Hacker News Reader

Comment by estebarb | Hacker News Reader

Meanwhile in Costa Rica the treatment for even more poisonous snakes would cost zero dollars with zero zero cents (including helicopter or small plane, if required). Here antiofidics are produced by the Universidad de Costa Rica, and every public health center has a reserve of it. Those serums are exported too. I really can't understand how USA got public health so wrong. Here we pay like 9% of tax over salary and get "ALL the health cover you may need": broken legs, cancer, HIV, transplants... You name it: each and every treatment is free: no deductible, no coverage limits, no contractual exceptions, no preexisting conditions, not even a call to the insurance company before receiving treatment or having to provide your ID. Sometimes I had thought about applying to a cool techco at USA, then I remember the health system differences and I forget it.

View on HN

Well McCarthyism removed just about everyone who would have fought for public health care in the 60s with the rest of the western world.

What foreigners with socialized systems dont understand is that financing is not the same as cost.

The us has individual financing and high cost. The industrialized world has medium-high cost and no individual financing. Third world countries have no individual financing and low cost.

Individual financing does have an impact on cost, but thats not what makes healthcare in the US expensive as a whole. Its a combination of regulatory capture and subsidies and regulation. And the public is also very responsible for such a system because americans are very averse to sub-standard care.

How does any of this explain haggling over a medical bill?

That’s what individual financing means.

Most people who respond with mock disbelief in US medical discussions are actually responding to the perception of medical care being expensive, not in shock at the idea that anyone would ever have to pay out of pocket.

The point is that US medical care is expensive because we pay nurses and doctors an order of magnitude more than they’re paid in Costa Rica. That makes everything expensive; where that expense precisely gets billed is mostly window dressing.

Paying for healthcare you need out of pocket is pretty fucked up.

How does any of this explain haggling over a medical bill?

That’s... what I just explained? Haggling over a medical bill == individual financing.

That Costa Rica reference threw me off, I didn't realize that your claim is the haggling over medical bills is built in into the US health care system.

Costa Rica was the starting point for this thread.

Haggling over medical costs is built into individual financing, but of course most people in the US don’t do individual financing, so my argument is more that arguing over idiosyncrasies of individual financing is usually a red herring when discussing the US health care system.

As long as a human being provides a service and another human being wishes to consume it, there will be haggling. You just might not see it happening when a third party does it for you.

Taking this to the logical conclusion we have "I will break your teeth if you don't give that stuff of yours because I can". Social structures and laws evolved for a reason.

Thats violence. A doctor choosing to provide a service is not violence.

This has nothing to do with the practice of medicine, or choices doctors make.

Anyway it's a threat, just like "we will send a collection agency", or "your credit score will be affected"

> The us has individual financing and high cost.

I think that's quite an understatement given total healthcare spending in the US is over 2x the OECD average: https://data.oecd.org/healthres/health-spending.htm

Services are also very different. One must adjust to that: US has many more high-end healthcare services.

In any case, you cant lower spending and increase access by socializing care: government will have to ration it.

But that's even worse - now the $143k bill is sent to the government which just shrugs its collective shoulders and pays it... until the money runs out.

As an Australia who enjoys universal healthcare, not once have I ever worried about being sick financially and how much it would cost me.

I can go to any doctors I want and easily afford the medication I may need, and may visit a doctor preemptively and without worry about cost.

It saddens me that American citizens are suffering with such an awful healthcare system, and no where in the galaxy would I ever wish a system like yours to enter Australia.

You should vote for universal, single payer healthcare.

No you should not. Can you please stop advocating for something that cannot be comparable to your specific case in Australia ? Do you know the costs of the real medicine and procedures that you mgiht never ever experience but they are still there ?

Happily, this extended to me (US citizen) while visiting and requiring stitches. No cost, wonderful people, even though I didn't have my insurance card with me at the clinic and they had to take my word on faith that I would call it in later.

Why would there be a $143k bill at any point? You only get that if there are profit-maximizing companies in the supply chain.

Wish I could upvote this more. This is on point. There never was $143k involved in that service.

That's not what happens in practice - a government has a lot more negotiating power, and less skin in the game, than individuals who need the treatment. Governments can and do sometimes refuse to pay treatments that are too expensive. This may cause citizens who want that treatment to be upset, but for 99.99% of treatments it leads to them being a lot more affordable.

Not really: hospitals are public, and doctors are on government payroll, which keeps their prices on check. For example, a similar emergency here would cost nothing to the patient, and less than $2500 to the public health system (mostly helicopter gas): more or less $0.001/tax payer. Costa Rica has around 1000 cases like this per year, so state of the art snake poisoning treatment coverage costs less than $1/tax payer/year (most cases doesn't require air transport).

The public health coverage covers everyone depending on the worker so the system receives money (from salary taxes) proportionally to the amount of people it has to cover (think of it like a non for profit health insurance company).

A nice result is that competition from government keeps private sector prices low, and more or less still accessible to most population. That is why here private hospitals are profiting from medical tourism.

Other countries spend substantially less on healthcare, not more.

You make it sound as if single-payer will lead to higher costs but that's demonstrably not the case. Look at the OECD healthcare spending, which includes both government and individual expenses: https://data.oecd.org/healthres/health-spending.htm

The US is over 2x the average with its free for all system while the single payer countries all pay substantially less.

Reply on news.ycombinator.com