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Comment by prostoalex | Hacker News Reader

Um, there are more not-for-profit hospitals than there are for-profit hospitals, which doesn't dramatically change the pricing equation.

http://www.aha.org/research/rc/stat-studies/fast-facts.shtml

One man's profit is another man's stash for bonuses and building a new wing of the hospital.

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The hospitals aren't the problem, every hospital in the Boise, ID area is non-profit and frequently they work with those without coverage to significantly reduce or completely write off their medical expenses.

It's the insurance system that is the problem, since I have insurance the hospitals won't give me a dime off my bill, and my costs are heavily inflated because those of us WITH insurance are subsidizing those without.

Now, I'm a software engineer, I make a comfortable income and have a high deductible healthplan and a health savings account, I know I will be able to afford health expenses should they come up, at worst I can make payment arrangements because my annual out-of-pocket max is $5K/10K (individual/family).

But many families in my area are just scraping by on barely above minimum wage, and planning for health issues is not high on their priority list. If something happens to them, the $5K debt can be devastating, and it would take them YEARS to pay off what I can in months.

Just to clarify: a bunch of people pooling their resources together to negotiate a lower price are a problem, but provider charging high prices to those not able to negotiate a discount is not a problem?

Sorry, I may have mis-phrased this, I've edited my original comment. The problem is those pooling their resources into insurance companies are subsidizing those who are NOT. This is what the insurance mandate of the Affordable Care Act is trying to fix, we have yet to see if this will work or not.

Ultimately, the simplest solution to the resource pooling problem is to eliminate the insurance industry and go single-payer, then EVERYONE pays with their taxes. However, many insurance companies are for-profit and they'll keep fighting against single-payer until they go out of business.

Insurers almost always negotiate huge discounts with hospitals. So the bill you see is not the bill they pay, and what they pay is considered confidential.

I've never gotten a bill from a hospital that didn't include the adjusted amount from the insurance companies. The crazy original charges from the hospitals are usually as high as they are because the insurance companies ALWAYS negotiate them down, even with these discounts the bills are still crazy expensive, it ended up costing $2,500 for my wife to have a Cesarian when my daughter was born after insurance paid.

Unless the insurance falls through entirely or partially, and then the patient is stuck with some or all of the massively unreasonable bill.

That used to be the case, but ACA regulates maximum out-of-pocket costs now.

The goal is zero profit in health care.

Where does a dentist then raise money to buy a new XRay machine?

Where do you find money if your top doctor wants a raise or threatens to leave for a competitor?

Profit != revenue.

Ok, but zero profit = zero flexibility on meeting unplanned expenses.

Ridiculous, profit is what drives innovation. You think the billions of dollars a year that go into healthcare R&D comes from the goodness of people's hearts?

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