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Comment by abat | Hacker News Reader

For a lot of stuff, the idea of pre-negotiating price between patient and provider sounds great. I'm not sure how emergency care can work well though without some third party to help set fair pricing.

You get taken to a hospital out of your control, and they're allowed to decide what services to provide and as well as the price they're going to charge you. After the fact your only leverage to negotiate the bill down is declaring bankruptcy.

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Here's a wild idea: emergency care should be handled by the state, and just accepted as the cost of living in a modern civilized society.

Here's a wild idea - it is handled by the state. (Unless you already have insurance)

So... if you don't have insurance, guess where you can go? That's right - to the emergency room, where they are legally obligated to treat you. And if you don't/can't pay, then the hospital. It is one of the costs of doing business, and if you are a county hospital, then the cost is eaten by the gov't.

Needless to say, without handling the rest of the healthcare industry, just having the state pay for emergency care won't work.

What you'll end up with is a one-way ticket toward emergency rooms packed with people there to get routine (non-emergency) care. Or, you get people that have legit emergencies caused by lack of routine care... pick your poison.

Or the opposite: Have the state take care of routine preventative care (exams, age-related tests, etc), the patient would have a high-deductible policy for stuff like cancer, auto-accidents, etc. And everything else people pay on a fee-for-service basis.

Society benefits because we're paying to ensure a basic level of health for everyone and not the current system of inflated prices. The insurance industry gets to stay in business (which they wouldn't under a government run single-payer system), and patients benefit because they get to shop for a provider based on outcomes and price, for everything that isn't catastrophic.

I agree with you, but that ripples outward. If I don't have to pay for emergency care, then why pay for insurance at all? I can just go hang out in the emergency room and they will take care of me. I realize a large sum of people do that right now, but that just reinforces how broken our current system is.

We have to fix healthcare in total before we can say thats a done deal, but it is the right direction.

Honestly, I think that the final answer really ought to be state-run hospitals that provide intensive and emergency care for free, and state-run doctor practices that serve as GPs and whatnot for communities. Private practices can exist, but they get to play in the market normally and price accordingly.

The problem is the metric crapton of Americans who will grind the system down as they fall prey to the beetus and obesity, and the number of wrongheaded bozos who think that letting the .gov handle this is somehow automagically a bad idea.

Here's a better idea: require all hospitals and Dr offices to publish fee schedules in a centralized location, allowing the customer to price-shop procedures. Then there would be downward pressure on prices, and you could plan in advance of elective procedures.

Operator, I'm having a heart attack! Please direct me to the nearest centralized location of the fee schedule, so that I might begin studying my options.

There's no reason you couldn't compare costs before an emergency occurs. Not that you'd know off the top of your head which hospital is cheapest for any given procedure when you need it, but you could get a good general idea.

> I'm not sure how emergency care can work well though without some third party to help set fair pricing.

And how much of healthcare spending does emergency care constitute? There's no reason not to drop pre-paid plans for non-emergency services.

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