22 ms·

People are willing to pay anything for food or clothes as well. Still, free (well, at least way more free than in case of healthcare) market works decently, at

People are willing to pay anything for food or clothes as well. Still, free (well, at least way more free than in case of healthcare) market works decently, at least when it comes to providing cheap and decent food options. The problem with healthcare is the opposite: there is no free market and it's impossible to compete without huge investment and even then it's sometimes still impossible (patents, long approval periods etc.). The problem is for sure not simple but a lot of basic healthcare services could be a lot cheaper if it was easier to get in.

timthelion 9y ago
When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?
- fennecfoxen 9y ago
  1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage can count here.) To the extent that (1) is a small number, this question is a non sequitor. To the extent that (2) is large, even that small number is further mitigated. There are lots of arguments about why it might be better to structure health care as a centrally-planned activity instead of a market-based activity. This isn't one of the good ones.
  - dagw 9y ago
    1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? If just you're counting all issues it's obviously quite few. If you're weighting by potential costs then it's very high. Basically the more expensive and necessary a procedure is the less chance you have to shop around. If I was to break down the costs of all medical procedures I've had over the past 30 years I'd say that almost all of it would be taken up by a single series of emergency surgeries.
  - crusso 9y ago
    If outrageous healthcare costs were only kicking in for life-or-death emergencies then you might have a point. Healthcare costs across the board - except in unregulated, uninsured spheres like plastic surgery, lasik, etc. - are extraordinarily high.
    - tertius 9y ago
      The point he's making is that it's only unfeasible to negotiate when you need treatment this minute. Therefore a free market system is feasible for everything else. Not that it's what we currently have as you point out.
      - mattkrause 9y ago
        Even there though.... Do you think (or the average person) knows enough to shop around? This stuff is complicated! I'm not sure I could make a rational decision between treatments that have different prices, but also different likelihoods of success, side effect profiles, and all that. This is even more complicated when you're paying for a diagnosis too, rather than just a treatment. Lasik and plastic surgery are interesting because they're essentially commodities and the patient can easily evaluate the results themselves.
        tertius 9y ago
        > Do you think (or the average person) knows enough to shop around? Do I think that education surrounding general health has diminished. I feel very strongly about this. There should not be as large of a chasm between my knowledge or ability to diagnose (i.e. is something serious enough to go to the doctor for) and the knowledge of a doctor/PA etc. But yes, the average person deals with market economics every day and they're certainly smart enough to make decisions there. > Lasik and plastic surgery So are office visits, annuals, screenings, minor procedures (think stitches to Tonsillectomy). I.e. the bulk of medical service.
  - NoGravitas 9y ago
    Even for non-emergency care, it's not feasible to shop around in the US healthcare market. Doctors don't know prices. Typically, front-office staff won't know prices until they've talked to your insurance company. It's probably not possible to get prices from your insurance company except in the context of a very specific claim, which can only come from the doctor's office or hospital's office staff. A small difference in coding for the same issue/procedure can result in huge cost differences. It might be possible to shop around for prices on particular surgical procedures (eg), but only after you've paid an unpredictable amount for diagnosis. And you may have to pay twice for diagnosis to make this possible.
    - maxerickson 9y ago
      I believe their point was in the abstract. In a system where it is feasible to shop around, people will tend to do so and it will put downward pressure on prices. Maybe the thing to do is to start treating insurance-hospital networks that do not disclose pricing as collusion. It certainly makes no sense to me that our system has individual patients having adversarial dealings with 2 huge institutions every time they need care.
  - Avshalom 9y ago
    >>1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 100%, in theory at least. See I'm vaguely poor--18421 before taxes last year, currently about 5000 before taxes this year--which means I can't afford to go see a doctor because "I'm not sure but I think this is more than a sprain", "that's weird this lymph node has just swollen to thrice it's normal size over night" or "hmm this is definitely infected"[1]. In fact anything that isn't 0-copay, which isn't much because I can't afford swanky insurance, is basically out of reach. ALSO because I'm 31 and spent my adult life insurance-less I have almost literally no idea how to even get myself care if I could afford it (I mean what do you just throw a dart at a phone book? walk into a hospital and keep asking nurses questions?) As a result any[2] health care I receive is going to be a result of some one else calling an ambulance for me. Which will leave me in exactly no state to be comparison shopping. [1]true stories [2]well I did manage to get on some anti depressents and counseling last year by crying at the good people at my student health center for an hour or so, only after some one pointed out that generics for chronic conditions are covered by my insurance (a fact which does not actually appear in the policy packet but is only mentioned in small print on a PDF comparing the different plans) and the first month of counseling being covered by my student activity fees.
- deleted 9y ago
  [deleted]
bryanlarsen 9y ago
"The problem with healthcare is the opposite: there is no free market" Every other developed nation has less of a free market in health care than the United States, and every other developed nation seems to do better on this front than the United States does. It could well be that you're right, but the examples of other nations make this an extraordinary claim requiring extraordinary evidence. Or we could just stop experimenting on our vulnerable populace and just choose a system that works better and adopt that. It may not be perfect, but perfect is the enemy of the good.
- tertius 9y ago
  > Every other developed nation has less of a free market in health care than the United States Generally what you're referring to is government run healthcare. This isn't "less" free market, it is no free market, (at least for the non-rich). So it's in a different realm. I can agree that this like infant mortality is much better in a lot of countries. But this doesn't change the the U.S. pretends to have a "market" for medical services when the prices aren't set by government but only by providers and insurance companies. The people who are required to make free markets work, the consumers, have very little power in negotiation. Hence, it's not a free market. Apples, oranges. But the free market that we should have will likely never exist given political pressure. Single payer it is.
  - BeetleB 9y ago
    >Generally what you're referring to is government run healthcare. This isn't "less" free market, it is no free market, (at least for the non-rich). So it's in a different realm. Nope. It's not government run in a number of those countries. Although I do not mean to include them in my comment, but even Canada's health care industry is not government run.
    - tertius 9y ago
      Hence the "generally." And Canada does on a large scale what Medicare does in the U.S. it is a single point of negotiation. This may be good or bad depending on how well medicare is run. Many are saying that medicare should just be expanded to cover all people, prices should go down.
dragonwriter 9y ago
> The problem with healthcare is the opposite: there is no free market No, it's not; this is evident from all the other countries without free markets in healthcare that provide universal access and equal or better overall outcomes and far less cost (per capita, and even as a share of GDP) than the US, without anything more of a “free market”.
- crusso 9y ago
  I'd say that it's more that we're caught in the middle. We can't get the advantages of a free market because there's too much regulation and a competition-hostile legal framework. We can't get the advantages of socialized medicine because we lack the regulatory and legal framework. We're just kind of stuck in a local maximum in a poor area of the search space. In order to see a much better maximum, we'd have to move to an entirely different area of the search space.

timthelion 9y ago

When I'm hungry, I'm still able to visit multiple restaurants/ stores to compare prices. But when I'm having a heart attack, do I really have the option to shop around?

fennecfoxen 9y ago
1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 2. Have you or someone you know in the United States ever "shopped around" or otherwise prepared in advance for an emergency through the provision of, say, catastrophic health care insurance, which promises to pay for emergency room visits? (Employer coverage can count here.) To the extent that (1) is a small number, this question is a non sequitor. To the extent that (2) is large, even that small number is further mitigated. There are lots of arguments about why it might be better to structure health care as a centrally-planned activity instead of a market-based activity. This isn't one of the good ones.
- dagw 9y ago
  1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? If just you're counting all issues it's obviously quite few. If you're weighting by potential costs then it's very high. Basically the more expensive and necessary a procedure is the less chance you have to shop around. If I was to break down the costs of all medical procedures I've had over the past 30 years I'd say that almost all of it would be taken up by a single series of emergency surgeries.
- crusso 9y ago
  If outrageous healthcare costs were only kicking in for life-or-death emergencies then you might have a point. Healthcare costs across the board - except in unregulated, uninsured spheres like plastic surgery, lasik, etc. - are extraordinarily high.
  - tertius 9y ago
    The point he's making is that it's only unfeasible to negotiate when you need treatment this minute. Therefore a free market system is feasible for everything else. Not that it's what we currently have as you point out.
    - mattkrause 9y ago
      Even there though.... Do you think (or the average person) knows enough to shop around? This stuff is complicated! I'm not sure I could make a rational decision between treatments that have different prices, but also different likelihoods of success, side effect profiles, and all that. This is even more complicated when you're paying for a diagnosis too, rather than just a treatment. Lasik and plastic surgery are interesting because they're essentially commodities and the patient can easily evaluate the results themselves.
      - tertius 9y ago
        > Do you think (or the average person) knows enough to shop around? Do I think that education surrounding general health has diminished. I feel very strongly about this. There should not be as large of a chasm between my knowledge or ability to diagnose (i.e. is something serious enough to go to the doctor for) and the knowledge of a doctor/PA etc. But yes, the average person deals with market economics every day and they're certainly smart enough to make decisions there. > Lasik and plastic surgery So are office visits, annuals, screenings, minor procedures (think stitches to Tonsillectomy). I.e. the bulk of medical service.
- NoGravitas 9y ago
  Even for non-emergency care, it's not feasible to shop around in the US healthcare market. Doctors don't know prices. Typically, front-office staff won't know prices until they've talked to your insurance company. It's probably not possible to get prices from your insurance company except in the context of a very specific claim, which can only come from the doctor's office or hospital's office staff. A small difference in coding for the same issue/procedure can result in huge cost differences. It might be possible to shop around for prices on particular surgical procedures (eg), but only after you've paid an unpredictable amount for diagnosis. And you may have to pay twice for diagnosis to make this possible.
  - maxerickson 9y ago
    I believe their point was in the abstract. In a system where it is feasible to shop around, people will tend to do so and it will put downward pressure on prices. Maybe the thing to do is to start treating insurance-hospital networks that do not disclose pricing as collusion. It certainly makes no sense to me that our system has individual patients having adversarial dealings with 2 huge institutions every time they need care.
- Avshalom 9y ago
  >>1. What percentage of your health issues are "emergency, heart attack RIGHT NOW"-class issues? What percentage of health care spending overall are these issues? 100%, in theory at least. See I'm vaguely poor--18421 before taxes last year, currently about 5000 before taxes this year--which means I can't afford to go see a doctor because "I'm not sure but I think this is more than a sprain", "that's weird this lymph node has just swollen to thrice it's normal size over night" or "hmm this is definitely infected"[1]. In fact anything that isn't 0-copay, which isn't much because I can't afford swanky insurance, is basically out of reach. ALSO because I'm 31 and spent my adult life insurance-less I have almost literally no idea how to even get myself care if I could afford it (I mean what do you just throw a dart at a phone book? walk into a hospital and keep asking nurses questions?) As a result any[2] health care I receive is going to be a result of some one else calling an ambulance for me. Which will leave me in exactly no state to be comparison shopping. [1]true stories [2]well I did manage to get on some anti depressents and counseling last year by crying at the good people at my student health center for an hour or so, only after some one pointed out that generics for chronic conditions are covered by my insurance (a fact which does not actually appear in the policy packet but is only mentioned in small print on a PDF comparing the different plans) and the first month of counseling being covered by my student activity fees.
deleted 9y ago
[deleted]

bryanlarsen 9y ago

"The problem with healthcare is the opposite: there is no free market" Every other developed nation has less of a free market in health care than the United States, and every other developed nation seems to do better on this front than the United States does. It could well be that you're right, but the examples of other nations make this an extraordinary claim requiring extraordinary evidence. Or we could just stop experimenting on our vulnerable populace and just choose a system that works better and adopt that. It may not be perfect, but perfect is the enemy of the good.

tertius 9y ago
> Every other developed nation has less of a free market in health care than the United States Generally what you're referring to is government run healthcare. This isn't "less" free market, it is no free market, (at least for the non-rich). So it's in a different realm. I can agree that this like infant mortality is much better in a lot of countries. But this doesn't change the the U.S. pretends to have a "market" for medical services when the prices aren't set by government but only by providers and insurance companies. The people who are required to make free markets work, the consumers, have very little power in negotiation. Hence, it's not a free market. Apples, oranges. But the free market that we should have will likely never exist given political pressure. Single payer it is.
- BeetleB 9y ago
  >Generally what you're referring to is government run healthcare. This isn't "less" free market, it is no free market, (at least for the non-rich). So it's in a different realm. Nope. It's not government run in a number of those countries. Although I do not mean to include them in my comment, but even Canada's health care industry is not government run.
  - tertius 9y ago
    Hence the "generally." And Canada does on a large scale what Medicare does in the U.S. it is a single point of negotiation. This may be good or bad depending on how well medicare is run. Many are saying that medicare should just be expanded to cover all people, prices should go down.

dragonwriter 9y ago

> The problem with healthcare is the opposite: there is no free market No, it's not; this is evident from all the other countries without free markets in healthcare that provide universal access and equal or better overall outcomes and far less cost (per capita, and even as a share of GDP) than the US, without anything more of a “free market”.

crusso 9y ago
I'd say that it's more that we're caught in the middle. We can't get the advantages of a free market because there's too much regulation and a competition-hostile legal framework. We can't get the advantages of socialized medicine because we lack the regulatory and legal framework. We're just kind of stuck in a local maximum in a poor area of the search space. In order to see a much better maximum, we'd have to move to an entirely different area of the search space.