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Comment by ChuckMcM | Hacker News Reader

tl;dr version, law works as expected and takes money out of the pockets of people who were over charging. They are mad and so they are throwing around as much FUD as they can dig up in an effort to keep this from spreading.

I know, the question of "over charging" is a difficult one to answer. All of the evidence on people willing to be doctors in California suggests that there are plenty of suppliers who will work willingly in the new system. That says to me it is working as intended.

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> the question of "over charging" is a difficult one to answer

Not really. Just disclose the price up front. Prior to the procedure. The problem with these billing practices is the consumer has zero clue what they'll be billed by whom ex ante.

Honestly, let's go a step further - make those procedure prices publicly listed so that third parties can easily aggregate those list and let people find cheap care - then, finally, there will be market pressure to actually provide competitive services.

Do you mean "hide them away in a price list you must pay a fee and request by registered mail" when you say "publicly listed"?

That also only works if the patient can choose a different provider. If the only anesthesiologist authorized to assist in the only in-network hospital in the area equipped to do a particular urgent surgery charges an arm and a leg, there's not much knowing the price will do

This gets into some murky areas as well though. For example, infectious disease physicians struggle a lot under pay for procedure-based schemes because so much of their work is supplementing existing teams and consults, rather than "Did Thing X".

Good. Free market doesn't work when refusing to pay for the product costs you in health or even life.

Actually - this is an effort to bring the free market into the system. Ie, doctors have to tell you UP FRONT what they will charge you, and cannot just drop by your room while you are out and then bill you for the evaluation.

You can then decide if the specialist out of network is worth it, or go in-network or to your medical / medicare provider and work with them.

In particular (for those who don't know) California's law protects you ONLY if you go to an IN NETWORK facility. If you do, then if somehow an out of network doctor drops by or helps with the knock out gas or whatever, they can't then bill you for the "out of network" service. It turns out this was pretty common (my guess is some kind of kickback to the in-network facility to allow this).

You can still be charged or over charged by any provider if you agree to be, and sometimes still even if you don't (ambulance ride to out of network)

Prices being known ahead of time is not an inherent property of a free market. Fair billing is not an inherent property of a free market.

The "free market" doesn't really exist. It is an ideal, and an ill defined one at best. What does exists are mechanisms. A law that forces prices to be visible is a mechanism that is likely to increase economic efficiency at little cost. In absence of a rent-seeking doctor's guild, it would not be needed, true, but it is certainly better than nothing.

In fact, full availability of information (including price and quality) is a key feature of a free market, at least as defined in my ECON 101 class.

It's generally called a "racket" rather than a "free market" in the absence of pricing information, free choice, and fair billing.

Without accurate an available information, there is no free market. Just lots of betting.

"I'm going to buy this great new car. I wonder if it will cost me $15k or $45k? Can't wait to find out!" Said no market participant ever.

It’s more like: you get in a car accident and the mechanic forces you to get a new car. The only thing is: you won’t know the price of the car until you receive the dozens of bills for the different steps of manufacturing (one for the steel press factory, one for the leather factory, one for the aluminum factory, one for the person who put it together, one for the factory it was assembled in, etc.) You also can’t find the price of this new car online and the mechanic won’t (or sometimes can’t) tell you.

Practically everything about the health care system makes it the opposite of a free market. Patients often lack the domain knowledge to know what care they need, or what it should cost; even when they do, they often have few choices of where to get it (due to geography and/or insurance restrictions), or no choice at all (if they're receiving emergency care, or if their care requirements change while they are hospitalized). All of this adds up to a marketplace where "customers" are largely forced to pay whatever they are charged, and have very little choice in the matter.

I think there is genuinely a libertarian argument that healthcare is partly expensive due to government over-regulation.

A lot of what you said also applies to car mechanics. But they are less regulated, and there's unregulated alternatives, which makes things cheaper and more competitive.

But since the US does have a high amount of government interference (apparently it's a big deal when a child dies, while a dodgy mechanic is something we just deal with), maybe it's best to just create a public system rather than a highly compromised hybrid with most of the cons of both public and private systems (the US actually has a higher tax burden due to healthcare than Canada, since the people who get it free on Medicare and Medicaid end up costing a fortune - the private sector can be way smarter than the government at the subsidies and incentives game).

Very little of what they said applies to auto mechanics, outside of consumers not having much domain knowledge.

And even less when the seller refuses to disclose ahead of time what you will be charged.

This is called inelastic demand.

> Free market doesn't work when refusing to pay for the product costs you in health or even life.

The free market works great to provide food.

If you are in the US, food is one of the most heavily subsidized items people typically buy.

which "free market" is that?

in the US the "free market" for food continually gets porked up "Ag bills", leaves food deserts in low income areas, subsidizes complete and utter garbage used to feed livestock, and pays farmers directly even though it's not efficient by any means.

despite all of this you almost certainly want this to continue because in the event the ol' "free market" decides that it's not worth, say, maintaining food infrastructure due to a few good years, you'll probably die in a famine or the chaos that comes as a result of it.

This amuses me as I'm familiar with the quality and price of hospital food - both sold to visitors and given to patients. The food given to patients is nearly always of a decent quality since making people sicker really doesn't help, but it usually isn't nutritionally great and it's always over priced - for visitors the food is even more overpriced and the production of it is usually farmed out to a random restaurant in the area that can cater for it so quality will vary wildly.

And just you try to find some competition in terms of food suppliers while you're in a hospital - it's the cafeteria or nothing.

Food is simple. Practically everyone understands what food is, knows where and when they can get it, and (usually) has plenty of choices of where to eat.

All of these things are untrue of health care.

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