Diagnosis: Insufficient Outrage • Hacker News Board

Re: Diagnosis: Insufficient Outrage

#61

Post by lostlogin » Sun, Jul 07, 2013, 8:09 AM UTC

haldujai wrote: post #60

vacri wrote: post #58

Earlier quoted context omitted.

$2000 is utterly ridiculous for a stress test. I used to work as a neurology tech, mostly dealing with epilepsy. Our tests themselves could invoke seizures, and we frequently saw seizures anyway, which can be life threatening if not handled. We were a private department in a hospital - as techs, we knew enough first aid to keep the person alive and call for the crash cart. $2000 might sound reasonable if every single…

You're assuming the cost is $200. In Canada it can be up to 6 months (from my own experience) to get a stress test booking. In the states you can do it the next week. That gets a significant premium. Compare it to buying something on eBay from Hong Kong and waiting 5-8 weeks vs paying 4x and getting it right this second from Best Buy. At the end of the day you're going to get what you need either way but it's how lon…

A good thing about socialised systems (don't get me wrong, there are plenty of problems too) is that they often have more protocol homogeneity. What this helps with is that best practice gets codified and protocols written. Then a clear pathway is made for clinicians to follow, with a review system to allow for improvements. Fragmented systems with owner operators (usually sub specialists) can have other motives ($) and little to zero feedback on care quality. Large systems with set protocols helps reduce unneeded tests. Getting the money saved put back into other parts of the system however, can be.... Tricky.

Re: Diagnosis: Insufficient Outrage

#62

Post by cmccabe » Sun, Jul 07, 2013, 8:17 AM UTC

xxpor wrote: post #19

jeswin wrote: post #17

Earlier quoted context omitted.

I wasn't planning to either. But buying any medicine requires a prescription in the US, which may be fine depending on how you look at it. What I was trying to say was that I found treatment 10x more expensive in the US; while other expenses are merely higher and generally affordable.

I'm agreeing with you. We don't get medicine for things like pink eye, we just let it run it's course.

now that is silly. you don't know what kind of infection it is unless you go to the doctor.

You really need to get a health plan if you don't have one. If you're young it might only be $100/$200 a month, even if you're unemployed.

Re: Diagnosis: Insufficient Outrage

#63

Post by batbomb » Sun, Jul 07, 2013, 8:34 AM UTC

On the proton therapy: As a particle physicist whose best friend just finished (photon) radiation therapy for brain cancer, I know a good chunk about this. First off, not all proton therapy is the same. It's heavily dependent on the linac and gantry a hospital has. UCSF has proton therapy in Davis or somewhere targeting glaucoma and stuff, which is completely different than the facilities at Loma Linda or Massachusetts General. Of higher energy proton therapy centers, there's only about 5 such facilities in the US. As far as general hadron therapy goes, there's none. So a proton therapy center in Washington isn't likely to serve just Washington and/or Baltimore, it's likely to service Virginia, West Virginia, Maryland, New Jersey, and even farther out possibly. On top of that, it's still heavily research based, and moving pretty quickly as we've moved towards modeling human tissue with GEANT4 and Monte Carlo simulations.

Anyway, while I don't know the specifics of the proton therapy centers mentioned, the assumption that a proton therapy center would just service Washington/Baltimore metropolitan areas is silly. After LLNL shut down their proton therapy center/experiment, we don't even have any proton therapy centers in the Bay Area.

Re: Diagnosis: Insufficient Outrage

#64

Post by stass » Sun, Jul 07, 2013, 8:37 AM UTC

haldujai wrote: post #18

gregsq wrote: post #10

Earlier quoted context omitted.

Actually Indonesia, a country clawing its way out of third world status, is in the process of introducing universal health care, [1] so it's not only commonwealth countries. Hopefully, this 'socialised' system can be implemented in such a way as to flourish within the rapidly growing economy to come. In the UK, after we've charged you nothing in the NHS, we'll give you the bus fare home. 1. http://www.marketplace.org…

Yes but try getting an appointment with a doctor in a reasonable time under NHS. It's been a while since I've left the UK but I remember getting appointments with a primary care physician using private insurance I would get one the next day, with NHS the next month.

It takes me a month to get a physician appointment with private insurance in US (and you cannot go to the doctor without first going to physician). I don't even bother anymore and just go directly to urgent care.

Part of the problem with US healthcare is not just that prices are insane, but that it does not provide an adequate service even given those prices. Again, a sign of a non-free market.

Re: Diagnosis: Insufficient Outrage

#65

Post by zanny » Sun, Jul 07, 2013, 9:09 AM UTC

jamesaguilar wrote: post #55

zanny wrote: post #33

Earlier quoted context omitted.

My Uncle is a doctor, went the full 9 years at Tulane and everything. He had to close his own practice because Medicare paid dirt, insurers would delay payments for years, and malpractice insurance was thousands a month. He was running around a 2,000 a month deficit when he had to fire his secretary and close down. He now works in a general hospital as a surgeon, and is actually happier not having to try to haggle ge…

The overhead of insurance companies are minimal. Less than five percent of the overall spend (edit: this is wrong, it is more like 8%, see [1]). As much as you prefer to think of your uncle as the good guy and faceless insurance companies as the bad guy, a big part of the problem is he makes between 150% and 200% what his European and Canadian counterparts make. http://economix.blogs.nytimes.com/2009/07/15/how-much-d…

And I'm not saying his practice went under exclusively from insurance companies. And it wasn't how much they were taking, it was more that it took them months to actually pay him for services rendered, and it consumed tons of time to just keep track of who hasn't compensated him yet (besides copays). And medic___ were just as slow.

He might have made it all up, was living it lavishly and just lied about it, but it seems like that would be hard to hide from the extended family. He's had the same car for 8 years now, and his wife works. But he was still a general practice doctor in Augusta that closed his practice and went to work elsewhere for some reason, and if he was making a lot of money, it wasn't showing in how he was living (one house he had for 20 years).

Re: Diagnosis: Insufficient Outrage

#66

Post by zanny » Sun, Jul 07, 2013, 9:11 AM UTC

bmmayer1 wrote: post #32

Yes, if prices are skyrocketing it must be a "Crime" caused by all the dirty capitalists enriching themselves. There could be no possible explanation for it. Unless, of course, you want to consider: 1) The stifling HIPAA regime that makes it almost impossible for small, potentially competitive practices to stay open without insane amounts of overhead, explaining their sellouts to larger at-scale healthcare corporatio…

In response to #1, I know my uncle had to close his private practice (he is a practicing doctor of 18 years now and had his practice for 8) because of absurd costs and time investment in doing bookkeeping and playing hardball with everyone. He closed and is now working as a surgeon at a major hospital, but says he likes it a lot more since hes actually a doctor now and not a barterer or economist.

Re: Diagnosis: Insufficient Outrage

#67

Post by zanny » Sun, Jul 07, 2013, 9:14 AM UTC

zaroth wrote: post #53

pyre wrote: post #42

Earlier quoted context omitted.

| The necessity to offset insanely low negotiated | and subsidized Medicare/Medicaid rates My understanding is that insurance companies often get rates lower than Medicare. It goes something like this: 1) Government mandates the rates for procedure X to make sure that the government is getting the 'best' deal. 2) Hospitals charge insurance companies using these rates (they aren't allowed to be lower, or it wouldn't b…

As it was explained to me by the CFO of a major hospital, you are incorrect. Hospitals would be out of of business if their average revenue per procedure was equal to the Medicare rates per procedure. But that's not to say that hospitals are "losing money" on every Medicare patient, it's much more complicated. Running a hospital is like running an airline, there are extraordinary fixed costs just to open the doors, r…

> No one buys more than Medicare, so it's not surprising that they get the best rates.

It is almost as if a public option might be economically efficient.

Re: Diagnosis: Insufficient Outrage

#68

Post by alan_cx » Sun, Jul 07, 2013, 9:29 AM UTC

loginalready wrote: post #40

Qantourisc wrote: post #22

Seriously, just copy the EU on healthcare. You might need to pay extra taxes, and take an extra insurance against hospitals fees. But it's all very affordable. If it wasn't for A) getting the same answer for most of my ills: inflammations :p B) The doctor being very busy. C) Basic respect to not stress our medical system. One would go for the tiniest medical complain.

The EU is not a country. The EU has no single healthcare system. Every country has it's own system, which range from anything between 100% government provided to mostly privatized. No system is the same. And it's not just the EU, it's the entire Western civilization outside the US. This is extremely important, because the healthcare debate in the US is falsely framed as a choice for or against "socialized medicine",…

As I understand it, there sort of is the same health care across the EU. There is an EU healthcare card which means any EU citizen gets treated in any EU country. The systems are different, but in the end we can all get healthcare free at the point of delivery. No absurd bill.

The details of how each country does it are different, but the result is the same. No insane bills to stay alive. No poor turned away or treated like second class citizens.

I have to say, of all the things I cant get my head round about the US, the health care system is the biggest jaw dropper for me. Not only is it not universal, but the people who run it make incredible profit out of it. Seems mad to me.

Re: Diagnosis: Insufficient Outrage

#69

Post by bmmayer1 » Sun, Jul 07, 2013, 9:38 AM UTC

zanny wrote: post #67

zaroth wrote: post #53

Earlier quoted context omitted.

As it was explained to me by the CFO of a major hospital, you are incorrect. Hospitals would be out of of business if their average revenue per procedure was equal to the Medicare rates per procedure. But that's not to say that hospitals are "losing money" on every Medicare patient, it's much more complicated. Running a hospital is like running an airline, there are extraordinary fixed costs just to open the doors, r…

> No one buys more than Medicare, so it's not surprising that they get the best rates. It is almost as if a public option might be economically efficient.

Not at all, because when you have monopsony pricing you end up below market price, which drives marginal producers out of business and ends up reducing supply. It's the same reason the argument for the government buying up all the food and distributing it doesn't work: because no one would go into a business where they are guaranteed to make a loss.

Re: Diagnosis: Insufficient Outrage

#70

Post by ars » Sun, Jul 07, 2013, 9:38 AM UTC

leetrout wrote: post #3

This rings so true. When I had graduated college I was in a 3 week lull between graduation and a job around January when I was struck with a kidney stone. No health insurance. I took a trip to the ER around 10pm one evening in agonizing pain and was treated like a drug addict. I wasn't even triaged for over 2 hours (peak flu season) and everyone acted like I was just trying to score pain meds. Finally, after 3.5 hour…

> Took me over 2 years to pay all of it off. It pretty much wrecked my personal finances

Why did you pay it then? Tell the hospital you can't pay and move on with life. If you do well financially pay it then.

> threats from collection agencies finally forced me to put it all on my credit card

I don't understand this. Why do you even answer the phone when they call? Or open the letters they send?

Just ignore them, and when you are ready to pay, then pay the hospital directly.

Completely ignore the credit collection agencies. They are utterly impotent, especially when it comes to medical debt which has no effect on your credit score.

I mean it - completely ignore them. I don't mean answer the phone, listen to the threats and ignore it. I mean utterly ignore them. You have caller ID.

Any letters get placed unopened in a box.