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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

#421

Post by conanbatt »

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…

> Furthermore when the alternative is death or debilitation, the price a "consumer" is willing to pay is effectively everything they possess and can borrow.

This is also true with food. What keeps the price down is competition, not price controls.

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

#422

Post by conanbatt »

cogman10 wrote: post #354
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…

"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 fa…

Insurance is complicated in the US in no small part because of government intervention.

Starting with the fact that employers pick insurance plans for their employees, eliminating enormous market power: and this happens because the government doesn't tax the money that is spent on insurance plans.

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

#423

Post by conanbatt »

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…

All demand is always infinite: you can always get more. (i.e. I want my cold to be checked out by a panel of CDC experts

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

#424

Post by conanbatt »

crasch4 wrote: post #308
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…

Here here. There is an ideological divide between those that want socialized medicine and those that want a free market.

But what the US has now is neither. And many of the most pervasive problems it has now are very much attributable to current regulations and laws.

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

#425

Post by thisisit »

tokyodude wrote: post #402
cogman10 wrote: post #354

Earlier quoted context omitted.

"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 fa…

I've had different experiences from you. My experience in the UK was wait 90 minutes in a waiting room and when it was finally close to my turn I was told I could only see a nurse and she wasn't allowed to proscribe any medicine so if I wanted to see a doctor I should go down the street to the private doctor. This was in London near Soho. In Japan the first time I went to a doctor it was for stomach pain. He gave me…

> In Japan the first time I went to a doctor it was for stomach pain. He gave me on ultrasound and declared I had hepatitis.

Ultrasound? That is absurd.

I can't speak for UK/US/Japan but in India situation is quite similar. Opaque pricing along with quacks (or maybe genuine doctors) out to milk as much as they can, especially if they know that you have insurance.

A colleague of mine who had stomach pain was told that he had to get his appendix removed. When he refused the doctor actually threatened him with a write-up to ensure that he doesn't receive any insurance money. After the company got involved he was moved to another hospital, only to be told that he had stomach gas.

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

#426

Post by conanbatt »

Wowfunhappy wrote: post #122
pitaj wrote: post #60

Earlier quoted context omitted.

Emergency situations are exactly what insurance is for. Emergencies account for a minority ( Nobody advocating for free market healthcare is expecting people to shop around in emergencies. People are expected to shop around for good insurance plans which will cover emergency situations to their satisfaction. That is why many free market healthcare supporters also support removing the incentives for employer-provided…

> That is why many free market healthcare supporters also support removing the incentives for employer-provided insurance plans Among people who support "free market healthcare", who specifically is seriously pushing a plan like this? It is not something I've seen before.

This was famously denounced by Milton Friedman a long time ago.

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

#427

Post by conanbatt »

fitzroy wrote: post #193
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…

With Medicaid (in New York, at least) a provider isn't allowed to bill a beneficiary for treatment. It is such a huge stress reliever. I can't figure out how so many people continually fall for the propaganda against single payer / Medicaid/care-for-all. Source: https://www.nyacep.org/practice-resources-2/resources/practi...

Well, the bill gets to the tax-payer instead of the patient.

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

#428

Post by conanbatt »

rootusrootus wrote: post #154
briandear wrote: post #143

Earlier quoted context omitted.

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 am skeptical of a causal relationship there. In the United States, approximately 2/3 of healthcare costs are already borne by the government. My parents are both enrolled in Medicare and they are very satisfied. Why would it not work if we just dropped the eligible age for Medicare to zero? Hasn't this been extensively studied recently?

Medicare has 30 million patients and costs about 3% of gdp. Multiply by 10, and you would need to almost double the tax-base to pay for medicare.

I propose the other thought experiment: why doesnt medicare just compete in the market with other insurance plans: it charges X and provides the service. If its truly more efficient it will beat all the rest.

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

#429

Post by conanbatt »

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…

> Having just experienced first world level healthcare in another country and paying for it out of pocket at 1/20th or less of what it runs in the US, I am certain we are getting shafted.

We are, but not by insurance companies. Their profit margins are thin. The issue is hospitals.

Sarah Kliffs idea to reduce the cost of hospitals is price controls: for the government to tell them they cant choose a price, and to ban them from accepting other insurance.

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

#430

Post by conanbatt »

rootusrootus wrote: post #205
dragonwriter wrote: post #161

Earlier quoted context omitted.

> In the United States, approximately 2/3 of healthcare costs are already borne by the government. Less than half; US healthcare spending was around 8.5% GDP public, 8.8% GDP private in 2016. https://www.healthsystemtracker.org/chart-collection/health-...

I've heard the 2/3 number (sometimes a little less, most recently slightly over, 68%) from a few reputable sources recently. At the same time, I generally consider Kaiser pretty reliable. I think the discrepancy comes from what is being included in the total -- all costs, direct payments only, tax subsidies, etc. At least from what research I've done. Even if we take the value to be 50%, my point stands -- the gov't…

You should look into what Kaiser does to its providers. Its pretty grim.
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