reserve, the rest has to be paid out as benefits that calendar year. United Healthcare’s profit margin is like 2-4%.

And of course they fight to lower their insurance premiums, that’s how they attract new customers.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#263

Post by pietrovismara » Sat, Nov 20, 2021, 2:22 PM UTC

vadfa wrote: post #228

pietrovismara wrote: post #134

Earlier quoted context omitted.

Public money, that as you might know comes from a variety of sources, including taxes. But to say some taxpayer is paying your "free" treatments is a grotesque simplification.

That means higher taxes, which are undesirable for some.

Then, as someone who doesn't own property, why should I pay taxes that go in police funding just to protect your property? That means higher taxes which is very undesirable for someone who's already near poverty.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#264

Post by Semaphor » Sat, Nov 20, 2021, 2:24 PM UTC

smcleod wrote: post #27

I'm in my mid 30s and have left fixing up some damaged teeth and my large wisdom teeth impacted for 17 years too long, this Monday I'm going to get them removed under general anaesthetic at a private hospital. The Australian government covers hardly any dental unless your teeth have completely rotted through and are chasing other issues. So far my costs are: - $4500 in fillings and general dental. - $1800 for a crown…

Ouch. Germany is pretty bad with dental for public health insurance, but at least necessary basics are covered. So you’d have had to pay for general anesthesia (only local is covered unless deemed necessary), and for the gold crowns (only some cheap and ugly material is covered, same for fillings)

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#265

Post by refurb » Sat, Nov 20, 2021, 2:24 PM UTC

jac241 wrote: post #195

bottled_poe wrote: post #62

Earlier quoted context omitted.

This seems poignant. The cost/benefit analysis does not seem to be aligned with the market. I suspect it’s driven purely by lack of qualified practitioners.

It's not. Physician reimbursement has been going down year over year since the late 90s. Each unit of physician work (relative value units, RVUs) is worth 50% of what it was in 1998 for Medicare at least, and most insurers peg their reimbursement at a specific multiple of the Medicare rate. Sorry, the insurance companies, PBMs, and hospital administration is to blame for the high cost of care, not the physicians who…

If that’s true then why have physicians wages continued to increase for most specialties? Some have stagnated, but I wouldn’t say physicians are underpaid.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#266

Post by pietrovismara » Sat, Nov 20, 2021, 2:25 PM UTC

Broken_Hippo wrote: post #84

nyamada wrote: post #18

My daughter here in France had a bike accident two months ago which requires 14 stitches in her foot. We received 3 follow-up visits from nurses to clean and redress her wounds -- We pay about 100€ a month for supplemental private insurance on top of the public health insurance here -- Total cost for us? about 40€. We would have had to pay about 100€ more for the nurses' visits, but the mutuelle covered it. These are…

These are some of the reasons why my wife and I moved from the US to France -- she's French, I'm American; but I can't imagine returning to the nightmare complexity of billings and profiteering that the US system has become... I'm American and live in Norway. I feel the same. My out of pocket here is around $300, after which a lot of things simply become free. I don't have to consider whether or not I can afford to t…

> My taxes aren't higher than in the US: IN fact, they might be lower than taxes plus insurance premiums - and that doesn't even touch on the deductibles.

I start to think that some people aren't really concerned by the amount they are paying. What they deplore is the idea that some "freeloader" could benefit from their taxes. Even if the net result is that they're spending less.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#267

Post by sheerdried13 » Sat, Nov 20, 2021, 2:25 PM UTC

jonplackett wrote: post #53

Why is the discussion in America always private VS nationalised healthcare instead of just making private healthcare value for money / less insane. Here in the UK we have the NHS which is great. But we ALSO have private insurance / hospitals / healthcare that is reasonably priced.

Australia is the same, and if you decide to get private insurance you get the 2% medicare tax levy taken off your taxable income.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#268

Post by sheerdried13 » Sat, Nov 20, 2021, 2:31 PM UTC

jdub wrote: post #109

One day, probably not very soon, Americans will learn that universal healthcare is freedom.

Not american, so it's kind of insane when I hear talking them wanting to quit there job, but can't because of the health insurance.

Basically being held hostage, either stay at your crappy job, or risk massive debt and bankrupty becaue of medical bills. It's insane this is what's considered "freedom".

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#269

Post by kibwen » Sat, Nov 20, 2021, 2:31 PM UTC

trixie_ wrote: post #205

jjoonathan wrote: post #129

Earlier quoted context omitted.

Our mostly private health care system is twice as expensive as the social systems in other developed countries because the government got involved? By what fraction will the new set of tweaks have to shrink costs to pay for the last 30 years of the private health care market's failure to deliver on its "more efficient" promise? Remember, it has to cut them by 50% just to break even, and it'll have to go further to ma…

There already is a massive public healthcare system in America called Medicare and Medicaid which is the root of distorted prices. The lack of price transparency adds fuel to the fire and allows those prices to stay high without any upfront awareness given to the end consumer.

A lack of price transparency is indeed deplorable, but it isn't the root of the problem. The root of the problem is that demand for emergency treatment is inelastic. Inelastic demand curves result in wildly volatile prices. And when the service is a basic human need rather than a luxury, to prioritize a free market solution is to prioritize the market over the human. Markets must operate for the good of people, not the other way around.

Re: The ER charged him $6,589.77 for 6 stitches, cost that led his wife to avoid ER

#270

Post by pietrovismara » Sat, Nov 20, 2021, 2:32 PM UTC

causi wrote: post #2

Somehow everybody in this system claims they're not the ones making bank on this swindling. The doctors say they're underpaid. The hospital admin says they're underpaid. The insurance companies say they're barely covering their payouts. So who is lying?

It's not secret knowledge at all. Just invested 2 minutes in searching:

> US health insurers report billions in first quarter as small providers face stress

> UnitedHealth Group, reported $4.9bn in profits in the first quarter of 2021 while CVS Health reported $2.2bn

- https://www.theguardian.com/business/2021/may/08/us-health-i...

> Major U.S. Health Insurers Report Big Profits, Benefiting From the Pandemic

- https://www.nytimes.com/2020/08/05/health/covid-insurance-pr...

> The health insurance industry continued its tremendous growth trend as it experienced a significant increase in net earnings to $31 billion and an increase in the profit margin to 3.8% in 2020 compared to net earnings of $22 billion and a profit margin of 3% in 2019.

- https://content.naic.org/sites/default/files/inline-files/20...