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Comment by leighmcculloch | Hacker News Reader

US health bills seem extraordinarily high, maybe 5x in comparison to other first world countries. Why is this?

It is a game. Insurance companies and government insists on paying pennies on the dollar of the cost, so the medical care profession pretends like it charges some large multiple of the cost so that the "pennies on the dollar" is much closer to the true cost. The government and big insurance companies have contracts stating they only pay the lowest published price, so you can't give anyone else a more sensible price. There are all kinds of perverse incentives.

In this particular case, most of the bill is for the anti-venom treatment course. Anti-venom serums are pretty expensive to produce, and if you do not know the exact species of animal the venom came from (which often happens if the creature was not killed), they give you an anti-venom cocktail serum that covers all the common venoms in the region. It generally requires a couple days in the hospital too because the damage to the body from the venom can be extensive even though you survive, it depends on how lucky you are.

Proper treatment of pit viper envenomation is going to be relatively expensive in any country. It isn't like treating a broken bone.

It's a big shell game, hospitals send big bills because they can't legally bill people differently and they know insurance companies are going to be paying pennies on the dollar for their procedures so naturally they crank it up so those pennies from insurance companies will cover their costs knowing they will never see anything close to what's on that bill.

Unfettered, for-profit medical system.

In short, capitalism.

The same toxic structure is at work in the US penal system.

Unfettered

Are you for real? Nearly every aspect of medicine in America is regulated: from the number of people entering training to become new doctors, to whether a procedure will be reimbursed and at what rate, to what devices and drugs will be permitted for sale, to whether or not physicians are allowed to unionize, or discuss what their procedures cost (they are not in either case).

Whatever your ideology is, it doesn't change the fact that the health care is one of the most heavily regulated industries in our economy.

Unfettered in the capitalist sense and over-arching system, not necessarily administration thereof. Also remember that it is precisely unfettered capitalism that leads to layers of said administration, seeking profit at every turn.

Turning over a few rocks and we can quickly see that the cost of administration of medicine, including devices, pharmaceuticals, etc. is also wound up in this dance of maximal profit at all cost. This doesn't even begin to examine the cultural role capitalism has played in the legislation the enshrines the administrative layers to preserve profits for the corporate entities.

The last concern under such a system is the person and their health, or the ethical-societal implications, because such a model provides no such metric.

Capitalism unfettered by what?

Capitalism, in pure form, is a political system (this is not a typo - I did not mean to write "economic") in which a strong central government protects the individual rights of each of its citizens (mainly by going after people who murder, theft, fraud). A capitalist government does not regulate industry.

Despite what you say above, what we have today is not capitalism. In healthcare in the US today, it's 80% state control, 20% private (if not 90/10).

I'm not going to comment on the rest of what you've written because the above is a more fundamental point, and we clearly don't agree on it.

Because in other countries you pay these costs over time in taxes, and/or insurance, also you often receive lower quality care.

eg. In a province of 4.6 million there are 2 MRI machines, and its a 2 month waiting list because they don't even bother running them 24/7.

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