Price discovery doesn't help you. If you get knocked out, heart attack, your arm cut off, whatever (i.e. a lot of the expensive stuff) you just go to the nearest hospital, no consumer market finagling is even possible other than trying to live near a good hospital.

Other times with chronic conditions where theoretically price discovery could help, the problem is that you need care badly so all the chronic care providers jack up the prices super high beyond what is needed. Treating this as a market in any way is a crazy system. If the government pays market rate, they jack it up even more. So the solution has to be that the government has to set the prices either directly or by negotiating with an entire population at its back and no competitors (i.e. monopsony in the public interest).

The biggest fuck you is that Medicare can't negotiate.. it's actually written into the law.

That's not true. Medicare can and does negotiate the cost of procedures and doctor's services. What the law says is that Medicare can't negotiate prescription drug prices. That's because Medicare doesn't directly pay for drugs, except what's used incidentally in the course of covered hospital stays.

Medicare didn't provide coverage for prescription drugs until the adoption of Part D. That is structured differently than other parts of Medicare. Instead of the government serving as the insurer directly, the government subsidizes premiums for a private Part D insurer. The private insurer can and does negotiate drug prices.

The fact that Medicare can't negotiate prescript drug prices is often invoked as a talking point, but Medicare prescription drug spending accounts for a relatively small proportion of. overall Medicare spending: https://www.heritage.org/medicare/commentary/good-and-bad-id... ("Consumer choice and competition have made Part D the rarest of government programs: one in which spending hasn’t spiraled out of control. In fact, government actuaries report that federal general revenue spending on the program was $67.8 billion in 2018—that’s less than what it spent in 2015 ($68.4 billion).").

That's 1/10th of the military budget for drugs that can be often be manufactured for pennies (drugs with biological elements requiring glass column filtration and such are a different story but are far more rarely used).

A point in case is the Hep C vaccine: https://www.medicalnewstoday.com/articles/323767#drug-types-...

The manufacturing costs are irrelevant for new drugs. If the drug companies couldn’t sell them at a profit, they would never develop them in the first place.

There is an issue with some old out of patent drugs that costs a lot despite being very cheap to manufacture, but that typically has to do with FDA certification deciding who can be allowed to produce what, which is also expensive to obtain.

And the Moderna vaccine was designed in two days: https://www.businessinsider.com/moderna-designed-coronavirus.... Is that all there is to it?

There was 10+ years of research prior, but much of that research was academic. Phased studies must be conducted regardless of whether manufacture is public or private. There does not appear to be any need for private profit, we are sufficiently motivated to research this stuff out of a desire for self-preservation.

I'll admit that profit seeking would work better* in a society that doesn't have a strong state or other coordinating body, but given that one exists to counterpose our existing system is not reasonable.

EDIT: * In the sense that products might be produced at all. Without a strong regulatory body, the market would be flooded with snake oil medicine and the average consumer would not be able to make heads or tails of things. This is because it's much cheaper to make a fake medicine than a real one, which is what profit optimizes for: the cheapest solution with the highest payoff for the seller regardless of costs not borne by the seller (such as death and destruction writ large).

I believe that’s specific to drug prices. Services are interesting in that they just dictate it.

Blackmail. I believe that is the word. Then end of life care comes along and you better own your house, because that is going to be gone after all the bills come in for end of life care.

The sad thing is, as expensive as healthcare is they probably have to jack up those rates because they are getting screwed everywhere else. In the end, though, the consumer is always the one who ends up getting the ultimate screw... exactly why healthcare shouldn't be seen as a service to consume.

While so much of the cost is the care that the organizations provide and what they choose to charge there is some truth to what you are saying.

Had to get an MRI and the lab corporation that performed the MRIs said that it would be ~$850 if billed through insurance. This included the total cost minus what was covered by insurance so the initial cost of the procedure was in the ~$1200 range. BUT, then they said if we just paid them directly and they didn't have to bill through insurance it would only be $650. So our insurance didn't even cover the absolutely ridiculous amount of overhead that was added just to deal with our insurance provider.

You don't really need anyone else screwing over the hospital to have for-profit hospitals be incentivized to screw the patient by jacking up prices on demand inelastic goods. Not to even mention that many times the patient chooses these procedures while not thinking clearly, when under duress, etc.

These organizations charge exorbitant amounts of money for the care they provide. This is care which very few people are able to refuse. And if you do refuse care you are likely to die. What hospitals do would be considered extortion if a private citizen did it.

I have no sympathy for them whatsoever.

Sympathy has nothing to do with it.

> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand.

Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected side benefit is that a large percentage of their patients are un/underinsured. They can quote the prices for most common procedures from memory.

The other day I was getting a blood test and they asked if I wanted to bill my insurance or pay cash for it. I asked about the cost and they said "two-sixty". My response: "For two hundred sixty bucks we better bill the insurance. They laughed: no, $2.60 (it was an add on to another test for my physical). When I got home I googled pricing - the exact same test normally bills for around $65.

We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets. Thus the best way forward is to try what has been successful elsewhere.

The annoying thing is, most people would agree that the whole system sucks... until you start talking about politics and suddenly you'd think a bunch of people have a love affair with their insurance company and healthcare providers.

> until you start listening to politicians who have a vested interest in making the general public believe such things

FTFY

People "love their health insurance" when they have it forever through their employment, and feel safe in their position.

80% of people in the US, including 50% of Republicans, support M4A precisely because they are not part of the upper-crust minority who are afforded such luxuries.

I've never heard of a prominent Republican politician voice support for taxpayer funded healthcare. It would require a significant increase in federal income/FICA taxes. And in the enormous portion of federal spending that Medicare/Medicaid is, it doesn't even include outpatient services/medications for everyone over 65.

Of course, this would be mitigated by the elimination of health insurance premiums and other redundancies, but a federal taxpayer funded solution would result in a more transparent wealth transfer, whereas the employer sponsored tax deductible health insurance gimmick allows for better discrimination on who receives healthcare, and ideally reduces the amount of wealth transfer by reducing the healthcare many people receive.

> I've never heard of a prominent Republican politician voice support for taxpayer funded healthcare.

Just goes to show where our "representative" democracy has gone. The number I quoted is for voters registered Republican.

People will talk the talk, but they won’t walk the walk when it comes to paying.

My conversations are usually reminiscent of this:

https://www.youtube.com/watch?v=r2TxX0E4U1A

"People love their insurance!" Is a dead giveaway that a politician is a sock puppet. Biden kept saying it during the primaries.

I'm not a politician and I will say: I love my insurance. Because it's actually pretty great.

My insurance is good, but I wouldn't need it if we had a sensible alternative, and neither would you. And many other less fortunate people (including those in my immediate family) wouldn't need it either. Not wanting to give up your insurance because you "love" it (fucking gag me) is "fuck you I got mine" energy. Cancerous to a society.

I hate my insurance. I hear its great for America, but it's shit compared to back home

I see that alot in the stuff my insurance bills. $60 test they paid $3 for, another $180 test they paid $21 for or a $37 test that paid $2.80.

How can you shop around when prices are that distorted?

> Other countries seem to have solid solutions for "socializing" medicine

What baffles me the most is that most "socialized" systems functions much like a tax-paid insurance policy that covers everything and has no profit motive.

Even in a normal insurance situation you're "paying for someone else's treatment". That's the whole point of insurance.

Most of these systems works like an extra payroll tax: it is a tax on salary as percentage, as opposed to a car or house insurance that is linked to the value of the risks insured, not the income of the payer. This is why some people are opposing to that system, the tax vs insurance debate.

It is not just tax-paid insurance. Main point is that single-payer is essentially monopolist buyer and can use its market power to push prices down. Which is good to get cheap and good medical care, but may lead to systemic underfinancing of healthcare and associated problems.

I had a full blood screen....first number $2000, Negotiated price $1600, Out of Pocket $48.

It's all funny money til it lands in my lap, then suddenly it's real.

Lab costs are outsourced, and they charge separately from a doctor's bill. Biopsies are completely separate as well.

> We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets.

The government is perfectly capable of ensuring access to a market without regulating it to death. The SNAP program (Food Stamps) is a great example of how this works in a separate market with very little elasticity in demand.

I don't understand this.

Almost every other developed country has a system that works for healthcare. It's almost always single payer or something where you definitely don't go shopping around for hospitals.

Doesn't it start to feel a bit like indoctrination when arguing for a "free market" when no other developed country has a free market for healthcare?

Is everyone else stupid? What aren't they seeing? Especially in the age of the internet?

I just can't follow this logic.

I would love to get someone who argues from the "free market" point of view do some introspection and explain the logic in a way that doesn't feel like repeating the same 2-3-4 ideas which as far as I can see, are common talking points in the US.

So, repeating the question, what is every other developed country missing?

Why aren't they all doing this, if it's obviously superior?

I’m very much a free marketer for most things, as it seems to work well. It’s possible that it might work for health care too, but I don’t think we really know. For a lot of folks the free market is an article of faith, and I think that’s where a lot of support for this idea comes from.

Even if a free market could work in the US, I have no idea how we could get from here to there without making things worse along the way.

I look forward to the utter absense of any answers to this question, or the entertainingly inventive ones.

> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay.

What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)

I asked my new dentist why her recommendations were so different from her predecessor.

She said that there's not always one "correct" treatment. Some dentists will try to nip potential problems in the bud, lest they get worse. Others have more of a wait-and-see attitude which can avoid some procedures but make others worse.

Doctors, plumbers, builders, and mechanics all do the same thing. Do you replace the brake pads now, while the wheels are off anyway, or do you squeeze another season out of them since there's still a bit left? Rebuild the whole deck, or maybe just replace the more banged up boards and wobbly railing?

Difference being is all break pads eventually wear out and need to be replaced and all decks need regular maintenance. Not all teeth are going to eventually need work.

Plus the huge disparity in recommended treatments is an indication some are just throwing shit at the wall to see what sticks:

https://www.theatlantic.com/magazine/archive/2019/05/the-tro...

>Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000.

Doctors disagree about medical treatment too. At least with the dentist you'll know how much each opinion costs.

Seriously, I’ve had dentists differ in opinions by an order of magnitude. Turns out “necessary” is a pretty broad grey area.

I consistently tell my dentist to make treatment decisions as if this were her mouth/teeth. Of course, I'll never know if that gives her a license to "go profitable" over "go optimal", but I'm also extremely unlikely to go chase multiple opinions over a cracked tooth or filling.

True, but at least the dentist can tell me how much I will need to pay.

That's because most common dental procedures are relatively straightforward and the mechanical processes of the mouth are relatively well understood compared to most of the rest of the body. Plus most dental procedures are elective in the sense that you can usually just have an offending tooth pulled if it gets too bad, so for most people there's a price ceiling that is much lower than say a lifesaving heart procedure.

Why can't a hospital tell me how much an xray costs then? If I come in with a broken arm, why can't they tell me how much it will cost to get it xrayed yet the dentist can do the exact same thing with a broken tooth?

A dentist office is more comparable to an urgent care clinic than a hospital. And in many cases an urgent care clinic can tell you what simple procedures will cost. There are imaging services companies that can tell you upfront how much diagnostic tests are going to cost as well.

A broken tooth is a much less complex injury than a broken arm. In many cases you don't even need to be a dentist to diagnose it. Try walking into a dentist office with a more complex injury that could involve multiple different dental specialties and severe underlying complications. You aren't going to get an immediate upfront price.

I don't understand how this answers the question about X-ray cost.

1. Dental x-rays are more straightforward and involve fewer people, so the price is easier to calculate.

2. Dental x-rays are more often than not elective procedures. It's much easier to comparison shop elective procedures than emergency procedures. Therefore market forces frequently compel the dentist to come up with an up front cost for an x-ray.

The same market forces don't apply to hospitals because you can't wait a week or more while you shop around for treatment for a shattered hip.

Which one is better probably depends on if you value your money more, or your body.

Same as code refactoring, needing it is a very subjective matter even is similar circumstances.

On the other hand, try calling ahead to various dentists in order to find the one that has the cheapest price for the procedure you need to have done. Surprisingly difficult. Not as impossible as in other aspects of healthcare, but I spent hours and hours and mostly didn’t get the details I wanted

there seem to be alternatives for e.g. non emergency surgeries. this organization has prices listed which include follow ups, anesthesiologist, etc.

https://surgerycenterok.com/pricing/

they also seem to have a lower risk of infection compared to the national average:

https://surgerycenterok.com/faqs/

i'm not sure what could account for that. i was thinking that maybe because they are incentivized to provide the procedure at the baked in rate that there's a strong incentive to get patients out of surgery successfully as best as possible (to free up another bed, etc), but i'm not sure what their demand is like.

a more macabre hypothesis is that hospitals don't care much about patients who end up in their own ICU as it's just additional billable coverage, so the precautions aren't as strict.

> Try getting a price for a procedure or visit beforehand

"I tried to find out how much my son’s birth would cost. No one would tell me." [0]

[0] https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...

The answer is always “your out of pocket maximum” if it’s all done with in network providers, and infinity if any out of network providers are involved.

Which is a problem when out of network providers sneak in, such as commonly happens with surgical assistants. Have a covered and pre approved procedure from an in network surgeon at an in network hospital, and then oops because the surgeon added someone else to the room they never told you about now here's an out of network bill.

And often every price the dental office provides you is an estimate, as once they enter each procedure’s code the insurance may price that work above or below the estimated price. That’s dental, which often isn’t life or death. If you’re in an ER or ICU you’re not processing “by golly, can I afford saving myself or should I negotiate the hospital’s Tylenol?”

My dentist obscures things... I have msrp then estimated personal contribution. Only later do I get the final negotiated rates. Usually I get money back. Also with a dental PPO to go out of network you have to negotiate yourself! Insurance will only reimburse zip code rates.

How is that not a "free market"? Private, corrupt back room business deals dictate the prices that screw over patients. It's entirely determined by the private market. That sounds like a free market to me.