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Comment by dmh2000 | Hacker News Reader

dmh2000

for one thing, we Americans demand instant service even for the more expensive things. For example, I live in a small-ish town, and yet there are 3 clinics with an MRI machine within 15 minutes of where i live. If I needed one, I would be on the slab in the amount of time it took me to drive there and fill out the paperwork. Maybe an hour or two if someone was there ahead of me. I would never have to wait a day or more. I don't have the stats on other countries, but I bet most are not like that.

And that shit is expensive. The way medical competition works in the US is that prices go up when there is more competition because the competing clinics need to keep purchasing the latest technology to keep up. As long as insurance covers the alternatives, we go to the best and most expensive.

In the US we have WAY too much health care.

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Having an MRI machine that doesn't see nearly 24/7 use is a complete waste of someones money. It's either the patients money or the governmenbts money - but it's a huge waste of resources.

This is why waiting times isn't a bad thing but actually a requirement for efficient resource use. The number of MRI machines for example should be enough to meet just above average demand so that queue times are acceptable while machines are used efficiently, and queues don't grow longer. If the machines are sitting idle - then that money could have been put to better use elsewhere.

This is true, but US prices are very hard to connect to sane machine costs.

(Expensive machines cost $3 million. Assume operating costs are double that per year and amortize the whole thing in 1 year and you get to $10 million. At the US price of ~$2500, that's 15 uses a day per machine.)

States that regulate capacity (certificates of need) don't really see lower prices.

Here the state even decides who can operate a CT scanner

https://www.michigan.gov/documents/mdch/CON-212_CON_Rev_Stds...

I'm not sure I believe "more competition drives medical costs higher".

Healthcare competition is, at times, more like Gucci vs. Prada - expensive, intensive tests and treatment make people feel like they got better care, even when the patient just needed the healthcare equivalent of a $20 purse. There are companies all over the US that heavily market entirely unnecessary things like "full body scans", elective surgeries, etc.

It's pretty plausible. We don't have price transparency or price competition; generally when a doctor asks a patient to get an expensive test, if insurance covers it and it's not inconvenient, the patient will get it. So, if there are more places to get expensive tests, that's competition, but also is likely to lead to more expensive tests being done.

This raises the question of efficacy of the tests for patients who wouldn't have had the test done when there was less access. If spending more for the tests improves health outcomes, that's valuable, and if it saves money on treatment that's even better.

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