What I learned from reading a thousand emergency room bills • Hacker News Board

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

#351

Post by Delmania » Thu, Dec 20, 2018, 1:22 AM UTC

ddebernardy wrote: post #139

y-c-o-m-b wrote: post #28

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad tim…

I'm at a loss as to why the US is still dead set to have no meaningful health coverage. I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday. Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from…

The health insurance industry spends millions in donations to politicians on both sides. So, the reason we have a poor health insurance industry is money.

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

#352

Post by Novashi » Thu, Dec 20, 2018, 1:24 AM UTC

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.

Even if you could flip a switch and go to a free market, that doesn't reset where the current players are, so they will use that going in to insulate themselves and abuse the market.

For pricing, Hospitals/Insurance Co.'s are unwilling to absorb the cost of the statistical chances that something goes wrong or extra labor/things are needed during healthcare. That's why the patient-facing price could be anything and you get an itemized bill.

The only way to get slow-moving and predictable patient-facing prices is to get the hospitals/insurance to absorb these costs.

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

#353

Post by jopsen » Thu, Dec 20, 2018, 1:25 AM UTC

ttcbj wrote: post #248

rootusrootus wrote: post #80

Earlier quoted context omitted.

I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have…

For the record, this is exactly how I feel. They did it to themselves. I really believe in free markets, and I really see the downsides of gov't intervention, but my direct experience with this particular market says we'd be better off with the gov't.

You can still have aspects of a free market..

Correct me if I'm wrong, but Medicare-for-All is just public insurance. It's not a state take over of all private hospitals.

But instead of negotiating a price with you, the hospital will be negotiating with the state. Hospitals can still compete on prices and likely the state will grant contracts for non-urgent services to the cheapest provider..

Modulo, whatever level of free choice is left and what capacity is available, etc..

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

#354

Post by cogman10 » Thu, Dec 20, 2018, 1:26 AM UTC

nordsieck wrote: post #319

xenadu02 wrote: post #318

Earlier quoted context omitted.

Price discovery requires pricing some people out of the market. Period. There is no "free market" healthcare system that can or ever will deliver required health services to everyone. Furthermore when the alternative is death or debilitation, the price a "consumer" is willing to pay is effectively everything they possess and can borrow. That is both a massive distortion and non-optimal for the economy as a whole. The…

> Price discovery requires pricing some people out of the market. Period. There is no "free market" healthcare system that can or ever will deliver required health services to everyone. There is no economic system that can deliver all of the health care to everyone who wants it. Fundamentally, health care resources are limited: doctors, beds, MRI machines, etc. Desire for health care is much less limited. The questio…

"Don't let The Perfect be the enemy of The Good."

We are overspending on the quality of health care we get today. Further there is a lot of fear mongering about socialized medicine.

I've experienced medicine in both the UK and the US. I can tell you, there isn't a difference in quality. Further, when I got a cold and went in, wait time wasn't 6 hours or whatever other BS people claim. Wait time was ~10 minutes. In fact, the time to see a doctor in the US is almost always longer. Why? Because half the time you have to fill out forms and provide proof of insurance and a whole host of other information for them before they will put you on the waiting list.

What did I have to fill out to see a doc in the UK? A card that had my name and current address. Even that, they told me, was optional.

Cheaper medicine for less money is a reality. The only people that lose with socialized medicine are admin and insurance. Everyone else in the nation wins.

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

#355

Post by XorNot » Thu, Dec 20, 2018, 1:29 AM UTC

briandear wrote: post #143

rootusrootus wrote: post #80

Earlier quoted context omitted.

I find myself in the same boat. I've spent more from my HSA this year than I put into it (and I put in $6900) while I'm nowhere near hitting my deductible ($6K) because for whatever reason the insurance only thinks I've spent $2.7K. During this time I've tried to shop around, find the least expensive option (none of my medical needs this year have been urgent) and it's been impossible. Nobody can tell me. "You'd have…

The problem with single payer is that it results in shortages. Look at waiting lists for the NHS, especially for mental health or routine surgery. That is a direct consequence of single payer. An unpopular view, but it is a fact.

I live in a country with single payer (Australia).

I've never had to wait for an elective procedure because I can choose to privately pay for care on a schedule more convenient to me. I have private health cover which tries to compete on this basis.

But if I had any emergency needs, then I'd be treated immediately at any hospital by the public system, which I pay into with taxes. And the waiting list for those elective procedures, if I couldn't afford private care, is a priority list - based on need.

The idea that shortages don't exist in the US is absurd - sure they do, you can't afford critical care then you just don't get it. The US waiting list is infinite.

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

#356

Post by FireBeyond » Thu, Dec 20, 2018, 1:29 AM UTC

JshWright wrote: post #324

FireBeyond wrote: post #290

Earlier quoted context omitted.

Companies like Rural/Metro, traditionally ambulance/EMS companies, have expanded into private fire, in those places (one notable city is Grants Pass, OR).

Rural/Metro is now American Medial Response (they were acquired and all the operations rebranded).

Oh yeah, forgot about that!

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

#357

Post by cgag » Thu, Dec 20, 2018, 1:41 AM UTC

tivert wrote: post #155

cgag wrote: post #67

Earlier quoted context omitted.

I would imagine regulation is a lot of what stops competing on price like everything else.

> I would imagine regulation is a lot of what stops competing on price like everything else. Say again? Unconscious people don't have the agency to make price competition work, regulation or no. You need to be conscious to comparison shop. You also need lots of time to do so, time you don't have when you're having a heart attack or bleeding out from a severe injury. Regulation isn't the problem here, it's the lack of…

Being conscious or not has little to do with inability to comparison shop for healthcare in general. I wouldn't disagree that what you're talking about should be illegal and I would expect it to already be illegal.

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

#358

Post by TheCoelacanth » Thu, Dec 20, 2018, 1:54 AM UTC

minikites wrote: post #349

nordsieck wrote: post #319

Earlier quoted context omitted.

> Price discovery requires pricing some people out of the market. Period. There is no "free market" healthcare system that can or ever will deliver required health services to everyone. There is no economic system that can deliver all of the health care to everyone who wants it. Fundamentally, health care resources are limited: doctors, beds, MRI machines, etc. Desire for health care is much less limited. The questio…

Are you saying that the richest country in the world can't accomplish something that already exists in plain view in some of the poorest countries in the world?

There is no country on earth that gives people all the healthcare they might want with no limits and that is not what we should be aiming for. There are many that give people enough healthcare and that is what we should be aiming for.

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

#359

Post by amalcon » Thu, Dec 20, 2018, 1:55 AM UTC

dv_dt wrote: post #266

krupan wrote: post #242

Earlier quoted context omitted.

Is cost the only measure we want to optimize for?

I think the US has better cancer survival rates in areas than other nations, but if that is all-around significant one would think that would reflect out in better life expectancy overall. However, the US is a huge negative outlier in life expectancy and child mortality with universal healthcare nations outperforming on those measures too. https://ourworldindata.org/the-link-between-life-expectancy-... The most recen…

Life expectancy is a weird stat by which to measure healthcare outcomes. For starters, it responds rather strongly to demographics. E.g. having more males reduces life expectancy holding all else equal. There are many things like this.

Age-adjusted all-cause death rate is the better stat for measuring life-saving outcomes.

Child mortality is certainly a useful stat for its purpose, though.

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

#360

Post by 6t6t6t6 » Thu, Dec 20, 2018, 1:58 AM UTC

ptaipale wrote: post #204

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…

Not everywhere, though. In Denmark, private operators have been handling emergency services since 1926; currently one company (Falck) is handling 65 percent of municipal fire brigades and 85 percent of ambulance services. No particular nastiness has been reported afaik.

Denmark is quite different than US. In terms of size, culture and corruption issues [1].

This works in Denmark because of Denmark, but it's still a system that has obvious weakness.

[1]: https://en.wikipedia.org/wiki/Corruption_Perceptions_Index