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Comment by bigchewy | Hacker News Reader

you may not be familiar with how healthcare works. There is, generally, almost no price pressure. In fact, consumers of healthcare, because they aren't paying for it, often equate higher price with higher quality so I wouldn't bet on the prices going down

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but with medical tourism becoming more reliable and trusted, as well as companies hq'd in countries unencumbered by our insistence on patents for biology, it's likely this is where another country takes the "top" spot from the US. China, Brazil, and India all seems like good potentials.

Medical tourism doesn't work for chronic disease requiring recurring visits/treatments... unless you move there.

unless you move there

It's a big opportunity for Mexico, then. Already home of the most cost effective first world (OECD) universal health care system, Mexico has good facilities right on the US border in half a dozen cities and is popular for eye and dental procedures for US visitors already.

> There is, generally, almost no price pressure.

That's not actually true. There's tons of price pressure, but it all happens behind the scenes, and in a way that's invisible to patients.

The way payments are structured, downward price pressure on suppliers may even correspond to an increase in the (apparent) out-of-pocket cost to patients. That doesn't mean that the overall amount that the manufacturers are getting paid isn't decreasing, though.

Health consumers are rarely the customers, though; providers' customers are actually the carriers, and the customers make the market in healthcare. The asymmetry in price signaling between patients and carriers causes, as you point out, weird distortions in the market. (It doesn't help that price transparency for patients is basically zero.)

This is changing. In the USA, the increased prevalence of high-deductible health insurance plans tied to HSAs gives consumers a direct incentive to shop around. Of course that only goes so far. Patients with really serious problems tend to hit their out-of-pocket maximum quickly, at which point they no longer feel the price pressure.

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