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Comment by khannn | Hacker News Reader

I was on a blood thinner and the medication was very pricey. Didn't have insurance and the "savings card" covered fuck all unless you had insurance. There are three blood thinners on the US market and they all cost a lot.

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> There are three blood thinners on the US market and they all cost a lot.

What about Warfarin? Its $21 for 30 pills, according to https://www.goodrx.com/warfarin

Warfarin needs blood tests at least every 2 or 3 weeks. I bet those tests are not cheap in the USA. Furthermore you can't have any food with significant amounts of vitamine K or its precursors. There are pills that cost more but don't require any of that. And actually they cost very little or zero, at least in my European country. Prescription only, of course.

>I bet those tests are not cheap in the USA.

Within 5 minutes of searching I found a PT time with INR test for $24 [0]. Add in the testing fee and it's probably around $30.

[0] https://www.ultalabtests.com/test/prothrombin-time-with-inr-...

If you don’t have insurance, you’re essentially fucked in the US but this thread is not referencing that situation. My CAT scan was billed for $10,000 but what I paid was about $200 with insurance. Without insurance I would owe $10k.

> Without insurance I would owe $10k.

Without insurance you would be _billed_ $10k but in reality you likely end up paying less than that. It's still scandalous, mind you.

Why stop the conversation here? And if you don't have insurance but go to an ER (can't be turned away) and end up getting some expensive procedure you can't afford, you can just tell them that you're broke and they negotiate way, way down, or even just forgive it. And it's setup like this to ensure only people who have proper full time jobs or who can write a good enough sob story can get care. Because so many of the people in charge of this mess are far more obsessed with blocking out people they can't get enough data on or who aren't working, then figuring out reasonable public prices that make some effort to strike some fair market balance. So that if you have some savings and aren't employed, you are forced to find any job with benefits so you aren't left bankrupt, which makes taking care of health struggles harder as you have to work instead of take care of yourself.

> go to an ER (can't be turned away)

This won’t work too well for most stuff. They don’t have to treat anything you present with, and don’t have to fully treat even e.g. a heart attack. They just have to stabilize you. So they can turn you away under most medical circumstances. Like you’re not going to get free chemo or (non-emergency) prenatal care or what have you. They also can triage you into the “maybe in twelve hours… maybe” group until you go away if you don’t seem like you’re dying, or likely to pay.

It’s priced that way because Medicare has to get the best price by law. Everyone else gets a lessor discount, with cash payers getting nothing by default.

It makes sense - the largest payer should get the best price. But it doesn’t make sense because it’s not really a market.

We’d have much better outcomes with a Medicare for all model, and then private insurance could actually be priced with an insurance model and be used as a fringe benefit again.

The insurance company is not a charity. You will (or already have) pay the full price.

Not necessarily; your costs are pooled with others like any other insurance. Some will pay more over time, others less.

Im 41 and haven't been to a doctor since I was 10. I have had insurance coverage my whole life. So technically I (my employer on my behalf I guess) have paid for many other people's services. I have been a huge net positive for insurance companies. Other people get way more services than they ever paid.

Nobody in my family has any kind of crazy chronic conditions. A few surgeries, a couple of c-sections, a week in the NICU, a few short stays in some hospitals. We've experienced nearly half a million in healthcare benefits from our insurance companies over the years. I don't think I'm ever going to pay enough in premiums to cover these costs.

Lucky them... Having the privilege to... checks notes be sick.

I'm just pointing out this line:

> You will (or already have) pay the full price.

Isn't true for a lot of people.

Depending on your situation, if non emergency and you were able to ask the cash price beforehand you might be surprised that you can get the same CT scan for less than what insurance ultimately paid. At least that’s my experience ($450 vs $1200). You may have to ask at a diagnostic imaging place, not the hospital since the hospitals can never tell you what anything costs they aren’t set up for it. (Of course I went through insurance since I didn’t want to pay out of pocket, but it was an interesting lesson in one of the reasons why healthcare is unnecessarily expensive in the US.)

Was $10k before or after the insurance negotiated discount? Pre-discount prices mean nothing: I had the same tests ordered twice (needed the results urgently), once through my PCP/HMO and once paid to a walk-in doctor's office in cash. The cash price was $700. My PCP claimed a price of insurance $3500, who then negotiated it down to a "discounted" $710. So the worst of both worlds would have been a high deductible plan.

The way you have those loopholes and you have to watch out for them else you're on the hook for thousands of dollars is nuts. I mean, sure, you _might_ get a good deal or you might get completely screwed. This is absolutely not normal or fair. A society of gotcha's induces a lot of inefficiency. And as much as the US sometimes rails against inefficiency, it seems it's only a problem when you're not used to it.

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