4 ms·

Eh, technically yes, but that's not really what I'm talking about. The way we use the word "cost" varies depending on the context, and I'm responding to a speci

Eh, technically yes, but that's not really what I'm talking about. The way we use the word "cost" varies depending on the context, and I'm responding to a specific usage of that word. I'm not making a broad claim that drugs need to be sold at cost, I'm making a claim that drug costs are not so highly variable that coming up with a consumer price needs to take days of research after a procedure. jonathan-adly is making the argument that the inherent "cost" of drugs is itself highly variable for hospitals, and that means it's normal and expected that hospitals should not be able to tell patients the price of procedure before it happens. I'm arguing that the "cost" of the drugs is not actually that variable, that hospitals are just downstream of another part of the industry that is engaged in the same price-hiding behavior that hospitals are engaged in. Of course, under Capitalism "cost" doesn't determine price, the market determines price. But I would also point out that under Capitalism, signing a contract usually involves the terms of that contract being made upfront. Pretty much every other industry in America has figured out how to put a price tag on the products they sell, and I'm not sympathetic towards the medical industry just because up until now it's never needed to learn how. Apple sources its components from manufactures, those manufacturers could change their prices someday. But Apple still puts a price tag on iPhones, and because it needs to put a price tag on iPhones it's incentivized to form long-term contracts with suppliers and to demand a level of consistency in the prices its suppliers offer. Hospitals haven't needed to do that in a long time. Price transparency is an important part of most industries under Capitalism, and the medical industry hiding behind variable "cost" as an excuse to avoid pricing their products shouldn't be something we tolerate. Martin Shrekili's practices (as abhorrent as they might be) are a different conversation. I think that price limits and price transparency are two very different issues.

learc83 5y ago
>But I would also point out that under Capitalism, signing a contract usually involves the terms of that contract being made upfront. There's nothing inherent to Capitalism that prevents variable priced contracts. >Pretty much every other industry in America has figured out how to put a price tag on the products they sell, Maybe for mass produced products they have, but certainly not for custom work. You aren't paying for a product but for a custom service. Paying a doctor to fix your body in many cases is more complex than paying someone to build a house, a bridge, or a piece of software. You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing, now it's $50k. A builder starts digging the foundation to your house only to discover a huge boulder that has to be moved. There are parts of medicine that could be made more transparent, but there is an inherent complexity that makes complete or even mostly complete price transparency impossible.
- danShumway 5y ago
  > There's nothing inherent to Capitalism that prevents variable priced contracts. Definitely not the norm though, and it is inherent to Capitalism that price transparency is an important part of creating an efficient market. But sure, it's not a rule. A lot of common things in Capitalism aren't rules, but they're still often signals of a healthy market. > You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing. A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. > but there is an inherent complexity Not in the places that we're talking about. The kind of complexity and guesswork and change in procedure you're talking about is not present in the situations that jonathan-adly discusses above. The inherent complexity of fixing someone's body and the inherent variability of what drugs/procedures will be necessary to do so is a good explanation of why pricing a surgery or an entire hospital visit is very difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable".
  - learc83 5y ago
    >Definitely not the norm though It most certainly is the norm when purchasing complex custom services. >A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. If a surgeon could keep your chest open on an operating table while they walked you through the process this analogy would work. >a good explanation of why pricing a surgery or an entire hospital visit may be difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable". jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront. As for the price os a single x-ray. I'm sure the average cost of a single x-ray could be calculated. But how much is that worth when the entirety of the hospital visit is going to be a variable cost? If you're only interested in a single x-ray, there are already outpatient imaging clinics that will give you the upfront cost.

learc83 5y ago

>But I would also point out that under Capitalism, signing a contract usually involves the terms of that contract being made upfront. There's nothing inherent to Capitalism that prevents variable priced contracts. >Pretty much every other industry in America has figured out how to put a price tag on the products they sell, Maybe for mass produced products they have, but certainly not for custom work. You aren't paying for a product but for a custom service. Paying a doctor to fix your body in many cases is more complex than paying someone to build a house, a bridge, or a piece of software. You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing, now it's $50k. A builder starts digging the foundation to your house only to discover a huge boulder that has to be moved. There are parts of medicine that could be made more transparent, but there is an inherent complexity that makes complete or even mostly complete price transparency impossible.

danShumway 5y ago
> There's nothing inherent to Capitalism that prevents variable priced contracts. Definitely not the norm though, and it is inherent to Capitalism that price transparency is an important part of creating an efficient market. But sure, it's not a rule. A lot of common things in Capitalism aren't rules, but they're still often signals of a healthy market. > You won't even get an upfront price for something as simple remodeling your kitchen. A contractor estimates that it will cost $20k and then finds that a leak in your attic completely rotted some of the framing. A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. > but there is an inherent complexity Not in the places that we're talking about. The kind of complexity and guesswork and change in procedure you're talking about is not present in the situations that jonathan-adly discusses above. The inherent complexity of fixing someone's body and the inherent variability of what drugs/procedures will be necessary to do so is a good explanation of why pricing a surgery or an entire hospital visit is very difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable".
- learc83 5y ago
  >Definitely not the norm though It most certainly is the norm when purchasing complex custom services. >A contractor will not however replace the framing and then charge me after the fact. They'll discover the rotten framing, inform me of the new conditions and the new price, and then let me decide. A good contractor will walk me through that process. If a surgeon could keep your chest open on an operating table while they walked you through the process this analogy would work. >a good explanation of why pricing a surgery or an entire hospital visit may be difficult. But it is not a good explanation for why hospitals have claimed that the price of a single x-ray is "unknowable". jonathan-adly has done a great job explaining why drug prices are difficult to calculate upfront. As for the price os a single x-ray. I'm sure the average cost of a single x-ray could be calculated. But how much is that worth when the entirety of the hospital visit is going to be a variable cost? If you're only interested in a single x-ray, there are already outpatient imaging clinics that will give you the upfront cost.