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Comment by bliblah | Hacker News Reader

>> just needs to be actually thought through,

It's impossible because you both political parties want exclusively mutual results

You can't have cheap insurance without making it mandatory since only the sick will get it

You can't have easily accessible insurance without forcing healthcare companies to comply with new regulations forcing them to increase costs

You can't have good insurance if you aren't willing to pay the market price which happens to be very inflated in the US

You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts

Overall, it's a shitshow that will keep being patchworked every time the administration changes between parties.

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> You cant lower costs in the US without having a more aggressive regulatory body which 50% of political bodies strongly oppose alongside lobbying efforts

Here is the fundamental problem from my point of view. Compare human medical costs to veterinary costs. Yes, people expect a slightly higher standard for themselves than they do their animals, but you can get a major knee surgery for your dog for a small fraction of what they charge for humans. The process is performed in a sterile environment by professionals in either case. We're smarter than animals on average, but our bodies and medical needs aren't vastly different.

The problem is price gouging because the providers and insurance companies know we have no real ability to shop around. They conspire with each other to publish false rates when the true costs are much lower after you agree to them.

You could maybe solve this with regulation on prices (a socialist approach), but you could also solve it by mandating they advertise true prices and re-enable competition (a capitalist approach). Either way could fix this, and the problem is corruption (lobbying) not party ideology.

You don't even have to go all the way to veterinary medicine. This is an old article, but compare the $100,000 cost for a joint replacement in the USA vs. $13,000 for that same procedure in Belgium. https://www.nytimes.com/2013/08/04/health/for-medical-touris...

They do have to publish prices, right? See: https://www.google.com/search?q=doctors+and+hospitals+must+p...

Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work.

What kind of knee surgery am I having? Will I have to pay extra for the anesthesiologist? What kind of anesthesia will they be using? What about surgery preparation? What costs do I need to include for that? What about post surgery? There's probably a dozen cost items to add to the total for post surgery. The nurse brought me a glass of water. I'm not sure if that comes with a charge or not? Presumably someone has to pay for the plastic cup. Etc.

>Maybe these aren't the "true prices"? I certainly wouldn't know where to look to find how much a "knee surgery" would cost, and I'd probably need to know some obscure medical code I don't have access to, as well as the intricacies of the knee surgery to know exactly what price to look up. I don't know how publishing "true prices" would work.

This is exactly the problem. They publish "prices" but those prices don't mean anything.

Published medical prices are not real because most procedures are paid by collective programs like private insurance or Medicare, which use their bargaining power to pay less--sometimes MUCH less--than the public "list price".

You're right that the complexity of medical billing also makes it difficult to anticipate and compare prices. However, that might be more of a side effect of how the billing is done, rather than an unavoidable attribute of medical care.

Arguably, medical providers have the information and capability to package procedures and publish what it actually costs to do them. But they have no incentive to do so, and many incentives to not do so.

Many many years ago, auto mechanics would gouge customers after fixing their cars. This resulted in laws in all US states requiring written estimates in advance.

We should expect hospitals to meet the minimum ethical standards of auto mechanics.

> you can get a major knee surgery for your dog for a small fraction of what they charge for humans.

I mean you can't really compare vet bills to surgery bills. Veterinarians have actual price constraints where the owner is willing to put their foot down once it gets beyond a certain point. They love their pets but they aren't willing to go financially insolvent for them.

No such constraint exists for American healthcare. You pay what they tell you until you are destitute and on Medicaid.

> by mandating they advertise true prices

I think most Americans want this to be the solution and it still won't work unless there is pressure on the entire system. Doctors, hospitals, surgery theaters, radiology, and diagnostics have such complex billing that even if you could price compare are you even capable of understanding what those options do?

Well, the start would be mandating that the cost must be same to all patients. Which means that uninsured/underinsured patients will face bills no greater than the payout the medical professionals get from large health insurance companies. Part of the problem is that no only are the prices not transparent (for comparison shopping), they are also different for different buyers.

  It's impossible because you both political parties want exclusively mutual results

You can't blame ACA's flaws on party disputes -- Republicans were allowed no input to the process, and it passed on Democrat votes alone. Republicans and rank-and-file Democrats* weren't even given the final bill to read before the vote*.

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