Thank you for your sane reply.
94 karma · joined September 21, 2011
Not familiar with Kaiser being in NYC, but I can say that Aetna is probably the best insurer here (again, depending on your plan).
Most providers do communicate with the payor and have a decent idea of what you owe, so I was being a bit snarky there. If they know you have a zero copay, you make no payment on site with no follow up bill afterwards.
Good example is MDVIP - https://www.mdvip.com/. I have no relation to the company other than being a customer. I pay $1,600 a year for my Mom to be a member and it's the best money I've ever spent.
And God-forbid you use a narrow network plan like an EPO because it's hard to figure out ahead of time what services are covered by the network and what's not. I went to see a doc who was in-network and only paid a $25 copay, which was great, but the lab where my routine blood work was sent was NOT in network and now I'm looking at $1,000 in lab bills for a test I didn't ask for.
If, however, if you have a situation where you are using co-insurance (you pay x% and the insurance pays 1-x%) the backend bills and related paperwork can be a nightmare.
In terms of quality I'm really talking about the plan design moreso than the insurer and I'm really talking about a benefit rich plan, which is always going to cost more (and a lot more upfront).
Number one recommendation: spend $$$ on a concierge primary care doc. Depending on your market can be anywhere from $1,500 to $15,000 per year. Why? Concierge doc will help you triage your problems, give you great access, keep you out of the hospital/ER, and help you cut through red tape if you need to engage the system.
Number two recommendation: seek care in facilities in high-income communities with relatively small general hospitals (i.e. Greenwich Hospital in CT) UNLESS you need tertiary/quarternary care. Why? Much better staffing. Much less riff-raff common people stuff (i.e. like homelessness) and much higher patient expectations about quality of care.
Number three recommendation: pay up for/seek out a cadillac insurance plan from a high quality insurer like Aetna or United with a low deductible (not high) and low copays. Why? Makes the patient experience much better on the back end with much less paperwork if you do engage the system.
Yes, I understand that I'm saying "be rich", but if you can afford any of the three recommendations above your healthcare experience will be MUCH better.
1.) How many Americans STILL don't have access to healthcare? 2.) How many Americans who have access to healthcare underutilize because of cost? 3.) How many Americans working physical jobs are having their bodies destroyed because of lack of workplace protections? 4.) How many Americans live paycheck-to-paycheck and have to make hard decisions every month about food? 5.) How many Americans live in isolation because our economy encourages a nomadic existence even (especially?) for high income workers? 6.) How many American children are raised without supervision because their parents are trying to scratch out an existence at low-wage jobs? 7.) How many American children are separated from a parent by incarceration?
I could go on and on... Most Americans don't understand what they're living through because most Americans have no lived experience outside of our country.
No country is perfect, and it's hard to compare the USA to other nations, but there are many countries (mostly in northern Europe) where the average person is much happier and much healthier than the typical American.
Tribel looks like another option that many people have been talking about.
Lately, I've been spending more time on Reddit.
Another option is to replacement Twitter with ... nothing.
Food for thought.
I've been a heavy user X 15 years and I'm still not a blue check. I perceive no benefit in being verified and I doubt being verified would have/will change my experience as a user.
If they verified me for FREE I wouldn't care. $20/month to be verified on a site controlled by a maniac in the process of making the product unusable? No way.
After 3 days of Musk's ownership I'm already half-way out. As soon as these paid options are rolled out I will gladly be gone from the platform forever.
HUNDREDS of different systems on the market. Some with maybe a handful of doctor's offices using a particular system.
Worst UIs you could ever imagine. Limited interoperability.
In even well-established systems with large numbers of installs you'll see multiple bugs in production code that don't get fixed.
Switching costs are essentially infinity so doctors get locked into a system no matter how bad it is.
1.) Good choice 2.) You need to consider co-pays as well as allowable charges, deductibles, co-insurance (if applicable), and benefit maximums. 2b.) The quality data out there sucks (hard to measure quality in HC) and is hard to find. 3.) Cool 4.) Ibid 5.) Clever
HC now is like the internet in the early 90s. Huge opportunities that will hopefully attract talented developers, technologists, and entrepreneurs.
1.) Not sure if you grabbed "charges" or "payments", but "charges" are what the providers (hospitals) billed to Medicare, and "payments" are what Medicare actually paid the providers. "Payments" would be the best indicator of "price".
2.) Regardless of whether you are using "charges" or "payments", it's pretty much irrelevant for the average person. Why? Because the patient never pays the full amount (except for the uninsured...see below).
3.) While you don't pay the full amount in most cases, you will have to pay something. However, what you actually pay varies WIDELY based on your health insurer (the "payor") and the design of the health insurance plan.
4.) Also note that every "payor" negotiates a different price, so the Medicare price does not equal the Commercial Insurance price which does not equal the Medicaid price which does not equal the price the uninsured person pays.
5.) Finally, the diagnostic/procedural terminology in this dataset is impenetrable to most people. For example, does anyone on HN know what "transient ischemia" is? And if you do, do you understand that you can have transient ischemia in many parts of your body (FTR, I'm an MD)?
Although I appreciate the effort and the clean visualization, I don't think this data is particularly useful to an individual trying to make health care decisions for reasons 1, 2, 3, 4, and 5 (and probably others that I'm missing).
The one place where this data may be useful on an individual level is in the case of the uninsured. When you have no insurance the hospital basically makes up a price (taken from something called the "chargemaster") that is way more than what commercial insurance would pay, and WAY WAY more than what Medicare would pay. Having access to this data might help an uninsured person negotiate a lower price when the hospital comes after you with a giant bill. Medicare is a pretty solid standard to compare to - i.e. "you're charging me 5X, whereas you would only charge Medicare X".
On a societal level I think this data is also extremely valuable because now you can start to analyze pricing disparities across procedure types and geographies, which is really helpful. You can also put pressure on providers who are gouging individuals paying sticker price (i.e. the uninsured), which is important given that medical bills drive the majority of personal bankruptcies.
We ran a competition on this topic recently at Health 2.0 and you can learn more about the issue and the datasets on our site. You can also view other visualizations of this very important data:
http://www.health2con.com/devchallenge/rwjf-hospital-price-t...
Transparency in health pricing is a very important topic and something you'll hear a lot more about in the future. Happy to discuss further with anyone who wants to learn more (@jeanlucneptune, jeanlucneptune@gmail.com).