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Comment by zbrozek | Hacker News Reader

We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress.

If we want the free market approach to work, we need to make it possible, easy even, to make informed decisions among competitors.

But fixing this is increasingly feeling intractable, and this pushes me further and further towards believing a single-payer (maybe not exactly, but that's the buzzword) system is the better fix.

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I want a comprehensible restaurant-like menu.

Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it.

[1]: https://www.icd10data.com/ICD10PCS/Codes

Yup! And what will you do about it anyways? Like "Oh, you need xyz, it will cost $1000" Ok. Now that I know that, what am I supposed to do? Shop around? What if I'm in the emergency room, what then? Are they supposed to give me a price menu for every single drug or treatment they need to perform against me?

"Hey, we'll do CPR, but that'll will be $100, please sign here so we can save your life".

The ala cart method seems like it might work until you start thinking about the logistics. If someone goes to a doctor complaining about chest pain, do we really want them to leave because an EKG and blood test are going to cost $200. No matter how much the doctor explains to them "You might be dying" plenty of people will walk out of the hospital once the bill is presented. In some of those situations, that's going to be deadly.

For some perspective, I’m pretty sure there are a lot of non-Americans reading this thread amazed at just how comical current US thinking around healthcare has become.

Absolutely. By the way, in most cases you don't have to bill it at all, because the actual cost is negligible.

Part of the problem is that the coding happens after the doctors do their thing, are incredible complex, and have to be checked/fixed by a specialist before they can be sent onwards.

Yes, we need price transparency, but the last time I had a surgery, it was an emergency surgery, in the sense of "get him to the nearest ER or he'll die."

By the time the anesthesiologist came around, I was drifting in and out of consciousness -- no way to ask if they were in-network. (They weren't, by the way.)

This isn't an uncommon scenario, and one where price transparency isn't really going to help.

Also, what am I supposed to do, decline the services of an anesthesiologist and request an in-network one? What if there isn't an in-network one on duty? What if they're busy? if I need a surgery now, what choice do I have?

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