6 ms·

I'm not sure it would. Given the information asymmetries involved, how does it avoid the "market for lemons" problem?

phil21 9y ago
I think HN could do with some older folks on it. Heck, I remember growing up and using insurance was rare. You paid cash for your doctor visits, and typically only used insurance for major hospital stays as that's more or less all it covered. Doctor visits just 30 year ago did not cost what they do today. You could get a clean break in your arm, go into your GP, have it fully fixed and be out the door for less than a week's wages for an average blue collar worker. This was actually considered very expensive, but it prices were held down for the simple fact that people cared and there was a hard limit - can't get blood from a stone. When insurance started to become "cadillac" plans I very much noticed an insane explosion in everyday medical costs and a nosedive in quality of care. It's now a corporate factory system where everyone is miserable - the doctors and the patients. The only winners are executives and shareholders. The insanity of average cases of stuff like the flu now going to a doctor also is very new, and only is happening due to the incentives of "free visit" for the average consumer. The typical argument used against a return to "free market" health care where insurance is actually insurance again is one much like yours - if you're sick you don't care about the price. This was proven untrue just in my recent childhood, and something like 90%+ of all healthcare is not urgent or emergency related. If 90% of the market is setting prices via free market discovery the remaining 10% will be drug along or can be forced to via limited regulation. Healthcare costs in the US are almost entirely a principal agent problem. Absolutely no one has a damn clue of what anything costs at any point in the entire process. And the real issue is the consumers don't actually care since they are only harmed in an indirect sense.
- whb07 9y ago
  So much this! I broke my leg a decade ago and asked my doctor how much did it cost to get X done if I wanted to pay in cash. He didn’t know and looked dumbfounded by such a simple question. In what other profession can a professional perform a task not knowing what he’s charging for the services being rendered?
  - westbywest 9y ago
    Plenty of professions, actually. Especially those where skills cultivated by individuals become highly specialized, and companies thus maintain a large number of employees to ensure their business requirements (including billing and bookkeeping) are met by dedicated staff of sufficient skill level. Not all medical practice can be done like sole-proprietor design shops.
    - monocasa 9y ago
      Yeah, almost everything B2B has prices listed that no one actually pays; they're just meant as an initial negotiating position.
- Retric 9y ago
  Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. However, this improvement takes a lot of effort and really does mean higher prices. So, all you are proposing is rationing care aka if people can't get care then cost is not a problem. I would suggest a public option that excluded any patented medication or extensive intervention could be really cheap if you also removed most paper work and the ability to sue. But, nobody would accept a significantly lower standard of care.
  - tinokid 9y ago
    >Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. No. These rates are affected by more screening procedures. Some nipped a potentially fatal cancer in the bud, others just found and removed something that wouldn't have killed the person. To first order there is no change in the effectiveness of cancer treatment as compared to 50 years ago.
    - Retric 9y ago
      That's demonstrably false. Early screening is useful, but that's also a medical procedure. Really what we care about is cancer deaths at a specific age AKA what % of 15 year old people die of cancer and that really has dropped. Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population numbers of 193 per 100k. PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer rates will similarly drop from the HPV vaccine.
      - vonmoltke 9y ago
        You are referring to cancer prevention, while the GP is referring to cancer treatment.
        grzm 9y ago
        I'm not sure I follow. Screening detects cancer that is already there, hopefully in early stages when it might be treated more easily. In both cases, cancer is already present.
- tinokid 9y ago
  "People cared" maybe plays a bigger role than you realize here. There were stronger social norms back then about the role of medical care in society. Most hospitals were community or religious owned, physicians were content with merely above average professional salaries, and you never saw any kind of advertisement that ended with "ask your doctor about X". I think it's naive to assume the 16.5%-of-GDP octopus we've created wouldn't figure out a way to profit from the removal of all regulations.
  - HarryHirsch 9y ago
    You also wonder how much consolidation has had to do with the erosion of social norms. An owner of a community practice might feel constrained in a different way than an employee at a healthcare company.
saint_fiasco 9y ago
Add a regulation that says every hospital must publish anonimized aggregated patient outcomes. Remove as many other regulations as it would take for them to be willing to compromise and accept this one.
- conanbatt 9y ago
  Good reason to shy away care for bad patients if it affects your stats. Surgeons do this today to maintain a high success rate.
  - saint_fiasco 9y ago
    Either make that count as a forfeit or hire specialized diagnosticians who make the prognosis and rate the surgeons on how well they do relative to the prognosis.

I think HN could do with some older folks on it. Heck, I remember growing up and using insurance was rare. You paid cash for your doctor visits, and typically only used insurance for major hospital stays as that's more or less all it covered. Doctor visits just 30 year ago did not cost what they do today. You could get a clean break in your arm, go into your GP, have it fully fixed and be out the door for less than a week's wages for an average blue collar worker. This was actually considered very expensive, but it prices were held down for the simple fact that people cared and there was a hard limit - can't get blood from a stone. When insurance started to become "cadillac" plans I very much noticed an insane explosion in everyday medical costs and a nosedive in quality of care. It's now a corporate factory system where everyone is miserable - the doctors and the patients. The only winners are executives and shareholders. The insanity of average cases of stuff like the flu now going to a doctor also is very new, and only is happening due to the incentives of "free visit" for the average consumer. The typical argument used against a return to "free market" health care where insurance is actually insurance again is one much like yours - if you're sick you don't care about the price. This was proven untrue just in my recent childhood, and something like 90%+ of all healthcare is not urgent or emergency related. If 90% of the market is setting prices via free market discovery the remaining 10% will be drug along or can be forced to via limited regulation. Healthcare costs in the US are almost entirely a principal agent problem. Absolutely no one has a damn clue of what anything costs at any point in the entire process. And the real issue is the consumers don't actually care since they are only harmed in an indirect sense.

whb07 9y ago
So much this! I broke my leg a decade ago and asked my doctor how much did it cost to get X done if I wanted to pay in cash. He didn’t know and looked dumbfounded by such a simple question. In what other profession can a professional perform a task not knowing what he’s charging for the services being rendered?
- westbywest 9y ago
  Plenty of professions, actually. Especially those where skills cultivated by individuals become highly specialized, and companies thus maintain a large number of employees to ensure their business requirements (including billing and bookkeeping) are met by dedicated staff of sufficient skill level. Not all medical practice can be done like sole-proprietor design shops.
  - monocasa 9y ago
    Yeah, almost everything B2B has prices listed that no one actually pays; they're just meant as an initial negotiating position.
Retric 9y ago
Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. However, this improvement takes a lot of effort and really does mean higher prices. So, all you are proposing is rationing care aka if people can't get care then cost is not a problem. I would suggest a public option that excluded any patented medication or extensive intervention could be really cheap if you also removed most paper work and the ability to sue. But, nobody would accept a significantly lower standard of care.
- tinokid 9y ago
  >Heath care has gotten vastly better over time. Look at 5 year cancer survival rates for example. No. These rates are affected by more screening procedures. Some nipped a potentially fatal cancer in the bud, others just found and removed something that wouldn't have killed the person. To first order there is no change in the effectiveness of cancer treatment as compared to 50 years ago.
  - Retric 9y ago
    That's demonstrably false. Early screening is useful, but that's also a medical procedure. Really what we care about is cancer deaths at a specific age AKA what % of 15 year old people die of cancer and that really has dropped. Even beyond that the absolute rate of cancer deaths in the US peaked in 1990 216 per 100k vs 2015 at 158 per 100k. Which is a massive drop even over 1950's pre screening and younger population numbers of 193 per 100k. PS: Stomach cancer is flat out much less common because we understand a major cause now. Cervical cancer rates will similarly drop from the HPV vaccine.
    - vonmoltke 9y ago
      You are referring to cancer prevention, while the GP is referring to cancer treatment.
      - grzm 9y ago
        I'm not sure I follow. Screening detects cancer that is already there, hopefully in early stages when it might be treated more easily. In both cases, cancer is already present.
tinokid 9y ago
"People cared" maybe plays a bigger role than you realize here. There were stronger social norms back then about the role of medical care in society. Most hospitals were community or religious owned, physicians were content with merely above average professional salaries, and you never saw any kind of advertisement that ended with "ask your doctor about X". I think it's naive to assume the 16.5%-of-GDP octopus we've created wouldn't figure out a way to profit from the removal of all regulations.
- HarryHirsch 9y ago
  You also wonder how much consolidation has had to do with the erosion of social norms. An owner of a community practice might feel constrained in a different way than an employee at a healthcare company.

saint_fiasco 9y ago

Add a regulation that says every hospital must publish anonimized aggregated patient outcomes. Remove as many other regulations as it would take for them to be willing to compromise and accept this one.

conanbatt 9y ago
Good reason to shy away care for bad patients if it affects your stats. Surgeons do this today to maintain a high success rate.
- saint_fiasco 9y ago
  Either make that count as a forfeit or hire specialized diagnosticians who make the prognosis and rate the surgeons on how well they do relative to the prognosis.