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The vast majority of health care decisions are not life and death. Many times it is still hard to know how much something will cost and it is hard to price shop

The vast majority of health care decisions are not life and death. Many times it is still hard to know how much something will cost and it is hard to price shop. But the same thing applies to auto repair. You need a car to get around and it is extremely expensive to toll your car to other body shops. You need to take the price the person offers you a lot of the time. But in medicine some times it is not time critical and you can shop around. We don't do it know because we don't pay.

CPLX 9y ago
All healthcare decisions are life and death. Just not necessarily directly. That fact complicates matters significantly.
- paulddraper 9y ago
  All decisions are life decisions
- hnal943 9y ago
  That's not true. I have mild allergies. It's not a life and death decision to get care or not. If the costs outweigh the benefits, I will opt out.
- canes123456 9y ago
  By that logic, so it auto and food decisions. Postponing changing brakes has bigger life and death decisions than skipping the marginal medical test.
devwastaken 9y ago
But this isn't a car. The attempts at trying to simplify healthcare discussion only contribute to muddying it, because there's significantly more factors than that. A healthcare decision doesn't have to be life or death for it to still be something you need. Diseases can hurt, or they can kill you slowly, and its not a simply 'yes or no' when it comes to what /could/ happen to you without treatment. So, yes, you have to have treatment. Everybody will be convincing you that you need treatment, and you most likely do. Meaning, you have a guaranteed market. In a guaranteed market, even if you have bad quality, even if you do the wrong things, it doesn't matter, you're still going to get customers, because they need it, and thats exactly what happens in healthcare today. Get a knee operation and the problem comes back a year later? Get another operation. Because you don't have the option of not doing so. No, you don't. Quitting work and not making money, or not being able to contribute to society around you, is not a realistic or beneficial option, and certainly not one that can be advocated for with any consciousness of socioeconomics. "But the same thing applies to auto repair. You need a car to get around and it is extremely expensive to toll your car to other body shops. You need to take the price the person offers you a lot of the time. But in medicine some times it is not time critical and you can shop around. We don't do it know because we don't pay." What kind of 'shopping around' are you advocating for? A car is replaceable if something goes wrong, you have insurance on that car even. On your body, if something doesn't go right, thats not on the hospital. Thats you, you are irreplacable, and because of that, whatever service is perceived to be better will be used. Typically, in the form of cost, as it is now. Thats assuming competition would just 'rise up' if we could pay directly, which as I said before, was already happening and we still had the same issue. With universal care, the root costs of care, such as equipment and devices, are more standardized and leveraged in bulk. You need 10,000 hip replacements for your hospitals in the coming years? 5 companies get to compete with who can make and sell them the cheapest. But they better be safe, tested, and work. Atleast, in the U.K. thats how it works. But what this does is creates an entity that negotiates on your behalf, to predict the majority of costs and reduce them. Without that, you are at the mercy of whoever is setting the prices, because you're not going to get to 'shop around' when your medication is sold from one entity.
- canes123456 9y ago
  This post is muddying arguments by mixing everything in healthcare together. Lasik has gotten much better AND much cheaper because people shop around. There are many more things that can be handled like this. Instead, doctors and patients tests to be on the safe side because it is "free". Lets take a quick aside for MRIs. The machine has a high fixed cost but the margin cost is pretty low. Just the time of the operator and 2 minutes of a doctors time to read it. They actually cost between 1k-12+k. Why is there such a huge cost difference? This would not happen anywhere else. Yes, MRI might be required right now but they can also be required in a few days, or weeks. Some cases you can wait and see if it is needed at all. All of the people could shop around and go to the 1k place. Right now there is no incentive to shop around. If there was an incentive, the 1k places would get way more business. Some people would still be willing to pay 14k but it much smaller. Eventually they would need to lower prices to stay in business. In all markets, most people are willing to pay more than the list price. However, the list price is determined by the marginal customer. Eventually the person that would have paid 100k would still only need to pay 1k. Your example of knee surgery works the same way. If you are paying the whole cost or even 25% of the cost, you will care about the cost. You will want a good doctor that will actually fix your knee. But you would not want to pay 2x the going rate from a slightly better doctor. With other big expenses like buying a home, car, getting married, or even buying a computer, people read reviews, consider several options, and look for a good value. With healthcare, they only care about quality since there is no price. People need many goods beyond healthcare. They need food, water, and shelter. We still can have prices for all those things. I am baffle by your definition of a guaranteed market. Yes there is guaranteed market for food but that does mean that any given supplier will get that market. It seems like you are assuming a monopoly or something. Finally, none of this precludes supporting health care of poor people or have insurance to protect people from getting huge amounts of healthcare debit.
  - ubernostrum 9y ago
    "Health care" is an umbrella term which subsumes both things where "wait and see, shop around" is viable, and things where doing that results in death or serious lifelong disability. Hence the common refrain about how you can't shop around for price quotes when you're having a heart attack: you're going to get taken to a hospital, with little choice of which one, and billed for whatever that hospital charges, because the alternative is you die right then and there. It is a non sequitur to talk about how Lasik has gotten cheaper due to shopping around when others are discussing the heart-attack case.
emodendroket 9y ago
Frankly that's just not true. Many people are uninsured, in the first place, and even if they weren't, insurers are shifting more and more costs to patients (think about something like co-insurance where you're subject to a lot of the risk the insurer would be subject to in a traditional co-pay situation). What mostly happens when you shift costs to consumers is they don't get necessary care. Incidentally, one reason I find this singularly unpersuasive is that the United States is unique in the degree to which you are directly responsible for your medical bills and yet spending is wildly above what you see in other OECD countries. We don't have to rely purely on theory here.
- canes123456 9y ago
  We don't have prices. We have a few huge companies trying to justify higher and higher cost. Consumers have no way to predict what hospitals are cheaper than others.
  - emodendroket 9y ago
    But neither do any of the places where government insurance prevails and costs are way lower.

CPLX 9y ago

All healthcare decisions are life and death. Just not necessarily directly. That fact complicates matters significantly.

paulddraper 9y ago
All decisions are life decisions
hnal943 9y ago
That's not true. I have mild allergies. It's not a life and death decision to get care or not. If the costs outweigh the benefits, I will opt out.
canes123456 9y ago
By that logic, so it auto and food decisions. Postponing changing brakes has bigger life and death decisions than skipping the marginal medical test.

devwastaken 9y ago

But this isn't a car. The attempts at trying to simplify healthcare discussion only contribute to muddying it, because there's significantly more factors than that. A healthcare decision doesn't have to be life or death for it to still be something you need. Diseases can hurt, or they can kill you slowly, and its not a simply 'yes or no' when it comes to what /could/ happen to you without treatment. So, yes, you have to have treatment. Everybody will be convincing you that you need treatment, and you most likely do. Meaning, you have a guaranteed market. In a guaranteed market, even if you have bad quality, even if you do the wrong things, it doesn't matter, you're still going to get customers, because they need it, and thats exactly what happens in healthcare today. Get a knee operation and the problem comes back a year later? Get another operation. Because you don't have the option of not doing so. No, you don't. Quitting work and not making money, or not being able to contribute to society around you, is not a realistic or beneficial option, and certainly not one that can be advocated for with any consciousness of socioeconomics. "But the same thing applies to auto repair. You need a car to get around and it is extremely expensive to toll your car to other body shops. You need to take the price the person offers you a lot of the time. But in medicine some times it is not time critical and you can shop around. We don't do it know because we don't pay." What kind of 'shopping around' are you advocating for? A car is replaceable if something goes wrong, you have insurance on that car even. On your body, if something doesn't go right, thats not on the hospital. Thats you, you are irreplacable, and because of that, whatever service is perceived to be better will be used. Typically, in the form of cost, as it is now. Thats assuming competition would just 'rise up' if we could pay directly, which as I said before, was already happening and we still had the same issue. With universal care, the root costs of care, such as equipment and devices, are more standardized and leveraged in bulk. You need 10,000 hip replacements for your hospitals in the coming years? 5 companies get to compete with who can make and sell them the cheapest. But they better be safe, tested, and work. Atleast, in the U.K. thats how it works. But what this does is creates an entity that negotiates on your behalf, to predict the majority of costs and reduce them. Without that, you are at the mercy of whoever is setting the prices, because you're not going to get to 'shop around' when your medication is sold from one entity.

canes123456 9y ago
This post is muddying arguments by mixing everything in healthcare together. Lasik has gotten much better AND much cheaper because people shop around. There are many more things that can be handled like this. Instead, doctors and patients tests to be on the safe side because it is "free". Lets take a quick aside for MRIs. The machine has a high fixed cost but the margin cost is pretty low. Just the time of the operator and 2 minutes of a doctors time to read it. They actually cost between 1k-12+k. Why is there such a huge cost difference? This would not happen anywhere else. Yes, MRI might be required right now but they can also be required in a few days, or weeks. Some cases you can wait and see if it is needed at all. All of the people could shop around and go to the 1k place. Right now there is no incentive to shop around. If there was an incentive, the 1k places would get way more business. Some people would still be willing to pay 14k but it much smaller. Eventually they would need to lower prices to stay in business. In all markets, most people are willing to pay more than the list price. However, the list price is determined by the marginal customer. Eventually the person that would have paid 100k would still only need to pay 1k. Your example of knee surgery works the same way. If you are paying the whole cost or even 25% of the cost, you will care about the cost. You will want a good doctor that will actually fix your knee. But you would not want to pay 2x the going rate from a slightly better doctor. With other big expenses like buying a home, car, getting married, or even buying a computer, people read reviews, consider several options, and look for a good value. With healthcare, they only care about quality since there is no price. People need many goods beyond healthcare. They need food, water, and shelter. We still can have prices for all those things. I am baffle by your definition of a guaranteed market. Yes there is guaranteed market for food but that does mean that any given supplier will get that market. It seems like you are assuming a monopoly or something. Finally, none of this precludes supporting health care of poor people or have insurance to protect people from getting huge amounts of healthcare debit.
- ubernostrum 9y ago
  "Health care" is an umbrella term which subsumes both things where "wait and see, shop around" is viable, and things where doing that results in death or serious lifelong disability. Hence the common refrain about how you can't shop around for price quotes when you're having a heart attack: you're going to get taken to a hospital, with little choice of which one, and billed for whatever that hospital charges, because the alternative is you die right then and there. It is a non sequitur to talk about how Lasik has gotten cheaper due to shopping around when others are discussing the heart-attack case.

emodendroket 9y ago

Frankly that's just not true. Many people are uninsured, in the first place, and even if they weren't, insurers are shifting more and more costs to patients (think about something like co-insurance where you're subject to a lot of the risk the insurer would be subject to in a traditional co-pay situation). What mostly happens when you shift costs to consumers is they don't get necessary care. Incidentally, one reason I find this singularly unpersuasive is that the United States is unique in the degree to which you are directly responsible for your medical bills and yet spending is wildly above what you see in other OECD countries. We don't have to rely purely on theory here.

canes123456 9y ago
We don't have prices. We have a few huge companies trying to justify higher and higher cost. Consumers have no way to predict what hospitals are cheaper than others.
- emodendroket 9y ago
  But neither do any of the places where government insurance prevails and costs are way lower.