Diagnosis: Insufficient Outrage • Hacker News Board

Re: Diagnosis: Insufficient Outrage

#81

Post by waps » Sun, Jul 07, 2013, 11:48 AM UTC

lostlogin wrote: post #61

haldujai wrote: post #60

Earlier quoted context omitted.

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 ($)…

As someone living under a "socialist" system, let me tell you : "practice" is codified, yes. Best practice is not, unless some politician's kid or granddad has the disease/condition in question.

Someone I know needed a root canal treatment, and I found out that ... it's not covered - at all - under the national system. Nor is it covered under normal insurance except for a small token amount (< $250 equivalent, and yes it will cost $2k+ here too). And there is no way to get it done quickly, which makes no sense. We're talking about a root canal here. Delaying it at the point where it hurts will make things worse FAST. WTF ?

Re: Diagnosis: Insufficient Outrage

#82

Post by jnhnum1 » Sun, Jul 07, 2013, 12:02 PM UTC

ars wrote: post #70

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…

> 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.

Source? Googling for medical debt and credit score seems to indicate that it will in fact impact your credit score once they hand the bill over to a third party collections agency.

Re: Diagnosis: Insufficient Outrage

#83

Post by ctdonath » Sun, Jul 07, 2013, 12:48 PM UTC

namlem wrote: post #25

jakobe wrote: post #8

I don't get how a cardiac stress test can cost 2000USD. You put someone on a home trainer, let them pedal for 20 minutes, and look at their EKG. It's usually performed by a nurse, and the doctor spends 30 seconds looking at the EKG (the analysis of the EKG is even partially automated). If there was actual competition on the market, I'm sure a health service provider would find a way to perform the test for 75USD.

The hospitals just charge that because they can. What most people don't know is that you can often negotiate them down.

The word "cash" works wonders. 4-10x discounts.

If you're paying list price you're not even trying.

Re: Diagnosis: Insufficient Outrage

#84

Post by caw » Sun, Jul 07, 2013, 12:57 PM UTC

xxpor wrote: post #14

p37307 wrote: post #7

I have seen all of my doctors office swallowed up by hospitals in the last year. In Southwestern Ohio Mercy Health Systems and TriHealth are buying them up. They are following the lead of Christ Hospital who started this years ago at an alarming rate. As far as my rates go, I did notice almost everything, even items done at the local office, was an outpatient procedure billed by the mother hospital, at least in part.…

NE Ohio is the same way. University Hospitals and Cleveland Clinic own everything. One of the last independant hospitals, Parma Regonal, was purchased by UH this past week.

My uncle works for a hospital system that's doing the same "buy up everything" plan. He says it's because once they own all of the medical providers in the county, then they will be able to dictate the price to the insurance, instead of the other way around. What can the insurance companies tell their customers? Go to the next county for healthcare?

Another relative of mine just merged his surgical practice into the hospital system's. The overhead on his practice was getting too high, in particular malpractice insurance.

Re: Diagnosis: Insufficient Outrage

#85

Post by robbiep » Sun, Jul 07, 2013, 1:12 PM 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…

Thats borderline malpractice, or perhaps more properly, very aggressive monetizing practice: a stone, or any renal cause, is always investigated initially with ultrasound.

I wonder if there is a role for disputing charges on the basis of unnecessary investigations (especially in the ED setting) based on a standard of care- sort of opposite a medical malpractice suit.

But I'm in Australia and don't need to worry about having 2 years worth of debt from an emergency illness..

Re: Diagnosis: Insufficient Outrage

#86

Post by vacri » Sun, Jul 07, 2013, 1:15 PM 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…

Having been a medical technician, I'm aware of the cost of equipment, consumables, wages, rent, and so forth. The consumables in the bulk of stress tests are minimal - you're basically paying equipment and wages, and there's no real reason why a stress test should be an order of magnitude more than what I used to do (all my tests required vendor equipment). Where I worked had a two-week waiting period instead of a one-week, but there were spaces for emergencies. It's certainly not worth 10x more in order to chop your wait from 2 to 1 weeks.

That it's still $2k for uninsured patients is still very much the problem. It's not particularly mollifying that 'only some people' get hit with that bill. No-one should be fleeced simply because they're unwell.

I think a better tactic is to break the student cap. As long as the students remain high quality and there are facilities to train them, there is no reason to limit the number of graduates. It's basically cartel behaviour if that's happening. Doesn't solve things in the short term, though. This being said, in healthcare, there is no golden bullet. Fixing a failing system requires multitudinous tactics.

Re: Diagnosis: Insufficient Outrage

#87

Post by robbiep » Sun, Jul 07, 2013, 1:21 PM UTC

bmmayer1 wrote: post #69

zanny wrote: post #67

Earlier quoted context omitted.

> 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.

Except this isn't the international experience.

In Aus we have a mixed public private system- everyone is treated free but if you want an elective procedure or to see a doctor of your own choice you can pay to do so. I have private health insurance and it costs me $1,500 a year (get dental and optical rebates etc, if I was to require serious treatment it would cover anything under the sun to be done my way) We have public hospital elective surgery waiting lists but the upside is people with no money can actually get the medical treatment they deserve in order to live functional lives.

I have been involved (as a medical student) in the us system- I know a little about it- and the creation of 'the medical poor' - there are probably better terms for it but basically those unable to get the treatment they need and thus unable to live their lives as functionally as possible - strikes me as sad and unjust.

BTW any comment along the lines of 'but doctors don't get paid for their services so less people will be willing to do it' - next year I will be practicing, in 4 years I can expect to be earning $150,000 and in 10-15 I will expect to be earning $350,000 inflation adjusted. More than enough for a comfortable life in my chosen specialty

Re: Diagnosis: Insufficient Outrage

#88

Post by xentronium » Sun, Jul 07, 2013, 4:56 PM UTC

Here, in Russia, basic medical assistance is mostly free (or costs peanuts compared to US), but on the flip side you have to sit through enormous queues, talk to incompetent doctors and doctors themselves might extort you. Paid medicine is better and sometimes better qualified, and you get better service, but it's totally out of budget for anyone below middle class.

Good news is that you won't be charged bajillion dollars after you broke your hand, bad news is that you'll have to wait and suffer in horrible insanitary that is Russian polyclinic.

I have mixed feelings about our health care system. I believe, it will gradually disintegrate as doctors from soviet era get older and retire.

Re: Diagnosis: Insufficient Outrage

#89

Post by malandrew » Sun, Jul 07, 2013, 5:25 PM UTC

sentenza wrote: post #45

zanny wrote: post #28

Earlier quoted context omitted.

I broke my knee this spring but didn't go to a hospital on my families request because the last time I broke a bone I reset it myself and the hospital still charged $8k. I still have blood in the joint, but I can't get it drained because no doctor will stick a needle in without an x-ray, but those are expensive. So I'm waiting till I move out and get a full time position in a bigger city to get health care to have it…

If you know that arthritis is coming, adjust now and move to Germany (or another similar place). Waiting times for specialists might be a little longer, but you (=everybody) will be treated for treatable diseases and injuries. What you have to do, of course, is to move here legally (work visum?).

How easy is it to move to Germany as an experienced software developer and get a job there? I know Berlin has a large startup community, but is it large enough to absorb as many software developers that show up there like it is in Silicon Valley?

Do you already have to know German or can you get by with learning the language after making the move?

Re: Diagnosis: Insufficient Outrage

#90

Post by malandrew » Sun, Jul 07, 2013, 5:31 PM UTC

clicks wrote: post #31

leetrout wrote: post #9

Earlier quoted context omitted.

Thanks very much for dropping that name. I had looked once before but somehow missed Health One. I was specifically looking for testosterone and thyroid previously (before starting a new training plan) and they seemed to be off limits with the providers I had located. Awesome to see those listed and a participating lab within 10 miles of my home.

I think you guys are on to something. I choose to fix my own car when it has small issues, I choose to fix my own computer when things go haywire (whether it's a hardware or software problem), I choose to install/fix issues relating to the washing machine & dryer, furniture, faucets, etc. etc. To get to the point where I could fix these things I had to learn various things from others, from reading up, and so on. I c…

Unfortunately you still can't fill out your own prescriptions diagnosing your own problem, so you'll still end up paying for a doctor's visit if something is wrong.