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Comment by pkaye | Hacker News Reader

My understanding is the insured patients are subsidizing all the others covered by medicare, medicaid or those uninsured.

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Exactly! Nobody seems to realize that we already have a shitty (for-profit) form of socialized health care.

Yup. We've taken the worst aspects of both sorts of system and combined them into a Kafkaesque nightmare.

Why? Why are insurance companies not demanding cash price and reducing premiums? There should be lawsuits against hospitals, this seems like something which is generally considered highly illegal at this sort of scale... charging different customers different prices -- especially when the ones paying more are more than capable of taking hospitals to court.

The 80/20 Rule could be one reason -- the more they spend on health care, the more they can spend on other things.

https://www.healthcare.gov/health-care-law-protections/rate-...

Sounds like the government needs to sue both insurance companies and hospitals for collusion to stop this.

It's extremely unlikely that there's actual collusion. But actors acting in their selfish best interest can definitely look like collusion.

I believe this rule came out of the ACA (Obamacare) however all the problems have existed well before that.

I'm a generally anti-legislation kind of person, but as long as breaking up big tech is a hot topic, why not pass a bill requiring cash prices for any not-for-profit insurance providers and co-pay networks? There's a lot of interesting competition happening in those spaces, and making not-for-profit insurance a better deal seems like a great way to get capitalism grinding at the issue of overpriced healthcare.

That doesn’t work for emergency care - where the patient really doesn’t have the time to go window-shopping while having a cardiac arrest.

And while greater transparency is good - not everyone in the public is able - or willing - to understand a medical price-sheet and might opt for a cheaper but medically-inappropriate procedure with similar-sounding-name to the procedure they actually need.

OK, how about mandatory cash prices for non-emergency care?

And what if that price is too high for any uninsured to afford?

Your taxes already pay for emergency care.

I would prefer a system where they charge everyone the same amount. It wouldn't surprise me if the insurance companies would be in favor of that, the whole price negotiation overhead goes out the window.

Hospitals could also be charging insurance companies more, but not for subsidizing cash patients but for greater profit.

For-profit hospitals, maybe, but what about the non-profit ones?

"non-profit" doesn't mean "doesn't make money" its just rules on how you have to spend that money.

There's nothing saying a non-profit can't raise prices of service and then expand the hospital to buy a new wing, or better equipment or hire more doctors. They need the money to provide their services.

I understand that, but there is a limited amount of that which can be done before it becomes spending for spending's sake, which is pointless.

Also "expand the hospital to buy a new wing, or better equipment or hire more doctors" sounds like exactly what they should be doing, because it means they can service more people at a higher standard of care (which is the reason they exist in the first place).

I found this interesting article on the situation. They say 1/3 are profitable, 1/3 are break even and 1/3 are losing money. And a lot of those losing money are in rural areas. And "In general, hospitals lose money on Medicare and Medicaid patients, but make up for that by charging private-sector insurers more."

https://www.nbcnews.com/business/business-news/hospitals-mad...

But god forbid we make that official with some sort of oversight and functional standard system.

God knows there is a ton of oversight.

(As anyone who starts an insurance company can attest to.)

Oversight into how much we overpay to cover underpayments, like single payer.

[citation needed]

This is a common talking point that smells like an oversimplification.

I can't speak to Medicare/Medicade but the general idea is this: Doctors and the things they use/services they provide have a cost associated with them. Insurance works by spreading risk. Guy who breaks his wrist essentially takes money from the pool that wasn't used by the guy who hasn't been to a hospital in 6 years. So far everything is fine.

When you have people who exist outside that system of resource reallocation, the doctors have to find ways to ensure they're still getting enough money to cover their costs. One way they can do this is by suing patients who don't pay, but that takes time and more money and doesn't always work. Another option, would be that they then raise their rate to the insurance companies because they know that the insurance companies can afford it since they have such large pools of money. The insurance companies then raise the rates for everyone buying into the resource reallocation pool, and eventually everything spirals out into our current non-system.

Is it more complicated than this: yes, but that's the elevator pitch on it.

> they know that the insurance companies can afford it since they have such large pools of money

This is exactly why Medicare for All is touted as a solution. It would create the largest pool.

It would also reduce the significant overhead presently involved with billing N different insurance companies. Why isn't the conversation about those costs imposed by the current system?

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