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Comment by scheme271 | Hacker News Reader

This will probably help a bit but in an emergency people don't have the time to compare prices. And with US health care, it just takes one accident that sends you to the ER and where someone that's out of network performed a procedure to end up with a bill that's tens or hundreds of thousands of dollars.

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There is a little bit of good news here from the omnibuss budget passed at the end of 2020. Search for “NO SURPRISES ACT” on this page:

https://congressionaldish.com/cd227-coronabus-health-care/

“Starting on January 1, 2022, any health insurance company that provides “any benefits” in an emergency department can not require pre-authorization of those services or deny coverage because the emergency department is out of their network. If emergency services are provided out-of-network, there can not be any limits on coverage any more restrictive than what would be covered by an in-network emergency department and the out-of-pocket costs can’t be more than they would be in-network. Out-of-pocket payments at an out-of-network emergency room must count towards in-network deductibles and out-of-pocket maximums.”

Yes but emergencies are the exception, not the norm for most hospitals. Most hospitals make 40-60% of their revenue on elective surgeries, ie things that can wait 2-6 months. So patients have time to shop around.

Source: currently work at a big hospital in IT.

Emergencies are the norm, not the exception, for most people. Elective surgeries are mostly the well-insured and the wealthy. Poor working people go to the hospital when it hurts so bad that they're missing work, and when they miss work they don't get paid.

The other big conflict here is that I'm not an expert and I'm not about to turn down services if recommended to me by an expert in a field which I have no experience.

I get the whole "do your research", but often it's in areas in-which I have no real capability - especially with healthcare.

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> And with US health care, it just takes one accident that sends you to the ER and where someone that's out of network performed a procedure to end up with a bill that's tens or hundreds of thousands of dollars.

Agree. And to add, all it takes is one procedure that your insurance company doesn't want to cover to put you into literal billing hell for months on end. My point being, even with price transparency they can just chose not to pay even if they're obligated (and they do this). If there's any way they can weasel out of paying they will.

I'm still 100% in support of price transparency in healthcare however... there's just so much broken with it and I've lived through the hell.

> I get the whole "do your research", but often it's in areas in-which I have no real capability - especially with healthcare.

Oh the system has answers – just happen to be high enough at your company, or the spouse of someone who is.

> While a benefits expert at a mid-sized company may create a narrow network, an executive's spouse, for example, may want to go somewhere not in the network. "And there's a pillow talk that happens. And the next thing you know that hospital is in the network," Ladd said.

This whole "employer provides your healthcare" thing we have going on in the US is just nuts.

A recent federal regulation which implements the No Surprises Act of 2021 should reduce some of those abuses by hospitals.

https://www.cms.gov/newsroom/press-releases/hhs-announces-ru...

Emergency care accounts for just 2% of healthcare spending.

https://www.politifact.com/factchecks/2013/oct/28/nick-gille...

That is not a useful statistic here. We are talking about an individual’s financial obligations in a medical emergency. A $10,000 bill is not 2% of an individual’s yearly spending.

You’re missing the bigger picture. It’s worthwhile improving transparency around the vast majority of healthcare needs/spending. ER costs are also a problem, but it’s an orthogonal issue. Don’t let the perfect be the enemy of the good.

No, I don't oppose hospital price transparency. My comment was basically a procedural one. Saying that ER visits are 2% of nationwide costs does not meaningfully address the toplevel poster's concerns.

> ER costs are also a problem, but it’s an orthogonal issue.

It's natural to want to discuss this orthogonal issue, and the solutions to the two issues are not mutually exclusive.

And yet: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income.

https://www.amjmed.com/article/S0002-9343%2809%2900404-5/pdf

That is old information. In the US, your deductible and copay have to be the in-network price in emergencies, and balance bills from the provider will not be allowed in emergencies starting next year (and you can already usually get the balance waived with sliding scale charity etc.)

The whole out of network aspect in hospitals is ridiculous

Yes, in a single-payer environment everyone is in-network.

Every doctor in Canada providing covered medical services is in-network.

I was told by a cancer patient in the US, who is a Canadian citizen, that specialized equipment and certain tests are not available in the entire system, or months-long wait times.

Medical bankruptcy is the most common form of bankruptcy in the US. I would say that for the massive portion of the US that is un-insured, under-insured or faces bankruptcy in the event of a medical procedure that substantially any tests and equipment for them are not available.

Canada has some of the best cancer survival rates in the world, and is substantially identical to the US. [1]

Further the US tends to skew towards early detection without a commensurate increase in survival rates, which means 5-year numbers in the US are higher than elsewhere in the world but it does not necessarily translate to lower mortality.

[1] https://www.ctvnews.ca/canada-gets-high-ranking-for-cancer-s...

Not all treatments are statistically useful. In the US you can get anything you can pay for, even if it costs a million dollars and hasn't been shown to have any beneficial effect. In a national system you make statistical decisions based on cost and effectiveness.

I'd imagine that prices will now plummet simply due to the fact that prices are now transparent and real competition can actually exist.

You don't pay up front in an emergency, so people can consult the information and ask questions before they do pay. They can call their insurance company and ask why they pay more than average. And so on.

Its just the first step

To shock and awe into future laws

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