[HN Gopher] $1,944 for a coronavirus test? Readers helped us spo...
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$1,944 for a coronavirus test? Readers helped us spot an unusual
trend
Author : prostoalex
Score : 103 points
Date : 2021-02-04 15:59 UTC (7 hours ago)
(HTM) web link (www.nytimes.com)
(TXT) w3m dump (www.nytimes.com)
| criddell wrote:
| There was a similar story last September. Here's the lede:
|
| > Physicians Premier ER charged Dr. Zachary Sussman's insurance
| $10,984 for his COVID-19 antibody test even though Sussman worked
| for the chain and knows the testing materials only cost about $8.
| Even more surprising: The insurer paid in full.
|
| https://www.texastribune.org/2020/09/05/austin-texas-coronav...
| elliekelly wrote:
| I don't understand why insurance companies pay ridiculous bills
| like this but will fight tooth and nail to avoid paying for
| obviously necessary procedures.
| smnrchrds wrote:
| In the US, insurance company profit margins are capped by
| law. The insurance companies have to spend at least a certain
| percentage of their premiums on claims. If they spend less
| than that, they have to partially refund premiums [0]. So
| insurance companies are unable to increase their profit
| percentage by law. The only way for them to increase their
| profits is if they keep the same percentage by increase the
| size of the pie. Higher across-the-board healthcare cost
| benefits insurance companies as much as healthcare providers
| --if the healthcare costs double, they get to keep 20% of 2X
| instead of 20% of X.
|
| [0] https://www.nytimes.com/2020/08/05/health/covid-
| insurance-pr...
| garmaine wrote:
| That is beyond fucked up.
| hammock wrote:
| Do you think we should add some laws or something to protect
| insurance companies' profits, which are suffering from this
| type of fraud?
| themaninthedark wrote:
| Do you think this is affecting insurance companies' profits?
|
| >Insurers that sell individual and small group health
| coverage must spend at least 80% of premiums on medical
| claims and quality improvements for members. No more than 20%
| of premium revenue can be spent on total administrative
| costs, including profits and salaries. For insurers that sell
| large group coverage, the minimum MLR threshold is 85%.
|
| >Insurers that fail to meet these guidelines (ie, they spend
| more than the allowed percentage on administrative costs, for
| whatever reason) are required to send rebates to the
| individuals and employers groups who had coverage under those
| policies. From 2012 to 2019, under the MLR rule
| implementation, insurers rebated $5.3 billion to consumers.
|
| https://www.verywellhealth.com/health-insurance-companies-
| un...
|
| Insurance Companies probably see these extra costs as a good
| way to meet their spend targets.
|
| I was not able to find any source but have heard that the
| government is giving healthcare providers monetary assistance
| for Covid-19.
|
| Looking at those two factors and no-one has any reason to try
| and control cost.
| gabereiser wrote:
| Any laws introduced would only tangle the mess called
| Healthcare even further. Government doesn't know how to
| administer healthcare (at least in the US) so it defers it to
| the private sector. Putting caps in place was already done,
| the issue is pricing transparency is not a thing. The
| insurance company pill just pay it and amortize it on the
| claimants group (or however they account for losses).
|
| I wish we could fix this broken system. The only way to fix
| it now is open-heart surgery while driving.
| fragmede wrote:
| If the issue is pricing transparency, and that it's "not a
| thing", we could maybe make laws requiring pricing
| transparency?
| gabereiser wrote:
| My memory of ACA may be hazy but I do remember talks of
| having that as part of the ACA law. Not sure if it made
| it in (probably not due to lobbyists).
|
| I think if insurance carriers had the ability to verify
| the charges before paying we would see naturalized reform
| from sheer market power. No one will pay for a $5k thing
| if the site says it's $350.
| criddell wrote:
| Was this fraud?
| joshuaissac wrote:
| Fraud is already illegal, so we just need better enforcement
| mechanisms. For now, insurance companies are turning a blind
| eye, but once they are out of the spotlight, they would be
| less hesitant to resume denying claims involving fraud, and
| the user would be stuck with the bill.
| [deleted]
| ExcavateGrandMa wrote:
| The great WorldWide Hold Up :D
|
| "Democracies dies in darkness"
| EamonnMR wrote:
| It would be really interesting to see a crowdsourced index of
| real cost and insurer-paid cost for procedures across the US.
| Maybe a service that pays patients some nominal sum to share the
| data, then aggregates it and presents it to patients,
| journalists, etc.
| threwaway4392 wrote:
| Here is another incentive:
|
| When users share their bills and EOB, provide them with an
| automated analysis of their bills: what seems weird, which
| billed items were far above average prices, etc.
|
| This information can be precious when negotiating with the
| doctor's office, when Yelp/google-maps reviews, or when
| contacting your politicians about the absurdity of health care
| costs.
| dizzant wrote:
| This is an excellent idea. Also, sell aggregated data on cost
| of care in local areas to doctors and insurance companies, so
| they can make clear business decision on how to compete
| against the local market.
| [deleted]
| EamonnMR wrote:
| Though that creates an incentive for the company to not share
| its own data.
| gok wrote:
| tldr: One doctor is defrauding thousands of people by charging
| $2000 for a test that costs him nothing, and presumably making
| millions doing so.
| jacurtis wrote:
| I recently had COVID, so I have just gone through all of the
| stuff in this article.
|
| You would be surprised how many "COVID Testing Sites" are
| scams. Pure scams.
|
| Many of them are not even able to bill your insurance, probably
| because Insurance companies would refuse to pay the fees they
| are charging for. So you will be paying out of pocket for them.
|
| I actually did shop this around, trying to find a legit one.
| Several of the ones I called charged $400 for a "screening
| visit" which is basically the person that comes to your car
| window and asks if you have any COVID symptoms. If you say "yes
| I have a cough" or you list any other symptom of COVID (which
| is almost anything) then they will determine that you should
| get a COVID test. This screening visit is laughable. Many of
| the people screening you aren't even licensed medical
| professionals in any way. Even more disgusting, half of them
| are volunteers. They think they are helping the community and
| have volunteered. They simply listen for a single symptom and
| when they hear it then they give you the test. This screening
| cost ranges from $200 - $600 in my area. But the average was
| $400. Then they administer the test which can be charged $99 -
| $299. Many of these "drive up testing sites" that you see
| advertised are legit scams. They want people to see the sign,
| pull up in their car, get the test without asking any
| questions, and they will get a surprise bill of $500 - $1000+
| in a few months. The other charge that you often get is a test
| results charge. Some of these testing sites are charging you
| for the phone call they make to tell you the test results.
|
| So be very wary if you are getting COVID tested. THere are a
| lot of places out there doing COVID testing that are PURE
| SCAMS!
|
| Good news: there are some legit ones. But you need to really do
| your research ahead of time. I eventually went and got tested
| at a testing site that is operated by my state. They are
| authorized to bill the CARE Act which was the emergency bill
| that allows for free COVID testing and COVID care. They were
| also authroized to bill your insurance. They bill insurance a
| flat $99 fee. And if your insurance doesn't cover it then the
| CARE Act can cover the rest.
|
| So please be careful out there. If you are getting COVID
| testing, make sure to do some research and go to a legit
| testing site. Call them and see if they can bill the CARE Act.
| Even if you have insurance, you want to go to these sites
| because they are the "official ones". If they are doing it
| legit enough that the CARE Act covers them, then the insurance
| companies will also cover tests from that same place. Make sure
| there are no additional costs for screening or delivering
| results. If they have any of those costs or are NOT covered by
| the CARE Act, then run. Those places are likely profiting off
| the pandemic and will surprise you with expensive bills that
| your insurance will refuse to cover.
| hammock wrote:
| Not patients. Insurance.
|
| > she was "shocked" to see a drive-through coronavirus testing
| site bill her insurance $1,944
| jacurtis wrote:
| Yes they bill the insurance $1,944. But the insurance isn't
| going to pay that. Most of the insurance companies have
| capped COVID testing at $100. That is what they will cover
| because that is what the CARE Act requires them to cover. So
| that person probably got a bill for $1,844 from their
| insurance because the insurance probably paid $100.
| garmaine wrote:
| Insurance doesn't bill the patient.
| programmertote wrote:
| If people think it's just one doctor/one clinic profiting off
| from this pandemic, they'd be wrong.
|
| I know a couple of people who worked at these COVID testing
| sites in NYC (area near Columbia University), Brooklyn and in
| New Jersey for $15/hour. If one wants to work there, s/he
| doesn't even need to have work permit (because these sites hire
| foreign medical graduates for cheap labor). One just need to be
| able to draw blood, if necessary and that's the main
| requirement to work there.
|
| All of these clinics are owned by doctors. I'm 100% sure these
| clinic owners get reimbursed more than $15 per test from the US
| government. It is a financial windfall for those
| entrepreneurial doctors and clinic owners who are willing to
| ignore proper screening in hiring COVID testers at the sites.
| fragmede wrote:
| It's a blood draw, not brain surgery. It sounds like you have
| problems with a for-profit healthcare system run under
| capitalism, however.
| 8bitsrule wrote:
| Could well be. Many people are saddened by the whole idea
| of a for-profit healthcare system ... regardless of the
| politics ... and I'm among them. Health is a Human Right.
|
| As for the predatory equity firms that control many of
| them, I'd be delighted to see them thrown out of the US ...
| after their owners serve serious jail-time.
|
| Edit: While we're at it, how about 1 year of jail time for
| every US citizen who has died of opioids made by US
| pharmas. They can divide that time up however their
| employees decide is fair.
| meee wrote:
| This article is confusing. I was excited to see someone using
| research to bubble up a story. Then the writer puts a doctor on
| the hot seat with no conclusion in the article for him to refute.
| Is this a teaser for an article to come? I think a good article
| would tell us how the insurance providers felt about the charges.
| Do they disagree with the doctor's assesment? Does this represent
| fraud? Is he taking advantage of ill defined rules?
| tylerchilds wrote:
| I enabled JavaScript because I thought the rest of the article
| needed to load, but it just ends abruptly.
| mandevil wrote:
| This is a special behind-the-scenes article describing _how_
| the journalist did her work. If you read the article with JS
| turned on, you would see a link to the original article this
| is the backstory for:
| https://www.nytimes.com/2020/11/10/upshot/covid-testing-
| doct...
|
| Published back in November.
| tylerchilds wrote:
| this makes so much more sense now, thanks!
| istjohn wrote:
| > Times Insider explains who we are and what we do, and
| delivers behind-the-scenes insights into how our journalism
| comes together.
|
| The actual article is:
| https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...
| trulyme wrote:
| Thank you! The link should be changed, this article actually
| makes sense.
| Chromozon wrote:
| Another related issue posted today:
| https://www.kut.org/covid-19/2021-02-04/covid-19-testing-has...
| teekert wrote:
| Ah, the American Health Care system. I think we are all starting
| to learn that indeed, capitalism is great, as long as agents have
| a choice. In healthcare there often isn't (drug or death is not
| really a choice, iPhone or Galaxy is). Not great to leave such a
| market free to optimize for profitability.
| revscat wrote:
| The traditional view of libertarian capitalists where
| government, democratic or otherwise, has no moral validity when
| regulating or prohibiting various forms commerce, falls on its
| face when confronted with the real world. The free market works
| passingly well for basic items that people are free to chose
| whether to purchase or not. It fails spectacularly when one
| party is forced. In situations such as those presented in TFA
| the market fails spectacularly, and government can and should
| step in, and so long as backed by the democratic will, has the
| moral justification to do so.
| josh_fyi wrote:
| It's not a free market. The US health system is highly
| regulated, and most importantly, there is a huge tax
| incentive for health care to be paid for not by individuals
| but by employers who buy full coverage.
| revscat wrote:
| This response is common, but flawed. At root it is a "no
| true Scotsman" fallacy. Behind that, it argues, or at least
| heavily implies, that the only "true" free market is one
| wholly unburdened by regulation. Such a thing does not
| exist outside of history books, and there are good,
| historical reasons as to why.
|
| The fundamental premise, though -- that the market is not
| ideal for healthcare --- remains. For shoes and
| smartphones, the market is fine. For MRIs and insulin, it
| is not.
| ninjinxo wrote:
| >It's not a free market.
|
| If you hadn't opened with that I think we could have gotten
| another two or three people extending the chain of
| indirectly stating as much.
| gwd wrote:
| From TFA:
|
| > The patients who went to one of these drive-through testing
| sites had no chance of knowing what charges they would face
| beforehand.
|
| This is just stupid. There are similar stories about the cost
| of going to the ER. If all health care providers were required
| to be transparent about pricing up front, then there might be
| some possibility for people to shop around.
| waterheater wrote:
| The healthcare market isn't free. Also, we should call it
| "lifecare" rather than "healthcare", because the market doesn't
| care if you're healthy or not, just alive and using medical
| services.
|
| "If the image of medicine I have conveyed is one wherein
| medicine lurches along, riven by internal professional power
| struggles, impelled this way and that by arbitrary economic and
| sociopolitical forces, and sustained by bodies of myth and
| rhetoric that are elaborated in response to major threats to
| its survival, then that is the image supported by this study."
|
| - Evelleen Richards, "Vitamin C and Cancer: Medicine or
| Politics?"
| pochamago wrote:
| We've done a really good job of removing choice from the system
| at every available opportunity. Certificate of Need laws
| reducing the number of medical machines in localities.
| Insurance limiting provider choice. Totally opaque pricing for
| consumers. Restrictions on interstate licensing. There's a lot
| of mess that's entrenched.
| Nbox9 wrote:
| The healthcare system is not a free market.
|
| 1. It's very hard to shop around to find better prices or
| better service.
|
| 2. People often make choices like "Do you want this expensive
| life saving procedure or not?"
|
| 3. The average person isn't informed enough to understand what
| their medical treatment needs are. Patients ask doctors what
| their recommendation is. Doctors often have an incentive to
| sell the most healthcare they reasonably can.
|
| 4. My ability to pay for healthcare is directly tied to my
| employer. There simply are less jobs that provide good
| healthcare than people that would like them. My ability to
| change positions in society is limited by my desire to continue
| to have access to affordable healthcare. This is practically a
| freedom limiting mechanism.
|
| 5. I'm limited in my choice of which healthcare to purchase
| based on my Insurance policy. My choice in insurance policy is
| similar to a suburbanite's choice in an ISP. I have very few
| choices.
| tiborsaas wrote:
| > The healthcare system is not a free market.
|
| You hit the nail on the head. Compared to buying a car,
| computer or apartment I'm not choosing to have a particular
| disease or accident. It just happens to us (yes, we can
| prevent some). Once you have a medical condition you are
| forced to "shop" for a solution in a "free market" so you can
| escape that situation. This is when people become vulnerable
| and the US healthcare model takes full advantage of their
| position.
| jacurtis wrote:
| Just to add another item to your list:
|
| 6. Pricing is almost impossible to know ahead of time, even
| if you ask.
|
| Trust me, I have asked how much something will cost ahead of
| time and no one can tell you.
|
| One time I had to go into a specialist for my leg. I had hurt
| my MCL, but the doctor wasn't sure if it was torn or pulled.
| So he sent me to a specialist to give advice on whether
| surgery was needed. Before I made the appointment I asked the
| receptionist how much it was going to cost for this
| appointment. She couldnt tell me. I asked her to figure it
| out and call me back. She never did. I called back before my
| appointment and talked to the clinic manager. She again
| refused to quote me a price.
|
| In the end I went to the appointment. The doctor listened to
| me, then grabbed my leg and twisted it a few different
| directions and asked me to describe the pain as he did so.
| Then he told me it was a simple pull. I didn't need surgery.
| I just needed to rest. No prescriptions, no medications
| rendered, no operations performed, no diagnostic tests given.
| A simple 15 minute doctor visit.
|
| 3 months later I get the bill. It was $800. I had to pay it
| all out of pocket because this specialist was out of network.
| I had tried to get a price ahead of time and couldn't. The
| doctor didn't do anything for me except tell me to rest. The
| visit cost him 15 mins of his time. Nothing more. At this
| rate, he is billing $3,200 per hour. Possibly more because
| the 15 minute time estimate is me being generous. It was very
| possibly closer to 10 minute visit.
|
| Another one that I won't go into detail with because it would
| take too long was for a pinched nerve in my back. I went to
| urgent care because the pain was so bad I couldn't stand.
| Again, a simple question+answer with the doctor revealed the
| pinched disc in my back. No xrays or diagnostic tests were
| given. She prescribed me a pain killer and a steroid to
| reduce inflamation which would allow the disc to naturally
| slip back into place. Because I was traveling and so was
| again out of network when this happened, I asked the
| receptionist as I was checking in how much a simple visit
| runs. She of course can't quote me anything. I pressed her
| and said, "what is the base price. I know it is more if they
| have to run tests and do things, but what is the cost of the
| visit". She refused to tell me. As I was now wheelchair bound
| because I couldn't stand, I had no choice but to gamble and
| get the help and learn the price 4 months later. The visit
| cost me $1,900. I had to pay 100% out of pocket. Despite
| having insurance that I already pay $500 a month for.
|
| Furthermore I had $120 in out of pocket expenses on the
| medications.
|
| Not only can you not figure out a price ahead of time, but it
| is equally crazy that I pay this much out of pocket when I
| have insurance that I pay $500 a month for ($6,000 per year).
| And no don't tell me to "get better insurance". That means
| finding a different employer and guess what... it's not like
| you can see what insurance the other employers have until
| after you start working there. There is no way to really shop
| insurance, you are stuck with what your employers offers,
| usually with 2-3 options from the plans they have selected.
| throwaway0a5e wrote:
| >The average person isn't informed enough to understand what
| their medical treatment needs are.
|
| The average person isn't informed about anything other than
| however they make money from 9-5
|
| Consumer ignorance is not an excuse for a crappy market.
| toomuchtodo wrote:
| It is the job of regulators to coerce the market, through
| regulation, into one that is less harmful to consumers.
|
| It is unreasonable to expect every consumer to be an expert
| in every commerce transaction that takes place in their
| daily lives.
| adolph wrote:
| Once captured, the regulators coerce the market, through
| mis-regulation, into one that more effectively captures
| consumer value for certain producers.
|
| Is the price of specialization and sophistication the
| movement of decision power away from the source of
| decision quality information? I find it paradoxical to
| use regulation as a response to the fact that "it is
| unreasonable to expect every consumer to be an expert" in
| that it is likewise unreasonable to expect regulators to
| be expert in the context and values of each individual
| consumer.
| [deleted]
| minikites wrote:
| The main purpose of capitalism is to shift blame onto the
| consumer. You didn't want your new lawn mower to maim
| you? You should have done your research, it's your fault.
| Nbox9 wrote:
| Consumer ignorance is not an excuse for a crappy market.
| Consumers should have access to advice from a third party.
|
| When I want finical advice I hire an expert that gets paid
| the same no matter where I invest my money, because his
| incentive is to give me the best advice so I stick with
| him. If I get finical advice from someone that gets
| commission based on selling specific investments then the
| advice is more likely to be less than the best.
| TimBurr wrote:
| If you don't mind me adding :)
|
| 6. Prices are often unknown at time of service.
|
| No amount of research can make up for hospitals that haven't
| decided how much your surgery will cost until after the fact.
|
| I recently paid a hospital invoice, and received a receipt
| covered in "PENDING FINAL BILL". I can't tell if the hospital
| will refund me some excess, or charge an extra $1000.
|
| To extend the metaphor elsewhere in this thread, it's like
| going into a garage and being told that an oil change will
| cost between $40 and $400. It depends. We'll let you know.
| waterheater wrote:
| Hospitals enjoy that luxury, of course:
|
| https://www.healthcaredive.com/news/hospitals-pledge-to-
| figh...
|
| However, it looks like that practice won't be allowed for
| much longer:
|
| https://www.cnn.com/2021/01/04/politics/hospital-price-
| trans...
| 49para wrote:
| The answers for Canada's public health care system differ
| slightly but aside from the potential monetary issues for
| people without adequate insurance in the US, the Canadian
| system depends on capacity if you aren't a) a critical care
| patient b) high profile i.e. athelete, politician etc
|
| 1. Almost impossible to shop around 2. Instead this is a Dr's
| or a public system policy choice. 3. Dr's incentive is to
| minimize costs 4. Your ability to aquire healthcare is based
| on limited availability and your condition. If you are
| critical you will get immediate care, if you need a MRI -
| perhaps 6 months, if you need a specialist i.e. liver doc,
| sleep study, orthopedic surgeon etc, 1+ year 5. You have very
| little choice. Finding a family doc is very constrained
|
| OBVIOUSLY, this depends on the province as health care is a
| provincial domain.
| legitster wrote:
| "You're never as careful when spending other people's money."
|
| I briefly worked in healthcare at a tech startup. The thing you
| quickly learn is that the market for healthcare is fundamentally
| broken. You could invent something that saves a patient $10,000
| and they will never know. The hospital and doctors won't care
| about saving money. And the insurance company has no leverage to
| make them. And it will never make it onto the patient bill in a
| way that they understand.
|
| And as much as doctors and hospitals love to paint insurance as
| the bad guy, the only reason things like prior authorization is a
| pain in the ass is because doctors don't actually put in any
| effort into prescribing generics or really learn how much
| anything costs. This is highly unusual in most professions:
| Imagine if your roofer grabbed whatever shingles they liked best
| and billed you for it after they were up. Now imagine every
| roofer worked the same way.
| anon946 wrote:
| The US HC system basically runs as a "skim" operation. Since
| skim is fundamentally percentage based, the more money that
| flows through the system, the greater the absolute amount that
| is skimmed. Thus, no one has incentive, in the long run, to
| reduce costs. Short term, insurance companies might benefit
| from cutting costs, but they know that ultimately, when costs
| go up, they can justify proportional premium increases, which
| increase their skim in absolute value.
| ballenf wrote:
| Not only that, no one has a financial incentive to improve
| outcomes. Surgeons are judged on outcomes, but no one judges
| them on whether they did the right surgery or just very
| skillfully gave everyone who came through the doors stents
| and spinal implants.
| foepys wrote:
| I'm from Germany and here it's exactly the other way around.
|
| Public health insurences (there are over 100, but they are all
| organized in an umbrella organization) give out licences to
| doctors to be allowed to practice on publicly insured patients.
| The doctors get some amount of money they can spent on patient-
| specific prescriptions, but in general the doctors only
| prescribe the active ingredient. When the patient goes to the
| pharmacy to get their prescription, the pharmacy looks up the
| insurence and hands the patient the medicine that the insurence
| dictates. A doctor can prescribe a specific medicine but has to
| pay for it themselves (mostly from the money the insurences
| previously provided, see above).
|
| Insurences check about 10% of all hospital bills and just don't
| pay what they deem unnecessary. Hospitals are therefore careful
| not to do things the insurences didn't approve of. There is an
| open catalog of therapies that the public insurences will
| definitely pay and how much it may cost, so it's not a secret.
|
| They will also push for modern treatments if they reduce
| recovery time and have less risks.
|
| There is a lot more to the system but that's the gist.
| gumby wrote:
| Ironically despite the lower cost, the German medical system
| also provides a wider range of services than are provided in
| the US.
|
| For example my mother in law had an unusual cancer and after
| her treatments she had a rest spa paid for; once the
| treatments could no longer help she had in home care. In the
| US, good luck.
| nicbou wrote:
| I came here to extol the virtues of the German system.
| There's a lot more to it:
|
| - It's priced according to income, not health condition
|
| - You will never, ever be refused necessary healthcare, and
| you'll know it's covered before work begins
|
| - You are not punished for using your insurance, and the
| premiums won't change
|
| - There is no deductible, except a 5-10EUR/month co-pay for
| prescriptions
|
| - Your employer/employment has no impact on your coverage, or
| the insurer you choose
|
| This is for the public system. The private system is a bit
| more complicated, but generally, the same rules apply. The
| only difference is the pricing structure, and the possibility
| of having a deductible (usually ~1000EUR/year).
|
| American expats tend to have trauma that affects their
| insurance choices. My job is to reassure them that our system
| is completely unlike the American system.
|
| If you want a plain English overview of the system, you can
| have a look here: https://allaboutberlin.com/guides/german-
| health-insurance
| ballenf wrote:
| One important caveat to the German system is that if you
| make over a certain amount and are healthy, the private
| system will actually be cheaper since it's not tied to
| income.
| munificent wrote:
| _> "You're never as careful when spending other people's
| money."_
|
| That's a nice description of:
| https://en.wikipedia.org/wiki/Principal%E2%80%93agent_proble...
|
| _> This is highly unusual in most professions: Imagine if your
| roofer grabbed whatever shingles they liked best and billed you
| for it after they were up. Now imagine every roofer worked the
| same way._
|
| I mean, this basically is my experience with contractors, auto
| mechanics and most other professions where there's a lot of
| information asymmetry between consumers and providers. In a
| capitalist exchange, buyer and seller are opponents and both
| will use the others' lack of knowledge to their advantage (or
| be outcompeted by others that do).
|
| It's a fundamental dilemma of our world. The more expertise a
| task requires, the more important it is to hire someone to do
| it instead of doing it yourself. But the more necessary that
| person is, the less qualified you are to evaluate their
| performance.
| AlanYx wrote:
| >I mean, this basically is my experience with contractors,
| auto mechanics and most other professions where there's a lot
| of information asymmetry between consumers and providers.
|
| The unique feature of the medical care system that's
| different from most other professions is that there's multi-
| way asymmetry.
|
| An auto mechanic generally does have some rough idea of how
| much a given repair costs (inclusive of labor and materials)
| or at least can easily inform him/herself. It's a basic two-
| party information asymmetry where the professional making the
| decision has more information than most consumers.
|
| In medicine, physicians often have no idea themselves what
| the total cost of treatment will be, and there are various
| structural and economic factors that discourage or make it
| very difficult for physicians to find this information. This
| is a very different type of information asymmetry, where both
| the providers and the consumers lack information.
| aaomidi wrote:
| Yes. The system is broken from the ground up. From doctors
| working with other doctors to make sure to limit new doctors
| coming into the workforce, to our multi-node insurance systems.
|
| Anyone selling you an easy solution is lying. Anyone selling
| you a "reform" solution is also lying. We need a holistic
| approach to this that means the government needs to hire a
| bunch of experts that are given a lot of power to change the
| system to make it work.
| stocknoob wrote:
| Everyone complains about the cost of healthcare and nobody
| asks why the AMA operates like a cartel. The number of
| doctors allowed to graduate hasn't changed in 40 years.
| whatshisface wrote:
| A lot of people talk about that, actually. I've heard it
| several times and it comes up in most of these discussions.
| However, doctor's pay is not enough on its own to explain
| even a small fraction of the cost problem. In reality it's
| an issue permeating every single component of the system,
| each one making a small contribution to the overall pile.
| I've heard of this situation being called "cost disease."
| stocknoob wrote:
| Perhaps in small, private forums, but in public
| physicians are a protected class. Not many op-eds
| criticizing the AMA vs the big, evil pharma companies.
| That said, it's not a panacea, but not great when a
| 15-min visit to get a $.10 pill costs $200.
| matthewdgreen wrote:
| Not great, but also: people above this asked why the
| system doesn't get reformed, and the answer is that
| doctors are popular with the voting population, and
| tackling their costs will only have a modest impact in
| reducing costs.
|
| This is not to say that doctor's pay shouldn't be
| addressed, but the system doesn't get reformed because
| every discussion on fixing it gets derailed into a
| discussion of doctor's pay, which is literally the
| highest-effort lowest-payoff part of the problem. And the
| situation stays bad because of this dynamic.
| whatshisface wrote:
| Oh, of course, it just hadn't occurred to me to consider
| op-eds a meaningful participant or representative of the
| public discourse.
| stocknoob wrote:
| They set the Overton window of allowed policies.
| lostapathy wrote:
| > doctor's pay is not enough on its own to explain even a
| small fraction of the cost problem
|
| Not on it's own, but doctor shortage can still contribute
| to medical costs.
|
| Do doctors make more mistakes due to high patient loads?
|
| Are preventable items missed because doctors can't spend
| enough time with patients?
|
| Would people be less likely to abuse the ER and/or wait
| to address conditions if they could get a primary care
| appointment more easily?
|
| If doctors had a little more slack in their schedules,
| might they innovate in other ways?
|
| If we had more doctors, would it be harder for mega-
| hospital chains to gobble up the supply of doctors in
| your area, leaving more independent practices to innovate
| in other ways?
| ardy42 wrote:
| > Everyone complains about the cost of healthcare and
| nobody asks why the AMA operates like a cartel.
|
| That's not entirely a bad thing. It would be bad for
| Medicine to turn out like Law, with a huge glut of
| unemployable graduates after a long, expensive training
| program (IIRC, an intense 7 years post-college, _minimum_
| ). There's a need to balance demand with the need for all
| (or nearly all) the graduates to be able to find a job.
|
| Also, you're neglecting Osteopathic schools, which aren't
| controlled by the AMA but graduate students with the same
| practice rights.
|
| > The number of doctors allowed to graduate hasn't changed
| in 40 years.
|
| Do you have any data to back that claim up? The Association
| of American Medical Colleges says enrollment rates are
| increasing:
|
| > In response to concerns that a projected doctor shortage
| could impact patient care, the AAMC in 2006 called on
| medical schools to increase first-year enrollment by 30%.
| That target was reached in 2018-19, when first-year
| matriculation reached 21,622 students. Osteopathic schools
| increased their enrollment by 164% during this same time
| period, with 8,124 first-year students enrolled.
| (https://www.aamc.org/news-insights/us-medical-school-
| enrollm...)
| salawat wrote:
| Enrollment != graduation and licensure.
|
| More people may be interested but nobody can practice
| until after residency, and you have a large pool of
| hopefuls basically in a lottery for residency slots.
|
| You can get all the theory, but not be able to get the
| requisite practicum. Even if you do get a slot, you also
| get treated like a stevedore from what I have heard.
| ardy42 wrote:
| > Enrollment != graduation and licensure.
|
| > More people may be interested but nobody can practice
| until after residency, and you have a large pool of
| hopefuls basically in a lottery for residency slots.
|
| But my understanding is that residency capacity is
| matched to graduating class sizes, at least in the US.
| The selectivity is intentionally placed up front (at med
| school admission) so the path is clear to residency and
| licensure as long as the student doesn't totally fall
| apart (which the selectivity is supposed to guard
| against).
|
| IIRC, it's foreign medical school graduates may have
| trouble getting a US residency.
| salawat wrote:
| That is not my understanding at all, as that would imply
| we never have med school admissions without a residency
| slot, and I have seen many mentions over the years about
| how the great bottleneck is not med school admissions,
| but residency slots.
|
| https://www.fiercehealthcare.com/practices/more-medical-
| stud...
|
| https://health.wusf.usf.edu/npr-
| health/2019-07-03/american-m...
|
| The above sources indicate residency matching is
| decoupled from graduation from Med school, and if I
| recall correctly, there is actually a legal cap on the
| number of residency slots.
|
| https://www.aha.org/news/headline/2019-03-14-bill-
| add-15000-...
|
| So everything I've seen suggests we actually have a
| dysfunctional system with no up front brakes. Our Medical
| education system maximizes fiscal extraction from
| hopefuls, but the residency slots don't scale elastically
| or in any way matched with demand. Quite literally, it
| seems to take an act of Congress to change the calculus
| of residency slots.
|
| I could still be wrong, and welcome the removal of the
| veil of mistaken impressions, but that's the gist of my
| current understanding.
| stocknoob wrote:
| Why do some professions get the benefit of cartel
| protection? Note that pharmacists don't have such
| restrictions and have similar training.
|
| For the data, I had done a quick search and found this
| (which only goes to 2010):
|
| https://www.researchgate.net/figure/Trends-in-the-Number-
| of-...
|
| However, digging more, even the AAMC is saying you need
| residency slots:
|
| https://www.medicaleconomics.com/view/enrollment-rates-
| rise-...
|
| Increasing first-year enrollment is a good first step,
| but doesn't move the needle on the number of doctors who
| can actually practice because the number of residencies
| is still limited.
| mattkrause wrote:
| If I were king, I'd look into retraining biomedical grad
| students/postdocs to go into medicine. We've got a
| massive (taxpayer-funded!) glut of the latter and many of
| them have a relevant background and even skills.
|
| Yet, only a few places currently try to convert PhDs to
| MDs; most places are overwhelmingly geared up for
| undergrads coming straight out of pre-med programs.
| ardy42 wrote:
| > However, digging more, even the AAMC is saying you need
| residency slots:
|
| Which are determined by federal government Medicare
| funding, btw. From your link:
|
| > Federally supported residency training slots have been
| capped by Congress for more than 20 years, limiting the
| spots for medical school graduates to undergo additional
| training in a residency program before they can practice
| medicine.
|
| So maybe this is more of a "call your congressman" issue.
| willcipriano wrote:
| Your congressman probably listens to the AMA more so than
| you when it comes to medical matters, here is one example
| of what they have to say on the subject I could find with
| a quick search:
|
| > In March 1997, months before the Balanced Budget Act
| was enacted, the AMA even suggested reducing the number
| of US residency positions by approximately 25% from
| 25,000 to fewer than 19,000. "The United States is on the
| verge of a serious oversupply of physicians," said the
| AMA and other physicians' groups in a joint statement.
| Since most states require at least some residency
| training for medical licensure, reducing the number of
| residency positions would curtail the supply of doctors
| in the US.
|
| > Fast forward two decades, and what once seemed like a
| glut now looks like a shortage. The growth in the number
| of residency positions--and thus the number of doctors--
| slowed after the passage of the Balanced Budget Act. From
| 1997 to 2002, the number of residents in the US increased
| by just 0.1%. Although the number of positions has
| increased since then, each year thousands of residency
| applicants fail to secure a position. Factor in an aging
| population and a projected increase in demand for health
| care services, and the US is now forecasted to experience
| a shortage of 46,900 to 121,900 physicians by 2032.
| Absent a meaningful response from Congress, it will be
| doctors--particularly residents--and their patients who
| pay the price.
|
| - https://qz.com/1676207/the-us-is-on-the-verge-of-a-
| devastati...
| jxramos wrote:
| what is this "allowed to graduate" business? What authority
| do they have to dictate such a thing and is it in writing
| anywhere what said quota is?
| aaomidi wrote:
| The number of residency spots is an artificial barrier to
| being able to properly practice medicine. That number is
| controlled by doctors.
| jxramos wrote:
| Is this the organization where the barrier to entry is
| enforced? https://en.wikipedia.org/wiki/National_Resident
| _Matching_Pro.... What does it look like precisely to the
| aspiring physicians who don't make the cut? Where exactly
| do they get communicated to that you didn't meet, get
| selected, etc for stage XYZ.
| fragmede wrote:
| Which is why Nurse Practitioners are the best thing to
| happen for patients in decades. Better access to healthcare
| means better treatment.
| civilized wrote:
| > doctors don't actually put in any effort into prescribing
| generics or really learn how much anything costs
|
| I'm hesitant to blame doctors, since I myself find it
| impossible to learn how much anything costs until after being
| billed for it. Is it any easier for the doctors?
|
| (Note: clearly the doctor in this article is scamming his
| patients, but I'm talking about the situation in general)
| thaumasiotes wrote:
| As much as Kaiser Permanente has been giving me awful, awful
| care, they tell you how much something will cost you before
| giving it to you, and you have to explicitly agree to pay
| that amount.
|
| (In my case, I also pay before getting whatever it is, but
| it's possible to have the charge added to your bill instead.)
| react_burger38 wrote:
| How do you do that? I tried to get Kaiser to tell me how
| much my wife's delivery would be and what they told us was
| much less than the actual bill, even though there weren't
| any complications
| thaumasiotes wrote:
| I have not made any effort to get them to do that. Most
| of my experience with them has been really routine stuff
| -- "visit copay", "get a blood sample taken", or the like
| -- but this also happened for a stomach biopsy involving
| cramming a huge device down my throat, and for which they
| wanted to have me sedated, which seems like a pretty
| close analogy to a childbirth with no complications. :/
| civilized wrote:
| I have never, ever had the experience of getting an answer
| to how much a health care procedure will cost, and believe
| me I've asked. Also never had Kaiser - mostly BCBS.
| llamataboot wrote:
| I have also worked in and around healthcare in various
| capacities (both tech and non-tech) and this is totally wrong.
| There are /many/ reasons the US healthcare system is broken,
| and I agree the issues are more systemic at this point, than
| any one bad actor, but if there /is/ a bad actor, it is
| definitely the health insurance companies.
|
| There are a lot of good people in the health insurance industry
| that want to improve health outcomes and make a profit and are
| swimming upstream as well against those systemic forces (just
| maybe the market isn't the best way to distribute
| healthcare...) but as a whole it's not the health insurance
| companies reining in the costs of frivious doctors and
| hypochondriac patients, it's the incredible layer of
| bureaucracy and arbitrary decisions there that soak up a ton of
| monetary resources, constrain doctors into not even being able
| to do the preventative care work they want, and lead to all
| sorts of perverse incentives like showing up in ER 5x a year,
| instead of getting to show up at your GP and nutritionist every
| week, etc
| chromatin wrote:
| > And as much as doctors and hospitals love to paint insurance
| as the bad guy, the only reason things like prior authorization
| is a pain in the ass is because doctors don't actually put in
| any effort into prescribing generics or really learn how much
| anything costs.
|
| The only reason? Don't put in any effort? How is this comment
| not flagged dead?
|
| This is patently false and essentially slanderous. (I guess
| libelous since we're on a written medium)
|
| If you and the rest of the public had any idea how much your
| insurance company literally does not give a shit about you,
| when you are for example battling cancer, there would be
| pitchforks in the street.
| hengheng wrote:
| Why is there no incentive for the insurance company to be
| frugal? That's how it works elsewhere, and they have a lot of
| bargaining power.
| pnutjam wrote:
| There is some incentive, but when you tell someone you can
| only make a profit of (for example) 10% of what you pay out;
| it warps their incentives.
|
| They don't want to bankrupt themselves, but they can raise
| rates and keep more money when they pay more.
| maxerickson wrote:
| This assumes they don't have any competition looking to
| take their market share (which reduces their intake).
|
| It can be the case that the market isn't very competitive,
| but it isn't the case that the companies can just
| arbitrarily raise rates.
| pnutjam wrote:
| Once a year the company can shop around, but you as an
| insured have no say. Your HR picks, and they may or may
| not be competent. They may optimize prices for family, or
| for single people, or any number of weird things.
| adolph wrote:
| _HMOs often have a negative public image due to their
| restrictive appearance. HMOs have been the target of lawsuits
| claiming that the restrictions of the HMO prevented necessary
| care._
|
| https://en.wikipedia.org/wiki/Health_maintenance_organizatio.
| ..
| legitster wrote:
| They don't actually have a lot of leverage. A hospital has a
| near monopoly on it's region/patients, but insurers have to
| compete with a dozen others to be accepted by the hospital.
| If the hospital wants to charge their patients, insurance
| just has a minimal amount of bitching they can do over
| prices.
| anon946 wrote:
| Short term, yes. But when costs go up, they know that they
| can then later use it justify a proportional increase in
| premiums.
| IG_Semmelweiss wrote:
| Incentives are there, they are just not going in the right
| direction. First, the buyer does not care that much since it
| is all tax-deductible.
|
| And there are other dynamics in play. Here is a nasty
| example:
|
| Employers care that premiums only increase by X% per year.
| Fine. As such, insurance will try to protect its contract
| with employer by going to the hospital provider, and
| demanding a low premium increase.
|
| Hospital says fine but "OK - but you agree to our increase of
| list price by 50%.... don't worry, we give you a discount on
| that amount. Insurance won't pay that increase"
|
| Insurer says "Great! In fact, let's push it to 100%? OK?"
|
| How did we come to this? Insurer and Hospital agreeing to
| increase price by 100% and discount that 100% back down?
|
| Its because of the incentives.
|
| Insurance will use this to go back to employer and say. "We
| got you that x% cap on increase in premiums. Employer, by the
| way, you still owe us money from the 100% discount we got you
| from the hospital bills " Employer says OK and pays a ~3%
| premium on the 100% 'discount' ("claims repricing" in
| industry parlance).
|
| Meanwhile, Hospital goes back to the government. "We had
| losses from discounts given to govt patients totaling X in
| discounts". Now hospitals recoup some of that money. (in
| industry parlance Disproportionate Share Hospital (DSH))
|
| Meanwhile, people with no insurance have to pay these
| inflated list prices...with no insurance discount whatsoever.
| HR staff gets promoted or leaves the job, because they did a
| great job securing that X% cap. The new person does not know
| what "claims repricing" is. It remains in the contract.
|
| Premiums go higher next year.
| [deleted]
| leoedin wrote:
| The full article
| (https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...)
| suggests that this doctor alone has run _60,000_ covid tests.
| Billing $2k a pop. That 's _$120 million_ (ok, maybe revenue, but
| you don 't need to skim much off $120 million to be very
| wealthy).
|
| Complete madness.
| IG_Semmelweiss wrote:
| for anyone wondering how US healthcare got to where it is today,
| this is a succinct historical summary in the form of a podcast,
| by a historian.
|
| https://www.econtalk.org/christy-ford-chapin-on-the-evolutio...
| 6gvONxR4sf7o wrote:
| This is a story about a story. Readers sent her bills and she got
| a story about it.
|
| https://www.nytimes.com/2020/11/10/upshot/covid-testing-doct...
| <---This is the actual story she wrote.
| arcticfox wrote:
| Incredible, especially the part about testing _asymptomatic_
| patients with a full panel. That 's...insane.
| jacurtis wrote:
| Thank you! I was very confused while reading this because the
| author never actually got to anything interesting. Just talks
| about their routine of sorting through other people's medical
| bills.
| IndrekR wrote:
| Just as a reference, in Estonia COVID antibody test costs
| 13.21EUR for the state (14.40EUR if you are private person) and
| PCR test costs 51.81EUR for the state (58EUR private). This
| includes PE, sampling and analysis. Most tests are paid for by
| the state. You may want to take privately funded one if you have
| no symptoms and want to travel; or are returning from affected
| area and want to shorten the 10 day isolation requirement to 6
| with two sequential negative tests.
| mrkwse wrote:
| Not sure about LFT, but in the UK private PCR tests (required
| for travelling, professional elite sport etc.) cost between
| PS80-130.
| [deleted]
| djrogers wrote:
| Here in California tests are $150 if you want to pay yourself
| (say because you're curious, or require a negative test to
| travel), or paid 100% by insurance (so no out of pocket costs)
| if you have symptoms and are referred to a test by your doctor.
|
| The issue at hand in the article is the amount being charged to
| insurance companies for the latter - due to lobbying and
| obscure regulations (which the article points out the Trump
| administration attempted to overcome), it is not uncommon for
| medical providers to charge insurance companies exorbitant
| amounts for services, and also charge them for unnecessary
| services.
| MegaThorx wrote:
| Where I live in Austria they charge just 45EUR for a PCR test
| and the antibody test is free.
| raincom wrote:
| In India, RT-PCR test costs Rs 500, about $7 at any private
| testing centers. And one can get the results in four hours.
| Also one can get Covid-negative report for travel purpose for
| $12 (a certificate in addition to the test). Even we quadruple
| this price in the developed world like US, it should be about
| $50; instead, 95% of Americans are fleeced to death.
| ed25519FUUU wrote:
| The tests are actually free in the USA. The contention here is
| about how much these testing sites are charging insurers.
| ed25519FUUU wrote:
| I'm not sure why I'm being downvoted. In the United States
| Covid 19 testing is free with or without insurance. Nobody
| needs to pay anything for a covid 19 test in the USA,
| regardless of their residency or insurance status.
|
| > _The Families First Coronavirus Response Act ensures that
| COVID-19 testing is free to anyone in the U.S., including the
| uninsured._
|
| https://www.hhs.gov/coronavirus/community-based-testing-
| site...
|
| The issue here is these testing sites were performing _more_
| than a covid 19 test and then billing for those tests without
| a person 's consent.
|
| > _Dr. Murphy wasn't just billing for coronavirus tests, as
| his patients thought. He was billing for 20 other respiratory
| pathogens, too._
| smnrchrds wrote:
| In Canada, it is free through public healthcare if it is for
| health concerns (e.g. if you are symptomatic). If you need it
| for non-health reasons, e.g. travel, it goes through a private
| company and the cost is 250 C$ (195 US$/165EUR) in Alberta.
| alextheparrot wrote:
| > He said the use of the larger test was appropriate because it
| could catch a wider range of diseases, particularly for those who
| were symptomatic. [0]
|
| Cant't believe this isn't an ethics violation, it is like going
| into the car dealership to change my oil and them charging me to
| take apart the engine because "It could catch a wider range of
| issues".
|
| I know what service I want and would consent to, this
| "Technically correct but costs 50x as much" is harmful.
|
| [0] This is the doctor's response when asked why he is testing
| for ~20 other respiratory diseases in the drive-through
| coronavirus line.
| danpalmer wrote:
| This also betrays a lack of understanding of testing by the
| doctor.
|
| If each test has a 1% chance of returning a false positive (and
| false positives are possible in most tests), there's a
| significant chance that one of the 20 will return a false
| positive, which will then prompt unnecessary treatments,
| further tests, etc.
|
| The general medical guidance is to only test when there's a
| legitimate suspicion that a patient has the illness. In this
| case, these patients wouldn't have been tested for a wide range
| of respiratory issues anyway, and given the pandemic it's much
| more likely that they've got coronavirus, so they really
| shouldn't be tested for the other things, especially if
| asymptomatic.
| peeters wrote:
| Yeah that's straight up malpractice. If there's a 99% chance
| it's Covid and not something else, you do the Covid test first
| and if that comes back negative, _then_ you test for the
| "something else" (if symptoms are severe enough).
| arcticfox wrote:
| It's even worse than that, he was testing _asymptomatic_
| patients with a full panel. That part takes it from probably
| unethical to full-blown fraud for me.
|
| > But in interviews, asymptomatic patients said they had also
| received the more expensive test.
| vharuck wrote:
| For asymptomatic patients, doing those tests could easily
| cause net harm from follow-up to false positives. So, even
| if the tests had been free, it's probably unethical.
|
| This is why organizations like the United States
| Preventative Services Task Force exist. They review studies
| and recommend best practices for medical screening. They do
| recommend against asymptomatic screening for a lot of
| tests.
| throwaway0a5e wrote:
| >it is like going into the car dealership to change my oil and
| them charging me to take apart the engine because "It could
| catch a wider range of issues".
|
| This kind of stuff is pretty par for the course. They try and
| up-sell. If you agree then you're on the hook for the bill.
| That's just how the industry works. But businesses that make a
| habit of being sleazy don't survive long because the bill must
| be agreed upon beforehand and customer is free to go elsewhere
| with little friction and there isn't all sorts of gatekeeping
| and regulatory capture constraining supply.
| sjg007 wrote:
| There's a reason it's endemic and that's because people fall
| for it. Every few months there's an investigation by the
| government and some oil changer business gets fined for it.
| Dealers do it too but if your car is under warranty these
| days it tends to be less of an issue. Cars are more reliable
| now too. Out of warranty though, hold onto your hat!
| joombaga wrote:
| What exactly do they get fined for? I recognize this sort
| of upselling is sleazy, but I'm curious about the wording
| of laws that make it a fineable offense.
| sjg007 wrote:
| It usually starts with an investigation by the attorney
| general who responds to customer complaints alleging
| fraud and deceit etc... Sometimes things are kicked off
| by a local news channel sting.
| h_anna_h wrote:
| > Cars are more reliable now too
|
| This is hard to believe. If anything they are more
| disposable.
| omgwtfbyobbq wrote:
| Average age has been ticking up for a while, at least in
| the US.
|
| https://www.bts.gov/content/average-age-automobiles-and-
| truc...
|
| I feel like the disposability angle comes from having
| relatively expensive parts/repair costs with low value
| older vehicles, which results in them being retired
| because of the economics of having someone else repair
| them.
| pnutjam wrote:
| That and the ever present complaint that they can't take
| a hit like they used too.
|
| Never mind that makes them way safer and saves tons of
| lives. Some people want to crash up derby their car every
| weekend.
| throwaway0a5e wrote:
| Having a crumple zone turn to mush in a 10mph parking lot
| mishap does pretty much nothing to make your car more
| survivable in a crash that might hurt you.
|
| There's no real reason slow speed crashes have to be as
| damaging as they are. It's just a result of what our
| tests our and natural optimization toward them. If the
| NHTSA reintroduced a "is the vehicle drive-able after a
| minor hit" type crash things would get a lot better very
| quickly.
| mrguyorama wrote:
| It's also not even remotely true. Check out the IIHS
| crashing a 60s bel air into a modern malibu.
|
| "They don't make them like they used to" has always been
| a nostalgic crock of shit, like the people who think the
| NES was the golden age of video games, despite the vast
| majority of the 700 or so releases being utter trash for
| $60 that sometimes didn't even work!
|
| https://www.youtube.com/watch?v=C_r5UJrxcck
| h_anna_h wrote:
| I can give you an anecdote. A modern car crashed on our
| nissan from 1990's a while ago and while absolutely
| nothing happened to ours the other car looked like a
| wreck. Maybe the behind of the car is made to be more
| durable than the front? I do not know.
| mrguyorama wrote:
| The body may not have warped much, but that just means
| the force was transferred directly to the occupants with
| zero reduction from crumple zones. This is terrible for
| safety but good for the pocket book if you are lucky
| enough to escape unscathed.
|
| With significant and well engineered crumple zones and
| fairly expensive components, modern cars are
| significantly easier to total.
| omgwtfbyobbq wrote:
| I think they're talking about damage from low speed hits.
| Older cars can take those without as much apparent damage
| because they have big heavy bumpers and aren't designed
| for occupant/pedestrian safety, but like you said they'll
| fold up like a tin can in higher speed crashes.
| throwaway0a5e wrote:
| That's a promotional video for showcasing how far safety
| has come. It's about as grounded in reality as that Top
| Gear episode with the Hilux that the online fanboys all
| beat it to but people who actually work in industry roll
| their eyes at.
|
| Nobody's ever done an 80s Town Car vs a 2010 Town Car at
| 30mph because a crash test where the result is "both
| drivers would have walked away" is boring and doesn't
| make for the kinds of DARE-esque media that the people
| who do crash testing have found it worthwhile to put out.
| sjg007 wrote:
| I'd imagine that there are companies that buy these
| vehicles from salvage or auction and rehab them for sale
| in other countries.
| floren wrote:
| People used to consider it a major milestone for their
| car to hit 100,000 miles. It wouldn't be particularly
| surprising if you needed your engine or transmission
| rebuilt before that point. American cars didn't even have
| 6-digit odometers for a long time. These days, your
| average inexpensive sedan will hit 100,000 miles with
| nothing but oil changes (every 10,000 miles instead of
| every 3,000 like it used to be), a couple sets of tires,
| and some new brake pads.
|
| Of course, if it breaks, it's full of all these complex
| little systems that let modern cars run for hundreds of
| thousands of miles at 40mpg, and you'll need to pull in a
| professional, but they break a LOT less frequently.
| Amezarak wrote:
| My experience is that the drivetrain is MUCH more
| reliable than it used to be, but the various electronic
| systems are subject to high failure rates - displays,
| buttons, computers, sensors, etc. Many of these failures
| don't impact your actual driving ability, but are just a
| nuisance, like if your AC button stops working or your
| cars information displays.
| DavidPeiffer wrote:
| Going back to when my parents were growing up, a car with
| 60,000 miles was near the end of its life. They checked
| the oil every time they got gas out of necessity.
|
| Now almost nobody needs to check the oil that frequently
| (though it'd be good practice) and even lower end cars
| routinely last to 100,000 miles.
|
| I'm driving a 2010 Honda Civic with 100k miles and fully
| expect to replace it with a newer vehicle out of concern
| for safety, desire for an electric vehicle, and wanting
| some better creature comforts. The thing will probably
| run to 250k miles, which would take me another 13 years
| to achieve.
| lostapathy wrote:
| Cars today may be harder/more expensive to fix, but they
| do seem to last a lot longer before they need it, and as
| pointed out down thread they tend to last a lot longer in
| the absolute sense.
|
| As a kid, we had a van that made it to 150k miles and my
| parents friends were amazed it was still on the road.
| I've personally owned 4 or 5 vehicles older than that,
| all in better shape than that van at 150k.
| bcrosby95 wrote:
| Trustworthy mechanics are worth their weight in gold. Our
| local mechanic spent a lot of time diagnosing a problem and
| when he found out it was covered by the standard warranty
| (it was a part that has a longer than normal one, don't
| remember which exactly) sent us on our way to get it fixed
| by a dealership.
|
| We brought them coffee and bagels the next day.
| sjg007 wrote:
| I mean, you should pay for the diagnostic time, which is
| usually $100 or so.
| StillBored wrote:
| I've had multiple dealers discover a laundry list of
| problems on my/wifes "out of warranty" vehicles. Frequently
| for thousands of dollars. Then its pointed out its actually
| under a factory extended warantty (certified preowned from
| another dealer). And the resulting scrambles have been
| entertaining, as they do a ton of work replacing stuff on a
| vehicle no one in their right mind would have "fixed".
| Although at least a few times the repairs have been denied
| ("worn out" engine mounts).
| SilasX wrote:
| Yes, they do slimy stuff, but nothing like the parent was
| describing. I've never heard of a maintenance place taking
| apart your engine without asking you first.
| throwaway0a5e wrote:
| That's exactly my point. Why aren't costs agreed upon first
| in healthcare? Sure the doctors, hospitals, insurance, etc
| will lose their ass on some jobs but it should more than
| balance out over time.
| SilasX wrote:
| Oh sorry I misunderstood you, I thought you were
| referring to the car repair industry's upsells.
|
| My own story is when I went to an ENT for something
| unrelated and he asked me if it was okay to pull out a
| hair he saw on my ear and I said yes, and then the bill
| had a $500 charge for it.
| nitrogen wrote:
| Was this a modern machine-based test where testing for one
| disease is just as easy as testing for 20 at a time? There's
| been a lot of false information and insurance screwups in the
| news about such tests. A single lab test that the machine
| vendor charges $200 for, and thus costs the hospital probably
| $50 or less if they own the machine, gets coded by insurance as
| 20 separate tests.
|
| _We 100% should be using these kinds of tests way more often._
| If this was such a rapid multi-test, the villain here is the
| billing department and insurance.
| sjg007 wrote:
| It is probably an ethics violation. I am sure he probably
| covered himself in the fine print but as you can see the
| customers are confused so that means they didn't expect the
| full respiratory panel testing. Insurance companies may have
| rules on it too so he could be in violation of contracts. I
| would expect negative flu test, negative covid test, then that
| justifies the remaining panel if symptoms worsen or what not.
|
| This is though the same thing car dealers do. They always want
| to up sell services.
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