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Comment by awinter-py | Hacker News Reader

Lack of price transparency is the fatal flaw in nationalized healthcare. I'm endlessly surprised it's not top on the list at every debate.

Lasik is an out-of-pocket procedure. It has the highest satisfaction rate of any surgery and the price has gone steadily down since it was introduced.

Should all healthcare be out of pocket? Maybe not. But if most consumers purchased most health services retail instead of via invisible negotiated prices, insurance would get cheaper too. (And until that happens, prices will continue to go up).

Medicare set a cap on the first 30 days post heart-attack care in the 90s and hospitals respected it -- but day 31 got a lot more expensive.

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Inelastic demand is the fatal flaw in any non-nationalized non-single payer-system.

Lasik is great, but it is a very optional surgery. Lots of people opt to just go with contact lenses or glasses, Lasik is just a more convenient longer term solution to the problem, but it isn't necessary for anyone.

Where the the screws really get turned in health care costs are for the treatments that you actually need to have a reasonable chance to continue to exist should you have certain health issues: Hep-C regimens, EpiPen-type systems, etc.

(Of course there are other factors that contribute on top of inelastic demand, like what I would consider too-lengthy intellectual property coverage for patented treatments, eliminating the possibility of cheaper alternatives altogether in some cases).

If there's a single effective treatment for Hep C that's a different question. This article is about an injector for naloxone. Are we really saying there's no market for a cheaper syringe?

I hear your point that some treatments are difficult to make subject to market forces.

There's a market for cheaper syringes, but nobody is serving it.. possibly due to what appears to be blatant and wide-scale price fixing in the pharmaceutical industry (including the generic manufacturers).

https://www.nytimes.com/2016/12/15/business/generic-drug-pri...

https://www.washingtonpost.com/news/wonk/wp/2016/12/14/feds-...

For every medical condition, there is a long list of treatment options with varying levels of cost, efficacy, pain, convenience, etc. It can be quite elastic because of this.

Lack of transparency is an even greater fatal flaw in _non_ nationalized healthcare.

Actually from what I've seen, market forces fix this. In Asian countries with capitalist medicine (e.g. India and Thailand), you can just call up to inquire about the price for things.

Consumers won't make a purchase if they don't know the price.

Then why does this not happen in the US? Even in Germany you can call a doctor and get a reasonable estimate upfront. Try doing this in the US.

Most likely because the US does not have capitalist medicine.

Gotta love the libertarians. If the market thing doesn't work they can just say "It's not capitalist enough". Same as the scrum people "Scrum not working for you? You are just doing it wrong."

I'm not a libertarian. I have no idea how you can possibly characterize the US's highly regulated health system as capitalist - could you explain?

In the US the quality of service is regulated but there are not many price regulations. Tell me, in what way would the US system have to change for medical providers to give clear pricing information? Be specific, don't use words like "capitalist" or "regulation".

To start with, eliminate the massive subsidies for low deductible health insurance, and eliminate the regulations which mandate the provision of specific services. Then the high cost of low deductible health insurance will induce consumers to choose high-deductible plans, making them more price sensitive.

As a non-libertarian, regulator friendly way to achieve this, you could also ban first dollar coverage.

What you are pretty much saying is that first we need to put a lot more financial pain on patients so the high cost will force them to become more price sensitive. And somehow doctors and hospitals will then quote accurate prices?

Yes, doctors and hospitals will need to quote prices, otherwise consumers will take their business elsewhere. At least, that's what happens here in India.

Are Americans somehow unable to do the same?

You can't take your business elsewhere because there is nobody else who will give you a quote.

We can't do that for many basic surgeries or medicines. Not because it's impossible, it's just that many hospitals and doctors don't know how much something costs [1, 2]. At the same time, for traumatic injuries, etc, you get shipped to the nearest hospital. You have no price negotiation power at that point. We should have a book value like shop rates for autos.

1 - http://frugalnurse.com/2016/08/doctors-dont-know-healthcare-...

2 - http://www.healthcareitnews.com/blog/doctor’s-don’t-know-or-...

Yet somehow, in India I can simply ask a price and be told one. Is Apollo Health just asking Shiva, and He refuses to answer outside the borders of India?

You never know, Garry, you never know [1].

Honestly it's silly boarding on stupid that we can't do that. I've heard various arguments. Most of them come down to a) doctors are sacrosanct, or b) it would cost too much money.

1 - https://www.youtube.com/watch?v=GcxNzPdp_2g

You can ask for a price, but perhaps there's a different reason for that than the one you provided?

A couple of misconceptions here I think:

1. You're saying higher deductible will increase the 'financial pain' to the consumer. Wrong -- what matters to consumer is cost for services + cost of insurance.

2. You're saying quoting accurate prices is the goal -- I think quoting prices at all is the goal. If consumers aren't moving to cheaper providers, prices will always go up. There are price controls built into insurance programs but they're not based on the real cost of providing a service so they can hurt quality.

3. You're saying 'financial pain' comes from high prices today. The real concern is that 0 price sensitivity increases the % of GDP allocated to health care to unsustainable levels. I can suffer pain today if it turns health cost growth from positive to negative.

What kind of subsidies for low deductible health insurance are you talking about? (not from US, so I don't know)

The biggest is that employers can give you health insurance without paying taxes on it. There are a variety of Obamacare and other such rules which insist on low deductibles for certain categories of events. And of course, medicare/medicaid.

for elective/ non-essential medical needs, private healthcare is good. but for essential care, what price can someone put on their life? it's a means to extort if life saving procedures are private!

> for elective/ non-essential medical needs, private healthcare is good. but for essential care, what price can someone put on their life? it's a means to extort if life saving procedures are private!

Only of the provider is a monopoly. One provider can't charge $5000 when the other will do the same thing for $50.

Same reason a can of beans doesn't cost a thousand dollars even though you have to eat to live.

When I'm hungry I don't get taken to a bean factory and force fed beans, then given a bill for my beans in 3 months. I see the price before I eat them.

That only applies to emergency care, which is not a majority of healthcare expenses and should reasonably be handled in the same way we handle the Fire Department.

Which is "I hope you had homeowners insurance or you just lost everything you own?"

We suck at taking care of the weak.

The Fire Department is paid for by taxes and puts out the fire. If you don't want to lose everything you own you can either carry fire insurance or manage to not have your house catch fire.

Are you suggesting that we should have government fire insurance?

I am pointing out that the current healthcare model IS very close to the current fire department model. In both cases, you likely need private insurance to deal with catastrophic loss. So saying "make medicine more like fire insurance" doesn't really make sense.

The problem is that it isn't. You need insurance for catastrophic loss, not for everyday expenses -- that's the problem with existing medical insurance.

Suppose you needed a new garage door opener for your house. If fire insurance was medical insurance then you would have the insurance company buy you one because it would be dangerous to not be able to get out of your garage if there was a fire. Then garage door openers and plumbing and doorknobs and smoke alarms would all cost ten times as much because people aren't price conscious when the insurance is paying for something, and fire insurance premiums would get completely out of hand.

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