4 ms·

Just imagine what a hamburger would cost if you could only purchase them through some kind of hamburger insurance. You would hand over a small copayment and ge

by nsxwolf 13y ago

Just imagine what a hamburger would cost if you could only purchase them through some kind of hamburger insurance. You would hand over a small copayment and get your burger. Months later, you would receive a really confusing looking Explanation of Benefits from your burger insurance provider with multiple pages of line items - full of really high prices for pickles, pickle slicing fees, etc... ending with an "Amount You May Owe Provider" that would be many times more than we pay for hamburgers on our current free market system. We'd then demand a huge law be passed that would slightly decrease out of pocket costs for some, increase them for others, and force everyone to buy burgercare. And when it caused even more problems, we'd throw up our hands and finally adopt a single payer burger system. In the end, we'd have long forgotten and laugh at anyone who suggested that burgers were once far cheaper, and that it was therefore a lot easier to buy a burger for someone who couldn't afford one.

tdfx 13y ago
But then again, nuclear medicine devices were never on the dollar menu.
- novalis78 13y ago
  Hm... who used to be able to afford cars? Cell phones? when they initially hit the market. I remember last year going to a radiologist, for my wife's ultrasound. The machine looked like a desktop, I thought pretty cool, the thing gets smaller. I asked how much it cost. The nurse said it they bought it for 50k USD. I almost fell off the chair. Year 2013 - an ultrasound for 50k. Sounded like progress backwards. Obviously, there are incentives at work that raise the price in health care, and less forces that would let them fall. Great example is that recent article in the NYT about the 5 artificial hip manufacturers in the US that basically run a cartel.
  - vacri 13y ago
    You make it sound like an ultrasound setup is a bulk consumer device. They very much aren't. They're quite low turnover items, and require significant specialist knowledge across a couple of fields to make. They're not consumables - if you sell one, it could be in service for 5, 10, 20 years. $50k for this kind of lasting professional tool isn't that much. I'd say $50 might be a touch high for this kind of thing, but not by much, and depending on the model, not at all. I used to work at a place that made medical electronics, and the idea that 'because smartphones that are churned out by the million only cost half a grand, every other electronic item should be similarly cheap' is just wearying.
    - novalis78 13y ago
      If there would truly be an enormous price pressure on hospitals and clinics driven by a free market setup, I am pretty sure they would turn around and talk to said equipment manufacturer: Hey, we know you are selling us a desktop with an audio card. We are pretty sure you can still survive if you reduce your $50k profit and sell us the same equipment for 20k or 10k. Then, said equipment manufacturer, would have to increase volume by starting to sell it to developing markets (what a novel idea) or find ways to produce it cheaper etc etc... but I get it - these are daily considerations of entire industries that the medical sector does not need to be concerned about. What if we tried and see where this would lead though? Right now, I think, we have a pretty good idea how a healthcare system looks like when it is run without any price incentive or cost assessment.
      - vacri 13y ago
        The high price of an ultrasound setup has nothing to do with the desktop PC component. Ultrasound probes are the specialty part of the hardware costings, the clinical know-how for the software is another expense, compliance is another, and low turnover contributes yet another. Similarly, 'just sell in developing countries' is an utter throwaway line for medical devices the way you're using it - and you'll find that these products already do sell in such markets anyway (what a novel idea indeed!). Not to mention that developing countries have extremely limited medical budgets, and 'allied health' stuff like ultrasounds are luxuries - they're available and have sales teams, but the turnover is extremely low.
  - noonespecial 13y ago
    The machine really was a $1500 desktop with a $500 usb peripheral that was little more than a jazzed up sound card. The other $48k was for FDA compliance and insurance. We get the system we (collectively and emergent-ly) ask for.
novalis78 13y ago
Love it ;-). Now, here is a crazy idea: The burgercare just got passed, everybody was hoping for lower burger premiums, but instead they doubled - in fact co-pay at the restaurant went up as well! Anger, confusion. Now imagine, people find a way to look at the actual cost of a burger, maybe by looking at some restaurants that show their prices. People dump burgercare and rather pay directly - at least for the triple mac to save money. they find small restaurants that sell them burgers directly without burgercare. they find out that they won't be penalized if they don't sign up for burgercare as long as their tax witholdings are near zero. Pathway to a competitive high quality burger market?

by nsxwolf 13y ago

tdfx 13y ago

But then again, nuclear medicine devices were never on the dollar menu.

novalis78 13y ago
Hm... who used to be able to afford cars? Cell phones? when they initially hit the market. I remember last year going to a radiologist, for my wife's ultrasound. The machine looked like a desktop, I thought pretty cool, the thing gets smaller. I asked how much it cost. The nurse said it they bought it for 50k USD. I almost fell off the chair. Year 2013 - an ultrasound for 50k. Sounded like progress backwards. Obviously, there are incentives at work that raise the price in health care, and less forces that would let them fall. Great example is that recent article in the NYT about the 5 artificial hip manufacturers in the US that basically run a cartel.
- vacri 13y ago
  You make it sound like an ultrasound setup is a bulk consumer device. They very much aren't. They're quite low turnover items, and require significant specialist knowledge across a couple of fields to make. They're not consumables - if you sell one, it could be in service for 5, 10, 20 years. $50k for this kind of lasting professional tool isn't that much. I'd say $50 might be a touch high for this kind of thing, but not by much, and depending on the model, not at all. I used to work at a place that made medical electronics, and the idea that 'because smartphones that are churned out by the million only cost half a grand, every other electronic item should be similarly cheap' is just wearying.
  - novalis78 13y ago
    If there would truly be an enormous price pressure on hospitals and clinics driven by a free market setup, I am pretty sure they would turn around and talk to said equipment manufacturer: Hey, we know you are selling us a desktop with an audio card. We are pretty sure you can still survive if you reduce your $50k profit and sell us the same equipment for 20k or 10k. Then, said equipment manufacturer, would have to increase volume by starting to sell it to developing markets (what a novel idea) or find ways to produce it cheaper etc etc... but I get it - these are daily considerations of entire industries that the medical sector does not need to be concerned about. What if we tried and see where this would lead though? Right now, I think, we have a pretty good idea how a healthcare system looks like when it is run without any price incentive or cost assessment.
    - vacri 13y ago
      The high price of an ultrasound setup has nothing to do with the desktop PC component. Ultrasound probes are the specialty part of the hardware costings, the clinical know-how for the software is another expense, compliance is another, and low turnover contributes yet another. Similarly, 'just sell in developing countries' is an utter throwaway line for medical devices the way you're using it - and you'll find that these products already do sell in such markets anyway (what a novel idea indeed!). Not to mention that developing countries have extremely limited medical budgets, and 'allied health' stuff like ultrasounds are luxuries - they're available and have sales teams, but the turnover is extremely low.
- noonespecial 13y ago
  The machine really was a $1500 desktop with a $500 usb peripheral that was little more than a jazzed up sound card. The other $48k was for FDA compliance and insurance. We get the system we (collectively and emergent-ly) ask for.

novalis78 13y ago

Love it ;-). Now, here is a crazy idea: The burgercare just got passed, everybody was hoping for lower burger premiums, but instead they doubled - in fact co-pay at the restaurant went up as well! Anger, confusion. Now imagine, people find a way to look at the actual cost of a burger, maybe by looking at some restaurants that show their prices. People dump burgercare and rather pay directly - at least for the triple mac to save money. they find small restaurants that sell them burgers directly without burgercare. they find out that they won't be penalized if they don't sign up for burgercare as long as their tax witholdings are near zero. Pathway to a competitive high quality burger market?