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Who is to blame? The government for not collecting taxes from you and using that money to pay the doctor? The doctor for billing too high for the visit? The

Who is to blame? The government for not collecting taxes from you and using that money to pay the doctor? The doctor for billing too high for the visit? The insurance company for not covering more of the price? Personally I would seek to understand why the doctor is billing so much and how that can become more fair for everyone involved.

Taek 6y ago
A big element here is that the free market is being choked out. Consumers walk into healthcare facilities without any idea what they will be paying when they walk out, and therefore have no ability to choose one facility over another based on price. Because that ability doesn't exist, there is no downwards price pressure anywhere at the consumer level for medical services. I think we'd see a lot more results if we asked 'why aren't these facilities putting more efforts into reducing costs' rather than asking 'what makes this so expensive?'
- ianleeclark 6y ago
  > Because that ability doesn't exist, there is no downwards price pressure anywhere at the consumer level for medical services. It's important to note that the downward pressure you'd see here is only for elastic goods which most healthcare-related things likely aren't.
  - lotsofpulp 6y ago
    There are plenty of healthcare related things that one can shop for, such as this COVID test. The price could easily be advertised on the healthcare facilities website. But it’s not because it would hurt revenue since price transparency benefits buyers, and price obfuscation benefits sellers by allowing them to price discriminate and charge each seller the most each seller is able to pay.
    - ianleeclark 6y ago
      > But it’s not because it would hurt revenue since price transparency benefits buyers, and price obfuscation benefits sellers by allowing them to price discriminate and charge each seller the most each seller is able to pay. Are you against a monopsony in healthcare? If you care about having a fair-shake for every consumer, then that's the most consistent way of wielding power against would-be price gougers.
      - lotsofpulp 6y ago
        There’s a balance to be had, a marketplace functions best when there are many buyers and many sellers. Obviously, health issues aren’t a perfect marketplace due to buyers not being able to shop around many times, and due to buyers not having sufficient knowledge about what they are buying due to the complexity inherent in medicine. In all cases though, I think price transparency is always good as that is what helps to properly allocate resources in the long run. And I think that published healthcare prices coupled with high deductible health insurance is a good idea as it would allow proper information about pricing to be transmitted, at least for minor issues such as covid tests or broken bones or routine visits and procedures. For more complex cases, I would have to defer to those with expertise on how to ration resources.
- dragonwriter 6y ago
  > A big element here is that the free market is being choked out. Given that every developed country has much lower per capita and per GDP costs, and pretty much none have more of a free market in health than the US, I'm pretty sure that's not the problem driving US prices high. I get that free market fundamentalism is one of the most influential religions in the US, but it's popularity doesn't make it contentions true any more than the popularity of Christian fundamentalism does for young earth creationism.
  - jackcosgrove 6y ago
    Other developed countries' public health facilities ration care based on medical need rather than ability to pay. There is always concierge medicine but it's not nearly to the extent in the US. Rationing of care this way means fewer medical procedures on the whole. I've seen numbers to the effect that health outcomes are 30% genetic, 30% diet, 30% lifestyle, and 10% medical intervention. Frankly Americans don't need as many procedures done as they have done. Medical care is rationed everywhere and there is no way for supply to meet demand. The only question is how do you ration it. Turns out rationing by ability to pay leads to unnecessary procedures with no boost in outcomes. The hard part to accept is that the system that imposes a 3-6 month wait for non-life threatening treatments is better because some number of cases resolve themselves during that time period and reduce total demand. Overall medicine has limited tools to improve health compared to diet and exercise. We like to believe an intervention by someone else - surgical, pharmaceutical, etc. - can fix our problems, but that's not the case for many people. Medicine can really help with things such as pain management and trauma, but to an unsettling degree we rely on the body to heal itself.
  - mrfredward 6y ago
    Most developed nations have highly regulated healthcare systems, and part of the government involvement is in setting prices. The U.S., through everything from safety regulations to IP laws to insurance regulation has destroyed competition, but outside of medicare isn't involved in determining prices. The result is predictable. Markets work great when the incentives are right. It's hard to get incentives right in healthcare and most nations want medicine to be part of a government safety net, so they go the direction of socializing healthcare. Almost anything would be better than the system the U.S. has now.
lotsofpulp 6y ago
> Personally I would seek to understand why the doctor is billing so much and how that can become more fair for everyone involved. For the same reason a McDonald’s worker bills closer to minimum wage - because that is the most the buyers are willing to pay. Solution to bringing prices down is to increase supply and/or decrease demand, and increase price transparency.
francisofascii 6y ago
For who to blame, I think it is shared. The govt could have set a price ceiling for testing so people actually get tested. Yes, I think the bill was too high for the service provided, which was the test and checking vitals. For me I essentially had to get tested because I had a fever and my wife was not allowed to go back to work until I was cleared. Maybe I could have shopped around better.
amanaplanacanal 6y ago
Part of the issue is that the supply of doctors is kept artificially low in the US. Another part is: why the heck do you need an office visit for this? Why can’t you go directly to the lab?
- francisofascii 6y ago
  For the record, it was not a brick/mortar office, but a temporary tent set up specifically for Covid testing.
  - sushshshsh 6y ago
    Horrific to be charged that much for a tent visit :(
Retric 6y ago
A huge factor is multiple insurance companies add a lot of overhead to the system as they all try to negotiate lower prices. It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead.
- lotsofpulp 6y ago
  > It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead. How do you know the doctor wouldn’t be billing erroneously anyway? People have no idea what doctors do or what is appropriate. The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacists) to reduce over billing. Yes, the people working at insurance companies could be over zealous, but the same applies to healthcare providers. If doctors didn’t want to deal with insurance, they are free to hang a sign that says $50 per 15 min consultation.
  - dragonwriter 6y ago
    > The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacists) to reduce over billing. Insurance company profits are capped at a percentage of payout, and they are part of oligopolies protected by high barriers to entry, why would they reduce overbilling or advocate for patients?
    - lotsofpulp 6y ago
      Because if they payout too much then they have higher premiums compared to their competitors, which means customers would opt for a different insurer? Obviously not forcing everyone to go through healthcare.gov crippled the ability for numerous health insurance to exist and compete, but that is a political problem.
  - Retric 6y ago
    With single payer systems it’s much easier to sanity check what’s going on. For example billion one organization for 20 hours of work per day is laughable, but spread that across 10 companies and they can’t tell. Similarly, having more data allows for better statistical analysis when combined with random sampling.

Taek 6y ago

A big element here is that the free market is being choked out. Consumers walk into healthcare facilities without any idea what they will be paying when they walk out, and therefore have no ability to choose one facility over another based on price. Because that ability doesn't exist, there is no downwards price pressure anywhere at the consumer level for medical services. I think we'd see a lot more results if we asked 'why aren't these facilities putting more efforts into reducing costs' rather than asking 'what makes this so expensive?'

ianleeclark 6y ago
> Because that ability doesn't exist, there is no downwards price pressure anywhere at the consumer level for medical services. It's important to note that the downward pressure you'd see here is only for elastic goods which most healthcare-related things likely aren't.
- lotsofpulp 6y ago
  There are plenty of healthcare related things that one can shop for, such as this COVID test. The price could easily be advertised on the healthcare facilities website. But it’s not because it would hurt revenue since price transparency benefits buyers, and price obfuscation benefits sellers by allowing them to price discriminate and charge each seller the most each seller is able to pay.
  - ianleeclark 6y ago
    > But it’s not because it would hurt revenue since price transparency benefits buyers, and price obfuscation benefits sellers by allowing them to price discriminate and charge each seller the most each seller is able to pay. Are you against a monopsony in healthcare? If you care about having a fair-shake for every consumer, then that's the most consistent way of wielding power against would-be price gougers.
    - lotsofpulp 6y ago
      There’s a balance to be had, a marketplace functions best when there are many buyers and many sellers. Obviously, health issues aren’t a perfect marketplace due to buyers not being able to shop around many times, and due to buyers not having sufficient knowledge about what they are buying due to the complexity inherent in medicine. In all cases though, I think price transparency is always good as that is what helps to properly allocate resources in the long run. And I think that published healthcare prices coupled with high deductible health insurance is a good idea as it would allow proper information about pricing to be transmitted, at least for minor issues such as covid tests or broken bones or routine visits and procedures. For more complex cases, I would have to defer to those with expertise on how to ration resources.
dragonwriter 6y ago
> A big element here is that the free market is being choked out. Given that every developed country has much lower per capita and per GDP costs, and pretty much none have more of a free market in health than the US, I'm pretty sure that's not the problem driving US prices high. I get that free market fundamentalism is one of the most influential religions in the US, but it's popularity doesn't make it contentions true any more than the popularity of Christian fundamentalism does for young earth creationism.
- jackcosgrove 6y ago
  Other developed countries' public health facilities ration care based on medical need rather than ability to pay. There is always concierge medicine but it's not nearly to the extent in the US. Rationing of care this way means fewer medical procedures on the whole. I've seen numbers to the effect that health outcomes are 30% genetic, 30% diet, 30% lifestyle, and 10% medical intervention. Frankly Americans don't need as many procedures done as they have done. Medical care is rationed everywhere and there is no way for supply to meet demand. The only question is how do you ration it. Turns out rationing by ability to pay leads to unnecessary procedures with no boost in outcomes. The hard part to accept is that the system that imposes a 3-6 month wait for non-life threatening treatments is better because some number of cases resolve themselves during that time period and reduce total demand. Overall medicine has limited tools to improve health compared to diet and exercise. We like to believe an intervention by someone else - surgical, pharmaceutical, etc. - can fix our problems, but that's not the case for many people. Medicine can really help with things such as pain management and trauma, but to an unsettling degree we rely on the body to heal itself.
- mrfredward 6y ago
  Most developed nations have highly regulated healthcare systems, and part of the government involvement is in setting prices. The U.S., through everything from safety regulations to IP laws to insurance regulation has destroyed competition, but outside of medicare isn't involved in determining prices. The result is predictable. Markets work great when the incentives are right. It's hard to get incentives right in healthcare and most nations want medicine to be part of a government safety net, so they go the direction of socializing healthcare. Almost anything would be better than the system the U.S. has now.

lotsofpulp 6y ago

> Personally I would seek to understand why the doctor is billing so much and how that can become more fair for everyone involved. For the same reason a McDonald’s worker bills closer to minimum wage - because that is the most the buyers are willing to pay. Solution to bringing prices down is to increase supply and/or decrease demand, and increase price transparency.

francisofascii 6y ago

For who to blame, I think it is shared. The govt could have set a price ceiling for testing so people actually get tested. Yes, I think the bill was too high for the service provided, which was the test and checking vitals. For me I essentially had to get tested because I had a fever and my wife was not allowed to go back to work until I was cleared. Maybe I could have shopped around better.

amanaplanacanal 6y ago

Part of the issue is that the supply of doctors is kept artificially low in the US. Another part is: why the heck do you need an office visit for this? Why can’t you go directly to the lab?

francisofascii 6y ago
For the record, it was not a brick/mortar office, but a temporary tent set up specifically for Covid testing.
- sushshshsh 6y ago
  Horrific to be charged that much for a tent visit :(

Retric 6y ago

A huge factor is multiple insurance companies add a lot of overhead to the system as they all try to negotiate lower prices. It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead.

lotsofpulp 6y ago
> It’s common for a doctor to spend more time dealing with your insurance company after a visit than you. Which clearly means they need to dramatically raise prices to cover that overhead. How do you know the doctor wouldn’t be billing erroneously anyway? People have no idea what doctors do or what is appropriate. The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacists) to reduce over billing. Yes, the people working at insurance companies could be over zealous, but the same applies to healthcare providers. If doctors didn’t want to deal with insurance, they are free to hang a sign that says $50 per 15 min consultation.
- dragonwriter 6y ago
  > The insurance company serves as an educated advocate for the patient (they employ doctors and pharmacists) to reduce over billing. Insurance company profits are capped at a percentage of payout, and they are part of oligopolies protected by high barriers to entry, why would they reduce overbilling or advocate for patients?
  - lotsofpulp 6y ago
    Because if they payout too much then they have higher premiums compared to their competitors, which means customers would opt for a different insurer? Obviously not forcing everyone to go through healthcare.gov crippled the ability for numerous health insurance to exist and compete, but that is a political problem.
- Retric 6y ago
  With single payer systems it’s much easier to sanity check what’s going on. For example billion one organization for 20 hours of work per day is laughable, but spread that across 10 companies and they can’t tell. Similarly, having more data allows for better statistical analysis when combined with random sampling.