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Comment by rolph | Hacker News Reader

i wonder if a hospital would still charge you if you refused thier price gouge materials and used your own purchased at a proper price, as in "thanks for setting the bone, i dont need your sling i have my own and it will do fine, here is my lawyers contact card."

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We asked for an itemized price list when my wife gave birth. They claimed she received lactation consultation even though she rejected it, as this was our 2nd baby. Despite having documentation saying so it went back and forth and we just paid it because it was too time consuming.

Anyways. In the itemized bill they charge about $40 per ibuprofen. If we knew the price, we should have brought our own and just rejected theirs.

Someone might come along and reply with that $40 covers nurse salary, tracking the medicine etc. Yeah... Bull$hit.

Out of interest, can I ask how much the "lactation consultation" cost?

Here in the UK, my wife's breast feeding help consisted of an inexperienced midwife (possibly only a trainee), awkwardly being remarkably unhelpful.

I believe it was $200. For our first daughter ours was helpful. We took a class (paid by ourselves) before hand but it definitely helps to have someone walk through it with your actual baby. However for each delivery the nurses knew enough to be helpful too.

Also, since my wife has had surgery to remove a benign tumor in her breast, lactation consultation was covered the first time. No idea WTF happened the second time. This is the US medical system for you.

I'd also like to add we received a random bill for our first daughter 2 years later. No idea what it was, but the insurance covered all of it so I didn't care.

The hospital definitely didn't carefully consider the $40 price to cover the actual cost of delivering the medicine to you. They just multiply their cost by some number and call it a day.

The fact is that hospitals aren't built for itemized bills because very few patients pay the posted prices out of pocket. Medical debt is extremely hard to recover in the US, so why bother expending the resources to figure out a sensible pricing structure for a small minority of your customers who mostly aren't going to pay that price anyway?

“OK, the cost of setting that bone just went up $900.”

That’s probably what they would do. We know that they don’t base prices in any kind of rationally economic way.

hence the lawyers contact card.

I have Kaiser health insurance in the bay area. Whenever we needed a hand or foot brace or walking boot, they seemed to just give out the basic stuff at no extra charge beyond the visit copay. Per the insurance plan there is a copay but they just give it out. Other times they will just recommend something you can buy locally or online. They would give a printout with suggested brand/SKU to consider. They don't mind if you price shop.

IIRC prior to being treated you agree to be financially liable for the costs. Prior to even knowing that that will be or even the costs involved. Or even if you know what is involved are you going to understand what a reasonable cost is? EG: Sling is easy but what about a x-ray study? Is that 200$ or $150?

Just like a proper capitalist system! You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.

We don’t have a capitalist system, we have the worst of all possible systems. There’s no competition, yet the state doesn’t control the prices.

> You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.

I can contact Apple for help with any issues I have with my iPhone. I can contact my carrier for any issues I have with my iPhone. I can return my iPhone within a grace period if I don't like it.

Try doing any of that for medical costs.

For fun I do this: I ask them how much it'll cost upfront. (they can rarely even give bounds). Ask about refund policy (?!?!?!). Tho must be done nicely as the person handling the questions is no way responsible for the absurdity.

I know these won't actually succeed in adding a bit of capitalism but it does succeed in highlighting the absurdity.

I'm not sure what your argument is. Is it that it is fine that our healthcare is like shopping at an Apple store? Or that medical costs cannot be predicted? Or that we should be happy with the system we have?

Other than pedantry, what are you trying to get across?

Given the responses I succeeded in my goal: highlighting the absurdity in the current system :)

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