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Comment by x0054 | Hacker News Reader

This is exactly why I get so pissed about the Affordable Care Act! We are not solving the problem of why medical care in USA is so outrageously expensive, we instead are solving the problem of how to pay for it. The problem is, once most people have insurance, there will be no political will to solve the much more complex and important problem of reducing the healthcare costs for everyone.

Incidentally, totally agree. In any hospital, all you have to do is dispute the charges and demand documentation, and all of the sudden the bill is slashed tenfold! So, basically, the system is setup to screw the uninsured americans who may not know their rights or have the ability to challenge the hospital.

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Hope is that when big entities like the state or insurances have to pay the big bill, they have far superior means to enforce lower prices. That's not everything that needs to be done, but it is still useful.

They are actually pretty good at driving the prices down to something reasonable in most cases. While the headline prices are absurd, the prices actually paid by public and private insurers, whether Medicare or Blue Cross or Aetna, are much more reasonable. Not as reasonable as in much of the rest of the developed world, but the gap is not as gigantic as it initially seems.

The really big gap between the U.S. and the rest of the developed world on medical costs isn't the cost of individual procedures (once you've taken into account what insurers actually pay), but the much larger amount the U.S. spends on last-6-months-of-life "heroic care". If that were brought more in line with international norms, the overall cost-per-person numbers would be much better.

Where do you find a breakdown of the costs? Anyone have links?

This looks interesting:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/

If I get table 4 right, people who manage to live past 85 years will have 1/3 of their health care spending after their 85th birthday (not entirely accurate, but a reasonable simplification).

I wonder though, even if the insurers can drive down prices, how do the insurance companies verify that they are only paying for services that are actually rendered? With the massive amount of medical billing fraud, I suppose insurance companies will invest in investigating and eliminating this behavior? Either that, or they will go bankrupt.

A telling thing: if you make world-wide health insurance it's valid for every single country other than the US. If you want US coverage the price will usually double.

ACA is a step towards single payer, which enables capitation model, vs fee for service. Meaning paying to keep people healthy vs profiting from disease. It's all about the incentives.

Medicare is already transitioning to capitation.

Meanwhile, while not ideal, ACA has already significantly slowed down the growth of costs. Amazing what just adding some price transparency can do.

I think you hit the nail on the head. I had a similar story as the OP and after complaining and looking into the price I never heard back from the hospital. In hindsight their actions reminded of highway robbery. This year with the Surgical Center of Oklahoma and the time magazine article on medical billing though a lot of information has come out. Price comparision websites like pricepain.com, clearhealthcost, bluebook of healthcosts etc, are just the beginning. It's almost like a race against the clock where either ACA's price inflation will create so much political upheaval that the single payer system hands this inefficent (non existant!) market place over to the tax-payer (which will mean ever inflating prices) or a solution like this, with dramatically visible pricing information, direct doctor pay, low cost catastrophic insurance will emerge as the saner, cheaper and higher quality solution.

> We are not solving the problem of why medical care in USA is so outrageously expensive, we instead are solving the problem of how to pay for it.

Perhaps, but to the individual, the first problem is by far the gravest. One can feel outraged if the taxpayers are paying too much in general, but that is not exactly a life or death situation like not being able to pay for medical aid.

Also: Why can't you fix both problems?

Fixing both problems is ideal, and we should do both. But, I fear, that after fixing the "how to pay for it" problem, no politician will try to fix the much more complex, and much more important problem of the very high costs. At the rate we are going, by 2021 US is expected to spend nearly 20% of GDP on health care. To address this we will need to cut the spending on last-6-months care as well as reduce procedure costs. Even if we address the latter, I doubt any one in congress has the spine to address the former.

Forcing people to pay for health insurance they don't want to drive down the cost of healthcare seems backwards. The pressure should be on insurance companies to make insurance more appealing.

At this point, it's much easier to figure out how to pay for it than it is to revamp the entire system and stop some powerful players from making as much money as they do. It's much better to have this than to work towards fixing a societal problem for decades and get no where while doing so.

That's not quite true - part of the problem is that we don't know exactly how, in the American system, to reduce the healthcare costs effectively. But I feel like I've read multiple times that the ACA funds pilot programs to try out many many different ways to change incentives to see if they help health care costs come down.

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