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Bringing transparency to ER prices, one hospital bill at a time

227 points by smacktoward 8y ago

ForrestN 8y ago
Kliff's approach to covering healthcare is nothing short of miraculous. She's killing it on all fronts—dominating the beat as far as traditional reporting techniques, innovating new ways (like this) to unearth information, and on top of it, communicating an intricate and sometimes abstract area of public policy in a way that anyone can understand and relate to. In general, I think vox.com is underrated. But Kliff in particular stands out.
- fishtoaster 8y ago
  I love vox.com's depth (which their clickbaity headlines belie). Their podcast, The Weeds (where they get into, of course, the weeds of policy topics) is among my favorites. They are a little too liberal for my tastes, sometimes. I mean, I'm at least that liberal myself, but I sometimes feel I'm just getting the side of the story that caters to my existing beliefs from Vox. Sarah Kliff's reporting, specifically, though, has always stood out as unusually excellent to me. It doesn't seem to suffer from that problem as much as some other Vox reporters I like (eg Matthew Yglesias). Her healthcare coverage, of course, is supurb, but there's also great stuff like her piece[0] on the wage gap. [0] https://www.vox.com/2017/9/8/16268362/gender-wage-gap-explained https://www.vox.com/2017/9/8/16268362/gender-wage-gap-explai...
- joe_the_user 8y ago
  While Kliff's work seems good, the title has the "Helping X, one Y at a time" problem. The actually state of affairs is that arbitrary hospital bills are a problem that won't be solved one hospital at a time but rather are going require regulation, not just on all hospitals but of health care broadly.
  - tialaramex 8y ago
    The one Y at a time approach brings _transparency_ as mentioned in the title. Once there's transparency the conversation is more likely to be about the facts because that's what everybody can see. When you don't have transparency what happens is that everybody can bring their own anecdotes, maybe baseless, and you can watch as a group "wins the argument" based on claims _you_ know are spurious, because even though their position is unsupportable on the facts, nobody had those facts. So, you're right that Kliff's work doesn't itself fix the problem, but what it does is document the problem unmistakeably so that this thread has fewer people saying "I don't think that can be right, my friend's sister knew someone who worked in an ER and they never charge that much". Back in technology the Certificate Transparency system doesn't itself solve any problems per se. But it delivers transparency, and that has allowed clean-ups to happen in years that would undoubtedly have taken decades to complete without transparency. It still requires a Will in the right place to solve the problem, for example CT's effectiveness is in good part dependant on Mozilla. Would Google step up to the plate and do the same job if Mozilla didn't exist? Maybe, or maybe for political reasons as a for-profit they would fail. Certainly Symantec's leadership believed that going over our heads to Google management would get them what they wanted, but unless what they wanted was "Get out of this business" that does not seem to have worked. But the good news is that for healthcare Americans can vote to put that Will in place in your country.
halflings 8y ago
I moved to the US about a year ago. Went to ER for the first time ~3 months ago. I was charged about $4000 for: - Cleaning a wound (with water/desinfectant). - Some antibiotics. - A band-aid and gauze. I get how, with labor cost and all, that might cost $200. Maybe $300? I have no idea how this can cost $4000.
- village-idiot 8y ago
  And the worst thing is that there’s no way to predict the cost. Even if you go to an ER that’s in network (good luck with that in an emergency), you might be assigned an out of network doctor and be charged out of network prices
  - taurath 8y ago
    Worse - you can get a bill in the mail later for some out of network doctor who looked at a chart without ever interacting with you, in addition to the hospitals charge.
    - xvf22 8y ago
      Yup, or a bill from an out of network doctor that consulted while you were under or generally unaware [0] [0] https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...
    - maxerickson 8y ago
      My favorite is that the hospital will use the external consultation to charge more for the visit.
      - olliej 8y ago
        Recruitment fee for the out of network you didn’t ask for!
  - benmorris 8y ago
airstrike 8y ago
> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. This, to me, is a perfect example of why healthcare should be subsidized by the government (either directly or through a government-backed insurance plan that you receive as a fallback). Health isn't a good or service you choose to purchase. Demand is perfectly inelastic and everyone is subject to emergencies no matter how healthy their habits are.
- robertAngst 8y ago
  That sounds great, but our US government has failed us for 30 years on healthcare. Not sure why anyone thinks that tax dollars would make the problem better.
  - dreamdu5t 8y ago
    No. Politicians favoring policies that deliberately exclude the poor have failed us for 30 years. We have never been able to make extensive progress on healthcare because voters elect politicians that fight against government health insurance (even fighting against spending government money on insurance for the disabled and elderly). Free market ideologues have failed us, not the government. This is painfully obvious if you've ever been in another civilized country (Taiwan, Canada, UK, etc.).
    - dreamdu5t 8y ago
      Let's see, Republicans are for denying healthcare to people who can't afford it (a free market). Democrats are for ensuring access to healthcare for everyone, including those who can't afford it (using taxes, so everyone who can pay pays and the rich cover the poor). It's pretty fucking cut and dry at this point. We can dispense with the philosophical grandstanding.
  - astrodust 8y ago
    Something like 40% of Americans already receive "government health care" in some form or other. Any government employees, military, police, teachers, fire fighters, and so on, receive health care. Anyone who qualifies for Medicare does. Just push that number to 100%.
smacktoward 8y ago
As the person who submitted this story, I have a question: why was Sarah Kliff’s name removed from the headline? I submitted it with the same title it carries at CJR, which includes her name. The story is a profile of her and her work, so removing it makes the headline less informative, not more. And she’s not a celebrity, so mentioning her by name doesn’t make the headline any more clickbaity than it would be without it. Is there some reason HN believes she deserves to have her name struck out of the title of her own profile?
- robertAngst 8y ago
  I find HN borderline propaganda. Its the only educated place on the internet, but the front page and comments is what HN whales decide.
  - pokemongoaway 8y ago
    I support this comment. Especially considering the "free speech alternatives" like gab.ai are being forcefully taken down.
  - devwastaken 8y ago
    I would save the word propaganda for what it's meant to mean, and not for dissatisfaction in the bias of a platform.
  - dang 8y ago
    You're not giving the community enough credit. We moderate the site, but we certainly don't determine it—and if we do something the community doesn't like, they are anything but shy in letting us know.
- stephenbez 8y ago
  Same thing happened to me, where the title was changed from "Java Creator James Gosling: Why I Quit Oracle" to "Why I Quit Oracle". https://news.ycombinator.com/item?id=15163932 https://news.ycombinator.com/item?id=15163932 It doesn't make sense.
erentz 8y ago
For the past three weeks I’ve been going through a flare up of an autoimmune neurological condition. It’s been terribly painful. The treatment is high dose IVIG or plasmapheresis. Unfortunately my insurer doesn’t want to pay. I’m told if I had almost any other insurer they would. This has left me trying to find out just how much I’d have to pay out of pocket for either of these services. But absolutely no one knows and no one will work it out for me. All I know is it will be somewhere between $30k and $60k from various guesses that have been offered. Pricing in the US health system needs regulation. The best option would be all providers must charge the same rate to all customers. Then I could look up the price and know it’s been prenegotiated by big insurance companies.
- maxxxxx 8y ago
  "The best option would be all providers must charge the same rate to all customers. Then I could look up the price and know it’s been prenegotiated by big insurance companies. " This should be number one.
- ekarulf 8y ago
  I get IVIG 3x / week for a primary immune deficiency I’ve had since birth. For my dosage, it’s billed weekly at a rate of ~$32K of which my insurance company pays around ~$3K. I hit my max out of pocket the first month of each year and the rest of the year is “free.” I know that all the IVIG pharmaceutical companies offer a “I can’t afford this” option if you’re going out of pocket. Good luck, it’s stressful to get but it’s a miracle blood product for those who need it.
- fjsolwmv 8y ago
  What would justify such a law, in a free country like the USA? Even socialised medicine countries can't force private providers to charge constant rates to their private clients.
kayhi 8y ago
I can really relate to this problem as it also exists in scientific chemicals and supplies.
randyrand 8y ago
While it wouldn’t be my first go to, I have to wonder if complete 100% deregulation would be better than what we have today.
- 1stranger 8y ago
  I've wondered the same thing. It seems like we have the worst of both systems.
- MichaelApproved 8y ago
  Why would you even entertain that thought? When has anything even remotely the size of healthcare been 100% deregulated and successful? Why go for such far out nonsense like this when there are perfectly good examples of successful healthcare models in other countries.
  - randyrand 8y ago
    > When has anything even remotely the size of healthcare been 100% deregulated and successful Plenty. The electronics market huge and barely regulated. The hardware for smartphones are cheap and amazing, televisions, etc. Automobiles are huge and relatively unregulated. It's not a great comparison, but your question was bad. The size of the industry has nothing to do with whether or not it should be regulated. The reason to entertain this thought it because deregulation is part of the solution to high health care costs.
    - MichaelApproved 8y ago
      > electronics market huge and barely regulated. "Electronics market"?! That's like calling healthcare the "service industry". > Automobiles are huge and relatively unregulated. This is laughable. Air bags, seat belts, emissions, break lights, tires, and more. Cars are one of the most regulated industries out there. From how they're built to how they're sold (manufacturer can't own the dealerships). > It's not a great comparison, but your question was bad. Your attempt to add something meaningful failed.
- 8y ago
joecool1029 8y ago
Heh, funny they brought up the rabies vaccine anecdote. I was jogging and had a bat fly into my eye one night. This was during a period in my early 20's when I didn't have health insurance. My bill was around $14k for the immunoglobulin and vaccine series. I paid somewhere around $2k out of pocket for ER fees. There was a program through Sanofi Pasteur and the CDC to pay for it for people under a certain income threshold. Seems it's bad press if Americans catch symptoms of rabies and die, since prevention is straightforward... and it is such a deadly disease. The kicker was, around a year after this... the hospital reported me to collections for nonpayment of the full amount. I begged the guy that I submitted the application to, to provide me with a record of being covered under this program. Thankfully he violated HIPAA law and did it. Provided me with a complete report of everyone paid under the program that month. The hospital's response was to tell me to immediately destroy the document, citing privacy law, and to tell them where I got it from. I explained that I would not be doing that, and that I would go public with the situation to as many sources as possible. The next day the hospital had a meeting with their vice president and the head of their pharmacy department. Within the week, I had collections removed from my credit reports.
User23 8y ago
The medical profession's billing practices make used car dealers look reputable.
viburnum 8y ago
Just nationalize the whole damn thing already.
- novalis78 8y ago
  ...and make it 15 times as expensive, unfortunately.
  - smacktoward 8y ago
    This is the exact opposite of the truth. The US spends a disproportionately high amount on health care compared to other industrialized nations, and receives worse outcomes from that expenditure to boot. See https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-... for details.
calebm 8y ago
I consider myself a "pragmatic libertarian", and by "pragmatic", I mean I'm in favor of legislative intervention when the free market often goes awry. Examples of this would be combating monopolies (since I don't want feudal system 2.0) , preventing immoral practices (like child labor), and controlling prices when there is no competition at work, such as utilities. It seems that with hospitals, there effectively is no competition-driven pricing pressure due to unpublished pricing. This seems like a place ripe for legislative intervention... but perhaps the medical industry is so bad that it would be better to just nationalize it.
- bakenator 8y ago
  The US government has put in place extremely heavy barriers to open a medical care facility. If we were to allow people to open facilities that compete with hospitals, we would very quickly see advertised prices and dramatic price drops. The medical cartel and all its bizarre non-market activities are a result of the existing legislation in place.
  - masonic 8y ago
    The US government has put in place extremely heavy barriers to open a medical care facility That's not true at all. The federal government wouldn't gave any reason to intervene unless you end up falsely billing a Federal program like Midicare, Medicaid, or VA. The reason for consolidation in ERs is cost -- uf you run an ER, you are obligated to treat anybody who cones in without regard to ability to pay. It's a money pit in many urban areas.
    - trhway 8y ago
      Certificate of need. For example: https://www.vox.com/policy-and-politics/2018/7/31/17629526/mri-cost-certificate-of-need-north-carolina-lawsuit https://www.vox.com/policy-and-politics/2018/7/31/17629526/m...
- zaarn 8y ago
  Hospitals in the US not only benefit from unpublished pricing, they also benefit from the situation of customers. A lot of their customers will be unable to compare multiple hospitals and "shop around", so to speak. Either because their conditions is life threatening, they're actively dying or they're no longer responsive. The ambulance, in any rational scenario, will drive you to the closest hospital in terms of time-spent-driving So from a corporate perspective it's perfect; the customer arrives and you're legally obligated to start spending money while they are likely unable to object and then you can bill them for it.
wonderwonder 8y ago
Anecdotal story, a few years ago my dad had a heart attack. He was self employed, living the american dream so no insurance. He had to stay 2 nights plus ambulance ride. Total bill ~80k. I kid you not, 3 days after he got out my mom shattered her wrist and was taken to emergency surgery. ~40K. They wracked up a bill slightly less than their mortgage in under a week. Of course they could not pay and the hospital dropped it down to something affordable over a long period of time. How could the hospital expect anyone to pay either of the bills? Don't get me wrong, hospitals and doctors do amazing things and deserve to get paid well, but their has to be some sort of reality applied to the billing process or they are just breaking people.
- novalis78 8y ago
  A similar motivation got a friend and me started with pricepain.com - but the ACA made us take a step back and see if anything changed / got better... apparently not. Though some of these state bills that try to force more transparency have since pushed the topic a bit further. Still so far from a market place.
  - wonderwonder 8y ago
    Checked out the site, very cool concept. Obviously needs some polish but the idea could be very monetizable if you can get traffic. Nice work.
- olliej 8y ago
  That’s easy - medical debt isn’t written off by bankruptcy. So they’re pretty much guaranteed unending money.
  - grandmczeb 8y ago
    At least in the USA, this isn’t true. Medical debt can be discharged in bankruptcy.
  - victor106 8y ago
    Source? “Medical debt can be completely discharged if you qualify for Chapter 7 bankruptcy or you can pay it over three to five years through a Chapter 13 repayment plan” https://www.thebalance.com/tactics-to-deal-with-medical-debt-960859 https://www.thebalance.com/tactics-to-deal-with-medical-debt...
hedvig 8y ago
Standardize the bill format across all providers, and provide EDI billing option, or a digital copy, and then we have something very easy to parse and store and make comparisons. Barring that, develop OCR parser. There's probably just a few programs that hospitals use that generate the bill paper so most formats could be profiled.
jolmg 8y ago
> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. We had a bill from someone who had gotten a rabies vaccine at an emergency room What the... I'm pretty sure vaccines only work to prevent illnesses and are very much useless to treat them. I mean they're supposed to be small quantities of the virus or bacteria that causes a given illness to train the immune system to defend itself. Why would you add more of the rabies virus when you might potentially already have more than you can handle after being bitten? I thought she was just giving a bad imaginary example, but she says she "had a bill from someone who had gotten a rabies vaccine at an emergency room". Could she have misinterpreted why the vaccine was administered? but why would anyone need a vaccine in an emergency?
- nsillik 8y ago
  The rabies vaccine is usually only given post-bite, unless you’re unusually likely to be bitten (e.g. veterinarian). If you don’t get the rabies vaccine shortly after being infected, you will almost certainly die.
- Sniffnoy 8y ago
  No, that's how rabies vaccines are typically used. You get them after (potential) exposure but before the disease kicks in. You can also get it in advance -- they last about 10 years -- but this isn't typically done, presumably because most people don't expect to get bitten by wild animals very often.
- mintplant 8y ago
  This is referring to postexposure rabies prophylaxis (PRP); see https://www.cdc.gov/rabies/medical_care/ https://www.cdc.gov/rabies/medical_care/ under "Postexposure Vaccinations": > Rabies postexposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14.
- maxerickson 8y ago
  Rabies is a slow moving infection that hides from the immune system and usually doesn't become lethal until it hits the central nervous system. The vaccine stimulates immunity before the infection becomes serious. Modern treatment also includes antibodies that will immediately work against the virus.
jhinra 8y ago
I love that Kliff gives a shout out to Kaiser Health News’ Bill-of-the-Month feature (https://khn.org/news/tag/bill-of-the-month/ https://khn.org/news/tag/bill-of-the-month/), which is a really similar project. I wonder if these two projects were independently inspired? Either way, totally a good thing to get more public visibility into medical billing.
esotericn 8y ago
The practices espoused here confuse me quite a bit (essentially, variants of not being quoted a price before a thing happens). In the UK it's common to, say, go to a pub and buy a pint. It's not usual to ask for the price first. It's possible a bar could decide to quote me 500 quid after pouring. I'd obviously decline and walk out. How is it any different in the healthcare case? If you've made an honest effort to determine a price, been told it'll be about X, and then receive a bill for 10x, it sounds like a scam that cannot be enforceable.
- LeftTurnSignal 8y ago
  You forgot the part about forcing you to sign paperwork saying you'll pay everything insurance doesn't before you see anyone. That's how I went from being told I was only getting charged $100ish and wound up being forced to pay $600.
shawn 8y ago
Actually, when you do things a community member disagrees with, you ban them and say they aren’t really a part of the community. The front page ranking is determined entirely by you. The comment ranking isn't far behind. Credit where credit is due.
- deleted 8y ago
  [deleted]
- dang 8y ago
  None of that is true. Since you either can't or won't stop posting like this, we're not going to unban you after three months, because clearly this problem is just continuing. But if you can go three months without posting any abusive, off-topic, meta comments, we'll consider it. In the meantime, we're continuing to unkill good comments that you post, if the community hasn't vouched for them first. We detached this comment from https://news.ycombinator.com/item?id=18289284 https://news.ycombinator.com/item?id=18289284 and marked it off-topic.
  - pokemongoaway 8y ago
    Typical dang reply... I've demonstrated this many times and offered to email you plenty of evidence that lots of reasonable and credentialed members agree with me. You are the censor here; you are in the wrong. Unless censorship is right, then please support that notion. The reason why you do not support it publicly is because you know that you will lose the debate. "In the meantime, we're continuing to unkill good comments that you post" -- So you are deciding which comments are good and which are bad. Exactly as I had claimed, and that you had denied. Previously you claimed that the "rules" decided which comments lived & died. Pretty incredible how few of my comments have made it through in the past 3 months, considering that. I am vouching for this comment. And let it be known that I have had many comments vouched for by others that were killed regardless.
  - shawn 8y ago
    Note that I never revealed the secrets about HN that you trusted me with. Remember? That makes it rather hard to prove that you do in fact determine the front page ranking, except perhaps for stories that the community initially upvotes. The comment ranking is determined by you to the extent that you specifically micro manage comments that you feel don’t deserve the top slot, even if the community disagrees. I have several examples of this. I don’t understand why you have a problem with someone simply stating what they know to be true.

227 points by smacktoward 8y ago

Kliff's approach to covering healthcare is nothing short of miraculous. She's killing it on all fronts—dominating the beat as far as traditional reporting techniques, innovating new ways (like this) to unearth information, and on top of it, communicating an intricate and sometimes abstract area of public policy in a way that anyone can understand and relate to. In general, I think vox.com is underrated. But Kliff in particular stands out.

fishtoaster 8y ago
I love vox.com's depth (which their clickbaity headlines belie). Their podcast, The Weeds (where they get into, of course, the weeds of policy topics) is among my favorites. They are a little too liberal for my tastes, sometimes. I mean, I'm at least that liberal myself, but I sometimes feel I'm just getting the side of the story that caters to my existing beliefs from Vox. Sarah Kliff's reporting, specifically, though, has always stood out as unusually excellent to me. It doesn't seem to suffer from that problem as much as some other Vox reporters I like (eg Matthew Yglesias). Her healthcare coverage, of course, is supurb, but there's also great stuff like her piece[0] on the wage gap. [0] https://www.vox.com/2017/9/8/16268362/gender-wage-gap-explained https://www.vox.com/2017/9/8/16268362/gender-wage-gap-explai...
joe_the_user 8y ago
While Kliff's work seems good, the title has the "Helping X, one Y at a time" problem. The actually state of affairs is that arbitrary hospital bills are a problem that won't be solved one hospital at a time but rather are going require regulation, not just on all hospitals but of health care broadly.
- tialaramex 8y ago
  The one Y at a time approach brings _transparency_ as mentioned in the title. Once there's transparency the conversation is more likely to be about the facts because that's what everybody can see. When you don't have transparency what happens is that everybody can bring their own anecdotes, maybe baseless, and you can watch as a group "wins the argument" based on claims _you_ know are spurious, because even though their position is unsupportable on the facts, nobody had those facts. So, you're right that Kliff's work doesn't itself fix the problem, but what it does is document the problem unmistakeably so that this thread has fewer people saying "I don't think that can be right, my friend's sister knew someone who worked in an ER and they never charge that much". Back in technology the Certificate Transparency system doesn't itself solve any problems per se. But it delivers transparency, and that has allowed clean-ups to happen in years that would undoubtedly have taken decades to complete without transparency. It still requires a Will in the right place to solve the problem, for example CT's effectiveness is in good part dependant on Mozilla. Would Google step up to the plate and do the same job if Mozilla didn't exist? Maybe, or maybe for political reasons as a for-profit they would fail. Certainly Symantec's leadership believed that going over our heads to Google management would get them what they wanted, but unless what they wanted was "Get out of this business" that does not seem to have worked. But the good news is that for healthcare Americans can vote to put that Will in place in your country.

halflings 8y ago

I moved to the US about a year ago. Went to ER for the first time ~3 months ago. I was charged about $4000 for: - Cleaning a wound (with water/desinfectant). - Some antibiotics. - A band-aid and gauze. I get how, with labor cost and all, that might cost $200. Maybe $300? I have no idea how this can cost $4000.

village-idiot 8y ago
And the worst thing is that there’s no way to predict the cost. Even if you go to an ER that’s in network (good luck with that in an emergency), you might be assigned an out of network doctor and be charged out of network prices
- taurath 8y ago
  Worse - you can get a bill in the mail later for some out of network doctor who looked at a chart without ever interacting with you, in addition to the hospitals charge.
  - xvf22 8y ago
    Yup, or a bill from an out of network doctor that consulted while you were under or generally unaware [0] [0] https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur...
  - maxerickson 8y ago
    My favorite is that the hospital will use the external consultation to charge more for the visit.
    - olliej 8y ago
      Recruitment fee for the out of network you didn’t ask for!
- benmorris 8y ago

airstrike 8y ago

> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. This, to me, is a perfect example of why healthcare should be subsidized by the government (either directly or through a government-backed insurance plan that you receive as a fallback). Health isn't a good or service you choose to purchase. Demand is perfectly inelastic and everyone is subject to emergencies no matter how healthy their habits are.

robertAngst 8y ago
That sounds great, but our US government has failed us for 30 years on healthcare. Not sure why anyone thinks that tax dollars would make the problem better.
- dreamdu5t 8y ago
  No. Politicians favoring policies that deliberately exclude the poor have failed us for 30 years. We have never been able to make extensive progress on healthcare because voters elect politicians that fight against government health insurance (even fighting against spending government money on insurance for the disabled and elderly). Free market ideologues have failed us, not the government. This is painfully obvious if you've ever been in another civilized country (Taiwan, Canada, UK, etc.).
  - dreamdu5t 8y ago
    Let's see, Republicans are for denying healthcare to people who can't afford it (a free market). Democrats are for ensuring access to healthcare for everyone, including those who can't afford it (using taxes, so everyone who can pay pays and the rich cover the poor). It's pretty fucking cut and dry at this point. We can dispense with the philosophical grandstanding.
- astrodust 8y ago
  Something like 40% of Americans already receive "government health care" in some form or other. Any government employees, military, police, teachers, fire fighters, and so on, receive health care. Anyone who qualifies for Medicare does. Just push that number to 100%.

smacktoward 8y ago

As the person who submitted this story, I have a question: why was Sarah Kliff’s name removed from the headline? I submitted it with the same title it carries at CJR, which includes her name. The story is a profile of her and her work, so removing it makes the headline less informative, not more. And she’s not a celebrity, so mentioning her by name doesn’t make the headline any more clickbaity than it would be without it. Is there some reason HN believes she deserves to have her name struck out of the title of her own profile?

robertAngst 8y ago
I find HN borderline propaganda. Its the only educated place on the internet, but the front page and comments is what HN whales decide.
- pokemongoaway 8y ago
  I support this comment. Especially considering the "free speech alternatives" like gab.ai are being forcefully taken down.
- devwastaken 8y ago
  I would save the word propaganda for what it's meant to mean, and not for dissatisfaction in the bias of a platform.
- dang 8y ago
  You're not giving the community enough credit. We moderate the site, but we certainly don't determine it—and if we do something the community doesn't like, they are anything but shy in letting us know.
stephenbez 8y ago
Same thing happened to me, where the title was changed from "Java Creator James Gosling: Why I Quit Oracle" to "Why I Quit Oracle". https://news.ycombinator.com/item?id=15163932 https://news.ycombinator.com/item?id=15163932 It doesn't make sense.

erentz 8y ago

For the past three weeks I’ve been going through a flare up of an autoimmune neurological condition. It’s been terribly painful. The treatment is high dose IVIG or plasmapheresis. Unfortunately my insurer doesn’t want to pay. I’m told if I had almost any other insurer they would. This has left me trying to find out just how much I’d have to pay out of pocket for either of these services. But absolutely no one knows and no one will work it out for me. All I know is it will be somewhere between $30k and $60k from various guesses that have been offered. Pricing in the US health system needs regulation. The best option would be all providers must charge the same rate to all customers. Then I could look up the price and know it’s been prenegotiated by big insurance companies.

maxxxxx 8y ago
"The best option would be all providers must charge the same rate to all customers. Then I could look up the price and know it’s been prenegotiated by big insurance companies. " This should be number one.
ekarulf 8y ago
I get IVIG 3x / week for a primary immune deficiency I’ve had since birth. For my dosage, it’s billed weekly at a rate of ~$32K of which my insurance company pays around ~$3K. I hit my max out of pocket the first month of each year and the rest of the year is “free.” I know that all the IVIG pharmaceutical companies offer a “I can’t afford this” option if you’re going out of pocket. Good luck, it’s stressful to get but it’s a miracle blood product for those who need it.
fjsolwmv 8y ago
What would justify such a law, in a free country like the USA? Even socialised medicine countries can't force private providers to charge constant rates to their private clients.

kayhi 8y ago

I can really relate to this problem as it also exists in scientific chemicals and supplies.

randyrand 8y ago

While it wouldn’t be my first go to, I have to wonder if complete 100% deregulation would be better than what we have today.

1stranger 8y ago
I've wondered the same thing. It seems like we have the worst of both systems.
MichaelApproved 8y ago
Why would you even entertain that thought? When has anything even remotely the size of healthcare been 100% deregulated and successful? Why go for such far out nonsense like this when there are perfectly good examples of successful healthcare models in other countries.
- randyrand 8y ago
  > When has anything even remotely the size of healthcare been 100% deregulated and successful Plenty. The electronics market huge and barely regulated. The hardware for smartphones are cheap and amazing, televisions, etc. Automobiles are huge and relatively unregulated. It's not a great comparison, but your question was bad. The size of the industry has nothing to do with whether or not it should be regulated. The reason to entertain this thought it because deregulation is part of the solution to high health care costs.
  - MichaelApproved 8y ago
    > electronics market huge and barely regulated. "Electronics market"?! That's like calling healthcare the "service industry". > Automobiles are huge and relatively unregulated. This is laughable. Air bags, seat belts, emissions, break lights, tires, and more. Cars are one of the most regulated industries out there. From how they're built to how they're sold (manufacturer can't own the dealerships). > It's not a great comparison, but your question was bad. Your attempt to add something meaningful failed.
8y ago

joecool1029 8y ago

Heh, funny they brought up the rabies vaccine anecdote. I was jogging and had a bat fly into my eye one night. This was during a period in my early 20's when I didn't have health insurance. My bill was around $14k for the immunoglobulin and vaccine series. I paid somewhere around $2k out of pocket for ER fees. There was a program through Sanofi Pasteur and the CDC to pay for it for people under a certain income threshold. Seems it's bad press if Americans catch symptoms of rabies and die, since prevention is straightforward... and it is such a deadly disease. The kicker was, around a year after this... the hospital reported me to collections for nonpayment of the full amount. I begged the guy that I submitted the application to, to provide me with a record of being covered under this program. Thankfully he violated HIPAA law and did it. Provided me with a complete report of everyone paid under the program that month. The hospital's response was to tell me to immediately destroy the document, citing privacy law, and to tell them where I got it from. I explained that I would not be doing that, and that I would go public with the situation to as many sources as possible. The next day the hospital had a meeting with their vice president and the head of their pharmacy department. Within the week, I had collections removed from my credit reports.

User23 8y ago

The medical profession's billing practices make used car dealers look reputable.

viburnum 8y ago

Just nationalize the whole damn thing already.

novalis78 8y ago
...and make it 15 times as expensive, unfortunately.
- smacktoward 8y ago
  This is the exact opposite of the truth. The US spends a disproportionately high amount on health care compared to other industrialized nations, and receives worse outcomes from that expenditure to boot. See https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/ https://www.healthsystemtracker.org/chart-collection/health-... for details.

calebm 8y ago

I consider myself a "pragmatic libertarian", and by "pragmatic", I mean I'm in favor of legislative intervention when the free market often goes awry. Examples of this would be combating monopolies (since I don't want feudal system 2.0) , preventing immoral practices (like child labor), and controlling prices when there is no competition at work, such as utilities. It seems that with hospitals, there effectively is no competition-driven pricing pressure due to unpublished pricing. This seems like a place ripe for legislative intervention... but perhaps the medical industry is so bad that it would be better to just nationalize it.

bakenator 8y ago
The US government has put in place extremely heavy barriers to open a medical care facility. If we were to allow people to open facilities that compete with hospitals, we would very quickly see advertised prices and dramatic price drops. The medical cartel and all its bizarre non-market activities are a result of the existing legislation in place.
- masonic 8y ago
  The US government has put in place extremely heavy barriers to open a medical care facility That's not true at all. The federal government wouldn't gave any reason to intervene unless you end up falsely billing a Federal program like Midicare, Medicaid, or VA. The reason for consolidation in ERs is cost -- uf you run an ER, you are obligated to treat anybody who cones in without regard to ability to pay. It's a money pit in many urban areas.
  - trhway 8y ago
    Certificate of need. For example: https://www.vox.com/policy-and-politics/2018/7/31/17629526/mri-cost-certificate-of-need-north-carolina-lawsuit https://www.vox.com/policy-and-politics/2018/7/31/17629526/m...
zaarn 8y ago
Hospitals in the US not only benefit from unpublished pricing, they also benefit from the situation of customers. A lot of their customers will be unable to compare multiple hospitals and "shop around", so to speak. Either because their conditions is life threatening, they're actively dying or they're no longer responsive. The ambulance, in any rational scenario, will drive you to the closest hospital in terms of time-spent-driving So from a corporate perspective it's perfect; the customer arrives and you're legally obligated to start spending money while they are likely unable to object and then you can bill them for it.

wonderwonder 8y ago

Anecdotal story, a few years ago my dad had a heart attack. He was self employed, living the american dream so no insurance. He had to stay 2 nights plus ambulance ride. Total bill ~80k. I kid you not, 3 days after he got out my mom shattered her wrist and was taken to emergency surgery. ~40K. They wracked up a bill slightly less than their mortgage in under a week. Of course they could not pay and the hospital dropped it down to something affordable over a long period of time. How could the hospital expect anyone to pay either of the bills? Don't get me wrong, hospitals and doctors do amazing things and deserve to get paid well, but their has to be some sort of reality applied to the billing process or they are just breaking people.

novalis78 8y ago
A similar motivation got a friend and me started with pricepain.com - but the ACA made us take a step back and see if anything changed / got better... apparently not. Though some of these state bills that try to force more transparency have since pushed the topic a bit further. Still so far from a market place.
- wonderwonder 8y ago
  Checked out the site, very cool concept. Obviously needs some polish but the idea could be very monetizable if you can get traffic. Nice work.
olliej 8y ago
That’s easy - medical debt isn’t written off by bankruptcy. So they’re pretty much guaranteed unending money.
- grandmczeb 8y ago
  At least in the USA, this isn’t true. Medical debt can be discharged in bankruptcy.
- victor106 8y ago
  Source? “Medical debt can be completely discharged if you qualify for Chapter 7 bankruptcy or you can pay it over three to five years through a Chapter 13 repayment plan” https://www.thebalance.com/tactics-to-deal-with-medical-debt-960859 https://www.thebalance.com/tactics-to-deal-with-medical-debt...

hedvig 8y ago

Standardize the bill format across all providers, and provide EDI billing option, or a digital copy, and then we have something very easy to parse and store and make comparisons. Barring that, develop OCR parser. There's probably just a few programs that hospitals use that generate the bill paper so most formats could be profiled.

jolmg 8y ago

> If you are bitten by a raccoon, you can’t really decide not to get the rabies vaccine. It’s literally a life-or-death situation. But the price is incredibly high. We had a bill from someone who had gotten a rabies vaccine at an emergency room What the... I'm pretty sure vaccines only work to prevent illnesses and are very much useless to treat them. I mean they're supposed to be small quantities of the virus or bacteria that causes a given illness to train the immune system to defend itself. Why would you add more of the rabies virus when you might potentially already have more than you can handle after being bitten? I thought she was just giving a bad imaginary example, but she says she "had a bill from someone who had gotten a rabies vaccine at an emergency room". Could she have misinterpreted why the vaccine was administered? but why would anyone need a vaccine in an emergency?

nsillik 8y ago
The rabies vaccine is usually only given post-bite, unless you’re unusually likely to be bitten (e.g. veterinarian). If you don’t get the rabies vaccine shortly after being infected, you will almost certainly die.
Sniffnoy 8y ago
No, that's how rabies vaccines are typically used. You get them after (potential) exposure but before the disease kicks in. You can also get it in advance -- they last about 10 years -- but this isn't typically done, presumably because most people don't expect to get bitten by wild animals very often.
mintplant 8y ago
This is referring to postexposure rabies prophylaxis (PRP); see https://www.cdc.gov/rabies/medical_care/ https://www.cdc.gov/rabies/medical_care/ under "Postexposure Vaccinations": > Rabies postexposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14.
maxerickson 8y ago
Rabies is a slow moving infection that hides from the immune system and usually doesn't become lethal until it hits the central nervous system. The vaccine stimulates immunity before the infection becomes serious. Modern treatment also includes antibodies that will immediately work against the virus.

jhinra 8y ago

I love that Kliff gives a shout out to Kaiser Health News’ Bill-of-the-Month feature (https://khn.org/news/tag/bill-of-the-month/ https://khn.org/news/tag/bill-of-the-month/), which is a really similar project. I wonder if these two projects were independently inspired? Either way, totally a good thing to get more public visibility into medical billing.

esotericn 8y ago

The practices espoused here confuse me quite a bit (essentially, variants of not being quoted a price before a thing happens). In the UK it's common to, say, go to a pub and buy a pint. It's not usual to ask for the price first. It's possible a bar could decide to quote me 500 quid after pouring. I'd obviously decline and walk out. How is it any different in the healthcare case? If you've made an honest effort to determine a price, been told it'll be about X, and then receive a bill for 10x, it sounds like a scam that cannot be enforceable.

LeftTurnSignal 8y ago
You forgot the part about forcing you to sign paperwork saying you'll pay everything insurance doesn't before you see anyone. That's how I went from being told I was only getting charged $100ish and wound up being forced to pay $600.

shawn 8y ago

Actually, when you do things a community member disagrees with, you ban them and say they aren’t really a part of the community. The front page ranking is determined entirely by you. The comment ranking isn't far behind. Credit where credit is due.

deleted 8y ago
[deleted]
dang 8y ago
None of that is true. Since you either can't or won't stop posting like this, we're not going to unban you after three months, because clearly this problem is just continuing. But if you can go three months without posting any abusive, off-topic, meta comments, we'll consider it. In the meantime, we're continuing to unkill good comments that you post, if the community hasn't vouched for them first. We detached this comment from https://news.ycombinator.com/item?id=18289284 https://news.ycombinator.com/item?id=18289284 and marked it off-topic.
- pokemongoaway 8y ago
  Typical dang reply... I've demonstrated this many times and offered to email you plenty of evidence that lots of reasonable and credentialed members agree with me. You are the censor here; you are in the wrong. Unless censorship is right, then please support that notion. The reason why you do not support it publicly is because you know that you will lose the debate. "In the meantime, we're continuing to unkill good comments that you post" -- So you are deciding which comments are good and which are bad. Exactly as I had claimed, and that you had denied. Previously you claimed that the "rules" decided which comments lived & died. Pretty incredible how few of my comments have made it through in the past 3 months, considering that. I am vouching for this comment. And let it be known that I have had many comments vouched for by others that were killed regardless.
- shawn 8y ago
  Note that I never revealed the secrets about HN that you trusted me with. Remember? That makes it rather hard to prove that you do in fact determine the front page ranking, except perhaps for stories that the community initially upvotes. The comment ranking is determined by you to the extent that you specifically micro manage comments that you feel don’t deserve the top slot, even if the community disagrees. I have several examples of this. I don’t understand why you have a problem with someone simply stating what they know to be true.