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Automobile mechanics are required to provide a written estimate in advance. I don't see why health care should be any different. Before anyone objects with "bu

Automobile mechanics are required to provide a written estimate in advance. I don't see why health care should be any different. Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures.

enraged_camel 8y ago
>>Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures. That is true, but emergency care disproportionately results in bankruptcies compared to other forms of care.
- falcolas 8y ago
  I imagine this is directly related to the inflated costs of emergency care. A dose of ibuprofen (two tablets) costing in the $40+ range?
  - skellera 8y ago
    Well they have to pay for storage and for that very well paid employee to pass you the pills. Moderate sarcasm. But really that’s a deeper issue with insurance causing most of that. If you don’t have insurance, most hospitals will severely discount the costs that you are originally charged if you just work with them. It shows those prices are bullshit to begin with.
    - ryandrake 8y ago
      Even if they are willing to give you a discount if you don’t have insurance, those ibuprofen pills are still going to be charged 10x or 100x over their cost. Health industry knows nobody can shop around and get quotes and regulators are unwilling to protect patients. It’s no wonder we are in the mess we are in. My locality has a ballot initiative up this year that would put a % cap on what hospitals can charge over their costs, and boy oh boy are the industry mouthpieces out in force to oppose it! They are having a field day with patients’ wallets, they know it, and they don’t want it to end.
    - datavirtue 8y ago
      No, as the article clearly detailed, insurance has no hand in it other than removing the actual cost away from the person receiving the care. The hospital is a monopoly which the insurer MUST do business with. Read the fucking article before you try to speak with authority.
      - dang 8y ago
        Posting aggressively like that will get you banned here. Please read https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and post civilly and substantively, or not at all. Edit: since we only just warned you about this, I've banned your account until we get some indication that you intend to follow the rules from now on. You're welcome to email hn@ycombinator.com if that's the case.
lstodd 8y ago
It's like being given a potentially ancient, bit-rotten code base and asked to refactor the shit out of it for a fixed price. And you can't know that upfront. It might take a day. It may take a decade. It may take you the customer to change your entire approach. This is not feasible. You can not disregard hidden defects and the cost of fixing them unless you do not really want reliabilty. If you do not want it, then don't complain. In IT this requested lack of reliability is accepted. In healthcare and auto repair it is barred by law. EDIT: i hate autocorrection.
- wyattpeak 8y ago
  GP suggested a written estimate, not a quote.
- manicdee 8y ago
  GP was booking an appointment for a routine procedure which has a known scope, effort, and bill of materials. There is nothing in this procedure that even remotely resembles refactoring a legacy codebase.
- segmondy 8y ago
  It's not the same. The nurse, the doctor was not a surprise. Bet you given 20 cases of people coming to check for strep, chances are their bills would have been around $400 too not $60. So they should use that amount.
- scalablenotions 8y ago
  > i hate autocorrection. No you don't, or you'd turn it off. I'm sure there's a metaphor in there somewhere.
- dantheman 8y ago
  All of those fees are completely predictable. Sure if the doctor noticed a problem, they could then offer advice/treatment and the new price. This idea that medicine is different than other fields is crazy.
u801e 8y ago
The example above is essentially an estimate of the cost of parts (the strep throat test). The cost of a sick patient visit is known and could have been easily included in the estimate.
GeekyBear 8y ago
One current problem is that even if you have insurance, and seek emergency care at a hospital that is part of the network covered by your plan, you still often end up with a huge surprise bill. >Vox's database shows that patients are especially vulnerable to these surprise bills when out-of-network doctors work at in-network hospitals. “It does happen quite a lot in the emergency room,” says Christopher Garmon, an assistant professor at the University of Missouri Kansas City. Garmon published a study last year that found as many as one in five emergency room visits led to a surprise bill from an out-of-network provider involved in the care. https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network https://www.vox.com/2018/5/23/17353284/emergency-room-doctor...
- abathur 8y ago
  Anecdata: had to take spouse to ER earlier this year. She had a reasonably run-of-the-mill cold, but the cough had irritated her throat enough that everything she attempted to eat was triggering her gag reflex. She was getting pretty feeble from lack of food (and throwing what little she could get down back up). Insurance is through her work, so I had to coax her through logging in to her account so that I could try to find an in-network ER list. After spending ~30 minutes grumbling at the website over the complete lack of anything resembling clarity, I had a list of 3 hospitals that appeared to be in-network (and a sinking feeling that this could easily cost thousands of dollars). Set off around 2am. Arrived at first. 5+hour wait. Went to the next, no wait. They didn't manage to do much aside from giving a few tests that came up negative, administered fluids, gave her a steroid shot, and did a blood panel. Her blood panel had one abnormal result that the doctor was willing to admit her for observation over (and had admitted people in the pass for less), but the doctor also noted that the parameter can vary a lot person to person; some people would be fine at that level. I had a sinking feeling in my stomach and decided it would be better to take her home to keep an eye on her than risk financial ruin. I think we were there 2-3 hours. When the bill came months later, it was $2600 because the doctor was out of network.
  - nojvek 8y ago
    We had a baby 4 months ago. We still get surprise bills from things we don’t even know about. Some of them could be scams but I have very little idea on how to even verify. Calls get stuck on automated helpdesk. For all technological advancements in US, the healthcare system is quite backwards. It’s not a new problem. Tons of countries do it well “Canada, Australia, Sweden ...” The US political and healthcare system refused to accept other models since there is sooooo much money to be made at the expense of “some-other” people dying and going bankrupt. House insurance, car insurance, all other forms of insurance are transparent, US healthcare is the most “mafia-like money extortion” system.
debacle 8y ago
> emergency care is a single-digit percentage of total health expenditures. How does that contrast with "care provided by emergency departments?"
killjoywashere 8y ago
> "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures. Right, as soon as the patient is admitted, it's a cardiothoracic surgery issue, or an oncology issue, or a high-risk obstetrics issue, or a critical care issue, or a neurosurgery issue, or a nephrology issue, or a general surgery issue, or an in-patient psych issue, or an ENT issue, or an opthalmology issue, or a geriatrics issue, etc.
rayiner 8y ago
It’s hilarious that people suggest that doctors should provide written estimates in advance, on a site full of programmers where the accepted wisdom is that its impossible for them to provide accurate estimates for the work they do.
- vvillena 8y ago
  Here's a relevant quote from a nice article [1]: """ When you are estimating tasks that are done over and over, you can look to your historical execution time for insights. We average chopping X logs per hour. If I hand you a Rubik's Cube and ask you to tell me how long it will take you to solve it...what is your answer going to be? If you've done it before you might have an idea. Maybe you just kept plugging away until you finally solved it? Maybe you've watched one of those videos about how to solve a Rubik's Cube, have practiced it and are confident that you could do it in 3 minutes flat? Maybe you have no idea? Complexity and experience will dictate your answers, but then those estimates still only reflect your perception of the task...not everyone else on your team. At best those numbers are a guess. Every step in a software project is solving problems. You don't know how long it will take to solve the problem. You don't know how many new problems you might run into along the way. Can the new problems be solved by you or do they need to be solved by other people? """ [1]: https://www.brightball.com/articles/reality-driven-development-fixing-project-management-in-software https://www.brightball.com/articles/reality-driven-developme...
- d1zzy 8y ago
  There's a big difference between not being able to provide an exact estimate because of unforeseen events[1] and not providing an estimate that includes services that are being provided to pretty much everyone visiting the health care provider for the given condition. I mean the nurse and the doctor costs quoted above are not "unforeseen". [1] If you're going to try to say that what is "unforeseen" is relative it's not that relative, you can get an independent committee of doctors and provide a percentage based on their experience how much often that event is expected in that situation
- stickfigure 8y ago
  Doctors, like auto mechanics, repeat the same tasks over and over and have a pretty good idea what something will cost. Like with automobiles, there are sometimes surprises, and those can require a new estimate to be signed off on. Software development is inherently nonrepetitive and therefore unpredictable. Healthcare is much closer to auto repair than software development.
wonderwonder 8y ago
Doctors and the health care industry have better lobbyists than auto mechanics.
- nojvek 8y ago
  Too expensive to fix an auto issue. Oh well, let’s just dump the car and get another one. Too expensive to fix healthcare issue. You’ll probably die or make it worse if you don’t fix it. “How much is your life worth to you?” You can get a ton more random money by holding people’s lives over them. That is in summary the US healthcare system. Full of middlemen squeezing every penny they can out of you because they can. Whoever campaigns for a transparent healthcare system, I’m voting for them. Our broken healthcare system kills more people than all terrorist attacks and natural disasters combined because people can’t afford to pay the bill mafia. That’s just a very sad state of affairs.
shrumm 8y ago
Singapore does this really well. A hospital is mandated by law to provide you financial counselling - it’s like a predictive charge sheet of what you will be charged when you’re admitted to the hospital. It’s unreasonable to expect 100% accuracy, they give you an estimate based on everything they know. if circumstances change, they are required to provide you an updated financial counsel sheet.

enraged_camel 8y ago

>>Before anyone objects with "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures. That is true, but emergency care disproportionately results in bankruptcies compared to other forms of care.

falcolas 8y ago
I imagine this is directly related to the inflated costs of emergency care. A dose of ibuprofen (two tablets) costing in the $40+ range?
- skellera 8y ago
  Well they have to pay for storage and for that very well paid employee to pass you the pills. Moderate sarcasm. But really that’s a deeper issue with insurance causing most of that. If you don’t have insurance, most hospitals will severely discount the costs that you are originally charged if you just work with them. It shows those prices are bullshit to begin with.
  - ryandrake 8y ago
    Even if they are willing to give you a discount if you don’t have insurance, those ibuprofen pills are still going to be charged 10x or 100x over their cost. Health industry knows nobody can shop around and get quotes and regulators are unwilling to protect patients. It’s no wonder we are in the mess we are in. My locality has a ballot initiative up this year that would put a % cap on what hospitals can charge over their costs, and boy oh boy are the industry mouthpieces out in force to oppose it! They are having a field day with patients’ wallets, they know it, and they don’t want it to end.
  - datavirtue 8y ago
    No, as the article clearly detailed, insurance has no hand in it other than removing the actual cost away from the person receiving the care. The hospital is a monopoly which the insurer MUST do business with. Read the fucking article before you try to speak with authority.
    - dang 8y ago
      Posting aggressively like that will get you banned here. Please read https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html and post civilly and substantively, or not at all. Edit: since we only just warned you about this, I've banned your account until we get some indication that you intend to follow the rules from now on. You're welcome to email hn@ycombinator.com if that's the case.

lstodd 8y ago

It's like being given a potentially ancient, bit-rotten code base and asked to refactor the shit out of it for a fixed price. And you can't know that upfront. It might take a day. It may take a decade. It may take you the customer to change your entire approach. This is not feasible. You can not disregard hidden defects and the cost of fixing them unless you do not really want reliabilty. If you do not want it, then don't complain. In IT this requested lack of reliability is accepted. In healthcare and auto repair it is barred by law. EDIT: i hate autocorrection.

wyattpeak 8y ago
GP suggested a written estimate, not a quote.
manicdee 8y ago
GP was booking an appointment for a routine procedure which has a known scope, effort, and bill of materials. There is nothing in this procedure that even remotely resembles refactoring a legacy codebase.
segmondy 8y ago
It's not the same. The nurse, the doctor was not a surprise. Bet you given 20 cases of people coming to check for strep, chances are their bills would have been around $400 too not $60. So they should use that amount.
scalablenotions 8y ago
> i hate autocorrection. No you don't, or you'd turn it off. I'm sure there's a metaphor in there somewhere.
dantheman 8y ago
All of those fees are completely predictable. Sure if the doctor noticed a problem, they could then offer advice/treatment and the new price. This idea that medicine is different than other fields is crazy.

u801e 8y ago

The example above is essentially an estimate of the cost of parts (the strep throat test). The cost of a sick patient visit is known and could have been easily included in the estimate.

GeekyBear 8y ago

One current problem is that even if you have insurance, and seek emergency care at a hospital that is part of the network covered by your plan, you still often end up with a huge surprise bill. >Vox's database shows that patients are especially vulnerable to these surprise bills when out-of-network doctors work at in-network hospitals. “It does happen quite a lot in the emergency room,” says Christopher Garmon, an assistant professor at the University of Missouri Kansas City. Garmon published a study last year that found as many as one in five emergency room visits led to a surprise bill from an out-of-network provider involved in the care. https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network https://www.vox.com/2018/5/23/17353284/emergency-room-doctor...

abathur 8y ago
Anecdata: had to take spouse to ER earlier this year. She had a reasonably run-of-the-mill cold, but the cough had irritated her throat enough that everything she attempted to eat was triggering her gag reflex. She was getting pretty feeble from lack of food (and throwing what little she could get down back up). Insurance is through her work, so I had to coax her through logging in to her account so that I could try to find an in-network ER list. After spending ~30 minutes grumbling at the website over the complete lack of anything resembling clarity, I had a list of 3 hospitals that appeared to be in-network (and a sinking feeling that this could easily cost thousands of dollars). Set off around 2am. Arrived at first. 5+hour wait. Went to the next, no wait. They didn't manage to do much aside from giving a few tests that came up negative, administered fluids, gave her a steroid shot, and did a blood panel. Her blood panel had one abnormal result that the doctor was willing to admit her for observation over (and had admitted people in the pass for less), but the doctor also noted that the parameter can vary a lot person to person; some people would be fine at that level. I had a sinking feeling in my stomach and decided it would be better to take her home to keep an eye on her than risk financial ruin. I think we were there 2-3 hours. When the bill came months later, it was $2600 because the doctor was out of network.
- nojvek 8y ago
  We had a baby 4 months ago. We still get surprise bills from things we don’t even know about. Some of them could be scams but I have very little idea on how to even verify. Calls get stuck on automated helpdesk. For all technological advancements in US, the healthcare system is quite backwards. It’s not a new problem. Tons of countries do it well “Canada, Australia, Sweden ...” The US political and healthcare system refused to accept other models since there is sooooo much money to be made at the expense of “some-other” people dying and going bankrupt. House insurance, car insurance, all other forms of insurance are transparent, US healthcare is the most “mafia-like money extortion” system.

debacle 8y ago

> emergency care is a single-digit percentage of total health expenditures. How does that contrast with "care provided by emergency departments?"

killjoywashere 8y ago

> "but what about emergencies!" note that emergency care is a single-digit percentage of total health expenditures. Right, as soon as the patient is admitted, it's a cardiothoracic surgery issue, or an oncology issue, or a high-risk obstetrics issue, or a critical care issue, or a neurosurgery issue, or a nephrology issue, or a general surgery issue, or an in-patient psych issue, or an ENT issue, or an opthalmology issue, or a geriatrics issue, etc.

rayiner 8y ago

It’s hilarious that people suggest that doctors should provide written estimates in advance, on a site full of programmers where the accepted wisdom is that its impossible for them to provide accurate estimates for the work they do.

vvillena 8y ago
Here's a relevant quote from a nice article [1]: """ When you are estimating tasks that are done over and over, you can look to your historical execution time for insights. We average chopping X logs per hour. If I hand you a Rubik's Cube and ask you to tell me how long it will take you to solve it...what is your answer going to be? If you've done it before you might have an idea. Maybe you just kept plugging away until you finally solved it? Maybe you've watched one of those videos about how to solve a Rubik's Cube, have practiced it and are confident that you could do it in 3 minutes flat? Maybe you have no idea? Complexity and experience will dictate your answers, but then those estimates still only reflect your perception of the task...not everyone else on your team. At best those numbers are a guess. Every step in a software project is solving problems. You don't know how long it will take to solve the problem. You don't know how many new problems you might run into along the way. Can the new problems be solved by you or do they need to be solved by other people? """ [1]: https://www.brightball.com/articles/reality-driven-development-fixing-project-management-in-software https://www.brightball.com/articles/reality-driven-developme...
d1zzy 8y ago
There's a big difference between not being able to provide an exact estimate because of unforeseen events[1] and not providing an estimate that includes services that are being provided to pretty much everyone visiting the health care provider for the given condition. I mean the nurse and the doctor costs quoted above are not "unforeseen". [1] If you're going to try to say that what is "unforeseen" is relative it's not that relative, you can get an independent committee of doctors and provide a percentage based on their experience how much often that event is expected in that situation
stickfigure 8y ago
Doctors, like auto mechanics, repeat the same tasks over and over and have a pretty good idea what something will cost. Like with automobiles, there are sometimes surprises, and those can require a new estimate to be signed off on. Software development is inherently nonrepetitive and therefore unpredictable. Healthcare is much closer to auto repair than software development.

wonderwonder 8y ago

Doctors and the health care industry have better lobbyists than auto mechanics.

nojvek 8y ago
Too expensive to fix an auto issue. Oh well, let’s just dump the car and get another one. Too expensive to fix healthcare issue. You’ll probably die or make it worse if you don’t fix it. “How much is your life worth to you?” You can get a ton more random money by holding people’s lives over them. That is in summary the US healthcare system. Full of middlemen squeezing every penny they can out of you because they can. Whoever campaigns for a transparent healthcare system, I’m voting for them. Our broken healthcare system kills more people than all terrorist attacks and natural disasters combined because people can’t afford to pay the bill mafia. That’s just a very sad state of affairs.

shrumm 8y ago

Singapore does this really well. A hospital is mandated by law to provide you financial counselling - it’s like a predictive charge sheet of what you will be charged when you’re admitted to the hospital. It’s unreasonable to expect 100% accuracy, they give you an estimate based on everything they know. if circumstances change, they are required to provide you an updated financial counsel sheet.