Comment by dr_ | Hacker News Reader

Comment by dr_ | Hacker News Reader

Interesting read, and a valid criticism of the costs associated with ACL repair in the US. It would be nice to know, however, how much your insurance company actually paid for the procedure. There's probably a large discrepancy there.

My own thoughts are that if there were a true free market for healthcare, with insurance only for real medical emergencies, the costs of a lot of these services would drop, including physician fees, equipment etc. Most of the population would not, and likely could not, pay 68,000 for an ACL repair, which would leave medical providers the option of 1) lowering prices substantially or 2) being out of work. Having put ourselves on high deductible health plans, we are super vigilant now about how we spend our healthcare dollars. And having realized the impact of this, since we are medical providers ourselves, we are now transitioning to a model where we are not participating with many insurance plans, but our fees will be completely transparent - published online - and fairly reasonable (I think).

"with insurance only for real medical emergencies"

You then have people putting off preventive care, tests etc and then you have to cover a bigger problem down the line.

I'll give you an example. You are a landlord with a tenant and you tell the tenant "you have to take care of minor repairs I will cover anything major". As a result they don't do normal maintenance either because they forget, don't care, who knows. Then because of lack of that maintenance the compressor fails on the HVAC and you end up having to replace a unit. Good luck with trying to tie that to the lack of maintenance. Or saying you won't cover it.

That is an interesting hypothesis. There is, however, very little evidence to support it.

The idea is to have the right incentives in place. The premium for medical emergency insurance would go down as you are more proactive in your healthcare.

For example, by having an annual physical, maintaining your weight, etc. you would get a discount.

> The idea is to have the right incentives in place.

The recent article about Finland's baby box was a great example of this and their infant mortality statistics show that it worked.

You pay $100 for preventative care now to avoid paying the $5,000 deductible down the line.

"care now to avoid paying the $5,000 deductible down the line."

Does not answer the question of what to do with people who don't have a pot to piss in. You aren't going to deny them medical care. That's the problem. Just like you can't say "if you smoke we won't fix your lung cancer" (forgetting even if the link could be clearly established).

Bottom line: You have to prevent people from their folly. Although certainly some people would respond to the incentive in your example.

You're right, there is a discrepancy and I didn't think to put it in the article.

I couldn't find the doctor's charges on-hand, but the total cost for the facilities/drugs/equipment was $48,851.82. The insurance ended up paying $14,742.88 of that post-adjustments.

$14,742.88 is the real cost since hospital are running off of the income from what insurance actually pays. if average people were able to pay the "insurance adjusted price" for most things they would not need insurance for most things.

Somewhere within the regulatory frameworks in which health insurance and hospitals operate, there's got to be the leverage to make pricing and other metrics like infection rate, readmission rate, etc., transparent.

Otherwise you can hide some serious price gouging in that fog of bogus prices.

I'd rather just let any citizen/taxpayer pay the medicare or medicaid rate for a medical procedure out of pocket if he wishes. That's even lower than the insurance negotiated rate, and hospitals/doctors would have every right to exclude all medicare/medicaid patients if they want (many private doctors do, but generally hospitals don't, since they depend on the volume from medicare, and there are some other benefits for residencies).

There's a slow trend toward doctors not taking insurance. A few of the higher profile cases have seen private practices reduce their prices between 50% and 80%, while still making a very healthy profit. For those that need charity care, they're actually able to provide it due to having a huge block of resources (time and money) not being tied up dealing with insurance claims.

I commend your move toward transparent prices for the services you provide in the medical industry.

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