[HN Gopher] Health insurers just published close to a trillion h...
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Health insurers just published close to a trillion hospital prices
Author : sl-dolt
Score : 325 points
Date : 2022-09-06 15:49 UTC (7 hours ago)
(HTM) web link (www.dolthub.com)
(TXT) w3m dump (www.dolthub.com)
| gigatexal wrote:
| Price transparency is an essential part of a healthy market. Or
| so says the theory. I hope they release it. I wonder what I can
| do to help? I'm capable in db design, sql, etc being a data
| engineer by day perhaps I can help this effort.
| flowersjeff wrote:
| From my understanding though, these 'prices' are outdated nearly
| as quickly as they are published. I.e. sure you have a set, but
| everything is dynamic and changing. Seems like it would require a
| ML approach to 'understand' such a dataset going forward.
| MichaelZuo wrote:
| 6000 hospitals x say around 10000 priced items, on average, per
| hospital x 100 different negotiated pricing formulas = 6 trillion
| unique prices.
|
| Of course many hospitals negotiate en bloc as part of a
| healthcare network, and there probably are more than 100
| different organizations that negotiated unique healthcare pricing
| but the ballpark number seems to make sense.
| sl-dolt wrote:
| I'm the author. A question I have is: how did so many prices ever
| get negotiated in the first place? What kind of systems are in
| place to do this kind of micro-negotiation?
| gmarx wrote:
| The next question would be 'how long did the average
| negotiation take' followed by 'how much were the average people
| on each side of the negotiation paid?" (or are most of these
| negotiations the result of computers talking to each other?
| Either way with a few assumptions one could make an estimate of
| the smallest amount these different prices cost the system.
| Might be huge
| balderdash wrote:
| I would assume these get negotiated as a large list with each
| payer so if you have 500 services, and 4 payers, you probably
| and up with 1k-2k unique prices?
| bawana wrote:
| Today in Massachusetts, physicians cannot get paid unless they
| belong to an organization that negotiates their rates with the
| insurers. These negotiating entities are like unions but not
| really. If the insurer and the organization disagree, the
| insurer simply goes to a different organization to make a
| contract. Prices were not publicly available so each
| negotiation resulted in a different fee schedule. On top of
| that, insurers invent different 'products' with different
| amounts of 'coverage' for different premiums. Each of these
| 'products' had their own negotiation, their contracts, and
| their own subset of physicians who chose to participate. So
| what do these organizations do for the cut that they take? They
| reduce the burden of the insurers so they dont have to
| negotiate with each individual provider.
|
| Hospitals are an entirely different system. They have much more
| negotiating power and if an insurer has a customer that goes to
| a hospital emergency room outside of their contract, the
| insurer has to pay outlandish rates. So it is in the insurer's
| interest to make a deal. They achieve this by inventing
| different 'products' with different amounts of 'coverage' for
| different premiums. Each of these 'products' had their own
| negotiation and their contracts.
|
| Price transparency is the first good thing that has been
| mandated. However, this misses the mark. The focus is the
| patient, not the insurer, the hospital or the physician.
| Accordingly, patients should be allowed to submit their
| explanation of benefits and their bills-this is the data that
| reflects the true cost of healthcare. All of the numbers
| provided by hospitals, insurers and physicians has been
| massaged and buried in a forest of minutiae.
| dj_gitmo wrote:
| The US healthcare system is wildly complicated and inefficient
| because it is a double-bureaucracy; pubic and private. The
| government bureaucracy makes a bunch of rules and also provide
| healthcare through Medicare/Medicaid. The private bureaucracy
| compete with each other, and hospitals, and pharma companies,
| ect.
|
| Many of the private health providers are for-profit and lobby
| against rule changes that would reduce complexity and save the
| system money. It know this may sound glib, but if you are
| trying to understand the US healthcare system and something
| seems strange, usually it's because it makes someone money and
| they'll fight hard to keep it that way.
| spaetzleesser wrote:
| "usually it's because it makes someone money and they'll
| fight hard to keep it that way"
|
| And it's not just some money but very BIG money they make.
| KennyBlanken wrote:
| > Many of the private health providers are for-profit and
| lobby against rule changes that would reduce complexity and
| save the system money.
|
| This is almost certainly an anti-competitive move. By keeping
| many rules and regulations, you need more staff to deal with
| them - and smaller insurers have fewer patients to amortize
| those salaries over.
| ChrisMarshallNY wrote:
| _> pubic and private_
|
| Eek.
|
| Just. Eeek.
|
| :P
| e_i_pi_2 wrote:
| My understanding (not an expert by any means) is that we
| basically have two tiers of negotiation - the fed. govt. has
| way more leverage but also some amount of corruption that goes
| into pricing, then afterwards individual hospitals and
| "networks" of providers will negotiate with the insurer -
| sometimes after the procedure has already happened - to figure
| out the final price.
|
| The end result is that you might end up with an individual
| doctor having to work with the insurance company for pricing,
| so the same procedure can cost vastly different amounts at
| hospitals down the road from each other providing the same
| level of care. To make it worse we also have laws preventing
| healthcare providers from providing prices upfront, out of a
| fear that people will forego necessary care they can't afford.
|
| Edit: seems like this changed 01-01-2021, now we do have some
| price transparency laws - https://www.cms.gov/hospital-price-
| transparency
| celestialcheese wrote:
| > To make it worse we also have laws preventing healthcare
| providers from providing prices upfront, out of a fear that
| people will forego necessary care they can't afford.
|
| What are these laws? This seems so backwards - I know
| personally I have put off medical care in my past because I
| had high deductible insurance, and no guarantee that the bill
| I'd get wouldn't wipe me out, and no way to price shop.
| Paralysis of unknown.
| e_i_pi_2 wrote:
| Ah thanks for making me look this up! Seems like it did
| change recently (Jan 1, 2021)
|
| https://www.cms.gov/hospital-price-transparency
|
| Now assuming the hospital is compliant the information
| should be available. To be fair my understanding of the
| argument for the old law was that you didn't want a
| hospital with a big sign out front saying "Broken arm
| repair: $10k" and having people not go in for it when there
| might be some financial aid they could get afterwards
| willcipriano wrote:
| I'm sure the real reason is that the hospital up the road
| will set up a sign "Broken arm repair: $9k" to compete
| and that isn't something the lobbyists want.
| elliekelly wrote:
| It's not the case. The No Surprises Act requires a good
| faith estimation for most procedures. Although IIRC it
| _doesn't_ apply to people who don't have insurance, which
| seems kind of backwards as those people would likely be the
| most price-sensitive and have the least amount of
| bargaining power in the market. I guess they also tend to
| have the least amount of political power, too...
| woobar wrote:
| Are we sure they negotiated unique prices with each provider? I
| wouldn't be surprised if they have a dozen of templates that
| get replicated every time a new entity accept preexisting price
| sheet. Basically they have dumped a denormalized data set.
| tyingq wrote:
| What was negotiated was probably more blanket style discounts
| like "10% off your published medicare rate for procedures in
| categories a/b/c" for one customer and "15% off retail price
| for all categories other than x/y/z but only in these
| geographic areas" for another customer, and so on.
|
| But, when publishing, they omit the context and just dump every
| negotiated rate. Because it's technically compliant, but keeps
| things opaque.
| gffrd wrote:
| Super curious about this, too.
|
| Also! What did they do before they could store 100TB of pricing
| data? How has pricing (and care quality) changed as a result of
| being able to do this type of thing?
| yojo wrote:
| Possibly the original data is logically compressed. E.g.
| payer A pays 110% of our standard rates, payer B pays 85% of
| our standard rates. Those two rows could translate into
| thousands of CSV lines depending on the number of procedures.
|
| Maybe you have a couple one off negotiations for high volume
| procedures, but even still the source data could be several
| orders of magnitude smaller than the dumps.
| kderbyma wrote:
| this would be a great social study. cases where technology
| has enabled the racketeering and price gouging by
| corporations with almost no gains in efficiency or output or
| quality or any metric of value.
| acchow wrote:
| They are obviously not computing pricing this way. Their
| pricing system applies rules. But they are dumping every
| possible combination.
| thechao wrote:
| Any time you can convert a problem from an `N x K` problem to
| an `N + K` problem, there's some asshole administrator trying
| to turn an `N + K` problem into an `N x K` problem. It wouldn't
| surprise me if there's huge amounts of redundant information in
| there.
| acchow wrote:
| > In the newly-released data, each "negotiated rate" (or
| simply "price") is associated with a lot of metadata, but it
| boils down to: who's paying, who's getting paid, what they're
| getting paid for, plus some extra fluff to keep track of
| versioning. The hundreds of billions of prices in the dataset
| (probably over a trillion) result from all the possible
| combinations of these things.
|
| They basically denormalized all the dimensions.
|
| Imagine you have a function which takes 5 arguments and
| returns one value. You could give me the source code and let
| me run this function. Or you could give me a mapping of every
| possible combination of the 5 inputs to the returned value.
| The former could be quite small, but the latter would be a
| massive number of rows.
| imoverclocked wrote:
| > You could give me the source code and let me run this
| function
|
| If I understand correctly, in this case, that function's
| source is highly distributed in wetware. It's about as
| closed-source as it gets; nobody has anywhere near the full
| source. Each hospital is its own fiefdom!
| acchow wrote:
| Yeah this is part of the problem.
|
| But even if you had like 10M rows of pricing and then
| gave a 2% discount to entity A, 3% discount to entity B,
| 4% discount to C, etc.
|
| You could publish these discount rules.
|
| Or you could just multiply the 10M rows by the number of
| different entities giving 10*n M rows.
|
| And then let the consumer of the data try to figure out
| the rules from the output...?
| huslage wrote:
| They aren't negotiated individually. They are negotiated
| categorically. They generate individual prices based on some
| discount rate off of a negotiated max.
| coding123 wrote:
| Maybe good, maybe bad. I suspect the good will be lower prices as
| we resolve major conflicting prices for the same service. Maybe
| bad as we find that nurse Jackie is spending too much time taking
| care of your sick husband and that needs to cut back as the
| prices the hospital is negotiating drops. The service will become
| more standardized and robotic.
| jamestimmins wrote:
| Seems like every week there's a new massive scale DB project or
| company getting announced on HN.
|
| If they're looking for projects that create public value and
| demonstrate the power of their products at scale, digitizing this
| and making it searchable may be a good marketing project that's
| appealing to certain kinds of customers.
| sl-dolt wrote:
| Figuring out the size of this data was part of the research
| phase for doing just that: building out that database. I'm
| curious to know if other people are already working on it
| (maybe Turquoise Health?)
| ageitgey wrote:
| Yep, we have built this database at Turquoise Health. I
| agree, the data is massive - and don't forget that it is all
| refreshed monthly!
| JackFr wrote:
| Is that from the hospital side or the insurer side?
| ageitgey wrote:
| We have built databases for both and can compare between
| them.
| withinboredom wrote:
| It's my understanding these prices are negotiated to some
| degree, so it's probably both sides at various times.
| jamestimmins wrote:
| It's cool seeing that Turqoise Health exists. One of my
| first programming projects back in the day (when I was
| trying to get a jr role in 2014) involved building a simple
| version based on data.gov medicare data. The inputs were
| terrible and tiny (e.g. chest pain at hospital X costs
| ~$60k on average across 5 patients), so I was always
| curious what a real world version might look like.
|
| edit: As I reflect, I'm amused to recall that this was
| early enough in my path that I didn't know about DB
| indexes, so I was very proud that I figured out how to
| basically roll my own indexes by pre-sorting the columns by
| lat and lon. I don't remember whether my solution
| _actually_ prevented a full-table scan, but it felt like a
| major breakthrough at the time.
| jamestimmins wrote:
| Very cool. Who do you see as the likely users of that
| database? Is it primarily for researchers/data journalists,
| or is there a commercial value to it?
|
| I'd be very curious to read more about the data cleaning
| phase when you get there. Specifically, how hard it is to
| combine this data and construct good schemas.
| atourgates wrote:
| As someone who's worked on the provider side in different
| capacities, I can tell you that there could be tremendous
| value on the provider side.
|
| It's entirely possible that two surgeons with offices next
| to each other could be getting reimbursed at wildly
| different rates for their most common procedures for their
| most common procedures by the same provider.
|
| If you're that provider, you ABSOLUTELY want to know what
| the surgeon next door is getting paid the next time your
| group is negotiating with the insurance provider.
| bob1029 wrote:
| It would appear us SQLite zealots have encountered the final
| boss.
|
| Petabytes uncompressed would be tricky if you need to slice
| those columns. SQLite caps out at ~281 terabytes of storage
| before it can't track any additional pages.
|
| None of this is to say you couldn't partition the data across a
| lot of SQLite instances in varying ways. I will probably take a
| shot at it this weekend. Looking to see just how unlimited my
| AT&T fiber connection is anyways.
| salawat wrote:
| >It would appear us SQLite zealots have encountered the final
| boss.
|
| Just wait. It's actually a multi-boss fight, since you have
| to wrangle the Pharmacy Benefits Management datasets, plus
| Medispan, plus Medicare, plus all the MedicAid datasets, plus
| VA.
|
| Are you and all your mightiest boxen bad enough dudes to make
| sense of the entire U.S. Healthcare industry?
|
| <Actuary Stormrage in the background>
|
| _You are not prepared!_
| topspin wrote:
| > It would appear us SQLite zealots have encountered the
| final boss.
|
| That's cute. :)
|
| There isn't much value in feeding it all into a conventional
| RDBMS. OLAPs and columnar stores are what is needed here. But
| first it will need a great deal of grooming and ETL work.
| gizmodo59 wrote:
| Yeah.. It would be much easier to copy the data to S3/any
| object storage (better to convert it into a columnar format
| like parquet) and query it directly using a SQL on lake
| engine like Dremio or Athena or S3Select would work too.
| mskar wrote:
| I work in data at https://www.carrumhealth.com/, and I've been
| parsing this data for weeks. The transparency prices allow us to
| meaningfully negotiate with providers, and make tangible,
| incremental progress toward cheaper health care. Providers and
| existing insurance carriers leverage information asymmetry to
| control the market otherwise.
|
| For context, we bundle the 100's of itemized costs into a single,
| static bill per surgery type. In doing so, we've built a custom
| virtual-network with the most efficient surgeons. These surgeons
| are able to meet the volume and quality requirements to allow for
| lower margins. We're able to get negotiated rates that are 10-40%
| cheaper than traditional insurance contracts when we have data
| that we trust.
|
| Unfortunately, this data alone isn't enough to properly determine
| prices because organizations will spread costs across procedure
| and billing codes that often occur in aggregate groups. For
| example, in a joint replacement surgery, some organizations may
| dump the cost into the billing for the implant itself, while
| others may put it under the procedure code. You have to gather
| billing data en masse to see which charges occur together, then
| combine this pricing data to determine what costs will actually
| look like for someone experiencing a procedure.
|
| It's a nightmare!
| riskable wrote:
| How much do you think it costs to maintain all these negotiated
| contracts VS just having a single payer system with the same
| price for all procedures?
| hayst4ck wrote:
| PBS put out a documentary ages ago comparing America to other
| countries. At the time our administrative overhead was 25%
| while Taiwan's overhead was 2%.
| mskar wrote:
| It's very expensive, carriers have an economic incentive to
| simplify it and this is still where they end up. There are a
| long tail of provider circumstances that the single-payer
| model will need to figure out. Some examples:
|
| * Small hospitals in low-density, underserved areas have to
| make up for underutilized equipment and personnel costs. They
| raise prices on unrelated, common procedures to break even
| (This is very common)
|
| * CMS (medicare/medicaid) sets a low price for a procedure
| that's overly common in a particular facility, now that
| facility loses money for each occurrence. They choose other
| procedures to raise the price to try to break even.
|
| * Larger hospitals have higher administrative and operations
| costs (for things like training and research) that benefit
| society, but need to be averaged out across all procedure
| costs. This differs from hospital to hospital.
|
| * Smaller professional facilities or physicians groups (like
| Ambulatory Surgery Centers) have much lower administrative
| costs and a smaller staff, so they have lower overhead per
| procedure. They are designed to be efficient, and can handle
| lower prices. However if there are any major complications,
| they won't be able to service the patient, and have to send
| to a hospital. This then pushes all the highest-cost, ICU-
| type procedures into hospitals, where there is already a
| higher overhead, causing hospitals to need separate pricing
| to cover more complex patients.
|
| A large single payer price set will probably force
| efficiencies into the healthcare system. It'll be great for
| folk's costs, but we may see many facilities close, and lines
| of care will be consolidated into specialty centers. (more
| travel to get imaging, procedures, or to see a specialist)
| narrator wrote:
| What do you think about how Kaiser has handled the whole
| thing? The insurance company employing the doctors and just
| paying them a standard salary seems to create all the right
| incentives.
| drak0n1c wrote:
| Sounds like an application for ML, to determine which codes
| frequently coincide per-patient at each provider and then
| assign those groupings to cross-provider "Treatment XYZ"
| buckets to enable apples-to-apples comparisons.
| mskar wrote:
| Great call, many orgs in health tech use billing/procedure
| code embeddings to group, just like you're suggesting.
| didgetmaster wrote:
| Is the data unique or has it been duplicated for multiple
| formats? In other words is there a CSV file right alongside a
| Json file and an XML file that contains the exact same data,
| just in different formats?
|
| Is the data partitioned at all (e.g. by state) so that you can
| just download the data for California without downloading all
| the data; loading it into a huge database table; and then
| querying it (e.g. SELECT * from <table> WHERE state =
| 'California')?
| mskar wrote:
| There is some duplication, where different networks under the
| same carrier could benefit from normalization, but in-general
| duplication isn't the primary issue.
|
| The data is partitioned for some carriers at the network
| level, but unless that carrier has networks that are unique
| to a given state it's difficult to partition by location.
|
| The majority of the data is lumped into very large, single
| JSON (not newline delimited), so an initial parsing step is
| required to break out substructures for parallel processing
| via warehousing technologies. I think Aetna has a 300Gb
| compressed (single) json file.
|
| After breaking the json to a single array entry per
| provider/network, parsing is still a bit tricky because there
| are some very "hot" keys. Some provider array entries may
| only have 1000 code and cost entries, others may have 100k.
| We've seen array entries >50Mb for a single
| provider/network/carrier.
| planetsprite wrote:
| I wonder what percentage of work in the US healthcare system is
| completely unnecessary from a general perspective but made
| necessary deliberately to justify the unethical system that
| allows millions to die unnecessarily.
| suoduandao2 wrote:
| Judging by the US's price/outcome ratio compared to other
| developed nations, a little over half[1].
|
| [1]https://www.pgpf.org/blog/2022/07/how-does-the-us-
| healthcare...
| ChrisLomont wrote:
| Why that article points out the US spends $12k/capita on
| healthcare the singles out administrative costs at $1k/capita
| while ignoring all the other relevant factors is beyond me.
| They then use the misleading infant mortality stat, ignoring
| that the US considers vastly more babies viable than any
| other country, meaning we try to save infants that other
| countries write off, thus they count against the US when it
| fails, but not against the other countries that don't count
| them as viable. It's a really poor article ignoring important
| nuance in what it presents.
|
| The US pays about twice per nurse or doctor in the system,
| and part of that is because the US pays nearly twice for most
| skilled work. So, to get prices like most other developed
| nations, we would be forced to cut nurse and doctor salaries,
| which would likely lower quality of workers as future workers
| went to more lucrative fields, which would likely lower
| outcomes.
|
| The US can have higher cost or lower quality. How would you
| make this tradeoff?
| kaesar14 wrote:
| Which part of this equation is contributing to hospitals
| charging 50 dollars for a bag of IV fluid? I'd cut that
| part out. Whatever it is.
| geraldwhen wrote:
| That price pays for the parking deck, security, janitors,
| nurses to administer the bag, needle disposal, IT, admin
| salaries, the hospital building itself, etc etc.
|
| An urgent care can probably administer an IV. If that's
| all you need, go there. They are far cheaper and not as
| lavish (or equipped) as hospitals.
| Judgmentality wrote:
| > So, to get prices like most other developed nations, we
| would be forced to cut nurse and doctor salaries, which
| would likely lower quality of workers as future workers
| went to more lucrative fields, which would likely lower
| outcomes.
|
| Why are you ignoring all of the costs that go to people
| besides nurses and doctors? I know very rich people whose
| entire careers are built around selling overpriced products
| to hospitals. These people are leeches that provide no
| value other than profiting off of dumb compliance laws. If
| you can buy the same product at any store for 1/10 the
| price, there is no benefit to requiring it be gatekept by
| people whose sole incentive is squeezing blood from a
| stone.
|
| Get rid of graft. The problem is the system and the
| incentives it creates. US healthcare is dictated primarily
| by insurance companies who care more about maximizing
| profit than providing healthcare.
|
| To fix the system you start with increased transparency,
| then you focus on accountability. Why do we allow such
| blatant corruption? Let's get rid of all the leeches first,
| since they provide no actual value while jacking up prices.
| There are so many areas we can improve results and cut
| costs before we address the salaries of doctors and nurses.
| paulmd wrote:
| > The US pays about twice per nurse or doctor in the
| system, and part of that is because the US pays nearly
| twice for most skilled work.
|
| which is in turn because in the US an average GP comes out
| of medical school with $200k-300k of student debt that has
| to have interest serviced and paid off within some 10-20
| year timespan. That cost ultimately ends up being borne by
| the patient and their insurance.
|
| unfortunately the US is very resistant to the idea of
| education reform in general, very very resistant to student
| debt relief, and very very very resistant to student debt
| relief for "high earners" like doctors and lawyers, even
| when a huge chunk of that earn is going to debt service.
| But there is a shortage of doctors and we're doing
| everything in our power to make the path unattractive for
| new students. And this time the problem isn't even the AMA
| - the AMA agrees there is a problem and is onboard with
| expanding the pipeline... it's just not all that attractive
| a profession anymore when you can make equal/higher
| compensation (after considering the debt) in software or
| other fields.
|
| doctors are still extremely well-paid professionals in
| other countries, but if we tackle the cost of education we
| can get our numbers down much closer to theirs. conversely
| if you push salaries too low then servicing $200-300k of
| student debt won't be realistic and the path becomes even
| less attractive.
|
| medical care is probably the single most complex political
| problem in the US because it's basically at the nexus of
| every single social and political problem we have. doctors
| are too expensive... because they're trucking around a
| quarter million of student loan debt from our shitty
| education system. we spend way too much on end-of-life care
| and not enough on earlier care... because seniors vote. we
| have way too much overhead due to the multi-payer insurance
| system and the market-driven pricing system's overheads...
| and all those insurance companies are huge lobbyists too.
| Drug and device costs are out of control... because the US
| doesn't allow conditioning of regulatory approval on price
| negotiations, or reimportation from other countries, etc.
| It's just every single political problem in the US in a
| single field all at once and every hand is dipping into the
| till as much as they can get away with, and it's
| politically infeasible to slap the hands that are necessary
| to slap to actually get costs reduced.
| jahewson wrote:
| A debt of 1 to 1.5 years salary does not go very far to
| explain why US doctors are paid double what they would be
| in other countries.
|
| The US brought this problem upon itself by cutting
| medical school funding in the 1980s to reduce the number
| of doctors and keep salaries high. That situation
| remained until 2005. Now we have too few doctors, too few
| schools, and a generation that grabbed all the money for
| themselves and is now retiring.
| ChrisLomont wrote:
| > to justify the unethical system that allows millions to die
| unnecessarily
|
| Which people are those millions?
|
| The system saves millions of lives that would have died in
| generations past. How do you factor that into your claim?
| spaetzleesser wrote:
| There are lot of people who don't go to a doctor when they
| should. Even taking an ambulance after an accident is a
| gamble a lot of people can't afford.
| fishtockos wrote:
| Anyone knows if this dump contains drug insurance coverage?
| duffpkg wrote:
| I'm author of Hacking Healthcare for O'Reilly, 20 year health
| system executive, blah, blah.
|
| It's very easy for people to forget the scale of the US "health
| system", we are talking 1/5, maybe more, of the entire US
| economy. If US healthcare spending were a country, it would have
| the third largest GDP in the world. Accidents of history and the
| massive federal beauracracy created the crazy monster of ICD/CPT
| codes that results in the very clumsy way of pricing healthcare
| services that results in this massive matrix of data.
|
| As pointed out elsewhere there is a tremendous amount of cost
| distribution that goes into the code matrix and this plays a
| large role in negotiations with health insurers as well. Ground
| is given in one set of procedures and lost in others.
|
| This is a big step in shining light into areas that need it to
| improve the system overall.
| esotericimpl wrote:
| e_i_pi_2 wrote:
| Do you consider the amount that the US spends per capita on
| healthcare relative to other countries for the same standard of
| care a "failure" of the healthcare industry? Or is there some
| other reason healthcare "just costs more" here?
|
| Also wondering what you think a solution is - single-payer for
| better and simpler price negotiations, or some other approach?
|
| My main concern is if we're spending 20% of GDP on something
| other countries accomplish with 10%, then that's a huge waste,
| especially in a country with a larger total GDP pool.
| medlazik wrote:
| As with everything it touches, it's the intrinsic failure of
| capitalism (ofc success for the capitalists / bourgeoisie).
| It's the amount of capitalism that defines prices. In every
| other country the more healthcare is a public matter, the
| cheaper it is for the people.
| gwright wrote:
| Healthcare in the US is definitely _not_ driven by the free
| market. It is probably one of the _most_ regulated
| industries. Whatever disfunction you want to call out in US
| healthcare it is going to be difficult to pin that on the
| free market.
| medlazik wrote:
| Free market? Capitalism. I know we're on HN but, say the
| word? Capitalists take a cut. Shareholders of big pharma,
| insurance companies and hospitals are why healthcare in
| the US is expensive. Public sector not being monopolistic
| is why healthcare in the US is expensive. In France,
| social security reimburses about 70% of most costs. Cheap
| private insurance reimburses the rest. About 75% of
| public hospitals and not for profit. Generic medicine
| being prescribed is the norm. The state _naturally_ fixes
| healthcare prices because it 's monopolistic on
| healthcare. Same as all public services.
| a-user-you-like wrote:
| Non free market? Communism. I know we're on HN but, say
| the word?
|
| Of course the US market is highly regulated and so the
| market is not free to lower prices. Of course the AMA is
| a racket. Of course needs of certificate are abhorrent.
|
| Given the customer non--coerced access to his preferred
| provider, and not taking his money and slapping a bunch
| of regulations on him will of course lower prices and
| give him better care.
|
| I don't see why the other side can't see it.
| medlazik wrote:
| That's right, communism. Social security in France is
| _literally_ a communist system, founded by a communist
| minister. Hence why neoliberals want to destroy it.
| brightball wrote:
| I've heard a lot of complaints about Medicare/Medicaid. It
| does not inspire confidence in single payer.
| duffpkg wrote:
| Healthcare is such a base layer of the economy, I find
| comparisons to be extraordinaly difficult between countries.
| On the most basic level our pathway to becoming a healthcare
| provider of all sorts is dramatically more expensive and
| limited than other countries, what healthcare providers are
| paid is dramatically more than other countries, we invest
| many times per capita what other countries put into basic
| medical research, the way are population is taxed is very
| different than other countries, our patient population is
| very different from other countries, our expectations are
| very different from other countries, our scale is
| dramatically different than other countries, and so on. The
| US is a singular animal politically in that it is a compact
| of individual states that especially in regards to
| healthcare, the federal goverments powers (though it may not
| seem so at times) are actually quite limited. It's all but
| impossible to come up with reasonable numerators and
| denominators for comparison.
| anonymouse008 wrote:
| > Healthcare is such a base layer of the economy
|
| Academically this sounds enlightening, but it only takes
| one cursory walk around a supermarket in the US to see this
| is unequivocally false. Healthcare is an externality, not a
| base of anything. From the average customer to the product
| in the aisle to the marketing - everything is 100% not a
| direct cost benefit function in terms of healthcare.
| skybrian wrote:
| I'm not sure what that proves, given that you went to a
| grocery store instead of a pharmacy.
| tbihl wrote:
| I'm guessing parent was saying that most medical spending
| is payback for terrible US American eating habits?
| rgrieselhuber wrote:
| And add on top the oft-repeated that "health insurance is
| healthcare." That's how you obfuscate a whole of things.
| e_i_pi_2 wrote:
| My current assumption is that private healthcare/insurance is
| to blame, because countries without that or with less
| generally have better outcomes at less cost. Looking for
| evidence to the contrary
| coredog64 wrote:
| As two quick examples, both Switzerland and France have
| private healthcare providers and insurers. I think that's
| enough to falsify your assumption :)
| simonw wrote:
| Those countries both have "less generally" than the USA.
| e_i_pi_2 wrote:
| I don't think that disproves a general trend that
| increased socialization in healthcare costs leads to
| better outcomes and less per-capita spending.
|
| Also FWIW France and Switzerland both have universal
| healthcare, under different systems where France splits
| payments 3 ways and covers more with the govt[1], and
| Switzerland seems to have a system like the ACA in the US
| where it's compulsory, but they also set caps on the
| deductibles and maximum price.
|
| [1]: https://en.wikipedia.org/wiki/Health_care_in_France
|
| [2]:
| https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
| bhupy wrote:
| It's not just Switzerland and France; the Netherlands
| also has a private-only health insurance system. It's
| also very difficult to draw decisive conclusions since,
| across countries, there are hundreds of confounding
| variables -- it's not just public vs private, but it's
| also which regulations exist in each country, whether
| it's employer-sponsored vs individual, general
| willingness to pay, etc. You're correct that Switzerland
| has a system like the ACA in the US, but the biggest
| difference is that it's not common for the Swiss to get
| their private insurance from their employers; it's all on
| the individual market. The US is actually unique in that
| regard, and is probably the most significant difference
| -- the vast majority of working age adults in the US get
| their insurance from their employers, and as a result the
| ACA's individual market has been in a dire state since
| the program's inception.
|
| Also "socialization" is very different from
| "nationalization". The general trend you're talking about
| is more to do with the fact that having society
| _subsidize_ healthcare for the poor can lead to better
| outcomes. As it relates to who actually does the
| insuring, underwriting, and payment (public vs private),
| one isn 't necessarily better than the other; each has
| its trade-offs. It's just that the US (in particular) has
| chosen the worst of both worlds.
|
| I work in this industry, and from where I sit, the
| closest thing we have to a clean A/B test that controls
| for all of those confounding variables is actually being
| run in the US right now, with Medicare. 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.
|
| - 48% 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 the CBO projects that by 2023,
| the majority of beneficiaries with choose the private
| over the public option. The CBO further projects this
| proportion to increase to 61%(!!) by 2032.
| (https://www.kff.org/medicare/issue-brief/medicare-
| advantage-...)
|
| - For most beneficiaries, Medicare Advantage costs about
| 40% less than Original Medicare and are, on average, of
| higher quality than 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...)
|
| So no, you cannot look the cost difference between the US
| and other countries and simply conclude that it's because
| of private insurance, because the actual data tells a
| different story. And "universal healthcare" is not the
| same as "public" healthcare. It might help to think about
| it this way: universal access to food can be achieved
| without nationalizing the food industry, or the food
| payment industry.
| PaulDavisThe1st wrote:
| From medicare.gov:
|
| > Medicare Advantage Plans are another way to get your
| Medicare Part A and Part B coverage. Medicare Advantage
| Plans, sometimes called "Part C" or "MA Plans," are
| offered by Medicare-approved private companies that _must
| follow rules set by Medicare._ (emphasis added)
|
| Those rules are, IIUC, substantively different than the
| ones that cover the non-medicare private insurance
| industry, and as a result I'm not sure what any of the
| (true) facts that you've quoted really mean in the
| context of the questions being asked here.
|
| Also, from reading up about MA, it would seem that MA is
| operating on the "HMO" (health maintainance organization)
| model that started to be touted in the 1990s. AFAIK, the
| HMO model has not done much to contain consts in the
| broader US private health insurance world. It would be
| interesting to know if it is specifically the combination
| of the HMO model and Medicare rules that has allowed MA
| to apparently work better than OM.
| bhupy wrote:
| I actually work in this industry and adjust claims myself
| from time to time, so I love talking about this stuff!
|
| > that must follow rules set by Medicare. (emphasis
| added)
|
| Yeah, I'm not sure that anyone seriously believes that
| insurance companies should operate in a 100% unregulated
| fashion. Even the US's food industry (which is
| predominately privatized) is regulated in some capacity.
| The argument is whether _regulated private insurance_ can
| deliver good outcomes. That is very much the case, as
| evidenced by Switzerland, the Netherlands, and Medicare
| Advantage.
|
| > Those rules are, IIUC, substantively different than the
| ones that cover the non-medicare private insurance
| industry, and as a result I'm not sure what any of the
| (true) facts that you've quoted really mean in the
| context of the questions being asked here.
|
| First of all, the non-Medicare private insurance industry
| is _heavily regulated_ , often more so than Medicare
| Advantage private insurers. In fact, you raise an
| important point: it's important to consider _which
| specific regulations_ are helping and which are hurting.
| Outside of Medicare Advantage, there are regulations that
| strictly control insurance company 's profit margins, how
| much of premiums can be spent on collecting medical
| claims (see: the 80/20 rule and Medical Loss Ratio
| rules), the fact that every beneficiary must be treated
| exactly the same (ERISA, parts of ACA), a minimum amount
| of coverage required (the ACA added this), the employer
| mandate (ACA), etc.
|
| To give you a sense for some of the unintended
| consequences that have been created by regulations on
| non-Medicare Advantage health insurance plans, due to
| Federal mandates and tax incentives, health insurance is
| predominately provided by employers rather than the
| individual market (unlike Switzerland, Germany, or the
| Netherlands). 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. A big reason for
| this is that employers (especially medium-to-large
| businesses) have a much higher purchasing power (and
| hence, willingness to pay) than individuals. If you take
| this behavior and combine it with the fact that health
| insurers' profit margins are capped by law, insurers pay
| more absolute dollars 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
| increased prices.
|
| This cocktail of regulations does not exist for Medicare
| Advantage insurers -- even though they are still
| regulated in different ways. That's a very important
| distinction. Currently, Medicare Advantage insurers are
| allowed to return 50 percent to 70 percent of any cost
| savings to beneficiaries in the form of reduced premiums
| or expanded benefits -- whereas with employer-sponsored
| insurance, even if such cost savings existed, they would
| accrue to employers (unbeknownst to worker beneficiaries)
| -- and that's assuming there are cost savings for
| employers; there aren't, due to the aforementioned
| regulatory concoction. A big part of why Medicare
| Advantage actually works really well is because it's
| effectively a basic income for health insurance, it's
| just that individuals are empowered to use those dollars
| to buy whichever healthcare plan meets their needs
| (including a public option), as opposed to being forced
| to choose among a small selection of plans curated by an
| employer.
|
| > Also, from reading up about MA, it would seem that MA
| is operating on the "HMO" (health maintainance
| organization) model that started to be touted in the
| 1990s. AFAIK, the HMO model has not done much to contain
| consts in the broader US private health insurance world.
| It would be interesting to know if it is specifically the
| combination of the HMO model and Medicare rules that has
| allowed MA to apparently work better than OM.
|
| Medicare Advantage plans can both be HMOs as well as PPOs
| (https://www.medicare.gov/types-of-medicare-health-
| plans/pref...), it's just that _there happen to be_ many
| MA plans that are HMOs. HMOs can have very good outcomes
| with significant cost savings (think of the pre-2010 UK
| NHS as a public HMO), but can also have bad outcomes if
| managed poorly (think of the 2022 NHS or US 's VA as
| poorly managed public HMOs). With Medicare Advantage,
| seniors have the option to choose.
| nicoburns wrote:
| The obvious regulation which almost every other country
| has is direct price controls on medicines, treatments
| etc. Not profit percentage controls. A dead simple "this
| is how much you're allowed to charge".
|
| I don't really understand why anybody would be against
| introducing this in the US.
| bhupy wrote:
| It is not so obvious at all. Medicare Advantage does not
| have price controls, and it still costs less per capita
| than Original Medicare.
|
| > A dead simple "this is how much you're allowed to
| charge".
|
| This has its own set of unintended consequences,
| including physician rationing (it's a huge crisis of the
| NHS right now), and a reduction of investment in new
| medical research. There are _many good reasons_ to be
| against introducing this in the US.
|
| Switzerland does not have price controls on medicines,
| treatments, etc. and the reason why it is so often cited
| is because it enjoys a comparable level of healthcare
| innovation to the US while still ensuring universal
| access (through its ACA-like subsidies). It also costs a
| lot per capita (among the highest in the OECD), but it
| actually gets what it pays for
| (https://pubmed.ncbi.nlm.nih.gov/26766626/)
| (https://www.theweek.in/news/world/2022/05/07/7-reasons-
| why-s...)
|
| In fact, of the countries that usually make up the global
| leaders in health/medical innovators, all but 1 (the UK)
| engage in price controls
| (https://immigrantinvest.com/insider/the-best-healthcare-
| coun...), and the UK's NHS is suffering from a rationing
| crisis, and (ironically) a cost crisis.
| JumpCrisscross wrote:
| > _France and Switzerland both have universal healthcare_
|
| You said private healthcare/insurance were to blame.
| Switzerland has private health insurance.
|
| Universal healthcare is a separate goal post. For what
| it's worth, I'm unclear its comprehensive iteration is
| compatible with America's immigration model. (It
| absolutely is for life-saving measures.)
| ggrrhh_ta wrote:
| Switzerland has very strictly and non-deniable obligatory
| minimum (very broad in coverage) insurance, with
| regulated yearly price adjustments and on top of that,
| publicly funded hospitals and clinics (mostly
| unprofitable but of high quality and offering treatments
| that would not be profitable for private hospitals) that
| issue their bills to the health insurances. And, to put
| the icing on the cake, there are treatments and
| operations (e.g. congenital defects and invalidity-
| related) that are directly billed to the public social
| insurance (funded by salary deductions) to help health
| insurances reduce their risk.
|
| Switzerland's compulsory private health insurance is
| nothing comparable to other countries' private insurance.
| There is "additional private insurance" in Switzerland
| (covering alternative medicine treatments, access to
| single bed rooms in hospitals, etc.) which do operate as
| private insurances elsewhere.
| PaulDavisThe1st wrote:
| What aspect of America's immigration model do you think
| intersects with this?
|
| > You said private healthcare/insurance were to blame.
| Switzerland has private health insurance.
|
| Private business in all western countries operates within
| the regulations and laws that cover them. The health
| insurance industry in Switzerland operates under a very
| different set of regulations and laws than the same
| industry in the USA. If you want to blame the OP for not
| being more explicit - "private healthcare/insurance and
| the regulatory framework are to blame" - then fine, but
| ... this is actually the crux of the issue.
| JumpCrisscross wrote:
| > _but ... this is actually the crux of the issue_
|
| I'm not sure it is. Universal healthcare is orthogonal to
| private health insurance. That's the lesson of
| Switzerland's example. I don't believe this is commonly
| known or accepted in American politics. Instead, any
| attempt at reform is pitched and vilified as an attempt
| to end private health insurance.e
| bhupy wrote:
| Not sure why you're getting downvoted, but this is
| exactly correct. Universal healthcare != public
| healthcare.
| e_i_pi_2 wrote:
| Ah good catch I was moving the goalposts there - I think
| in my head public and universal and basically
| interchangeable - if everyone has it is it a public good
| regardless of if it's provided by a collection of
| "private" companies
| pessimizer wrote:
| > countries without that or with less generally have better
| outcomes at less cost.
|
| This isn't necessarily a great metric, because almost all
| countries have better outcomes and all countries have lower
| per capita cost, whether their systems are public, private,
| or mixed. The US spends more _public_ funds on healthcare
| than countries with universal socialized health care
| systems. The fact that we 're also personally bankrupted
| after spending the same tax proportion on healthcare is
| just a bonus.
|
| It's not specifically private healthcare or insurance
| that's the problem, it's the specific corruption of the
| people who own the healthcare industry and their
| legislators.
| mikem170 wrote:
| Across the board price controls seem to be a common to the
| various European health care systems. It is my
| understanding that upper limits are set for the cost of
| medicine.
|
| There is quite a bit of variety across Europe - U.K. is
| 100% government run, France is a public/private mix,
| Germany is similar to Obamacare in some ways, others are
| single payer, apparently some are private, also. But I've
| read that they all have cost controls.
| Barrin92 wrote:
| beyond Europe as well. Singapore which has exceptionally
| low healthcare spending (5.9% of GDP) heavily controls
| prices and purchases down to individual equipment in
| hospitals.
| rayiner wrote:
| Most countries have private healthcare (meaning private
| providers). Many others have a mix of for profit and non
| profit insurance companies. There's not a whole lot of
| difference between Obamacare and say the system in say the
| Netherlands, Switzerland, or Japan. Those are also
| "individual mandate" systems.
| spaetzleesser wrote:
| Number one is full price transparency of the whole chain. I
| work for a medical device company and even the marketing
| people can't really tell what our stuff costs. There are a
| ton of middlemen with obscure contracts and very high
| markups. My ex got one of our devices and I was told by our
| people that the hospital should have received the device for
| between 20k-30k (nobody seems to really know) and the
| hospital charged 80k for the device alone. They also charged
| another 200k for a one hour surgery with a total hospital
| stay of six hours.
|
| It's also hard to explain that US patients pay a multiple of
| the drug price people in other parts of the world pay for the
| something.
|
| The problem is that if the US wastes 10% of GDP on health
| care inefficiencies this creates a huge lobby that will fight
| tooth and mail to keep that money.
| linkdink wrote:
| In your opinion, what would be the lowest hanging fruit that
| could be changed to have the largest positive impact?
| duffpkg wrote:
| People are rarely satisfied with this answer but its
| demonstrably true and was proven time and time again at the
| facilities ClearHealth managed.
|
| 1) Feverent, almost religious, adherence to hand washing. 2)
| No neck ties or dangly sleves whatsoever in buildings that
| house patients. 3) Change from stainless steel hardware for
| doors and travel touch surfaces back to "brass/copper".
|
| Those are simple, virtually free, things that have a very
| meaningful impact on outcomes. Some of the most viscous
| fights I've had with hospital boards were over what amounted
| to the "uglier look" of copper/brass.
|
| It is an extremely unpopular topic in healthcare but the area
| that takes a lot of effort to solve but also has a
| tremendously out-weighted benefit is reducing preventable
| medical errors. My opinion after being in healthcare ~20
| years is that preventable medical error is absolutely in the
| top 3 causes of death in the US. The easiest subset of it to
| resolve is prescription related errors, we have all the tools
| to resolve those but not the will.
| linkdink wrote:
| Well, I'm satisfied with that answer. But maybe that's
| because I think brass and copper look better than stainless
| steel.
| BitwiseFool wrote:
| >"3) Change from stainless steel hardware for doors and
| travel touch surfaces back to "brass/copper".
|
| Because of the pandemic I started encountering doors that
| have a shoe pull, where you can use your foot to open the
| door instead of having to touch the handle. I really hope
| these catch on, but they are still quite rare.
| snuxoll wrote:
| Also stop getting rid of paper towels if you still have
| manual faucets. Nothing grosses me out more than going to
| a public restroom with only air dryers, but manually
| operated faucets that now require you use clean hands to
| turn off after you turned them on with presumably dirty
| hands.
| hyperbole wrote:
| This seems very much like the episode of Veep'Boxes of lies'
| where they try to hide their nefarious deeds alongside the real
| day to day inter-workings of the vice presidents office but
| inundating the public with data.
| anigbrowl wrote:
| This is a common strategy in litigation as well - if someone
| complains that you have pricked them with a needle, dump
| haystacks on your opponent's doorstep while also insisting on
| your right to a speedy trial.
| Titan2189 wrote:
| Someone with the right connections should call up Google Cloud
| and ask them to ingest the data into BigQuery as an example
| dataset like the NY taxi trips. It would be a great way for them
| to show off the capabilities of the engine and helpful for
| everyone wanting to do analysis on it.
|
| https://cloud.google.com/bigquery/public-data
| inetknght wrote:
| You want to _encourage_ Google to own more health data?
|
| Sorry, I think that idea is bonkers. Google already "owns" way
| too much data.
| franga2000 wrote:
| Who said anything about owning it? Just making it available
| for processing through their platform too.
| CobrastanJorji wrote:
| Sometimes people do a thing where they see certain keywords
| in combination and reflexively respond without regard to the
| meaning those words are expressing. For example, it's what
| happens if I use a word like "welfare" near that one uncle at
| Thanksgiving. The signature feature is a very strong negative
| reaction but with content that doesn't seem related to what
| the previous person was saying, except that it involves
| certain keywords.
|
| I think that's maybe what happened here. You saw "Google,"
| "data," and "ingest," and your sentiment analysis report came
| back positive, and it triggered a response.
| nojito wrote:
| This data is already available cleaned here.
|
| https://turquoise.health/
| JackFr wrote:
| I think that's hospitals not insurers.
| sl-dolt wrote:
| I know it's not in the business interest of Turquoise Health,
| but I'd like to see that data be downloadable. There's a lot of
| insight sitting in the data.
|
| This blog was a feasibility analysis to see what kind of work
| it would take to get that data. If we do get it, we plan on
| making it free to download.
| metadat wrote:
| Where is the raw 50-100TB of compressed data available for
| download?
|
| Is it fully public or does it require registration to access?
| sl-dolt wrote:
| It's all fully public. Here are some tools that will get you
| the negotiated rates links along with the sizes of all the
| files: https://github.com/alecstein/transparency-in-coverage-
| filesi...
|
| This won't get you all of the insurers, but it'll get you a a
| few of the major ones.
|
| If you want links to the files of more insurers, here's a
| project from one of my friends at Postman:
| https://github.com/postman-open-technologies/us-cms-price-tr...
| thelastgallon wrote:
| I wonder what their egress bill will be if a large number of
| people are interesting in parsing this data.
| daniel-cussen wrote:
| Yeah the whole SaaS breaks expectations as far as using a
| server.
| cwillu wrote:
| Unrelated: "dolt" vs "doIt" is one of my standard font competence
| tests
| salawat wrote:
| dolt vs do<capital>I<\capital>t you mean?
| cwillu wrote:
| No, do<lowercase>l</lowercase>t vs doIt.
| RhodesianHunter wrote:
| Anyone else get the feeling this is malicious compliance on
| behalf of the insurance companies?
|
| "Oh, they're going to force us to publish our prices are they?
| Well we'll publish so much data it'll take a herculean effort to
| make it readable to anyone that doesn't work in data engineering"
| spaetzleesser wrote:
| They may have that thought but crunching large amounts of data
| is not exactly hard these days. Better too much than too little
| data.
| geraldwhen wrote:
| There are a lot of billing codes. It's not as simple as you
| hope. A giant csv export is easy enough to process and
| synthesize for normies.
| outside1234 wrote:
| Oh totally. It also probably is the formats they already had --
| so they just dumped them into a file -- versus making something
| more orthogonal and ergonomic.
| sl-dolt wrote:
| I'm not sure what format they store their records in, but I
| have a hunch it's a lot more structured than what we see in
| the CSV files. The data dumps have to comply with some CMS
| guidelines set out here: https://github.com/CMSgov/price-
| transparency-guide
| kube-system wrote:
| They use relational databases. Then a zillion ETLs to
| massage that data into every format they need it in, of
| which this is one of them.
| teeray wrote:
| Just be glad the lawyers didn't make the prices exclusively
| available via the traditional UHaul full of Banker's Boxes.
| axus wrote:
| The article mentioned CSV files, it seems more like a
| reflection of what a huge bureaucracy the US healthcare system
| is. I liked their suggestion that the government should have
| created the database as part of the law, done the processing on
| the raw data, and made it more accessible.
| orangepurple wrote:
| import a CSV into Postgres with
| open(filepath) as fd: first_line = fd.readline()
| cols = [] for col in
| first_line.strip().split(','): col2 =
| f'''"{col.strip('"')}" text'''
| cols.append(col2) cols2 = ','.join(cols)
| print(f"create table {table_name} ({cols2});")
| print(f"\copy {table_name} from '{filepath}' csv header;")
|
| this variant will ingest whatever trash is in your CSV fields
| as-is (cast & cleanup later)
|
| run the output in a psql instance connected to your db
|
| (important note: \copy is a psql client command and it is
| critical to use \copy instead of COPY in many cases where the
| server process may not have the permission to read your CSV
| file. with \copy you can read any file the user that launched
| psql client has permission to read. to make things more
| confusing it is indeed possible to stream stdin through psql
| but you use the regular COPY for that instead of \copy)
| [deleted]
| lumost wrote:
| meh, I'd prefer the raw data. We can always create DBs out of
| the raw data, we can always link data. Handling this after
| the fact would be impossible.
|
| Linking a few trillion records doesn't seem that difficult.
| It should be doable with a good data warehouse and a
| reasonable entity linking model. I suspect that we'll find
| more than a few instances of fraudulent behavior once the
| data is linked.
|
| My father was nearly pushed into ~2 Million dollars worth of
| brain surgery that was unnecessary. Not only was the
| procedure unnecessary, the price for it was >5X what a top-3
| hospital would have charged. I only became privy to this once
| I pushed him to come to Mass General Hospital (MGH) for a
| second opinion. The surgeon we saw at MGH also believed the
| suggested procedure to be dangerous.
|
| I wonder if it's possible to cross-reference
| mortality/complication rates with prices...
| daniel-cussen wrote:
| jjulius wrote:
| ... what in the blue hell...?
| vxNsr wrote:
| Most likely a poor ai attempt.
| 1MachineElf wrote:
| From the user's "about" section:
|
| _Perhaps you 'll think my comments are unthinkable. My
| only response to that is that they were legibly written,
| not by a machine, but by a writer with a soul._
| jjulius wrote:
| Yeah, it's unclear to me. A lot of the more personal
| things that are mentioned throughout the account's posts
| seem to match up with some of the quickly-googleable
| details that can be found just via their username. I
| suppose that it could be baked into the AI, but... /shrug
| secondcoming wrote:
| So I should never visit a doctor in Chile?
| A4ET8a8uTh0 wrote:
| In their defense, if it was anything but CSV files, they
| would be accused of making it too complicated/locking into
| proprietary formats and so on. I can't say CSV would be my
| first choice, but I don't really want to think what the
| alternative would be.
| Victerius wrote:
| Millions of .xlsx files
| easrng wrote:
| NDJSON? Sqlite?
| carabiner wrote:
| lol, have you ever worked with data from a non-tech company?
| This is probably the best they have, even inside the company.
| watwut wrote:
| Can confirm. Also, it is not better in tech companies, they
| just have the same data in higher variety of formats and
| storage systems.
| mesozoic wrote:
| Say someone ingests this data and clean it up make it usable,
| who's the customer for that service? What would they want to know
| from it?
| dvaun wrote:
| I think that there is opportunity for some neat visualizations
| with map overlays, average costs of various categories of
| procedures, etc. As for the customer, I wouldn't know.
| 55555 wrote:
| I want to be able to visit a website, select my hospital, the
| procedure, and my insurance, and see what it will cost. Next to
| the result, please show me how much the same procedure would
| cost with the same insurance at other hospitals near my
| location.
|
| You will literally save American lives.
| muhammadusman wrote:
| Turqoise health kinda does this now, not as robust yet but I
| have been using it to check out prices. Hopefully, your use
| case becomes a reality soon.
| llanowarelves wrote:
| Restoring sanity and making it like any other product or
| service.
| sp332 wrote:
| A patient wants to know how much a procedure will cost. Now the
| hospital can look up that data, since apparently (from
| experience, not hyperbole) no one who works there actually
| knows.
| bravura wrote:
| Could we rename the title to: "Health insurers just published
| close to a trillion hospital prices"
|
| This post is lot more interesting and important than the current
| short title would suggest.
| anigbrowl wrote:
| Seconded
| dang wrote:
| Sure.
| intrasight wrote:
| Seems crazy that SEC rules require structured data but these
| health accounting rules did not. I guess health care has better
| lobbyists.
| nimbius wrote:
| this disclosure was spurned by recent federal legislation that
| required it. Im a full cynic on the disclosure, so be warned.
|
| - these prices, as negotiated between insurers and providers,
| were already well known inside the industry. so much so that many
| procedures could be declined coverage well in advance of a
| customer ever needing one. this insider knowledge formed the core
| of many earnings reports for insurers and hospitals alike,
|
| - Disclosure is meaningless if the customer has no alternative.
| most health services that bankrupt are emergency medicine, and as
| such youll pay anything to save your own life. thrusting a stack
| of price sheets at a faceless national healthcare monopoly and
| demanding a fair price is a laughable if not sad idea. Healthcare
| is not something capitalism is equipped to competently support.
|
| - hospitals have zero incentive to work with you on any price for
| any service, and no federal state or local law will compel them
| to do so by virtue of a combination of bureaucratic deadlock and
| regulatory capture. is it, for them, more profitable to sell your
| arbitrary debt to a credit collection agency? shove you into a
| debt counseling service they get kickbacks from? work a long and
| grueling payment plan through their own financial services
| division to bolster quarterly profit long-term in a recession? or
| just ignore your pleas entirely? what they charge is not up for
| debate by _you._
| xtracto wrote:
| For profit Health insurance is a scam.
|
| It's like if you signed a contract to pay Netflix a monthly fee
| to _eventually_ watch a movie, and for some reason Netflix
| profit would be based on _you watching as little as possible_.
| They would do all in their power to minimize the amount of
| content you could really watch. Unaligned objectives. And the
| problem is that unlike Netflix, Health Insurance (at least in
| the USA) is inelastic: You MUST pay for it.
| TimTheTinker wrote:
| I would _love_ to hear from an insider on what the difference is
| between these published files and the internal databases - I 'm
| sure the difference between the two is striking. Malicious
| compliance, indeed.
| bottlepalm wrote:
| This is the real solution to healthcare costs and quality.
| Instead of the government handing hospitals a blank check for low
| quality services in a single payer scenario, we allow price
| transparency, competition and the free market to drive down costs
| and increase quality. Hate him if you want, but this was a huge
| accomplishment by Trump that has just started to take effect.
|
| If you think the government can bring down the cost of anything
| please see education and NASA for great examples.
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