5 ms·

The problem is US health care providers are immune to true competition: 1. They often enjoy state-sanctioned monopolies in the form of overly restrictive licen

The problem is US health care providers are immune to true competition: 1. They often enjoy state-sanctioned monopolies in the form of overly restrictive licensing laws. They're basically unions that enshrine certain false assumptions about what form of training is necessary to accomplish tasks. 2. They don't even have to be held to any cost agreements. How can you have competition or any kind of viable health care economy when no one actually knows the price of a service until it is set by the provider after the fact, and there is no way of offering an alternative means of offering the service? It's absurd. I don't even understand how most of this is legal. The price should be set beforehand, or at least there should be an estimate on request, and the final price should be with in a small fraction of that estimate, and licensing should be dramatically loosened or eliminated, to allow providers who are competent but have alternate educational paths (e.g., optometrists expanding their practice, or psychologists prescribing, or nurses or pharmacists increasing their role).

amoorthy 9y ago
There is a downside to pricing being front-and-center. It encourages the patient to make a judgement call on what procedure to undertake based more on cost than on need. Since they are not qualified to assess need they rely on cost more than they probably should. The result may be poor short-term decisions which leads to health complications down the line. Healthcare is a service like none other. The consumer is not knowledgeable about the details and trusts a third party (doctor). They often buy the service when they are not in the best frame of mind. They may not have the ability to exercise choice in location or provider in an emergency situation. All these factors make it hard for consumers to make a rational decision when it comes to healthcare services. Since these factors are unlikely to change I don't think we should rely on a traditional market-based approach where competition will solve all ills. More important than transparent pricing is a singular price for a procedure regardless of if the patient has insurance or not. That alone will solve many problems.
- DenisM 9y ago
  You could go to one doctor to receive recommendations and to another to perform procedures. The former will have no incentive to over/under recommend, unless they are in cahoots. Also known as “second opinion”.
- csydas 9y ago
  But then again, the opposite of this is they're also not equipped to make a judgement for non-critical operations or and they also are provided with absolutely no information as to the costs they're about to undertake for procedures that otherwise would be in their right frame of mind, and they have poor ability to understand how their insurance will work each time they undergo a procedure, whether it's a routine check or a critical procedure. Already prior to the affordable care act people were performing their own medical procedures since they could not get medical coverage due to pre-existing conditions, making equally bad decisions because they had no means to determine how costly a procedure would be and they still lacked the ability to know whether or not a procedure was required. The information asymmetry is bad for many reasons, as I do appreciate what you're saying that we really don't want people self-diagnosing; but at the same time, should we really have people going into debt just to get a minor biopsy done? My last biopsy cost $6300 when it was all said and done and insurance refused to pay any of it on the basis that it was "unnecessary", never-ending that three separate doctors were extremely concerned as they had no idea what a lesion on my leg was and they were fearful it was cancerous. I'm not really sure how that can be deemed unnecessary; even from a straight cost perspective, $6300 out of their pocket now means saving potentially hundreds of thousands on costs later. I live abroad and my work colleagues are continually flabbergasted when I explain how health care and insurance works in the US - they cannot fathom the idea of paying for a service that can just decide not to hold up their end of the bargain for whatever reason, or that the answer to the simple question "Let's say I break my leg - how much can I expect to pay to get it fixed?" is "I really can't say, it depends on a lot of things." Here, they're used to pretty dead set figures; an X-Ray is this much, a cast is this much, each follow up visit is $X, and this is all provided ahead of time so that they know the total cost up front. So yeah, I do get what you're saying - we don't want people just going to WebMD and thinking they have SuperCancer. But the alternative is people terrified of the potential costs and having absolutely no idea what they're getting billed for or why, and an Insurance system that just dictates prices to them.
  - amoorthy 9y ago
    Agreed that cost transparency is good. Better is what your non-US friends are saying: "an X-ray is this much" regardless of where you get the service and if you have insurance or not. ps: hope your biopsy was ok. Must be a very stressful thing to go to, and then have to deal with payment issues after.
- maxxxxx 9y ago
  "singular price for a procedure regardless of if the patient has insurance or not. " this definitely would be helpful.
- arwhatever 9y ago
  But is the doctor really a third party?
chimeracoder 9y ago
> How can you have competition or any kind of viable health care economy when no one actually knows the price of a service until it is set by the provider after the fact, and there is no way of offering an alternative means of offering the service? It's not that nobody actually knows the price of a service because it's set by providers after-the-fact. It's that it's infeasible to predict what an individual patient will be required to pay until after it's submitted to insurance. That generally happens before the service is provided, particularly for outpatient services or planned procedures. Providers can't feasibly predict how much patients will be responsible to pay for a whole number of reasons, one of which is that they themselves don't always know how much they'll be paid by the insurers.
nradov 9y ago
Provider licensing restrictions isn't the major issue. Other countries have similar restrictions and don't end up with the same problems. We are already seeing Nurse Practitioners and Physician Assistants delivering more basic care. This saves a lot of money compared to using Physicians for every little thing.

amoorthy 9y ago

There is a downside to pricing being front-and-center. It encourages the patient to make a judgement call on what procedure to undertake based more on cost than on need. Since they are not qualified to assess need they rely on cost more than they probably should. The result may be poor short-term decisions which leads to health complications down the line. Healthcare is a service like none other. The consumer is not knowledgeable about the details and trusts a third party (doctor). They often buy the service when they are not in the best frame of mind. They may not have the ability to exercise choice in location or provider in an emergency situation. All these factors make it hard for consumers to make a rational decision when it comes to healthcare services. Since these factors are unlikely to change I don't think we should rely on a traditional market-based approach where competition will solve all ills. More important than transparent pricing is a singular price for a procedure regardless of if the patient has insurance or not. That alone will solve many problems.

DenisM 9y ago
You could go to one doctor to receive recommendations and to another to perform procedures. The former will have no incentive to over/under recommend, unless they are in cahoots. Also known as “second opinion”.
csydas 9y ago
But then again, the opposite of this is they're also not equipped to make a judgement for non-critical operations or and they also are provided with absolutely no information as to the costs they're about to undertake for procedures that otherwise would be in their right frame of mind, and they have poor ability to understand how their insurance will work each time they undergo a procedure, whether it's a routine check or a critical procedure. Already prior to the affordable care act people were performing their own medical procedures since they could not get medical coverage due to pre-existing conditions, making equally bad decisions because they had no means to determine how costly a procedure would be and they still lacked the ability to know whether or not a procedure was required. The information asymmetry is bad for many reasons, as I do appreciate what you're saying that we really don't want people self-diagnosing; but at the same time, should we really have people going into debt just to get a minor biopsy done? My last biopsy cost $6300 when it was all said and done and insurance refused to pay any of it on the basis that it was "unnecessary", never-ending that three separate doctors were extremely concerned as they had no idea what a lesion on my leg was and they were fearful it was cancerous. I'm not really sure how that can be deemed unnecessary; even from a straight cost perspective, $6300 out of their pocket now means saving potentially hundreds of thousands on costs later. I live abroad and my work colleagues are continually flabbergasted when I explain how health care and insurance works in the US - they cannot fathom the idea of paying for a service that can just decide not to hold up their end of the bargain for whatever reason, or that the answer to the simple question "Let's say I break my leg - how much can I expect to pay to get it fixed?" is "I really can't say, it depends on a lot of things." Here, they're used to pretty dead set figures; an X-Ray is this much, a cast is this much, each follow up visit is $X, and this is all provided ahead of time so that they know the total cost up front. So yeah, I do get what you're saying - we don't want people just going to WebMD and thinking they have SuperCancer. But the alternative is people terrified of the potential costs and having absolutely no idea what they're getting billed for or why, and an Insurance system that just dictates prices to them.
- amoorthy 9y ago
  Agreed that cost transparency is good. Better is what your non-US friends are saying: "an X-ray is this much" regardless of where you get the service and if you have insurance or not. ps: hope your biopsy was ok. Must be a very stressful thing to go to, and then have to deal with payment issues after.
maxxxxx 9y ago
"singular price for a procedure regardless of if the patient has insurance or not. " this definitely would be helpful.
arwhatever 9y ago
But is the doctor really a third party?

chimeracoder 9y ago

> How can you have competition or any kind of viable health care economy when no one actually knows the price of a service until it is set by the provider after the fact, and there is no way of offering an alternative means of offering the service? It's not that nobody actually knows the price of a service because it's set by providers after-the-fact. It's that it's infeasible to predict what an individual patient will be required to pay until after it's submitted to insurance. That generally happens before the service is provided, particularly for outpatient services or planned procedures. Providers can't feasibly predict how much patients will be responsible to pay for a whole number of reasons, one of which is that they themselves don't always know how much they'll be paid by the insurers.

nradov 9y ago

Provider licensing restrictions isn't the major issue. Other countries have similar restrictions and don't end up with the same problems. We are already seeing Nurse Practitioners and Physician Assistants delivering more basic care. This saves a lot of money compared to using Physicians for every little thing.