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Comment by Shank | Hacker News Reader

To what degree is this just another symptom of the US healthcare system being flawed and in need of rework? To what degree would anyone use such a service if the costs remained high?

I used Zocdoc in the past to find a doctor and ended up with a doctor who just charged out-of-pocket instead of insurance, and it worked great. Would an app that shows up-front pricing be better for the consumer?

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The costs are not high. It's the prices that are too high.

I don't really know, but according to one graph, US nursing salaries are second only to Luxembourg:

https://www.oecd.org/en/publications/2025/11/health-at-a-gla...

Ratio to average wages is 0.9 last with Switzerland.

US not UK

Red herring; high salaries are fine for people who actually directly interact with patients https://hmpi.org/2026/07/10/the-growth-in-healthcare-adminis...

Breaking: Richest Country has higher wages.

Overall US salaries are also second only to Luxembourg (https://www.statista.com/chart/13093/the-countries-with-the-...)

If you look carefully at the chart, US nurse salaries are high because US salaries are high. The ratio of US nurse salaries to average US salaries is nearly the same as the OECD average.

Yes, it’s not specific to nursing. Labor costs are often high in the US, which goes a long way to explain why labor-intensive services cost more in the US, relative to other goods and services.

Evidence?

Every serious analysis of the US healthcare system I've ever seen comes away with the takeaway "Americans consume a lot of healthcare services and the expensive part of that is the providers' salaries"

It’s pretty well known that vertical integration has been the issue with driving up costs. Salaries for physicians aren’t all that big of a cost, compared to all the administrative BS that hospitals and insurance companies drive up, and conveniently have agreements to heavily discount.

For example, on a roughly 400k surgery, maybe 4-5k of that goes to the providers (anesthesia and the surgeon), dependent one on the codes billed for the procedure.

There are private groups that purposely do not take insurance and bill purely out of pocket with a one time fee including all follow up’s and subsequent care, related to that procedure, and it is significantly lower (like 90%+ less) than what an average hospital is charging.

> There are private groups that purposely do not take insurance and bill purely out of pocket with a one time fee including all follow up’s and subsequent care, related to that procedure, and it is significantly lower (like 90%+ less) than what an average hospital is charging.

I would bet a LOT of money that it is 90% lower for a "typical" patient but not 90% lower (and very likely pretty comparable) on average.

To state it more plainly: every time you pay for medical care in the US, you are subsidizing a half dozen people who consume 5x the services you do and do not pay.

That's why "fee only" medical (which always conveniently has no emergency services, you'll notice) can offer such low rates.

The costs are too high, but the health care workers are paid too little.

To see how this is possible, enumerate all the other people getting paid, and then compare to a country with a working health care system.

The most obvious difference is that the US spends an absurd amount of money administering health insurance.

Doctors and nurses in the US are in both the average and the median earning significantly more than their counterparts in Canada, the UK, France, Germany…

https://www.oecd.org/en/publications/2025/11/health-at-a-gla...

I'm in the Bay Area. There's a serious shortage of general practitioners because the patient:doctor ratio is so high. Even if their absolute pay is high, the amount they are paid to see me is minuscule. They can make more and have many fewer patients / appointments per day if they switch to a specialty.

On the other hand, specialists are more profitable for the "non-profit" healthcare networks we have around here, so they're easy to get appointments with.

Maybe we'd have more money to fix the problem if "nursing at home" wasn't one of the main medicare fraud schemes that has persisted for years now.

> another symptom of the US healthcare system

You know the videos of those couriers eating your food and claiming that it was delivered?

This is marketed to hospitals to fill shifts rather than nurse-to-consumer which has been available for a long time.

> To what degree is this just another symptom of the US healthcare system being flawed?

100%.

Nobody living in a country with healthcare for all with no out of pocket costs would ever care about such a thing.

I spend as much time thinking about “fixing” my healthcare as I do thinking about fixing the supermarket or the roads around here.

Ie not one second because they work perfectly.

It’s the symptom of a system where more and more wealth goes to few people and the rest has to fight for the rest of wealth

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