13 ms·

Why an MRI costs $1,080 in America and $280 in France

241 points by Flemlord 15y ago

rsanchez1 15y ago
Anyone who has insurance doesn't care about the price. They only care about the deductible. When people shop around, they look for the insurance companies that provide the lowest deductibles and stick with them. After that, there's no pressure on the providers to lower prices. The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles. The providers can increase the price without fearing that patients will go to a different clinic or buy a different generic version of their drug. Medical care in the US is one of the only industries where raising the price can get your more customers, since it makes the government push for universal health insurance to keep deductibles low. There are a few solutions, two of which were mentioned in the article. The insurance companies can negotiate prices with providers, or the government can set the price. A third option is to let the patients themselves set the price by having them shop around. The patients would put pressures on the providers by going where they can get the cheapest MRI or the cheapest Lipitor. Then insurance would be reserved for emergency procedures, instead of being used as a medical credit card.
- Vivtek 15y ago
  I've heard this before. Do you think that Germans or the French end users care about the price? No - they're insured far better than any American without a (D) or (R) after their name. They just _go to the doctor when they're sick_. Period.
  - yummyfajitas 15y ago
    So France and Germany have some non-price rationing mechanism. Whatever mechanism they have, it causes them to half less than half as many MRI's (per capita) than the US. http://www.oecd-ilibrary.org/docserver/download/fulltext/8111101ec030.pdf?expires=1330842805&id=id&accname=guest&checksum=326DE1604FB53303F3F1E0EA2AC5C3D3 http://www.oecd-ilibrary.org/docserver/download/fulltext/811...
    - Cass 15y ago
      MRIs in Germany (or at least my part of it) tend to be relatively rare and booked almost completely full, because with the prices the way they are, they're not profitable unless they're utilized as much as physically possible. There's therefore usually a waiting period of a few days for a non-emergency MRI, which tends to make them a less attractive option for doctors and patients than they might be if they were instantly available. On top of that, they're still relatively pricy compared to other diagnostic procedures, and in Germany, a doctor or hospital who prescribes too many expensive procedures may get personally stuck with the cost, instead of being able to pass them on to the patient or insurer.
    - danmaz74 15y ago
      Just how many of those MRIs in the US are done without insurance or medicare - ie, are subjected to price rationing mechanisms? Moreover, in a system like the US health care the "average" isn't very meaningful, because if you and I have a sore knee, and you get 2 MRIs per year, and I get none, well...
- jrwoodruff 15y ago
  I don't know about you, but next time I need an emergency room or surgical procedure, I'm not going to be shopping for the cheapest one. The article addressed this - how do you 'shop around' when you're under anesthesia, and would you really hire the cheapest doctor to diagnose your daughters life threatening ailment? It just doesn't play out in reality.
  - davidhollander 15y ago
    Yes, most agree that security against unexpected and unpredictable costs, such as emergency room visits and catastrophic illness, is the proper role of insurance. However, for drugs, chronic treatment, and preventative procedures, costs would much lower if consumers were allowed to shop around and haggle prices without going through insurance. This is why you see certain operations like Lasik, which are elective and not covered by anyone's insurance, becoming highly roboticized and deflating in cost rather than inflating. http://www.youtube.com/watch?v=3WnS96NVlMI http://www.youtube.com/watch?v=3WnS96NVlMI
  - mark_up 15y ago
    Next time, read the comment you decide to respond to it. He clearly says that one would shop around only for non-emergency procedures.
  - yummyfajitas 15y ago
    Most medical procedures are not emergent. It's hard to shop around for emergency care, but shopping around for everything else is pretty straightforward. We have strong experimental evidence that when people are not insulated from price, they shop around and consume less medicine with no measurable effect on their health. http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html
    - mikebike 15y ago
      This article suggests that shopping around for, say, knee replacement surgery, is not so simple: http://www.washingtonpost.com/blogs/ezra-klein/post/how-much-is-that-surgery-in-the-window/2011/10/25/gIQAsdZaGM_blog.html http://www.washingtonpost.com/blogs/ezra-klein/post/how-much...
- tibbon 15y ago
  You make a good point, in that the end users in the US just care about the deductible. Part of this is that its hard (if not impossible) to find out what something will cost. The doctors don't (or rarely) know the cost, and it just isn't in the standard vocabulary of patients to inquire the cost and/or shop around.
- phreanix 15y ago
  "The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles." I'm sorry, this is wrong. The insurance companies actually DO negotiate lower prices. I recently had surgery and through my billing statements watched as first the hospital attempted to charge an obscene amount (that would have bankrupted me several times over had I not had insurance), then having my insurance company go through every line in the bill to let them know the max amt they will pay for each service provided. This was recently Reported on, I'll try and find the article.
dhughes 15y ago
If there was medical procedure that would cost a lot in a hospital an MRI would not surprise me, it such a large powerful, power hungry, complex device I can't see how it couldn't. I wish each person could get access to an MRI each year it would be nice to track your health visually.
- ocdprogrammer 15y ago
  Everything is big in USA. Even the MRI's. We in Europe developed some smaller MRIs. They are cheaper and have better mileage per gallon but are very uncomfortable.
- yummyfajitas 15y ago
  The capital costs for an MRI, while large, are not the biggest part of the price. I had an MRI done in Pune (with a good machine, 3T/32 channels) for 6500rs/$130. Labor costs are a biggie. In the US, you need to pay technicians high US salaries, in the $60-70k neighborhood from what I hear. In Pune, the technician is almost certainly poorer than 95% of Americans. The high ratio of capital costs/labor costs also causes higher utilization of the MRI - in the US, many MRI places are 9-6, I had my MRI done in Pune at 9:30pm, and someone went in after I finished. Labor costs are actually a much bigger deal than GDP figures would suggest. High skill individuals get a much bigger premium in the US than most of the rest of the world. A top 1% person in the US gets $384k/year, in Canada only $181k. http://www.statcan.gc.ca/pub/75-001-x/2007109/article/4096885-eng.htm http://www.statcan.gc.ca/pub/75-001-x/2007109/article/409688... http://www.nytimes.com/2007/03/29/business/29tax.html http://www.nytimes.com/2007/03/29/business/29tax.html
  - Anechoic 15y ago
    in the US, many MRI places are 9-6 A nit, but is this actually true? I've had 7 MRI's (5 health-related, 2 research-related) and only one of them was during business hours. I've had MRIs done at 9pm, 11pm, 1am, 4:30am, 6am etc.
    - yummyfajitas 15y ago
niels_olson 15y ago
Just a plug for Paul Starr's The Social Transformation of American Medicine. It's the definitive text on healthcare in America. After that, all the other writing is quaint. On a separate note, you should have seen the fear on the faces of the retired English couple I saw today when I sent the poor man to the ER. They're here on vacation, he had an MI 15 years ago, ran out of his aspirin a month ago on vacation, now he has had vertigo for a week (stumbling like a drink) and new onset high blood pressure. Never paid a dime for healthcare and I just sent them to the lion's den. I reimbursed them the cost of my office visit, but that will be a drop in the bucket.
InclinedPlane 15y ago
US: 91.2 MRI scans per year per 1,000 population France: 21.8 MRI scans per year per 1,000 population
- Aloisius 15y ago
  Shouldn't that make the cost in the US go down? After your fixed investment, the only thing you are paying for is the person running the machine.
  - true_religion 15y ago
    Not necessarily, if the person running the machine or the person screening the results has to be a trained medical professional. In those cases, due to monopoly and other concerns, we'd have a supply bottleneck which would increase price given increased demands. I don't however know if you have to be medically trained to use a MRI machine, or interpret the results
    - foogoo1 15y ago
      One obviously has to be trained to use the MRI machine, and that person is local. But the interpretation is even now not done on site. Low bandwidth costs mean that it can be done halfway around the world.
    - Cass 15y ago
      You don't need to be a doctor to run an MRI scan, but you do need to be one to interpret the results. In addition, you should really have at least one doctor around to decide exactly what you need to MRI in which way for optimal results for any given clinical problem, as the doctors who ordered the MRI done aren't usually specialists in that area.
  - InclinedPlane 15y ago
    In order to have access to an MRI scan you need to have a machine that's geographically close. If the nearest machine is 100 miles away the bar on what will justify a scan goes way up compared to if a machine is an elevator ride away. Buying more machines costs more money.
aculver 15y ago
For what it's worth, it's ~$160 in Japan. (http://www.npr.org/templates/story/story.php?storyId=120545569 http://www.npr.org/templates/story/story.php?storyId=1205455...) Interesting seeing this here on HN after my wife and I just finished watching "Frontline: Sick in America" on Netflix tonight, in which an American reporter travels to 5 countries that provide some form of universal healthcare to discuss (with doctors, administrators, and patients) the different mechanics, what percentage of GDP they spend on healthcare, what wait times and gate keeper policies are like, what financial issues exist, etc. The fixed, negotiated price for MRIs was one of the things he discusses. (http://movies.netflix.com/WiMovie/Frontline_Sick_Around_the_World/70098734?trkid=2361637 http://movies.netflix.com/WiMovie/Frontline_Sick_Around_the_...) I grew up with nationalized healthcare, but found the documentary quite informative.
- rdl 15y ago
  MRI specifically is overused and kind of crappy in Japan. In the rest of the world, the standard is for a 1-3T MR study; in Japan, you get a lot of 0.5 and even lower (0.2T! wtf) MR studies. They're used for a lot of health screenings, whereas in the rest of the world they're more often used for actual problems.
  - justinsb 15y ago
    Is this because as the price drops more applications become cost-effective?
    - yummyfajitas 15y ago
      From what I've been told (I used to do research in MRI), it's because MRI's are Japan's preferred method for allowing doctors to show they care. MRI's are used in Japan the way antibiotics are used in the US. Patients are often unsatisfied if the doctor tell them to go rest and hope things improve on their own (even if that is the best treatment), so doctors perform some harmless token medical procedure to make the patient feel he helped them.
      - 15y ago
tzs 15y ago
What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways. For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the government, then I could understand the US rejecting that as being too much government intrusion. (Note I didn't say I'd necessarily agree with such rejection--good health care arguably is more important than limited government power--I'm just saying I could understand such rejection). But looking around, what stands out is how diverse the approaches of other countries are. There are some that do have the government finance and provide health care, much the way the police or military are provided by the government. There are some that use private insurers paying, with care provided by private hospitals and doctors, but the insurance companies are non-profit and regulated. There are some that provide care via private hospitals and doctors, but have a government run insurance program to pay for it. There was a good look at how it is done in 5 capitalist democracies here: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/ http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/c... See also the link on that page to the explanation of the four basic models used around the world. That page includes a striking way to explain the other systems to Americans: These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.
- baddox 15y ago
  > good health care arguably is more important than limited government power Of course, even that only applies if increasing government power will even improve healthcare (in the long and/or short run), and if increasing government power won't have ancillary negative effects that counter the improvement in healthcare.
droithomme 15y ago
The US has inexpensive MRIs as well. This nationwide chain provides MRIs as low as $335 depending on the state. http://a2zimaging.com/ http://a2zimaging.com/ No insurance accepted, no payment plans. Those cost money. Just charges the cost.
- muhfuhkuh 15y ago
  In Florida, you can get an MRI plus a prescription written and filled for Oxycontin at a "Pain Management" clinic for less than $500[1]. [1] Vanguard documentary "Oxycontin Express": http://www.youtube.com/watch?v=J7DHMqHFSB8#t=1250s http://www.youtube.com/watch?v=J7DHMqHFSB8#t=1250s
- underwater 15y ago
  As someone who had insurance that doesn't help me. I might not have a pay out of pocket for an MRI but I'm still having to pay for it through higher charges. I'm unable to shop around to reduce the insurance company's (and therefore my own) costs.
- anateus 15y ago
  Similarly MedLion (http://www.medlion.com/ http://www.medlion.com/) provides primary care in Santa Cruz and Silicon Valley for $59/mo + $10 visit in part by not accepting insurance (they claim on their website it saves them 40% in costs). Insurance works great for catastrophic things, just like car insurance and then it clearly makes sense to make it universal. If you could only buy gas through your car insurance--who occasionally would decide you drive too much and not cover this months' gas--you can bet prices would go sky high.
  - danmaz74 15y ago
    I'm all in favor of universal health care, but having universal (private) insurance without a collective bargaining system raises a lot of problems. For example, here in Italy car insurance is mandatory, but people choose where to make their car repairs, and prices aren't regulated in any way. The results: Once I went for a repair, and got quoted something like 150€ - I told the repairman I thought I was covered by my insurance. Then I discovered that particular problem wasn't covered, and well - the prices magically came down to 70€ "You know sir, with insurances we have all those additional costs...".
jenhsun 15y ago
Here is Taiwan's: PET(full body): 1500 USD, CT(head/partial): 200 USD, MRI(head/partial): 670 USD
mindcrime 15y ago
Can't believe they didn't even mention the Monopoly Protection Certificate racket run by the government in many states: http://en.wikipedia.org/wiki/Certificate_of_need http://en.wikipedia.org/wiki/Certificate_of_need And never mind the huge monopoly granted to AMA certified physicians, in terms of providing medical care. Of course those guys have a huge incentive to keep as many people out of the physician pool as possible. We certainly couldn't allow competition, which might drive down costs. :~(
- prostoalex 15y ago
  The labor costs would vary from country to country. The article questions the price of a service performed by machine (that supposedly differs very little from country to country).
  - hudibras 15y ago
    So why doesn't the U.S. allow doctors to immigrate to this country? The median American MD makes $143K; I'm sure that plenty of foreign doctors would love to come here and make half that.
    - ktizo 15y ago
      Well, I suppose protectionism does have to have some unintended benefits for the rest of the world.
    - prostoalex 15y ago
      There's no specific provision disallowing immigration of doctors. For obvious reasons it's an occupation that requires licensing/certification, which is more cumbersome than many are willing to consider, and reasonable English, which is usually not a priority in medical schools around the world.
- jaems33 15y ago
  http://www.quora.com/Why-dont-we-train-more-doctors http://www.quora.com/Why-dont-we-train-more-doctors
knieveltech 15y ago
How does this come as a suprise? We're paying to support the margins of for-profit industries, including multiple tiers of middle-men.
nhebb 15y ago
The problem with studies like this is that they pick a single issue within healthcare and try to make a broad assessment from it. There have been other studies that break down the overall costs of health car in the US that are more informative. It's four years old, but this McKinsey study is a good example: http://www.mckinsey.com/Insights/MGI/Research/Americas/Accounting_for_the_cost_of_US_health_care http://www.mckinsey.com/Insights/MGI/Research/Americas/Accou... The Interactive Flash slide show is interesting as well (where "interactive" is defined as clicking forward and back buttons, I guess).
jostmey 15y ago
I once had to have a CAT scan done. I was really scared. I asked how much it would cost. No one was able to tell me! I was told the price would be negotiated with my health-care provider, if they opted to cover the procedure. How can there be competition when no-one can give you the price of the procedure? Seriously WTF.
- Cadsby 15y ago
  This is because no one is quite sure what it should cost. Literally. The hospital will try and charge whatever wild number they can get away with, and the insurance company will negotiate it down to whatever they feel they're willing to pay. My wife is a nurse and has seen this play out multiple times with patients and their families. Just to give you an idea of how disconnected the price is from logical factors, consider this - If the hospital bills the insurance company they might charge $1000 for the scan. If they bill you directly, (always after you've had the procedure of course), you will be charge much much more, say $3000. Why? Because it's next to impossible for you as an individual impossible to negotiate the price before hand. (How would you know what a fair price is? And are you really go to say no to a procedure that might be critical for your health?)
  - jostmey 15y ago
    I have never been inclined to additional government regulation. I think it is bad for society in so many ways. But when it comes to the Medical industry I am not so sure. I wish there were a law that Hospitals have to be able to quote the price of any procedure within a few hours after the patient asks for it.
  - underwater 15y ago
    People argue that the current system works because capitalism is more efficient. But when the prices are hidden from the customer by either fudging prices or hiding costs behind a fixed fee in the form of insurance the system is broken.
    - baq 15y ago
darksaga 15y ago
"The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it." This is probably the same reason we've taken close to 40 years to finally try and get off our dependence on foreign oil after Jimmy Carter said we needed to in 1978. Yet, we still pay more than we really should and haven't done anything about it. Why? Lobbyists, too many layers of bureaucracy, special interest groups. Take your pick, but at the end of day, it takes a lot of people wanting to do the right thing to make things change. In this country, that's a lot harder to do than most people think.
- redwood 15y ago
  One note here: we pay less for petrol than any other developing country, which makes it harder for alternatives to make economic sense.
  - rfrey 15y ago
    Did you mean "developed countries"? Because I got tired of copying Wikipedia (http://en.wikipedia.org/wiki/Gasoline_and_diesel_usage_and_pricing http://en.wikipedia.org/wiki/Gasoline_and_diesel_usage_and_p...) after: Country US$ / US Gallon U.S. $3.74 Vietnam $1.03 Yemen $2.76 Turkmenistan $0.72 Tunisia $3.75 Trinidad $2.42 Taiwan $3.78 Syria $3.15 Saudi Arabia $0.49 Quatar $0.83 Puerto Rico $3.63 Peru $3.60 Panama $3.14 Pakistan $3.46 Malaysia $2.31 Indonesia $2.23 Egypt $1.17
    - vacri 15y ago
      He did mean developed country. The US pays about two-thirds what Australians do for petrol, who in turn pay about two-third what Europeans do for petrol. The panic that the US gets itself into when discussing fuel prices is amusing to watch. Australia is a big country with spread out cities like the US (or even more than the US) and similar wage levels, yet we don't have problems with post-paying cash for our fuel. In six weeks of driving around the US west a couple of years ago, I never found a single place where I could post-pay with cash - they were all too afraid of drive-offs. Weird. Also, you've mangled the statistics - for example, you've used Vietnam's price per litre against the US's price per gallon.
asmithmd1 15y ago
High health care spending is yet another way the US subsidizes other countries. From the article: "This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.” In the past 30 years have you heard of any medical innovation or drugs coming from anywhere other than the US? Of course the MRI machine was itself invented in the US: http://web.mit.edu/invent/a-winners/a-damadian.html http://web.mit.edu/invent/a-winners/a-damadian.html
- illumen 15y ago
  "In the past 30 years have you heard of any medical innovation or drugs coming from anywhere other than the US?" Of course there is plenty of good medical stuff coming from many countries other than the USA. The market for medical care world wide is way larger outside the USA too. Finally, much medical research is multi national and collaborative.
  - jandrewrogers 15y ago
    A fact I find distressing is that the poster is largely correct. Somewhere around 70% of biomedical R&D is done in the US, the utter dominance of the US in this market is not controversial. Most of the rest is done in Asia. The biomedical R&D done in Europe is rapidly approaching a rounding error. I, for one, do not like the fact that the entire world is dependent on the biomedical R&D of US companies. Yet that is the current state of affairs. And the private companies in the US spend money on this research that dwarfs what all but a few countries spend. I wish more people would acknowledge this reality. I like biomedical technology advancement. Most of it is developed in the US because it is the one of the few countries that can absorb the cost of the R&D. If the US stops doing it, who is going to pick it up? There is ample evidence that the answer is "a little bit in Asia and nowhere else". That should be frightening to people. Biomedical R&D is important. Ignore for the moment that the US healthcare system is a wreck. The fact remains that the majority of biomedical advances come out of the US because it is the only country where people absorb the R&D cost. If Europe was pulling its weight with biomedical R&D it would be one thing but in practice it is producing so little in that regard that it is kind of shameful. If we eliminate US biomedical R&D by eliminating their ability to recover costs, who picks up the slack? There are no easy answers.
foogoo1 15y ago
FWIW, its roughly $100 or even less in India. Granted, the quality of medical care varies by a lot in India, but there are places and doctors in India who are so good, that if I am sick, all I want to do is take a flight back home... The lack of health insurance in general in India ( now, it is being sold to a growing section of the population ) has meant that prices are comparitively lower ( though, they are really rising these days ).
zaph0d 15y ago
... and it costs 200 USD in India.
cynix 15y ago
It's free in Australia.
visarg 15y ago
Because in USA the business part of health is more important than the health part.
deleted 15y ago
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cpeterso 15y ago
Not only do Americans spend more per-capita on health care than Canadians, the American government spends more per-capita on health care than the Canadian government. And yet Americans still need private medical insurance. And depending on how you count, more than 60% of American bankruptcies are for unpaid medical bills and about 78% of those people had medical insurance. https://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States https://en.wikipedia.org/wiki/Comparison_of_the_health_care_...
- ktizo 15y ago
  If you combine the money spent on state and federal health programs, the US government spends more per person on what people label 'socialised healthcare' than the UK does as well. Also, last time I checked the numbers on this was towards the end of Bush's presidency, so this is not a recent development.
- jasonlotito 15y ago
  Having lived in Canada for 10 years, and recently moved back to the US because of health care, I can attest that while Canadian health care looks good on paper, it's not. Sure, it's there when you need immediate emergency care. But for anything long term, it's horrendous. Autism, for example, is a perfect example, and something I know first hand. In Quebec? The best thing you can do for autistic children is to leave and get out of there. My wife, a Canadian, was afraid when she first heard about US healthcare, but when she finally got to experience first hand the full brunt of the system, she despised it. We had more help for my son in the first 2 weeks of being in the US then he'd had in more than year fighting for it in Canada. To top this all off, Canada still has private insurance, and while you don't need it, if you don't have it, it makes for much lower quality of care (and don't think the public option covers essentials, either). So, no. I could never put my sons through a system like that again. It was down right abuse, and I don't use that word lightly.
  - jaems33 15y ago
    Different strokes. Having lived in both countries, my experience in the U.S. was less than ideal. About the same amount of wait times as in Canada, and the doctors I saw gave me very little options as to how I could treat one of my chronic injuries. Never suggested a follow up appointment, physio, or even x-rays/MRI's to get a better look. In Canada, they recommended me a specialist, and I have a nurse at a clinic who has built a great relationship with me to assess my needs when I need help, as well as x-rays/MRI's done within a week. My experience isn't like all in Canada or the U.S. but after touting how much better I thought the U.S. would be because of my great insurance and living in one of the top cities in the country, I wasn't impressed at all.
FameofLight 15y ago
$25 in government hospital in India. $100 in Private ones.
18pfsmt 15y ago
Without yet reading any of the other comments, I have an anecdote that may be interesting to others: One of my father's business partners has a mother that lives in France. She is ~88 years old, and the family's net-worth is on the order of 100s of millions ($USD). She had a medical condition which required surgery, but due to her age, she was not eligible in France, so she had to come to the US for her surgery. So, it seems like the phrase, "The US has the best healthcare money can buy" still stands. [I will now read the other 80 comments...]
- agravier 15y ago
  Could it be that the surgery was deemed too risky to perform on an 88 years old person by french surgeons, and not by the american ones? I have heard similar stories, and that was the case.
- nooop 15y ago
  > but due to her age, she was not eligible in France I call bullshit on that. Due to general condition maybe, but if you are in great shape except on one risky point and the risk of treatment seems acceptable you are not going to be refused treatment because you are too old.
  - 18pfsmt 15y ago
    Well, she was. She was deemed too old to receive the organ transplant, and the fact that she was willing to pay extra didn't matter. She is now 95.
dutchbrit 15y ago
And that's why Obama's public healthcare idea was good.
- rsynnott 15y ago
  The watered-down implementation, though, may not stand up; as mentioned in the article, it will do little about prices besides force provider disclosure (itself an important step, as markets operate more efficiently when it's known what things cost, but not really enough).
deleted 15y ago
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Craiggybear 15y ago
You want to hear David Sedaris on this. He was amazed that his visits to the dentist and to hospitals in France where so cheap they didn't even bother to charge him. He had to force them to bill him and it would be for tens not hundreds or thousands of dollars. Social medicine works in Europe and in Cuba, where I've also seen it first hand. This is why it is so important to preserve the NHS here in the UK.
shingen 15y ago
Want to get our costs down to competitive levels? 85% of all healthcare costs in America are for those over the age of 65. America has the leading health care system for the elderly. We pay for 80 year olds to have surgeries that they can't get in Canada or France. Nobody wants to talk about it though, because it's not a nice thing to say, that grandma is buying six extra months at a price of a million in treatment. Socialized medicine will slice the most money out of treatment for people in that demographic. It's by far the largest savings spot. Good or bad, you can debate that endlessly; but that's exactly what will happen.
- phren0logy 15y ago
  Although I disagree with your flippant tone, it's a fact that over 30% of medical costs come from care delivered in the last 6 months of life. Obviously you'd expect some top-heaviness here, but it makes one wonder about the cost of futile care (both in $$ and human suffering).
  - shingen 15y ago
    It wasn't meant to be flippant (or insensitive), just matter of fact. My grandmother extended her life by about eight months by having breast cancer surgery at 87 or so. Was that ok? Personally I loved my grandmother. However, it was paid for by taxpayers. Her quality of life was terrible in those last eight months, but she did want to keep fighting to live. It's an extremely sensitive issue to debate on either side. The obvious bottom line is that we can't keep having our cake and eating it too.
- s_henry_paulson 15y ago
  Not true. The largest savings would be in not having to deal with the administrative overhead of our current system. A full 1/3 of the cost of healthcare in America goes into maintaining our system and not into actual patient care.
  - yummyfajitas 15y ago
    Um, no. Patient care is the biggest culprit in US overspending on medicine. Administrative overhead is minor. http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-%E2%80%93-conclusion/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...
ramblerman 15y ago
" If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive." Also world peace would break out and poverty would be eliminated. I liked the article, and I think this is most certainly a pressing problem for this country. But the facts are strong enough to independently make a strong case. No need for the hyperbole
deleted 15y ago
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ck2 15y ago
Because if it was $280 in America the insurance ceos, investors, doctors and administrators would not be able to buy their second vacation homes. As long as healthcare is a profit center, you will only have the right to die quietly if you cannot afford it in America.
- shingen 15y ago
  It's a profit center whether you like it or not, with or without the government. With the government the profit goes into the bureaucracy. The medicare + medicaid system has shown itself to be an extreme profit center for government employees and the bureaucracy. They take home massive sums in profit: wages and pensions. The government doesn't make the system more efficient by reducing profit from the equation. They reduce cost by reducing care options, reducing salaries for healthcare workers, and rationing. For example, nurses in America make 50% more than nurses in Germany. Socialized medicine will decimate that pay variance. http://www.worldsalaries.org/professionalnurse.shtml http://www.worldsalaries.org/professionalnurse.shtml There's nothing on earth more wasteful than government when it comes to spending money. Just ask the US government system (fed+state+local), it's a $7 trillion per year profit system, that flows directly into the hands of millions of employees that make on average $100k per year in wages + benefits, with that pay package doubling in size in just the last ten years, while the economy flat lined.
  - njs12345 15y ago
    How do you explain the low costs and relative success internationally of the NHS (in the UK)? I've no problem with a free market approach to healthcare when it works. But it seems hypocritical to criticise our approach for involving too much government intervention (something which supposedly reduces efficiency) as not being suitable for the US when it's more efficient than the current US system.
  - ck2 15y ago
    Except if the government wasn't taking their cut, the private executives would be working on their THIRD vacation homes. The government is a shield against abusive private industry, they just happen to be bad at it and expensive. Giving the government less money won't make it more efficient, just worse at it's job.
known 15y ago
Rates in India's best hospital http://www.aiims.edu/aiims/hosp-serv/hosp-rates/revised-rate-list.htm http://www.aiims.edu/aiims/hosp-serv/hosp-rates/revised-rate...
kingsidharth 15y ago
On a related note, medical toursim is a great business/startup opportunity for other countries. Let them spend a weekend in a new city and get that dental filling done for far less cost. It's $4 in some medical colleges in India.
jksmith 15y ago
I just got my shoulder redone by arguably one of the best sports orthos in the country. This guy handles a substantial percentage of high profile professional athlete cases per year. He charged me $3200 for a rotator repair and bicep reattach. I think that's a bargain for his skill level. My guess is the total bill will be another story though. I suspect my insurance will be dinged for about $11k. O.R. rental, nurse anesthetists who make $150/hr, etc are the source of expensive healthcare in the US, at least for surgery.
DanBC 15y ago
With an increasing elderly population there's a need for a lot more care, especially for people with dementias. Here's one fascinating article about US prisons which face a serious problem. (Caution: contains descriptions of violent crimes.) (http://www.nytimes.com/2012/02/26/health/dealing-with-dementia-among-aging-criminals.html?hp=&pagewanted=all http://www.nytimes.com/2012/02/26/health/dealing-with-dement...) This shows that big improvements in quality of life can be achieved with small changes. Give health care assistants better training about dementia and give them more time to talk to patients. This small cheap change has several benefits: nurses can do more nursing; meals get eaten; falls are reduced; people feel like they're getting better care; etc.
apinstein 15y ago
The article completely ignores structural problems that lead to high prices. Since the US health care market effectively has government price controls (due to Medicare, which is a huge percentage of revenue for most facilities), this causes some perturbations in the market. Pretend you're an optometrist. Historically you got paid well for your time, so you organized your business around seeing as many patients as possible and referring out things like labwork, glasses-making, etc, since you couldn't compete on price with shops that kept their capital equipment busy nearly 24/7. Life is good; you get paid well for your time and your customers get reasonable prices on things like labwork, glasses, etc. Over time, your medicare rates keep dropping. Eventually you actually start losing money when you see medicare patients. You then realize that the labwork/glasses part of the business is pretty high margin, and even if you buy a machine and keep it barely busy, you can still eek out some profit from keeping that work in-house. So you buy some equipment, and instead of referring out labwork and glasses, you start doing it in-house. Again you can finally make money on medicare patients. The medical device companies LOVE this. What better way to expand your market than "invest" (ahem lobby) so that your customers can make money with machines that are only busy 30-50% of the time. That's 2-3x as many devices as if they had 95% utilization, WIN! The doctors won't complain, b/c the system is so messed up that they know it's the only way for them to actually make money. And the insurers can't really do much about it b/c they can't force their patients to go to a different facility as that's too intrusive. So it's kind of a combination of market failure, lobbying, and price-fixing that causes procedures to be way too expensive in the US since the normal market mechanisms that cause prices to approach a small margin over the cost at high capital utilizations to fail. There's a lot more to it than that, but whenever I talk to my many relatives in the medical industry, this is always happening, and it's a major factor in prices. MRI machines aren't cheap (think $1M).
jakeonthemove 15y ago
I always had the idea that American health care is more expensive because there's not much competition - there are just a few major companies that control the pharma industry and the hospitals, and it's pretty much impossible for someone to just barge in and start offering their services at a lower price - they'd have to pass by the government first (with their impossibly high fees and heavy regulations), then if successful, they'd be harrased to bankruptcy by the established monopoly. It's much easier to open a private practice or hospital in the EU, for example...
foreverbanned 15y ago
Reminds me that according this NYT infographic : http://www.nytimes.com/packages/html/newsgraphics/2012/0115-one-percent-occupations/index.html http://www.nytimes.com/packages/html/newsgraphics/2012/0115-... about 20% of physicians are in the top one percent. This is the highest percentage of all occupations.
seanieb 15y ago
GlaxoSmithKilne Ventolin Inhaler USA -$41 Ireland ~$10 France -$10 Canada - $10

241 points by Flemlord 15y ago

Anyone who has insurance doesn't care about the price. They only care about the deductible. When people shop around, they look for the insurance companies that provide the lowest deductibles and stick with them. After that, there's no pressure on the providers to lower prices. The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles. The providers can increase the price without fearing that patients will go to a different clinic or buy a different generic version of their drug. Medical care in the US is one of the only industries where raising the price can get your more customers, since it makes the government push for universal health insurance to keep deductibles low. There are a few solutions, two of which were mentioned in the article. The insurance companies can negotiate prices with providers, or the government can set the price. A third option is to let the patients themselves set the price by having them shop around. The patients would put pressures on the providers by going where they can get the cheapest MRI or the cheapest Lipitor. Then insurance would be reserved for emergency procedures, instead of being used as a medical credit card.

Vivtek 15y ago
I've heard this before. Do you think that Germans or the French end users care about the price? No - they're insured far better than any American without a (D) or (R) after their name. They just _go to the doctor when they're sick_. Period.
- yummyfajitas 15y ago
  So France and Germany have some non-price rationing mechanism. Whatever mechanism they have, it causes them to half less than half as many MRI's (per capita) than the US. http://www.oecd-ilibrary.org/docserver/download/fulltext/8111101ec030.pdf?expires=1330842805&id=id&accname=guest&checksum=326DE1604FB53303F3F1E0EA2AC5C3D3 http://www.oecd-ilibrary.org/docserver/download/fulltext/811...
  - Cass 15y ago
    MRIs in Germany (or at least my part of it) tend to be relatively rare and booked almost completely full, because with the prices the way they are, they're not profitable unless they're utilized as much as physically possible. There's therefore usually a waiting period of a few days for a non-emergency MRI, which tends to make them a less attractive option for doctors and patients than they might be if they were instantly available. On top of that, they're still relatively pricy compared to other diagnostic procedures, and in Germany, a doctor or hospital who prescribes too many expensive procedures may get personally stuck with the cost, instead of being able to pass them on to the patient or insurer.
  - danmaz74 15y ago
    Just how many of those MRIs in the US are done without insurance or medicare - ie, are subjected to price rationing mechanisms? Moreover, in a system like the US health care the "average" isn't very meaningful, because if you and I have a sore knee, and you get 2 MRIs per year, and I get none, well...
jrwoodruff 15y ago
I don't know about you, but next time I need an emergency room or surgical procedure, I'm not going to be shopping for the cheapest one. The article addressed this - how do you 'shop around' when you're under anesthesia, and would you really hire the cheapest doctor to diagnose your daughters life threatening ailment? It just doesn't play out in reality.
- davidhollander 15y ago
  Yes, most agree that security against unexpected and unpredictable costs, such as emergency room visits and catastrophic illness, is the proper role of insurance. However, for drugs, chronic treatment, and preventative procedures, costs would much lower if consumers were allowed to shop around and haggle prices without going through insurance. This is why you see certain operations like Lasik, which are elective and not covered by anyone's insurance, becoming highly roboticized and deflating in cost rather than inflating. http://www.youtube.com/watch?v=3WnS96NVlMI http://www.youtube.com/watch?v=3WnS96NVlMI
- mark_up 15y ago
  Next time, read the comment you decide to respond to it. He clearly says that one would shop around only for non-emergency procedures.
- yummyfajitas 15y ago
  Most medical procedures are not emergent. It's hard to shop around for emergency care, but shopping around for everything else is pretty straightforward. We have strong experimental evidence that when people are not insulated from price, they shop around and consume less medicine with no measurable effect on their health. http://www.rand.org/health/projects/hie.html http://www.rand.org/health/projects/hie.html
  - mikebike 15y ago
    This article suggests that shopping around for, say, knee replacement surgery, is not so simple: http://www.washingtonpost.com/blogs/ezra-klein/post/how-much-is-that-surgery-in-the-window/2011/10/25/gIQAsdZaGM_blog.html http://www.washingtonpost.com/blogs/ezra-klein/post/how-much...
tibbon 15y ago
You make a good point, in that the end users in the US just care about the deductible. Part of this is that its hard (if not impossible) to find out what something will cost. The doctors don't (or rarely) know the cost, and it just isn't in the standard vocabulary of patients to inquire the cost and/or shop around.
phreanix 15y ago
"The insurance companies in the US don't negotiate lower prices, they just pass on the cost to policy holders in their deductibles." I'm sorry, this is wrong. The insurance companies actually DO negotiate lower prices. I recently had surgery and through my billing statements watched as first the hospital attempted to charge an obscene amount (that would have bankrupted me several times over had I not had insurance), then having my insurance company go through every line in the bill to let them know the max amt they will pay for each service provided. This was recently Reported on, I'll try and find the article.

dhughes 15y ago

If there was medical procedure that would cost a lot in a hospital an MRI would not surprise me, it such a large powerful, power hungry, complex device I can't see how it couldn't. I wish each person could get access to an MRI each year it would be nice to track your health visually.

ocdprogrammer 15y ago
Everything is big in USA. Even the MRI's. We in Europe developed some smaller MRIs. They are cheaper and have better mileage per gallon but are very uncomfortable.
yummyfajitas 15y ago
The capital costs for an MRI, while large, are not the biggest part of the price. I had an MRI done in Pune (with a good machine, 3T/32 channels) for 6500rs/$130. Labor costs are a biggie. In the US, you need to pay technicians high US salaries, in the $60-70k neighborhood from what I hear. In Pune, the technician is almost certainly poorer than 95% of Americans. The high ratio of capital costs/labor costs also causes higher utilization of the MRI - in the US, many MRI places are 9-6, I had my MRI done in Pune at 9:30pm, and someone went in after I finished. Labor costs are actually a much bigger deal than GDP figures would suggest. High skill individuals get a much bigger premium in the US than most of the rest of the world. A top 1% person in the US gets $384k/year, in Canada only $181k. http://www.statcan.gc.ca/pub/75-001-x/2007109/article/4096885-eng.htm http://www.statcan.gc.ca/pub/75-001-x/2007109/article/409688... http://www.nytimes.com/2007/03/29/business/29tax.html http://www.nytimes.com/2007/03/29/business/29tax.html
- Anechoic 15y ago
  in the US, many MRI places are 9-6 A nit, but is this actually true? I've had 7 MRI's (5 health-related, 2 research-related) and only one of them was during business hours. I've had MRIs done at 9pm, 11pm, 1am, 4:30am, 6am etc.
  - yummyfajitas 15y ago

niels_olson 15y ago

Just a plug for Paul Starr's The Social Transformation of American Medicine. It's the definitive text on healthcare in America. After that, all the other writing is quaint. On a separate note, you should have seen the fear on the faces of the retired English couple I saw today when I sent the poor man to the ER. They're here on vacation, he had an MI 15 years ago, ran out of his aspirin a month ago on vacation, now he has had vertigo for a week (stumbling like a drink) and new onset high blood pressure. Never paid a dime for healthcare and I just sent them to the lion's den. I reimbursed them the cost of my office visit, but that will be a drop in the bucket.

InclinedPlane 15y ago

US: 91.2 MRI scans per year per 1,000 population France: 21.8 MRI scans per year per 1,000 population

Aloisius 15y ago
Shouldn't that make the cost in the US go down? After your fixed investment, the only thing you are paying for is the person running the machine.
- true_religion 15y ago
  Not necessarily, if the person running the machine or the person screening the results has to be a trained medical professional. In those cases, due to monopoly and other concerns, we'd have a supply bottleneck which would increase price given increased demands. I don't however know if you have to be medically trained to use a MRI machine, or interpret the results
  - foogoo1 15y ago
    One obviously has to be trained to use the MRI machine, and that person is local. But the interpretation is even now not done on site. Low bandwidth costs mean that it can be done halfway around the world.
  - Cass 15y ago
    You don't need to be a doctor to run an MRI scan, but you do need to be one to interpret the results. In addition, you should really have at least one doctor around to decide exactly what you need to MRI in which way for optimal results for any given clinical problem, as the doctors who ordered the MRI done aren't usually specialists in that area.
- InclinedPlane 15y ago
  In order to have access to an MRI scan you need to have a machine that's geographically close. If the nearest machine is 100 miles away the bar on what will justify a scan goes way up compared to if a machine is an elevator ride away. Buying more machines costs more money.

aculver 15y ago

For what it's worth, it's ~$160 in Japan. (http://www.npr.org/templates/story/story.php?storyId=120545569 http://www.npr.org/templates/story/story.php?storyId=1205455...) Interesting seeing this here on HN after my wife and I just finished watching "Frontline: Sick in America" on Netflix tonight, in which an American reporter travels to 5 countries that provide some form of universal healthcare to discuss (with doctors, administrators, and patients) the different mechanics, what percentage of GDP they spend on healthcare, what wait times and gate keeper policies are like, what financial issues exist, etc. The fixed, negotiated price for MRIs was one of the things he discusses. (http://movies.netflix.com/WiMovie/Frontline_Sick_Around_the_World/70098734?trkid=2361637 http://movies.netflix.com/WiMovie/Frontline_Sick_Around_the_...) I grew up with nationalized healthcare, but found the documentary quite informative.

rdl 15y ago
MRI specifically is overused and kind of crappy in Japan. In the rest of the world, the standard is for a 1-3T MR study; in Japan, you get a lot of 0.5 and even lower (0.2T! wtf) MR studies. They're used for a lot of health screenings, whereas in the rest of the world they're more often used for actual problems.
- justinsb 15y ago
  Is this because as the price drops more applications become cost-effective?
  - yummyfajitas 15y ago
    From what I've been told (I used to do research in MRI), it's because MRI's are Japan's preferred method for allowing doctors to show they care. MRI's are used in Japan the way antibiotics are used in the US. Patients are often unsatisfied if the doctor tell them to go rest and hope things improve on their own (even if that is the best treatment), so doctors perform some harmless token medical procedure to make the patient feel he helped them.
    - 15y ago

tzs 15y ago

What annoys me as an American about our health care is not that some other countries achieve better outcomes at much lower cost--it is that they do so in so many different ways. For instance, if they all did it by having the government completely run the health care system, with all doctors working for government hospitals and clinics, and being trained in government medical schools, with all costs set by the government, then I could understand the US rejecting that as being too much government intrusion. (Note I didn't say I'd necessarily agree with such rejection--good health care arguably is more important than limited government power--I'm just saying I could understand such rejection). But looking around, what stands out is how diverse the approaches of other countries are. There are some that do have the government finance and provide health care, much the way the police or military are provided by the government. There are some that use private insurers paying, with care provided by private hospitals and doctors, but the insurance companies are non-profit and regulated. There are some that provide care via private hospitals and doctors, but have a government run insurance program to pay for it. There was a good look at how it is done in 5 capitalist democracies here: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/ http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/c... See also the link on that page to the explanation of the four basic models used around the world. That page includes a striking way to explain the other systems to Americans: These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany. For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.

baddox 15y ago
> good health care arguably is more important than limited government power Of course, even that only applies if increasing government power will even improve healthcare (in the long and/or short run), and if increasing government power won't have ancillary negative effects that counter the improvement in healthcare.

droithomme 15y ago

The US has inexpensive MRIs as well. This nationwide chain provides MRIs as low as $335 depending on the state. http://a2zimaging.com/ http://a2zimaging.com/ No insurance accepted, no payment plans. Those cost money. Just charges the cost.

muhfuhkuh 15y ago
In Florida, you can get an MRI plus a prescription written and filled for Oxycontin at a "Pain Management" clinic for less than $500[1]. [1] Vanguard documentary "Oxycontin Express": http://www.youtube.com/watch?v=J7DHMqHFSB8#t=1250s http://www.youtube.com/watch?v=J7DHMqHFSB8#t=1250s
underwater 15y ago
As someone who had insurance that doesn't help me. I might not have a pay out of pocket for an MRI but I'm still having to pay for it through higher charges. I'm unable to shop around to reduce the insurance company's (and therefore my own) costs.
anateus 15y ago
Similarly MedLion (http://www.medlion.com/ http://www.medlion.com/) provides primary care in Santa Cruz and Silicon Valley for $59/mo + $10 visit in part by not accepting insurance (they claim on their website it saves them 40% in costs). Insurance works great for catastrophic things, just like car insurance and then it clearly makes sense to make it universal. If you could only buy gas through your car insurance--who occasionally would decide you drive too much and not cover this months' gas--you can bet prices would go sky high.
- danmaz74 15y ago
  I'm all in favor of universal health care, but having universal (private) insurance without a collective bargaining system raises a lot of problems. For example, here in Italy car insurance is mandatory, but people choose where to make their car repairs, and prices aren't regulated in any way. The results: Once I went for a repair, and got quoted something like 150€ - I told the repairman I thought I was covered by my insurance. Then I discovered that particular problem wasn't covered, and well - the prices magically came down to 70€ "You know sir, with insurances we have all those additional costs...".

jenhsun 15y ago

Here is Taiwan's: PET(full body): 1500 USD, CT(head/partial): 200 USD, MRI(head/partial): 670 USD

mindcrime 15y ago

Can't believe they didn't even mention the Monopoly Protection Certificate racket run by the government in many states: http://en.wikipedia.org/wiki/Certificate_of_need http://en.wikipedia.org/wiki/Certificate_of_need And never mind the huge monopoly granted to AMA certified physicians, in terms of providing medical care. Of course those guys have a huge incentive to keep as many people out of the physician pool as possible. We certainly couldn't allow competition, which might drive down costs. :~(

prostoalex 15y ago
The labor costs would vary from country to country. The article questions the price of a service performed by machine (that supposedly differs very little from country to country).
- hudibras 15y ago
  So why doesn't the U.S. allow doctors to immigrate to this country? The median American MD makes $143K; I'm sure that plenty of foreign doctors would love to come here and make half that.
  - ktizo 15y ago
    Well, I suppose protectionism does have to have some unintended benefits for the rest of the world.
  - prostoalex 15y ago
    There's no specific provision disallowing immigration of doctors. For obvious reasons it's an occupation that requires licensing/certification, which is more cumbersome than many are willing to consider, and reasonable English, which is usually not a priority in medical schools around the world.
jaems33 15y ago
http://www.quora.com/Why-dont-we-train-more-doctors http://www.quora.com/Why-dont-we-train-more-doctors

knieveltech 15y ago

How does this come as a suprise? We're paying to support the margins of for-profit industries, including multiple tiers of middle-men.

nhebb 15y ago

The problem with studies like this is that they pick a single issue within healthcare and try to make a broad assessment from it. There have been other studies that break down the overall costs of health car in the US that are more informative. It's four years old, but this McKinsey study is a good example: http://www.mckinsey.com/Insights/MGI/Research/Americas/Accounting_for_the_cost_of_US_health_care http://www.mckinsey.com/Insights/MGI/Research/Americas/Accou... The Interactive Flash slide show is interesting as well (where "interactive" is defined as clicking forward and back buttons, I guess).

jostmey 15y ago

I once had to have a CAT scan done. I was really scared. I asked how much it would cost. No one was able to tell me! I was told the price would be negotiated with my health-care provider, if they opted to cover the procedure. How can there be competition when no-one can give you the price of the procedure? Seriously WTF.

Cadsby 15y ago
This is because no one is quite sure what it should cost. Literally. The hospital will try and charge whatever wild number they can get away with, and the insurance company will negotiate it down to whatever they feel they're willing to pay. My wife is a nurse and has seen this play out multiple times with patients and their families. Just to give you an idea of how disconnected the price is from logical factors, consider this - If the hospital bills the insurance company they might charge $1000 for the scan. If they bill you directly, (always after you've had the procedure of course), you will be charge much much more, say $3000. Why? Because it's next to impossible for you as an individual impossible to negotiate the price before hand. (How would you know what a fair price is? And are you really go to say no to a procedure that might be critical for your health?)
- jostmey 15y ago
  I have never been inclined to additional government regulation. I think it is bad for society in so many ways. But when it comes to the Medical industry I am not so sure. I wish there were a law that Hospitals have to be able to quote the price of any procedure within a few hours after the patient asks for it.
- underwater 15y ago
  People argue that the current system works because capitalism is more efficient. But when the prices are hidden from the customer by either fudging prices or hiding costs behind a fixed fee in the form of insurance the system is broken.
  - baq 15y ago

darksaga 15y ago

"The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it." This is probably the same reason we've taken close to 40 years to finally try and get off our dependence on foreign oil after Jimmy Carter said we needed to in 1978. Yet, we still pay more than we really should and haven't done anything about it. Why? Lobbyists, too many layers of bureaucracy, special interest groups. Take your pick, but at the end of day, it takes a lot of people wanting to do the right thing to make things change. In this country, that's a lot harder to do than most people think.

redwood 15y ago
One note here: we pay less for petrol than any other developing country, which makes it harder for alternatives to make economic sense.
- rfrey 15y ago
  Did you mean "developed countries"? Because I got tired of copying Wikipedia (http://en.wikipedia.org/wiki/Gasoline_and_diesel_usage_and_pricing http://en.wikipedia.org/wiki/Gasoline_and_diesel_usage_and_p...) after: Country US$ / US Gallon U.S. $3.74 Vietnam $1.03 Yemen $2.76 Turkmenistan $0.72 Tunisia $3.75 Trinidad $2.42 Taiwan $3.78 Syria $3.15 Saudi Arabia $0.49 Quatar $0.83 Puerto Rico $3.63 Peru $3.60 Panama $3.14 Pakistan $3.46 Malaysia $2.31 Indonesia $2.23 Egypt $1.17
  - vacri 15y ago
    He did mean developed country. The US pays about two-thirds what Australians do for petrol, who in turn pay about two-third what Europeans do for petrol. The panic that the US gets itself into when discussing fuel prices is amusing to watch. Australia is a big country with spread out cities like the US (or even more than the US) and similar wage levels, yet we don't have problems with post-paying cash for our fuel. In six weeks of driving around the US west a couple of years ago, I never found a single place where I could post-pay with cash - they were all too afraid of drive-offs. Weird. Also, you've mangled the statistics - for example, you've used Vietnam's price per litre against the US's price per gallon.

asmithmd1 15y ago

High health care spending is yet another way the US subsidizes other countries. From the article: "This is a good deal for residents of other countries, as our high spending makes medical innovations more profitable. “We end up with the benefits of your investment,” Sackville says. “You’re subsidizing the rest of the world by doing the front-end research.” In the past 30 years have you heard of any medical innovation or drugs coming from anywhere other than the US? Of course the MRI machine was itself invented in the US: http://web.mit.edu/invent/a-winners/a-damadian.html http://web.mit.edu/invent/a-winners/a-damadian.html

illumen 15y ago
"In the past 30 years have you heard of any medical innovation or drugs coming from anywhere other than the US?" Of course there is plenty of good medical stuff coming from many countries other than the USA. The market for medical care world wide is way larger outside the USA too. Finally, much medical research is multi national and collaborative.
- jandrewrogers 15y ago
  A fact I find distressing is that the poster is largely correct. Somewhere around 70% of biomedical R&D is done in the US, the utter dominance of the US in this market is not controversial. Most of the rest is done in Asia. The biomedical R&D done in Europe is rapidly approaching a rounding error. I, for one, do not like the fact that the entire world is dependent on the biomedical R&D of US companies. Yet that is the current state of affairs. And the private companies in the US spend money on this research that dwarfs what all but a few countries spend. I wish more people would acknowledge this reality. I like biomedical technology advancement. Most of it is developed in the US because it is the one of the few countries that can absorb the cost of the R&D. If the US stops doing it, who is going to pick it up? There is ample evidence that the answer is "a little bit in Asia and nowhere else". That should be frightening to people. Biomedical R&D is important. Ignore for the moment that the US healthcare system is a wreck. The fact remains that the majority of biomedical advances come out of the US because it is the only country where people absorb the R&D cost. If Europe was pulling its weight with biomedical R&D it would be one thing but in practice it is producing so little in that regard that it is kind of shameful. If we eliminate US biomedical R&D by eliminating their ability to recover costs, who picks up the slack? There are no easy answers.

foogoo1 15y ago

FWIW, its roughly $100 or even less in India. Granted, the quality of medical care varies by a lot in India, but there are places and doctors in India who are so good, that if I am sick, all I want to do is take a flight back home... The lack of health insurance in general in India ( now, it is being sold to a growing section of the population ) has meant that prices are comparitively lower ( though, they are really rising these days ).

zaph0d 15y ago

... and it costs 200 USD in India.

cynix 15y ago

It's free in Australia.

visarg 15y ago

Because in USA the business part of health is more important than the health part.

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cpeterso 15y ago

Not only do Americans spend more per-capita on health care than Canadians, the American government spends more per-capita on health care than the Canadian government. And yet Americans still need private medical insurance. And depending on how you count, more than 60% of American bankruptcies are for unpaid medical bills and about 78% of those people had medical insurance. https://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States https://en.wikipedia.org/wiki/Comparison_of_the_health_care_...

ktizo 15y ago
If you combine the money spent on state and federal health programs, the US government spends more per person on what people label 'socialised healthcare' than the UK does as well. Also, last time I checked the numbers on this was towards the end of Bush's presidency, so this is not a recent development.
jasonlotito 15y ago
Having lived in Canada for 10 years, and recently moved back to the US because of health care, I can attest that while Canadian health care looks good on paper, it's not. Sure, it's there when you need immediate emergency care. But for anything long term, it's horrendous. Autism, for example, is a perfect example, and something I know first hand. In Quebec? The best thing you can do for autistic children is to leave and get out of there. My wife, a Canadian, was afraid when she first heard about US healthcare, but when she finally got to experience first hand the full brunt of the system, she despised it. We had more help for my son in the first 2 weeks of being in the US then he'd had in more than year fighting for it in Canada. To top this all off, Canada still has private insurance, and while you don't need it, if you don't have it, it makes for much lower quality of care (and don't think the public option covers essentials, either). So, no. I could never put my sons through a system like that again. It was down right abuse, and I don't use that word lightly.
- jaems33 15y ago
  Different strokes. Having lived in both countries, my experience in the U.S. was less than ideal. About the same amount of wait times as in Canada, and the doctors I saw gave me very little options as to how I could treat one of my chronic injuries. Never suggested a follow up appointment, physio, or even x-rays/MRI's to get a better look. In Canada, they recommended me a specialist, and I have a nurse at a clinic who has built a great relationship with me to assess my needs when I need help, as well as x-rays/MRI's done within a week. My experience isn't like all in Canada or the U.S. but after touting how much better I thought the U.S. would be because of my great insurance and living in one of the top cities in the country, I wasn't impressed at all.

FameofLight 15y ago

$25 in government hospital in India. $100 in Private ones.

18pfsmt 15y ago

Without yet reading any of the other comments, I have an anecdote that may be interesting to others: One of my father's business partners has a mother that lives in France. She is ~88 years old, and the family's net-worth is on the order of 100s of millions ($USD). She had a medical condition which required surgery, but due to her age, she was not eligible in France, so she had to come to the US for her surgery. So, it seems like the phrase, "The US has the best healthcare money can buy" still stands. [I will now read the other 80 comments...]

agravier 15y ago
Could it be that the surgery was deemed too risky to perform on an 88 years old person by french surgeons, and not by the american ones? I have heard similar stories, and that was the case.
nooop 15y ago
> but due to her age, she was not eligible in France I call bullshit on that. Due to general condition maybe, but if you are in great shape except on one risky point and the risk of treatment seems acceptable you are not going to be refused treatment because you are too old.
- 18pfsmt 15y ago
  Well, she was. She was deemed too old to receive the organ transplant, and the fact that she was willing to pay extra didn't matter. She is now 95.

dutchbrit 15y ago

And that's why Obama's public healthcare idea was good.

rsynnott 15y ago
The watered-down implementation, though, may not stand up; as mentioned in the article, it will do little about prices besides force provider disclosure (itself an important step, as markets operate more efficiently when it's known what things cost, but not really enough).

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Craiggybear 15y ago

You want to hear David Sedaris on this. He was amazed that his visits to the dentist and to hospitals in France where so cheap they didn't even bother to charge him. He had to force them to bill him and it would be for tens not hundreds or thousands of dollars. Social medicine works in Europe and in Cuba, where I've also seen it first hand. This is why it is so important to preserve the NHS here in the UK.

shingen 15y ago

Want to get our costs down to competitive levels? 85% of all healthcare costs in America are for those over the age of 65. America has the leading health care system for the elderly. We pay for 80 year olds to have surgeries that they can't get in Canada or France. Nobody wants to talk about it though, because it's not a nice thing to say, that grandma is buying six extra months at a price of a million in treatment. Socialized medicine will slice the most money out of treatment for people in that demographic. It's by far the largest savings spot. Good or bad, you can debate that endlessly; but that's exactly what will happen.

phren0logy 15y ago
Although I disagree with your flippant tone, it's a fact that over 30% of medical costs come from care delivered in the last 6 months of life. Obviously you'd expect some top-heaviness here, but it makes one wonder about the cost of futile care (both in $$ and human suffering).
- shingen 15y ago
  It wasn't meant to be flippant (or insensitive), just matter of fact. My grandmother extended her life by about eight months by having breast cancer surgery at 87 or so. Was that ok? Personally I loved my grandmother. However, it was paid for by taxpayers. Her quality of life was terrible in those last eight months, but she did want to keep fighting to live. It's an extremely sensitive issue to debate on either side. The obvious bottom line is that we can't keep having our cake and eating it too.
s_henry_paulson 15y ago
Not true. The largest savings would be in not having to deal with the administrative overhead of our current system. A full 1/3 of the cost of healthcare in America goes into maintaining our system and not into actual patient care.
- yummyfajitas 15y ago
  Um, no. Patient care is the biggest culprit in US overspending on medicine. Administrative overhead is minor. http://theincidentaleconomist.com/wordpress/what-makes-the-us-health-care-system-so-expensive-%E2%80%93-conclusion/ http://theincidentaleconomist.com/wordpress/what-makes-the-u...

ramblerman 15y ago

" If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive." Also world peace would break out and poverty would be eliminated. I liked the article, and I think this is most certainly a pressing problem for this country. But the facts are strong enough to independently make a strong case. No need for the hyperbole

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ck2 15y ago

Because if it was $280 in America the insurance ceos, investors, doctors and administrators would not be able to buy their second vacation homes. As long as healthcare is a profit center, you will only have the right to die quietly if you cannot afford it in America.

shingen 15y ago
It's a profit center whether you like it or not, with or without the government. With the government the profit goes into the bureaucracy. The medicare + medicaid system has shown itself to be an extreme profit center for government employees and the bureaucracy. They take home massive sums in profit: wages and pensions. The government doesn't make the system more efficient by reducing profit from the equation. They reduce cost by reducing care options, reducing salaries for healthcare workers, and rationing. For example, nurses in America make 50% more than nurses in Germany. Socialized medicine will decimate that pay variance. http://www.worldsalaries.org/professionalnurse.shtml http://www.worldsalaries.org/professionalnurse.shtml There's nothing on earth more wasteful than government when it comes to spending money. Just ask the US government system (fed+state+local), it's a $7 trillion per year profit system, that flows directly into the hands of millions of employees that make on average $100k per year in wages + benefits, with that pay package doubling in size in just the last ten years, while the economy flat lined.
- njs12345 15y ago
  How do you explain the low costs and relative success internationally of the NHS (in the UK)? I've no problem with a free market approach to healthcare when it works. But it seems hypocritical to criticise our approach for involving too much government intervention (something which supposedly reduces efficiency) as not being suitable for the US when it's more efficient than the current US system.
- ck2 15y ago
  Except if the government wasn't taking their cut, the private executives would be working on their THIRD vacation homes. The government is a shield against abusive private industry, they just happen to be bad at it and expensive. Giving the government less money won't make it more efficient, just worse at it's job.

known 15y ago

Rates in India's best hospital http://www.aiims.edu/aiims/hosp-serv/hosp-rates/revised-rate-list.htm http://www.aiims.edu/aiims/hosp-serv/hosp-rates/revised-rate...

kingsidharth 15y ago

On a related note, medical toursim is a great business/startup opportunity for other countries. Let them spend a weekend in a new city and get that dental filling done for far less cost. It's $4 in some medical colleges in India.

jksmith 15y ago

I just got my shoulder redone by arguably one of the best sports orthos in the country. This guy handles a substantial percentage of high profile professional athlete cases per year. He charged me $3200 for a rotator repair and bicep reattach. I think that's a bargain for his skill level. My guess is the total bill will be another story though. I suspect my insurance will be dinged for about $11k. O.R. rental, nurse anesthetists who make $150/hr, etc are the source of expensive healthcare in the US, at least for surgery.

DanBC 15y ago

With an increasing elderly population there's a need for a lot more care, especially for people with dementias. Here's one fascinating article about US prisons which face a serious problem. (Caution: contains descriptions of violent crimes.) (http://www.nytimes.com/2012/02/26/health/dealing-with-dementia-among-aging-criminals.html?hp=&pagewanted=all http://www.nytimes.com/2012/02/26/health/dealing-with-dement...) This shows that big improvements in quality of life can be achieved with small changes. Give health care assistants better training about dementia and give them more time to talk to patients. This small cheap change has several benefits: nurses can do more nursing; meals get eaten; falls are reduced; people feel like they're getting better care; etc.

apinstein 15y ago

The article completely ignores structural problems that lead to high prices. Since the US health care market effectively has government price controls (due to Medicare, which is a huge percentage of revenue for most facilities), this causes some perturbations in the market. Pretend you're an optometrist. Historically you got paid well for your time, so you organized your business around seeing as many patients as possible and referring out things like labwork, glasses-making, etc, since you couldn't compete on price with shops that kept their capital equipment busy nearly 24/7. Life is good; you get paid well for your time and your customers get reasonable prices on things like labwork, glasses, etc. Over time, your medicare rates keep dropping. Eventually you actually start losing money when you see medicare patients. You then realize that the labwork/glasses part of the business is pretty high margin, and even if you buy a machine and keep it barely busy, you can still eek out some profit from keeping that work in-house. So you buy some equipment, and instead of referring out labwork and glasses, you start doing it in-house. Again you can finally make money on medicare patients. The medical device companies LOVE this. What better way to expand your market than "invest" (ahem lobby) so that your customers can make money with machines that are only busy 30-50% of the time. That's 2-3x as many devices as if they had 95% utilization, WIN! The doctors won't complain, b/c the system is so messed up that they know it's the only way for them to actually make money. And the insurers can't really do much about it b/c they can't force their patients to go to a different facility as that's too intrusive. So it's kind of a combination of market failure, lobbying, and price-fixing that causes procedures to be way too expensive in the US since the normal market mechanisms that cause prices to approach a small margin over the cost at high capital utilizations to fail. There's a lot more to it than that, but whenever I talk to my many relatives in the medical industry, this is always happening, and it's a major factor in prices. MRI machines aren't cheap (think $1M).

jakeonthemove 15y ago

I always had the idea that American health care is more expensive because there's not much competition - there are just a few major companies that control the pharma industry and the hospitals, and it's pretty much impossible for someone to just barge in and start offering their services at a lower price - they'd have to pass by the government first (with their impossibly high fees and heavy regulations), then if successful, they'd be harrased to bankruptcy by the established monopoly. It's much easier to open a private practice or hospital in the EU, for example...

foreverbanned 15y ago

Reminds me that according this NYT infographic : http://www.nytimes.com/packages/html/newsgraphics/2012/0115-one-percent-occupations/index.html http://www.nytimes.com/packages/html/newsgraphics/2012/0115-... about 20% of physicians are in the top one percent. This is the highest percentage of all occupations.

seanieb 15y ago

GlaxoSmithKilne Ventolin Inhaler USA -$41 Ireland ~$10 France -$10 Canada - $10