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This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches

This is absurd. Even in a country with liberal economics and "free choice" health system (however with universal care, and state regulation), the same stitches in a world-class private clinic in Santiago, Chile would cost 400 USD, before insurance. The clinics there are not the ones Americans imagine from a middle-income country, most of them have better infrastructure and doctors than the ones I know in Europe. And I don't even need to start talking about health services in Europe, where I live. This is the kind of things that show how inviable is a market-led economy without proper regulation. Let the powerful profit from the weak and you'll see this kind of thing every time. If you compare life expectancy in Chile and some other Latin-American countries with universal care[1], they are higher than in the US, despite being a more unequal and/or poorer. [1] https://ourworldindata.org/grapher/life-expectancy?tab=chart&time=1999..latest&country=CHL~URY~CRI~ARG~USA~DEU https://ourworldindata.org/grapher/life-expectancy?tab=chart... Edit: Many commenters miss the point. The US leads the way in too many areas and at least I expect them to be an example of the benefits of free market economy. Some have mentioned that regulation is indeed the problem. I would say, that we need the right regulation so the right incentives are put in place, in benefit of the market and competition. So at best it would be better not to have the industry dictate the regulation.

HPsquared 5y ago
The stitches are expensive mostly because of many regulatory factors that restrict the supply of medical services and drive costs up, with the "free market" component being in how much they can charge the patients. It's the worst of both worlds in the US.
- helloguillecl 5y ago
  I can tell you that you cannot freely open a clinic in Chile, and Doctors have the monopoly on many treatments that are delivered by nurses or other workers in Europe. Becoming a Doctor is not easy, and foreign Doctors must go through difficult tests before working for the public system. Additionally, I remember that many supplies come from... the United States? So what regulations are you talking about? Maybe you meant monopolies?
  - chiph 5y ago
    There's three areas that I'm aware of. Certificates of Need, which some states require before you can offer certain services (like MRI/CT scanning). Supply contracts, where a hospital has a pre-set price for consumables like IV solutions, scalpels, and bandages with a supplier. And advertising. The Certificate reduces competition because they impose geographical exclusivity. If you want to buy a MRI machine for your clinic, you cannot if the state determines if your area already has enough of them. And if you file a Certificate with the state intending to buy one, your nearby competitors are likely to place objections to your purchase. This is because the machines are expensive and the other clinics want to ensure their investment gets paid for. But this process also ensures they're expensive because the machines aren't able to be built in volumes large enough to result in a cost reduction. The supply contracts make things easier for the hospital, as they only have to deal with one supplier for an item or class of item. The price is known up front for the duration of the contract. But this also means that the hospital cannot change suppliers if another one has a lower price for the same item midway through the contract period, reducing competition. They also restrict choice by the doctors at the hospital - doctors have strong preferences for items like gloves because of sizing & fit, and the way they transmit feeling through them (thinness, texture, etc). If a hospital changes suppliers to one that doesn't carry their favorite glove, they aren't able to perform as well. And they can't bring their own into the operating room because of liability. I don't know how many advertisements you see in Chile for medicine, but here in the US I would guess that a quarter of advertisements on TV are for them. All those ads cost a lot of money, and they're not being targeted at doctors, but patients: "Ask your doctor if {brand} is right for you"
    - vidarh 5y ago
      The certificate of need business seems bizarre. I live in London, and the place is so crowded with clinics offering cheap MRIs it's ridiculous, despite the fact you'll get them covered in the NHS I'd you actually need them (literally the very first ad I found for MRIs offered them for 200 pounds).
      - maxerickson 5y ago
- tasubotadas 5y ago
  Exactly. What the US lacks is actually more liberal market in health. Less regulations and more competition. When talking about regulations people usually mean regulating pricing and/or service quality but what actually needs to be tackled are the factors that limit competition, like: - process for opening new clinics/hospitals should have little to none restrictions - requirements for doctors (no doctors from outside can work in the US unless they complete $400k degree) - Drugs from outside countries should be allowed to be imported without FDA's approval and so on
  - namdnay 5y ago
    None of the other countries being discussed have any of that, and yet their systems work fine. So I don’t think the solution is there
- watwut 5y ago
  Regulatory factors exists in all mentioned countries. Medical services being restricted is not some kind of exception.
  - deleted 5y ago
    [deleted]
- temac 5y ago
  Not so sure for the impact of regulatory. Tons of other countries/areas have equivalent regulatories req, if not more strict, yet does not yield to absolutely insane prices. Regulatory is there to prevent e.g. killing patients in a Therac-25 like events. When you have a too weak reg, you end up with things like 737-max situations. Now maybe regulatory can also go too far in some niches, but the correct solution is not to blindly go in the other direction. And anyway, absurd prices in cases of e.g. ER are most of the time explained not by the cost of medical supplies but by random attempts to purely extorts the patients: 6 stiches and a shot do not imply thousands of dollar of BOM, nor are physicians paid hundreds per minute. Look at the cost of covid vaccines if you want to know more realistic costs.
- coldtea 5y ago
  We have more "regulatory factors" in Europe, and much cheaper treatment... Like 1/40 or so as much in this case...
  - nameunimportant 5y ago
    WHen I stopped living in the USA, I realized that there is only one reason the USA is behind the rest of the developed world when it comes to healthcare, a social safety net and education. The USA likes it that way. The American culture is one of rugged individualist pioneering cowboys who won't be told what to do, even if you're warning them that if they take another step they'll fall off a cliff.
    - christophilus 5y ago
      I don’t think it’s the rugged individualism that’s at fault, so much as an emergent, insane incentive structure that has grown out of control. The confluence of big insurance, big hospitals/ practices, and regulatory capture have given us a completely warped system.
    - adnmcq999 5y ago
      In just what century did you live here?
      - kcplate 5y ago
        Definitely a common mindset, particularly of gen x and generations prior. I know I have it. Wouldn’t surprise me a bit if someone born and raised outside the us came away with this impression after living here for a while. Honestly when I read the headline my first thought was “six stitches? Crazy glue is cheaper…”
        throwaway0a5e 5y ago
        >Honestly when I read the headline my first thought was “six stitches? Crazy glue is cheaper” Unless you live across the street from the hospital it's just less hassle to do it that way. Any injury not worthy of an ambulance can be cleaned, glued and taped in the time it would take to sit in the waiting room while they serve all the people who are dying faster.
garmaine 5y ago
$400 still sounds high, to be honest.
- donatj 5y ago
  I paid $400 for a plumber to do 30 minutes of work this week. A doctor has more training and a lot higher infrastructure costs and overhead, and thus a higher hourly fee.
  - code4tee 5y ago
    And yet ironically, in the US at least, there’s a decent chance that plumber actually makes more than a physician.
    - sgerenser 5y ago
      Unlikely, but if he does it’s because he’s the “owner of a plumbing business” not just a plumber.
    - docinabox 5y ago
      I want whatever you’re smoking!
    - dheera 5y ago
      Possibly upto a point, if you factor in that the physician has to contend with paying back $400K in loans and $1M+ in lost income from not working during earlier years in life.
  - 300bps 5y ago
    Same thing happened to me with a plumber 12 years ago. I spent a couple hours on YouTube and now I can solder my own copper pipes, install a new toilet and anything else I need. Even being a software engineer I couldn’t compete with the hourly rate of a plumber so it makes financial sense for me to do the work myself.
  - dheera 5y ago
    But plumbers have to deal with a lot of nauseating stuff. "Amount of nauseating substances you have to deal with" should be a huge factor in pay rate.
refurb 5y ago
The plastic surgery and vision correction industries work pretty well in the US. You see price competition and patients have the ability to shop around and make choices that are important to them (references from other patients, doctor personality, etc). Now contrast that with going to a hospital for a procedure where you have time to shop around. Can you get a price? No. Can you easily get appointments with doctors to get their opinions on your case? Maybe. Can you get other patient references? Unlikely (but maybe). What’s the difference? One insurance covers (thus the patients is cut out of price conversations) and one insurance doesn’t cover (this patient is the end payer). The big problem is more and more costs are being shifted to patients as deductibles and co-insurance, but hospitals treat it like it was 1990 and the patient pays some token amount so “who cares”? And sure, an emergency doesn’t leave you much time to shop around, but something like 80% of healthcare procedures aren’t emergent.
- helloguillecl 5y ago
  The United States leads the way in treatments and medical tech, but this gives me the impression that the US society is not benefiting as it could from that.
  - bottled_poe 5y ago
    This seems poignant. The cost/benefit analysis does not seem to be aligned with the market. I suspect it’s driven purely by lack of qualified practitioners.
    - deleted 5y ago
      [deleted]
    - jac241 5y ago
      It's not. Physician reimbursement has been going down year over year since the late 90s. Each unit of physician work (relative value units, RVUs) is worth 50% of what it was in 1998 for Medicare at least, and most insurers peg their reimbursement at a specific multiple of the Medicare rate. Sorry, the insurance companies, PBMs, and hospital administration is to blame for the high cost of care, not the physicians who don't control how much they are reimbursed for each office visit or procedure.
brobdingnagians 5y ago
The US is not a market-led economy in healthcare; I currently live in a country with universal healthcare and I make clear to people that when I disagree with universal healthcare it is not because I think it should be more like the US.
- ben_w 5y ago
  I’m curious what your proposal is, in that case?
- busyant 5y ago
  Can you elaborate on where you disagree with universal healthcare? Your opinion sounds nuanced and, therefore, possibly interesting.
- melenaboija 5y ago
  It is not uncommon in US going to the hospital and they giving you a list of options and prices. I don't know how to call that but definitely feels like a market. BTW, I come from from a European country with universal healthcare and have been living in US for almost a decade and the feeling of someone making money of your health is at least weird. If I ever have some severe health issue no doubt I will go to treat myself to my country of origin. EDIT: Also tired to hear about the problems of universal health care, specially with wait times. It is true that less important treatments could take some extra time but I have never seen a case where a fast intervention was needed and did not happen. I would say that common sense is something that works for universal healthcare. At least where I come from.
  - vidarh 5y ago
    > EDIT: Also tired to hear about the problems of universal health care, specially with wait times. It is true that less important treatments could take some extra time but I have never seen a case where a fast intervention was needed and did not happen. I would say that common sense is something that works for universal healthcare. At least where I come from. Almost all countries with universal care also have private options (Norway used to be an exception where offering private options for services available from the public healthcare system used to be practically impossible, but even Norway has relented on this though). Often the private options are also cheaper than the US. E.g. for elective surgeries Americans might want to check London hospitals - many world-leading private hospitals for various conditions that are used to targeting foreign patients - especially wealthy ones - but still often charging much lower prices. It's also not that unusual for those of us in the UK who can afford to go private to do so when we have some condition that the NHS certainly will treat but where there's a waiting list because it's not important. And there are plenty of private insurers - only because the NHS offers a baseline, they're far cheaper than most US plans because almost all of them rely on the NHS as a first line and instead of picking up the bill for everything they only pick up the bill to accelerate care whenever there's a wait to see certain NHS specialists. People need to consider the universal care to be the baseline. How much people are prepared to pay for the baseline over taxes will affect how fancy the baseline is, so if you want something better you'll need to pay. But at least it ensures everyone gets the baseline.
js2 5y ago
Meanwhile, Congress passed a bill that's supposed to help with surprise billing. The Biden administration has started to implement it, but doctors and their representatives (Democrats and Republicans alike) claim the administration is not implementing the bill as intended and they are favoring insurance companies over medical providers by trying to keep costs down. > “The Administration’s recently proposed regulation to begin implementing the law does not uphold Congressional intent and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and potentially force small practices to close thus limiting patients access to care,” Rep. Larry Bucshon (R-Ind.), who is a doctor and helped spearhead a letter of complaint this month, said in a statement to KHN. https://khn.org/news/article/surprise-medical-bills-policy-congressional-doctors-backlash/ https://khn.org/news/article/surprise-medical-bills-policy-c... This shit makes my blood boil. Various vested interests, but mostly doctors, have stymied virtually all legislation (the ACA, Medicare and Medicaid being the notable exceptions) for a century. https://pnhp.org/a-brief-history-universal-health-care-efforts-in-the-us/ https://pnhp.org/a-brief-history-universal-health-care-effor...
- jac241 5y ago
  Those greedy doctors trying to protect their livelihoods from a bill that gives insurers an easy path to drive down their reimbursement when an alternate method of doing the same thing (New York's law on surprise billing) exists that does not have that same feature. I for one know that software engineers would certainly support bills that would reduce their pay for the greater good! Physicians are the only group that everyone expects to work for less and less money. It may surprise you, but most software engineers will have an easy time outearning the majority of physicians. It's not the 80s anymore. Doctors aren't super rich. Doctors aren't the ones who made you sick, but they are the ones who trained for 7+ years to take care of the problem. Shame on them for wanting to earn a living.
  - js2 5y ago
    https://www.bls.gov/ooh/mobile/highest-paying.htm https://www.bls.gov/ooh/mobile/highest-paying.htm
  - 5y ago
goodluckchuck 5y ago
The ER has all the pricing power when you need medical care and can’t go anywhere else. The customer has all the pricing power when the medical care has already been provided and the ER hasn’t been paid.
trixie_ 5y ago
Free market works fine, unfortunately like tuition prices the government got involved and prevented what the free market is good at and driving down prices. Fortunately now there a new price transparency laws which the full the effects haven’t been felt yet and are a step in the right direction.
- ElDji 5y ago
  When free market doesn't work, free market advocates have their solution : there wasn't enough free market, so we need MORE free market.
  - trixie_ 5y ago
    A free market wouldn’t be dumb enough to give a teenager a loan for 100k. That idiocy is reserved for the government.
    - sofixa 5y ago
      Hence the free market would have excluded any teenager who doesn't have rich parents from higher education. Hardly a good thing.
      - trixie_ 5y ago
        Free market brings prices down and quality up. The government tried to ‘help’ 50 years ago and now the prices have become so distorted that without government help you would need to be rich to go to school. People like you think the government should solve a problem that they themselves created.
        sofixa 5y ago
        > Free market brings prices down and quality up In theory, but in practice there are many markets where that simply doesn't work, mostly due to natural monopolies, such as any type of infrastructure, healthcare or education, where competition is impractical or impossible, equal access for everyone is extremely important, and costs are high.
claviska 5y ago
My wife and her family are from Peru. It’s not uncommon for our relatives that are living in the U.S. to fly back to Peru and pay cash for procedures instead of doing it through their U.S. insurance.
mbreese 5y ago
> example of the benefits of free market economy Healthcare is rarely a good example of the free market. Medical decisions aren’t made by comparing costs between providers. And if you’re in rural America, you’re lucky if you have any provider. Price transparency would be nice, but maybe not as helpful as you’d like. Let’s say you’re in the middle of a rural area and the ER says you need stitches — but they cost $6000. What are you going to do about it? Are you really in a position to negotiate? Your choices might just be 1) get the treatment, or 2) go without. Many things in rural areas cost more than they should. Usually on this forum we talk about the high cost of internet access and the lack of options, but medical is very similar in that regard. Services are hard to find, providers are covering a very large geographic area, and many costs are higher. It’s not a good example of how a well functioning free market would work.
- TheOtherHobbes 5y ago
  But that's exactly how a free market does work. It's exactly what any rational person would expect from a corporate free-for-all designed for maximum extraction potential based on maximising political power differentials. Good state-owned care smooths out the inequalities, so farmers in the middle of rural area will at least have affordable access to basic care, and more advanced care will be within easy travelling distance. This ends up being far cheaper for everyone who needs medical care - which is basically everyone. The only losers are profiteering shareholders. Of course you still pay for it, but you don't pay as much. And you won't be bankrupted by bills for which you either have no cover at all, or limited insurance cover which still leaves you with a huge sum.
  - t0suj4 5y ago
    When the state or its delegates decide who can offer what service to whom it cannot be free market. What's preventing you from opening a clinic and stitching people for $300?
    - ipaddr 5y ago
      Laws that say I must have completed some state certification. That limits supply. I don't understand why they can't limit price.
dheera 5y ago
Yep, and the same shits go around telling everyone to get an ambulance instead of Uber to go to the hospital and go to the ER instead of urgent care for certain symptoms. Fix your fucking system first. Even I avoid the ER because of costs.
FirstLvR 5y ago
Eso solo aplica si tienes Isapre, seguro, etc etc Los gringos están mal pero en chile tampoco estamos bien bien
- helloguillecl 5y ago
  En mi comentario, estoy hablando de precios sin seguro, o sea que para cualquiera, con FONASA ISAPRE o sin seguro.
WriterGuy2021 5y ago
> This is the kind of things that show how inviable is a market-led economy without proper regulation. The medical industry is highly regulated. I can't just go open up a practice giving people stiches. I would need a whole slew of certifications in order to do so. That's why this situation in the US is so absurd. The market is regulated to limit the competition at the expense of the consumer. In the U.S. the "free market" is mostly a myth.
1cvmask 5y ago
The US medical system is incredibly regulated and constricted by the government and the rules and regulations. It is NOT a free market. An English friend who moved to the Bay area for work at Genentech had a wife who was a doctor from the UK. She could NOT practice as a doctor in California. This is deliberate by design. The AMA restricts the number of doctors to prevent their incomes being reduced. The third party payment system of medicine is both directly paid for by the government and subsidized by tax writeoffs for the private insurance industry (which is tied to employment). And meanwhile during a pandemic majority of Americans supported Medicare for all. Yet the corporate politicians are against it. The performative art of the "squad" was at full display when they had a chance to force the "Medicare for all" vote and passed on it. https://www.opindia.com/2020/12/jimmy-dore-vs-cenk-uygur-democrats-progressives-force-the-vote-medicare-for-all-nancy-pelosi-aoc/ https://www.opindia.com/2020/12/jimmy-dore-vs-cenk-uygur-dem... https://www.businessinsider.com/aoc-rejects-left-wing-calls-to-force-pelosi-to-hold-medicare-for-all-vote-2020-12 https://www.businessinsider.com/aoc-rejects-left-wing-calls-... https://thehill.com/hilltv/what-americas-thinking/412545-70-percent-of-americans-support-medicare-for-all-health-care https://thehill.com/hilltv/what-americas-thinking/412545-70-... We deserve what we vote for.

HPsquared 5y ago

The stitches are expensive mostly because of many regulatory factors that restrict the supply of medical services and drive costs up, with the "free market" component being in how much they can charge the patients. It's the worst of both worlds in the US.

helloguillecl 5y ago
I can tell you that you cannot freely open a clinic in Chile, and Doctors have the monopoly on many treatments that are delivered by nurses or other workers in Europe. Becoming a Doctor is not easy, and foreign Doctors must go through difficult tests before working for the public system. Additionally, I remember that many supplies come from... the United States? So what regulations are you talking about? Maybe you meant monopolies?
- chiph 5y ago
  There's three areas that I'm aware of. Certificates of Need, which some states require before you can offer certain services (like MRI/CT scanning). Supply contracts, where a hospital has a pre-set price for consumables like IV solutions, scalpels, and bandages with a supplier. And advertising. The Certificate reduces competition because they impose geographical exclusivity. If you want to buy a MRI machine for your clinic, you cannot if the state determines if your area already has enough of them. And if you file a Certificate with the state intending to buy one, your nearby competitors are likely to place objections to your purchase. This is because the machines are expensive and the other clinics want to ensure their investment gets paid for. But this process also ensures they're expensive because the machines aren't able to be built in volumes large enough to result in a cost reduction. The supply contracts make things easier for the hospital, as they only have to deal with one supplier for an item or class of item. The price is known up front for the duration of the contract. But this also means that the hospital cannot change suppliers if another one has a lower price for the same item midway through the contract period, reducing competition. They also restrict choice by the doctors at the hospital - doctors have strong preferences for items like gloves because of sizing & fit, and the way they transmit feeling through them (thinness, texture, etc). If a hospital changes suppliers to one that doesn't carry their favorite glove, they aren't able to perform as well. And they can't bring their own into the operating room because of liability. I don't know how many advertisements you see in Chile for medicine, but here in the US I would guess that a quarter of advertisements on TV are for them. All those ads cost a lot of money, and they're not being targeted at doctors, but patients: "Ask your doctor if {brand} is right for you"
  - vidarh 5y ago
    The certificate of need business seems bizarre. I live in London, and the place is so crowded with clinics offering cheap MRIs it's ridiculous, despite the fact you'll get them covered in the NHS I'd you actually need them (literally the very first ad I found for MRIs offered them for 200 pounds).
    - maxerickson 5y ago
tasubotadas 5y ago
Exactly. What the US lacks is actually more liberal market in health. Less regulations and more competition. When talking about regulations people usually mean regulating pricing and/or service quality but what actually needs to be tackled are the factors that limit competition, like: - process for opening new clinics/hospitals should have little to none restrictions - requirements for doctors (no doctors from outside can work in the US unless they complete $400k degree) - Drugs from outside countries should be allowed to be imported without FDA's approval and so on
- namdnay 5y ago
  None of the other countries being discussed have any of that, and yet their systems work fine. So I don’t think the solution is there
watwut 5y ago
Regulatory factors exists in all mentioned countries. Medical services being restricted is not some kind of exception.
- deleted 5y ago
  [deleted]
temac 5y ago
Not so sure for the impact of regulatory. Tons of other countries/areas have equivalent regulatories req, if not more strict, yet does not yield to absolutely insane prices. Regulatory is there to prevent e.g. killing patients in a Therac-25 like events. When you have a too weak reg, you end up with things like 737-max situations. Now maybe regulatory can also go too far in some niches, but the correct solution is not to blindly go in the other direction. And anyway, absurd prices in cases of e.g. ER are most of the time explained not by the cost of medical supplies but by random attempts to purely extorts the patients: 6 stiches and a shot do not imply thousands of dollar of BOM, nor are physicians paid hundreds per minute. Look at the cost of covid vaccines if you want to know more realistic costs.
coldtea 5y ago
We have more "regulatory factors" in Europe, and much cheaper treatment... Like 1/40 or so as much in this case...
- nameunimportant 5y ago
  WHen I stopped living in the USA, I realized that there is only one reason the USA is behind the rest of the developed world when it comes to healthcare, a social safety net and education. The USA likes it that way. The American culture is one of rugged individualist pioneering cowboys who won't be told what to do, even if you're warning them that if they take another step they'll fall off a cliff.
  - christophilus 5y ago
    I don’t think it’s the rugged individualism that’s at fault, so much as an emergent, insane incentive structure that has grown out of control. The confluence of big insurance, big hospitals/ practices, and regulatory capture have given us a completely warped system.
  - adnmcq999 5y ago
    In just what century did you live here?
    - kcplate 5y ago
      Definitely a common mindset, particularly of gen x and generations prior. I know I have it. Wouldn’t surprise me a bit if someone born and raised outside the us came away with this impression after living here for a while. Honestly when I read the headline my first thought was “six stitches? Crazy glue is cheaper…”
      - throwaway0a5e 5y ago
        >Honestly when I read the headline my first thought was “six stitches? Crazy glue is cheaper” Unless you live across the street from the hospital it's just less hassle to do it that way. Any injury not worthy of an ambulance can be cleaned, glued and taped in the time it would take to sit in the waiting room while they serve all the people who are dying faster.

garmaine 5y ago

$400 still sounds high, to be honest.

donatj 5y ago
I paid $400 for a plumber to do 30 minutes of work this week. A doctor has more training and a lot higher infrastructure costs and overhead, and thus a higher hourly fee.
- code4tee 5y ago
  And yet ironically, in the US at least, there’s a decent chance that plumber actually makes more than a physician.
  - sgerenser 5y ago
    Unlikely, but if he does it’s because he’s the “owner of a plumbing business” not just a plumber.
  - docinabox 5y ago
    I want whatever you’re smoking!
  - dheera 5y ago
    Possibly upto a point, if you factor in that the physician has to contend with paying back $400K in loans and $1M+ in lost income from not working during earlier years in life.
- 300bps 5y ago
  Same thing happened to me with a plumber 12 years ago. I spent a couple hours on YouTube and now I can solder my own copper pipes, install a new toilet and anything else I need. Even being a software engineer I couldn’t compete with the hourly rate of a plumber so it makes financial sense for me to do the work myself.
- dheera 5y ago
  But plumbers have to deal with a lot of nauseating stuff. "Amount of nauseating substances you have to deal with" should be a huge factor in pay rate.

refurb 5y ago

The plastic surgery and vision correction industries work pretty well in the US. You see price competition and patients have the ability to shop around and make choices that are important to them (references from other patients, doctor personality, etc). Now contrast that with going to a hospital for a procedure where you have time to shop around. Can you get a price? No. Can you easily get appointments with doctors to get their opinions on your case? Maybe. Can you get other patient references? Unlikely (but maybe). What’s the difference? One insurance covers (thus the patients is cut out of price conversations) and one insurance doesn’t cover (this patient is the end payer). The big problem is more and more costs are being shifted to patients as deductibles and co-insurance, but hospitals treat it like it was 1990 and the patient pays some token amount so “who cares”? And sure, an emergency doesn’t leave you much time to shop around, but something like 80% of healthcare procedures aren’t emergent.

helloguillecl 5y ago
The United States leads the way in treatments and medical tech, but this gives me the impression that the US society is not benefiting as it could from that.
- bottled_poe 5y ago
  This seems poignant. The cost/benefit analysis does not seem to be aligned with the market. I suspect it’s driven purely by lack of qualified practitioners.
  - deleted 5y ago
    [deleted]
  - jac241 5y ago
    It's not. Physician reimbursement has been going down year over year since the late 90s. Each unit of physician work (relative value units, RVUs) is worth 50% of what it was in 1998 for Medicare at least, and most insurers peg their reimbursement at a specific multiple of the Medicare rate. Sorry, the insurance companies, PBMs, and hospital administration is to blame for the high cost of care, not the physicians who don't control how much they are reimbursed for each office visit or procedure.

brobdingnagians 5y ago

The US is not a market-led economy in healthcare; I currently live in a country with universal healthcare and I make clear to people that when I disagree with universal healthcare it is not because I think it should be more like the US.

ben_w 5y ago
I’m curious what your proposal is, in that case?
busyant 5y ago
Can you elaborate on where you disagree with universal healthcare? Your opinion sounds nuanced and, therefore, possibly interesting.
melenaboija 5y ago
It is not uncommon in US going to the hospital and they giving you a list of options and prices. I don't know how to call that but definitely feels like a market. BTW, I come from from a European country with universal healthcare and have been living in US for almost a decade and the feeling of someone making money of your health is at least weird. If I ever have some severe health issue no doubt I will go to treat myself to my country of origin. EDIT: Also tired to hear about the problems of universal health care, specially with wait times. It is true that less important treatments could take some extra time but I have never seen a case where a fast intervention was needed and did not happen. I would say that common sense is something that works for universal healthcare. At least where I come from.
- vidarh 5y ago
  > EDIT: Also tired to hear about the problems of universal health care, specially with wait times. It is true that less important treatments could take some extra time but I have never seen a case where a fast intervention was needed and did not happen. I would say that common sense is something that works for universal healthcare. At least where I come from. Almost all countries with universal care also have private options (Norway used to be an exception where offering private options for services available from the public healthcare system used to be practically impossible, but even Norway has relented on this though). Often the private options are also cheaper than the US. E.g. for elective surgeries Americans might want to check London hospitals - many world-leading private hospitals for various conditions that are used to targeting foreign patients - especially wealthy ones - but still often charging much lower prices. It's also not that unusual for those of us in the UK who can afford to go private to do so when we have some condition that the NHS certainly will treat but where there's a waiting list because it's not important. And there are plenty of private insurers - only because the NHS offers a baseline, they're far cheaper than most US plans because almost all of them rely on the NHS as a first line and instead of picking up the bill for everything they only pick up the bill to accelerate care whenever there's a wait to see certain NHS specialists. People need to consider the universal care to be the baseline. How much people are prepared to pay for the baseline over taxes will affect how fancy the baseline is, so if you want something better you'll need to pay. But at least it ensures everyone gets the baseline.

js2 5y ago

Meanwhile, Congress passed a bill that's supposed to help with surprise billing. The Biden administration has started to implement it, but doctors and their representatives (Democrats and Republicans alike) claim the administration is not implementing the bill as intended and they are favoring insurance companies over medical providers by trying to keep costs down. > “The Administration’s recently proposed regulation to begin implementing the law does not uphold Congressional intent and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and potentially force small practices to close thus limiting patients access to care,” Rep. Larry Bucshon (R-Ind.), who is a doctor and helped spearhead a letter of complaint this month, said in a statement to KHN. https://khn.org/news/article/surprise-medical-bills-policy-congressional-doctors-backlash/ https://khn.org/news/article/surprise-medical-bills-policy-c... This shit makes my blood boil. Various vested interests, but mostly doctors, have stymied virtually all legislation (the ACA, Medicare and Medicaid being the notable exceptions) for a century. https://pnhp.org/a-brief-history-universal-health-care-efforts-in-the-us/ https://pnhp.org/a-brief-history-universal-health-care-effor...

jac241 5y ago
Those greedy doctors trying to protect their livelihoods from a bill that gives insurers an easy path to drive down their reimbursement when an alternate method of doing the same thing (New York's law on surprise billing) exists that does not have that same feature. I for one know that software engineers would certainly support bills that would reduce their pay for the greater good! Physicians are the only group that everyone expects to work for less and less money. It may surprise you, but most software engineers will have an easy time outearning the majority of physicians. It's not the 80s anymore. Doctors aren't super rich. Doctors aren't the ones who made you sick, but they are the ones who trained for 7+ years to take care of the problem. Shame on them for wanting to earn a living.
- js2 5y ago
  https://www.bls.gov/ooh/mobile/highest-paying.htm https://www.bls.gov/ooh/mobile/highest-paying.htm
- 5y ago

goodluckchuck 5y ago

The ER has all the pricing power when you need medical care and can’t go anywhere else. The customer has all the pricing power when the medical care has already been provided and the ER hasn’t been paid.

trixie_ 5y ago

Free market works fine, unfortunately like tuition prices the government got involved and prevented what the free market is good at and driving down prices. Fortunately now there a new price transparency laws which the full the effects haven’t been felt yet and are a step in the right direction.

ElDji 5y ago
When free market doesn't work, free market advocates have their solution : there wasn't enough free market, so we need MORE free market.
- trixie_ 5y ago
  A free market wouldn’t be dumb enough to give a teenager a loan for 100k. That idiocy is reserved for the government.
  - sofixa 5y ago
    Hence the free market would have excluded any teenager who doesn't have rich parents from higher education. Hardly a good thing.
    - trixie_ 5y ago
      Free market brings prices down and quality up. The government tried to ‘help’ 50 years ago and now the prices have become so distorted that without government help you would need to be rich to go to school. People like you think the government should solve a problem that they themselves created.
      - sofixa 5y ago
        > Free market brings prices down and quality up In theory, but in practice there are many markets where that simply doesn't work, mostly due to natural monopolies, such as any type of infrastructure, healthcare or education, where competition is impractical or impossible, equal access for everyone is extremely important, and costs are high.

claviska 5y ago

My wife and her family are from Peru. It’s not uncommon for our relatives that are living in the U.S. to fly back to Peru and pay cash for procedures instead of doing it through their U.S. insurance.

mbreese 5y ago

> example of the benefits of free market economy Healthcare is rarely a good example of the free market. Medical decisions aren’t made by comparing costs between providers. And if you’re in rural America, you’re lucky if you have any provider. Price transparency would be nice, but maybe not as helpful as you’d like. Let’s say you’re in the middle of a rural area and the ER says you need stitches — but they cost $6000. What are you going to do about it? Are you really in a position to negotiate? Your choices might just be 1) get the treatment, or 2) go without. Many things in rural areas cost more than they should. Usually on this forum we talk about the high cost of internet access and the lack of options, but medical is very similar in that regard. Services are hard to find, providers are covering a very large geographic area, and many costs are higher. It’s not a good example of how a well functioning free market would work.

TheOtherHobbes 5y ago
But that's exactly how a free market does work. It's exactly what any rational person would expect from a corporate free-for-all designed for maximum extraction potential based on maximising political power differentials. Good state-owned care smooths out the inequalities, so farmers in the middle of rural area will at least have affordable access to basic care, and more advanced care will be within easy travelling distance. This ends up being far cheaper for everyone who needs medical care - which is basically everyone. The only losers are profiteering shareholders. Of course you still pay for it, but you don't pay as much. And you won't be bankrupted by bills for which you either have no cover at all, or limited insurance cover which still leaves you with a huge sum.
- t0suj4 5y ago
  When the state or its delegates decide who can offer what service to whom it cannot be free market. What's preventing you from opening a clinic and stitching people for $300?
  - ipaddr 5y ago
    Laws that say I must have completed some state certification. That limits supply. I don't understand why they can't limit price.

dheera 5y ago

Yep, and the same shits go around telling everyone to get an ambulance instead of Uber to go to the hospital and go to the ER instead of urgent care for certain symptoms. Fix your fucking system first. Even I avoid the ER because of costs.

FirstLvR 5y ago

Eso solo aplica si tienes Isapre, seguro, etc etc Los gringos están mal pero en chile tampoco estamos bien bien

helloguillecl 5y ago
En mi comentario, estoy hablando de precios sin seguro, o sea que para cualquiera, con FONASA ISAPRE o sin seguro.

WriterGuy2021 5y ago

> This is the kind of things that show how inviable is a market-led economy without proper regulation. The medical industry is highly regulated. I can't just go open up a practice giving people stiches. I would need a whole slew of certifications in order to do so. That's why this situation in the US is so absurd. The market is regulated to limit the competition at the expense of the consumer. In the U.S. the "free market" is mostly a myth.

1cvmask 5y ago

The US medical system is incredibly regulated and constricted by the government and the rules and regulations. It is NOT a free market. An English friend who moved to the Bay area for work at Genentech had a wife who was a doctor from the UK. She could NOT practice as a doctor in California. This is deliberate by design. The AMA restricts the number of doctors to prevent their incomes being reduced. The third party payment system of medicine is both directly paid for by the government and subsidized by tax writeoffs for the private insurance industry (which is tied to employment). And meanwhile during a pandemic majority of Americans supported Medicare for all. Yet the corporate politicians are against it. The performative art of the "squad" was at full display when they had a chance to force the "Medicare for all" vote and passed on it. https://www.opindia.com/2020/12/jimmy-dore-vs-cenk-uygur-democrats-progressives-force-the-vote-medicare-for-all-nancy-pelosi-aoc/ https://www.opindia.com/2020/12/jimmy-dore-vs-cenk-uygur-dem... https://www.businessinsider.com/aoc-rejects-left-wing-calls-to-force-pelosi-to-hold-medicare-for-all-vote-2020-12 https://www.businessinsider.com/aoc-rejects-left-wing-calls-... https://thehill.com/hilltv/what-americas-thinking/412545-70-percent-of-americans-support-medicare-for-all-health-care https://thehill.com/hilltv/what-americas-thinking/412545-70-... We deserve what we vote for.