How on earth can you think a free market solution is appropriate for emergency medical care? For elective procedures, sure. For the ER? How do you expect the consumer to have perfect knowledge, rationality and freedom of choice in that scenario?
If your kid is gushing blood, you call an ambulance to take them wherever they can get patched up the fastest. To expect someone to shop around until they find an equilibrium between supply and demand in that situation is ludicrous. It is absolutely the role of government to provide a safety net in these situations.
Source: I live in a first-world country and thus have universal health care.
+1 If you priced it like an airline, you'd have dynamic pricing models to obfuscate the fact that you are ~front-running clients based on their route-inquiry history (& cookies)!
At the nursing stations on every floor of a “not for profit Health Care Ministry” hospital that I regularly deliver patients to, and take from them, in front of every terminal, is the following motto:
Nice dig disingenuously implying the US isn't a first world country, it is of course the very definition of one. The term also doesn't relate to economic development. Anyway, even some developing countries have universal healthcare, e.g. Cuba.
It was definitely a dig, but I don't think he was seriously implying the US isn't a first world country. I think the frustration stems from the fact that the US is the most obvious example of a first world country, and yet still hasn't figured out how to provide cost-effective and universally available healthcare to its citizens.
The commenter is making a perfectly apt joke about the state of healthcare in the US, as exemplified in the linked article. It is indeed a "nice dig" because it's sadly true, and Americans should all know it.
> How on earth can you think a free market solution is appropriate for emergency medical care?
You could say the same thing about funeral services.
Yet it is a free market. And it works well. Because people buy plots ahead of time and negotiate services well in advance.
Nothing is stopping you from walking into an emergency room at your local hospital and negotiating a fair hourly or daily rate for care.
Well, nothing except them looking at you like you belong at a loony bin because why should anybody give a shit what things cost? Insurance pays for everything! Until it doesn't.
What a wonderful world we live in, where we don't need to worry about what something costs ... until your premium is thousands per month and you run to some halfwit politician to fix it. I would laugh, but I know many are crying right now, trying to make Obama's website work for them.
> You could say the same thing about funeral services. Yet it is a free market. And it works well. Because people buy plots ahead of time and negotiate services well in advance.
Well, except that when I die, my corpse only goes one place: the ground or the incinerator. And, as an added bonus, I get to choose that destination in advance. Oh, for the joys of only ever potentially needing emergency (or even urgent) care in a single location.
> Nothing is stopping you from walking into an emergency room at your local hospital and negotiating a fair hourly or daily rate for care.
I'm pretty sure that this is called insurance.
> until your premium is thousands per month and you run to some halfwit politician to fix it.
Or until you buy insurance on the open, free market and then have that insurance canceled for some obscure reason usually related to your suddenly becoming too expensive for your insurance carrier. Or knowing in advance that actually going to the doctor for that pain in your side will mark you as having a preexisting condition (even if the insurance doesn't pay for it and never even sees a bill) thus previously making you uninsurable or only able to receive coverage for a staggeringly high premium.
I could go on but I don't want to bore you with my real life tales of navigating our so-called health care system.
I would laugh, but I know many are crying right now, trying to make Obama's website work for them.
It's not as if the private insurance system that existed before Obama came to office was working especially well. While I agree that Obamacare's rollout has been a big mess, from the way some people talk you'd think insurers had never raised premiums or dropped people from coverage until last October. I'm guessing that a few years from now the bumps in rolling out Obamacare are going to be no more memorable than the bumps in rolling out Medicare ~50 years ago.
> I'm guessing that a few years from now the bumps in rolling out Obamacare are going to be no more memorable than the bumps in rolling out Medicare ~50 years ago.
Yes, of course. By that point, they would have gotten used to the incompetence and stupidity, fully expecting it.
Based on your reply, I can surmise that you haven't even tried to use the system and sign up for a plan.
No, I'm happy to acknowledge it doesn't work well at the moment - which is why I mentioned the problems in the first place. However, I also expect it to improve in response to consumer demand.
Oh but that's the point! If you can plan it in advance, the free market solution may actually be appropriate. You have time to shop around, compare providers, etc. Whether it's necessary or not isn't the issue, just the time that you have to plan.
Emergency calls dispatched to competing ambulance/hospitals.
Competing emergency dispatch services, say 911, 922, 933,...
Customized emergency dispatch services - We'll have a life flight helicopter on call for only $99 a month!
Plus any ideas from millions of people looking out for their best interests.
Everything old is new again! We could have rival ambulance gangs battling to take custody of an unconscious patient, just like the New York fire crews of the 1800s. [1]
This seems like "in the long run" eventually-we'll-get-to-933-then-everything-will-be-better thinking, and if so it lies at the root of the problem: market forces are non-stationary, making equilibrium-based-reasoning necessarily flawed. Most of those who work all day every day selling X have consistently been able to develop and exploit profitable inefficiencies more quickly than the market can correct them. As such, the success of such proposed free-market solutions depends on the particulars of how the system's higher-level dynamics are parameterized. In other words, naive deregulation and free-market-introduction will not reliably improve things, and could make (/definitely have made) things much much worse.
Just as there's no communist utopia, there's no laissez-faire promised land.
No, no, no, please don't promote the idea that having multiple numbers is a good thing. Coming from Brazil where such thing is the case, I can tell you the moment you have multiple numbers people have no clue what number to call on an emergency.
We need price caps for emergency care. Limiting prices to a small multiple of Medicare rates should solve the problem. Private providers can operate with price limits. Look at private electric utilities as an example. I'd like to see a price cap proposition at a future California election. I think it would pass.
When we (note: "we" is defined as the set of individuals located on plant Earth who are legally able to cast a vote in the political unit known as the United States of America) can have an ideological disagreement on the role of government that no longer includes one major participant in the debate being able to effect that participant's desired outcome (little-to-no government) by simply standing on the side and refusing to debate, I think we'll then be ready to debate the relative merits of the system we currently have versus any other system in the world.
And yet, almost undoubtedly, his presumably socialist nanny-state government is providing an equivalent standard of healthcare for a fraction of the cost and complexity. Sign me up!
Wow. That ideology you've got there is impressive, especially considering your current system either kills people who can't afford it, or bankrupts them. Any universal healthcare is the wrong system? Laughable.
I had a panic attack in the beginning of the year which lead to severe PVCs in my heart. I freaked out and thought I was about to have a heart attack, so I decided to go to the ER. They hooked me up on an EKG and told me I was OK and that it was just anxiety. After more than an hour of monitoring and a few blood tests, they let me go home.
A few days later a $4K bill came through the mail :(
I'm appalled by the cost of health care in the US. For routine stuff the level of treatment and the expertise of doctors is not different than in Brazil, where I come from, but here I pay orders of magnitude more than I used to pay there. Health care here is so expensive that my wife said the other day that next year she's doing all her medical exams when she goes to Brazil.
What is the reason for such absurd prices in the US?
Had the exact same thing happen except my bill was only for $1800 after insurance.
The kicker was that when I called the insurance company to ask about the cost they told me that it was unknowable in advance because they have rates negotiated with each hospital individually. When I asked if there was any way to estimate my out of pocket expense of if there was any cap they told me no.
So, there's literally no way to know what it's going to cost, at least with blue cross, because the rates are negotiated on a per facility basis and not public.
"Administrative costs of running our health care system are astronomical...Duke University Hospital has 900 hospital beds and 1,300 billing clerks. The typical Canadian hospital has a handful of billing clerks."
> Orla’s forehead was sealed with a dab of skin glue for $1,696.
On Reddit, where this stuff is discussed more, I just urge people if they can get away with it (they are conscious and can hide their wallet, for ex), to just give them a fake name. Almost $2k for a dab of skin glue? No! I don't care what complicated politico-economical factor lead to that. Free market, over-regulated market,expensive doctor's education loans, health insurance lobbyists, politicians, aliens, terrorists, gnomes. Doesn't matter. Putting that on the bill and sending to a parent is criminal. Fuck everything about it. Lie and cheat them and run away without feeling bad. They can say "oh but because people cheat it is so expensive", doesn't matter. They are stealing and screwing over the sick and disadvantaged, if you can turn right back and screw them, do it. Everybody for themselves.
Have you seen the profit margins for the hospitals with these high prices? They certainly aren't raking it in.
I agree that's stupid, but that's how the system works for paying for medical care in the US. From the perspective of the hospital, it makes perfect sense.
That makes little difference, or brings little consolation to the parent of the child at end of the day. That was kind of my point. Take the hospital system, laws, economic environment, regulations, solar wind, doesn't matter, mix it all in, shove it in one side of the black box, and at the other side, a bill of $1600 comes out and gets sent to a parent for a dab of glue to fix a minor stitch. Whoever needs to lose and go bankrupt, the insurance company, the hospital, the doctors, the congress-person, doesn't matter, as a supposed "developed" society we have collectively and miserably failed if at the end of the day, it is the parent who has to pay that price for that procedure.
Have you seen the profit margins for the hospitals with these high prices? They certainly aren't raking it in.
These hospital are almost exclusively non-profits. Measuring the profit margins of non-profits is folly. They funnel the excess money into salaries, marketing, equipment and expansion (often unnecessary).
A tumor doesn't have a profit , it just grows diverting more blood from the body and expending energy with one purpose of growing. In hospitals case, their purpose is to grow and provide fat salaries to their executives.
Profit margins is just a jargon thrown around here. A doctor/exec taking back ~$1.5 million an year for sure isn't working on a non profit venture. They are working on a venture, which may be a non-profit at an organization level to avoid paying taxes but use that saved taxes to optimize individual salaries.
Either way 'non-profit' venture in nearly all countries have been classic ways to avoid paying taxes. If you are rich, all you need to do is create a non-profit trust- Name it for religious, social or whatever charity. Once you do that you can thrown some peanuts towards a social cause and at the same time park millions worth wealth without paying taxes. Suddenly you can grow your wealth without paying taxes.
This is how it works in my country, India. You will see non-profit trusts, especially religious with billions in assets- Who don't pay a penny in taxes. They will occasionally have some religious festival and may be feed the poor on an auspicious day. While at the same time the trust grows fatter in assets and money everyday as they attract donations in billions, literally!!
They are raking in revenue. If they aren't making a profit, that's simply evidence that they are less efficient than socialised systems. Presumably because of moral hazards (health insurers or the government pays, not customers), and information asymmetries (customers can't judge whether or not they are being conned).
Well i haven't seen it but they must be low if you say so. But that just means they are spending way too much and making the patients pay for it. Perhaps they need to redistribute their costs better. Why make the guy who needs skin glue pay for the expensive stuff he hasnt even used (or needed)
The problem with medical pricing seems to be the same as pricing for students and pricing for housing. When people can borrow the money or have it payed by insurance, the prices skyrocket to match the available funds.
It completely screws anyone not 'in the game'.
Luckily medical costs are generally reasonable here in Australia, but we still see crazily inflated housing prices due to residential property being treated like a stock.
Huge tax incentives are given to those 'investing' in property while 'buy to live' buyers like families get screwed.
Also, having your employer involved AT ALL with your medical insurance/bills is fucking insane.
The skyrocketing prices in healthcare and education have the same root problem: too many non-essential people (read: clerks) are on the payroll (e.g. search for "Dean-to-Professor ratio"). The government will not solve this problem, it will make it worse.
I think the only real solution to the problem is to break both hospitals and universities into smaller pieces with more direct correlation between performed work and rewards. Right now gigantic organizations ("too big to fail") in hospitals and universities make it impossible for staff members to see how the money is spent. The smaller doctor offices can be more effective and offer lower prices to patients. Same goes to smaller schools. This is one of the examples where scale makes things worse, not better.
Of course, you also have to have shared facilities with expensive equipment. However, these facilities does not need to be a part of the hospitals/universities. For example, there are already 3rd party labs that provide services to hospitals and doctors. Same can be done for other procedures (e.g. MRI) and this can also help to use equipment more efficiently.
These high chargemaster prices are a consequence of how insurance companies pay providers. Private insurance companies never pay the list price, but rather a percentage of it.
It's sort of like if your boss asked you to something and offered to pay 200% of your costs. You'd certainly have an incentive to overstate them!
In Japan, stitching of that size would've been around $20-30. And that's not patient portion. That's the amount doctor is reimbursed by the government.
Could this be the problem rising from US having a increased reliance on Allopathic System of Medicine?
In India, Allopathic System exist together with other 4 big system, namely Unani (Old Greek), Chinese, Ayurveda & Homeopath.
Yes, all practitioners have to register themselves to a certain extent with the medical board of India, but the system is not as highly centralized, and is more like professionals working mostly as practitioners, instead of hired workforce.
This can be ironically put as something similar to free market, since the prices are being defined by market forces.
The war over Polio, which India as per WHO has won, would not have been possible if polio vaccine drops were made free, and also their administration, for all people, including upper class.
What I'm sure about is this that if I were to travel to US, to get hurt, and get such a bill, I would go bankrupt over night.
3000$ you can buy Tata Nano!
Also, its worth mentioning, that there is a creed of medical practitioners called "Pehelwaans" (word meaning=wrestler), which is one of the most autonomous individuals around. A stitch for comparison costs around 1$ from them. They appeared out of the sportpersons treating themselves in medieval India, and then making that into community business.
In simple words, compare Pehelwaans with Calculator, very few functions, cheap yet effective in daily life. Both PCs and Calculator exist in real world, same way, Allopathy has been adapted by people for serious stuff, while traditional fields stay prevalent for simple stuff.
Practically speaking, just google how India has become a medical tourism destination, and people from both lower income groups like in Africa, as well as from higher income group from US are coming here.
As of right now, in terms of skill of doctors, US still has the upper hand by far for rare diseases, and everything out of the ordinary. Which is good in one way, but seriously, I'm very disturbed by the fact that 500$ for a few stitches!
You seem to be flagged, i can't imagine why. Probably for criticizing modern medicine? Either way i see what you are saying. That "not-fully-qualified-as-a-doctor" professionals seem to be the go-to people for minor injuries like stitches and sprains, while for major injuries you go to a hospital. Makes sense. Why open a whole computer when you just want to know 121451*1231 right? And i guess that does bring the price down because these people aren't buried under education loans for their medical studies
As a Canadian, I think it would be really cool if every doctor/hospital visit you went to in Canada, you got an e-mail copy of the invoice showing how much it cost, and how much was covered, just so people would start to understand:
a) how much they're costing themselves in taxes
b) so they could see how awesome we have it compared to others.
I should build this. I have the connections to make it happen. Hmm...
Sure, we do get billed. But as a patient, I never see it. The only bill I've ever seen is for ambulance rides, if I ever need to take one. That's ~$35-45. I've never received charges for anything else.
When I used to volunteer at the ER, I saw patients come in to pay some bills related to wheelchair rentals or crutches. Sometimes they had their prescriptions filled at the pharmacy, and they had to pay for that. But again, that's the extent of the bills that patients would see.
I once saw a guy come in via ambulance, screaming in pain. The paramedics rushed him in, and yelled to the staff that they needed a Resusc room immediately, since the guy had no detectable pulse or pressure, and she suspected he had a triple-A (I found out later that this was an abdominal aortic aneurysm.). The nurses fumbled to clear a room for them, but they eventually did. A quick ultrasound by the ER Dr. to confirm, and he was wheeled off to surgery.
That "bill" likely cost the taxpayers of Ontario upwards of $50k by my uninformed guess. Not sure if he survived or not, AAAs typically have extremely high mortality rates and have to be addressed within 30 minutes. In any case, I do appreciate the fact that him and his family don't have to worry about a thing, except getting better and appreciating life. However, I'm not sure what value it would provide for them to know the financial cost. shrug Something worth thinking about.
(Recounting this story makes me somewhat regret not continuing along the path to medical school. shrug Guess I have to contribute in a different way.)
Time to start sacrificing credit ratings and default like fuck all on these bullshit bills.
I'll run the gauntlet. I'll take the devil's mark as a freeloader. Hunt me to the ends of the earth, credit machine. You'll never catch me on my motorcycle.
Wow... Things like these actually make me glad I am in a developing country. We have top of the line medical facilities as well (we have sucky ones too), but even the best hospital in town[1] wouldn't cost this much. Heck a few stitches would gost me entire annual health insurance there!
[1] Aga Khan University Hospital, Managed by AKDN, the 2nd largest NGO in the world (2nd only to the UN)
What can we do about this ? Is this a technological problem ? Who is protecting the status-quo ? What exactly makes healthcare so expensive in the US than other first world countries ? Thats what I want to know.
Amortized over the uninsured people who don't eventually pay list price, and the insured people whose insurance only pays 20% of the list price? (oh, and over the billing department that is 10 to 100 times bigger than it is anywhere else in the world) - not much profit.
It's an article in the New York Times, an American newspaper. By default, it is about America. Not every news article needs to declare a globally unique namespace.
My point has nothing to do with where HN is focused. The NYT is an American newspaper written for an American audience, so when they refer to "the healthcare system", it is implied that they are talking about the American healthcare system. If this were an article in an Indian newspaper, I would likewise assume that it was talking about healthcare in India. That doesn't make HN into "HN India".
Adding an American specific context to headlines talking about the healthcare system do serve as a reminder how exceptional the American system is. Many issues cut across international lines, as with technical articles, but this is not one of those things.
The New York Times is an international newspaper, it covers stories from all parts of the world. While they have a default America implied, yes, but why does this habit have to carry over to Hacker News?
> why does this habit have to carry over to Hacker News?
Because HN submissions are generally expected to be titled the same as the page/article being submitted, and this policy seems to be enforced by moderators. But luckily, HN also shows what domain the submission links to, so what you see is
> As Hospital Prices Soar, a Single Stitch Tops $500 (nytimes.com)
from which you can determine that the article is most likely about American healthcare.
According to the article, a paltry 2% of your net revenue goes to uncompensated care (that's the California average).
"Though hospitals’ nonprofit status allows them to reap tens or hundreds of millions of dollars in tax benefits, California Pacific Medical Center’s main campuses spent 1.27 percent of their more than $1.1 billion in net patient revenues in 2011 on free care for indigent or uninsured patients, lower than the state average of 2.07 percent, according to statistics compiled by the San Francisco Department of Public Health. The far smaller St. Luke’s branch spent 5.32 percent that year."
http://usatoday30.usatoday.com/news/washington/2011-05-09-un... 49 billion in 2011. Yes and that's a far off estimate. Just go to the billing dept. in any major hospital in the Southwest. The gov needs to pay its bills. Yes, and hospital costs are out of control and need to come down.
Both my kids required a few stitches near their eyes. Did I opt for the $30 suture kit and do it myself? or did I opt for on-demand (there & ready, patients or not) doctor analysis (risks of fractured skull or aggressive infection), sedatives (both wriggled & screamed as I held them still, how much worse without?), experienced threading, and whatever other ideals applied?
"Sure you can buy a hamburger for a dollar. But then you'd have to eat it." - local restaurant ad
Half an hour job for a $200.000/year professional is $50; doubling for overhead is a roughly $100 cost for that service. Doubling it again for profit&stuff is $200 reasonable price.
Charging $2000 for a $200 service is the problem here, especially since that is not an informed market price, but an ultimatum set without a market negotiation or possibility for competition.
In most countries, including first world countries with medical facilities and doctor training comparable or better than USA, the full price would be $100 or less - disregarding who'd pay that bill (you, insurance or government), that is the full price charged by hospitals for such a service.
Same service? Remember, your kid. And it's not just the service; you could go to the urgent care clinic instead of the hospital[1] and pay less; you could go to your regular doctor and pay even less; heck, I know people who just keep sutures & glue on hand and just patch the kid up themselves. There's also the matter of demand & supply: are you confident you'll get immediate treatment if needed? that an ER staff is on hand if that small cut suddenly proves itself a skull fracture and whatever unseen complications ensue?
I'm not going to argue that the pricing is perfect; I am going to argue that there's a whole lot more behind that price than just overcharging. I've looked both my kids in the eyes while holding them still while being stitched up for one injury or another, thought thru a range of what-ifs, and had no problem paying the bill knowing there was more to it than just a little sewing. When both the doctor and urgent care clinic take one look at the injury and say "not here, she needs a hospital for this" and pass on billable treatment, there's a reason.
[1] - seems different cultures have different notions of what the term "hospital" entails. Methinks this confuses the discussion a great deal.
Considering the order of magnitude the lead article is generating consternation with, fact is I do buy $10 and $20 hamburgers at times ... and yes, it is worth the difference.
If your kid is gushing blood, you call an ambulance to take them wherever they can get patched up the fastest. To expect someone to shop around until they find an equilibrium between supply and demand in that situation is ludicrous. It is absolutely the role of government to provide a safety net in these situations.
Source: I live in a first-world country and thus have universal health care.