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> Ultimately, I'm going to trust my doctor and insurance company. You're already benefiting from the brand-trust type of system. You trust your insurance comp

> Ultimately, I'm going to trust my doctor and insurance company. You're already benefiting from the brand-trust type of system. You trust your insurance company (currently because the market is regulated, but if the market wasn't as regulated, you'd probably be choosier about who you shop with). Your insurance company pays the most for in-network doctors. Doctors probably need malpractice insurance and not be complete frauds to be in an insurance network. I think the airline industry is a good example in the US. I could often save money by going with a smaller carrier, but I choose to spend a little more to go with the bigger carriers, primarily because I know if there are any problems, they're more likely to have extra flights to get me where I'm going. Another good example is HVAC companies. You can pay someone working out of a truck to install a new A/C system for slightly less than the name-brand (factory authorized dealer) in your area. You're probably going to get what you pay for. Companies want to stand by their name. This is a once-in-a-while transaction that can cost multiples of 10's of 1000's of dollars (depending on size/complexity of the system, obviously).

dragontamer 7y ago
In my case: the Tomed MAD cost me $1000. The actual device is worth 150 EUR from Germany (where Tomed is located). The US-distributer sells it for $500. Somehow, the markup got all the way up to $1000 by the time it got to me. Clearly, something, somewhere, has gone wrong in the system. This is a 150 EUR mouthguard that is being sold to me for $1000. As in, what I've literally paid for. Why?
- wait_a_minute 7y ago
  You've been making great arguments. I appreciate them. However, why not order the device from Germany yourself? Are there stringent regulations in place that prevent customers from purchasing across state or even country lines?
  - dragontamer 7y ago
    First, there's no reason for me to buy the device. I already own one (the one my doctor gave me), and I have no need for a 2nd (yet). So... why did I buy it from my doctor at first? Well, because the doctor said I needed one. I setup an appointment with the nurse, who then gave me the device. A week later, I got a bill for $1000. Shocked at the price of the device, I ended up doing research. $500 is the cheapest I could find it in the USA, and if I include doctor fees + nurse fees, it is "reasonable" that they would mark it up a few hundred dollars above that. In any case, I already "bought" the device before I realized. So I don't think I really have any choice aside from paying the bill. I'll try to buy it straight from Germany in the future. But I didn't even know the name of the device until after I got it from the nurse. I'm kinda new to this whole doctor / taking care of my health thing. But I'm just sharing my experience with everyone, so maybe other people can learn from my mistakes. My general presumption was that my insurance company would be improving the cost-efficacy of the overall system. Apparently not however. Now, its just a $1000, and now I'm over my yearly deductible, so I've basically got free health-care for the rest of the year because of this. (So I don't consider this a big financial mistake, even if it cost $1000. Its more proof that the insurance company is slacking in its job of efficiently pricing these medical devices I'm using...)
    - linuxftw 7y ago
      Yeah, there's a multitude of issues with the health insurance-scam system in the US. It's easy to get swindled in the health care industry. Brand-trust relationship dynamics don't say much about how things should be priced, but it does imply well-known and trusted brands will likely command a premium.
- AnthonyMouse 7y ago
  > Clearly, something, somewhere, has gone wrong in the system. This is a 150 EUR mouthguard that is being sold to me for $1000. As in, what I've literally paid for. Why? There are multiple factors, but a motivator is that US regulators are under pressure from both sides to adopt rules that make healthcare consumers less price sensitive. On the one hand, the supplier is quite happy to be collecting $1000 rather than $150. On the other hand, people don't like paying $1000, so they go to the government and ask them to do something about it. The government could then push for more price transparency and make sure that existing regulations aren't impairing competition and driving up prices, but that's exactly the opposite of what the people making $1000 instead of $150 want. The alternative is to get somebody else to pay for it in enough cases that the remaining cases (i.e. yours) don't have enough political power to actually fix it. So they cause the money to come from insurance premiums or taxpayers in most cases, whose costs are in turn laundered through employer-provided health insurance or general tax revenues. But the seller can't charge $150 retail and still get $1000 from insurance, so they set high prices and anyone without [sufficient] insurance coverage is relegated to either overpaying or using whatever kind of need-based assistance if any that the seller provides, or figuring out a way to order from overseas. This type of regulatory corruption is obviously not a cost efficient way to provide healthcare. And it's much the same reason branding and private certifications are ineffective. If regulators get rid of most of the charlatans then consumers become willing to trust that anything approved by regulators is safe. Then when it isn't (as with the MAX8), there is a single point of failure, both because people are then less wary of things that are potentially dangerous, and because independent private infrastructure to verify quality atrophies when government embeds their own safety standards into law, even if they do a mediocre job of it.
  - linuxftw 7y ago
    > ...independent private infrastructure to verify quality atrophies when government embeds their own safety standards into law, even if they do a mediocre job of it. Pretty much the story for every aspect of government.

dragontamer 7y ago

In my case: the Tomed MAD cost me $1000. The actual device is worth 150 EUR from Germany (where Tomed is located). The US-distributer sells it for $500. Somehow, the markup got all the way up to $1000 by the time it got to me. Clearly, something, somewhere, has gone wrong in the system. This is a 150 EUR mouthguard that is being sold to me for $1000. As in, what I've literally paid for. Why?

wait_a_minute 7y ago
You've been making great arguments. I appreciate them. However, why not order the device from Germany yourself? Are there stringent regulations in place that prevent customers from purchasing across state or even country lines?
- dragontamer 7y ago
  First, there's no reason for me to buy the device. I already own one (the one my doctor gave me), and I have no need for a 2nd (yet). So... why did I buy it from my doctor at first? Well, because the doctor said I needed one. I setup an appointment with the nurse, who then gave me the device. A week later, I got a bill for $1000. Shocked at the price of the device, I ended up doing research. $500 is the cheapest I could find it in the USA, and if I include doctor fees + nurse fees, it is "reasonable" that they would mark it up a few hundred dollars above that. In any case, I already "bought" the device before I realized. So I don't think I really have any choice aside from paying the bill. I'll try to buy it straight from Germany in the future. But I didn't even know the name of the device until after I got it from the nurse. I'm kinda new to this whole doctor / taking care of my health thing. But I'm just sharing my experience with everyone, so maybe other people can learn from my mistakes. My general presumption was that my insurance company would be improving the cost-efficacy of the overall system. Apparently not however. Now, its just a $1000, and now I'm over my yearly deductible, so I've basically got free health-care for the rest of the year because of this. (So I don't consider this a big financial mistake, even if it cost $1000. Its more proof that the insurance company is slacking in its job of efficiently pricing these medical devices I'm using...)
  - linuxftw 7y ago
    Yeah, there's a multitude of issues with the health insurance-scam system in the US. It's easy to get swindled in the health care industry. Brand-trust relationship dynamics don't say much about how things should be priced, but it does imply well-known and trusted brands will likely command a premium.
AnthonyMouse 7y ago
> Clearly, something, somewhere, has gone wrong in the system. This is a 150 EUR mouthguard that is being sold to me for $1000. As in, what I've literally paid for. Why? There are multiple factors, but a motivator is that US regulators are under pressure from both sides to adopt rules that make healthcare consumers less price sensitive. On the one hand, the supplier is quite happy to be collecting $1000 rather than $150. On the other hand, people don't like paying $1000, so they go to the government and ask them to do something about it. The government could then push for more price transparency and make sure that existing regulations aren't impairing competition and driving up prices, but that's exactly the opposite of what the people making $1000 instead of $150 want. The alternative is to get somebody else to pay for it in enough cases that the remaining cases (i.e. yours) don't have enough political power to actually fix it. So they cause the money to come from insurance premiums or taxpayers in most cases, whose costs are in turn laundered through employer-provided health insurance or general tax revenues. But the seller can't charge $150 retail and still get $1000 from insurance, so they set high prices and anyone without [sufficient] insurance coverage is relegated to either overpaying or using whatever kind of need-based assistance if any that the seller provides, or figuring out a way to order from overseas. This type of regulatory corruption is obviously not a cost efficient way to provide healthcare. And it's much the same reason branding and private certifications are ineffective. If regulators get rid of most of the charlatans then consumers become willing to trust that anything approved by regulators is safe. Then when it isn't (as with the MAX8), there is a single point of failure, both because people are then less wary of things that are potentially dangerous, and because independent private infrastructure to verify quality atrophies when government embeds their own safety standards into law, even if they do a mediocre job of it.
- linuxftw 7y ago
  > ...independent private infrastructure to verify quality atrophies when government embeds their own safety standards into law, even if they do a mediocre job of it. Pretty much the story for every aspect of government.