4 ms·

Well, it doesn't have to cost that much to take care of a heart attack. Remove the AMA from the equation and it'll clear up. The real problem is that we restric

Well, it doesn't have to cost that much to take care of a heart attack. Remove the AMA from the equation and it'll clear up. The real problem is that we restrict the supply of doctors. Without that, competing hospitals can arise that will compete on price.

maxxxxx 8y ago
Why don't they compete now or why can't you even get a price upfront from them? EDIT: I am responding to a comment that the AMA is the problem. Maybe the AMA is a problem but it has nothing to do with hospitals not competing over prices.
- whb07 8y ago
  Because price negotiations aren’t disclosed and are privy between hospitals and insurance provusers. The real crux is that point, the patient is removed from pricing and so the whole market becomes distorted. It’s like going to a store without price tags and complaining that your bill is much higher than you expected.
  - maxxxxx 8y ago
    "t’s like going to a store without price tags and complaining that your bill is much higher than you expected." It's more like only having stores without price tags and then when you overpay people telling you that you should have shopped around for a good price.
- jjeaff 8y ago
  You can get a price upfront in my experience. Especially for standard procedures. And definitely for outpatient stuff. But it isn't reasonable to expect upfront pricing in things as complicated as heart surgery. Or where you are going in for unknown problems. There is no way to know what complications may arise or additional procedures, x-rays or scans may be required.
  - maxxxxx 8y ago
    When I had an HSA I called doctors to get estimates and only rarely got one. The only exception is dentists. They have pretty good price lists.
  - fatalogic 8y ago
    As someone who used to work in the medical field it can be a pain to even know how much insurances will reimburse for procedures. Especially when it comes to smaller / union insurance providers, health care providers have to call and wait for a fax or snail mail for a reimbursement table. This leads to balance billing or the provider just eating the cost. On the consumer side I just found out about healthcare blue book and they have prices for just about any procedure.
  - eric_the_read 8y ago
    I was having trouble sleeping for a while; at one point my doctor recommending I go on oxygen for a while until she could figure it out. I called the company that provided the oxygen, and asked how much it would cost. Nobody knew. I called back 3 times, and still nobody could tell me. I called my insurance company; they couldn't tell me either. I ended up electing not to use it (which turned out to be perfectly fine), but it does seem like this was a fairly standard procedure, for outpatient stuff, and nobody involved knew what the prices were.
    - maxxxxx 8y ago
      That matches my experience. Or you get quoted $100 and charged $3000 which after some back and forth turns into $50.
- scarejunba 8y ago
  The doctors are the scarce factor. They determine the price.
xyzzyz 8y ago
I'm not sure if our patient here was quite in a mood for price shopping, with the whole ongoing heart attack thing.
- scarejunba 8y ago
  When there's enough competition, all hospitals will be cheap. He won't price shop at illness time. He'll know which hospitals close by he can afford. There'll be three or four equivalently accessible ones and he'll already know which one he's going to go to. Surgery outcomes in Indian top cardiology hospitals are better than in America. And they're cheaper. And more available. And perform more surgeries per week. Competition is good.
  - s73v3r_ 8y ago
    Competition isn't likely everywhere, though. Rural areas, for instance, probably could not support more than one hospital.
byebyetech 8y ago
Supply of doctors is definitely an important issue. But prices are high not because they can't find doctors. It is high because they have no real competition. When someone is suffering from a heart attack what options do they have than to go to the nearest hospital? Even in non-emergency situations people chose to go to the healthcare provider nearest to them. Also even if we assume people magically able to chose any healthcare provider in the country by teleporting themselves. On what basis they are going to make decision? Prices of healthcare services are opaque and almost secret until they surprise you with 6 figure bill. That is why i laugh at republicans (Ben Shapiro et al) argument that healthcare competition is what making it the "best" in the world. Don't compare it with restaurant business.
- scarejunba 8y ago
  If this were true, then nations with deregulated health care would also have high prices. Instead they have low prices and better outcomes. Patients shop on reputation. In a country with less regulation, like India, you see competing hospitals across the spectrum of price and performance. Everyone knows which ones are good and which ones are expensive. People know which hospitals they're going to attend before they fall sick. The outcomes in their top cardiology departments are way better than those in top American cardiology departments. Their doctors perform way more surgeries and are therefore far more practiced and experienced. They are far cheaper because there are so many more of them.
  - pushtheenvelope 8y ago
    the Indian example you cite is correct, but only works well for the middle and upper classes who can afford to pay for the care (for now, see below). For the majority of lower-middle and poor class, medical care is hard to obtain because they cannot afford the private care, and the government-run hospitals that offer low-cost care suffer from bad service, and inadequate facilities/medicine. India is well on its way to emulating the American medical system: (1) medical costs have been rising at a rate of 15-25% a year (where inflation has been 5-10%). This is okay for now, but in about 2 decades will price out even the affluent classes. (2) Health insurance is being touted by the Indian government as a solution to this -- which is the first step to going down towards the American model of healthcare. India also has poor safeguards against crony capitalism so I expect large insurance companies to capture the regulatory framework to frame rules in their benefit.

maxxxxx 8y ago

Why don't they compete now or why can't you even get a price upfront from them? EDIT: I am responding to a comment that the AMA is the problem. Maybe the AMA is a problem but it has nothing to do with hospitals not competing over prices.

whb07 8y ago
Because price negotiations aren’t disclosed and are privy between hospitals and insurance provusers. The real crux is that point, the patient is removed from pricing and so the whole market becomes distorted. It’s like going to a store without price tags and complaining that your bill is much higher than you expected.
- maxxxxx 8y ago
  "t’s like going to a store without price tags and complaining that your bill is much higher than you expected." It's more like only having stores without price tags and then when you overpay people telling you that you should have shopped around for a good price.
jjeaff 8y ago
You can get a price upfront in my experience. Especially for standard procedures. And definitely for outpatient stuff. But it isn't reasonable to expect upfront pricing in things as complicated as heart surgery. Or where you are going in for unknown problems. There is no way to know what complications may arise or additional procedures, x-rays or scans may be required.
- maxxxxx 8y ago
  When I had an HSA I called doctors to get estimates and only rarely got one. The only exception is dentists. They have pretty good price lists.
- fatalogic 8y ago
  As someone who used to work in the medical field it can be a pain to even know how much insurances will reimburse for procedures. Especially when it comes to smaller / union insurance providers, health care providers have to call and wait for a fax or snail mail for a reimbursement table. This leads to balance billing or the provider just eating the cost. On the consumer side I just found out about healthcare blue book and they have prices for just about any procedure.
- eric_the_read 8y ago
  I was having trouble sleeping for a while; at one point my doctor recommending I go on oxygen for a while until she could figure it out. I called the company that provided the oxygen, and asked how much it would cost. Nobody knew. I called back 3 times, and still nobody could tell me. I called my insurance company; they couldn't tell me either. I ended up electing not to use it (which turned out to be perfectly fine), but it does seem like this was a fairly standard procedure, for outpatient stuff, and nobody involved knew what the prices were.
  - maxxxxx 8y ago
    That matches my experience. Or you get quoted $100 and charged $3000 which after some back and forth turns into $50.
scarejunba 8y ago
The doctors are the scarce factor. They determine the price.

xyzzyz 8y ago

I'm not sure if our patient here was quite in a mood for price shopping, with the whole ongoing heart attack thing.

scarejunba 8y ago
When there's enough competition, all hospitals will be cheap. He won't price shop at illness time. He'll know which hospitals close by he can afford. There'll be three or four equivalently accessible ones and he'll already know which one he's going to go to. Surgery outcomes in Indian top cardiology hospitals are better than in America. And they're cheaper. And more available. And perform more surgeries per week. Competition is good.
- s73v3r_ 8y ago
  Competition isn't likely everywhere, though. Rural areas, for instance, probably could not support more than one hospital.

byebyetech 8y ago

Supply of doctors is definitely an important issue. But prices are high not because they can't find doctors. It is high because they have no real competition. When someone is suffering from a heart attack what options do they have than to go to the nearest hospital? Even in non-emergency situations people chose to go to the healthcare provider nearest to them. Also even if we assume people magically able to chose any healthcare provider in the country by teleporting themselves. On what basis they are going to make decision? Prices of healthcare services are opaque and almost secret until they surprise you with 6 figure bill. That is why i laugh at republicans (Ben Shapiro et al) argument that healthcare competition is what making it the "best" in the world. Don't compare it with restaurant business.

scarejunba 8y ago
If this were true, then nations with deregulated health care would also have high prices. Instead they have low prices and better outcomes. Patients shop on reputation. In a country with less regulation, like India, you see competing hospitals across the spectrum of price and performance. Everyone knows which ones are good and which ones are expensive. People know which hospitals they're going to attend before they fall sick. The outcomes in their top cardiology departments are way better than those in top American cardiology departments. Their doctors perform way more surgeries and are therefore far more practiced and experienced. They are far cheaper because there are so many more of them.
- pushtheenvelope 8y ago
  the Indian example you cite is correct, but only works well for the middle and upper classes who can afford to pay for the care (for now, see below). For the majority of lower-middle and poor class, medical care is hard to obtain because they cannot afford the private care, and the government-run hospitals that offer low-cost care suffer from bad service, and inadequate facilities/medicine. India is well on its way to emulating the American medical system: (1) medical costs have been rising at a rate of 15-25% a year (where inflation has been 5-10%). This is okay for now, but in about 2 decades will price out even the affluent classes. (2) Health insurance is being touted by the Indian government as a solution to this -- which is the first step to going down towards the American model of healthcare. India also has poor safeguards against crony capitalism so I expect large insurance companies to capture the regulatory framework to frame rules in their benefit.