7 ms·

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult"

I most am most likely going to need an ACL surgery in a couple of months so we will see how it goes. So far I found out that pretty much every "X is difficult" is a gospel peddled by lazy. This is my first relatively major incident so I'm running pretty blind -- I'm approaching it as I approach needing to do something in business. Instead of going to the ER ($2,500), I went to a walk in medical center ($120), got seen by an emergency medicine doc. I got a $120 (ER) brace for free in that clinic -- it is probably one of 100 in NYC, open 7 days a week from 8 am to midnight -- i did not go to their other one which is 24x7 Instead of spending $800 on X-ray at the ER, I spent $40 and got results on a CD within 10 minutes at the same walk in clinic. My MRI was not $2800 but $600 because instead of doing it in a hospital I did it at the radiology center. Both the doc at the walk in clinic and the surgeons said "You can do it in the hospital but it would cost a lot more and take a lot longer. Go to Lenox Hill Radiology -- they have about fifty locations in the city and you would be able to get it done today oh and your results will be emailed to us". My two visits to orthopedic surgeons ( there were two different doctors working at the same office ) specializing in sports medicine ( fixing athletes ) cost me $260 ( first visit ) and $120 ( follow up ) -- same two surgeons looked at me and the second visit included a second set of X-rays ( not extra cost ). My one on one PT specializing in sports rehab is costing me $100/h rather than unknown amount. I have a hunch simply because I let my fingers do the Googling my ACL surgery wont cost me $50k even though I won't be leaving NYC to do it. What is that magic thing that I did? Googled "Sports medicine surgeons" and sent emails to the email addresses. I also googled "Physical therapy near me" and emailed all of them, getting the prices and asking if they had any experience with rehabbing athletes -- I read reviews of the ones that did not respond after -- none of them had good reviews. The ones that did respond had very decent prices, used tech and were on the ball oh and they had stellar reviews. But I guess that is hard. Edit: Cute. Bring on the downvotes. That's the crux of the problem. Personal responsibility is "hard" so no wonder those who tend to outsource it get fleeced. When HN re-enables my posting ability I will respond to the individual questions/positions.

8ytecoder 8y ago
What's the incentive for me to save all that money when my insurance pays for it anyway and my company pays for my insurance? Insurance is supposed to do this job - negotiate prices ...etc., but, people are so attached to their doctors that insurance usually caves giving hospitals a much higher bargaining power.
- notyourday 8y ago
  High Deductible Plan. Takes care of big ass expenses, steep cost in the beginning.
  - ams6110 8y ago
    It's a start, but imperfect because most people with a high deductible plan will also have a health savings account (HSA). The HSA may even be required, not sure. The problem with HSAs is that although it's "your" money, it can only be spent on qualified health expenses. So there's a reduced incentive to spend carefully, because you can't use the money for anything else.
    - leetcrew 8y ago
      if you end up with "too much" money in your HSA, can't you just reduce the amount of money that goes into it? obviously you can't just go buy a car with the money, but to me it seems like there is a strong incentive not to overspend from your HSA if you control how much of your paycheck goes into it.
      - ams6110 8y ago
        Yes but I always contribute the max to get the most tax reduction. I like paying taxes less than I like paying doctors.
        leetcrew 8y ago
        have you already maxed out your company 401k and IRA contributions?
    - bzbarsky 8y ago
      > it can only be spent on qualified health expenses Once you reach retirement age it can be used like any Traditional IRA account, except for inability to roll it over to another IRA or do a Roth conversion, if I understand correctly.
arcticbull 8y ago
This sounds a lot like the Bitcoin Be Your Own Bank™ approach to healthcare. Being your own bank sucks. Being your own hospital is even worse. Socialized medicine can't come soon enough.
bena 8y ago
How did you know it was an ACL injury? Did you injure yourself and went to a medical center and they told you to go to a radiology center who then told you you had an ACL injury? I ask because at the end, you said you searched for "sports medicine surgeons" which already looks like you have _some_ knowledge about what was going on. Which is great. But part of the problem we have is education. Most people don't even know of other options available to them and don't have the vocabulary to effectively search for what they want. "Torn ACL" is way more specific than "Knee hurts".
- notyourday 8y ago
  > How did you know it was an ACL injury? Crash on a Super-G, followed by a quick prelim diagnostics of knee stability. Diagnosed as a possible tear of MCL or ACL and possible fractures. > Did you injure yourself and went to a medical center and they told you to go to a radiology center who then told you you had an ACL injury? You might find it interesting: all such diagnostics is actually done only using an X-rays and MRIs. Physical evaluation is just used to decide what to X-ray and what to MRI. > Which is great. But part of the problem we have is education. Most people don't even know of other options available to them and don't have the vocabulary to effectively search for what they want. Probably, but this is a vastly different problem from "Something unknown costs too much"
redisman 8y ago
The average case where people go to the ER they don't have a week to Google and research their options. More likely minutes to hours. You can definitely find some value in the US medical system if you have the time, like coupons for prescription drugs that aren't covered. But yes, don't go to the ER for non-emergencies and you'll save money and everyones resources. Hopefully that's basic logic to most people.
- notyourday 8y ago
  It took me three hours ( and I waited patiently for more responses ) before receiving the information and picking what seemed like an reasonable course of action. I obviously googled before to prepare myself of having my HSA wiped out. The horror stories told me it would be.[0] In fact when the walk in center referred me to an ortho and said "It will be expensive. Here's a list of good ones" I asked if it was going to be "$800 dollar expensive?" at which point I was looked at by both the front-desk person and the Emergency medicine doctor as if I had grew two heads in front of them. They said "About 250 to see a specialist and about $800 for an MRI." One of the two surgeons that I have selected based on their responses who could see me the next day were on the list of good ones ( ~30 ) that I was provided by the walk in center. No referral code was needed. The surgeon offices, the walk in center and the physical therapists were having near orgasmic reactions hearing that it was going to be paid as a part of high deductible plan because it means that it is paid from a regular Mastercard as if I was a cash patient, immediately, the same day. [0] I have taken friends to ER. They were never seen faster than 3-4 hours.
superhuzza 8y ago
What happens when someone has an emergency like a stroke or heart attack? Not a lot of time to email all the local hospitals. What happens when the patient is unconscious? What happens if their condition can only be treated by a certain facility or medication? But yes, surely people are only getting screwed over the healthcare system because they are lazy. /s
- notyourday 8y ago
  That's the only time when one cannot get quotes. Depending on a location ( ave/st in NYC and a time of day ) the ambulance would take one to a specific emergency room in a specific hospital chain. But again, that's not where most of medical services "waste" is occurring.
  - dredmorbius 8y ago
    Most medical expense is care of chronic conditions and end-of-life care. Not elective procedures. https://www.qualityhealth.com/health-lifestyle-articles/10-most-expensive-medical-conditions https://www.qualityhealth.com/health-lifestyle-articles/10-m...
    - notyourday 8y ago
      So if it is chronic there's even more reason to ensure that one does not overpay for what one would be consuming all the time?
      - dredmorbius 8y ago
        It's both the duration and increasing severity that account for much of the cost, along with the systematic cost-inflating aspects of the US healthcare system. Individual actions play little role.
        notyourday 8y ago
        That's just hand waving. If the duration increases it makes absolutely no sense not to attempt to get the cheapest way to manage the condition. People do it all the time if they are on a hook for payments -- that's why we have drugs being grey important from Canada, Europe and India, especially if those drugs are not covered by the US insurance. Suddenly saving $200/mo per type of a pill becomes important. As soon as it is covered by insurance it becomes "Whatever, insurance pays"
deleted 8y ago
[deleted]
Frondo 8y ago
I had my gallbladder removed in a emergency surgery over a decade ago. It happened on a Wednesday night. I had excruciating pain, enough to nearly black out -- and a friend took me to an emergency room, where they did an ekg, ultrasound, put me on a morphine drip and operated the next day. Once the pain set in, I was in no position to do research for a variety of reasons. I'm not sure what kind of shopping around could have taken place for that. Could you explain how your technique would work for something like my situation?
- Scoundreller 8y ago
  Isn’t the solution an advanced care directive? Where you make decisions in advance of something happening, just in case you end up in a situation where you can’t decide yourself? E.g. no extraordinary measures or no CPR, or, get me into one of these nursing homes and not this one. Even in public health care countries, there’s plenty of decisions that are a good idea to make in advance. I don’t see why they can’t be scaled toward cash healthcare countries.
  - benmaraschino 8y ago
    Comparison shopping arguably isn’t the intended purpose of advance care directives—which, FYI, can only go into force if the person is legally incapitated, and being in pain, however extreme, is a grey area as I’m sure you could make the case that decision-making capacity still exists. There’s also the issue of having the agent available when such an event happens, and having them be in possession of the directive. Anyway, even then, it’s infeasible to enumerate all the possible decisions in advance—not only is it impossible to know what your costs will be ahead of time, there’s a lot of variation in cost. There isn’t going to be a single hospital in your region that’ll have the cheapest prices across the board, so it’s not as simple as “send me to the cheapest hospital”.
- notyourday 8y ago
  It will not work for emergencies however that's not where most of the money is burned. Most of the money is spent on non emergency medical care that can be priced using a phone or an email. That's exactly why medical tourism is possible. It is a case of vertical capture: should you walk into a Mount Sinai hospital, the $600 MRI of Lennox Hill will cost you between $1800 and $2800. It will be done using the exact same MRI machine. The result will be sent to India probably to the exact same company that Lennox Hill sends the MRI for a radio tech readout, except that Mount Sinai MRI won't be available for 5-7 days vs. in an hour at Lennox Hill. So why is Mount Sinai is able to charge that amount of money for an MRI? Because it is a vertical capture. Should you walk into a Mount Sinai it is extremely unlikely that you would go out of the hospital to get an MRI. They could probably charge $7,000 and still get 90% of the patients doing it.
anigbrowl 8y ago
That's very interesting information, but I could have done without your snide allegations of laziness towards everyone not in your fortunate position - being both educated and confident enough to research and negotiate pricing, and having a relatively non-urgent problem. The last time I was in the ER I woke up there with no clue as to how I had arrived.
- notyourday 8y ago
  Most of the problems in the health care are non-urgent. Most of people at the ER are not there "waking up and not knowing why they are in the ER". They walk into ER with something not working for them. That's exactly why it takes 3-4 hours to be seen by the ER doctor. People like you, who wake up in the ER, are rarities. Those people are either brought to the ER in ambulances or are triaged and seen immediately. It is for those cases one could justify the costs of an ambulance ride and 500% markup of an bandage.
  - anigbrowl 8y ago
    I do not agree that most visitors to the ER do so for non-urgent reasons, although few complaints are so severe. I don't think you've fully grasped the point people are trying to communicate to you here.
    - notyourday 8y ago
      I believe I understood it quite well. It just does not match either my experience or what I read. There are lot of articles on the topic. Here's a random one: https://www.wmpllc.org/ojs-2.4.2/index.php/ajdm/article/view/815 https://www.wmpllc.org/ojs-2.4.2/index.php/ajdm/article/view... Green triage means that there were no reason for the patient to be in the ER. With the over-triage, green is still over 70%. So lets presume that between red and yellows it is actually 30% and none of them are triaged up ( based on the article that I linked it seems triaged up red is high single digit which is in the same ballpark that my friends who are in emergency medicine rotation say ). Those would be the only cases where one cannot pick a non-crazy expensive service ( in fact only reds cannot, and yellow probably can which is why their service is delayed ). So at least 70% pay 7-10x because they showed up in ER rather than in a walk in center/doctors office.
geofft 8y ago
> Personal responsibility is "hard" so no wonder those who tend to outsource it get fleeced. What is the effect on the market when everyone engages in "personal responsibility"? If everyone finds out about Lenox Hill Radiology and goes there instead of to hospitals for MRI, won't the effect be that demand goes up without supply obviously going up, causing increased prices and wait times? What will be the effect on hospitals that were subsidizing their other business by pricing their MRIs higher? The reason people don't like "personal responsibility" as a general-case solution is not that it's hard, but that it's not a general-case solution. This article is talking about an actual general-case solution.
- DuskStar 8y ago
  Or the effect could be that Lenox Hill Radiology discovers it's getting a ton of MRI patients, has utilization above 85%, and can now afford to get another machine. A group doing a thing well getting more business is typically not a bad thing. Yes, if it's a loss leader then bad things can happen - but that doesn't seem to be the case here. "Personal Responsibility" is just "making the market actually be a market". Markets are great - but situations where the person paying isn't the person choosing or receiving the benefit tend to be horrible in some dimension.
- notyourday 8y ago
  > What is the effect on the market when everyone engages in "personal responsibility"? If everyone finds out about Lenox Hill Radiology and goes there instead of to hospitals for MRI, won't the effect be that demand goes up without supply obviously going up, causing increased prices and wait times? The current situation for the same MRI is: Mount Sinai - cost $2800, wait to schedule 5 days, wait for read out 5 more days. Lennox Hill - cost $600, wait to schedule ~1.5 hours, wait for read out, next business day. Distance between two locations: opposite side of an avenue and half a block. Realized savings by crossing a road: $2,200. Where else is it possible for two identical products to be offered in that close proximity at that kind of a price difference and have people defend the pricing of the more expensive one while complaining that the services that include this product cost too much? But here's what I think should happen: Lennox Hill would slowly increase its prices and Mount Sinai would drop its prices until it would not be possible to save $2,200 by crossing an Ave and walking for five minutes. Of course if we are to look around this is not current more likely outcome - rather Mount Sinai would buy Lennox Hill Radiology which is an independent radiology center, make it a part of the Mount Sinai hospital chain and increase Lennox Hill' price to whatever level that it currently charges ( hospital chains have been buying up independent centers hurting their cash cows for years ). Unfortunately for hospital chains radiology centers now are a proven way to make money so new ones are popping up more and more. > What will be the effect on hospitals that were subsidizing their other business by pricing their MRIs higher? I have never heard of this argument being used by any of the hospital chains to justify high prices for the services that can be done out of hospital and it is definitely the kind of argument that should get traction had it been possible for any hospital to bend some numbers to make it remotely plausible so I would say it is unlikely to be the case.
digitaltrees 8y ago
Were these amounts after insurance? just your share out of pocket? Or actual total?
- notyourday 8y ago
  These were the actual costs that I have to pay out of pocket until I reach the deductible of my insurance ( yearly ). I was at zero since it is a new year. In my case it is coming out of my HSA. Basically, cash price.
  - digitaltrees 8y ago
    That means you don’t actually know the real cost since insurance shields you from the actual amount and it can be drastically different for each insurance company. You’re just estimating with a false sense of information.
    - notyourday 8y ago
      I actually do because I get to provide the receipts in order for them to be deducted from my "still due" pile. Pricing of this stuff is easy. One just needs to get off the couch to do that, or at least do as much as one does when looking for super duper 75" TV.

8ytecoder 8y ago

What's the incentive for me to save all that money when my insurance pays for it anyway and my company pays for my insurance? Insurance is supposed to do this job - negotiate prices ...etc., but, people are so attached to their doctors that insurance usually caves giving hospitals a much higher bargaining power.

notyourday 8y ago
High Deductible Plan. Takes care of big ass expenses, steep cost in the beginning.
- ams6110 8y ago
  It's a start, but imperfect because most people with a high deductible plan will also have a health savings account (HSA). The HSA may even be required, not sure. The problem with HSAs is that although it's "your" money, it can only be spent on qualified health expenses. So there's a reduced incentive to spend carefully, because you can't use the money for anything else.
  - leetcrew 8y ago
    if you end up with "too much" money in your HSA, can't you just reduce the amount of money that goes into it? obviously you can't just go buy a car with the money, but to me it seems like there is a strong incentive not to overspend from your HSA if you control how much of your paycheck goes into it.
    - ams6110 8y ago
      Yes but I always contribute the max to get the most tax reduction. I like paying taxes less than I like paying doctors.
      - leetcrew 8y ago
        have you already maxed out your company 401k and IRA contributions?
  - bzbarsky 8y ago
    > it can only be spent on qualified health expenses Once you reach retirement age it can be used like any Traditional IRA account, except for inability to roll it over to another IRA or do a Roth conversion, if I understand correctly.

arcticbull 8y ago

This sounds a lot like the Bitcoin Be Your Own Bank™ approach to healthcare. Being your own bank sucks. Being your own hospital is even worse. Socialized medicine can't come soon enough.

bena 8y ago

How did you know it was an ACL injury? Did you injure yourself and went to a medical center and they told you to go to a radiology center who then told you you had an ACL injury? I ask because at the end, you said you searched for "sports medicine surgeons" which already looks like you have _some_ knowledge about what was going on. Which is great. But part of the problem we have is education. Most people don't even know of other options available to them and don't have the vocabulary to effectively search for what they want. "Torn ACL" is way more specific than "Knee hurts".

notyourday 8y ago
> How did you know it was an ACL injury? Crash on a Super-G, followed by a quick prelim diagnostics of knee stability. Diagnosed as a possible tear of MCL or ACL and possible fractures. > Did you injure yourself and went to a medical center and they told you to go to a radiology center who then told you you had an ACL injury? You might find it interesting: all such diagnostics is actually done only using an X-rays and MRIs. Physical evaluation is just used to decide what to X-ray and what to MRI. > Which is great. But part of the problem we have is education. Most people don't even know of other options available to them and don't have the vocabulary to effectively search for what they want. Probably, but this is a vastly different problem from "Something unknown costs too much"

redisman 8y ago

The average case where people go to the ER they don't have a week to Google and research their options. More likely minutes to hours. You can definitely find some value in the US medical system if you have the time, like coupons for prescription drugs that aren't covered. But yes, don't go to the ER for non-emergencies and you'll save money and everyones resources. Hopefully that's basic logic to most people.

notyourday 8y ago
It took me three hours ( and I waited patiently for more responses ) before receiving the information and picking what seemed like an reasonable course of action. I obviously googled before to prepare myself of having my HSA wiped out. The horror stories told me it would be.[0] In fact when the walk in center referred me to an ortho and said "It will be expensive. Here's a list of good ones" I asked if it was going to be "$800 dollar expensive?" at which point I was looked at by both the front-desk person and the Emergency medicine doctor as if I had grew two heads in front of them. They said "About 250 to see a specialist and about $800 for an MRI." One of the two surgeons that I have selected based on their responses who could see me the next day were on the list of good ones ( ~30 ) that I was provided by the walk in center. No referral code was needed. The surgeon offices, the walk in center and the physical therapists were having near orgasmic reactions hearing that it was going to be paid as a part of high deductible plan because it means that it is paid from a regular Mastercard as if I was a cash patient, immediately, the same day. [0] I have taken friends to ER. They were never seen faster than 3-4 hours.

superhuzza 8y ago

What happens when someone has an emergency like a stroke or heart attack? Not a lot of time to email all the local hospitals. What happens when the patient is unconscious? What happens if their condition can only be treated by a certain facility or medication? But yes, surely people are only getting screwed over the healthcare system because they are lazy. /s

notyourday 8y ago
That's the only time when one cannot get quotes. Depending on a location ( ave/st in NYC and a time of day ) the ambulance would take one to a specific emergency room in a specific hospital chain. But again, that's not where most of medical services "waste" is occurring.
- dredmorbius 8y ago
  Most medical expense is care of chronic conditions and end-of-life care. Not elective procedures. https://www.qualityhealth.com/health-lifestyle-articles/10-most-expensive-medical-conditions https://www.qualityhealth.com/health-lifestyle-articles/10-m...
  - notyourday 8y ago
    So if it is chronic there's even more reason to ensure that one does not overpay for what one would be consuming all the time?
    - dredmorbius 8y ago
      It's both the duration and increasing severity that account for much of the cost, along with the systematic cost-inflating aspects of the US healthcare system. Individual actions play little role.
      - notyourday 8y ago
        That's just hand waving. If the duration increases it makes absolutely no sense not to attempt to get the cheapest way to manage the condition. People do it all the time if they are on a hook for payments -- that's why we have drugs being grey important from Canada, Europe and India, especially if those drugs are not covered by the US insurance. Suddenly saving $200/mo per type of a pill becomes important. As soon as it is covered by insurance it becomes "Whatever, insurance pays"

deleted 8y ago

[deleted]

Frondo 8y ago

I had my gallbladder removed in a emergency surgery over a decade ago. It happened on a Wednesday night. I had excruciating pain, enough to nearly black out -- and a friend took me to an emergency room, where they did an ekg, ultrasound, put me on a morphine drip and operated the next day. Once the pain set in, I was in no position to do research for a variety of reasons. I'm not sure what kind of shopping around could have taken place for that. Could you explain how your technique would work for something like my situation?

Scoundreller 8y ago
Isn’t the solution an advanced care directive? Where you make decisions in advance of something happening, just in case you end up in a situation where you can’t decide yourself? E.g. no extraordinary measures or no CPR, or, get me into one of these nursing homes and not this one. Even in public health care countries, there’s plenty of decisions that are a good idea to make in advance. I don’t see why they can’t be scaled toward cash healthcare countries.
- benmaraschino 8y ago
  Comparison shopping arguably isn’t the intended purpose of advance care directives—which, FYI, can only go into force if the person is legally incapitated, and being in pain, however extreme, is a grey area as I’m sure you could make the case that decision-making capacity still exists. There’s also the issue of having the agent available when such an event happens, and having them be in possession of the directive. Anyway, even then, it’s infeasible to enumerate all the possible decisions in advance—not only is it impossible to know what your costs will be ahead of time, there’s a lot of variation in cost. There isn’t going to be a single hospital in your region that’ll have the cheapest prices across the board, so it’s not as simple as “send me to the cheapest hospital”.
notyourday 8y ago
It will not work for emergencies however that's not where most of the money is burned. Most of the money is spent on non emergency medical care that can be priced using a phone or an email. That's exactly why medical tourism is possible. It is a case of vertical capture: should you walk into a Mount Sinai hospital, the $600 MRI of Lennox Hill will cost you between $1800 and $2800. It will be done using the exact same MRI machine. The result will be sent to India probably to the exact same company that Lennox Hill sends the MRI for a radio tech readout, except that Mount Sinai MRI won't be available for 5-7 days vs. in an hour at Lennox Hill. So why is Mount Sinai is able to charge that amount of money for an MRI? Because it is a vertical capture. Should you walk into a Mount Sinai it is extremely unlikely that you would go out of the hospital to get an MRI. They could probably charge $7,000 and still get 90% of the patients doing it.

anigbrowl 8y ago

That's very interesting information, but I could have done without your snide allegations of laziness towards everyone not in your fortunate position - being both educated and confident enough to research and negotiate pricing, and having a relatively non-urgent problem. The last time I was in the ER I woke up there with no clue as to how I had arrived.

notyourday 8y ago
Most of the problems in the health care are non-urgent. Most of people at the ER are not there "waking up and not knowing why they are in the ER". They walk into ER with something not working for them. That's exactly why it takes 3-4 hours to be seen by the ER doctor. People like you, who wake up in the ER, are rarities. Those people are either brought to the ER in ambulances or are triaged and seen immediately. It is for those cases one could justify the costs of an ambulance ride and 500% markup of an bandage.
- anigbrowl 8y ago
  I do not agree that most visitors to the ER do so for non-urgent reasons, although few complaints are so severe. I don't think you've fully grasped the point people are trying to communicate to you here.
  - notyourday 8y ago
    I believe I understood it quite well. It just does not match either my experience or what I read. There are lot of articles on the topic. Here's a random one: https://www.wmpllc.org/ojs-2.4.2/index.php/ajdm/article/view/815 https://www.wmpllc.org/ojs-2.4.2/index.php/ajdm/article/view... Green triage means that there were no reason for the patient to be in the ER. With the over-triage, green is still over 70%. So lets presume that between red and yellows it is actually 30% and none of them are triaged up ( based on the article that I linked it seems triaged up red is high single digit which is in the same ballpark that my friends who are in emergency medicine rotation say ). Those would be the only cases where one cannot pick a non-crazy expensive service ( in fact only reds cannot, and yellow probably can which is why their service is delayed ). So at least 70% pay 7-10x because they showed up in ER rather than in a walk in center/doctors office.

geofft 8y ago

> Personal responsibility is "hard" so no wonder those who tend to outsource it get fleeced. What is the effect on the market when everyone engages in "personal responsibility"? If everyone finds out about Lenox Hill Radiology and goes there instead of to hospitals for MRI, won't the effect be that demand goes up without supply obviously going up, causing increased prices and wait times? What will be the effect on hospitals that were subsidizing their other business by pricing their MRIs higher? The reason people don't like "personal responsibility" as a general-case solution is not that it's hard, but that it's not a general-case solution. This article is talking about an actual general-case solution.

DuskStar 8y ago
Or the effect could be that Lenox Hill Radiology discovers it's getting a ton of MRI patients, has utilization above 85%, and can now afford to get another machine. A group doing a thing well getting more business is typically not a bad thing. Yes, if it's a loss leader then bad things can happen - but that doesn't seem to be the case here. "Personal Responsibility" is just "making the market actually be a market". Markets are great - but situations where the person paying isn't the person choosing or receiving the benefit tend to be horrible in some dimension.
notyourday 8y ago
> What is the effect on the market when everyone engages in "personal responsibility"? If everyone finds out about Lenox Hill Radiology and goes there instead of to hospitals for MRI, won't the effect be that demand goes up without supply obviously going up, causing increased prices and wait times? The current situation for the same MRI is: Mount Sinai - cost $2800, wait to schedule 5 days, wait for read out 5 more days. Lennox Hill - cost $600, wait to schedule ~1.5 hours, wait for read out, next business day. Distance between two locations: opposite side of an avenue and half a block. Realized savings by crossing a road: $2,200. Where else is it possible for two identical products to be offered in that close proximity at that kind of a price difference and have people defend the pricing of the more expensive one while complaining that the services that include this product cost too much? But here's what I think should happen: Lennox Hill would slowly increase its prices and Mount Sinai would drop its prices until it would not be possible to save $2,200 by crossing an Ave and walking for five minutes. Of course if we are to look around this is not current more likely outcome - rather Mount Sinai would buy Lennox Hill Radiology which is an independent radiology center, make it a part of the Mount Sinai hospital chain and increase Lennox Hill' price to whatever level that it currently charges ( hospital chains have been buying up independent centers hurting their cash cows for years ). Unfortunately for hospital chains radiology centers now are a proven way to make money so new ones are popping up more and more. > What will be the effect on hospitals that were subsidizing their other business by pricing their MRIs higher? I have never heard of this argument being used by any of the hospital chains to justify high prices for the services that can be done out of hospital and it is definitely the kind of argument that should get traction had it been possible for any hospital to bend some numbers to make it remotely plausible so I would say it is unlikely to be the case.

digitaltrees 8y ago

Were these amounts after insurance? just your share out of pocket? Or actual total?

notyourday 8y ago
These were the actual costs that I have to pay out of pocket until I reach the deductible of my insurance ( yearly ). I was at zero since it is a new year. In my case it is coming out of my HSA. Basically, cash price.
- digitaltrees 8y ago
  That means you don’t actually know the real cost since insurance shields you from the actual amount and it can be drastically different for each insurance company. You’re just estimating with a false sense of information.
  - notyourday 8y ago
    I actually do because I get to provide the receipts in order for them to be deducted from my "still due" pile. Pricing of this stuff is easy. One just needs to get off the couch to do that, or at least do as much as one does when looking for super duper 75" TV.