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

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

#511

Post by liveoneggs » Thu, Dec 20, 2018, 3:07 PM UTC

justaguyhere wrote: post #504

ddebernardy wrote: post #139

Earlier quoted context omitted.

I'm at a loss as to why the US is still dead set to have no meaningful health coverage. I got burned by this in California a decade ago. A dentist charged me $4,500 to fix a broken tooth (panic!) and fill in a cavity on a Sunday. Had I known then what it might have cost I'd have simply flown back to Europe in the next flight ($600-800 at the time) and get the same thing done for under $100-200 with a full refund from…

There was a story about an Indian guy - he flew all the way from California, spent two weeks in India, took a bunch of MRI etc scans and went back. The entire of the trip, including airfare, hotel, scans etc was less than the cost of a scan in the U.S. Not sure how much of this is true (and yes, I do realize I shouldn't be comparing US with a developing country like India, cost wise), but it is definitely believable.

medical tourism is a booming industry in places where US doctors tend to originate :)

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

#512

Post by bluGill » Thu, Dec 20, 2018, 3:08 PM UTC

fencepost wrote: post #327

bluGill wrote: post #127

Earlier quoted context omitted.

We do not have a free market. Most people get their health insurance from their employer - you cannot reasonably get insurance elsewhere (the same plan I have now for $100/month would cost over $1000/month, but I can't take that $1000/month to anyone else if I don't like my insurance so I accept it). This keeps me from taking a long leave of absence to live off my savings - until I quality for retirement (medicare).…

$1000/month is probably a heck of a plan or in a really expensive market if it's for a single person, and it's probably still decent for family coverage. If it was through the ACA Exchange it's probably also a Gold plan that when you look at maximum out of pocket costs simply loads up the premium rather than the OOP payments.

I have a family, obviously for single people the numbers are different.

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

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Post by krupan » Thu, Dec 20, 2018, 3:26 PM UTC

vec wrote: post #275

krupan wrote: post #258

Earlier quoted context omitted.

So think of it in terms of food then. We don't have "food insurance," yet food is a short-term need and it works pretty darn well as a free market.

A) We do have socialized food insurance. That's literally what EBT is. B) I'm not going to wake up in the morning to discover that my expected annual food costs have suddenly increased by four or five orders of magnitude. There is no budget-conscious version of a lot of non-emergency, but still lifesaving, medical care.

A) we do not have universal single payer food. Some welfare for the poor yes.

B) that's because food is a free market

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

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Post by normal_man » Thu, Dec 20, 2018, 3:40 PM UTC

daniel_iversen wrote: post #77

It makes me sad that there are places in the world where people have to pay to go to an emergency doctor. I know it’s a political hot topic but all that aside doesn’t most people deep down inside think that every fellow human should have the right to free doctor?

Absolutely not. Just look through this thread. So many people fetishize "markets" to the point where they act like it's reasonable for people to simply roll over and die if they haven't achieved a certain level of wealth, it's disgusting.

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

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Post by mattkrause » Thu, Dec 20, 2018, 3:40 PM UTC

isoskeles wrote: post #406

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.

If it's such a free market, I implore HNers to explain what it might take to start your own free market hospital in the United States. Let me know what regulations you'll need to meet. Compare to opening a cafe. And I'm not saying a hospital or a cafe ought to be at all similar. That's not the point. The point is how odd it is to pretend that health care is a "free market" in the current state as some rhetorical devi…

> Free market health care would operate in the same way, if it existed.

Any particular reason you think that?

Cafes sell standardized products--if we order the same small latte, we get the same thing and pay the same price. If you "require" something different, you pay a different price. Almond milk, for example, is $0.50 extra, near me. Flavored syrups cost a quarter.

Medicine is a lot less one-size-fits-all. Your fractured arm could be harder to repair than mine and thus takes longer or requires more supplies (and those aren't cheap--bone screws can run $40+/each). Maybe a diagnostic test is inconclusive and needs a more expensive follow-up. You can't really know how some of this is going to go beforehand. I suppose some places could offer a prix fixe option, based on their expected cost + a safety margin. I bet many wouldn't though, because the variance can be huge.

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

#516

Post by mattkrause » Thu, Dec 20, 2018, 3:51 PM UTC

Broken_Hippo wrote: post #475

ThomPete wrote: post #165

Earlier quoted context omitted.

The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various ill…

Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. I really don't understand why it being a big country would make things difficult. Any sane person would adjust the needs dependent on state and smaller. Norway's population is about the same as Indiana's, but is more sparsely populated - so some of the same problems as the…

> Not every immigrant gets free healthcare

I think it depends on the job. If you work for a foreign company and are temporarily in Norway (e.g., spending a quarter at the Olso branch from your HQ elsewhere), you're on the hook for your own insurance: https://helsenorge.no/bo-i-utlandet/posted-workers-outside-t...

If you immigrate to Norway for a job, you're covered like everyone else: https://helsenorge.no/foreigners-in-norway/employee-from-a-c...

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

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Post by HillaryBriss » Thu, Dec 20, 2018, 4:07 PM UTC

the most amazing and unbelievable part of this story is "Congress wants to do something about the issue"

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

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Post by conanbatt » Thu, Dec 20, 2018, 4:26 PM UTC

kwhitefoot wrote: post #456

conanbatt wrote: post #434

Earlier quoted context omitted.

Price controls never work. Its bad economics.

Works in this context in several European countries. Switzerland for instance has compulsory insurance schemes where the prices are regulated and the insurer cannot refuse to insure.

I'd be surprised to hear of a case where price controls work, since it would go contrary to the core tenets of micro-economics. Do you have a link where I could read your source about this?

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

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Post by conanbatt » Thu, Dec 20, 2018, 4:30 PM UTC

namdnay wrote: post #461

conanbatt wrote: post #435

Earlier quoted context omitted.

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.

Ofc you can invent an infinite amount of models, and Sanders has not specified which one clearly yet afaik.

In the case that Medicare is expanded and is optional, medicare will have the following fair challenges: it has to compete with other private insurances, which means is has to pay as much, and any administrative cost dissipates, in fact it gets worse, as providers still have to do multiple billing. If it has to charge ,it will also have to turn away patients. It it doesnt charge, everyone will have medicare, and private insurance will not provide services that medicare gives for free or without restriction.

Up to this point, "single payer" has not provided a single cost reduction means.

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

#520

Post by conanbatt » Thu, Dec 20, 2018, 4:32 PM UTC

swish_bob wrote: post #457

conanbatt wrote: post #435

Earlier quoted context omitted.

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…

This is quite evidently rubbish, as demonstrated by the fact that I live in the UK, receive most of my healthcare for free, on the NHS and also have private medical insurance (provided by my employer).

The problems the UK has and the US has are completely different. Starting with the fact that the model of providing both a public and a private insurance system in the US will not save a single buck.