What Happens When Doctors Only Take Cash (2017) • Hacker News Board

Re: What Happens When Doctors Only Take Cash (2017)

#91

Post by Turing_Machine » Mon, Jan 15, 2018, 10:03 PM UTC

killjoywashere wrote: post #30

This whole thread is full of young, SV libertarians who haven't really thought out what healthcare involves. Lawyers don't have an upfront, all inclusive price for divorce, they charge by the hour. I'm pretty sure software developers charge by the hour, at least for the interesting work. Sure, I'll build you a Wordpress blog for $3k. Would you gaurantee you could build a clinic website that supports major insurance a…

> Orthopods might be able to replace knees on a fixed budget, but I'm thinking neurosurgeons and trauma surgeons would have a heckuva time.

Why would they? That's basically how existing insurance companies work, dude -- they typically pay doctors a specific amount for a specific procedure.

> This whole thread is full of young, SV libertarians who haven't really thought out what healthcare involves.

In my youth, I worked in a drug store. Part of my job was to hassle insurance companies for payment, any time I wasn't busy doing something else. Not only have I "thought it out", I know exactly how it works from personal experience. It works the same way for surgery and other medical procedures, too. The insurance company has a specific amount they'll pay (assuming you can convince them to pay you at all).

Re: What Happens When Doctors Only Take Cash (2017)

#92

Post by [deleted] » Mon, Jan 15, 2018, 10:09 PM UTC

killjoywashere wrote: post #30

This whole thread is full of young, SV libertarians who haven't really thought out what healthcare involves. Lawyers don't have an upfront, all inclusive price for divorce, they charge by the hour. I'm pretty sure software developers charge by the hour, at least for the interesting work. Sure, I'll build you a Wordpress blog for $3k. Would you gaurantee you could build a clinic website that supports major insurance a…

[deleted]

Re: What Happens When Doctors Only Take Cash (2017)

#93

Post by ksenzee » Mon, Jan 15, 2018, 10:13 PM UTC

javadocmd wrote: post #54

ksenzee wrote: post #28

Earlier quoted context omitted.

This is probably a simplification. Normally if you use an out-of-network provider, the cost counts against your out-of-network deductible, which is significantly higher than your in-network deductible. So it may well be that his insurance would count this against his out-of-network deductible, which is so high that he would never reach it anyway.

No. In order to utilize your insurance plan's out-of-network services, the insurance company has to be in the loop. A cash-based system completely circumvents insurance.

Right, you certainly have to loop in your insurance company, by filing a claim (which they won't pay, obviously).

Re: What Happens When Doctors Only Take Cash (2017)

#94

Post by conanbatt » Mon, Jan 15, 2018, 10:16 PM UTC

SpikeDad wrote: post #80

conanbatt wrote: post #66

Earlier quoted context omitted.

I don't think thats true. There is a price bias, but thats not the only quality signal for medical care. There's reviews, facility and installations, reputation, etc. People are price sensitive regarding their own life and their children's. You can find how much they value things with "revealed preferences", an economists principle. Its a bigger problem that as a consumer you don't have to or face the decision of cho…

"Little Billy - would you mind biting on a bullet for an hour while I check Yelp and online reviews to find the cheapest doctor to set your broken arm." ...said no one ever.

"No time to look for the closest hospital, we need to drive straight to the one I know thats 1h away, lets go".

Also, most care is not urgent care.

Re: What Happens When Doctors Only Take Cash (2017)

#95

Post by smachiz » Mon, Jan 15, 2018, 10:17 PM UTC

refurb wrote: post #70

cwbrandsma wrote: post #33

Earlier quoted context omitted.

Reality is they don't know. They know how much it will cost them...sort of. They have a log of how much they charge for each procedure, and then individual insurance providers will pay a percentage of that. Some of which the hospital will pass on you. Even then, it is up to insurance company to figure out how much they will pay. "Adam Ruins Everything" had a really good segment on this.

But it's no different with a car mechanic. The mechanic gives you a quote. If the costs changes they get your explicit approval. That would be nice to start there on the medical side.

Can't really do that in the middle of surgery...

Re: What Happens When Doctors Only Take Cash (2017)

#96

Post by conanbatt » Mon, Jan 15, 2018, 10:18 PM UTC

noobhacker wrote: post #84

conanbatt wrote: post #62

Earlier quoted context omitted.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

The high health care cost is due to a lot of unnecessary procedures being performed. This can happen in two ways. First, there are a lot of tests and procedures ordered by doctors that only have some, but very small, benefits for the patients [0]. Doctors are incentivized to do this because each procedure has a set price (negotiated with insurance companies and Medicare / Medicaid) and the only way to get more revenu…

Sure, but then the 'bad actor' is the provider, not the health insurance company.

Re: What Happens When Doctors Only Take Cash (2017)

#97

Post by conanbatt » Mon, Jan 15, 2018, 10:19 PM UTC

javadocmd wrote: post #79

conanbatt wrote: post #62

Earlier quoted context omitted.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

It's a gigantic market though. (Revenue of $850 billion in 2016 according to https://www.statista.com/statistics/214544/total-revenue-of-... ) I'm not an economist, but it seems like a 5% margin on a $850 billion market is worth a 10% margin on a $425 billion market.

Thats not how capital investment works, at a certain scale, % of profit is all that matters, because it tells you how much you need to invest to make a buck.

Its a big market, but insurance companies are not the ones making a killing.

Re: What Happens When Doctors Only Take Cash (2017)

#98

Post by conanbatt » Mon, Jan 15, 2018, 10:21 PM UTC

allannienhuis wrote: post #67

conanbatt wrote: post #62

Earlier quoted context omitted.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

It it too tin-foil-hat to think that the majority of shareholders in health insurance providers are medical professionals who benefit from the arrangement?

Providers get a decent slice, specially big hospitals and specialists.

Doctor pay is really high in the US and its very regulated. Its expensive to be a doctor (long schooling, expensive mal praxis insurance), license ceilings, state-licensing and effective banning of doctor importation.

Doctors get a decent share of the cost (1/10 i read somewhere), buts its still not the bulk. Nevertheless, just allowing doctors to come in and have unlimited licensing would hit costs a lot.

Re: What Happens When Doctors Only Take Cash (2017)

#99

Post by conanbatt » Mon, Jan 15, 2018, 10:22 PM UTC

wu-ikkyu wrote: post #65

conanbatt wrote: post #62

Earlier quoted context omitted.

And yet, health insurance companies have very low profit margins, the lowest amongst the insurance companies. So who is getting all the money?

Pharmaceuticals

ding ding ding. These ones take most of the share.

It is quite incredible that the U.S., the symbol of freedom, can't freely import drugs from abroad. Considering the rampant use of pharma specially, dropping the costs 1/2 of meds would lower the cost of healthcare overnight by an enormous amount.

Re: What Happens When Doctors Only Take Cash (2017)

#100

Post by killjoywashere » Mon, Jan 15, 2018, 10:26 PM UTC

gedy wrote: post #42

killjoywashere wrote: post #23

Earlier quoted context omitted.

Should software developers and lawyers also have upfront pricelists for all services? I will gladly develop a cure for cancer, for the low, low price of $20B.

Software folks mostly do: "I will do mgmt's random projects and requests for $xxxxxx a year."

Doctors mostly work on a similar principle: "I will take whatever comes through that door and then fill out the billing the hospital requests, which will be further worked out by the hospital, and hopefully I get paid after a month or so."