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Comment by feanaro | Hacker News Reader

That still doesn't explain how prices of medical services in many other countries turn out several order of magnitudes smaller than commonly encountered prices in the US.

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I've discussed this before, but I think there's quite a bit of funny money in hospital bills -- a 10k bill rarely actually materializes in 10k transferred across all parties involved.

Doctors bill $10k to your insurance, the insurance decides its too much, lawyers are on-hire to negotiate and take a 30% cut of the outcome, and finally 2k is paid out; the absurd bill naturally accounts for the absurd process, and I don't think anyone except the consumer ever expects 10k to really be 10k. And ofc, the insured consumer only ever pays $500 of it from his deductible.

This was basically Shkreli's defense as well -- the insured patient doesn't pay anything close to the bill given; and I'm pretty sure, neither does the insurance. If you want to raise the price be $10, you add $1000 to the bill.

This type of billing practice causes a mess of winners and losers, essentially unless your insurer has good pricing with wherever you end up getting treatment (often not a choice you get to make in an emergency), you can end up holding the bag for the cash price, usually half of the $10k number you mention. Quite ridiculous when other insurers are paying less than half that price, smells of a scam.

My conspiracy theory is it was designed this way over time so that people “needed” insurance (before it was required).

Not too much of a conspiracy theory.

What’s ironic (?) is that by mismanaging a scheme to get everyone on private insurance they’re really working towards socialized insurance. Which good or bad, there is no going away from once you have it.

Agreed, providers are not as willing to negotiate with you as they are with insurance companies. Probably because they've already negotiated...

Just go all cash with an HSA.

I'd be curious to know how much of that is caused by malpractice insurance. I mean if hospitals were overcharging so much, then surely we should see lines of rolls royce in the hospital parking lot. Doctors are well paid in the US but they are typically not rich.

> Doctors are well paid in the US but they are typically not rich.

What doctors do you know? My friends who are just getting out of residency and such are making a few hundred thousand a year. My college roommate’s father was an anesthesiologist making $800k/year.

Just because they don’t draw attention to themselves with ostentatious vehicles doesn’t mean they couldn’t afford to (the anesthesiologist only had a Porsche for each of his kids).

The first result on google (that I don't particularly vouch for) seems more in line with what I would expect:

https://www.sokanu.com/careers/doctor/salary/

So between $200k-400k depending on seniority and speciality. It's not really outrageous compared to other, highly educated professions.

Not outrageous, but that puts all of them in the top 4% of US incomes, and after a decade or two of that basically all should be counting a few million in assets. That’s rich and far, far beyond average in this country let alone the world. Compare to other first world nations where doctors typically make half that (or less), but probably aren’t saddled with the unreasonable educational expenses.

As I said, I don’t think they’re actually charging that much — negotiation with insurance is expected, with like 80% reductiond to initial price. They’re still paid very well ofc, but I think complaining about the high initial bills itself is a red herring, because no one involved expects that amount to actually materialize

HDHPs are becoming extremely common. A $500 deductible would be amazing. Deductibles in the thousands of dollars are more common - mine is on the higher end, $6600, while still costing more than 20k a year.

Are the prices that Medicare pay orders of magnitude different? ISTR that Medicare and the VA both pay about $10k per patient per year, which I think is comparable with the NHS. No sources as this is half-remembered.

People on Medicare are over 65 and people in the VA have been in the military. Both of those groups of people are going to have much higher medical needs than the general population.

NHS spending is £2892 per person/year, that's quite a bit lower.

Interesting, this paper gives £2256 (table 2) https://www.health.org.uk/sites/default/files/AutumnBudgetWh...

This page gives $4246: https://www.healthsystemtracker.org/chart-collection/health-...

Huh, that's much lower than I thought.

There's a bit of complication because we're comparing one system with not much insurance with a different system that has a lot of insurance.

Here's a nice run through of the numbers.

https://www.bbc.co.uk/news/uk-42950587

We would also need to know the average number of visits per patient before this data means anything otherwise it's just data without context or meaning.

US health spending in aggregate is between 2-3% more than comparable European countries. Life expectancy is several years lower.

Because doctors in the US can easily make $300k+.

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