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Comment by spsrich | Hacker News Reader

Any parent has similar stories. Consumer law does not seem to apply to doctors and hospitals.

Imagine if you took your car into the shop - there is no price list, they won't give you an estimate, and for weeks after they send you random bills without indicating what it's for?

This affects everybody in the US, and I don't understand why it's allowed to continue, except the medical industry has bought off all the politicians

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It’s predicated on the HMO model where you pay a copay and your insurance company negotiates the rates. Under the guise of consumer choice insurance companies have expanded copays and coinsurance to shift the burden to the insured. Out of network Hospitals and doctors balance billing needs to be outlawed. They should only be able to balance bill up to the Medicaid rate.

Medicaid is already at the lowest payment rate, so balance billing to that would be a net negative actually.

Why should hospitals and doctors be forced to accept contacts from insurers that underpay for services rendered for nothing in return (being part of limited network)?

> so balance billing to that would be a net negative actually

If the regulated standard treatment costs were somehow lower than the actual delivery costs, sure. But how on eath could that happen? It's in everyone's best interest for hospital administrators to be heavily involved in setting these costs, and they have no interest in losing money.

Hospital administrators are the problem. They don't contribute to medical care, and their job is to increase profit that goes to higher salaries of themselves and other administrators.

Regarding balance billing:

If Medicaid pays $100 for a $500 procedure, and private insurance pays $400 with the expectation of a 20% coinsurance from the patient but patient refuses to pay, who is going to pay the other $100? Is the expectation that hospitals or doctors shouldn't be compensated for services rendered? Should they work for free and go out of business?

What other business exists where it's ok for people to get something and refuse to pay the bill? Auto repair? Groceries? Legal advice? Housing construction? Land purchase? Auto fuel? Electricity?

> If Medicaid pays $100 for a $500 procedure

On what planet would the special interest groups responsible for setting reimbursements make it less than the cost of delivery?

Let's try again:

> If a medical provider overcharges $100 for a $400 procedure

Ok now your position makes more sense. Debt recovery is a well-known problem and yes, providers write it off or sell the debt on.

> What other business exists where it's ok for people to get something and refuse to pay the bill?

Loans, contracts, anything covered by tort law really.

>On what planet would the special interest groups responsible for setting reimbursements make it less than the cost of delivery?

Take a guess what Medicaid pays for a labor epidural for a pregnant mother, which involves putting a very large needle next to a woman's spinal cord, with possible complications of paralysis, death, headache, back pain, infection, failure of epidural, etc?

If you run a hospital where 100% of patients are on Medicaid, the hospital will shut down immediately.

Medicaid simply pays less than the cost of delivery, and it does so because government knows it can get away with it. The government can impose its will with regulation and certification.

You have no idea how ridiculously underpaying Medicaid is. Can you imagine what would happen if government mandated that Facebook employees could only be paid a maximum of 10/hour?

> Take a guess what Medicaid pays for a labor epidural for a pregnant mother, which involves putting a very large needle next to a woman's spinal cord, with possible complications of paralysis, death, headache, back pain, infection, failure of epidural, etc?

I've looked up the price and for one hospital in Belgium [0]. The rates, including the room you stay in, are:

Uninsured: €140~€420 Insured: €17~€200 Insured with low income: €10~€190

The large variation is due to shared common room vs single personal room.

An epidural really shouldn't be insanely expensive. Of course, exposure to litigation and risk for the doctor is much lower here.

[0] https://www.azdelta.be/nl/patient/wat-het-u-zal-kosten/prijs... (in dutch)

This is not true.

https://www.kff.org/report-section/understanding-medicaid-ho...

'Any _American_ parent' has similar stories

That may be changing soon: https://www.infectiousdiseaseadvisor.com/practice-management...

* in 2021

I think price transparency is a bit of a red herring. That's not to say I don't support the idea of requiring hospitals to be upfront about costs, but it isn't going to fix issues with ER visits referenced in the Vox article. Emergency medical treatment is not really a consumer good, where if you don't like the price your can shop around or just decline to spend money. What's more, there is massive information asymmetry. If a physician diagnoses you with X and recommends treatment Y, you're not in a position to evaluate whether there's some cheaper option Z instead. Price transparency is great for elective care, but most medical treatment is not elective in nature.

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