Hacker News Reader

Comment by stdplaceholder | Hacker News Reader

Even if you ask for the price and even if you get it in writing up front you will still get a different bill later.

Legislation requiring up-front presented costs to be honored and any additional procedures/costs to be cleared with patient consent as they happen (or a consent waiver obtained from the patient with a promised limit or incentive such as overall discount) might be an improvement. Or it may increase costs for the worse. Who knows.

Careful there though. If a surgeon is operating on cancer and discovers that the tumor is much larger than expected the operation will take longer - be more expensive - or the surgeon does the operation as planned and then charges even more for the second surgery to remove the rest. Or maybe all operations are estimated as the worst case and so you end up with no more clue about what you will pay than today - in some imaginable worst case this could be a five million dollar operations, so even though 99% are only fifty thousand you get that high estimate.

Which is to say don't propose something until you understand the unintended side effects. You can get your desired result but while making everything worse. (this paragraph applies to everything in politics)

> Which is to say don't propose something until you understand the unintended side effects. You can get your desired result but while making everything worse.

I think the American experiment in trying to provide market health care has demonstrated that you can, in fact, have a 'free' market for healthcare, while making almost everything about that healthcare worse.

The american way is not a free market. The employer tax break on health insurance is a significant manipulation.

A constant 30% discount on employer insurance via tax breaks does not explain the ludicrous growth in hospital bills over the last 4 decades.

Your vision benefits enjoy similar tax breaks, but I've yet to see an optometrist try to bill someone without benefits $800 for a vision exam, or $4,000 for a pair of glasses.

Its not the tax break. It's something else.

Insurance companies benefit from all those tricks: medical care billing is too complex to understand unless you have a full time team of people to understand it. Insurance companies have this team and you don't.

Vision doesn't work that way because enough people don't have basic vision care that they won't stand for the complexity.

So, the problem is that medical billing can be made too complicated for the free market to work - not the flat ~30% tax break?

NO, the problem is medical billing was allowed to become too complicated, and it is very hard to unwind that situation.

I'll contend (though of course there is no way to prove this) that if we hadn't had the advantage to company provided insurance the complex billing wouldn't have developed in the first place.

That’s not really the problem we face, though. Our problem is you ask how much it costs to give birth at a hospital and then everything goes according to plan and later you get endless bills for much more than they said, often from providers who weren’t even in attendance, for materials that weren’t even used, and so forth.

I mean, I guess, but that's kinda a worst case. My vet, for instance, quoted me up front, made me sign to say that I was willing to pay (I think) up to $x000 and notified me that they might contact me if they need to do extra work, and then did the surgery with an up front payment. They ended up refunding me money after the fact.

No reason we can't have something similar that in US health care as far as I'm aware, at least for the happy path where the patient is lucid and in a reasonable state of mind up front. But then again, why do we have to worry about this when plenty of countries have a basically-zero-fee system in place?

Reply on news.ycombinator.com