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Comment by Berobero | Hacker News Reader

I was in Japan two years ago; got pneumonia and needed antibiotics.

Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but he was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70 USD.

Ultimately I left the hospital after being seen, getting chest xrays, the additional labs, and antibiotics in hand. No insurance and I paid less than ~$160 USD.

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Exactly the way it works in a SE Asian country I grew up. The private and public hospitals have price quotes on different procedures and it's for everyone to see. The comments above using Boglehead's quote as a justification of why medical pricing has a lot of variance is mostly a lie. My wife, who is a doctor trained in our home (SE Asian) country and is doing her residency in the US, and I were just laughing at the fact that it's much, much more expensive to get an X-ray here in the US than it is in our country (which costs ~$4 at most). Here, there's no price list for procedure as simple as taking an X-ray.

Hospitals, doctors, insurance companies and pharma companies are all scamming the US population. Every evening, my wife and I watch TV (WNBC to be exact) and we see many commercials from hospital networks, insurance companies and drug companies. This reminds us everyday that medicine and healthcare is commercialized to the max in this country and the only way from here is downhill. We both don't hope to retire in the US; when we grow old, we will go back to our home country and live there in the hope of getting much more affordable (and yet, of more or less similar quality) medical treatments.

Have you seen radiologist salaries?

It's a scam, Jim.

There are four pigs at the trough of US health care:

Insurance Device/Drug Lawyers Doctors

Everyone points the finger at other people and desperately fight to maintain their bloated share of the bloating pie.

Unfortunately doctors are not your friends in hospitals. They are trying to get billing.

Indeed! As she was applying for residency programs, my wife briefly entertained the thought of becoming a radiologist because boy, they made a load of money for 8am-2pm work! We both are 100% self-aware that healthcare industry has a lot of bad actors including doctors, pharma companies, hospital admins, lawyers and pretty much everyone involved.

If residents cry about 60+ hours/week of work during the first year residency, I don't pity them much. First of all, the hours aren't really that bad even for a hospital in metro NY area (speaking from my wife's residency experience so far). In our home country, residents have it worse; my wife had night float EVERY THREE DAYS over there. In the US, it's at most four times a month! Second of all, the "grueling hours" are for the first year of residency (in fact, during those hours, there's not much happening especially in night floats, so you can get decent sleep) and after that, things got much, much better. Sacrificing just one year and paying exorbitant exam/school fees--in the region of ~$250K total--to make $250K as starting salary is TOTALLY WORTH it. If any of the doctors complain that they are debt-laden, they are either fiscally irresponsible or are simply exaggerating. They can repay $250K debt + interest in less than 5 years if they really want to. Of course, it's much easier to use these (debt and hours/years sacrificed) as excuses to justify their pay.

If the doctors are true and honest, they should be advocating AMA to relax the residency and medical school requirements. No more than five years total (no undergrad necessary) is needed to treat garden variety problems. Then each specialty/fellowship can take however long it needs to take. But AMA and its leechers (KAPLAN, ECFMG, USMLE, FSMB, etc.) won't allow that because they make loads of money from exam and preparation fees. Everything about healthcare is business now and whether it is good or bad depends on one's moral compass (and how strongly one feels about capitalism).

"advocating AMA to relax the residency and medical school requirements"

People talk about the constriction of supply of doctors, but aren't NPs and PAs doing everything these days anyway?

The crazy work hours for residents are basically a protectionist racket to keep wages for doctors high.

They don't serve any rational purpose in medical education and just serve as barrier to entry.

> Everything about healthcare is business now

https://i.imgur.com/t22Lg5Y.jpg

This is also a side effect of how much medical education costs in the US, though. Education is so expensive that medical professionals have to have eye-watering salaries to have any hope of paying it off.

Of course, this is partially the fault of the AMA restricting medical school slots, but also is part of the general trend of tertiary education in the US being ridiculously expensive.

And also partly the fault of the government paying whatever schools ask for in loans.

> that medicine and healthcare is commercialized to the max

There are commercial problems but it isn't totally fair to call a system where nobody can tell you a price 'commercialised to the max'.

The problem isn't the commerce, the problem is that someone has set up a regulatory framework where people don't pay for services.

A perspective that could be important when it comes to American healthcare: insurance doesn't on average pay out more than people pay in. My understanding is traditionally insurance actually pays out exactly what people pay in and profits off the float. 'Having insurance' doesn't make anything more affordable for anyone, it is more like hiring someone else to track the savings for you and a few conveniences massaging risk through time.

Japan's system is interesting. Perhaps one of the most successful in the world.

Their life expectancy has gone up which obviously means the amount of care to be provided goes up. Costs haven't followed suit and the other side of the equation - outcomes, has also gotten better (comparing against 1990 since that's the first result set i can see attributed to the MHLW in JP) The challenges of their economy are well known yet they've pulled off what other countries probably would not be able to.

Yet they spend approximately half what America does - and for better outcomes.

If you're talking about life expectancy, certainly lifestyle means more than an excellent (as opposed to a good) hospital system.

> Their life expectancy has gone up which obviously means the amount of care to be provided goes up. Costs haven't followed suit

While their healthcare costs are much lower than eg the US, Japan is currently in the middle of a healthcare cost crisis in fact:

"annual health-care expenditure grew at a pace 40 times faster than the economy from 2000 to 2016." [2]

Their healthcare expenditures have more than doubled in the last ~27 years, while their economy hasn't expanded and their population hasn't expanded. While I don't consider a 100% increase over 27 years to be extremely alarming, especially in the healthcare field, it's a substantial increase given the context that Japan is dealing with (budget buried in debt costs, declining standard of living due to debasing of the Yen due to debt, aging population, zero population growth, net negative economic expansion over 25-30 years).

While the US has the ability to cut a lot of unnecessary fat in healthcare to bring down costs, I don't see how Japan is going to be able to do that without harming care (as their system is already well run). The US also has had dramatic economic growth during the time in which Japan has had none, including adding an economy the size of Japan to itself in just the last six years.

Nippon.com, Oct 2019: "Growing Medical Woes: Japan’s Healthcare Expenditures Rise to Record ¥42.6 Trillion"

[0] https://www.nippon.com/en/japan-data/h00561/growing-medical-...

Bloomberg, May 2018: "Japan Seeks Private Sector's Help With Blowout Health Costs"

"Faced with an aging crisis that’s projected to push up heath-care spending by more than 50 percent in the decade through 2025, the economy ministry is leading efforts for local governments to draw on the expertise of private companies."

[1] https://outline.com/59VNKA

Bloomberg, Dec 2018: "World’s longest-living citizens are causing medical costs to soar."

[2] http://archive.is/OxW7n

Similar story, s/France/Japan.

I had to go into emergency for a bronchitis, after all tests and getting everything the spot, the bill was around 40eur. The doctor asked me if I wanted the additional forms and paperwork to claim it on my US insurance.

I just said no.

Prices for care in Japan are basically systematically set by government committees.

https://en.wikipedia.org/wiki/Health_care_system_in_Japan

In contrast, in the US, there are 16 non-medical, mostly billing personnel per doctor.

Where does that figure come from?

Its from a book, Code Blue: Inside Americas Medical Industrial Complex, by Mike Magee. The author is a Doctor and distinguished medical academic and past hospital executive.

I believe you, but it's hard to square that ratio with the actual administrative overhead of US health care, which is under 15%.

Billing Personnel to Doctors seems to ignore the squads of Nurses and maybe it also ignores the Doctors in Residency?

The book contains many references, but it's dense. I thought admin overhead tended to go to 15% because of ACA provisions of 85% spending requirement on direct care? I would likely have to do a fair bit of digging to compare how the scope is defined exactly vs an ACA definition. Makes for something of a perverse incentive if the companies want/need to route additional absolute dollars into their service depts - but I don't know how much it actually gets bent in that direction.

Can you cite that number? Even pulling numbers out of thin air for receptions, call center, it, hospitality, food, nursing, etc I find it hard to get thathigh.

This study puts the billing staff to doctors ratio at 0.67.

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.4....

I was in Philadelphia last year and had a bad fall and had to get about 10 staples in my head. I went to a local urgent care center and the total cost was $150 without any insurance.

This is great. We in Third World nations can afford this .

US hospitals are a cesspool of crony capitalism.

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