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Diagnosis: Insufficient Outrage

nytimes.com

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Re: Diagnosis: Insufficient Outrage

#91

Post by malandrew »

ctdonath wrote: post #83
namlem wrote: post #25

Earlier quoted context omitted.

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.

The problem is the the overwhelming majority of Americans don't know this. I've had this conversation with many people and almost all don't know that you can get your cost discounted and that you can usually get them discounted to the Medicare/Medicaid price (which you just need to discover by matching it to CPT codes).

My mom was told about a procedure that would have cost her $120k, in one question the price dropped to $30k. That's such an unfathomable discount that I think many people are ignorant because it sounds too good to be true. They end up thinking that it doesn't exist, there is some catch or that they probably don't qualify somehow.

Re: Diagnosis: Insufficient Outrage

#92

Post by lostlogin »

waps wrote: post #81
lostlogin wrote: post #61

Earlier quoted context omitted.

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 ye…

Hmm.. That's bad. I live in a country with socialised healthcare, and there is some dental care. Most isnt covered, but if its an accident or an emergency (such as bad pain), it will get done. Imperfect, yes.

Re: Diagnosis: Insufficient Outrage

#93

Post by BadCookie »

rquantz wrote: post #5
BadCookie wrote: post #2

What if every clinic had to make a price list of procedures publicly available, and could not legally charge people different amounts for the same procedure (regardless of insurance status and so on)? That would solve at least some of the problems. But I think it's obvious that almost no one actually wants to fix the broken system, because too many people are making too much money from it. (Doesn't that apply to almo…

By "almost no one" you mean "probably most people, but some people who make lots of money from the current system are using part of that money to bribe politicians not to fix it, and we live under a government where that is tolerated."

I suppose I meant "almost no one" who actually has the power to do it. So yeah, what you said.

Re: Diagnosis: Insufficient Outrage

#94

Post by BadCookie »

crs wrote: post #51
BadCookie wrote: post #2

What if every clinic had to make a price list of procedures publicly available, and could not legally charge people different amounts for the same procedure (regardless of insurance status and so on)? That would solve at least some of the problems. But I think it's obvious that almost no one actually wants to fix the broken system, because too many people are making too much money from it. (Doesn't that apply to almo…

I actually had a discussion with my doctor on this very subject. He was complaining that he could not actually advertise prices as it is apparently considered price fixing if doctors do that (or so he says). He also told me he would be stupid not to bill the highest possible price he could for things because he doesn't know exactly what the insurance companies will accept and he could be leaving money on the table ot…

Interesting. It's cool that your doctor tried to be honest with you about it. It would be so much better if you were his customer and not your insurance company.

Since I have an HSA, I write checks to every doctor that I see. (My company buys me high deductible insurance and puts $6k into an HSA each year for my family.) When I visit my GP, it's $72 for usually 20 minutes of his time and I can get in to see him the same day. Specialist appointments are $800+ for what often feels like a more cursory conversation that I waited a month or two for. That's why I am not as quick to blame GPs. They have to rent office space and hire office staff on top of acquiring an expensive education, so the price that they charge (to someone with insurance like me, anyway) feels pretty justifiable.

Re: Diagnosis: Insufficient Outrage

#95

Post by sentenza »

malandrew wrote: post #89
sentenza wrote: post #45

Earlier quoted context omitted.

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?

Although Berlin has more of a reputation, I'd recommend to also consider other places within Germany. Berlin, while having a lot of startups, is not the center of the "real" software industry. I recommend taking a serious look at companies in the Rhein-Main-Neckar region. This region has a cluster of big software firms, such as SAP, SoftwareAG and the companies working on software for the financial industry (Frankfurt), as well as Technical Universities (these are the ones that produce CS graduates).

Be warned, however, that you won't find anything comparable to SV in Germany. And I have to admit that there is also a problem regarding startups: The largest cluster of startups is in Berlin, but most of the money in the software biz is in West Germany. Btw, please don't get scammed by the Samwers.

Experience is definitely a plus, but probably more with the more "traditional" software companies than with the startups. Many German startups live off fresh degrees and high hopes (in the sense that they are founded by people out of the University), with all the positive and negative side-effects that this brings.

With regards to language, I'd say English and a willingness to learn German should suffice. Most of the software people already know enough English to work with them, and some corporations that operate internationally even mandate some degree of English usage. A few more rules of thumb: If the company is big or works in an innovative field, English should be all you need. If, on the other hand, it is located in a rural place or in East Germany, there might be problems.

These are of course generalizations. In any case, learning German will be helpful, even if it is only to facilitate the interactions with your surroundings outside work.

Re: Diagnosis: Insufficient Outrage

#96

Post by Groxx »

malandrew wrote: post #91
ctdonath wrote: post #83

Earlier quoted context omitted.

The word "cash" works wonders. 4-10x discounts. If you're paying list price you're not even trying.

The problem is the the overwhelming majority of Americans don't know this. I've had this conversation with many people and almost all don't know that you can get your cost discounted and that you can usually get them discounted to the Medicare/Medicaid price (which you just need to discover by matching it to CPT codes). My mom was told about a procedure that would have cost her $120k, in one question the price droppe…

Fwiw, I've asked this at two locations, mostly for curiosity's sake. In both cases, the cash price was about 50% higher than what would have been paid through insurance, which was 100% not covered by my insurance.

Their reason was that insurance companies usually pay a predictable amount, but people paying cash frequently stop paying and get punted to collection agencies, ending up with (significantly) less money actually going to the hospital.

I'll keep asking, but it's not that clear-cut.

Re: Diagnosis: Insufficient Outrage

#97

Post by mathgladiator »

ars wrote: post #78
mathgladiator wrote: post #77

Earlier quoted context omitted.

> Why did you pay it then? Hospitals can be rather unhospitable. They want their money, and they don't exactly hire the nicest/knowledgeable people. I routinely get collection calls for someone else based on this issue (who either had my number prior to me getting my phone OR the person gave them my number randomly), and I wouldn't invite them over for dinner.

Just because they want their money doesn't mean you have to pay it. Why allow them to decide what you do?

My point is that they apply pressure, and it's only natural that people will pay to get it off

Re: Diagnosis: Insufficient Outrage

#98

Post by ars »

mathgladiator wrote: post #97
ars wrote: post #78

Earlier quoted context omitted.

Just because they want their money doesn't mean you have to pay it. Why allow them to decide what you do?

My point is that they apply pressure, and it's only natural that people will pay to get it off

I got that. My point is why do you allow them to apply pressure?

Simply ignore them.

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