4 ms·

In theory, competition should take care of the escalating costs, though?

patryn20 9y ago
In a "market" in which costs are unpredictable and not disclosed until AFTER care is complete, there is not truly competition. Try asking a cardiologist or neurologist for a fixed price estimate before a test is run. If you press the issue you'll be labeled a "confrontational" or "hostile" patient and rejected from the practice.
- anothercomment 9y ago
  They will reject you as long as they have enough other patients who don't care about the price. Somewhere the systemic error is injected into the system. There has to be a way to fix it or improve it.
  - eeZah7Ux 9y ago
    In some countries it's illegal to refuse service to customers unless they are doing something illegal. This applies to shops and restaurants as well.
- sjg007 9y ago
  Or even a dentist.
  - krallja 9y ago
    Dentists are much easier to get estimates from, because they know most of their patients are paying out of pocket. My last visit they gave me an estimate for my checkup and cleaning without my even asking.
- geomark 9y ago
  This is what drives me crazy about US health care. Where I currently live the estimated costs are given to you in advance, even advertised on the websites of hospitals and clinics. But back in the US where I used to live it is just like you said - nobody will quote prices.
- gehwartzen 9y ago
  The inresting thing is that it is very easy to get a detailed quote for any medical procedure that is not covered by insurance and payed for out of pocket by the consumer directly.
s_kilk 9y ago
In addition to the price issues pointed out in a sibling comment, you can't pause mid-heart-attack to shop around for the best deal. It's time to admit that not all problems are amenable to market solutions.
- anothercomment 9y ago
  I am not yet convinced it is not amenable. For example who gets to serve a city with emergency services? I guess there could be bidders to the city council, offering services for a certain price. That would lead to competition. Likewise, insurances would negotiate rates for certain procedures. Of course it is not the task of the patient during cardiac arrest to do so. But the patient would choose the insurance provider.
  - crdoconnor 9y ago
    >I am not yet convinced it is not amenable. For example who gets to serve a city with emergency services? I guess there could be bidders to the city council, offering services for a certain price. That would lead to competition. This sort of thing is usually fertile breeding ground for corruption and backhanders. The NHS has been dogged by scandals caused by this sort of pseudo-privatization. It works for smaller and short term contracts, especially for things which the private sector also needs, but the larger the size of the contract the more likely it is that the price will be determined by backhanders and which ministers play golf with which chief execs. For something the size of "supply a city with emergency services", you could practically guarantee that the city council leader's cushy post-political job would be determined by which company they picked. tl;dr read up on the principal/agent problem.
    - anothercomment 9y ago
      But then how can it be solved? With the blockchain? (that was sarcasm, although, perhaps worth thinking about - transparency, at least) Sure, governments/councils spending other people's money is always a fertile ground for corruption.
ollifi 9y ago
Yes I agree. I don't know if this Charlie Munger musing [1] on how some fields figure out not to engage in cut throat competition is relevant here. [1]http://theinvestmentsblog.blogspot.fi/2014/09/munger-on-airlines-cereals-and-bottlers.html http://theinvestmentsblog.blogspot.fi/2014/09/munger-on-airl... full speech [2]http://old.ycombinator.com/munger.html http://old.ycombinator.com/munger.html

In a "market" in which costs are unpredictable and not disclosed until AFTER care is complete, there is not truly competition. Try asking a cardiologist or neurologist for a fixed price estimate before a test is run. If you press the issue you'll be labeled a "confrontational" or "hostile" patient and rejected from the practice.

anothercomment 9y ago
They will reject you as long as they have enough other patients who don't care about the price. Somewhere the systemic error is injected into the system. There has to be a way to fix it or improve it.
- eeZah7Ux 9y ago
  In some countries it's illegal to refuse service to customers unless they are doing something illegal. This applies to shops and restaurants as well.
sjg007 9y ago
Or even a dentist.
- krallja 9y ago
  Dentists are much easier to get estimates from, because they know most of their patients are paying out of pocket. My last visit they gave me an estimate for my checkup and cleaning without my even asking.
geomark 9y ago
This is what drives me crazy about US health care. Where I currently live the estimated costs are given to you in advance, even advertised on the websites of hospitals and clinics. But back in the US where I used to live it is just like you said - nobody will quote prices.
gehwartzen 9y ago
The inresting thing is that it is very easy to get a detailed quote for any medical procedure that is not covered by insurance and payed for out of pocket by the consumer directly.

s_kilk 9y ago

In addition to the price issues pointed out in a sibling comment, you can't pause mid-heart-attack to shop around for the best deal. It's time to admit that not all problems are amenable to market solutions.

anothercomment 9y ago
I am not yet convinced it is not amenable. For example who gets to serve a city with emergency services? I guess there could be bidders to the city council, offering services for a certain price. That would lead to competition. Likewise, insurances would negotiate rates for certain procedures. Of course it is not the task of the patient during cardiac arrest to do so. But the patient would choose the insurance provider.
- crdoconnor 9y ago
  >I am not yet convinced it is not amenable. For example who gets to serve a city with emergency services? I guess there could be bidders to the city council, offering services for a certain price. That would lead to competition. This sort of thing is usually fertile breeding ground for corruption and backhanders. The NHS has been dogged by scandals caused by this sort of pseudo-privatization. It works for smaller and short term contracts, especially for things which the private sector also needs, but the larger the size of the contract the more likely it is that the price will be determined by backhanders and which ministers play golf with which chief execs. For something the size of "supply a city with emergency services", you could practically guarantee that the city council leader's cushy post-political job would be determined by which company they picked. tl;dr read up on the principal/agent problem.
  - anothercomment 9y ago
    But then how can it be solved? With the blockchain? (that was sarcasm, although, perhaps worth thinking about - transparency, at least) Sure, governments/councils spending other people's money is always a fertile ground for corruption.

ollifi 9y ago

Yes I agree. I don't know if this Charlie Munger musing [1] on how some fields figure out not to engage in cut throat competition is relevant here. [1]http://theinvestmentsblog.blogspot.fi/2014/09/munger-on-airlines-cereals-and-bottlers.html http://theinvestmentsblog.blogspot.fi/2014/09/munger-on-airl... full speech [2]http://old.ycombinator.com/munger.html http://old.ycombinator.com/munger.html