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Why an MRI costs $1,080 in America and $280 in France
- Nathanael47 14y ago+1 for price controls in medicine
- octix 14y agoNo way! This will be socialism!
- tibbon 14y agoJust like libraries, fire, police, roads, government buildings and the army :)
- chris_mahan 14y agoAnd, huh, those aren't exactly at the forefront of advances in technology. And they are not necessarily cheap either.
- ChuckMcM 14y agoI always wondered if we could run a 'medical service' that was a viable 'public service' alternative to spending time in the military or peace corps. Basically let young people volunteer to be health care workers, give them training, and guaranteed employment for 4 - 6 years. At the end of their enlistment they can go out to the private health care system or other jobs. Can you imagine the horror of spend a billion dollars a week "invading" a country like Afghanistan and having a 100,000 health care workers on the ground making everyone healthier?
- tjic 14y agoLibraries work ok. Re police: just reading an article over at popehat.com about how a cop framed someone for a murder and sent her to death row. Re roads: here in Massachusetts we've got toll roads that spend 80 cents of every dollar collected...on paying the tolltakers. Re army: take a look at the defense budget some time. There are some decent arguments in favor of government, but you picked some of the worst.
- stevenameyer 14y agoWould those things be better if they were privately run for profit? My personal opinion is that there are certain things that you can't allow the the private sector to run because it leaves too much room for abuse by individuals looking to make a profit. As a Canadian who's mother is a doctor, the one thing that really bothers me about the healthcare system in the US is that from a business stand point insurance companies are more profitable the more claims they deny, which really doesn't sit well with me. I'm not saying our system is perfect by any means, or that the US doesn't have a high quality of healthcare (if you can afford it). But the thought of someone making a profit on someone else not get a medical treatment that they need leaves a bad taste in my mouth.
- weavejester 14y agoAre you suggesting that we'd be better off with private security forces replacing the role of the police and army?
- paulgb 14y agoLibraries, police, roads, and the army are great examples in favor of government. All you've done is demonstrate that there are exceptions, as there are to anything.
- chris_mahan 14y agoThe defense budget is not an exception to the rule. It is the rule. (Almost the Rule, as in kings and rulers.)
- stevesearer 14y agoI like the idea of transparent pricing that some surgery centers are implementing. One example is the Surgery Center of Oklahoma which simply displays the prices of their procedures on their website. This way, people can make informed decisions about their health and purchase procedures at rates far below what is charged through insurance. "Transparent, direct, package pricing means the patient knows exactly what the cost of the service will be upfront. Fees for the surgeon, anesthesiologist and facility are all included in one low price. There are no hidden costs, charges or surprises." http://www.surgerycenterok.com/pricing.php http://www.surgerycenterok.com/pricing.php
- will_brown 14y agoI too like the transparent pricing, CVS Minute Clinics are a great example, if they offer a service it is listed on their price chart. In FL medical facilities that post prices of their 50 most common treatments are given a discount on their license fee. I think that is great, but you have to laugh at how pro-business states get businesses to do anything pro-consumer. Separately, under the FL Patient Bill of Rights, even if a medical facility does not post their pricing, if requested by the patient the provider must provide a reasonable estimated charges of such service.
- anoneconomist 14y agoEither that or take away the legally protected monopolies that doctors (licensing of physicians and accreditation of medical schools, both of which are used to restrict the supply of doctors to ensure US doctors are the highest paid in the world), hospitals (certificates of need) and drug companies (drug patents) all enjoy. If these monopolists didn't have the government protecting them from competition, they would not be able to gouge consumers so hideously.
- danielweber 14y agoWhile I think there is lots of medicine that is wasteful, if your plan is to tell Americans "it is illegal to pay more than $X for procedure Y" it is a complete non-starter.
- dmishe 14y agomedicare for everybody!
- uvdiv 14y agoIs that why the US has four times as many MRI machines per person? http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/02/index.html?contentType=/ns/StatisticalPublication,/ns/Chapter&containerItemId=/content/serial/19991312&itemId=/content/chapter/health_glance-2011-30-en&mimeType=text/html http://www.oecd-ilibrary.org/sites/health_glance-2011-en/04/... And has no queues for MRI scans, where France has a 32-day mean waiting period? http://mjperry.blogspot.com/2007/09/canadian-medicine-is-sick.html http://mjperry.blogspot.com/2007/09/canadian-medicine-is-sic... http://sante.lefigaro.fr/actualite/2011/05/10/10863-irm-delais-dattente-stagnent-32-jours-france http://sante.lefigaro.fr/actualite/2011/05/10/10863-irm-dela...
- pessimizer 14y agoCan it really be called cherry picking if you only pick one cherry? At least make an effort.
- Rexxar 14y agoMRI exams, 2009 : - US 91.2 per 1000 inhabitants - France 55.2 per 1000 inhabitants Better usage ratio => lower price
- scarmig 14y agoAnd to make an equally relevant point: more MRIs doesn't necessarily equate to better health outcomes. It depends on who is getting them, and how likely they are to actually be sick. Lots of rich people getting marginally useful MRIs in the USA may be an inferior system to everyone having access to MRIs but fewer being done in total.
- uvdiv 14y agoIt's also symptomatic of a shortage. Being able to meet everyone's needs every time means keeping certain overcapacity.
- danielweber 14y agoBigger installed base => more capital costs to be paid for. Trying to roll down medical costs to one- or two-line sentences is really dangerous with the US health care system, because so many things you could normally expect in a functioning economy aren't there. In fact, increased access to medical devices and procedures may drive costs up with no change in patient outcomes. This was a pretty well-discussed article in economics circles a few years ago that talks about the phenomenon: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_... We do get something for our expensive MRI machines (lower wait times), but I doubt anyone, or even the invisible hand of the market, decided it was a good trade-off. It just happened.
- allsystemsgo 14y agoI don't see how this is related to Hacker News.
- Vlaix 14y agoThat's an interesting matter and people comment on it. Related enough to HN for me.
- SkyAtWork 14y agoWe talk a lot about disrupting businesses here; there's a reasonable number of folks in the audience who want to do this to health care. Likely no deeper than that, but understanding the entrenched solutions in a market can be valuable if that's your plan.
- Maven911 14y agoI see your point, but I see a lot of non-tech news here. And this opens our eyes to an industry that might need changing (sort of like when pg mentioned that Hollywood is in need for disruption one year ago) You have some big companies like General Electric trying to do things like improving hospital visits (http://www.gequest.com/c/hospital http://www.gequest.com/c/hospital)..and a lot of people making fitness apps. But not much else then what from what I can see....
- tzs 14y agoMuch of the discussion on HN is about startups. Health care costs are a major issue for nearly anyone starting a startup in the US and for most people considering working for a US startup.
- zbruhnke 14y agobefore clicking on this post to read it and even still after reading it I think the true reason for this can be summed up in a single word "Litigation" As someone who has been in court rooms and seen the amount of litigation that businesses deal with in America I would find it hard to believe it does not play a significant role in the higher prices than places where Class Action Lawsuits and Ambulance chasing attorneys aren't the norm
- jcmoscon 14y ago^^THIS^^
- pchristensen 14y agoMore like 5 words: Litigation Profit Center Supply monopolies (of hospitals/providers vs insurance) See: http://www.time.com/time/magazine/article/0,9171,2136864,00.html http://www.time.com/time/magazine/article/0,9171,2136864,00....
- rayiner 14y agoWrong guild: http://www.press.uchicago.edu/Misc/Chicago/036480.html http://www.press.uchicago.edu/Misc/Chicago/036480.html, http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/ http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort..., http://dartmed.dartmouth.edu/fall05/html/disc_myth.php http://dartmed.dartmouth.edu/fall05/html/disc_myth.php, http://www.forbes.com/sites/rickungar/2010/09/07/the-true-cost-of-medical-malpractice-it-may-surprise-you/ http://www.forbes.com/sites/rickungar/2010/09/07/the-true-co..., http://online.wsj.com/article/SB10001424127887324096404578356544137516914.html http://online.wsj.com/article/SB1000142412788732409640457835...
- daniel_solano 14y agoThis article didn't seem all that great. It just claims "the prices are higher" without any substantive recommendations on how that problem can be solved. Nonetheless, it does make one interesting point: 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 other words, the low prices for health care found in other countries is, in part, subsidised by the American consumer. As a result, it would stand to reason that if price controls were implemented in the U.S., it could result in less medical innovation or rising prices elsewhere in the world.
- bickfordb 14y agoAlso, this article doesn't explain the price of MRIs at all. Is the price higher due to higher worker costs, more expensive machines being used, more expensive facilities or more pricing power on behalf of the providers?
- gmac 14y agoI thought the implication from the comparison with other countries is that it's primarily pricing power: i.e. profit for the providers. But I agree that the article doesn't address the title very directly.
- scott_s 14y agoThis Planet Money podcast gets into it somewhat: http://www.npr.org/blogs/money/2013/02/26/172996963/episode-439-the-mysterious-power-of-a-hospital-bill http://www.npr.org/blogs/money/2013/02/26/172996963/episode-... Part of the problem is that few people even know what the prices are.
- homosaur 14y agoNot to mention prices are and always have been variable depending on whether you're an individual or insurance company.
- arbuge 14y agoI went to the ER here in Dallas a couple of weeks ago because of some chest pains I was having. The good news - it's just some stomach acid. ER doctor prescribed Prilosec OTC and sent me away. The bad news - $4,500 in medical bills for 3 hours spent in the ER. Most of that was spent watching TV waiting for the results of blood tests & x-rays to be announced.
- morsch 14y agoSprained my ankle very badly on January 1. Had an x-ray (nothing broken, yay). Got some crazy painkillers and some Diclofenac gel. Waited for about 15 minutes. Never saw a bill and didn't pay a dime. And by that I mean besides the roughly 300 EUR that's taken out of my pay check every month now that I'm gainfully employed. People less fortunate get it for free, of course.
- deleted 14y ago[deleted]
- datalus 14y agoI spent the night in an ER once after being knocked unconscious during a mugging, grand total of 5k which half was for the 8 block ambulance ride. Mugged twice! All jokes aside I learned the value of employer provided health insurance.
- VeejayRampay 14y agoAs a French citizen who's enjoyed the goodness that is subsidized health care, it needs to be stressed that all this has a cost for the country. The vision that taxpayers support a system where everyone is granted access to next-to-free / affordable health care has a natural cost in certain areas. Sure it's great when you're both poor and sick cause you get to be treated like everyone else, you get the day care for your kids, you get the MRI's, the cancer treatment, you're being taken care of at the ER etc. But at the same time, everyone has to realize that this has a cost in terms of taxes. Taxes for companies, home buyers, CEOs, businesses, cigarettes and alcohol, gas, etc. It's the old chasm between putting the emphasis on the individual or on the nation/country as a whole. America has traditionally favoured private/capital-oriented solutions so far for most of its services (postal services, health care, public transportation, part of its schools, water, electricity, Internet infrastructure, etc.) and was thus able to keep the burden of taxes lower for individuals. If it were to move to a system where everyone pitches in for cheap state-driven services, the money would have to come from somewhere and it would be sure to somehow stifle economic growth in certain areas (see the economic situation of France or other countries where the involvement of the state is still strong). TL;DR: The idea of cheap MRI is nice on paper (and I believe it to be awesome in practice), but there's no magic wand to make that happen, the money has to come from somewhere and it requires that a whole country accepts paying more to the state to get more at the other end, a paradigm shift that will be tough to swallow for the USA given its economic culture.
- InclinedPlane 14y agoBecause in the US there are vastly more MRI machines and they are newer. France has 1/3 the number of CT machines per capita and 1/5th the number of MRI machines per capita compared to the US. And the US has the highest number of MRI scans per capita per year in the developed world (4 times more than French citizens). Stats: http://www.oecd-ilibrary.org/sites/health_glance-2009-en/04/03/index.html?contentType=%2Fns%2F+Chapter%2C%2Fns%2FStatisticalPublication&itemId=%2Fcontent%2Fserial%2F19991312 http://www.oecd-ilibrary.org/sites/health_glance-2009-en/04/...
- epscylonb 14y agoSo the price should be lower in the US because supply is greater right?.
- InclinedPlane 14y agoThese numbers alone don't tell the whole story either. In the US total spending on MRIs is higher than in France because there are more machines (per capita) and those machines are generally newer. And this gives patients in the US greater access to MRIs and increases the likelihood of an MRI scan being diagnostic (due to the machines being newer and more sensitive). But note that the number of scans per machine is actually lower in the US than in France, even though you are 4x more likely to actually receive a scan in the US.
- chris_mahan 14y agoSo essentially the MRIs cost less in France because they use older, less accurate machines longer. Right?
- greeneggs 14y agoJapan slightly contradicts your points, having much cheaper MRI scans (~$200), many more MRI machines and scans per capita than the US. But yes, they tend to be less advanced MRI machines (not sure about older/newer). This is all put out in the Planet Money podcast linked just above. http://www.npr.org/templates/story/story.php?storyId=120545569 http://www.npr.org/templates/story/story.php?storyId=1205455...
- will_brown 14y agoFirst, it is good to look at this on an international perspective, but an entirely separate article can be done on why an MRI costs $1,080 for a patient with insurance and the same treatment would be arbitrarily more for an uninsured patient usually about 4x as expensive. This issue has gone to court in California (2006-2008) resulting in over $1 billion dollars returned to uninsured patients because Courts found hospitals were illegally "price gouging" uninsured. However, price gouging uninsured is a practice that continues around the US, for example in September I received 17 stitches from a FL hospital and the bill was over $12,000 because I am uninsured. I recorded the entire event on my phone including asking how much the stitches would cost and the staff telling me the bill would be $2,000 if I were insured. I challenge the bill since I was quoted $2,000 for the treatment and my bill was $12,000 and when I produced the video of the staff acknowledging different price structures for insured and uninsured the hospital immediately agreed to cover my entire bill. Second, I can not believe the Washington Post would publish an article titled "Why an MRI costs $1,080 in America and $280 in France", "America" really? I try to never comment on a spelling or grammatical error, but honestly we are talking the Washington Post who should know to use "US" not "America".
- ef4 14y ago> Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say “no.” But there are other products that we absolutely need to stay alive that don't suffer the runaway prices we see in healthcare. The best example is food. You can't say no to buying food. So why don't food sellers have us over a barrel? Because consumers see prices and force the many providers to bid competitively against each other. My point is that inelastic demand is not the fundamental cause of high costs in healthcare. It has much more to do with the many layers of abstraction we place between patient and provider that prevent price signals from passing through.
- sliverstorm 14y agoFood and healthcare are both inelastic demands, yes. But that doesn't mean they are comparable. I have 8 hours between hunger spikes; plenty of time to shop around. I know when I am going to be hungry, and I will be hungry again soon. The issue as I see it with healthcare is the the nature of the beast itself. When you are bleeding from the femoral artery, you don't have time to shop around, and you don't know when it will happen. Additionally, it is a rare event, unlike your drive for food.
- MoreMoschops 14y agoWhen you have one of the big ticket items that they make the big money on, such as cancer, you have a lot of time to shop around.
- InclinedPlane 14y agoI disagree that healthcare is an inelastic demand, it's obviously quite elastic. There are levels of service and of care. Take something like a broken femur for example. One person may opt for a cast and crutches and little else while someone else may opt for a motorized wheelchair and extensive hands-on rehabilitation therapy afterward. Or look at, say, prosthetics. There are amazing cutting-edge almost bionic prosthetic hands and legs these days, but does it make sense to bankrupt the public in order to guarantee everyone access to those who might want them? Or just look at something as simple as diet and exercise (what we know to have one of the biggest impacts on health), one person may be able to afford a personal chef and dietitian who can plan all their meals and to hire a personal trainer to keep them in shape, but many wouldn't be able to afford that or even necessarily want it. The notion that everyone should be guaranteed equal health outcomes is a very seductive one, but once you start digging into the details it falls apart quite rapidly.
- piyush_soni 14y agoThe giant "insurance scam" that the US medical industry is... By the way, it costs something around $83 in India. Of course we can't compare directly just by converting the currency, but it's also true that a lot of American insurance companies these days pay patients to go and get themselves treated in the best hospitals of India as that (including the trip costs) would still be cheaper than getting themselves treated here.
- saturdaysaint 14y agoAlso see Time's extensively researched "Why Medical Bills are Killing Us" http://healthland.time.com/why-medical-bills-are-killing-us/ http://healthland.time.com/why-medical-bills-are-killing-us/ the tl;dr of it: hospitals are charging the uninsured exhorbitant markups over Medicaid (which they bitch about, but they actually do well enough that they advertise to Medicaid patients) because they can. Without pricing information (which they hide as much as possible), every emergency is a miniature monopoly. "Non-profit" hospital administrators have every incentive to expand the facilities/prestige of their institution, so they act like the most rapacious "for-profit" corporations imaginable.
- sachingulaya 14y agoAn MRI doesn't have a cost in America. The cost depends on, obviously, your perspective. Are you a patient? If so, are you insured? Are you a hospital? Medicare? What state are you in? Are we talking cost or are we talking reimbursement?
- deleted 14y ago[deleted]
- abrown28 14y agoDo they include the amount the government kicks in to pay for that MRI in France?
- codex 14y agoMy thesis: Health care costs are higher in the US largely because the US has more per capita wealth than other counties. Look at per capita spending: http://www.oecd.org/norway/BriefingNoteNORWAY2012.pdf http://www.oecd.org/norway/BriefingNoteNORWAY2012.pdf The biggest spenders are the US, Norway, Switzerland and Luxembourg--the same counties with the highest per capita GDP. Health care is simply something a person will spare no expense on: everybody eventually enters a period of chronic poor health as they age in affluent Western societes, but would pay anything to remedy it.