Comment by s1artibartfast | Hacker News Reader

Comment by s1artibartfast | Hacker News Reader

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I think One "silver bullet" would be to give the patient more skin in the game when selecting treatments and balancing cost/benefit.

The current system is a tragedy of the commons. Costs are opaque and distributed. Patients have insurance and may as well buy the most expensive treatment (everybody else is doing it). There is nobody in the entire health system with incentives to trade 1% less benefit for 99% cost reduction.

In Europe, this is often handled by government purchasing discretion (not price caps as many simplistically believe). If X treatment is too expensive, it simply isnt covered. If generics medication get 99% of the job done, that is what you get.

This might mean replacing employee healthcarecare with employee payments, MORE copays, and more transparent pricing (there has already been some improvement in this area).

If a CT cost is 10x at one hospital, and 1x at the other, the patient needs an incentive to seek out the 1X cost. Similar, if one cancer drug is 10k and the other 100k, with a life extension of X days, the patient is the only one that can really make the call.

The way this should work is that providers have to publish their prices for each service and then insurers publish how much they pay regardless of where you go, which might be something like 90% of the median price, i.e. the equivalent of a 10% copay.

But then the patient can go to whichever provider they want. The one across the street from you charges $3000 more than the one which is a two hour drive away? It's your $3000 and it's your two hours each way.

You might even find a provider that charges less than your insurance pays, and then you could put the balance in your HSA for the next time it isn't.

We keep trying to pretend that some important price negotiation is happening between bureaucracies that has to be preserved, but a CT scan for example is a standard service. If the prices had to be published and put in a database where patients can see them, you don't need anyone to negotiate anything, people would just choose the one with the best price absent some specific reason to do otherwise, which would exert a downward pressure on prices that doesn't currently exist.

> In Europe, this is often handled by government purchasing discretion (not price caps as many simplistically believe). If X treatment is too expensive, it simply isnt covered. If generics medication get 99% of the job done, that is what you get.

The amount of times I’ve proposed this only to be responded with “government death panels” is astounding.

> If a CT cost is 10x at one hospital, and 1x at the other, the patient needs an incentive to seek out the 1X cost.

Healthcare is weird because the demand is inelastic and you aren’t always in a place to price shop. However, I agree with your broader point.

I think that that demand is more elastic than most give it credit for being. There are often many ways to treat an issue, with different costs and efficacy, and the demand for which and how many depends on who's footing the bill.

Similarly, I think most people vastly overestimate how much of Healthcare expenses involves an ambulance ride or emergency room

The trump administration did an executive order that forces hospitals to list all their prices. Imo easily his best move. Now, the current implementation does not work for a myriad of reasons that are mostly "hospitals have good lawyers and don't want to reveal prices" but the law can be fixed. A working implementation would make price shopping easy as someone would build a centralized site and you could have your health care provider put in the treatment needed along with your location and distance willing to travel.

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