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Comment by endisneigh | Hacker News Reader

If you cannot broadcast medical debt then you cannot bound accumulation of such. I expect this to be counterproductive like subsidized mortgages and student loans.

At the end of the day, hospitals need to pay people, if this increases the losses for hospitals it’ll be bad in the end.

A better rule IMO would be not just transparency which is law, but forced disclosure. Hospitals should have to disclosure full costs and breakdown to insurance and to you for procedures before actions are taken. Bonus points if said procedures are then compared to local, state and national averages.

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Medical debt already isn't really subject to usual incentives because people rather not die.

People that help you not die want your business. Why isn't there a competitive market pushing prices down?

Because people who are dying are in no position to shop around.

Price transparency can still help the rest of us

This would make sense as the answer if there were sky high prices for time sensitive things but much lower for things that don't need to be done right now.

My impression of US health care is everything involving a hospital being expensive.

I suppose it is subjective, but I consider about any health problem requiring a professional time sensitive. Time lost potentially leads to damage of one’s most irreplaceable asset.

I am visiting a hospital every 2-4 weeks for years now. There is a very tiny minority of dying people. Those should of course get every regulation and help they need.

Many visitors are actually coming to shop around - meet the doctor, hear their plan, compare with others and then decide.

Shop around? In the US, that's not really a thing. Your choices are very much restricted by the health insurance you have. Some health insurance plans are better. Mine is pretty good by US standards, and it still has all sorts of restrictions on what's covered, and by which health care facility.

Even with my insurance, I would go bankrupt if I was at a US hospital every 2-4 weeks for years.

I'm not in the US, I live in Europe and health insurance is a personal thing completely unrelated to an employer. But my treatment isn't covered at all because it's not immediately life threatening and not the cheapest most traditional treatment option - a big issue with the EU systems is that it's either the regulated but usually pretty bad option, or 100% out of pocket (and the prices are not very different from what an US hospital bills). I can't just submit an invoice and get at least part of it covered. In my case I'd have problems even if I used the regulated option because there isn't an official code for my illness - it exists but only for children.

I wouldn't be able to function if I didn't go and I'm sure there's plenty of people like that in the US too... And yes, I'd go bankrupt if I didn't work in software for US company. Sucks to be poor - regardless of which continent.

i thought the prices were made up after the procedure? I'm not in the us, this is the impression I get from reading about it online.

There isn't a competitive market, there's a shortage of doctors and healthcare workers.

> which is law, but forced disclosure. Hospitals should have to disclosure full costs and breakdown to insurance and to you for procedures before actions are taken

Fun fact, this is already the law. The price of your appendectomy will be $2000-$80000, does that help? Your insurance will also tell you that an appendectomy costs $14 if you get it done out of network and so that's all they're paying.

Which law is this (in the United States), and a range is not indicative of how much you actually will pay.

It was added by the Affordable Care Act.

https://www.cms.gov/priorities/key-initiatives/hospital-pric...

https://www.cms.gov/files/document/hospital-price-transparen...

Hospitals responded by giving quotes with stupidly wide ranges like this -- "your medical procedure will cost.. let me check here, an amount of money." The reason for this does actually make sense but is still impossible to plan around. Hospitals bill for the work they actually do, not "here's the all-inclusive price for an appendectomy" and so they won't/can't say in advance how much it will cost until they do it. They can guess with things like "the average price" but it's still a guess.

Once you leave the world of "necessary" medical care you start to see all-inclusive pricing again because folks are paying for it themselves. You will get an actual price for a nose-job. However this is a bit of a lie because they also require you to have insurance for complications which goes back to a la carte billing so it's better but still not ideal. It's a big ole game of "nobody wants the risk."

That’s the transparency I alluded to, but disclosure is not forced, and as you mention the values are disambiguated and not standardized. Plenty of room for improvement.

> A better rule IMO would be not just transparency which is law, but forced disclosure. Hospitals should have to disclosure full costs and breakdown to insurance and to you for procedures before actions are taken. Bonus points if said procedures are then compared to local, state and national averages.

Mechanics are required to provide a reasonably accurate quote before they begin work. Seems reasonable for doctors too, outside of emergent conditions; I don't need to be woken from surgery to sign off on extra stuff that shows up and needs to be done; but if it's something that's happens in 10%+ of cases, maybe it should be quoted too.

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