Comment by abalone | Hacker News Reader

Comment by abalone | Hacker News Reader

> Modern Healthcare decided to see how long it would take to present the data in a more consumer-friendly format. It took less than two hours

Having been through several hundred thousand dollars of chargemaster charges with one of the hospitals on this list I can confidently say this info is not consumer-friendly at all.

First of all, did anyone look at the damn PDFs? Do you have any idea what a "HCHG SP EVAL MTN FLUOR SWAL 75" is or a "HCHG XR RIBS BILAT W PA CXR"? Does this really equip the typical healthcare consumer with the ability to "shop 'n save"? No. They are going to ask their health insurance provider if the hospital is in network, and the health insurance bureaucracy has the experts who pour through and negotiate all this crap.

Second, even if you had about a year of your life to educate yourself about the hundreds of myriad codes like this that are involved in various procedures and take it upon yourself to compare hospitals, this would be like comparing hotels based on their rack rate. You might get a sense for things but nobody pays that. Everything is negotiated down. Even for the uninsured who usually either get a 50%+ discount or pay whatever they can pay and kill their credit or go bankrupt. Which is not to imply in any way this is affordable for anyone, just that chargemasters aren't a super useful way to compare pricing even if you could figure it out.

Third, it's a free market fantasy that more "consumer" info will fix this system. Many patients are not in a position to comparison shop anyway. It is the epitome of a market failure.

If you want to fix this system we need Medicare For All.

I'm a doctor. I'm pretty sure I know what those things mean. But ya, wouldn't expect you to.

Ultimately that's irrelevant, because you don't choose the services you get in a hospital, "I" do. If I come in and recommend this or that test, are you going to check the price? Of course not, because the issue is only partially hidden prices. Its also knowledge asymmetry and fear. I think most doctors only recommend tests they feel will be helpful and in my current position I have absolutely no incentive to order extra or unnecessary testing, so I try not to.

I suspect (but I guess it hasn't been proven) that moving away from fee-for-service towards Medical Home type payments will resolve a lot of this as long as quality measures are carefully monitored and decreases in quality are appropriately sanctioned.

I thought doctors had to be a but conservative due to lawsuit concerns and insurance requirements. I hear about concern over doctors misdiagnosing, so I'm guessing that doctors order more tests than strictly necessary to cover themselves.

> I think most doctors only recommend tests they feel will be helpful

Why are the rates of over-testing and over-diagnosis so high?

"helpful" may be defined as helpful in preventing the doctor from being sued

> Why are the rates of over-testing and over-diagnosis so high?

It is something health systems are aware of and working on, but if you go to the doctor with lower back pain and they say, get a better pair of shoes, take epsom salt baths, and deal with it, you might get frustrated. It doesn't cost the physician anything to order an MRI, but that procedure alone can costs $10k to your insurance, and may very well not reveal anything novel from the physical. But both the patient and physician feel more confident and there is no incentive against the physician for ordering the test. This particular example is such an issue, that a national quality measurement standards org has a measure dedicated to it:

https://www.ncqa.org/hedis/measures/use-of-imaging-studies-f...

And now that we are monitoring it (at some cases, down to the physician level), we can see awareness grow and individual physicians are changing their ordering habits. Very cool.

Medicare for all would easily bankrupt hospitals. The money needs to come from somewhere. Either force people to buy insurance or raise taxes massively. Pick your poison.

Firing all of those billing specialists and insurance people would save a LOT of money.

They are nevertheless a small part of the total bill.

Nope. They’re 8% of the bill, several times higher than countries with Medicare For All type systems.[1]

[1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...

That's total administrative cost. Given that (current) Medicare has high administrative costs as well, there's no reason to believe that the US will suddenly do much better with all its regulations.

Either way, whether it is 2% or 8% the bill will be astronomical. You would have to cut health care worker's salaries significantly to make a big dent in it. I'm not saying that shouldn't happen, but you better own up to it.

Literally every other industrialized country has a Medicare For All type system and somehow the hospitals manage to stay open.

And you can’t mention a tax increase without mentioning the savings of not having to pay for private insurance.

I am talking about actual Medicare, which causes big losses for hospitals. Those need to be covered, that is my point.

You can not just import other nations healthcare systems. Those are cheaper because the doctors and nurses earn less and the service is worse.

You don’t cite any evidence to support your claim. Most U.S. doctors graduate with >$100K in medical education debt. Other countries have better health outcomes, so that pretty much kills your “worse service” claim.

Rob Delaney is a great example of an American who experienced both US and U.K. systems in depth. Look him up.

> You don’t cite any evidence to support your claim. Most U.S. doctors graduate with >$100K in medical education debt.

You posted a source yourself:

https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...

Salaries are almost twice as high. Those other countries also tend to have higher taxes and other salary deductions, so doctors earn less.

> Other countries have better health outcomes, so that pretty much kills your “worse service” claim.

No it doesn't. Not every US citizen actually receives the service, because they want to (or have to) save money, kicking the problem down the road, exacerbating the issue. Americans also tend to be more obese.

You call the "cancer survival" rate a cherry pick, but it's actually a good indicator how good the actual treatment is and how timely it is administered.

> Rob Delaney is a great example...

One guy's opinion isn't "evidence" either. I could give you individual health care horror stories from single payer countries, but that would be emotional manipulation.

Everyone knows that 5 year cancer survival rates in the US are high because the US over-tests so much.

This is evidence that harm is being caused. It's not evidence of a good health care system.

Why are male incontinence products so prevalent in the states? It's because men are pushed to get PSA and similar screening for prostate cancer. This means the US detects a lot of slow growing cancer that's unlikely to kill someone (which improves the 5 year survival stats), but it also means that the US then provides treatment to those men. That treatment has side effects.

It doesn't seem like "over testing" or "harm" if the end result is less people dying. The fact of the matter is that I was able to get an MRI the same day I went to the doctor with an issue twice in the US. One of those times was for severe recurrent headaches. The doctor didn't think it was a tumor (and it wasn't), but he did it to be sure. If I were in Canada chances are I would have waited months for that appointment. In the worst case that would mean the tumor had time to grow. In the best case that's months of unnecessary worry, which isn't healthy in itself.

If you were in Canada you could get that MRI privately and still probably save quite a bit of money.

> if the end result is less people dying

That isn't the end result.

> > Other countries have better health outcomes, so that pretty much kills your “worse service” claim.

> No it doesn't. Not every US citizen actually receives the service, because they want to (or have to) save money

So by “better” service you mean no service for the poor. That’s better? This is how you spin a system with worse health outcomes into something “better” — again, without citing a shred of evidence.

Switzerland...

...is a total outlier country in every respect. It also has a vastly higher cost of living. Nominal salaries are not comparable with the US. Still, they're better than in other European countries, so their doctors (and many other professionals) flock to Switzerland (after having taken all their "free" training in their home countries).

By the way, health insurance in Switzerland is entirely private, but its affluent citizens are forced to buy insurance by law.

> the service is worse.

You keep saying this but you've never provided any evidence, and it's clear the US care is worse across a range of indicators.

Some people say the US system works best for the rich and healthy, but even they suffer because of the weird amount of over-testing and over-diagnosis that happens.

Another possibility is to reduce the cost of care.

Below market rate? That will be a shortage then.

Find cheaper options for people who don't want to pay as much. Innovate.

That's what I'm hoping for by making procedure prices transparent.

Indeed! Countries with Medicare For All type systems have a cost of care that’s half as much as the U.S.[1]

[1] https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more...

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