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

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

#561

Post by nybble41 » Thu, Dec 20, 2018, 11:05 PM UTC

vec wrote: post #554

nybble41 wrote: post #551

Earlier quoted context omitted.

You haven't rendered private health care "obsolete", you've just forced people to join your public system. Obviously people aren't going to pay for two health providers (unless the public system is completely inadequate). That does not imply that the private service is uncompetitive. There can be no competition when one service must find willing customers while the other takes its funding by force. This is the same i…

True, but that's subtly different than the point I'm trying to make. Imagine your hypothetical were reversed. Imagine we already had a network toll roads priced at an average of $5/100 miles, and that we had a plan to build and maintain public roads at an expected cost of $1/100 miles. There might be plenty of good reasons not to prefer the more efficient public plan, but the fact that it would put toll road vendors…

> There might be plenty of good reasons not to prefer the more efficient public plan, but the fact that it would put toll road vendors out of business isn't one of them.

I have no particular sympathy for any private provider that can't compete with other private providers in the market. However, from my point of view private and public providers aren't in the same market, or even providing the same product: one is simply selling access to roads, or health care, while the other is giving these things away bundled with the dubious "service" of compelling other people to pay the bill. To me that bundled "service" is of immense negative value, and the existence of the public system is driving the providers of the unalloyed product I actually do want out of the market. So, from my point of view, the fact that the public plan would put the toll road vendors out of business and thus leave me with no decent travel options that don't involve externalizing the cost onto others is actually a good reason to oppose the public plan. (There are others: While I don't want to participate in this externalization process as an unwilling beneficiary on moral grounds, I'd also prefer not to become one of its victims.)

Of course, if there exists a way to build and maintain a road at a cost of $1 per 100 miles, there is no particular reason why that cost couldn't be payed through tolls instead of taxes, thus giving us the best of both worlds. There are basically only two ways which public services can manage to cut costs compared to a private provider. One is by externalizing the cost of the service onto non-users, and the other is by being exempt from regulations which private providers would be forced to follow (or, equivalently, having the regulations tailored to suit the public service by sympathetic legislators).

> Capitalists don't mindlessly prefer private things just because they're private.

Whereas libertarians such as myself do prefer private things simply because they're private, which is to say: because they don't involve the use of force. Which is not to say that there aren't practical reasons to prefer private systems as well—just that, to me, any system which involves force is automatically more costly than any voluntary system, which makes these other reasons more-or-less irrelevant.

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

#562

Post by nybble41 » Thu, Dec 20, 2018, 11:22 PM UTC

WalterBright wrote: post #559

nybble41 wrote: post #550

Earlier quoted context omitted.

> A free market police system cannot work, because the police use force against people, which is not allowed by the free market. The "free market" (in a libertarian sense) does not permit the initiation of force against people who have not resorted to force themselves. If that is a significant restriction on your police department's activities then there is something seriously wrong with your police department. > Wor…

Arresting someone suspected of a crime is not responding to initiation of force, because the suspect hasn't been convicted yet. There are private police forces, we call them the "mafia", and people pay them for "protection". Sure, they're corrupt, but with no government funded police, whatcha going to do about it?

> Arresting someone suspected of a crime is not responding to initiation of force, because the suspect hasn't been convicted yet.

If the suspect is eventually convicted (of something at least as serious as kidnapping) then that conviction retroactively justifies the arrest.

If the suspect is never convicted then arresting them is little better than kidnapping. If the police at least had a reasonable belief that the person they arrested would be convicted then it falls under the heading of accidental harm rather than negligence or malicious intent, which shields them from retribution, but that doesn't avoid the need to pay restitution to make their victim whole.

In short: Be sure you're arresting the right person, and don't do anything to them in the process which you'd find difficult to set right.

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

#563

Post by ThomPete » Fri, Dec 21, 2018, 12:30 AM UTC

vec wrote: post #560

ThomPete wrote: post #557

Earlier quoted context omitted.

That's because you haven't considered how big the US is and you haven't considered that the US is mostly a land of immigrants not a land of people who lived their almost all their lives for several generations. Healthcare systems like the scandinavian are established over decades as the young needs to pay for the old until they get old themselves and have to get covered by the young. This kind of system is more or le…

> This kind of system is more or less impossible in the US and it would be extremely expensive. That's literally how Social Security works, and the fact that more guest workers pay payroll taxes into the system than are eligible to collect benefits from it actually makes it slightly cheaper than it would otherwise be.

That's how social security works and it works great in countries with little immigration not in countries like the US where there have historically been.

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

#564

Post by bumby » Fri, Dec 21, 2018, 1:20 AM UTC

vec wrote: post #539

bumby wrote: post #505

Earlier quoted context omitted.

Does it have an end goal of maximizing profits, though? Couldn't the goal of price discovery be to find the point where supply = demand, without necessarily maximizing profit? Granted, this ignores the human trait to increase consumption when removed from directly paying all associated costs (e.g., my behavior at Golden Corral)

If maximizing profits (or, more precisely, maximizing expected value) isn't a terminal goal for all involved parties then it isn't a free market.

I see your point if the term profit is defined in a general sense, but with the exception of "corporations as people" caveat there's plenty of everyday examples where people are trying to maximize outcomes other than capital (sometimes at the expense of capital). I'm not sure that makes it any less of a free market

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

#565

Post by WalterBright » Fri, Dec 21, 2018, 1:55 AM UTC

nybble41 wrote: post #562

WalterBright wrote: post #559

Earlier quoted context omitted.

Arresting someone suspected of a crime is not responding to initiation of force, because the suspect hasn't been convicted yet. There are private police forces, we call them the "mafia", and people pay them for "protection". Sure, they're corrupt, but with no government funded police, whatcha going to do about it?

> Arresting someone suspected of a crime is not responding to initiation of force, because the suspect hasn't been convicted yet. If the suspect is eventually convicted (of something at least as serious as kidnapping) then that conviction retroactively justifies the arrest. If the suspect is never convicted then arresting them is little better than kidnapping. If the police at least had a reasonable belief that the p…

Arresting someone is no joke and cannot be done using free market principles.

Enforcing laws is the point of government, and a free market requires enforcement of laws. This is why countries with a non-functioning government are an anathema to business, not a paradise.

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

#566

Post by WalterBright » Fri, Dec 21, 2018, 1:56 AM UTC

pfisch wrote: post #465

WalterBright wrote: post #367

Earlier quoted context omitted.

> 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.

I've never heard your theory of economics before from any faction.

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

#567

Post by setr » Fri, Dec 21, 2018, 2:49 AM UTC

Verdex_3 wrote: post #547

setr wrote: post #244

Earlier quoted context omitted.

One issue with describing figures like 600k is that I think the medical industry has a lot of funny money running around. The doctor somewhat arbitrarily charges 10k to the insurance company, insurance disputes, the doctor hires a lawyer who takes 30% of the negotiated outcome, and negotiation finally ends up at $2k. The patient sees a $10k bill, pays a $300 deductible, and only $2k ever actually materializes in the…

Yeah, some of the explanation of benefits I've received are insane. Insurance is apparently able to negotiate ~50% bill reductions for multi 10K bills.

Dealing with Indians, the normal bargaining tactic is apparently start with like 300%/10% of the expected, and end up at 110%/90% as anywhere else would. From America, starting is 120%/80% or so. Totally confounding when you first start negotiations, because they're offering these absurd numbers as if its normal..

I think the same culture exists with doctors/insurance. It's not that they're skilled enough or have enough power to negotiate down 50%... doctors are putting numbers up expecting to be reduced to 50%.

And then us poor saps get slapped with these absurd numbers and thank the gods we had insurance... but no one involved ever really expected to pay that number. And ofc, without insurance, you're like an american trying to shop in india -- no idea how to play the game, trying to negotiate in the american fashion with 120%/80% when the other guy started with 300%, and don't have the information to realize that initial $20 offer negotiated down to $18 isn't even close to what an indian would have managed (probably $5).

And its not like he's going to correct you when you fail to negotiate properly.

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

#568

Post by maxerickson » Fri, Dec 21, 2018, 2:52 AM UTC

ams6110 wrote: post #479

bogle wrote: post #470

Earlier quoted context omitted.

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).

It depends entirely on the employer. Some places will require a doctors note if you miss more than two shifts. So in places like that, people typically go to work sick, and just spread the disease. This includes most fast food restaurants so think about the implications of that.

Still, it's their fault for not seizing political power and installing a better legislative framework.

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

#569

Post by maxerickson » Fri, Dec 21, 2018, 2:53 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…

The problem in the US is that you can't just go get your throat swabbed for a strep test in that situation. That could take 5 minutes and cost less than $50, but nope.

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

#570

Post by refurb » Fri, Dec 21, 2018, 8:16 AM UTC

ceejayoz wrote: post #528

refurb wrote: post #459

Earlier quoted context omitted.

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.

Based on the success of private MRI clinics, I would say the demand is quite high for selective procedures. Either procedures that are relatively cheap but have very long wait times or procedures where patients are willing to pony up for expertise (joint surgery).