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Comment by perakojotgenije | Hacker News Reader

Americans and their health insurance problems.

I live Serbia, to use Trump's words - in a "shithole country" (and I fully admit it is :-( ). I've never had a colonoscopy but I had a gastroscopy two months ago and it was fully covered by our single payer insurance.

At the same time a friend of mine needed to have a gastroscopy and a colonoscopy. He decided to go the private route and also chose a full anesthesia. That costed him 30.000 serbian dinars (~255 euros).

So it seems to me that you could buy a return plane ticket to Serbia, stay here for a few days, do a colonoscopy here and it would still cost less than what you need to pay there.

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The thing is, American healthcare prices are horribly overblown. IDK why, maybe the need for malpractice insurance in a litiguous society, but I am always shocked when I learn how much do relatively routine things (LASIK, uncomplicated birth) cost in the USA. Usually at least ten times as much as in Europe.

It’s a complex question but the problem is that _everyone_ that points out one reason or another is usually right - we disagree upon which factor is the biggest. Malpractice, bloated administrations in insurance and hospitals (just like our educational and corporate systems), a dysfunctional market leading to profiteering, bad / outdated regulations, Medicare being unable to negotiate costs, bad patient health across the country, and so forth. What I will argue against is that we have the best healthcare - maybe only if you exclude the outcomes for our poor, but even the outcomes for our wealthy are no better than the middle class in other developed Western countries.

LASIK is generally a few hundred dollars per eye. Is it really $50 in Europe?

As far as births, the lifetime cost of the injuries that do happen are built into the price. Maybe not a good system, but it's clear enough where the money goes.

Haha, nope ! As a convenience procedure, and as such exposed to liability risks, and because of the extremely high cost of the lasers, you'll have to pay 2-3000 euros for both eyes (in France, at least). It is in fact cheaper in the US.

However, I'm always surprised by the cost of health in the US. The most surprising thing is that it looks like most Americans seem to not realize that it is perfectly possible to have high quality medicine and well payed doctors if the insurances don't suck all the money between the healthcare system and the patient. Our system has flaws, sure, but the US system looks like crazy to me.

It's not just insurers, it's death of 1000 cuts. Poor regulation, misaligned incentives, greed, etc.

This is my fault, I have old info here.

I underwent LASIK in 2002. At that time, it cost me about 1000 USD here in Czechia. On American web discussions, mostly quoted amounts were USD 5-7000.

American health care prices are a constant series of traps. If you are not careful, the insurance won't pay, or the hospital will out of network doctors or they will run tests you don't need or want. And pretty much everything is way overpriced without the patient having a realistic chance to determine the fair price. All in the pursuit of sucking more money out of you.

And it's almost impossible to avoid these traps. It's basically a gamble every time.

The system is so convoluted that nobody knows where the money is going. Every player can point their finger at someone else and say: "Those people are gouging you." But every player has an investment stake in the other players[0]. It means, when it comes right down to it, they're all gouging us.

[0] For instance I read that the majority of stock in malpractice insurance companies is held by doctors.

One reason for this is the artificially limited supply of doctors. The AMA combined with the government keeps the number of doctors down by keeping the number of medical schools and medical residencies low, driving up prices.

Among many other big factors.

Yeah, health insurance is interesting over here. I've been fortunate and never had many problems with health insurance. Once or twice we got a surprise bill because a doctor deceptively ordered a test that our insurance wouldn't cover, and we had to pay the full cost (probably 1-2K). In one instance, we explained the issue to the company that produced the test and they comped it to us (and somehow the cost counted toward our deductible, which was really nice). Anyway, IIRC, there's legislation to make this kind of deceptive practice illegal (doctors can't refer you out of network or order tests without your explicit approval), but I might be misremembering.

None of the above is to make any sort of political point. I still want universal healthcare. Too many people aren't insured or are under insured and it's far too easy for hospitals and insurance companies to screw you and leave you with no recourse, especially if you're already vulnerable. There was a time when I was undecided on the issue, but it seems like every country that has universal healthcare really likes it even if some of them complain endlessly that their healthcare system is a financial black hole (e.g., my UK friends complaining about NHS always getting more money and yet the quality of care doesn't improve perceptively--although that was a pre-COVID sentiment).

I also know American friends who have flown to India to have lasik and paid full price for a reputable Indian doctor to perform it because all-in it was cheaper than paying for it domestically (it's possible that their insurance didn't cover lasik? I'm not really sure how that worked out).

There are two things that UKans seem to consistently complain about with respect to NHS: taxes and queues. You don’t have to pay for individual procedures but you have to wait for them because the politicians don’t necessarily take enough of the tax paid in and apply it to care.

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