3 ms·

Sure, this is the reason why you can't get an answer but it's not a justification. There are 2 parts to it. The first, which is reasonable, is that a lot of tr

Sure, this is the reason why you can't get an answer but it's not a justification. There are 2 parts to it. The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Even for flights, the truth is I can get a bespoke flight if I can afford it. And if I want to know how much it is then I ring them up. The idea that you can't know what something costs, until after the event, because it's expensive is perverse. But the second part, that everyone pays a different price, is solely a function of the lack of transparency and has no justification beyond perpetuating the scam. Even in that socialist utopia that is the UK, we have private health care. If I wish to use it without insurance, then they'll tell me the cost upfront. If I use it with insurance then they'll tell me the same cost but I'll only pay the excess. At each stage in the process you get the cost information upfront because TBH it's insane to think that you wouldn't. Honestly, this is a solved problem. The only real reason it's not solved in the US is because a lot of interested parties are very determined that it doesn't get solved.

notyourday 7y ago
> The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Treatments are billed using billing codes so they are definitely not bespoke.
- enjo 7y ago
  Those billing codes are CRAZY complex tho. One example: when you see a doctor you may generate multiple billing events. For instance they may draw blood, take an X-Ray, and perform a specific type of test. In a sane world you would generate three billing codes, sum them, and you'd have your price. But that's not how it really works. Instead certain billing codes can be combined to form new billing codes which makes things stupid crazy hard to reason about. Those rolled up billing codes can then even roll up to different billing codes when combined with other procedures or other grouped billing codes. When billing is this complex the treatments do begin to look relatively bespoke. Basically we're inefficient from basically every direction in the USA. Because every player in the system negotiates with basically everyone else individually you end up with a nightmare of complexity and all of the associated insanity. Hospitals love it because it means that they can take advantage of the complexity to bill for all sorts of things that they otherwise couldn't simply because no one can audit this stuff effectively.
  - jagged-chisel 7y ago
    Don't forget each piece of equipment involved in drawing blood. Had to try three times because you're dehydrated? Different-sized needles because you're a person of smaller stature? Gotta bill you for each piece consumed, and the premium for being outside the range for 'average.'
  - Broken_Hippo 7y ago
    "Basically we're inefficient from basically every direction in the USA" This, and so much this. And I don't always understand this. To use the example here, billing codes: I'd think this is something that could be standardized - and being such, pricing would need to be standardized. I truly don't understand why this isn't coded into law. The negotiation gets me as well - it means that no one can tell you a price. In a more perfect world, there would just be a price, and you could simply get the price from the hospital and it would be illegal for the hospitals to charge one price for cash patients and another for those with insurance.
- ska 7y ago
  CPT codes are ... complex. They also aren't the only thing billed for (just the simplest to do). Also what you bill and what you get paid are not the same thing. And they payers do not pay the same thing for the same bill.
SilasX 7y ago
Interesting comparison, because airline pricing is notoriously complicated, resulting in things like hidden-city fares[1] and such considerations as "do we expect to be able to be to sell that seat to some business traveler at the last minute whose only choice is us?" Furthermore, there are all kinds of unknowns that can happen on the flight.[2] And yet they still have no problem quoting you a price. [1] where a flight from A to B costs more than a flight from A to C with a stop in B. [2] Earlier discussion of whether unexpected events make it comparable to health care: https://news.ycombinator.com/item?id=18719867 https://news.ycombinator.com/item?id=18719867
- deleted 7y ago
  [deleted]

notyourday 7y ago

> The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Treatments are billed using billing codes so they are definitely not bespoke.

enjo 7y ago
Those billing codes are CRAZY complex tho. One example: when you see a doctor you may generate multiple billing events. For instance they may draw blood, take an X-Ray, and perform a specific type of test. In a sane world you would generate three billing codes, sum them, and you'd have your price. But that's not how it really works. Instead certain billing codes can be combined to form new billing codes which makes things stupid crazy hard to reason about. Those rolled up billing codes can then even roll up to different billing codes when combined with other procedures or other grouped billing codes. When billing is this complex the treatments do begin to look relatively bespoke. Basically we're inefficient from basically every direction in the USA. Because every player in the system negotiates with basically everyone else individually you end up with a nightmare of complexity and all of the associated insanity. Hospitals love it because it means that they can take advantage of the complexity to bill for all sorts of things that they otherwise couldn't simply because no one can audit this stuff effectively.
- jagged-chisel 7y ago
  Don't forget each piece of equipment involved in drawing blood. Had to try three times because you're dehydrated? Different-sized needles because you're a person of smaller stature? Gotta bill you for each piece consumed, and the premium for being outside the range for 'average.'
- Broken_Hippo 7y ago
  "Basically we're inefficient from basically every direction in the USA" This, and so much this. And I don't always understand this. To use the example here, billing codes: I'd think this is something that could be standardized - and being such, pricing would need to be standardized. I truly don't understand why this isn't coded into law. The negotiation gets me as well - it means that no one can tell you a price. In a more perfect world, there would just be a price, and you could simply get the price from the hospital and it would be illegal for the hospitals to charge one price for cash patients and another for those with insurance.
ska 7y ago
CPT codes are ... complex. They also aren't the only thing billed for (just the simplest to do). Also what you bill and what you get paid are not the same thing. And they payers do not pay the same thing for the same bill.

SilasX 7y ago

Interesting comparison, because airline pricing is notoriously complicated, resulting in things like hidden-city fares[1] and such considerations as "do we expect to be able to be to sell that seat to some business traveler at the last minute whose only choice is us?" Furthermore, there are all kinds of unknowns that can happen on the flight.[2] And yet they still have no problem quoting you a price. [1] where a flight from A to B costs more than a flight from A to C with a stop in B. [2] Earlier discussion of whether unexpected events make it comparable to health care: https://news.ycombinator.com/item?id=18719867 https://news.ycombinator.com/item?id=18719867

deleted 7y ago
[deleted]