5 ms·

Your solutions rely on something that does not exist in health care: information parity. A true free market requires information parity. Health care is complica

Your solutions rely on something that does not exist in health care: information parity. A true free market requires information parity. Health care is complicated, thus information parity does not exist. Regulation is the answer to dealing with that lack of information parity. A hospital cannot "publish prices" because prices vary wildly based on many factors. Even if they did, how am I supposed to know what I need for my healthcare? If I go to the doctor and they say "you need a surgery and it will cost 10,000" the posted prices do not tell me if I need that surgery at all, just what they cost. And, of course, the most expensive medical care is emergency, a time when price shopping is not possible. > Remove the boundries of the state borders. This is regulation. Not allowing companies to work and provide across state lines is ridiculous and again government overreach that could quickly drive down costs. I'm not opposed to this, but it does remove state control over insurance regulation, which is an anathama to Republicans. I also have no idea how it will drive down costs? Are some states that much healthier than others? > Birth Control, yes and no. We should be able to opt out paying for it, especially if it goes against my religion and frankly it does, but I won't stop others from opting in and paying for it. I don't even know where to start. If I can opt out of paying for some medically approved procedures, where does it end? Can I say that I want to opt out of ob/gyn care for unmarried women?

bzbarsky 10y ago
> A hospital cannot "publish prices" because prices vary wildly based on many factors. Here's a question: Dentists routinely publish prices. If you ask them how much some procedure will cost, they will tell you. If there is uncertainty, they will give you a range (e.g. to account for the possibility that complications will arise during an oral surgery). What is different in the hospital situation, apart from some rather extreme measures taken to obfuscate pricing? > And, of course, the most expensive medical care is emergency Is it? Or is it end-of-life? Genuinely curious to see numbers here! > I also have no idea how it will drive down costs Prices, not costs. The current situation is that in a lot of states there are somewhere on the order of 1-3 companies offering insurance of certain types at all. For example, for Maryland, I believe there is only one company offering an ACA-compatible PPO (everyone else has HMOs or even EPOs). See https://news.ycombinator.com/item?id=13393287 https://news.ycombinator.com/item?id=13393287 for where I got that data. Of course in a monopoly situation there is absolutely no incentive for a monopolist to cut prices. Why would they? So to the extent that prices represent excessive profits (as opposed to the actual costs of health care), allowing cross-state insurance sales should drive them down. People who believe insurance companies are price-gouging should be _very_ in favor of removing restrictions on such sales.
- stinkytaco 10y ago
  Insurance companies don't really make that much money. Neither do hospitals. The median profit margins are between 3-4%. The problem isn't an insurance monopoly. Pharmaceutical and medical equipment companies are raking in double digit profits. And they can sell wherever they want.
  - bzbarsky 10y ago
    There's a lot of argument as to how much money insurance companies make, and whether the right thing to measure is profit margin, or return on capital, or something else. For example, an insurance company that gets $100 in income, then spends $90 on medical care and $7 on lobbying to keep its monopoly has a profit margin of $3, which is not very much. But it's not obvious to me that a company that spent $90 on care, nothing on lobbying, and got $2.50 in profit by charging $92.50 would not be viable, absent the lobbying. And you're right: by no means are insurance companies the only ones in this sector that engage in attempts at regulatory capture and creation of monopoly profits. Though I should note that pharma companies have a lower return on capital than insurance companies last I checked, because pharma is so capital-intensive in practice. I haven't really looked into medical device manufacturers.
- fattire 10y ago
  So should they explain the pricing schedule while you're still unconcious from the accident at the crash site or when your eyes are fluttering in the ambulance? Then at the E.R., they can talk you through your various choices in surgery, a menu of blood products, and let you peruse through a catalog of doctor histories. If you decide this isn't the place you'd like to have the steering wheel removed from your rectum, you can always go online and browse a few local options from the dozens of hospitals in your area until you find a price point and payment plan that's right for you and your intestinal needs. Similarly, when your diagnosis comes in and surgery is required, you can take time off from your three jobs to carefully research the pros and cons of various procedures to determine which is most financially appropriate for you. I mean, it's not exactly heart surgery we're talking about here. Well, technically and literally it is, but it shouldn't be too hard for anyone to understand the pros and cons of different surgical equipment and procedures to evaluate the risks and cross-compare with the clear apples-to-apples data sets to arrive at a medically and economically responsible decision while blood is pouring out of your extremities and your body feels like it's on fire. Take the time and shop carefully. You are a model fiscal actor and will make the right call. Free market forces will make this system work and work well. The invisible hand has been after all such a huge success in setting health care prices and has proven to be the model every modern industrial country has taken because it's so intuitive and has great proven results.
jimlawruk 10y ago
Politics aside, is birth control is really a drug that is used to make people healthy? Fertility == healthy. Health insurance should be for getting medical care in the event that someone gets sick. It's like mandating car insurance companies to block the A/C from working. It blocks normal, healthy functioning. It just doesn't seem to make sense. There are cases where it is required for health reasons, but isn't it mostly used as a lifestyle drug?
- jakemauer 10y ago
  I'm going to assume you're being purposefully contrarian but in case you're not, or for the benefit of anyone reading your comment and considering agreeing, know that hormonal birth control medicine has many, many benefits aside from preventing pregnancy: https://www.asrm.org/FACTSHEET_Noncontraceptive_Benefits_of_Birth_Control_Pills/ https://www.asrm.org/FACTSHEET_Noncontraceptive_Benefits_of_... Also consider the case of a woman who does not want to become pregnant due to genetic or physiological issues that would make pregnancy dangerous for her or the baby. I know this is a common retort, but are pills to give men erections worthy of medical coverage? What about hair loss medications? If your rubric is based on fertility, should we not cover women once they reach menopause? Finally I have a critique of your rhetorical strategy, "let's face the truth" is lazy and weak. For example, "Let's face the truth, jimlawruk hates women."
  - jimlawruk 10y ago
    Ouch, that's pretty harsh. I really don't. And I would agree your examples fit medical care and are excellent points. I just wanted to people to consider, is artificial hormones really more healthy? Is healthcare an accurate term?

bzbarsky 10y ago

> A hospital cannot "publish prices" because prices vary wildly based on many factors. Here's a question: Dentists routinely publish prices. If you ask them how much some procedure will cost, they will tell you. If there is uncertainty, they will give you a range (e.g. to account for the possibility that complications will arise during an oral surgery). What is different in the hospital situation, apart from some rather extreme measures taken to obfuscate pricing? > And, of course, the most expensive medical care is emergency Is it? Or is it end-of-life? Genuinely curious to see numbers here! > I also have no idea how it will drive down costs Prices, not costs. The current situation is that in a lot of states there are somewhere on the order of 1-3 companies offering insurance of certain types at all. For example, for Maryland, I believe there is only one company offering an ACA-compatible PPO (everyone else has HMOs or even EPOs). See https://news.ycombinator.com/item?id=13393287 https://news.ycombinator.com/item?id=13393287 for where I got that data. Of course in a monopoly situation there is absolutely no incentive for a monopolist to cut prices. Why would they? So to the extent that prices represent excessive profits (as opposed to the actual costs of health care), allowing cross-state insurance sales should drive them down. People who believe insurance companies are price-gouging should be _very_ in favor of removing restrictions on such sales.

stinkytaco 10y ago
Insurance companies don't really make that much money. Neither do hospitals. The median profit margins are between 3-4%. The problem isn't an insurance monopoly. Pharmaceutical and medical equipment companies are raking in double digit profits. And they can sell wherever they want.
- bzbarsky 10y ago
  There's a lot of argument as to how much money insurance companies make, and whether the right thing to measure is profit margin, or return on capital, or something else. For example, an insurance company that gets $100 in income, then spends $90 on medical care and $7 on lobbying to keep its monopoly has a profit margin of $3, which is not very much. But it's not obvious to me that a company that spent $90 on care, nothing on lobbying, and got $2.50 in profit by charging $92.50 would not be viable, absent the lobbying. And you're right: by no means are insurance companies the only ones in this sector that engage in attempts at regulatory capture and creation of monopoly profits. Though I should note that pharma companies have a lower return on capital than insurance companies last I checked, because pharma is so capital-intensive in practice. I haven't really looked into medical device manufacturers.
fattire 10y ago
So should they explain the pricing schedule while you're still unconcious from the accident at the crash site or when your eyes are fluttering in the ambulance? Then at the E.R., they can talk you through your various choices in surgery, a menu of blood products, and let you peruse through a catalog of doctor histories. If you decide this isn't the place you'd like to have the steering wheel removed from your rectum, you can always go online and browse a few local options from the dozens of hospitals in your area until you find a price point and payment plan that's right for you and your intestinal needs. Similarly, when your diagnosis comes in and surgery is required, you can take time off from your three jobs to carefully research the pros and cons of various procedures to determine which is most financially appropriate for you. I mean, it's not exactly heart surgery we're talking about here. Well, technically and literally it is, but it shouldn't be too hard for anyone to understand the pros and cons of different surgical equipment and procedures to evaluate the risks and cross-compare with the clear apples-to-apples data sets to arrive at a medically and economically responsible decision while blood is pouring out of your extremities and your body feels like it's on fire. Take the time and shop carefully. You are a model fiscal actor and will make the right call. Free market forces will make this system work and work well. The invisible hand has been after all such a huge success in setting health care prices and has proven to be the model every modern industrial country has taken because it's so intuitive and has great proven results.

jimlawruk 10y ago

Politics aside, is birth control is really a drug that is used to make people healthy? Fertility == healthy. Health insurance should be for getting medical care in the event that someone gets sick. It's like mandating car insurance companies to block the A/C from working. It blocks normal, healthy functioning. It just doesn't seem to make sense. There are cases where it is required for health reasons, but isn't it mostly used as a lifestyle drug?

jakemauer 10y ago
I'm going to assume you're being purposefully contrarian but in case you're not, or for the benefit of anyone reading your comment and considering agreeing, know that hormonal birth control medicine has many, many benefits aside from preventing pregnancy: https://www.asrm.org/FACTSHEET_Noncontraceptive_Benefits_of_Birth_Control_Pills/ https://www.asrm.org/FACTSHEET_Noncontraceptive_Benefits_of_... Also consider the case of a woman who does not want to become pregnant due to genetic or physiological issues that would make pregnancy dangerous for her or the baby. I know this is a common retort, but are pills to give men erections worthy of medical coverage? What about hair loss medications? If your rubric is based on fertility, should we not cover women once they reach menopause? Finally I have a critique of your rhetorical strategy, "let's face the truth" is lazy and weak. For example, "Let's face the truth, jimlawruk hates women."
- jimlawruk 10y ago
  Ouch, that's pretty harsh. I really don't. And I would agree your examples fit medical care and are excellent points. I just wanted to people to consider, is artificial hormones really more healthy? Is healthcare an accurate term?