5 ms·

A month ago, I was traveling in Germany with my family and my daughter had an emergency, so I had to go to a German hospital in the middle of the night. Within

A month ago, I was traveling in Germany with my family and my daughter had an emergency, so I had to go to a German hospital in the middle of the night. Within 1 hour, they had given my daughter an ultrasound and two doses of medicine to treat her problem, the cost to me: $130 euro, and I didn't even use my health insurance (which does cover international emergencies) 3 years ago, I had a gallbladder attack in Shanghai. I didn't know what was happening at the time, it felt like a heart attack, like I was dying. Went to a Chinese hospital, they did an ultrasound, chest x-ray, CT scan, EKG, blood and urine tests within 2 hours, plus gave me morphine and antibiotics. The cost was on the order of $200. I don't think the problems with the US healthcare system can be boiled down to capitalism vs socialism alone, it's much more nuanced than that. Also, comparing a highly automated, elective procedure, that takes 1-2 people, and on an out-patient basis from a private office to something like a heart bypass or hernia surgery I think oversimplifies the situation. If a doctor tells you that you need to have an MRI and a biopsy, how are you, an untrained "consumer" supposed to know a) whether or not it's really needed or excessive and b) how to shop around for it. c) if you can't afford it, and it's not an emergency, but it could save your life later, what then? If someone gets routine upper GI endoscopies if they have a high genetic potential for esophageal cancer, and they can't afford these procedures, should they just wait until they are chocking from cancer and go to an emergency room so the state can pay for much more expensive late stage cancer treatments? I'm all for comparison shopping, but there's still an element of right-to-healthcare for preventative care for those that can't afford it, and there's still the issue that people can't be expected to reason properly about risks and costs when their life is on the line. If a doctor prescribes a test, chances are, you'll want to do it out of fear alone of what might happen if you skip it.

JPKab 13y ago
I used to be on a High Deductible Health Plan, which is designed to be just like the author suggests: only for catastrophes. For anything else, you use a Health Savings Account (a tax free account you put money into) and use it to just pay cash prices. IT WAS HORRIBLE. The concept of course, is great. But the problem is one of chicken and egg. Because the entire system is set up for 3rd party payment, NOBODY, and I mean NOBODY, has a clue what they charge for anything. Go ahead, take the challenge. Ask a receptionist or even a doctor how much they charge for a procedure. They have no idea. The effect was that going to any medical appointment was a crap shoot. I had no clue what I was going to be paying until AFTER treatment. The amount of friction in just getting a price was so painful that shopping around was impossible. Since "shopping around" is the whole basis behind "price clearing" in markets, the current system of HSAs implemented by Bush is bullshit. Had he gone all the way, and just forced every insurance company to only offer HDHPs, then it would be different. Medical providers would have been forced to share pricing information.
- hayksaakian 13y ago
  wasn't there a Show HN recently that solved this exact problem of exposing pricing of medical procedures and such.
  - JPKab 13y ago
    No offense to the Show HN tool you are talking about, (I applaud anyone building anything) but it wasn't nearly as sophisticated as people think it was. It was just a pretty web app put on top of a DB loaded with data from a spreadsheet that was released by CMS.gov (Center for Medicare/Medicaid Studies) which is a breakdown for all of the major hospitals in the country, priced out by procedure code. It's a very cool dataset, and I recommend checking it out. Its also useless for anything other than stuff done in hospitals.
- refurb 13y ago
  It might have been your HDHP plan. I know the one my employer offers still have "networks". That is, the fees are pre-negotiated by the plan (you basically pay the same as for the non-HDHP plans). It's not hard to find out what they are either.
- EvanAnderson 13y ago
  My family is having exactly the same experience with our HDHP. I like the cost of the plan (and I'm saving every last red cent I can to cover future expenses) but I'm regarded like I'm crazy when I bring up cost to providers.
- felideon 13y ago
  Is it possible to pay cash prices without an HSA? I'm under the impression that if you have health insurance (high deductible or not) you are required to use it. The one time I asked for a cash price for a shot at a hospital, it was pretty quick for the receptionist to give it to me. (Incidentally, $150 cash vs. the $300 bill that came in the mail later, since I used my insurance. For a shot of Rhogam.)
  - EvanAnderson 13y ago
specialist 13y ago
...capitalism vs socialism alone, it's much more nuanced than that. Profiteering. Seems pretty simple to me. I'm exhausted by the -ism debates and mythical free markets. To me, it's about the incentives. So I support a single payer using the capitation model, reward wellness vs treating disease. With ACA (Obamacare), I hope that we're on our way towards single payer in the USA. Meanwhile, I'm impressed with improvements gained so far with the modest initial reforms (eg health exchanges). Who would have thought that a well regulated market with price transparency would lead to price competition? /sarcasm
- refurb 13y ago
  Profiteering is too simplistic of explanation. If you read up on the various regulations and how they create incentives for hospitals to do this, it makes more sense. And you have to be careful with the regulations you institute. A LOT of the current problems with the US healthcare system are due to gov't regulations. If you want to see an example, just google "average selling price ASP" and see the utter mess that regulation created for Medicare. Doctors and pharmacists milk the hell out of that gov't regulation. Same with 340b.
  - specialist 13y ago
    So fewer regulations will lower healthcare costs in the USA?
- ahallock 13y ago
  The free markets are mythical because they're not allowed to happen. Single payer is a horrible idea. Why would you trust a centralized agency (which can be bribed and corrupted so easily) with such an essential service? The government purchasing healthcare from outside organizations is bound to be overrun with special interests and obscene contracts (like we see with the military). I want to be able to vote with my wallet; I don't want a single entity, especially one that can levy taxes and borrow massive amounts of money from the Fed, to have a monopoly. The State will then just choose winners and losers, make certain activities illegal so we can't test alternatives, etc. I just don't see how that can end well.

JPKab 13y ago

I used to be on a High Deductible Health Plan, which is designed to be just like the author suggests: only for catastrophes. For anything else, you use a Health Savings Account (a tax free account you put money into) and use it to just pay cash prices. IT WAS HORRIBLE. The concept of course, is great. But the problem is one of chicken and egg. Because the entire system is set up for 3rd party payment, NOBODY, and I mean NOBODY, has a clue what they charge for anything. Go ahead, take the challenge. Ask a receptionist or even a doctor how much they charge for a procedure. They have no idea. The effect was that going to any medical appointment was a crap shoot. I had no clue what I was going to be paying until AFTER treatment. The amount of friction in just getting a price was so painful that shopping around was impossible. Since "shopping around" is the whole basis behind "price clearing" in markets, the current system of HSAs implemented by Bush is bullshit. Had he gone all the way, and just forced every insurance company to only offer HDHPs, then it would be different. Medical providers would have been forced to share pricing information.

hayksaakian 13y ago
wasn't there a Show HN recently that solved this exact problem of exposing pricing of medical procedures and such.
- JPKab 13y ago
  No offense to the Show HN tool you are talking about, (I applaud anyone building anything) but it wasn't nearly as sophisticated as people think it was. It was just a pretty web app put on top of a DB loaded with data from a spreadsheet that was released by CMS.gov (Center for Medicare/Medicaid Studies) which is a breakdown for all of the major hospitals in the country, priced out by procedure code. It's a very cool dataset, and I recommend checking it out. Its also useless for anything other than stuff done in hospitals.
refurb 13y ago
It might have been your HDHP plan. I know the one my employer offers still have "networks". That is, the fees are pre-negotiated by the plan (you basically pay the same as for the non-HDHP plans). It's not hard to find out what they are either.
EvanAnderson 13y ago
My family is having exactly the same experience with our HDHP. I like the cost of the plan (and I'm saving every last red cent I can to cover future expenses) but I'm regarded like I'm crazy when I bring up cost to providers.
felideon 13y ago
Is it possible to pay cash prices without an HSA? I'm under the impression that if you have health insurance (high deductible or not) you are required to use it. The one time I asked for a cash price for a shot at a hospital, it was pretty quick for the receptionist to give it to me. (Incidentally, $150 cash vs. the $300 bill that came in the mail later, since I used my insurance. For a shot of Rhogam.)
- EvanAnderson 13y ago

specialist 13y ago

...capitalism vs socialism alone, it's much more nuanced than that. Profiteering. Seems pretty simple to me. I'm exhausted by the -ism debates and mythical free markets. To me, it's about the incentives. So I support a single payer using the capitation model, reward wellness vs treating disease. With ACA (Obamacare), I hope that we're on our way towards single payer in the USA. Meanwhile, I'm impressed with improvements gained so far with the modest initial reforms (eg health exchanges). Who would have thought that a well regulated market with price transparency would lead to price competition? /sarcasm

refurb 13y ago
Profiteering is too simplistic of explanation. If you read up on the various regulations and how they create incentives for hospitals to do this, it makes more sense. And you have to be careful with the regulations you institute. A LOT of the current problems with the US healthcare system are due to gov't regulations. If you want to see an example, just google "average selling price ASP" and see the utter mess that regulation created for Medicare. Doctors and pharmacists milk the hell out of that gov't regulation. Same with 340b.
- specialist 13y ago
  So fewer regulations will lower healthcare costs in the USA?
ahallock 13y ago
The free markets are mythical because they're not allowed to happen. Single payer is a horrible idea. Why would you trust a centralized agency (which can be bribed and corrupted so easily) with such an essential service? The government purchasing healthcare from outside organizations is bound to be overrun with special interests and obscene contracts (like we see with the military). I want to be able to vote with my wallet; I don't want a single entity, especially one that can levy taxes and borrow massive amounts of money from the Fed, to have a monopoly. The State will then just choose winners and losers, make certain activities illegal so we can't test alternatives, etc. I just don't see how that can end well.