Hospitalized in Split – Intoxication | Hacker News Reader

Hospitalized in Split – Intoxication

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92 pointsrahuldottech54 comments

I’m a big free-market person, and generally skeptical of regulation and government programs.

That being said, I think there are conditions when a free market can fail, and one of those conditions is when you don’t have supply and demand working rationally for one reason or another.

I’ve come to see healthcare as one of those cases.

If a doctor says the cost of your life, or your child’s life, is X... who is going to shrug that off and refuse to pay? Thus in an unregulated market, medical practitioners can very nearly charge whatever a patient is capable of paying, and in my experience that’s exactly what they do.

Simple reforms that I think could help:

1) Published prices for all medical services offered. You should be able to get an exact price quote and comparison shop.

2) A ban on drug advertisements. Only the US and New Zealand allow this in the first place.

3) A cap on drug prices based on their age and manufacturing cost. I understand that the actual cost of a new drug is much more R&D than manufacturing, but that doesn’t justify pharma company. Given a reasonable and predictable price cap formula, pharma will adapt.

There are a lot of other interesting and more radical ideas out there, but these seem to me like relatively straightforward starting points that would help remove some of the worst opacity in the US healthcare system, which should in turn create more accountability.

Universal healthcare would be a great boon for employers, as then they would no longer have to worry about providing and paying for it as part of employee compensation.

I get that now. I didn’t understand it for a long time.

While a government-run universal care program doesn’t thrill me, I find the current employer-based system to be borderline immoral.

The more I deal with the system the more it strikes me as a corrupt, crony deal to make workers more dependent on their employer, depress wages, and drive up medical industry profits.

It will also benefit lower income employees and consumers who will see good wage/price changes relative to taxes.

Another possibility is a cap on drug profits declining with drug age. This will allow enough market to avoid having to guess production costs in advance and set them in stone. The drawback is incentives to efficiency. Perhaps a mixture of price cap and profit cap would hit the sweet spot.

“Borderline” immoral?

Unemployed people doing gofundme’s for insulin...

My partner and I have, for the last couple months, been going through the medical system hoops over a broken elbow and resulting surgery. We've fiiiiinally started getting the bills in, along with the 'Explanation of Benefits', and so far 100% of the bills have included a patient-oriented error. And then spent many many hours on the phone getting them corrected.

It's goddamn criminal.

[edit: it's also 'fun' to think how much harder it would have been to identify the bad charges prior to the ACA's explanation of benefits requirements.]

If universal healthcare were to be implemented, they'd probably copy what most other countries do: financing it through taxes paid by employers for each employee.

In France, if you want to spend 120k euros on an employee, you'd pay about 40k towards healthcare and the national retirement plan (and a few other things). The employee gets paid 80k, and then pays income tax on that. Income tax is quite lower than in the US though. All in all, my experience has been that the taxation levels in France are comparable to what you'd pay if you lived in New York City.

What is the income tax rate in france roughly?

In us, federal reaches to 36% or so on highest bracket, and about 10% on states like california. I dont know how much is average, however.

From years ago when I lived in CA, taxes for mid-range income were comparable with France (and Western Europe in general), just itemized differently. The main difference in my opinion was in the quality/quantity of public services one got.

I can give some information from Finland, which I imagine is relatively similar to France. For a hypothetical 100k EUR/year salary you'd pay total 40% income tax. I think the top bracket is somewhere north of 50%. To more accurately compare the taxation, I think it is prudent to mention that we pay usually 24% VAT for most goods we purchase, which iirc is bit higher than typical sales taxes in US.

Taxes on employers are taxes on employees. Employers have set compensations that include the payroll taxes and insurance plans and everything. Why have an extra layer of obscurity when you could just tax income directly? Unnecessary complication that makes doing business harder just so the taxes are hidden from the working class.

Probably because paying that tax is just extra paper work that doesn't have to be done by the employee. So let accounting of your employer figure it out.

Income tax on the other hand is something the employee will have to figure out himself, because he may have other income streams.

This keeps the work where there is expertise as much as possible.

I don't know the particular situation in Croatia when it comes to how it cross-finances private healthcare but I would assume that this patient was billed for everything they recieved accordingly and not directly subsidized.

Of course there are indirect/externalized cost like the the health worker education system, potentially having hospitals and their equippment set up not to maximize profit but for coverage in the population etc. which this patient now may be freeloading on.

There is another perspective though if you consider free movement of labor in the EU (and to some extent globally for highly educated individuals) and the comparatively low salaries for medical professionals in Croatia and other cost-saving medical travel destinations (Hungary, Poland, Thailand, Mexico and others). If the doctors in the country can make an attractive buck on the side doing private practice then this alleviates the pressure to some extent. Especially if it allows the more senior doctors to stay in country and thus continue to train the next generation in med schools and the facilities.

Now I don't have a source to back it up but my feeling tells me that it is a net-positive activity for the destination countries. Depending on the scale of business, the foreign money might buy a new machine that other patients can use as well or quality improvements via the international certifications and accreditations.

That is not guarantee against potentially canibalising the local social system and could in worst cases lead to a two-class system so i suppose an adequate system to regulate access and subsidize for social fairness is in place where private and public seem equally "healthy".

Full disclosure: I work in tech at https://www.medigo.com We help facilitate global medical travel and publish prices to bring the best of capitalism to work in an ethical manner. We also have our own critical illness insurance for global treatment available for employers.

If a doctor says the cost of your life, or your child’s life, is X... who is going to shrug that off and refuse to pay?

Of all healthcare dollars spent, what percentage are these kind? 20%?

Well, there is a reason why infant mortality is so low in western countries, so you can imagine pretty big.

Lowering of infant mortality was mostly driven by preventative measures.

The current American system is heavily regulated and nowhere close to a free market.

> Thus in an unregulated market, medical practitioners can very nearly charge whatever a patient is capable of paying, and in my experience that’s exactly what they do.

Emergency situations are exactly what insurance is for. Free market advocates don't expect patients to shop around in that kind of situation, but they do expect them to shop around for insurance, general practitioners, specialists for non-emergency treatments, etc.

Right now, none of those things are realistic for the vast majority of Americans because the government has incentivized and now mandates employers to provide comprehensive insurance, which introduces a layer of opacity between consumers and prices.

You make some okay suggestions but even more can be done without resorting to mandates:

1. Remove the requirements and incentives for employer-provided insurance, introduce a program for transitioning employer insurance into private individual/family coverage.

2. Reduce or eliminate medical patents. You suggest price controls, which are a bad idea, commonly leading to shortages. Pharmas can't charge such outrageous prices when faced with competition.

3. Reduce or eliminate minimum coverage requirements, introducing a new type of medical plan that covers only catastrophic unpreventable emergencies.

4. Reduce the onerous nature of the FDA to a level on par with such agencies in other countries. Make it cheaper to develop drugs. The FDA should have two branches: safety and efficacy, with separate certifications. A drug can be released whenever it is safe, but they can't directly advertise until it's proven effective.

Applying market forces to medical services is another way to spell extortion. What blows my mind is how easy it seems to condition so many people into believing that extortion is a normal way to approach healthcare.

It is not.

Market forces apply to every other necessity of life, why would they not apply to healthcare?

Maybe because it doesn't seem to work well?

This is false.

Imagine every street being a toll road, dynamically adjusting price to the maximum people driving to work, or to to their wedding, are willing to pay.

Imagine a fire engine arriving only after establishing the market price the owner of a burning house is willing to pay.

I'm not American but there must be something different about the USA regarding healthcare than market forces as for 1500$/month I can get a private insurance that covers full medical costs in every country on earth ... except the USA, which must be bought separately at double the price.

And that private insurance is cheaper than what I pay for healthcare with the state system, so it would seem that private insurances can provide reasonably priced services, just not in the USA.

The USA has refined the art of extracting money from people who are scared for their well being.

Edit:

Here are a couple of the many forces contributing to this:

* Political corruption is legal, in the form of lobbying. Politicians spend up to 70% of their time negotiating campaign money and large corporate donors can effectively fire (not-re-elect) any politician by not donating their campaign. Donors use this to "independently" lobby for laws that benefit them, effectively writing laws. Large health insurance companies, pharmaceuticals, etc. take full advantage of this.

* Large employers are able to negotiate and purchase insurance at lower prices, and then offer better/any health insurance as employment benefits. This allows them to negotiate cheaper labor, on a very large scale -- if you want health insurance for your children and spouse, you are more likely to put up with an employer who pressures you for more work and treats you badly.

I needed to have a metal plate taken out of my ankle a year after it was broken.

After comparing prices around the world, I realised that the cheapest option would be to fly to Taiwan for ~500 USD and have the surgery done without insurance for ~300 USD. The total is less than what it would cost with insurance in other countries.

There's a recurring meme saying "Don't call an ambulance, get an Uber to take me to hospital instead". Tangentially related, there's plenty of discussion here on HN that led me to conclude that it's best to never talk to police, even if something bad happens.

I have the greatest respect for firefighters, because they seem to be the only emergency service that aren't yet horrifically corrupt.

They once were, look into 19th century firefighting gangs.

Did you know that there are parts of the United States where paying for firefighters is optional(not included in taxes), but if you don't pay and you have a fire they will not put it out.

Also broke my ankle, and also had a plate installed via ORIF surgery. My insurance company was billed nearly $80,000 USD, and I was asked to pay $6k of that. And that was just the single procedure, not any of the follow-up visits or physical therapy.

The doctor who performed the initial surgery said that it is not common to remove the plate due to the risk and expense of another surgery procedure, so I still have it. Been nearly 5 years. Would love to get rid of it.

If I may ask, what was your consultation conversation like when you discussed having the plate removed with your doctor /surgeon?

The plate was put in by the same doctor in Taiwan a year earlier, who recommended removing it. I can also recommend taking it out - I feel much better without it.

Doctors in Europe/NZ/etc recommended not removing it because of the expense. It was sensitive to temperature changes, so I really wanted it out. When my bone and titanium expanded and contracted at different rates when going from a cold winter outside to a warm house, it was uncomfortable.

If you can take a couple of weeks to fly to Asia and sit around waiting for it to heal, that would be best. Once the stitches are out (surgery + 2 weeks) you're able to fly again and walk without crutches. So I guess that's the shortest time you could do it in. I'm staying for 2 months though, because I'm waiting for a visa to move down under.

Thanks for that info. I'm a permanent resident of Australia now, with access to the public (and private) medical care down here. My injury and procedure happened in the US though, and I've moved around quite a bit since then, and haven't really seen anyone about my ankle since my last post-op visit 4+ years ago. I enquired about speaking to a syndesmotic specialist down here but it still seemed to be an expensive visit to be told "yeah nah everyone just keeps the plate in nowadays mate," which is what I was expecting...so I'm always very curious when someone has had the implant removed. Thanks again.

friend of mine does hospital consulting, basically improving whatever metrics the hospitals have in mind i.e.: fast throughput emergency room, more non critical sendhomes, ...

one hospital in denmark purchased an US software solution and everything became much slower, so he was called in.

wherby the most EU patient software are focused on checkin, diagnosis and treatment – at the end you compile an invoice – the US was focused around billing. you need to do the billing first, then you can do the next step, then billing, next step, then billing ...

Did he fix without changing the system? The story of how the hospital chose the software would also be interesting. I guess the people who made the decision had close to no input from people that would actually use the system.

interestingly, china is the same. bill for every step. but without the exorbitant prices...

So to summarize

1. He is surprised because he didn't pay the taxes which fund healthcare in Croatia

2. He's not making Croatian wages

3. He's accostomed to taking most of the wages he earns back in America to his private bank account.

While I personally feel it's good that people receive the help specially medical help when they need but at the same time I believe it's unfair for the Croat taxpayers to fund treatment of foreigners because it creates a dynamic where people with means (who can fly to and from America) get best of both the world. A low tax environment and a place where government takes away 60% of your earning in return of free healthcare and cheap healthcare cost.

1) To scale, this is about quarter of median Croatian wage. Imagine a $400 bill.

2) Croatian would pay 0 kn, because taxes and it is a routine kind of care. Only extended stay (beyond doctor's recommendation) would be extra paid and not too much. Rehab if any might cost something but still not a lot.

3) Trouble begins when surgery or rare medicine is required, either in form of long queues, high cost or plain unavailability.

There’s always a middleman in America, and they tend to spend unlimited amounts of money to justify their leeching off of everyone. We’ve really gone very far away from what humans actually need or want in some areas.

I had something like this happen to me in Ecuador. One morning I was suddenly struck by intense pain in my torso. It just kept getting worse. I called a taxi and told the driver to take me to a doctor, clinic, hospital etc, whatever was closest. He took me to a clinic, where they told me I had a kidney stone. I spent the day in a bed there, on really strong pain killers, with doctors and nurses checking in on me periodically. Total bill, $18. I was astounded.

One of the ways America maintains itself is by maintaining distance. Between cars, sprawl, and ultimately, the Atlantic Ocean, its populace is kept in the dark of what it's neighbors deal with and have or don't have. It's very convenient really.

I just got back from Bali, Indonesia where one of my friends crashed a scooter, the total bill for two ambulance rides, urgent care, hospital, and scooter repair was around Rph 10,000,000 which is $700 in round numbers

Some of this can be accounted for by cost of living differences - $3 an hour would be a good income in Bali, you can eat a reasonable meal for $2 even in a touristic area

Some can be accounted for by the rather more minimal service that was received compared to an American ER, and certainly my friend will need further treatment in the US, they stabilized a broken arm, but didn't set it

Can you also relate the median wage in Croatia ? And how much taxes are taken by socialistical system on the salary ?

I can understand the surprise of this person to discover that 36$ is not much compared to what she could expect in America for similar treatment.

Most of american i meet are very surprised by the price of healthcare in France too, but they tend to forget that State is taking aroung 60% of income.

As i am my own boss in a IT consultant job, in France, for 4500euros net (4325 euros on my private bank account), i will spend around 9000 euros from my company (4325 transfered on my private bank account, and 4675 on monthly taxes like healthcare, unemployement care, retirement care....).

And on those 4325euros monthly, i will be also taxed at end of year depending on my total yearly income and my family situation (married, single, children or not...).

So basically i should earn 9000x12= 108000 euros per year , but in reality i get 4325x12= 51900 euros per year (minus private taxes like house taxes, and final income taxes which is around 3000/year). So my real earning is around 48900euros yearly.

I also forget that i will have to pay a private supplementary healthcare insurance, cause on those 36$, State will just reimburse me 21$, so private insurance costs more than 100euros/month to sometime get those remaining 15euros back.

So 48900 euros/year for a 40yo IT guy, working in devops (married and father of two )...ask yourself why all young talents in France are going to work in Silicon Valley... This is not even the wage of an internship at google or faceboo

What is the connection between taxes and low health care costs?

Look at this graph, not all these countries are high-tax.

https://www.investopedia.com/thmb/Y4EFa4HoQXxh4Vbal80eq7mAd6...

I didnt talk about pricing issue..But more than often, low healthcare price is related to high income taxes...

You cannot get paid 200k$/year as a basic IT guy and have free healthcare. This is my point.

What i wanted to illustrate is the real cost you have to pay to get almost free healthcare. And if you followed news since few months in France, you know we have Yellow Jacket movemement, which were at the begining peoples like me, middle class, owner of company, paying huge taxes for really bad public system (ranked 16 for healthcare system, and ranked 35 in school system). And supported a large class of unemployed people (10millions over 70millions citizens) in age of working.

https://en.m.wikipedia.org/wiki/List_of_countries_by_tax_rev...

Would imply that Croatia is not nearly as heavily taxed as e.g. France, or the Nordics.

The comments in the Reddit thread imply that a doctor might earn 1500-2000 EUR a month, so that does hint on the general income level, and does partially explain the low bill.

Now if you were in the US, you'd get much more money from the start on you bank account. But you'll have to individually pay for health insurance, and individually plan for retirement. In the end it will cost you exactly as much, but instead of collective bargaining you're on your own against big insurance companies. Unsurprisingly, this rarely ends well for the lone individual against corporate behemoths.

Well, just to illustrate, there is a private insurance company from Uk called Amariz, very famous in europe. I asked to a proposal for my familly (2 adults/2 children). And where i was asked around 40k euros/year in healthcare taxes, it will cost me around 7k at better level of coverage and service. But even if european law are allowing it, leaving state insurance company in favor of private in France expose individuals to justice harrassment...So most of business owner prefer to stay away from trouble and pay far biggest fee.

I think there may be a misunderstanding. Taxes may have nothing to do with this specific case because the surprisingly low price is for a foreigner who does not pay taxes in Croatia, that is why he had to pay in the first place. I am not a Croatian but I live in other EU state with similar system - here locals who pay taxes would not have to pay anything.

> Can you also relate the median wage in Croatia? And how much taxes are taken by socialistical system on the salary ?

Croatian here.

Croatian authorities usually don't publish median wage, but the mean wage, so that the numbers can look less bad compared to the rest of EU.

When talking about wages, Croatians are usually using monthly net wage (after the taxes). The mean net wage for Zagreb (country capital) is around €1000, and in the rest of the country around €800.

For this net salary of €800, there is around €700 of taxes on the top of it, so the mean monthly brutto/gross salary is around €1500, so that's €18,000 yearly (around $20,000 yearly), where €8000 goes to taxes and €10,000 is the money that is left for you to spend.

Median wages would be lower than that.

So putting those figures into a tax calculator for California. First adjust income by GDP per capita (so marginal tax rates are comparable) giving gross amount of $183k, at roughly $60k per capita in CA vs $40k in FR.

Income taxes /social security is $61k. Employers social security an additional 10K. Then you need health insurance at $8-11k for a single 40yo. Property tax in a median 400k CA home is another 4K a year. So a total perhaps $85k/183k a year in taxes an health insurance. A little less but not all that different, maybe 5% lower overall for someone earning 2.5-3.0x median wage.

He'll also be surprised at a paycheck that Croatian doctors get compared to US

I had a zero cost drunken ambulance ride and anti-nausea shot in Australia and the doctors here seem to be paid reasonably enough - although maybe here they get more people going into medicine interested in helping people over profiting from them.

And I'm sure the cost of a medical degree in America also has something to do with that :)

I can add a bit about China — prices here vary by triple digits, and medical profession is largely unregulated in smaller cities besides the most basics (you have to have just any paper of medical qualification, and even that is not always given.)

Quite extensive surgeries are priced in few thousand dollars each, but emergency medicine is an outlier: a hospital in a big city can bill you up to $15k for a trivial appendicitis surgery, but you may be lucky in a small town and have it for just $300-$400.

Price collusions are also real here when it comes to such things.

Relevant discussion: https://www.reddit.com/r/bestof/comments/c7gfxj/american_guy...

How is that surprising though? Medical tourism has always been a thing.

This is a quick rant that is going to be obliviated, but is this really worthy of gaining traction on the front page of HN? It’s a quick anecdote from Reddit about how health care is affordable outside the US. This is just comment bait for everyone with a relevant gripe who wants to use this as a soapbox for how they would change the US healthcare system or an echo chamber for validating their troubles. There’s no tech discussed, no news involved, and it’s the same conversations that come up in every healthcare related article’s comment section.

I don’t really care what people use this site for. I have no authority as a gatekeeper for your discussions or this community. I just think it’s really lame that a link like this gets traction

On the contrary: stories like these are a constant reminder that certain things need to be changed, in spite of extremely powerful forces that would prefer the status quo.

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