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Comment by brianwawok | Hacker News Reader

> when a person is sick or injured, they usually are not able to comparison shop.

Strongly disagree.

According to NPR today, something like 75% of in-patient and 90% of out-patient events are shoppable.

Think something like having strep throat, or having a possible broken arm. Nothing stops you from looking at a few places before treatment.

Sure some cases are you got shot or had a heart attack and had to get rushed to the ER. Of your total medical visits in your life, what % of your total visits were like this?

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> According to NPR today, something like 75% of in-patient and 90% of out-patient events are shoppable.

What are these numbers based on? I recently needed to have some blood tests done (cholesterol and A1C) and blood tests aren't covered by my NYS marketplace purchased health plan. So, I called multiple labs in my area and I couldn't get a single one of them to give me a number. They couldn't even give me a ballpark. I couldn't even get anybody at any of my local hospitals or doctor's offices to give me a base cost of an appointment with an allergist to look at a rash.

Lucky for you they have to publish it now.

I think you misunderstand shoppable. This just means that if anyone WOULD give you the prices you would be able to choose. Contrast with emergencies or procedures where there is only one specialist in the area etc.

This is the point of transparent pricing. It's impossible to do so right now, even with insurance. If they can even give a ball park number for a particular procedure or test (average, or min-max range, or SOME number) it would help with shopping around.

The point of those numbers is exactly the same as what you describe. They are saying the majority of medical issues are things you could call around for beforehand, just the same as you tried and failed to do. The point of the executive order is to force places to actually give you a price when you ask.

...having a possible broken arm...Nothing stops you from looking at a few places before treatment

Except that you're laying on the ground writhing in pain, not the easiest time to pull out your phone and pull up pricewatch.com before you call 911 to find out which hospital has the best deal on x-rays today.

Most people have some family members or friends who would do that. Where i live (admittedly not USA) it's very rare for a person to go to a doctor alone.

In the case of a broken shoulder (collarbone), the ER often does some X-rays, puts you in a sling, prescribes painkillers, and sends you home.

You find a specialist the next day. And if you require surgery, that's another day or two. There's no reason you couldn't do a cursory sanity-check on pricing in this case (if pricing info was easily accessible).

yep, sounds correct. Broke hand, went to the closest urgent care, they did xrays, confirmed it was broken, put it in a sling, and referred me to a specialist (by just giving me a note confirming that they referred me with the specialist's phone number) that they thought was good and was close to where I lived. However, they didn't have to pick that specific specialist. In fact, they even asked me if I had a preferred specialist and/or hospital. I called the specialist the same day, had the appointment a few days after.

Having had plenty of surgeries from fractured bones and torn ligaments you can certainly do this. There will be emergencies where you can't but I would think in the typical scenario you have the time and ability to price compare.

I've even broken bones on vacation and only had x-rays after I've arrived home. Does it hurt? Yes. Am I incapacitated? No.

I've only seen one person break his arm, and that was a fall from a tree, the bone was completely broken (his arm was bent at an unnatural angle), and he was in severe pain, the EMT's injected him with a painkiller almost immediately.

That's definitely going to the emergency room but there's a good chance it's a temporary cast and then surgery is scheduled the next day. That said, I'm not a physician and I'm only relying on my own experiences.

> Except that you're laying on the ground writhing in pain, not the easiest time to pull out your phone...

It's very doable. When I broke my arm in highschool, I was in mind bending agony for a few minutes. Then I put some ice on it and went to work the next day. Didn't get a cast on it until after work.

Very seldom does going to ER 1 vs ER 2 15 minutes apart for a broken arm matter. It needs treated in hours or days, but not minutes.

When I broke my arm, I immobilized it for a few days, then when the pain was still present after a week I went to urgent care. They took an X-ray and scheduled me to visit an orthopod a week later. He prescribed that I keep immobilizing it for a few months until it felt better, after charging me lots of money for an MRI.

When I broke two fingers a year later, I took my own x-rays at a dental clinic for which I did some maintenance work. Yep, they were broken. No, I didn't pay anyone to tell me to stop using them for a while.

Sure, lots of broken arms need a cast, but this idea that you can't shop if you're in pain is goofy.

Once you start a complex procedure, many different things can happen, some very costly to respond to. So how does an organization price for that? Do you price in every emergency contingency? Do you shop for one regular heart bypass with or without emergency resuscitation in case of heart stoppage, or extra drugs needed to be pushed in for any of a number of different outcomes. Is there a fine for not adhering to the advertised price - does that create an incentive to avoid some measures independently of what would be good treatment?

Seems really convenient to claim that because of an edge-case that no price-transparency is possible. Americans seem to have a habit of claiming things are impossible/infeasible that plenty of other western nations have managed to implement successfully decades ago.

Edit: To clarify I am an American myself and this irritates me.

I don't claim it's impossible, but trying to point out that pricing and pretending that healthcare is like choosing one laundry detergent or another is simplistic. At the very least it pushes the complexity into trying to package a probabalistic fuzzy cloud of outcomes into a one price thing isn't an end all, and introduces all sorts of price gaming. At the very least, you increase the quoted price to cover some slice of probabilities - just like if you were a contractor quoting firm fixed price at a much higher cost.

Personally, I favor what many other nations of done and that's setting a set of fair prices through an expert panel - nations like Japan, Germany, and France do that IIRC.

You're talking about the non-shoppable expenses. Those would be handled the same way that they are now.

But most expenses are pretty predictable, like the colonoscopies that I have to get periodically (and which I do shop around for, altho it's damn difficult). Yeah, if there's a bowel perforation all bets are off, but that happens 1/1000 times.

This is the standard fallacy of "impossible to do it in 100% of every edge case means impossible to do it in 90% of common cases". Yes, in medical emergency it's impossible to put upfront price on everything. That doesn't mean one can't put known prices on thousands of more routine procedures and events - which still does not happen, or functionally does not happen - i.e. prices may exist, but they are not accessible, inquires about them are stonewalled, and every customer-facing employee is trained to say "you pay what we bill you or GTFO".

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