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Comment by 88913527 | Hacker News Reader

You can always try a different hospital for better service. Of course this won't work in situations where timing is critical, but most surgery is scheduled. We might as well treat it for the business that it is. If they can't give you a reasonable estimate up front, then don't sign the paperwork. If they care about earning your money they will negotiate with you, and it's always better to negotiate terms up front proactively than deal with it reactively. The strongest power a consumer has is to vote with their money.

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You can try to comparison shop all you want, but no hospital will give you details in the chargemaster if they aren't legally obligated to.

Even if you are in a position to shop around, journalists have documented their futile attempts to do price estimation for routine procedures. Here's one example: https://youtu.be/Tct38KwROdw

There have been recent laws that requiring publishing some of that information (which are being heavily contested), but comparison shopping remains effectively impossible in the US.

I'm not sure it exists. Every hospital I've ever contacted is a complete shitshow and can never accurately tell you the price of something ahead of time.

Dealing with our fertility doctor was great though. They knew the price of everything. But they were ran out of an office, not a hospital.

It’s funny how anything elective or cosmetic is like that. To be clear, infertility is a serious medical condition, and I’m not making light of it. The distinction I’m making is an economic one. When patients have more choice as to whether to even be a patient, you see much, much more consumer-friendly openness about pricing. So it is possible. Fertility treatment is a great example. So is elective eye surgery. These areas of healthcare are very different from the “sign your life away now and we’ll send you the bill later” standard of most healthcare.

If something goes wrong in the surgery and you need emergency care do they just cover it free through their own for of elective surgery insurance, or is it an opaque cost?

This reminds me of the situation with the telecoms in the east europe - it's almost the same. There were no incumbents, so both internet access and private healthcare are leagues above US. It's just not comparable. Also include online banking here.

You need stuff done - you go and get it, end of the story. No bullshit, no courts, no nothing, and it's orders of magnitude cheaper.

Bascially, the joys of free, open, not schizophrenically regulated market mechanisms and competition, unlike the U.S. healthcare system, which despite many common claims to the contrary is a shitshow of protectionism, half-assed regulation regimes and all sorts of bizarre half-measured meddling.

Dentists can usually give precise charges.

Kaiser Permanente usually has a precise copay for just about anything they do. So you have a good idea what the charges will be going in. And nothing like an extra $10,000 because one of the surgical team was "out of network".

You're assuming the hospitals don't all do this. You're basically discussing market dynamics with a legalized cartel.

This is like when people point out problems with fiat currency which are very real, and then people suggest theoretical solutions from cryptocurrency. It doesn't actually help solve the problem in any meaningful way, and you are living in an alternate reality from the problem space we are discussing.

People say it's impossible to negotiate prices at modern grocery chains. They only had brand name lactose supplements. The manager gave me a hard time about it, I asked about a price matching policy, shrugged, and let me pay the generic price. I'm sharing this anecdote because I don't think people try hard enough and you might be surprised if you do. You won't win every time, but try asserting some authority.

By assuming markets are so rigged against you, it discourages people from even trying. Price discovery can only happen if you attempt to be firm. If you'll roll over instantly, then sure, they can do as they wish.

I've had the misfortune of suing insurance companies in the past; I'm very aware of how the system works. You are technically correct. It's just that you're grossly exaggerating exceptions as though they will ever be useful to a majority of people.

I tried this exact thing when my wife was going to have a baby.

None of the hospitals within 100 miles, the doctors, or the the insurance company would give me so much as an estimate, and this is for something that they do every day.

> If they can't give you a reasonable estimate up front, then don't sign the paperwork.

That's the issue, they don't give you estimates that they are actually bound by.

And if you're an hour away from being in the operating theater, and they have all the specialists there, and in that moment you choose not to sign-- it's more their problem than yours.

…no it isn’t? You need to get surgery, they want to provide surgery

That's what makes it your problem. They can just say 'no' until you sign the document agreeing to pay whatever they bill you later.

I think GGP commentor typo'd - it says the opposite at time of writing.

They'd likely ask you to sign way before that..

This whole nonsense with chargemasters is an industry standard practice. It's hard to find a hospital that will open the book for you.

No, you cannot

I have no time to look it up RN, but I read a few years ago about a new hospital President/CEO who literally could not get a cost/price list for the services their hospital provided - obviously a key management data set, yet it did not exist.

Just because you think something SHOULD exist, does not mean that it does.

The cost accounting for most hospitals is totally opaque. How do you assign overhead to each activity? Does the ER make or lose money?

How much of a nurse's time to give patient a Tylenol? Zero? Five minutes? And how much does that nurse's time actually cost the hospital?

Nobody has the slightest idea.

> How do you assign overhead to each activity?

Every business has to deal with this problem, and hospitals have already done so, because they do somehow come up with the amount to charge you.

The possibilities for manipulation?

Or simple overcharging.

This SHOULD be true, but it is not.

Once again, SHOULD =/= IS

Just because they quote charges does NOT mean that they have solved the problem or that the charges are accurate.

There is absolutely nothing that requires the charges to have any relation with the actual costs, even if they are known, particularly at the item level. Only the total charges must exceed the total costs (less any external support e.g., from govt, philanthropy, grants, etc.), and that is on a basis of multiple years before any serious reckoning happens.

IOW, they can and in fact do literally just make it up. Also, charges that are heavily scrutinized may have some relation to costs, but other charges may be "just add a few zeros" to make up for it.

If you have some detailed and complete internal accounting data from any major hospital that proves me wrong, please post it. But when I read about congressional testimony that a CEO of a hospital literally cannot get the same data that you claim exists because 'of course it's been solved because every other business solves it', I find it difficult to believe you.

I can also state from running a business that the relationship of costs to charges is very loose. Sometimes I will sell things below cost for a number of reasons, and for some customers (e.g., those with high bureaucratic overhead requirements) the charges will be substantially higher. And when those charges are made, I may do detailed studies of what the increased costs are, or I may just say "one data point shows that's going to cost 4% more, but I don't like it, so add 7% - basically a whim. And no one in the world besides me knows the difference (and I forget about it after a few cycles and it becomes the baseline). So, yeah, perhaps stop posting speculation.

Regulated utilities, for example, are under constant scrutiny to be sure that they are allocating costs appropriately, and that any subsidies conform to public policy.

Somehow the medical industry has so far largely avoided such oversight.

Even within a single enterprise, misallocation of costs can lead to inefficiencies.

You need to wake up and stop accepting this as normal or okay.

Hospitals are not just any business and if it starts to hurt us as a society we need to interven.

Maybe in some libertarian dream land only, not in reality. You think a hospital will personally negotiate rates ahead of time with a single patient? Absolutely fictitious.

They could offer a flat rate based on the length of the procedure...

Huh? Over here in Germany, every single step of a treatment is documented and has country-wide standard rates. The actual cost depends on the specifics of the treatment, expressed in various parameters like required personell and their working time, goods used, complexity etc. In the end of course the insurance company pays for everything, but you still get to see how much everything costs - insurers are of course very keen to keep costs down. On the other hand, I know a few MDs which constantly complain how much of a hassle it is to document everything, but live over here in „liberarian dream land“ is very much real and a joy as the patient.

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