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Comment by majormajor | Hacker News Reader

What does "make pricing transparent and competitive" mean to you?

I hear this a lot but I don't see people explaining what exactly their desired outcome looks like, and to me, I can see lots of ways it potentially changes things without actually improving them.

Are you picturing a world where before you call an ambulance after injuring yourself you have to get on something like yelp to look at prices for 10 different ambulance services, and ten different local urgent care or ERs? Are you picturing a world where it's obvious that some surgeons and doctors are 10 times better than others, so the rich pay $$$$$$ for 10x better care, and the poor are left with the scraps? Or a world where it's hard to tell, so people compete on price alone, and the doctors who care most about outcomes vs bottom line are at a disadvantage?

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When I take my cat to the vet I get upfront estimates.

When I take myself to the doctor no one can tell me how much anything costs.

Regardless of insurance status the vet gets paid the same amount.

My pets get better healthcare then I do and I pay less for it and they don’t have insurance. I’m relatively healthy, my cat has FIV. I have insurance my pets don’t.

> When I take myself to the doctor no one can tell me how much anything costs.

Not an American so asking out of curiosity - don't hospitals have price lists?

In America, you spend a few hours in the hospital, and then for the next year you receive separate snailmail bills for each procedure, medication, machine, instrument, outsourced clinic, and every doctor who happened to pop in to greet you. All in unpredictable, exorbitant amounts. And any of these bills may be sent to you again even if you pay.

If you're well insured, you still get all the fun reading material, but they say "amount you owe: 0.00"

"Amount you owe: $15,000 MOOP (max out of pocket) and $230 premium." There I fixed it for you buddy.

Nope. Here is a personal example that I love to use.

When my wife was first pregnant, we had health insurance amd we picked a hospital whose business was 50% baby delivery.

Not a single person could tell me how much it would cost to deliver the child. The OBG couldn't tell me. My health Insurance couldn't tell me. The hospital couldn't tell me. I know - for a fact - the hospital had delivered babies from other people with my insurance. They couldn't tell me the cost of a delivery.

Also, someone screwed something up and I was improperly charged for a hearing test. SMH.

No. Doctors make a show out of a professional indifference to filthy lucre, except when they cash the checks.

Because the federal government insures the poor and old, the law requires that they get the best pricing. So every other insurer pays a little more, until you get to an uninsured person, who pays some unfathomable rate.

Technically as of January 2021 hospitals in the US are supposed to have price transparency now. https://www.cms.gov/hospital-price-transparency

While it's a step in the right direction, most people don't know about it, the accuracy is questionable, what insurance will cover isn't clear, and what random additional fees will be added are unknown.

Noone is enforcing it, it was enacted by the Trump administration in 2019, effective Jan 2021, but the Biden administration isn't enforcing it and hospitals are defying it.

https://healthcareexecintelligence.healthitanalytics.com/new...

"Are you picturing a world where it's obvious that some surgeons and doctors are 10 times better than others, so the rich pay $$$$$$ for 10x better care, and the poor are left with the scraps?"

Isn't this the case already?

I mean, it could probably be worse, but I doubt Bill Gates will go to the same clinic that I do.

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