> Of course then you get taxed on the remaining 90% as income.

What? No, that's not how it works.

No, because it wasn't income. When you find something on sale, you don't pay income tax on the difference between the sale price and full price.

That depends on if they are willing to negotiate with you before considering it a debt. If they send you to receivables with a 100k bill and you negotiate down to 10k cash, they are well within their rights to write off the 90k as debt forgiven. If they do so, you will be taxed on it.

Good luck finding a 90% off coupon for a surgery prior to the event.

What? You do not get taxed on anything. Discounts are not income.

Hmm, forgiving a debt is considered income. I wonder if the situation with hospitals depends on a lot of technical details.

> Hmm, forgiving a debt is considered income. I wonder if the situation with hospitals depends on a lot of technical details.

It doesn't. It's not a debt yet. You don't have to pay taxes on the difference.

It's not debt (yet) if you are negotiating the invoice.