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Comment by BadCookie | Hacker News Reader

What if every clinic had to make a price list of procedures publicly available, and could not legally charge people different amounts for the same procedure (regardless of insurance status and so on)? That would solve at least some of the problems.

But I think it's obvious that almost no one actually wants to fix the broken system, because too many people are making too much money from it. (Doesn't that apply to almost everything in the United States nowadays? It's pathetic.) I'm happy to see the author pointing the finger at hospitals and doctors. It doesn't seem like that happens often enough. (When I say "doctors" I really mean specialists. I don't think that GPs are as much to blame.)

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By "almost no one" you mean "probably most people, but some people who make lots of money from the current system are using part of that money to bribe politicians not to fix it, and we live under a government where that is tolerated."

I suppose I meant "almost no one" who actually has the power to do it. So yeah, what you said.

Most of the West has free healthcare - and it works pretty darn well, considering. I would imagine many people are still shocked that healthcare is not free in the US. This is yet another reminder of how lucky we are ... those of us who are covered by free health (eg. in Commonwealth countries).

Actually Indonesia, a country clawing its way out of third world status, is in the process of introducing universal health care, [1] so it's not only commonwealth countries. Hopefully, this 'socialised' system can be implemented in such a way as to flourish within the rapidly growing economy to come.

In the UK, after we've charged you nothing in the NHS, we'll give you the bus fare home.

1. http://www.marketplace.org/topics/world/health-care/indonesi...

Yes but try getting an appointment with a doctor in a reasonable time under NHS. It's been a while since I've left the UK but I remember getting appointments with a primary care physician using private insurance I would get one the next day, with NHS the next month.

It does seem to have got worse in the last few years - not that I go to a GP often (maybe once every 3 or 4 years) but I was used to getting an appointment within 1 or 2 days and the last time the only appointement was about a week away.

However, it is worth noting that recent published statistics (for 2011/2012) show that:

"85 per cent could see or speak to a doctor or nurse within two working days compared to 90 per cent in 2009/10."

Note that this is for NHS Scotland - there actually isn't a single NHS for the entire UK.

http://www.scotland.gov.uk/Publications/2012/05/8250/3

One of the problems with the NHS is that it seems to suffer from having regular waves of (probably very expensive) management re-organisation inflicted on it in efforts to make it "more efficient" - often with non-medical managers being incentivized on performance, so they end up gaming the metrics.

Still, I think the NHS and the concept of "free at the point of delivery" championed by Nye Bevan "In Place of Fear" are still fantastically important to society the UK - though nobody claims it is perfect. Clearly the absolute best level of individual care are to be found elsewhere (probably in the US). However, when I see quotes elsewhere in this thread such as:

"I broke my knee this spring but didn't go to a hospital on my families request because the last time I broke a bone I reset it myself and the hospital still charged $8k."

Those pretty much fill me with horror/fear that anyone has to put up with that - which is precisely the reason the NHS was created.

I actually like the dual system offered in the UK. I was in London back before 97, it appears things have gotten much better (http://www.mirror.co.uk/news/uk-news/exclusive-nhs-hospital-...).

Although specialist visits are still lagging behind the US (23 weeks for knee replacements).

Yes, the non medical managers (i.e. those annoying MPH people who make drastic irrational changes to justify their positions), we have the same problem in Canada.

Of course, one thing about the NHS in the UK, as with state provided education, you can opt out of using it but you can't opt out of paying for it!

Yes but try getting an appointment with a doctor in a reasonable time under NHS.

You can usually get an appointment with your GP within days, sometimes the next day (depends on your local GP). In an emergency you can call them and get an appointment straight away. It's never been a problem when I needed to see a UK doctor.

The GP can decide with you if you need to see a specialist and refer you (the vast majority of people don't).

It takes me a month to get a physician appointment with private insurance in US (and you cannot go to the doctor without first going to physician). I don't even bother anymore and just go directly to urgent care.

Part of the problem with US healthcare is not just that prices are insane, but that it does not provide an adequate service even given those prices. Again, a sign of a non-free market.

I actually had a discussion with my doctor on this very subject. He was complaining that he could not actually advertise prices as it is apparently considered price fixing if doctors do that (or so he says). He also told me he would be stupid not to bill the highest possible price he could for things because he doesn't know exactly what the insurance companies will accept and he could be leaving money on the table otherwise. So don't try to distinguish between specialists and GP's, they all do it.

Interesting. It's cool that your doctor tried to be honest with you about it. It would be so much better if you were his customer and not your insurance company.

Since I have an HSA, I write checks to every doctor that I see. (My company buys me high deductible insurance and puts $6k into an HSA each year for my family.) When I visit my GP, it's $72 for usually 20 minutes of his time and I can get in to see him the same day. Specialist appointments are $800+ for what often feels like a more cursory conversation that I waited a month or two for. That's why I am not as quick to blame GPs. They have to rent office space and hire office staff on top of acquiring an expensive education, so the price that they charge (to someone with insurance like me, anyway) feels pretty justifiable.

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