8 ms·

One thing that sticks to me when I read such articles (I am not from US) is how ridiculously pricey medical services are. Common, 1k$ for a regular exam that co

by ssijak 8y ago

One thing that sticks to me when I read such articles (I am not from US) is how ridiculously pricey medical services are. Common, 1k$ for a regular exam that costs like 20euros in my country in private clinics?! And I read about this ridiculous prices US so often that I am dumbstruck that people are cool with it. Another thing that struck me is that if you don`t have money, evil people can just silence you by suing you (look at those court costs, 20k and counting?!)

danans 8y ago
> am dumbstruck that people are cool with it. Huge numbers, perhaps a majority, are not cool with it. We've had national elections fueled by the discontent. But at least so far the political configuration of that discontent, not the magnitude of it, has prevented progress on lowering the cost of health care.
- DoreenMichele 8y ago
  But at least so far the political configuration of that discontent, not the magnitude of it, has prevented progress on lowering the cost of health care. Health insurance in this country suffers from kind of a legacy situation. It is sort of like how the qwerty keyboard is terribly inefficient, but most people continue to use it. From what I have read, at some point health insurance was offered as a means to beef up compensation in a way that was tax friendly for employees, thus helping to entice better employees to come work for your company. This became kind of the standard default and typically covered the family, not just the employee. This was considered a perk in a situation where most people whipped out their check book to pay for medical care because it was relatively reasonably priced. Then health insurance became kind of the default and it adds overhead and complexity. Obomacare was passed as the only politically viable solution and it's a terrible solution. Health insurance coverage for basic services doesn't really make sense. Insurance only makes sense as a bet to defray unexpected expenses. When you use it cover annual exams and other basics that you know are guaranteed to happen, it essentially creates an unnecessary middleman, pushing prices higher without providing any real benefit for the cost involved. This is where we are now and most people don't know how to get out of this mess. It doesn't help that Obamacare puts a gun to your head and insists that most people participate in this charade or be fined at tax time, in essence. Ugh.
  - danans 8y ago
    One can argue over the implementation method, but fundamentally a society must decide whether they believe health care - both routine/simple and unexpected/severe - is a right of all or a privilege for just some. If you say it's a right, everyone has to participate and those of means have to help pay for those who have none. The individual mandate was an admittedly roundabout way to achieve that. The old system of paying a doctor outright with a check or cash was not a universal healthcare solution - a lot of people couldn't afford it even back then. Most developed countries deal with the cost problems of health care through strong price regulation, even the relatively laissez-faire systems like Singapore [1] or Switzerland. Obamacare did a lot to improve access [2] (subsidies, pre-existing conditions, adult children on parents plans) - it's a lot like the Swiss system, - but unlike that system, it did very little to address costs. 1. https://mobile.nytimes.com/2017/10/02/upshot/what-makes-singapores-health-care-so-cheap.html https://mobile.nytimes.com/2017/10/02/upshot/what-makes-sing... 2. https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ https://www.kff.org/uninsured/fact-sheet/key-facts-about-the...
    - DoreenMichele 8y ago
      I agree with you. So I'm not sure what the argument is here. I was only describing how we got to the current morass and why it is so hard to extricate ourselves and do something not crazy.
      - danans 8y ago
        Sorry, I'm not arguing with you. What I'm addressing is that the particular mechanisms only matter once the objective - affordable health care as right or a privilege - is broadly established and agreed upon. Until then, debating the mechanisms, whether taxes or mandates, or nothing at all if one believes health care is a privilege, doesn't address the root problem.
        DoreenMichele 8y ago
        Ah. I generally find it helps to understand the problem space. With a sufficient understanding, sometimes one can come up with elegant solutions that can cut past the BS. That approach of mine is frequently misunderstood and perceived to be things like making excuses or justifying the current status quo, etc.
OscarCunningham 8y ago
The "prices" are moves in a game played between hospitals and insurance providers, and don't correspond to anything real or to the amount that gets paid. If a hospital discovers that the patient doesn't have insurance they'll be charged the real (more reasonable) prices instead.
- lightbyte 8y ago
  That's not true at all. I currently have a ~$450 bill for a test where I breathed in a tube for 10 seconds at a constant rate. That's after my insurance paid 4k for it already.
- liveoneggs 8y ago
  sometimes maybe if that patient is lucky and smart enough to know the inside tricks The discount is not guaranteed.
- nambit 8y ago
  Millions of americans pay those sticker prices. Just because millions more don't or get discounts doesn't change the fact that those are very real prices.
  - OscarCunningham 8y ago
    Yes. The system is bad.
- knodi123 8y ago
  > and don't correspond to anything real or to the amount that gets paid. Aren't designed to correspond to real payments. But like a sumo wrestling match in a kindergarten, sometimes the little guy gets squashed by accident. And you wind up with people getting $20k bills that don't necessarily know how to get out from under them. It's
- ballenf 8y ago
  That used to be the case, but in the last two years I have gotten $1k+ bills after insurance that are very real. For relatively common visits to in-network providers.
Fej 8y ago
A significant amount of people have been duped into voting against their own interests.
- CM30 8y ago
  Not really. That would imply people value every aspect of a politician/party platform the same, and will give up on various beliefs to fight for other rights and benefits. The problem is that you've got a two party system where groups that don't share much in common are lumped together and people are voting for the 'least worst' option. There's no reason the social and economic positions of the Democrats/Republicans have to be linked together like they are. If they weren't, people may vote differently.
mnm1 8y ago
Half or almost half of the population here would let you die of curable sickness or disease just to save a couple bucks (for what purpose, I'm not sure, probably to kill more Arabs or line rich people's pockets). When you understand the underlying hate in America, all the things you list above become obvious as to why they exist. But look on the bright side: if you're lucky enough you can be here profiting off of all these sick people's misery instead of being one of them. You just need to be born in the right family at the right time. That's what most Americans hope for: that they were born to the right family at the right time instead of the one they were born into. Because they sure aren't about to change social class after being born...
- hackerman12345 8y ago
  How can you claim to understand them when you're posting their oppositions propaganda instead of their own arguments? That's like starting a conversation by referring to a pro-choicer as a pro-death... even if you have great arguments against the choice of abortion it's not going to lead to a productive conversation. As a sibling poster to you said, the ridiculous pricing is part of a game between insurers and care providers. Throwing more money at insurers might not be the ideal answer.
  - mnm1 8y ago
    Obviously throwing money at insurers isn't the solution. We've been doing that for decades. Other countries have already figured out how to provide healthcare for their citizens. America can too if people stop opposing it. Instead, we have movement in the other direction because a lot of people hate others so much they do not want them to have healthcare. That viewpoint is inexcusable in my opinion. Also, your first paragraph in unintelligible to me.
    - hackerman12345 8y ago
      Do you realize that Obamacare is based on throwing more money at insurers - and furthermore wanted to legally require that every American throw a share of money at a for-profit insurer? Is everyone against that really a "person that hates others so much"?
Applejinx 8y ago
Yes. Evil people can just silence you by suing you, and yes, you cannot afford to defend yourself. Present company (much of the HN demographic) excepted: a fair number of HN posters are very atypical in terms of their resources for doing things like hiring lawyers.
phonon 8y ago
The price they billed her (after her insurance negotiated its standard discount) was $427.
- ssijak 8y ago
  For 400$, in my country, I paid (well not me, my job but that is not the point) for private health insurance for a WHOLE YEAR. It covers all the basic stuff, pregnancy costs, some surgery costs, etc.. Aside from that we are all covered by the state and are not billed for anything apart from some medications. Yeah, hospitals are not that great of a place and there is a lot to be improved, but at least you know that even if you are very poor, you will not be left to die (or with some ridiculous bills) if you are very ill. And before someone asks, why to pay for private if you have state coverage.. It is a job perk, and in any case, you pay for your time. Service is much faster and more convenient for the basic stuff/illnesses.
  - phonon 8y ago
    You are paying for private supplemental health insurance in a low cost region. I'm sure lawyers charge much less there than ones in New York as well.
    - ssijak 8y ago
      Of course. But if I roughly compare medical and/or litigation costs between my region and US, taking into account average wage, US is still whey pricier. Our law also does not require you to have a lawyer if you don`t want it. Also if you are poor you can have free legal counseling (but not to be represented in the court).
- Broken_Hippo 8y ago
  To be fair... that 427 is more than I'll pay for normal doctor's services in an entire year. (Some things have a different category, but I'm still in less than $1k for the year). I'm in Norway, which isn't exactly known for being a low-cost nation. Now, I understand I pay taxes to cover health care. This isn't really any worse than I was paying in the states in my monthly premiums. The thing is that it creates a wonderful sort of stability in life. I can plan on taxes, I can plan on the out-of-pocket costs for a year. I won't go bankrupt. I no longer feel I'm getting ripped off for something I might have little to no control over.
ataturk 8y ago
Your overall costs are subsidized by high taxes.
reaperducer 8y ago
>Common, 1k$ for a regular exam that costs like 20euros in my country in private clinics?! I don't know where you get US$1k for a regular exam, but that is wrong. My doctor, for example, charges a base (list/MSRP/whatever) rate of $120-$180 for a regular exam. The "negotiated" rate with the insurance company is $80. The amount I pay, as a patient, is $10. If you don't have insurance (for a while I didn't), he charges $50. $1k for a regular exam is fiction.
- FireBeyond 8y ago
  > The "negotiated" rate with the insurance company is $80. > The amount I pay, as a patient, is $10. This is Shkreli math. "Oh, insurance companies pay larger amounts, most people will get this drug for a $10 copay!" Oh yes, the insurance companies, those philanthropists magicking money out of ... somewhere other than your pocket, be it directly or indirectly.

by ssijak 8y ago

danans 8y ago

> am dumbstruck that people are cool with it. Huge numbers, perhaps a majority, are not cool with it. We've had national elections fueled by the discontent. But at least so far the political configuration of that discontent, not the magnitude of it, has prevented progress on lowering the cost of health care.

DoreenMichele 8y ago
But at least so far the political configuration of that discontent, not the magnitude of it, has prevented progress on lowering the cost of health care. Health insurance in this country suffers from kind of a legacy situation. It is sort of like how the qwerty keyboard is terribly inefficient, but most people continue to use it. From what I have read, at some point health insurance was offered as a means to beef up compensation in a way that was tax friendly for employees, thus helping to entice better employees to come work for your company. This became kind of the standard default and typically covered the family, not just the employee. This was considered a perk in a situation where most people whipped out their check book to pay for medical care because it was relatively reasonably priced. Then health insurance became kind of the default and it adds overhead and complexity. Obomacare was passed as the only politically viable solution and it's a terrible solution. Health insurance coverage for basic services doesn't really make sense. Insurance only makes sense as a bet to defray unexpected expenses. When you use it cover annual exams and other basics that you know are guaranteed to happen, it essentially creates an unnecessary middleman, pushing prices higher without providing any real benefit for the cost involved. This is where we are now and most people don't know how to get out of this mess. It doesn't help that Obamacare puts a gun to your head and insists that most people participate in this charade or be fined at tax time, in essence. Ugh.
- danans 8y ago
  One can argue over the implementation method, but fundamentally a society must decide whether they believe health care - both routine/simple and unexpected/severe - is a right of all or a privilege for just some. If you say it's a right, everyone has to participate and those of means have to help pay for those who have none. The individual mandate was an admittedly roundabout way to achieve that. The old system of paying a doctor outright with a check or cash was not a universal healthcare solution - a lot of people couldn't afford it even back then. Most developed countries deal with the cost problems of health care through strong price regulation, even the relatively laissez-faire systems like Singapore [1] or Switzerland. Obamacare did a lot to improve access [2] (subsidies, pre-existing conditions, adult children on parents plans) - it's a lot like the Swiss system, - but unlike that system, it did very little to address costs. 1. https://mobile.nytimes.com/2017/10/02/upshot/what-makes-singapores-health-care-so-cheap.html https://mobile.nytimes.com/2017/10/02/upshot/what-makes-sing... 2. https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/ https://www.kff.org/uninsured/fact-sheet/key-facts-about-the...
  - DoreenMichele 8y ago
    I agree with you. So I'm not sure what the argument is here. I was only describing how we got to the current morass and why it is so hard to extricate ourselves and do something not crazy.
    - danans 8y ago
      Sorry, I'm not arguing with you. What I'm addressing is that the particular mechanisms only matter once the objective - affordable health care as right or a privilege - is broadly established and agreed upon. Until then, debating the mechanisms, whether taxes or mandates, or nothing at all if one believes health care is a privilege, doesn't address the root problem.
      - DoreenMichele 8y ago
        Ah. I generally find it helps to understand the problem space. With a sufficient understanding, sometimes one can come up with elegant solutions that can cut past the BS. That approach of mine is frequently misunderstood and perceived to be things like making excuses or justifying the current status quo, etc.

OscarCunningham 8y ago

The "prices" are moves in a game played between hospitals and insurance providers, and don't correspond to anything real or to the amount that gets paid. If a hospital discovers that the patient doesn't have insurance they'll be charged the real (more reasonable) prices instead.

lightbyte 8y ago
That's not true at all. I currently have a ~$450 bill for a test where I breathed in a tube for 10 seconds at a constant rate. That's after my insurance paid 4k for it already.
liveoneggs 8y ago
sometimes maybe if that patient is lucky and smart enough to know the inside tricks The discount is not guaranteed.
nambit 8y ago
Millions of americans pay those sticker prices. Just because millions more don't or get discounts doesn't change the fact that those are very real prices.
- OscarCunningham 8y ago
  Yes. The system is bad.
knodi123 8y ago
> and don't correspond to anything real or to the amount that gets paid. Aren't designed to correspond to real payments. But like a sumo wrestling match in a kindergarten, sometimes the little guy gets squashed by accident. And you wind up with people getting $20k bills that don't necessarily know how to get out from under them. It's
ballenf 8y ago
That used to be the case, but in the last two years I have gotten $1k+ bills after insurance that are very real. For relatively common visits to in-network providers.

Fej 8y ago

A significant amount of people have been duped into voting against their own interests.

CM30 8y ago
Not really. That would imply people value every aspect of a politician/party platform the same, and will give up on various beliefs to fight for other rights and benefits. The problem is that you've got a two party system where groups that don't share much in common are lumped together and people are voting for the 'least worst' option. There's no reason the social and economic positions of the Democrats/Republicans have to be linked together like they are. If they weren't, people may vote differently.

mnm1 8y ago

Half or almost half of the population here would let you die of curable sickness or disease just to save a couple bucks (for what purpose, I'm not sure, probably to kill more Arabs or line rich people's pockets). When you understand the underlying hate in America, all the things you list above become obvious as to why they exist. But look on the bright side: if you're lucky enough you can be here profiting off of all these sick people's misery instead of being one of them. You just need to be born in the right family at the right time. That's what most Americans hope for: that they were born to the right family at the right time instead of the one they were born into. Because they sure aren't about to change social class after being born...

hackerman12345 8y ago
How can you claim to understand them when you're posting their oppositions propaganda instead of their own arguments? That's like starting a conversation by referring to a pro-choicer as a pro-death... even if you have great arguments against the choice of abortion it's not going to lead to a productive conversation. As a sibling poster to you said, the ridiculous pricing is part of a game between insurers and care providers. Throwing more money at insurers might not be the ideal answer.
- mnm1 8y ago
  Obviously throwing money at insurers isn't the solution. We've been doing that for decades. Other countries have already figured out how to provide healthcare for their citizens. America can too if people stop opposing it. Instead, we have movement in the other direction because a lot of people hate others so much they do not want them to have healthcare. That viewpoint is inexcusable in my opinion. Also, your first paragraph in unintelligible to me.
  - hackerman12345 8y ago
    Do you realize that Obamacare is based on throwing more money at insurers - and furthermore wanted to legally require that every American throw a share of money at a for-profit insurer? Is everyone against that really a "person that hates others so much"?

Applejinx 8y ago

Yes. Evil people can just silence you by suing you, and yes, you cannot afford to defend yourself. Present company (much of the HN demographic) excepted: a fair number of HN posters are very atypical in terms of their resources for doing things like hiring lawyers.

phonon 8y ago

The price they billed her (after her insurance negotiated its standard discount) was $427.

ssijak 8y ago
For 400$, in my country, I paid (well not me, my job but that is not the point) for private health insurance for a WHOLE YEAR. It covers all the basic stuff, pregnancy costs, some surgery costs, etc.. Aside from that we are all covered by the state and are not billed for anything apart from some medications. Yeah, hospitals are not that great of a place and there is a lot to be improved, but at least you know that even if you are very poor, you will not be left to die (or with some ridiculous bills) if you are very ill. And before someone asks, why to pay for private if you have state coverage.. It is a job perk, and in any case, you pay for your time. Service is much faster and more convenient for the basic stuff/illnesses.
- phonon 8y ago
  You are paying for private supplemental health insurance in a low cost region. I'm sure lawyers charge much less there than ones in New York as well.
  - ssijak 8y ago
    Of course. But if I roughly compare medical and/or litigation costs between my region and US, taking into account average wage, US is still whey pricier. Our law also does not require you to have a lawyer if you don`t want it. Also if you are poor you can have free legal counseling (but not to be represented in the court).
Broken_Hippo 8y ago
To be fair... that 427 is more than I'll pay for normal doctor's services in an entire year. (Some things have a different category, but I'm still in less than $1k for the year). I'm in Norway, which isn't exactly known for being a low-cost nation. Now, I understand I pay taxes to cover health care. This isn't really any worse than I was paying in the states in my monthly premiums. The thing is that it creates a wonderful sort of stability in life. I can plan on taxes, I can plan on the out-of-pocket costs for a year. I won't go bankrupt. I no longer feel I'm getting ripped off for something I might have little to no control over.

ataturk 8y ago

Your overall costs are subsidized by high taxes.

reaperducer 8y ago

>Common, 1k$ for a regular exam that costs like 20euros in my country in private clinics?! I don't know where you get US$1k for a regular exam, but that is wrong. My doctor, for example, charges a base (list/MSRP/whatever) rate of $120-$180 for a regular exam. The "negotiated" rate with the insurance company is $80. The amount I pay, as a patient, is $10. If you don't have insurance (for a while I didn't), he charges $50. $1k for a regular exam is fiction.

FireBeyond 8y ago
> The "negotiated" rate with the insurance company is $80. > The amount I pay, as a patient, is $10. This is Shkreli math. "Oh, insurance companies pay larger amounts, most people will get this drug for a $10 copay!" Oh yes, the insurance companies, those philanthropists magicking money out of ... somewhere other than your pocket, be it directly or indirectly.