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I have a high-deductible plan, and have had one for ~7 years now. It doesn't really change my decision process that much, honestly. Especially when I'm consider

I have a high-deductible plan, and have had one for ~7 years now. It doesn't really change my decision process that much, honestly. Especially when I'm considering a procedure that my doctor has told me I need, but I don't know / understand the technical details of... I will try to go in-network, but I don't really have the capability to go shop around and assess which providers will give me a better outcome per dollar spent. I especially don't usually have the necessary skill set to assess if some cheaper option that's not my doc's first choice would really be a good choice. With healthcare, it's not just about "what's the cheapest option", it's also "who will deliver the best service"... given the relatively limited ability to optimize the first, I generally will focus on the second, and I think that's what most folks do - they go with providers they trust. It all comes back to my original point: healthcare, particularly non-elective healthcare, is not well-suited to a free market solution.

Consultant32452 9y ago
Assuming you are not an auto mechanic, how do you go about deciding which cars to purchase? If you're unable to discern whether your doctor's preferred solution is the best one, then what is the purpose of asking your doctor in the first place? Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider?
- tomkarlo 9y ago
  Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) If I was qualified to discern if my doc's preferred solution was the best one, I'd be a doctor. I ask my doctor because he's been specifically trained to make that determination. > Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider? You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more.
  - Consultant32452 9y ago
    >Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) TIL there's no testing, rating, or regulating in the medical industry. >I ask my doctor because he's been specifically trained to make that determination. I agree, so this concern of yours is alleviated. The market provided you an expensive option which is the one your trusted advisor recommends, and there's a cheaper one which may offer lower quality service. You are now empowered to make your own decision on the matter. >You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more. Moving to single payer does not help you differentiate the best from the worst. All it does is force the good provider and the bad provider to charge the same. The current insurance regime is not better, because your provider can choose the worse provider for you if they're cheaper, leaving you no option at all.
- romwell 9y ago
  >Assuming you are not an auto mechanic, how do you go about deciding which cars to purchase? I can't believe we're going with car analogies here. HN is now the Slashdot of yore. I do hope you realize that people use fundamentally different methods of choosing things in life depending on the importance and consequences of that choice, and hence asking about how one chooses cars doesn't apply to choosing a healthcare provider. Unless you are, in fact, a robot, in which case I welcome our new, ah nevermind.
  - Consultant32452 9y ago
    The answer is you choose a car based on personal experience, referrals from friends, and trusted third party reviews. That's exactly how you choose a healthcare provider today. There is no magic here just because healthcare is more important than car choice. You're no more or less safe because you're paying out of pocket. It's not as if paying out of pocket means you're going to be getting healthcare from Joe the crackhead in the back alley. It will still be doctors, NPs, etc. all licensed in your state.
    - emodendroket 9y ago
      Fundamentally the analogy doesn't work because cars can be replaced. I can't trade in my body because the doctor can't figure out what's wrong with it and it's getting too expensive to keep getting care.
    - romwell 9y ago
      >The answer is you choose a car based on personal experience, referrals from friends, and trusted third party reviews. You can speak for yourself. I bought my Honda Fit because I saw a video ad on Youtube. Worked for me, I love the thing. And if I didn't? No biggie, would have sold it off on Craigslist and bought something else. Would I select a doctor based on an ad? No, no, and no. Which is my point, actually.

Consultant32452 9y ago

Assuming you are not an auto mechanic, how do you go about deciding which cars to purchase? If you're unable to discern whether your doctor's preferred solution is the best one, then what is the purpose of asking your doctor in the first place? Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider?

tomkarlo 9y ago
Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) If I was qualified to discern if my doc's preferred solution was the best one, I'd be a doctor. I ask my doctor because he's been specifically trained to make that determination. > Or how would it be beneficial if the "worst" provider was forced to charge you the same as the best provider? You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more.
- Consultant32452 9y ago
  >Cars have the nice property of being mass-produced goods, where there's an established mechanism for testing, rating, and regulating them. There's no such thing for healthcare (and it's a service, not a hard good.) TIL there's no testing, rating, or regulating in the medical industry. >I ask my doctor because he's been specifically trained to make that determination. I agree, so this concern of yours is alleviated. The market provided you an expensive option which is the one your trusted advisor recommends, and there's a cheaper one which may offer lower quality service. You are now empowered to make your own decision on the matter. >You've got that backwards. Right now, we basically allow the worst provider to charge as much as the best one, because we don't really have any way to differentiate the best from the worst. There's no need to force any business to charge more. Moving to single payer does not help you differentiate the best from the worst. All it does is force the good provider and the bad provider to charge the same. The current insurance regime is not better, because your provider can choose the worse provider for you if they're cheaper, leaving you no option at all.
romwell 9y ago
>Assuming you are not an auto mechanic, how do you go about deciding which cars to purchase? I can't believe we're going with car analogies here. HN is now the Slashdot of yore. I do hope you realize that people use fundamentally different methods of choosing things in life depending on the importance and consequences of that choice, and hence asking about how one chooses cars doesn't apply to choosing a healthcare provider. Unless you are, in fact, a robot, in which case I welcome our new, ah nevermind.
- Consultant32452 9y ago
  The answer is you choose a car based on personal experience, referrals from friends, and trusted third party reviews. That's exactly how you choose a healthcare provider today. There is no magic here just because healthcare is more important than car choice. You're no more or less safe because you're paying out of pocket. It's not as if paying out of pocket means you're going to be getting healthcare from Joe the crackhead in the back alley. It will still be doctors, NPs, etc. all licensed in your state.
  - emodendroket 9y ago
    Fundamentally the analogy doesn't work because cars can be replaced. I can't trade in my body because the doctor can't figure out what's wrong with it and it's getting too expensive to keep getting care.
  - romwell 9y ago
    >The answer is you choose a car based on personal experience, referrals from friends, and trusted third party reviews. You can speak for yourself. I bought my Honda Fit because I saw a video ad on Youtube. Worked for me, I love the thing. And if I didn't? No biggie, would have sold it off on Craigslist and bought something else. Would I select a doctor based on an ad? No, no, and no. Which is my point, actually.