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The Man Who Was Treated for $17,000 Less

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Re: The Man Who Was Treated for $17,000 Less

#71

Post by rthomas6 »

joshuahedlund wrote: post #23
bmmayer1 wrote: post #4

"Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care." Sadly, most people forget this. They think that healthcare is somehow immune from the laws of economics, that it is "special."

I like this argument, too, but the common response is that Lasik and cosmetic surgeries are elective - voluntary improvements to your body that are a sort of luxury that lend themselves to competition (shopping around, taking your time). By contrast, a lot of expensive medical procedures are much more critical and time-sensitive (you could say the demand is much less elastic), which makes it a lot harder for competit…

If my breaks need replacing or my A/C goes out, I'm not going to use my car insurance to pay for that, because that would make the insurance really expensive, and create a similar price insensitivity. I don't see how that's different than getting knee surgery or whatever.

OTOH if I get in an accident where I'm not at fault (let's assume the other person didn't have insurance), I'll use my insurance to fix the car, because it's a sudden emergency with a high cost. I don't see how that's different than a heart attack or whatever.

I don't see why people conflate all medical care into one group. Routine care and emergency care are clearly separate.

Re: The Man Who Was Treated for $17,000 Less

#72

Post by JPKab »

cromwellian wrote: post #27

A month ago, I was traveling in Germany with my family and my daughter had an emergency, so I had to go to a German hospital in the middle of the night. Within 1 hour, they had given my daughter an ultrasound and two doses of medicine to treat her problem, the cost to me: $130 euro, and I didn't even use my health insurance (which does cover international emergencies) 3 years ago, I had a gallbladder attack in Shangh…

I used to be on a High Deductible Health Plan, which is designed to be just like the author suggests: only for catastrophes. For anything else, you use a Health Savings Account (a tax free account you put money into) and use it to just pay cash prices.

IT WAS HORRIBLE. The concept of course, is great. But the problem is one of chicken and egg. Because the entire system is set up for 3rd party payment, NOBODY, and I mean NOBODY, has a clue what they charge for anything. Go ahead, take the challenge. Ask a receptionist or even a doctor how much they charge for a procedure. They have no idea.

The effect was that going to any medical appointment was a crap shoot. I had no clue what I was going to be paying until AFTER treatment. The amount of friction in just getting a price was so painful that shopping around was impossible. Since "shopping around" is the whole basis behind "price clearing" in markets, the current system of HSAs implemented by Bush is bullshit. Had he gone all the way, and just forced every insurance company to only offer HDHPs, then it would be different. Medical providers would have been forced to share pricing information.

Re: The Man Who Was Treated for $17,000 Less

#73

Post by specialist »

cromwellian wrote: post #27

A month ago, I was traveling in Germany with my family and my daughter had an emergency, so I had to go to a German hospital in the middle of the night. Within 1 hour, they had given my daughter an ultrasound and two doses of medicine to treat her problem, the cost to me: $130 euro, and I didn't even use my health insurance (which does cover international emergencies) 3 years ago, I had a gallbladder attack in Shangh…

...capitalism vs socialism alone, it's much more nuanced than that.

Profiteering. Seems pretty simple to me.

I'm exhausted by the -ism debates and mythical free markets. To me, it's about the incentives. So I support a single payer using the capitation model, reward wellness vs treating disease.

With ACA (Obamacare), I hope that we're on our way towards single payer in the USA. Meanwhile, I'm impressed with improvements gained so far with the modest initial reforms (eg health exchanges).

Who would have thought that a well regulated market with price transparency would lead to price competition? /sarcasm

Re: The Man Who Was Treated for $17,000 Less

#74

Post by rfnslyr »

TDL wrote: post #55
rayiner wrote: post #30

So what do you do if you don't have $3,000 to pay for what can be a life-threatening operation (a hernia)? The Cato Institute answer, let the person die, is economically nonsensical. The economic value of that person's lost labor is almost certainly worth way more than $3,000.

Could you provide the link to where the Cato Institute says that letting the person die is an acceptable option?

Read HN like I do. Take every statement as fact! I call it truth hacking.

Re: The Man Who Was Treated for $17,000 Less

#75

Post by hayksaakian »

JPKab wrote: post #72
cromwellian wrote: post #27

A month ago, I was traveling in Germany with my family and my daughter had an emergency, so I had to go to a German hospital in the middle of the night. Within 1 hour, they had given my daughter an ultrasound and two doses of medicine to treat her problem, the cost to me: $130 euro, and I didn't even use my health insurance (which does cover international emergencies) 3 years ago, I had a gallbladder attack in Shangh…

I used to be on a High Deductible Health Plan, which is designed to be just like the author suggests: only for catastrophes. For anything else, you use a Health Savings Account (a tax free account you put money into) and use it to just pay cash prices. IT WAS HORRIBLE. The concept of course, is great. But the problem is one of chicken and egg. Because the entire system is set up for 3rd party payment, NOBODY, and I m…

wasn't there a Show HN recently that solved this exact problem of exposing pricing of medical procedures and such.

Re: The Man Who Was Treated for $17,000 Less

#76

Post by munificent »

Ensorceled wrote: post #43
munificent wrote: post #33

God, what a terrible article. So we canceled the surgery and started the scheduling process all over again, this time classifying my patient as a "self-pay" (or uninsured) patient. Yeah, how well does that strategy work when you're having a heart attack and are moments from death? I quoted him a reasonable upfront cash price, as did the anesthesiologist. We contacted a different hospital and they quoted him a reasona…

How does that make the article terrible? He's not saying that this is a good thing he's using this as an example of how broken the medical system is. Did you read to the end? Or did you just get annoyed after the first few paragraphs and write this screed?

The author is arguing that we should use a free market for healthcare. He cites exactly one anecdote where a free market exchange happened to have worked out in the patient's benefit and then generalizes that to the entire healthcare industry.

But he completely fails to take into account the fact that healthcare is about as far from an efficient market as you can get:

1. Patients often need healthcare right now or they will die which does not give them the time, opportunity or mindset to weigh alternatives and make an informed choice.

2. Patients are often unconscious when healthcare decisions must be made.

3. Patients are constrained in their choices by time and place. When you need healthcare, you often need it immediately and are unable to travel, which means you can only choose from the venues nearby.

4. Quality of product is nigh impossible for a patient to ascertain. You might be able to find the outcome history for a few care providers you're considering, but that presumes you can reliably tell which doctor will actually be the one to give you care. If you take a turn for the worse when they're off duty, now it's out of your hands.

5. Patients can't pick and choose pieces of care. Assuming somehow you do have the data to make decisions about which nurses, facilities, equipment, doctors, and anesthesiologists you want, you can't pick and choose them and assemble your own A-Team.

No one argues that the medical system isn't broken, but arguing that we should replace it with individual customer chosen free markets is making the claim that somehow a bunch of stressed out amateurs with little time or medical knowledge who are currently suffering a medical malady will somehow be able to bargain more effectively than what we see now.

Re: The Man Who Was Treated for $17,000 Less

#77

Post by refurb »

JPKab wrote: post #72
cromwellian wrote: post #27

A month ago, I was traveling in Germany with my family and my daughter had an emergency, so I had to go to a German hospital in the middle of the night. Within 1 hour, they had given my daughter an ultrasound and two doses of medicine to treat her problem, the cost to me: $130 euro, and I didn't even use my health insurance (which does cover international emergencies) 3 years ago, I had a gallbladder attack in Shangh…

I used to be on a High Deductible Health Plan, which is designed to be just like the author suggests: only for catastrophes. For anything else, you use a Health Savings Account (a tax free account you put money into) and use it to just pay cash prices. IT WAS HORRIBLE. The concept of course, is great. But the problem is one of chicken and egg. Because the entire system is set up for 3rd party payment, NOBODY, and I m…

It might have been your HDHP plan. I know the one my employer offers still have "networks". That is, the fees are pre-negotiated by the plan (you basically pay the same as for the non-HDHP plans). It's not hard to find out what they are either.

Re: The Man Who Was Treated for $17,000 Less

#78

Post by rjsw »

to3m wrote: post #54
nether wrote: post #36

Earlier quoted context omitted.

I'm glad I bit the bullet and got lasik last year. It beats the nonzero risk of eye infection every time I touch my eyes with contact lenses. These problems can cause vision loss and sometimes require eye removal: http://www.webmd.com/eye-health/news/20061010/lasik-surgery-...

I have some solid lenses made out of plastic, held in front of my eyes. "Non-contact Lenses", I suppose you'd call them. Or perhaps, "binocularettes"? Anyway, they're sort of like monocles, but attached to a little frame that fits around my ears and above my nose, keeping the lenses in place. A minor hassle but you soon get used to it. Ask me on my death bed to be sure - but I'm pretty sure that the risk of eye remov…

I mostly use the same "non-contact lenses" as you but have also used contact lenses for 35 years and not needed to have an eye removed.

Deliberately putting things in your eye does have one advantage, you can easily fish out any bits of grit that get in there by accident.

Re: The Man Who Was Treated for $17,000 Less

#79

Post by refurb »

specialist wrote: post #73
cromwellian wrote: post #27

A month ago, I was traveling in Germany with my family and my daughter had an emergency, so I had to go to a German hospital in the middle of the night. Within 1 hour, they had given my daughter an ultrasound and two doses of medicine to treat her problem, the cost to me: $130 euro, and I didn't even use my health insurance (which does cover international emergencies) 3 years ago, I had a gallbladder attack in Shangh…

...capitalism vs socialism alone, it's much more nuanced than that. Profiteering. Seems pretty simple to me. I'm exhausted by the -ism debates and mythical free markets. To me, it's about the incentives. So I support a single payer using the capitation model, reward wellness vs treating disease. With ACA (Obamacare), I hope that we're on our way towards single payer in the USA. Meanwhile, I'm impressed with improveme…

Profiteering is too simplistic of explanation. If you read up on the various regulations and how they create incentives for hospitals to do this, it makes more sense.

And you have to be careful with the regulations you institute. A LOT of the current problems with the US healthcare system are due to gov't regulations. If you want to see an example, just google "average selling price ASP" and see the utter mess that regulation created for Medicare. Doctors and pharmacists milk the hell out of that gov't regulation. Same with 340b.

Re: The Man Who Was Treated for $17,000 Less

#80

Post by Retric »

jbooth wrote: post #38
baddox wrote: post #16

Earlier quoted context omitted.

Many people will unabashedly say that they believe healthcare to be special. It's not uncommon to hear people say that they don't believe profit motive has any place in healthcare. I don't buy it. I don't see how healthcare is any more special than, say, food production (both are obviously vital to health), yet I think most people have come around to recognizing that profit motive is a spectacular way to organize the…

Of course healthcare is special, it's not a normal market because of extreme demand inelasticity. Food is special too, but it manages to function as a market because we have a food surplus, a plethora of replacement goods within the food category and it's much less specialized to produce. This doesn't mean that people don't deserve to earn a living. The doctor in the article managed to find a way to make the man's pr…

What separates heathcare from a food is you know how hungry you are you have no idea what blood tests should be done. And the person ordering blood tests has no incentive to hold back as they make more money the more they do and can be suied if there to passive.
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