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

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

#521

Post by conanbatt » Thu, Dec 20, 2018, 4:33 PM UTC

pjc50 wrote: post #445

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…

"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.

There is nothing single about adding a payer to a set of a dozen that already exist.

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

#522

Post by conanbatt » Thu, Dec 20, 2018, 4:34 PM 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?

The decision is done before the accident, when you pick insurance.

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

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Post by dv_dt » Thu, Dec 20, 2018, 4:39 PM UTC

amalcon wrote: post #359

dv_dt wrote: post #266

Earlier quoted context omitted.

I think the US has better cancer survival rates in areas than other nations, but if that is all-around significant one would think that would reflect out in better life expectancy overall. However, the US is a huge negative outlier in life expectancy and child mortality with universal healthcare nations outperforming on those measures too. https://ourworldindata.org/the-link-between-life-expectancy-... The most recen…

Life expectancy is a weird stat by which to measure healthcare outcomes. For starters, it responds rather strongly to demographics. E.g. having more males reduces life expectancy holding all else equal. There are many things like this. Age-adjusted all-cause death rate is the better stat for measuring life-saving outcomes. Child mortality is certainly a useful stat for its purpose, though.

> Age-adjusted all-cause death rate is the better stat for measuring life-saving outcomes.

Are there sources of that stat over time and between nations that you would recommend?

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

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Post by conanbatt » Thu, Dec 20, 2018, 4:55 PM UTC

actsasbuffoon wrote: post #480

credit_guy wrote: post #469

Earlier quoted context omitted.

> 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 minut…

In Boston I recently had to wait in an emergency room for 5 hours with multiple broken bones. This was at one of the best rated hospitals in the country. I recently moved to a new state and I’m trying to get set up with a new primary care provider. I’ve been trying to get an appointment for six months, but they keep bumping my appointment back. Did I mention that I had to settle for a nurse because none of the doctor…

Nurse or Nurse practitioner?

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

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Post by conanbatt » Thu, Dec 20, 2018, 4:57 PM UTC

Animats wrote: post #261

heavyset_go wrote: post #66

Earlier quoted context omitted.

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…

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. Usually credited to Marcus Licinius Crassus, who had a fire brigade for just that purpose. Contemporary of Julius Caesar.

The richest man of his time. And maybe well earned ,by literally saving people's houses from burning down.

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

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Post by vec » Thu, Dec 20, 2018, 5:01 PM UTC

krupan wrote: post #513

vec wrote: post #275

Earlier quoted context omitted.

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

A) Right. We have universal single payer food insurance, also known as taxpayer funded welfare for the poor. We're in essence covered by, and paying premiums to, a mandatory State-run insurance policy such that if we ever can't afford the minimum necessary food to survive the State will (at least in theory) step in and buy it for us from the open market.

B) Let me rephrase. I'm not going to wake up one day to find that my required daily calorie intake has increased by multiple orders of magnitude. There are very few household budgets that could reasonably be expected to absorb such a shock, no matter how efficiently the market for those calories functions.

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

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Post by ishjoh » Thu, Dec 20, 2018, 5:02 PM UTC

specialist wrote: post #503

geezerjay wrote: post #438

Earlier quoted context omitted.

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…

How many of your fellow citizens declare bankruptcy because of of their medical expenses, debts?

That's definitely rising as can be seen in recent research of the topic: https://www.nytimes.com/2018/08/05/business/bankruptcy-older...

Medical expenses, unlike credit card debt or student loans, can still be discharged through bankruptcy. For lower income elderly folks, that coupled with low paying job opportunities usually leads to disaster.

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

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Post by ceejayoz » Thu, Dec 20, 2018, 5:03 PM UTC

refurb wrote: post #459

bdamm wrote: post #284

Earlier quoted context omitted.

That's a stretch. There are still a lot of private clinics operating in Canada for various grey-area medical needs. Also, Canadian (really, provincial) healthcare doesn't typically cover dental, and there's a massive grey area in rehab and injury recovery where private clinics abound. Certainly it is true, I agree, that emergency hospitals and ambulances are public-option only.

Doctors in Canada have to choose to participate in either the public system or private system. They can’t straddle both. Hence there are VERY few private clinics in Canada except for services where the govt realized it was in their benefit to allow it (MRIs).

That sounds like the market for private care isn't really as big as is often claimed, then.

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

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Post by ceejayoz » Thu, Dec 20, 2018, 5:05 PM UTC

darawk wrote: post #287

nogrammer wrote: post #283

Earlier quoted context omitted.

...because even if you end up at a hospital where your coverage is great, they often have doctors or providers that won't accept your insurance, and there's just about no way to know this beforehand.

So force hospitals and doctors to align on insurance acceptance, seems pretty simple.

And buy travel insurance any time you want to drive more than a hundred miles or so?

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

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Post by DanBC » Thu, Dec 20, 2018, 5:09 PM UTC

wastedhours wrote: post #460

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…

The UK system isn't amazing, unless you're evidently having an "emergency", you can be waiting for hours (once waited for 4 hours with a broken wrist for example) - that being said, the triage is pretty solid and you'll cycle through intermediate steps in the meantime. I think the best part is not having the mental burden of potentially going bankrupt afterwards...

There are severe problems with the English NHS, but we need to remember that it costs the tax payer a lot less than the US system.

That's the thing I don't understand: they pay more in tax, and they pay more in insurance, and they don't get universal coverage and have worse outcomes across a range of measures.