Hacker News Reader

Comment by lisper | Hacker News Reader

You weren't paying for the glue and the five minutes. You were paying for the overhead of maintaining all the other stuff that was there that you might have needed under different circumstances but happened not to need that day.

View on HN

While that's true, that's also true for all other countries where hospitals don't bill you $2,600 for glue and five minutes. So now the question merely shifts to why America needs that much money for stocking supplies and keeping doctors sitting at hospital.

Good point. There are three additional items that U.S. hospitals have to pay for that non-US hospitals don't (or that they have to pay a lot more for):

1. Malpractice insurance

2. The overhead incurred by insurance companies and

3. The cost of serving uninsured patients who can't pay out of pocket.

The third one is huge. US emergency rooms by law must treat serious conditions -- but only serious conditions -- whether the patient can pay or not (for some value of "serious" -- I'm not sure of the details, but that don't really matter here). So there's a substantial population that can't get preventive treatment and so have no choice but to let minor conditions go untreated until they become serious (and, of course, much more expensive to deal with).

So currently if you get sick, you "win" the sick lottery and get to pay for other people's illness as a result.

What's a fair rate for a cut that just needs skin glue and some antibiotics? $500? or is it more like $2600? Because it sounds like he's paying somewhere around a 5x multiplier just because 1) he got a cut and 2) he can pay it.

At some point that won't be sustainable, and emergency rooms will shut down from the cost. People will just stop going to emergency rooms if it means getting a bill for 5x for what it should cost.

It’s already not sustainable.

It's more that they paid to cover the costs of all of the other emergency room patients that never paid their bills.

No one actually pays the sticker price anyway, that's an artifact of the strange ways that medical billing works. People that pay in cash (rather than insurance) are given large discounts.

If I go to an Apple store and buy a mouse would it be reasonable for them to add on $300 for keeping iMacs in stock just in case I'd wanted one?

Is it reasonable for Apple to charge $89.95 for a switch?

https://www.apple.com/shop/product/HJBD2LL/A/ablenet-plate-s...

Also, Apple doesn't have to factor in the cost of malpractice insurance.

This product costs 5 cents more on the manufacturer's website, and the manufacturer charges $9 for shipping.

That would make sense if it was a fixed charge regardless of treatment. But if you did need those extra facilities they would charge you even more!

Sure, the overhead charges are spread proportionally according to usage, not equally among all patients. I see nothing wrong with that.

No none of that overhead was needed. He was giving them free money. That's what this system is more akin too.

Please go back and re-read what I wrote, paying particular attention to "might have needed under different circumstances but happened not to need that day".

Oh, I didn't notice that my bad. So like the hospital is prepared to do open heart surgery on me, I should pay for that just in case I need it when I go to the hospital for a common cold. Makes 100% sense.

If that overhead cost was required the insurance company wouldn't have been able to negotiate it down

You could make the same argument for any discount offered by any company to anyone at any time.

It needs to be billed and itemized then because that's racketeering language.

Moreso for the indigent patients who don't pay at all for ER use.

Reply on news.ycombinator.com