The Man Who Was Treated for $17,000 Less • Hacker News Board

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

#81

Post by gwright » Thu, Aug 22, 2013, 9:09 PM UTC

JohnTHaller wrote: post #47

gwright wrote: post #25

Earlier quoted context omitted.

You seem to be suggesting that the only valid opinions on any topic are those that originate from a person without any bias but who is somehow intimately informed about the topic. Those people generally don't exist. The best we can hope for is some reasonable amount of transparency along with a variety of opinions.

The best we can hope for is people attempting to take their personal bias out of reporting and investigate the full story, especially when what happened contradicts their worldview. Real journalists do this. News Corporation (Fox News/WSJ/etc) specifically does the opposite.

You are not being very observant if you think that Fox News, WSJ, etc. are the only media outlets that have a bias.

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

#82

Post by duskwuff » Thu, Aug 22, 2013, 9:10 PM UTC

Smudge wrote: post #62

bmmayer1 wrote: post #28

Earlier quoted context omitted.

What the commenter suggested is exactly the situation right now: the hospital sets the prices as astronomically high as possible because they can get away with it, because the patients aren't paying it. Don't you think introducing patient choice into the equation would put some downward pressure on prices? And certainly if it puts any downward pressure on prices, it's a better situation than we have now.

If you're having a heart attack, are you really in a position to negotiate on price? At all? I get that there might be some downward pressure, but what prevents the hospital from just laying an absurd bill on you after the procedure?

It's somewhat akin to emergency non-medical services - say, a tow truck, locksmith, or plumber. Many of these services cost quite a bit more than they should. Why? Because the people who need them are in no position to shop around.

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

#83

Post by refurb » Thu, Aug 22, 2013, 9:10 PM UTC

javajosh wrote: post #66

There is no such thing as a free-market in health-care. Period. Patients are not customers. We don't shop. And you know what the biggest tell-tale about that is? Hospitals don't advertise. Sure, you see ads for a handful of elective procedures like teeth whitening and boob jobs - but when did you see an ad for hernia surgery? Now, it would be an interesting world where there was indeed some sort of marketplace for he…

You're already buying your healthcare based on price! The difference is that your insurance company is doing it for you (assuming you are insured). That's why they have "in-network" providers.

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

#84

Post by plock » Thu, Aug 22, 2013, 9:12 PM UTC

roc wrote: post #67

joshuahedlund wrote: post #23

Earlier quoted context omitted.

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…

The real point to them being elective luxuries is that the would-be consumer can actually walk away entirely. You needn't get lazik from anyone . The same can't be said of many/most medical procedures. You can't research the market and just skip getting a knee replacement altogether, the way you could with lazik. To say nothing of more serious problems.

The consumer also can't entirely walk away from the food market. That doesn't make food prices go out of control.

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

#85

Post by superuser2 » Thu, Aug 22, 2013, 9:17 PM UTC

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."

Healthcare most certainly is covered by the laws of economics. It's a service for which there is inelastic demand. Laisk and cosmetic surgery are optional, so the price influences the quantity demanded. Nobody would buy a $100,000 cheeseburger. Treatment that's needed to end suffering or make people functional again is inelastic; if you charge someone's annual salary, he still has to pay it.

It's true that there could be competition on price for non-emergency care. It's okay for someone to eat cheap, low-quality food or live in shitty housing, because for the most part they'll be okay. Should there really be a Ramen of surgery? Are you really willing to inflict that on people?

A good portion of this country is. Those of us who voted Democrat aren't.

http://www.investopedia.com/terms/e/inelastic.asp

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

#86

Post by EvanAnderson » Thu, Aug 22, 2013, 9:24 PM UTC

umsm wrote: post #34

EvanAnderson wrote: post #15

In my experience having a high-deductible health insurance policy that that I purchase myself I think this bit of the article can't be understated. "I explained that just because he had health insurance didn’t mean he had to use it in every situation. After all, when people have a minor fender-bender, they often settle it privately rather than file an insurance claim. Because of the nature of this man’s policy, he co…

I'm not a health-care professional, so I don't know: But wouldn't you be able to not tell the hospital that you have insurance? Pretend like you don't have any from the beginning? Or can this backfire?

The practices we had our issues w/ were an imaging clinic and a pediatrician. I kinda expect that telling either one of them that we didn't have insurance would have resulted in them refusing to take us as patients. My wife and I talked about trying it with the prospective next provider, actually.

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

#87

Post by EvanAnderson » Thu, Aug 22, 2013, 9:27 PM UTC

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…

My family is having exactly the same experience with our HDHP.

I like the cost of the plan (and I'm saving every last red cent I can to cover future expenses) but I'm regarded like I'm crazy when I bring up cost to providers.

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

#88

Post by sejje » Thu, Aug 22, 2013, 9:32 PM UTC

superuser2 wrote: post #85

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."

Healthcare most certainly is covered by the laws of economics. It's a service for which there is inelastic demand. Laisk and cosmetic surgery are optional, so the price influences the quantity demanded. Nobody would buy a $100,000 cheeseburger. Treatment that's needed to end suffering or make people functional again is inelastic; if you charge someone's annual salary, he still has to pay it. It's true that there coul…

But a 325,000 burger, on the other hand, is fair game.

http://www.nytimes.com/2013/08/06/science/a-lab-grown-burger...

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

#89

Post by roc » Thu, Aug 22, 2013, 9:38 PM UTC

plock wrote: post #84

roc wrote: post #67

Earlier quoted context omitted.

The real point to them being elective luxuries is that the would-be consumer can actually walk away entirely. You needn't get lazik from anyone . The same can't be said of many/most medical procedures. You can't research the market and just skip getting a knee replacement altogether, the way you could with lazik. To say nothing of more serious problems.

The consumer also can't entirely walk away from the food market. That doesn't make food prices go out of control.

Which would be a great point if not for the oversight, subsidies, reserves and incentives that affect staple foods.

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

#90

Post by dragonwriter » Thu, Aug 22, 2013, 9:46 PM UTC

bmmayer1 wrote: post #28

joshuahedlund wrote: post #23

Earlier quoted context omitted.

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…

What the commenter suggested is exactly the situation right now: the hospital sets the prices as astronomically high as possible because they can get away with it, because the patients aren't paying it. Don't you think introducing patient choice into the equation would put some downward pressure on prices? And certainly if it puts any downward pressure on prices, it's a better situation than we have now.

> Don't you think introducing patient choice into the equation would put some downward pressure on prices?

If you could magically make healthcare look like an Econ 101 market where rational choice theory and perfect competition both were even remotely reasonable models of what was going on, sure.

But "patients don't pay directly for services" isn't even close to the only way that healthcare doesn't look like an Econ 101 market. Rational choice theory is a deeply and fundamentally flawed model to start with, but its a tolerable approximation of behavior in lots of important cases (mostly, classes of products which are frequently purchased and used and whose utilities are very clear upon use, allowing any misperceptions about expected utility to be resolved so that most purchase decisions are in fact made with reasonably strong information about costs and utilities.)

Look, the rest of the developed world does as good or better (by most measures) healthcare than the US at vastly lower cost (whether measured per capita or per GDP), and they don't do it by making patient pay directly for services. The whole idea that we have to resort to abstract Econ 101 theory to determine how to control prices in healthcare ignores the fact that the rest of the developed world exists.