

Bitter Pill: Why Medical Bills Are Killing Us - arbuge
http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/?hpt=hp_c1

======
pchivers
It's worth noting that there is no relationship between a U.S. hospital bill
and the actual cost of the service:

<http://truecostofhealthcare.org/hospital_billing>

"Hospitals see no problem in sending bills to insurance companies for five to
ten times the amount that they actually expect, because they are simply
playing the game that the insurance companies fashioned. But remember, they
only produce one kind of bill, and it’s designed to send to someone who holds
all the cards (an insurance company), and so can just refuse to pay anything
they don’t want to pay. That’s their game. But what happens when you have to
play the game with the hospital alone (if you don’t have insurance, or if your
insurance doesn’t cover that stay for some reason). Then you’re on the hook
for the ENTIRE amount. Most hospitals have a policy that allows people to
negotiate for a lower amount, but most people don’t know this. And don’t
expect the hospital to tell you about it, let alone help out. So even if you
can remember to negotiate while you’re convalescing from a long hospital stay,
good luck trying to get the deal the insurance company gets.

For the average person, this is no small matter. In the first case, a two day
hospitalization that the insurance company got for $2,100 (after the insurance
adjustment), would cost an uninsured person over $21,000. The adjusted charge
($2,100) would be a pretty nasty kick in the finances for most families, but
they could bounce back. The unadjusted charge, which is what you’ll get if you
don’t have insurance, is an almost certain trip to bankruptcy."

~~~
barking
_It's worth noting that there is no relationship between a U.S. hospital bill
and the actual cost of the service_

If this is true (and I don't know that it is) then it sounds to me that the
free market is not working in this area in the USA.

If it's not working then that may be because of supply restrictions because of
limited numbers of places and/or high costs at medical schools and excessive
restrictions on foreign trained medical professionals entering the US.

On the other hand becoming a doctor requires a high degreee of intelligence,
high tuition fees and years of long hours as a junior at low pay while you
continue to study and do further exams. When you finally get to the promised
land you have large debts and a relatively short career ahead of you. You also
have rare skills and are a person who has delayed gratification to an extent
that few others would be prepared to. You are also in a highly responsible job
and are likely to be subjected several stressful lawsuits during your career.

In a society where no limit seems to be placed on the earnings of sports stars
and others in their early twenties, why should doctors be expected to restrict
themselves to less than their market can bear?

~~~
droidist2
It's true the free market isn't functioning in healthcare. You mentioned
doctor supply. During the late 1990s the American Medical Association
convinced the government there was going to be a "doctor glut" so the American
taxpayer subsidized medical schools in exchange for not graduating doctors,
$100,000 for each doctor not trained.

~~~
NoPiece
You give a good example but it is worth clarifying that more than it being a
non-functioning free market, it is absolutely not even close to being a free
market. The Federal government is the biggest spender in the market, and with
that comes a mountain of regulation and price controls. The states are
probably the second biggest players in the market. Even things that almost
everyone would agree with make it a less free market, like licensing doctors,
certifying medical schools, and approving drugs. I think you could make the
case that either a much freer market, or a completely state controlled system
would lead to lower costs. The current situation reminds me of the pseudo
deregulation of power in California that ended in catastrophe.

------
christkv
It's interesting when this comes up. Having grown up in a medical family I
think there are some interesting misunderstandings about medicine between
laymen (see fancy words here).

1\. The treatment outcome between the standard treatment and the deluxe
treatment is more often than not statistically insignificant. Basically
medicine is still a barbarically primitive science where we barely understand
what happens in a body. Thus trials take years and years and yet even if new
drugs are approved they end up hurting people.

2\. The medical "market" will never be a perfect, due to information asymmetry
between the doctor and you the patient. Even if you think you know it's
unlikely you are able to understand if option A is better than option B for
your treatment.

3\. If you have a heart attack you are in no position to negotiate what is a
fair price or not, nor are you able to take a rational decision about what
treatment is the best cost/benefit for your acute condition. Thus the
"provider" has all negotiation power and can charge you what they want (you
can of course refuse treatment but that's unlikely to happen).

4\. Throw in a boondoggle of more or less serious insurance providers that
creates what amounts to hundreds of "distinct" overstaffed administrative
systems and you've got the recipe for a dysfunctional expensive non
sustainable health care system where more and more "non-poor" people will
outside any sensible coverage for themselves and their families.

Any solution to this problem will be drastic both for the industry as a whole
and for society.

That said there are some possible good things happening over the next decade.
Having a dad that works on cancer vaccines I can tell you that for certain
cancers in the next decade the treatment will be as easy as a shot in the arm
every week and the prognosis will be much better than the "literal" clubbing
of people half to death with inaccurate drugs and chemotherapy.

~~~
photorized
I would add:

5\. Some patients like to file lawsuits, hence expensive lawyers, malpractice
insurance etc.

Vicious cycle (involving hospitals, big pharma, lawyers, insurers) - can't
just fix one aspect.

However, as you said - the latest advancements in personalized treatment of
cancers are very encouraging. Treatments are becoming more effective, and
doctors are finally starting to treat the untreatable.

~~~
rayiner
The statistics show that most malpractice suits are meritorious, and
malpractice suits account for 2% of the total costs of the medical industry.
You can muddy the waters with "unnecessary testing" but then you have to
consider both sides of the coin. If bills would come down if doctors did less
tests out of fear of malpractice suits, how much would injuries from mistakes
go up? The problem is: there is actually a lot of malpractice going on, and
that has costs too.

Tort reform is politically attractive, but it's not clear it's solving a real
problem. See: <http://www.press.uchicago.edu/Misc/Chicago/036480.html>,
[http://archive.sph.harvard.edu/press-
releases/2006-releases/...](http://archive.sph.harvard.edu/press-
releases/2006-releases/press05102006.html),
[http://www.slate.com/articles/health_and_science/medical_exa...](http://www.slate.com/articles/health_and_science/medical_examiner/2006/07/the_medical_malpractice_myth.html)

The basic issue is that the medical field is unusual in being self-regulated.
The malpractice system is really the only way we have to hold doctors
accountable, and even within that, we adopt the unique practice of letting
doctors themselves adopt the standards to which they are held, rather than
using objective standards.[1]

We don't need to handle malpractice via the tort system. But in its absence
we'd need something, say an OSHA-like agency that handled administrative
complaints against doctors accused of malpractice. There isn't a free lunch
here.

[1] Note that e.g. automotive engineers don't get to set the standards for
negligence in the context of designing cars!

~~~
brownbat
I've found there are some natural obstacles to getting clear data on tort
reform.

One example comes to mind, from a few years back, when there was a movement to
repeal tort damage caps in Kansas. Insurance companies turned out literal
dozens of experts to testify before the state senate, all claiming that rates
would skyrocket if the tort reforms were repealed. (There were something like
34 experts against the repeal to one lone attorney as an expert witness in
favor of it, if I recall correctly.)

Now, it just so happened that Iowa had added the very same damage caps to
their code the previous year. Bit of a fortuitous natural experiment, eh?
Naturally, the curious senators asked each expert in turn how much premiums
were lowered in the nearby state over the course of the last year. Sadly, they
couldn't get an answer on the record, because every one of them fainted as
soon as they heard the phrase "lower premiums."

~~~
rayiner
Pretty much everything is this way. We get mad that politicians don't govern
based on what the experts say, but the fact is that you can find an expert to
say anything, and what is "obvious" or even "true" depends on what circles you
travel in. Moreover, just as in this situation, a lot of the people who are in
a position to really understand how a policy change affects the system (in
this case, insurance companies and lawyers) also have a personal interest one
way or another.

I'm personally quite wary of tort reform. Not because I'm a lawyer (I'm a
lawyer because I'm the kind of person who is wary of tort reform!) They
promised us the same thing about binding arbitration. It would get those
overpriced lawyers out of the equation and let businesses just hash it out
civilly with each other, they said. And look what happened--binding
arbitration basically just became a way for big companies to force consumers
to give up their right to sue. Companies rarely use it amongst themselves:

"When it comes to contracts with each other, corporations are far less likely
to use arbitration clauses than they are in contracts with consumers. This was
the finding of a December 2007 study by Cornell Law Professors Theodore
Eisenberg and Emily Sherwin and Professor Geoffrey P. Miller of NYU Law
School, who examined contracts from 21 financial and telecommunications
companies. The data showed mandatory arbitration clauses in over 75 percent of
consumer agreements but in less than 10 percent of their negotiated non-
consumer, non-employment contracts." ([http://centerjd.org/content/fact-sheet-
mandatory-binding-arb...](http://centerjd.org/content/fact-sheet-mandatory-
binding-arbitration-corporate-end-run-around-civil-justice-system)). In other
words, corporations reserve their right to litigate. Arbitration is for the
poors.

I don't really see tort reform playing out any other way, unfortunately. I
wouldn't be opposed to a more regulatory or administrative scheme, but damages
caps are just a way of shifting costs from the medical system (not just
sympathetic doctors, but billion dollar hospitals and insurance companies)
onto the people they injure. Indeed, of all the various reforms, damages caps
are the worst possible one. By and large, if a jury awards someone a couple of
million dollars, it's because the doctor really fucked up. Damages caps under
compensate plaintiffs in the precise situations in which they are the most
likely to be in the right! If we're worried about shakedowns, a far more
sensible approach would be a "damages threshold." If you can't show you
suffered more than say $10,000 of damages, nobody pays up. That would deter a
lot more of the people just looking to make a quick buck.

~~~
brownbat
Another option would be just giving some fraction of punitive damages to the
state.

When lay people are shocked by judgment amounts, usually its because the judge
was using some sort of damage amount that would actually make the offending
institution change its behavior. But you could provide basic damages to make
the patient whole plus lawyers fees to the patient, then allow the judge to
reserve some portion of punitives for the state, and just label it something
like a regulatory fine. People understand that fines can be high, they don't
understand when people appear to get a windfall well beyond what might make
them whole.

(OTOH, maybe if someone goes through having a scalpal left in them, they
deserve whatever "windfall" they can get.)

------
tbatchelli
I am a European doing the entrepreneurship thing in the US, with a wife and 2
young kids, and I find the health care situation here my biggest problem and
worry. I start every month owing $1400 to some health care company that, when
push comes to shove, will to avoid paying the bills, sometimes with little
recourse from our part. And this is being lucky because we found a company to
take us...

When I hear my friends in Spain how hard it is to start a company there
because you have to pay $300 to the public health system, I have to laugh. But
seriously, the current healthcare environment is effectively turning away many
entrepreneurs at their prime, since family and kids are usually in the
picture, as parents cannot and will not risk their family's health. Sometimes
taking a corporate job seems like the only option to avoid such risk, which
again, yay for entrepreneurship!

~~~
novalis78
Agreed, same situation here. Still, I don't believe the fictitional costs are
the point where one should start fixing the system, not adding more
beaurocracy. Insurance rates in Europe go up every year and the quality of
service goes down. If the prices were really transparent, for everyone to see
& upfront that would be a first step. Shame alone at such a criminal ripoff
would make some doctors think twice - let alone trigger some good ideas how
the system could be changed.

------
guylhem
[EDIT: Immediate downvote? New personal record! HN is becoming more and more
liberal I guess. Never mind.]

Once again, there are many opportunities for improvement. Business
opportunities.

Healthcare is plagued by inefficiencies, over regulation, and "just think of
these people who suffer" mentality- basically, we undertreat, overtreat and in
both case overspend because of inefficiencies caused by overregulation, just
because we don't have the guts to say "no". (the fear of prosecution might
also help.) To those who are so worried about people being left to die in pain
as the result of a "no", just think about how cheap morphine is. There is no
need for pain and suffering.

It might take a long time to solve all these issues, if it can be done at all,
but there are many good ideas thrown around.

Price transparency - ie knowing in advance how much a procedure will cost
depending on the most possible outcomes would help. It should be mandatory -
for the most typical stays, give a detailed pricing in advance then let the
market solve the problem.

Ending the price discrimination would also be a great thing. Same service =
same price. Insurance are getting low costs not because of their "volume
purchase" but because they use their market power, as oligopsonies, to get the
low price they receive, subsidized by the non-insured.

The current incentives make sure that the minimum is being done (if only to
code and bill for that - like the chest X ray in the example. If it was not
billed, how certain would you be that it was performed 100% of the time?) and
it is a good thing, because I am more worried by undertreatment than by
overtreatment. The latter may only cost more, but the former may cost more due
to delayed proper treatment _and_ may cost lives.

As shocking to my libertarian values as it can be, I recently came to the
conclusion that subsidized first line triage should be offered, not even at
costs, but for free.

Healthcare has an information problem - it's hard for patients, especially if
they are uneducated, to determine how grave their symptoms are. Even if they
are intellectual and successful - so don't think it can easily be solved by
education. Read about Don Rosa eye problem, how he delayed treatment for a
grave retinal disease.

In economy, self rationing is usually good - but when that decision is based
on a lack of proper information of the consequences and their future costs,
it's not.

I'm not suggesting to provide free treatment here - just at least free
information. A right diagnosis, upon which the patient can decide what to do.

Markets work best when some basic conditions are met. There is no real market
in healthcare at the moment because prices are not published, and the
information asymetry, while less important than before thanks to the internet,
remains strong.

Once we have a medical tricoder and an ebay-like place for medical procedures,
I guess the situation will improve.

[medical tourism is a step in the right direction, but even discarding the
information problems, until prices are properly aggregated and compared, it
won't be enough]

~~~
IvyMike
> Ending the price discrimination would also be a great thing. Same service =
> same price.

This is actually an anti-libertarian idea.

But is a very good idea. This is a service industry, not a manufacturing
industry, so there is very little "economy of scale" coming into play, and the
consumers with the least ability to pay have the highest prices.

Heck, you could even say "prices must be within a factor of 4" and it would
still be an improvement over today's system.

~~~
guylhem
If it was a working market, with published MSRP and true competition, price
discrimination could theoretically be used to increase surplus. But it's not
currently a market!

At the moment, it's not. I'm not concerned with dogma so much - I care about
efficiency. Ideally, all regulations would be removed.

But we are not starting from scratch - we have the current status of
healthcare. We want to go to a working market - the question is how can we do
that?

Enforcing uniform prices is a step in the right direction - because the
uninsured will stop subsidizing the abnormal low rates insurance companies can
strongharm the hospital.

------
Avenger42
Discussion on an earlier item here:

<http://news.ycombinator.com/item?id=5256808>

------
guylhem
Instead of complaining, one should try to see the business opportunities
there.

Many talk about finance and Wall St and the quants. Healthcare is 20% of the
GDP, and based on the most basic human need, the lowest of the Maslow pyramid.

(disclaimer- I work on hospital billing issues)

~~~
arbuge
It's probably easy to say that if you're not one of those directly affected by
this nightmarish system. Maybe you should read the article and see if you can
sympathise with some of those who were. With a system so grossly broken and
unfair, it seems to me there is plenty to complain about indeed.

~~~
mtrimpe
I'd say building a business that improves these issues is close to the best we
can do to help those directly affected by the system.

I can imagine an app that would help the uninsured to survive a hospital
without going bankrupt could do quite well. You would have a very clear
distribution channel (hospitals and word-of-mouth while at the hospital) and a
strong need with a quantifiable upside.

You could probably make an app that's just an e-book that's already worth $20,
let alone when you add things like a TrueCar.com for hospital charges.

~~~
gnaritas
> I'd say building a business that improves these issues

Business is the issue. Money is not the correct incentive to solve every
problem; healthcare needs to be treated as a public good, not as a business
opportunity.

~~~
mtrimpe
I'm Dutch so I couldn't agree more, but unless you're a professional lobbyist
there's not much else you can do.

~~~
gnaritas
We can stop contributing to the problem by trying to make a buck off people's
misery, and stop voting for those opposed to doing healthcare as a public
service.

~~~
mtrimpe
Americans don't really vote, they just choose between two dictators every four
years.

~~~
gnaritas
Trite and untrue.

------
guard-of-terra
What makes americans go to American hospitals unless they have insurance? If I
was this guy, I'll bolt to, I don't know, Thailand or Hong Kong or maybe even
Switzerland.

You'll get all the examinations and all the treatment for a fraction of the
cost (in case of Switz, all of it), tickets and living included.

~~~
tn13
I am from India. Some of my family members settled in United States visit us
just for dental treatment. Cost of entire treatment in India is much lesser
than Insurance for 2 years + flight tickets.

~~~
kamaal
Hold on,

The prices are lower for you relatives in India only because they pay in
dollars. But if you are a Indian, working and making a living in India. Expect
a similar rip off!!

~~~
tn13
My aunt had bladder cancer was detected in early stage and she survived. She
had no insurance. Cost of total medical services were below $10k (Surgery was
performed by the best surgeons in India, the same people who also treated
celebrities and politicians).

------
ef4
If you want a practical takeaway from this article, it's _don't buy cheap
health insurance_. It just gives you a false sense of security, when in
reality you're still uninsured against the biggest health expenses.

Any health insurance policy that includes uncapped coinsurance, lifetime
benefit caps, or limits on per-day payout is going to leave you high and dry
if you really need it.

A good policy that doesn't have these limitation is probably going to cost
three times more, but it's going to be worth a thousand or ten thousand times
more if you actually need it.

If you can only afford a crappy policy, consider whether you might be better
off saving that money instead so you can at least cover your own minor medical
expenses. The major ones are going to leave you screwed either way.

~~~
rthomas6
I don't think "cheap" is the best way to explain it. I have a high deductible
plan which is pretty cheap and tied to an HSA. My wife and I are on the hook
for the first $5,000 per year, and the insurance will pick up 100% of the
costs after that. I won't run into the problems you're talking about. I like
it because I don't really think minor medical expenses should really be
covered by insurance anyway. I liken it to having car insurance pay for
routine car maintenance.

~~~
nitrogen
The problem with paying for routine health maintenance out of pocket (or HSA)
is that, in the absence of insurance negotiating the price down, a routine 15
minute doctor visit costs $85, and a routine blood test costs $400. Granted,
hiding those prices behind a monthly insurance premium allows them to remain
high -- there's a bit of a chicken and egg problem.

~~~
ams6110
You should look into finding a doctor who doesn't take insurance. There are a
few here and there, normally family/primary care type docs. You pay them cash,
and because they have zero overhead in their practice for insurance billing,
they can charge you less AND spend more time with you.

~~~
nitrogen
Interesting. If one found oneself seeking an insurance-free doctor in the
future, how would one go about locating such a doctor? What questions would
one ask, keywords would one search, or directories would one consult?

~~~
NoPiece
One advantage to a high deductible policy (besides being covered in case of
something big and bad happening) is that your normal care will be billed at
the rate the insurance company negotiates for all its clients, even if you are
paying out of pocket or via HSA because you haven't hit your deductible.

------
tn13
This is horrible. Also this is an opportunity for countries like India. For
example for $83k they would have got VIP treatment in India. Yes, India may
not have the high-tech stuff in there but for that kind of money you can
easily get more value for your money.

I have worked in a cancer hospital in India and I know for sure that Indian
doctors are way too experienced than their American counterparts. I have seen
doctors working 15 hours a day conduction 5-6 surgeries as day and seeing upto
70 patients per day.

------
pm90
Here's an anecdote of what happened to me as an international student in the
US. My mother stayed with me for about 4 months after I first arrived in the
states, helping me to set up the apt, teaching me how to cook etc. My dad, who
is paranoid about such things (he always buys travel insurance even for very
short trips) insisted on getting health insurance for my mother, and
reluctantly, I agreed to get it. There are many plans out there for a short
term insurance, and I got one from a local company for about $400 for 6
months, which was an exorbitant amount back then when I had almost no money in
the bank.

Anyways, come winter, and my mother gets respiratory problems. I took her to
the local hospital, where they told me that I would have to put her in the ER.
Turns out everything was fine, but she needed the reassurance of the doctor
that everything was OK. We spent some 20 mins with the doctor. Bill for the
visit? $250. Expensive, though expected, as it was exactly what it said in the
insurance plan.

Anyway, much later, I found out that the insurance claim by the hospital was
around $1000. I figured I had saved about $350 by taking insurance, but it
struck me as odd that just meeting with a patient for 20 mins would cost so
much!

------
suyash
That is why Everyone in America needs a really good health insurance plan.
Lesson Learned, don't be cheap while choosing your insurance plan at your
company. Go #ObamaCare!

------
rdl
There should be a way to pay cash (if you prepay) and get the lowest price
available (legally, the medicare rate; I think the government legally requires
the hospital to give it the best rate offered to anyone.)

The one big advantage of my $3500 annual deductible HSA (+RX) for everything
routine is that I get Blue Shield's negotiated rates even though I effectively
pay out of pocket for my <$500 in annual medical expenses. Out of pocket
without insurance, I'd probably be paying $1-2k. Then, on top of that, I get
the unlimited lifetime catastrophic 100% coverage after $3500 or $6000 or
whatever, so if I had a serious medical issue in any given year, my total
costs would be $1500 or so for annual premium plus the $6k out of pocket
maximum.

If you're healthy, the HSA seems like the ideal plan, and really is how all
insurance should be run. The weak link is that doctors/hospitals don't
disclose prices upfront, and really have no way to telling you how much
something will cost under your insurance, so it's hard to price shop.

------
chris_mahan
This is why Obamacare is bad. Now we will be taxed to pay for this.

Edit: I worked for 5 years at a HMO in data analytics.

~~~
cma
In a year or two a part of Obamacare phases in that changes reimbursement
structure from per-procedure payments to payments for overall effectiveness,
whether it actually works is up in the air:

2015: "A new provision will tie physician payments to the quality of care they
provide. Physicians will see their payments modified so that those who provide
higher value care will receive higher payments than those who provide lower
quality care. "

<http://www.healthcare.gov/law/timeline/>

~~~
ams6110
Sounds like that will work out about as well as rewarding schools for
performance. The doctors who treat the sickest patients who are likely to die
anyway will get screwed.

------
tyoma
For long term non-emergency treatment like described in the article, isn't it
possible to travel to country with a cheaper healthcare system?

I would be curious to know if the same cancer treatment is available and costs
the same in a place like Singapore, or Australia, or even Mexico.

~~~
acabal
I'm hedging my bets in that way; should I be diagnosed with something serious
like cancer, I'll probably just fly to be treated with first-world health care
at a reasonable price and in a tropical setting, in the country where my
family lives.

Unrelatedly, I was recently in Monterrey, Mexico, where there's a huge
industry around medical tourism; get treated with class just a few hours south
of the border.

Despite what many Americans believe, hospitals outside the US are not
candlelit caves staffed with black-toothed surgeons holding meat cleavers.

------
whiddershins
As I read further into the very long article, I think we as a society should
consider statutory / compulsory licensing for medical patents, especially
drugs. In Europe they limit prescription drug prices to a certain profit
margin. This is again "cost plus" pricing that reduces the prices relative to
what we pay in the states.

It may raise everyone's costs however, because this "cost plus" regulation
incents manufacturers to increase costs to increase profits.

Statutory licensing would do the opposite: allow companies to compete with
patent holders on efficiency of manufacturing while creating a mechanism to
repay R&D.

------
RougeFemme
Excellent (and depressing) article. I didn’t think there was much else I could
learn about hospital “overbilling”; I was wrong. For example: I had assumed
that very specialized hospitals such as MD Anderson placed “extraordinary”
profit margins _only_ on very specialized medications and medical services,
e.g., cancer medications and oncologists’ services – not on more standard
medical services and commodities. Another example: I knew that “non-profit”
hospitals were non-profit in only the loosest sense. This article _really_ re-
defines non-profit hospital.

------
whiddershins
It's surreal that the government pays LESS for these services. "Cost plus" is
a common practice for government contracts and often people point at it to
explain why the military pays so much for a simple product. The contractor
gets a fixed profit over whatever the costs end up being, which obviously
provides no incentive to reduce costs, subverting market pressures to innovate
or increase efficiency. Medicare is essentially paying cost plus, yet that is
less than everyone else pays. How is this even possible?

------
dmitri1981
I honestly wish I could summarise the economic causes that lead to these
scenarios, but that would take too long. Instead, I would strongly suggest
this boook if you are really interested in Public Economics:
[http://www.amazon.co.uk/Economics-Public-Sector-Joseph-
Stigl...](http://www.amazon.co.uk/Economics-Public-Sector-Joseph-
Stiglitz/dp/0393966518/ref=sr_1_3?s=books&ie=UTF8&qid=1361489844&sr=1-3)

------
angersock
So, the entire medical system--care providers and whatnot--could be improved
(I believe) by nationalization: one of the best implementations of care in the
US is actually the VA (Veterans Administration) hospital system, leading the
way in medical records and treatment.

There is nothing other than greed, fear, and entrenched interests that forces
such a poor quality of health care availability on our population.

EDIT: A pretty good read (from one of Houston's own) on this is the O'Reilly
_Hacking Healthcare_ book ( [http://www.amazon.com/Hacking-Healthcare-
Standards-Workflows...](http://www.amazon.com/Hacking-Healthcare-Standards-
Workflows-
Meaningful/dp/1449305024/ref=sr_1_1?ie=UTF8&qid=1361483430&sr=8-1&keywords=fred+trotter)
). It's got some insight on how _absolutely fucking crufty and retarded_ the
billing and coding system for hospitals is.

~~~
johngalt
I agree completely. The VA is a excellent example of a national healthcare
system. Talking to veterans who've spent time in the VA, and visiting VA
hospitals are a surefire way of convincing people what side to be on for the
NHS debate.

~~~
rdl
The problem with the VA is the quality of care seems to vary greatly by
facility, and until maybe 4-5 years ago, the VA was essentially structured to
give care to some very aged WW2/Korea veterans (and relatively indigent
Vietnam veterans (i.e. not even most of them) who could claim service-related
disability.) I'm not sure if that was due to resource constraints or what.

Post Iraq/Afghanistan returnees with service-related disabilities (TBI,
amputations, etc.), I think VA has gotten more resources and is now treating a
younger/healthier patient population. It also cooperates a lot more with DOD
active-duty care than it used to.

------
ck2
Bills are killing us because it's a for-profit industry and once you are in
that mode, it's a race for the most profit.

Doesn't matter if you are going to die or suffer from not being able to afford
it, they know they have plenty more customers.

This is where society falls victim to yet another one of those myths that if
it isn't for (massive) profit, people won't be motivated to help you.

------
ctdonath
Hard reality: a thing is worth exactly what another is willing to pay for it.

~~~
jlarocco
On almost any other topic I'd be the first to agree with you.

But people aren't buying this kind of medical care voluntarily, and that
throws a lot of capitalist idealism out the window.

In fact, there are a lot of reasons why normal supply and demand aren't quite
applicable for medical care.

Imagine a person having an accident that injures them and knocks them
unconscious. They don't pick the ambulance service, they don't pick the
hospital they go to, they don't pick which doctors work on them, etc. But they
still get the bill for all of it.

~~~
danielweber
I use that ambulance example myself. It's a pretty good visualization of why
we can't put all of the health care system under a free market.

However, there are parts of it that can be. (And even for the instances where
you really have no choice, price visibility could still provide some cost
containment.)

------
Alex3917
"In the U.S., people spend almost 20% of the gross domestic product on health
care"

This is false. It was 17.9% in 2011.

------
martinced
The system is rotten to its core. I'm a "lucky" one. I'm in Europe and I've
got a mandatory healthcare which I'm paying big bucks for and I'm also taking
an additional insurance, covering fancy costs (like if I want a chamber alone
in case I'm hospitalized etc.).

The problem is that this whole crazy-high-prices / insurance / pharmaceutical
/ medical / doctors / nurses costs are giving a sense of entitlement to
basically everyone in this mafia: from the state (which feels entitled to tax
everybody up to level that are already considered to be confiscatory to some,
like in France) to the practitioners to the insurance companies to the doctors
and to the... patients!

And don't you there criticize the highly-socialist nanny state for running on
deficit, always creating more and more state debt, or you'll be labelled an
ennemy of the human race: "what!? you want the state to give less money to
healthcare, you are a cold-hearted selfish man!"

The whole system is rotten and I this point I wonder if I'm going to keep
doing exams and going to the doctors.

The drain on the economy is so gigantic that we could already be, today,
lagging behind in our understanding of science and medicine compared to where
we should have be if we hadn't allocate such a gigantic amount of our
resources to this mafia.

It's a big business and it's ugly.

It is indeed slowly killing the entire economy. The problem is way more
serious than the derive of finance. Finance looks like a tiny toy compared to
the whole healthcare / pharmaceutical / insurance mafia.

In the end socialist and their never to be questioned healthcare cost are
going to drive countries to the only possible exit: state default.

And when _that_ is going to happen I can tell you that the quality of the
healthcare system is going to take a nasty hit.

You socialists are going to get what you're begging for.

~~~
dietrichepp
So, is your claim that countries with socialized health care (e.g. France)
have economic problems due to the immense spending on health care compared to
countries without socialized health care (e.g. United States)?

<http://en.wikipedia.org/wiki/Health_care_in_France>

> In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita, a
> figure much higher than the average spent by countries in Europe but less
> than in the US.

[http://en.wikipedia.org/wiki/Health_care_in_the_United_State...](http://en.wikipedia.org/wiki/Health_care_in_the_United_States)

> According to the World Health Organization (WHO), the United States spent
> more on health care per capita ($7,146), and more on health care as
> percentage of its GDP (15.2%), than any other nation in 2008.

> And don't you there criticize the highly-socialist nanny state for running
> on deficit, always creating more and more state debt

I thought that the U.S. already did that.

