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Comment by bostonpete | Hacker News Reader

Your comment seems to overlook the fact that insurance companies negotiate better rates on many (most?) services than an individual would get going at it alone. From that perspective, I think it's reasonable to say that in our current system, insurance can allow you to essentially avoid high prices even for things that are predictable/regular.

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I worked in health care and saw so much money wasted. The ACA was suppose to bring the same risk factors to everyone, so you got the same premiums based on age, gender and smoking status. Big companies got big breaks for employees and the rich paid less.

This might have worked if everyone was required to buy from the market place and there were no employer plans. Obama's famous "You can keep your existing health coverage" was a terrible, terrible decision.

I watched the Medicare/Medicate group for my company and they might have complained about not getting enough money, but I really think they did. Things had fixed prices and there'd be plenty of money if BlueCross didn't spend money on advertising, useless wellness programs and shitty IBM technology.

Everyone should just get Meidcare/Medicade. The government won't control healthcare, it will just get contracted out to providers. They'll have to cut costs and not waste so much money (they waste A LOT!)

Capitalism + Health care is a failed experiment. Socialized health care does work, in every high income country that's not the United States. Australia fought against the Abbot government when they wanted to introduce copays. That's right, Australians don't have doctor co-pays (they kinda do now, but wavers are in place and the plan was effectively defeated).

The fact that the US government requires us to buy private health insurance at insane rates is absolutely insane and the Supreme Court should have struck it down. You are not a car. Your body shouldn't have a fee for existing.

It shouldn't have a fee for existing so long as you're cool with me not paying a fee for when your body breaks down.

This is not clear, in that "concierge doctors" or cash only doctors to some, seem to have rates that are lower than what the insurance companies claim they are billed for a service. That would suggest they are lousy negotiators.

For the doctor, a great benefit of being cash only is you don't have to do billing, a non-trivial task.

I don't disagree, but I observe that if the interests of getting the lowest cost were aligned with the insurance company, and if the complexity of billing was a significant cost factor, it should be well within the capabilities of the insurance company to simplify the billing (by simplifying the requirements) in order to lower overall costs. And yet here we are :-)

I don't think this is true at all. The doctors have to justify their costs and the insurance companies have to validate that they are worth covering. Neither of those seem simple unless the insurance companies simply said, "Whatever the doctor wants to do, and whatever they charge is fine."

How do you come to that conclusion? I've seen a number of articles and cases like [1] where a company decides to charge apparently "what ever it wants" and the insurance company said "fine" and paid it. This article[2] talks about the wide range of prices for the exact same procedure within the same area. Is it your understanding that each of those different doctors justified their costs and the insurance company validated them?

[1] https://www.law360.com/articles/940691/fla-compounding-pharm...

[2] https://www.usatoday.com/story/news/politics/2016/04/27/huge...

Each doctor offers hundreds of services/procedures. Each one has a different price. The insurance company needs a certain number of doctors in the network to be competitive and they can't really have hard cutoffs for every single item. It's not that surprising that there are outliers.

Additionally, lots of doctors often bill incorrectly on purpose so that a particular services/procedure gets covered, so I am not sure we should keep "justified" and "validated" in these discussions.

Most doctors in my area will charge less in cash for people who don't have insurance vs. what they charge insurance companies for the same services.

You can also negotiate on your own. I've occasionally had medical bills that for whatever reason were not covered. I call the provider and if I owe $1,000 I'll say I can pay $500 today to settle it. That's more than they will get selling the debt to a collector so they will take it.

You generally can't negotiate in advance though, because most providers seem unable or unwilling to tell you what anything is going to cost.

That is because providers can't refuse healthcare to someone that needs it and can't afford it, so those costs get inflated just to be able to get a fraction of it. As rsync says, it's still not insurance, it's just the ability to be part of a group large enough to negotiate pricing, and has enough credibility for providers to trust them to be able to pay.

AFAIK that only applies to hospital emergency rooms. Your local doctor certainly can refuse service if you can't pay the bill.

Yes, of course. I meant to convey that for the providers that can't refuse, like hospitals or ambulances, sticker prices not realistic because the provider is having to gamble on which portion of the people they treat can and cannot pay, and how much, so they inflate their prices extremely high. And also to negotiate with insurers.

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