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Comment by devoply | Hacker News Reader

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.

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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-...

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

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.

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

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...

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'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.

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