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Comment by lettergram | Hacker News Reader

I’ve worked in billing and basically it starts with the fact there’s no competition.

Hospitals can veto any building plans of a hospital near them. This is to “keep the current hospital profitable”

The AMA artificially limits the number of doctors coming out of school (limiting supply).

FDA puts a ton of regulation around producing drugs and equipment.

Insurance companies and Medicare set the price for goods and obviously need to make a profit so they gouge. There’s a long tail there, so the average person pays FAR more than their share to cover the long tail.

When you wrap this all up, yes. But the solution is massive deregulation. Let the market drive down prices similar to Mexico or India. Socializing medicine basically just regulates it to maximize profits, which is why Europe and US has insanely expensive healthcare (I added Europe because they’re subsidized by taxes, not massively cheaper).

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In addition to AMA artificially limiting number of docs coming out of school, teaching hospitals prefer to take on specialists, since they get paid more for specialists than GPs. As a result, in the US specialists represent ~70% of doctors and in other countries, specialists represent 30%.

> added Europe because they’re subsidized by taxes, not massively cheaper).

Then you don't know what you're talking about. European prices are much cheaper including tax spend. In fact, the US has about the same public spending on healthcare as European countries do. You just don't get covered by it

> Hospitals can veto any building plans of a hospital near them. This is to “keep the current hospital profitable”

wow that is absolutely wild and maybe one the most transparent profits over people i've heard of

It’s HHS that can do that not the hospital itself. The intent is to avoid oversupplying an area with hospital services. Because individual demand is inelastic and the government directly pays for half of care (Medicare, Medicaid) adding more supply means increased aggregate healthcare spending. Of course existing firms take advantage of this regulatory process to hobble competition.

This is an emergent problem of third party payment. Normal supply and demand mechanisms are not at play.

It’s not just HHS, it’s typically at the state level where they ask the hospitals — https://reason.com/2020/02/26/these-state-level-health-care-...

I’ve seen first hand hospitals “justify” not letting competitors as local hospitals always give input (they need to pull records). What happens is the hospitals generate projected reports and showing they’d be bankrupt if another hospital is allowed.

Certificates of Need are absolutely not issued without input from current hospitals and facilities in that area.

The group responsible for lobbying for them to be introduced in the first place?

Hospitals.

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