Hacker News Reader

Comment by kashunstva | Hacker News Reader

I don’t understand the connection between the cost of hospitalization and a DIY 2d x-ray machine. Where exactly do you go with that? The article states that he underwent an abdominal CT, but of course that’s not what he built. Probably a good thing, too, as whatever radiation he’s emitting would have been substantially higher. I’m just confused about the motivation. There are lots of costs embedded in procedure pricing - some legitimate, some less so. Heaven forbid he goes into hospital and has to have an MRI. I can’t imagine the monstrosity that would result from that DIY project.

View on HN

It just sounds to me like a good story to introduce the project. I suppose he is kind of saying "how can they charge this much when I can build one of these at home".

Yeah it seems like an excuse to do the project. X-rays aren't all that expensive, usually under $100. Maybe with a reading by a radiologist it can go into the hundreds

You are right to question the narrative. These days it's common for news articles to play this kind of trick. There are just a lot of hidden costs the DIY youtuber is ignoring.

He's right to question the narrative but absolutely insane not to question the 69k cost.

That xray is not worth 69k. It's a literal crime that the hospital charges that much.

have you run a major medical center? Acquired an x-ray machine? Operated it (and paid the staff) for 10 years?

if you haven't done that, I'm not sure you have the experience to say how much an x-ray should cost.

I know dog shit isn't worth 69k and nobody needs to acquire a dog shit maker, and operate a dog shit maker nor pay for the staff making a dog shit maker to know that dog shit isn't worth 69k. Basic common sense.

Maybe the above is a bad analogy. Put it this way.

I've been to hospitals outside of the US and paid for x-ray services. That's how I know. That's how Everyone knows ...

69k a crime.

What I don't understand is why there exists someone defending something so obvious. Are you an X-ray operator?

No, I'm not an x-ray operator, but I work in health care and have good knowledge of what it costs to run a hospital in America.

What you are describing is what your out of pocket expenses were. That's completely different from "what an x-ray costs". For example, if your expenses were lower than it cost the x-ray provider, they had to have some extra credit from- say- a health care org or the government. Where did the government get that money... well, taxes, of course! That money you paid to them (if you had to pay taxes) eventually gets converted into paying doctor and X-ray tech salaries, the cozy office for the hospital administrator, electrical companies, x-ray companies, etc (x-ray machines cost $5-10M to install and over a million a year to operate).

The way to think about this is the "all-in" cost: if you could somehow magically see the bills the hospital pays you'd see that out of pocket payments are only a fraction of the total costs of a service.

(I am not arguing that $69K is a reasonable expense for a routine x-ray. It's just that most people don't pay that, and in this case, nobody did- the health care org paid a different amount entirely, which was negotiated between the health care company and the service provider).

> No, I'm not an x-ray operator, but I work in health care and have good knowledge of what it costs to run a hospital in America.

That's the key word. "In America," and nowhere else on the face of the entire earth. You are one component of a criminally corrupt system. By being a component, you are shielded from full responsibility. It's like being a shareholder of a corrupt company. Same thing.

>if you haven't done that, I'm not sure you have the experience to say how much an x-ray should cost.

>I am not arguing that $69K is a reasonable expense for a routine x-ray.

Don't try to change the topic. You were saying that I am not justified to know how much an x-ray should cost. I'm saying I am justified, and that YOU are the beneficiary of said high costs and THEREFORE YOU are actually unqualified to justify ANYTHING related to this.

Let's say the cost is 5k. It's still a criminal rip off. Also who is making up that BS number 69k? Which industry is making up that number and for what insidious purpose? I'll tell you the answer. Your industry: The American medical industry. You.

Don't come on this site and tell me I'm not justified in saying something is a complete rip off when you're part of the industry taking advantage of peoples lives.

I don't benefit from you being ripped off. In fact, my entire career has been dedicated to identifying unnecessary medical costs, and eliminating them. It's an uphill battle.

So you're arguing it's okay to send out numbers that have no bearing with reality? That seems to fit the literal definition of insane.

Yes, this is known as "blue sky negotiation technique" and is a well-understood an successful way to frame prices.

I find this perspective absolutely alien when discussing healthcare, so I don't think there's much useful I can say about how it isn't crazy. Different cultural attitudes I suppose.

> It's just that most people don't pay that, and in this case, nobody did- the health care org paid a different amount entirely

Except people do, right? The video said that if you are uninsured in America, that is what you would get charged.

No, that's the opening to a negotiation. Many uninsured people either pay a fraction of that, or don't pay anything at all (at which point those costs are then borne by somebody else). My wife spent a bunch of time on the phone after her father died and basically by saying "we can't pay this" they would just offer another, smaller amount, until we agreed on a payment plan. This is actually how a lot of debt collection works in the US.

Are you framing this as a defense of the practice? It's hard to imagine that you view it as a positive thing that you get a massive bill you can't hope to pay, and you then have to call and beg to be lowered to some reasonable amount.

you're right about the hidden costs not mentioned in the article. He stayed at the hospital for 2 days, consulted with doctors, and received medication. this is why the bill is so high.

however, an x-ray should cost around $200. there's no need for an "expert" medical billing administrator here, $200 is double or triple the price of an x-ray in many european countries, and many facilities in america (where the youtuber lives) will charge less than $1000.

So, an x-ray machine costs $5-10M to purchase. That's just the capital cost. You operate it 8 hours a day, 6 days a week, 50 weeks a year- that's 2400 x-rays. So the amortized cost for one X-ray over a year is $2400. But! The x-ray machine runs on special generator power because it's expensive to shut these machines down, and it's run by a fulltime tech, and the hospital has many other expenses related to your visit. This is why hospitals run their x-ray machines at such a high rate of utilization- to amortize the capital costs. NOte that x-ray machines in modern hospitals aren't cheap off the shelf units- they're major installations which require dedicated rooms with shielding, etc, etc.

$200 is the out of pocket cost. Your government has already prenegotiated some payment details that you couldn't see.

Reply on news.ycombinator.com