3 ms·

I have slowly been coming around to an understanding that healthcare really is different due to the uniquely massive information asymmetries of doctors versus p

I have slowly been coming around to an understanding that healthcare really is different due to the uniquely massive information asymmetries of doctors versus patients (and payors and everyone else), plus irremediable difficulties with market search or "comparison shopping". I appreciate that it may be bad to mix profit incentive into an industry that simply cannot operate as a real market. (That said, problems don't all evaporate the moment you take out profit incentive, and you probably introduce new problems as a side effect.) These radical critiques that basically say "putting a monetary value on things that matter is fundamentally wrong" have made my progress much slower. I'm not here to hate on markets! They work great (and much better than collectivist alternatives) for a lot of things that we value greatly, like being able to feed ourselves. Selective sentimentality about the value of human life and human needs doesn't bring anything to this conversation. We all care about human life and children and agree that they can't be bought and sold. But when you're asking someone to do something for someone else, you have to compensate them, and you have to compensate them enough for it to be worth their while given their alternatives. So you have to put an economically-driven monetary value on it in some way or other. There are no perfect benevolent angels we can call down from the heavens to be our doctors.

bko 11mo ago
I think comparison shopping works great, even with health related things. When you pay out of pocket, like for Lasik or cosmetic surgery, it works. And most medical expenses are non-emergency. There exists asymmetry in all markets. I don't know anything about cars, but I take it to a mechanic. I get a quote, and ask around and eventually some mutually beneficial trade happens. The market aspects of healthcare work well but so much of it is not a market and the third party payer system. Try asking a doctor what somethings costs, they will look at you like you have two heads. They have no clue. The fact is healthcare today is not a market, not even close. Things that are a market generally work well (supermarkets, mechanics, cosmetic surgery). We should have healthcare become more of a market. As just one example a healthcare provider cannot open up in many states without a "certificate of need" > Certificate of need (CON) laws are state regulatory mechanisms for approving major capital expenditures and projects for certain health care facilities. In a state with a CON program, a health planning agency or other entity must approve the creation of new health care facilities or the expansion of an existing facility’s services in a specified area. CON programs primarily aim to control health care costs by restricting duplicative services and determining whether new capital expenditures meet a community need. Imagine to open a restaurant you would need to go to some board and argue how your restaurant is needed in this neighborhood, or the idea that opening a restaurant would INCREASE restaurant prices by offering duplicative services. Madness! https://www.ncsl.org/health/certificate-of-need-state-laws https://www.ncsl.org/health/certificate-of-need-state-laws
- ebiester 11mo ago
  It's much harder on many surgeries. They come in with "it depends" and completely avoid discussing it. The doctors often do not even know, and those who know will refuse to discuss. On top of that, consultations are not free and often expensive. And something like cancer treatment is nigh impossible to get a quote on. They obfuscate the costs even when required to post them - see https://www.healthcaredive.com/news/hospital-price-transparency-continues-drop-patient-rights-advocate/733703/ https://www.healthcaredive.com/news/hospital-price-transpare... as but one example. There is an entire industry built around reading hospital bills and watching for double charges. https://www.tomshardware.com/tech-industry/artificial-intelligence/grieving-family-uses-ai-chatbot-to-cut-hospital-bill-from-usd195-000-to-usd33-000-family-says-claude-highlighted-duplicative-charges-improper-coding-and-other-violations https://www.tomshardware.com/tech-industry/artificial-intell... was discussed earlier on HN.
- FireBeyond 11mo ago
  > Imagine to open a restaurant you would need to go to some board and argue how your restaurant is needed in this neighborhood, or the idea that opening a restaurant would INCREASE restaurant prices by offering duplicative services. Madness! And the board goes to the other restaurants and asks them, "hey, if this new restaurant opened, would you reduce your business?" > Certificate of need (CON) laws are state regulatory mechanisms for approving major capital expenditures and projects for certain health care facilities ... and any time someone likes to defend them, I like to point out that CoNs were an invention of hospital owner lobby groups, and that those hospital owners pushed for them.
- nradov 11mo ago
  Cost transparency and comparison shopping have gotten a bit better in recent years. Health plans are now required to give members access to cost estimation tools. If you need an expensive procedure like an MRI then it's worth shopping around. https://www.cms.gov/priorities/healthplan-price-transparency/overview/consumers https://www.cms.gov/priorities/healthplan-price-transparency... For patients without health insurance they have the legal right to insist on a good faith estimate. https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate https://www.cms.gov/medical-bill-rights/help/guides/good-fai... There are still some technical obstacles to giving patients with insurance accurate estimates for out-of-pocket costs. The current HIPAA adopted standards for most electronic claims don't allow for prospective claims to see exactly how much a health plan would pay for a treatment. CMS is working on a proposal to adopt a newer version of those standards which will support prospective claims. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct...

bko 11mo ago

I think comparison shopping works great, even with health related things. When you pay out of pocket, like for Lasik or cosmetic surgery, it works. And most medical expenses are non-emergency. There exists asymmetry in all markets. I don't know anything about cars, but I take it to a mechanic. I get a quote, and ask around and eventually some mutually beneficial trade happens. The market aspects of healthcare work well but so much of it is not a market and the third party payer system. Try asking a doctor what somethings costs, they will look at you like you have two heads. They have no clue. The fact is healthcare today is not a market, not even close. Things that are a market generally work well (supermarkets, mechanics, cosmetic surgery). We should have healthcare become more of a market. As just one example a healthcare provider cannot open up in many states without a "certificate of need" > Certificate of need (CON) laws are state regulatory mechanisms for approving major capital expenditures and projects for certain health care facilities. In a state with a CON program, a health planning agency or other entity must approve the creation of new health care facilities or the expansion of an existing facility’s services in a specified area. CON programs primarily aim to control health care costs by restricting duplicative services and determining whether new capital expenditures meet a community need. Imagine to open a restaurant you would need to go to some board and argue how your restaurant is needed in this neighborhood, or the idea that opening a restaurant would INCREASE restaurant prices by offering duplicative services. Madness! https://www.ncsl.org/health/certificate-of-need-state-laws https://www.ncsl.org/health/certificate-of-need-state-laws

ebiester 11mo ago
It's much harder on many surgeries. They come in with "it depends" and completely avoid discussing it. The doctors often do not even know, and those who know will refuse to discuss. On top of that, consultations are not free and often expensive. And something like cancer treatment is nigh impossible to get a quote on. They obfuscate the costs even when required to post them - see https://www.healthcaredive.com/news/hospital-price-transparency-continues-drop-patient-rights-advocate/733703/ https://www.healthcaredive.com/news/hospital-price-transpare... as but one example. There is an entire industry built around reading hospital bills and watching for double charges. https://www.tomshardware.com/tech-industry/artificial-intelligence/grieving-family-uses-ai-chatbot-to-cut-hospital-bill-from-usd195-000-to-usd33-000-family-says-claude-highlighted-duplicative-charges-improper-coding-and-other-violations https://www.tomshardware.com/tech-industry/artificial-intell... was discussed earlier on HN.
FireBeyond 11mo ago
> Imagine to open a restaurant you would need to go to some board and argue how your restaurant is needed in this neighborhood, or the idea that opening a restaurant would INCREASE restaurant prices by offering duplicative services. Madness! And the board goes to the other restaurants and asks them, "hey, if this new restaurant opened, would you reduce your business?" > Certificate of need (CON) laws are state regulatory mechanisms for approving major capital expenditures and projects for certain health care facilities ... and any time someone likes to defend them, I like to point out that CoNs were an invention of hospital owner lobby groups, and that those hospital owners pushed for them.
nradov 11mo ago
Cost transparency and comparison shopping have gotten a bit better in recent years. Health plans are now required to give members access to cost estimation tools. If you need an expensive procedure like an MRI then it's worth shopping around. https://www.cms.gov/priorities/healthplan-price-transparency/overview/consumers https://www.cms.gov/priorities/healthplan-price-transparency... For patients without health insurance they have the legal right to insist on a good faith estimate. https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate https://www.cms.gov/medical-bill-rights/help/guides/good-fai... There are still some technical obstacles to giving patients with insurance accurate estimates for out-of-pocket costs. The current HIPAA adopted standards for most electronic claims don't allow for prospective claims to see exactly how much a health plan would pay for a treatment. CMS is working on a proposal to adopt a newer version of those standards which will support prospective claims. https://www.cms.gov/priorities/key-initiatives/burden-reduction/administrative-simplification/hipaa/adopted-standards-operating-rules https://www.cms.gov/priorities/key-initiatives/burden-reduct...