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Comment by antisthenes | Hacker News Reader

Hospitals should be legally mandated to accept replacement of materials in lieu of payment.

If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.

It's not as if medical supplies are unavailable to the end consumer.

https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available for under $1000.

When I had a broken finger and was uninsured, I was charged ~$40 for a finger splint that costs $7 at Walgreens (yeah, the very basic one made out of aluminum and blue foam).

Also, a word of advice - never ever pay what you were sent from the hospital right away. I personally throw most medical bills in the trash and wait until they call me, then negotiate it down to a fraction of what was billed, offering to pay in cash.

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> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.

> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.

Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game. Consumers shouldn't care in particular about the cost of supplies — overall cost is what matters.

Price-fixing in general does not really work. The difference is made up somewhere. Things that would actually reduce pricing stupidity and surprise bills are obvious things like: increased pricing transparency, consumer stake in reducing costs (HDHPs are a stab in this direction), and single payer.

Trivially disproven by UK's health care system, which consistently ranks #1 in the world by outcomes and employs price caps for health care suppliers.

https://www.commonwealthfund.org/press-release/2017/new-11-c...

> Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game.

That's not what I suggested in my post at all.

Also, if it reduces costs for the end consumer, what's the harm? Why should consumers subsidize hospitals with cutthroat billing departments who make up numbers out of thin air?

> Trivially disproven by UK's health care system

Not trivially? [1]

[1] https://www.theguardian.com/society/2017/jul/18/uk-cancer-su...

> Also, if it reduces costs for the end consumer, what's the harm?

Less profit for the company.

Are you suggesting that a sick person, recovering from an operation, be responsible for researching prices on the parts that were used in surgery? Most do not have the time or expertise for that, nor would anyone want to do it.

Have your spouse/relative shop around for replacement while you recover. Or be destitute for 10 years after being bankrupted by medical bills. I know which one I'd prefer.

> Most do not have the time or expertise for that, nor would anyone want to do it.

Is that a joke? You can find most of those things with a 30 second Google search. I thought this was a forum with technically apt people?

NHS is a single-payer system, which is one of the solutions I proposed.

Yes, mandating supplies be sold at-cost is exactly what you proposed:

> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.

> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.

And to address:

> Also, if it reduces costs for the end consumer, what's the harm?

The problem is in the condition. At the end of the day, ineffective regulation increases costs for the consumer.

Health care is not a regular market. You can't shop around for emergency care when your leg is severed or you are unconscious in a car accident.

Healthcare can and should be heavily regulated, its not like buying a hammer.

Emergency care is not a great market to be a buyer in, but that does not change that market economics apply. And it is beside the point. The vast majority of healthcare is boring, predictable, non-emergency expenses that can be shopped around.

I agree that regulation makes sense, just not with the extremely specific proposal that medical devices be sold at cost (or whatever slightly higher unit cost is available to consumers).

Is anyone working on an app that can do this? There were those parking ticket negotiating apps for a bit. I wonder if there is a way to systemize the negotiation process here. I bet you could charge people up to 10% of the money you save them.

> never ever pay what you were sent from the hospital right away

This is actually good advice. It shocked me when I realised it. But it’s good advice.

People are surprised when I tell them I simply refused the 3k dollar (after insurance) couple hour hospital bill for having the flu. They couldn't tell me why two tylenols, a saline drip, and a prescription cost that much. (I was vomiting blood which is why I was taken in).

They ended up dropping the bill altogether as insurance had already paid them.

> They couldn't tell me why two tylenols, a saline drip, and a prescription cost that much

I know the US system is different to what I grew up with (UK NHS), but I have had similar "treatment" when ill as a tourist in 3rd world countries: couple of pills / drip.

I understand that the difference of systems in regards to extensive care, but a couple of pills and a drip - why on earth is such basic care just not free to all?

Have you been following the quality of people running our government?

I mean, I know this seems like just a snarky political comment. But it's just the honest answer. Our federal government is simply completely dysfunctional right now, incapable of solving anything.

For what it's worth, "Medicare for All" has been polling increasingly higher recently, due to more Americans being basically ready to give up on the current private system entirely.

> dysfunctional right now

Just now? It’s seemed dysfunctional to me since I was capable of understanding government, circa 15 years ago. My parents felt the same way 30 years ago, and their parents felt the same way 50 years ago.

It's dysfunctionaler.

Nope. No way. Have we learned nothing from "fulfilled by Amazon" counterfeits?

The supply chain has to be verifiable as genuine goods from the factory to the hospital floor. Trying to verify the authenticity of patient-supplied replacements would be a nightmare.

Then force hospitals to price match or force them to show YOU, the customer, how much the item actually cost when it was delivered to them for storage.

I wasn't actually seriously suggesting that patients be required to source the item physically, then physically deliver it to the hospital in person.

Yes. It would be expensive, and that cost would be pushed onto consumers in some other way.

Honest question - does this really work? I have tried it once or twice without success. Are there particular 'magic phrases' you need to use, or is it jut a question of persistence? Does it impact your credit?

> Are there particular 'magic phrases' you need to use, or is it jut a question of persistence?

My situations varied, but when I had no insurance and was living off of savings, I found a generic "hardship" form and explained my situation to them - they waived 80% of the fee without much resistance. This is compared to the laughable discount of 2% they offered me on the spot if I paid in cash (at the moment of the visit)

In other situations, I'd imagine it's more a question of persistence, but I'd venture to say you can knock off at least 50% on _any_ hospital bill.

I recently bought a house, and my credit was 800+, so I don't think it does in any appreciable way.

That wasn't the gist of my post though. I was advocating more to resist the bullshit and to legislate something that allows the customer to replace materials instead of paying a hugely marked up item.

Same concept would be applicable, for example, for a car mechanic shop. Just because they billed me $600 for brake pads doesn't mean that they've actually provided me with a 10x markup of value on having bought brake pads myself for $60 - at some point this needs to be treated as "usury" (I don't know if there's a word for exorbitant markup on a regular good).

Another thing I would add - don't put your social security number on medical forms. I've never seen it enforced and there's no medical reason for them to have it.

Hospitals generally operate on <5% margins. If you force them to provide supplies at cost then they'll have to get that revenue from somewhere else.

Also, people like you who force hospitals to chase you down to pay a bill are part of the reason why it's so expensive in the first place.

The hospital in OP article is part of HCA, that has perpetuated $billions in fraud profits. https://en.m.wikipedia.org/wiki/Hospital_Corporation_of_Amer...

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