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Comment by lutorm | Hacker News Reader

How about everyone gets to bill through the hospital instead of every person who tangentially heard of you one way or another sending you their own bill. If the hospital is in-network, they bill based on in-network rates, and all those "providers" can take up their bill with the hospital (who at least knows they're there, unlike the patient).

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How about the state gets a bill for everyone and the risk is distributed over the population minimizing the cost and improving efficiency? This happens by maximizing the risk pool size and eliminating waste from marketing and executive compensation (and the claims denial department). This happens to also incentivize the state to ensure everyone gets the preventative care they need, and line up incentives re: legislation (for instance around cigarettes and alcohol). Then we can call it “what every other civilized country does.”

How do you then provide higher-quality but more expensive healthcare to those who can afford it?

It's pretty simple: https://www.nuffieldhealth.com/ https://www.bupa.co.uk/

But then you can’t have “everyone is charged the same” which some posters were suggesting... basically all I’m saying is that “just public” is barely better than “just private” - ideally you’d have a reasonable mix (with, of course, full transparency of prices, ratings, quality control etc.)

How is it barely better than 'just private'? WHO rankings show that not to be true (the US is 36th at $7500 per capita spend, Canada's single-payer system is 30th at $3600 per capita spend, the UK's 'single-payer' system is 18th, Spain's single-payer system is 7th). The reality is that if you're attempting to minimize illness and suffering, doing that at a larger scale is always strictly better than restricting it to those who are lucky enough to be able to pay. You can of course optimize further but single payer is strictly better than private cover. Two-tier is another valid solution.

I don't know about Canada's and Spain's system, but UK's (where I live) definitely isn't "single-payer" - there does exist private insurance, it allows you to "skip the line", get better diagnosis and probably also better treatment.

The "just public" system doesn't work for similar reasons as communism doesn't work. (1) Lack of incentives and (2) corruption. A paid-for healthcare encourages innovation (you can sell expensive new treatment to rich people who want to live longer, when the technology is mature it is then distributed to the masses), and prevents corruption - e.g. in Slovenia, which is "almost public" (i.e. the private healthcare system is severely limited by the government), there is rampant corruption - if rich/powerful people can't "jump the lines" by paying more, they will (try to) jump the lines by utilizing other forms of power (threats, favors, gifts, ...).

It's easy to shit on US/Switzerland, but keep in mind that their "expensive" healthcare systems also fund a huge amount of farmacy research that then "trickles down" to other countries.

You provide the same high-quality healthcare to everyone because nobody is better than anyone else on account of wealth. Wealthy people don't suddenly need different healthcare when they make money.

Why not also provide the same high-quality cars, housing, jobs etc to everyone?

Hint: communism doesn't work.

Also, the reality is you have to prioritize. A public health-care system has a limited amount of money (by definition) and needs to spend it in a carefully balanced way. E.g. you'd rather operate/save a kid than a 90 year old person. Another example is, governments "advise" citizens to do preventative exams based on cost-efficiency, not on "best quality healthcare" - it's simply unrealistic to perform a mammography on 50% of the older than 25 population every year. But if someone wants to do that, and can pay for the costs themselves, why would I, you or the government limit their freedom?

The system described above, as applied specifically for healthcare, works wonderfully for most in countries that use it - significantly better than in US, anyway. That alone is already a reasonable answer to your "why?".

But also, there's no reason why you can't have private insurers providing better options on top of a public system. In fact, most countries do exactly that.

This seems like a reasonable solution. It's basically how we handle telecom and utility billing.

Hell, it’s how we handle restaurant billing.

let's talk about the tip again?

If it is mandatory, it is not a tip. My old boss told me how he was at a dinner with our Australian overlords (long story) and they said nobody will leave any tip.

If a tip is mandatory, it is a service charge. I don't go to the extreme of never tipping but I usually do not tip if the bill has an itemized service charge.

Services that are "out of network" are not optional.

(warning: may make you angry) https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-sur... (2014)

archive fo: https://archive.fo/TBmrO

screenshot https://screenshotscdn.firefoxusercontent.com/images/adb3850...

When there is an itemized service charge, tipping is rarely expected. It is an option, but not expected.

Yet there always seems to be a space for it, or a step to skip. Sure makes it seem expected when it's not simply leaving bills on the table before you leave.

If it fixes all other medical billing, I am OK with doctors office is asking me for an optional tip based on how good I think the service is.

That would be LIGHTYEARS easier to understand than what currently exists.

Friendly reminder, those things are optional, and not human rights.

Being provided healthcare is a “human right”? Sounds more like forced labor to me.

That's absurd. Nobody in any OECD country where healthcare is a human right is required by law to practice medicine. People do it as a public service, because they care. No doctor in Canada has a whip behind them as they apply bandaids. In fact, it's absurdly difficult to get into medical school in Canada, but people do it anyways because it's a mid-six-figure good job. That people who are sick are entitled to healthcare via voluntary labor is in violation of nobody's rights and you know it.

Not even Canada's furthest-right-wing parties advocate privatizing healthcare. They don't even talk about it. Because Canadians know that fully private healthcare is a shit system.

Healthcare as a right is your freedom to pursue your life regardless of the circumstances of your birth. It's the ultimate freedom - the freedom from worry, from illness, from bankruptcy. Freedom to pursue your own business or being an independent contractor without fear of death.

Your "slavery with extra steps" argument is long dead. Maybe read this? From 2009. [1]

[1] https://www.pri.org/stories/2009-10-15/canadian-health-care-...

It's forced labor in that the state takes the proceeds of some of your labor in order to pay those doctors to treat others. I.e. Taxes. No one is saying that doctors are put into work-camps or threatened into working.

Oh, I see - so are you suggesting the interstate system, the fire department, the post office, the public school system, the water pipes, electricity, gas, medicare, medicaid, the army, every regulatory body, and so on are all forced labor? If so, great, count me in. It feels like an entirely arbitrary place to draw the line to say you support public education and the fire department but not public health. If you support neither, well, the dark ages are that way. Literally because the power grid is socialized.

Either way, nobody's forced to work. Neither you, nor your doctor.

If we don't work, we starve. Yes, every living being is 'forced to work'. The gun may be held by an opressive government, or nature itself, but work is as omnipresent as death and taxes.

I have read that hospitals actually tell providers to not be in network so they can make more money.

I've never hears of anything like this, where can I learn more?

I don't know about his allegation, but if you are seen at an in-network hospital by an out-of-network doctor, you pay out-of-network. Even if you were unconscious, anesthetized, etc.

Right, I'm moreso curious about the validity of the conspiracy theory.

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