Re:Show HN: Compare prices that US hospitals charge patients...
by ska on Monday January 18, 2021 @03:12PM
(#25826041)
> I don't get this at all.
I think this is why I suggested looking it as two markets. Your examples (estate lawyers, auto repair, dental care) look a bit like a visit to your GP's office. None of it looks much like some of the other things healthcare provides for us (e.g. many major and emergency procedures). And it's not like all of those markets are working particularly well currently (auto /house sales/ opticians/ etc. suck)
I don't think anyone would disagree that one-size-fits-all is the right approach, which is why nobody really tries that. What you are essentially saying is that you think is that you will get more flexibility if you open that market further, and that it will be both a better solution for more people, and not a horribly worse for any significant number of them (which is probably not acceptable here).
I'd agree with the first part, but the second requires faith - that in practice the signalling that you are talking about is clear enough (in both directions) and the response time short enough that you arrive at a better solution and in a reasonable amount of time. This is not at all clear. This isn't about treating doctors as "gods" either, they aren't able to make the systemic decisions well either, individually.
> What actually bothers me most about this whole thing is that nobody is willing to get serious about the tradeoffs their system entails.
This I agree with entirely. Two big ones come to mind - we need to have a conversation about appropriate end-of-life care and costs, and we have to be very transparent that our current level of medical capability means that there is an appreciable risk that (to a first approximation) anyone may end up with a medical condition that (a) we know how to cure or mitigate and (b) that person will never be able to afford. To me paying for these (or choosing not to) is quite different than making sure you can get antibiotics when you get strep throat.
You point out some symptoms of the problem currently, but I'm a bit curious about why you are resistant to pursue know solutions that look more like, say France (or Canada, etc.) , than Singapore. Is it just ideological? I'd rather take some known improvements and then iterate to improve rather than NIH syndrome.
I think this is why I suggested looking it as two markets. Your examples (estate lawyers, auto repair, dental care) look a bit like a visit to your GP's office. None of it looks much like some of the other things healthcare provides for us (e.g. many major and emergency procedures). And it's not like all of those markets are working particularly well currently (auto /house sales/ opticians/ etc. suck)
I don't think anyone would disagree that one-size-fits-all is the right approach, which is why nobody really tries that. What you are essentially saying is that you think is that you will get more flexibility if you open that market further, and that it will be both a better solution for more people, and not a horribly worse for any significant number of them (which is probably not acceptable here).
I'd agree with the first part, but the second requires faith - that in practice the signalling that you are talking about is clear enough (in both directions) and the response time short enough that you arrive at a better solution and in a reasonable amount of time. This is not at all clear. This isn't about treating doctors as "gods" either, they aren't able to make the systemic decisions well either, individually.
> What actually bothers me most about this whole thing is that nobody is willing to get serious about the tradeoffs their system entails.
This I agree with entirely. Two big ones come to mind - we need to have a conversation about appropriate end-of-life care and costs, and we have to be very transparent that our current level of medical capability means that there is an appreciable risk that (to a first approximation) anyone may end up with a medical condition that (a) we know how to cure or mitigate and (b) that person will never be able to afford. To me paying for these (or choosing not to) is quite different than making sure you can get antibiotics when you get strep throat.
You point out some symptoms of the problem currently, but I'm a bit curious about why you are resistant to pursue know solutions that look more like, say France (or Canada, etc.) , than Singapore. Is it just ideological? I'd rather take some known improvements and then iterate to improve rather than NIH syndrome.