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Comment by Steeeve | Hacker News Reader

> They can continue to set their own rates, but a different rate for each patient must be prohibited.

This is a terrible idea. That means no discounts for people in need, and no doctors saying "don't charge her for that aspirin" as both would become illegal.

I'm all for transparency in pricing, but the lack of flexibility in charging customers is already a big problem. When you go to the hospital, everything is charged at max-price, then insurance companies pay out their negotiated rates. People without insurance don't have the ability to negotiate and end up with ludicrous bills that even the most generous insurance company wouldn't pay.

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Instead of subsidising those in need through price changes, the government can simply subsidise those in need directly, paying part of the bill itself. This is how it works in many other countries.

The 46% of the country that gets to decide who runs the country hates doing that.

This is the same as the used car problem. Flexibility in pricing and negotiation increases prices overall, because the base price now needs to be set higher than the objective price of the good. Plus the seller will be much more skilled at negotiating.

In the current model, people without insurance see their prices increase compare to people without insurance. Hospitals charge double to these people because they expect to recover 10% of the bill, so they compensate for that in the model.

The way to capture needs-based payments is an across the board discount. Charge everyone $100 for the treatment, and then offer 90% off for people in need for the entire bill.

This will clarify the real costs and discounts being provided, and reduce ambiguity.

No, it would just take some more creativity on the part of the doctor/clinic/hospital. Perhaps in the form of "pro bono" work where they waive the standard fees for their work.

Isn't what you are describing (individuals being charged more than insurances who have negotiating power) exactly what this suggestion is trying to prevent?

That's the stated intent, but the plain reality is that it evens the playing field for insurance companies at the expense of leaving the uninsured and underinsured out in the cold.

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