Comment by diogenescynic | Hacker News Reader

Comment by diogenescynic | Hacker News Reader

Sutter Health is my local hospital monopoly. They're the only reason that Sacramento is the most expensive place in the country to have a baby. And the quality isn't exactly high. I know someone who just had knee replacement surgery and they were sent home a few hours after their surgery. When my grandpa had the same surgery in the 90s, they had him stay for a few days to recover. Now they just want to churn and burn their 'customers'. In addition, my wife after giving birth was only allowed to stay the bare minimum. It's shockingly gross how we've commoditized access to healthcare into this assembly line style racket. Contrast to Europe, when I hit my head on a train and needed stitched, I got a free ambulance to their ER where two nurses and a doctor immediately stitched me up for less than 40 EUR and was given world class care. We're doing something wrong in America when we pay the most extreme prices for the most basic care. We're getting gouged so executives can line their pockets. We should be rioting but we all just accept it. And it's not like Obamacare or Biden have done a single thing to change things. Obamacare just forced everyone to buy insurance... it didn't really change the fact that when you go to use it you get crappy care. And even when you go to a place like UCSF, the quality of care isn't that great. They put my wife's IUD in wrong and we ended up with a second kid. Healthcare in America is shit quality.

Sutter is not a monopoly, especially in the Sacramento area. In Sacramento there's Kaiser, Dignity, Sutter and UCD, plus numerous smaller office chains such as Hill Physicians, etc.

What you likely meant is your employer's health plan is only Sutter... which is entirely a different thing.

> I got a free ambulance to their ER where two nurses and a doctor immediately stitched me up for less than 40 EUR and was given world class care

With most health insurance plans, everything you described would cost you only a co-pay as well (usually $20-40). Uninsured people are the ones stuck with $10k ambulance ride bills... after all, someone has to pay for the services.

Even with the government funded healthcare here in Spain people don't spend thousands a month in taxes. In fact very few people pay that much anyway.

I'm genuinely shocked how much health insurance costs in the US. I'm glad we just cover this through the state here. It works fine and I never have to pull out my wallet.

Majority of people in the US don't pay thousands a month in healthcare/insurance either. Really premium, high-end health insurance plans can exceed $1K monthly for families, yes, but regular plans don't. In addition, for employer-based health insurance, the individual often pays only a small portion of the total monthly premium (1/3 is common, but varies).

> I'm glad we just cover this through the state here.

You mean you cover this through your taxes. The state does not just literally or figuratively print money to pay for health care. In the US, over 40% of the population pays $0 income taxes, yet still has access to government provided healthcare via Medicaid.

In fact, when you combine Medicaid and Medicare, the US has the largest national healthcare system in the world - in terms of dollars spent and people covered.

yeah the crazy costs will certainly make the US healthcare system look large if you measure largeness by how crazy the costs are

I have the cheapest kaiser plan available, with a 10k deductible. It is 1900/month for my family.

> Majority of people in the US don't pay thousands a month in healthcare/insurance either. Really premium, high-end health insurance plans can exceed $1K monthly for families, yes, but regular plans don't. In addition, for employer-based health insurance, the individual often pays only a small portion of the total monthly premium (1/3 is common, but varies).

yeah but I really really don't want to be dependent on my employer for health insurance. This means I'm pretty much blackmailed into staying there until I have something else lined up. And when I get fired it compounds the problems hugely.

> You mean you cover this through your taxes. The state does not just literally or figuratively print money to pay for health care. In the US, over 40% of the population pays $0 income taxes, yet still has access to government provided healthcare via Medicaid.

I know, it's my taxes. But that's fine. It's worth paying taxes for cheap healthcare for everyone. I want poor people to be healthy too. The good thing about it is that nobody has to worry about crazy bills. We spread the cost over everyone and that's great. There's no deductibles either. And we don't pay a fortune in taxes.

Also, the way the health system operates keeps it cheaper. The hospitals work together and they purchase together in bulk. General Practitioners have central offices in every neighbourhood with all standard treatment rooms so they are assigned one every day. They don't need to buy their own practice. They don't need to worry about running a business, doing accounting, finding suppliers.

It was especially ideal during covid when some of these centers were specifically assigned for covid patients and others for other things, reducing cross-contamination.

> In fact, when you combine Medicaid and Medicare, the US has the largest national healthcare system in the world - in terms of dollars spent and people covered.

But yet people can still be bankrupted if they get sick. This is the one thing that's avoided here.

No, they’re effectively a monopoly for most of the services people actually need. It’s well researched and documented. Google it. They even settled an anti-trust lawsuit with the state a few years back.

https://www.capradio.org/articles/2019/12/20/sutter-health-s...

https://amp.sacbee.com/news/local/health-and-medicine/articl...

https://www.abc10.com/article/news/local/sacramento/californ...

https://www.nytimes.com/2019/10/03/health/sutter-hospitals-m...

https://www.latimes.com/business/la-fi-sutter-health-prices-...

https://www.cbsnews.com/amp/news/california-sutter-health-ho...

https://m.youtube.com/watch?v=n5FFIkdVzq4

It’s a racket. They’re just ripping people off. Sutter is the sole reason healthcare in Sacramento costs more than in LA-and for worse quality care. They’re a grift.

> With most health insurance plans, everything you described would cost you only a co-pay as well (usually $20-40). Uninsured people are the ones stuck with $10k ambulance ride bills... after all, someone has to pay for the services.

You’re either uninformed, lying, or both. Have you ever called an ambulance in California? It’s $2000 minimum even with insurance. This is with an Anthem Blue Cross PPO from a tech company. I’ve had to use an ambulance twice in the last decade and it was considerably more than $20-$40… you were only off by a factor of 50x or 100x.

Not one of your links provides any evidence of Sutter being anything close to a monopoly. They do not own the market in California or Sacramento, and the are many other major healthcare providers here including Kaiser.

"Anti-Trust" actions cover a wide variety of anti competitive behaviors.

Additionally, you are misleading people on the cost of an ambulance ride by conflating out-of-network prices and/or medically unnecessary rides.

"Balance Billing" for out of network ambulance rides is now illegal, and uninsured people are capped at billings equal to Medi-Cal.

You’re obtuse. They’re charging more for comparable services in a lower cost of living area of the state, they get away with it because they are effectively a monopoly and there are no real alternatives or competition. They have even been sued and settled anti-competitive behaviors which is evidence to my point… They may not be the literal only healthcare provider but they are clearly able to use their size and scale to rip off locals. Otherwise there’s no other reason Sacramento should be the most expensive place to give birth… it’s a no brainer. You probably work for them or some other PR firm to spread propaganda like this.

> Additionally, you are misleading people on the cost of an ambulance ride by conflating out-of-network prices and/or medically unnecessary rides.

How am I misleading? Those were my real experiences. It’s not like the 911 operator asks about your insurance and makes sure the ambulance is in network. What about when the ambulance is called for you? How is that “unnecessary” if you don’t even have a choice?

I bet you get paid to spread propaganda and lies. This shit is why America sucks—we all get worse healthcare so some rip off company can pay shills like you to spread lies and misinformation. The only people who benefit from the US system are insurance and healthcare executives. We get objectively worse care for objectively higher costs. It’s lose lose for the average person.

> They have even been sued and settled anti-competitive behaviors which is evidence to my point…

No, its not. Its actually evidence against your point that the conditions alleged in the suit – which even in the accusations in the suit were the product of practices discontinued in the settlement – are the current conditions.

(The fact that of the two parallel suits on largely the same allegations covering the same time period under state and federal law, they won the federal suit outright at trial after settling the state suit, is also evidence against the conditions alleged in those suits having been facts even at the time covered by the suits.)

> you are misleading people on the cost of an ambulance ride by conflating out-of-network prices

So I get in an accident and break my leg, someone calls me an ambulance, and while I'm screaming in pain I also need to ask to make sure they get an "in-network ambulance"?

How can anyone defend this system?

> So I get in an accident and break my leg, someone calls me an ambulance, and while I’m screaming in pain I also need to ask to make sure they get an “in-network ambulance”?

No, because as stated in GP, “‘Balance Billing’ for out of network ambulance rides is now illegal.”

That was edited in, it wasn't there when I replied.

Living in Sac, we are not remotely in the same league as what is described in OP. Sutter may have outsized market power, but you can definitely get care at a ton of different providers in the area, on e.g. the open market CA insurance plans. I know this because I did it.

Definitely can't speak to the ambulance thing, we've been lucky enough to avoid those at least, if not the ER.

> No, they’re effectively a monopoly for most of the services people actually need.

No, they aren’t. There's an argument that they may have been in the past, but the practices on which that accusation was based were terminated in a settlement with the state and when the same accusations went to trial in a federal lawsuit, Sutter won outright.

> They even settled an anti-trust lawsuit with the state a few years back.

That was based pricing power for insurance contracting through having must-have hospitals in some areas in Northern California and a system of all-or-nothing insurance contracts that required insurance vendors to make all of their hospitals in-network if it wanted any of them in-network, and other similar bundling. (Interesting, they won outright at trial a federal anti-trust suit on basically the same grounds that was proceeding in parallel, reaching court later, than the state one that they settled.)

And the settlement of the state suit addressed those practices, which is important to the current monopoly accusation, because the accusation in that suit was not that Sutter had a freestanding monopoly (market/pricing power) and illegally leveraged it (in which case, addressing the ways they leveraged it would be expected to leave the freestanding monopoly) but that it had market/pricing power because of the combination of must-have hospitals for insurers and the set of anticompetitive practices that leveraged that into market power.

What?

My "premium" healthcare plan, whose premiums are in the four digit a month tier (to your sister comment's point, although to my good fortune, my employer covers 100%)...

the ER copay is $250. Then you will be paying for labs, DI, and medications beyond that.

In fact, as someone who has worked as a paramedic for 12 years, and worked in health insurance software for a similar period, I have -never- seen an ER stay that you'll get only a co-pay of $20 for.

To back this up:

I'm retired military, with a health insurance plan that most people would kill for. It may be the best you can get in the country, seeing as I pay no premiums.

My ER copay is $75 or $136, depending on my plan (HMO or Self Managed; both have the same $4200 max out of pocket per year).

[0]: https://www.tricare.mil/comparecosts

> With most health insurance plans, everything you described would cost you only a co-pay as well (usually $20-40).

No, that would only be true of most HMO plans, but most plans aren’t HMOs.

On top of the highway robbery of private health insurance we have a defacto single payer public healthcare system for retirees and those on public assistance that is the government's largest expense, currently sitting in the #2 spot (a major issue that keeps getting kicked down the road), after that you have interest on the debt that is borrowed to fund everything, and then defense (and no, defense can't be cut, don't even go there). We are heading for a surprise failed bond auction (where private investors cause a government shutdown because they refuse to purchase bonds).

Biden is going after a major elephant in the room: the sprawling UnitedHealth monopoly. And Trump took the first stab at the other sprawling healthcare monopoly: regional hospitals.

If the people do not start voting in moderate statesman and serious legislators then all their petty dumb ass concerns are going to get crushed out of existence in one fell swoop of mandatory fascist-socialism...if they are lucky. Honestly, I can't venture to guess the fallout of a bond auction hiccup. All I know is that it will involve pain for everyone in the world.

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