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Comment by Balanceinfinity | Hacker News Reader

Makes one wonder - in the absence of thorough regulation, why a third-party evaluator hasn't arisen to provide real risk analysis for patients regarding each device (the good device seal) - and I'm surprised insurance companies aren't more aggressive in ensuring that they aren't making the patients worse 9which would increase their insurance costs).

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My theory is that insurance companies don’t try to save money as long as they can pass the cost to the patient or whoever pays the premiums. Otherwise I can’t explain the insanity of the charges hospitals are getting away with.

If your limited to a certain percentage of costs as your profits, you have an incentive to increase costs. Hospitals and insurance enter into an unholy pact to increase costs implicitly as a result.

Doesn't gaming the system to increase profits by increasing costs show malevolent motives which would not be fixed by removing profit restrictions? I mean if you're "evil" with regulations, why should I trust that removing regulations will make you "less evil"? It sounds like a crook asking you to remove the handcuffs.

Removing the profit regulations has less to do with enabling greed (which exists either way) than it does with aligning incentives.

The idea is that you want the insurance companies to profit from patients getting timely, cost-effective care, rather than incentivizing them to drive up costs and delays.

If you remove the profit regulations insurances will keep doing exactly what they are doing now while making more profit. The won’t pass savings to the patient unless forced to do so. Health care is just a very bad area to apply regular economics. As far as I know most countries have some kind of price control including the US with Medicare.

You are proposing a cost spiral due to greed; why doesn't this happen in every industry which provides 'essentials' but has no profit-limiting regulations?

Examples would be grocery stores, clothing, transportation, etc. You can say 'this one is different' about every single industry, but why does that difference matter?

Because in all these industries pricing is relatively clear, customers have some level of understanding of the product and they can choose between competitors. In US health care you have zero pricing information, the employer chooses insurance based on their needs, not the patient’s, and people are not in a position to judge the quality of procedures so they do what the doctor tells them. It’s not a functioning market and probably can’t be.

Employer-provided healthcare is a result of tax policy, so it is tough to blame that on insurance companies.

The average person understands much more about healthcare products than they do about transportation products. Your car is made up of >20k components, and extremely intricately designed. Understanding the factors that go into a reliable car requires a fairly advanced understanding of thermodynamics, metallurgy, fracture mechanics, electronics, software engineering, statistics, and manufacturing. Most healthcare is comparatively primitive.

If you're worried about the quality of procedures (as I am), it's a doctor/hospital issue, not an insurance issue. Doctors have very effectively avoided oversight, and they often cause huge problems for their patients. The leading cause of death in hospitals in medical error.

“Employer-provided healthcare is a result of tax policy, so it is tough to blame that on insurance companies.“

Agreed. However, they make a very good living off this and will fight to keep things that way.

When you buy a car, you know all competitors, their prices, there is ton of information about maintenance, durability and all other factors that may cost you money. In healthcare you get none of this.

I am not trying to single out one factor in health care. Insurers, providers, pharmaceuticals and the various middlemen are all guilty of making an excellent living off this insanely stupid system on the back of patients who suffer from it health wise and financially. Where it gets evil is the fact they lobby for keeping things that way by spreading a lot of misinformation.

The ones making the real money in healthcare are the doctors and nurses, who have been very successful in restricting competition. Doctors and nurses in the USA (and to a lesser extent Canada) make far more money than they do almost anywhere else in the world (in either absolute or relative terms). Doctors have also been successful in preventing/avoiding tracking their results; some are much worse than others, but it is very tough to find out how good/bad they are.

Hospitals and clinics in some states have been very successful in reducing competition, to the extent that you often need permission from your competitors to open a new one. Hospitals have also avoided much scrutiny by avoiding cost-accounting, which is a very interesting tactic.

Pharmaceuticals and insurance companies are the bogey-men of the industry, but they're not as profitable as most imagine, and their high overheads are largely due to regulatory burden.

You are making the mistake of singling out one participant. In the US health system all players are making “the real money”. The only exception is the patient.

The American healthcare industry is fascinating for a number of reasons. First, when insurance is involved you have the person seeking the service completely removed from the person paying for it - which almost always will result in overconsumption. Then, you have life or death issues, which people won't apply their usual cost/benefit analysis. Do you need a new car? Depends, is it worth the added expense. Do you need brain surgery even if the chance of success is 4%? Will it possibly extend my life? Yes, no matter how much it costs.

Why would they not increase executive pay, raise prices and deliver worse service? Private industry is not perfect at utilizing resources or delivering great products all the time. You just assume they will deliver a better product, but their undermining of the current system shows that profit over patient outcome is already their top priority. Deregulate so the crooks are less crooked has blown up in our face before.

How exactly would this work? Station someone on the sidewalk outside the hospital and interview people leaving the building? "Excuse me sir, have you received a medical implant today? We're interested in enrolling you in our study group which will take a good deal of your time and give you no benefit..."

More systematically: offer a "good housekeeping" seal. Presumably those who have good implants will cooperate and open their books so you can look at who they install to and outcomes. Being a reliable 3rd party, cooperating and getting a gold medal seal will help with sales.

1) For current patients, how will you get their data. I'm reluctant to give some places my email address; access to my complete medical records for the rest of my life is a giant stretch.

2) For future patients (or their doctors), how will you convince them that your recommendation is credible and not some kind of front for a specific manufacturer?

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