I mean, it's just the 'cost.' Not necessarily the 'cost to the patient.'
I understand that it's helpful to see for people who are under/uninsured, but for most of the people it'll just max out at out of pocket/annual deductible max (which for example is like $250 per annum for me).
Further, what hospitals charge to insurance is not necessarily the rate insurance pays either. My counselor charges my insurance $400 an hour, but insurance negotiates it to like $80, of which I pay $0.
The counseling office charges people who do not have insurance like $96 per session.
What hospitals charge is not necessarily cost to patient is all I'm saying.
Using insane prices and then marking them down to reasonable levels "as an insurance discount" only has a few possible purposes and none of them are good:
1. Ripping off anyone without insurance who doesn't realize they may be able to negotiate it
2. Misrepresenting the true cost of healthcare for anyone who goes off the "original price"
3. Establishing that insurance companies have to push for deep, 90%+ discounts on everything, meaning nobody can offer sane pricing because the insurance company will say "But <HOSPITAL> gives us 95% off!"
I recently had a genetic test done. They told me that if my cost after insurance was more than $200 they'd notify me ahead of time so I could decide how to proceed, one option was a simple pay-cash option for $250. Turns out the "Amount billed" to insurance was $ 25,000, which was then "discounted" by about $ 24,600 and they were paid $400 or something. So, this is a service the lab is happy to provide for $250 -- and they make money at that price, yet in some fantasy universe, $ 25,000 is in play. This is why people want to burn the US health system to the ground.
Curious question, if the amount 'billed' to your insurance was as you say, 25000, and if a patient went there and they were told without insurance they'd get charged say, $300 (slightly higher than with-insurance price), does it matter to that end user, or the users with insurance that the insurance is being charged $25 grand?
Ultimately the end user is paying $250/300. Eg, my counselor example.
The problem comes when insurance denies the claim for whatever reason. Now, the provider is going to try to bill you the $25,000. It's up to you to either get your insurance to cover the procedure properly or to negotiate it back down to something close to the $300 price. They won't just offer it to you after processing through insurance.
The inflated procedure costs help shape the premiums we all pay for (either directly, or through our employers, or though the overhead costs of business with employees where we shop and do business). It's just a sneaky way to extract as much value from society as they can get away with.
"What hospitals charge is not necessarily cost to patient is all I'm saying."
It is cost to the patient in the form of ever rising insurance premiums and deductibles (mine is $3000 and a lot of people have even higher deductibles).
Your counselor example also shows the insanity of US healthcare pricing. $400 vs $80 vs $96. How is anybody supposed to make economical decisions with such crazy pricing differences? There should be a regulation that providers charge the same price for the same procedure, no matter if they are insured or not or what insurance they have.
I mean, to an extent I agree. I just think that the current pricing structure is lack of competition and a result of overregulation (I may be wrong?) in how hard it is to get into healthcare market. If you make it insanely hard only certain companies will be able to get in and they can then charge whatever they want.
Which specific regulations could we remove to cut prices without seriously impacting care quality?
Generally the level of regulatory compliance necessary to enter the healthcare market is proportional to the risk of patient harm. If you want to sell healthcare analytics software not directly involved in patient care then there are basically no more regulations on vendors than in any other software market. On the other hand, if you want to start a new company to make implanted pacemakers then you'll have to spend years working through FDA compliance issues because a single tiny error can easily kill a patient.
The US still spends almost triple (per capita) what any other country spends on healthcare. Between the hospitals and the insurance companies, Americans are definitely getting a bad deal.
This is true only until insurance decides not to pay arbitrarily. In my case I was stuck with a $112k bill. Hospital offered 50% self pay discount. Now what?
Totally possible that it was an invalid denial, too. I don’t know if insurers face any consequences for just denying some percentage of claims initially, and then only paying out for customers who push back.
If they continue to accept the rate that the insurance company reimburses at, it is not reasonable to describe them as charging some other rate. They know what the insurance is gonna pay when they provide you the service.
Don't forget that they first send bills for that absurd amount to anyone who's uninsured, or anyone unlucky enough to go to an out-of-network facility. If you don't contact them and find a solution, like signing up for retroactive Medicaid or negotiate somehow, they will 100% sell your debt to a collection agency and can basically ruin your life. This does happen every day to people. I don't think it should be okay for prices orders of magnitude above what they actually accept from insurers, to be used to bill uninsured patients.
Insurance: "Look how much we saved you! (Don't question our value.)"
And maybe even the medical provider being able to write off the difference as a business loss or being able to say: "Look how much we discounted your service!"
This only matters to end user if they actually pay for insurance themselves. If their employer covers it (as mine does), I don't think they care that much how much their insurance 'saved' them if the net cost ends up being $0.
Very, very few employers offer an insurance plan without any employee premium. And I would be shocked if those insurance companies didn't highlight to the employer how much was "saved".
Even those employers that do pay 100% of the insurance premium could have paid more to their workers if the insurance costs were less.
Employers who pay less on benefits (pay less health insurance premium, pay fewer vacation days, pay less FICA, etc.) have more cash available. They could use that to pay higher salaries. I'm sure you've heard and that you actually do take into consideration the "full compensation package" when evaluating one job against another.
Also not trying to fight. "Could have paid you more" does actually happen in the right type of competitive environment -- though most employers are more likely to avoid direct salary increases to instead increase other parts of the "full compensation package". It's relatively much easier to later reduce those other things than it is to reduce direct salary, if things go sideways down the road.
I guess it's arguable whether better dental health, plus cancer, could be considered a benefit. Would heavily depend on the rates of cancer or other harms vs. the rates of improved dental health. Certainly without thinking too deeply about it, childhood cavities would seem vastly preferable to nearly any sort of cancer unless the risk is minuscule.
Assuming you are not being disingenuous: there is a trade off with a lot of uncertainty - other things are also implicated in stomach cancer, and at the same time untreated dental disease causes other health problems too.
But I prefer to rely on brushing my own teeth and avoiding certain foods to maintain my own health, rather than have a medication added to my water supply because the guy next door does not take care of his health.
I've had longer delays in the UK. My car was damaged by another driver. I sent my dash cam recording to my insurer and then both insurers dithered for months until I threatened to get the government ombudsman involved.
There have been a few products like this announced recently and they all have intro level examples on the home page. Can yours deal with things like entity-attribute-value model tables?
This is a case where it could help to give the AI some example values of the actual data. The same applies for e.g. JSON fields.
I've been thinking about ways to make it possible for users to easily provide examples to the AI. Essentially that would mean selectively giving access for specific rows/columns to the AI.
I tried chat gpt for the first time today. I asked it to write me a script to fetch some data from an API. It didn't succeed, and this kind of common task from a well-documented API should (I thought) be a slam dunk.
I tried driving a car for the first time today. I just wanted to drive from my house to the end of the block. I crashed into a fire hydrant and almost killed three people. This should be a very simple and common task, going from your house to the end of the block, and yet the car failed miserably.
Sarcasm aside, at my company I've noticed a very disturbing split among my co-workers. One group of co-workers hold the above attitude, that they should be able to just use a tool on day one and it should be able to solve problems that even just a couple of months ago would have been unimaginable. That group of co-workers looks at ChatGPT and thinks it's basically underwhelming and a big nothingburger.
The other group of co-workers are learning how to use ChatGPT to solve their problems. They're learning clever ways of prompting ChatGPT, how to give it a proper system message, how to take large tasks and break it down into smaller tasks to offload a lot of the grunt work onto ChatGPT while they focus more on the overall architecture. That group of co-workers is seeing excellent gains in productivity.
The idea that you would just use a tool on day one, probably don't really know much about it or understand it that well, and expect it to magically solve your problems is about as foolish as driving a car for the first time, not really knowing anything about cars, and expecting nothing bad to happen.
ChatGPT is a tool, the people who take the time to learn that tool and understand how it works will become much more productive software developers, and those who don't will get left behind.
I am reminded of this intro by Marc Andreessen for Breaking Smart[1]:
> A great deal of product development is based on the assumption that products must adapt to unchanging human needs or risk being rejected. Yet, time and again, people adapt in unpredictable ways to get the most out of new tech. Creative people tinker to figure out the most interesting applications, others build on those, and entire industries are reshaped.
There will high group of people who will tinker and adapt to the way the gpts work and make the best of it - creating new apps, industries, and so on. This has been the case all through the tech cycles.
We will change ourselves to the new tech and we won't even realize we changed.
I am re-reading Breaking Smart book in the context of chatgpt and I'm getting way more insights than I read the first time.
You have no information on how I approached using chat gpt, what prompts I used, how close its replies came to being correct/useful or not, but you decided to regale us with an irrelevant car metaphor anyway.
My reply is just as informative and insightful as your original comment, in fact the entire purpose of that metaphor was to respond with the exact same precision and using the exact same structure as you did and the fact that you find it to be irrelevant is exactly the point.
Now look in the mirror and instead of denigrating my post, reflect on your own comment and hopefully you'll see it is equally irrelevant.
The burden is on you to communicate any information you think is relevant to fully appreciate or understand your circumstance. The burden is on you to indicate what prompts you provided, in what aspects did ChatGPT fail as well as the approach you took using it, that could open up an interesting discussion where you, me, and others can learn something new.
The fact that you failed to do so and instead made a mostly irrelevant comment whose pointless nature is something you only recognize after seeing it reflected in my post is something you need to correct, not me.
A big one for me is being able to decide when to use GPT3.5 and when to use GPT4 for a given prompt. Perhaps it will be short term that this is a "skill", sooner or later they will lift the GPT4 cap and speed it up, but for right now I can stretch out a GPT4 session indefinitely if I know what gpt3.5 can and can't handle.
Besides that though, chatGPT has been nothing short of a huge product....I don't even want to say a "huge productivity boost", that implies like good sleep or drinking coffee, its been like an augmentation that allows be to bat above my league. Like a free (well $20/mo) co-worker who knows a lot about programming.
GPT-4 is a lot better at things like that. That said, you'll either have to pay for it, or instead use some severely rate-limited but free interface you might find by asking around.
Prompt engineering is a thing for sure. Might want to search the news here for some clues on ycombinator to get better at it. And some tasks are beyond it.
Involuntary admission is not automatically inhumane, but you do need to be admitting people to well-run hospitals and have a system in place to protect everyone from malicious admission. Both of those things cost money.
(But I concede that effort and productivity are not the same thing.)