4 ms·

This Is Why Health Care Costs So Much

28 points by abawany 9y ago

xupybd 9y ago
I think the lack of choice is key here. There is no driver for efficiency if the patient / customer has no bargaining power.
- mac01021 9y ago
  There's also the fact that consumers are not aware of the price of the services until (and only sometimes) after the services have been rendered. Noone ever goes into a restaurant, orders a bowl of soup, eats it, and then becomes mortified upon receiving a bill of $250. People find out how much the soup costs before they order it. And any medical system that is going to price operations reasonably will probably have people doing the same for their tongue tie operations.
  - qrbLPHiKpiux 9y ago
    People don’t know what, or who, to ask. I have declined treatment until I knew what I would pay for it. I’m looking at you, you Anesthesiologists.
    - toomuchtodo 9y ago
      When my wife needed an emergency C-section, I couldn’t schedule a conversation with the chargemaster to price shop. I just assumed I’d either negotiate once the bill came in the mail or file for bankruptcy, depending on the total amount due.
      - mac01021 9y ago
        > I couldn’t schedule a conversation with the chargemaster to price shop. Nor should you. In emergency situations where you would be willing to pay almost anything there's really nothing you can do. I don't think such situations are a majority of medical care though. In all the other, nonemergency situations, it should be way easier to price shop, and obvious before-the-fact what your insurance provider will agree to cover.
  - u801e 9y ago
    > Noone ever goes into a restaurant, orders a bowl of soup, eats it, and then becomes mortified upon receiving a bill of $250. Another problem is that even if you have the exact CPT or ICD codes for the procedure/lab and call the place to inquire about the price, the best you can get is that they will get back to you after several days and give you an approximate figure. To extend the analogy quoted above: No one ever calls a restaurant, inquires about the price of a bowl of a particular type of soup, and has to wait for several days for the restaurant to get back to them and say it could cost anywhere from $100 to $300.
    - mac01021 9y ago
      Agreed. This is the sort of issue that regulations will need to address if we're to eliminate the systematic overcharging that goes on.
- raarts 9y ago
  This can't be the only reason since this isn't different from other countries.
  - abawany 9y ago
    I imagine the reason is that in other countries, the government may have negotiated maximum rates and coverage, ensuring that while choice is limited, the upper bound on usurious behavior is contained.
  - RonanTheGrey 9y ago
    Except it is, though. Mexico, for example, has a very modern health care system and the pricing is incredibly low: and they tell you the prices up front. Private hospitals (and even some public health services) come in a range of prices, and you can choose the one that represents the level of service you want. Some private doctor visits cost 30 pesos (approx $1.50 US); some cost 500 ($25 US). I have never seen one more than 500. Again - you know up front, and you can choose. There is both public and private sector care, public sector care is very cheap but no lower in quality, you just (predictably) have longer waits, depending on the procedure. Private sector is exactly what you'd expect it to be - but it is still within reach of middle class Mexicans, which, unlike the US, is a growing group. Mexico is competitive, the US is not. This may turn out to be very surprising to some.
  - xupybd 9y ago
    It is here in NZ. If I got to the doctor they'll tell me my options. Price is often something to consider. We have a "Free" health system for many things. But if I want anything done without waiting for years I'll probably have to go private if I do I'll find out the price before getting the service. They also often push you to the lowest level of treatment possible.
  - xtreme 9y ago
    In India, private hospitals are very upfront about the estimated costs of medical procedures. They also provide various options at different price points (some devices can be costlier than others, or some rooms can have more facilities etc.). Patients often choose where to get the procedure done based on the cost, proximity of the hospital, and how well-known the doctor is in their field. While the small number of hospitals compared to the large population means that the hospitals still have the upper hand (some hospitals have long waiting lists), this kind of competition has improved the quality of healthcare as well as reduce the cost.
- ibeckermayer 9y ago
  The reason behind the lack of choice is state backed monopolization of regulation and licensing. In any endeavour where there is a licensure and/or regulatory cartel, incompetence and malice will cause prices to skyrocket. Of course most of the eminent "thinkers" in America believe this problem will be solved by giving the government even more control.
deleted 9y ago
[deleted]

28 points by abawany 9y ago

I think the lack of choice is key here. There is no driver for efficiency if the patient / customer has no bargaining power.

mac01021 9y ago
There's also the fact that consumers are not aware of the price of the services until (and only sometimes) after the services have been rendered. Noone ever goes into a restaurant, orders a bowl of soup, eats it, and then becomes mortified upon receiving a bill of $250. People find out how much the soup costs before they order it. And any medical system that is going to price operations reasonably will probably have people doing the same for their tongue tie operations.
- qrbLPHiKpiux 9y ago
  People don’t know what, or who, to ask. I have declined treatment until I knew what I would pay for it. I’m looking at you, you Anesthesiologists.
  - toomuchtodo 9y ago
    When my wife needed an emergency C-section, I couldn’t schedule a conversation with the chargemaster to price shop. I just assumed I’d either negotiate once the bill came in the mail or file for bankruptcy, depending on the total amount due.
    - mac01021 9y ago
      > I couldn’t schedule a conversation with the chargemaster to price shop. Nor should you. In emergency situations where you would be willing to pay almost anything there's really nothing you can do. I don't think such situations are a majority of medical care though. In all the other, nonemergency situations, it should be way easier to price shop, and obvious before-the-fact what your insurance provider will agree to cover.
- u801e 9y ago
  > Noone ever goes into a restaurant, orders a bowl of soup, eats it, and then becomes mortified upon receiving a bill of $250. Another problem is that even if you have the exact CPT or ICD codes for the procedure/lab and call the place to inquire about the price, the best you can get is that they will get back to you after several days and give you an approximate figure. To extend the analogy quoted above: No one ever calls a restaurant, inquires about the price of a bowl of a particular type of soup, and has to wait for several days for the restaurant to get back to them and say it could cost anywhere from $100 to $300.
  - mac01021 9y ago
    Agreed. This is the sort of issue that regulations will need to address if we're to eliminate the systematic overcharging that goes on.
raarts 9y ago
This can't be the only reason since this isn't different from other countries.
- abawany 9y ago
  I imagine the reason is that in other countries, the government may have negotiated maximum rates and coverage, ensuring that while choice is limited, the upper bound on usurious behavior is contained.
- RonanTheGrey 9y ago
  Except it is, though. Mexico, for example, has a very modern health care system and the pricing is incredibly low: and they tell you the prices up front. Private hospitals (and even some public health services) come in a range of prices, and you can choose the one that represents the level of service you want. Some private doctor visits cost 30 pesos (approx $1.50 US); some cost 500 ($25 US). I have never seen one more than 500. Again - you know up front, and you can choose. There is both public and private sector care, public sector care is very cheap but no lower in quality, you just (predictably) have longer waits, depending on the procedure. Private sector is exactly what you'd expect it to be - but it is still within reach of middle class Mexicans, which, unlike the US, is a growing group. Mexico is competitive, the US is not. This may turn out to be very surprising to some.
- xupybd 9y ago
  It is here in NZ. If I got to the doctor they'll tell me my options. Price is often something to consider. We have a "Free" health system for many things. But if I want anything done without waiting for years I'll probably have to go private if I do I'll find out the price before getting the service. They also often push you to the lowest level of treatment possible.
- xtreme 9y ago
  In India, private hospitals are very upfront about the estimated costs of medical procedures. They also provide various options at different price points (some devices can be costlier than others, or some rooms can have more facilities etc.). Patients often choose where to get the procedure done based on the cost, proximity of the hospital, and how well-known the doctor is in their field. While the small number of hospitals compared to the large population means that the hospitals still have the upper hand (some hospitals have long waiting lists), this kind of competition has improved the quality of healthcare as well as reduce the cost.
ibeckermayer 9y ago
The reason behind the lack of choice is state backed monopolization of regulation and licensing. In any endeavour where there is a licensure and/or regulatory cartel, incompetence and malice will cause prices to skyrocket. Of course most of the eminent "thinkers" in America believe this problem will be solved by giving the government even more control.

deleted 9y ago

[deleted]