[codegeek]

"If a patient had disclosed that they have health insurance, the provider was not allowed to offer a cash price (which is often cheaper)"

Sums up the problem with our Health Industry in America. The middle-man Health Insurance mafia is too powerful to let anything else happen.

[avgDev]

To be fair is not like providers are hurting either. Nobody wants better pricing.

"Physicians in the United States are among the best paid in the world (Bodenheimer, 2005). The average U.S. specialist physician earns $230,000 annually—78 percent above the average in other countries, as shown in Table 2. Primary care physicians earn less (they earn $161,000 on average), but the same percentage more than their peers in other countries." - sauce https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511963/

[hn_throwaway_99]

I think this comparison misses the impact of Baumol's cost disease in the US. I mean, your link says a primary care physician earns $161k in the US. That's after going into a ton of debt with 4 years of medical school, and then making slave wages and horrendous hours as a resident for 4-5 years.

Meanwhile, it's pretty easy for a software engineer in the US to make that much not long after graduating college (I don't want to over reference something like FAANG salaries, which relatively few engineers make, but still, it's totally reasonable for a software dev to make that much somewhere between 0-10 years after graduation). That's after going into much less debt, and software jobs are way, way, way easier than medical jobs - honestly I think anyone who says otherwise is just full of shit (I'm a software eng for what it's worth).

So most people who can go on to be doctors have at least a similar level of intelligence/work ethic etc. as software devs (or lots of other careers in business, etc.) There is no way doctors are ever going to get paid significantly less than similarly credentialed professionals in the US.

[Calavar]

Insurance based reimbursement is not financially lucrative for physicians. That's why plastic surgeons, who take almost entirely out of pocket payments, are the highest paid physicians.

As for why US salaries are so high, it's because the training it so much longer and more expensive than it is in other countries. The most common training scheme for general practitioners internationally is 6 years of medical school + 1 year of internship. In the US, it is 4 years of undergrad + 4 years of medical school + 3 years of residency. Add on the ridiculous pricing for higher education in the US (public medical schools charge about 50k/year, and since medical school is a type of graduate degree, med students do not qualify for subsidized Stafford loans) and it would be financially untenable to be a physician in the US if salaries were the same as they are in Europe.

[haldujai]

Not sure how accurate those numbers are. "Physician" is not a singular job even within a single specialty and varies significantly based on practice pattern so averaging the numbers like that doesn't make a lot of sense.

For similar job descriptions most equivalent physicians would have higher compensation in Canada than the US, contrary to what that dated study says.

Definitely agree the majority of physicians aren't hurting in either country although I think the US/Canadian compensation is fair given the years sacrificed/intensity/work hours/stress (disclosure: I'm a physician). Some specialties like primary care and pediatrics remain very underpaid.

[FireBeyond]

That number is higher now. $351,000 for physicians across the board, $382,000+ for specialists.

Source: https://www.whitecoatinvestor.com/how-much-do-doctors-make/ (actually a MedScape survey, but that requires a login, so I found this which summarizes the survey).

[lotsofpulp]

The provider entered an agreement to give the health insurer the lowest publicly available price, which is usually how all insurance companies operate.

How would it work if the insurance company’s vendors charged the insurance company more than they charged random people off the street?

[TheJoeMan]

I can tell you haven’t ever received a self-pay bill, waited a month, and unrequested a cheaper bill shows up and mysteriously Dr. Popped-in-for-5-minutes got dropped from billing. Sure it’s the “cheapest rate” but they’re billing for every tiny thing.

[lotsofpulp]

No, I have seen that. I have even called and asked why I was charged $15 for a towel to wipe the ultrasound gel off my wife's belly, when it was just paper towel, and if I knew it was going to cost me $15 I would have done it myself. And I was told to ignore it.

But that seems irrelevant to my point. If you worked at an insurance company (not just health), and were tasked with contracting vendors (such as doctors or mechanics or construction), would you not want to stipulate that your vendor is giving you the lowest price publicly available from that vendor to avoid paying more than necessary, which would then allow you to offer your customers lower insurance premiums and compete with other insurance companies?

[amluto]

Health insurance companies have weird incentives. For one thing, they are not permitted to charge more in premiums than what they pay out times a small multiplier. So health care being expensive is good for insurers.

[lotsofpulp]

This is tempered by the fact that they have to compete with each other on pricing of premiums.

And if they had such amazing power to unilaterally increase healthcare costs, there would not be many people complaining about healthcare not being covered.

[shellfishgene]

I don't understand how this works. So if you have insurance the procedure is 120$, which you pay as the patient because it's not covered, but if you paid cash it's 100$? Where does the 20$ go, and why does the insurance want this?