A CT scan costs $1,100 in the US – and $140 in Holland | Hacker News Reader

A CT scan costs $1,100 in the US – and $140 in Holland

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71 pointsalweare68 comments

Wife recently needed a CT scan of the chest. It was the correct imaging modality for the potential DX in question. An X-ray would be useless as it wouldn’t show the suspected issue. First insurance denied saying we had to have an X-ray first and that X-ray needed to be abnormal in order to justify the CT. But this would just be a waste of time and money since the X-ray is useless for the suspected issue in question, and then it would also undoubtedly caused problems because they would deny the CT when the X-ray wasn’t abnormal.

It took 3 hours of my time. About 3 hours of medical assistant time and about an hour of two different doctors time to get this simple 5 minute CT approved. This is all on top of the time of admins at the insurance company.

The CT was done and low and behold did show an abnormality.

The charge was around $2000 to insurance which was lowered to about $1150 by the negotiated rates. Of which we paid the $115 coinsurance (10%). We asked what the cash price would’ve been to avoid all this, $450.

So our 10% coinsurance is actually more like 25% of the real price. And the insurance companies denial and absurd process could only possibly make sense over just always unquestionably paying the cash price if 1 in 3 CTs ordered by doctors in such a scheme was fraudulent. I seriously doubt that would ever be the case. And that’s still ignoring the personnel cost in this example. And the opportunity cost of those personnel not being able to spend that time on actual medical needs of other patients.

The system is disgustingly broken in this country, we need to move to a single payer system and get these insurance companies out of the way.

No we do not. The government has screwed the system up enough, giving this government even more control is a terrible idea. Just stop enforcing monopolies, Force providers to have a clear pricing structure and let market forces deal with it.

The market forces did deal with it and created entities large enough to perform regulatory capture and here we are.

The government created these entities by giving the insurance companies a priveliged position in their regulatory structure starting in WW2, and increasing this with every promised legislative "fix" including the creation of the HMO in the 70's with the HMO Act of 1973, all the way through Obamacare, which was considered to be the best thing since Sliced Bread, right up until "We can't handle any of this Capitalism shit, we need Single Payer!"

From my Non-American view, this is a classic case for the need of regulation. The government define a set of medical treatments that were scientifically proved, don't allow the insurance companies to deny the request of medical treatments from the doctor.

The only problems we face is some malicious doctors requests unnecessary treatments, or malicious doctor and patient working together to request the money for treatments that didn't happen. But these are trivial fraud techniques and it happens anyway regardless of context so it can be dealt with usual criminal law system.

The Affordable Care Act (Obamacare) included mandatory insurance funding for homeopathy, chiropractors, acupuncture, and naturopaths. My wife worked at a chiropractors office who got paid by Medicare to shock elderly diabetics legs while they chowed down on candy bars. Homeopathy is one of the dumbest scams known to man, and I don’t really know about the other two but I wouldn’t call them “medicine”. The more government there is around to fund things, the more dumb bloat there is and we’ll get more glorified massage therapists cutting children’s “tongue ties” and selling amber teething necklaces for $40. Let people waste their own money on this stuff.

Not everything magically works well under free market forces. Two examples are healthcare and prison management.

Because you incentivize either people being sick, or in prison. It's really as simple as that.

>It took 3 hours of my time. About 3 hours of medical assistant time and about an hour of two different doctors time to get this simple 5 minute CT approved. This is all on top of the time of admins at the insurance company.

At this rate, most of the costs are human wages, not the medical equipment and its operating cost.

If we can cut all these unnecessary middle men whose job is just confirm/deny the requests, the cost will be a lot cheaper. That's UK.

Why the insurance companies has a privilege to deny a medical test when fully-qualified doctor said it's necessary in the first place?

If the government regulation set the standard medical procedures and its price, insurance companies has no privilege to deny the requests, only the fully-qualified doctor decide the treatments, it can also cut some costs and more importantly, it's fair. That's Japan.

> Why the insurance companies has a privilege to deny a medical test

They aren’t denying the test, they’re denying payment for it from the insurance company. Also, many times, the insurance company is not making its rules, but they are implementing them per the payer’s instruction. The payer can be the government, who outsourced Medicare and Medicaid administration, it could be employers that self fund employee’s insurance, etc.

That's denying, or more like denying the the whole purpose of insurance.

Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad.

So the better incentive design is not to allow the insurance company to deny the payment.

Take a look at my country(Japan) and my insurance company for example. They offer a free cancer test. Why? The treatment of later stage cancer costs so much money. Since they can't deny the payment, it's better to find the cancer as early as possible. That will reduce their cost, increase their profit. It also lead to healthier people as a bonus.

Then who will contain costs? Healthcare providers are also for profit, and have an incentive to get paid.

US insurance companies can’t deny providing insurance, but they can dictate following established guidelines, and requiring justification for straying from them. They are also requiring to pay out 80% of the premiums they collect.

It is not an ideal system, especially with stories like the above, but in the US, there is a ton of money being extracted in the healthcare field, and someone must be the arbiter to prevent waste and abuse. In many countries it’s the government, but absent that, who will?

Note that since the ACA law passed, healthcare costs have stopped rising at the meteoric rates they used to. Again, the system isn’t close to perfect, but someone with knowledge (doctors in government or insurance company) must be used to prevent abuse by healthcare providers billing excessively. Or at least in a lower trust society.

I have a close family member who is a doctor works at health insurance companies and sees doctors trying to experiment with off label uses of medications that cost thousands of dollars per month. If the insurance company approved every one, the premiums would have to skyrocket for it to stay in business, so they follow the CDC and FDA and other research to create rules so that it’s used in cases where it has a chance of working.

> Also, it's bad design of incentive. The insurance companies has an incentive to deny the payment, because it does reduce the cost and increase the profit. For profit companies try to increase the profit that's not wrong, but in this context , it's morally bad.

A for-profit company has no incentive to deny a test that may prevent even costlier treatments down the line. It must stay within budget, however. Socialized systems also have a budget and they also deny/limit/delay treatment all the time.

Also, look at the profit margins of insurances, they aren't that great (about 5% tops). If you sincerely believe a government bureaucracy can do a better job at this for less than the profit margin of a private company, by all means, vote for it.

Cancer testing absent symptoms has come under increasing scrutiny in terms of effectiveness. A "positive" test puts immense pressure on care providers to do something, even though doing something may not actually improve outcomes. It also adds immense stress to the patient.

>They aren’t denying the test, they’re denying payment for it from the insurance company.

What's the difference?

The difference is the person can still get the test.

Only if they're rich!

Then the solution is taxpayer funded healthcare, not private insurance companies.

> If we can cut all these unnecessary middle men whose job is just confirm/deny the requests, the cost will be a lot cheaper.

Not true, administrative overhead accounts for less than 10% in healthcare costs in the US [1].

NHS sets a price for services, which providers have to follow. That evidently leads to waiting times and shortages, as well as lower wages and inferior equipment. There's no free lunch, you need to pick your poison.

There's also a difference between costs and prices. Labor costs in the US are higher, because all staff earns better than in the UK. The industry is highly regulated and liabilities are high as well.

In the US, lots of hospitals run a loss for treating Medicare patients, as well as people who end up not paying. In order to stay in business, hospitals charge as much as they possibly can, and it's very opaque. If you get a huge hospital bill, you must negotiate.

Lastly, technology in the US needs to be up-to-date all the time, otherwise you run the risk of costly lawsuits. That's not the case in countries where settlements are far lower.

Ultimately, the headline is wrong, a CT does not cost $1100, it costs whatever you or your insurance pays for it. You can get it for 450$ or even less. You need to shop around, but it's quite difficult, because prices are not transparent.

[1] https://www.americanprogress.org/issues/healthcare/reports/2...

> we need to move to a single payer system

The only reason you say that is that you haven't actually experienced Medicare.

It's much much much worse than what you experienced with your insurance company.

The only type that is even remotely sane is Medicare Advantage which is administered by private insurance companies.

What you have described is a huge problem, I 100% agree, but it will not be solved by single-payer.

> The only reason you say that is that you haven't actually experienced Medicare.

I have experienced Medicare (along with pre- and post-ACA Gold level individual marketplace plans, small group plans, premium employer-sponsored plans, and Medicaid). The only system I’ve experienced which is better than Medicare was my state’s Medicaid system. Every private insurance plan I’ve had has been significantly worse in every metric—more expensive, less coverage, super stressful (imaging having a kidney stone and having to decide whether to spend $300 + coinsurance to go to the emergency room on a Sunday night or wait in excruciating pain until you can get an appointment for a $10 office visit instead the next day).

On Original Medicare with a Medigap plan I pay $377/mo in premiums and have 100% coverage for hospitals, doctors, surgeries, ambulances. There are no provider restrictions. The “coverage area” is the whole country. Outpatient services in hospitals is fine. There’s no arguing over billing, no copays, no coinsurances, no hassle.

Drug coverage is a whole different thing, but it sucks about as much as it did with private insurance—which it would, since Part D is just a marketplace of private insurers! Notably, though, any drugs I get in a clinic, like super expensive biologics, are covered under Original Medicare for that $377 premium.

What is your experience that makes you think so differently?

I completely agree that Medicaid is the best one of all. But I need to point out that (at least in my state) Medicaid is simply contracted out to local insurers, it is not run by the government.

It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone.

And you have to buy private insurance to fix what the government doesn't do right.

Medicare Advantage is the same exact thing: you have to buy private insurance and the one the government offers is terrible.

So basically your experience exactly confirms what I said.

Medicare for all is not a good plan. Medicare Advantage for all however is a good plan.

And Medicare Advantage is simply private insurance companies that are paid by the government.

And personally I think that's the best option. Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely.

Thank you for sharing your thoughts with me.

> It's the fact that you need to buy a medigap plan that is exactly the problem. Those plans are not available to everyone.

I’m not sure I understand this comment. There is a guaranteed issuance period after you become eligible for Medicare. Several states also either have permanent guaranteed issuance periods, or annual guaranteed issuance enrolment periods. What do you mean when you say the plans are not available to everyone?

> And you have to buy private insurance to fix what the government doesn't do right.

Sure, but supplemental insurance exists in Canada and the UK too, even though those care systems are quite good. Most people don’t need it because the basic services are comprehensive and reasonable. A Medicare for All plan just needs to offer the same level of service that you see in other universal health care systems.

> Medicare for all is not a good plan.

There are multiple plans that are described as “Medicare for All”. Which specific version of this concept do you think is bad? Why?

> Leave it as private insurers, but let the government give every family an allowance to help pay for it or even pay for it entirely.

The main thing I don’t understand about this approach is where cost savings and improved patient experience are supposed to come from. Having multiple insurers means that all the billing and administrative overhead costs continue to exist. Insurers will demand a profit margin on top of the actual cost of providing services. We’ll still have the restricted networks and copays and coinsurances and denials and appeals and prior authorisations and formulary exceptions and annual enrolments that make navigating care in the U.S. a nightmare. Can you explain how you think these problems would be mitigated under a “Medicare Advantage for All” type system?

Let's call it health industrial complex.

If you have a white collar job at any one of health care companies in the u.s. (medical health insurance, hospital, pharma, device makers, pharmacy benefits, retail pharmacies, doctors office) you know why healthcare is really expensive in the U.S.

There are lots and lots of white collar jobs that are extremely handsomely paid. So many duplication of functions across competing private companies. No good standardization. Surgeons that make well into 7 figures. Thousands of executives making tens of millions of dollars in total comps. Thousands of highly paid IT professionals just at one large healthcare companies. Pharmacists raking in $130-150k. Lawyers and malpractice suits. All #1 in the world.

Somebody has to pay for all these rackets.(of which I'm also part of)

Oh please, cherry pick all you want. Healthcare is expensive in the US because of government, not just the industry. From certificate of need rules to conflicting regulation at nearly all levels and unreasonable coverage requirements that do not take the patient into account.

throw in the simple fact the US Congress cannot even be shamed into fixing the Veteran Affairs health system nor the Bureau of Indian Services and people dare suggest we let take more control?

fixing US health care will require a lot of work but the first step in fixing it is realizing all the bad players involved and that simply comparing to other systems isn't helping anyone.

This seems like whataboutism.

is it just veteran care thats broken? Is active duty the same issue?

We spend $843 per capita on just Administrative expenses in the US on healthcare. Its like 7-10% of Healthcare expenses.

Do we really dare let this waste continue using private companies?

Active duty care is bad as well. A running joke in the military is that "motrin and water" is a miracle cure because it's the only thing you'll get prescribed without a ton of doctor visits. I personally know of two people that were diagnosed with cancer while they were active duty, and both were lucky to survive. One told the doctor he was having severe pain near his abdomen, and instead of doing any sort of examination, they just put him on a 6 month waiting list for hernia surgery. Turns out he had testicular cancer and after the 6 month wait, it had advanced pretty far and he immediately needed to start chemo. They told him he only had a 10% chance of living because the cancer had spread to his lymph nodes during the wait. Another friend kept complaining about headaches and they kept sending him away with motrin, and after a few months they finally did a full exam and they found out he had a brain tumor.

Active duty care varies wildly from post to post. My wife and I experienced spectacular care but I have heard dozens and dozens of horror stories from people who were stationed elsewhere.

What is really amazing is that active duty family care is basically magic. USFHP is virtually free and you can go to virtually any private doctor, practice, or hospital you want. It's the impossible dream of what government sponsored health care could be.

The fact that other countries have effective health care systems run by the government suggests that the conclusion we should draw from the VA fiasco is that either the U.S. government is particularly incompetent or the incompetence is local and limited to a specific department(s). I'm inclined to believe the latter.

That being the case, a further conclusion I would end up drawing is that both largely private and largely public health care systems work well, but that the U.S. suffers from running a health care system that takes no opinion as to which form it should take.

Our "effective health care systems" might not be so effective in the U.S. Some of your states have big immigration problems.

It's neither of those two.

The actual problem is the huge number of people employed by the industry.

The US government is incapable of fixing anything because it would require firing huge numbers of people.

That's obviously a non-starter for any politician.

This situation can only be fixed by giving power to an entity that doesn't care about firing people, that only cares about the bottom line.

And by the time people realize what's happening it'll be too late to change it.

Basically private insurance companies that are not monopolies. There was a plan I remember from years ago about allowing people to buy health insurance from any state.

In my opinion that's the best option. It would also be necessary to get rid of employer based insurance because employees don't get to pick.

I have zero expectation of this ever happening.

Seems obviously a problem of size. Can you point to a working healthcare system in any other country that has a population anywhere close to the US?

Comparing us to countries that are hardly as populous as one US state is not a fair comparison.

As anyone in the tech industry should know, there are a lot of unforeseen issues that popup when scaling something. It's rarely as easy as adding more CPUs or more people for that matter.

"Seems obviously a problem of size. Can you point to a working healthcare system in any other country that has a population anywhere close to the US?"

Healthcare in the US is run at the state level, moreover, in Canada it's also run at the Provincial level.

Germany's healthcare 'system' is bigger than NY and California combined.

In Switzerland, insurance is at the cantonal level.

Scale is not the issue - in fact, scale should mean lower prices.

There actually is not a lot of competition for Medical services in the US, you have very powerful guilds with power handed to them by the gov.

It's almost Mercantilist in a way.

If that were true, then solve the problem state by state.

That is what should likely happen and is already the case to a point. Much of the existing programs are funded at the state level. But the federal government is already meddling so you can't exactly do what works best for you. You have to follow the federal ACA rules no matter what you implement at this point.

I've always considered that a fair objection.

If there is a bottleneck at scale, though, it'd be nice to know what exactly it is.

This also doesn't detract from my broader point that U.S. healthcare seems to intentionally exist in a no mans land.

And scale I think is only part of the issue. The problem of scale is compounded with 50 different states, all with their own laws, unique geography, and demographics. Then add to that the very high levels of diversity in the U.S. population. There is a diversity of races, religions, and income that doesn't exist in most of these other countries that have been able to implement universal healthcare. (For example, the U.K. is something like 86% white.)

Brazil.

Holland doesnt have government run healthcare. Which country does? UK has a lot of problems with their NHS

Health care in the US is expensive because the bad players are the insurance industry. It’s just a huge middleman that doesn’t need to exist, and yet it consistently makes record profits.

You’ll run into hurdles when you try to bypass this layer because big insurance execs won’t be happy when they don’t get their cut. Then there’s all the people working for them that will be unemployed. But we just need to bite the bullet and remove the industry completely.

When peoples’ health is at risk, there can’t be a notion of profit involved to get in the way of availability of treatment.

A drug for my kid's IBS costs $1400 in the US and $30 in Russia (and moreover, it's available over the counter there). Same exact drug. Made in Italy, so it's probably cheaper still in Italy. It's not genetic or anything else that would justify a high price - it's a simple antibiotic. Probably costs a dollar a gallon to make.

I'm seriously considering finding a good clinic in e.g. Israel where I could pay cash for treatment, and giving up US medical insurance entirely. Thankfully now I can do that without paying a penalty. $15K/yr for a family of 3, with crazy deductibles is kooky. If I get cancer or something, getting treatment in the US would be an insane proposition.

What is the point of the US having the worlds largest GDP when even basic health and education is denied or difficult for large groups of its citizens?

I mean it seems bad on paper but my uncle just recently got cancer and despite having no money is now cured. He ended up on disability, but he received prompt treatment. It just sort of works out. My daughter was born when I was unemployed and this actually ended up being better for us, as the private insurance would have had a copay but instead Medicaid applied retroactively and then covered her 8 month NICU stay. Thank you, taxpayers, for supporting my daughters $300,000 a month hospital stay.

Maybe some people’s lives get ruined by medical debt but I’ve never met them. People just don’t pay and even mortgage companies just sort of shrug and barely care when you’re getting a loan.

Do you realize how many complicated terms are in your first paragraph? Assuming that everybody can figure out how all those mechanisms work, which is a big stretch, it is terribly stressing to have a medical need of any sort. And I know that because I have family there.

Compare it with the single-payer system where I live: it works really well, and I don't need to add financial stress to any doctor visit.

My wife had a series of CT scans in the ER after a car accident. I noticed that most of them were only paid out at 1/20th of the billed rate. I wonder if the pricing is gaming the accounting, since most people either have some sort of coverage, or can't realistically pay (so the hospital doesn't get the full amount either way)?

One reason also is that the workers in healthcare in the Netherlands are not paid much. As an IT person (clinical programmer, bioinformatician, application specialist,...) there is no way to get above scale 60 in this table https://cao-ziekenhuizen.nl/media/45/download Most get ~3k some with insane amount of experience get ~4k brutto a month

It's the same reason the median radiologist in France will earn $150,000 while radiologists in the US can easily earn four to six times that depending on location. I know a radiologist in the middle of nowhere - one of the poorest states in the US, small city - earning over half a million per year, or roughly 15 times the median full-time income there. In major cities they can get up around a million dollars per year.

The healthcare industrial complex racket is a wealth transfer from everybody else to a million people working overly compensated jobs in the healthcare sector, from admin to doctors to nurses to IT workers to insurance salespersons.

Everyone complains about the wasted money in the military industrial complex. The healthcare industrial complex is 5x worse when it comes to that, or roughly a minimum of $1 trillion in overspending. The reason there are so few suggesting spending cuts in healthcare, is because there would be a never-ending line of strikes if you attempt to slash pay. The Democrat candidates for President for example all know we have a vast overspending problem in healthcare, they know taxes on the middle class have to go up to match Europe (for the same reason their taxes are so high), and salaries have to go way down in the healthcare field to similarly match Europe, and yet none of them dare say it.

Health care in the Netherlands is mostly financed via an income dependent fee collected by the tax authority, supplemented with a fairly minimal mandatory insurance. Assistance for “low” income families is available to help pay this insurance.

The per treatment budgets do sometimes cause issues where budget for certain treatments is consumed and patients have to wait to receive treatment.

Yes, it’s 6,9% over the total gross of all salaries, paid by the employer. See also: https://www.belastingdienst.nl/wps/wcm/connect/bldcontentnl/... (Dutch)

Depends where you shop

https://surgerycenterok.com/blog-category/veterinarian-cat-s...

"but the US system has to actually pay for the R&D the rest of the world piggybacks on", goes the standard counter.

I am in the US and my Ct cost $180, because i bothered to shop around, even a little.

Coming from a country with excellent universal healthcare, I find it absurd that you should need to "shop around" for any procedure.

For this case, it is silly for a CT. However, for procedures and surgeries, not all doctors are equal. Do you have any choice in your country?

Yes, you can absolutely choose. There's a web site for finding hospitals/clinics for your particular procedure, although your doctor can also refer you directly. The web site tracks the wait time and (often) publicly available quality metrics collected by the health authorities. Travel expenses are covered to some extent if you don't want to use your local options.

Next on Vox: "Magic mushrooms are illegal in the US — but they're legal in Holland".

I thought it was only truffles that were legal.

Actually, Colorado legalized magic mushrooms earlier this year. Go figure...

It's pretty disingenuous when articles are written about the US healthcare system and they don't talk about methodology for how they determined the price. It's absurd that a methodology is needed, but it is. Is it the average price of the item on the chargemaster? Is it the average price billed to the insurance company? Or is is the average price billed to the patient? Is it the average price for those with insurance, those without, or both? If it's the average price billed between insured and uninsured, is it weighted? And if we are talking about uninsured, is it the average price billed or paid?

US healthcare is a disaster, but these kinds of articles are just promo pieces for universal healthcare. Which I guess is the point, but I still find it extremely misleading. I suppose this is what passes for journalism these days though.

The only major healthcare provider I know of that posts prices actually charged for most items, publically, is Kaiser. Even then you'd need to know the relative breakdown of plans to determine the average cost paid by the patient. That information may be available, I don't know.

Normally I think we wouldn't really need 'promo' pieces for universal healthcare, since it's been proven to work literally everywhere (except the US). Hell, even China has some form of universal healthcare.

My CT cost $180 in the US because i bothered to shop around.. I see these articles all the time cherry-picking The only reason healthcare in the US is high is government enforcing monopolies, Giving them more power over healthcare is foolish. If you are the least bit smart you call around, that is the nature of a market.

When my health is on the line, I do not want to do anything like shopping around. I want the hospital I'm currently at to do the thing for a reasonable rate. Preferably the same rate as every other hospital in the country charges for the same scan.

The US is too large to have the same uniform price. The cost of materials, rent, and labor vary radically across state lines. Second, for things like CT, they might now be immediate. Therefore you can shop around. For example I had an MRI. $200 after shopping around. Now it wasn’t an emergency, just a check for cancer. Don’t let the assumed to be perfect be the enemy of the good.

The US is too corrupted with evil politicians to have adequate health care, because you need adequate, healthy people to implement that and we have Donald Trump and his kindred spirits. It's not rocket science, you have to care to make changes, and they simply don't care. Melania said it best.

Of the cases I heard where people did try to shop around, simply getting price information was nearly if not completely impossible.

> When my health is on the line, I do not want to do anything like shopping around.

How do you obtain food then? Do you not go to grocery stores or restaurants?

But talking about just medical services, sure there are many situations where a patient has vanishingly little opportunity to shop around, and applying the market ethic is really just a blessing to price gouge. But there are also many situations that aren't so time critical (like anything that insurance companies currently insist on "authorizing"), where it would be quite easy to shop around if providers had to charge everyone the same price and publish it.

Giving government lots of power over healthcare is demonstrably not foolish, as evidenced by all the countries having success doing just that.

The whole “shopping around” thing sounds awful to me, but I don’t know specifically what it involved for you. So can you elaborate? How many people did you call? Did you do background research? How did you know who to call?

Where you stressed by sickness or other life things while shopping around? Do you think you found a deal somewhere near the price floor or is it possible you can get a scan for ~$100?

Most of the time this doesn’t work. Their is no market because their is no price transparency. The price is different for everyone based on their insurance and whether or not it’s “covered”.

The ACA made this a little better since more things are forced to be covered, but not much.

It is near-universally accepted that a perfectly competitive free market is an optimal means of distributing resources.

That statement makes some assumptions: all the parties involved have symmetrical information, equal bargaining power, and are free to choose not to participate in the market.

At the point where I am experiencing a health emergency, the resources I can devote to shopping around are limited, as is the time available to choose.

Also, as I am not a health professional, my ability to compare providers by the one parameter that actually matters - the likelihood of a positive outcome - is severely limited. Meanwhile, the providers will be trying their hardest to get me to choose them, and thus bombarding me with irrelevant but comprehensible and good-sounding metrics.

Finally, when the alternative is life changing injury or death, I am not really free to walk away entirely from taking a deal.

(I'll not even start on the perverse incentives involved in preventative medicine vs emergencies).

So the free market fails me here, at the time I most need it, in several ways:

* an inequality of bargaining power exists

* information asymmetry exists

* I am forced by circumstance to participate

Without outside intervention, in such situations, we expect the costs charged to me to rise to match or exceed my ability to pay; and this is, in fact, what we actually observe when we look at the US healthcare system.

In general, free markets are great; however, for some situations, like healthcare, the assumptions that make markets work in general are not true, and to the extent they are not true, some outside force needs to step in to restore balance. In countries where the government chooses to do so, largely regardless of the precise means, healthcare systems are more efficient and are more accessible to the population.

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