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Hospitals Must Now Post Prices. But It May Take a Brain Surgeon to Decipher Them (nytimes.com)
73 points by wjossey 34 days ago | hide | past | web | favorite | 98 comments



Any business that can afford to splice, destructure, and recompose their pricing into undecipherable mess is a strong sign they're doing too well, and have an unhealthy stronghold on their customers.

If the markets are free enough I'd imagine some hospitals coming up with reasonable price lists that amortise the variance between successive operations and between the hospital and the patient. Most calls are routine anyway.

Even car repair shops are able to quote rough price ranges even if they face a lot of unknowns. They will call you back if they find something else, and at least locally should the mechanic commit to a fixed offer he's only allowed to deviate from it by X percent. And routine jobs are generally advertised with fixed prices. The shops will undoubtedly swallow some of the accidental costs themselves to provide tighter quotes which is what customers like.

Surely treating a human patient is more involved than that but the mechanism for pricing doesn't need to be. The hospital can calculate how much extra they need to add in the fixed prices to be able to "insure themselves" against the rare pathological case, to some extent. There's always the route of escalation from a routine operation to operating an acute trauma, but I can't imagine that would be common enough to explain the inability to provide reasonable quote ranges.


"splice, destructure, and recompose" - this gives the impression that they're making complicated on purpose. In this regard you're giving them way, way too much credit. I can practically guarantee they're just dumping a report (or more likely a union of several reports).

It is a giant bureaucracy that has had zero price pressure to force them to simplify. It is a function of 30 years of new inventions, complicated laws and IT as an afterthought. It akin to asking the IRS exactly how many taxable transactions exist. They have no effin' idea. They'll just push the 74,000 pages of the tax code at you and say "you figure it out"


I agree. You do have players like Kaiser that show success on vertical integrations, but that is a slow business.

The core key to achieve this is to separate insurance from the employer, and make health services truly compete with each other. Most people would probably end up with High deductible plans, and they will be very price sensitive to basic care costs.


This seems like a great opportunity for a company to invest serious time and money into creating a better-centralized database which will allow people to decipher and compare prices. It sounds like a highly-complicated task, but if someone can pull it off, that would be huge.


The opportunity is likely more B2B than B2C, where insurers are more apt to negotiate down prices if they see they are "overpaying" based on comps.

GoodRx already does this somewhat with prescription medication, by getting pricing data on prescriptions from local pharmacies.

Perhaps, based on the GoodRx model, the opportunity is to improve price pressure on recurring procedures for patients who require ongoing dialysis treatment, dermatology care, physical therapy, etc. For emergency based care in hospitals, I still don't think it's a major net-win for consumers, as you don't care enough to ask about price when your leg is broken.


As a non American, based on what I've heard of the US system, I would absolutely ask about price for any medical treatment in the US if I was still physically capable of asking.

Haven't broken a leg, so can't be sure whether I'd be functional - probably depends on how bad the break is :D


You can try, but the answer is likely to be “we don’t know, ask the billing department afterwards”.


Ha, yeah, I can imagine :-/


Looking at comments from last week here on HN it seems to be _very_ common that the prices quoted are a fraction of what you then end up getting billed.

How that can be legal, I don't know.


> For emergency based care in hospitals, I still don't think it's a major net-win for consumers, as you don't care enough to ask about price when your leg is broken

If I know in advance Hospital A is cheaper than and of the same quality as Hospital B, that could affect my decision around where to go for something like a broken bone. (Urgent, but not critical.)


who would you sell to - provider or payer? Payers should already be comparing across the providers they service. Providers would definitely find value - the challenge here is comparison based on list price are not inherently useful, yet obtaining negotiated prices would be difficult. I'm all ears for partnering if someone can get access to negotiated prices, even for a specific region.


Insurers already do this.


Why on earth should a person have to compare prices between hospitals?


Because hospitals vary widely in pricing, people often get stuck with part of the bill, and if it's not an emergency you've got time to comparison shop.

(But if you're asking "why do we have such a crazy healthcare system," I have no answer.)


It's marginally better than getting surprised by questionable bills afterwards.


Directly paying for a hospital to the point of service is an alien enough concept to most of the civilized world, this is a minor step forward at least.


An unaffiliated group with plenty of cash could also incentivize individuals to submit records, and automate the process of requesting records


Americans must think markets are like Gods. If we could previously say, "Kill 'em all and let God sort them out." Now we can say, "Starve them all and let markets sort them out."

The only difference is in who we outsource our morality to. Either way we, as mere mortals, are not responsble for determining morality. Or quite literally in this case, who gets to live and who gets to die.

The markets will fix it. Believe in the markets. They are our saviours and they are a fickle beast that we mere mortals cannot understand. Their actions are mysterious and their outcomes capricious, but we must believe because they are the one true God.


MArkets are people. When you make your rhetoric on markets what you are actually raging against is the desire of human beings: that is what you despise.


Markets, such as they are currently implemented in the US, empirically give health care providers all the leverage. You can blame "human beings" for the fact that they then abuse this power -- or you can do what nearly every other developed country in the world has done and fix the problem by taking (some of) it away.


Your analysis is not a market criticism or advocacy, is that the stacks are in favor of one against the other, and you wished the stacks were in your favor instead.

Thats what all players want. How they go about getting their advantages is the market.


Thats what all players want.

That's not true. There are people who advocate for other systems, and there are people who actually find more satisfaction in everyone getting a good deal rather than themselves getting everything and screwing everyone else over.


That other system always screws someone, and its never them.


I believe you have been tricked by survivor bias. There is a great deal of evidence of against what you say.

Your statements are absolutist; I believe you are speaking from ideology.


"Markets are people". That's quite a statement. On the face of it, it's clearly not literally true, and neither is it true that markets are "the desire of human beings", although that's certainly a little closer. So what exactly are you saying?

The fundamentalist wing of the market religion does an awful lot of damage. It's quite possible to dislike how markets can be gamed, captured, distorted, abused, twisted and made to serve rich individuals without despising humans.


A market is by definition a group of agents buying and selling from each other. Agent a formal word that eventually boils down to "person". Unless the lizard people have taken over.


So markets aren't people, and they aren't people's desire. "Market" barely qualifies as a noun; market is the actions of a group of buyers and sellers. A long way from the sensationalist original statement.


Nonsense. You'll have to find another argument to fix the cognitive dissonance of the statements "I want the best for people" and "Markets(people trading with each other) are evil"


Don't hate the player, hate the game.


That's a copout if I've ever heard one.

A few years ago, there was a game some adolescents would play where they would run up to an unsuspecting person person and bludgeon them as hard as possible to knock them out. There have been variants of the same pattern of behavior except involving strikes to other areas.

It is absolutely justifiable to hate a person for engaging in a game that involves inflicting harm on others. This attitude to hate the game rather than those forcing it on everyone else just seeks to divest blame from the actors that perpetuate the malignant activity, to an assumption that "the game" is some mysterious standalone force that subverts the will of the participants and justifies their innocence.

In short, "the devil made me do it" is not an excuse for poor moral choices.

Lets take it even further.

I have a game.

I'm going to get all the lifesaving equipment I can, and open a facility. This facility is going to specialize in a particular type of highly asymmetric transactions, and I'm going to do everything I can to inflict the greatest financial harm I can, because gee, the way we keep score mandates I do so to keep the game going.

It's a hard realization to come to, but as human beings and individuals, our collective behavior is dependent and a composition our individual choices.

And for a not insignificant portion of our population, we have succeeded in allowing it to scrape together a world around itself where maybe it takes a week to explain the technicalities, but it doesn't take a layman more than an a 15 minutes to come to the conclusion there is something seriously wrong.

This is one of those cases where rationalization has been left unchecked or unquestioned for far too long.

To wrap around to the true meaning underlying your aphorism, which is diluted without context:

Don't hate the market participants for participating in the market; but feel free to call out the hypocrisy of dealing in grievous financial harm in trade for necessary care. If you can't question or shame the actions of the ones perpetuating the status quo, you'll never change a blessed thing.

Mrs. Bloom in Accounting is still a part of it. Even if she'd rather not think about it.


I agree with most of your post but do you have any evidence that "the knockout game" was an actual thing and not just a few unconnected instances played up with scaremongering?


If someone hates both, and that includes you, do you hate back or hate the game that made them hate you?

Seems like too much given to a silly one-liner for movies.


markets are not infallible. They're not perfect either. But in the long run, they produce much better results than command and control


You know, can you just stop it with the superiority complex ? I'm European and I travel to the US on a very regular basis. European healthcare is mostly market based, and where it's not it has exactly the problem economics predict: rationing. And rationed health care is quite simply worse than expensive health care.

"Markets" simply means that mostly people can take care of each other. For the most part, that's true, and has many very positive sides.


"And rationed health care is quite simply worse than expensive health care"

Not true. With rationed care you can still buy additional services if you want to whereas with expensive care like in the US even the simplest problem can cost you a lot of money or bankrupt you and there is not much you can do other than hope (pray?) for the best.


  With rationed care you can still buy additional services if you want
No, that's not truly rationed, then -- that's variable pricing.

If food/fuel/etc is rationed, that's all you get without venturing into a black market, if one is available.


American healthcare is also rationed, just by different people. “We’re not covering that” tends to be an obstacle, whether it’s the NHS or Anthem saying so.


If you find the 'rationing' of the public health system an issue just buy private insurance? It's the best of both worlds.


I think you'll find in much of Europe that's not possible, or only provided on the condition that you use the (rationed) public system first.

Ironically does tend to be possible if you're NOT a citizen of the EU, in many places.

I guess this is similar to Obamacare (not very sure though). I hear you don't get to have an insurance independent of Obamacare. But the "integration" if you will is further along in Europe.


You should add where you are coming from. In Germany for example you can spend as much as you desire but there are also affordable good quality options. BTW the word "rationing" is used in the US as a propaganda word just as "socialism". really not a good word to use lightly.


I've checked out the price lists from the hospitals in my area. They are useless. It's clearly a case of malicious compliance, and it seems to have been done universally and consistently across different markets, suggesting a criminal conspiracy to evade the law.

Hospitals are already dangerous to go to since either the hospital is not covered by any given insurance plan, or the doctors at the hospital are not covered. It's pretty much impossible to get taken to a hospital that actually accepts your insurance and be treated by doctors who also accept your insurance. This has been bifurcated so precisely that it also indicates an intentional and designed conspiracy.


> It's clearly a case of malicious compliance, and it seems to have been done universally and consistently across different markets, suggesting a criminal conspiracy to evade the law.

Do you really believe this is a conspiracy instead of, you know, healthcare is complicated and the US market isn't working?

Knowing something about hospital pricing, I looked at Johns Hopkins Hospital pricing and it looked perfectly legible. Item pricing in healthcare is pretty useless, that's just how it is.


> Do you really believe this is a conspiracy instead of, you know, healthcare is complicated and the US market isn't working?

Yes -- and I think it's pretty well documented. Though less conspiracy and more regulatory capture. Between several insurance companies - patients, doctors, and hospitals - , "not for profit" ever expanding and state sponsored hospitals, medicare, lost bills, medical debt, and somewhere in this, medicare and medicaid.


Hence the "US market isn't working" part. None of that is new and it all explains perfectly why the price listings are useless. Which is why suggesting a criminal conspiracy to evade the price listing law is ridiculous.


These price lists look like "malicious compliance."

Based on the quality of published data, one could rank hospitals in order of probable honesty. Crowd sourcing estimated bills based on price data vs. actual bills would provide another metric.

If we in tech treated hospitals as being engaged in predatory wealth destruction, we could probably make a dent in the harm they cause. The most authoritative data could come from medical bill debts in collection, with signals in regard to how likely a given hospital is to make an egregious claim.


I'm baffled that in comments people in all seriousness say things like "a great opportunity for a company to invest serious time and money into creating a better-centralized database" and "a great opportunity for startups who does price/cost aggregation and comparison".

Are you serious?!

It's not even like trying to cure the symptoms of a disease. It's like trying to treat a symptom of a symptom with essential oils.


What's the underlying disease?

And, even if this isn't the path you'd like our healthcare system to take, isn't this new state of affairs a big opportunity for some startup?


The underlying disease is the healthcare system in the US. No amount of startups will fix that.


Of course, but it's going to take a long time to really fix that. In the meantime, scraping some websites and aggregating their data could help.


The data, posted online in spreadsheets for thousands of procedures, is incomprehensible and unusable by patients — a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital. It is nearly impossible for consumers to compare prices for the same service at different hospitals because no two hospitals seem to describe services in the same way. Nor can consumers divine how much they will have to pay out of pocket.

I took a look at the Vanderbilt charges[0] mentioned at the top of the article. If they could at least provide proper medical codes for procedures like they did in the drugs export, that would make it a lot easier to cross reference procedures/etc. between hospitals.

You can look through my comment history on my complaints about it, but if these csv files or pdfs were generated with jasper reports or mirth connect (any other integration engine), its a shame that they missed out on either one extra column or one extra join to get all their corresponding codes in their exports.

To the other comments' points, yeah someone could go ahead and start cross referencing codes, if they were all there, but the problem is that most systems are usually behind in code systems (e.g ICD9 vs ICD10) or they are made up using their own internal codes. You might end up with yet another set of standard codes that you would have to map to the official codes.

Here are some value sets[1] that are listed on the HL7 site. If anyone did want to tackle this problem, start there to at least get a baseline in the types of labels/descriptions you will be seeing across the board.

[0] https://finance.vumc.org/chargemaster/

[1] http://hl7.org/fhir/us/core/terminology.html

CPT - https://www.ama-assn.org/amaone/cpt-current-procedural-termi...

SNOMED - http://www.snomed.org/snomed-ct/get-snomed

ICD-10 - https://www.icd10data.com/

RXNORM - https://www.nlm.nih.gov/research/umls/rxnorm/


Having had some experience with both SNOMED and RXNORM (for scraping and ETL for updates), you need login credentinals for both and I'm not sure how much they cost.

Also they come in some large zip files (some are nested) so if you want to process it efficiently you should probably think about reading a particular file located inside, write to disk, process it, and deleting it and move on to the next without extracting it as whole.


Are there legal risks to gathering hospital pricing data and re-displaying it in a nice way?


Why do we always act like brain surgeons are any smarter than -- well any other type of surgeon?

It seems to me it is mostly a dexterity thing. Much like a good butcher.

Don't get me wrong. I am not trying to put down brain surgeons, I just think their job is less brain power and more physical performance.


Not necessarily smarter than... other scientists: https://www.youtube.com/watch?v=THNPmhBl-8I


Probably people mixing up "power over brains" with "brain power".


>It seems to me it is mostly a dexterity thing. Much like a good butcher.

While it requires that too, being a brain surgeon is not about moving your hards delicately.

Hopefully nobody goes to a "good butcher" for your their next brain surgery...

mcv 33 days ago [flagged]

I thought the notion of brain surgeon being synonymous with smart had died with Ben Carson's candidacy. His undeniable talent as a brain surgeon doesn't seem to translate very well to other areas.


This article strikes me as unnecessarily negative. This only began to roll out as of Jan 1, and the dust is still settling. Even if it's not perfect, it's still an improvement over the previous situation and I'm sure it will be iterated on.


It's a NY Times about something the Trump administration did. Relatively speaking, its surprisingly positive.

There is a benefit to publicize the program and its shortcomings, so I am happy they wrote it up.


Here is the link to Vanderbilt's pricing [1] mentioned in the article. Has a few CSVs and PDFs, also Johns Hopkins[2].

Searching google generically for the term "chargemasters csv download" seemed to uncover a few more hospitals.

Interestingly, I tried searching for "chargemaster" on Google Datasets search[3], and it only came back with one file. I think this shows the work needed to be done in this area (datasets search).

[1] https://finance.vumc.org/chargemaster/

[2] https://www.hopkinsmedicine.org/patient_care/billing-insuran...

[3] https://toolbox.google.com/datasetsearch/search?query=charge...


This is a great opportunity for startups who does price/cost aggregation and comparison.


In case anyone was curious, there isn't a centralized list of everything yet. All the chargemasters are posted on the individual hospital websites.


I have a feeling some of these non-profits that are mentioned will take a crack at creating a centralized index. But, it sounds like it'll be a borderline impossibility to make it accurate and useful.

To me, the argument that people can "shop around" for healthcare is just peculiar. For elective / non emergency scenarios, I get it. Dentists, for example, are more likely to face pricing pressure, given that dental work tends to be non-emergency. However emergency care, which is where insurance really matters, is by definition an emergency. If you cut off a finger, you don't call ten hospitals to find out who will stitch it on the cheapest. You head to the nearest hospital so you don't lose your finger!

I'm generally quite sympathetic to Hayekian economics, but the model doesn't strike me as universal (which doesn't make it flawed, just not some grand unified theory). Behavioral economics change during time sensitive & life threatening situations in a way that "throw the rulebook out the window", so to speak.


Most healthcare costs are not emergency care; its probably somewhere from 2% - 10% of healthcare costs: https://www.politifact.com/truth-o-meter/statements/2013/oct...


Fair point. But by the same token, the closer to an emergency good a procedure is, the less likely people are to buy it.

To illustrate: I know someone who took off the top of her finger in a car door. She picked it up and drove to the nearest hospital. Database or no, the "cheapest ER near her" wouldn't have been an option. Admittedly, this is extremely, but it still communicates the point.

Let's also not forget that cheaper often is correlated with a worse standard of care. The nearest ER happened to be a hospital with an expert hand surgeon on staff, and the hand of the lady in question looks nearly the same. The "cheapest ER near her" would likely have stitched up a stump. Functional, but inferior. Furthermore, the standard of care becomes much more important with anything life-threatening.



Read a random one, "Kaiser Foundation Hospital - San Francisco", Common25 is quite readable. but "CDM" is exactly as described in the article, it's basically an endless list of codenamed items.

> Emergency Room Visit, Level 2 (low to moderate severity) $1,185.00

> Emergency Room Visit, Level 3 (moderate severity) $2,105.00

> Emergency Room Visit, Level 4 (high severity without signigicant threat) $3,263.00

> Emergency Room Visit, Level 4 (high severity with significant threat) $5,009.00

I guess that's the very minimum base price, quite offensive for an european like me.


Yes, here the emergency rooms are not allowed to even ask for name in case it will be a deterrent for an illegal immigrant to seek health care.

Health care is a basic human right.

We had an incident where a hospital here tried to charge an illegal for giving birth. It was an uproar in the news for weeks and the bill was dropped and hospital fined.


[flagged]


I'm struggling to understand how you've connected "health care is a basic right" to the state imposing something on a person by threat of violence.


Forcing people under threat of violence is a popular strawman with people who oppose a civil society. Maybe it's the only way they can think of to get things done?


It's not a straw man, it's a practical question. If healthcare was a human right, you should be able to describe how you enforce that right, especially when someone infringes upon that right, such as a physician who refuses to provide services requested by a patient.


Physicians may very well refuse services requested by a patient if the physician doesn't think those services are good for the patient. Health care is not a self-serve buffet. This has nothing to do with health care being a basic right.

And if a physician denies a patient necessary treatment, there are already ways to deal with that. Physicians are (usually?) subject to disciplinary committees that deal with malpractice and other bad behaviour by physicians. Furthermore, a physician who refuses to do their job can be fired just like anyone else who refuses their job. This also has nothing to do with health care being a basic right.

So what exactly is your practical question is it's neither a straw man nor one of these two issues?


[flagged]


I think you are a couple of steps behind in the discussion. When people say that health care is a basic human right, they don't mean that physicians don't deserve to get paid for their work, they mean that everybody should have affordable (possibly government provided) health insurance. That insurance pays the physician. In some cases, the government simply pays for all care whether or not the patient is a citizen.

But yes, if an unlicensed physician tries to practice without a license, that's generally considered illegal in most countries, and for good reason. Charlatans pretending to be able to cure patients have cost lives. There's a good reason why physicians need to meet certain standards before they're allowed to call themselves physician.

Physicians can absolutely be and often are self-employed, even in countries where health care is considered a right. They too need to meet those standards. No, they can't be fired, but they can lose their license if they violate those standards. I'm not sure to what extent they're free to refuse to accept patients, but if they do accept a patient, that does come with a certain responsibility towards that patient.


[flagged]


I'm not sure why you're latching on to this notion of appropriating the work of others.

In the Netherlands (what I'm familiar with), healthcare functions through compulsory private insurance. Healthcare is paid for both by insurance contributions (on the order of 120eur per month, with a deductible of about 385eur) and by taxes. If one can't afford to pay the premiums, it is subsidized by the government. It's free if you're under 18. The system functions with a sort of gatekeeping by general practicioners, where GP visits cost nothing in addition to the health insurance premiums and if there is some issue beyond which the GP can handle you are referred to a specialist.

>Health insurance is supposed to pay for catastrophic losses, similar to auto and home insurance.

In the Netherlands it pays for routine, preventative care as well as catastrophic losses. That's why it's compulsory for everyone.

> Is health insurance a human right?

Yes, in the NL.

>What does "affordable" mean? What happens when hospitals and physicians reject your insurance? What co-pays and coinsurance are considered affordable?

Government policy, which also dictates who is eligible for subsidy. Insurance rejection isn't a thing.

>Does the right to health insurance extend to people who willingly destroy themselves for pleasure? Do they pay the same amount as people who take care of themselves?

Yes, though I'm not sure what medical discretion there is if for example an elderly life-long smoker needs a transplant. Suffice to say everyone has the right to health insurance.

>Can "healthcare is a human right" extend to Americans who travel to Europe for the purpose of obtaining free elective medical care at the expense of European taxpayers

An American cannot travel to the NL for free healthcare.


> Insurance rejection isn't a thing.

The opposite is a thing, though: that your insurance refuses to cover some treatment. It's not a free-for-all buffet, after all. That's where the GP comes in: for many treatments, the GP first has to refer you to a specialist for the treatment by that specialist to be covered. For some more experimental treatments, a physician from the insurance company has to approve coverage.

And some things aren't covered at all. There's some variation in what various insurers cover, although they all cover the serious hospital stuff (because that will bankrupt you if they don't).

> Yes, though I'm not sure what medical discretion there is if for example an elderly life-long smoker needs a transplant. Suffice to say everyone has the right to health insurance.

I believe there was talk a couple of years ago about whether smokers should pay a higher premium. Then it was discovered that smokers actually used less health care due to dying younger, and everybody shut up about it.

> An American cannot travel to the NL for free healthcare.

But if an American travels to the UK and gets ill or an accident there, they are mostly covered, because of the socialised nature of the NHS. In Netherland with its privatised system, you still need to have actual insurance. Most tourists do, although that's not going to cover pre-existing conditions, obviously. (Well, that sounds American.)


> How are the phrases "healthcare is a human right" and "everybody should have affordable health insurance" even remotely connected?

The latter is to ensure the former.

I suppose it would be better to have a system like the NHS, because it saves on paperwork and ensures everybody has access to health care with the fewest hurdles possible, but that's not the only way to do it. It can be done through a system of private health insurance as long as it's very well regulated.

But however you do it, a system where people are denied health care or go bankrupt trying to pay for health care, is not good enough.

Look, you're clearly putting a lot of effort into trying not to understand this, and I guess I can't stop you. If you were honestly interested in these questions, you could just look around you at how various countries handle this, instead of grasping at straw men.


> If healthcare was a human right, you should be able to describe how you enforce that right, especially when someone infringes upon that right, such as a physician who refuses to provide services requested by a patient.

Why is this a problem for healthcare, but not, say, voting (which requires people to staff the polling places etc.), or the right to a jury trial (which requires judges, baliffs, etc. as well as the jurors)?


How do you compel physicians to treat someone who comes to them asking for services?

If a physician refuses to perform a knee replacement, for instance, because a patient does not want to pay for it, does the government step in and force the physician to do it?

In the United States, physicians have autonomy to decide how they practice. Do physicians in Europe have autonomy?


The vast majority of emergency departments in the US is not allowed to turn someone away if they need emergency care. Somehow, that works even there. (even though due to lack of universal healthcare payment is not secured)

Many jurisdictions, including some US states, legally require everyone to provide emergency aid if possible, not just doctors.

The entire talking point about the individual doctor is a tired straw man, societies manage people having rights guaranteed by the system of society all the time, they do not break down if an individual person steps out of line.


What are you on about? Having the right to it doesn't mean you're forced to have it.


No, I'm asking about how you go about forcing physicians to provide services against the physician's wishes.

Maybe frame it in a different field: if programming services was declared a human right, how would you go about ensuring that every programmer provides services to everyone who asks for services regardless of payment? How do you ensure quality as well?


Standards, regulation and ensuring people get paid. If programming services was decided to be a human right, and I was in the business of providing those services, I'd expect there to be a system in place to ensure my services meet the standard, and to ensure that I get paid for my work.

Consider legal representation: that is also a right. Sadly it's often very expensive, but for people who cannot afford a lawyer, one is generally provided by the government. And while there's certainly a lot that can be improved about the lawyering business, lawyers aren't exactly starving.

I am aware that for most examples I can come up with, the US tends to do a poorer job than most countries. I guess it's no surprise that health insurance is in such a sorry state in the US, and that many people have such weird misconceptions about things like this.


>If programming services was decided to be a human right, and I was in the business of providing those services, I'd expect there to be a system in place to ensure my services meet the standard, and to ensure that I get paid for my work.

What if you get paid 25% of what you get paid right now because those in charge of regulating programming have determined that you have been getting paid too much?

What if those regulators have determined that your current documentation is insufficient to be paid for, and that you are now required to spend 25% more of your day on additional documentation requirements that do not actually improve the quality of your actual program?


If I didn't like the job for whatever reason, I'd get a different job of course.

But if health care and lawyers are any indication, there's little risk of that happening. Well, neither are immune to paperwork, but they're very well compensated for it.


Doctoring is a job. If you wish to have absolute control over which patients you take you work in private practice.

If you want a bit less control over which patients you take you work for the hospital.

No guns needed.


Found this github repo[1] about a proposed schema etc, and a wikipedia article about chargemasters[2].

[1] https://github.com/docgraph/Hospital_Charge_Master_Data_Sche...

[2] https://en.wikipedia.org/wiki/Chargemaster


Soon there will be Lemonade style app driven per hospitalization insurance on top of normal health insurance where for elective procedures you will be able to protect yourself from surprises like balance billing etc.


A step almost. The price charged to direct payers will not be the same price billed to anyone else, so fraud is still abound.


Nothing that a few convictions of hospital executives / accountants for fraud can't fix.


Seem to remember insurance sets pricing somehow not the doc/hospital? One of the reasons they don't have an answer to that question is it depends on what your insurance carrier negotiated with the care network the doctor is probably loosely affiliated with because it was required by whoever now controls the administration in the builsing they currently work...except more complicated and less direct with lots more opportunities for people to pad the price another few % for each layer of abstraction because abstraction is always free.


Priceline for hospitals, when?


Heart attacks, for one, don't wait for them to accept your offer. Also when you call 911 they decide where to take you.

These lists are useless. God knows how many of those charges will they tack on your appendectomy, from unwrapping the syringe to administering the $4 pain killer.

What we need is is a simple list like some surgery centers have. This operation will cost this much and includes everything.


Most hospital visits are for non-emergency care. Even for emergencies, I've put several people in ambulances over the last couple years and the drivers always asked which hospital we wanted.

You're certainly right about needing total costs.


I wonder how they got the raw hospital price data, is it published anywhere?


Just run a search for '<your local hospital name> chargemaster'. I found my hospital's price sheets in xlsx format easily.

Just had a CT done a couple weeks ago for abdomenal pain, $750 without contrast according to the sheet (if I did not have insurance).

I looked into costs for past procedures I had done in high school. I had kidney stones at 16. Lithotripsy was required which alone would have cost ~$65k according to the sheets. Tallying up the other minor stuff like meds and facility fees would have brought me close to $100k.

Now you argue, 'well insurance pays less'. Of course they do. But I had experience in my mid-20's having to use hospital services without insurance. Rabies shots came to around $17k billed, I paid around $2k, and spent a year fighting to have my credit brought back to normal (hospital never applied a payment from a CDC program then reported me to collections).


> Rabies shots came to around $17k billed, I paid around $2k

Am I understanding something wrong or what ? Rabies vaccinations are something about $10 in India. I knew prices are up in US but this seems another level.


Yeah, this is real. Cheaper to fly to India if you don’t have insurance and need medical care.


So rabies vaccine should be dirt cheap. Like real cost is $10.

I had immunoglobin, which is given if you have been exposed to rabies vector without being vacinnated beforehand. This is where the money is as it's made from modified human cells. I would guess this would still run a couple thousand even in India.




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