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Of course doctors and hospitals don't want price transparency. That would create pricing competition, which would drive down consumer prices, lower profit margi

by XG6 7y ago

Of course doctors and hospitals don't want price transparency. That would create pricing competition, which would drive down consumer prices, lower profit margins, and force them to become more efficient. Price transparency is one of the key elements of the highly successful Singapore healthcare system. Add in universal tax-free (or tax-deferred) Health Savings Accounts, and we could not only improve the US healthcare system but also help more Americans save for retirement and build wealth. There's no excuse not to try simple regulatory solutions before committing to a massive government takeover. I hope we get bipartisan support for price transparency.

noelsusman 7y ago
In Singapore, the government forces you to deposit a percentage of your income into an HSA, and then they tell you what you can and cannot spend that money on. You're only allowed to use that money to buy government-approved drugs, for example, and it's not like the FDA where they're just testing for effectiveness and safety. Also, most hospitals are owned by the government, most doctors are government employees, and most hospital visits are mostly paid for by the government. Price transparency is a relatively minor part of what makes the Singapore health system work.
- shantly 7y ago
  I'm not aware of a single advanced-economy state (I usually shorthand this "OECD" but Singapore's not a member, AFAIK) that doesn't use price controls, explicitly or de facto (monopsony), in their health care system. Price controls, non-profit status requirement for insurers, and a non-ruinously-expensive "public option" seem to be common factors in the most "free market" (relatively speaking) systems of our peer states. Despite Obamacare we've achieved zero of those, nor have we opted to go further "left" to mimic any other proven-to-control-costs-and-deliver-care system.
commandlinefan 7y ago
> doctors and hospitals don't want price transparency Well, I do want price transparency - IF it works the way they promise. It’s hard for me, as a programmer, not to draw parallels to every employer’s expectation that I should be able to listen to them describe a software problem and quote them a timeframe on the spot (which, of course, they’ll then try to “negotiate” down). On the one hand, as a non-medical-professional outsider looking in, it seems to me that _of course_ they should be able to say ahead of time how much a cataract removal surgery should cost, they’ve done it hundreds of times (I hope). On the other hand, I know how much variability occurs in software projects and how little of that is trivially predictable. On the other other hand, I can’t for the life of me imagine any possible reason why they can’t say EXACTLY how much an MRI will cost before they do it.
- umvi 7y ago
  Yeah but come on. It's one thing to program something with nebulous requirements. The cost of the X-ray machine is known. The cost of collecting X-rays can be calculated deterministically. The only thing similar to programming is trying to diagnose a rare disease or tricky condition. But for run-of-the-mill deterministic procedures, the cost should absolutely be known.
  - commandlinefan 7y ago
    Well, I think so too, but - just to play devil’s advocate - many of my former bosses would almost certainly say something like, “the cost of the web server is known. The cost of collecting the web traffic can be calculated deterministically. We’re just talking about a website here, the cost should absolutely be known.”
    - umvi 7y ago
      Well are you asking me to setup infrastructure or to design you a website? The first is deterministic and I can certainly give you a fixed price/timeframe to set up your web servers/DNS/etc. Designing a website on the other hand, isn't deterministic. That mandates lots of requirements gathering and suffering through iterations where the peanut gallery criticizes every CSS choice and demands minor CSS tweaks until some arbitrary "feel" is achieved.
    - carapace 7y ago
      The prices don't change in a supermarket if you edit your shopping list, eh? A hospital can't predict everything a patient will need (their shopping list), but they should be able to account for the cost of each procedure/drug/test/bandage/etc... eh?
      - Fomite 7y ago
        The problem is a lot of that isn't deterministic. There's a lot of "If Then" statements that aren't easy to price ahead of time. Like, your procedure is very different if your doctor decides they could use a specialist consult.
Shivetya 7y ago
Indiana funds the HSA deductible on their plans and saw a good deal of savings. Combine this with price transparency and health care costs could and should fall and do so rapidly. however the biggest obstacle to health care reform and cost reduction are the federal and state governments. in particular CON (Certificate of Need), thirty plus states still have these which are used to block new hospitals and other care facilities. the ACA banned new Doctor owned hospitals in a further move to protect the big hospitals; the CON law at Federal level was done away with in 87. People need to have skin in the game. This means that prices must be revealed as well as handing control over to patients where how the money is spent. So HSA with paid deductibles can save states a large amount of money and help people make better decisions. with preventative treatments normally being free and people seeing hsa money rolls over and its theirs it really changes how people behave. the US should have great health care but the government is stuck in VA for all mode and that is the charge being led by current candidates. Look at it this way, the VA system has been a wreck for decades and if Congress cannot or will not fix that why should you trust them to take over what we have now?
jseliger 7y ago
Probably, but not certainly: https://marginalrevolution.com/marginalrevolution/2019/06/will-price-transparency-in-health-care-markets-work.html https://marginalrevolution.com/marginalrevolution/2019/06/wi... I favor price transparency (https://seliger.com/2018/11/11/health-insurance-security-fqhcs/ https://seliger.com/2018/11/11/health-insurance-security-fqh...) but the Dutch cement market work does give one pause.

by XG6 7y ago

noelsusman 7y ago

In Singapore, the government forces you to deposit a percentage of your income into an HSA, and then they tell you what you can and cannot spend that money on. You're only allowed to use that money to buy government-approved drugs, for example, and it's not like the FDA where they're just testing for effectiveness and safety. Also, most hospitals are owned by the government, most doctors are government employees, and most hospital visits are mostly paid for by the government. Price transparency is a relatively minor part of what makes the Singapore health system work.

shantly 7y ago
I'm not aware of a single advanced-economy state (I usually shorthand this "OECD" but Singapore's not a member, AFAIK) that doesn't use price controls, explicitly or de facto (monopsony), in their health care system. Price controls, non-profit status requirement for insurers, and a non-ruinously-expensive "public option" seem to be common factors in the most "free market" (relatively speaking) systems of our peer states. Despite Obamacare we've achieved zero of those, nor have we opted to go further "left" to mimic any other proven-to-control-costs-and-deliver-care system.

commandlinefan 7y ago

> doctors and hospitals don't want price transparency Well, I do want price transparency - IF it works the way they promise. It’s hard for me, as a programmer, not to draw parallels to every employer’s expectation that I should be able to listen to them describe a software problem and quote them a timeframe on the spot (which, of course, they’ll then try to “negotiate” down). On the one hand, as a non-medical-professional outsider looking in, it seems to me that _of course_ they should be able to say ahead of time how much a cataract removal surgery should cost, they’ve done it hundreds of times (I hope). On the other hand, I know how much variability occurs in software projects and how little of that is trivially predictable. On the other other hand, I can’t for the life of me imagine any possible reason why they can’t say EXACTLY how much an MRI will cost before they do it.

umvi 7y ago
Yeah but come on. It's one thing to program something with nebulous requirements. The cost of the X-ray machine is known. The cost of collecting X-rays can be calculated deterministically. The only thing similar to programming is trying to diagnose a rare disease or tricky condition. But for run-of-the-mill deterministic procedures, the cost should absolutely be known.
- commandlinefan 7y ago
  Well, I think so too, but - just to play devil’s advocate - many of my former bosses would almost certainly say something like, “the cost of the web server is known. The cost of collecting the web traffic can be calculated deterministically. We’re just talking about a website here, the cost should absolutely be known.”
  - umvi 7y ago
    Well are you asking me to setup infrastructure or to design you a website? The first is deterministic and I can certainly give you a fixed price/timeframe to set up your web servers/DNS/etc. Designing a website on the other hand, isn't deterministic. That mandates lots of requirements gathering and suffering through iterations where the peanut gallery criticizes every CSS choice and demands minor CSS tweaks until some arbitrary "feel" is achieved.
  - carapace 7y ago
    The prices don't change in a supermarket if you edit your shopping list, eh? A hospital can't predict everything a patient will need (their shopping list), but they should be able to account for the cost of each procedure/drug/test/bandage/etc... eh?
    - Fomite 7y ago
      The problem is a lot of that isn't deterministic. There's a lot of "If Then" statements that aren't easy to price ahead of time. Like, your procedure is very different if your doctor decides they could use a specialist consult.

Shivetya 7y ago

Indiana funds the HSA deductible on their plans and saw a good deal of savings. Combine this with price transparency and health care costs could and should fall and do so rapidly. however the biggest obstacle to health care reform and cost reduction are the federal and state governments. in particular CON (Certificate of Need), thirty plus states still have these which are used to block new hospitals and other care facilities. the ACA banned new Doctor owned hospitals in a further move to protect the big hospitals; the CON law at Federal level was done away with in 87. People need to have skin in the game. This means that prices must be revealed as well as handing control over to patients where how the money is spent. So HSA with paid deductibles can save states a large amount of money and help people make better decisions. with preventative treatments normally being free and people seeing hsa money rolls over and its theirs it really changes how people behave. the US should have great health care but the government is stuck in VA for all mode and that is the charge being led by current candidates. Look at it this way, the VA system has been a wreck for decades and if Congress cannot or will not fix that why should you trust them to take over what we have now?

jseliger 7y ago

Probably, but not certainly: https://marginalrevolution.com/marginalrevolution/2019/06/will-price-transparency-in-health-care-markets-work.html https://marginalrevolution.com/marginalrevolution/2019/06/wi... I favor price transparency (https://seliger.com/2018/11/11/health-insurance-security-fqhcs/ https://seliger.com/2018/11/11/health-insurance-security-fqh...) but the Dutch cement market work does give one pause.