Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

One hospital charges $8,000 — another, $38,000

washingtonpost.com

Post reply on HN
Print view View original

61–70 of 107 posts

Re: One hospital charges $8,000 — another, $38,000

#61

Post by seanmcdirmid »

anonymoushn wrote: post #57
seanmcdirmid wrote: post #25

Earlier quoted context omitted.

The nice thing about making something mandatory is that their is then outrage when people can't afford what they must have. Society can't ignore the problem anymore and must attack it head on. Can't afford insurance? Well, here is a subsidy, or why not just go on medicaid? Can't afford insurance and make $60K a year; well, maybe individual plans should be more affordable...single payer is looking more desirable. Oh,…

> Oh, you just don't want to buy it because you are young and invincible? That's not how insurance works. In the US it does. It will be much more cost-effective for healthy people to pay the penalty each year than to buy insurance. When they need care, they can buy insurance at the normal rate, since it will be illegal to deny them coverage based on a pre-existing condition. This is more than a little bit like shoppi…

Not sustainable to game the system like that. I think the whole system will strain at the contradictions in place, but that is what was politically viable. Now that we have to live with a new reality, the contradictions will be solved eventually.

This kind of system works very well in Switzerland, but the swiss system is much more mature and they've figured out all the kinks (the people are also responsible enough to vote for it directly).

Re: One hospital charges $8,000 — another, $38,000

#62

Post by rdl »

nostromo wrote: post #27

I wonder, since we strangely expect employers to provide healthcare insurance in the US, what if employers just decided to provided actual healthcare. Imagine taking all of the health premiums Google pays for its employees, and instead of feeding it in to a broken system, you build a world class health facility in Mountain View that's free to employees.

I believe there are employers who do that. (it's really hard to google for right now). It's done in cooperation with some kind of integrated organizations like Cleveland Clinic or something I think.

http://www.fiercehealthcare.com/story/cleveland-clinic-wal-m...

Says Walmart, Boeing, and Lowes have this for certain things (heart care, which is expensive and fairly predictable demand and common enough to be worthwhile)

http://www.employerdirecthealthcare.com/solutions/employers seems to be one model -- for employers that self-insure, they have negotiated cheaper case rates for common planned procedures.

Re: One hospital charges $8,000 — another, $38,000

#63

Post by SEMW »

rdl wrote: post #60
lucian1900 wrote: post #49

Earlier quoted context omitted.

That still sounds like a terrible deal to me. In the UK, I pay around 10% of my salary for national health care and get free care for any problem I might have (and so does my girlfriend, of course). Medication is always exactly £7 (or similar, it might have changed slightly recently) regardless of what it's for.

So my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage. (I also think the top US care, if you are in the right place, is better than the top NHS care, but only for cancer or very rare diseases; for everything common they're comparable, but NHS covers everyone, so the average quality of care…

> my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage

You're not comparing like with like. Comparing a figure (presumably) calculated by taking the GP's effective tax contributions and multiplying by the proportion of UK public spending that goes to health (~19%)[1], with a figure of the direct cost of insurance, is not an accurate way of comparing healthcare costs between countries.

Most actual comparisons I can find between effective cost of healthcare between the US and UK, e.g. [2], seem to conclude that the US pays just over twice as much as the UK per capita (~$7k vs ~3k).

(Also, it's not a "flat 10% on all your income", you misunderstand the GP. Our income tax system is progressive, just like the US's. The NHS is funded from general taxation (including NI payments)).

[1] http://www.guardian.co.uk/news/datablog/2013/mar/20/budget-2...

[2] http://www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s...

Re: One hospital charges $8,000 — another, $38,000

#64

Post by smcl »

lucian1900 wrote: post #49
rdl wrote: post #21

Earlier quoted context omitted.

The weird thing about having an HSA is that because I pay essentially 75% of a lot of things out of pocket (as long as I'm below my deductible), it often makes sense for me to negotiate and "pay cash" rather than running through my insurance. And yes, the doctors, pharmacies, etc. drop the prices a lot. One of the weird things going on right now is that Doxycycline (a common antibiotic) has gone up in price 10-20x in…

That still sounds like a terrible deal to me. In the UK, I pay around 10% of my salary for national health care and get free care for any problem I might have (and so does my girlfriend, of course). Medication is always exactly £7 (or similar, it might have changed slightly recently) regardless of what it's for.

> Medication is always exactly £7

Except in Scotland, Northern Ireland and Wales where since 2011 it is always exactly £0

http://www.bbc.co.uk/news/uk-12928485

Re: One hospital charges $8,000 — another, $38,000

#65

Post by rdl »

SEMW wrote: post #63
rdl wrote: post #60

Earlier quoted context omitted.

So my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage. (I also think the top US care, if you are in the right place, is better than the top NHS care, but only for cancer or very rare diseases; for everything common they're comparable, but NHS covers everyone, so the average quality of care…

> my coverage is maximum out of pocket per year $5-7k. It's very reasonable to assume HN readers make more than $50-70k/yr, so that's better than 10% of income for the same coverage You're not comparing like with like. Comparing a figure (presumably) calculated by taking the GP's effective tax contributions and multiplying by the proportion of UK public spending that goes to health (~19%)[1], with a figure of the dir…

This is an interesting link from the Forbes article: http://www.nejm.org/doi/full/10.1056/NEJMp0907172#t=article

Apparently the variation across regions in the US (controlled for all other factors like race, income, etc.) almost half as much as the variation between the US and UK, even though the entire US has the same financial structure.

Re: One hospital charges $8,000 — another, $38,000

#66

Post by rdl »

axefrog wrote: post #42

Why does the US tie health care to employment? Why is it not tied to the individual and thus transferrable between employers?

It started as a legacy of wage controls during WW2 (they added a bunch of fringe benefits to compete without technically breaking the law), but continues because medical insurance is tax deductible for an employer who buys it for his employees, but NOT for an individual who buys it for himself or his own family. So it essentially costs an individual 20-55% more than it could cost an employer.

(There's also the risk-pooling aspect; an employer can get a group rate with guaranteed issuance because it's assumed they will be selecting employees for moderate to good health (or else they'd be disabled vs. working), or at worst randomly, with only random-in-population odds of high-cost dependents. There's an adverse selection with voluntary individual insurance; healthy people would rationally not get insurance if it were really expensive relative to their expected utilization, whereas someone with a chronic condition or high risk actually would get insurance even at a relatively high cost. Which in turn drives up the costs per insured, which drives up the rate...eventually becoming uneconomic. In practice, a lot of people with chronic conditions in their families actually do seek out stable jobs with big employers with good insurance to cover it, vs. doing startups or whatever, which imposes a loss on the economy if they would otherwise have been the next Elon Musk.)

The Republicans in 2008 (McCain?) were actually arguing for making medical insurance non-deductible for employers and I think deductible for individuals, which was then seized upon as "taking away your health insurance". Ironically that position of moving insurance away from employers seems to be a long-term goal of the ACA/ObamaCare.

Re: One hospital charges $8,000 — another, $38,000

#67

Post by chii »

Xylakant wrote: post #39
gordaco wrote: post #37

8000, 38000, both insanely expensive. I haven't seen a single sane price in the whole article.

8000 USD for a hospital treatment does not seem insanely expensive for me. Hospitals are by definition expensive - 24/7 on-site staff, highly trained experts (doctors), lots of expensive machines. A simple bed in a hospital is far more complicated and expensive than your standard home mattress. Hospitals need to overprovision on a constant basis since the can't just return a "503 Retry Later" in case of emergencies.…

> a fifth of the highest price?

may be because those higher charges are more bureaucracy than actual value adding?

Re: One hospital charges $8,000 — another, $38,000

#68

Post by jws »

300bps wrote: post #58
Jayschwa wrote: post #16

Earlier quoted context omitted.

One good aspect doesn't make it a boon. In my personal experience, the law has made insurance less affordable. I'm in between jobs and bought an inexpensive short-term, high-deductible plan. However, the plan has been deprecated (no renewals after a certain date) because it does not meet all provisions of the ACA.

>In my personal experience, the law has made insurance less affordable. Last year I had a PPO insurance plan at work that cost $216 per month for a family plan and had very tiny out of pocket expenses. This year my employer dropped the PPO as being unaffordable and switched to a HDHP that costs the same $216 per month for my family plan. Now the plan pays literally nothing for the first $3,000. And then 80/20 up to t…

$216 sounds like only your part of the payment. Do you know how your employer's contribution (the bulk of the total cost) changed? Sounds like they saved a lot of money.

Re: One hospital charges $8,000 — another, $38,000

#69

Post by chii »

gordaco wrote: post #36
girvo wrote: post #3

Earlier quoted context omitted.

Kind of defeats the whole "free market" thing, doesn't it?

No captive market can ever be a free market. And everything health-related is a captive market, because you can't afford not to pay for the service.

> because you can't afford not to pay for the service.

you mean you can't afford to not _have_ the service? you can certainly be unable to pay!

Re: One hospital charges $8,000 — another, $38,000

#70

Post by whiddershins »

nostromo wrote: post #27

I wonder, since we strangely expect employers to provide healthcare insurance in the US, what if employers just decided to provided actual healthcare. Imagine taking all of the health premiums Google pays for its employees, and instead of feeding it in to a broken system, you build a world class health facility in Mountain View that's free to employees.

One of the least known factors in American health care is that many large employers operate the health insurance directly, and at a profit.

Many large corporations are the health insurance provider for their employees, and then contract the administration of the insurance to one of the known brands like AETNA or Blue Cross or whatever.

So, they are one step ahead of you. Not exactly what you meant, but a more profitable version.

Post reply on HN