[HN Gopher] Health insurers just published close to a trillion h...
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       Health insurers just published close to a trillion hospital prices
        
       Author : sl-dolt
       Score  : 325 points
       Date   : 2022-09-06 15:49 UTC (7 hours ago)
        
 (HTM) web link (www.dolthub.com)
 (TXT) w3m dump (www.dolthub.com)
        
       | gigatexal wrote:
       | Price transparency is an essential part of a healthy market. Or
       | so says the theory. I hope they release it. I wonder what I can
       | do to help? I'm capable in db design, sql, etc being a data
       | engineer by day perhaps I can help this effort.
        
       | flowersjeff wrote:
       | From my understanding though, these 'prices' are outdated nearly
       | as quickly as they are published. I.e. sure you have a set, but
       | everything is dynamic and changing. Seems like it would require a
       | ML approach to 'understand' such a dataset going forward.
        
       | MichaelZuo wrote:
       | 6000 hospitals x say around 10000 priced items, on average, per
       | hospital x 100 different negotiated pricing formulas = 6 trillion
       | unique prices.
       | 
       | Of course many hospitals negotiate en bloc as part of a
       | healthcare network, and there probably are more than 100
       | different organizations that negotiated unique healthcare pricing
       | but the ballpark number seems to make sense.
        
       | sl-dolt wrote:
       | I'm the author. A question I have is: how did so many prices ever
       | get negotiated in the first place? What kind of systems are in
       | place to do this kind of micro-negotiation?
        
         | gmarx wrote:
         | The next question would be 'how long did the average
         | negotiation take' followed by 'how much were the average people
         | on each side of the negotiation paid?" (or are most of these
         | negotiations the result of computers talking to each other?
         | Either way with a few assumptions one could make an estimate of
         | the smallest amount these different prices cost the system.
         | Might be huge
        
         | balderdash wrote:
         | I would assume these get negotiated as a large list with each
         | payer so if you have 500 services, and 4 payers, you probably
         | and up with 1k-2k unique prices?
        
         | bawana wrote:
         | Today in Massachusetts, physicians cannot get paid unless they
         | belong to an organization that negotiates their rates with the
         | insurers. These negotiating entities are like unions but not
         | really. If the insurer and the organization disagree, the
         | insurer simply goes to a different organization to make a
         | contract. Prices were not publicly available so each
         | negotiation resulted in a different fee schedule. On top of
         | that, insurers invent different 'products' with different
         | amounts of 'coverage' for different premiums. Each of these
         | 'products' had their own negotiation, their contracts, and
         | their own subset of physicians who chose to participate. So
         | what do these organizations do for the cut that they take? They
         | reduce the burden of the insurers so they dont have to
         | negotiate with each individual provider.
         | 
         | Hospitals are an entirely different system. They have much more
         | negotiating power and if an insurer has a customer that goes to
         | a hospital emergency room outside of their contract, the
         | insurer has to pay outlandish rates. So it is in the insurer's
         | interest to make a deal. They achieve this by inventing
         | different 'products' with different amounts of 'coverage' for
         | different premiums. Each of these 'products' had their own
         | negotiation and their contracts.
         | 
         | Price transparency is the first good thing that has been
         | mandated. However, this misses the mark. The focus is the
         | patient, not the insurer, the hospital or the physician.
         | Accordingly, patients should be allowed to submit their
         | explanation of benefits and their bills-this is the data that
         | reflects the true cost of healthcare. All of the numbers
         | provided by hospitals, insurers and physicians has been
         | massaged and buried in a forest of minutiae.
        
         | dj_gitmo wrote:
         | The US healthcare system is wildly complicated and inefficient
         | because it is a double-bureaucracy; pubic and private. The
         | government bureaucracy makes a bunch of rules and also provide
         | healthcare through Medicare/Medicaid. The private bureaucracy
         | compete with each other, and hospitals, and pharma companies,
         | ect.
         | 
         | Many of the private health providers are for-profit and lobby
         | against rule changes that would reduce complexity and save the
         | system money. It know this may sound glib, but if you are
         | trying to understand the US healthcare system and something
         | seems strange, usually it's because it makes someone money and
         | they'll fight hard to keep it that way.
        
           | spaetzleesser wrote:
           | "usually it's because it makes someone money and they'll
           | fight hard to keep it that way"
           | 
           | And it's not just some money but very BIG money they make.
        
           | KennyBlanken wrote:
           | > Many of the private health providers are for-profit and
           | lobby against rule changes that would reduce complexity and
           | save the system money.
           | 
           | This is almost certainly an anti-competitive move. By keeping
           | many rules and regulations, you need more staff to deal with
           | them - and smaller insurers have fewer patients to amortize
           | those salaries over.
        
           | ChrisMarshallNY wrote:
           | _> pubic and private_
           | 
           | Eek.
           | 
           | Just. Eeek.
           | 
           | :P
        
         | e_i_pi_2 wrote:
         | My understanding (not an expert by any means) is that we
         | basically have two tiers of negotiation - the fed. govt. has
         | way more leverage but also some amount of corruption that goes
         | into pricing, then afterwards individual hospitals and
         | "networks" of providers will negotiate with the insurer -
         | sometimes after the procedure has already happened - to figure
         | out the final price.
         | 
         | The end result is that you might end up with an individual
         | doctor having to work with the insurance company for pricing,
         | so the same procedure can cost vastly different amounts at
         | hospitals down the road from each other providing the same
         | level of care. To make it worse we also have laws preventing
         | healthcare providers from providing prices upfront, out of a
         | fear that people will forego necessary care they can't afford.
         | 
         | Edit: seems like this changed 01-01-2021, now we do have some
         | price transparency laws - https://www.cms.gov/hospital-price-
         | transparency
        
           | celestialcheese wrote:
           | > To make it worse we also have laws preventing healthcare
           | providers from providing prices upfront, out of a fear that
           | people will forego necessary care they can't afford.
           | 
           | What are these laws? This seems so backwards - I know
           | personally I have put off medical care in my past because I
           | had high deductible insurance, and no guarantee that the bill
           | I'd get wouldn't wipe me out, and no way to price shop.
           | Paralysis of unknown.
        
             | e_i_pi_2 wrote:
             | Ah thanks for making me look this up! Seems like it did
             | change recently (Jan 1, 2021)
             | 
             | https://www.cms.gov/hospital-price-transparency
             | 
             | Now assuming the hospital is compliant the information
             | should be available. To be fair my understanding of the
             | argument for the old law was that you didn't want a
             | hospital with a big sign out front saying "Broken arm
             | repair: $10k" and having people not go in for it when there
             | might be some financial aid they could get afterwards
        
               | willcipriano wrote:
               | I'm sure the real reason is that the hospital up the road
               | will set up a sign "Broken arm repair: $9k" to compete
               | and that isn't something the lobbyists want.
        
             | elliekelly wrote:
             | It's not the case. The No Surprises Act requires a good
             | faith estimation for most procedures. Although IIRC it
             | _doesn't_ apply to people who don't have insurance, which
             | seems kind of backwards as those people would likely be the
             | most price-sensitive and have the least amount of
             | bargaining power in the market. I guess they also tend to
             | have the least amount of political power, too...
        
         | woobar wrote:
         | Are we sure they negotiated unique prices with each provider? I
         | wouldn't be surprised if they have a dozen of templates that
         | get replicated every time a new entity accept preexisting price
         | sheet. Basically they have dumped a denormalized data set.
        
         | tyingq wrote:
         | What was negotiated was probably more blanket style discounts
         | like "10% off your published medicare rate for procedures in
         | categories a/b/c" for one customer and "15% off retail price
         | for all categories other than x/y/z but only in these
         | geographic areas" for another customer, and so on.
         | 
         | But, when publishing, they omit the context and just dump every
         | negotiated rate. Because it's technically compliant, but keeps
         | things opaque.
        
         | gffrd wrote:
         | Super curious about this, too.
         | 
         | Also! What did they do before they could store 100TB of pricing
         | data? How has pricing (and care quality) changed as a result of
         | being able to do this type of thing?
        
           | yojo wrote:
           | Possibly the original data is logically compressed. E.g.
           | payer A pays 110% of our standard rates, payer B pays 85% of
           | our standard rates. Those two rows could translate into
           | thousands of CSV lines depending on the number of procedures.
           | 
           | Maybe you have a couple one off negotiations for high volume
           | procedures, but even still the source data could be several
           | orders of magnitude smaller than the dumps.
        
           | kderbyma wrote:
           | this would be a great social study. cases where technology
           | has enabled the racketeering and price gouging by
           | corporations with almost no gains in efficiency or output or
           | quality or any metric of value.
        
           | acchow wrote:
           | They are obviously not computing pricing this way. Their
           | pricing system applies rules. But they are dumping every
           | possible combination.
        
         | thechao wrote:
         | Any time you can convert a problem from an `N x K` problem to
         | an `N + K` problem, there's some asshole administrator trying
         | to turn an `N + K` problem into an `N x K` problem. It wouldn't
         | surprise me if there's huge amounts of redundant information in
         | there.
        
           | acchow wrote:
           | > In the newly-released data, each "negotiated rate" (or
           | simply "price") is associated with a lot of metadata, but it
           | boils down to: who's paying, who's getting paid, what they're
           | getting paid for, plus some extra fluff to keep track of
           | versioning. The hundreds of billions of prices in the dataset
           | (probably over a trillion) result from all the possible
           | combinations of these things.
           | 
           | They basically denormalized all the dimensions.
           | 
           | Imagine you have a function which takes 5 arguments and
           | returns one value. You could give me the source code and let
           | me run this function. Or you could give me a mapping of every
           | possible combination of the 5 inputs to the returned value.
           | The former could be quite small, but the latter would be a
           | massive number of rows.
        
             | imoverclocked wrote:
             | > You could give me the source code and let me run this
             | function
             | 
             | If I understand correctly, in this case, that function's
             | source is highly distributed in wetware. It's about as
             | closed-source as it gets; nobody has anywhere near the full
             | source. Each hospital is its own fiefdom!
        
               | acchow wrote:
               | Yeah this is part of the problem.
               | 
               | But even if you had like 10M rows of pricing and then
               | gave a 2% discount to entity A, 3% discount to entity B,
               | 4% discount to C, etc.
               | 
               | You could publish these discount rules.
               | 
               | Or you could just multiply the 10M rows by the number of
               | different entities giving 10*n M rows.
               | 
               | And then let the consumer of the data try to figure out
               | the rules from the output...?
        
         | huslage wrote:
         | They aren't negotiated individually. They are negotiated
         | categorically. They generate individual prices based on some
         | discount rate off of a negotiated max.
        
       | coding123 wrote:
       | Maybe good, maybe bad. I suspect the good will be lower prices as
       | we resolve major conflicting prices for the same service. Maybe
       | bad as we find that nurse Jackie is spending too much time taking
       | care of your sick husband and that needs to cut back as the
       | prices the hospital is negotiating drops. The service will become
       | more standardized and robotic.
        
       | jamestimmins wrote:
       | Seems like every week there's a new massive scale DB project or
       | company getting announced on HN.
       | 
       | If they're looking for projects that create public value and
       | demonstrate the power of their products at scale, digitizing this
       | and making it searchable may be a good marketing project that's
       | appealing to certain kinds of customers.
        
         | sl-dolt wrote:
         | Figuring out the size of this data was part of the research
         | phase for doing just that: building out that database. I'm
         | curious to know if other people are already working on it
         | (maybe Turquoise Health?)
        
           | ageitgey wrote:
           | Yep, we have built this database at Turquoise Health. I
           | agree, the data is massive - and don't forget that it is all
           | refreshed monthly!
        
             | JackFr wrote:
             | Is that from the hospital side or the insurer side?
        
               | ageitgey wrote:
               | We have built databases for both and can compare between
               | them.
        
               | withinboredom wrote:
               | It's my understanding these prices are negotiated to some
               | degree, so it's probably both sides at various times.
        
             | jamestimmins wrote:
             | It's cool seeing that Turqoise Health exists. One of my
             | first programming projects back in the day (when I was
             | trying to get a jr role in 2014) involved building a simple
             | version based on data.gov medicare data. The inputs were
             | terrible and tiny (e.g. chest pain at hospital X costs
             | ~$60k on average across 5 patients), so I was always
             | curious what a real world version might look like.
             | 
             | edit: As I reflect, I'm amused to recall that this was
             | early enough in my path that I didn't know about DB
             | indexes, so I was very proud that I figured out how to
             | basically roll my own indexes by pre-sorting the columns by
             | lat and lon. I don't remember whether my solution
             | _actually_ prevented a full-table scan, but it felt like a
             | major breakthrough at the time.
        
           | jamestimmins wrote:
           | Very cool. Who do you see as the likely users of that
           | database? Is it primarily for researchers/data journalists,
           | or is there a commercial value to it?
           | 
           | I'd be very curious to read more about the data cleaning
           | phase when you get there. Specifically, how hard it is to
           | combine this data and construct good schemas.
        
             | atourgates wrote:
             | As someone who's worked on the provider side in different
             | capacities, I can tell you that there could be tremendous
             | value on the provider side.
             | 
             | It's entirely possible that two surgeons with offices next
             | to each other could be getting reimbursed at wildly
             | different rates for their most common procedures for their
             | most common procedures by the same provider.
             | 
             | If you're that provider, you ABSOLUTELY want to know what
             | the surgeon next door is getting paid the next time your
             | group is negotiating with the insurance provider.
        
         | bob1029 wrote:
         | It would appear us SQLite zealots have encountered the final
         | boss.
         | 
         | Petabytes uncompressed would be tricky if you need to slice
         | those columns. SQLite caps out at ~281 terabytes of storage
         | before it can't track any additional pages.
         | 
         | None of this is to say you couldn't partition the data across a
         | lot of SQLite instances in varying ways. I will probably take a
         | shot at it this weekend. Looking to see just how unlimited my
         | AT&T fiber connection is anyways.
        
           | salawat wrote:
           | >It would appear us SQLite zealots have encountered the final
           | boss.
           | 
           | Just wait. It's actually a multi-boss fight, since you have
           | to wrangle the Pharmacy Benefits Management datasets, plus
           | Medispan, plus Medicare, plus all the MedicAid datasets, plus
           | VA.
           | 
           | Are you and all your mightiest boxen bad enough dudes to make
           | sense of the entire U.S. Healthcare industry?
           | 
           | <Actuary Stormrage in the background>
           | 
           |  _You are not prepared!_
        
           | topspin wrote:
           | > It would appear us SQLite zealots have encountered the
           | final boss.
           | 
           | That's cute. :)
           | 
           | There isn't much value in feeding it all into a conventional
           | RDBMS. OLAPs and columnar stores are what is needed here. But
           | first it will need a great deal of grooming and ETL work.
        
             | gizmodo59 wrote:
             | Yeah.. It would be much easier to copy the data to S3/any
             | object storage (better to convert it into a columnar format
             | like parquet) and query it directly using a SQL on lake
             | engine like Dremio or Athena or S3Select would work too.
        
       | mskar wrote:
       | I work in data at https://www.carrumhealth.com/, and I've been
       | parsing this data for weeks. The transparency prices allow us to
       | meaningfully negotiate with providers, and make tangible,
       | incremental progress toward cheaper health care. Providers and
       | existing insurance carriers leverage information asymmetry to
       | control the market otherwise.
       | 
       | For context, we bundle the 100's of itemized costs into a single,
       | static bill per surgery type. In doing so, we've built a custom
       | virtual-network with the most efficient surgeons. These surgeons
       | are able to meet the volume and quality requirements to allow for
       | lower margins. We're able to get negotiated rates that are 10-40%
       | cheaper than traditional insurance contracts when we have data
       | that we trust.
       | 
       | Unfortunately, this data alone isn't enough to properly determine
       | prices because organizations will spread costs across procedure
       | and billing codes that often occur in aggregate groups. For
       | example, in a joint replacement surgery, some organizations may
       | dump the cost into the billing for the implant itself, while
       | others may put it under the procedure code. You have to gather
       | billing data en masse to see which charges occur together, then
       | combine this pricing data to determine what costs will actually
       | look like for someone experiencing a procedure.
       | 
       | It's a nightmare!
        
         | riskable wrote:
         | How much do you think it costs to maintain all these negotiated
         | contracts VS just having a single payer system with the same
         | price for all procedures?
        
           | hayst4ck wrote:
           | PBS put out a documentary ages ago comparing America to other
           | countries. At the time our administrative overhead was 25%
           | while Taiwan's overhead was 2%.
        
           | mskar wrote:
           | It's very expensive, carriers have an economic incentive to
           | simplify it and this is still where they end up. There are a
           | long tail of provider circumstances that the single-payer
           | model will need to figure out. Some examples:
           | 
           | * Small hospitals in low-density, underserved areas have to
           | make up for underutilized equipment and personnel costs. They
           | raise prices on unrelated, common procedures to break even
           | (This is very common)
           | 
           | * CMS (medicare/medicaid) sets a low price for a procedure
           | that's overly common in a particular facility, now that
           | facility loses money for each occurrence. They choose other
           | procedures to raise the price to try to break even.
           | 
           | * Larger hospitals have higher administrative and operations
           | costs (for things like training and research) that benefit
           | society, but need to be averaged out across all procedure
           | costs. This differs from hospital to hospital.
           | 
           | * Smaller professional facilities or physicians groups (like
           | Ambulatory Surgery Centers) have much lower administrative
           | costs and a smaller staff, so they have lower overhead per
           | procedure. They are designed to be efficient, and can handle
           | lower prices. However if there are any major complications,
           | they won't be able to service the patient, and have to send
           | to a hospital. This then pushes all the highest-cost, ICU-
           | type procedures into hospitals, where there is already a
           | higher overhead, causing hospitals to need separate pricing
           | to cover more complex patients.
           | 
           | A large single payer price set will probably force
           | efficiencies into the healthcare system. It'll be great for
           | folk's costs, but we may see many facilities close, and lines
           | of care will be consolidated into specialty centers. (more
           | travel to get imaging, procedures, or to see a specialist)
        
             | narrator wrote:
             | What do you think about how Kaiser has handled the whole
             | thing? The insurance company employing the doctors and just
             | paying them a standard salary seems to create all the right
             | incentives.
        
         | drak0n1c wrote:
         | Sounds like an application for ML, to determine which codes
         | frequently coincide per-patient at each provider and then
         | assign those groupings to cross-provider "Treatment XYZ"
         | buckets to enable apples-to-apples comparisons.
        
           | mskar wrote:
           | Great call, many orgs in health tech use billing/procedure
           | code embeddings to group, just like you're suggesting.
        
         | didgetmaster wrote:
         | Is the data unique or has it been duplicated for multiple
         | formats? In other words is there a CSV file right alongside a
         | Json file and an XML file that contains the exact same data,
         | just in different formats?
         | 
         | Is the data partitioned at all (e.g. by state) so that you can
         | just download the data for California without downloading all
         | the data; loading it into a huge database table; and then
         | querying it (e.g. SELECT * from <table> WHERE state =
         | 'California')?
        
           | mskar wrote:
           | There is some duplication, where different networks under the
           | same carrier could benefit from normalization, but in-general
           | duplication isn't the primary issue.
           | 
           | The data is partitioned for some carriers at the network
           | level, but unless that carrier has networks that are unique
           | to a given state it's difficult to partition by location.
           | 
           | The majority of the data is lumped into very large, single
           | JSON (not newline delimited), so an initial parsing step is
           | required to break out substructures for parallel processing
           | via warehousing technologies. I think Aetna has a 300Gb
           | compressed (single) json file.
           | 
           | After breaking the json to a single array entry per
           | provider/network, parsing is still a bit tricky because there
           | are some very "hot" keys. Some provider array entries may
           | only have 1000 code and cost entries, others may have 100k.
           | We've seen array entries >50Mb for a single
           | provider/network/carrier.
        
       | planetsprite wrote:
       | I wonder what percentage of work in the US healthcare system is
       | completely unnecessary from a general perspective but made
       | necessary deliberately to justify the unethical system that
       | allows millions to die unnecessarily.
        
         | suoduandao2 wrote:
         | Judging by the US's price/outcome ratio compared to other
         | developed nations, a little over half[1].
         | 
         | [1]https://www.pgpf.org/blog/2022/07/how-does-the-us-
         | healthcare...
        
           | ChrisLomont wrote:
           | Why that article points out the US spends $12k/capita on
           | healthcare the singles out administrative costs at $1k/capita
           | while ignoring all the other relevant factors is beyond me.
           | They then use the misleading infant mortality stat, ignoring
           | that the US considers vastly more babies viable than any
           | other country, meaning we try to save infants that other
           | countries write off, thus they count against the US when it
           | fails, but not against the other countries that don't count
           | them as viable. It's a really poor article ignoring important
           | nuance in what it presents.
           | 
           | The US pays about twice per nurse or doctor in the system,
           | and part of that is because the US pays nearly twice for most
           | skilled work. So, to get prices like most other developed
           | nations, we would be forced to cut nurse and doctor salaries,
           | which would likely lower quality of workers as future workers
           | went to more lucrative fields, which would likely lower
           | outcomes.
           | 
           | The US can have higher cost or lower quality. How would you
           | make this tradeoff?
        
             | kaesar14 wrote:
             | Which part of this equation is contributing to hospitals
             | charging 50 dollars for a bag of IV fluid? I'd cut that
             | part out. Whatever it is.
        
               | geraldwhen wrote:
               | That price pays for the parking deck, security, janitors,
               | nurses to administer the bag, needle disposal, IT, admin
               | salaries, the hospital building itself, etc etc.
               | 
               | An urgent care can probably administer an IV. If that's
               | all you need, go there. They are far cheaper and not as
               | lavish (or equipped) as hospitals.
        
             | Judgmentality wrote:
             | > So, to get prices like most other developed nations, we
             | would be forced to cut nurse and doctor salaries, which
             | would likely lower quality of workers as future workers
             | went to more lucrative fields, which would likely lower
             | outcomes.
             | 
             | Why are you ignoring all of the costs that go to people
             | besides nurses and doctors? I know very rich people whose
             | entire careers are built around selling overpriced products
             | to hospitals. These people are leeches that provide no
             | value other than profiting off of dumb compliance laws. If
             | you can buy the same product at any store for 1/10 the
             | price, there is no benefit to requiring it be gatekept by
             | people whose sole incentive is squeezing blood from a
             | stone.
             | 
             | Get rid of graft. The problem is the system and the
             | incentives it creates. US healthcare is dictated primarily
             | by insurance companies who care more about maximizing
             | profit than providing healthcare.
             | 
             | To fix the system you start with increased transparency,
             | then you focus on accountability. Why do we allow such
             | blatant corruption? Let's get rid of all the leeches first,
             | since they provide no actual value while jacking up prices.
             | There are so many areas we can improve results and cut
             | costs before we address the salaries of doctors and nurses.
        
             | paulmd wrote:
             | > The US pays about twice per nurse or doctor in the
             | system, and part of that is because the US pays nearly
             | twice for most skilled work.
             | 
             | which is in turn because in the US an average GP comes out
             | of medical school with $200k-300k of student debt that has
             | to have interest serviced and paid off within some 10-20
             | year timespan. That cost ultimately ends up being borne by
             | the patient and their insurance.
             | 
             | unfortunately the US is very resistant to the idea of
             | education reform in general, very very resistant to student
             | debt relief, and very very very resistant to student debt
             | relief for "high earners" like doctors and lawyers, even
             | when a huge chunk of that earn is going to debt service.
             | But there is a shortage of doctors and we're doing
             | everything in our power to make the path unattractive for
             | new students. And this time the problem isn't even the AMA
             | - the AMA agrees there is a problem and is onboard with
             | expanding the pipeline... it's just not all that attractive
             | a profession anymore when you can make equal/higher
             | compensation (after considering the debt) in software or
             | other fields.
             | 
             | doctors are still extremely well-paid professionals in
             | other countries, but if we tackle the cost of education we
             | can get our numbers down much closer to theirs. conversely
             | if you push salaries too low then servicing $200-300k of
             | student debt won't be realistic and the path becomes even
             | less attractive.
             | 
             | medical care is probably the single most complex political
             | problem in the US because it's basically at the nexus of
             | every single social and political problem we have. doctors
             | are too expensive... because they're trucking around a
             | quarter million of student loan debt from our shitty
             | education system. we spend way too much on end-of-life care
             | and not enough on earlier care... because seniors vote. we
             | have way too much overhead due to the multi-payer insurance
             | system and the market-driven pricing system's overheads...
             | and all those insurance companies are huge lobbyists too.
             | Drug and device costs are out of control... because the US
             | doesn't allow conditioning of regulatory approval on price
             | negotiations, or reimportation from other countries, etc.
             | It's just every single political problem in the US in a
             | single field all at once and every hand is dipping into the
             | till as much as they can get away with, and it's
             | politically infeasible to slap the hands that are necessary
             | to slap to actually get costs reduced.
        
               | jahewson wrote:
               | A debt of 1 to 1.5 years salary does not go very far to
               | explain why US doctors are paid double what they would be
               | in other countries.
               | 
               | The US brought this problem upon itself by cutting
               | medical school funding in the 1980s to reduce the number
               | of doctors and keep salaries high. That situation
               | remained until 2005. Now we have too few doctors, too few
               | schools, and a generation that grabbed all the money for
               | themselves and is now retiring.
        
         | ChrisLomont wrote:
         | > to justify the unethical system that allows millions to die
         | unnecessarily
         | 
         | Which people are those millions?
         | 
         | The system saves millions of lives that would have died in
         | generations past. How do you factor that into your claim?
        
           | spaetzleesser wrote:
           | There are lot of people who don't go to a doctor when they
           | should. Even taking an ambulance after an accident is a
           | gamble a lot of people can't afford.
        
       | fishtockos wrote:
       | Anyone knows if this dump contains drug insurance coverage?
        
       | duffpkg wrote:
       | I'm author of Hacking Healthcare for O'Reilly, 20 year health
       | system executive, blah, blah.
       | 
       | It's very easy for people to forget the scale of the US "health
       | system", we are talking 1/5, maybe more, of the entire US
       | economy. If US healthcare spending were a country, it would have
       | the third largest GDP in the world. Accidents of history and the
       | massive federal beauracracy created the crazy monster of ICD/CPT
       | codes that results in the very clumsy way of pricing healthcare
       | services that results in this massive matrix of data.
       | 
       | As pointed out elsewhere there is a tremendous amount of cost
       | distribution that goes into the code matrix and this plays a
       | large role in negotiations with health insurers as well. Ground
       | is given in one set of procedures and lost in others.
       | 
       | This is a big step in shining light into areas that need it to
       | improve the system overall.
        
         | esotericimpl wrote:
        
         | e_i_pi_2 wrote:
         | Do you consider the amount that the US spends per capita on
         | healthcare relative to other countries for the same standard of
         | care a "failure" of the healthcare industry? Or is there some
         | other reason healthcare "just costs more" here?
         | 
         | Also wondering what you think a solution is - single-payer for
         | better and simpler price negotiations, or some other approach?
         | 
         | My main concern is if we're spending 20% of GDP on something
         | other countries accomplish with 10%, then that's a huge waste,
         | especially in a country with a larger total GDP pool.
        
           | medlazik wrote:
           | As with everything it touches, it's the intrinsic failure of
           | capitalism (ofc success for the capitalists / bourgeoisie).
           | It's the amount of capitalism that defines prices. In every
           | other country the more healthcare is a public matter, the
           | cheaper it is for the people.
        
             | gwright wrote:
             | Healthcare in the US is definitely _not_ driven by the free
             | market. It is probably one of the _most_ regulated
             | industries. Whatever disfunction you want to call out in US
             | healthcare it is going to be difficult to pin that on the
             | free market.
        
               | medlazik wrote:
               | Free market? Capitalism. I know we're on HN but, say the
               | word? Capitalists take a cut. Shareholders of big pharma,
               | insurance companies and hospitals are why healthcare in
               | the US is expensive. Public sector not being monopolistic
               | is why healthcare in the US is expensive. In France,
               | social security reimburses about 70% of most costs. Cheap
               | private insurance reimburses the rest. About 75% of
               | public hospitals and not for profit. Generic medicine
               | being prescribed is the norm. The state _naturally_ fixes
               | healthcare prices because it 's monopolistic on
               | healthcare. Same as all public services.
        
               | a-user-you-like wrote:
               | Non free market? Communism. I know we're on HN but, say
               | the word?
               | 
               | Of course the US market is highly regulated and so the
               | market is not free to lower prices. Of course the AMA is
               | a racket. Of course needs of certificate are abhorrent.
               | 
               | Given the customer non--coerced access to his preferred
               | provider, and not taking his money and slapping a bunch
               | of regulations on him will of course lower prices and
               | give him better care.
               | 
               | I don't see why the other side can't see it.
        
               | medlazik wrote:
               | That's right, communism. Social security in France is
               | _literally_ a communist system, founded by a communist
               | minister. Hence why neoliberals want to destroy it.
        
           | brightball wrote:
           | I've heard a lot of complaints about Medicare/Medicaid. It
           | does not inspire confidence in single payer.
        
           | duffpkg wrote:
           | Healthcare is such a base layer of the economy, I find
           | comparisons to be extraordinaly difficult between countries.
           | On the most basic level our pathway to becoming a healthcare
           | provider of all sorts is dramatically more expensive and
           | limited than other countries, what healthcare providers are
           | paid is dramatically more than other countries, we invest
           | many times per capita what other countries put into basic
           | medical research, the way are population is taxed is very
           | different than other countries, our patient population is
           | very different from other countries, our expectations are
           | very different from other countries, our scale is
           | dramatically different than other countries, and so on. The
           | US is a singular animal politically in that it is a compact
           | of individual states that especially in regards to
           | healthcare, the federal goverments powers (though it may not
           | seem so at times) are actually quite limited. It's all but
           | impossible to come up with reasonable numerators and
           | denominators for comparison.
        
             | anonymouse008 wrote:
             | > Healthcare is such a base layer of the economy
             | 
             | Academically this sounds enlightening, but it only takes
             | one cursory walk around a supermarket in the US to see this
             | is unequivocally false. Healthcare is an externality, not a
             | base of anything. From the average customer to the product
             | in the aisle to the marketing - everything is 100% not a
             | direct cost benefit function in terms of healthcare.
        
               | skybrian wrote:
               | I'm not sure what that proves, given that you went to a
               | grocery store instead of a pharmacy.
        
               | tbihl wrote:
               | I'm guessing parent was saying that most medical spending
               | is payback for terrible US American eating habits?
        
               | rgrieselhuber wrote:
               | And add on top the oft-repeated that "health insurance is
               | healthcare." That's how you obfuscate a whole of things.
        
           | e_i_pi_2 wrote:
           | My current assumption is that private healthcare/insurance is
           | to blame, because countries without that or with less
           | generally have better outcomes at less cost. Looking for
           | evidence to the contrary
        
             | coredog64 wrote:
             | As two quick examples, both Switzerland and France have
             | private healthcare providers and insurers. I think that's
             | enough to falsify your assumption :)
        
               | simonw wrote:
               | Those countries both have "less generally" than the USA.
        
               | e_i_pi_2 wrote:
               | I don't think that disproves a general trend that
               | increased socialization in healthcare costs leads to
               | better outcomes and less per-capita spending.
               | 
               | Also FWIW France and Switzerland both have universal
               | healthcare, under different systems where France splits
               | payments 3 ways and covers more with the govt[1], and
               | Switzerland seems to have a system like the ACA in the US
               | where it's compulsory, but they also set caps on the
               | deductibles and maximum price.
               | 
               | [1]: https://en.wikipedia.org/wiki/Health_care_in_France
               | 
               | [2]:
               | https://en.wikipedia.org/wiki/Healthcare_in_Switzerland
        
               | bhupy wrote:
               | It's not just Switzerland and France; the Netherlands
               | also has a private-only health insurance system. It's
               | also very difficult to draw decisive conclusions since,
               | across countries, there are hundreds of confounding
               | variables -- it's not just public vs private, but it's
               | also which regulations exist in each country, whether
               | it's employer-sponsored vs individual, general
               | willingness to pay, etc. You're correct that Switzerland
               | has a system like the ACA in the US, but the biggest
               | difference is that it's not common for the Swiss to get
               | their private insurance from their employers; it's all on
               | the individual market. The US is actually unique in that
               | regard, and is probably the most significant difference
               | -- the vast majority of working age adults in the US get
               | their insurance from their employers, and as a result the
               | ACA's individual market has been in a dire state since
               | the program's inception.
               | 
               | Also "socialization" is very different from
               | "nationalization". The general trend you're talking about
               | is more to do with the fact that having society
               | _subsidize_ healthcare for the poor can lead to better
               | outcomes. As it relates to who actually does the
               | insuring, underwriting, and payment (public vs private),
               | one isn 't necessarily better than the other; each has
               | its trade-offs. It's just that the US (in particular) has
               | chosen the worst of both worlds.
               | 
               | I work in this industry, and from where I sit, the
               | closest thing we have to a clean A/B test that controls
               | for all of those confounding variables is actually being
               | run in the US right now, with Medicare. When you turn 65,
               | you have the option to enroll either in "Original
               | Medicare", which is what we usually think of when we talk
               | about "single payer healthcare in America", or you can
               | enroll in Medicare Advantage (aka Medicare "Part C"),
               | where the premiums that would go to the CMS instead go to
               | private insurers like Humana, United, Oscar Health,
               | Aetna, Clover, etc. These plans replace Original
               | Medicare.
               | 
               | - 48% of Medicare beneficiaries are on private Medicare
               | Advantage plans instead of the public "Original
               | Medicare". Because everyone is entitled to "Original
               | Medicare", this is purely voluntary. This number has been
               | growing so rapidly that the CBO projects that by 2023,
               | the majority of beneficiaries with choose the private
               | over the public option. The CBO further projects this
               | proportion to increase to 61%(!!) by 2032.
               | (https://www.kff.org/medicare/issue-brief/medicare-
               | advantage-...)
               | 
               | - For most beneficiaries, Medicare Advantage costs about
               | 40% less than Original Medicare and are, on average, of
               | higher quality than Original Medicare
               | (https://healthpayerintelligence.com/news/medicare-
               | advantage-...)
               | 
               | - In Urban areas, Medicare Advantage costs less per
               | capita to administer than Medicare -- and that's not
               | including the extra Medicare Part D insurance that you
               | would have to buy if you're on the Original Medicare plan
               | (https://www.commonwealthfund.org/publications/issue-
               | briefs/2...)
               | 
               | So no, you cannot look the cost difference between the US
               | and other countries and simply conclude that it's because
               | of private insurance, because the actual data tells a
               | different story. And "universal healthcare" is not the
               | same as "public" healthcare. It might help to think about
               | it this way: universal access to food can be achieved
               | without nationalizing the food industry, or the food
               | payment industry.
        
               | PaulDavisThe1st wrote:
               | From medicare.gov:
               | 
               | > Medicare Advantage Plans are another way to get your
               | Medicare Part A and Part B coverage. Medicare Advantage
               | Plans, sometimes called "Part C" or "MA Plans," are
               | offered by Medicare-approved private companies that _must
               | follow rules set by Medicare._ (emphasis added)
               | 
               | Those rules are, IIUC, substantively different than the
               | ones that cover the non-medicare private insurance
               | industry, and as a result I'm not sure what any of the
               | (true) facts that you've quoted really mean in the
               | context of the questions being asked here.
               | 
               | Also, from reading up about MA, it would seem that MA is
               | operating on the "HMO" (health maintainance organization)
               | model that started to be touted in the 1990s. AFAIK, the
               | HMO model has not done much to contain consts in the
               | broader US private health insurance world. It would be
               | interesting to know if it is specifically the combination
               | of the HMO model and Medicare rules that has allowed MA
               | to apparently work better than OM.
        
               | bhupy wrote:
               | I actually work in this industry and adjust claims myself
               | from time to time, so I love talking about this stuff!
               | 
               | > that must follow rules set by Medicare. (emphasis
               | added)
               | 
               | Yeah, I'm not sure that anyone seriously believes that
               | insurance companies should operate in a 100% unregulated
               | fashion. Even the US's food industry (which is
               | predominately privatized) is regulated in some capacity.
               | The argument is whether _regulated private insurance_ can
               | deliver good outcomes. That is very much the case, as
               | evidenced by Switzerland, the Netherlands, and Medicare
               | Advantage.
               | 
               | > Those rules are, IIUC, substantively different than the
               | ones that cover the non-medicare private insurance
               | industry, and as a result I'm not sure what any of the
               | (true) facts that you've quoted really mean in the
               | context of the questions being asked here.
               | 
               | First of all, the non-Medicare private insurance industry
               | is _heavily regulated_ , often more so than Medicare
               | Advantage private insurers. In fact, you raise an
               | important point: it's important to consider _which
               | specific regulations_ are helping and which are hurting.
               | Outside of Medicare Advantage, there are regulations that
               | strictly control insurance company 's profit margins, how
               | much of premiums can be spent on collecting medical
               | claims (see: the 80/20 rule and Medical Loss Ratio
               | rules), the fact that every beneficiary must be treated
               | exactly the same (ERISA, parts of ACA), a minimum amount
               | of coverage required (the ACA added this), the employer
               | mandate (ACA), etc.
               | 
               | To give you a sense for some of the unintended
               | consequences that have been created by regulations on
               | non-Medicare Advantage health insurance plans, due to
               | Federal mandates and tax incentives, health insurance is
               | predominately provided by employers rather than the
               | individual market (unlike Switzerland, Germany, or the
               | Netherlands). What we're seeing in healthcare costs is
               | analogous to what you might see happen to airline ticket
               | costs if we all got our air tickets through our
               | employers: the vast majority of us would fly business
               | class, while the unemployed would be simply unable to pay
               | for business class fares out of pocket. A big reason for
               | this is that employers (especially medium-to-large
               | businesses) have a much higher purchasing power (and
               | hence, willingness to pay) than individuals. If you take
               | this behavior and combine it with the fact that health
               | insurers' profit margins are capped by law, insurers pay
               | more absolute dollars for treatments (which doctors
               | happily accept), charge more to employers (who are
               | generally less price conscious vs individuals), thus
               | bring in more absolute revenue, and therefore more profit
               | because a capped profit percentage of a higher revenue is
               | higher than a capped percentage of lower revenue. It's
               | somewhat counter-intuitive, but the policy combination of
               | an employer mandate and insurance profit cap results in
               | increased prices.
               | 
               | This cocktail of regulations does not exist for Medicare
               | Advantage insurers -- even though they are still
               | regulated in different ways. That's a very important
               | distinction. Currently, Medicare Advantage insurers are
               | allowed to return 50 percent to 70 percent of any cost
               | savings to beneficiaries in the form of reduced premiums
               | or expanded benefits -- whereas with employer-sponsored
               | insurance, even if such cost savings existed, they would
               | accrue to employers (unbeknownst to worker beneficiaries)
               | -- and that's assuming there are cost savings for
               | employers; there aren't, due to the aforementioned
               | regulatory concoction. A big part of why Medicare
               | Advantage actually works really well is because it's
               | effectively a basic income for health insurance, it's
               | just that individuals are empowered to use those dollars
               | to buy whichever healthcare plan meets their needs
               | (including a public option), as opposed to being forced
               | to choose among a small selection of plans curated by an
               | employer.
               | 
               | > Also, from reading up about MA, it would seem that MA
               | is operating on the "HMO" (health maintainance
               | organization) model that started to be touted in the
               | 1990s. AFAIK, the HMO model has not done much to contain
               | consts in the broader US private health insurance world.
               | It would be interesting to know if it is specifically the
               | combination of the HMO model and Medicare rules that has
               | allowed MA to apparently work better than OM.
               | 
               | Medicare Advantage plans can both be HMOs as well as PPOs
               | (https://www.medicare.gov/types-of-medicare-health-
               | plans/pref...), it's just that _there happen to be_ many
               | MA plans that are HMOs. HMOs can have very good outcomes
               | with significant cost savings (think of the pre-2010 UK
               | NHS as a public HMO), but can also have bad outcomes if
               | managed poorly (think of the 2022 NHS or US 's VA as
               | poorly managed public HMOs). With Medicare Advantage,
               | seniors have the option to choose.
        
               | nicoburns wrote:
               | The obvious regulation which almost every other country
               | has is direct price controls on medicines, treatments
               | etc. Not profit percentage controls. A dead simple "this
               | is how much you're allowed to charge".
               | 
               | I don't really understand why anybody would be against
               | introducing this in the US.
        
               | bhupy wrote:
               | It is not so obvious at all. Medicare Advantage does not
               | have price controls, and it still costs less per capita
               | than Original Medicare.
               | 
               | > A dead simple "this is how much you're allowed to
               | charge".
               | 
               | This has its own set of unintended consequences,
               | including physician rationing (it's a huge crisis of the
               | NHS right now), and a reduction of investment in new
               | medical research. There are _many good reasons_ to be
               | against introducing this in the US.
               | 
               | Switzerland does not have price controls on medicines,
               | treatments, etc. and the reason why it is so often cited
               | is because it enjoys a comparable level of healthcare
               | innovation to the US while still ensuring universal
               | access (through its ACA-like subsidies). It also costs a
               | lot per capita (among the highest in the OECD), but it
               | actually gets what it pays for
               | (https://pubmed.ncbi.nlm.nih.gov/26766626/)
               | (https://www.theweek.in/news/world/2022/05/07/7-reasons-
               | why-s...)
               | 
               | In fact, of the countries that usually make up the global
               | leaders in health/medical innovators, all but 1 (the UK)
               | engage in price controls
               | (https://immigrantinvest.com/insider/the-best-healthcare-
               | coun...), and the UK's NHS is suffering from a rationing
               | crisis, and (ironically) a cost crisis.
        
               | JumpCrisscross wrote:
               | > _France and Switzerland both have universal healthcare_
               | 
               | You said private healthcare/insurance were to blame.
               | Switzerland has private health insurance.
               | 
               | Universal healthcare is a separate goal post. For what
               | it's worth, I'm unclear its comprehensive iteration is
               | compatible with America's immigration model. (It
               | absolutely is for life-saving measures.)
        
               | ggrrhh_ta wrote:
               | Switzerland has very strictly and non-deniable obligatory
               | minimum (very broad in coverage) insurance, with
               | regulated yearly price adjustments and on top of that,
               | publicly funded hospitals and clinics (mostly
               | unprofitable but of high quality and offering treatments
               | that would not be profitable for private hospitals) that
               | issue their bills to the health insurances. And, to put
               | the icing on the cake, there are treatments and
               | operations (e.g. congenital defects and invalidity-
               | related) that are directly billed to the public social
               | insurance (funded by salary deductions) to help health
               | insurances reduce their risk.
               | 
               | Switzerland's compulsory private health insurance is
               | nothing comparable to other countries' private insurance.
               | There is "additional private insurance" in Switzerland
               | (covering alternative medicine treatments, access to
               | single bed rooms in hospitals, etc.) which do operate as
               | private insurances elsewhere.
        
               | PaulDavisThe1st wrote:
               | What aspect of America's immigration model do you think
               | intersects with this?
               | 
               | > You said private healthcare/insurance were to blame.
               | Switzerland has private health insurance.
               | 
               | Private business in all western countries operates within
               | the regulations and laws that cover them. The health
               | insurance industry in Switzerland operates under a very
               | different set of regulations and laws than the same
               | industry in the USA. If you want to blame the OP for not
               | being more explicit - "private healthcare/insurance and
               | the regulatory framework are to blame" - then fine, but
               | ... this is actually the crux of the issue.
        
               | JumpCrisscross wrote:
               | > _but ... this is actually the crux of the issue_
               | 
               | I'm not sure it is. Universal healthcare is orthogonal to
               | private health insurance. That's the lesson of
               | Switzerland's example. I don't believe this is commonly
               | known or accepted in American politics. Instead, any
               | attempt at reform is pitched and vilified as an attempt
               | to end private health insurance.e
        
               | bhupy wrote:
               | Not sure why you're getting downvoted, but this is
               | exactly correct. Universal healthcare != public
               | healthcare.
        
               | e_i_pi_2 wrote:
               | Ah good catch I was moving the goalposts there - I think
               | in my head public and universal and basically
               | interchangeable - if everyone has it is it a public good
               | regardless of if it's provided by a collection of
               | "private" companies
        
             | pessimizer wrote:
             | > countries without that or with less generally have better
             | outcomes at less cost.
             | 
             | This isn't necessarily a great metric, because almost all
             | countries have better outcomes and all countries have lower
             | per capita cost, whether their systems are public, private,
             | or mixed. The US spends more _public_ funds on healthcare
             | than countries with universal socialized health care
             | systems. The fact that we 're also personally bankrupted
             | after spending the same tax proportion on healthcare is
             | just a bonus.
             | 
             | It's not specifically private healthcare or insurance
             | that's the problem, it's the specific corruption of the
             | people who own the healthcare industry and their
             | legislators.
        
             | mikem170 wrote:
             | Across the board price controls seem to be a common to the
             | various European health care systems. It is my
             | understanding that upper limits are set for the cost of
             | medicine.
             | 
             | There is quite a bit of variety across Europe - U.K. is
             | 100% government run, France is a public/private mix,
             | Germany is similar to Obamacare in some ways, others are
             | single payer, apparently some are private, also. But I've
             | read that they all have cost controls.
        
               | Barrin92 wrote:
               | beyond Europe as well. Singapore which has exceptionally
               | low healthcare spending (5.9% of GDP) heavily controls
               | prices and purchases down to individual equipment in
               | hospitals.
        
             | rayiner wrote:
             | Most countries have private healthcare (meaning private
             | providers). Many others have a mix of for profit and non
             | profit insurance companies. There's not a whole lot of
             | difference between Obamacare and say the system in say the
             | Netherlands, Switzerland, or Japan. Those are also
             | "individual mandate" systems.
        
           | spaetzleesser wrote:
           | Number one is full price transparency of the whole chain. I
           | work for a medical device company and even the marketing
           | people can't really tell what our stuff costs. There are a
           | ton of middlemen with obscure contracts and very high
           | markups. My ex got one of our devices and I was told by our
           | people that the hospital should have received the device for
           | between 20k-30k (nobody seems to really know) and the
           | hospital charged 80k for the device alone. They also charged
           | another 200k for a one hour surgery with a total hospital
           | stay of six hours.
           | 
           | It's also hard to explain that US patients pay a multiple of
           | the drug price people in other parts of the world pay for the
           | something.
           | 
           | The problem is that if the US wastes 10% of GDP on health
           | care inefficiencies this creates a huge lobby that will fight
           | tooth and mail to keep that money.
        
         | linkdink wrote:
         | In your opinion, what would be the lowest hanging fruit that
         | could be changed to have the largest positive impact?
        
           | duffpkg wrote:
           | People are rarely satisfied with this answer but its
           | demonstrably true and was proven time and time again at the
           | facilities ClearHealth managed.
           | 
           | 1) Feverent, almost religious, adherence to hand washing. 2)
           | No neck ties or dangly sleves whatsoever in buildings that
           | house patients. 3) Change from stainless steel hardware for
           | doors and travel touch surfaces back to "brass/copper".
           | 
           | Those are simple, virtually free, things that have a very
           | meaningful impact on outcomes. Some of the most viscous
           | fights I've had with hospital boards were over what amounted
           | to the "uglier look" of copper/brass.
           | 
           | It is an extremely unpopular topic in healthcare but the area
           | that takes a lot of effort to solve but also has a
           | tremendously out-weighted benefit is reducing preventable
           | medical errors. My opinion after being in healthcare ~20
           | years is that preventable medical error is absolutely in the
           | top 3 causes of death in the US. The easiest subset of it to
           | resolve is prescription related errors, we have all the tools
           | to resolve those but not the will.
        
             | linkdink wrote:
             | Well, I'm satisfied with that answer. But maybe that's
             | because I think brass and copper look better than stainless
             | steel.
        
             | BitwiseFool wrote:
             | >"3) Change from stainless steel hardware for doors and
             | travel touch surfaces back to "brass/copper".
             | 
             | Because of the pandemic I started encountering doors that
             | have a shoe pull, where you can use your foot to open the
             | door instead of having to touch the handle. I really hope
             | these catch on, but they are still quite rare.
        
               | snuxoll wrote:
               | Also stop getting rid of paper towels if you still have
               | manual faucets. Nothing grosses me out more than going to
               | a public restroom with only air dryers, but manually
               | operated faucets that now require you use clean hands to
               | turn off after you turned them on with presumably dirty
               | hands.
        
       | hyperbole wrote:
       | This seems very much like the episode of Veep'Boxes of lies'
       | where they try to hide their nefarious deeds alongside the real
       | day to day inter-workings of the vice presidents office but
       | inundating the public with data.
        
         | anigbrowl wrote:
         | This is a common strategy in litigation as well - if someone
         | complains that you have pricked them with a needle, dump
         | haystacks on your opponent's doorstep while also insisting on
         | your right to a speedy trial.
        
       | Titan2189 wrote:
       | Someone with the right connections should call up Google Cloud
       | and ask them to ingest the data into BigQuery as an example
       | dataset like the NY taxi trips. It would be a great way for them
       | to show off the capabilities of the engine and helpful for
       | everyone wanting to do analysis on it.
       | 
       | https://cloud.google.com/bigquery/public-data
        
         | inetknght wrote:
         | You want to _encourage_ Google to own more health data?
         | 
         | Sorry, I think that idea is bonkers. Google already "owns" way
         | too much data.
        
           | franga2000 wrote:
           | Who said anything about owning it? Just making it available
           | for processing through their platform too.
        
           | CobrastanJorji wrote:
           | Sometimes people do a thing where they see certain keywords
           | in combination and reflexively respond without regard to the
           | meaning those words are expressing. For example, it's what
           | happens if I use a word like "welfare" near that one uncle at
           | Thanksgiving. The signature feature is a very strong negative
           | reaction but with content that doesn't seem related to what
           | the previous person was saying, except that it involves
           | certain keywords.
           | 
           | I think that's maybe what happened here. You saw "Google,"
           | "data," and "ingest," and your sentiment analysis report came
           | back positive, and it triggered a response.
        
       | nojito wrote:
       | This data is already available cleaned here.
       | 
       | https://turquoise.health/
        
         | JackFr wrote:
         | I think that's hospitals not insurers.
        
         | sl-dolt wrote:
         | I know it's not in the business interest of Turquoise Health,
         | but I'd like to see that data be downloadable. There's a lot of
         | insight sitting in the data.
         | 
         | This blog was a feasibility analysis to see what kind of work
         | it would take to get that data. If we do get it, we plan on
         | making it free to download.
        
       | metadat wrote:
       | Where is the raw 50-100TB of compressed data available for
       | download?
       | 
       | Is it fully public or does it require registration to access?
        
         | sl-dolt wrote:
         | It's all fully public. Here are some tools that will get you
         | the negotiated rates links along with the sizes of all the
         | files: https://github.com/alecstein/transparency-in-coverage-
         | filesi...
         | 
         | This won't get you all of the insurers, but it'll get you a a
         | few of the major ones.
         | 
         | If you want links to the files of more insurers, here's a
         | project from one of my friends at Postman:
         | https://github.com/postman-open-technologies/us-cms-price-tr...
        
       | thelastgallon wrote:
       | I wonder what their egress bill will be if a large number of
       | people are interesting in parsing this data.
        
         | daniel-cussen wrote:
         | Yeah the whole SaaS breaks expectations as far as using a
         | server.
        
       | cwillu wrote:
       | Unrelated: "dolt" vs "doIt" is one of my standard font competence
       | tests
        
         | salawat wrote:
         | dolt vs do<capital>I<\capital>t you mean?
        
           | cwillu wrote:
           | No, do<lowercase>l</lowercase>t vs doIt.
        
       | RhodesianHunter wrote:
       | Anyone else get the feeling this is malicious compliance on
       | behalf of the insurance companies?
       | 
       | "Oh, they're going to force us to publish our prices are they?
       | Well we'll publish so much data it'll take a herculean effort to
       | make it readable to anyone that doesn't work in data engineering"
        
         | spaetzleesser wrote:
         | They may have that thought but crunching large amounts of data
         | is not exactly hard these days. Better too much than too little
         | data.
        
         | geraldwhen wrote:
         | There are a lot of billing codes. It's not as simple as you
         | hope. A giant csv export is easy enough to process and
         | synthesize for normies.
        
         | outside1234 wrote:
         | Oh totally. It also probably is the formats they already had --
         | so they just dumped them into a file -- versus making something
         | more orthogonal and ergonomic.
        
           | sl-dolt wrote:
           | I'm not sure what format they store their records in, but I
           | have a hunch it's a lot more structured than what we see in
           | the CSV files. The data dumps have to comply with some CMS
           | guidelines set out here: https://github.com/CMSgov/price-
           | transparency-guide
        
             | kube-system wrote:
             | They use relational databases. Then a zillion ETLs to
             | massage that data into every format they need it in, of
             | which this is one of them.
        
         | teeray wrote:
         | Just be glad the lawyers didn't make the prices exclusively
         | available via the traditional UHaul full of Banker's Boxes.
        
         | axus wrote:
         | The article mentioned CSV files, it seems more like a
         | reflection of what a huge bureaucracy the US healthcare system
         | is. I liked their suggestion that the government should have
         | created the database as part of the law, done the processing on
         | the raw data, and made it more accessible.
        
           | orangepurple wrote:
           | import a CSV into Postgres                   with
           | open(filepath) as fd:             first_line = fd.readline()
           | cols = []             for col in
           | first_line.strip().split(','):                 col2 =
           | f'''"{col.strip('"')}" text'''
           | cols.append(col2)             cols2 = ','.join(cols)
           | print(f"create table {table_name} ({cols2});")
           | print(f"\copy {table_name} from '{filepath}' csv header;")
           | 
           | this variant will ingest whatever trash is in your CSV fields
           | as-is (cast & cleanup later)
           | 
           | run the output in a psql instance connected to your db
           | 
           | (important note: \copy is a psql client command and it is
           | critical to use \copy instead of COPY in many cases where the
           | server process may not have the permission to read your CSV
           | file. with \copy you can read any file the user that launched
           | psql client has permission to read. to make things more
           | confusing it is indeed possible to stream stdin through psql
           | but you use the regular COPY for that instead of \copy)
        
           | [deleted]
        
           | lumost wrote:
           | meh, I'd prefer the raw data. We can always create DBs out of
           | the raw data, we can always link data. Handling this after
           | the fact would be impossible.
           | 
           | Linking a few trillion records doesn't seem that difficult.
           | It should be doable with a good data warehouse and a
           | reasonable entity linking model. I suspect that we'll find
           | more than a few instances of fraudulent behavior once the
           | data is linked.
           | 
           | My father was nearly pushed into ~2 Million dollars worth of
           | brain surgery that was unnecessary. Not only was the
           | procedure unnecessary, the price for it was >5X what a top-3
           | hospital would have charged. I only became privy to this once
           | I pushed him to come to Mass General Hospital (MGH) for a
           | second opinion. The surgeon we saw at MGH also believed the
           | suggested procedure to be dangerous.
           | 
           | I wonder if it's possible to cross-reference
           | mortality/complication rates with prices...
        
           | daniel-cussen wrote:
        
             | jjulius wrote:
             | ... what in the blue hell...?
        
               | vxNsr wrote:
               | Most likely a poor ai attempt.
        
               | 1MachineElf wrote:
               | From the user's "about" section:
               | 
               |  _Perhaps you 'll think my comments are unthinkable. My
               | only response to that is that they were legibly written,
               | not by a machine, but by a writer with a soul._
        
               | jjulius wrote:
               | Yeah, it's unclear to me. A lot of the more personal
               | things that are mentioned throughout the account's posts
               | seem to match up with some of the quickly-googleable
               | details that can be found just via their username. I
               | suppose that it could be baked into the AI, but... /shrug
        
             | secondcoming wrote:
             | So I should never visit a doctor in Chile?
        
           | A4ET8a8uTh0 wrote:
           | In their defense, if it was anything but CSV files, they
           | would be accused of making it too complicated/locking into
           | proprietary formats and so on. I can't say CSV would be my
           | first choice, but I don't really want to think what the
           | alternative would be.
        
             | Victerius wrote:
             | Millions of .xlsx files
        
             | easrng wrote:
             | NDJSON? Sqlite?
        
         | carabiner wrote:
         | lol, have you ever worked with data from a non-tech company?
         | This is probably the best they have, even inside the company.
        
           | watwut wrote:
           | Can confirm. Also, it is not better in tech companies, they
           | just have the same data in higher variety of formats and
           | storage systems.
        
       | mesozoic wrote:
       | Say someone ingests this data and clean it up make it usable,
       | who's the customer for that service? What would they want to know
       | from it?
        
         | dvaun wrote:
         | I think that there is opportunity for some neat visualizations
         | with map overlays, average costs of various categories of
         | procedures, etc. As for the customer, I wouldn't know.
        
         | 55555 wrote:
         | I want to be able to visit a website, select my hospital, the
         | procedure, and my insurance, and see what it will cost. Next to
         | the result, please show me how much the same procedure would
         | cost with the same insurance at other hospitals near my
         | location.
         | 
         | You will literally save American lives.
        
           | muhammadusman wrote:
           | Turqoise health kinda does this now, not as robust yet but I
           | have been using it to check out prices. Hopefully, your use
           | case becomes a reality soon.
        
           | llanowarelves wrote:
           | Restoring sanity and making it like any other product or
           | service.
        
         | sp332 wrote:
         | A patient wants to know how much a procedure will cost. Now the
         | hospital can look up that data, since apparently (from
         | experience, not hyperbole) no one who works there actually
         | knows.
        
       | bravura wrote:
       | Could we rename the title to: "Health insurers just published
       | close to a trillion hospital prices"
       | 
       | This post is lot more interesting and important than the current
       | short title would suggest.
        
         | anigbrowl wrote:
         | Seconded
        
         | dang wrote:
         | Sure.
        
       | intrasight wrote:
       | Seems crazy that SEC rules require structured data but these
       | health accounting rules did not. I guess health care has better
       | lobbyists.
        
       | nimbius wrote:
       | this disclosure was spurned by recent federal legislation that
       | required it. Im a full cynic on the disclosure, so be warned.
       | 
       | - these prices, as negotiated between insurers and providers,
       | were already well known inside the industry. so much so that many
       | procedures could be declined coverage well in advance of a
       | customer ever needing one. this insider knowledge formed the core
       | of many earnings reports for insurers and hospitals alike,
       | 
       | - Disclosure is meaningless if the customer has no alternative.
       | most health services that bankrupt are emergency medicine, and as
       | such youll pay anything to save your own life. thrusting a stack
       | of price sheets at a faceless national healthcare monopoly and
       | demanding a fair price is a laughable if not sad idea. Healthcare
       | is not something capitalism is equipped to competently support.
       | 
       | - hospitals have zero incentive to work with you on any price for
       | any service, and no federal state or local law will compel them
       | to do so by virtue of a combination of bureaucratic deadlock and
       | regulatory capture. is it, for them, more profitable to sell your
       | arbitrary debt to a credit collection agency? shove you into a
       | debt counseling service they get kickbacks from? work a long and
       | grueling payment plan through their own financial services
       | division to bolster quarterly profit long-term in a recession? or
       | just ignore your pleas entirely? what they charge is not up for
       | debate by _you._
        
         | xtracto wrote:
         | For profit Health insurance is a scam.
         | 
         | It's like if you signed a contract to pay Netflix a monthly fee
         | to _eventually_ watch a movie, and for some reason Netflix
         | profit would be based on _you watching as little as possible_.
         | They would do all in their power to minimize the amount of
         | content you could really watch. Unaligned objectives. And the
         | problem is that unlike Netflix, Health Insurance (at least in
         | the USA) is inelastic: You MUST pay for it.
        
       | TimTheTinker wrote:
       | I would _love_ to hear from an insider on what the difference is
       | between these published files and the internal databases - I 'm
       | sure the difference between the two is striking. Malicious
       | compliance, indeed.
        
       | bottlepalm wrote:
       | This is the real solution to healthcare costs and quality.
       | Instead of the government handing hospitals a blank check for low
       | quality services in a single payer scenario, we allow price
       | transparency, competition and the free market to drive down costs
       | and increase quality. Hate him if you want, but this was a huge
       | accomplishment by Trump that has just started to take effect.
       | 
       | If you think the government can bring down the cost of anything
       | please see education and NASA for great examples.
        
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