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

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

#461

Post by namdnay » Thu, Dec 20, 2018, 10:54 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…

No, the single payer portion doesn't have to compete with other plans. The other plans supplement the single payer insurance. E.g. single payer will cover everything up to a certain amount, and then you can buy a private plan to bring that amount higher, or maybe cover non-essential extras.

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

#462

Post by notatcomputer68 » Thu, Dec 20, 2018, 11:00 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…

>Price discovery requires pricing some people out of the market. Period.

A well working competitive market doesn't charge the maximum consumers can bear. It charges cost of service plus a profit margin.

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

#463

Post by crottypeter » Thu, Dec 20, 2018, 11:01 AM UTC

sonnyblarney wrote: post #390

lumost wrote: post #381

Earlier quoted context omitted.

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 eco…

> Maybe that's beneficial due to the risk 'it could be something bad'.

I would assume it's detrimental because it results in doctors' waiting rooms full of people with colds (making it a dangerous place for anyone who is immunosupressed and really needs to see the doctor).

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

#464

Post by wastedhours » Thu, Dec 20, 2018, 11:02 AM UTC

ThomPete wrote: post #450

fencepost wrote: post #393

Earlier quoted context omitted.

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…

Your comment was making an implied link between the difficulties in the US healthcare system and the 11 million illegal immigrants - whether you intended or not (if you didn't, there'd be next to no reason to bring up illegal immigration at all).

Why would illegal immigration have any impact on healthcare, unless you were implying that they were a drain on the system (which is an assertion needing to be backed up by facts)?

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

#465

Post by pfisch » Thu, Dec 20, 2018, 11:05 AM UTC

WalterBright wrote: post #367

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. I don't see the connection between posting prices and pricing people out of the market.

If no one is priced out and you are operating in the free market then you need to raise your prices. Repeat until you maximize profits.

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

#466

Post by agent008t » Thu, Dec 20, 2018, 11:13 AM UTC

chasontherobot wrote: post #443

conanbatt wrote: post #421

Earlier quoted context omitted.

> 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?

No; but suppose we agree that emergency response services (fire, medical, police) should be state-run. The goal of such state-run ER is to get you as quickly as possible to a hospital, where care can be provided. The state can then shop around for the cheapest/best private provider for each catchment area. One could also make a case that the state should pay for this emergency care out of tax money - unless the state can show that you were the one responsible (e.g. if you end up in a hospital because of excessive drinking on a night out - taxpayers should not have to pay for you in this case).

But such true emergency response seems like actually a very minor part of all medical care. It would be better for people to have private emergency arrangements through their insurance - but, of course, this is not always viable (if you are bleeding out in a car accident, there is no time to figure out which hospital you have a deal with), so that is one area where the state should probably be involved.

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

#467

Post by gambiting » Thu, Dec 20, 2018, 11:49 AM UTC

willyt wrote: post #453

tokyodude wrote: post #402

Earlier quoted context omitted.

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…

Assuming you are not an EU citizen, you are don't get free healthcare in the UK anyway. They probably told you to go to the private doctor because if you are non-EU you would have health insurance which would cover this no?

That's not how this works. If you are from outside of EU you are not limited to private doctors and hospitals - you can still go and be seen by any NHS doctor, but you have to disclose the fact that you are not covered by national insurance - they will simply ask you for personal details and send you the bill few weeks later(well, if it's worth if - if you're only seeing a doctor about a cold or a broken wrist they will not even bill you anything because it's not worth the time spent filling out documentation, and pretty much no hospital even has a billing department).

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

#468

Post by gambiting » Thu, Dec 20, 2018, 11:55 AM UTC

geezerjay wrote: post #438

minikites wrote: post #349

Earlier quoted context omitted.

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?

You really should get the facts on how those systems actually operate. I'm currently living in an european country that has a national health service that supposedly ticks all the socialist talking points, including free (in theory) access to emergency care, but not only is the service largely inoperational with year-long waiting periods for surgeries, including cancer treatments, but also has a disgruntle workforce…

While I also come from a country like the one you described, there is a very simple fact that cannot be ignored - when my dad got cancer 8 years ago, every single one of his operations and all the drugs(including incredibly expensive Glivec) were 100% free. He was even reimbursed for the cost of travelling to the hospital for his monthly check-up.

If he had the same disease in US, he would die much earlier than he did, I'm 100% certain of it, because quite simply there is no way he could afford the treatment or the premiums that americans are paying for their healthcare. Even when he was sick enough that he couldn't work anymore, he was still 100% covered and didn't have to pay anything for anything ever.

My point is - there are people in our countries who are probably dying because they have to wait months to be seen by someone. True. But there are also people in US who are dying because they cannot afford the treatment they need. I feel like this is far worse than the first situation - after all, we only have a finite number of doctors, a finite amount of hospitals, and limited capacity to add more(for reasons other than financial too). But US is the richest country in the world - and its citizens die because they cannot afford cancer drugs? That's abhorrent.

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

#469

Post by credit_guy » Thu, Dec 20, 2018, 11:58 AM UTC

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…

> I've experienced medicine in both the UK and the US. I can tell you, there isn't a difference in quality.

My experience was very different. In January-February this year I had to visit (unfortunately) both the Emergency Room in NYC and the A&E in London. While the quality of the medical equipment in London matches the one in NYC, the understaffing is much more severe. In neither place was my wait time only 10 minutes, but in NYC I had to wait for about 1 hour (including paperwork), while in London for about 6 hours.

I talked with other people in London about my experience that the medical system is severely understaffed, and all agreed. On the plus side, I did not have to pay anything in the UK (they didn't even care that I was not a UK resident). In the US I had to pay north of $1000, despite having insurance.

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

#470

Post by bogle » Thu, Dec 20, 2018, 12:03 PM UTC

tdsamardzhiev wrote: post #391

bko wrote: post #377

Earlier quoted context omitted.

Why did you go to a doctor for a cold? That seems to be a problem. You send someone to school for 10 years and they spend their time talking to patients about a runny nose due to a common cold. And for what? To write a prescription?

To get an absence note for school/work? To make sure it's a common cold?

For a cold, just wait a week or two. There's nothing medicine can do for you anyway. If it's still there, then it's worth checking. Also, you shouldn't need a sick note unless you are off for more than a week (your legislative framework may vary).