Comment by amluto | Hacker News Reader

Comment by amluto | Hacker News Reader

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I would like to see a stronger law:

Hospitals and doctors must post their price list online.

Hospitals and doctors must disclose to each patient before any non-emergency service how much that service will cost. The disclosed cost must be consistent with the price list and must not depend on what insurance is involved.

Hospitals and doctors must not give any non-charitable discount to anyone that lowers the total amount that they charge below the listed price. (With the possible exception of Medicare.)

Hospitals and doctors must not attempt to collect more than the listed and disclosed price from any patient for any service.

In other words, if a doctor is willing to see a patient with some particular insurance plan for $100 (split between the insurer and patient however the insurer sees fit), then that doctor cannot bill a patient $300 for the same service becaues they have a different insurer.

Yes, a law like this would thoroughly invalidate the entire way that insurance contracts work right now in the US.

Interesting that many states have laws mandating this for auto care.

I'm hoping we reach consensus soon that healthcare isn't somehow "special". It's just an industry, with incumbent interests, fighting to earn as much profit as possible, just like any other industry.

What do you mean by „auto care“?

In the U.S., "auto care" means automobile (car) maintenance. In other words, car repair shops must list or quote you a price before service.

How would doctors and hospitals account for complications or non-standard 'things' that come up during treatment? I don't think it's reasonable to try to document every outcome or potential action taken. It's easy for me to think "setting a cast on a broken arm should cost $X.", but having had it done before, there can be complications - existing fractures, location of fracture, skin conditions, etc.

I absolutely would love things to be transparent, but I think healthcare is more like fixing software bugs than delivering well-scoped features. It's very hard to estimate anything beyond the most basic, superficial issues.

Just to be totally clear, I want prices posted online. I'm just worried there would be asterisks next to everything and then they would be useless. Perhaps that's an opportunity for differentiation in hospitals: "broken bone - cast set: $X - all inclusive".

There are at least two ways to approach variable costs. One is to have a price to treat a condition, e.g. a hospital can charge $X for a pregnancy, regardless of whether it’s a C-section or a vaginal birth. The other is to allow the variable charge but to disclose it as it happens, just like auto shops do. If I see a doctor for $75, and the doctor determines that I need a $17 strep test, the doctor can tell me that the strep test is $17 before doing it.

This does impose an annoyance cost on every little charge, which I think is a good thing. If a medical practice really wants to charge for every piece of gauze they use, then this should annoy the patient up front so the practice has an incentive to stop doing it.

> One is to have a price to treat a condition, e.g. a hospital can charge $X for a pregnancy, regardless of whether it’s a C-section or a vaginal birth

The side effect of such a policy is that hospitals will then have huge incentives to perform the cheaper procedure. E.g. if the real price of C-section is higher than the real price of vaginal birth, but the effective price for both is mandated by the government, then hospitals will have too much pressure not to perform C-sections (even when they'd result in better outcomes for the patient).

What you just described is the ultimate bait and switch scam though.

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