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Comment by dialtone | Hacker News Reader

Your sentence is strangely ironic... You want a completely free market without regulations and yet you are complaining that a company doesn't give out standard billing rates.

The idea of the non-regulated free market is that you'd choose with your wallet by going for another health care provider that tells you the billing rates.

If you want to force companies to reveal standard rates you are adding regulation. So is regulation needed or not?

Not even Adam Smith argued for a free market without regulation... He himself even identified several pain points and warned against "laissez-faire" economy.

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In India's free market healthcare system, I had no difficulty finding out billing rates. The common stuff (e.g., cost of a hospital room or a blood test) was posted on the wall, and the doctors gave me details on more specific stuff.

That's at least one data point suggesting that in a free market, prices will become transparent.

Japan does that, too. They have a big book doctors follow for every procedure. Their system is regulated, price-fixed, and universal.

Pretty much true of dental, optical, and veterinary care in the USA, too (which are often paid directly out of pocket; dental and vision insurance is just a taxable vs. untaxable thing, but doesn't really spread risk like insurance).

Rather than focusing on the "meaningful use" EHR stuff, I wish the government would demand machine-readable and easily accessed pricing (list, prevailing, medicare, and all negotiated insurance, as well as actual collection rates) for services, at least from any doctor who accepts medicare or medicaid. Publish this, let people build awesome tools.

I take it you're not an american? Almost all health providers will not give out their rates, it's extremely hard to get prices on prescriptions, and you're rarely billed in full up front. It's damn near impossible to do anything remotely resembling a free market based approach to healthcare. There's this relationship between insurance providers and the health industry today that's impenetrable. It's very hard to explain, because nothing in the world exists like it. It's a horrible mess.

P.S. I never shared my opinion on the matter, but since you brought it up, I'm actually on the fence about the matter. I'm not a fan of the health care bill, but more because it seems to me like it's going to make things even more complicated than before. Also, I'm not a fan of the precedent the supreme court's ruling has set essentially weakening the states' powers. But, that's all fairly irrelevant to the discussion at hand.

But are you asserting that this is somehow the result of regulation? Because I have trouble understanding that.

I asserted nothing of the sort. Regulation is just a part of it. Again, I could go on for days. It's the result of both employer subsidized health insurance and bad regulation. I'm not against regulation. I'm just against stupid regulation and there's a ton of stupid regulation in the health industry today. Prime example: not being able to purchase health insurance out of state, which forces insurance corporations to setup shell companies in every state complicating the claims process and creating a ton of bureaucratic waste. On the employer provided bit, by having the employer negotiate the terms of the coverage, it removes the insured from the process. I, as an individual, have nearly no choice in the matter. I either go with the employer provided plan or I go with an ubsubsidized plan where there's nearly no competition in the marketplace, among other things (so rates are ridiculous).

You did not address the question.

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