Simone Giertz – Back from brain surgery [video]

The whole system is awe-inspiring. Have a medical emergency? We'll send a several-ton box on wheels speeding your way within minutes. If you're in a city, the traffic lights will turn red as the emergency vehicle approaches to make passing safer. Paramedics trained in evidence-based pre-hospital medicine will perform the interventions most likely to save you based on their field impression.

And when you arrive at the hospital it gets really cool - at a level 1 trauma center, they should be prepared to give you a CT scan and treat you in 10 minutes or less. That might involve snaking a tiny wire through your arteries all the way from your leg to your head, or administering one of thousands of drugs that has exactly the desired effect.

It's easy to take it all for granted but the technology and systems in place to take care of us are amazing.

The thing that blows me away is the idea that nobody knows how to make a pencil. Essentially no one on Earth knows how to make a regular ol' number 2 pencil in it's entirety, from scratch with no materials to a finished product. I saw it in a TED Talk over 9 years, but I don't remember which one. I googled a bit and found a Wikipedia page on a book I'd never heard about called I, Pencil. [1] That's probably source material for the video I watched, which may be the TED talk referenced in the the external link section.

[1] https://en.m.wikipedia.org/wiki/I,_Pencil

That is true. I would like to add, however, that first and foremost we don't know what anything of this actually is, which I find most awe-inspiring.

I once walked into a supermarket and really started to look at what was available, every item, how I could buy fresh oranges in the middle of january, trying to imagine the insane number of persons who had to a involved in all the globe spanning supply lines.

It doesn't compare to brain surgery, but the experience was so profound it came close to breaking my mind (if such a thing is possible), I had to give up and leave, because I just couldn't take it.

Marvels and horrors. As amazing as our current medical science is, if you get a tiny ball of cancer cells in your pancreas, there's a good chance you'll go years without anyone having any idea, and then slowly die while the foremost experts in the world can do absolutely nothing except feed you poison with the hope of hurting the cancer more than the rest of you.

I recently switched from iPhone to Andriod.. I am utterly blown away by the voice to text feature. With 0 mistakes it is able to recognize and transcribe audio. I can write 500 words in a matter of a few minutes. I can just say switch on the flashlight and it comes on. Turn off the bluetooth and it gets turned off.

I can even just say "call (insert name of restaurant)" and it directly calls them up. I am beyond blown away. The future is now.

Because of the way insurance tends to work in America, care providers tend to throw shit at the wall to see what sticks. In other words the first bill is always an outrageous amount of charges that may or may not be valid. Additionally there's something called a negotiated rate that an insurer has with the care provider, usually the care provider's bill does not show this rate but rater some fiction that not even those without insurance pay. If you look at the claims your insurer pays out to the care provider you will see significantly lower amounts than what's billed.

If anyone knows why care providers high ball the rates on bills when insurers have negotiated rates, I'd love to hear it. Is it something in the insurer's contract that gives insured the illusion that insurance is saving them a lot?

In any case I've received first medical bills in the many thousands of dollars only to have them go through four or five revisions before settling down to hundred dollars. This is because the first bill you receive reflects all of the claims to insurance (e.g. if your insurance covers 80% you're on the hook for 20%) but as the insurer and the care provider negotiate and revise the billing the price falls.

In my opinion it's a horrible experience for the insured and the added stress of the huge bills certainly doesn't help with recovery.

Two years ago my wife (25 weeks pregnant with twins) was admitted to the hospital because of some concerning ultrasound findings for one of the twins they wanted to monitor closely. Two months later they were delivered by c-section, both healthy but very small (3 lb 14oz, and 1 lb 13oz). The bigger one spent ~3 weeks in the NICU and the smaller one ~7 weeks.

All told it was ~18 weeks of hospitalization (the only major procedure was the c-section, and obviously the NICU care is a little more intensive than average, but neither of the twins needed super high acuity care). Total bill was a bit over a million dollars. We were out of pocket ~$5k (our annual out of pocket max at the time).

With most insurance I feel like you will hit your max out of pocket before you would hit that amount. Depending on your insurance plan you could be talking $3,000-$10,000 max you would have to spend.

Because you asked about Medicare specifically, that information IS somewhat available. It'll take some digging into it but the raw data is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen...

I will tell you it's HEAVILY dependent on the zip code and procedures.

Private insurance is a whole different mess, likely going to hit deductible and be done. Last time my partner had to have surgery and billed insurance she paid $1000 and the insurance picked up the other $10k+ (precancerous mass removal, 45 minute surgery).

I remember someone on HN recommending to send a copy of the bill to some health billing transparency project, but I can't find the right link. Google comes up with https://www.fairhealthconsumer.org/ although I'm pretty sure it's a different service (they don't use the submitted bills from what I understand)

Unless you have access to a private repository of billing and insurance data, no.

There is no publicly available source for price cross lookups. This is largely due to the fact that billing, coverage and pricing varies not only from hospital to hospital but even within the same provider on the same service (a given CPT). So now, there is no way to know the likeness of billing/coverage and it's also highly likely that if she disputes the claim, or there is a renegotiation then she will end up paying significantly less.

Many insurance plans have a yearly max you pay for covered services. For my plan it's way less than 38k. I believe it's something like 10-12k

Did she do it in the US? I was under the impression she did it in Sweden, which would cost her $0.

EDIT: Ok, she lives in San Fransisco now. Didn't know.

If she is covered on a self-only health insurance plan, she has to pay at most $7,350. Source: https://www.shrm.org/resourcesandtools/hr-topics/benefits/pa...

$38k is probably unlikely, she'll have hit her deductible first which will have made several things fully covered and other things probably some% coinsurance, and then later hit the out of pocket limit on the plan and be fully covered from there onwards.

It really depends. I have an PPO / HSA plan where I have discounts up to a certain set "total annual amount" (currently around $5k) -- then insurance kicks in and I start paying a lot less.

That $5k (for me) resets every year.

Maybe the deductible part is a fixed amount and not a % of the total bill?

(I have no knowledge of health care in the US - both countries I lived in have free health care)

Even if the surgeon doesn't deal with the insurance company directly, you should at least be able to submit the bill to them yourself?

Huh, why does the doctor care who pays the bill?

It's really sobering to think about how often this happens per day, to less charismatic/attractive people without social media presences or worse/no insurance. Very happy for Simone (and felt the same way as you following the story) but also trying to take the opportune to empathize with a wider group of people.

>Yikes, what a bill.

Yeah, cancer-related bills can add up fast. Worse, they'll send you bills for years after the fact... my father had been dead almost a decade from his cancer and the occasional bill would still come and my mom would have to spend hours arguing with them on the phone "uh yeah, he's dead, he's been dead, this happened a decade ago, get your shit together" and they'd usually be all 'oops our bad' almost like they were trying to double dip.

We need some serious healthcare reform in the US.

A lot of people have a lack of imagination and empathy. It's not a problem until it happens to them.

If everyone really internalized that it could just as easily happen to them, I bet things would change pretty quick.

I think the second explanation works better - if we look at the way people vote. It's a religious thing to abandon people in suffering to banks and creditors. This way the holy right to make money is put in the first position.

I believe it is highly American to believe in self-sufficiency and to minimize the role of luck in success or failure. Whether we go back to the Protestant work ethic, the Puritan sensibility, gold rushes, unfettered capitalism, the Gilded Age, and our current second gilded age, to me it is clear that caring for others is a secondary concern for many Americans. Just look at the "makers/takers" model of our populace put forward by the top current lawmakers. In this framework, sick people are takers and capitalists are makers.

Decades of pop-econ has pushed the narrative that GDP or Purchasing Power Parity is somehow related to how individuals can access capital.

It always finds the form of "America is the richest country in the world, yet they can't [insert problem]."

This assumes that there is some objective resource need recognition system and misses that there is no overarching explicit capital allocation system to direct funds in such a way.

The cash balance of Apple corporation has no connection to whether a blogger can afford brain surgery or not.

So I'm not sure why this keeps coming up.

I think the fundamental personal issue in this country is that nobody wants to be told exactly what their government-mandated health regimen should be, or have the government decide which procedures they'll be allowed to have for their condition.

That ultimately means that they're locked into what their insurance company mandated health regimen should be. But at least they can sort of choose their insurer, or no insurer (which is usually 10-100 times cheaper on the total medical bill).