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> Where as other high income/developed countries, citizens don't have to shop around because everyone is insured by the State and pays the same prices. Exactly

> Where as other high income/developed countries, citizens don't have to shop around because everyone is insured by the State and pays the same prices. Exactly. Everyone praising this is doing so because they think it's great that this will allow Americans to "shop around" when it comes to healthcare, but they seem to be missing the fact that even the very concept of "shopping around" for healthcare is absurd. If you're having a heart attack, or just have a broken bone, or even if you just have a stomach ache, the last thing that you are going to want to have to spend time doing is "shopping around" before getting your problems fixed. Being able to shop around isn't something that should be praised, it's something that should be relentlessly mocked and is evidence of a failing healthcare system.

ams6110 9y ago
Completely disagree. Providers are not all the same. Some doctors are so incompetent they should not be allowed to practice, some are excellent. People should have full information on their providers, including costs, to be able to make informed choices.
- txcwpalpha 9y ago
  >Some doctors are so incompetent they should not be allowed to practice Which is yet more evidence of a failing healthcare system, and is certainly not reason to praise the concept of having to "shop around" just to get adequate and reasonably priced care.
  - bluGill 9y ago
    You seem to be using the wrong (though obvious) definition of what it means to be incompetent. A doctor who is incompetent because of poor treatment is handled by the system. However there are other incompetents that someone who is medically competent can not the less fall into. The doctor with poor human interaction skills makes the patient feel horribly before, during and after treatment. The doctor who takes "bribes" to prescribe a more expensive treatment when a cheaper alternative would work as well. Those are just a couple examples of how someone can be incompetent yet still not raise to the level of not being allowed to practice.
    - txcwpalpha 9y ago
      I'm not using the wrong definition. A doctor who is considered "incompetent" because they take "bribes" should certainly be terminated by the system. If they aren't, it is a failing system.
      - bluGill 9y ago
        I put bribes in quotes for a reason. Outright bribes are handled by the system. However I'm implying any way to get around the rules without getting caught. Some are legal loopholes, some are illegal. The only point is by some way you got around the rules without getting caught.
        txcwpalpha 9y ago
        That doesn't change my answer. If you have a system in which doctors carry out shady tactics and are able to "get around the rules without getting caught", and that system is so rife with such issues that you have to actively "shop around" to avoid them, then the system is failing.
- darkerside 9y ago
  This makes sense in theory, but the healthcare market isn't a great example of a free market. One example, especially for emergency care, you don't have many repeat customers (I realize there are exceptions). Word of mouth doesn't travel very far, even if people had time to examine reviews on Yelp. People aren't educated enough to understand if they received quality care or not anyway, beyond bike shedding (ie. bedside manner). If you receive poor care, you don't typically have options when it comes to getting a refund.
  - repsilat 9y ago
    Emergency room costs are less than 10% of the total in the US. A popular, credible figure is 2%. In any case it's less than 100%. And even if it were 100%, wouldn't transparency provide substantial, concrete benefits? Really, I'm not sure how "some customers won't shop around" works as an argument against public knowledge of price and quality.
    - darkerside 8y ago
      Not an argument against, just an observation that it's unlikely to be part of a realistic solution to the problems we face in healthcare. Interesting point about emergency care costs. Do you have a source you could share?
      - repsilat 8y ago
        Late reply, sorry, and an old third-hand source: http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ http://www.politifact.com/truth-o-meter/statements/2013/oct/... I figure "it can't hurt, there is a significant market failure, and price transparency can only help." I'd like to hear someone knowledgeable provide a counterargument, though. Maybe it would be expensive or impossible to enumerate those costs. Maybe preferential ("discriminatory") pricing is really important to the smooth functioning of the system.
        darkerside 8y ago
refurb 9y ago
very concept of "shopping around" for healthcare is absurd No it's not. A very large percentage of medical care is planned, not urgent. There is no reason why price comparison can't happen for those. A great example of a highly functional healthcare market is vision correction laser surgery. Every time I look around some deal is being offered. Competition is what drove those prices down. Can you do that with everything? Of course not. But you can do it with a lot of planned medical care.
- andrewla 9y ago
  And it's not purely a race to the bottom; as expected price levels are achieved, it also becomes possible to read signals in the price, so that medical practitioners who are willing to do extra work (reduce wait times, better followup, home visits, etc.) can charge more to compensate for that, rather than just doing the minimum amount of work necessary in order to get the fixed payment.
- omegaworks 9y ago
  >No it's not. A very large percentage of medical care is planned, not urgent. And for those procedures, a hybrid system should suffice. All Americans, should, at minimum, be able to get urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Of course, nothing is black and white. Issues that could have been treated in a planned way become urgent if they're left to fester. Obamacare started shifting the incentives to make preventative measures more palatable, and healthcare cost growth has come down as a result. ACA is a /conservative/ set of policies. Even still, it elicits extreme reactions from loud people on the fringes.
  - bobwaycott 9y ago
    I’d suggest a slight addition: > All Americans should, at minimum, be able to get routine and urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Elective procedures are obviously a thorny issue people will debate over where to draw the lines. But standard checkups, routine wellness procedures, and covering the unexpected ought to be the bare minimum—the healthcare floor of social decency beneath which we do not allow any member of society to fall without recognizing we are failing as a society.
vidarh 9y ago
It's absurd, but as long as it's politically untenable to go all the way to something reasonable, things like this which will presumably be a lot easier to defend is still better than nothing - a huge proportion of medical needs are not emergency care, after all.
eldavido 9y ago
This analysis ignores the secondary effects of the mere ability to shop around. Right now, for many insurance plans, consumers of care are 100% price insensitive. If even, say, 5% of a market starts to take their business elsewhere out of concern for price, it starts to put more cost discipline onto the system, which encourages competition. You can't suggest a huge change and then assume the world will stay the same post-change. It won't. What the health system needs is some incentive to control cost; today, it has very few.
Consultant32452 9y ago
Emergency care for things like a heart attack or broken bone only account for 2% of healthcare spending. So your primary case for why "shopping around" is bad is mostly irrelevant. Nothing is stopping you from creating a not-for-profit healthcare co-op, getting participants to voluntarily turn over their healthcare decisions to you, and then demanding reduced prices from vendors. All I ask is that you don't force me to join it against my will. http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ http://www.politifact.com/truth-o-meter/statements/2013/oct/...
- txcwpalpha 9y ago
  I never said anything about emergency care being my "primary case". My comment even specifically lists 2 instances of non-emergency care. Needing to shop around is an absurd concept for any medical care.
  - Consultant32452 9y ago
    Please don't force me against my will to live by the whims of what you personally consider absurd in your own life. You are free to abdicate responsibility and choice to a third party all you like.
    - txcwpalpha 9y ago
      Your choice to live by an absurdly low standard of care is what forces the rest of us to suffer from a low standard of care as well (against our will). Your request to "don't force me against my will" is hypocritical.
      - Consultant32452 9y ago
        Please don't force me against my will to be limited to what you personally consider to be an acceptable standard of care. How I choose to live or die is none of your business.

ams6110 9y ago

Completely disagree. Providers are not all the same. Some doctors are so incompetent they should not be allowed to practice, some are excellent. People should have full information on their providers, including costs, to be able to make informed choices.

txcwpalpha 9y ago
>Some doctors are so incompetent they should not be allowed to practice Which is yet more evidence of a failing healthcare system, and is certainly not reason to praise the concept of having to "shop around" just to get adequate and reasonably priced care.
- bluGill 9y ago
  You seem to be using the wrong (though obvious) definition of what it means to be incompetent. A doctor who is incompetent because of poor treatment is handled by the system. However there are other incompetents that someone who is medically competent can not the less fall into. The doctor with poor human interaction skills makes the patient feel horribly before, during and after treatment. The doctor who takes "bribes" to prescribe a more expensive treatment when a cheaper alternative would work as well. Those are just a couple examples of how someone can be incompetent yet still not raise to the level of not being allowed to practice.
  - txcwpalpha 9y ago
    I'm not using the wrong definition. A doctor who is considered "incompetent" because they take "bribes" should certainly be terminated by the system. If they aren't, it is a failing system.
    - bluGill 9y ago
      I put bribes in quotes for a reason. Outright bribes are handled by the system. However I'm implying any way to get around the rules without getting caught. Some are legal loopholes, some are illegal. The only point is by some way you got around the rules without getting caught.
      - txcwpalpha 9y ago
        That doesn't change my answer. If you have a system in which doctors carry out shady tactics and are able to "get around the rules without getting caught", and that system is so rife with such issues that you have to actively "shop around" to avoid them, then the system is failing.
darkerside 9y ago
This makes sense in theory, but the healthcare market isn't a great example of a free market. One example, especially for emergency care, you don't have many repeat customers (I realize there are exceptions). Word of mouth doesn't travel very far, even if people had time to examine reviews on Yelp. People aren't educated enough to understand if they received quality care or not anyway, beyond bike shedding (ie. bedside manner). If you receive poor care, you don't typically have options when it comes to getting a refund.
- repsilat 9y ago
  Emergency room costs are less than 10% of the total in the US. A popular, credible figure is 2%. In any case it's less than 100%. And even if it were 100%, wouldn't transparency provide substantial, concrete benefits? Really, I'm not sure how "some customers won't shop around" works as an argument against public knowledge of price and quality.
  - darkerside 8y ago
    Not an argument against, just an observation that it's unlikely to be part of a realistic solution to the problems we face in healthcare. Interesting point about emergency care costs. Do you have a source you could share?
    - repsilat 8y ago
      Late reply, sorry, and an old third-hand source: http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ http://www.politifact.com/truth-o-meter/statements/2013/oct/... I figure "it can't hurt, there is a significant market failure, and price transparency can only help." I'd like to hear someone knowledgeable provide a counterargument, though. Maybe it would be expensive or impossible to enumerate those costs. Maybe preferential ("discriminatory") pricing is really important to the smooth functioning of the system.
      - darkerside 8y ago

refurb 9y ago

very concept of "shopping around" for healthcare is absurd No it's not. A very large percentage of medical care is planned, not urgent. There is no reason why price comparison can't happen for those. A great example of a highly functional healthcare market is vision correction laser surgery. Every time I look around some deal is being offered. Competition is what drove those prices down. Can you do that with everything? Of course not. But you can do it with a lot of planned medical care.

andrewla 9y ago
And it's not purely a race to the bottom; as expected price levels are achieved, it also becomes possible to read signals in the price, so that medical practitioners who are willing to do extra work (reduce wait times, better followup, home visits, etc.) can charge more to compensate for that, rather than just doing the minimum amount of work necessary in order to get the fixed payment.
omegaworks 9y ago
>No it's not. A very large percentage of medical care is planned, not urgent. And for those procedures, a hybrid system should suffice. All Americans, should, at minimum, be able to get urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Of course, nothing is black and white. Issues that could have been treated in a planned way become urgent if they're left to fester. Obamacare started shifting the incentives to make preventative measures more palatable, and healthcare cost growth has come down as a result. ACA is a /conservative/ set of policies. Even still, it elicits extreme reactions from loud people on the fringes.
- bobwaycott 9y ago
  I’d suggest a slight addition: > All Americans should, at minimum, be able to get routine and urgent, surprise medical issues addressed in a way that doesn't completely destroy them financially. Elective procedures are obviously a thorny issue people will debate over where to draw the lines. But standard checkups, routine wellness procedures, and covering the unexpected ought to be the bare minimum—the healthcare floor of social decency beneath which we do not allow any member of society to fall without recognizing we are failing as a society.

vidarh 9y ago

It's absurd, but as long as it's politically untenable to go all the way to something reasonable, things like this which will presumably be a lot easier to defend is still better than nothing - a huge proportion of medical needs are not emergency care, after all.

eldavido 9y ago

This analysis ignores the secondary effects of the mere ability to shop around. Right now, for many insurance plans, consumers of care are 100% price insensitive. If even, say, 5% of a market starts to take their business elsewhere out of concern for price, it starts to put more cost discipline onto the system, which encourages competition. You can't suggest a huge change and then assume the world will stay the same post-change. It won't. What the health system needs is some incentive to control cost; today, it has very few.

Consultant32452 9y ago

Emergency care for things like a heart attack or broken bone only account for 2% of healthcare spending. So your primary case for why "shopping around" is bad is mostly irrelevant. Nothing is stopping you from creating a not-for-profit healthcare co-op, getting participants to voluntarily turn over their healthcare decisions to you, and then demanding reduced prices from vendors. All I ask is that you don't force me to join it against my will. http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ http://www.politifact.com/truth-o-meter/statements/2013/oct/...

txcwpalpha 9y ago
I never said anything about emergency care being my "primary case". My comment even specifically lists 2 instances of non-emergency care. Needing to shop around is an absurd concept for any medical care.
- Consultant32452 9y ago
  Please don't force me against my will to live by the whims of what you personally consider absurd in your own life. You are free to abdicate responsibility and choice to a third party all you like.
  - txcwpalpha 9y ago
    Your choice to live by an absurdly low standard of care is what forces the rest of us to suffer from a low standard of care as well (against our will). Your request to "don't force me against my will" is hypocritical.
    - Consultant32452 9y ago
      Please don't force me against my will to be limited to what you personally consider to be an acceptable standard of care. How I choose to live or die is none of your business.