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Comment by mc32 | Hacker News Reader

That's insane. Unfortunately politicians will not touch this issue because most people either have insurance which covers these idiotic baseless fees or indigent people go to the emergency room and avoid these fees as well. But the poor sap who wants to do things the right way gets effed over like these people. What a shame.

I don't care who, Bernie, Trump, some socialist, take this cause (hospital billing) and have them come correct. They need someone to get tough and straighten them out.

I mean, it's legalized robbery. Nothing less.

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The amount an health insurance company pays is kept secret and we can assume is far less. Otherwise, insurance companies would find ways to open up more hospitals to compete with the large irrational ones, or face huge costs. The hospitals know they can get away these amounts on paper, so they do.

We should demand price transparency -- as we do for almost all direct-to-consumer purchases. Businesses can charge different amounts for volume purchases to other businesses, but it would be considered discriminatory if a restaurant didn't show their prices and then when you got your bill, it said -- oh, your company's not paying for it -- so it's $15,000 in extra fees.

Is it a secret? I get letters from my insurance company about how much they paid for medical treatment and even the provider sends me invoices with how much insurance paid. Last one was for blood tests were the provider(think was labcorp) charged $200 for a test and insurance paid $20.

Good point. Prices for each CPT code accepted by by insurance company are kept secret, and the chargemaster published by a hospital is so inflated it's basically useless. For some diagnostic tests, it's pretty straightforward to understand, but for others like an ER bill where there can be dozens of claim lines and codes, it can be really hard to understand and the patient is relatively powerless to do anything about it after the fact.

No secret. It's all itemized on your insurance bill. What is secret is the deal insurance companies have with hospitals which allows hospitals to charge astronomical fees. That is then ultimately passed on to companies/patients through high premiums. And no one really chucks a stint over it with public shaming so the vicious cycle continues.

You're right, patients get an itemized bill. The thing is the bill is pretty cryptic with CPT codes (and modifiers, ICD codes etc) practically unique to each payer as each payer interprets the AMA's guidelines differently. Payer A, say Blue Shield, asks for codes 99453 while Payer B (e.g. Aetna) wants code 92502 for the same procedure. So the patient is really clueless to know if 1) it's the right code, 2) they got charged too much, or 3) the insurance made a mistake in adjudicating the claim.

I know a company that was trying to help patients understand their medical bills, and for one bill, the hospital accidentally put down 10cc for an antidote for a snake bite, 10 times, when it should have been just once. The cost was in the tens of thousands instead of the thousands, and the hospital eventually fixed the claim and resubmitted, but the insurance company simply billed the patient.

Article mentions the bulk of the bill was a "trauma activation". This is an alert from the EMS units to the hospital that they are bringing a patient with indications of trauma requiring additional medical resources to be diverted. The reaction and resources differ per trauma facility. SFGH is a level 1 center [1]. There are better news sources that describe the trauma system within the context of this story.

My opinion based on limited information within the article is that the field EMS suspected a closed head injury. The trauma "doctors at the hospital quickly determined that baby Jeong Whan was fine". If the baby had an MRI instead of a medical exam by a team of specialists, the headline would lose some weight.

The fee is to staff ED specialists 24/7. I believe the better question is: "should we charge for resources that were used but stood down after initial assessment by the trauma team?" From the perspective of the EMS field, there are protocols that describe tbe patient condition, mechanism of injury and other indicators which dictate a trauma activation.

[1] https://en.m.wikipedia.org/wiki/Trauma_center#Level_I

Sorry but $15 grand for “Activating trauma protocol” which was then rescinded is ridiculous and an absurd amount. It’s bald robbery.

> If the baby had an MRI instead of a medical exam by a team of specialists, the headline would lose some weight.

How so? In my country (Italy) for an MRI I would pay from 42 USD to 81 USD, depending on my income.

Not saying that's its real cost since we pay taxes to grant this to everyone, but from here to 18k...

Bad comparison. Italy has far inferior health system, barely able to provide 2x better infant mortality rate at 1/3 the cost when compared to US. /sarcasm

Just how many specialists were they keeping available, and how much do those specialists cost? Let's say five different preeminent medical professionals were needed to respond to that emergency. Let's say that it used an hour each of their time. That's still $1000 an hour, which is exorbitant regardless of your credentials.

And that's the most charitable evaluation. They "quickly determined that the baby was fine." So what did the hospital do, charge out the entire cost of running the ER to one unlucky family since they were the only case who was brought in that hour?

That's the whole point of the article, thanks.

MRI avg price is $2,611 in the US. Google it. A hospital once charged my insurance US$12,000 for a CT Scan through emergency. A CT scan costs $1K (avg based on resolution) in the US. When I pointed out the stupidity of this to my insurance (with public twitter shaming) they quickly decided to cover my copay. Robbery or what?

Any ideas on how to fix the healthcare market? The feedback loops seem to be totally broken, in more than one place. I've long wondered how they could be restored, short of government action to try to make things drastically more efficient. Unfortunately, there seem to be strong incentives for officials not to do anything, given that that inefficiency means that healthcare is a major, growing, and well distributed employer.

Improved price transparency might help, and would be a relatively easy thing to improve, but with most patients not being responsible for paying their own costs, I'm not very optimistic about that route.

"but with most patients not being responsible for paying" -- right there lays the answer and the problem. I thought about this a lot while doing my 1st healthcare startup in silicon valley and connected with many startups "disrupting healthcare through price transparency". 5 years later... None succeeded.

If one could incentivize every patient to upload their bills to an open source service that would crunch the data and spit it out anonymously online showcasing hospitals & services rendered + insurers et al.. then I think we might be on our way to true price transparency and a potential disruption in US healthcare.

I spent some time thinking about ways to incentivize patients to upload bills, you'd only need a very small fraction to get a representative sample of how much different services cost at different hospitals. I haven't come up with anything very motivating, except maybe the desire to expose how ridiculous some of them are.

I've often wondered if we could open up private clinics in Canada for Americans where we charge reasonable rates. Kind of start a medical tourism industry by the border.

Comfy buses would be nice. Maybe some outpatient services where you recover at a local sporting event, fishing maybe....

Thailand has a fairly large medical tourism industry - a number of hospitals in Bangkok are considered world-class (if not world-leading). I know a few people who just go there once a year for a weekend for their annual check-up, since the difference in price from doing it in a decent private hospital in Hong Kong can cover the cost of flights and accommodation, plus you get a weekend in Bangkok which is nice...

Would not help because many of those without insurance cannot afford a trip up to Canada. And secondly it will not help for emergency care.

While many would not be able to afford a trip to Canada, I would think there would still be a sizeable number who live within 1-2h from the border who could drive there for non-emergency care.

Fucking Universal healthcare is the only solution for this garbage.

With universal healthcare come other issues like waiting months for a bed. The real solution (and it's maybe 100 years away) is automating hospitals to a point where humans no longer play a role in healthcare management and it's 100% funded by the state/country. Maybe we won't even have hospitals and instead a portable home healthcare unit. One can dream ;-)

We have universal healthcare in Germany. The longest time I had to wait was 17 days for a stationary colonoscopy because I wanted that exact hospital. And a MRI of the knee would have been 12 days of waiting until I called different radiologists in my area and got one the nextday. * Yes, our healthcare can be improved and politics is constantly trying to make it worse. But I doubt that the average person waiting for a bed in Germany can even afford a bed in the US.

* ah, no co-pay by the way, I have no idea how expensive those things are.

Co-pay / co-insurance can run into the thousands literally up to your out of pocket maximum. For me as an individual, I think that's about $4-5k and for a family about $8-10k but this is with the second best insurance available. That's every year, an amount that you might have to pay if you are sick. With a chronic condition or a major trip to the hospital one is very likely to hit those limits. Not to mention the months to years of dealing with bills afterwards, when one is trying to recover, and companies wrongly billing, billing for too much, not billing insurance, double billing. No drawbacks to universal healthcare even come close to this absolute fucking hell. It's hell for the patients' family, so one can only imagine how it is for the patient. And then, of course, there are the times when care is simply refused outright and your father dies the day after he leaves the hospital ... but hey, insurance companies gotta make money off of some people dying. They don't care it's someone's father or mother or children.

co-pay example: a friend broke his collar bone few months back in Tahoe and had surgery to fix it. Full cost ~$60K. Out of pocket: ~$7K on Gold (80/20) insurance. You can read about the metal categories (ie. Gold) and other things I wrote about the US healthcare here: https://medium.com/the-road-to-silicon-valley/us-healthcare-...

More market would also work. The problem is lack of transparency and unequal negotiating power. The former can easily be fixed with laws; the latter is a bit harder to fix, but probably there are other solutions as well except for "universal healthcare" (i.e. an even more powerful negotiator).

Politicians won't touch this issue because healthcare costs are approaching 20% of GDP and every election since the 70s has been a jobs election.

This is something I really hope Trump hits on. He's proven repeatedly he doesn't care what is popular, and was booed during the debates for saying that he wouldn't let people die in the streets, as sick as that situation is. I like that about Trump, he sets popularity aside in his decisions. That said, this is my single biggest issue at the moment. I have great health insurance, probably better than 90 pct of people here. It's not about me, it's about a broken system. I, or any of us, could lose our coverage in the blink of an eye. I will fully support any candidate who runs on nationalised healthcare. I don't care if my taxes go up. Our country is gross that people are afraid to seek treatment, or even ride an ambulance, because of our broken system. And I say this as a fiscal conservative...

It'd be great if he or anyone did. Unfortunately, I don't think it will be picked up by traditional politicians because doctors are active donors and they don't want to upset that. But, who knows. If it becomes a populist cause, maybe... maybe.

That's what I don't understand. The parties are at each others throats, even physically. I think the majority of both parties support reform and/or single payer. It seems like such an easy political win, even if not an easily solvable problem.

Doctors aren't the schemers here. When a doctor submits a claim to your insurance for let's say $500 what he gets back is a magic and opaque number. His only choice is take it, or don't accept your insurance. For programs like medicaid this number is often a tiny fraction of what was charged, which is why some doctors or hospitals simply will not accept it. If you pay in cash at a doctor you'll often pay a much more reasonable price, and that's because they're not at the whims of insurance companies who incentivize them to charge as much as they possibly can.

I don't think Trump, Clinton or anyone can tackle this issue. Remember presidents don't really run the country. Their essential backers do. Presidents need to support their keys to power, the telecom companies, the oil companies, the big Tech companies, big pharma ...

The only way this changes in our fucked up system is if one big supporter, say tech companies, have a reason to collectively force the politicians that support them to start an assault on the big health/pharma industries. But no company wants that. All industries benefit from the fucked up health insurance system because it means all American must have jobs. It's not an option because no one can afford to get sick or break and arm without one (with health insurance).

I'd suggest reading The Dictator's Handbook. It goes into this pretty extensively.

Trump/Hillary hate/loyalty we see in this country is really sad and misguided. It's attacking the runny nose and not the bacteria that's causing the infection. The people who run this country are not the Congress and Senators and President, but all the people who pay their wages: Microsoft, BASF, Boeing, Facebook, Timewarner, Exxon, Google, etc.

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