[HN Gopher] Show HN: Compare prices that US hospitals charge pat...
___________________________________________________________________
Show HN: Compare prices that US hospitals charge patients,
insurance companies
Author : ageitgey
Score : 358 points
Date : 2021-01-18 14:04 UTC (8 hours ago)
(HTM) web link (turquoise.health)
(TXT) w3m dump (turquoise.health)
| Abishek_Muthian wrote:
| Congratulations on the launch!
|
| Turquoise Health could be solving this need gap - 'How much will
| I be charged for my treatment'[1] posted on my problem validation
| platform.
|
| You're welcomed to explain how Turquoise Health helps solve their
| problem in that thread.
|
| [1]https://needgap.com/problems/122-how-much-will-i-be-
| charged-... (Disclaimer: It's a problem validation platform I
| created).
| hedora wrote:
| It would be nice if I could set my insurance plan once, and then
| see the cash and insured prices in the search results.
| ageitgey wrote:
| This is in the works! We hope to implement this as soon as
| we've cross-referenced all the plans across providers.
| [deleted]
| treeman79 wrote:
| Walked into a clinic for a weekly shot. Paid 60 dollar co-pay
| each week.
|
| One day I asked how much go get shot without insurance.
|
| It was $15.
|
| I was paying 4x to use insurance. And insurance was getting
| billed on top of that.
| kwhitefoot wrote:
| Did you switch to getting it without insurance?
| ummonk wrote:
| And of course the FTC doesn't care about the blatant
| anticompetitive behavior by hospitals.
| huitzitziltzin wrote:
| Where do you get that from?
|
| The FTC has challenged a lot of hospital mergers. They are not
| always successful, but they _do_ challenge them.
|
| Source: healthcare/competition economist.
| 5cents wrote:
| A famous Norwegian professor of social medicine, Per Fugelli,
| once told a story in a talk that has stuck with me for some
| reason; Per was talking to a taxi driver, and the driver told him
| that he was having surgery on his heart valve. Per asked if he
| was scared , and the driver looked at him and said "No, Per,
| would you like to know why? Because the surgeon who will operate
| me has also operated the King" (the King of Norway has had
| several heart surgeries through ht eyears). I think it's a nice
| story.
|
| Unfortunately, most of his works are in Norwegian, but his last
| essay before dying from cancer was called Thank you, Norway - and
| good luck on your watch (Google Translate uses "god vakt", but I
| guess it is an idiomatic greeting to guards whos shift is
| starting) [0] - he was afraid the three pillars of the Norwegian
| society was somewhat threatened: justice, trust, freedom
|
| [0]
| https://translate.google.com/translate?sl=no&tl=en&u=https:/...
| SteveCoast wrote:
| A number of people, including me, have been building similar
| things, see http://price.hospital
|
| The problem seems to be figuring out a revenue model, and
| translating all the medical terms in to human.
| egillie wrote:
| Same, I've been mapping out CA average prices at
| http://hospitalprices-env.eba-r2yhwdcw.us-west-1.elasticbean...
|
| Comparing just the price of a hip replacement is difficult,
| because there are so many other services that will bundled in
| with a hip replacement (anesthesia etc) that may not be
| represented in the service price alone.
|
| The "average cost by diagnosis code a patient comes in with"
| transparency requirement is an attempt at solving that, but
| doesn't differentiate between insurance plans.
|
| Also, I love OpenStreetMap, thanks for your work on that!
| technics256 wrote:
| Are you scraping this or just visiting each site manually and
| getting the machine readable data? Cool stuff!!
| egillie wrote:
| California collected all of their hospitals' data at
| https://oshpd.ca.gov/data-and-reports/cost-
| transparency/hosp...
|
| The average prices for common procedures is on the 1045
| sheet
|
| I have my gripes with California but I love that they did
| this
| technics256 wrote:
| Woah, I'm a CA resident and also surprised and happy. Are
| you seeing a lot of non-compliance?
| ageitgey wrote:
| For us, the revenue model isn't this site itself. It's other
| work we do in the industry - this just helps us get notice and
| leads to the other things we can build on top of this data in
| combination with other data. I'd be happy to chat more about
| this if you were ever interested.
|
| Side note - I'm a long, long time OSM fan and contributor.
| Thanks!
| fiatjaf wrote:
| This sort of thing must make some cheaper alternatives appear.
| zachmu wrote:
| We're running a $10,000 bounty to assemble this information into
| a queryable database:
|
| https://www.dolthub.com/repositories/dolthub/hospital-price-...
|
| You get paid based on the percentage of rows you contribute to
| the dataset. So if you fill in 20% of the rows, you get $2,000.
|
| More details here:
|
| https://dolthub.awsdev.ld-corp.com/blog/2021-01-14-hopsital-...
| egillie wrote:
| This is amazing! Will the data be public after it's assembled?
| stevofolife wrote:
| Can someone explain why US medical costs are so absurd? Why is it
| the way it is?
| dr_faustus wrote:
| It's always fascinating to see that even compared to prices you
| pay as a self-paying patient in Germany (which are already 1.5x -
| 2x higher than what the "public" insurances, ie. 85% of the
| population, pay for the same procedures), the prices in the US
| are about 5x to 10x higher. The standard of care seems to be
| quite comparable if you look at outcomes, so there must be huge
| inefficiences in the American system (doctors in Germany are
| consistently ranked as the highest paid academics, so I guess it
| cant be doctors' salaries alone).
| [deleted]
| pc86 wrote:
| Saying German doctors are "the highest paid academics" isn't
| really useful information. _How much_ are they paid? Is it
| comparable to an American physician? German docs can be the
| highest paid academics in German by a factor of 10, but if
| American docs make 3x what any German doc makes it 's kind of a
| moot point.
|
| To do a real analysis you'd need to see a breakdown of where
| the money goes. What percentage is to a physician's salary,
| hospital overhead, insurance premiums, etc. for both countries
| and see where the big disparities are. My guess is,
| _everything_ is more expensive on the US side, including
| salaries, and adds up to the big difference in price.
| p00dles wrote:
| this podcast episode has an excellent breakdown of the
| healthcare pricing system in the U.S.
|
| https://econtalk.simplecast.com/episodes/keith-smith-on-free...
| Triv888 wrote:
| There's some kind of monopoly going on too:
| https://www.cbsnews.com/video/why-it-costs-so-much-more-to-d...
| emteycz wrote:
| I don't believe any medical professional in Germany has wage
| exceeding 150k EUR yearly after taxes - doctors in the US
| sometimes have multiples of that, coincidentally 5x to 10x more
| is not unusual.
| electriclove wrote:
| Is this getting downvoted for saying German docs don't make
| more than 150k EUR or that US docs sometimes make multiples
| of that?
| dante_dev wrote:
| Just throwing some data, average general practice doctor is
| 150k$ in US vs 61k$ in germany.
|
| https://www.payscale.com/research/DE/Job=Physician_%2F_Docto.
| ..
|
| https://www.payscale.com/research/US/Job=Physician_%2F_Docto.
| ..
| rtx wrote:
| That's good, doctors should be paid more. 15 years for a
| license.
| persedes wrote:
| I believe that doctors in the US get paid more than in
| germany, but 60k seems very very low. Teachers have an
| income in that range....
|
| Edit: Looking at some german articles, maybe they did not
| convert from eur to usd, ~80,000-100,000$ (depending on
| expertise etc) seems more likely for a dr working at a
| hospital (which is still low imho compared to US
| salaries...).
|
| https://www.arzt-wirtschaft.de/wie-hoch-ist-das-gehalt-
| bzw-d...
| dante_dev wrote:
| I think the difference in wages narrows down with
| specializations. I linked just the "general practitioner"
| because I couldn't find an average including all the
| specializations.
| the_monocle wrote:
| You have to keep in mind that med school and the
| equivalent of premed in germany is completely free. Of
| course that does not make up for the pay difference
| completely but it changes the perspective quite a bit
| imo, since med school in the US is extremely expensive.
| Additionally I could totally see doctors being ok with
| less pay for the trade off of living in a more fair
| system. Coincidentally I know one expat here that
| specifically does not want to return to the US to become
| a doctor there for that very reason. She specifically
| does not want to move back because she feels the
| healthcare system in the US is unfair and she would be
| profiting off of that system.
| amagasaki wrote:
| And furthermore you have to differentiate between
| "assistance" doctors (~82k $) and "chef" doctors (~336k
| $). (I don't know the comparable titles in the US system)
|
| Both values are taken from the parent's article and
| converted using Google. Of course, mostly without serious
| student debt
| [deleted]
| analog31 wrote:
| I don't believe that salary income is the complete picture
| for physicians in the US. There are still a lot of doctors
| who are also "insider investors" in clinics, diagnostic
| equipment, and other medical businesses.
| lotsofpulp wrote:
| That's a terrible source, $150k is laughable for the US.
| Maybe for a part time doctor working 2 or 3 days a week.
|
| This is more accurate:
|
| https://www.medscape.com/slideshow/2020-compensation-
| overvie...
| u678u wrote:
| Yeah surgeons make multiples
| https://www.physiciansweekly.com/2018-physician-
| compensation.... That doesn't include profits from owning
| their own biz.
| sithlord wrote:
| not 100% sure on this, but don't most doctors in other
| countries go to medical school for free? Whereas US doctors
| are going into 3-400k+ debt.
| notsureaboutpg wrote:
| Can confirm. $600k+ is normal in low cost of living areas in
| the US. Excessive pay for doctors is definitely part of the
| problem here. People don't like to hear it and don't like to
| admit it because the work they do is so important and because
| there are other, bigger costs, and I get that. But difficult
| situations have difficult answers, and doctor pay is huge in
| the US in a way it isn't in every other country and doctors
| themselves know this. It may not fix the problem overnight,
| but regular people would see instant savings if we fixed this
| issue.
| Redoubts wrote:
| I'm sure German doctors don't have oodles of student debt
| too.
| emteycz wrote:
| Yeah, that for sure.
| travisp wrote:
| It's true that US doctors are paid more (although the gap
| isn't as big as it used to be). However, pay for US doctors
| makes up a fairly small portion of overall US medical
| expenditures (less than 10%). So, you could ask every doctor
| to work for free and not significantly change costs.
| huitzitziltzin wrote:
| >pay for US doctors makes up a fairly small portion of
| overall US medical expenditures (less than 10%)
|
| That is likely too low.
|
| The Centers for Medicare and Medicaid Services provides a
| National Health Expenditure estimate annually. [1]
|
| Physician and clinical services represented $772 billion
| out of about $3.8 trillion, so more like 20%.
|
| Hospital services are the other big one: about $1.2
| trillion.
|
| US physicians are paid terrifically relative to their
| counterparts almost anywhere else, this is especially true
| for specialists.
|
| In fact, physicians represent about 15% - 16% of the top 1%
| of income earners in the US. See table 2 from this paper: h
| ttps://web.williams.edu/Economics/wp/BakijaColeHeimJobsInco
| ... which was written using _tax return data_ , not, e.g.,
| self-reported income data.
|
| [1] https://www.cms.gov/Research-Statistics-Data-and-
| Systems/Sta...
| tfehring wrote:
| There's a similar (but smaller) differential for other
| medical professionals too. But more generally, when I've
| done high-level comparisons of medical spending between the
| US and Western European countries, it seems like _every
| single cost element_ is more or less proportionately higher
| in the US. It seems like basically everyone is spending
| money in roughly the same proportions, including on things
| like doctors' salaries - everything is just scaled up by
| ~40% to ~100% in the US, depending on which country you
| compare it to.
| aksss wrote:
| And doing so more frequently in the US, so cost is higher
| but so is rate of consumption, particularly of services
| and products that make us feel like we have more mastery
| over outcomes but in fact do not result in better
| outcomes on the whole.
| [deleted]
| dheera wrote:
| Everything is inflated the whole way in the American system.
|
| Universities overcharge in the US. The medical education costs
| upwards of $800K if you include the cost of lost opportunity
| had you gone into a different field and worked those years
| instead. So doctors need higher salaries. That, combined with
| idiotic market dynamics around medical supplies, means that all
| medical costs are higher. That in turn means everyone
| absolutely needs insurance or risk personal bankruptcy.
| mindslight wrote:
| You can't waste money on the scale of the US system by simply
| paying doctors too much. Rather, you need to hire entire
| departments of nonproductive people - eg billing and
| administration. When you zoom in, most of these positions
| look like a necessary function, but systematically they don't
| need to exist. Take for instance a "nurse navigator", whose
| entire job is to deal with insurance company rigmaroles - as
| a patient you're extremely thankful to have them, but their
| position is actually only necessary due to a corresponding
| insurance company department (that you're also paying for!)
| trying to deny you care.
|
| The ultimate problem is this planned economy mandate of "full
| employment". It is in no individual's interest to declare
| that their own job is counterproductive, otherwise they'll
| starve. So they hang on performing in their own little niche,
| sucking resources out of the system so they personally can
| continue living a dignified life. We're stuck in a paperclip
| maximizer, and the healthcare industry is one of the best
| small-scale illustrations of this.
| analog31 wrote:
| I believe a reform of the healthcare system should include
| paying for medical school. Let's offer a deal: You go to med
| school for free, then you work for the government for a
| decent professional salary.
| Sprbdg wrote:
| You don't need the government to solve this problem, they
| helped create the problem in the first place. You need to
| reform your political system to actually make it work.
| analog31 wrote:
| Near as I can tell, reforming the political system and
| changing government policy are intertwined to the point
| where they amount to the same thing.
| coredog64 wrote:
| US medical education length is insane. Get an undergraduate
| degree (pre-med). Then go to med school. Then a residency.
| Then you can practice.
|
| Other countries do just fine with much less.
| _jal wrote:
| Capitalists are expensive.
| dcolkitt wrote:
| Before coming to any conclusions on this topic, I highly
| suggest reading this extremely in-depth analysis on cross-
| country healthcare spending.[1]
|
| The simple answer is that Americans really do consume
| significantly more healthcare than Europeans. The most
| straightforward signature of this is the fact that a much
| higher proportion of Americans work in the healthcare industry
| than any other large country. The US also tends to consistently
| lead on the highest utilization of cutting-edge technology
| (such as ICDs, insulin infusion pumps, linear accelerators, and
| small bowel transplant) at any given time.
|
| Cost per inpatient discharge is exactly in line with a
| regression of European countries against average household
| disposable income. (The US having nearly double the household
| disposable income as Western Europe.) Rather than being some
| signature of American dysfunction, globally we observe hospital
| bills rising super-linearly with income levels. This strongly
| suggests that hospital costs primarily rise because of higher
| intensity of care per encounter.
|
| The strongest counterpoint to this is that despite America's
| high healthcare consumption, that health outcomes are
| significantly worse than Europe. In particular in terms of life
| expectancy. But healthcare economists have known for decades
| that medicine, on the margin, has virtually zero impact on
| health.[2] The US is an extremely unhealthy country, especially
| because of obesity. No level of healthcare would ever be able
| to counteract that.
|
| But again this disjointed relation between medicine and health
| is not an American-specific phenomenon. The ratio of healthcare
| spending between Norway and Spain is about the same as between
| the US and Norway. Yet Spaniards enjoys significantly longer
| life expectancies than their Norwegian counterparts.
|
| [1]https://randomcriticalanalysis.com/why-conventional-
| wisdom-o...
|
| [2]https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-
| med...
| thatfrenchguy wrote:
| > The strongest counterpoint to this is that despite
| America's high healthcare consumption, that health outcomes
| are significantly worse than Europe. In particular in terms
| of life expectancy.
|
| Just look at the life expectancy of France and Germany to
| disprove your theories.
|
| The big difference between the American healthcare system and
| the one in these countries is that people don't have to worry
| about the bills, which means healthcare providers have a much
| bigger incentive to learn what cost benefit analysis means.
| whiddershins wrote:
| Hey there. The comment you are replying to specifically
| addresses this.
|
| I find reading comment threads containing comments that
| don't seem to account for the literal assertions made in
| the previous comment tend to be difficult to follow and
| quickly degrade.
| wskinner wrote:
| > The big difference between the American healthcare system
| and the one in these countries is that people don't have to
| worry about the bills, which means healthcare providers
| have a much bigger incentive to learn what cost benefit
| analysis means.
|
| Can you go into a bit more detail about how exactly this
| incentive linkage works?
| dcolkitt wrote:
| I'd really encourage you to read through the first link
| because it goes into very careful detail. But the point is
| there's nothing unusual about America's high spending given
| its very high income levels. In particular look at this
| chart from the source.[1]
|
| Let's use France as a comparison point since you mentioned
| it. Household disposable income in the US is about 36%
| higher than France. That's about equivalent to the wealth
| gap between France and Slovenia. The US spends about 70%
| more per hospital stay than France, and very similarly
| that's almost the exact same spending gap between France
| and Slovenia.
|
| The point being it's easy to ask "why does the US spend
| more than Western Europe?" But, analogously you should also
| ask "why does Western Europe spend more than Southern and
| Eastern Europe"? And the most clear answer is because
| wealthier countries tend to spend a higher percent of their
| income on healthcare.
|
| [1] https://i0.wp.com/randomcriticalanalysis.com/wp-
| content/uplo...
| huitzitziltzin wrote:
| > The simple answer is that Americans really do consume
| significantly more healthcare than Europeans.
|
| I do not believe this is correct.
|
| From the OECD, average length of hospital stay across rich
| countries:
|
| https://data.oecd.org/healthcare/length-of-hospital-stay.htm
|
| We pay more but we generally consume less. EDIT: let me add
| this comparison of health prices across countries from the
| Health Care Cost Institute. See Table 1:
|
| https://healthcostinstitute.org/hcci-
| research/international-...
|
| Our prices _are_ higher.
|
| The US is an obese country, but you will find if you look
| that obesity rates are similar or worse in (e.g.) Mexico and
| some Gulf States (I think the UAE though I don't have a
| source for you).
|
| We are not a wild outlier in terms of measured unhealthiness.
| Life expectancies here are lower though, despite vastly
| higher expenditure than other rich countries.
|
| There are important failures on the supply side of the
| market:
|
| From the OECD, we have fewer hospital beds per capita than
| most rich countries:
|
| https://data.oecd.org/healtheqt/hospital-beds.htm
|
| We have fewer doctors per capita than most countries:
|
| https://data.oecd.org/healthres/doctors.htm
|
| Failures of competition throughout the market (including
| hospital consolidation) keep prices high. We do basically
| zero evaluation of cost effectiveness.
| Daniel_sk wrote:
| I think a lot of people are missing one key difference.
| Healthcare in EU is based on solidarity system where every
| citizen pays a percentage share of his monthly salary to the
| medical insurance. So if you earn more, then you will also pay
| more medical insurance - but you will get the same treatment as
| others (unless you have some fancy private insurance on top of
| the regular insurance). So basically any medical expense is
| subsided by every citizen in the country indirectly.
|
| I believe this is a completely different way of looking at
| things than in the US. The average EU citizen doesn't really
| think that the monthly medical deduction from his salary is
| just for his use or it's his own insurance, it's only a
| contribution to the whole system.
| ews wrote:
| This is how progressive taxation works. For some reason, US
| people happily pay for police, firemen, infrastructure or the
| military as a necessity of a functioning society but have
| serious problems considering healthcare in the same group.
| ep103 wrote:
| County level vs national level
| kazen44 wrote:
| which in a lot of european countries, doesn't even exist
| as a differentiator.
| msandford wrote:
| Right but the biggest country in the EU isn't ~330
| million people from about a half-dozen fairly distinct
| cultures. Remember that the US has cultural
| representation from many European countries and also
| quite a few non-European countries.
|
| I'm not suggesting that Italy or Greece or Germany are
| actually homogeneous culturally but with smaller
| populations and significantly less immigration than the
| US I suspect that the variances are smaller and perhaps
| more surmountable.
|
| Germany's population (83 million) is only about 1/4 of
| the US and as you go down the list the countries only get
| smaller.
| xyzzyz wrote:
| Taxation in the US is significantly more progressive than
| in most (if not all) of Europe. In Europe, bulk of tax
| revenues come from high tax rates on middle class, while in
| the US, most of the tax revenue is paid by the wealthy. In
| concrete terms, Americans in top 1% of income distribution
| pay nearly 40% of all federal income tax, and top 10% pays
| 70% of all federal income tax. That's significantly more
| progressive than all large European countries.
| leetcrew wrote:
| one could make the argument than the benefits of police,
| firemen, and military scale somewhat proportionately with
| wealth. people with meaningful assets have a lot to lose if
| the police stop protecting their property or the US navy
| can't guarantee relatively safe trade by sea. their house
| is probably worth more too. a homeless person probably gets
| hassled by police much more often than protected by them.
| socialized healthcare mostly benefits people who don't have
| and/or can't easily afford good insurance.
| Daniel_sk wrote:
| That's a very American way of thinking. I am totally fine
| that I contribute with a bigger part and it's used for
| people that would not be able to afford it.
| whiddershins wrote:
| I don't know if you realize this, but when you write it
| this way it seems that you are implying an 'American way
| of thinking' is a morally inferior one.
| tyoma wrote:
| Police and fire are paid for by local or state taxes, with
| some federal outlays via matching grant programs. Cities
| and states are free to start their own local and state tax
| funded programs. The only thing getting in the way is the
| enormous cost!
|
| Because the US does provide for tax funded healthcare for
| the old (Medicare) and the pregnant/poor/disabled
| (Medicaid). The [cost of these
| programs](https://www.kff.org/medicare/issue-brief/the-
| facts-on-medica...) is greater than US military spending.
| btbuildem wrote:
| I imagine it's on account of all the administration and
| intermediaries.
| bhupy wrote:
| It's not. There's a good breakdown that compares what drives
| healthcare spending between the US vs Germany (and others).
|
| https://www.healthsystemtracker.org/brief/what-drives-
| health...
|
| The vast majority of the difference comes from just the raw
| cost of inpatient and outpatient care. Even if you were to
| completely zero out the administrative costs per capita,
| you'd hardly make a dent in bridging the gap.
| arppacket wrote:
| The "administrative costs" in that analysis are misleading.
| "Administrative costs include spending on running
| governmental health programs and overhead from insurers but
| exclude administrative expenditures from healthcare
| providers." I don't think the blue bar is representative of
| the "raw cost" of care.
|
| This study says over one-third of all US healthcare costs
| are administrative.
|
| https://www.reuters.com/article/us-health-costs-
| administrati...
| therealdrag0 wrote:
| Do they ever try to break down why IO care is more
| expensive? Cuz that's a very broad and vague bucket.
| giorgosera wrote:
| > The vast majority of the difference comes from just the
| raw cost of inpatient and outpatient care.
|
| Question: What do we mean by "inpatient and outpatient
| care"?
| pkaye wrote:
| I think outpatient care mean you don't stay in the
| hospital overnight. So you could have a surgery and leave
| within an hour in the recovery area and that is
| outpatient.
| bhupy wrote:
| Inpatient care refers to any treatment where the patient
| is required to be admitted to a hospital or health care
| facility facility. On the other hand, the OECD defines
| outpatient care as care that "comprises medical and
| ancillary services delivered to a patient who is not
| formally admitted to a facility and does not stay
| overnight." Thus, studies like this try to break out
| "inpatient and outpatient care" as an attempt to
| represent the "real" service in question, while isolating
| things like administrative costs.
| roganp wrote:
| Inpatient: services provided by a hospital, after patient
| is admitted. Outpatient: services provided in other
| settings
| aaronblohowiak wrote:
| >raw cost of inpatient and outpatient care
|
| I am interested to understand what makes the "raw" costs so
| wildly different.
|
| When my son had an infection in germany, we went to the
| equivalent of pediatric urgent care and after seeing the
| nurse, having bloodwork done and a few different 15 minute
| sessions with the physician we came to the end of the visit
| with the doctor, they apologized that we had to be charged
| the full uninsured rate and that a bill would be given to
| us later that we could use to have our insurance (they
| could not bill our insurance internationally.) We paid the
| 50 euros and asked what the total amount would be, assuming
| that was the co-pay. There was a lot of confusion because
| the 50 euro wasn't the copay -- it was the full-freight
| amount. Getting a single 15 minutes with a doctor, let
| alone the prep with the nurses and bloodwork being rushed
| would be _far_ more than that in USA.
| mschuster91 wrote:
| > I am interested to understand what makes the "raw"
| costs so wildly different.
|
| In the US, hospitals lose a _lot_ of money on patients
| who don 't pay at all or pay pennies, and in order to not
| make a loss at the end of the year they charge those who
| can pay more money.
|
| Also, insurances have an incentive in having hospitals
| set high "sticker prices" because then they can claim
| "higher savings" for their members.
|
| Contrast to that, in Germany as long as a patient has any
| insurance (and 99.9999% of Germans do) the hospitals and
| doctors will get their services paid (so no need to
| overcharge for financial reasons), and both the mandatory
| insurance scheme and the private insurance companies pay
| fixed, government-regulated fees (https://de.wikipedia.or
| g/wiki/Einheitlicher_Bewertungsma%C3%... for the
| government insurance, https://de.wikipedia.org/wiki/Geb%C
| 3%BChrenordnung_f%C3%BCr_... for the private insurance
| system).
| maxerickson wrote:
| Uncompensated care (includes unpaid and forgiven charges)
| is in the ballpark of 5% of costs, according to hospitals
| themselves.
| SilasX wrote:
| That's what I find so depressingly hilarious about the US
| vs the rest of the developed world [1]: that even when
| they super-apologetically hit you with the full, no-mercy
| price, it's less than what you'd way with (already
| overpriced) insurance in the US.
|
| [1] Well, also developing, but super-low prices aren't as
| surprising or embarrassing to the US in that case.
| bhupy wrote:
| > I am interested to understand what makes the "raw"
| costs so wildly different.
|
| There are a number of reasons. One big one is simply that
| doctors in the US command a much higher salary than their
| counterparts elsewhere in the world:
|
| https://economix.blogs.nytimes.com/2009/07/15/how-much-
| do-do...
|
| https://www.politico.com/agenda/story/2017/10/25/doctors-
| sal...
|
| Another big reason is that the US is unique in that it's
| one of the only countries in the world where you get your
| healthcare through your employer. What we're seeing in
| healthcare costs is analogous to what you might see
| happen to airline ticket costs if we all got our air
| tickets through our employers: the vast majority of us
| would fly business class, while the unemployed would be
| simply unable to pay for business class fares out of
| pocket. Employers (especially medium-to-large businesses)
| have a much higher purchasing power (and hence,
| willingness to pay) than individuals.
|
| Now, if you take this behavior and combine it with the
| fact that health insurers' profit margins are capped by
| law by percentage, insurers pay more for treatments
| (which doctors happily accept), charge more to employers
| (who are generally less price conscious vs individuals),
| thus bring in more absolute revenue, and therefore more
| profit because a capped profit percentage of a higher
| revenue is higher than a capped percentage of lower
| revenue. It's somewhat counter-intuitive, but the policy
| combination of an employer mandate and insurance profit
| cap results in the mother of all local optima.
|
| Disclaimer: I work on health pricing in the US and
| sometimes adjust claims myself.
| whiddershins wrote:
| If you think about it, you just weren't actually charged
| for what you used.
|
| If what you did were reflective of the doctor's hourly
| rate, that doctor would be making around $150,000
| usd/year.
|
| And that's ignoring the costs of every other aspect of
| the overhead.
|
| The cost is being born some other way.
| dalbasal wrote:
| What does "raw" mean, in this circumstance?
|
| Looking at the article, it's pretty hard to understand what
| what's actually costing more. "Inpatient and outpatient
| care" is a pretty enormous bucket and probably accounts for
| a whole lot of salaries, services, and such of pretty much
| any job title with "medical" in it.
|
| Admin, does in fact represent the largest % difference...
| but it's not clear what's grouped into it. I assume it
| means government departments, insurance firms, external
| legal/finance services. I don't think the data refers to a
| salary-bysalary breakdown of costs.
|
| Sometimes it's best to look at these things from the ground
| up. Doctors, nurses. How many? How much are they paid? Is
| the diff more or less than mean diff? If no, move on, If
| yes, dig deeper.
|
| You really can't even rely on price data to tell you much.
| Most of these markets have a broken or absent price system.
| The underlying answer though, inevitably will likely be
| "because they're run differently."
| mancerayder wrote:
| This is useful - as a starting point.
|
| I want to be able to make a case for a single payer system
| in the U.S., but I think to be effective it's a comparison
| of costs and outcomes that needs to be had. In the data
| linked above, we're told that the 'inpatient and outpatient
| care' is significantly higher than in 'comparable
| countries.'
|
| I believe it. But isn't 'inpatient and outpatient care'
| just about .. everything that goes into a health care
| system aside from the paper pushing and insurance pieces?
| And are hospitals really breaking that stuff out ?
|
| Someone in favor of the U.S. system would say, ah hah,
| that's because we in the U.S. have access to better care,
| and more sophisticated technology, than in France or
| Germany, and also we don't have long waiting lists. I don't
| know the technology claim, but I've seen the wait list
| claim and I do think it's true when comparing the U.S. with
| Canada or the UK (the latter two have long waits for
| essential surgeries compared to the U.S.)
|
| How would one counter this claim?
| bhupy wrote:
| You're right that it's a useful starting point, but I
| think that it's even more complicated than "single payer
| is better".
|
| First of all, it isn't obvious that single payer is the
| best system, because there are many countries in the
| world that have exemplary health care systems that are
| not "single payer". You cited Germany as an example, but
| Germany doesn't have a single payer system, it has a
| public-private mix. It's a universal multi-payer system.
| Netherlands has a purely private universal healthcare
| system, Switzerland has a purely private universal
| healthcare system, Australia has a public-private mix
| (44% choose private), Singapore has universal
| catastrophic coverage but everything else is driven by
| savings accounts and private insurance among the upper-
| middle class, etc etc -- Belgium, South Korea
| (technically "single payer" but only covers 60% of costs,
| private insurance fills in the gaps), Japan, etc.
|
| From where I sit, the most apples-to-apples A/B test of
| single-public-payer vs private insurance is actually
| being run in the US, as we speak. When you turn 65, you
| have the option to enroll either in "Original Medicare",
| which is what we usually think of when we talk about
| "single payer healthcare in America", or you can enroll
| in Medicare Advantage (aka Medicare "Part C"), where the
| premiums that would go to the CMS instead go to private
| insurers like Humana, United, Oscar Health, Aetna,
| Clover, etc. These plans replace Original Medicare, also
| cover Part D prescription drug benefits, and often
| include supplemental benefits that Original Medicare
| doesn't already cover. There are some interesting
| findings so far:
|
| - 39% of Medicare beneficiaries are on private Medicare
| Advantage plans instead of the public "Original
| Medicare". Because everyone is entitled to "Original
| Medicare", this is purely voluntary. This number has been
| growing so rapidly, that we expect by 2025, more seniors
| to be on a private plan than the public one. There's also
| great variance by State. In Florida, Pennsylvania,
| Wisconsin, Michigan, Minnesota, Oregon, Alabama, Hawaii,
| and Connecticut -- nearly 50% of beneficiaries are on
| Medicare Advantage. By 2022, we expect more seniors in
| those States to be on a private plan than a public one.
| https://www.kff.org/medicare/issue-brief/a-dozen-facts-
| about...
|
| - For most beneficiaries, Medicare Advantage costs about
| 39% less than Original Medicare.
| https://healthpayerintelligence.com/news/medicare-
| advantage-...
|
| - Medicare Advantage plans are, on average, of higher
| quality than the public "Original Medicare"
| https://healthpayerintelligence.com/news/medicare-
| advantage-...
|
| - In Urban areas, Medicare Advantage costs less per
| capita to administer than Medicare -- and that's not
| including the extra Medicare Part D insurance that you
| would have to buy if you're on the Original Medicare
| plan.
| https://www.commonwealthfund.org/publications/issue-
| briefs/2... From this same research, public "Original
| Medicare" is still cheaper in rural areas, but not by a
| whole lot.
|
| So to make things more complicated, we're not just
| talking about whether "Medicare For All" is better than
| the status quo, we also need to litigate if private-
| insurance driven "Medicare Advantage For All", is even
| better.
| nabilhat wrote:
| Given that inpatient + outpatient = 100% of the category,
| I have to agree. Lumping the cost of "Medical Care" into
| a single metric in a breakdown of spending on, well,
| medical care, doesn't offer much insight. Showing exactly
| the same data in 4 different graphing methods doesn't add
| anything but clutter. The lack of effort honestly makes
| me question this organization's mission.
|
| I think the most useful bit is the reference to the OECD
| data source. For those not already aware, OECD has far
| more detailed data available to browse [0], and heaps of
| more informative and competent presentations [1].
|
| [0] https://stats.oecd.org/
|
| [1] http://www.oecd.org/health/health-expenditure.htm
| kwhitefoot wrote:
| > (the latter two have long waits for essential surgeries
| compared to the U.S.)
|
| References?
| mancerayder wrote:
| "Wait times for cancer treatment -- where timeliness can
| be a matter of life and death -- are also far too
| lengthy. According to January NHS England data, almost
| 25% of cancer patients didn't start treatment on time
| despite an urgent referral by their primary care doctor.
| That's the worst performance since records began in 2009.
|
| And keep in mind that "on time" for the NHS is already 62
| days after referral.
|
| Unsurprisingly, British cancer patients fare worse than
| those in the United States. Only 81% of breast cancer
| patients in the United Kingdom live at least five years
| after diagnosis, compared to 89% in the United States.
| Just 83% of patients in the United Kingdom live five
| years after a prostate cancer diagnosis, versus 97% here
| in America."
|
| (https://www.forbes.com/sites/sallypipes/2019/04/01/brita
| ins-...)
|
| Yes, I know Forbes has a bent. And I'm generally in favor
| of single-payer options and not defending the U.S.
| However I have seen the Wait Time stat over the years in
| the context of cancer patients, and this is one data
| point. Canada is apparently worse.
| DanBC wrote:
| > live at least five years after diagnosis,
|
| Five year survival rates don't give you much information,
| because the US engages in massive over testing. You need
| to know all cause mortality, and the US does worse here
| than the UK.
|
| The US over tests people and over treats cancer; that
| costs a lot of money and isn't pleasant for people but it
| doesn't make them live longer.
|
| If hypothetical Beth dies age 82 does it matter if she is
| told she has cancer at age 75 or age 79?
| mancerayder wrote:
| I'm always willing to learn more - do we have a one-stop-
| shop apples to apples comparison of U.S. vs. UK and other
| countries' healthcare models with stats and explanations,
| one that is free from strong biases ? I struggled to find
| a non-political, but still meaningful comparison data
| site online via Google.
| [deleted]
| Sprbdg wrote:
| How can that possibly be true?
|
| How can in/out patient care be so vastly different in cost?
| treeman79 wrote:
| Middle men. Lots and lots of middlemen.
| bhupy wrote:
| That figure cuts out the middle-men by breaking out
| administrative costs.
| marcinzm wrote:
| Probably some of it but I suspect the lack of limitations on
| services rendered plays into it as well. If someone in the US
| wants to see specialists 50 times in a month due to
| munchausens then they'll just be charged their co-pay each
| time (in most insurance plans). In Germany I suspect they'd
| not be allowed to book appointments anymore or would require
| a gatekeeping referral. Same with expensive drugs that don't
| help outcomes but are advertised to patients and doctors.
| moooo99 wrote:
| Thats not right. You can easily get an appointment in
| Germany, even multiple times. If you have a referral, you
| usually get an appointment earlier than people who directly
| went to the specialist. However, if you have acute pain you
| will quickly get an appointment on the same or the next
| day.
|
| Source: Me. just made the second appointment with a
| specialist within a week thanks to pain, appointment is
| tomorrow
| marcinzm wrote:
| In the US on self-referral plans (60% of health plans)
| you can get an appointment without any acute symptoms and
| with no delay versus a referral. I'd say that's a fairly
| large difference in ease of access without probably any
| impact on patient outcomes.
| jgeada wrote:
| > In Germany I suspect they'd not be allowed to book
| appointments anymore or would require a gatekeeping
| referral.
|
| This is the kind of comment that immediately classifies the
| commenter as never having lived outside the US and/or not
| reading anything but US news sources. And with the wilful
| blindness to how exactly those gatekeeping referrals are
| present in most every single healthcare plan in the US.
| marcinzm wrote:
| >And with the wilful blindness to how exactly those
| gatekeeping referrals are present in most every single
| healthcare plan in the US.
|
| This is only required by HMO plans which cover around 40%
| of the US population. PPO plans don't have such a
| requirement.
|
| So please don't call other people willfully blind when
| you yourself make broad factually incorrect statements.
| Pot please meet kettle.
|
| edit: Also my statements about Germany are based on
| comments Germans have made on hacker news regarding their
| own health plans. So you should really go yell at those
| Germans for not knowing how their own health system
| works.
| dboreham wrote:
| Also lack of shame and, greed.
| bazooka_penguin wrote:
| Physicians and hospitals have 2 of the most powerful lobbies
| in the US and have previously gatekept the doctor profession.
| 1024core wrote:
| AMA (American Medical Association) is known to play games
| to limit the supply of doctors, so they can keep salaries
| high.
|
| http://www.econ.yale.edu/seminars/strategy/st03/nicholson-0
| 3...
| bazooka_penguin wrote:
| Do you have a different link? The file is missing
| chaboud wrote:
| Chargemaster prices (the non-negotiated price) are ridiculously
| high in the US. They're so high that some hospitals will give
| uninsured patients a break of "half off" without even
| negotiating.
|
| The reason for this is that chargemaster price is a fake dollar
| price resulting from a broken incentive structure and process.
| Here's a setup:
|
| A hospital is working out a negotiated rate for aggregate
| services with an insurance company. The insurance company wants
| to pay less, and they're willing to put the hospital "in
| network" and bring their block of customers with them by doing
| it. But the negotiators on both sides aren't going to sit and
| figure out the "right" price of every procedure. That would
| take forever (and there's dinner at a Michelin starred
| restaurant to go to after this deal is done), so they agree
| that they will just pay some percentage of the chargemaster
| price, say, 50%.
|
| Over time, the hospital administrators say "we need more money
| for this" and realize they have a lever. 95% of their customers
| are paying negotiated rates that are a percentage of the
| chargemaster price. The percentage is locked in stone, but the
| chargemaster rate? Yeah. They can change that.
|
| The insurance company cries foul at their Michelin two-star
| dinner the next month, and the hospital agrees to lower the
| percentage a little in the next contract. Now the insurer is
| feeling flush, and the hospital is making about what they were
| doing before from that 95%. The remaining 5% who were uninsured
| are hanging upside down and getting shaken for loose change.
|
| The cycle continues, and, eventually, the negotiated percentage
| drops to something comical, like 12%, but the chargemaster
| rates have soared. In the end, a pair of Advil "costs" $68 and
| uninsured patients have nosebleeds from being hung upside down
| for so long.
|
| But there's a new restaurant to try out, and someone else's
| personal bankruptcy is a small price to pay for no-fuss managed
| care...
|
| (Note: Marketing and administration accounts for more than a
| third of health care costs in the US, which is to say that
| health care bloat and weight due to a multi-player adversarial
| privatized system accounts for more than 5% of our GDP, so the
| chargemaster isn't the only reason for sky high healthcare
| costs in America.)
| JohnCohorn wrote:
| I wonder how much truth there is in the theory that insurers
| are incentivized to let costs go way up and may be complicit
| in it. Basically the theory I've heard is that Obamacare
| limited by law the percentage margin that insurers can make
| as their piece of the pie. So then one of the only easy ways
| left for them to grow their profits in an absolute sense is
| to increase the amount of money flowing through the system.
| peytn wrote:
| The other factor is that hospitals have wised up over the
| years and started merging, which turns them into local
| monopolies and makes insurance companies price-takers.
| mynameismonkey wrote:
| I have a go-to piece on chargemasters here
| https://jaz.co.uk/2015/10/15/hospital-retail-pricing-for-
| dum...
|
| (Worked on hospital pricing reports since 2001)
| tomca32 wrote:
| That's a great piece thanks!
| huitzitziltzin wrote:
| This is not that plausible as an analysis of the role of
| chargemasters.
|
| I agree that the chargemaster prices are fake, but what you
| are proposing is:
|
| Hospital: "Our insurance partners pay us a fraction x of
| Chargemaster charge X, so _let 's make C larger_."
|
| The insurer understands the game being played here, just like
| you do. It's not like the insurer doesn't _also_ realize just
| like you do that the chargemaster price is fake.
|
| The insurers are not going to say "Oh C got bigger this year?
| Well, let's pay more!"
|
| More important are failures of competition in the
| marketplace, especially consolidation on the hospital side
| (most markets are now served by large hospital systems, so
| insurers cannot plausibly threaten to exclude hospitals from
| networks), the lack of exposure of consumers to most of the
| price, and the lack of incentives on the consumer side to
| search for cheaper prices (plus a general lack of any
| information about which facilities might be cheaper).
| eightysixfour wrote:
| My understanding is the insurance companies are incented
| for C to increase as well - under the ACA insurance
| companies can only have a certain profit margin, so the
| only way to increase profit is to increase revenue and
| payouts.
| peytn wrote:
| From a personal conversation with an insurance company
| board member, I've been told this isn't a factor as most
| aren't running anywhere close to that line. The bigger
| factor in his eyes is healthcare providers building local
| monopolies. I don't know how true that is, but I wanted
| to share.
| fakedang wrote:
| Well he was just shoving the issues under the rug.
|
| In fairness, he's not wrong, and neither is parent.
| Hospitals companies have local monopolies, which they can
| use to charge ridiculously high prices. On the other
| hand, insurance companies do get a kickback of sorts when
| the hospitals bump prices - the negotiators get
| compensation based on the dollar amount of savings they
| can bring from negotiation, so effectively, even if the
| hospital bumps prices high enough and renegotiates the
| chargemaster rates to a lower one, while still ensuring a
| profit for the negotiators, they'll go for it. Bloomberg
| did a nice write up of it a few years back, but it's now
| behind pay wall.
| peytn wrote:
| Yeah, that's another good nuance. Ultimately many factors
| drive hyperinflationary healthcare costs. Everyone's
| making money.
|
| I think my takeaway from the whole conversation is that
| the insurance business can be counterintuitive to
| outsiders. Salvation may not be as simple as getting rid
| of them.
|
| Another tidbit is that insurance companies don't mind
| being the bad guys. I'm not sure if our focus on that
| industry blinds us to effective solutions for controlling
| costs.
| alisonkisk wrote:
| Those are "sticker prices", the opening for
| negotiation/haggling.
| Jackim wrote:
| Do you think that is a good way to provide healthcare?
| 52-6F-62 wrote:
| There's a bit of a lopsided leverage situation there...
| zoomablemind wrote:
| I wonder if the reported prices are the aggregated total price
| for treatment? Or is it just a price of an individual
| procedure, excluding whatever else that normally goes into the
| treatment, like diagnostics, admin and nurse time,
| room/facilities expense etc?
| mrnickel001 wrote:
| Generally, every hospital reported price is different. Many
| of the prices reported are "all in" service packages, but
| several also wouldn't include these ancillary charges.
| Forthcoming price transparency legislation puts more pressure
| on hospitals/insurance cos to quote these "all-in" bundles.
| On the Turquoise site, we'll be representing all inclusive
| bundles with a checkmark + explanation that the provider has
| verified with us the rate is inclusive of all
| professional/ancillary charges.
| mc10 wrote:
| I think this is a bit of an oversimplification; there are
| places where the out-of-pocket price ends up actually cheaper
| than the negotiated insurance price, which is mind-boggling to
| me.
| coredog64 wrote:
| A long time ago, when I was poor and underinsured, I had a
| medical situation that required imaging. The doctor's office
| said they had the machines on prem, but they couldn't give me
| any kind of price break. So he sent me to a specialist.
| Signing in to the specialist, they told me that the cash up
| front discount was 75%, and that even a hint of having to
| deal with insurance companies was going to mean a higher
| effective out of pocket.
|
| Practically any US medical practice is going to have huge
| staffing overhead for the people who maintain the accurate
| billing records and wrangle with insurance companies.
|
| I can directly compare with the French system: Doctor has a
| receptionist, you pay him cash right there on the spot, and
| he's very limited in what he can do. E.g. he has to send you
| to the pharmacy to buy your shots, but he'll administer them.
| When it's all done, you fill out a crapload of forms, staple
| all the receipts to the stack, and your employer (via
| insurance) returns somewhere between 60-80% of it.
|
| I have long maintained that moderate reimbursement for
| outpatient care would be a huge improvement for the US. At
| the same time, there's a fairly large entrenched interest
| that wouldn't like this at all.
| fireeyed wrote:
| This is made possible thanks to the current administration's CMS
| price transparency rule which went into effect Jan 1,2021
| http://www.cms.gov/hospital-price-transparency
|
| Edit: By "current" I mean the Trump administration.
| analog31 wrote:
| Out of curiosity, how much will this reduce the cost of health
| care? The idea, as it's been explained to me, is that
| visibility into the cost of medical care will result in
| downward price pressure. How much?
| noelsusman wrote:
| It's complicated so nobody really knows. I've seen a few
| studies that have showed real but modest effects (2-5%
| decrease). The benefits tend to be concentrated because most
| healthcare spending is on patients who don't have an
| incentive to be price sensitive.
| lotsofpulp wrote:
| Transparent pricing enabling the comparison of pricing
| between different sellers is only one piece of a functioning
| marketplace. You also need multiple informed sellers and
| multiple informed buyers.
| analog31 wrote:
| So it's a step towards a complete policy. What is the
| complete policy? Granted we might not see it enacted now,
| but it would at least clarify where the administration was
| headed.
| lotsofpulp wrote:
| Increasing supply of doctors by increasing residency
| funding, decreasing education costs, and decreasing the
| sacrifice that needs to be made to become a registered
| doctor.
|
| I have no idea why doctors need to sacrifice their entire
| 22 to 30 year old lives constantly slaving away, working
| on call, sometimes 24 hours at a time.
|
| Relax some of the draconian, outdated hazing rules.
| Attract more smart people, make it so young people can
| have lives and become doctors.
|
| That might address the cost of labor. The cost of
| medicine on the other hand is simple, the government
| should be funding research into medicines and then
| offering it for sale at basically the cost of production.
| Only other way is to reform patents and whatnot, but it
| seems easier to just do the research with the top tier
| research facilities the US already has via the higher
| education system.
|
| There's probably some other issues such as tort reform
| and medical equipment costs that need to be address too.
| But I think all prices can be brought down by increasing
| supply.
| analog31 wrote:
| Indeed, bringing down the cost of med school might also
| have the effect of attracting people with a working class
| background, who see it as a form of labor, not as a
| return on an investment.
|
| I'm not sure what the impact of tort reform would be.
| It's possible to look up how much is paid in premiums,
| but we don't know who owns the malpractice insurance
| industry, and I've read that it's doctors.
| coredog64 wrote:
| There's two costs to the US legal environment: Insurance
| premiums and defensive medicine. It's in the doctor's
| interest to run every test because it's free to him, but
| failure to do so raises his risks. So you wind up
| spending money non-productively and you have a non-zero
| rate of false positives, unnecessary treatment, etc.
| knubie wrote:
| The current tax code incentivizes insurance as
| compensation, which drastically distorts the market. The
| ACA made things even worse by introducing the individual
| mandate.
| lotsofpulp wrote:
| The ACA made things better than they were by eliminating
| maximum benefit amounts, implementing out of pocket
| maximums, implement maximum age rating factors, and
| removing all pre existing condition clauses guaranteeing
| access to healthcare. The individual mandate ensured that
| all of these increases in access to healthcare could be
| paid for by forcing young and healthy people to pay
| premiums. Without the individual mandate, premiums would
| have had to be even higher, causing even more people to
| not buy insurance, etc.
|
| That the tax code was not updated to remove the tax
| benefit for employers, or give it to individuals is a
| shortcoming (and has long been a handout to big
| businesses prior to ACA). What really needed to happen
| was forcing everyone into healthcare.gov onto a single
| marketplace so healthy lives wouldn't be locked up in
| employer sponsored risk pools. Then the costs would truly
| be shared across the whole population, and sufficient
| healthy lives would exist to enable multiple insurance
| companies to compete.
|
| Or we could have gone with taxpayer funded healthcare and
| made it all simpler. But that obviously wasn't in the
| cards.
| analog31 wrote:
| Indeed when ACA was passed, it was acknowledged that it
| was intended to reform _access_ to health care, not the
| _cost_ of health care. It was a compromise that appeased
| the insurance industry.
| huitzitziltzin wrote:
| Personal opinion (as a health economist) is that this is a
| nice policy, but probably not going to do that much.
|
| You as a consumer now have the ability to search, but do you
| have an incentive to do so? Do the savings come to you?
|
| Some of it, perhaps. But it's likely not that much and only
| under some circumstances.
|
| E.g., if you are just faced w/ a copay on a visit, your copay
| is going to be the same at two facilities.
|
| Coinsurance is different - there you may realize some
| savings. IF you are below your deductible for the year that
| is also different. You may realize savings and care.
|
| But there are a decent number of patients who for most of
| their visits will not see much incentive to search.
|
| Also... it is possible for these releases to help hospitals
| coordinate on prices in a way which they currently do not. (
| _Tacit_ collusion, not explicit, back-room, definitely-
| illegal collusion.)
|
| Hospital A now knows exactly what Hospital B gets from Aetna,
| so Hospital A may realize it can hold out for more w/ Aetna
| b/c Aetna is willing to pay their competitor more for the
| same procedure.
|
| Both of these questions are _above all_ empirical questions
| and one to which we do not yet know the answer. I would be
| wary of confident predictions.
| 11thEarlOfMar wrote:
| For example, an appendectomy (MSDRG 343) in my area will cost
| $56,000. With my insurance plan, that will max out my $8,000
| deductible, + another $8,000 co-insurance to hit my out of
| pocket maximum of $16,000. That's what I'd pay, $16,000.
|
| Or, I can go to Tennessee and get the appendectomy (MSDRG
| 343) for $4,700 and pay that directly.
|
| Many people will make that choice Kaiser gets less business
| putting downward pressure on their pricing. And the folks in
| Tennessee might see they can raise their prices so that it
| starts to equalize to some point.
| analog31 wrote:
| How many appendectomies are elective? I was immobilized by
| pain and possibly close to death when I had mine. The
| economic impact depends on actually realizing the cost
| savings, which could be compounded by a variety of factors.
| 11thEarlOfMar wrote:
| True, appendectomy was not a good choice. Perhaps hip
| replacement would have been better.
| apiimporter wrote:
| And by "current" administration you mean the Trump
| administration because people here don't like to give credit
| where credit is due.
| lostcolony wrote:
| I mean, we can discuss how much credit and where it's due,
| but I'm pretty sure "current administration", on a given
| date, makes it kinda apparent?
| ogre_codes wrote:
| I think the idea is that the poster wants people aware that
| at least once in his administration Trump has done
| something remotely correct.
|
| Of course the fact that he did this after spending 3 years
| trying his damndest to gut our already mediocre public
| healthcare system makes it a bit of a eye roller, but you
| know, even a broken clock is right and all that.
| 11thEarlOfMar wrote:
| For completeness, a couple of other health related
| actions by the current administration:
|
| - 'Most Favored Nation' drug pricing. Also as of 1/1, big
| pharma has to charge US payers the same price as the
| lowest price they charge to other countries. One example
| cited is insulin. Apparently, the price of Insulin from
| the same pharma is 10% the price in Canada as it is in
| the US. Now that this law is enacted, that pharma has to
| charge the same in the US as they charge in Canada.
|
| - 'Right to Try'. Greatly reduces restrictions on
| terminally ill patients' access to experimental
| treatments.
|
| - Removed the mandate on the affordable care act. People
| who do not have any health insurance were liable to pay a
| fine. That fine was removed.
|
| - eHealth across state lines. Doctors were not permitted
| to see patients via video calls across state lines.
| During the pandemic, that restriction was removed.
| aksss wrote:
| We should not ignore the attempt to relax restrictions on
| Association Health Plans in 2019, which would have made
| it easier for small businesses to band together to
| negotiate insurance terms using combined group numbers on
| par with that of larger corporations. This was struck
| down by a federal court[0], but would have moderately
| improved one of the biggest barriers to small business
| ownership/employment - unobtanium health insurance. This
| was a huge loss of something almost great.
|
| [0]https://www.shrm.org/resourcesandtools/hr-
| topics/benefits/pa...
| [deleted]
| lotsofpulp wrote:
| The better, and simpler option is to remove employers
| from the equation entirely. Either go with taxpayer
| funded healthcare, or force everyone to buy from
| healthcare.gov where they can choose whichever insurance
| company they want.
| dubcanada wrote:
| Everyone knows who the current administration is, assigning a
| name of a bobble head to it doesn't mean anything.
|
| The bill [1] was introduced by Mike Braun and others. None of
| which have anything to do with Trump or his "administration",
| these are voted governs who did this all on their own.
|
| 1 - https://www.congress.gov/bill/116th-congress/senate-
| bill/410...
| smueller1234 wrote:
| Suggestion: I hope I didn't completely miss something, but the
| site seems to put average prices for procedures all over the
| place when the median price would actually be much more
| informative to somebody searching for a provider. Looking at a
| few procedures, the prices seem to have significant outliers,
| which exacerbates this.
| ageitgey wrote:
| Thanks, we're working on figuring out the best way to represent
| those and maybe making them more location-specific. Even with
| median prices, it doesn't always make sense to show a country-
| wide median since there is a huge difference in price ranges
| between markets. A super high price in Nashville might be a
| super low price in Los Angeles, for example.
| curiousllama wrote:
| Great solution. I hope this will make asking about costs at the
| hospital more normal!
|
| I once went to a doctor for vaccinations before traveling. The
| nurse said "You need X, I recommend Y, and the CDC recommends Z."
| I responded "great, let's get X right now. Not sure about Y or Z
| - how much do they cost?"
|
| The question just didn't compute. No matter how I phrased it
| ("just want to price compare" ... "there's a bunch of travel
| clinics and I'm trying to get this cheaply" etc), I couldn't make
| myself understood.
|
| The NP ended up coming in to give me their "anti-vax" spiel. I
| had walked in to a hospital wanting a vaccine, and asking about
| costs was so foreign to them that they thought the only reason I
| could hesitate to get a vaccine was anti-vax sentiment.
|
| All this to say - this tool is very much needed, and has the
| potential to do a lot of good!
| rohanagarwal94 wrote:
| Hope this was available for India
| KingMachiavelli wrote:
| It would be nice to be able to see the lowest & highest prices &
| other stats. I can manually find the lowest price by sorting by
| price but I can't seem to reverse it to show the highest price
| first...
|
| Anyway, it seems that there are orders of magnitude differences
| for the same service.
|
| The service 'MRI Lumbar Spine With & Without Contrast Material'
| has a lowest price of $210 while the closest and highest I
| personally could find was ~$4109.
|
| How can there be such a large difference in price for something
| that, I believe, is legally & medically the same procedure?
| LatteLazy wrote:
| >How can there be such a large difference in price for
| something that, I believe, is legally & medically the same
| procedure?
|
| If no one publishes their prices how do you set yours? 2
| dollars? 2000 dollars? 2m dollars?
| spaetzleesser wrote:
| I am pretty sure the providers and insurers know exactly what
| everyone is charging. It's the patients that are being kept
| in the dark.
| sib wrote:
| When I needed a similar non-emergency procedure (cervical,
| rather than lumbar, MRI), my neurosurgeon, at a large,
| university-affiliated hospital, referred me to the in-house
| radiology department.
|
| Within a day or two, I received a phone call from some
| department at my health insurance provider telling me "Hey,
| we see that you are going to get an MRI; did you know that
| you can get the exact same procedure at providers A, B, and
| C, for a lot lower cost?" They did this even though the
| hospital's radiology department was in-network.
|
| In this case, the cost difference was similar to what's
| noted here - about $4,000 vs $450. Since the insurance
| company was paying most of it, aside from my copay / share
| of cost, they were motivated to provide me a little
| transparency.
|
| To be honest, as a patient, I would have preferred to get
| the MRI at the hospital; their facility was nicer, cleaner,
| more modern, and there was better data integration for
| getting the results to my neurosurgeon and keeping them as
| part of my holistic medical record. Nonetheless, I went to
| the cheaper provider.
| [deleted]
| LatteLazy wrote:
| Like any opaque market, bigger players will have more info,
| but I doubt anyone will share information as its collusion
| (maybe illegal) and also advantages either your negotiating
| opponent or your competitors...
| mrnickel001 wrote:
| Exactly. Small payers are actually pretty hungry for this
| data. Generally, big payers are more privy to market
| rates (by paying for datasets, owning clearinghouses,
| etc).
| eldavido wrote:
| I realized over the past few years that there is no "natural"
| price for anything. It's 100% set by competition.
|
| Economic research confirms this. Mergers result in higher
| prices due to less competition.
|
| What we need is way, way, WAY more competition in healthcare.
| 10x as many providers, 10x as many clinics, with prices
| posted on the wall. When they start losing business, they'll
| notice.
| LatteLazy wrote:
| I think you're right. The issue with these services is that
| they're extremely local. Really, only cities will likely
| really have much competition. That relies on there being
| separately owned facilities. And even then there is the
| issue that 2-3 providers never really compete even if
| they're not colluding...
|
| I honestly think that free market healthcare is doomed to
| failure. The information a-symmetry, the size of hospitals
| compared to populations, localization, the degree of
| specialization, strategic nature of services, and the
| social externalities are just too great to ever really have
| a market. But that's just me on my soap box.
|
| Hopefully transparent pricing will do some good at least. I
| wonder if requiring insurers to share savings in cash would
| further encourage people to shop around (eg going to the
| place 4h away to get a 2k MRI instead of a 4k MRI means you
| get say half the saving [1k] back from your insurer)...
| electriclove wrote:
| There will never be 10x as many providers due to the AMA
| and lobbying. Existing interests don't want to see lower
| prices and competition.
|
| If this was possible, I'd agree with you. But the reality
| is that the best we can hope for is single payer.
| eldavido wrote:
| I was arguing with a doctor friend recently about the
| AMA. He's on team New York Times, "knows" the Koch
| brothers are Satan incarnate, "knows" Trump owes Russian
| oligarchs money, etc.
|
| It just didn't register that the AMA is the sixth-biggest
| spending organization on DC lobbying [1], right behind
| Blue Cross Blue Shield (an insurer) and the American
| Hospital Association.
|
| People worry about the NRA and all kinds of other stuff.
| They should really get mad about how outrageously the
| medical industry lobbies (as do the realtors), and how
| much they've managed to extract from ordinary Americans.
| It's an utter coup of PR that people aren't rioting in
| the streets about this. Everything about the medical
| industry -- licensing, high physician salaries, etc. is
| rigged to be good for insiders.
|
| [1] https://www.opensecrets.org/federal-lobbying/top-
| spenders
| mrnickel001 wrote:
| Yeah, actually I can attest that a lot of our hospital
| clients have no idea what the hospital next door is charging
| / getting paid by insurance. So, a lot of price setting is
| guessing. It's often not cost-based. And often, negotiations
| will arbitrarily shift high prices over to one service type,
| eg Blue Cross will say: "Fine, if you want to get paid that
| much for knee replacements, we get a lower rate for bariatric
| surgery." So you'll find weird price discrepancies within the
| same provider.
| nugget wrote:
| In 2015 I did several months of due diligence in this market -
| price comparison for diagnostic imaging - before concluding
| that it wasn't feasible to build the product we wanted to
| build. This new law provides the data that we were unable to
| access (at scale) on our own.
|
| From the data we did get our hands on, I remember seeing price
| differences like $200 vs $4k for the exact same procedure. The
| low cost provider was usually a private practice radiologist in
| a small shopping mall type retail location who ran a very
| efficient, low overhead practice. They were terrible at
| marketing and ran discounts for volume from certain channels.
| They were only open Monday to Friday from 8am to 4pm, read
| times could often (but not always) be slow, they handled the
| least complex cases and no emergencies. Cash pay up front from
| patients resulting in no/minimal collections. The high cost
| provider was usually a large University affiliated medical
| center who ran a less efficient, high overhead radiology
| department but who also, in their defense, had to handle more
| complex cases as well as be open 24/7 to service one or
| multiple emergency departments with faster read times. Lots of
| fighting with insurance companies for eventual reimbursement.
| Lots of bad debt that went to collections and had to be written
| down.
|
| If you pay University prices for a simple MRI you are
| effectively subsidizing the ED admit who needs a complex
| imaging procedure in the middle of the night. If consumers
| start to shop for MRIs the way they shop for airline tickets -
| which they probably should - one downstream effect will be to
| remove billions of dollars of "subsidies" from the most well-
| resourced radiology departments in the country. If I remember
| correctly the diagnostic imaging market was something like $150
| billion/year in 2015, and probably even bigger now, i.e. plenty
| of potential fat to cut.
| wjossey wrote:
| For folks who don't believe in universal medical coverage,
| this is part of the reason why it's so inefficient for it not
| to exist.
|
| The uninsured person going to the hospital at 1AM that
| requires an MRI because slipped a disc in their back still
| ends up getting that MRI. When they fail to pay that bill,
| which would be 5%-10% of their annual earnings, we all still
| pay for it. We just decided to layer in debt collection,
| anxiety, and depression onto the patient in lieu of cash.
|
| As someone who still considers themselves a fiscal
| conservative, and also believes we need true universal
| coverage for all Americans, this seems like a no brainer to
| me at this point (and I say that as someone who would have
| not supported this in the 00s but has evolved significantly
| on this issue).
| rtx wrote:
| Why add additional steps, government should open hospitals
| and provide healthcare directly.
| sib wrote:
| Why? (Seriously - you seem to be assuming the answer
| here.)
|
| Would the same statement be true for food and shelter
| (also necessary for life)? Should the government be the
| provider for all food and shelter in order to avoid
| additional steps?
| lotsofpulp wrote:
| Because a person is capable of determining good produce
| from bad produce and make informed decisions when
| purchasing groceries.
|
| The same is not true for healthcare. Even when purchasing
| shelter, people are not sufficiently informed to be able
| to make a good decision, hence the existence of
| electrical, plumbing, and structural codes and
| inspections.
|
| With healthcare, people are extremely uninformed. The
| costs are extremely high. The government doesn't
| necessarily need to vet the doctors' diagnoses and
| prescribed remedies, but they could. So could insurance
| companies, which is what currently happens in the US.
| aksss wrote:
| This is a bit chicken-and-egg. People are uninformed
| about cost and quality of healthcare because the third-
| party payer system obscures detail (often intentionally).
|
| Spend some time uninsured and you become a very
| discerning consumer.
|
| Further, for every service that requires healthcare
| advocacy (often provided by family members, btw, not
| professionals even in existing system) there are probably
| >five that are commodity services (labs, prescriptions,
| diagnosis, imaging, etc.)
| nugget wrote:
| My takeaway from all that research was the same. Almost
| everyone benefits from universal coverage but the system
| has to incentivize patients to shop around for the optimal
| balance of price, quality, and convenience. This can be
| accomplished with an annual deductible of a few thousand
| dollars perhaps capped at a % of income. Without this
| incentive, costs skyrocket. Price transparency is a pre-
| requisite without which consumers can't easily shop around,
| so this law is a giant leap forward in the right direction.
|
| That is the #1 most effective thing that Americans can do
| to reduce health care costs. #2 would be to change the
| standard American diet and eat healthier to reduce rates of
| obesity and diabetes. Almost every other proposed
| structural change or intervention we looked at was minimal
| by comparison.
| smachiz wrote:
| Do you have any studies or sources to back this up?
|
| As I understand it, in most EU markets there's no price
| component, nor much of a choice component and costs
| haven't skyrocketed.
| coredog64 wrote:
| I lived under the French system for years, and it's
| entirely untrue that there is no cost or choice
| component. You pick the doctors and you pay them fully
| out of pocket. Your insurance company reimburses you at
| ~80% of reasonable and customary rates. If you wind up
| going for inpatient care it's different, as is the
| situation for those in extreme poverty. Also, you can pay
| extra for 100% coverage if you want, but ISTR it was
| expensive and not really worth it for us.
|
| Now, when I left, the doctors and insurance companies
| were setting up an analog of the US system: If you saw
| certain doctors, they would not charge you at point of
| delivery and there was no co-insurance requirement. It
| was still new and inconvenient, so I don't know how
| that's worked out.
|
| I don't have direct experience with the Swiss system, but
| from everything I've read, conversations, etc., it's a
| slightly cheaper version of the US system. You buy
| leveled insurance, you have to pay some out of pocket,
| etc.
| vinay427 wrote:
| > I don't have direct experience with the Swiss system,
| but from everything I've read, conversations, etc., it's
| a slightly cheaper version of the US system. You buy
| leveled insurance, you have to pay some out of pocket,
| etc.
|
| I moved from the US to Switzerland so maybe I can offer
| some anecdotes here. You're basically right in that it's
| a slightly cheaper version of the US system. However,
| some things that I didn't have to pay for in the US such
| as calling am ambulance without riding in it or seasonal
| flu shots do cost money here ($500+ for an ambulance to
| show up in the middle of a large city...), but I think
| these small lapses are overshadowed by expensive
| inpatient treatment being essentially completely covered
| minus some reasonable deductibles as well as outpatient
| treatment that is usually partially covered depending on
| the insurance plan.
|
| The positives compared to the US largely revolve around
| necessary and typically expensive treatment being far
| more likely to be covered under insurance with relatively
| low copays and deductibles. The downsides in common with
| the US are the administrative hassles of dealing with an
| insurance company and its own billing middlemen (e.g. a
| COVID test was improperly billed to me which needed to be
| sorted out), the large monthly premiums for most people
| (~$250 is typical except for those who qualify for
| subsidies), and the lack of clarity over what and how
| much of anything is covered even when the billing is done
| correctly.
|
| Do I call an ambulance? Do I go in to see a doctor? Will
| I end up with a massive charge? I'd prefer a single-payer
| or completely comprehensive system for this last point
| alone.
| grey-area wrote:
| _Almost everyone benefits from universal coverage but the
| system has to incentivize patients to shop around for the
| optimal balance of price, quality, and convenience._
|
| Universal coverage does not need to incentivise shopping
| around in a single payer system. Also, the majority of
| patients are not capable of evaluating quality of
| healthcare, nor should they be.
| aksss wrote:
| Any system should incentivize shopping around unless it
| wants inflated cost. That or discourage frequent
| engagement (the US consumes comparatively massive amounts
| of healthcare product and service with inefficient
| outcomes). Our present system is _designed_ to prevent
| price comparison and shopping around via price opacity,
| network lock-in, state-level artificial supply barriers,
| etc.
|
| Universal coverage on par with Europe would mean we all
| start consuming less individually (which isn't a big deal
| to outcomes but not part of our culture), or we need to
| have a far more competitive environment for suppliers.
| Either would be better than what we have today, whether
| insurance is public, private, or a mix of both.
| zaphod12 wrote:
| There was an attempt at this with prescription drugs.
| Encourage patients to take generics by forcing a larger
| amount of cost onto the patients in the form of higher
| copays.
|
| Pharma companies realized and started giving copay
| vouchers (still charge insurance more, but short circuit
| the patient incentive). When that loophole got tighter
| they formed charitable foundations to give the vouchers
| instead.
|
| I'm not disagreeing with your points, per se. It's just
| amazing what entrenched interests can manage.
| eldavido wrote:
| Also a fiscal conservative, I completely agree single-payer
| would be much better than what we have now.
|
| What I think would be best though, is to eliminate
| medicare/medicaid, hand people cash, and get out of the
| way.
|
| The high-order problem with medicine isn't coverage or
| insurance. It's price. There are only two ways to get price
| under control: meaningful competition, or government price
| controls (e.g. single payer). Single payer would end up
| like public schools: one choice for everyone, probably OK
| quality, but not great.
|
| I think we could do so much more here if we just created a
| cash market and handed people money. It's what Singapore
| does. It would let doctors compete on -- even discover --
| what actually matters to consumers -- wait times, when
| procedures take place, even how comfortable the office is.
| I would much rather have a market with choice and variety
| than one that straitjackets everyone into a one-size-fits-
| all system that might work for some but probably won't for
| others.
|
| I know people are going to worry about rare (expensive)
| conditions not being covered, and this is indeed a problem.
| I don't have an answer to this. One good thing about
| competition though, is that it drives innovation. Provider
| prices will absolutely be set based on what they know
| people can pay. If people can't pay as much, the only thing
| for them to do is drop prices.
|
| It's funny. In a community where people are so focused on
| innovation, and startups, and choice, I see a lot of
| support for a national single-payer scheme. I would much
| rather take the collective energies of this community and
| apply them to innovation in this market, with meaningful
| choice and competition. Medicine needs more of a startup
| mindset. And for those roasting me about how it's
| different/dangerous/risky: what we have today is KILLING
| us, economically.
| jimmaswell wrote:
| Patients would still decide where to be treated based on
| those factors, the only difference is the insurance is
| standardized. Nobody in countries with socialized health
| insurance seems to complain about lack of choices or any
| of that, and rich people in those places can still get
| private insurance to get their nose job done right away
| from a private practice. For everyone else I get the
| impression it works just fine.
| eldavido wrote:
| I'm less convinced. The NHS, Britain's version of this,
| is constantly underfunded, and has long wait times for a
| variety of procedures. The Economist writes about this
| frequently.
|
| https://www.economist.com/britain/2018/06/28/the-three-
| myths...
| jimbob45 wrote:
| You're advocating for the same system that ruined
| colleges: guaranteed loans.
|
| Also coverage is also a huge deal in the US, although it
| may not be a problem for you specifically. Obamacare
| covered millions who otherwise might have stayed home
| instead of seeing the doctor.
|
| The problem with US health is scoping. Insurance
| companies are effectively "certifying" which hospitals
| and doctors you can see instead of actual certification
| bodies.
| aksss wrote:
| > Obamacare covered millions
|
| I was one of the people who lost insurance starting a new
| business - too rich to get subsidized (cutoff was/is
| >~50k/yr), too poor to pay the equivalent of a second
| mortgage for individual insurance because of runaway
| premiums on individual market post-ACA. And penalized a
| few grand for it come tax season until the mandate was
| effectively rolled back. Was more than supportive of that
| rollback.
|
| It's a risk management game for new business owners, and
| a big incentive for people to keep working for the man.
| eldavido wrote:
| I never said anything about loans.
|
| What I'm suggesting is food stamps. Everybody can pay
| cash. If you can't, you get government assistance in the
| form of a cash-like subsidy that can be spent anywhere
| food is sold.
|
| It's a fast, efficient way of ensuring universality of
| care while benefiting from the market discipline you get
| from having a (mostly) competitive, cash market. Not to
| mention, there is no insane "food insurance" bureaucracy.
| You swipe the card at the checkout line and you're good.
| jfk13 wrote:
| > I know people are going to worry about rare (expensive)
| conditions not being covered, and this is indeed a
| problem. I don't have an answer to this. One good thing
| about competition though, is that it drives innovation.
| Provider prices will absolutely be set based on what they
| know people can pay. If people can't pay as much, the
| only thing for them to do is drop prices.
|
| I don't think so. If providers can't expect to be paid
| adequately (in relation to their capital investment,
| research costs, operating costs, etc) for dealing with
| "rare (and expensive) conditions", because people don't
| have insurance (whether private, medicare, or whatever),
| just a modest amount of cash in any given patient's
| pocket, do you really think they'll want to stay in that
| market?
| ska wrote:
| aside: Singapore is a weird case and probably not a good
| comparitor for most healthcare systems.
|
| > If people can't pay as much, the only thing for them to
| do is drop prices.
|
| Or not offer the product at all. One problem with this
| entire area is that "healthcare" is really not one
| service/product area, and it is probably a mistake to
| treat it as such.
|
| To be transparent, I don't share your optimism about
| market solutions to problems like this in general (more
| about their implementation in practice than theoretical
| benefits) but I can see how it might help with parts of
| the routine healthcare. However, when you are talking
| emergency and major treatments, it's well into the range
| where direct consumer driven decisions are more likely
| going to mess up the incentives badly.
|
| If you are lucky enough to have the time (often not
| true), most people can become reasonably expert in their
| own disease state and treatment options. But that is a
| tiny slice of what is going on in a hospital system for
| example, and it's completely unreasonable to expect
| people to become informed enough to make good decisions
| there. If we want to benefit from market forces here,
| it's probably much more effective to have large (or
| single) payers who understand what the standard of care
| should be, and can encourage price competition from
| providers.
|
| It's worth noting that in theory this is what the
| insurance industry does in the US, though, but is an
| expensive mess. Another confounding factor is that many
| obvious price discovery mechanisms will be completely
| unacceptable to most people.
|
| Honestly, it's a mostly faith-based argument that a cash-
| based market approach can find a better global solution
| than universal health care, at least in a relevant amount
| of time. It's really hard for me to see why the country
| should take that risk when there are well understood and
| well modelled approaches (albeit imperfect) that should
| be able to reduce costs by at least 1/2, probably more.
|
| Why not start there?
| eldavido wrote:
| The main thing I take on faith is that people are
| different and one-size fits all solutions don't produce
| good outcomes. We have different car brands, grocery
| stores, non-health insurance companies, package delivery
| companies, retailers, and housing options. Some people
| want fast and cheap. Others want to drive an hour to save
| a few bucks.
|
| This isn't some technical academic point. Without a range
| of choices, you actually _can 't know_ what people truly
| want. So things don't get better. People can't signal
| what's _truly_ important by voting with their wallet.
|
| > If we want to benefit from market forces here, it's
| probably much more effective to have large (or single)
| payers who understand what the standard of care should
| be, and can encourage price competition from providers.
|
| I don't get this at all. There are so many markets where
| complex, highly-paid specialists do work customers might
| not understand: estate/trust lawyers, auto repair, even
| dental care. We don't have nearly the same problems as in
| medicine due to this culture of treating doctors like
| God. They aren't. They're just a person doing a service,
| just like a chef or a guy painting a house.
|
| What actually bothers me most about this whole thing is
| that nobody is willing to get serious about the tradeoffs
| their system entails. Health care in the US is _failing_
| right now. Companies are trying to stay beneath ACA
| limits because health insurance would crush them. My
| premiums are $380 /month as a healthy, 36-year old
| nonsmoker with no rare conditions. That is INSANE.
| There's ever-more incentive to keep people off of W2
| employment because premiums have gotten so out of
| control. If you take the current system, where
| bankruptcies are the norm, this monster is devouring
| almost 20% of our GDP, and every time I go to the doctor
| it's a major hassle, I'll come out and say that yes,
| maybe I'd prefer to fix that even if someone can't get a
| $150,000 drug anymore.
|
| >aside: Singapore is a weird case and probably not a good
| comparitor for most healthcare systems.
|
| Umm...why not? You can't just hand-wave that away.
| ska wrote:
| > Umm...why not? You can't just hand-wave that away.
|
| Sorry, I should have elaborated. It's a city state with
| unusually high levels of both social compliance and
| government control, population is fairly wealthy and
| fairly evenly distributed. So - small population is a
| very small area simplifies logistics a ton. Especially
| ignoring problems related to migrant workers (it's own
| set of problems), most people have both high social
| support and some financial depth, there is also little to
| no housing insecurity.
|
| It's basically unclear if you can successfully scale the
| Singapore model, nobody has tried. As against, e.g. , the
| several universal models that are outperforming the US
| currently, with more comparable populations etc.
| ska wrote:
| > I don't get this at all.
|
| I think this is why I suggested looking it as two
| markets. Your examples (estate lawyers, auto repair,
| dental care) look a bit like a visit to your GP's office.
| None of it looks much like some of the other things
| healthcare provides for us (e.g. many major and emergency
| procedures). And it's not like all of those markets are
| working particularly well currently (auto /house sales/
| opticians/ etc. suck)
|
| I don't think anyone would disagree that one-size-fits-
| all is the right approach, which is why nobody really
| tries that. What you are essentially saying is that you
| think is that you will get more flexibility if you open
| that market further, and that it will be both a better
| solution for more people, and not a horribly worse for
| any significant number of them (which is probably not
| acceptable here).
|
| I'd agree with the first part, but the second requires
| faith - that in practice the signalling that you are
| talking about is clear enough (in both directions) and
| the response time short enough that you arrive at a
| better solution and in a reasonable amount of time. This
| is not at all clear. This isn't about treating doctors as
| "gods" either, they aren't able to make the systemic
| decisions well either, individually.
|
| > What actually bothers me most about this whole thing is
| that nobody is willing to get serious about the tradeoffs
| their system entails.
|
| This I agree with entirely. Two big ones come to mind -
| we need to have a conversation about appropriate end-of-
| life care and costs, and we have to be very transparent
| that our current level of medical capability means that
| there is an appreciable risk that (to a first
| approximation) anyone may end up with a medical condition
| that (a) we know how to cure or mitigate and (b) that
| person will never be able to afford. To me paying for
| these (or choosing not to) is quite different than making
| sure you can get antibiotics when you get strep throat.
|
| You point out some symptoms of the problem currently, but
| I'm a bit curious about why you are resistant to pursue
| know solutions that look more like, say France (or
| Canada, etc.) , than Singapore. Is it just ideological?
| I'd rather take some known improvements and then iterate
| to improve rather than NIH syndrome.
| kfarr wrote:
| Response time / availability is not something I considered in
| medical service pricing before but wow it makes a lot of
| sense.
| mrnickel001 wrote:
| Thanks for the feedback! We'll be improving our filter/sort
| here in the coming days and we'll take this feedback into our
| plan.
| ilaksh wrote:
| My searches so far show insane differences between insurance
| rates and cash rates. The cash can be 5-10x higher than what
| the insurance company pays.
|
| It seems like a clear case of systemic fraud to me. Am I
| missing something?
|
| Also I am not able to find any fundoplication or LINX
| (43284).
| subhro wrote:
| > How can there be such a large difference in price for
| something that, I believe, is legally & medically the same
| procedure?
|
| I hope this never happens, but let's say you got in a
| motorcycle accident and need that lumbar MRI to figure out the
| damage. What are going to do, get back on that wrecked
| motorcycle with a fucked up spine and go to that 210$ place?
|
| They do it because they can do it and get away with it.
| eldavido wrote:
| I see this argument a lot.
|
| The trouble is that emergency care isn't what drives the
| majority of healthcare spend. What does is actually chronic
| conditions: dialysis, diabetes, autoimmune disorders, chronic
| weight conditions.
|
| That's what we need to worry about.
|
| And if there was a real market here, you wouldn't need to
| shop around because all the people that do, would enforce
| some level of price discipline on the market.
|
| Think about it. For any good sold at, say, Wal-Mart, say
| Gatorade, there are some people that want it a LOT, even NEED
| it, while others are more on the fence. There's only one
| price on the shelf and it's calculated to get a lot of people
| buying. So in effect, the people who are more indifferent
| (want it less) are actually doing a pretty significant
| service to the people who want it a lot, by guaranteeing the
| price will be set low _for everyone_.
|
| There's no reason something like this can't apply in
| healthcare.
| fartcannon wrote:
| Is there a Walmart for medical procedures? A jiffy-lube?
| hedora wrote:
| You mean Walmart Health?
|
| https://one.walmart.com/content/usone/en_us/company/walmart-...
|
| :-)
| swebs wrote:
| Yes, CVS MinuteClinic.
| dakial1 wrote:
| Come to Brazil. The best Brazilian hospital (Albert Einstein
| Hospital in Sao Paulo) charges 1.7k USD for a C section (my son
| was born recently there), while the lowest I've found in that
| site is 2.6K USD (don't know about the quality) and median
| seems to be 8K USD. I bet the other procedures have similar
| price differences.
|
| You can pay for the trip, get the best care (it is a really
| good, international level, hospital) and still have some loney
| left.
| pqdbr wrote:
| And what about an MRI? This website lists rates around 2k
| USD, while in Brazil you can get one (in high-end modern
| hospitals in Sao Paulo) for around R$ 600 (== $120).
| xtracto wrote:
| MRI in Mexico cost ~$200 USD (
| https://www.chopo.com.mx/zapopan/estudios/resonancia-
| magneti... ) and is way closer than Brazil.
|
| There are laboratories even at walking distance of the USA
| haha ( https://www.google.com/search?tbs=lf:1,lf_ui:4&tbm=l
| cl&q=lab... )
| dakial1 wrote:
| Might be interesting to check how much "Medical Tourism"
| happens between US and other countries. This might be an
| interesting industry to get into. If I remember well
| there was a health insurance company that was promoting
| Medical Tourism for their clients
| BurningFrog wrote:
| Closest thing is Surgery Center of Oklahoma, which does not
| deal with insurance and has an easily accessible public price
| list on the web site.
|
| https://surgerycenterok.com/about/
| BurningFrog wrote:
| This Econtalk interview with the founder is very
| enlightening:
|
| https://www.econtalk.org/keith-smith-on-free-market-
| health-c...
| subhro wrote:
| This seems to be the GoodRx of medical procedures. This is
| tremendously helpful.
|
| How do you plan to keep the data current?
|
| Also, in the US, is a patient realistically able to say,
| "Hospital X is able to get my compound fracture surgery done for
| 65% less. Match it or I walk", especially when insurances have
| negotiated rates.
|
| Or is this only useful for people with no insurance?
| mrnickel001 wrote:
| Hey man! This is a great comment. I work with Turquoise. We're
| actually building some stuff where patients can collectively
| bargain outside their insurance. But for now, it's most useful
| to people with insurance that see that one hospital down the
| road has a lower rate for their given insurance. (EG, the blue
| cross rate is better the next town over). We're going to make
| it easier to filter for insurance shortly.
|
| Also, very useful for cash pay.
| dubcanada wrote:
| How accurate is this? Some of the threads point out extremes
| between different hospitals, is that because X hospital does more
| stuff then Y, and Y charges you the same as X it's just a bunch
| of hidden/extra stuff that isn't billed as "MSDRG 343"? Or is it
| because the hospital like any business can charge you what ever
| you want and may charge more or less depending on the
| neighbourhood, rent, etc?
| ageitgey wrote:
| I think part of it is that there is a huge difference in cost
| between some facilities. But another part of it is that a lot
| of hospitals don't really _know_ what they charge. They had to
| scramble and hire consultants to come up with these numbers to
| meet the deadline and the numbers will probably get more
| accurate and vary less over time as hospitals get better used
| to working with prices out in the public.
| ketanmaheshwari wrote:
| Looking at some of the prices, I can't help but think how great
| an incentive it is to be healthy in the US. "Health is wealth" if
| it applies anywhere it is in the US.
|
| I have taken extra measures to ensure that myself and my family
| are healthy in the last year and with a tax-free HSA account that
| is invested into ETFs, I am literally printing dollars just by
| following basic principles of being healthy.
| originalvichy wrote:
| Health privilege becomes a thing when access to healthcare
| becomes a barrier. I know the word "privilege" is quite
| radioactive.
|
| I was sick often as a kid and after finding a diagnosis I've
| been performing well among my age peers. Thank you Finnish
| healthcare. Couldn't imagine how much it sets you back
| cognitively to have health issues as well as financial issues
| burdening your mind 24/7. Completely avoidable pain and
| suffering purely for profit.
| ketanmaheshwari wrote:
| Agreed. I was just looking at the positive aspect of it.
| echelon wrote:
| How do we disrupt the fucking debacle that is US healthcare?
|
| Would it be possible to create a subscription-based health
| network that was vertically integrated and provided just basic
| outpatient needs? Charge $9/mo or something ridiculously low and
| encourage everyone to check their health often and maintain
| healthy lifestyles?
|
| Use automation to reduce costs. Then gradually increase the scope
| of care.
|
| That won't help with surgery, cancer, childbirth, etc. right
| away, but it might create a gravitational shift that puts swaths
| of expensive general practitioners out of business, creating
| excess supply and lowering the range of what insurance covers.
| That might greatly reduce costs.
|
| We have to eat away at this bloated, inaccessible system somehow.
| SteveCoast wrote:
| IMHO You need to make it legal to open and run a hospital
| (hospitals are basically local state-granted monopolies like
| cable companies). You make it legal to offer differential
| pricing. You decouple healthcare from employment. You allow
| employers to offer more than one insurer.
|
| Most of what we need to do is just remove the monopoly rules.
| voicedYoda wrote:
| Looks interesting. How is this different than test claim
| submissions available from Eligible, Waystar, PokitDoc, etc?
|
| And are you licensing out cpt codes from the ama? IMHO the AMA
| and their copyright of CPT codes is the biggest setback to
| progressive change, transparency, and adaptive change in tech...
| Payers and well funded companies can afford licensing, otherwise
| they will strangle you with lock down...
| yding wrote:
| Very cool! We've been working an app that is looking for this
| exact type of data. Do you have an API or plans for making an API
| for this?
| ageitgey wrote:
| We do have plans for an api, but we are currently working out
| the model for it - feel free to get in touch via the site and
| let us know you are interested and what you might want to do
| with it.
| yding wrote:
| Thank you. Just did.
| 11thEarlOfMar wrote:
| Even I am surprised:
|
| Appendectomy: MSDRG 343: at Kaiser in Santa Clara: $56,000
|
| Appendectomy: MSDRG 343: at Holston Valley Medical Center, TN:
| $4,700
|
| Our healthcare system is even more broken than I ever imagined.
| batrat wrote:
| What the ..... My wife paid non evasive extraction of appendix
| 600 euros in a private hospital (and was an emergency) in East
| EU and is considered luxury by some. It's free in public
| hospitals.
|
| You guys are swimming in cash.
| Rebelgecko wrote:
| What does pricing at Kaiser even mean? When I last looked at
| them, every plan had a $0 deductible and even surgery just had
| a single copay. Is that the price for someone out of network
| who goes there in an emergency?
| yyhhsj0521 wrote:
| Too bad it is an emergency condition, otherwise people could
| just fly to TN for the same procedure...
| dudul wrote:
| I used to think that, but my wife had one last year and she
| only got her surgery almost 2 months after the diagnosis. She
| was on antibiotic the whole time to reduce and control the
| infection. Apparently it's the new way to deal with it, since
| it makes the surgery much easier to perform, instead of when
| the patient is in pain.
|
| Anecdote aside, your point stands. Shopping, across state
| lines for surgery is ridiculous.
| azalemeth wrote:
| For a contrast [1] from the other side of the pond, you could
| get by on about $3k USD (most British people have no idea about
| this! [2]):
|
| > RESULTS
|
| > Fifty laparoscopic appendicectomies were performed. Median
| operative time was 60 min. The median total operative cost of
| laparoscopic appendicectomy was PS906. Median equipment cost
| for laparoscopically completed cases was PS254. Median total
| in-patient cost was PS1617 (range, PS880-PS3360). This compared
| with a mean re-imbursement of PS1981 representing a [hospital]
| cost benefit of PS233 per case (P = 0.0009).
|
| > CONCLUSIONS
|
| > Despite a liberal use of disposable equipment, laparoscopic
| appendicectomy can still be performed within the confines of
| the national tariffs. There is a considerable variation in the
| cost of this procedure, and it may be possible to reduce costs
| by more stringent use of disposable equipment and standardising
| recovery protocols.
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966171/ [2]
| https://www.theguardian.com/society/ng-interactive/2016/feb/...
| mrnickel001 wrote:
| Yeah that's a generally interesting one because Kaiser's
| pricing is inflated assuming that all their patient's also have
| Kaiser insurance. But appendectomies do range quite a bit.
| huitzitziltzin wrote:
| Do not draw conclusions from this _specific_ case because
| Kaiser in particular is very, very different.
|
| You may be able to find similarly insane examples at other
| hospitals, but Kaiser is vertically integrated: generally
| Kaiser doctors send Kaiser-insured patients to Kaiser
| hospitals.
|
| I am not sure how they reach their measure of a "price" here
| but it is entirely possible it's unusual and or different.
|
| Again you can probably find something similar at non-Kaiser
| hospitals (Just for fun... check the Sutter system in NorCal -
| it's extremely expensive), but _Kaiser_ is not the reason you
| should think this is insane.
| Pjki889 wrote:
| The branding (design, typography) looks very similar to
| OneMedical.
| rplnt wrote:
| Why are the prices so insane? Where do the money go? I'm from
| Eastern Europe so of course the prices would be different, but by
| an order of a magnitude at the minimum seems strange.
| swebs wrote:
| >Why are the prices so insane?
|
| Because up until a few weeks ago, people weren't allowed to see
| what hospitals charged until AFTER getting their bill. It was a
| ridiculous system, and I'm glad Trump got rid of it.
| timonoko wrote:
| It is a sliding scale. American prizes are 3 times more than
| private clinic in Helsinki, and again those are 3 times higher
| than in Lithuania.
|
| For example ultrasonic diagnosis of your frozen shoulder is 600
| Euros in USA, 200 Euros in Finland and 80 Euros in Vilnius.
|
| This issue is relevant, because European healthcare wont fix
| your shoulder, because it is a "cosmetic problem" and will
| disappear on its own in a year or two.
| timonoko wrote:
| Why this was downvoted? It would be nice get even some clue
| why this is happening so often on totally trite statement of
| facts.
| dnautics wrote:
| - paying for services for people who don't have/can't afford
| insurance.
|
| - medical malpractice insurance -> legal system
|
| - big pharma/med devices industry
| huitzitziltzin wrote:
| Everyone hates pharma (not entirely without reason!) but
| _all_ drug spending is _about 10%_ (slightly less) of US
| health care spending.
|
| If you spent $0 on drugs next year, we would not save that
| much money.
|
| If you want to cut spending, you need to cut spending on
| doctors and hospitals.
|
| If you want sources for these numbers, here is the National
| Health Expenditure summary from the Centers for Medicare and
| Medicaid Studies:
|
| https://www.cms.gov/Research-Statistics-Data-and-
| Systems/Sta...
| spaetzleesser wrote:
| You should add
|
| - doctors are paid higher in the US than in another countries
|
| - billing staff overhead because of the insane insurance
| system
|
| - highly paid hospital administration
|
| - lots of middlemen that stay invisible because there is no
| price transparency
|
| - shiny new buildings that are built by friends of the
| hospital administration
| excannuck wrote:
| "billing staff overhead because of the insane insurance
| system"
|
| While true, I would generalize to "insane bureaucratic
| system" unless you want to include public "insurance" into
| the mix. Medicaid and Medicare aren't simple!
| zoomablemind wrote:
| ... Add also the medical equipment prices inflated by
| layers of distributors.
| ArtDev wrote:
| Look up the salary of your local hospital president. In my
| medium town of (Pop 200K) they pay him $980k per year. That
| is an absurd salary for a relatively small hospital!
| therealdrag0 wrote:
| How do I look that up?
| huitzitziltzin wrote:
| AFAIK, certain non-profits are required to report the
| salaries of their ten highest paid employees.
|
| Doesn't mean it will be easy to find, but you _might_ be
| able to find it that way.
|
| But this is not information the hospital would share w/
| you w/ great enthusiasm, obviously.
| dominotw wrote:
| Big pharma?
|
| Big pharma has actually reduced the hospitalization costs
| over the past two decades.
|
| Edit: can someone explain downvotes?. How is big pharma
| increasing hospital costs?
|
| please take a look at this,
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669633/
|
| "The major empirical finding from this research is that
| medication use by Medicare beneficiaries is significantly
| negatively associated with hospital spending. Moreover, the
| cross-effect is quite large: each additional prescription
| drug fill reduces hospital costs by slightly more than $100
| or about 5 percent measured at the mean level of Medicare
| payments in 2000 for inpatient hospital services for study
| subjects. "
| excannuck wrote:
| For every COVID vaccine, how many BS "re-patented"
| medications == harmless vitamin + actual_medicine?
|
| Or medications that don't really work (p-hacking) but are
| prescribed anyway?)
|
| Or manufacturers that buy out all US competitors to have a
| monopoly of a particular medicine?
| LatteLazy wrote:
| Plus
|
| - Gold plating everything to avoid getting sued.
|
| - Inflated medical school costs
|
| - the price of a huge bureaucracy for billing people, chasing
| them, disputing it, agreeing rates with insurers,
| renegotiating rates with insurers, applying the right
| discounts, billing a dozen different state and federal
| programs for various bits, those being disputed, managing all
| that etc.
| dominotw wrote:
| I moved to usa from a poor country to work at a hospital. I
| was shocked by how awesome, clean and luxurious everything
| looked. Top end fancy hotel in my country would look like a
| slum dwelling compared to a hospital in USA.
| ArtDev wrote:
| Going from the USA to a hospital in Thailand is a similar
| experience. Everything is so clean!
| annoyingnoob wrote:
| -Disposable everything, priced at a premium
| fireeyed wrote:
| Don't forget AMA antitrust violations but curbing the number
| of doctors that could get into the system.
| huitzitziltzin wrote:
| Underrated answer, but it isn't an anti-trust violation
| when they have permission to accredit med schools!
|
| To be clear: I totally agree w/ you that the AMA is a
| cartel.
| eldavido wrote:
| It's simple: waste. Everywhere.
|
| There is no incentive for doctors to be efficient so they
| aren't. They order too many supplies, do too many procedures
| quickly (when doing them slowly would be fine, and cheaper,
| etc).
|
| Price discipline is like gravity. It affects everything. In
| most American businesses subject to market forces, there is an
| enormous push to optimize every single little bit of the
| business to control costs.
|
| This force simply doesn't exist in healthcare.
| hhjinks wrote:
| Market forces aren't exactly prevalent in nationalized
| healthcare systems like the ones seen in Scandinavia either,
| and they keep costs way down compared to the US.
| terse_malvolio wrote:
| Sometimes the cost is bigger than the cost in a different country
| plus the plane ticket.
| annoyingnoob wrote:
| From this data, I could do that by going to another state.
| PragmaticPulp wrote:
| The U.S. healthcare system is built around the idea that
| everyone has health insurance. Obviously, that's not a valid
| assumption at all, which is one of many reasons why it's such a
| problem.
|
| Insurance companies each negotiate a rate for various services
| with hospitals. People pay different rates depending on the
| insurance they have, due to these different negotiated rates.
|
| This creates a perverse incentive where hospitals want to list
| their "cash" price as being higher than the negotiated rates,
| otherwise insurance companies will come back to negotiate their
| rates down to the obviously lower cash price.
|
| In reality, it's usually surprisingly easy to get hospitals to
| give significant discounts if you tell them you're without
| insurance and you'll be paying in cash. Patients without
| insurance can often negotiate their bills down to a fraction of
| the original list price by simply calling in and telling the
| billing office they don't have insurance.
|
| It's obviously not a great system.
| ArtDev wrote:
| It's a criminal racket.
|
| You have no position to negotiate and I have never got them
| to budge. I have tried and gotten pretty angry about it.
|
| Short-term insurance is a waste of money because the rates
| did not appear to be negotiated at all. They paid 5% of the
| bill and stuck me with the rest.
|
| The only reason to actually pay your bills is the hospital
| might eventually sue you. Its messed up.
| alisonkisk wrote:
| If you don't pay, they'll budge eventually. Unless you're
| rich, maybe, but then paying more is socialized health
| care.
| astrophysician wrote:
| Unfortunately not my experience -- went to nearest ER for
| sudden and agonizing abdominal pain, got some basic pain
| meds, got a CAT scan to diagnose pneumonia, was sent home
| within a couple of hours (lots of waiting).
|
| Turned out the hospital was not in network, they charged
| me $15,000 (including $10,000 for a "level 5" ER room
| stay, which is twice the most expensive price listed on
| the OP's website and is 10x the local average price for
| that service, despite the fact that my experience could
| not possibly have been Level 5 service). Eventually they
| just sold the debt to a collections agency. I tried to
| fight but they didn't seem to care, and why would they?
| They already sold the debt!
| swebs wrote:
| What country lets non-citizens just walk in to use the health
| care system?
| mportela wrote:
| Brazil
| tin7in wrote:
| The whole European Union for EU citizens with an EU health
| card.
| dudul wrote:
| I actually can't think of one I've visited that doesn't.
| miguelrochefort wrote:
| Thailand.
| jogjayr wrote:
| I assume they were referring to countries where you can pay
| out of pocket for care at private clinics and hospitals, as a
| visitor. It's called medical tourism. India is a major
| destination.
| kwhitefoot wrote:
| Norway, Poland.
|
| I'm a UK citizen, resident in Norway, who has visited Poland
| on business many time.
|
| I stayed a night in the Krakow Neurological Institute
| somewhere between fifteen and twenty years ago, cost me about
| 100 USD. The ambulance that took me there was free.
| stevenwoo wrote:
| Wow, you might already know this but in the USA people
| decline ambulance trips because the cost out of pocket can
| break them financially. A ambulance helicopter trip (which
| people are usually not in a position to decline) costs
| roughly 40,000 last time I read about it, a lot of people
| crowdfund to pay for this.
| dominotw wrote:
| UK
| dominotw wrote:
| I guess you could roll the dice and hope the for best but you
| will lose your ability to sue the hospital for malpractice if
| they mess up.
| terse_malvolio wrote:
| Maybe there is a chance that insurance could be enabling
| malpractice? I'd have to get hard data on this to make a
| determination but I'd wager that most reputable medical
| professionals try to avoid malpractice regardless of country.
| BurningFrog wrote:
| The alternative is often to not have the procedure at all.
| jasonpeacock wrote:
| You're making a lot of assumptions here that an out-of-
| country hospital would be of questionable quality and not
| have medical malpractice laws.
|
| Just because other countries medical & legal systems are
| different than the US doesn't mean they are inferior.
| TameAntelope wrote:
| Even the best hospitals make mistakes, malpractice is not
| just some cudgel used to beat good doctors over their
| heads, and America has some of the most comprehensive
| malpractice law in the world.
|
| That said, if I'm wrong about that I'm interested in
| learning more.
| dominotw wrote:
| > legal systems are different than the US doesn't mean they
| are inferior
|
| Yes. Indian legal system is very inferior compared to USA.
| My family is fighting a garden variety land dispute case
| for over a decade. I cannot even imagine someone
| successfully suing a doctor here for malpractice while
| living in USA.
| learc83 wrote:
| The GP was talking about losing your ability sue for
| malpractice not implying that every other country has
| inferior medical or legal care.
|
| A country can have a fine legal system for locals that's
| difficult or prohibitively expensive to access for non-
| citizens living outside the country.
| londons_explore wrote:
| One of my businesses refuses to serve Americans simply
| _because_ they have a habit of reaching for the legal
| system if they aren 't happy with the service.
|
| All the Americans end up going to my competitor, who is
| currently in the midst of three lawsuits which will
| probably sink the company. Two of the lawsuits are with
| clients I turned away simply _because_ they looked likely
| to sue!
|
| You can bet that as an American, you will pay
| substantially more than a local for many services simply
| because Americans have a reputation for this sort of
| stuff, and local businesses don't want to take the risk.
|
| I really wish there was some kind of certificate saying
| "I have never set foot in a courtroom, threatened legal
| action, or hired a lawyer".
| snakeboy wrote:
| That's why I don't let black people into my restaurant.
| Statistically, they're more likely to commit a crime once
| inside, so I don't want to take the risk. All the black
| people in town end up going to the restaurant down the
| street, who had their register robbed one time by a dark-
| skinned fellow that I turned away because he sure looked
| suspicious! I sure hope they've learned their lesson by
| now.
|
| You can bet that as a black person in our town, you'll
| pay substantially more than white folks, because most of
| us understand that black people have a reputation for
| this sort of stuff and general trouble, and we don't want
| to take the risk.
|
| I really wish there was some kind of certificate to let
| us know which ones are the docile blacks...
|
| ( _Note_ : It should go without saying that this is a
| tongue-in-cheek response)
| londons_explore wrote:
| I'd be all for banning discrimination based on
| nationality. But we need to start with the biggest
| discriminators - governments. Why is an American allowed
| into America, but a Syrian isn't?
| alisonkisk wrote:
| Theta a terrible idea. Why "start" somewhere?
|
| Should we abuse and enslaved more people just because
| someone is abused or enslaved elsewhere?
| alisonkisk wrote:
| It's a poor response. Nationality is tied to legal
| system. For example, if a product injures me as an USAn,
| I need to sue to get my bills paid. As a European, I can
| simply get public healthcare.
| snakeboy wrote:
| If I'm a USAn doing business with a private company in a
| foreign country, that's not relevant. OP is using
| population-level trends to influence develop his bias
| towards individuals.
| ArtDev wrote:
| And then the hospital can't sue you if you can't pay the
| absurd bill?
| dominotw wrote:
| Here in India. You pay upfront. No payment = no surgery.
| londons_explore wrote:
| It isn't the people with legit complaints.... It's the
| people who do something foolish and then try to sue
| someone else blaming them...
|
| If I rent you a jetski for an hour, it isn't my fault if
| you drive over your child with it... It's a jetski. It's
| dangerous. Don't expect someone else to pay if you mess
| up.
| alisonkisk wrote:
| In a country with socialized medical care, someone else
| does pay.
| skeeter2020 wrote:
| I have never anticipated a medical procedure, emergency or
| otherwise, and considered "my ability to sue for malpractice
| if this goes wrong". I just don't believe this is a
| consideration for the actual patient, even if it was relevant
| (example: Canada with universal public system essentially has
| no malpractice lawsuits).
| duffpkg wrote:
| One important piece of context here is that these rates are
| negotiated as part of a contract bundle where an insurer is
| bringing a pool of patients to the facility. Prices can vary
| widely procedure to procedure because they are associated with
| over or under representation of certain factors within that pool.
| For example, grossly simplified, I might have a particular
| service line, hip replacements (an ortho program). The insurer
| whose patient population is going to 'keep the lights on' in that
| service line is going to see a very different rate per service
| than a different insurer who rarely has patients that need it.
| Nothing about these prices shown are really reflective of the
| costs of doing the procedure such as pricing in a retail store.
|
| I do think this transparency initiative will result in more
| consistent costs but not necessarily net lower costs.
|
| Comparisons to other countries that are smaller than the united
| states are somewhat apples to oranges. There are a lot of factors
| that are glossed over when someone says "costs are 5x higher in
| the US than my country" including real estate, energy subsidy,
| and so on. Its a deep well.
| zirkonit wrote:
| Cardiac valve procedure at Kaiser Foundation Hospital - Redwood
| City Medical Center - $458,254.00 cash price. Oh my.
|
| I get it that it's an expensive procedure, but OH MY.
| huitzitziltzin wrote:
| Kaiser might be a weird outlier. IT is a very different kind of
| organization (vertically integrated -
| physicians/insurers/hospitals).
|
| It might be that the price is that insane elsewhere, but Kaiser
| may not be the best way to judge.
| brundolf wrote:
| I had this exact idea ~6 months ago but didn't know where to
| begin. I'm sincerely glad someone else built it. We're in such
| desperate need of justice when it comes to U.S. healthcare and
| this is a really good first step in holding the system just a
| little bit more accountable.
| baskire wrote:
| Having hospitals compete on price will bring healthcare costs
| down.
|
| Just like how we can choose between generics and name brands.
|
| Great job!
| forgingahead wrote:
| This was a big accomplishment of the Trump admin. Regardless of
| what your other opinions of his administration are, healthcare
| pricing transparency in the US is a very important step forward
| to improving the healthcare situation there.
|
| Source (one of many): https://www.reuters.com/article/us-usa-
| trump-drugs/white-hou...
| citrus1330 wrote:
| How is it possible that this was not required before? I am so
| glad that we had Trump, even if it was just for 4 years.
| ttul wrote:
| It's too bad that all the other insane things he did will
| overshadow literally anything of value that he accomplished.
| the-dude wrote:
| Could you enlighten me and name some of those things? Not
| things he said, but things he did according to you.
| ttul wrote:
| The 2017 tax reform bill [1] "seeks to address some widely
| acknowledged issues with corporate taxation, and takes some
| steps toward broadening the tax base, in part by reducing
| the incentive to itemize deductions." It was the first
| substantive piece of tax reform since 1986, and while there
| are many things to criticize, it at least started to align
| US corporate tax rates with those in other developed
| countries.
|
| One of the significant changes that the tax reform brings
| is an increase in the cost of capital raised in the form of
| debt. That is a good thing. The deductibility of interest
| on corporate debt creates an enormous distortion that
| causes firms to favour leverage, which leads to greater
| instability in the economy. Should interest be tax
| deductible? Well, whether or not you think it should be, it
| is. And so reducing the corporate tax rate makes that
| deduction less valuable than it was before.
|
| The tax reform is hugely regressive in reducing the top
| marginal tax rates for high income earners. That is a giant
| negative IMHO, because wealth and income inequality are a
| huge problem in American society. So, personally, I believe
| the only good from the tax reform is on the corporate
| taxation side by, effectively, making things a little more
| efficient than they were before.
|
| Other things that I think were a positive:
|
| 1. Rejecting Chinese firms' from the 5G network build-out.
| His diplomacy and trade policy were really random, but this
| was one move that worked out well.
|
| 2. Operation Warp Speed. While Hillary Clinton likely would
| have done a FAR, FAR better job of handling the pandemic
| overall, credit is due to Trump for getting behind the
| advanced purchase of billions of dollars worth of vaccines
| before they were even approved.
|
| 3. Greatly increasing the standard tax deduction for low
| income earners. "For income earned in 2020, single people
| pay no income tax on their first $12,400, heads of
| household on their first $18,650, and married couples on
| their first $24,800." [2]
|
| Again, it's too bad that all the insane stuff he did and
| all the things he neglected will overshadow his
| accomplishments. History will likely judge Trump harshly,
| which I think is richly deserved.
|
| [1] https://pubs.aeaweb.org/doi/pdf/10.1257/jep.32.4.73
|
| [2] https://www.theatlantic.com/ideas/archive/2020/12/the-
| things...
| hedora wrote:
| These are all well documented:
|
| https://www.indy100.com/news/donald-trump-bad-things-
| list-b1...
|
| There are 55 things on the list. There's a mixture of
| things he said and things he did. As president, his words
| have real consequences, so drawing the line at "things he
| said" is strange.
| the-dude wrote:
| Are you serious about bringing that article/site to the
| table as a source to try and make your point? Or is this
| sarcasm?
| zingermc wrote:
| Don't feed the troll.
| ryandrake wrote:
| His attacks on the immigration and asylum systems were
| particularly insane and cruel. A just future will forever
| associate the man with this dark period of Family
| Separation and caged children.
| pnw_hazor wrote:
| President Obama's DOJ broke the asylum system by allowing
| local non-state crime or poverty to be grounds for
| claiming asylum. This change triggered the
| family/children caravans and general flooding of the
| border with women and children.
| burlesona wrote:
| Came here to post the same. My guess is he will go down as the
| worst president in US history, but even a terrible
| administration can have a few noteworthy accomplishments. This
| and the airline reforms (1) will probably be remembered as the
| best things that came out of the Trump administration.
|
| 1: https://www.inc.com/bill-murphy-jr/president-trump-just-
| sign...
| adwww wrote:
| Seems a sensible bill - amazing that some of them were not
| already the case. Eg. mininum rest times for cabin crew.
|
| However, what on earth has this got to do with aviation?!
|
| > authorizes $1.68 billion for relief for Hurricane Florence,
| which hit the Carolinas last month;
| Inhibit wrote:
| That's how those bills work. It was either the most
| expedient way to get it in a bill or the Carolina congress
| people were needed to pass it.
| redis_mlc wrote:
| > My guess is he will go down as the worst president in US
| history
|
| Nope, best President in terms of:
|
| - foreign policy since Reagan, and maybe Roosevelt
|
| - over 400 miles of border wall built
|
| - significant repeal of anti-business laws.
|
| - excellent response to CCP, stunning even China watchers.
|
| All that despite almost 4 years of baseless Mueller
| investigation.
| spaetzleesser wrote:
| Agreed. This is only a small first step towards some level of
| sanity but let's hope that the Biden administration keeps going
| down that path.
| craftinator wrote:
| Oh, I assumed the greatest accomplishment of the Trump
| Administration was the peaceful transition of power to the new
| administration? This does seem like a good thing though.
| azalemeth wrote:
| I think something else that would be of interest would be doing
| this for drug prescriptions: compare the cost that my employer,
| the NHS, pay for a compound and those that Americans pay for the
| exact same compound. This is easy on my end at least -- prices
| and prescription guidance are released in the BNF / British
| National Formulary annually and are all made available in public.
| I have never understood the US system of "co-pays" and found the
| whole thing very confusing.
|
| For a few "popular" random examples that I think HN might have
| heard of: one branded Epi-Pen is PS26.45; Naproxen (the NSAID
| painkiller) is PS4.29 / 56 pack; and omeprazole (PPI used to
| treat gastric reflux) is PS0.84 / 28 pack.
|
| A more expensive example might be the cystic fibrosis "designer
| drugs" lumacaftor with ivacaftor -- 112 tablets are PS8000 (to be
| prescribed by a specialist, if the patient has the genotype to
| respond to it -- a total annual cost of about PS26k). The US
| equivalent is $379,780 [1].
|
| (NB: The price you pay as a British patient is usually PS0,
| unless you are a working-aged and working English person -- at
| which point it is PS9.15 per item [independent of its cost] or a
| fixed "all you can eat" prepayment certificate that works out at
| about PS8.83/month -- which is what I have. Oh, and plus the
| taxes, of course...).
|
| [1] https://www.jmcp.org/doi/pdf/10.18553/jmcp.2018.24.10.987
| tape_measure wrote:
| _PS9.15 per item [independent of its cost]_
|
| That's basically what a copay is.
| huitzitziltzin wrote:
| The Health Care Cost Institute has something like what you want
| - see Figure 2 about halfway down this page:
|
| https://healthcostinstitute.org/hcci-research/international-...
| pkaye wrote:
| One of the things that EU countries do is negotiate with the
| the drug manufacturers. So UK in this case of Lumacaftor,
| didn't cover the drug until they got a reasonable price. This
| meant a 4 year delay in access to the drug vs the US.
|
| > It was approved for medical use in the United States in 2015,
| and in Canada in 2016.[3][5] In the United States it costs more
| than $US 22,000 a month as of 2018.[6][7] While its use was not
| recommended in the United Kingdom as of 2018,[4] pricing was
| agreed upon in 2019 and it is expected to be covered by
| November of that year.[8]
|
| https://en.wikipedia.org/wiki/Lumacaftor/ivacaftor
| CogitoCogito wrote:
| > I have never understood the US system of "co-pays" and found
| the whole thing very confusing.
|
| I think you're mixing up a few things here. The co-pays are
| meant to make the patient directly pay some of the cost to
| decrease abuse of the system. There are many different
| structures for co-pays so saying anything general is kind of
| difficult, but there are reasonable arguments supporting such a
| system. In Sweden for example you do have to pay certain costs
| (which are capped) for essentially the same reason.
|
| But that has nothing to do with the fact that prices vary so
| widely for the same products and services. Personally I think
| that the US system should at a minimum require that
|
| 1. All medical products' and services' costs to published
| publically;
|
| 2. All costs to be non-discriminatory (meaning everyone
| regardless of any insurance plan or none must pay the same);
|
| 3. All costs be available prior to any services provided.
|
| In other words, there are no negotiated plans with different
| prices, there are no surprise bills, patients actually are able
| to understand costs, and real competition is actually
| theoretically possible. None of this would necessarily preclude
| an insurance plan from having co-pays, it would just make the
| only point of the insurance plan purely financial and open as
| it should be.
|
| Of course the US could just move to a single-payer government-
| run system, but that's a different discussion. If the goal
| truly is to have a market-based system, then I think my points
| above should be implemented.
| hehehaha wrote:
| Here's another consideration: care quality is very disparate
| across the country in the US. And what's even more frustrating is
| that cost is not correlated to quality. While I am a bit more
| critical because I've seen "how the sausage is made" first hand
| for years, this also makes it that much harder to implement
| universal health care in the US. Don't think someone living in
| rural Wyoming should pay the same HC tax/premium as someone
| living right across the street from MGH.
| ageitgey wrote:
| Definitely true - quality and price are only very loosely
| related. Right now we have care quality information on the
| hospital "information" page, but most people aren't finding it
| in the current design and we are going to re-work it so it's
| more visible when browsing prices.
| hkt wrote:
| Just came here to remind everyone that free at the point of use
| healthcare is great.
|
| I tried to total the cost of the care my son received when he was
| born, had we been American. I stopped counting at $1million.
|
| Being in the UK, I even got a few meals at the hospital canteen
| thrown in. Not to mention the time in nICU etc. It is horrifying
| that people have to compare prices and haggle for care anywhere
| on earth.
| ageitgey wrote:
| Fun fact - I'm a cofounder of this and a US citizen, but I live
| in London. I agree completely with this. I spend my days
| working on US healthcare data and seeing how crazy it is while
| I use the NHS for my actual care.
|
| But the US system is tricky because while it is an huge
| mishmash of layers of middlemen and clearing houses taking a
| slice of the pie, those layers also employ a huge number of
| Americans across the country. It would be extraordinarily
| difficult (both logistically and politically) to rip all that
| out in one fell swoop. I feel like the only possible way to
| bring in socialized medicine in the US would be a gradual
| expansion of opt-in 'Medicare for All' or something along those
| lines.
| hkt wrote:
| It doesn't seem like there's a way to do it without
| aggressive opposition, really. Divide and rule (taking out
| one rentier middleman at a time) will take decades I'd
| imagine.
|
| So yeah, expand and improve existing programs until they're
| universal and comprehensive like the NHS. Sane approach.
| 4ec0755f5522 wrote:
| I just read an article about quiet / dream jobs (park ranger
| etc.) In it, every single person has a side gig(s) or is
| otherwise making decisions on their careers based on medical
| coverage. Every one of them! One of the people says most people
| leave when they turn 26 because they can't stay on their parents'
| health insurance. What?! > And like other dream
| jobs I learned about, it's not enough to survive on: During
| > off-seasons, Krumbholz also works as a substitute teacher and
| an aquarium dolphin > tank cleaner; since being on
| university health insurance would mean she'd constantly >
| lose it during the off-season, Krumbholz decided to stay on the
| state exchange > instead.
|
| The idea that health care is tied to your employer, and your
| employment status, is so unacceptably broken. I've never heard of
| anything so broken in terms of the obvious social and economic
| harm a bad policy is creating. Having the freedom _from_ health
| care costs is _more_ freedom for _more_ people than the
| "freedom" to not pay health insurance or taxes to cover it.
| peytn wrote:
| That sounds extreme. Without taking sides, I suggest another
| possibility is that the author may have a bias, agenda, or
| angle to the story.
| xyzelement wrote:
| // Having the freedom from health care costs is more freedom
| for more people than the "freedom" to not pay health insurance
| or taxes to cover it.
|
| This is not how freedom works. Your argument is akin to saying
| "freedom from hearing uncomfortable opinions" benefits more
| people than "freedom of expression" does.
|
| On the broader level, I got to experience healthcare in the US
| both as a broke-ass immigrant child and as a working adult. It
| ranged from good to amazing in terms of availability of
| appointments, treatments, quality and comfort. Night and day
| beyond what I experienced in the USSR as a kid. So while people
| are shitting on the system we have, many people find it
| excellent and amazing and we like the freedom to continue
| enjoying it.
| bcrosby95 wrote:
| My experience as a child was great. As a working adult I
| spend hours fighting with insurance, hospitals, and doctors
| to get my bills properly covered. It feels like a bunch of
| wolves arguing over whose gonna eat the sheep (me). For this
| privilege I get to pay insurance a minor fee of 3k/month for
| my family of 5.
| xyzelement wrote:
| There definitely had been a few snags with insurance that
| we had to work through - not claiming it's perfect.
|
| However I recall the night my son was born - the
| facilities, staff and resources of the hospital were
| unmatched - the mother and baby would not have the same
| experience anywhere else in the world.
|
| My wife works in the ER - they constantly use procedures
| and deploy resources in ways that would be considered
| impractical elsewhere in the world.
|
| For example: an 65+ year-old patient comes in with a
| specific complaint. It could be cause A or the more rare
| but serious cause B. It takes imaging to determine whether
| it's A or B. Elsewhere in the world, they just assume it's
| A as the patient is "old" because it's financially
| impractical to test for B. My wife on the other had has no
| constraints from ordering the imaging test even though 9/10
| times it's "wasted" as it just confirms A. But the other
| 10% of the time, it saves the life.
|
| We make a different tradeoff in the US, some of us prefer
| this trade off.
| dghlsakjg wrote:
| There is a huge Caviat in your scenario. A lot of people
| won't come in because they can't afford it, or they won't
| get the test because they can't afford it. Your wife can
| order the imaging test, but she doesn't have to deal with
| the debt, and/or months of arguing on the phone with
| administrators that her patient sees.
|
| I live in Canada where I am enrolled in the provincial
| health plan. If a doctor recommends a test or treatment I
| get it. Cost isn't a consideration. My age isn't a
| consideration. Please don't spread lies about how
| universal healthcare works. Unlike insurance in the US,
| if the doctor orders it, it is covered by the healthcare
| system here.
|
| Truth: I may have to wait based on a triage system.
|
| If the doctor doesn't recommend a test as necessary or I
| don't want to wait for my place in line, I can go to a
| medical clinic that offers these tests privately and
| pay/have my employer provided secondary coverage pay.
|
| In that way it turns out that we don't have to make the
| tradeoff.
|
| I've had the best insurance I could buy in the US, and
| now I have the standard health care that every person in
| my Canadian province gets. My experience, which is backed
| up by studies, is that I am healthier, and the population
| in general is healthier under the Canadian system.
| Falling3 wrote:
| > However I recall the night my son was born - the
| facilities, staff and resources of the hospital were
| unmatched - the mother and baby would not have the same
| experience anywhere else in the world.
|
| We had a wonderful experience with the birth of our
| daughter, but I have no idea how I could claim it was
| better than anywhere in the world. I'm asking because you
| seem to be making a low-hyperbole claim here: what is
| your basis for saying that? Particularly, when the US has
| some of the worst metrics for infant mortality, birth
| weights, and mother mortality rates in the developed
| world.
|
| > My wife works in the ER - they constantly use
| procedures and deploy resources in ways that would be
| considered impractical elsewhere in the world.
|
| Does this actually lead to better health outcomes? The US
| ranks low in the developed world in many health-related
| areas. Some of them are at least in part due to cultural
| issues and it is completely fair to attribute to our
| healthcare system. But some of them like our rates of
| medical and lab errors clearly are. I'm genuinely looking
| for data to support the idea that the tradeoff you
| mentioned actually exists.
| xyzelement wrote:
| // but I have no idea how I could claim it was better
| than anywhere in the world. I'm asking because you seem
| to be making a low-hyperbole claim here: what is your
| basis for saying that?
|
| Conversations with friends and family abroad.
|
| // Particularly, when the US has some of the worst
| metrics for infant mortality, birth weights, and mother
| mortality rates in the developed world.
|
| Not an expert but I understand there's a ton of
| measurement variability. Something like:
|
| Baby born 3 months premature and dies shortly after. Many
| countries just consider that still birth and it doesn't
| count towards infant mortality. In the US we actually
| fight to save these kids so if they die, they count
| towards infant mortality. Perhaps weight at birth works
| the same way?
| 5cents wrote:
| All countries do their best, and Sweden seems to be the
| most successful country at the moment [0]. Neonatal
| mortality rate in Sweden was 1.38 per thousand in 2019,
| compared to 1.4 in Norwy, 2.77 in the UK and 3.7 in the
| US [1]. But you are right that the rate of premature
| births is higher in the US than most European countries
| (10-15% in the Us compared to <10% in Europe) [2], and so
| is the rate of very preterm births (14.1 per thousand in
| the US compared to 8.3 in Norway, 7.7 in Sweden and 6.7
| in Finland) [3]. It is likely that the rate of premature
| births is also a sign of the quality of maternal care.
|
| The rate of still birth in 2009 in the US was 2.95/1000
| compared to 2.74 in Sweden and 2.2 in Norwy [4]
|
| That the statistics of neonatal deaths are manipulated is
| also a bold claim, it deserves some references?
|
| [0] https://news.ki.se/sweden-leads-the-world-in-saving-
| extremel...
|
| [1]
| https://www.who.int/data/gho/data/indicators/indicator-
| detai...
|
| [2] https://www.reddbarna.no/born-too-soon-the-global-
| action-rep...
|
| [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346062/
|
| [4] http://chartsbin.com/view/1445
|
| Edit: spelling
| CogitoCogito wrote:
| > For example: an 65+ year-old patient comes in with a
| specific complaint. It could be cause A or the more rare
| but serious cause B. It takes imaging to determine
| whether it's A or B. Elsewhere in the world, they just
| assume it's A as the patient is "old" because it's
| financially impractical to test for B. My wife on the
| other had has no constraints from ordering the imaging
| test even though 9/10 times it's not needed. But the
| other 10% of the time, it saves the life.
|
| This just plain isn't true in general. I grew up in the
| US with probably the best insurance of anyone I've ever
| known. I've also lived in Sweden with the state-run
| insurance (without any private addition). I've had great
| care in the US. I've had great care in Sweden. In fact,
| my care in Sweden has honestly probably been better in my
| cases including where I had overuse injury to my knee due
| to sports where they really could just say "well quit
| running so much and let your body rest and leave the
| healthcare system to those not actively inducing their
| own injury", but they did not. Fast MRIs, fast diagnosis,
| fast help, fast everything. I understand this is entirely
| anecdotal, but the fact is there are many much cheaper
| systems out there run by governments that actually
| function _better_ than the US system even for those in
| the US with good insurance.
| throwaway4220 wrote:
| YMMV (as I'm sure the below comments will show you) on the
| efficacy of the US healthcare system. My experience ranged
| from 1/10 (like denying emergency care until I fought for it)
| to 10/10 (same-day treatment after diagnosis). Even from the
| supply side, I have little power on how to help even my own
| patients navigate the system unless it's an urgent/emergent
| need. It is important to hear the system is working well for
| some; we should focus on improving it for more people.
| CoolGuySteve wrote:
| That may be true but the USSR is a collapsed state, we should
| be comparing wealthy countries.
|
| According to this the US is mostly in the high top 10 for
| outcomes in cancer and cardiovascular disease treatment
| outcomes:
|
| https://en.wikipedia.org/wiki/List_of_countries_by_quality_o.
| ..
|
| But the US spends more than double the OECD average per
| capita to achieve those marginal gains:
|
| https://upload.wikimedia.org/wikipedia/commons/thumb/0/0b/OE.
| ..
|
| There's an argument to be made that the cost overruns are
| paying for better outcomes, or maybe the outcomes have some
| sample bias due to Americans being less healthy, or sicker
| people are seeking treatment in the US.
|
| But on the other hand, the gains are so marginal that those
| costs might also be due to significant corruption and
| regulatory capture.
| xyzelement wrote:
| I didn't make this clear - I agree with you about the USSR,
| but the point I meant to make is that on metrics like cost
| and availability of care, it would look "better" than the
| US.
| stjohnswarts wrote:
| No one who is legit just compares cost and availability
| they are going to also include the health levels of the
| nation, time to actually getting an appointment, time to
| get a surgery for a condition, etc. You can't just pick
| out two variables and say "see I'm right!" . There are a
| ton of European health markets that are superior to the
| US market when comparing multiple variables. We need to
| copy them or do something very similar rather than being
| stubborn assholes and think everything has to be home
| grown.
| Trill-I-Am wrote:
| Would the general public of other developed nations be
| happier if their healthcare systems were more like the US's?
| dghlsakjg wrote:
| I've lived in the US, and now live in Canada.
|
| Despite right-wing propaganda that we're all flocking to
| the states for care (never met a single person who has even
| considered that), or that we're all dying on years long
| wait lists (there is an element of truth to that, but it's
| a triage system. So cancer patients get priority for
| surgery before the skier who blew his ACL).
|
| I still have yet to meet a single person who doesn't think
| the US system is batshit crazy.
|
| Canadians recognize that their system has problems, and can
| be improved (which is true of ANY complex system). But they
| also don't think that the US system is functional or
| desirable.
|
| I know that the nearest border crossing to me regularly has
| ambulances waiting for people that preferred to travel sick
| or injured than seek healthcare in the US. In other words,
| people literally flee the country to avoid being treated in
| the US.
| LouisSayers wrote:
| Haha nope, ya'll be crazy
| stjohnswarts wrote:
| You're being single minded here. You should compare it to
| what is available in Europe, Cuba, Canada, etc not what's
| going on in Russia. We want everyone to have good health
| care, not just people in silicon valley and the tech industry
| who by and large to get good insurance.
| cmurf wrote:
| If folks had to butcher their own cow, there'd be more
| vegetarians. And if folks had to shop and pay for their own
| health care plans on exchanges like the self-employed do, we'd
| have universal health care.
| y-c-o-m-b wrote:
| My first question to a potential new employer has become "what
| are your health insurance benefits and how much do you cover?"
| rather than "what's the salary range you're hiring for?"
| (although this still comes second). If it's anything less than
| 80% employer-paid coverage or they don't offer traditional PPO
| plans, it's an automatic withdrawal of my application.
|
| I've recently found I now need to add another filter to this:
| "WHO is your insurance through?" because apparently even 90%
| employer paid health insurance through UnitedHealthcare still
| sucks compared to inferior coverage through BlueCross or Aetna.
| I had to switch primary care doctors for everyone in my family
| (me, wife, kids all had different docs) because none of them
| were in network with United. Confused by this, I called around.
| I found out doctors offices _loathe_ dealing with UHC due to
| UHC 's reluctance to pay or the generally obnoxious claims
| process. Their "in-network" providers is contained to a much
| smaller list of providers that put up with their bullshit. I'm
| seriously considering leaving my current employer (which I'm
| very happy with) for this reason alone.
|
| Lack of reliable (or any) health insurance is the #1 reason I
| don't take contract jobs even though they're more attractive to
| me.
| spaetzleesser wrote:
| Employer based health insurance should be abolished. There
| should be one risk pool either nation or state wide and within
| that everybody can get insurance for the same price. It would
| reduce a lot of administrative effort in companies (why does my
| employer have to worry about my health insurance but not my car
| insurance?) and allow people to change jobs without worrying
| about health care. Religious employers also couldn't control
| things like birth control because health insurance would be
| none of their business.
| TheOsiris wrote:
| it should be, and it needs to be if we ever want to fix this
| problem, but it'll be political suicide for anyone that even
| says this out loud. corporations would be all for it to.
|
| (majority of) people with jobs have no idea how bad/expensive
| healthcare really is. they have excellent insurance coverage
| and they pay very little for it. if we make them responsible
| for buying their own it'll be impossibly expensive. but this
| is exactly what they need to realize so that we can have the
| political movement to overhaul the entire system
| stjohnswarts wrote:
| I like this idea, especially nation wide. I think the US
| should set one up along side private policies though as a
| stepping stone so people can see/envy it. You will never ever
| get rid of private insurance in one fell swoop it will take
| steps.
| mtalantikite wrote:
| This is great (and totally unfortunate that it needs to exist in
| the US), thanks for building it.
|
| One issue: it looks like the search is not respecting the zip
| code for me if I change it. For example, if I search for a
| procedure using the zip code the site auto-populates, my results
| are great. However, if I change the zip code to my actual
| neighborhood here in NYC, I'm seeing results from all over the
| country.
| ageitgey wrote:
| Thanks, I'll take a look! If you don't mind, would you mind
| dropping me an email at adam@turquoise.health with the zip code
| you are trying?
| k3liutZu wrote:
| Oh wow, so a "Tonsil Removal (Patient Under 12)" procedure has a
| huge price-range:
|
| $298.00
|
| $7,830.76
|
| $7,299.85
|
| $10,243.23
|
| $13,964.19
|
| ---
|
| How are these even comparable?
| theplague42 wrote:
| It's probably bad data. 7k vs 13k is reasonable, but nobody is
| removing tonsils for $300.
| CogitoCogito wrote:
| $300 seems low to me as well, but the order of magnitude
| spread isn't suprising at all. About 5 years ago I went into
| the ER in NYC due to extreme dehydration. They gave me some
| saline and sent me home a few hours later. Later I got a bill
| for $250 which was above my ER $150 copay so I called them up
| and it turned out they didn't realize I had insurance. A
| month later I got a "fixed" bill for $3000 to my insurance of
| which $150 was my responsibility.
|
| My example of a magical 12x increase given single exact same
| procedure coded identically, means I find a price increase of
| ~43x from $300 to $13,000 between different hospitals quite
| believable.
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