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Comment by darkerside | Hacker News Reader

Good Lord, people truly just don't get it. Hospitals are not evil; they are tasked with saving people's lives. People who nobody else can save. All the worst medical problems in the world--sometimes sudden trauma, sometimes a festering problem left to burst--they all end up on the doorstep of the hospitals, full of doctors, nurses, and technicians who are humans just like you and me. And they work ridiculous hours saving as many of us as they can, dragging bodies back from the footsteps of Death itself. Some of them making great money doing it, but others just because it's not in their nature to do anything but help. And yes, like any organization, hospitals scramble for cash to keep the lights on and keep operations going for a mission they hold sacred. But you show up at an ER, and you will get a minimum standard of care, no questions asked. And that's pretty amazing.

Disclaimer: None. I don't work in the medical industry.

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> Good Lord, people truly just don't get it. Hospitals are not evil; they are tasked with saving people's lives. People who nobody else can save. All the worst medical problems in the world--sometimes sudden trauma, sometimes a festering problem left to burst--they all end up on the doorstep of the hospitals, full of doctors, nurses, and technicians who are humans just like you and me. And they work ridiculous hours saving as many of us as they can, dragging bodies back from the footsteps of Death itself. Some of them making great money doing it, but others just because it's not in their nature to do anything but help. And yes, like any organization, hospitals scramble for cash to keep the lights on and keep operations going for a mission they hold sacred. But you show up at an ER, and you will get a minimum standard of care, no questions asked. And that's pretty amazing.

I don't think people are complaining about the doctors and nurses. They're complaining about the institutional billing & pricing practices -- and not just the exorbitant prices. Americans have trouble even getting price quotes for routine procedures [1]... a problem that, as I understand, many other countries simply don't have. How can you completely miss these fundamental problems and then claim "people truly just don't get it"?

[1] https://www.reuters.com/article/us-hospitals-prices/hospital...

All you are saying is correct but you can't excuse their billing practices.

I work for a hospital and I agree with you that the billing practices are shitty, but I couldn't tell you what a procedure will cost you even if ordered to. At best I could give you an average for a procedure but if you're in for a few days you may see dozens of doctors and have hundreds of procedures including an operating room procedure or two and a whole lot of blood tests, imaging, poking and prodding (e.g. assessing your risk of pressure ulcers). Each of these has a base cost and then each insurance company has a different amount they're willing to cover of that base cost and an discount rate that varies by company. Many of these factors will also depend on your personal history of diagnosis and treatment.

It's a big mess and I don't see billing practices improving significantly until the reimbursement system changes. Single payer could really simplify things for the end user.

It's not only that. Our local hospitals can't give us prices for procedures that other places can.

We tried price shopping an hsg test because we had to out of pocket it. Hospitals took hours on the phone and multiple call backs. Other places could give us a quote in minutes.

We chose a hospital based on price. The morning of the procedure they told us it doesn't include everything. But they said we were wrong and our insurance covered it, so we didn't worry. But it got denied, and then we had to pay their shitty insurance inflated price.

An HSG test at a private hospital in the UK is about £400, if you'd like to compare. That's according to forum posts, the provider's websites are mostly referring to a newer procedure now, with a similar cost. (Just search HSG test UK private.)

I think private healthcare in the UK would have very clear pricing. They have to compete with "free" (in this case, "free but not urgent, so your appointment is in six weeks") and deceiving patients is not going to attract further custom.

It's frustrating. Neither the hospital nor the insurer typically has sufficient information to give you an answer. It's even worse when your information like age or diagnosis history factors into it.

Somehow they can figure it out after the procedure. They could easily give you the cost for each billing code upfront but they choose to hide the information from the patient;

Last time I had a procedure done it took 9 months before a bill showed up. It's a many to many communication problem so they only bother to figure it out when they need to, and then it can take a while for the hospital and insurer to hash things out. I'm not saying 9 mos is typical, but I wouldn't wait anywhere near that long to get an answer on how long something will cost me. They just don't have the incentives to form all the necessary lines of communication among themselves prospectively.

That's the thing. They don't even give averages. In my view they should have to publish all costs for procedures they have done. The current system is totally opaque and as patient you are often forced to do something hoping it won't ruin you but you have no way get something concrete upfront.

> I couldn't tell you what a procedure will cost you even if ordered to.

Is that the case even if I give you the exact CPT code (or possible set of codes) for a given imaging or lab procedure? That is, could you not provide the out-of-pocket and insurance covered rate if I provide my health insurance information?

For what it's worth, the last time I tried this, I still had to wait for several days to get an estimate of cost. But I don't really see why it should be the case provided that the information I mentioned above is available.

In that case I may be able to look it up. Granted this isn't the area I work in but in theory I have access to the necessary data. The people who do work in this area should be able to tell you, at least for some outpatient procedures. But more to the point if you have an inpatient stay or show up in the ER it's pretty uncertain what procedures you'll actually wind up having, which is where the price opacity really comes in.

Blaming one specific part of a profit-centric health care system for being profit-centric seems a little silly

Well, some of us blame the whole thing. Why shouldn't healthcare be a government service? Why is that less appropriate than police and military? Or roads?

The same reason any industry benefits from being privatized: to incentive innovation. The antibiotics revolution would never have happened, at least not in America, had there not been a profit incentive.

The other services you listed are less dependent on innovation.

OK, I get the dogma.

But reality is more complicated.

See https://www.pharmaceutical-journal.com/news-and-analysis/fea...

You can call it dogma. I think of it as a fundamental principle of human nature. Balancing creativity and efficiency effectively is quite the trick, and capitalism actually pulls it off. People and companies who take risks are the ones that thrive. Those that don't "fade away". It uses survivorship bias to our advantage.

Fading away used to mean dying in the streets. Sometimes it still does, but much more rarely. It's a dearly paid price for the innovation that brought us the world as it is today.

i'm not sure if you're trying to argue with me about this, but i couldn't agree more.

I thought that I was, but I misunderstood your comment :)

This is not about profit but about being opaque and dishonest in their business practices.

That's certainly true for many hospitals, even most. And for most of their staff. But some of the profit-driven chains are nowhere that idealistic. And some physicians are jerks.[0]

0) http://www.americanpatient.org/drive-by-medicine.html

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