3 ms·

I think there needs to be some new approach to how medical services are being paid for. My 70yo father fell off a ladder and drove himself to the hospital in Ca

I think there needs to be some new approach to how medical services are being paid for. My 70yo father fell off a ladder and drove himself to the hospital in Calhoun Georgia (2 hours north of Atlanta, a small town) with a bruised eye and a broken wrist. He got in late afternoon, left the next day, and the bill to insurance (which of course they won't pay) was $69,000... more than per capita income in the US. The system is ridiculous. In my opinion, healthcare has reached the state where the people who receive the benefit are too far removed from the people who pay for it and given there is no "victim" of price gauging, the prices will just keep going up up and way. I defer to those wiser than me for the solution. I don't like complaining without being constructive so here is my ignorant pass at it. This will require a few key steps: 1) Yes, we need more supply (by deregulating the profession) 2) I personally think a more effective solution would be to gradually eliminate insurance except for catastrophic risk (like emergency medical care from a car accident). #2 will shift responsibility to the individual and the system will be capped at what they can charge based on the average person's ability to pay for it (which is how it works in many parts of the world).

lettergram 4y ago
> left the next day, and the bill to insurance (which of course they won't pay) was $69,000 I agree with you and the quote above is because of insurance. Medicare will pay 10% of that total and your father would be charged 2-5%. If he has private insurance you’ll see something different, maybe 15% and your father would be charged 3-6%. If he’s going out of network could be 100%. Hospitals / practices charge insane bills because people pay just a small fraction typically. It really impacts those without insurance or private insurance the worst. It is insane. This is why I have suggested deregulation, particularly around licensing. It drives down the cost. Insurance may cover doctor X, but if nurse Y can do it for 5% the price... well use the nurse. All doctors would have to reduce prices and insurance would have to raise the coverage amount to compete. It’s what is done elsewhere in the world.
ClumsyPilot 4y ago
> Yes, we need more supply (by deregulating the profession) So it looks like software development? Are you comfortable for your life to be in the hands of a rando who just finished a 6-months bootcamp?
- lefstathiou 4y ago
  I don't think it has to be binary. For situations that are life threatening, I'll opt for a premium service and for situations that are not, I may opt for an alternative. I think almost anyone at our company can be trained to reliably operate and interpret an x-ray machine for the vast majority of use cases.
  - ClumsyPilot 4y ago
    'For situations that are life threatening, I'll opt for a premium service' 1 - what does the 'non-premium', i.e. bottomn of the barrel service look like, is that incompetent people offering rock bottom prices (resulting in death?). 2 - are you sure you can identify a life threatening situation correctly? Because my father did not. 3 - how do you know the 'premium' provider in question results in better outcomes, rather than being the same rubbish well presented in fancy packaging?
    - lefstathiou 4y ago
      Re #1 and 3: you have this problem with or without my system (take a look at plastic surgery clinics in Miami for example). Doctors can be incompetent too and the system is so opaque you can’t readily identify or measure the outcome. I think markets are efficient here and there are plenty of services we operate in now with similar spectrums of quality (food, airlines, general contracting, dental work, etc). The gap between my position and yours i believe fundamentally is that I believe people can and ultimately should be accountable for their decisions. I suspect you believe they need to be protected by a system of accreditation. I guess I don’t put too much weight into that. When you own the outcome, you are far more likely to do research, ask questions, compare etc. 2- I’m very sorry to hear that. I believe most people can most of the time. The more people are tasked with doing this, the more likely they will be to invest the time and effort to understand their health choices, seek counsel of others and potentially lead healthier lives. I too am a bit scarred by the medical system. My sister was diagnosed with colon cancer at 33 and it was discovered “just in time” because she kept rejecting the quick diagnoses multiple doctors in Boston gave her. Had she not self advocated she’d likely be dead. I made a similar mistake when my son was born during Covid. We went into an nyc hospital foolishly thinking that if you are nice, quiet and well mannered you will be treated with respect. My wife went into labor alone in a waiting room where she was abandoned for hours despite us telling them how long she was already in labor and her ringing the help button numerous times. I wasn’t allowed until she went into the delivery room but she never made it there. The lesson for me was clear 1- do your research 2- be prepared to self advocate 3- doctors are humans. Humans make mistake, they have limited and often flawed memories but unlike software development professionals, they do not have the benefit of being able to deploy state of the art systems, technologies and libraries Happy to take this offline if you care to. My email is in the profile.

lettergram 4y ago

> left the next day, and the bill to insurance (which of course they won't pay) was $69,000 I agree with you and the quote above is because of insurance. Medicare will pay 10% of that total and your father would be charged 2-5%. If he has private insurance you’ll see something different, maybe 15% and your father would be charged 3-6%. If he’s going out of network could be 100%. Hospitals / practices charge insane bills because people pay just a small fraction typically. It really impacts those without insurance or private insurance the worst. It is insane. This is why I have suggested deregulation, particularly around licensing. It drives down the cost. Insurance may cover doctor X, but if nurse Y can do it for 5% the price... well use the nurse. All doctors would have to reduce prices and insurance would have to raise the coverage amount to compete. It’s what is done elsewhere in the world.

ClumsyPilot 4y ago

> Yes, we need more supply (by deregulating the profession) So it looks like software development? Are you comfortable for your life to be in the hands of a rando who just finished a 6-months bootcamp?

lefstathiou 4y ago
I don't think it has to be binary. For situations that are life threatening, I'll opt for a premium service and for situations that are not, I may opt for an alternative. I think almost anyone at our company can be trained to reliably operate and interpret an x-ray machine for the vast majority of use cases.
- ClumsyPilot 4y ago
  'For situations that are life threatening, I'll opt for a premium service' 1 - what does the 'non-premium', i.e. bottomn of the barrel service look like, is that incompetent people offering rock bottom prices (resulting in death?). 2 - are you sure you can identify a life threatening situation correctly? Because my father did not. 3 - how do you know the 'premium' provider in question results in better outcomes, rather than being the same rubbish well presented in fancy packaging?
  - lefstathiou 4y ago
    Re #1 and 3: you have this problem with or without my system (take a look at plastic surgery clinics in Miami for example). Doctors can be incompetent too and the system is so opaque you can’t readily identify or measure the outcome. I think markets are efficient here and there are plenty of services we operate in now with similar spectrums of quality (food, airlines, general contracting, dental work, etc). The gap between my position and yours i believe fundamentally is that I believe people can and ultimately should be accountable for their decisions. I suspect you believe they need to be protected by a system of accreditation. I guess I don’t put too much weight into that. When you own the outcome, you are far more likely to do research, ask questions, compare etc. 2- I’m very sorry to hear that. I believe most people can most of the time. The more people are tasked with doing this, the more likely they will be to invest the time and effort to understand their health choices, seek counsel of others and potentially lead healthier lives. I too am a bit scarred by the medical system. My sister was diagnosed with colon cancer at 33 and it was discovered “just in time” because she kept rejecting the quick diagnoses multiple doctors in Boston gave her. Had she not self advocated she’d likely be dead. I made a similar mistake when my son was born during Covid. We went into an nyc hospital foolishly thinking that if you are nice, quiet and well mannered you will be treated with respect. My wife went into labor alone in a waiting room where she was abandoned for hours despite us telling them how long she was already in labor and her ringing the help button numerous times. I wasn’t allowed until she went into the delivery room but she never made it there. The lesson for me was clear 1- do your research 2- be prepared to self advocate 3- doctors are humans. Humans make mistake, they have limited and often flawed memories but unlike software development professionals, they do not have the benefit of being able to deploy state of the art systems, technologies and libraries Happy to take this offline if you care to. My email is in the profile.