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Comment by pkaye | Hacker News Reader

I don't how much that will accomplish. Lots of people without insurance have no means to even pay the discounted rates. I had a drug that until it was available in generic form was $90 (so at 10% copay, I presume it cost the pharmacy $900) But lets say that was a lie and it actually cost $200. Without insurance it would still be too expensive to many people.

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What actually often happens is that drugs priced at $90 get marked up to $200 with the knowledge that insurers will get a $90 price. The rebate system paradoxically creates an incentive system where it is insurers best interests for list prices to increase dramatically and then receive a discount than for the products to be sold at the discounted price in the first place. It’s a broken system and replacing it should help medicines be priced closer to what real people can pay for.

Yes, the $90 was my copay and I got a copay reimbursal from the drug company so my net was $5. The drug company is trying to mask the cost of the drug from the consumer so they can charge the insurer a higher price. The insurer is charging a copay so the patient feels some of the cost.

However disclosing these practices is not enough. The end consumer has no negotiating leverage particularly if they have no insurance. The government or some big organization needs to negotiate the best price for them.

I agree that this would not enable people to suddenly be able to afford medical services that they otherwise would not, but I do see some advantages to the system in general:

1. For people without insurance it would possibly give them a little more bargaining power in the negotiations around bills. Right now the hospital holds all the cards, especially when it comes to "costs".

2. It would shine a little light into an area that is generically murky. A lot of people are champions of capitalism/markets being the solution for all/most problems, but market systems do not work well at all when there is a heavy information imbalance. Pretty much every theory of capitalism talks about that. Right now an enormous information imbalance pretty much sums up the U.S. healthcare system.

Are hospitals really that profitable? Take SF general hospital for example. Its obligated to take care of the homeless, drug addicts, under insured that they seem to overcharge the few insured that get admitted to balance their budgets. I'd be curious for an actual fair accounting of things. Are they really flush with money and just overcharging?

Public hospitals don't operate on a profit model.

If you go down the street, however:

https://www.vox.com/2019/1/22/18183534/zuckerberg-san-franci...

I can't help but think the fine is too low. It would be more profitable to pay the $100,000/year in fines than disclose the discounted rates. shrug

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