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Comment by jb775 | Hacker News Reader

Not to mention dentists, doctors, hospitals, etc.

I have an eye doctor appt this week and I literally have no idea if it's gonna cost me $50 or $500.

I asked straight up before seeing the doc about the cost and nobody knew. They finally estimated "about $1,500" and my total bill was around $5,000. And if I refuse to pay it, they send me to collections. It's insane what they are allowed to do.

Ask for itemized bill, dispute every single item

https://www.aarp.org/money/credit-loans-debt/info-2019/dispu...

That's both a very useful post, and also enraging that we would have to do something like that to protect ourselves from getting raped by the system.

watch what happens to that bill when you tell them you are going to pay out of pocket instead of using insurance. suddenly, everything has a different price.

I've heard this before and so I tried it, but unfortunately it was not true in my case. They didn't seem to give a crap about that. In one case they actually told me "you should run it through insurance so you get their negotiated price. otherwise it will a lot more expensive"

The real kicker: Before the doc will even see you, you need to sign an agreement that basically says: "You agree to be responsible for paying whatever amount this doctor decides to charge, which could be any amount from $0 to $infinity, and which the doctor will not know prior to treatment."

Really this should be medical misconduct - how can the customer give informed consent if they don't know what they're consenting to?

The opposite unknown is also part of the problem -- the facility doesn't necessarily know what procedures are going to happen until you're in the facility being seen by a professional with the authority to order any procedures. Any speculations about what procedures might be necessary by anyone not qualified to order them is akin to practicing medicine without a license, and so is highly avoided.

I've always wondered which part of the medical supply chain is causing healthcare prices to rise so rapidly. There's no way these are natural market rates being driven by supply/demand, it's gotta be something artificial. My guess is something along the lines of medical device companies colluding to prop up prices to hospitals.

It's not collusion, it's a natural consequence of the way healthcare billing is structured in the US. You don't get to comparison shop but also have a captive audience (you're not just going to decide to be blind right?) so there's no pressure to keep prices reasonable.

This makes a lot of money for powerfully connected companies, so don't expect it to change anytime soon. This is why our congress and mass media treat Medicare For All as a joke or something to attack politicians on even though it's popular with a majority of Americans.

No, it’s Medicare cross-subsidization as well as the EMTALA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769684/

You might take a look at some things from e.g. this result[1] around what parts of USA healthcare are negotiatiable and which are fixed. The "$1500 for a gauze bandage" meme makes a little more sense if you view it from the perspective of "we can't charge market price for expensive things like an MRI since Medi___ pays a flat $1.5k/ea, so lets gouge everywhere we can to make up for it". In addition, the business setup of hospitals/providers and lack of a single customer-facing entity/provider that charges you for services makes these even more Kafkaesque.

On top of this, my friends who work at (private, non-general) hospitals work a lot and are not paid what someone on HN might expect for what they put in. This isn't even necessarily ownership vs labor, since afaik the hospitals themselves are not usually in the best of places financially.

To me, the short version is: can't easily negotiate, information asymmetry, and captured regulators. Imo, this isn't helped that in USA we say "healthcare insurance" but what we mean/want seems to actually be "healthcare subsidy/guarantee".

[1] https://www.kff.org/medicare/issue-brief/whats-the-latest-on...

There is no one part, the excessive costs can only be analyzed as a symptom of the system as a whole. One fellow online dubbed this "Coasian hell" and has a good writeup explaining where it comes from: http://www.harrowell.org.uk/blog/2018/01/31/in-the-eternal-i...

It's pretty typical in my experience to go to a clinic like that and the staff will have no idea what your insurance will eventually charge you.

It's a complete mess that we need a uh, universal, solution for.

Especially if you don't pay for a really good insurance policy or your employer provides you with a really good insurance policy. You will get screwed with no remorse.

Interestingly I did the math last benefit cycle and if your employer doesn't fully pay for it the better insurance may not be worth it. The additional per month cost cancels out any savings no matter how much usage you get out of it (if you take the out of pocket max into account).

The expectation with all forms of useful insurance (health, auto, umbrella, home/renter's, life, etc.) is that for most people most of the time, they'd be better off not having it.

But in the rare cases when someone does genuinely need it (e.g. your house and all of your possessions burn down, you need treatment for cancer, etc.), it prevents financial ruin.

My point isn't insurance vs. no insurance. My point is that the type of insurance doesn't actually matter that much if you're the one paying for it (versus having premiums covered by your employer). If you get a bad accident on the low end company insurance you pay your $10k out of pocket max. On the top end insurance you pay $4k but also paid $8k more in premiums during the year. The insurance companies did the math to make sure they come out ahead no matter what you choose.

A $10k medical bill is not what I would call catastrophic. Highly unusual, yes. But not catastrophic.

A catastrophic event would be something like you get run over by a car and have to spend weeks in urgent care racking up a six figure bill. Of course, such an event is highly unusual and the vast majority of people will never make a claim of that size or even approaching that size.

By design, people who don't make very much in claims pay for the people who do make those claims but also get the benefit of knowing if such an event ever occurred to them, they wouldn't be financially ruined.

> The insurance companies did the math to make sure they come out ahead no matter what you choose.

That's plainly false. See any true medical catastrophe.

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