Hacker Music? - <AUTHOR> Really wondering? What kind of music do you guys listen to? I realize everyone is different, but is there a majority?<p>Can everyone comment with their favorite artist or group + genre? <comment><USER2> Favorites are Mozart, Brahms, Bach, Chopin, and Beethoven but like dfranke 'omnivorous classical' is a pretty good description. But I will pretty much listen to anything.

Some of my favorite performers are John Eliot Gardiner, Andre Previn, the Kronos Quartet, Cecelia Bartoli, Murray Perahia, Mitsuko Uchida, Emmanuel Ax, Alison Hagley, Bryn Terfel, and Yo Yo Ma.

And I also often prefer quiet when hacking, and only listen to music to drown out distractions.

<comment><USER2> Eh, how could I forget Helen Grimaud:

<http://en.wikipedia.org/wiki/H%C3%A9l%C3%A8ne_Grimaud>

She has a great recording of what is probably my favorite piece: _Brahms Piano Concerto no. 1_

[http://www.amazon.com/H%C3%A9l%C3%A8ne-Grimaud-Brahms- Piano-...](http://www.amazon.com/H%C3%A9l%C3%A8ne-Grimaud-Brahms-Piano- Concerto/dp/B000006CS6/ref=sr_1_2/103-6892741-1586267?ie=UTF8&s=music&qid=1191339306&sr=1-2)

</comment></comment><comment><USER3> Most often I listen to indie music. My favorites are Rilo Kiley, The Decemberists, Metric, The Arcade Fire, Feist and Stars. It doesn't look like I have any peers here.

But, I do enjoy some Pop (like Ben Folds and Dispatch), Baroque, Ska and Big Band as well.

edit: I also love Gunther and Swizz Beatz. I don't know why.

That said, of course, I prefer soothing tapes of Paul Graham's voice.

<comment><USER4> I'm exclusively indie rock. You're a bit softer in taste than I, but there's some overlap. The Arcade Fire is one of the best bands playing right now. Their live show is astoundingly good...best I've seen in years.

My faves are: Spoon, Midlake, Fugazi, Death from Above 1979, Voxtrot, Mission of Burma, Cat Power, The Lemonheads.

When I'm working I'm most productive with things that have no lyrics or illegible lyrics, but are familiar. Jesu, The Fucking Champs, and electronica like Booka Shade and Apparat. Embarrassingly, perhaps, I'm totally loving working to old school metal lately--some from before my time, actually, but I like it anyway--Judas Priest, in particular. Also stuff I liked in high school and college: Carcass, Godflesh, Neurosis.

I made a list of my favorite tracks at emusic a while back (need to update it with Arcade Fire and a few other recent faves):

[http://www.emusic.com/lists/showlist.html?lid=564452&p=1](http://www.emusic.com/lists/showlist.html?lid=564452&p=1)

You can't beat emusic if you like indie music. It's cheap, non-DRM, and they've got nearly all of the best bands and labels.

<comment><USER5> Then you should try <http://wazee.org/> as streaming radio.

</comment></comment></comment><comment><USER6> Anything Trip-hop (Massive Attack, Morcheeba, Portishead, Sneaker Pimps, Bjork, AIR, EBTG, Zero 7, Tricky, etc.)

<comment><USER7> Music with VOCALS?

You guys have some _weak_ taste in programming music. Only the hardest electronic for me. Stuff that makes you feel like adrenaline is being injected into your brain with a firehose, yet predictable and non-distracting. Who else listens to that?

<comment><USER8> Are you talking about Vitalic, by any chance?

</comment></comment></comment><comment><USER9> Omnivorous classical, but particularly the Renaissance and Baroque periods. My favorite composers are Bach, Dufay, Ockeghem, Morley, Byrd, Mussorgsky, and Respighi. Ensemble Unicorn is my favorite group of performers.

</comment><comment><USER10> While programming, I prefer either baroque classical music or weird glitchy sounding electronic music. When I'm not programming, anything goes.

<comment><USER9> I can't listen to Baroque music while coding. The same brain cells that I'm trying to use for coding get tied up with unweaving the strands of melody.

<comment><USER7> Yeah I tried baroque but it made my mind wander too. Distractions must die.

<comment><USER10> That's interesting... I specifically chose baroque vs. other forms of classical music because it is more repetitive. Bach is way easier for me to zone out with than Beethoven. ;)

</comment></comment></comment></comment><comment><USER11> Recent rotation:

     * Do Make Say Think (recent album I think)
     * Alice Coltrane "Journey in Satchidananda"
     * Various - "Putamayo World Lounge"
     * Hybrid - Live DJ set from Moscow, 2004

In general while hacking, anything ambient, repetitive (electronica) or without vocals (jazz/classical), or vocals in a language I mostly don't understand (tropicalia, death metal, stereolab) is a great soundtrack.

While _designing_ though, no sounds at all! Maybe something _really_ ambient to shut out environmental noise, like Stars of the Lid.

<comment><USER12> Stars of the Lid is great, thanks for the recommendation. I tend to listen to ambient stuff when coding. Shpongle, Bonobo, Boards of Canada, Andrew Coleman, Bill Laswell, Birdy Nam Nam (definitely not ambient), Broken Social Scene are all good.

<comment><USER13> I've got to second Boards of Canada. Also, Four Tet, Alan Sparhawk's solo guitar (his band, Low, is some of my favorite music for when I'm not hacking), Sigur Ros, Collections of Colonies of Bees, Mouse on Mars, Do Make Say Think, Squarepusher, Dirty Three, Six Organs of Admittance, and Labradford

</comment></comment></comment><comment><USER14> Generally, familiar music. I can't think of any other commonality beyond what stems from the fact that programming doesn't facilitate the ability to listen to _new_ music.

I was going to say--oh, Debussy and Chopin. But why be a snob when I also listen to early Madonna music, and stuff too horrible to mention except anonymously:

<http://www.youtube.com/watch?v=Dsi8ho1PgKM>

<http://www.youtube.com/watch?v=sI5LWwC-cE8>

</comment><comment><USER15> um, im classic rock, led zeppelin, blue oyster cult and stuff

i guess im a little different than most programmers/hackers judging by the other posts

<comment><USER16> silence anyone?

<comment><USER17> Nothing like silence.

</comment></comment></comment><comment><USER18> Oddly enough - game and movie soundtracks. Mostly game though, because it's music designed to be ignored.

I knew a coder who listened to the Muppets Christmas Sing-Along on repeat for about 10 hours during a marathon coding session. At about hour 9 she started to feel like she had lost her mind.

Edit: I just listened to Zero 7 on pandora, and it's awesome. I think I've found a new favorite.

<comment><USER19> About game soundtracks: they're also designed to be catchy given very constrained sequencing. On, say, the PS3 or the Wii, you can just have a full, ambient MP3 and nobody will bat an eyelash. But on, say, the NES, you had to make every tone count, just like you had to make every pixel count. This pushed games composers to focus on the core melody, giving the world such memorable tunes as Mario and Zelda (Tetris was just a conversion of a real song, interestingly.)

Of course, after these well-thought-out melodies are born, they can be dressed up all you like. <http://ocremix.org/> is the exemplar there.

</comment></comment><comment><AUTHOR> I figured I'd start.

Kanye West (& The Roots) + Hip-hop

</comment><comment><USER20> Current favorite hacking music: Pink Floyd, Goo Goo Dolls, Guster, Real McCoy, Dar Williams, bunch of college acapella, Van Canto, Crash Test Dummies, Sophie B. Hawkins, Savatage, Nightwish, Postal Service, Narnia soundtrack, LotR soundtrack, some Dream Theater.

</comment><comment><USER21> gotta love guitar hero music :).

<http://anywhere.fm/derek/guitar_hero> <http://anywhere.fm/derek/freezepop>!

</comment><comment><USER22> Mostly progressive rock, jazz, power metal. Favorite artists: Spock's Beard, Savatage, The Strawbs, The Tangent, Gentle Giant, Herbie Hancock, Thelonious Monk, Stratovarius, Rhapsody, Dream Theater, Sonata Arctica.

</comment><comment><USER23> Uh, gregorian/rennaissance/etc. chant? Classical too, though don't really know who's playing usually. I like Chopin alot. The best is music that sounds like thinking.

I also second silence. That's the usual case.

</comment><comment><USER24> Punk/Hardcore (bands like Bane, Paint it Black, Modern Life is War, Good Clean Fun, Minor Threat, Gorilla Biscuits) mostly, with some Pink Floyd and Violent Femmes thrown in there for good measure.

</comment><comment><USER25> I'm a musician, and particularly a composer/arranger/orchestrator, so it's hard for me to listen to things without having them distract me.

Thus, when I want background music that _doesn't_ distract me, I go with something I've listened to about 3,000 times in the past. Doesn't really matter what it is: Schubert sonatas, 70s Herbie Hancock, showtunes ...something that requires the same number of brain cells to take advantage of as a library that I wrote a long time ago and have been using ever since.

</comment><comment><USER26> I used to love happy hardcore, acid jazz, progressive house, and electro metal, but now i mostly listen to electroclash, eurotrash, synthpop and all of the other hipster variations.

<comment><USER27> Thumbs up for happy hardcore and acid jazz. I love highly active, fast techno. Anything from the breakbeat, big beat, 2-step, hardcore, happy hardcore, gabba, drum & bass, and jungle subgenres. The problem with rap for me is that the lyrics distract my thinking while coding. Other types of electronic music don't keep me energized.

But when reading something more substantial than, say, looking something up in documentation, silence is excellent.

</comment></comment><comment><USER28> Ambient. It never taxes my brain and helps me focus: Brian Eno (Music for Airports, Apollo: Atmospheres and Soundtracks), Sigur Ros, Four Tet, Cliff Martinez (Traffic, Solaris).

</comment><comment><USER29> Most anything Orbital, Sasha and John Digweed - Northern Exposure, most NIN remix / single releases, Any Tool (but mostly Lateralus), Enya, Sarah McLachlan - Remixed or Surfacing, sometimes other stuff of hers, Brian Eno, Yoko Kanno, sometimes Audioslave or APC's first albums, Mushroomhead, TCM's Vegas album, and as others have said, glitchy electronic stuff - I'm especially partial to Download's stuff and some other cEvin Key stuff.

</comment><comment><USER30> Amon Tobin, William Orbit, Miles Davis, Moby, Fatboy Slim, DJ Food, Speaker Pimps, Telepopmusik, Rara Avis, Robbyn Rhodes, Trilok Gurtu...

Those are just some of the artists I've been listening to recently. Usually chill/ambient electronica with good repetitive beats-- the best example is Angel by Massive Attack. I turn that way up and hack the night away, sometimes.

</comment><comment><USER31> I made a group for Hacker News members to join for last.fm It will create charts and statistics if the group reaches over 15 members. Here is the link: <http://www.last.fm/group/Hacker%20News%20%28Ycombinator%29>

<comment><USER32> I has joined your group.

Also, this is me: <http://www.last.fm/user/codepolice>

</comment></comment><comment><USER33> Even thought I don't listen to rap that much, Method Man works for me. I find rap like that, where it's just a constant flow of lyrics and rhymes, really gets me going.

<http://zviband.com/2007/09/30/getting-in-the-zone/>

</comment><comment><USER34> I like ambient electronic music for coding. Check out:

<http://www.limbikfreq.com/>

</comment><comment><USER35> I fluctuate between indie-ish stuff and techno type things. I'm not up on my music categories, but bands like Say Hi To Your Mom and spoon.

Also piano music. <http://jamendo.com> has some great free music, particularly Rob Costlow.

</comment><comment><USER36> I really enjoy video game remixes:

[http://www.ocremix.org/list.php?type=remixes&offset=0...](http://www.ocremix.org/list.php?type=remixes&offset=0&sort=datedesc)

<http://remix.kwed.org/>

</comment><comment><USER37> I listen to 202.fm and c9radio.fr while coding.

If I listen to something local to my disk, I get distracted wondering what's coming up next, or otherwise fiddling with the order of play. If that's not in my control, I don't think about it.

</comment><comment><USER38> Lately I've been listening Jack Johnson, but I like any kind of music.

I also love to dance Salsa :P

<comment><USER39> +1 for Salsa. It's also a great way to meet women while doing something fun. And it is a learned skill, something you can become good at if you practice, and it makes you seem a bit less nerdy, I think. My wife agrees.

<comment><USER38> hehehe, It is a great rhythm, and not so hard to learn. That kind of music is the best for dancing!

</comment></comment></comment><comment><USER40> Bonobo, Clint Mansell (The guy who scored The Fountain. Try listening to Death is the Road to Awe, it's worth your time), Talking Heads, Moody Blues, Pink Floyd.

I'll mix in some hip-hop if I'm feeling a burst of excitement.

</comment><comment><USER41> * metal (heavy metal, progressive metal, death metal, some goth...), rock, jazz, some electronic music...

You can check my tastes: <http://last.fm/user/egimenez> :P

</comment><comment><USER42> Lots of Hip-hop and classic rock; Some metal (lots of 3 Inches of Blood recently); some indie (i guess) stuff (Fall of Troy, etc); some Funk and some Jazz; the occasional orchestral track never hurts.

</comment><comment><USER7> 80s porn music.

<comment><USER43> "I only watch it for the music."

</comment></comment><comment><USER39> I love eclectic bands with a ska/horns bent, like Fishbone, The Cherry Poppin' Daddies (from my hometown, Eugene, Oregon), Los Fabulosos Cadillacs, plus other stuff like the Voodoo Glow Skulls.

</comment><comment><USER44> Kraftwerk, DMX Krew, Boards of Canada, Aphex Twin, Autechre, IT & My Computer, anonymous minimal house, Daft Punk

Radiohead, Modest Mouse, Jose Gonzales, The Knife,

Timbaland

</comment><comment><USER45> <http://anywhere.fm/luxiou/top_trance>

A mix of old school and some new school melodic trance :o

</comment><comment><USER46> House music, downtempo chill type.

Avoid music with vocals, or that is too upbeat/danceble type, as it will be hard to concetrate on anything.

</comment><comment><USER47> try stars of the lid's "and their refinement of the decline." some of the finest ambient music since eno.

[http://www.amazon.com/Their-Refinement-Decline- Explicit/dp/B...](http://www.amazon.com/Their-Refinement-Decline- Explicit/dp/B000QR0EBW/ref=dmusic_cd_album/103-6827144-3190204?ie=UTF8&qid=1191345943&sr=8-1)

</comment><comment><USER48> Most active for me while working (from iTunes): Skye, Coldplay, Keane, Morcheeba, Afro Celt, Zeppelin.

</comment><comment><USER49> <http://www.last.fm/user/kevin143/>

</comment><comment><USER50> Telefon Tel Aviv! or any kind of good intelligent dance music.... (check lastfm...)

</comment><comment><USER51> \- Whatever is on radio 4 (bbc.co.uk/radio4/) \- Jungletrain.com

</comment><comment><USER52> Jackson and his Computer Band. (pardon the pun)

</comment><comment><USER53> Maurice el Medioni's album Descarga Oriental.

</comment><comment><USER54> late, i know: tiesto(some), atb(more), always looking for more will check out z7.

</comment><comment><USER55> luke vibert all day long.

</comment><comment><USER56> 80s and classic rock

</comment><comment><USER57>

</comment><comment><USER58> yanni</comment>


Doctors Are Fed Up with Being Turned into Debt Collectors - <AUTHOR> https://www.bloomberg.com/news/articles/2018-11-15/doctors-are-fed-up-with-being-turned-into-debt-collectors <comment><USER2> Part of the problem is that hospitals don't disclose prices before performing services.

So patients must agree to a procedure -- yet only afterward find out how much it costs. That price can be shocking, and the patient never agreed to pay it. No wonder it becomes hard to collect from them.

In the rest of the economy, we agree on a price beforehand. That makes customers more likely to pay.

The medical system, however, has given up on disclosing prices to patients, because everything is paid by insurance. And now we have Doctors who say:

> "It's harder to collect from the patient than it is from the insurance," > said Amy Derick, a doctor who heads a dermatology practice outside Chicago.

If you want people to pay, then make an agreement with them _before_ you perform the service!

<comment><USER3> >In the rest of the economy, we agree on a price beforehand

This occurs in auto repair as well (though maybe less than it used to). Those repairs, in my opinion, have been quite stressful as well. Are there other industries where we bill afterward?

<comment><USER4> Maybe find a different shop? I've had mechanics that acted the way described, but I called around and found one that would give me an upfront price for a diagnostic and then called back with a detailed plan for parts and labor to do the required work. I've lived in a number of cities in the US and always managed to find one that does this over the phone.

<comment><USER5> My shop does the same thing. They charge a diagnostic fee that's equivalent of 1 hour's labor and give me an estimate to fix the issue. The diagnostic fee counts toward the repair. Sometimes they find other things when doing the work, but I can relate: who hasn't gotten into fixing a bug and found out it's more complicated than they thought at first?

</comment></comment></comment></comment><comment> old-gregg Poor "providers"... They charged us $250 for a can of apple juice and two Advil pills (AKA "recovery kit") after a broken wrist surgery, which itself was $45K without a hospital stay.

No wonder they now have a "problem" having to chase non-paying people. It's like charging $10K for a handshake and then sponsoring an article on Bloomberg about being unable to collect it.

<comment><USER6> I occasionally get random bills from "providers", and I think it shows just how awful medical billing is.

The worst was whenever we had our first child. I thought it would just be a single bill or something, but instead I received about 10.

One from the hospital, one from a surgeon, one from the OBGYN, and one from an anesthesiologist. We only met one pediatrician during our stay, but we received a bill from every pediatrician that did a rotation while we were there, so that added four more. One because a nurse working was an independent contractor, and one from the wet nurse who we talked to for like 5 minutes.

Two of them we never actually received bills for because they had an outdated address, so they were sent to collections. We discovered them a year later when we were trying to buy a house. It dinged my wife's credit so bad that we were recommended to not put her on our mortgage application.

<comment><USER7> "One from the hospital, one from a surgeon, one from the OBGYN, and one from an anesthesiologist. We only met one pediatrician during our stay, but we received a bill from every pediatrician that did a rotation while we were there, so that added four more. One because a nurse working was an independent contractor, and one from the wet nurse who we talked to for like 5 minutes."

This is it. This is the US medical scam crystallized. What you need to focus on as a US patient is the "Out-of-pocket maximum/limit." (a number) - which is the yearly maximum you pay as an insured person. Basically, once you enter into an ER you are going PAY this this number. This number is reset every January 1st. So If you have a child January 2nd -- you are in GOOD* shape -- since you will hit your yearly max ("Out-of-pocket maximum/limit.") early in the year -- all other medical is free.

My friends that had a child December 30th, are in bad shape. They pay for yearly "Out-of-pocket maximum/limit" two times: one for the current year and one for the next year.

<comment><USER8> Stories like this are what keep me as a Kaiser member. In the years I've been with them, I've been to the ER twice and have yet to hit the yearly maximum. Usually they correctly bill me while I am on-site, only rarely do they have a follow up bill.

</comment></comment></comment></comment><comment><USER9> Doctors being debt collectors is annoying for both the doctor and the patient, and they're also bad at it. Just the other day I got a bill for a procedure in July of 2017, despite 1) not having seen that doctor since 2016 and 2) never having had that procedure. Now I have to fight with them to prove a negative, until it goes to collections and I can make _them_ prove the debt, and then wait for my credit to get fixed after they figure it the debt isn't valid. Yay.

<comment><USER10> Agreed. Just got contacted by collections about unpaid services. Contacted the doctor's office about this and they said our insurance denied the claim and they couldn't get in touch with us to resolve the matter. Turns out they were submitting to our old health insurance company, and using our old home address. We were also at this office about 3-4 times before and 3-4 times after the procedure that went to collections.

Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping.

Also, the amount of time spent following up with doctors, payments, procedures, claims, etc is mind boggling. At least 4-8 hrs a week. Getting an answer about what is and isn't covered also seems to be some kind of black art.

<comment><USER11> > Tangentially, we've started to notice that doctor offices will often claim > that procedures aren't covered and we have to pay out of pocket. However, we > keep track of these out of pocket expenses since we're close to hitting out > of pocket maxes. Turns out most of the time, the doctor's offices will still > submit the claim to our health insurance company even though we paid, > effectively double dipping.

Let's not beat about the bush, this is _insurance fraud_, not "double dipping". The provider has to assert to the insurer that they have not been paid for that service rendered when they bill insurance.

<comment><USER12> Let me guess, the Attorney General is not interested in prosecuting, because if he were physicians would be more honest. The advice would be to let the dubious bills go to collection, they'll never end up in court because that would make a paper trail.

<comment><USER11> The AG doesn't need to be involved. Insurers, for all their faults, _love_ to hear about provider fraud and can make that an entirely uncomfortable situation for the provider.

</comment></comment></comment></comment></comment><comment><USER13> Every time I read this stuff I feel truly privileged. I'm a New Zealand citizen living in Australia. Not only do both countries have universal healthcare, but they have a reciprocal agreement to provide free healthcare to each others citizens.

Australia has bulk-billed doctors and there's no shortage of them. I can book an appointment online for tomorrow, wait for 10 minutes in a waiting room and see a GP for free. I can even choose which GP I want to see. And I'll likely get anything they prescribe me for free as well. Medicare refunds so much money I sometimes feel guilty because I know I can afford it.

My partner has a chronic health condition that resulted in her large intestine being removed and she requires thousands of dollars worth of medication a month, likely for the rest of her life. We've never paid for surgery or medication beyond admin or prescription fees.

I want this for everyone and I pay my taxes gladly. I would pay more for an even better system. You don't have shit if you don't have your health.

<comment><USER14> Going to Australia and NZ earlier this year was when I finally had to admit that there is absolutely no justifiable reason why we have such a shitty system in the US. I paid out of pocket for an MRI because it was cheaper than anything I would have gotten in the US with insurance. The end-to-end experience was great.

I returned to find that I couldn't enroll in health insurance until 2019 unless I joined a company as a fulltime employee, resulting in a terrifying 6-month coverage gap where the only option was BOTH paying the lack-of- coverage penalty AND paying for shit "no way they're reimbursing anything" temporary coverage from an agency that didn't even send an insurance card. Our system is undeniably and unjustifiably fucked.

</comment></comment><comment><USER15> Healthcare, in America, is broken.

We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in the area, and if it doesn't like the rate, supports patients via the military systems).

That includes vision and dental; being able to see and being able to consume food properly tend to be requirements for workforce productivity.

Cosmetic and luxury care (like cutting triage lines in non-emergencies) can be premium services.

<comment><USER16> > supports patients via the military systems

Why should the military be involved?

<comment><USER15> Provider of last resort / "I can do it better"; the argument is generally that private healthcare can do things better/faster/cheaper. So then why not let the infrastructure that serves the active military provide care? Or training for doctors beyond what civilian residency programs provide?

<comment><USER16> Military healthcare is specialised for a young and healthy population of disciplined people who report problems early and do what they're told in treatment. I'm not sure the results scale to civilians.

</comment></comment></comment></comment><comment><USER17> Anecdotally I just find it ridiculous that they can't charge me whatever I'm going to owe at the time of the visit. I'm fine paying it then and there, but when you send me a dead tree 3 months later and want me to either send a check or write down my credit card number and send that back forget it - I'll pay you when I see you again.

Seems like a much better solution would be for the insurance to just pay it and then charge me the rest. At least that way I only have one entity to deal with and they probably support online payments. And they're in a much better position to exert leverage to get me to pay - if I'm too far behind on paying them they can suspend my insurance whereas a care provider that I'm unlikely to see for months or years really has no recourse other than sending me more dead trees begging for payment.

<comment><USER18> Or just be consistent about the bills. If I get a bill for $850 and then another one for $1150 do I owe $1150? $2000? Have you run this by my insurance yet?

So I just wait 60 days and go with whatever the last bill is they sent me. I could do 30 days but I'm already pissed that they can't get their shit together (and at the state of health care) so they can stew for all I care.

</comment></comment><comment><USER19> This is exactly how insurance and medicine ought to work. The only way we're going to fix the costs in our healthcare system is through high-deductible plans and transparent pricing.

> Now, instead of getting paid by insurance companies on a predictable > schedule, health-care providers have to engage in an awkward dance. One > moment they're removing a pre-cancerous skin mole. The next, they're > haranguing patients to pay what's become a growing portion of the total > medical bill.

In a situation like that, why aren't they just taking the money upfront? It's not like a skin mole is ultra urgent.

<comment><USER20> Considering high deductible plans are a scam and part of the reason why we're in this situation in the first place, I disagree.

<comment><USER21> High deductible plans are the closest thing to health insurance by definition. Your home insurance doesn't cover routine and expected problems such as roofing replacement or seal coating the driveway. It's for unexpected AND unaffordable damages.

<comment><USER20> I would say anything that discourages people from getting basic preventative care is a bad thing even if in your strange world HDHP is somehow closer to 'real' health insurance.

HDHPs as I mentioned encourage people to bet against their own health, that they will never get in an accident, or their body won't decide to crap out on them and so forth. Additionally they defeat the entire purpose of insurance which is that the people at risk are subsidized by the healthier people; if you separate the two pools then the healthy pay marginally less while the unhealthy pay a lot more.

For example, would you consider HDHPs that don't cover vaccines to be a good or a bad thing? It's a routine checkup, yet we've established that in general it's of greater benefit to society if we do get those routine checkups done.

<comment><USER19> > I would say anything that discourages people from getting basic preventative > care is a bad thing even if in your strange world HDHP is somehow closer to > 'real' health insurance.

 _Does_ it discourage that? You still want to get preventative care, because if you don't, you'll have to pay more later. Secondly, people are still strongly disincentivized to become sick because of the way that being sick feels.

> HDHPs as I mentioned encourage people to bet against their own health, that > they will never get in an accident, or their body won't decide to crap out > on them and so forth. Additionally they defeat the entire purpose of > insurance which is that the people at risk are subsidized by the healthier > people; if you separate the two pools then the healthy pay marginally less > while the unhealthy pay a lot more.

Who said anything about separating pools?

> For example, would you consider HDHPs that don't cover vaccines to be a good > or a bad thing? It's a routine checkup, yet we've established that in > general it's of greater benefit to society if we do get those routine > checkups done.

Vaccines are cheap and plentiful. We already require kids to be vaccinated before they can attend school. I'm not sure why insuring them would increase or decrease their rates.

<comment> nikki-9696 "We already require kids to be vaccinated before they can attend school."

No, not everywhere does anymore.

"I'm not sure why insuring them would increase or decrease their rates."

Because some people are very poor. My friend didn't get her flu shot because she couldn't afford the extra $50 this month. And that's a cheap vaccine that doesn't also require a doctor visit to go with. Some people have to worry more about today than tomorrow or they don't have food and rent money this month.

<comment><USER21> Everyone I know who has health insurance through employer or healthcare.gov has flu vaccines paid for, and an annual physical.

</comment></comment></comment></comment></comment></comment></comment><comment><USER22> > _"There's a burden on both sides," said Callas. "But health-care providers > get caught in the middle."_

Caught in the middle my arse. This is bigly shirking the responsibility and falsely playing the victim. Healthcare providers are extremely well versed in the billing rules and are playing dumb when they pretend not to know. There are literally manuals and seminars on how to bill (i.e. "code") one service as several, or code to a more profitable option when several options are possible, while hiding behind a veneer of respectable neutrality. Multiple large providers have been sued for essentially insurance fraud and go back to doing exactly the same.

It's a big business driven by quarterly numbers and providers don't hire expensive staff to lose at gaming the system. Do _you_ as a patient have a full-time staff to go through billing arcana for you all day? It's impossible to even find a patient advocate. Then on top of that larger providers like hospitals aggressively sell bills to collections agencies on any dispute, abusing the power over the patient's credit as their first resort at price gouging. Thank god for the CFPB and the 2015 credit reporting rule change [1]. The day of reckoning is coming and doctors need a long look in the mirror for why they are in this line of work.

[1] [https://ag.ny.gov/press-release/ag-schneiderman-announces- gr...](https://ag.ny.gov/press-release/ag-schneiderman-announces- groundbreaking-consumer-protection-settlement-three-national)

</comment><comment><USER23> I am always amazed at how little of the total bill insurance pays for normal visits. By the time you include copays, coinsurance, and the insurer's negotiated rates, nearly half of what the doctor gets paid is paid by me.

<comment><USER11> Pretty much. They'll argue that the negotiation is part of the "value" they add, but beyond that in many cases they're merely rent seeking.

</comment></comment><comment><USER24> "We can't do it for free" but you can't just set any price. I dislike doctors and hospitals for never disclosing the service fee or being truthful about their treatments done on the patients, especially the ER ones. They often perform unnecessary procedures and mark up the fees so high to jack up the cost and settle with a bit less which is still ridiculously high.

</comment><comment><USER25> In any industry that involves insurance companies predominantly paying bills, will eventually lead to out of control costs (health, auto collision repair etc)

Higher the costs, more incentive (or mandatory) for users to buy insurance and also more profits to insurance companies.

<comment><USER26> It's true - a higher proportion of cost borne by insurance companies and the private sector is very strongly correlated with higher healthcare spending - this is from OECD data: [https://images.theconversation.com/files/44253/original/3y3h...](https://images.theconversation.com/files/44253/original/3y3hh26p-1395196169.jpg)

Full article - [https://theconversation.com/private-insurance-reliance- means...](https://theconversation.com/private-insurance-reliance-means- countries-pay-more-for-health-care-24486)

</comment></comment><comment><USER27> Cry me a river. Stop charging obscene amount of money for services.

<comment><USER28> I don't know why you're being downvoted. Everyone tries to lay the problems with healthcare everywhere else BUT the actual cost of the service.

My aunt went to the ER for a snakebite. They gave her the anti-venin and let her stay for 12 hours.

It cost 46,000 dollars. It was a rattle snake. They do this thing all the time in India for COBRA bites and it's not even close to being that expensive.

<comment><USER29> > They do this thing all the time in India for COBRA bites and it's not even > close to being that expensive.

US Pharma would say because India doesn't care about medical patents and R&D cost. (Not saying I agree at all, but that's the excuse given)

<comment><USER30> Heres an article breaking down the cost of precisely that rattlesnake antivenin [1]

Unsurprisingly, its mostly blatant money grabbing.

70% is pure markup that insurers don't pay but uninsured do.

2% is the R&D cost. Probably for something we invented 100 years ago which makes you wonder just how the R&D continues to cost $100+ per dose decades after its basically perfected anyways.

[1] [https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the-c...](https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the- crazy-reason-it-costs-14000-to-treat-a-snakebite-with-14-medicine)

</comment></comment></comment></comment><comment><USER31> Patients are fed up with being turned into money bags

</comment><comment><USER32> Here's an idea. Make it legal to get lower quality service and pay less. Like every other good and service.

</comment><comment><USER33> Then what are these additional bills I get from Doctors service companies. I recently paid $250 for an ER visit. That was an expected deductible as outlined in my healthcare plan. What I didn't expect was a separate bill from the ER doctor for an additional $200 for a 5 minute visit.

<comment><USER11> Many hospitals like to have their physicians as contractors or consultants.

For bonus points, not all hospitals require their physicians to be in the same network as the facility, so you can get an "out of network" bill for the ER doc at an in network hospital.

Or, to get even more ridiculous, I went to a large chain urgent care. They had labs in house. I got a blood draw there as part of a physical from the PA-C. And an out of network bill. Lab ABC, owned by healthcare provider ABC, inside an ABC urgent care, was somehow out of network, in contrast to the facility and the provider. Cue a $600 bill...

</comment></comment><comment><USER34> It's baffling to me that so many smart people on this website don't understand how complex health insurance is or seem to think that people don't pay their bills because they don't like the prices

<comment><USER35> Rich or poor, money is money and if you feel like your getting screwed there is very little reason to feel obligated to pay when due or ever.

<comment><USER34> People don't file for bankruptcy to stick it to their hospital, and their hospital isn't putting 7 administrators and clerical workers per 10 physicians on payroll to negotiate repayment and answer questions w/ people who could easily pay their full bill. Let me clarify that I'm not siding w/ the hospitals: you are getting screwed, there's no question about that.

My problem w/ the discourse here is people who treat this like some econ 101 practice problem, when there's no evidence that "price transparency" does anything to address healthcare costs [1].

[1]: [https://www.nytimes.com/2016/12/19/upshot/price- transparency...](https://www.nytimes.com/2016/12/19/upshot/price-transparency- is-nice-just-dont-expect-it-to-cut-health-costs.html)

<comment><USER35> I don't know how often people are filing bankruptcy over hospital bills but I don't it would matter even if there was price transparency. I haven't seen any hospitals going bankrupt lately.

The cost of healthcare for those not under a group insurance plan or subsidized ACA plans is crazy expensive for a family regardless. To the point of what's more important your house payment or health ins payment? People are just barely scraping by so the intent to pay in the bill in full is just a dream, even if it's just a $100. They would rather face the consequences of bill collectors nagging them which they just ignore.

<comment><USER34> I'm not arguing that there aren't people who are technically (but not practically) capable of paying their hospital bills and don't, and for the most part I don't disagree w/ any of the above (though medical debt has more detrimental effects than just being "nagged", especially given there's a documented effect of debt judgements creating a spiral of entanglements w/ the criminal justice system [1]).

[1]: [https://www.aclu.org/issues/smart-justice/mass- incarceration...](https://www.aclu.org/issues/smart-justice/mass- incarceration/criminalization-private-debt)

</comment></comment></comment></comment></comment><comment><USER36> The real issue here is that HSAs are criminal.. Do not work for a company if the only health insurance plan available is an HSA... unless you are young of course.

</comment><comment><USER37> Procedures can't cost more than the average cost of the same procedure across similar oecd countries.

We pop the corruption bubble and all fights about insurance costs would just disappear because in reality the reason they are so high is because all of this is just a shakedown from the medical/pharma industry.

I'm so sick of this all being framed as a battle over single/multi provider obamacare insurance bullshit when it is really just misdirection and we are being wildly overcharged for services.

It's like we can only debate whether we pay 1000% markup using a credit card, paypal or cash, and not talk about the 1000% markup.

<comment><USER38> In my view, the only way to reduce the cost is to figure out where the money is going. Otherwise, everybody can say: "We had to charge $58000 because we had to pay someone else $57000." Right now everybody points to everybody else as the culprit for high health care costs.

A centralized system has a better way of tracking this. If everybody involved with the health care system is working for a government salary, and everybody who sells equipment is selling it to the government, then we know who is getting rich by exactly how much.

<comment><USER39> > In my view, the only way to reduce the cost is to figure out where the money > is going.

It isn't going to any specific place. The system is designed to destroy price sensitivity, so everything is overpriced and everyone is charged for things they don't actually need.

When there is a bill for $58000, it's not that the procedure costs $1000 and there is this one place receiving the remaining balance we could just cut out. It's that the procedure _would_ cost $1000 only everything that should have cost $20 was charged for $200 and then 500% more steps were performed than were necessary.

Trying to play the blame game is pointless because everyone will come up with a reason to justify their high margin or unnecessary step and the truth is nobody is innocent. What's needed is to actually make purchasing decisions based on price. If one provider charges $58000 and the other charges $56000, the patient should know _ahead of time_ that there is a $2000 price difference, and actually pay the entire $2000 less by choosing the less expensive one.

Do that and there is price competition, and the provider that does the work of eliminating unnecessary costs for you will be the one with the lowest price. And once you have someone offering to do a $1000 procedure for $1000, who is going to pay $58000?

<comment><USER37> Why should we have to figure this shit out for them at all!?

This procedure costs $x because it is the oecd average cost and that is the end of the discussion. It is on them to fight over their slices of the pie with each other. They don't get to make their problems our problems.

Its not realistic to act like people have time to price compare for emergency medical services. It just isn't a normal free market so much as it is like a mugging. When you get mugged the question is how much will you trade for your life, and the answer is everything you have. We need to stop pretending like it is a free market and trying to apply free market solutions that do not apply.

<comment><USER39> > This procedure costs $x because it is the oecd average cost and that is the > end of the discussion. It is on them to fight over their slices of the pie > with each other.

When their costs are lower than the OECD average then you're still paying too much, but it's even worse when they're higher. Each country has different regulations, taxes and subsidies, real estate costs, medical licensing rules and supply of medical professionals, average income and cost of living which affects how much workers have to be paid etc.

When the OECD average price for a procedure is $5000 but the zero-profit cost of doing it in your country is $7000, nobody will do it. Or the provider who already owns the equipment as a sunk cost will do it, but the waiting list for the procedure will be 22 months. (Hopefully it's not related to an active pregnancy.)

> Its not realistic to act like people have time to price compare for > emergency medical services.

It's not realistic to act like all medical services are emergencies. Most of them aren't, what's the excuse then?

And once you have a baseline for what a procedure costs in a competitive market on a non-emergent basis in your location, it becomes a lot easier to identify a 10,000% markup for no reason in an emergency situation as manifestly unreasonable.

<comment><USER37> The only way the profits could be 0 is if people's salaries are too high.

Vet school costs a lot, almost as much as medical school. Yet the procedures are much, much cheaper. Probably because vets are paid half as much or less than doctors.

<comment><USER39> > The only way the profits could be 0 is if people's salaries are too high.

Salaries are supply and demand. If you lower salaries you get fewer doctors -- you have to convince people to go to medical school instead of law school or business school.

And the OECD average salary may be too low if the relevant city has a higher cost of living than the OECD average, requiring higher salaries to get people to practice there rather than somewhere their money goes further.

</comment></comment></comment></comment></comment></comment></comment><comment><USER40> Author of the article here: if anyone wants to talk more about their surprise bills, shoot me an email at firstname.lastname@example.com

</comment><comment><USER41> Am I the only one who finds it strange to hear a doctor refer to a hospital/practice as a "small business"?

</comment><comment><USER28> Does any one else think that traditional capitalism 'supply and demand' doesn't apply to medicine?

Because the demand for your life and health is infinite.

</comment><comment><USER29> Here's a thought: Maybe doctors should do what nearly every other industry can do. Provide a price quote upfront? I will say there was one circumstance where I received upfront billing without health insurance and that was for a colonoscopy. It was around $2k and they gave a 25% discount for payment upfront. So it's certainly possible for healthcare providers to do this. As I mention below, it's not usually the case:

I broke my hand a little over a year ago during a gap without health insurance. Knowing the ER would start at $1000 for a 'hello' and that I might not have a competent specialist, I decided to take matters into my own hands (haha). First was a call to a friend in Montreal with a sister that's a surgeon. I assessed that while driving to Canada would be more cost effective than a US emergency room, the border might give me issues and followup visits would be troublesome.

So, I walked off the mountain and made a makeshift splint at a Rite Aid with medical tape and a plastic ruler for around $5 ( [https://twitter.com/vvtgd/status/879360595526635520](https://twitter.com/vvtgd/status/879360595526635520) ). When I got back home a few days later I went to a hand specialist, told them I'd pay upfront and had them set it. All in with followups it was around $800.

Initially the specialist's receptionist idiots couldn't figure out how to bill me in person. If you have staff that doesn't know how to invoice a client that pays in cash, you shouldn't be in business. Full stop. Why should a cash paid- in-full client pay more than any other insurance company is beyond me.

Another back on insurance anecdote: I needed an urgent visit not too long ago. PCP wasn't updated on my card, but I did it through health insurance website. Dr still wouldn't accept. Had to pay in person with my CC. Receptionist stole the CC details (it was the only place I used that card for magstripe transaction at in weeks). I needed to get a new card and manually submit the payment details. It's been two months and I still don't have the money back for the visit.

(I'm not going to repeat myself but many years back I also had a rabies vaccination story in which I received almost $20k in hospital bills)

What the above anecdote suggests is that the industry is broken and relies on fantasyland pricing because providers no longer have to compete due to insurance networks. The new hotness is VC's getting into running clinics because as universities can do, they can charge unlimited pricing and force the market to accept it. You don't have an option to barter with health providers, you can't sue them when they are scumbags (because professional protections, etc), and in most situations you don't have a choice whether you get sick/injured... it's just the risk of living.

<comment><USER42> > colonoscopy. It was around $2k

What? It takes less than an hour and only two medical people (doctor doing the dirty work and a nurse observing the patient and double checking the video) plus a few minutes to finish the paperwork. The machinery involved is very cheap nowadays and anyway lasts for many thousands of procedures. The consumables are some lubricant, sterilising solutions, paper towels, and something to clear your bowel the night before. At least that's basically what it was like when I had one a few years ago in Norway.

How does that add up to two thousand dollars? Of course I don't know what mine cost because I only had to pay about NOK 250 (very roughly USD 30).</comment></comment>


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