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Comment by AnthonyMouse | Hacker News Reader

> Is that actually true? I always hear that line but nobody every backs it up with data. If Medicare is losing money for hospitals why do they still take it?

Fixed costs vs. variable costs. It costs a million dollars to have a hospital, then there is a further $250 marginal cost to treat another patient. If there are 2000 patients then the average patient has to be charged $750 ($250 + $1M/2000) to cover costs. If Medicare says $500 or GFTO then $500 is more than $250 and they "make" $250 by accepting Medicare, but if they received that much from the average patient they wouldn't cover their costs.

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At a minimum a lot of money would be saved by standardized billing practices and costs. If Medicare pays too little then reimbursement could be adjusted. It would lead to more transparency and less bureaucracy. I think that’s how it works in Germany. There are different insurers but they operate on a set of standards. It’s nuts that in the US every insurance negotiates separately with each provider. It’s extremely inefficient and also makes it basically impossible for the patient to do any price shopping.

Germany saves money by paying doctors $70k/yr. There isn’t a clever, low-impact policy shift that’ll save a ton of money in the US. Something really big has to give.

German doctors have much lower school debt and relatively lower tort exposure. Salaries in Germany are significantly lower across the board, so German physicians enjoy similar financial positioning relative to other professionals, and high social status.

Any attempt to reduce physician salaries in the US is going to have to also address medical school debt and physician insurance requirements & administrative overhead.

I grew up there and the doctors I knew had very nice houses and cars. Maybe they were not as rich as of US doctors but certainly pretty well paid.

Do you have a citation for that? The sources I found suggest that’s the starting salary and it goes up considerably.

Some doctors are paid that little in Germany. Here’s an comparative analysis on 2008 data: average net outflows to physicians are higher, but it seems like US physicians may be receiving a substantially larger slice of the budgetary pie https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010....

That shows MDs making almost twice what you claimed ($130k vs. $70k). Not as high as Americans but that seems insufficient to explain the huge cost differential.

and on top of that, there is a pervasive risk that a patient's provider (doctor or surgeon) may drop 'out of network' without any notice to patients. If you ever schedule surgery in the US then you need to confirm on the day of the surgery that all the attending doctors are still in network, meaning that your insurance will cover it.

You also have to check any new doctor during and after surgery while you are unconscious :-).

Especially, in my experience, anesthesiologists. They often aren't on my plan, even though the entire rest of the hospital is.

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