3 ms·

Where are the costs then? Is it the MRI that costs $1000?

sarchertech 2y ago
Equipment is heavily regulated and so it’s insanely expensive, drugs are heavily regulated and expensive to develop in general, infrastructure, malpractice insurance, non-physician labor, regulatory compliance, insanely expensive software, administrators etc… Then you add in the profit that has to be extracted at every level. Private equity buys up hospitals, physicians groups, and ambulance operators. They need to take their cut. Insurance companies need to take their cut. The free market doesn’t work great for to keep rent seekers from extracting profits because of insurance and the very nature of healthcare which reduces the ability of customers to shop around.
- hedora 2y ago
  Last I checked (10 years ago?), 33% of US healthcare costs went to haggling between the insurance company and the administrative assistants the doctor has to hire. I’d guess it’s higher now. It also seems really easy to fix: Just have a standard price list, and auto accept/reject 99% of procedures at the time of administration. Also, have a billing system that lets the patient pay on discharge (like restaurants). Edit: Concrete example. I needed some medicine. There are two interchangeable options. One retails for $30, and the other for $600. The doctor chose the $600 version, and insurance rejected it. This wasted my afternoon, an hour of the pharmacist’s time, 15 minutes of insurance company time, and at least 45 minutes of time at the doctor’s office. On top of that, the doctor had to context switch back to my case to change the prescription. If the doctor had a UI when writing the prescription that contained a price list, whether insurance covers which drug, and a “no really, we need the expensive one” button (there is already such an override that the insurance company honors), then all of this waste would have been avoided.
  - teruakohatu 2y ago
    Wouldn’t a better regulation be that pharmacists can dispense cheaper generics with patient consent? If the doctor really wants something specific they can state no substitutes on the script. Here in New Zealand I am pretty sure that’s the case.
    - zo1 2y ago
      Here in South Africa, the pharmacist is obligated to offer a generic to you, irrespective of which medicine it is. Some days I just go sure, other times I specifically want the non-generic because it is slightly (at least to me) better.
      - hedora 2y ago
        It works that way in the US too. These were different drugs, and there is no generic for the expensive one. In my case, there was zero reason to prefer one over the other. That’s not true in all cases.
  - toast0 2y ago
    > Also, have a billing system that lets the patient pay on discharge (like restaurants). If we're wishing, let's wish for it to be like car repair. Where they have to give us a quote before they begin service. Need some allowance for billing for care when you were unable to consent, like when an ambulance picks you up for an emergency, or if something unexpected comes up during a surgery.

Equipment is heavily regulated and so it’s insanely expensive, drugs are heavily regulated and expensive to develop in general, infrastructure, malpractice insurance, non-physician labor, regulatory compliance, insanely expensive software, administrators etc… Then you add in the profit that has to be extracted at every level. Private equity buys up hospitals, physicians groups, and ambulance operators. They need to take their cut. Insurance companies need to take their cut. The free market doesn’t work great for to keep rent seekers from extracting profits because of insurance and the very nature of healthcare which reduces the ability of customers to shop around.

hedora 2y ago
Last I checked (10 years ago?), 33% of US healthcare costs went to haggling between the insurance company and the administrative assistants the doctor has to hire. I’d guess it’s higher now. It also seems really easy to fix: Just have a standard price list, and auto accept/reject 99% of procedures at the time of administration. Also, have a billing system that lets the patient pay on discharge (like restaurants). Edit: Concrete example. I needed some medicine. There are two interchangeable options. One retails for $30, and the other for $600. The doctor chose the $600 version, and insurance rejected it. This wasted my afternoon, an hour of the pharmacist’s time, 15 minutes of insurance company time, and at least 45 minutes of time at the doctor’s office. On top of that, the doctor had to context switch back to my case to change the prescription. If the doctor had a UI when writing the prescription that contained a price list, whether insurance covers which drug, and a “no really, we need the expensive one” button (there is already such an override that the insurance company honors), then all of this waste would have been avoided.
- teruakohatu 2y ago
  Wouldn’t a better regulation be that pharmacists can dispense cheaper generics with patient consent? If the doctor really wants something specific they can state no substitutes on the script. Here in New Zealand I am pretty sure that’s the case.
  - zo1 2y ago
    Here in South Africa, the pharmacist is obligated to offer a generic to you, irrespective of which medicine it is. Some days I just go sure, other times I specifically want the non-generic because it is slightly (at least to me) better.
    - hedora 2y ago
      It works that way in the US too. These were different drugs, and there is no generic for the expensive one. In my case, there was zero reason to prefer one over the other. That’s not true in all cases.
- toast0 2y ago
  > Also, have a billing system that lets the patient pay on discharge (like restaurants). If we're wishing, let's wish for it to be like car repair. Where they have to give us a quote before they begin service. Need some allowance for billing for care when you were unable to consent, like when an ambulance picks you up for an emergency, or if something unexpected comes up during a surgery.