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What I learned from reading a thousand emergency room bills

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Re: What I learned from reading a thousand emergency room bills

#301

Post by gnopgnip »

lolsal wrote: post #18

I wonder what healthcare bills would look like if they were itemized so that things like Ibuprofen were literally billed at cost ($0.25 per?) and there were line items for services/labor that captured the real cost of being a medical professional: - Emergency room wait: $0.10 for lights - OTC eyedrops (4 drops): $0.20 - Triage by on-duty nurse: $100 (@ $300/hr) - Consult by on-duty physician: $220 (@ $600/hr) - Late-…

Many ER bills are broken down similar to that now. I was in the ER earlier this year for about 12 hours and there were 30 different line items. The big ones were "part trauma tm response activat" for $26k, "critical care 30-74 min with mo" $5.5k, and a couple related to ct scans. I was only billed $5.92 for ibuprofen 600mg.

Re: What I learned from reading a thousand emergency room bills

#302

Post by ip26 »

maxxxxx wrote: post #296
ip26 wrote: post #289

Earlier quoted context omitted.

Why is this dirty? If you don't pay for fire protection, not even through taxes, why does anyone owe you incredibly hard & extremely dangerous labor saving your house? Firefighting is not a safe profession. (I certainly prefer publicly funded fire service)

" the company might negotiate the purchase of the burning property at a steep discount." This creates the perverse incentive to demand an outrageous price so they can get an property for cheap. Next step would be setting fires to buy even more property.

Without their offer, the market value of the property is zero. Who is going to buy a house that has no fire insurance and is currently on fire? Is a steeply discounted price really outrageous? They might perish in the fire, they might fail to save it. Firefighting back then was no sure thing.

Now, if two crews showed up and bid against each other, things start to get interesting.

Re: What I learned from reading a thousand emergency room bills

#303

Post by ThomPete »

xixixao wrote: post #182
ThomPete wrote: post #165

Earlier quoted context omitted.

The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various ill…

Agreeable until the last sentence: > Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. US Population: 325 million US Immigration: 1.5 million (2016) EU Population: 512 million EU Immigration: 2 million (2016) (taken from top Google results) It's fairly accurate to say that, compared to the US, the whole of EU has a "Scandi…

Scandinavia is different than the rest of europe and they dont have 11 million illegal immigrants too. Belive me i know both places pretty intimately.

Re: What I learned from reading a thousand emergency room bills

#304

Post by root_axis »

merpnderp wrote: post #53
edoo wrote: post #10

Health care is the only industry where the felony laws regarding up front pricing aren't enforced. It was allowed to become a twisted regulatory nightmare where the laws were written by the industry itself utilizing kneejerk methods to obtain profit at the cost of systemic corruption.

And yet it is by far the most regulated industry in the US. Almost as if the more invasive the regulations the more invasive the corruption.

"Regulation" is not a monolith, the specific details of a particular regulation are absolutely essential to evaluating its efficacy. This tendency to suggest that all regulations are bad reflects an ignorant perspective.

Re: What I learned from reading a thousand emergency room bills

#305

Post by ThomPete »

xixixao wrote: post #276
krupan wrote: post #223

Earlier quoted context omitted.

There isn't a single EU health care system. Each country still does their own. Maybe each US state could do their own, but there are huge concerns about freeloader problems since we have unrestricted movement between states in the U.S. From what I've read the systems of European countries are being threatened by the freeloader problem that increase immigration as of late has caused.

There is unrestricted movement in the Schengen area, which is a subset of 21+ states of EU for the past 10 years, with current population of 420 million people. (8+ state for the past 21 years, those 8 states having population of 291 million today) source wikipedia

That doesent mean the healtcare system is the same, its not. Again you probably need to do a little more studying of scandinavia and the EU cause you are getting some fundamentals pretty wrong.

Re: What I learned from reading a thousand emergency room bills

#306

Post by chimeracoder »

ceejayoz wrote: post #198
vonmoltke wrote: post #183

Earlier quoted context omitted.

> Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit. Including all the non-profit hospitals? What's their motivation?

Fancy new buildings, giant endowments, amenities for staff, raising administrator salaries "to retain premium talent", etc. "Non-profit" doesn't mean "can't make a profit".

> Fancy new buildings

Rarely paid for with reimbursement revenues.

> giant endowments

Definitely not paid for with reimbursement revenues.

> amenities for staff

Try cutting these, and see how quickly 1199 SEIU comes down on you.

> raising administrator salaries "to retain premium talent", etc.

Even if you assumed that there were no relationship between the wages paid and the quality of work performed (there is), these are nowhere near big enough to account for the difference. They're also not that far out of line with other countries, either: 25% in the US, compared to 20% in the Netherlands, for example.

But more so than that: they're SG&A expenses, which are further down the balance sheet than the reimbursement revenues. And yet, hospitals actually lose money on the top line for Medicare patients (who represent about 40% of the market). That's the real reason reimbursement rates are raised for private insurers - the private insurers are required (by law) to pay more, and they need to subsidize the sub-COGS reimbursements from the public insurers (Medicare, and to a lesser extent Medicaid).

So no, none of the things you listed actually explain the reason hospitals charge private insurers the rates they do.

Re: What I learned from reading a thousand emergency room bills

#307

Post by ThomPete »

tormeh wrote: post #191
ThomPete wrote: post #165

Earlier quoted context omitted.

The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various ill…

My previous Norwegian employer gave me private health care as a perk. You had to get a recommendation from a government general practitioner first, but after that, it was all private, presumably to get employees back to work faster instead of having them wait for months for an operation. Of course, most people/companies can't be bothered with this, since the government health care is good enough, but paying for priva…

It is but they dont do the complex procedures which is the costly part.

Re: What I learned from reading a thousand emergency room bills

#308

Post by crasch4 »

vec wrote: post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

Price discovery is indeed difficult in the current market. However, the current healthcare market is no where close to a free market.

For example, suppose you wanted to start a hospital that offered price transparency, like the Surgery Center of Oklahoma does. (1)

In thirty-five states and the District of Columbia, you'd first have to acquire a certificate-of-need (CON) from the state healthcare regulators.

In order to get certificate of need, you must prove that the community “needs” the new or expanded service, and existing providers are invited to challenge your application.

Existing hospitals typically don't want new competitors taking away their patients, so they vigorously fight to prevent new CON's from being issued.

For example, Dr. Mark Monteferrante wanted to buy a second MRI machine for his radiology practice in 2003. But it took five years and more than $175,000 in fees to get the certificate. (2)

And conlaws are just one example of perverse effects of state intervention into the healthcare market, from state laws restricting insurance competition, to severe restrictions on new entrants to the medical labor market, to drug monopolies.

(1) https://surgerycenterok.com/pricing/

(2) https://www.modernhealthcare.com/article/20160123/MAGAZINE/3...

Re: What I learned from reading a thousand emergency room bills

#309

Post by Domenic_S »

dv_dt wrote: post #178
heavyset_go wrote: post #66

Earlier quoted context omitted.

The history of private firefighting is a particularly dirty one. In the past, fire companies would show up and demand payment before putting out fires. If a payment couldn't be made, the company might negotiate the purchase of the burning property at a steep discount. Later, insurance companies hired brigades to only put out fires on insured properties. Fire companies might have fought or sabotaged one another in ord…

With our level of inequality, this is coming back. In the last Southern California wildfire, there were reports again of private firefighting groups operating in the Malibu area.

This is a wildly different situation than what the GP was talking about. If you have the means, why wouldn't you hire a private crew? The public crews are there to get the best outcome at a macro level, not to protect your house in particular.

Re: What I learned from reading a thousand emergency room bills

#310

Post by henrikschroder »

rootusrootus wrote: post #264
CWuestefeld wrote: post #202

Earlier quoted context omitted.

In many cases, Medicare doesn't even cover the actual cost to provide the service. The providers make up the shortfall by charging other patients more - including charging uninsured patients a LOT more. So if everybody was covered by Medicare, either the providers would be going bankrupt left and right, or the Medicare reimbursements would have to rise - i.e., the price to the government would increase, and the only…

That is a pretty bold claim, can you cite someone more authoritative than your wife? Kaiser, who has a plausible claim to expertise in this field, puts the overhead cost of Medicare at 2%. The raw number is more like 1.4% but Medicare does get to piggyback a lot of the administrative workload on Social Security so perhaps that is why Kaiser's number is higher. Insurance industry advocates, who are incentivized to pro…

> Things will change dramatically if we eliminate the insurance industry and medical billing field.

It's important to note that this industry is a complete bullshit industry with complete bullshit jobs. Their only job is to say no, to stop money from going out of the insurance companies, in any way possible. That is their entire purpose.

Your medical insurance money props up this industry. Every person working in this industry and receiving a salary, and every person owning shares of companies in this industry receiving profits, are taking money that should have been spent on producing healthcare for themselves.

So however many billions of dollars of revenue this industry makes, we would instantly save most of it by getting rid of this industry.

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