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

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

#381

Post by lumost » Thu, Dec 20, 2018, 3:20 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…

That assumes that the desire for health care is unbounded like other consumables.

In reality most healthy individuals want a limited amount of care, sick individuals want the least amount of care required to return them to health - and there are fundamental limits on the amount of care that can be provided to those who are beyond the help of current technology.

As such you would expect a finite level of demand from the economy as a whole if everyone was allowed as much healthcare as they desired. Any attempt at rationing care will both reduce efficiency, and constrain supply - driving up prices. The most market oriented system would leave supply unconstrained and provide universal and automatic coverage allowing more suppliers to enter the market until supply outstrips demand and "prices" naturally fall.

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

#382

Post by dgzl » Thu, Dec 20, 2018, 3:21 AM UTC

Sooo.... It's the hospital's fault healthcare is expensive! (Mostly joking)

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

#383

Post by zinckiwi » Thu, Dec 20, 2018, 3:21 AM UTC

America: where hospitals advertise on the radio.

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

#384

Post by andrewfong » Thu, Dec 20, 2018, 3:31 AM UTC

I'm curious what percentage of costs were covered by insurance. I recently had some genetic testing done and they were pretty open that they charge one lower price if I paid out of pocket and another higher price if insurance covered it. My hunch is that some of the price variation is just from providers magically increasing prices to match whatever the insurer is willing to pay.

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

#385

Post by nonbel » Thu, Dec 20, 2018, 3:34 AM UTC

andrewfong wrote: post #384

I'm curious what percentage of costs were covered by insurance. I recently had some genetic testing done and they were pretty open that they charge one lower price if I paid out of pocket and another higher price if insurance covered it. My hunch is that some of the price variation is just from providers magically increasing prices to match whatever the insurer is willing to pay.

Yes, it is called the "chargemaster":

https://news.ycombinator.com/item?id=18722182

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

#386

Post by prewett » Thu, Dec 20, 2018, 3:35 AM UTC

fencepost wrote: post #327

bluGill wrote: post #127

Earlier quoted context omitted.

We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere (the same plan I have now for $100/month would cost over $1000/month, but I can't take that $1000/month to anyone else if I don't like my insurance so I accept it). This keeps me from taking a long leave of absence to live off my savings - until I quality for retirement (medicare).…

$1000/month is probably a heck of a plan or in a really expensive market if it's for a single person, and it's probably still decent for family coverage. If it was through the ACA Exchange it's probably also a Gold plan that when you look at maximum out of pocket costs simply loads up the premium rather than the OOP payments.

In California the cheapest plan is about $450/month from the Obamacare marketplace, so I'm not sure $1000/month is going to be that outstanding. And as I understand it, $450/month is about the minimum a plan can cost, since Obamacare outlawed the old high-deductible catastrophic insurance.

Also, I doubt that the average family has $12,0000 of medical bills a year, and would be better off paying out of pocket except for that fact that bills can be randomly expensive.

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

#387

Post by panic » Thu, Dec 20, 2018, 3:36 AM UTC

randyrand wrote: post #375

codemusings wrote: post #7

Despite the fact that in my opinion this could be fixed by Universal Healthcare I'm left wondering: how is it legal to be billed these insane amounts of money without even getting a quote beforehand? Like just waiting in the ER is worth more than buying a first class airplane ticket and getting treated in another country.

Doesnt UHC not solve any underlying problems and just pass the bill onto taxpayers?

These procedures don't actually cost as much as they're billing. The amount becomes much lower when you can collectively negotiate.

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

#388

Post by newyankee » Thu, Dec 20, 2018, 3:57 AM UTC

veb wrote: post #364

newyankee wrote: post #330

Earlier quoted context omitted.

Indeed. I am surprised though because the income taxes in NZ seem to be lower than the quality of healthcare then. Wondering what the catch is.

I've sadly been to hospital via ambulance quite a lot for seizure activity and that kinda carrying on. The biggest bill was when I received my $54 bill for the ambulance! Oh no. (St John is a volunteer ambulance service). So, I went and paid it and then paid them $80 for an annual househould membership - meaning if anyone in my house ever needs an ambulance, it's free! I'm aware however, with the rescue helicopters t…

Wow, the more i read, the more difficult it is for me to believe. At this point i feel that the US healthcare industry is the biggest rent extraction industry in the world and they try to get away with it to the extent they can with every stakeholder blaming someone else.

I have lived here for 9 years and although have paid my insurance diligently i always get anxiety at going to the doctor's office.

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

#389

Post by [deleted] » Thu, Dec 20, 2018, 3:58 AM UTC

xenadu02 wrote: post #318

crasch4 wrote: post #308

Earlier quoted context omitted.

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…

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…

[deleted]

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

#390

Post by sonnyblarney » Thu, Dec 20, 2018, 4:06 AM UTC

lumost wrote: post #381

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…

That assumes that the desire for health care is unbounded like other consumables. In reality most healthy individuals want a limited amount of care, sick individuals want the least amount of care required to return them to health - and there are fundamental limits on the amount of care that can be provided to those who are beyond the help of current technology. As such you would expect a finite level of demand from t…

No, the demand for healthcare is basically infinite.

I got a cold yesterday with a crazy bad sore throat, I thought of maybe popping into the doctor. But it turns out to be just a regular cold. My mother would have 100% gone to the doctor. The clinics here in Canada are chock full of kids with the flu and people coming in 'because'. Maybe that's beneficial due to the risk 'it could be something bad'. Or maybe the economics don't make sense i.e. for really mundane things it's better to just stay home and take Tylenol.

But the demand is super high. Once people cross 50, there are always problems. Always something. And it's all expensive.