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Comment by randysavage | Hacker News Reader

My wife needed an MRI last year. The hospital quoted us $4000 as self-pay, but would knock it down to $2000 if we paid cash up front. This was late December, so we picked up insurance through the marketplace and she had the MRI done in January, billed to insurance at $250.

This still boggles my mind... I understand the insurance provider negotiates bulk rates, but we were paying up front, in cash, and were still quoted 8x the insurance price.

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I've had a doctors office tell me that it was literally impossible for them to estimate, let alone quote me, a price for how much my visit would cost.

(My finger was infected. I needed a week of antibiotics. That was it.)

Yup. Same experience here... had to have an emergency appendectomy and my biggest worry wasn't the operation itself but its cost. I persisted in asking the doctors for an estimate, but they wouldn't budge. Neither would the clerical staff... which made 0 sense to me. Its not the first operation they have done, I just wanted rough figures (i.e. 5k? 50k? 500k?) but they wouldn't give me that either.

Final billing: 55k in total, but because of insurance I paid about 5k. Which still left me wondering... what did people without insurance do? How could they possibly pay that much money, if they couldn't even get insurance?

They go broke. The exact number is disputed [0], but health costs are a major cause of bankruptcy in the USA (as opposed to most other developed countries where this uncertainty about costs doesn't exist).

I discovered an interesting fact the other day about the US's massive % of GDP spent on health; they spend about the same % of public monies on health that other developed countries do, the extra % is private spending! [1]

Anecdata: I am in Australia and have private health insurance (notably: otherwise I'd be paying an extra tax levy and be worse of in $ terms), but all that has meant is that I can go to a private hospital instead of a public one for elective surgery. For ~$2k a year. A few years back I broke both my collarbone and my ankle on separate occasions. The ankle repair was entirely free. The collarbone was setting too slowly (opportunity cost: I needed to get back to work ASAP... normally they just put your arm in a sling and let it stitch naturally), so I opted to have a surgical repair, which was about $2k all up for the out-of-pockets.

[0]: https://www.thebalance.com/medical-bankruptcy-statistics-415... [1]: https://www.healthsystemtracker.org/chart-collection/health-...

go broke as you mention, and often go without care.

Sometimes being dumped from a hospital in the middle of the night drugged at some random location.

Often times a small problem gets put off and becomes a much larger problem.

It becomes a burden on family and friends, sometimes leads to amputations and other surgeries such that otherwise could of been avoided with better care.

This a huge problem for a lot of people, especially if you add in the dental care that is needed and not obtained around the country.

ymmv

My mum was on holiday in the US and had to go to hospital in NYC. For 2 days in hospital - no operations and only a few xrays - the bill was around $30,000. I had a look at the bill and over $10,000 of this was for drugs. If she had been given what they said she would have been dead. Basically the hospital just made up a number and fudged expenses. We asked friends about it and they said the way the system works is that they give you a bill then you negotiate - usually you pay around 30% of the first amount - pretty similar to the way bazaars work around the world. Luckily she had travel insurance so just gave it all to them to sort out.

You can also get out on a payment plan that lasts for like 20 years. Then after a few years the hospital writes off the debt and says you don't have to pay - assuming you haven't declared bankruptcy yet.

We had a baby. Bill is north of 25k. We paid about 3k out of pocket, rest was covered by insurance.

Even then it’s a pretty crazy amount for what is supposed to be a routine delivery. No epidural was administered.

I can see why young people aren’t having babies. You work like a dog to pay rent and barely make it. Having a kid puts those finances in jeopardy.

I'm just glad no other industry operates this way.

"oh need new tires? We can't tell you how much it costs till we actually install your tires"

Last time I visited a doctor without insurance I had the same experience. I visited a PA for half an hour and had a vial of blood drawn and apparently the mathematics required to determine the cost of that was so complicated it required several days of calculation.

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