8 ms·

Of course if you are in the top 5-10% of earners (which I suppose many/most on this forum are), a privately funded system will almost always be better simply be

Of course if you are in the top 5-10% of earners (which I suppose many/most on this forum are), a privately funded system will almost always be better simply because you can afford to pay for the best. For myself I’d much, much rather live in a society where a cancer diagnosis doesn’t financially ruin you and your family for you life, and where everyone no matter their income receives quality care when it’s needed. Even if that means that I have to wait weeks/months to get something non-critical seen.

LeoTinnitus 7y ago
I'm personally I the camp of, why the hell can I not know how much stuff costs up front, why can I not tell them no I dont an unnecessary x-ray, and why am I not told cost owed by me until after the procedure only to find out it's just an absurd amount of money Private insurance blows cause we're all basically required to have it but it's worse than a tax because we barely ever know how much we owe.
- EpicEng 7y ago
  >why the hell can I not know how much stuff costs up front Prices should be publicized, I agree, but you can ask to get something pre-authorized. It just takes longer. >why can I not tell them no I dont an unnecessary x-ray You can ask your doctor why you need an x-ray, why they deem it necessary, and refuse if you like >and why am I not told cost owed by me until after the procedure only to find out it's just an absurd amount of money Again, you can ask for pre-auth.
  - ridewinter 7y ago
    This doesn't seem to be something that's common knowledge. Can you point to information on how to use private health insurance like this?
    - EpicEng 7y ago
      You just ask the front desk to pre-authorize the prescribed treatment. They work with the insurance carrier and let you know what your cost will be.
  - roland35 7y ago
    Pre-authorization sounds good, but unfortunately a lot of the time it isn't possible. For example, when I was in the ER they gave me a few choices on how they could do stiches on a big cut... But there is definitely no way I could compare the costs! I just ended up paying a $500 bill a few months later.
    - EpicEng 7y ago
      Yes, emergency situations are different. Not much of a chance to wait and shop around.
    - refurb 7y ago
      Lack of pricing information is ridiculous in the US. You can’t base a system on the “free market” then prevent consumers from having pricing information. It certainly wouldn’t fix everything in the US, but it would be a huge help. To be honest, I’m not sure why hospitals in the US haven’t taken the lead on this. If I had a choice between two hospital of similar quality, but one provided price transparency and maybe even a price guarantee (your procedure will cost $X, guaranteed), I would certainly go to that hospital.
- enraged_camel 7y ago
  Price transparency is a tremendously difficult problem because healthcare is a multi-layered bureaucracy. Even then though, making prices transparent wouldn’t address the primary scenario that results in personal bankruptcy, which is emergency care. You can’t exactly shop around for the cheapest ER facility if you’re bleeding from a gunshot wound.
  - caseysoftware 7y ago
    What types of injuries/illnesses are the leading cause of personal bankruptcy?
  - mattkrause 7y ago
    Information asymmetries are a huge problem in "market solutions" and there's a huge one here: doctors have 8+ years of medical training and most patients....don't. It's going to be very hard for many people to second-guess a doctor's recommendation or estimate the expected value of decisions. In a non-emergency situation, you can certainly try to read up on your own, but the medical literature is not always easy to interpret. A friend of mine asked for advice after he was diagnosed with Parkinson's Disease. Despite having a PhD in neuroscience and working as a researcher in a PD Center of Excellence, I had a really hard time making a recommendation. (Neuro conditions are particularly hard, but this is also possibly the best-case match with my experience).
  - refurb 7y ago
    I had a good friend who worked in a leadership role at a major health system in CA. He readily admitted that the hospital has a very poor grasp on their own costs. At a high-level, they just charge as much as they can - sometimes they lose money, sometimes they make a 90% profit. They pool it all together (usually by line of business) and hope it all works out as a profit. That’s why specialized, stand alone clinics (e.g. MRI clinic) have some of the best prices. They know exactly what things cost and can make sure prices reflect it.
- deleted 7y ago
  [deleted]
- unishark 7y ago
  There's plenty cash-only doctors and clinics out there. There's also companies that handle healthcare for their employees via personal accounts (they put more cash in your account each year, and you spend or don't as you see fit). People on such plans do a lot more shopping around. And as the other poster said, you always have the right to refuse treatment, up to your death if you like (unless it is some kind of involuntary commitment where you are put there because you are supposedly dangerous). Many terminally ill people choose to go this way.
  - Joe-Z 7y ago
    Oh sounds like everything is fine then! Seriouy doesn‘t your hair stand up in horror when you re-read this?! „You can always choose to die when you can‘t afford treatment“. WTF?!
- Talanes 7y ago
  It's so ridiculous. I had Kaiser for a period, because I was under the impression the bundle of insurer and healthcare provider would avoid these issues. It worked that way for a bit, but then I got some X-Rays. Paid up front, and then a few months later got an additional bill.
  - newnewpdro 7y ago
    > I was under the impression the bundle of insurer and healthcare provider would avoid these issues. It gets worse, bundling those two is the epitome of conflict of interests when you find yourself the victim of the hospital's negligence and expect your insurer to act in your best interest. Nope!
  - winrid 7y ago
    Interesting. Kaiser paid for a 4 hour ambulance ride for me from one hospital to another for immediate surgery. I think I remember paying like $100.
harikb 7y ago
I just spent two hours today to wait at an “urgent care” facility in southbay (my regular doctor of 20 years! wouldn’t give me an apt after several days of trying). I think I owe north of $400+ for this one time visit because I am in the early phase of a high-deductible plan. But I haven’t got my bill yet. After the two hour wait, I didn’t even get to see a doctor, but a Physician Assistant. So much for my private plan..
- deleted 7y ago
  [deleted]
- Mirioron 7y ago
  I think this is the biggest issue with private healthcare. You pay a lot of money for it, yet you can still end up with subpar care and extra charges for out of network professionals
- zeroonetwothree 7y ago
  Well two hours < three months. I’ve had to wait longer for urgent care. If I can get it same day I’m happy.
- winrid 7y ago
  This was one interesting thing about my visit to China. Pay $25, see a doctor right away. In fact you can pick how good of a doctor you want to see (prices on the wall at the hospital I was at). This wasn't a small place - it's probably comparable to Kaiser in Redwood City. In contrast when I was in a much much smaller "community" hospital in China I just walked in, talked to the lady at the desk, and she gave me a prescription. No temperature taking or anything...
ivanhoe 7y ago
Problem is that sometimes you have to wait even for actually critical things - friend's mom waited almost 2 months for her cancer operation. In US if you've got money you're more or less covered, while in Europe the difference is that in some (admittedly rare) situations even if you earn well you're screwed just like everyone else.
- sjf 7y ago
  You can get private insurance in Europe if you want.
  - ryanlol 7y ago
    Yeah, I pay less than 1k/yr for fancy private health insurance in Europe.
    - anticensor 7y ago
      What do you mean by fancy?
      - ryanlol 7y ago
        Medevac, top tier hospitals around the world (except US, lol) in network.
        Twixes 7y ago
        Trauma Team too?
        ryanlol 7y ago
        Covered, but availability unsurprisingly depends on if the care provider decides to activate it.
        Twixes 7y ago
commandlinefan 7y ago
> where a cancer diagnosis doesn’t financially ruin you What OP is suggesting is that it doesn’t financially ruin you in Sweden, you just die waiting to see a doctor.
- freddie_mercury 7y ago
  Statistics on mortality don't show that happening.
- SolaceQuantum 7y ago
  Does that actually happen?
- ttsda 7y ago
  I don't think the wait for cancer patients is 4 months. Even in Portugal you'll get treated and we're much poorer with a much more deficient health system.
  - ryanmarsh 7y ago
    This leads me to wonder... Do cancer survival rates differ in countries with government health care vs. private?
    - tomschlick 7y ago
      Looks like the US has some of the highest rates across the board: http://worldpopulationreview.com/countries/cancer-survival-rates-by-country/ http://worldpopulationreview.com/countries/cancer-survival-r...
      - smnrchrds 7y ago
        I am not sure if 5-year survival rates are the best metric for this. Survival rate may be because of better outcomes or earlier detection. Is there any statistics that normalize for this?
    - 7y ago
ryanmarsh 7y ago
The chances of getting cancer are so low you’d think some smart insurance company would want to sell you a catastrophic cancer policy with a low monthly premium. Then it wouldn’t have to mean financial ruin, the same way I have homeowners insurance (without which a fire would spell financial ruin for most). Why isn’t this a thing? Can someone in the industry chime in?
- quickthrower2 7y ago
  Huh? I thought cancer was one of the big killers after heart disease. While you are relatively young maybe the probability is low. That’s also when you are working so private health insurance and income protection insurance would have you covered I imagine.
  - ryanmarsh 7y ago
    Ok went to cancer.gov and Approximately 39.3 percent of men and women will be diagnosed with cancer of any site at some point during their lifetime, based on 2014-2016 data. So, I can’t see why any insurance company could offer reasonable rates given those odds.
rayiner 7y ago
> Of course if you are in the top 5-10% of earners Do you go to a special doctors office for the top 5-10%? The one I go to is full of ordinary middle class people. 80% of Americans polled rate their healthcare as excellent or good: https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx https://news.gallup.com/poll/245195/americans-rate-healthcar.... The American healthcare system isn’t hard to fix because it only works for 5-10% of people. It’s hard to fix because it works for 80% of people. Americans don’t irrationally cling to a system that’s bad for 90% of them. (Even among Democrats, a large fraction oppose getting rid of current health insurance: https://slate.com/business/2019/10/medicare-for-all-is-getting-less-popular.html https://slate.com/business/2019/10/medicare-for-all-is-getti...) Americans stick to the current system, because it works for most people. Most middle class people don’t go bankrupt when they get sick. And the middle class pays the lowest taxes in the developed world, because they don’t pay 20-30% payroll taxes like in European countries to support healthcare for the bottom quarter of earners. That’s the bargain people have voted for. That is obvious, because candidates who campaign for Swedish style healthcare don’t propose Swedish style taxes to go with it. Elizabeth Warren isn’t running on a top tax bracket that kicks in at $75,000 — she’s running on a wealth tax Sweden abandoned and corporate taxes higher than Sweden. Because Americans won’t vote for the bargain between healthcare coverage and middle class taxes that Swedes have adopted. It’s not the system I’d prefer, I’d rather pay more taxes and make sure the bottom 25% have adequate healthcare. But the notion that everyone is actually irrational and the current system only benefits a small minority is self deception.
- cheez 7y ago
  So _why_ if it works for 80% of polled people does it keep being touted as it resulting in bankruptcy consistently?
  - lifeformed 7y ago
    The other 20% is a lot of people.
    - xeromal 7y ago
ekianjo 7y ago
> where a cancer diagnosis doesn’t financially ruin you and your family for you life, If a cancer related, life-saving surgery takes 4-5 months to happen before you can have it, I'm not sure it really matters if it ends up being free or not.
- skinnymuch 7y ago
  Life threatening stuff is obviously not going to be a 4 month wait. The OP obviously didn’t have this sort of issue.
  - ekianjo 7y ago
    No. Look at NHS stats in England https://www.theguardian.com/society/2019/jan/10/nhs-england-misses-multiple-targets-for-cancer-treatment https://www.theguardian.com/society/2019/jan/10/nhs-england-... > Over 18,000 suspected cancer patients a month in England are now not getting to see a specialist or starting their treatment within prescribed timescales, NHS England’s latest performance data has revealed.
    - deleted 7y ago
      [deleted]
    - dx034 7y ago
      And others get treatment same day. It all depends on criticality. One of the reasons for long wait times is that there are always urgent cases being pushed to the top of the list. I agree that it sucks having to wait for an important surgery. But they don't make you wait if it's life threatening.
      - ekianjo 7y ago
        > But they don't make you wait if it's life threatening. That's literally what is written in the article. People who wait several months to get a necessary CT or imagery before they can decide to do anything about it. Some cancers can progress very fast in the space of a couple of months, it's basically the difference between life and death in some cases.
winrid 7y ago
I mean, growing up on welfare/social security our family didn't have trouble seeing any kind of doctor.

LeoTinnitus 7y ago

I'm personally I the camp of, why the hell can I not know how much stuff costs up front, why can I not tell them no I dont an unnecessary x-ray, and why am I not told cost owed by me until after the procedure only to find out it's just an absurd amount of money Private insurance blows cause we're all basically required to have it but it's worse than a tax because we barely ever know how much we owe.

EpicEng 7y ago
>why the hell can I not know how much stuff costs up front Prices should be publicized, I agree, but you can ask to get something pre-authorized. It just takes longer. >why can I not tell them no I dont an unnecessary x-ray You can ask your doctor why you need an x-ray, why they deem it necessary, and refuse if you like >and why am I not told cost owed by me until after the procedure only to find out it's just an absurd amount of money Again, you can ask for pre-auth.
- ridewinter 7y ago
  This doesn't seem to be something that's common knowledge. Can you point to information on how to use private health insurance like this?
  - EpicEng 7y ago
    You just ask the front desk to pre-authorize the prescribed treatment. They work with the insurance carrier and let you know what your cost will be.
- roland35 7y ago
  Pre-authorization sounds good, but unfortunately a lot of the time it isn't possible. For example, when I was in the ER they gave me a few choices on how they could do stiches on a big cut... But there is definitely no way I could compare the costs! I just ended up paying a $500 bill a few months later.
  - EpicEng 7y ago
    Yes, emergency situations are different. Not much of a chance to wait and shop around.
  - refurb 7y ago
    Lack of pricing information is ridiculous in the US. You can’t base a system on the “free market” then prevent consumers from having pricing information. It certainly wouldn’t fix everything in the US, but it would be a huge help. To be honest, I’m not sure why hospitals in the US haven’t taken the lead on this. If I had a choice between two hospital of similar quality, but one provided price transparency and maybe even a price guarantee (your procedure will cost $X, guaranteed), I would certainly go to that hospital.
enraged_camel 7y ago
Price transparency is a tremendously difficult problem because healthcare is a multi-layered bureaucracy. Even then though, making prices transparent wouldn’t address the primary scenario that results in personal bankruptcy, which is emergency care. You can’t exactly shop around for the cheapest ER facility if you’re bleeding from a gunshot wound.
- caseysoftware 7y ago
  What types of injuries/illnesses are the leading cause of personal bankruptcy?
- mattkrause 7y ago
  Information asymmetries are a huge problem in "market solutions" and there's a huge one here: doctors have 8+ years of medical training and most patients....don't. It's going to be very hard for many people to second-guess a doctor's recommendation or estimate the expected value of decisions. In a non-emergency situation, you can certainly try to read up on your own, but the medical literature is not always easy to interpret. A friend of mine asked for advice after he was diagnosed with Parkinson's Disease. Despite having a PhD in neuroscience and working as a researcher in a PD Center of Excellence, I had a really hard time making a recommendation. (Neuro conditions are particularly hard, but this is also possibly the best-case match with my experience).
- refurb 7y ago
  I had a good friend who worked in a leadership role at a major health system in CA. He readily admitted that the hospital has a very poor grasp on their own costs. At a high-level, they just charge as much as they can - sometimes they lose money, sometimes they make a 90% profit. They pool it all together (usually by line of business) and hope it all works out as a profit. That’s why specialized, stand alone clinics (e.g. MRI clinic) have some of the best prices. They know exactly what things cost and can make sure prices reflect it.
deleted 7y ago
[deleted]
unishark 7y ago
There's plenty cash-only doctors and clinics out there. There's also companies that handle healthcare for their employees via personal accounts (they put more cash in your account each year, and you spend or don't as you see fit). People on such plans do a lot more shopping around. And as the other poster said, you always have the right to refuse treatment, up to your death if you like (unless it is some kind of involuntary commitment where you are put there because you are supposedly dangerous). Many terminally ill people choose to go this way.
- Joe-Z 7y ago
  Oh sounds like everything is fine then! Seriouy doesn‘t your hair stand up in horror when you re-read this?! „You can always choose to die when you can‘t afford treatment“. WTF?!
Talanes 7y ago
It's so ridiculous. I had Kaiser for a period, because I was under the impression the bundle of insurer and healthcare provider would avoid these issues. It worked that way for a bit, but then I got some X-Rays. Paid up front, and then a few months later got an additional bill.
- newnewpdro 7y ago
  > I was under the impression the bundle of insurer and healthcare provider would avoid these issues. It gets worse, bundling those two is the epitome of conflict of interests when you find yourself the victim of the hospital's negligence and expect your insurer to act in your best interest. Nope!
- winrid 7y ago
  Interesting. Kaiser paid for a 4 hour ambulance ride for me from one hospital to another for immediate surgery. I think I remember paying like $100.

harikb 7y ago

I just spent two hours today to wait at an “urgent care” facility in southbay (my regular doctor of 20 years! wouldn’t give me an apt after several days of trying). I think I owe north of $400+ for this one time visit because I am in the early phase of a high-deductible plan. But I haven’t got my bill yet. After the two hour wait, I didn’t even get to see a doctor, but a Physician Assistant. So much for my private plan..

deleted 7y ago
[deleted]
Mirioron 7y ago
I think this is the biggest issue with private healthcare. You pay a lot of money for it, yet you can still end up with subpar care and extra charges for out of network professionals
zeroonetwothree 7y ago
Well two hours < three months. I’ve had to wait longer for urgent care. If I can get it same day I’m happy.
winrid 7y ago
This was one interesting thing about my visit to China. Pay $25, see a doctor right away. In fact you can pick how good of a doctor you want to see (prices on the wall at the hospital I was at). This wasn't a small place - it's probably comparable to Kaiser in Redwood City. In contrast when I was in a much much smaller "community" hospital in China I just walked in, talked to the lady at the desk, and she gave me a prescription. No temperature taking or anything...

ivanhoe 7y ago

Problem is that sometimes you have to wait even for actually critical things - friend's mom waited almost 2 months for her cancer operation. In US if you've got money you're more or less covered, while in Europe the difference is that in some (admittedly rare) situations even if you earn well you're screwed just like everyone else.

sjf 7y ago
You can get private insurance in Europe if you want.
- ryanlol 7y ago
  Yeah, I pay less than 1k/yr for fancy private health insurance in Europe.
  - anticensor 7y ago
    What do you mean by fancy?
    - ryanlol 7y ago
      Medevac, top tier hospitals around the world (except US, lol) in network.
      - Twixes 7y ago
        Trauma Team too?
        ryanlol 7y ago
        Covered, but availability unsurprisingly depends on if the care provider decides to activate it.
        Twixes 7y ago

commandlinefan 7y ago

> where a cancer diagnosis doesn’t financially ruin you What OP is suggesting is that it doesn’t financially ruin you in Sweden, you just die waiting to see a doctor.

freddie_mercury 7y ago
Statistics on mortality don't show that happening.
SolaceQuantum 7y ago
Does that actually happen?
ttsda 7y ago
I don't think the wait for cancer patients is 4 months. Even in Portugal you'll get treated and we're much poorer with a much more deficient health system.
- ryanmarsh 7y ago
  This leads me to wonder... Do cancer survival rates differ in countries with government health care vs. private?
  - tomschlick 7y ago
    Looks like the US has some of the highest rates across the board: http://worldpopulationreview.com/countries/cancer-survival-rates-by-country/ http://worldpopulationreview.com/countries/cancer-survival-r...
    - smnrchrds 7y ago
      I am not sure if 5-year survival rates are the best metric for this. Survival rate may be because of better outcomes or earlier detection. Is there any statistics that normalize for this?
  - 7y ago

ryanmarsh 7y ago

The chances of getting cancer are so low you’d think some smart insurance company would want to sell you a catastrophic cancer policy with a low monthly premium. Then it wouldn’t have to mean financial ruin, the same way I have homeowners insurance (without which a fire would spell financial ruin for most). Why isn’t this a thing? Can someone in the industry chime in?

quickthrower2 7y ago
Huh? I thought cancer was one of the big killers after heart disease. While you are relatively young maybe the probability is low. That’s also when you are working so private health insurance and income protection insurance would have you covered I imagine.
- ryanmarsh 7y ago
  Ok went to cancer.gov and Approximately 39.3 percent of men and women will be diagnosed with cancer of any site at some point during their lifetime, based on 2014-2016 data. So, I can’t see why any insurance company could offer reasonable rates given those odds.

rayiner 7y ago

> Of course if you are in the top 5-10% of earners Do you go to a special doctors office for the top 5-10%? The one I go to is full of ordinary middle class people. 80% of Americans polled rate their healthcare as excellent or good: https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx https://news.gallup.com/poll/245195/americans-rate-healthcar.... The American healthcare system isn’t hard to fix because it only works for 5-10% of people. It’s hard to fix because it works for 80% of people. Americans don’t irrationally cling to a system that’s bad for 90% of them. (Even among Democrats, a large fraction oppose getting rid of current health insurance: https://slate.com/business/2019/10/medicare-for-all-is-getting-less-popular.html https://slate.com/business/2019/10/medicare-for-all-is-getti...) Americans stick to the current system, because it works for most people. Most middle class people don’t go bankrupt when they get sick. And the middle class pays the lowest taxes in the developed world, because they don’t pay 20-30% payroll taxes like in European countries to support healthcare for the bottom quarter of earners. That’s the bargain people have voted for. That is obvious, because candidates who campaign for Swedish style healthcare don’t propose Swedish style taxes to go with it. Elizabeth Warren isn’t running on a top tax bracket that kicks in at $75,000 — she’s running on a wealth tax Sweden abandoned and corporate taxes higher than Sweden. Because Americans won’t vote for the bargain between healthcare coverage and middle class taxes that Swedes have adopted. It’s not the system I’d prefer, I’d rather pay more taxes and make sure the bottom 25% have adequate healthcare. But the notion that everyone is actually irrational and the current system only benefits a small minority is self deception.

cheez 7y ago
So _why_ if it works for 80% of polled people does it keep being touted as it resulting in bankruptcy consistently?
- lifeformed 7y ago
  The other 20% is a lot of people.
  - xeromal 7y ago

ekianjo 7y ago

> where a cancer diagnosis doesn’t financially ruin you and your family for you life, If a cancer related, life-saving surgery takes 4-5 months to happen before you can have it, I'm not sure it really matters if it ends up being free or not.

skinnymuch 7y ago
Life threatening stuff is obviously not going to be a 4 month wait. The OP obviously didn’t have this sort of issue.
- ekianjo 7y ago
  No. Look at NHS stats in England https://www.theguardian.com/society/2019/jan/10/nhs-england-misses-multiple-targets-for-cancer-treatment https://www.theguardian.com/society/2019/jan/10/nhs-england-... > Over 18,000 suspected cancer patients a month in England are now not getting to see a specialist or starting their treatment within prescribed timescales, NHS England’s latest performance data has revealed.
  - deleted 7y ago
    [deleted]
  - dx034 7y ago
    And others get treatment same day. It all depends on criticality. One of the reasons for long wait times is that there are always urgent cases being pushed to the top of the list. I agree that it sucks having to wait for an important surgery. But they don't make you wait if it's life threatening.
    - ekianjo 7y ago
      > But they don't make you wait if it's life threatening. That's literally what is written in the article. People who wait several months to get a necessary CT or imagery before they can decide to do anything about it. Some cancers can progress very fast in the space of a couple of months, it's basically the difference between life and death in some cases.

winrid 7y ago

I mean, growing up on welfare/social security our family didn't have trouble seeing any kind of doctor.