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Comment by ryaniscool | Hacker News Reader

Something to keep in mind is healthcare providers are the main drivers of healthcare costs. The insurance company was not going to tell the doctor how long to put you under only how much time they would pay for.

I don't think it's unreasonable to put a cap on the cost of one of highest paid healthcare specialties.

Of the surgeries I've been involved in as a patient or family member, the anesthesiology bill does not seem proportional to the work they do. I mean they do some calculations for the amount of drugs to put you to sleep and then monitor your vitals. Seems like something a responsible and well-trained nurse could do.

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This is not an informed perspective. Anesthesiologists are some of the most highly trained physicians in a hospital.

Human physiology is complicated and on the surface, any job can seem simple if you have no understanding of what is happening. While a large portion of the time, the surgeries go smoothly, sometimes it doesn’t and it can go downhill fast. In that moment, you want an anesthesiologist that can quickly and thoroughly think through a patients medical history, what drugs they’re on at home, the current surgery, variant anatomy, what drugs they’ve given so far, etc to decide on the correct next drug to give or action to take. That takes training and experience.

The assertion that physicians are a primary driver of excess US healthcare costs requires evidence.

See here https://www.commonwealthfund.org/publications/issue-briefs/2...

Physician salaries are a driver, but the far bigger portion lies with insurance’s take, and the administrative costs required to respond to insurance shenanigans.

This report, linked in a vox article a sibling post, comes to the opposite conclusion.

https://www.healthsystemtracker.org/brief/what-drives-health...

It calculates US's spending on healthcare to be 87% higher than "Comparable Country Average", and attributes only a 10 percentage point of the price increase to "administration" costs, as opposed the report you linked which estimates 30 percentage points.

Anesthesiology average salaries

US: $438k/yr Australia: $203k/yr UK: £112k/yr

That seems like a big difference to me.

I don't understand why the insurance company is the one to decide when and how to cap the costs. If a doctor says I need X drug or Y procedure the insurance company shouldn't be allowed to just deny paying for it simply because they want to pad their margins. I have had doctors prescribe a certain drug for me, insurance denies it, then they switch me to something else which they say is inferior because it might cause other issues/side effects but that's what I have to do if the first option won't be covered. If someone smashes into the passenger door of my car can my car insurance company just say they don't feel like paying for it because I can still get into the car through the driver side?

Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.

>I don't understand why the insurance company is the one to decide when and how to cap the costs.

Because the insurance company is basically the only entity who has skin in the game.

>Sure premiums will go up, but the conversation should then shift to why does a 15 min ambulance ride cost $5,000 instead of fighting about whether or not an insurance company is going to cover it.

And the response if this is all covered would be "who cares? my insurance is covering it anyways". The patient doesn't have any incentive to choose a cheaper hospital, because he won't see any of the savings.

This is a straw man argument. Yes they shouldn't deny a prescription if your doctor says you need it.

What I'm talking about is capping the costs of a supporting doctor for a surgical procedure. From my quick research, there is no significant cost basis for surgery running longer than planned besides the anesthesiologist's time. So the doctor would make $400k instead of $500k per year.

Here is some perspective. The anesthesiologist's bill for my wife's colonoscopy in 2023 was $2k. This is a routine procedure that takes less than an hour. Also, the place was just filled with patients and there was one guy handling them all.

I agree. I'm just saying that instead of reducing healthcare costs by having insurance companies deny necessary procedures and medications seemingly randomly, there should be serious regulations capping healthcare costs. Generally speaking I am against any form of government-set price controls, but healthcare costs are so completely out of control that I don't know of any other way to deal with it. It's also a unique situation where the customer has no way of shopping around for a competitor - if you're having an emergency, your only choice is the nearest hospital - they should not be taking advantage of that situation and making you pay through the nose.

Remove / equalise the reasons that it makes sense for your employer to control your insurance provider. It was an act of government that caused it in the first place.

ACA needs 2 sequels before anything resembling a market can emerge.

Everyone is free to buy whatever insurance they want. But they won't be able to pay for it with pre-tax income like their employer is able to.

It's an explicit pro-big business tax policy that hurts businesses that aren't big enough to afford the paperwork and HR involved with administering insurance and other benefits, and also to prevent people from being able to easily compare compensation offers from various employers.

Just passing along some heresay here... I'm not fit to judge but this thread does have some support if trying to reel in anesthesiologist billings. Second hand report of an anesthesiplogist being in support of BCBS trying to limit unneeded expenses. https://bsky.app/profile/nemoblue.bsky.social/post/3lcllzxje...

The problem is that the proposed solution made no sense. If the surgery is taking longer than expected, that is not something driven by the anesthesiologist. And yet the proposal would be complicating the billing/payment relationship of the anesthesiologist & the patient. Meanwhile the actual surgeon is not at all affected.

There is a specific type of nurse called a CRNA that is basically a replacement for anesthesiologists. And half the nurses I know are going to school for that. It seems like hospitals and insurers want to replace the MD here.

> I mean they do some calculations for the amount of drugs to put you to sleep and then monitor your vitals. Seems like something a responsible and well-trained nurse could do.

https://xkcd.com/793/

Are there any countries in the world where they've replaced anesthesiologists with nurses? What's the data on outcomes for that look like?

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