[dr1337]

The cost blowout in healthcare isn't due to diagnosis or care but administrative costs. All these diagnostic AIs won't significantly reduce the cost of healthcare nor improve quality. What we really need is automated administration and billings to really move the needle and that's more human bottlenecked than technology.

[dragonwriter]

> What we really need is automated administration and billings to really move the needle

Right, because every other developed countries gets similar outcomes at lower costs (poor capita, per GDP, or on any other reasonable basis for comparison) because they are far ahead of us on automated administration and billing.

There might be countries where that's what's needed, but in the US there's clearly a lot of lower hanging fruit that doesn't require any new technology.

[PButtNutter]

Yeah, so I work at a huge health tech company. A lot of the issue is actually private insurance.

Currently in the US the largest health insurance provider is actually medicare/medicaid. When a patient with medicare goes to the doctor, the government says "This is what we will pay for that procedure, no exceptions." The hospital has a choice to either accept that rate, or to lose out on the massive medicare market.

Private health insurances plans have vastly fewer subscribers, and don't have the power to negotiate prices like the government does.

But regardless, why is health care and insurance a for-profit industry? It creates incentives to put profits ahead of people's health.

[dragonwriter]

> Currently in the US the largest health insurance provider is actually medicare/medicaid.

Medicaid is more 50 different insurance providers (it's run by each state—with separate programs for, at least, D.C., Puerto Rico, and Guam, and it's not even a single insurer in every state, e.g., California uses a number of county-level managed care plans as well as a traditional fee-for-service plan.) And all of them are separate from Medicare. Which also is less of a single insurer with common coverage policies than it seems on the face (even excluding Medicare Advantage, which is just publicly subsidized private insurance), since whether any given procedure in reasonable and necessary and therefore covered in any given geogrpahical area in Medicare depends on local coverage determinations made by the private insurer that is the Medicare Administrative Contractor for that region and claim type (there are separate contractors, with different geogrpahical regions, for regular part A&B claims, home health and hospice claims, and durable medical equipment claims.)

[bufferoverflow]

Another high cost of healthcare source is the lack of competition on price. You have zero idea how much each procedure costs. Imagine going to a supermarket where there are no price tags, and you must buy the items once you pick them off the shelf. It's madness.

[cure]

It's worse.

If you have insurance, the price tag will be X, and they will pay for some part (most?) of it.

If you don't have insurance, the price tag can easily be 100X and it's your responsibility.

If you have insurance, but you happened to pick up that can of pepsi from the left aisle (out of network) instead of the right aisle (in network), they won't cover it, and you're stuck with the 100X price. You won't know that before you buy the can of pepsi, of course.

If you try to ask your insurance if they cover the specific can of pepsi from the left aisle, they may or may not tell you. They may or may not give you the right answer, and if they tell you it's covered but then refuse to cover it, it's your problem (and again, the price will be 100X).

[zaroth]

It should be illegal to charge two different people two different prices for the same procedure at the same facility.

The whole model of negotiated rates, rebates, etc. needs to go.

I also think the concept of networks is bizarre on the face of it. A certified medical provider should be covered to perform procedures in their area of expertise. Period.

Personally I like the idea of anyone who wants to be able to buy into Medicare A & B. And if you don’t have Medicare then you can always pay the Medicare rate of the procedure at 100% (versus having Medicare where your copay is 20%).

If insurance companies can’t compete with that then great.

[davidjnelson]

I agree with you. I wonder what it would take to get rid of those discounts in terms of legislature and how individual voters could work together to fix it. The current system is ridiculous. A $17 procedure should not be billed at $1,200 "because they can".

[dmix]

So the solution is more layers of administration over the prices of the pseudo marketplace?

[zaroth]

How is that a fair representation of what I proposed?

I think part of the problem is absolutely opaque, discriminatory, and predatory pricing.

I went to get a basic blood count last month. I gave the lab my insurance card, but they must have copied a number wrong, because when I got the bill they had me down as self insured, and had a bill which said;

  Lab Services     :  $1,541.00
  Patient Adjust   : -$  385.25
  Total Due        :  $1,155.75

I called back and gave them my insurance card and they said ignore the bill a new one will come in the mail.

Last week I got the new bill:

  Lab Services     :  $   17.12
  Insurance Pay    :  $   12.12
  Total Due        :  $    5.00

Yes, I absolutely think it should be illegal to try to bilk a cash carrying customer over $1,000 for a $17 blood count test.

[hopler]

You missed the part where you chose an in-network can (hospital) that is filled with out-of-network soda (doctors).

[wsgeorge]

That's funny. I'm not familiar with the US, but are costs not disclosed at all until after they're incurred?

[jarito]

That's generally true in the states, but it is even worse. You as the patient don't see the actual price before the procedure (unless you ask). After the work is done, you then get a statement saying how much the procedure cost, what your insurance paid and what you owe. All those numbers are opaque and negotiable. Even better, it is common for insurance and the provider to continue sending you bills for months after even common procedures like child birth. It's a total mess.

[mikeash]

Even if you ask, they may not be able to tell you. Many places are just not set up to be able to give that information beforehand.

[logosmonkey]

Yeah, mostly a hospital could tell you what they will probably charge but they don't have all the variables to come up with what the actual negotiated charge will be nor what your co-pay would be.

[logosmonkey]

Oh and just wait until you get to the sleazy methodology for charging those rates. Childbirth for instance, the room will be billed to the Mother for the days before the birth. So the Mother probably meets their deductible, then as soon as the child is born the room and all the things in it get billed to the child who now has a new deductible to hit before the insurance company has to pay their full amount.

[skwb]

Costs in healthcare aren't very "real". US providers use what they call a charge master to determine prices. So while an "IV" may show up on the bill, it's not the actual IV you're purchasing when you're in the hospital. Behind that number the hospital has factored in all sorts of cost centers such as part of the nursing staff cost for example. These "costs" therefore do not represent the true actual cost of providing the service, but rather the charge that the insurance company will pay. Insurance companies have a negotiated rate that they will then pay to the hospital. One of the major "hidden" problems in our current healthcare market is that there exists extreme consumer price insensitivity (since most cases are covered by some type of insurance) alongside large consolidation of healthcare providers.

[leesec]

> All these diagnostic AIs won't significantly reduce the cost of healthcare nor improve quality.

Thanks but this sounds ridiculous to me. Doctors are people too who really do get paid and really do make mistakes.

Using AI to learn from the best of the best will improve results overall, and automating tasks that expensive doctors did will reduce cost.

Yes we need to handle the exploding and ridiculous administrative costs, but clearly there can be gains on both fronts of this battle.

[evrydayhustling]

Agree that it's silly to write off potential gains, but it's also important to recognize that consumer costs of healthcare aren't driven by supply costs. It may be easy for administrative and insurance layers to claim the surplus created by AI.

This is an important factor in how we choose to build products out of AI advances. If your product replaces a part of a service chain that is not either right next to the transaction or in a competitive part of the supply chain, it might only help incumbents aggregate more power and charge more rent. If you can deploy in a way that improves the competitive landscape, you not only distribute gains more but probably keep more leverage as a solution.

This is harder for AI than many technology areas because incumbents tend to have more data and regulatory protection on that data. Health care might be the boss level for that problem.

[Udik]

The cost blowout is a US thing, diagnostic AIs can be used anywhere. And even if the prices weren't affected (which doesn't seem plausible), this can hugely increase the availability and the timeliness of a reliable diagnosis.

[orbifold]

Its not a US thing, other countries such as Germany deal with it by making their hospital doctors work insane hours (manditatory 24 hour shifts on weekends from time to time (400-600€ extra for that unless you are in training, then you just have to do it), one assistant doctor for a psych ward over night) and by introducing collective bargaining. So regardless of whether you are a heart surgeon or a dermatologist you will be paid based on seniority and rank not individual performance. Unions in have for the most part colluded with industry, resulting in an inflation adjusted decrease in average salary over the last 30 years. Paperwork takes up the majority of time for a station doctor, they do a few rounds a day and the rest is spent booking treatments and billing for their patients in their internal 80-90s IT infrastructure.

[bookofjoe]

>It's not a US thing, other countries such as Germany deal with it by making their hospital doctors work insane hours (mandatory 24-hour shifts on weekends from time to time (400-600€ extra for that unless you are in training, then you just have to do it), one assistant doctor for a psych ward overnight)

In fact, it IS "a US thing": • Most major teaching hospitals mandate 24-hour weekend shifts for residents; • One "assistant" aka resident doctor for a psych ward overnight is standard

Retired neurosurgical anesthesiologist here who's been there and done that many, many times....

[fluffycat]

They could be actually better and much faster than humans for initial diagnosis. This has far greater implications, e.g. early detection actually reduces big burden from system.

[easytiger]

That has been available since the 1970s. Healthcare is not a very complex compsci issue for 80% of cases. The problem is presentation of symptoms is highly subjective and needs highly complex interpretation that no AI will ever be able to achieve and deal with the liability conundrum

[fluffycat]

No one claims AI will be the authority, it is good for finding candidates much earlier. We never had devices that has success rate of specialists on several eye problems in one go, definitely not in 70s. I don't understand what you are arguing against to be honest.

[est31]

> liability conundrum

So many programs and devices are used where someone would be liable if they malfunctioned. In a production line for example, if something goes wrong and it has to be turned off, every hour costs $$$ to the production plant owner. Similarly for robots: there have been cases where industrial robots have killed people. Accidents with machines can happen in so many industries. If the machine is wrong in 0.2% of cases, that's a risk that can be calculated. If its rate of misdiagnoses is equal to the rate of a human expert, then replacing non-experts with it will improve patient experience. Of course, there might be super experts whose patients would be worse off if they were treated by an AI.

[leesec]

>that no AI will ever be able to achieve

The Luddites are back! We'll see how this prediction holds up in 30 years.

[johnnycab]

The jury is out on whether the Luddites were indeed troglodytes[1]. If you were to apply the 30 year nostalgia rule in 2049, then we might be hankering for the present, where 'AI' and the surrounding issues are still in their infancy.

However, a pragmatic approach would suggest that any form of AI and it's derivatives, would be assistive in the medical field and play a hybrid role, rather than being a panacea[2].

[1] https://news.ycombinator.com/item?id=17667375

[2] https://towardsdatascience.com/why-ai-will-not-replace-radio...

[wsgeorge]

That user talked about "liability"

[nightfly]

I really don't believe we want more automation in this area. Think of Youtube or Google play store moderation, do you want that for medical billing? And I doubt even 10% of medical costs could be contributed to regular administrative overhead.

[midnightclubbed]

Depending on the type of procedure/practice a quick google search indicates somewhere north of 20% is administration. https://www.nytimes.com/2018/07/16/upshot/costs-health-care-...

Every time I visit the doctors in the US there is a trail of paperwork produced. Outside of basic checkups (where you don't dare mention any niggling health issues because your instantly going to get billed consultation fees) there is always a back and forth between the patient, doctors office and insurance over what the doctors office is asking to be paid and what the insurance says it is prepared to pay. This is an enormous time wasting game - the doctors (or their medical group) ask for much more than the procedure cost to perform knowing full well that the insurance company will push back with a lower accepted payment and the patient will sat in the middle having to negotiate between the two.

Removing the pricing game would lower costs substantially (and vastly reduce the time wasted by regular Americans calling their insurance/doctors trying to sort out their individual billing messes).

Having lived in both the USA and the UK there is no question in my mind that the US health care system is a dysfunctional mess. In my experience the only place the US system has an advantage is that the healthcare providers are very (too) willing to send a patient for tests/scans to check for every eventuality and are happy to prescribe whatever medicine is 'best' for an ailment.

In the UK a fit person with a common cold would get sent home and told to not waste the doctors time, in the US you'll get a consultation and a dose of Z-Pack (and hey if I'm paying for my insurance I should use it when I get sick, shouldn't I).