Comment by IG_Semmelweiss | Hacker News Reader

Comment by IG_Semmelweiss | Hacker News Reader

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While what you are saying is all true, in general terms, but the key story seems missing: The "top of the funnel" system is very much fighting to preserve itself.

- Insurance companies are in bed with hospitals to collaborate swindling money from the govt: read about kickbacks sent by the US Govt to hospitals as Disproportionate Share Hospital payments.

- Hospitals have a PR arm moving profits to defend their monopolies, including using SALT rules to create barriers to entry by geography.

- Hospitals also use govt rules against it. They were able to obtain an absolute advantage over all other players (ASCs, Independents) by getting the vaulted nonprofit status, which independents cannot get.

- Hospitals use their nonprofit status and barriers to entry to buy out competition: nimbler independent providers that are actually able to lower prices.

So, hospitals create their own rules, drive out competition, and create monopolies that leads them to hoard cash, which then they use to buy out competition and mire them in 1970s technology so we all pay more.

Then there's also PBMs, and Insurers. That's a story for another day, but plenty of blame to go around.

I post that hospital systems are so large, that at the bottom, Hanlon's razor may apply, but at the top, there's incentives one cannot ignore - and a lot of prejudice to keep the game as-is.

All valid, but you forgot another big story, for another day: "medical billing". This, in my minimally-informed opinion, is the syndicate keeping the fence running. I've had dealings with 4 owners of separate small-to-moderately sized billers and their top-brass all owned > 1 multi-million dollar homes around the world. Also, their toy boxes contained millions in cars, boats & flying machines. It must be nice, but incompetence doesn't smell right.

Medical billing is by a product of government mandates on insurance to cover everything + medicare and medicaid.

Make those programs go away, and CPT codes would eventually die.

It is not going to go away so unfortunately we need to learn to live life with it, and instead make it irrelevant, or niche, just like a ferrari is niche.

The best way to cope is to have an alternative to CPT coding, which means, alternative to insurance-based healthcare, which means, medicine between patients and doctors.

The only way to do that is that insurance and CPTs get so expensive that an alternative system is demanded by the market.. and people opt in (and regs allow for it). In effect, ferraris vs corolla. Corollas don't care about CPTs, Medical Billing, Eligibility, Copays, Coinsurance, or Authorizations.

The only way we can get more honda's is by having more independent doctors and less hospitals.

Hospitals create monopolies, independent doctors break monopolies with competition.

The best way to cope is to shift provider compensation from a fee-for-service model to a value-based care model. That reduces the need to code individual procedures using CPT for billing purposes. This industry shift is already underway, but moving slowly.

hard disagree.

value based care is another iteration of "pray for alternative" to non FFS model, aka the APM.

This is the road of the HMO, the RVU, the QCCS...and i could go on and on. Its the road that we have traveled on since the late 80s. Its the road of the wanderer in the desert.

It doesn't lead anywhere but more profits for the road-builders.

40 years of history with 0 decreases in healthcare costs is all the evidence you need to put this one to bed.

> Hospitals create monopolies, independent doctors break monopolies with competition.

The question might be: can we create an Uber-like business that has gives doctors the tech infrastructure to consult with patients without it feeling like a mom and pop shop?

Investors are betting that its possible.

Not in the strict uber model. Mind you. Providers will need to keep more of a share for it to work.

Yes, I think that is correct - ending government intervention in health insurance would wither the medical billing industry. To be fair, the medical billing industry is not parasitic - it adds value by navigating health insurance billing, which is notoriously complex and time-consuming. But health insurance billing is only so prevalent because of massive government intervention. For example:

- The federal government is by far the largest health insurer - through Medicare and Medicaid it pays for 38% of healthcare in the US [1]. - The federal government directly subsidizes private health insurance through ACA [2]. - The federal tax exemption for employer-paid health insurance is by far the largest by dollars exempted [3].

All these government interventions increase reliance on health insurance, which increases the complexity of billing, which grows the medical billing industry.

[1] https://www.statista.com/statistics/237043/us-health-care-sp... [2] https://www.healthcare.gov/glossary/subsidized-coverage/ [3] https://www.npr.org/sections/health-shots/2012/12/04/1664342...

If your incompetence continually makes you money you aren't incompetent, you're malicious.

Courtesy of Louis Rossman, possibly stealing the quote, speaking about governments screwing up their fines and regulations.

Don't forget the doctors who are part of that syndicate.

I'm a professional patient, 99.9% of the doctors I've took treatment from(not U.S.) for major ailments are businessmen masquerading as doctors and I'm not talking about some scrappy hospitals; These are world renowned hospital chains.

What happens when you optimize for profit, instead of medical science? Wrong diagnosis and prognosis; I'm a victim of one and it has ruined my life.

On the other hand, There are doctors who risk their lives every day to serve people in need e.g. Doctors without borders, Doctors who rushed to serve during pandemic(Many of them loosing their life to it) etc.

Is there any evidence that doctors in other countries have a lower rate of diagnostic errors?

I didn't include 'not U.S' for that but to not have comments suggesting I sue such doctors, hospitals etc.

I trust it will higher, because if patients was not directly killed by them, doctors always get same salary.

Huh?

They don't create their own rules. Most of the things in your list are failures of government.

Why are DSH payments bad?

Becuase they act as an incentive to raise prices with no incremental value in healthcare delivered.

DSH rules are gamed to extract more from the program

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