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Comment by robswc | Hacker News Reader

> In New York state half of property taxes is for county contributions to the state medicaid fund.

That is an insane statistic. Surely the state can throw some weight around to say enough is enough?

I just had my own insane encounter with healthcare. They "accidentally" billed us insurance rate which was about 4-5x more than self-pay. Why is there 4-5x overhead when dealing with insurance? (I know there's the negotiation stuff) but also seems to be quite a mess. I'm actually more mad at hospitals and clinics lately than insurance. Seems they have agreements with companies to "dispense" things at 4-5x the actual price, expecting insurance or taxpayers to pick up the tab. Seems like blatant fraud.

Sorry for the rant, I agree with everything else you mention :)

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I seem to recall that NY state medicaid expenditures are completely out of line even when comparing other liberal states with Medicaid expansion, when you compare how much every resident pays.

The answer is almost certainly large scale fraud by organized criminal groups, but investigating and publicizing this is, currently, extremely politically inconvenient.

Not NY resident but recently had an experience that I think is basically fraud but also "legal."

Went to clinic for fractured arm. Was given a sling, told it was included with the visit, verbally by the staff.

Later get a bill for nearly $500 for the sling that costs $50 if you get it outside of the clinic. Was told they think they accidentally billed me the insurance price. I can understand "convenience" being baked into the price but not at a 10x markup. The more I talked with the clinic trying to get them to fix it, the more it sounded like they had a partnership with the stupid sling company where they put slings on people and bill the insurance 10x the cost of the sling.

There is this whole stupid game between insurance companies and medical suppliers where the medical suppliers put a huge markup on the price and then the insurance companies negotiate a big 'discount' on that price. It's thoroughly unproductive for anything other than inflating the size of the bill the patient sees (and, in the case of someone uninsured, putting a ton of pressure on them to negotiate the price with the supplier themselves).

>Surely the state can throw some weight around to say enough is enough?

How do you know that it's enough? Baby boomers are old now, which means demand for healthcare has skyrocketed. There's an odd thing I've noticed in political commentary where nobody really thinks that healthcare is expensive, but it absolutely costs a ton to keep people alive. America might have problems with too much overhead, but even here in Ontario, healthcare is by far the province's biggest expense.

> How do you know that it's enough?

Because that is 17% above the US average, at an average of $13k per year per patient. This is _after_ medicare handles the bulk of the cost. I'm not disagreeing that healthcare is expensive, just the costs are excessive.

Taxpayers are getting milked by providers and insurance. I was given an arm sling that cost almost $500. If I got it outside of the clinic it would have been $50.

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