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Here in Canada, there is no price transparency whatsoever. Just when people are facing the stress and uncertainty of fighting a crisis like Cancer, they are giv
by braythwayt 7y ago
Here in Canada, there is no price transparency whatsoever. Just when people are facing the stress and uncertainty of fighting a crisis like Cancer, they are given absolutely no inkling what their treatment will cost.
When a physician makes an appointment for you with a plastic surgeon to discuss reconstructive surgery... No transparency about the cost.
When they prescribe chemotherapy... No transparency about what the doses cost.*
When they schedule surgery... You don't have any idea if they'll pull in another nurse or surgeon during the procedure, and again... No transparency about cost.
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I feel icky making jokes about this. But seriously, price transparency is a perfect example of the "XY Problem."
America asks, "How do we make paying for health care an efficient and transparent marketplace," but the correct answer is, "If what you want is a functioning, civilized country, stop trying to make healthcare a marketplace."
https://en.wikipedia.org/wiki/XY_problem https://en.wikipedia.org/wiki/XY_problem
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* Prescription drugs are still a quagmire in Canada. Basic chemotherapy is somewhat covered by various provincial drug plans, but if you're employed you usually rely on your employment benefits for prescription drugs much as Americans do.
Many of the things covered by employment plans are more convenient than those covered by the public plans. For example, the public plan may require a dose a day, while the product that only requires a dose a week is only covered by an employment plan.
But the bottom line is that if you aren't employed and can't afford chemotherapy, you will get treated.
- bcrosby95 7y agoThere are shades of bad. The US health care system with price transparency is better than the US health care system without it. The same procedure can cost 1,000x more if you go across town. It's been long reported that Hospitals mostly pull prices out of their asses. The health care problem in the US is not just a health insurance problem, it is also a health care provider problem. Even if you had a single payer system, pricing like this is insane.
- braythwayt 7y agoWhat you say is true, but does not negate or discount what I said in any way. Again, with the XY problem... If someone asks for X, but really needs Y and there is a better way to get Y than to help them with X... Of course X is better than no X and no Y. But that doesn't change the fact that Y is much, much better than X. And in the case of health care, it is not even close. Price transparency may lead to each person paying a little less, or at least being less stressed, but it still won't fix the fact that America has the most expensive system, with the worst outcomes, in the developed world. So yeah, X is better than --X, and ++X even better than X, but that doesn't change the fact that Y is still the correct solution when you focus on the problem you really want to solve rather than making the incorrect solution slightly less incorrect. --- Also, IANAE, but I do not believe that in Canada, hospitals are permitted to have a 1000x variance in pricing. I think that for those things we socialize, the government sets the price.
- carapace 7y agoI think you're right (profit motive and health care don't mix) but then how do you cut the Gordian Knot? I'm cautiously hopeful that price transparency might be a start.
- mrguyorama 7y agoHonestly? Stop electing people who scream that public health is a communist devil plot?
- carapace 7y agoI'll see what I can do.
- AtlasBarfed 7y agoLike the education system, the health care system's retail price is basically ludicrous. This is to extract maximum situational revenue, basically get as much from the patient as they can afford. Colleges charge 100k, but will adapt spending (as little as possible) to get students to be able to pay. They even preferentially let in richer students. It's the ideal way for a business to make money if they can charge based on how much each individual can pay (and bankruptcy is someone-else's-problem in both healthcare and tuition)
- wavepruner 7y agoThere are lots of sick people who want to know how much their treatment options cost. Not just Americans, but Canadians as well (I know some). When you have a poorly understood illness that is killing you you have two choices: pay out of pocket or die. It doesn't matter if your country has universal health care or not because treatments will not be covered until they go through a lengthy (decades) approval process. If your illness is controversial then it will be even longer. It doesn't harm anyone to publish real healthcare prices. Please do not fight something that will harm no one. This will benefit some of the most neglected people in society.
- braythwayt 7y agoI have empathy for where you're coming from, but to me it feel like the following: Imagine that in America, husbands are allowed to beat their wives, and the government proposes a law that they may not use a stick with a girth bigger than their thumb. Alice says, "This is insane. Husbands are not allowed to beat their wives in Canada, that is the correct solution." And then Bob says, "Well, that's just unrealistic here, so please do not undermine our efforts to make things better for wives by limiting how hard they can be beaten."
- wavepruner 7y agoDid you read my entire post? Universal health care does not solve the problem. Canadians that have my illness have just as much difficulty as I do. I swear you kinds of healthy people do not even read/listen to the words that I and other crippled people say. Your analogy is not even remotely appropriate. And how is open pricing incompatible with universal health care? Is your ideology so important to you that you will fight such an innocuous change?
- TurkishPoptart 7y agoI just wanted to say that your original post made plenty sense, and that I agree. And I found parent's wife-beating analogy quite confusing and unrelated.
- undersuit 7y agoI brought it up and got a wonderful discussion in a previous HN about this topic, https://news.ycombinator.com/item?id=20275097 https://news.ycombinator.com/item?id=20275097, that my experience with this will be: "All transparency will do is put a number in front of my single choice." Months later I'm convinced this is just a talking point to avoid talking about reforming US healthcare.
- coredog64 7y agoSo in your opinion, neither France nor Switzerland are “functioning, civilized countries”? Price discovery works for a certain kind of care (e.g. non-emergency outpatient care), and we shouldn’t discard it without any consideration.
- braythwayt 7y agoI am not familiar with France, but the first line in Wikipedia is: "The French health care system is one of universal health care largely financed by government national health insurance." https://en.wikipedia.org/wiki/Health_care_in_France https://en.wikipedia.org/wiki/Health_care_in_France Then when I look into Switzerland, I see: "Healthcare in Switzerland is universal and is regulated by the Swiss Federal Law on Health Insurance. There are no free state-provided health services, but private health insurance is compulsory for all persons residing in Switzerland" I also read: "Swiss are required to purchase basic health insurance, which covers a range of treatments detailed in the Swiss Federal Law on Health Insurance. It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans." "The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium." https://en.wikipedia.org/wiki/Healthcare_in_Switzerland https://en.wikipedia.org/wiki/Healthcare_in_Switzerland --- Now let's not quibble. The core question her is, "Should basic healthcare be a marketplace?" If basic healthcare is a marketplace, providers can charge what they like, and it's "caveat emptor" when it comes to purchasing healthcare, whether it's directly purchasing treatment, or purchasing insurance. Here in Canada there are lots of non-basic kinds of healthcare that are a marketplace. How much does it cost to get a cortisone shot so that I can cycle? I don't know until I shop around. Same for physiotherapy, chiropractic care (is that heath care or phrenology?), dental care, orthodontics, and lots of things involving mental health. But basic health care--for some definition of "basic"--is not a marketplace, and it is not optional whether you are covered.
- coredog64 7y ago
- _--___-___ 7y agoI've got some $3,000 saline to sell you or whoever it is that's willing to pay on your behalf.
- guyzero 7y agoIf a nurse comes into your hospital room with a bag of saline you're going to check the price tag and argue with him about whether it's the right brand?
- braythwayt 7y agoHere in Ontario, prices for basic health care are regulated. So the hospital doesn't get to charge $3,000 for that bag unless this is a procedure not covered by basic health care, or if the government has already approved that pricing, and it is the same in every hospital. On the other hand, the private room you're in is not covered by basic health care, so if they feel like charging you $3,000 a night just for the room, or $1,000 for television, or $500 for WiFi, that's allowed.