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Comment by pascalxus | Hacker News Reader

Employers are already paying more and more for health insurance and so are employees, it's eating up this country. 20% of GDP on healthcare is absolutely ridiculous.

They're not really focusing on the root cause of the problem: the sky high medical bills. We need to figure out what's causing such high costs and mitigate it. There are many causes: limited number of doctor/nurse seats available, monopoly problems, etc. Healthcare is not something that should be merely governed by the free market. This is the one area where govt can be a force for good. Step in and put some cost ceilings on the most predatory pricing: for example pills and ambulance service for 4000$ should be an absolute no-no.

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Drugs eat up a tiny fraction of total medical cost. If you dig into the breakdowns of where money is spent, and look at other countries, you'll find we are more expensive at every step. This includes doctor and nurse salaries, and litigation costs. It includes forcing drug companies to lower costs, which will reduce R&D since many rare conditions need high cost drugs to cover the R&D to bring a drug for a few people to market. It includes forcing everyone to pay into the system, so the insured aren't paying the medical bills of the uninsured emergency visits, which is proving difficult to do. It would involve denying care to those costing too much, which we do to some part, but not like many countries.

If you want to make our costs similar to other countries, we'd need to lower costs at each place, including doctor and nurse salaries (which will be politically impossible), cap litigation (which consumers complain about), and dozens of other components.

There is no one area that is the cause. It's death by 1,000 papercuts.

> There is no one area that is the cause. It's death by 1,000 papercuts.

Yup. A few minutes (of unnecessary) oxygen in an ambulance cost my insurance company about $500. A single oral dose of generic Keppra while in the hospital cost more than the cash price an entire month’s supply from CVS. The room I stayed in was billed at about $7300/day, but hey, it did include unlimited room service.

In fact, the only clearly reasonably priced item from my hospital stay was the generic Tylenol, I assume because it’s common enough to generate complaints.

I've been charged (or rather my insurance was) $42 for two slices of white bread, a slice of turkey, and 12 ounces of skim milk. Prices are outrageously padded everywhere.

It really boils my blood that I can take my dog to a vet and get a procedure done or procure drugs that would cost one or sometimes two orders of magnitude more if I was the one getting work done. I'm half tempted to dress up like Goofy and see if they'll be fooled...

On over priced drugs-- there's an episode of Dirty Money on Netflix on Valeant Pharmaceuticals' price gouging and fraud... It's mind boggling and depressing.

I'm not even sure they're overpriced. Profit/revenue for the pharma industry is not terribly high when taken over all pharma companies. They do well, but it's no where near the highest profit/revenue industry. I think industry profit margins are around 15%, which is not unreasonable for a high tech industry.

Hmm. I’m with you on most of these being areas of inefficiency, but I don’t agree it’s death by a thousand cuts.

Labor costs dominate healthcare.

Doctors and nurses are very popular. No one wins elections saying “hey, let’s pay healthcare providers half as much, like they do in other developed countries”. But that’s my understanding of what it would take to actually move the needle on US health care costs.

Agree with most of your points. These high deductible plans were supposed to encourage a "free market" approach to healthcare that would bring down costs, in that... "If I as the patient am paying out of pocket I will be responsible with the money". The problem is most doctors didn't get the memo, they continue with their pricing strategy, so that consumers of healthcare are not able to shop around. I don't mind if high deductible plans are the solution or if socialized medicine is the solution, as long as the end result is that health Care costs come down to what the rest of the developed world pays.

We still don't have price transparency, so it's not surprising the customers of health don't shop around.

I went to a grocery store health clinic without insurance and asked how much it would cost to see the doctor.

They were surprised I asked how much it cost, since they just assumed my insurance would pay for it. After insisting, I finally was able to get them to look it up. They told me it would be $100, but during my exit (and payment) they increased the price to around $200 based on my diagnosis. I asked why it should cost me more money for the doctor to diagnose me with something else, when the doctor didn't do any other special tests (e.g. I wasn't paying for a medical test), and they said "That's just the way it works."

Every time I've paid out of pocket, I paid for the procedure ahead of time. I never considered it, but this is one of those good examples of why to do it.

Nothing stops them from sending you a bill after.

Each time I signed a form saying that I was paying for this service at the agreed cost. There was no open ended clause about paying them anything else which is usually signed when insurance is involved. So no you are in fact entirely wrong.

And you're in the US? Have never heard of that.

Yes.

And honestly it makes a lot of sense. The main point of those "we can charge you whatever forms" is because they often don't know off hand what their deal is with your specific insurance company and furthermore they don't necessarily know which people involved are in which network, etc. yet they just want to make sure that you are left holding the bag when the final bill comes due. But if there is no insurance company involved, they only need to decide what they will charge you and it's done. In that case, the open-ended contract is entirely unnecessary.

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