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Comment by Spivak | Hacker News Reader

I pay cash for a lot of my medical care thanks to my HSA and this is exorbitant but but not insane assuming it’s about 2x thanks to the insurance premium which you would never pay yourself. The subject is sweeping under the rug the two nights in the hospital which is for sure the bulk of the cost — two days in the hospital is expensive as hell. Lots of hospitals bill by the half hour and an 8 hour overnight is about $10k when paying cash.

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I can't figure out in what way $1000/hr is tethered to any kind of reality. The bed and room don't cost that much. Nursing doesn't come close. The doctors tend to bill you separately for their services.

I get that isn't the game here. But most games are based on some kind of reality. This one seems completely disconnected.

Your $1000/hr bill is really covering 5 other indigent hospital patients who can't financially cover the care the hospital is legally required to give. Rather than design a medical system that works for everyone no matter their finances we'd rather stick it to the middle class (the rich go to very different hospitals) since they have the most to lose and are the weakest to negotiate.

Also, socialism.

My roommate's bill for my own 5 day, $24k hospital stay was $0. My after-insurance cost was $2k, though I negotiated that down to $800 that I was able to pay off over a year (grad student on a stipend). Initially I was a little bitter about my roommate getting a freebie due to lack of insurance, but I eventually learned some compassion. In his case, he was unemployed and couldn't work due to a back injury.

So, we end up in this situation where those who have insurance subsidize those who don't. Many people who are ok with this are very much against an identical arrangement where the government is involved.

The rich go to very different hospitals?

Yes, in my city there is a trauma 1, a few trauma 3s, and multiple hospitals who have no ER at all. T1 is downtown, surrounded by homeless encampments, and is perpetually broke. By city charter T1 cannot file for bankruptcy protection and cannot turn away anyone seeking emergency treatment. T3 and outpatient hospitals are in rich suburbs, no homeless camps, and the parking lot is full of luxury cars. They also cannot do most emergency services and will send you to T1.

The overnight stay in the T1 is $10k for a grimey room while the T3s are closer to $3k-5k before insurance. I've volunteered at both types and it is night and day difference in the staff and the patients.

There's a Voyager episode about this.

It isn't. It's totally and completely arbitrary. It's a classic example of "priced what the market will bear."

It's because it's the cash price. Medicare and Medicaid reimbursements are significantly less, so in order to make budgets make any sense, the bills that can be increased, increase enough to cover all of the others.

Even employer sponsored insurance will get significant discounts on that price.

They're protecting us from socialism.

Medical care is equally far from capitalism.

Depends if you are going with the book definition of capitalism or just "more money for rich people".

And that's why you don't get your term definitions from people that don't understand it.

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