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Comment by Wowfunhappy | Hacker News Reader

Realistically, how am I supposed to act in a financially responsible manner when I don't even know the order of magnitude a service will cost?

Unforeseen complications are not exclusive to the healthcare industry. Imagine if you were trying to build a house, but had no idea how much it would cost. "Realistically, no construction company will give out a price; they don't know what unexpected complications may arise."

Something needs to happen here. Either healthcare is socialized (my strong preference), or the industry needs to implement some type of price transparency.

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With respect to financial responsibility, if the cost of the delivery is a concern I don't think the couple in question is financially stable enough to start a family anyway. Even if this proposed change does occur there's a good chance it actually makes the procedure in question more expensive. If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an ucomplicated birth in order to subsidize those that do experience complications.

Not to mention, your analogy to construction works is a good one - but perhaps not in the way you intended. Plenty of construction projects run into complications and experience cost overruns. The only situation in which I can see hospitals giving out prices is in the same context as construction projects. Non-binding estimates that are projections based on prior assumptions, which will change if unexpected situations occur.

In fact the best analogy I've come across is with car mechanics. Fixing a person is like fixing a car. The shop can charge a set rate for labor, and will provide an invoice for parts. In that sense, price is perfect transparent. But even the best mechanics can't predict with certainty what it'll take to fix a car without seeing it first. Who knows when they'll pop open the hood expecting to do a standard operation only to find that the car is messed up way harder than was originally predicted.

> With respect to financial responsibility, if the cost of the delivery is a concern...

As the GP noted, if you don't even know the order of magnitude to expect, the cost will always be a concern. The upper bound on the price is in the trillions, after all.

> If we start making hospitals list prices beforehand, then they're going to have to raise the base price for an uncomplicated birth in order to subsidize those that do experience complications.

This function is currently performed by insurance companies; a frequent criticism is that insurance should limit itself to true emergency situations, but when any routine operation can balloon in price unexpectedly, it's not irrational to want its purchase mediated through the insurance provider.

While the exact prices may not be exposed, estimates from past customers can be found online without much difficulty. If you seriously think that a hospital charging trillions of dollars is a possibility, I don't think you're writing comments in good faith.

Prices negotiated with insurance companies are negotiated under conditions very different from an uninsured patient. For example, risk of non-payment is drastically higher among the uninsured. This had to be offset by charging a higher rate so those losses are made up on patients that do pay. If you offer to pay for medical procedures in cash and immediately then you can usually negotiate the price down to a fraction of the list cost.

> While the exact prices may not be exposed, estimates from past customers can be found online without much difficulty.

They can?

Vox's reporting over the past couple years has suggested quite the opposite—that past prices are not easy to find, and that even when they are, your price can drastically vary from someone else's even for the same service. That's why they started this "submit your emergency room bills" project.

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