Comment by notliketherest | Hacker News Reader

Comment by notliketherest | Hacker News Reader

most of the health care cost is NOT due to doctors salaries. the reason health care costs are so high in America is due to the way Providers (Hospitals, small clinics, and large Systems) charge insurance companies. Several decades ago when insurance really started getting big, they realized they had huge groups of people they could send to "in network" hospitals. they choose which Providers are in their network. therefore they have leverage over the Providers, and use it to negotiate the price they pay for all claims (the bill the provider sends the insurance company). They negotiate huge discounts on the "listed" price for a claim. Therefore, every year for decades, hospitals have been jacking up their prices in order to actually be able to stay in business (given that the large majority of costs are paid for by insurance companies, who are getting a huge discount). So 2 tylenol go from $3 to $10 to $100 to $500 over time, as the insurance companies negotiate bigger and bigger discounts. This is why the "cost of healthcare" is so high, even those it's not really the true cost. Unless you're not insured, in which case you have to pay the "actual" rate (ie $500 for 2 tylenol).

Here's an article that explains further http://www.npr.org/sections/health-shots/2014/11/15/36406408...

> most of the health care cost is NOT due to doctors salaries.

It bothers me that people continue to oversimplify problems and spin yarns about how "these people did this" and "those people did that" and that it's all due to one or two groups of bad or greedy actors.

The problem is so huge and so complex that it's worth considering that all of the proposed causes are contributing factors. There is now a systemic dysfunction that is broad, multi-faceted, and tough to dissect and study. Ultimately, many incentive systems are misaligned. The fact that the problem does have so many facets seems to always give rise to these distracting conversations where well-meaning commenters drive the discussion away from the actual findings to their favorite hobby horses instead.

RTFA. Doctor pay is an actual issue. They did not claim it is the whole problem. But it is a problem, and there are things we can do to tackle it.

And no, for the record, I am not disagreeing with you. But please, don't distract. Solve problems instead.

I feel a simple solution would be a law hospitals/clinic etc have to publish prices and all people/companies have to pay those prices.

It would stop this dual pricing and encourage healthy competition. And private insurance companies would negotiate better rates for the market as a whole.

Make an objectively true statement, watch it get voted to the bottom. You are now my Punxsutawney Phil for US healthcare: Six more years of overpriced healthcare.

Salaries make for a great distraction though, like hosepipe bans in California when 80% of the water use is agricultural.

$500 Tylenol anecdotes make for an even better distraction. The likely problem is a little of both.

Do you mean to suggest that physicians' incomes should be several orders of magnitude less than what they are currently? If not, I'll continue to be "distracted" by the Tylenol.

No, it means to suggest that the number of people who have actually paid anywhere near $500 for a couple Tylenol pills is so small as to be an irrelevant rounding error in the grand scheme of things.

Note I said paid, not billed.

20% is still a problem. Putting a cap on the the 20% contributes to the solution. If it was 1% of the problem then hosepipe bans would be inn-effective.

...While refusing to even entertain regulations on or reduction in the 80%? When the problem is truly massive, far exceeding what home use can hope to change?

I never said that. If political walls make it impossible to reduce the 80% then do what is possible. All I'm saying is that 20% contributes to the solution.

I would imagine that farmers will start revolutions if you cut off their water supplies, while city folks won't care too much if the lawn isn't watered. 20% is an easy target... hit it first and slowly work on the other problem.

The Centers for Medicare & Medicaid Services (aka the government) is the largest payor in the country and it sets floor prices for care per region. This is what primarily drives reimbursement rates.

Reply on news.ycombinator.com