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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

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.
      - ipython 3y ago
        I’ll be honest when I don’t have an urgent issue it’s hard to layer on additional mental load to compare prices. When my wife was diagnosed with cancer, how do I realistically compare prices? What services should I ask them to quote? How do I know what to ask for? How do I realistically compare two offers? What if they left out an important part of care that the other side included? What single entity even has all the information I need? For example even for a single outpatient surgery you have to include the hospital cost, the surgeons cost, the anesthesiologist, and that’s just what I can think of off the cuff. each one of those entities has their own billing department, costs etc. so who do I call?
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.

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.
    - ipython 3y ago
      I’ll be honest when I don’t have an urgent issue it’s hard to layer on additional mental load to compare prices. When my wife was diagnosed with cancer, how do I realistically compare prices? What services should I ask them to quote? How do I know what to ask for? How do I realistically compare two offers? What if they left out an important part of care that the other side included? What single entity even has all the information I need? For example even for a single outpatient surgery you have to include the hospital cost, the surgeons cost, the anesthesiologist, and that’s just what I can think of off the cuff. each one of those entities has their own billing department, costs etc. so who do I call?

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.