In general, I think vox.com is underrated. But Kliff in particular stands out.
Sarah Kliff's reporting, specifically, though, has always stood out as unusually excellent to me. It doesn't seem to suffer from that problem as much as some other Vox reporters I like (eg Matthew Yglesias). Her healthcare coverage, of course, is supurb, but there's also great stuff like her piece on the wage gap.
The actually state of affairs is that arbitrary hospital bills are a problem that won't be solved one hospital at a time but rather are going require regulation, not just on all hospitals but of health care broadly.
When you don't have transparency what happens is that everybody can bring their own anecdotes, maybe baseless, and you can watch as a group "wins the argument" based on claims _you_ know are spurious, because even though their position is unsupportable on the facts, nobody had those facts.
So, you're right that Kliff's work doesn't itself fix the problem, but what it does is document the problem unmistakeably so that this thread has fewer people saying "I don't think that can be right, my friend's sister knew someone who worked in an ER and they never charge that much".
Back in technology the Certificate Transparency system doesn't itself solve any problems per se. But it delivers transparency, and that has allowed clean-ups to happen in years that would undoubtedly have taken decades to complete without transparency.
It still requires a Will in the right place to solve the problem, for example CT's effectiveness is in good part dependant on Mozilla. Would Google step up to the plate and do the same job if Mozilla didn't exist? Maybe, or maybe for political reasons as a for-profit they would fail. Certainly Symantec's leadership believed that going over our heads to Google management would get them what they wanted, but unless what they wanted was "Get out of this business" that does not seem to have worked.
But the good news is that for healthcare Americans can vote to put that Will in place in your country.
Went to ER for the first time ~3 months ago. I was charged
about $4000 for:
- Cleaning a wound (with water/desinfectant).
- Some antibiotics.
- A band-aid and gauze.
I get how, with labor cost and all, that might cost $200. Maybe $300? I have no idea how this can cost $4000.
Hospital billed $6000 (already negotiated down with insurance). Insurance paid around $4000. They wanted me to pony up 2k. Told no. Went to collections, negotiated to just under 1000. According to the line items, doctor took ~$100.
I have no clue why this was so high. My wife did pelvic ultras-sounds at another hospital (so not exactly the same procedure), but was billed $300.
The only reason I can think of is the 'name' of the hospital. It's in the Bay Area and shares the name of a well known university.
Had I known, I would never have gone there. That incident caused me to ditch my plan and go with Kaiser. It's been ok so far. No ultra-sounds, but I got a sleep apnea exam and a cpap for about 150 - and that was disclosed upfront.
Normally I'd say that's far fetched but after having relatives advised to get unnecessary surgery I wouldn't be surprised.
Yet, I've heard on HN so many people love that place. I can't fathom how that is the case. Even military clinics are decades ahead of Kaiser.
The only positive thing I have seen about Kaiser is that they are an amazing drug company. Each campus has 2 to 4 pharmacies. That must be a very lucrative business.
First pregnancy we had a scare about genetic issues. Instead of wondering where the money would come from, I was able to take time off work and be there for my wife between the phone call and the battery of tests done 45 mins away. Another hour long ultrasound and a sit down with a geneticist in the afternoon. No bills, invoices, anything.
There's simply no reason for capitalism in healthcare to directly involved the patient. At least I believe that to be true.
There's simply no room for capitalism in healthcare
Heck, if you want to know why something in the US sucks, just look at that list.
Massive government corruption from legal bribery.
In all seriousness, that they are able to charge that much with no upfront warning is pretty insulting. But then again they know they have you hostage, its not like you are going to change your mind and tell the doctor to just leave it in there.
I hear people make this argument about patients who are bleeding out, and that's one thing. You're not going to suffer any extra harm from leaving a bean in your nose for a week. The nose just dumps out into the back of your throat. Why wouldn't you shop around in that case?
- (1) With an admirable humanitarian intention, the government forces hospitals to treat patients whose life is immediately in danger, and figure out later whether they'll be able to pay. If 1/10 people have the means to pay for the treatment they receive, then you're paying for your treatment, plus the expensive life-saving treatment of nine other destitute people who couldn't pay.
- (2) It's a monopoly. If your choice is letting your daughter possibly lose a finger, or taking her to the hospital, you'll take her to the hospital. Because you don't really have a satisfactory alternative.
- (3) It's opaque. You have no idea what treatment she'll need or how much it'll cost going in. They're loth to make promises about this up-front ahead of a diagnosis.
- (4) Because they can. Why would they ever charge $400 when they could charge $4000? The only surprise here is that it's not $40,000 or $400,000 or $40,000,000.
And almost all hospitals are walk-in without appointments, and many big ones have night coverage.
ER? sure, it's there. But only if you have rebar sticking out of your torso.
And, frankly, part of it is because hospitals can’t refuse care to anyone and if they can’t pay, someone else has to.
I think that's a cheap excuse they have to rip off everybody else. I would like to see the actual numbers of people who aren't paying and what losses they incur.
Somewhere in the ballpark of $40 billion dollars a year vs total revenues in the ballpark of $3 trillion. Various aspects of Obamacare had the effect of leveling them off.
There is likely additional underpayment due to Medicaid and Medicare (to the extent those programs are underfunded and operate by mandating care, they are a hidden tax).
There's benefit for everybody, which is risk reduction. You actually blame poor people for going to the ER in case of emergency.
As far as I can tell the problem is really the big HMOs seem to be essentially managing another companies money, rather than their own, and they essentially get a cut of money going in and out of them.
Even worse is receiving bills from various providers up to a year later. How are these people still in business?
The American system is literally (literally literally) unsustainable.
It's a lose lose situation.
Some urgent care clinics post wait time online so you can find out how to see a doctor the fastest way.
These are often misleading, though - the clinics that market this way essentially perform triage with docs instead of nurses, so you're technically seen by a doc quickly. Time-to-discharge would be a far more useful data point.
They're also often marketing like this because they're standalone clinics that are out-of-network for major insurers in the area. https://khn.org/news/surprise-that-urgent-care-center-may-se...
Pricing in the US health system needs regulation. The best option would be all providers must charge the same rate to all customers. Then I could look up the price and know it’s been prenegotiated by big insurance companies.
I hit my max out of pocket the first month of each year and the rest of the year is “free.”
I know that all the IVIG pharmaceutical companies offer a “I can’t afford this” option if you’re going out of pocket.
Good luck, it’s stressful to get but it’s a miracle blood product for those who need it.
This should be number one.
In the UK it's common to, say, go to a pub and buy a pint. It's not usual to ask for the price first. It's possible a bar could decide to quote me 500 quid after pouring. I'd obviously decline and walk out.
How is it any different in the healthcare case? If you've made an honest effort to determine a price, been told it'll be about X, and then receive a bill for 10x, it sounds like a scam that cannot be enforceable.
That's how I went from being told I was only getting charged $100ish and wound up being forced to pay $600.
I paid somewhere around $2k out of pocket for ER fees. There was a program through Sanofi Pasteur and the CDC to pay for it for people under a certain income threshold. Seems it's bad press if Americans catch symptoms of rabies and die, since prevention is straightforward... and it is such a deadly disease.
The kicker was, around a year after this... the hospital reported me to collections for nonpayment of the full amount. I begged the guy that I submitted the application to, to provide me with a record of being covered under this program. Thankfully he violated HIPAA law and did it. Provided me with a complete report of everyone paid under the program that month.
The hospital's response was to tell me to immediately destroy the document, citing privacy law, and to tell them where I got it from. I explained that I would not be doing that, and that I would go public with the situation to as many sources as possible. The next day the hospital had a meeting with their vice president and the head of their pharmacy department. Within the week, I had collections removed from my credit reports.
Of course they could not pay and the hospital dropped it down to something affordable over a long period of time. How could the hospital expect anyone to pay either of the bills? Don't get me wrong, hospitals and doctors do amazing things and deserve to get paid well, but their has to be some sort of reality applied to the billing process or they are just breaking people.
living the american dream so no insurance
Your dream, everybody else´s nightmare.
“Medical debt can be completely discharged if you qualify for Chapter 7 bankruptcy or you can pay it over three to five years through a Chapter 13 repayment plan”
Anyway, I’d directly correct my comment but it’s been too long for edits apparently :-/
Upvote the replies :)
The US government has put in place extremely heavy barriers to open a medical care facility
The reason for consolidation in ERs is cost -- uf you run an ER, you are obligated to treat anybody who cones in without regard to ability to pay. It's a money pit in many urban areas.
A lot of their customers will be unable to compare multiple hospitals and "shop around", so to speak. Either because their conditions is life threatening, they're actively dying or they're no longer responsive. The ambulance, in any rational scenario, will drive you to the closest hospital in terms of time-spent-driving
So from a corporate perspective it's perfect; the customer arrives and you're legally obligated to start spending money while they are likely unable to object and then you can bill them for it.
What the... I'm pretty sure vaccines only work to prevent illnesses and are very much useless to treat them. I mean they're supposed to be small quantities of the virus or bacteria that causes a given illness to train the immune system to defend itself. Why would you add more of the rabies virus when you might potentially already have more than you can handle after being bitten? I thought she was just giving a bad imaginary example, but she says she "had a bill from someone who had gotten a rabies vaccine at an emergency room". Could she have misinterpreted why the vaccine was administered? but why would anyone need a vaccine in an emergency?
> Rabies postexposure prophylaxis consists of a dose of human rabies immune globulin and rabies vaccine given on the day of the exposure, and then a dose of vaccine given again on days 3, 7, and 14.
Modern treatment also includes antibodies that will immediately work against the virus.
If you don’t get the rabies vaccine shortly after being infected, you will almost certainly die.
This, to me, is a perfect example of why healthcare should be subsidized by the government (either directly or through a government-backed insurance plan that you receive as a fallback).
Health isn't a good or service you choose to purchase. Demand is perfectly inelastic and everyone is subject to emergencies no matter how healthy their habits are.
Nah, this doesn't really work in the US. All it does is to funnel money into the coffers of the companies that are creating the problem in the first place.
There has to be some more regulation – companies need to be forced to be more transparent in their pricing, as well as to limit the markup they can add so they can 'negotiate' down.
And then, there has to be some competition, as in many places people have no alternatives. That competition could even be with the government itself, in the form of government-run clinics or hospitals. This works in Brazil – you don't have to carry any form of insurance whatsoever if you don't want to. For major issues, you are covered just fine – trauma surgeons in the public network are among the best (at least in big population centers), and are often the same doctors that practice in private hospitals. My mother also got top notch cancer treatment for free. The last one is more location-dependent though.
Even as a foreigner, should you get in a car crash or something, you'll be patched up nicely and not pay anything.
Now, if you got a non life-threatening issue, then it can be a problem, as even the big hospitals may lack resources for everybody, so your appointment may be scheduled far in the future. To counter that, you can choose (and most middle class people do) to carry private insurance and not burden the public network. Private insurance is then cheaper that it would otherwise be because there is an upper limit on how much they can charge you – go too high and many people will drop insurance and private insurers (plus hospitals and clinics) would lose customers.
The government will also provide essential medication for free (diabetes, high blood pressure, etc). It doesn't matter how high your income is.
It is really not supposed to be rocket science. If a third world 'developing' economy can do it, with a much lower economic output, then the US could do it too. But not if it's a <whatever>care program that's allowing companies to continue charging $100 for a band-aid.
As a Brazilian, this literally made me laugh out loud. Brazilian healthcare sucks balls. Even the US does a better job at it.
I'll just post this one article¹ about the guy who went to the ER in Rio to have one leg amputated and the doctors amputated the wrong one...
The only downside is that given underfunding there are waiting lists for a lot of ‘elective’ things so if you don’t have private insurance you might wait up to, say, a year for a hip replacement whereas you could get it done within a week or two privately. So I pay $1K a year for private insurance just in case.
But in our large cities the hospitals and emergency departments are as good as you’ll find anywhere so I always go to a public hospital in an emergency. You can even use your private insurance there so the state system gets some benefit.
Not sure why anyone thinks that tax dollars would make the problem better.
Just push that number to 100%.
We have never been able to make extensive progress on healthcare because voters elect politicians that fight against government health insurance (even fighting against spending government money on insurance for the disabled and elderly).
Free market ideologues have failed us, not the government. This is painfully obvious if you've ever been in another civilized country (Taiwan, Canada, UK, etc.).
It's pretty fucking cut and dry at this point. We can dispense with the philosophical grandstanding.
Why go for such far out nonsense like this when there are perfectly good examples of successful healthcare models in other countries.
Plenty. The electronics market huge and barely regulated. The hardware for smartphones are cheap and amazing, televisions, etc. Automobiles are huge and relatively unregulated. It's not a great comparison, but your question was bad.
The size of the industry has nothing to do with whether or not it should be regulated.
The reason to entertain this thought it because deregulation is part of the solution to high health care costs.
"Electronics market"?! That's like calling healthcare the "service industry".
> Automobiles are huge and relatively unregulated.
This is laughable. Air bags, seat belts, emissions, break lights, tires, and more. Cars are one of the most regulated industries out there. From how they're built to how they're sold (manufacturer can't own the dealerships).
> It's not a great comparison, but your question was bad.
Your attempt to add something meaningful failed.
I submitted it with the same title it carries at CJR, which includes her name. The story is a profile of her and her work, so removing it makes the headline less informative, not more. And she’s not a celebrity, so mentioning her by name doesn’t make the headline any more clickbaity than it would be without it.
Is there some reason HN believes she deserves to have her name struck out of the title of her own profile?
This is a misguided policy and I hope you reconsider it.
Including names seems like a good way to:
- let people exercise their people-related biases
- encourage gaming of the system by appealing to authority
- encourage gossip-y headlines "X's techchruch interview whatever whatever"
> Removing her name from the headline just obliterates the value of the headline as a way to determine what you're going to see when you land on the other side of the link.
I'm not sure I agree with this at all... What she did is what's valuable right? When I clicked that headline, I expect to see something or some process that is actually bringing transparency to ER prices.
Also at the end of the day HN isn't a democracy :), but I think I happen to fall in the majority here (or at least in line with what was decided).
ie: "Google paid Andy Rubin $90M while keeping silent about a misconduct claim"
A frivolous rule for lack of a better term...
It doesn't make sense.
I don't know why the mods have chosen to do that (I'm not going to speculate because there could be lots of reasons), but at the very least they're doing it consistently.
Its the only educated place on the internet, but the front page and comments is what HN whales decide.
Since you either can't or won't stop posting like this, we're not going to unban you after three months, because clearly this problem is just continuing. But if you can go three months without posting any abusive, off-topic, meta comments, we'll consider it. In the meantime, we're continuing to unkill good comments that you post, if the community hasn't vouched for them first.
We detached this comment from https://news.ycombinator.com/item?id=18289284 and marked it off-topic.