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Comment by nradov | Hacker News Reader

Feel free to blame doctors if that makes you feel better but the reality is that in most cases they literally have no way to accurately calculate a patient's out-of-pocket cost in advance. Like there's just no technical way to do it.

If you have specific suggestions for fixing the regulatory capture problem then you can submit a petition for rule making under the Administrative Procedures Act.

https://www.govinfo.gov/content/pkg/USCODE-2011-title5/html/...

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You keep misinterpreting "how much [a doctor] themselves will charge for something" as "patient's out-of-pocket cost". I'm certainly not asking for the doctor to get involved between the patient and their health plan [0], but rather what the doctor charges, regardless of who might pay. In other words, the straightforwardly-legible prices that exist in every other market - even markets where insurance companies often pay (eg auto repair).

I don't know the specific legal details that allow doctors to make up these post-facto bills (often fraudulent) and send them to patients, but I feel it's probably at the state level rather than federal. Also the big problem with regulatory capture is that businesses paying off politicians makes that kind of citizen feedback meaningless.

[0] in fact I think another good angle of reform would be "if a patient has a health plan, providers are prohibited from billing the patient directly". Any copays, outstanding balances, etc should flow through the health plan.

Are you perhaps unfamiliar with existing price transparency rules? Patients paying cash already have the right to demand a Good Faith Estimate in advance. Those using a commercial health plan can see the negotiated rates for every participating provider.

https://www.cms.gov/medical-bill-rights/help/guides/good-fai...

https://www.cms.gov/priorities/healthplan-price-transparency...

I'm aware of them, but I'm not familiar with them as they seem like band-aids that add even more patient self-administrative bloat, rather than fixing the core dynamic - making healthcare pricing work like every other industry. The word "demand" is a tell, showing that this is not the normal course of the relationship. Another tell is that it's two prongs - why can't everyone receive a "good faith estimate" from a provider? Note I'm still not asking the provider to grok the patient's health plan - rather to be upfront about the prices they themselves are choosing to charge.

Also the ambiguous place between the two cases - "you have a health plan but we didn't do the work to actually bill it" - is a common source of the fraudulent shakedown bills, and this does nothing to constrain those types of fraudulent bills!

In general, I don't need to request a "Good Faith Estimate" from a grocery store about my upcoming food purchase for when I go later in the week, nor for an oil change down at the mechanic. If I go to the mechanic with "something is making a noise", then they are upfront about any fixed diagnosis fee, and then give estimates routinely in terms of a shop rate and book hours. If there are still unknowns about what might need to be fixed/replaced, they are up front about that and readily communicate with the customer. All of this is straight up missing in the medical industry, even when you try to engage. Rather they shove "consent" forms at you that say nonsensical anti-contractual things like "we can bill you whatever we want and you're responsible" and when you start pushing back on them they look at you like you have three heads.

(and just to head off the inevitable drive by comments like "It's not practical to shop around while you're in an ambulance" - the vast majority of medical care is scheduled ahead of time rather than on an urgent basis)

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