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Comment by sonnyblarney | Hacker News Reader

Everyone in the medical industry is complicit.

Doctors, nurses - even if they are removed from it - they are essentially corrupt and responsible - they cannot wash their hands of it.

This is a deep, deep social problem in the US - far bigger than many of stupid things they talk about in the press.

It's probably bigger than prison reform, policing issues, privacy etc..

It might be the #1 social problem in the US given how many people it affects (basically everyone), and the vast sums in involved.

50% of bankruptcies are due to medical bills.

In 100 years I think they will look upon this period as Dickensian.

I think free markets are important but I'm not sure if any of this is free market at all ...

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> I think free markets are important but I'm not sure if any of this is free market at all ...

For reference, I worked in a large medical billing office for years.

It's not a free market, it's the opposite. Completely socialized, just in a very round about way.

Medicare pays roughly 10% of any bill that's charged. It's a flat rate now (but remains about 10% of what insured people pay). Essentially anyone with insurance is "taxed" by having to pay 100% (then negotiated down by the insurance companies). You legally cannot not have insurance, if you make over a threshold (in part due to Obamacare), which has made the issue worse.

The above combined with the inability to see prices beforehand and the way the U.S. foots the bill for the worlds medical research has made it pretty insane.

IMO the ideal solution is to make insurance illegal. Hospitals then need to manage the cost and risk of running procedures. Yes, this means some people get worse treatment, however -- they also only get paid if you live and are happy. The incentives are then aligned, and the hospital manages the risk so better hospitals stay in business longer.

There may be some middle ground there, but having worked in the industry, it's the only "good" solution I see.

> Completely socialized

No, unless words lost all meaning the US health system is far from socialized, it would be if the cost structure was under government control, it's quite the opposite, for-profit insurers and healthcare providers set their rates as they please. Medicare maybe makes it subsidized, not socialized.

> having worked in the industry, it's the only "good" solution I see

Well, that's quite surprising for a professional to not know that there is a whole bunch of countries that do things quite differently (actual socialized healthcare) and that don't have anywhere close to this sort of problems (See: Europe).

Insurance is up there with penicillin in terms of it's ability to help the masses. The idea that we can avoid the 1% chance we might lose our homes to fire if we just pay a small amount has transformed society.

So we still want insurance.

But we need a way to make it more competitive.

Ultimately - even with insurance - the 'price comes home' - and most of us are very price sensitive.

If we had to pay for plans out of pocket ... and they were different prices with transparent points ... we'd see competition.

Also as you say hospitals have to be fully transparent about stuff.

If someone working on your car can bill you for labour and materials, so can doctors. This 'billing problem' is BS.

For example - hospitals should just provide many things as complementary, i.e. just part of the stay in the 'grand hotel'.

Regular doctors + nurses time should just be part of the deal, you only pay extra for surgery time.

Inexpensive things like x-rays should be part of the daily rate, not a specific charge.

Can you imagine if the hotel charged you for every coffee creamer? My god.

I've worked in insurance for almost a decade (P&C), and I believe what the U.S. calls "health insurance" is a travesty.

"Insurance is a means of protection from financial loss. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss"

Insurance should never be used for something CERTAIN and inelastic such as healthcare. For specific health risks, sure, but for standard care? It makes absolutely no sense.

I don't know how the U.S. can fix its healthcare crisis, but it's an absolute disaster. Other countries don't have 48k allergy tests.

> You legally cannot not have insurance, if you make over a threshold (in part due to Obamacare), which has made the issue worse.

Huh?

You pay a penalty at the end of the year if you did not have insurance throughout the year. The penalty is a percentage of your yearly income

> 50% of bankruptcies are due to medical bills.

I wonder what percentage of those are people who could have negotiated their medical bills down further, but either were unaware of that fact, or had too high a Conscientiousness trait to think of "imposing" on the hospital that way.

I don't think it's 'conscientious' at all to not negotiate.

That's apprehension, fear, excessive humility.

It's actually conscientious to negotiate a fair price.

In any event, it was beyond their means - and there's no reason for it in most cases.

Ah, you're right, Conscientiousness is the wrong word. (Though, to be clear, either way, I'm not talking about the lay-usage, but rather the specific definitions of the https://en.wikipedia.org/wiki/Big_Five_personality_traits as jargon.)

I meant to refer to the Big-5 trait of "Agreeableness." Emphasis mine:

> [Agreeableness is the] tendency to be compassionate and cooperative rather than suspicious and antagonistic towards others. It is also a measure of one's trusting and helpful nature, and whether a person is generally well-tempered or not. High agreeableness is often seen as naive or submissive. Low agreeableness personalities are often competitive or challenging people, which can be seen as argumentative or untrustworthy.

Not nurses, not Doctors of Physical Therapy, not ocupational therapists.

Physicians, Pharmacists, pharma companies, hospitals, insurance companies, and pharmacies are the corrupt ones. Source:

https://www.opensecrets.org/lobby/top.php?indexType=s

These groups are lobbying the government to establish monoplies.

The previously mentioned practices are not paid anywhere similar to the ones lobbying/bribing.

Doctors and Nurses I understand are not directly involved, but they reap the rewards and are close enough to be complicit.

If Doctors guild's wanted this changed, they could. They have immense power.

The problem might be that nobody knows what the answer should be: it may not be socialized medicine.

But some basic things like price transparency, 'one price for all' (i.e. have to charge everyone the same price), requiring people to be informed ahead of time of the costs etc. might help.

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