7 ms·

I think the reason medical costs are on an upward spiral is not consumers not shopping around. It's that it's extremely hard to get a price for healthcare, that

I think the reason medical costs are on an upward spiral is not consumers not shopping around. It's that it's extremely hard to get a price for healthcare, that hospitals are being bought up by investment companies uninterested in improving outcomes but very interested in jacking up the price of service, and that it is perfectly legal to have the only cure for debilitating, potentially fatal illnesses like hepatitis C cost $24,000.

breadwinner 3y ago
You should take a look at the prices of medical procedures not covered by insurance, such as plastic surgery. The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. When consumers spend out of pocket, they are very much interested in seeing the price before they do the procedure, and hospitals can't and don't hide the price.
- ipython 3y ago
  I’d love to see the shopping around that you can do when you need urgent medical care. “Hold please 911, I need to first get three competing quotes for ambulance service”
  - NoZebra120vClip 3y ago
    You jest, surely, but keep in mind that one of the most financially significant decisions to be made is going to be the hospital which the ambulance transports you to. Some insurance plans charge a premium for mileage when it's not the "closest available", and you can imagine the damage if the chosen facility is "out of network" or not otherwise covered.
  - mindslight 3y ago
    Spoken like someone who has never sat waiting in an "emergency" room for hours. The sheer majority of medical services happen non-urgently.
    - ipython 3y ago
      I am trying to not take your comment personally. I understand that many medical services are not urgent. Part of the problem in the US at least is that ERs are obligated to stabilize any patient that walks through the door, regardless of ability to pay. So you end up with people misusing the ER for chronic non urgent care. I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)
      - antisthenes 3y ago
        In my experience, ER in the US can bill you at the highest rate pretty frivolously. I've been in the ER for "difficulty breathing", which was billed at the highest level, although still made to wait ~2 hours in waiting rooms before seeing _any_ medical professional. I've also been in the ER when brought in by an ambulance, in which case I was seen immediately. These were both billed at the highest level, when the 1st case clearly shouldn't have been.
      - mindslight 3y ago
        Focusing on the uncommon situations needing immediate attention implied that you haven't actually dealt with the system much. If your original comment wasn't reflective of your personal experiences, then don't take it personally. When people talk about the ability to compare prices (as one can do in basically every other industry), it's nonsensical to direct focus towards the small amount of cases that require (and generally get) immediate attention, rather than the bulk of the medical system that shamelessly books appointments months away. If there were well-defined prices, it would clearly be horrible to use that fact to further cement a fiction that a contract has been created with someone under medical duress (or further justify high prices when supply is being limited by the cartel). But reforming the industry has to start somewhere, and price signals are basically the only way we've found to coordinate large scale distributed behavior - regardless of who might be paying.
        3y ago
- fzeroracer 3y ago
  > The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. You are doing some extremely heavy lifting here with this sentence alone by trying to connect two unrelated clauses. Consider the following: Is Water expensive? Is it expensive due to an innate characteristic of water, or is it expensive due to scarcity? Now with that in mind, why is water the first thing price gouged during a crisis? People need fresh and clean water and you have individuals selling water at a premium. The same principle applies for healthcare. Plastic surgery is optional and on an indefinite timeline, so there is no patient lock in. If you have a severe injury or a heart attack or a stroke you cannot shop around. You cannot pre-shop for conditions you don't know you have. And so you pay the crisis premium.
  - breadwinner 3y ago
    > You cannot pre-shop for conditions you don't know you have. In some ways you can. When hospitals acquire a reputation for being pricey without offering better care, people tend to avoid them, and even in a crisis the hospital's name won't be the first that pops into your head.
nradov 3y ago
Well when the hepatitis C drug Sovaldi (sofosbuvir) was first introduced it cost $84K for a course of treatment, so $24K now is a lot less. And that is hardly the only cure: several other pharmaceutical companies have brought competing drugs to market so there are multiple options. https://www.statnews.com/2022/12/15/prisons-cant-afford-hep-c-drugs-but-some-figured-out-a-way/ https://www.statnews.com/2022/12/15/prisons-cant-afford-hep-... Branded prescription drug prices are high mainly due to patent rights. But without patent exclusivity, most of those drugs wouldn't have been developed in the first place. It now often costs $1B+ to take a new candidate drug through phase-3 clinical trials; that money has to come from somewhere and private companies won't invest in that research unless they can expect to profit. The countries which impose strict price caps on prescription drugs generally don't do much new drug development. For example, during the past few years US drug companies have launched about twice as many new drugs compared to European countries. https://www.efpia.eu/publications/downloads/efpia/the-pharmaceutical-industry-in-figures https://www.efpia.eu/publications/downloads/efpia/the-pharma...

breadwinner 3y ago

You should take a look at the prices of medical procedures not covered by insurance, such as plastic surgery. The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. When consumers spend out of pocket, they are very much interested in seeing the price before they do the procedure, and hospitals can't and don't hide the price.

ipython 3y ago
I’d love to see the shopping around that you can do when you need urgent medical care. “Hold please 911, I need to first get three competing quotes for ambulance service”
- NoZebra120vClip 3y ago
  You jest, surely, but keep in mind that one of the most financially significant decisions to be made is going to be the hospital which the ambulance transports you to. Some insurance plans charge a premium for mileage when it's not the "closest available", and you can imagine the damage if the chosen facility is "out of network" or not otherwise covered.
- mindslight 3y ago
  Spoken like someone who has never sat waiting in an "emergency" room for hours. The sheer majority of medical services happen non-urgently.
  - ipython 3y ago
    I am trying to not take your comment personally. I understand that many medical services are not urgent. Part of the problem in the US at least is that ERs are obligated to stabilize any patient that walks through the door, regardless of ability to pay. So you end up with people misusing the ER for chronic non urgent care. I have sat in an ER for hours. I’ve also had nurses at an ER clear the floor for my family when my wife was in septic shock due to a botched surgery, or when my son was run over by a car (both are fine now, not looking for sympathy just pointing out I have experienced this before)
    - antisthenes 3y ago
      In my experience, ER in the US can bill you at the highest rate pretty frivolously. I've been in the ER for "difficulty breathing", which was billed at the highest level, although still made to wait ~2 hours in waiting rooms before seeing _any_ medical professional. I've also been in the ER when brought in by an ambulance, in which case I was seen immediately. These were both billed at the highest level, when the 1st case clearly shouldn't have been.
    - mindslight 3y ago
      Focusing on the uncommon situations needing immediate attention implied that you haven't actually dealt with the system much. If your original comment wasn't reflective of your personal experiences, then don't take it personally. When people talk about the ability to compare prices (as one can do in basically every other industry), it's nonsensical to direct focus towards the small amount of cases that require (and generally get) immediate attention, rather than the bulk of the medical system that shamelessly books appointments months away. If there were well-defined prices, it would clearly be horrible to use that fact to further cement a fiction that a contract has been created with someone under medical duress (or further justify high prices when supply is being limited by the cartel). But reforming the industry has to start somewhere, and price signals are basically the only way we've found to coordinate large scale distributed behavior - regardless of who might be paying.
      - 3y ago
fzeroracer 3y ago
> The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. You are doing some extremely heavy lifting here with this sentence alone by trying to connect two unrelated clauses. Consider the following: Is Water expensive? Is it expensive due to an innate characteristic of water, or is it expensive due to scarcity? Now with that in mind, why is water the first thing price gouged during a crisis? People need fresh and clean water and you have individuals selling water at a premium. The same principle applies for healthcare. Plastic surgery is optional and on an indefinite timeline, so there is no patient lock in. If you have a severe injury or a heart attack or a stroke you cannot shop around. You cannot pre-shop for conditions you don't know you have. And so you pay the crisis premium.
- breadwinner 3y ago
  > You cannot pre-shop for conditions you don't know you have. In some ways you can. When hospitals acquire a reputation for being pricey without offering better care, people tend to avoid them, and even in a crisis the hospital's name won't be the first that pops into your head.

nradov 3y ago

Well when the hepatitis C drug Sovaldi (sofosbuvir) was first introduced it cost $84K for a course of treatment, so $24K now is a lot less. And that is hardly the only cure: several other pharmaceutical companies have brought competing drugs to market so there are multiple options. https://www.statnews.com/2022/12/15/prisons-cant-afford-hep-c-drugs-but-some-figured-out-a-way/ https://www.statnews.com/2022/12/15/prisons-cant-afford-hep-... Branded prescription drug prices are high mainly due to patent rights. But without patent exclusivity, most of those drugs wouldn't have been developed in the first place. It now often costs $1B+ to take a new candidate drug through phase-3 clinical trials; that money has to come from somewhere and private companies won't invest in that research unless they can expect to profit. The countries which impose strict price caps on prescription drugs generally don't do much new drug development. For example, during the past few years US drug companies have launched about twice as many new drugs compared to European countries. https://www.efpia.eu/publications/downloads/efpia/the-pharmaceutical-industry-in-figures https://www.efpia.eu/publications/downloads/efpia/the-pharma...