Charge someone $1 billion to change a tire. Nope, nope, nope, as an example.

I've never heard anyone argue that the billing and payment aspects of the US healthcare system are great.

I have heard people argue that the quality of care (by various metrics) or availability of services are great, but that's a different argument, and not mutually incompatible with having a broken payment and billing infrastructure.

> The very rich don’t have to worry, the very poor don’t have to worry.

I'm not sure how you're arriving at the conclusion that "the very poor don't have to worry"

I’ve never heard anyone argue this. The common argument is that it really sucks and that proposed changes suck as well. So the argument isn’t “don’t change because it’s great.” The argument is “It’s terrible and I’m worried that if you change it, it will get worse.”

I suspect those claiming US healthcare is superior are able to pay quarter of a million without blinking - however they still run the risk of unnecessary surgery and aggressive prescription of addictive substances.

So my point is, what use is excellent "care" if not only it's life endingly expensive, but it's also prescribed immorally to the point of actually causing harm!

And a comparison against caesarean rates in OECD, which can be higher rate of caesarean per birth: https://www.statista.com/statistics/283123/cesarean-sections...

These arguments are at best disingenuous

Even if you are in a position to shop around, journalists have documented their futile attempts to do price estimation for routine procedures. Here's one example: https://youtu.be/Tct38KwROdw

There have been recent laws that requiring publishing some of that information (which are being heavily contested), but comparison shopping remains effectively impossible in the US.

Dealing with our fertility doctor was great though. They knew the price of everything. But they were ran out of an office, not a hospital.

You need stuff done - you go and get it, end of the story. No bullshit, no courts, no nothing, and it's orders of magnitude cheaper.

Kaiser Permanente usually has a precise copay for just about anything they do. So you have a good idea what the charges will be going in. And nothing like an extra $10,000 because one of the surgical team was "out of network".

This is like when people point out problems with fiat currency which are very real, and then people suggest theoretical solutions from cryptocurrency. It doesn't actually help solve the problem in any meaningful way, and you are living in an alternate reality from the problem space we are discussing.

By assuming markets are so rigged against you, it discourages people from even trying. Price discovery can only happen if you attempt to be firm. If you'll roll over instantly, then sure, they can do as they wish.

None of the hospitals within 100 miles, the doctors, or the the insurance company would give me so much as an estimate, and this is for something that they do every day.

That's the issue, they don't give you estimates that they are actually bound by.

I have no time to look it up RN, but I read a few years ago about a new hospital President/CEO who literally could not get a cost/price list for the services their hospital provided - obviously a key management data set, yet it did not exist.

Just because you think something SHOULD exist, does not mean that it does.

How much of a nurse's time to give patient a Tylenol? Zero? Five minutes? And how much does that nurse's time actually cost the hospital?

Nobody has the slightest idea.

Every business has to deal with this problem, and hospitals have already done so, because they do somehow come up with the amount to charge you.

Once again, SHOULD =/= IS

Just because they quote charges does NOT mean that they have solved the problem or that the charges are accurate.

There is absolutely nothing that requires the charges to have any relation with the actual costs, even if they are known, particularly at the item level. Only the total charges must exceed the total costs (less any external support e.g., from govt, philanthropy, grants, etc.), and that is on a basis of multiple years before any serious reckoning happens.

IOW, they can and in fact do literally just make it up. Also, charges that are heavily scrutinized may have some relation to costs, but other charges may be "just add a few zeros" to make up for it.

If you have some detailed and complete internal accounting data from any major hospital that proves me wrong, please post it. But when I read about congressional testimony that a CEO of a hospital literally cannot get the same data that you claim exists because 'of course it's been solved because every other business solves it', I find it difficult to believe you.

I can also state from running a business that the relationship of costs to charges is very loose. Sometimes I will sell things below cost for a number of reasons, and for some customers (e.g., those with high bureaucratic overhead requirements) the charges will be substantially higher. And when those charges are made, I may do detailed studies of what the increased costs are, or I may just say "one data point shows that's going to cost 4% more, but I don't like it, so add 7% - basically a whim. And no one in the world besides me knows the difference (and I forget about it after a few cycles and it becomes the baseline). So, yeah, perhaps stop posting speculation.

Somehow the medical industry has so far largely avoided such oversight.

Even within a single enterprise, misallocation of costs can lead to inefficiencies.

Or simple overcharging.

Hospitals are not just any business and if it starts to hurt us as a society we need to interven.