7 ms·

Exactly right. People with insurance have zero idea how much medical care actually costs because it's really hard to keep up with all the health insurance docum

Exactly right. People with insurance have zero idea how much medical care actually costs because it's really hard to keep up with all the health insurance documents one receives. Try being hospitalized without insurance. You'll find out really fast. (I was, twice, circa 2010. I was unemployed and uninsured)

DebtDeflation 4y ago
People who get their insurance through their employer also typically have no idea how much their insurance premium costs because the average employer pays 70-80% of the actual monthly premium and what gets deducted from your paycheck every month is just the remainder.
- nightski 4y ago
  I'm guessing you are correct, seeing as in a similar fashion I'd imagine there are a lot of people who have no idea what their 401(k) is even invested in. However when going through the annual election process it generally makes it very clear how much you are paying out of each paycheck and what the employer contributes. Now whether people pay attention at all I can't say.
  - lotsofpulp 4y ago
    It is also listed in W-2 box 12 code DD. And many employers include the employer contribution on paystubs.
munk-a 4y ago
I would suggest a slight shift in wording from "how much medical care actually costs" to "how much medical care actually bills" since as we've seen both by examining the meteoric raise in healthcare billing from 1930s-today and by comparing the US health system to single payer systems abroad it's pretty clear that the billing for US medications, procedures, therapies and other healthcare items is completely fabricated and arbitrary when compared to the costs. I think Obama-care (as much as I still support it in contrast to just letting private healthcare continue as-is) actually made things worse in the US by letting insurers and providers use the government involvement as a justification for their BS.
- tzs 4y ago
  It's probably more complicated than that. When you compare US costs to countries like the UK, France, Germany, Japan, and similar it is indeed true that US is significantly more expensive. It is also true that over time US costs are rising significantly. However, the ratio of US costs to the costs of other countries has stayed roughly the same over time. In other words, the rest of them are having the same problem of rising costs that the US is, and their costs are rising at roughly the same rate. We pay a lot more than they do now because we paid a lot more than them a long time ago. This is worrisome, because it suggests that even if we can lower our health care costs to be in line with the rest of the developed world we are still heading for unaffordable healthcare--all we'd be doing is making so we reach that when the rest of the world does instead of a few years before they do. Here's some comments from earlier discussions with numbers and a link to the data [1] [2]. [1] https://news.ycombinator.com/item?id=32744920 https://news.ycombinator.com/item?id=32744920 [2] https://news.ycombinator.com/item?id=29768484 https://news.ycombinator.com/item?id=29768484
  - nradov 4y ago
    The majority of healthcare spending goes toward treating patients with chronic conditions primarily caused by lifestyle factors such as overeating, lack of exercise, and substance abuse. There is effectively infinite demand for healthcare services in that population. Depending on how you count, something like 1/7 of all healthcare dollars go to type-2 diabetes and related conditions alone. There is certainly some inefficiency in the US healthcare system but mostly it reflects the poor health of the population. Switching to some form of socialized medicine won't fix that problem. Other developed countries are doing a little better at the moment but they're on the same trend line and will inevitably hit the same crisis. At some point if we want to prevent a systemic collapse we're going to have to get serious about emphasizing prevention over treatment.
  - munk-a 4y ago
    Speaking as someone intimately familiar with healthcare pricing working really close to the industry specifically in pricing tracking - I can say yes - you aren't incorrect about the fact that healthcare costs going up over time (and the sibling comment about unhealthy lifestyles also isn't incorrect) but the US does indeed have completely arbitrary pricing. As a personal anecdote when I lived in the US there were three months in a row where I paid 10/pill, 3/pill and 1/pill (I also had earlier paid 0/pill when I qualified for VT medicaid) for the same medication[1] as I was 1) initially uninsured 2) covered by the "cigna preferred rate" but otherwise had no drug coverage 3) had regular drug coverage. As a bonus a few months after that run a generic for my medication came out and I paid .10/pill for the brand name because the generic existed but they didn't have it in stock. Please explain how that makes any sense at all. 1. Concerta - the 54mg version now apparently retails for $545 per 30 here's a weird website talking about it (I now live in Canada and while there isn't Pharmacare in my province the drug is free with some cheap insurance) https://www.singlecare.com/blog/concerta-without-insurance/ https://www.singlecare.com/blog/concerta-without-insurance/
mindslight 4y ago
> Try being hospitalized without insurance. You'll find out really fast Actually no, you still won't. Because the hospitals send out fraudulently inflated/overitemized bills to help their negotiating positions. To know how much medical care actually costs, you need to have "insurance" and read through the itemized bills and explanations of benefits. The top line large number is the fraudulent amount that has no basis in reality, there is an "adjustment" based on the rates the "insurance" company has actually agreed to pay, there is the amount the "insurance" company pays them, and then there is your portion. Adding the last two, or taking the first minus the second, is as close to knowing how much something costs as you can get in this fucked up system. Also it bears repeating, never pay a medical bill unless you're damn sure you're responsible for the amount [0]. Even if you have "insurance", often you'll get sent the fraudulent bill right away, and it will take a month or two for "insurance" to bother doing their job. Also billing departments have no problem blatantly lying to you about your (non) responsibility for the fraudulent bill, since it might get them more money. [0] Of course some times they have you over a barrel like ongoing care getting denied if you have an unpaid balance. In which case you just have to eat it and then hassle your "insurance" company for half a year to get your money back.
- peteradio 4y ago
  > Also it bears repeating, never pay a medical bill unless you're damn sure you're responsible for the amount [0]. Even if you have "insurance", often you'll get sent the fraudulent bill right away, and it will take a month or two for "insurance" to bother doing their job. Also billing departments have no problem blatantly lying to you about your (non) responsibility for the fraudulent bill, since it might get them more money. In practice how do you do this? I've never got a medical bill that made complete sense to me and when I did argue it went around in circles for so many months that it was not worth my time so I just paid it.
  - mindslight 4y ago
    Most of the time, just wait a few months for them to bill your "insurance" and for it to do its thing. The "due dates" on medical bills are basically meaningless. Then, you need to know your general deductible and copayment schedule. The bill should show original charges (fraudulent), "adjustments" to those charges to make them line up with what your "insurance" company has negotiated to pay, and then payment by the "insurance" company. The part remaining that you need to pay should line up with your deductible. If you've got a large deductible (common) and this is one of your first bills, then the "insurance" company won't have anything to pay, but there will still be an adjustment. If you think that is off, you can contact your "insurance" company to check if it matches their negotiated rates. In my experience, their customer service departments haven't been totally gutted yet. Calling the provider's billing department is generally pointless unless/until you know exactly what you're talking about. Once, a phone rep (at a small place even) called me to nag me about a bill. I told them that their charge was above the Medicare limit for a service, and that it needed to be corrected before I could pay. In response, they insisted harder that I "owed it" and I "had to pay". I told them they were wrong, ended the conversation, and just waited. Lo and behold 4-5 months later they finally billed the "insurance" and sent the correct bill. I think they were just hoping I'd fall for their fraud so they could pocket a few extra bucks. I'm certainly not an expert on this subject in particular, just generally experienced at cutting through the avalanches of paper that psychopaths try to bury us with.

DebtDeflation 4y ago

People who get their insurance through their employer also typically have no idea how much their insurance premium costs because the average employer pays 70-80% of the actual monthly premium and what gets deducted from your paycheck every month is just the remainder.

nightski 4y ago
I'm guessing you are correct, seeing as in a similar fashion I'd imagine there are a lot of people who have no idea what their 401(k) is even invested in. However when going through the annual election process it generally makes it very clear how much you are paying out of each paycheck and what the employer contributes. Now whether people pay attention at all I can't say.
- lotsofpulp 4y ago
  It is also listed in W-2 box 12 code DD. And many employers include the employer contribution on paystubs.

munk-a 4y ago

I would suggest a slight shift in wording from "how much medical care actually costs" to "how much medical care actually bills" since as we've seen both by examining the meteoric raise in healthcare billing from 1930s-today and by comparing the US health system to single payer systems abroad it's pretty clear that the billing for US medications, procedures, therapies and other healthcare items is completely fabricated and arbitrary when compared to the costs. I think Obama-care (as much as I still support it in contrast to just letting private healthcare continue as-is) actually made things worse in the US by letting insurers and providers use the government involvement as a justification for their BS.

tzs 4y ago
It's probably more complicated than that. When you compare US costs to countries like the UK, France, Germany, Japan, and similar it is indeed true that US is significantly more expensive. It is also true that over time US costs are rising significantly. However, the ratio of US costs to the costs of other countries has stayed roughly the same over time. In other words, the rest of them are having the same problem of rising costs that the US is, and their costs are rising at roughly the same rate. We pay a lot more than they do now because we paid a lot more than them a long time ago. This is worrisome, because it suggests that even if we can lower our health care costs to be in line with the rest of the developed world we are still heading for unaffordable healthcare--all we'd be doing is making so we reach that when the rest of the world does instead of a few years before they do. Here's some comments from earlier discussions with numbers and a link to the data [1] [2]. [1] https://news.ycombinator.com/item?id=32744920 https://news.ycombinator.com/item?id=32744920 [2] https://news.ycombinator.com/item?id=29768484 https://news.ycombinator.com/item?id=29768484
- nradov 4y ago
  The majority of healthcare spending goes toward treating patients with chronic conditions primarily caused by lifestyle factors such as overeating, lack of exercise, and substance abuse. There is effectively infinite demand for healthcare services in that population. Depending on how you count, something like 1/7 of all healthcare dollars go to type-2 diabetes and related conditions alone. There is certainly some inefficiency in the US healthcare system but mostly it reflects the poor health of the population. Switching to some form of socialized medicine won't fix that problem. Other developed countries are doing a little better at the moment but they're on the same trend line and will inevitably hit the same crisis. At some point if we want to prevent a systemic collapse we're going to have to get serious about emphasizing prevention over treatment.
- munk-a 4y ago
  Speaking as someone intimately familiar with healthcare pricing working really close to the industry specifically in pricing tracking - I can say yes - you aren't incorrect about the fact that healthcare costs going up over time (and the sibling comment about unhealthy lifestyles also isn't incorrect) but the US does indeed have completely arbitrary pricing. As a personal anecdote when I lived in the US there were three months in a row where I paid 10/pill, 3/pill and 1/pill (I also had earlier paid 0/pill when I qualified for VT medicaid) for the same medication[1] as I was 1) initially uninsured 2) covered by the "cigna preferred rate" but otherwise had no drug coverage 3) had regular drug coverage. As a bonus a few months after that run a generic for my medication came out and I paid .10/pill for the brand name because the generic existed but they didn't have it in stock. Please explain how that makes any sense at all. 1. Concerta - the 54mg version now apparently retails for $545 per 30 here's a weird website talking about it (I now live in Canada and while there isn't Pharmacare in my province the drug is free with some cheap insurance) https://www.singlecare.com/blog/concerta-without-insurance/ https://www.singlecare.com/blog/concerta-without-insurance/

mindslight 4y ago

> Try being hospitalized without insurance. You'll find out really fast Actually no, you still won't. Because the hospitals send out fraudulently inflated/overitemized bills to help their negotiating positions. To know how much medical care actually costs, you need to have "insurance" and read through the itemized bills and explanations of benefits. The top line large number is the fraudulent amount that has no basis in reality, there is an "adjustment" based on the rates the "insurance" company has actually agreed to pay, there is the amount the "insurance" company pays them, and then there is your portion. Adding the last two, or taking the first minus the second, is as close to knowing how much something costs as you can get in this fucked up system. Also it bears repeating, never pay a medical bill unless you're damn sure you're responsible for the amount [0]. Even if you have "insurance", often you'll get sent the fraudulent bill right away, and it will take a month or two for "insurance" to bother doing their job. Also billing departments have no problem blatantly lying to you about your (non) responsibility for the fraudulent bill, since it might get them more money. [0] Of course some times they have you over a barrel like ongoing care getting denied if you have an unpaid balance. In which case you just have to eat it and then hassle your "insurance" company for half a year to get your money back.

peteradio 4y ago
> Also it bears repeating, never pay a medical bill unless you're damn sure you're responsible for the amount [0]. Even if you have "insurance", often you'll get sent the fraudulent bill right away, and it will take a month or two for "insurance" to bother doing their job. Also billing departments have no problem blatantly lying to you about your (non) responsibility for the fraudulent bill, since it might get them more money. In practice how do you do this? I've never got a medical bill that made complete sense to me and when I did argue it went around in circles for so many months that it was not worth my time so I just paid it.
- mindslight 4y ago
  Most of the time, just wait a few months for them to bill your "insurance" and for it to do its thing. The "due dates" on medical bills are basically meaningless. Then, you need to know your general deductible and copayment schedule. The bill should show original charges (fraudulent), "adjustments" to those charges to make them line up with what your "insurance" company has negotiated to pay, and then payment by the "insurance" company. The part remaining that you need to pay should line up with your deductible. If you've got a large deductible (common) and this is one of your first bills, then the "insurance" company won't have anything to pay, but there will still be an adjustment. If you think that is off, you can contact your "insurance" company to check if it matches their negotiated rates. In my experience, their customer service departments haven't been totally gutted yet. Calling the provider's billing department is generally pointless unless/until you know exactly what you're talking about. Once, a phone rep (at a small place even) called me to nag me about a bill. I told them that their charge was above the Medicare limit for a service, and that it needed to be corrected before I could pay. In response, they insisted harder that I "owed it" and I "had to pay". I told them they were wrong, ended the conversation, and just waited. Lo and behold 4-5 months later they finally billed the "insurance" and sent the correct bill. I think they were just hoping I'd fall for their fraud so they could pocket a few extra bucks. I'm certainly not an expert on this subject in particular, just generally experienced at cutting through the avalanches of paper that psychopaths try to bury us with.