6 ms·

I keep getting that feeling that something must be done. Any suggestions HN readers?

csense 13y ago
Turn healthcare into a government bureaucracy. Because that's an effective way to combat waste, inefficiency, and overcharging </sarcasm>
- dnautics 13y ago
  at least all our patient data will be private. If we keep all of our private information in the hands of the HMOs and other corporations, the NSA might install a backdoor.
  - indefatigable 13y ago
    In other words, we should trust the DHHS and the IRS with information that the NSA can't be trusted to access? Am I reading that correctly?
  - ohWhatever 13y ago
    It's funny, because you seem to think that health care professionals, with their myriad Excel spreadsheets and mammoth stacks of Steelcase® file cabinets brimming with rainbow color-coordinated folders containing paper files seem to know the first thing about information security. These are non-technical people, who went to school mostly for biology and chemistry, or for the lowly clerks, and secretaries in your doctor's office, maybe two years of community college, with an associates degree in communications maybe. On average, take a random sample of the people who do the paper work for the lofty, priest-like physicians. Ask them what AES is, or what a SHA hash is, or even what SSL and TLS are. I guarantee you, that you'll get a blank stare. They know how to use the systems they're provided with, like they know how to open a bag of Oreo cookies. The doctors know how to pay IT professionals for services, like they know how to write a check, and know to procure electronic systems like they know how to make down payments on their Mercedes. You can be sure that they know how to shred all those e-mails that they print out and read over their morning coffee. It's only as private insofar as no one is supposed to look. This protects people under the law, in that, as a rule, certain information is not to be used as criteria for making certain business decisions. But this is merely a bureaucratic honor system, and it doesn't mean that people aren't aware of things they aren't supposed to know about. The information itself, frequently, isn't particularly "secure" according to more strenuous information security standards. Your credit card transactions are safer than your HIPAA information by a longshot, but mostly because there really isn't any sort of criminal profit motive behind obtaining and using that sort of information.
    - jes 13y ago
      You come down quite hard on healthcare professionals, with the comments about biology and chemistry being non-technical. Your comments about doctors also seem unrepresentative of what a modern doctor must actually know and accomplish in order to be a practicing physician.
- tibbon 13y ago
  Clearly, its a problem a free market will efficiently fix and prices will stay low. </sarcasm>
  - chrismonsanto 13y ago
    At least price transparency worked for surgeries in a hospital in Oklahoma: https://news.ycombinator.com/item?id=6014794 https://news.ycombinator.com/item?id=6014794 Perhaps a similar approach could work for IVs.
  - dnautics 13y ago
    the best solution is obviously some kind of public-private partnership, so that we can get the best parts of the public sector with the best parts of the private sector. There's no way we'll wind up with the worst parts of both.
- mapt 13y ago
  Turns out, it is. Even if one is willing to accept them into one's general worldview... First principles - like "government is wasteful" - only go so far in the face of conflicting data. And there is a lot of it on the topic of healthcare systems.
- chasing 13y ago
  Whelp, the private sector sure seems to be fuckin' it up, so maybe it's time we give the government a shot.
  - acheron 13y ago
    Which private sector is that? Because our current healthcare system is nowhere near "private".
    - mpyne 13y ago
      Well it's also nowhere near "public". For the most part we're talking about private hospitals and private insurance companies, the combination of which have failed to bring U.S. healthcare costs in line with the rest of the world. Don't simply blame "regulation" either. Many industries are regulated, some heavily so, and still manage to produce companies that are profitable and efficiently deliver good products. I don't think we'll see a real solution to the healthcare system in America until we stop treating it like it's just like any other industry.
- derleth 13y ago
  Only fools and ideologues argue against systems which have been demonstrated to work.
- noonespecial 13y ago
  The government is wasteful and inefficient, but it is not the most wasteful and inefficient system possible. Politics is the art of figuring out when to burn the extra resources on the government method because all of the other available methods are even worse.
chrismealy 13y ago
Copy the health care system of any other rich country. They all get about the same results for half the price or less.
- dnautics 13y ago
  We could kill about 9/10 of the population and get down to their size and ethnic homogeneity, as part of the copying process.
  - w1ntermute 13y ago
    I'm not sure why the overall size of the population is relevant here. If it works for countries with populations of 5 million (Norway), 63 million (UK), 82 million (Germany), and 126 million (Japan), I think it's completely reasonable to at least try it in a country of 319 million.
    - dnautics 13y ago
      Ethnic homogeneity is also an issue. If you think that an arab living in france gets the same quality of healthcare as a european french person at the same poverty level, you're kidding yourself. Not that the US doesn't have these problems. Ultimately, different ethnicities get different diseases, too, so the bureaucrats in charge of deciding what gets covered and to what extent are basically institutionalizing racial privilege. However, naive grass-is-greenerism is more of what I was railing against.
      - brohee 13y ago
        As someone that spent quite a bit of time in French hospitals visiting relatives recently, I have no reason whatsoever to think access to care is limited in anyway whether on ethnic or socioeconomic background... Do you care to cite some sources?
      - ucha 13y ago
        That is absolutely false. All French citizens and even foreigners enrolled in the "securite sociale" scheme have access to the same facilities, procedures and doctors. There is no discrimination in the public service. Any claims to the contrary are at best unfamiliarity with the subject if not deliberate misinformation.
uptown 13y ago
I'm nowhere near having an answer, but pricing transparency needs to be a major part of the solution. I realize OPEC isn't exactly a popular entity, but I wonder whether a similar model might have some benefits here. Form a group comprised of representatives from interested parties tasked with establishing pricing for services rendered that is consistent across the entire nation. Perhaps allow regional adjustments based on cost-of-living deviations, or some other relevant metric - but cap how much those deviations can actually influence the price of care. End the idiotic "billed rate" vs. the "negotiated rate" nonsense. Include patient transportation in the equation. If singular pricing isn't attainable, a local hospital's care is too expensive, and the patient can receive similar care at an alternate location in a cost-effective way - cover the transportation cost under their insurance. Tort reform. Liability insurance premiums for health care professionals is as crazy as the price for the care they provide. This is as big a problem as the price of a bag of saline. I know these aren't the answers - but pricing of services is key to the problem, and the Affordable Care Act did little to get that under control beyond attempting to move more individuals under the umbrella of insurance and outside of emergency care.
lifeformed 13y ago
What would happen if a hospital opened up that just had reasonable rates? It wouldn't make any deals with insurance companies other than to take payments. It posts all it's prices online and transparently for everyone to see. You can shop for treatments on their website. Could they make money this way?
- fnordfnordfnord 13y ago
  Apparently, a bidding war. Fancy that. http://kfor.com/2013/07/08/okc-hospital-posting-surgery-prices-online/ http://kfor.com/2013/07/08/okc-hospital-posting-surgery-pric...
angersock 13y ago
Start making the negative externalities of this pricing known to the bureaucrats in those hospital systems. Preferably with a lead pipe.

Turn healthcare into a government bureaucracy. Because that's an effective way to combat waste, inefficiency, and overcharging </sarcasm>

dnautics 13y ago
at least all our patient data will be private. If we keep all of our private information in the hands of the HMOs and other corporations, the NSA might install a backdoor.
- indefatigable 13y ago
  In other words, we should trust the DHHS and the IRS with information that the NSA can't be trusted to access? Am I reading that correctly?
- ohWhatever 13y ago
  It's funny, because you seem to think that health care professionals, with their myriad Excel spreadsheets and mammoth stacks of Steelcase® file cabinets brimming with rainbow color-coordinated folders containing paper files seem to know the first thing about information security. These are non-technical people, who went to school mostly for biology and chemistry, or for the lowly clerks, and secretaries in your doctor's office, maybe two years of community college, with an associates degree in communications maybe. On average, take a random sample of the people who do the paper work for the lofty, priest-like physicians. Ask them what AES is, or what a SHA hash is, or even what SSL and TLS are. I guarantee you, that you'll get a blank stare. They know how to use the systems they're provided with, like they know how to open a bag of Oreo cookies. The doctors know how to pay IT professionals for services, like they know how to write a check, and know to procure electronic systems like they know how to make down payments on their Mercedes. You can be sure that they know how to shred all those e-mails that they print out and read over their morning coffee. It's only as private insofar as no one is supposed to look. This protects people under the law, in that, as a rule, certain information is not to be used as criteria for making certain business decisions. But this is merely a bureaucratic honor system, and it doesn't mean that people aren't aware of things they aren't supposed to know about. The information itself, frequently, isn't particularly "secure" according to more strenuous information security standards. Your credit card transactions are safer than your HIPAA information by a longshot, but mostly because there really isn't any sort of criminal profit motive behind obtaining and using that sort of information.
  - jes 13y ago
    You come down quite hard on healthcare professionals, with the comments about biology and chemistry being non-technical. Your comments about doctors also seem unrepresentative of what a modern doctor must actually know and accomplish in order to be a practicing physician.
tibbon 13y ago
Clearly, its a problem a free market will efficiently fix and prices will stay low. </sarcasm>
- chrismonsanto 13y ago
  At least price transparency worked for surgeries in a hospital in Oklahoma: https://news.ycombinator.com/item?id=6014794 https://news.ycombinator.com/item?id=6014794 Perhaps a similar approach could work for IVs.
- dnautics 13y ago
  the best solution is obviously some kind of public-private partnership, so that we can get the best parts of the public sector with the best parts of the private sector. There's no way we'll wind up with the worst parts of both.
mapt 13y ago
Turns out, it is. Even if one is willing to accept them into one's general worldview... First principles - like "government is wasteful" - only go so far in the face of conflicting data. And there is a lot of it on the topic of healthcare systems.
chasing 13y ago
Whelp, the private sector sure seems to be fuckin' it up, so maybe it's time we give the government a shot.
- acheron 13y ago
  Which private sector is that? Because our current healthcare system is nowhere near "private".
  - mpyne 13y ago
    Well it's also nowhere near "public". For the most part we're talking about private hospitals and private insurance companies, the combination of which have failed to bring U.S. healthcare costs in line with the rest of the world. Don't simply blame "regulation" either. Many industries are regulated, some heavily so, and still manage to produce companies that are profitable and efficiently deliver good products. I don't think we'll see a real solution to the healthcare system in America until we stop treating it like it's just like any other industry.
derleth 13y ago
Only fools and ideologues argue against systems which have been demonstrated to work.
noonespecial 13y ago
The government is wasteful and inefficient, but it is not the most wasteful and inefficient system possible. Politics is the art of figuring out when to burn the extra resources on the government method because all of the other available methods are even worse.

chrismealy 13y ago

Copy the health care system of any other rich country. They all get about the same results for half the price or less.

dnautics 13y ago
We could kill about 9/10 of the population and get down to their size and ethnic homogeneity, as part of the copying process.
- w1ntermute 13y ago
  I'm not sure why the overall size of the population is relevant here. If it works for countries with populations of 5 million (Norway), 63 million (UK), 82 million (Germany), and 126 million (Japan), I think it's completely reasonable to at least try it in a country of 319 million.
  - dnautics 13y ago
    Ethnic homogeneity is also an issue. If you think that an arab living in france gets the same quality of healthcare as a european french person at the same poverty level, you're kidding yourself. Not that the US doesn't have these problems. Ultimately, different ethnicities get different diseases, too, so the bureaucrats in charge of deciding what gets covered and to what extent are basically institutionalizing racial privilege. However, naive grass-is-greenerism is more of what I was railing against.
    - brohee 13y ago
      As someone that spent quite a bit of time in French hospitals visiting relatives recently, I have no reason whatsoever to think access to care is limited in anyway whether on ethnic or socioeconomic background... Do you care to cite some sources?
    - ucha 13y ago
      That is absolutely false. All French citizens and even foreigners enrolled in the "securite sociale" scheme have access to the same facilities, procedures and doctors. There is no discrimination in the public service. Any claims to the contrary are at best unfamiliarity with the subject if not deliberate misinformation.

uptown 13y ago

I'm nowhere near having an answer, but pricing transparency needs to be a major part of the solution. I realize OPEC isn't exactly a popular entity, but I wonder whether a similar model might have some benefits here. Form a group comprised of representatives from interested parties tasked with establishing pricing for services rendered that is consistent across the entire nation. Perhaps allow regional adjustments based on cost-of-living deviations, or some other relevant metric - but cap how much those deviations can actually influence the price of care. End the idiotic "billed rate" vs. the "negotiated rate" nonsense. Include patient transportation in the equation. If singular pricing isn't attainable, a local hospital's care is too expensive, and the patient can receive similar care at an alternate location in a cost-effective way - cover the transportation cost under their insurance. Tort reform. Liability insurance premiums for health care professionals is as crazy as the price for the care they provide. This is as big a problem as the price of a bag of saline. I know these aren't the answers - but pricing of services is key to the problem, and the Affordable Care Act did little to get that under control beyond attempting to move more individuals under the umbrella of insurance and outside of emergency care.

lifeformed 13y ago

What would happen if a hospital opened up that just had reasonable rates? It wouldn't make any deals with insurance companies other than to take payments. It posts all it's prices online and transparently for everyone to see. You can shop for treatments on their website. Could they make money this way?

fnordfnordfnord 13y ago
Apparently, a bidding war. Fancy that. http://kfor.com/2013/07/08/okc-hospital-posting-surgery-prices-online/ http://kfor.com/2013/07/08/okc-hospital-posting-surgery-pric...

angersock 13y ago

Start making the negative externalities of this pricing known to the bureaucrats in those hospital systems. Preferably with a lead pipe.