4 ms·

Health insurance will cover much of it, but more importantly Northern California is overpriced for medical procedures. Boston is $5,000 less and has equally goo

Health insurance will cover much of it, but more importantly Northern California is overpriced for medical procedures. Boston is $5,000 less and has equally good hospitals. And St. Louis is down at $6,000 and has really good hospitals as well. I had a friend who got an appendectomy at Stanford that was paid for by Google (she was on business travel, works in the London office) and the price was obscene, far above what should ever be charged, literally 10x what other hospitals charge. That place is crazy.

lotsofpulp 8y ago
It’s not overpriced if there is no monopoly. No one is stopping other providers from moving to Northern California and stealing business by offering lower prices. If people want to live in a place with great weather, outdoors, food, and career opportunities, then they have to compete for it because lots of other people do too, and hence they have to compete to purchase things like homes and service from healthcare providers.
- mikeash 8y ago
  Nothing is stopping them, other than people not shopping medical procedures based on price, partly due to a complete lack of price transparency. Maybe you could move in and set up a maternity ward and advertise it as “only $10,000!” And then people will ask what the competition charges and you won’t be able to answer. They won’t be able to answer.
  - lotsofpulp 8y ago
    I would hope it’s common knowledge nowadays, at least amongst the educated, that you should call your insurance or check their website for in network providers. I can call mine and find out how much certain procedures or codes cost, and if it’s not an exact amount, they can usually give a pretty good estimate. Also, I would expect any service to cost 50% more in the Bay Area.
    - mikeash 8y ago
      Hospital stays are a whole different thing from more routine procedures. A lot of the costs are directly billed by the doctor and bypass the hospital, and hospitals don’t know what their own costs will be. If you have insurance that covers this, it’s simple. You don’t even need to call anyone. You’ll pay your deductible. If you want to compete on price, you’ll either need to charge substantially less than people’s dedictibles in order to make a noticeable difference, aim your price competition at insurance companies (who pay vastly lower prices already), or target the not-exactly-lucrative uninsured population.
    - VLM 8y ago
      You'd do all that complicated paperwork while semi-unconscious with pain before an emergency appendectomy?
      - lotsofpulp 8y ago
        I was referring to planned procedures such as giving birth.
        Balgair 8y ago
        Human childbirth is an amazingly complicated process with a LOT that can, and frequently does go 'wrong'. In CA, the first-birth c-section rates range from 15% to 60%, hospital depending [0]. That's 1/6th to 3/5ths of all CA first births, let alone the obvious fact that you cannot plan a birthday. Your pregnancy can go from 'low' risk to 'life-threatening' in seconds; there is no planning for this and no hospital will tell you the bills for it. [0] http://www.chhs.ca.gov/Press%20Releases/Smart_Care_California_Recognizes_111_Hospitals_For_Reducing_C-Sections.pdf http://www.chhs.ca.gov/Press%20Releases/Smart_Care_Californi...
        lotsofpulp 8y ago
        I know all of those things can happen, but for people with health insurance, the out of pocket max will kick in at that point. But if you are healthy and want to get a lower bound on how much you'll need to pay you can request that information.
- noonespecial 8y ago
  You are quite wrong about that. https://en.m.wikipedia.org/wiki/Certificate_of_need https://en.m.wikipedia.org/wiki/Certificate_of_need
  - lotsofpulp 8y ago
    Wow! Did not know about that. So many barriers to free market...
  - jstanley 8y ago
    > A number of factors spurred states to require CONs in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an over-saturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily. That is an incredible misunderstanding of supply-and-demand. Just, wow.

lotsofpulp 8y ago

It’s not overpriced if there is no monopoly. No one is stopping other providers from moving to Northern California and stealing business by offering lower prices. If people want to live in a place with great weather, outdoors, food, and career opportunities, then they have to compete for it because lots of other people do too, and hence they have to compete to purchase things like homes and service from healthcare providers.

mikeash 8y ago
Nothing is stopping them, other than people not shopping medical procedures based on price, partly due to a complete lack of price transparency. Maybe you could move in and set up a maternity ward and advertise it as “only $10,000!” And then people will ask what the competition charges and you won’t be able to answer. They won’t be able to answer.
- lotsofpulp 8y ago
  I would hope it’s common knowledge nowadays, at least amongst the educated, that you should call your insurance or check their website for in network providers. I can call mine and find out how much certain procedures or codes cost, and if it’s not an exact amount, they can usually give a pretty good estimate. Also, I would expect any service to cost 50% more in the Bay Area.
  - mikeash 8y ago
    Hospital stays are a whole different thing from more routine procedures. A lot of the costs are directly billed by the doctor and bypass the hospital, and hospitals don’t know what their own costs will be. If you have insurance that covers this, it’s simple. You don’t even need to call anyone. You’ll pay your deductible. If you want to compete on price, you’ll either need to charge substantially less than people’s dedictibles in order to make a noticeable difference, aim your price competition at insurance companies (who pay vastly lower prices already), or target the not-exactly-lucrative uninsured population.
  - VLM 8y ago
    You'd do all that complicated paperwork while semi-unconscious with pain before an emergency appendectomy?
    - lotsofpulp 8y ago
      I was referring to planned procedures such as giving birth.
      - Balgair 8y ago
        Human childbirth is an amazingly complicated process with a LOT that can, and frequently does go 'wrong'. In CA, the first-birth c-section rates range from 15% to 60%, hospital depending [0]. That's 1/6th to 3/5ths of all CA first births, let alone the obvious fact that you cannot plan a birthday. Your pregnancy can go from 'low' risk to 'life-threatening' in seconds; there is no planning for this and no hospital will tell you the bills for it. [0] http://www.chhs.ca.gov/Press%20Releases/Smart_Care_California_Recognizes_111_Hospitals_For_Reducing_C-Sections.pdf http://www.chhs.ca.gov/Press%20Releases/Smart_Care_Californi...
        lotsofpulp 8y ago
        I know all of those things can happen, but for people with health insurance, the out of pocket max will kick in at that point. But if you are healthy and want to get a lower bound on how much you'll need to pay you can request that information.
noonespecial 8y ago
You are quite wrong about that. https://en.m.wikipedia.org/wiki/Certificate_of_need https://en.m.wikipedia.org/wiki/Certificate_of_need
- lotsofpulp 8y ago
  Wow! Did not know about that. So many barriers to free market...
- jstanley 8y ago
  > A number of factors spurred states to require CONs in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an over-saturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily. That is an incredible misunderstanding of supply-and-demand. Just, wow.