Comment by Aloha | Hacker News Reader

Comment by Aloha | Hacker News Reader

Parent Full thread

I'd love for us to so some market-based reforms to the current system before we blow it up - I concede that Single Payer is likely the only workable answer in the end.

We need to do things like tort reform, the current system presumes that a doctor making a mistake is an extremely rare thing - its not, doctors are human like any other mechanic. Instead doctors over diagnose, and over treat out of fear of liability (which in most states is unlimited). we could limit liability to 2x the actuarial predicted lifetime earnings potential, and limit damages for pain and suffering to 1x that.

We need to allow insurers to pool together to purchase drugs to force the price down - medicare should also be unshackled and be allowed to negotiate pricing on drugs as well.

We should require cost transparency in healthcare - try asking how much a procedure is the next time you go to the doctor, you'll get a bunch of blank stares. People cant make reasonable choices if they cant perform a cost benefit analysis.

Those changes alone - while they may not reduce costs would stop the increases from occurring as quickly.

try asking how much a procedure is the next time you go to the doctor, you'll get a bunch of blank stares.

That's probably because the people you can ask who fully understand the procedure you need don't know what the prices for you are or everything you're going to need, and the people who know the prices aren't doctors and couldn't determine what exactly the procedure will entail. This is by design, of course, but it means that the people you might try to get a price from aren't able to tell you, even if they really want to.

Take your car to a mechanic, and ask how much a repair is before they look at your car. They can tell you typical costs, but can't tell you what your repair will cost yet. So you let them look the car over, then come back to you with an estimate. But that's still not the final cost, because once they start working something else might come up, and they'll have to stop to talk to you about the additional work. You don't know the final cost until all the work is done. That's the way it is with medical procedures too, except most of the time you can't stop midway through to discuss options and costs when something unexpected happens. The doctor just has to take care of it, and let you know about it afterwards.

There's a whole host of tests and services where price transparency would be easy. Billing simplification too (if the hospital picks the radiologist, they should pay the radiologist out of the fixed fee they charge for the xray...)

This is a great point to make too - if the hospital chooses who renders me service, I shouldn't be getting a separate bill from them.

Yeah, when it comes to really expensive stuff they'll know the minimum, because then they have their own incentives to make sure you can pay, and will be in a financial position to be able to do the post-procedure upkeep. This is especially true when it's stuff with scarce resources like transplants. It's gonna cost a fuckload, you'll have a lot of recurring costs, and they're going to evaluate if you'll be set up for success or not because otherwise there are other people who could use the organs.

Building on your car analogy, many auto repairs are common enough that their prices can be listed on the menu. Oil changes, tune-ups, tires, brakes, etc. Known quantities and easy to price. I'm sure the same is true for many non-emergency medical procedures. I don't understand why a doctor can't tell me how much it costs to put a broken arm in a cast, clean out earwax, or treat a rattlesnake bite. Well, actually, I do understand--there is a gravy train of money that comes out of hiding the expense of a service from customers until after the service is rendered.

Actually a lot of places use flat-rate pricing, where they charge the same rate regardless of how long it actually takes: https://www.aaa.com/autorepair/articles/auto-repair-labor-ra...

If a doctor wants to give me a vaccine for something, and I'm paying cash - they should be able to tell me how much it is. They can't. My mechanic can tell me how much a new alternator is and labor without looking at my car.

Yes, they should be able to tell you, but they can't because they don't know. There is a secret list of prices that are over-inflated which is used to send claims to insurance companies, with the understanding that the insurance companies will reject these prices and "allow" lower ones so they look like they are saving the patient money. The insurance company pays some portion of that, and passes the rest onto the patient. That's the number most patients want to know when they ask how much something costs, but the only way to find out is to submit the claim.

If you're paying cash, you're going to get charged that over-inflated price. It's up to you to negotiate a reduced "allowed" price, like the insurance companies do, except you have no clout. You're also not allowed to know what those prices are; they're secret because if they weren't the whole scam would be a lot more obvious and would probably fall apart. (Eg: get challenged in court)

Adam Ruins Everything - Hospitals - https://www.youtube.com/watch?v=CeDOQpfaUc8

Its an eye opener.

Yep, just saw that recently. I kind of knew how it all worked before, but he explains it well.

This place in Oklahoma has there prices listed: https://surgerycenterok.com/pricing/.

I'm sure there could always be complications but there are supposed to be laws in place to stop hospitals from price gouging.

That's great (really) but also see: https://surgerycenterok.com/pricing-disclaimer/

Those prices don't include a bunch of things you'll also need, which makes them a little misleading. Some of those things are predictable, and some, like your housing costs for the duration of your recovery, are not. In a typical hospital setting you're paying to stay in a hospital bed, and they can't tell you how much that'll cost ahead of time.

It's probably a lot easier to determine all of these costs on average rather than per-patient. Medical staff could be paid a salary, and hospitals/etc could set a budget based on average costs and workloads. Then a single-payer system could collect the money needed into one big pool and pay it out based on those budgets.

For the most part, generic drugs are cheap. It's patented drugs and out of patent drugs with only 1 producer that have high costs. Widely used drugs that aren't protected by a patent are pretty inexpensive.

I don't believe there is a functional pure market solution to health care in the world and I don't believe there ever will be.

The companies in question own system you almost can't reform it without first literally lynching the fat cats that run it.

We MIGHT be able to render it obsolete with a single payer system that actually takes care of the citizens.

I dunno, pharma companies paying middlemen to screw over consumers sounds like a pretty typical market based solution to me...

Reply on news.ycombinator.com