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Comment by jostmey | Hacker News Reader

My wife is a resident physician. She also went through the same experience of delivering a kid.

Here's what I've learned:

* Pricing is not transparent. When the hospital tells you how much the procedure will cost, they are not telling you about the anesthesiologists portion, or the room fee, ect. There will be surprise bills. Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?

* Doctors are in short supply. This is because becoming a doctor is impossibly hard. Why can't undergraduates enter straight into a medical school program? Doctor's are in the 30's when they complete training and are already halfway toward the retirement age

* If things go badly during the delivery, you will be glad you are at a well equipped Hospital. A $5000 bill is a small price to pay to ensure the baby does not arrive brain damaged.

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Doctors are in short supply. This is because becoming a doctor is impossibly hard

That's an entirely artificial problem created by the AMA (or BMA in the UK) to keep wages high. What if everyone who had the academic ability could train, rather than having to compete for a restricted number of slots? It's how every other discipline does it (they defer competing for places until the job market).

I'm sorry, but if someone is going to be cutting into my body, I want them well trained and I want them to have dissected a human. I don't want someone who "moves fast and breaks things" puking on my exposed parts.

The parent isn't talking about reducing quality, but rather waiting to pick "winners and losers" so to speak until after training.

This is a huge problem. The limiting factor appears to be the number of residency spots, not the number of accepted medical school students. We should take some of the billions our Federal government spends and increase the number of residency spots and increase funding for tuition reimbursement for practicing in underserved areas.

I can't personally speak to the accuracy of the linked claim below, but it suggests that the coverage of residency spots is controlled by a physician led advisory board called RUC that intentionally limits the reimbursement so as to control wages.

http://www.motherjones.com/kevin-drum/2013/11/its-doctors-wh...

AMA also blocks nurse practitioners from being able to take on more duties. Need to protect that market share.

Why can't undergraduates enter straight into a medical school program?

That is a thing called a direct entry medical program. It gets you the the end of medical school in 6 years instead of 8 by dispensing with the undergraduate degree. The extra two years cover the sciences and how to learn at medical school speeds.

It shaves two years off, but at the cost of pinning the student into a rigid track. The number of high school seniors who think they want to be doctors and change their mind during an undergraduate is pretty high.

Is there evidence that this leads to worse outcomes in all the countries that have direct entry out of high school as the standard path for doctors?

"Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?"

that's the first thing that should happen. Especially the free market people should want it.

You realize millions of babies are born in countries with better healthcare than the US and $5k is literally about 1000 times what they pay.

This is an important point. I think I'd be ashamed if my kid grew up and found my archives here, lamenting a $5k bill. Bringing a human into the world is a big deal, and worth at least that much. And I'm not lamenting too much; we were blessed enough financially to be able to cover it without going into debt.

But if it's being done for less elsewhere, then I don't think it's wrong to let that influence your expectations.

I believe in the UK, hospitals are by law required to give you the fully itemized bill. Knowing transaction price up-front seems to be an obvious part of market health.

There is no cost to the patient in the UK, nor is there any bill presented, so in that sense you're right.

Private health care exists in the UK. Some people chose it. If you do chose it the hospital must tell you the price up front.

https://www.legislation.gov.uk/uksi/2001/3968/regulation/7/m...

> Patients' guide

> 7.—(1) The registered person shall produce a written guide to the establishment or agency (in these Regulations referred to as “the patients' guide”) which shall consist of—

> (a)a summary of the statement of purpose;

> (b)the terms and conditions in respect of services to be provided for patients, including as to the amount and method of payment of charges for all aspects of their treatment;

> Doctors are in short supply

Yes, but also there is the fact that there is an artificial cap placed on total US residency class size, meaning there is a pretty effective bottleneck on actually becoming a medical doctor.

> the baby does not arrive brain damaged.

Or the woman dies.

Or both....

Seriously though, listen to the advice of giving birth in a hospital setting. If they have a midwife center then take advantage of it, but I would highly caution against the trend of birth clinics and home birth unless you live very close to an emergency room. Things can wrong in an instant.

Source: Experience. First born was in NICU for 12 days and mother had bad complications. We had to be rushed in an ambulance from a natural birth center when things went south.

And yet 30% of Dutch women choose to give birth at home and it seems to work out. https://www.expatica.com/nl/healthcare/Why-the-Dutch-cherish...

Actually Dutch child mortality (birth mortality?) is high compared to surrounding countries, in part because of home birthing (the occurrence of which is trending downwards, btw)

https://www.google.nl/amp/s/www.volkskrant.nl/wetenschap/typ...

Can't find english source easily - tl dr 13% of births are at home vs 23% 10 years ago.

> Why isn't it law that Hospitals provide transparent pricing for non-emergency procedures?

Medicare would oppose this tooth and nail. The lack of pricing transparency enables them to keep reimbursing less than cost, because they can expect private insurers to be forced to pay the difference.

Got a source for that?

https://www.cms.gov/apps/physician-fee-schedule

I'm not sure what you're implying by posting that link. Medicare posts its fees and schedules, yes, but the point is about what private insurers reimburse.

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