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

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

#441

Post by edanm » Thu, Dec 20, 2018, 8:48 AM UTC

xenadu02 wrote: post #396

thinkloop wrote: post #368

Earlier quoted context omitted.

> There are certainly regulatory inefficiencies and other inefficiencies in healthcare markets, but a truly "free market" in healthcare not morally justifiable Socialized healthcare has its own "immoral" trade-offs. We essentially reduce per capita quality in favor of all-inclusive coverage. Proponents of free-market healthcare would argue that the inefficient allocation of resources inherent to socialization is immo…

> Socialized healthcare has its own "immoral" trade-offs. We essentially reduce per capita quality in favor of all-inclusive coverage That's a false dichotomy; there are many mixed systems where the government provides a baseline level of care with private insurance providing additional services or benefits (eg: government covers a shared hospital room, private insurance covers a private room). >Libertarians would ar…

> True libertarians also argue that all taxation is theft (if they're purists anyway), making road construction immoral.

No, it doesn't make road construction immoral in the eyes of libertarians. It makes taking money from other people, by force, in order to build a road, immoral. People are totally free to build roads privately and pay for it themselves, and even band together to build these roads.

(Part of where the standard libertarian argument falls apart, in my eyes, is that government in many ways really is just a scaled up version of "people banding together to build a road". There are there are legitimate moral/philosophical questions around opt-in vs. opt-out though).

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

#442

Post by mcv » Thu, Dec 20, 2018, 8:52 AM UTC

xenadu02 wrote: post #396

thinkloop wrote: post #368

Earlier quoted context omitted.

> There are certainly regulatory inefficiencies and other inefficiencies in healthcare markets, but a truly "free market" in healthcare not morally justifiable Socialized healthcare has its own "immoral" trade-offs. We essentially reduce per capita quality in favor of all-inclusive coverage. Proponents of free-market healthcare would argue that the inefficient allocation of resources inherent to socialization is immo…

> Socialized healthcare has its own "immoral" trade-offs. We essentially reduce per capita quality in favor of all-inclusive coverage That's a false dichotomy; there are many mixed systems where the government provides a baseline level of care with private insurance providing additional services or benefits (eg: government covers a shared hospital room, private insurance covers a private room). >Libertarians would ar…

  > True libertarians also argue that all taxation is theft (if
  > they're purists anyway), making road construction immoral.

Why would you call those people "true" libertarians? There are a lot of people who consider themselves libertarians of various sorts who strongly disagree with this. Some consider property to be theft.

There are many kinds of libertarianism, and the American-style extreme capitalist libertarianism is not the only one, and probably one of the most irrational forms of libertarianism.

Personally, I feel providing essential care to everybody equally does the most to free people from oppression and extortion by those who wield power over them at a time when they're vulnerable.

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

#443

Post by chasontherobot » Thu, Dec 20, 2018, 8:55 AM UTC

conanbatt wrote: post #421

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…

> 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.

so when I get into a car accident and am bleeding internally, I can march down the street to the next hospital if I think the bill at the one I'm at is too high?

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

#444

Post by tialaramex » Thu, Dec 20, 2018, 8:56 AM UTC

Symbiote wrote: post #267

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.

Depending which side you want to believe, NHS waiting times are a direct result of Conservative government austerity, or excessive immigration.

To really hammer home the point here, that Conservative government, in an effort to make immigration numbers go down set immigration rules to impose a minimum income for jobs that could recruit outside the EU. That minimum was lower than the government austerity cut maximum pay for nurses. Result: can't hire non-EU nurses, shortage worsens. Waiting times increase.

Eventually, as this started to be more widely known the Conservative government "fixed" it. Not by paying nurses more, not by lowering the immigration income requirement to match what they pay skilled workers like nurses, but by specifically exempting nurses.

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

#445

Post by pjc50 » Thu, Dec 20, 2018, 9:00 AM UTC

conanbatt wrote: post #435

ncallaway wrote: post #219

Earlier quoted context omitted.

I don't believe that's true. What serious single payer proposals have been put forward that would eliminate private-pay, private insurance, or private care? I've never seen one. In fact, almost all "single payer" health systems that exist in other countries have private care and private insurance options. For example, such options are available in both the UK with the NHS and in Canada. I've never once spoken with an…

It most definitely means banning private insurance (not private care). Thats why its "single". IT has to, because otherwise it would have to compete on the market as any other plan, and it would fail because all private insurance would dump the expensive patients on to medicare, which will need to either increase prices or increase taxes to survive. Plus the whole point is to eliminate dealing with the adminsitrative…

"Single payer" means the state pays through the tax system. It doesn't mean banning private insurance, which coexists happily with the NHS. Whoever told you otherwise has been misleading you.

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

#446

Post by mcv » Thu, Dec 20, 2018, 9:01 AM UTC

eli wrote: post #268

vkou wrote: post #192

Earlier quoted context omitted.

Where is all the money going? Does the ambulance have a solid-gold steering wheel?

Most people don't/can't pay their hospital bills.

So prices are excessive because too many people don't pay their bills, leading more people to be unable to pay their bills, leading to even higher prices.

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

#447

Post by arethuza » Thu, Dec 20, 2018, 9:04 AM UTC

jessaustin wrote: post #361

chimeracoder wrote: post #312

Earlier quoted context omitted.

> I've had emergency dental treatment in an NHS hospital in the UK for an extremely painful dental abscess - was treated first thing on a Sunday morning. Emergency dental care is provided in the US as well. Filling a cavity is not considered an emergency.

Very few oral problems are emergent. GP's abscess would have been visible on examination for months, and certainly was uncomfortable before it was extremely painful. In many cases the first treatment is a course of antibiotics, which any USA ER could administer perfectly well.

"certainly was uncomfortable before it was extremely painful"

Actually it wasn't - went from nothing to blinding pain as if someone threw a switch. I'd have 10-15 minutes of agony then it turned off for the same time and it repeated at that frequency all of the Saturday until a GP came out on the Saturday evening and gave me painkillers and told me to go to the emergency dental clinic the next day.

It was right in the middle of my 3 years exams at University - which was a bit of bad timing!

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

#448

Post by jopsen » Thu, Dec 20, 2018, 9:06 AM UTC

toomuchtodo wrote: post #395

jopsen wrote: post #353

Earlier quoted context omitted.

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 o…

It’s effectively a state takeover, as providers can negotiate with the Health and Human Services department in the same way that my child can negotiate their allowance with me. Disclaimer: In full support of single payer/government managed healthcare

Not really, you could very well imagine private hospitals bidding against each other to win a contract on providing ER services. With penalties if capacity or quality suffers by objective standards. (Isn't this how most government contracts work)

It's not like there is any competition right now? You can't even get a price quote for elective surgery.

Also I wouldn't be so sure that your children don't have significant leverage over you, hehe :) (They probably don't realize how much leverage they have)

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

#449

Post by andyjohnson0 » Thu, Dec 20, 2018, 9:17 AM UTC

heavyset_go wrote: post #66

UnpossibleJim wrote: post #26

Earlier quoted context omitted.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

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…

> Later, insurance companies hired brigades to only put out fires on insured properties.

In some parts of the world, insured properties were marked with metal plaques (generically termed "Fire Insurance Marks" [1]) bearing the insurer's symbol/logo. This enabled the insurer's firefighting service to verify that they should protect the building. I've occasionally seen them on old buildings here in the UK. One I remember was a stylised representation of the sun, denoting The Sun Fire Office - which was founded in the 1700s and still exists as RSA Group plc.

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

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

#450

Post by ThomPete » Thu, Dec 20, 2018, 9:25 AM UTC

fencepost wrote: post #393

ThomPete wrote: post #363

Earlier quoted context omitted.

Huh? That's not what I said at all. I was explaining how the US system is very different than the Scandinavian system. That's all. You can't compare them at all. Whatever racist undertone you heard there was your doing not mine.

Any time you're in an online discussion of US healthcare expenses and use the phrase "11 million illegal immigrants" you've pretty much just placed yourself into a category as far as almost anyone else reading the discussion is concerned. That may not be what you meant to do and that categorization may not be fair, but it's one of many possible trigger phrases.

Its pretty obvious to anyone who is not looking to get triggered that there is nothing racist nor fingerpointing in what i say. The illegal immigration is used to illustrate one of the things that make the us system wastely different especially from the scandinavian system even though they are always used as an example. Almost every person there is has lived their whole life there.

And given i dont actually give you any other reason to think i am racist its pretty absurd that you decide to make that interpretation of what i say but unfortunately its becoming more and more the norm. Try asking me what i mean next time instead of just throwing words around accusing people you dont know anything about for being racist.