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> The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. Why does that imply that the

> The entire sector is rotten, easily demonstrated by providers not publishing a uniform list of prices for every single customer. Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food, for example. It's a valid negotiating strategy; it means that offering a low price to one consumer doesn't mean that they have to offer it to another. I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). In the UK, the NHS is funded from taxes. I don't get a choice whether I pay that or not. Mandatory insurance (or an equivalent) for all is a common factor in well-run healthcare systems worldwide. Without it, it's a bit like allowing car drivers to not purchase insurance until after they've crashed.

chimeracoder 8y ago
> I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). You've got it completely backwards - the providers and payers are dramatically less connected in the US compared to the NHS in the UK. In general, the US is moving towards more captitated models, but if anything, this is bringing their incentive structure closer in line to what providers in the NHS already experience.
- bovine3dom 8y ago
  Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Care provider was probably a poor choice of words. Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone.
  - chimeracoder 8y ago
    > Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Yes, and this is exactly what I'm talking about. > Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone. NICE is many things, but they're certainly not "nice". And where that shows the most is in treatments for complex conditions (especially cancer). But beyond that: providers under the NHS have dramatic leeway in determining appropriate steps for care (that's inherent to the practice of medicine itself), and they are both explicitly and implicitly expected to consider costs as a factor in that decision-making.
mindslight 8y ago
> Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food Supermarkets do publish the amount they charge people for food. In fact, they often push it to you every week whether you want it or not! It seems like you're trying to flip around the analogy and apply it to insurance companies rather than medical providers. But my point is that in a functioning market, we would expect there to be cash customers for many services - people who have the means to accept a higher variance for a higher expected value and thus forgo some level of insurance. The lack of uniform transparent pricing discourages this, pushing such customers into buying "insurance" to avoid being ripped off in an uncompetitive consumer market. And yes, opaque pricing is certainly a "negotiating technique" - right out of Oracle's playbook. This is not a justification though!
- bovine3dom 8y ago
  Sorry, I was talking about insurance companies. I forgot that you can actually pay cash in America for medical services. It's a totally alien idea to me. Insurance in America is supposed to be buyers of medical services clubbing together to get a better deal, similarly to people unionising for better conditions. Allowing people with no negotiating power to purchase services is a bit nuts, but I'd hope the high prices would put most people off. It's like letting people by food on trains. Of course it's overpriced, you're a captive market (sometimes literally in a hospital).
  - mindslight 8y ago
    From a USian perspective I think it's worthwhile to think in terms of the "base case" of individuals paying cash - from the perspective of the median person, our "health insurance" system is primarily a way of getting upfront pricing. I don't focus on the market dynamics to argue against a single payer system (it does seem to tackle the problem better than we've currently got), but to point out the utter hypocrisy of labeling the current regime as anything remotely market-based. As I said above, I'm personally open to a fusion of the two different philosophies when they're sensible together - not the worst of both as we tend to get in the US. To go with the train analogy - it's like knowing snacks are $8/ea on the train, so you're encouraged to buy a $20 pass for "all you can eat". Then you get hungry and find out that the pass just means you can wait in line for an hour to get one small snack at a time. The pass wasn't actually a solution to the high prices, and making buying the pass mandatory certainly isn't going to help the overall situation. Barring an honest train operator, the only thing that will keep prices down is actual competition - in this analogy the people who plan ahead and pack their own snacks obtained from an outside vendor.

chimeracoder 8y ago

> I suspect that the care-providers and care-purchasers are too close, and that collusion is a source of the extra cost that Americans experience. (They also have far reduced waiting times, which is a genuine expense). You've got it completely backwards - the providers and payers are dramatically less connected in the US compared to the NHS in the UK. In general, the US is moving towards more captitated models, but if anything, this is bringing their incentive structure closer in line to what providers in the NHS already experience.

bovine3dom 8y ago
Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Care provider was probably a poor choice of words. Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone.
- chimeracoder 8y ago
  > Sorry, I meant the somewhat cosy relationship between the drug companies, the insurers and the doctors. Yes, and this is exactly what I'm talking about. > Maybe it's because of the newspapers' portrayal of NICE as a death panel here, but I find it hard to believe that they're cosy with anyone. NICE is many things, but they're certainly not "nice". And where that shows the most is in treatments for complex conditions (especially cancer). But beyond that: providers under the NHS have dramatic leeway in determining appropriate steps for care (that's inherent to the practice of medicine itself), and they are both explicitly and implicitly expected to consider costs as a factor in that decision-making.

mindslight 8y ago

> Why does that imply that the sector is rotten? Supermarkets don't publish the amount they pay for food Supermarkets do publish the amount they charge people for food. In fact, they often push it to you every week whether you want it or not! It seems like you're trying to flip around the analogy and apply it to insurance companies rather than medical providers. But my point is that in a functioning market, we would expect there to be cash customers for many services - people who have the means to accept a higher variance for a higher expected value and thus forgo some level of insurance. The lack of uniform transparent pricing discourages this, pushing such customers into buying "insurance" to avoid being ripped off in an uncompetitive consumer market. And yes, opaque pricing is certainly a "negotiating technique" - right out of Oracle's playbook. This is not a justification though!

bovine3dom 8y ago
Sorry, I was talking about insurance companies. I forgot that you can actually pay cash in America for medical services. It's a totally alien idea to me. Insurance in America is supposed to be buyers of medical services clubbing together to get a better deal, similarly to people unionising for better conditions. Allowing people with no negotiating power to purchase services is a bit nuts, but I'd hope the high prices would put most people off. It's like letting people by food on trains. Of course it's overpriced, you're a captive market (sometimes literally in a hospital).
- mindslight 8y ago
  From a USian perspective I think it's worthwhile to think in terms of the "base case" of individuals paying cash - from the perspective of the median person, our "health insurance" system is primarily a way of getting upfront pricing. I don't focus on the market dynamics to argue against a single payer system (it does seem to tackle the problem better than we've currently got), but to point out the utter hypocrisy of labeling the current regime as anything remotely market-based. As I said above, I'm personally open to a fusion of the two different philosophies when they're sensible together - not the worst of both as we tend to get in the US. To go with the train analogy - it's like knowing snacks are $8/ea on the train, so you're encouraged to buy a $20 pass for "all you can eat". Then you get hungry and find out that the pass just means you can wait in line for an hour to get one small snack at a time. The pass wasn't actually a solution to the high prices, and making buying the pass mandatory certainly isn't going to help the overall situation. Barring an honest train operator, the only thing that will keep prices down is actual competition - in this analogy the people who plan ahead and pack their own snacks obtained from an outside vendor.