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

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

#51

Post by Arubis » Wed, Dec 19, 2018, 9:15 PM UTC

SlowRobotAhead wrote: post #40

smileysteve wrote: post #35

Earlier quoted context omitted.

Because, then the single payer, can say "your policies/prices don't work with our system", fix it, or we won't cover any patients, effectively shutting you down.

What is stopping insurance companies from doing that now? If you're paying for insurance, it's in your insurance company's best interest to pay low prices.

They can and do, at which point the hospital or other billing party directly bills the beneficiary of care or their guardian, which is how folks that think they're financially secure end up bankrupt.

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

#52

Post by ryanobjc » Wed, Dec 19, 2018, 9:15 PM UTC

SlowRobotAhead wrote: post #30

ttcbj wrote: post #24

Earlier quoted context omitted.

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc. My wife is a doctor, and at this point, I think single-payer is the least bad option.

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?

The presumption that competition between doctors and hospitals will create lower prices has not come to fruition. Individuals have no leverage or ability to make meaningful choices. There is no real healthcare market as a result.

In a larger system, we get lower prices via several mechanisms: - Preventative care replacing ER care due to universal coverage - Larger risk pool lowers per-participant costs - Single payer has more leverage and depth of time/knowledge to regulate/negotiate with individual hospitals

The reality of a competitive landscape, hand of market, etc, that just didn't happen.

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

#53

Post by merpnderp » Wed, Dec 19, 2018, 9:15 PM UTC

edoo wrote: post #10

Health care is the only industry where the felony laws regarding up front pricing aren't enforced. It was allowed to become a twisted regulatory nightmare where the laws were written by the industry itself utilizing kneejerk methods to obtain profit at the cost of systemic corruption.

And yet it is by far the most regulated industry in the US. Almost as if the more invasive the regulations the more invasive the corruption.

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

#54

Post by jclay » Wed, Dec 19, 2018, 9:16 PM UTC

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…

Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.

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

#55

Post by cableshaft » Wed, Dec 19, 2018, 9:17 PM UTC

AngeloAnolin wrote: post #4

Reading this article and seeing all the startups sprouting in the field of health care and medicine tells me that there's still a lot more areas to innovate and disrupt in this industry. One big issue though are that lobbyists who wanted to keep prices high - to squeeze in as much profit as they can out of these. Drugs, Antibiotics, Procedures, Medical Professionals. I know it would be far-fetched to standardize and…

I'm in the industry right now, and while there's certainly room for innovation and improvement (our company was one of those originally), anyone considering it should know that this industry is a huge legal and regulatory quagmire, which makes diving into it difficult if you're not already familiar with it.

Despite knowing a lot about how it works after being in the industry for several years, I don't think I'd have the stomach to take a stab at a startup in this field myself. I've already had to deal with it over the years as an systems engineer and I'm pretty sick of it.

Also, if you're planning to do business with the big companies in this field, at least from the standpoint of my company, they really drag their feet with signing any business deals with you, and just about every company doesn't really want to pay you to do anything. We've had multiple companies back out of contracts (or act like they're going to sign once things are negotiated, then don't), even after we've done significant development (in one case building a whole system for them) and not pay us for our work, and then have the gall to ask us for parts of the code afterwards.

The only reason we did that work also, is because there are some crazy hard deadlines with open enrollment and the process drags so much that by the time everything is signed the software basically already has to be complete immediately upon signing if we wanted their business or else it would miss the open enrollment window (or pre-open enrollment, or whatever else hard deadline they had).

Also, the industry has been upended and thrown into chaos with Obamacare, and if the Republicans ever succeed in repealing/replacing it, then it will probably be thrown into chaos again. This creates an opportunity for startups that can move much quicker than these behemoth companies can move in reaction to these things, but it also means that you could be building a business on top of quicksand, and might have to make significant and expensive changes yourself in a few years if it changes underneath your feet as well.

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

#56

Post by reaperducer » Wed, Dec 19, 2018, 9:17 PM UTC

ryandrake wrote: post #9

AngeloAnolin wrote: post #4

Reading this article and seeing all the startups sprouting in the field of health care and medicine tells me that there's still a lot more areas to innovate and disrupt in this industry. One big issue though are that lobbyists who wanted to keep prices high - to squeeze in as much profit as they can out of these. Drugs, Antibiotics, Procedures, Medical Professionals. I know it would be far-fetched to standardize and…

All this value being captured by middlemen “sprouting” up could also simply mean more money out of the pockets of healthcare customers, who already are going bankrupt paying for all of this inefficiency. The US healthcare industry is a raging river of money coming directly out of the wallets of consumers who have little choice. Not surprising that it attracts middlemen with spoons ready to dip into the river.

This is correct. The healthcare industry does not lack middlemen.

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

#57

Post by cabaalis » Wed, Dec 19, 2018, 9:18 PM UTC

UnpossibleJim wrote: post #26

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.

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…

> You simply don't get to "shop around" for emergency services

You do actually, by where you choose to live and also by the services as detailed in [1].

I think there's merit to investigating public health care. That line stops for me in eliminating private care.

1] https://www.theatlantic.com/technology/archive/2018/11/kim-k...

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

#58

Post by scott_s » Wed, Dec 19, 2018, 9:18 PM UTC

SlowRobotAhead wrote: post #50

Arubis wrote: post #45

Earlier quoted context omitted.

The party responsible for payment (the government, in this case) can tell a billing party "I won't pay you more than ___ for that service, and if you don't like it, you can sue me" without taking on the same risk that an individual would. Lawsuits are a pretty inefficient, high-overhead way to bill out, so billing parties are incentivized to not raise accountants and auditors eyebrows.

I must admit I'm skeptical of the claim that "only government can negotiate a better price"... I think anyone that's worked on government systems knows that is not typically the case. Why wouldn't insurers argue for better prices now?

They can and do, but as per an instance in the submitted piece, you can still encounter individual providers who never agreed to that price. Then the patient is responsible for it.

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

#59

Post by howard941 » Wed, Dec 19, 2018, 9:19 PM UTC

Florida typically comes dead-last consumer protection-wise except that it requires ER physicians to be "in-network" when the hospital is also "in-network".

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

#60

Post by pitaj » Wed, Dec 19, 2018, 9:20 PM 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.

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 insurance plans:

- remove the tax exemption for employer-provided insurance

- add a tax exemption for individual/family insurance, including a rebate for the amount of money payroll (social security and medicare) taxes would affect the amount of money available for that insurance

This way, people don't lose their insurance when they lose their job, and people have more insurance options. This would also likely have a beneficial affect on insurance competition.