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Comment by breckenedge | Hacker News Reader

I like the idea of getting rid of in/out of network. Both recent administrations have taken steps in this direction.

Psychologists want to charge $200-$250/hr, but insurance only reimburses $120-$160/hr. You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough. While a psychologist has gone to school for 10 years and paid for it.

It's gaps like that that lead to the entire in/out network split.

> You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough.

Silicon Valley/big tech is not the center of the universe. How is what "typical" engineers at big tech companies make relevant to a discussion of what psychologists and other medical professionals make? Are you suggesting that the medical profession is doing battle with big tech for (future) workers?

Any ambitious and smart enough American who wants to make a high income in exchange for working hard at prep has a choice of jobs they can go into. Many people who go into medicine are not necessarily the most passionate about medicine, but want a high paying, prestigious job.

So yes, it does effect the supply of future and even current psychologists and doctors. Supply is dictated partly by cost of that supply vs the demand in dollars for it, and the cost and barriers to med school and licensing is a big factor of supply costs.

> Any ambitious and smart enough American who wants to make a high income in exchange for working hard at prep has a choice of jobs they can go into.

I suspect that the number of people who are driven solely by money and prestige is smaller than you believe, but even so, careers in different fields aren't fungible for the simple fact that even ambitious and smart people aren't universally capable of excelling in any field they choose. A top heart surgeon, for instance, wouldn't necessarily have the ability to be a top software engineer, even if he or she tried, just as a top software engineer wouldn't necessarily have the ability to be a top heart surgeon.

> So yes, it does effect the supply of future and even current psychologists and doctors.

Do you have any hard evidence indicating that the lure of big tech jobs is reducing the number of individuals who are pursuing careers in psychology, medicine, law, etc.? A study perhaps?

Yes, all high paying careers are competing with each other for ambitious workers.

FWIW I pay mine in cash from my HSA because he doesn’t accept any insurance due to the headaches involved getting reimbursed.

That's fair but for people without HSA they should still file a claim against maximum out of pocket.

Networks are a double edged sword. They're a pain to use (especially for things where network facilities have non-network providers or network providers steer you towards non-network accessory care like labs and what not), but network agreements are also a way that insurers control costs. Forcing insurers to cover every provider means insurers can't exclude overpriced providers.

Yep. These agreements cut out some ridiculous fees some might try to charge.

E.g. when my wife had surgery, the hospital tried to charge $20k for the surgery room and $20k for the recovery room. Our insurance pointed out that by their agreement they aren't allowed to charge for use like that.

Instantly cut the hospital portion of the bill from $49k to $9k.

That’s the insanity. You are the same person, same procedure, everything same but somehow the hospital can reduce its bill from 49000 to 9000. That is just not normal for a business like a hospital where they have a ton of fixed costs (unlike a software company where delivery of their product often costs close to zero so they can easily give rebates). This seems to indicate that the 49k is an insanely high price with very high profit margin.

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