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Comment by golfstrom | Hacker News Reader

Medical providers in the US do not compete on price. There is in general little to no price transparency, as everything is traditionally paid for by private insurance. So as a rule, dentists will charge the maximum allowed by private insurance for x-rays.

In the US, people are complaining more and more about the cost of healthcare, but usually in terms of the cost of insurance. They never ask why providers charge what they do (p.s. - if you're in the hospital, don't ask your nurse to bring you a tissue, just buy some from the gift shop).

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As I have mentioned before, you don't expect your automobile insurance, even full coverage, to pay for a tuneup. Expecting medical insurance to pay for regular care is just inserting a middleman that extracts value while increasing costs and adding no benefit.

Of course, this means people would have to pay for their regular care and visit the doctor on schedule.

The reasonable alternative is single-payer health care. Insurance is for catastrophic things, not for regular maintanence. Using it to pay for penis pills and birth control only makes it more expensive. Pushing for insurance to cover more things is only making the fees go up and their profits greater. Insurance shouldn't cover your regular checkup.

And, as stated, single-payer appears to be the only rational solution. According to the vast amounts of evidence, it is even less expensive on the whole society AND has better overall outcomes. Those of us with money will still be able to pay for extra care, there would still even be an insurance industry.

>The reasonable alternative is single-payer health care. Insurance is for catastrophic things, not for regular maintanence. Using it to pay for penis pills and birth control only makes it more expensive. Pushing for insurance to cover more things is only making the fees go up and their profits greater. Insurance shouldn't cover your regular checkup.

I really hope that the dissident right and progressives can team up on this. We can offer every American access to quality, cost effective, non-discretionary care for less than we currently spend on the ACA's contorted cross-subsidy and insurance profit guarantee scheme.

We could offer everyone access to no-cost healthcare and cap the expenses at something like 10% of our GDP with a fully empowered rationing feature that gives us the best QALYs for the money. We'll have to fight past the views of extremists but it would go a long way to making the U.S a better nation.

And it would permit a separate completely private, minimally regulated healthcare system for those who wanted it.

"Charging the maximum allowed by private insurance" is the same thing as competing on price. You're just competing to please insurance plans, not consumers. Admittedly, the insurance plans have every incentive to play ball: they want to brag on large provider networks in order to sell themselves to employers/consumers, and every corporation and person in the US is legally obligated to buy health insurance, so they don't lose customers by failing to deliver value for money.

And health insurance companies have capped profit rates - the only way to return more money to shareholders is to cover more expenses. A $10 treatment means the insurance company gets to send about 80 cents to the shareholders, a $100 treatment means they get to send $8 to the shareholders. Is it any surprise that they don't really care about prices when they're incentivized to make prices more expensive and the law stipulates that you must buy health insurance if you can afford it?

Yep. Before the ACA passed, 50% of my claims (of which I had many) would come back denied and I had to go through and appeal all of them. After the ACA, no denials.

However, the actual prices have gone through the roof. Before the ACA, the total amount paid to Labcorp for some bloodwork was about $28 a few years ago, same bloodwork today I get a bill for $300. This year I needed some labs where my doctor normally charges $60. However, there was one test he couldn't do and I'm a hard stick, so he told me I should just get it all done at the hospital. I know hospitals are expensive, but I figured paying another $200-300 would be worth not getting stuck twice. When the bill came it was $1150 with the special test only being about $30 out of the $1150. Insurance never would've allowed this rate before but now they're incentivized to make prices higher.

America never ceases to surprise me. It’s amazing how many people have probably died and committed suicide because they couldn’t afford healthcare.

It’s really a shame how the wealthiest nation on the planet can’t provide for its citizens.

Or it means that to become the wealthiest nation, you’ve got to be ruthless and screw the poor. This means America will be a wealthy country, shitty healthcare, literally shit on the streets and will do absolutely fuck all when natural disasters hit.

American healthcare isn't universally crappy, it's just expensive at every quality level.

I don't think America became wealthy because it has crappy social services, but I think that a crappy social safety net and a big upside to personal success makes it an environment that really gets peak performance out of driven people.

I agree that almost all medical providers that take insurance do not compete on price.

However, even for medical services that insurance doesn't cover or cash only practices, people are terrible consumers. One of the biggest problems I see is that people have no idea on how to judge a physician and take price as a proxy for quality. For example, I found out my doctor did a medical treatment (not covered by insurance) for $150. Three other doctors quoted me $750-1150. One quoted $3500. When I told my friends about this bargain they all looked at me like I was insane. When I told my other healthcare providers, they went "Who? Oh, I know him. He does that? For $150? Really?! I'll have to go see him."

With dentistry, there's often total annual payment caps on insurance and a lot isn't covered. When I managed a call center I was astounded by how much the agents paid for dental work. They would just literally see dentist referral ad on TV, go to that dentist, and then when quoted $6k, would just go "ok" and agree. Of course, I also saw many of these people pay thousands above sticker on cars with no shortage (Nissan Altima).

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