Ask for itemized bill, dispute every single item

https://www.aarp.org/money/credit-loans-debt/info-2019/dispu...

That's both a very useful post, and also enraging that we would have to do something like that to protect ourselves from getting raped by the system.

watch what happens to that bill when you tell them you are going to pay out of pocket instead of using insurance. suddenly, everything has a different price.

I've heard this before and so I tried it, but unfortunately it was not true in my case. They didn't seem to give a crap about that. In one case they actually told me "you should run it through insurance so you get their negotiated price. otherwise it will a lot more expensive"

The real kicker: Before the doc will even see you, you need to sign an agreement that basically says: "You agree to be responsible for paying whatever amount this doctor decides to charge, which could be any amount from $0 to $infinity, and which the doctor will not know prior to treatment."

I've always wondered which part of the medical supply chain is causing healthcare prices to rise so rapidly. There's no way these are natural market rates being driven by supply/demand, it's gotta be something artificial. My guess is something along the lines of medical device companies colluding to prop up prices to hospitals.

It's not collusion, it's a natural consequence of the way healthcare billing is structured in the US. You don't get to comparison shop but also have a captive audience (you're not just going to decide to be blind right?) so there's no pressure to keep prices reasonable.

This makes a lot of money for powerfully connected companies, so don't expect it to change anytime soon. This is why our congress and mass media treat Medicare For All as a joke or something to attack politicians on even though it's popular with a majority of Americans.

You might take a look at some things from e.g. this result[1] around what parts of USA healthcare are negotiatiable and which are fixed. The "$1500 for a gauze bandage" meme makes a little more sense if you view it from the perspective of "we can't charge market price for expensive things like an MRI since Medi___ pays a flat $1.5k/ea, so lets gouge everywhere we can to make up for it". In addition, the business setup of hospitals/providers and lack of a single customer-facing entity/provider that charges you for services makes these even more Kafkaesque.

On top of this, my friends who work at (private, non-general) hospitals work a lot and are not paid what someone on HN might expect for what they put in. This isn't even necessarily ownership vs labor, since afaik the hospitals themselves are not usually in the best of places financially.

To me, the short version is: can't easily negotiate, information asymmetry, and captured regulators. Imo, this isn't helped that in USA we say "healthcare insurance" but what we mean/want seems to actually be "healthcare subsidy/guarantee".

[1] https://www.kff.org/medicare/issue-brief/whats-the-latest-on...

There is no one part, the excessive costs can only be analyzed as a symptom of the system as a whole. One fellow online dubbed this "Coasian hell" and has a good writeup explaining where it comes from: http://www.harrowell.org.uk/blog/2018/01/31/in-the-eternal-i...

No, it’s Medicare cross-subsidization as well as the EMTALA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769684/

Really this should be medical misconduct - how can the customer give informed consent if they don't know what they're consenting to?

The opposite unknown is also part of the problem -- the facility doesn't necessarily know what procedures are going to happen until you're in the facility being seen by a professional with the authority to order any procedures. Any speculations about what procedures might be necessary by anyone not qualified to order them is akin to practicing medicine without a license, and so is highly avoided.