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Comment by hs | Hacker News Reader

over my 9 years studying in usa, i never used my health insurance (always paid due to school regulation)

then 4 years in my country, i never buy one

actually over my lifetime, i never ever go to hospital and ask my insurance to pay for it (too much hassle and i hate meeting doctor)

the fud tactic used (you will pay 1 million dollar when you visit a hospital) always amuses me

maybe a better way is to take care of yourself, exercise, read health textbooks, read wikipedia on generic OTC drugs, eat real food, avoid extreme sports, don't smoke, use common sense etc

never ask an insurance company, "do i need coverage?"

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One of the things that nearly everyone here is missing is that insurance plans cap costs. Hospital costs for an uninsured person are 2 to 4 times that which an insurance company will pay. I had a heart attack. The hospital billed $80,000, but the insurance company paid only $18,000, and I paid $2,000. Same for dental plans. They cap the amount that provider can charge and stipulate that he can't bill you for the excess.

The idea that you can negotiate as an individual with health care providers is silly. When I had my heart attack, I was in no position to call half-a-dozen hospitals to get the best price. Try going to your pharmacy to get the price of a prescription knocked down. Individuals have very little negotiating power against corporations. If you doubt that, take a look at the history of the labor movement.

That said, if you are low income and need expensive meds, many pharmaceutical companies have plans for certain drugs. Costco gives a small discount for people with no insurance.

You can't shop around for trauma care. But why can't you shop around for the cheapest non-emergency MRI, chemo-therapy center or dermatologist?

Hint: you can, I've done it. Now that I have insurance, I just pick the guy closest to me. Why should I bother to price shop when I don't get the savings?

When consumers price shop, corporations compete on price. See for example Walmart, Jetblue and Dell. And a lot of medicine is delivered by individuals or small businesses (i.e., 5 doctors in 1 office), not by corporations.

I had a heart attack.

Why did that happen? Most people do not have heart attacks.

Believe the FUD.

In the U.S. an appendectomy can easily run you $20,000, and this is one of the most common non-elective surgeries.

Then look at car accident stats and the cost of trauma care.

Then look at new cancer incidence rates (there will be ~1.3 million new cases next year - CDC) and treatment costs.

The costs are absurd because of insurance. People are too isolated from prices and all the money the government pumps into the system inflates prices.

The whole healthcare cost problem would disappear almost immediately if people paid medical bills directly and were reimbursed for only the truly unforeseen medical expenses. If doctors and hospitals were forced to compete on price like normal businesses, costs would plummet. It's the lack of a real market that's the problem. What other business has no prices out on display or in advertisements? Try calling up a hospital and asking the cash price for a procedure. It typically doesn't even exist; they're only set up to bill insurance companies and the government at different rates.

"Healthcare in the US is socialism without a central plan and capitalism without markets or prices."

You're at least partly right. Some treatments would plummet, some would remain expensive. We really have no idea, the market is so distorted and the perfect system will always be subject to debate.

In my opinion, we can't ever have a true capitalist market for healthcare because the price elasticity of demand for some treatments is so high.

Another phenomena that raises the costs is the haphazard and/or non-existent approach to capping the value of awards in malpractice suits. It's a secondary manifestation of the separation between the people choosing the price and the people footing the bill.

I'm not an expert, but what from what I've gathered the outcry over malpractice suits is misplaced. There truly is a massive amount of medical malpractice.

I agree. And universal subsidies for care without addressing the incentive problems in the markets aren't going to help matters.

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