13 ms·

"Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes an

"Take the examples of Lasik eye surgery or cosmetic surgery. These services are not covered by insurance. Providers compete on the basis of quality, outcomes and price. And prices have continually dropped as quality and services have improved—unlike the rest of health care." Sadly, most people forget this. They think that healthcare is somehow immune from the laws of economics, that it is "special."

zellyn 13y ago
Every time I hear how much Lasik surgery has improved, I'm gladder I haven't let those damned lasers anywhere near my eyes. :-) For the hackernews spin, this trick works for software too - I learned it at my first job, where each client had a different stack and we had to evaluate lots of enterprisey vendors: look at the improvements. The same thing that makes vendors tell you their software will make you toast and find you dates makes them unable to resist crowing about the improvements from version to version. If you're choosing between two identical-looking products, go with the one whose recent release notes have things like "Fix problems when mixing Russian and Right-to-left scripts on EBCDIC systems" rather than, "Now includes support for backups!"
- nether 13y ago
  I'm glad I bit the bullet and got lasik last year. It beats the nonzero risk of eye infection every time I touch my eyes with contact lenses. These problems can cause vision loss and sometimes require eye removal: http://www.webmd.com/eye-health/news/20061010/lasik-surgery-safer-than-contacts http://www.webmd.com/eye-health/news/20061010/lasik-surgery-...
  - to3m 13y ago
    I have some solid lenses made out of plastic, held in front of my eyes. "Non-contact Lenses", I suppose you'd call them. Or perhaps, "binocularettes"? Anyway, they're sort of like monocles, but attached to a little frame that fits around my ears and above my nose, keeping the lenses in place. A minor hassle but you soon get used to it. Ask me on my death bed to be sure - but I'm pretty sure that the risk of eye removal from my non-contact lenses is pretty low. I much prefer it to the creaky old technology of actually putting things in your eye. Progress! (I used to have some fashioned from pure glass, and they were pretty decent - much more resistant to scratches - but obviously glass comes with a risk of breakage and therefore shards of glass in your eyes. I have to admit that such a thing never actually happened while I had them, though.)
    - rjsw 13y ago
      I mostly use the same "non-contact lenses" as you but have also used contact lenses for 35 years and not needed to have an eye removed. Deliberately putting things in your eye does have one advantage, you can easily fish out any bits of grit that get in there by accident.
stephengillie 13y ago
Some major insurance companies covered LASIK about 10 years ago, but have since stopped. My LASIK was paid 100% by my insurance co in 2003. I heard the logic that paying $2000 in 2003 was cheaper than paying $150-300 per year for exams, lenses & frames for 10-15 years.
- nether 13y ago
  I paid out of pocket for mine, but breakeven for me was 5 years because I previously wore one-day contacts ($$). For most contacts-wearers breakeven is around 10 years.
baddox 13y ago
Many people will unabashedly say that they believe healthcare to be special. It's not uncommon to hear people say that they don't believe profit motive has any place in healthcare. I don't buy it. I don't see how healthcare is any more special than, say, food production (both are obviously vital to health), yet I think most people have come around to recognizing that profit motive is a spectacular way to organize the production and distribution of food.
- bmmayer1 13y ago
  People think profit is a dirty word, especially if it is made "helping people." But why is it bad to make money helping people and not bad to make money not helping others, like people who make millions from selling fast food or selling iPhone apps?
- jbooth 13y ago
  Of course healthcare is special, it's not a normal market because of extreme demand inelasticity. Food is special too, but it manages to function as a market because we have a food surplus, a plethora of replacement goods within the food category and it's much less specialized to produce. This doesn't mean that people don't deserve to earn a living. The doctor in the article managed to find a way to make the man's procedure happen without taking a loss on it. But it's an inaccurate simplification to consider healthcare a market like any other -- inaccurate simplifications hurt any system and that's why our current 'market' system has more bureaucratic red tape, higher prices and worse outcomes than actual socialist systems in the rest of the western economies.
  - AlisdairSH 13y ago
    Emergency medicine is inelastic and not conducive to price shopping and other research. But, what percentage of medicine falls into that category? For example, I currently have a shoulder injury. I'm meeting with an ortho specialist next week. And it will likely require surgery to correct. So, while I "need" the surgery, there's no real hurry. I could take an extra week to meet with several providers and ask about pricing. Of course, I won't do that, because my medical plan is paying the vast majority of the cost. I'll just get nickle-and-dimed with co-pays for the next 6 months.
joshuahedlund 13y ago
I like this argument, too, but the common response is that Lasik and cosmetic surgeries are elective - voluntary improvements to your body that are a sort of luxury that lend themselves to competition (shopping around, taking your time). By contrast, a lot of expensive medical procedures are much more critical and time-sensitive (you could say the demand is much less elastic), which makes it a lot harder for competition to work (though more price transparency might help!), especially if as another comment says[0], "You get taken to a hospital out of your control, and they're allowed to decide what services to provide and as well as the price they're going to charge you..." [0]https://news.ycombinator.com/item?id=6258953 https://news.ycombinator.com/item?id=6258953
- bmmayer1 13y ago
  What the commenter suggested is exactly the situation right now: the hospital sets the prices as astronomically high as possible because they can get away with it, because the patients aren't paying it. Don't you think introducing patient choice into the equation would put some downward pressure on prices? And certainly if it puts any downward pressure on prices, it's a better situation than we have now.
  - Smudge 13y ago
    If you're having a heart attack, are you really in a position to negotiate on price? At all? I get that there might be some downward pressure, but what prevents the hospital from just laying an absurd bill on you after the procedure?
    - duskwuff 13y ago
      It's somewhat akin to emergency non-medical services - say, a tow truck, locksmith, or plumber. Many of these services cost quite a bit more than they should. Why? Because the people who need them are in no position to shop around.
    - nsxwolf 13y ago
      The hope with a real free market is that you wouldn't have to negotiate in that situation, the prices would already be reasonable.
mc32 13y ago
Not sure the impact, economically, but... Cosmetic and eye surgery, are for the most part, elective and the pool of potential clients pretty vast, depending on how it's marketed. Other surgeries/treatments are necessary (not as elastic) --it's not as if people would say, well, I have an extra $$$$$ so let me get a hip replacement. They are forced into having to (by the nature of the situation). I'm saying the economics are different, but that's not to say that scale should not apply to non-elective surgeries, but just that maybe to a lesser degree.
superuser2 13y ago
Healthcare most certainly is covered by the laws of economics. It's a service for which there is inelastic demand. Laisk and cosmetic surgery are optional, so the price influences the quantity demanded. Nobody would buy a $100,000 cheeseburger. Treatment that's needed to end suffering or make people functional again is inelastic; if you charge someone's annual salary, he still has to pay it. It's true that there could be competition on price for non-emergency care. It's okay for someone to eat cheap, low-quality food or live in shitty housing, because for the most part they'll be okay. Should there really be a Ramen of surgery? Are you really willing to inflict that on people? A good portion of this country is. Those of us who voted Democrat aren't. http://www.investopedia.com/terms/e/inelastic.asp http://www.investopedia.com/terms/e/inelastic.asp
- sejje 13y ago
  But a 325,000 burger, on the other hand, is fair game. http://www.nytimes.com/2013/08/06/science/a-lab-grown-burger-gets-a-taste-test.html?_r=0 http://www.nytimes.com/2013/08/06/science/a-lab-grown-burger...
MaysonL 13y ago
Of course, as well as not being covered by insurance, they aren't required to stay alive and in good health. How's that working for heart surgery?

zellyn 13y ago

Every time I hear how much Lasik surgery has improved, I'm gladder I haven't let those damned lasers anywhere near my eyes. :-) For the hackernews spin, this trick works for software too - I learned it at my first job, where each client had a different stack and we had to evaluate lots of enterprisey vendors: look at the improvements. The same thing that makes vendors tell you their software will make you toast and find you dates makes them unable to resist crowing about the improvements from version to version. If you're choosing between two identical-looking products, go with the one whose recent release notes have things like "Fix problems when mixing Russian and Right-to-left scripts on EBCDIC systems" rather than, "Now includes support for backups!"

nether 13y ago
I'm glad I bit the bullet and got lasik last year. It beats the nonzero risk of eye infection every time I touch my eyes with contact lenses. These problems can cause vision loss and sometimes require eye removal: http://www.webmd.com/eye-health/news/20061010/lasik-surgery-safer-than-contacts http://www.webmd.com/eye-health/news/20061010/lasik-surgery-...
- to3m 13y ago
  I have some solid lenses made out of plastic, held in front of my eyes. "Non-contact Lenses", I suppose you'd call them. Or perhaps, "binocularettes"? Anyway, they're sort of like monocles, but attached to a little frame that fits around my ears and above my nose, keeping the lenses in place. A minor hassle but you soon get used to it. Ask me on my death bed to be sure - but I'm pretty sure that the risk of eye removal from my non-contact lenses is pretty low. I much prefer it to the creaky old technology of actually putting things in your eye. Progress! (I used to have some fashioned from pure glass, and they were pretty decent - much more resistant to scratches - but obviously glass comes with a risk of breakage and therefore shards of glass in your eyes. I have to admit that such a thing never actually happened while I had them, though.)
  - rjsw 13y ago
    I mostly use the same "non-contact lenses" as you but have also used contact lenses for 35 years and not needed to have an eye removed. Deliberately putting things in your eye does have one advantage, you can easily fish out any bits of grit that get in there by accident.

stephengillie 13y ago

Some major insurance companies covered LASIK about 10 years ago, but have since stopped. My LASIK was paid 100% by my insurance co in 2003. I heard the logic that paying $2000 in 2003 was cheaper than paying $150-300 per year for exams, lenses & frames for 10-15 years.

nether 13y ago
I paid out of pocket for mine, but breakeven for me was 5 years because I previously wore one-day contacts ($$). For most contacts-wearers breakeven is around 10 years.

baddox 13y ago

Many people will unabashedly say that they believe healthcare to be special. It's not uncommon to hear people say that they don't believe profit motive has any place in healthcare. I don't buy it. I don't see how healthcare is any more special than, say, food production (both are obviously vital to health), yet I think most people have come around to recognizing that profit motive is a spectacular way to organize the production and distribution of food.

bmmayer1 13y ago
People think profit is a dirty word, especially if it is made "helping people." But why is it bad to make money helping people and not bad to make money not helping others, like people who make millions from selling fast food or selling iPhone apps?
jbooth 13y ago
Of course healthcare is special, it's not a normal market because of extreme demand inelasticity. Food is special too, but it manages to function as a market because we have a food surplus, a plethora of replacement goods within the food category and it's much less specialized to produce. This doesn't mean that people don't deserve to earn a living. The doctor in the article managed to find a way to make the man's procedure happen without taking a loss on it. But it's an inaccurate simplification to consider healthcare a market like any other -- inaccurate simplifications hurt any system and that's why our current 'market' system has more bureaucratic red tape, higher prices and worse outcomes than actual socialist systems in the rest of the western economies.
- AlisdairSH 13y ago
  Emergency medicine is inelastic and not conducive to price shopping and other research. But, what percentage of medicine falls into that category? For example, I currently have a shoulder injury. I'm meeting with an ortho specialist next week. And it will likely require surgery to correct. So, while I "need" the surgery, there's no real hurry. I could take an extra week to meet with several providers and ask about pricing. Of course, I won't do that, because my medical plan is paying the vast majority of the cost. I'll just get nickle-and-dimed with co-pays for the next 6 months.

joshuahedlund 13y ago

I like this argument, too, but the common response is that Lasik and cosmetic surgeries are elective - voluntary improvements to your body that are a sort of luxury that lend themselves to competition (shopping around, taking your time). By contrast, a lot of expensive medical procedures are much more critical and time-sensitive (you could say the demand is much less elastic), which makes it a lot harder for competition to work (though more price transparency might help!), especially if as another comment says[0], "You get taken to a hospital out of your control, and they're allowed to decide what services to provide and as well as the price they're going to charge you..." [0]https://news.ycombinator.com/item?id=6258953 https://news.ycombinator.com/item?id=6258953

bmmayer1 13y ago
What the commenter suggested is exactly the situation right now: the hospital sets the prices as astronomically high as possible because they can get away with it, because the patients aren't paying it. Don't you think introducing patient choice into the equation would put some downward pressure on prices? And certainly if it puts any downward pressure on prices, it's a better situation than we have now.
- Smudge 13y ago
  If you're having a heart attack, are you really in a position to negotiate on price? At all? I get that there might be some downward pressure, but what prevents the hospital from just laying an absurd bill on you after the procedure?
  - duskwuff 13y ago
    It's somewhat akin to emergency non-medical services - say, a tow truck, locksmith, or plumber. Many of these services cost quite a bit more than they should. Why? Because the people who need them are in no position to shop around.
  - nsxwolf 13y ago
    The hope with a real free market is that you wouldn't have to negotiate in that situation, the prices would already be reasonable.

mc32 13y ago

Not sure the impact, economically, but... Cosmetic and eye surgery, are for the most part, elective and the pool of potential clients pretty vast, depending on how it's marketed. Other surgeries/treatments are necessary (not as elastic) --it's not as if people would say, well, I have an extra $$$$$ so let me get a hip replacement. They are forced into having to (by the nature of the situation). I'm saying the economics are different, but that's not to say that scale should not apply to non-elective surgeries, but just that maybe to a lesser degree.

superuser2 13y ago

Healthcare most certainly is covered by the laws of economics. It's a service for which there is inelastic demand. Laisk and cosmetic surgery are optional, so the price influences the quantity demanded. Nobody would buy a $100,000 cheeseburger. Treatment that's needed to end suffering or make people functional again is inelastic; if you charge someone's annual salary, he still has to pay it. It's true that there could be competition on price for non-emergency care. It's okay for someone to eat cheap, low-quality food or live in shitty housing, because for the most part they'll be okay. Should there really be a Ramen of surgery? Are you really willing to inflict that on people? A good portion of this country is. Those of us who voted Democrat aren't. http://www.investopedia.com/terms/e/inelastic.asp http://www.investopedia.com/terms/e/inelastic.asp

sejje 13y ago
But a 325,000 burger, on the other hand, is fair game. http://www.nytimes.com/2013/08/06/science/a-lab-grown-burger-gets-a-taste-test.html?_r=0 http://www.nytimes.com/2013/08/06/science/a-lab-grown-burger...

MaysonL 13y ago

Of course, as well as not being covered by insurance, they aren't required to stay alive and in good health. How's that working for heart surgery?