The anatomy of a ripoff • Hacker News Board

Re: The anatomy of a ripoff

#51

Post by saucetenuto » Tue, Jan 10, 2012, 4:30 PM UTC

CWuestefeld wrote: post #21

rdtsc wrote: post #6

Earlier quoted context omitted.

> Medical care is the most highly regulated industry in the economy, and so nothing you see happening is going to bear very much resemblance to reality. You make it sound like one follows from the other in an obvious way. Can you expand on why that would be?

You make it sound like one follows from the other in an obvious way. I think it does follow logically. I'm assuming that the regulations were intended to serve some purpose. If the system was working as the regulators/legislators wanted, there would have been no point in regulation. The regulations were created for the purpose of altering the way things would normally work out. By analogy, if we see a canal, it's pro…

Speaking as someone who doesn't know much about this stuff, your analogy reads more like, "the canal diverted the waterway, so tigers devoured the Pope". It may well be true, but you need to flesh it out more: explain how the new course flooded the tigers' habitat, forcing them to migrate to Rome.

Re: The anatomy of a ripoff

#52

Post by ErrantX » Tue, Jan 10, 2012, 4:31 PM UTC

pavelkaroukin wrote: post #15

My wife recently had some tests done. Hospital's receptionist forgot to add insurance information to wife's profile, so accordingly to hospital's records she was uninsured. Month later we receive bill for ~$1,400. After quick googling we find that if she would go to any local hospital and pay up front with cash, it would cost her maximum ~$400. Obviously, she went back to hospital to find out what's wrong with them (…

hospital owned by insurance company, so it is very wrong

Wait what?

How on earth is that allowed to happen!

Re: The anatomy of a ripoff

#53

Post by goatforce5 » Tue, Jan 10, 2012, 4:33 PM UTC

jiggy2011 wrote: post #9

Wow , I'm glad I don't have to expend mental energy on stuff like this. Universal Healthcare, get it. It's really good. Honest.

Due to my own stupidity I fell off my bike on the weekend. A few minutes later I realised my little finger was swelling up and hurting a whole lot.

Universal healthcare let me go to a hospital get 3 x-rays and a doctor to tell me nothing was broken. Took 3 hours, but multiple people apologised for it taking so long while I was there (to be honest, I thought it was quick. A sore finger must just about be last on the list of emergency room priorities.)

Total out-of-pocket to me: $0.

I expect if I was in the US i'd currently be sitting here awaiting a bill for several thousand dollars.

Re: The anatomy of a ripoff

#54

Post by afterburner » Tue, Jan 10, 2012, 4:34 PM UTC

yummyfajitas wrote: post #28

joezydeco wrote: post #12

Something must be tightening up somewhere, though. Just before my daughter went through an outpatient surgical procedure, the hospital (which was acting as the surgical facility only here) called my wife. They noticed we had a high-deductible plan. Would we be willing to prepay part of the O/R costs now? I talked to the hospital at length to try and understand this change in procedure. Apparently the number of patien…

This is why high deductible insurance offers the best hope for cost control. Too bad it becomes illegal in 2014.

"Too bad"? You like thinking about a $5000 bill when you're headed to the OR, perhaps straight from the ER? You think this is feasible for the vast majority of people?

Re: The anatomy of a ripoff

#55

Post by jbooth » Tue, Jan 10, 2012, 4:35 PM UTC

CWuestefeld wrote: post #50

jbooth wrote: post #46

Earlier quoted context omitted.

Hang on, so medicare told the hospitals and insurance companies to run their businesses that way? The transaction described in the article was entirely between private business entities. I get that they set their prices in a way that distorts the market to some extent but it seems that that distortion is far less than what the really-smart-guys-in-suits have been able to manage all by themselves. I understand the imp…

I'll be honest. I don't get why hospitals continue to play the game. If I were running the place, I'd just pull out of Medicare. It seems that they're afraid of the millions of dollars of lost revenue, without considering the greater sum of expenses that they'd free up.

I sincerely doubt that the bean-counters at hospital are losing a ton of money on medicare but are too confused by the large 'revenue' figure to subtract a larger 'expenses' figure and realize they're making a loss.

As a matter of fact, I can't recall ever reading an op/ed or anything by a hospital administrator complaining that they're being fleeced by medicare and losing a bunch of money on it. But I've seen a billion op/eds in the same template as TFA, bemoaning the byzantine and obfuscatory private insurance regime as something that completely destroys any market forces that should exist in the industry. I mean, one hospital charged one thousand times as much as another for the same treatment.

I have to conclude that bringing up medicare while the private insurance industry system is this flagrantly broken is nothing but a red herring.

Re: The anatomy of a ripoff

#56

Post by afterburner » Tue, Jan 10, 2012, 4:35 PM UTC

yummyfajitas wrote: post #47

yardie wrote: post #38

Earlier quoted context omitted.

I think it only delays the inevitable and ends up making things worse. If people don't have the money for surgery (and really how many of us can pull ou $5000, right no). They'll delay it. Delay it too long and that $4000 surgery becomes a $50000 intensive care, emergency operation.

The RAND experiment disagrees with you. It shows that cost sharing induces people to use 30% less medicine with no significant effects on health. http://www.rand.org/health/projects/hie.html Unfortunately, we never repeated the rand experiment, so it's a bit dated. For some reason we never tried repeating it before pushing massive changes in the law.

Did they use 30% less surgery too?

Re: The anatomy of a ripoff

#57

Post by astrodust » Tue, Jan 10, 2012, 4:37 PM UTC

yummyfajitas wrote: post #28

joezydeco wrote: post #12

Something must be tightening up somewhere, though. Just before my daughter went through an outpatient surgical procedure, the hospital (which was acting as the surgical facility only here) called my wife. They noticed we had a high-deductible plan. Would we be willing to prepay part of the O/R costs now? I talked to the hospital at length to try and understand this change in procedure. Apparently the number of patien…

This is why high deductible insurance offers the best hope for cost control. Too bad it becomes illegal in 2014.

How does that help anyone in any way?

Re: The anatomy of a ripoff

#58

Post by llimllib » Tue, Jan 10, 2012, 4:37 PM UTC

Symmetry wrote: post #31

rdtsc wrote: post #6

Earlier quoted context omitted.

> Medical care is the most highly regulated industry in the economy, and so nothing you see happening is going to bear very much resemblance to reality. You make it sound like one follows from the other in an obvious way. Can you expand on why that would be?

As just one example, look at the RBRVS: http://www.slate.com/articles/news_and_politics/prescription... Paying people on a cost-plus basis provides them with an incentive to maximize costs, whether they're doctors or defense contractors. Then there's also the FDA's use of production quotas for drug production. We had a big shortage of Aderall recently because the FDA has to give permission ahead of time for a given a…

> We had a big shortage of Aderall recently because the FDA has to give permission ahead of time for a given amount of production of the drug for each company.

As I understand it, the DEA, not the FDA, sets the quotas. They're currently arguing publicly over the shortage: http://www.nytimes.com/2012/01/01/health/policy/fda-is-findi...

The DEA claims there is no shortage (insert Star Wars hand wave here) while the FDA wants them to raise the quotas. (How Soviet does that sound?)

No disagreement on the rest of your comment.

Re: The anatomy of a ripoff

#59

Post by afterburner » Tue, Jan 10, 2012, 4:38 PM UTC

sp332 wrote: post #45

lflux wrote: post #34

Earlier quoted context omitted.

Far from. In Stockholm, for a child she would have paid 120 SEK (~17 USD) for an ER visit. That is assuming she was a resident or in possesion of an EU/EEC insurance card. Going price for an ER visit without EU insurance would be 1650 SEK (~240 USD). So not close even there.

How do the doctors get paid if the patient is only paying $17 per visit?

Last I checked Sweden doesn't have a 0% tax rate.

Re: The anatomy of a ripoff

#60

Post by astrodust » Tue, Jan 10, 2012, 4:39 PM UTC

jiggy2011 wrote: post #9

Wow , I'm glad I don't have to expend mental energy on stuff like this. Universal Healthcare, get it. It's really good. Honest.

I don't care if it's communist, socialist, fascist, or all three at once. It's awesome. I'd gladly pay more if I had to if only to avoid all the paperwork related to private insurance.