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Comment by btilly | Hacker News Reader

Nobody can tell you because nobody knows. And nobody can know.

Here is a simple example that my sister (a nurse) gave me yesterday. Suppose that you go in for an operation at the hospital, spend a week recovering, and develop diarrhea on day 2 while you are there. That diarrhea is a "hospital acquired infection" and insurance won't pay a dime for your operation. Therefore until you've been through the hospital, nobody knows whether you'll get paid.

Oh right, and the possibility of this happening is a reason for the hospital to kick you out of the hospital as quickly as possible. Average patient outcomes may be better if you stay a week, but their odds of getting paid are better if you're kicked out within 48 hours.

This is just the tip of the iceberg. She went on about how broken health care is for an hour...

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> Nobody can tell you because nobody knows. And nobody can know.

That's definitely not the case, because they have to know in order to bill you. To get us back on the same page, let's rescope and consider only elective procedures and primary care.

Your example is extraordinary and could be specifically excluded. Even if I got a treatment plan with equivocating language about "risk of procedures / changes / infections / etc" and all that noise at least I could make an informed decision about which treatment plan I think is appropriate.

The guff I was sold when we were shoved to high deductible plans a ~decade or so ago was that we could make decisions about our healthcare. They come up with BS estimates or treatment calculators that are from the insurer and not the provider.

That's definitely not the case, because they have to know in order to bill you.

They bill you after the fact, after they know what they did and what insurance paid for. At that point it is easy. But before the operation, nobody knows what they will find or what insurance will decide.

Your example is extraordinary and could be specifically excluded.

On what evidence do you conclude that it is extraordinary?

All evidence that I have, including my conversation last night with a retired head nurse, is that confusion and uncertainty about what will be covered by insurance and what negotiated limits there might be on what can be charged are more the rule than the exception. And if my impression is correct, then what you want is impossible. Because before the fact, nobody really knows.

But this weirdness still happens when you have a combined entity like Kaiser.

I went for a routine visit, and paid the $30 copay before the visit.

After the visit, I get a bill for Ridiculous_Number_X - Ridiculous_Number_Y = $30.

The "actual cost" of the visit and the "negotiated discount" are numbers that are obviously pulled out of someone's ass because they magically align so that I have to pay $30.

And since everything was handled by Kaiser, how the hell could they not know before my visit that they would want $30 extra and just charge me $60 beforehand and be done with it?

So the predictable checkups are predictably priced, and the unpredictable treatments are unpredictably priced.

Here's a great video that I think is related to this topic about the near-impossibility of finding out the cost of giving birth: https://www.youtube.com/watch?v=Tct38KwROdw

I'd imagine the reasons for the complexity are the same as an injury.

Edit: Just a thought...

What if enough consumers went line-by-line AFTER the fact and shared what the specific breakdown of every item cost? So then you'd be able to say, okay, at this hospital them giving us an Advil cost $X and them doing this procedure cost $Y.

Some way of making the master price list for how much individual items cost public and grouping together ones that generally appear together...

Me and a friend were talking that idea a few weeks ago. You'd need to further include what insurance plan that consumer was on as well, so know what the hospital would charge knowing that information.

Crowdsourcing it would make it significantly more transparent, but the problem (to me, at least) is more that submitting that information somewhere is more of a privacy/HIPAA thing than most consumers and companies are willing to handle.

I could definitely envision a government system, like medicare, would hire people to do this, and make the prices more transparent to consumers, but this is the same medicare whose part D cannot negotiate drug prices due to lobbying efforts.

Hey, the hospitals could even hire actuaries to statistically analyze costs and charge everybody the expected average.

We could call that...oh wait. Nevermind.

I assume you didn't watch the video and therefore didn't understand the point.

Insurance!

> Your example is extraordinary and could be specifically excluded.

Complications and hospital related infections are not extraordinary. For most of the history of healthcare they were the norm.

If you read the very next paragraph, you'll note that they meant that nobody can now know the total costs beforehand. I.e., the total costs often include events that they are unable to reliable predict in advance, so they are unable to give you a reliable or accurate estimate of costs until its all done (which is when billing occurs)

Nobody can know your restaurant bill beforehand, since who knows what you will order for dessert, right? The hospital should still be able to give estimates for individual items beforehand. If they are not flying completely blind, someone must already know these numbers, it would just be a matter of making them public.

To me, the actual problem seems to be that they would like to make up the price after the fact, when they have a better idea how much they can charge and get away with. This gives them the unfair advantage of setting their own prices unchecked by market forces, and is frankly a reprehensible business practice.

They could provide mean, median and min/max.

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