[kiba]

I prefer insurance only for emergency, and everything else to be shopped. When you're bleeding to death, you don't care about if emergency care cost a lot of money, just that you get to the closest hospital possible.

We need shopping anyway, as people with insurance are quite insensitive to the cost of care. There's no need for hospitals to break someone's leg if competition can lower the price of service to a reasonable level.

[wpietri]

I have never met a person who suggests comparison shopping for health care who has actually been seriously ill.

If you have had a major illness requiring serious care (e.g., heart disease, cancer, organ failure, stroke), please talk about exactly how you would have comparison shopped for the best bargain in hospitals.

[wpietri]

And just in case my implication isn't clear, I think the notion of comparison shopping for treatment is insane. My mother was seriously ill last year, and the last thing we had time to do was get a serious of estimates and do a cost-benefit analysis on treating her brain tumor. Just understanding the treatment options was plenty. And, of course, picking the right doctors, because this actually was brain surgery. Oh, and we had to deal with the a loved one having a brain tumor. Little thing, that.

[kiba]

I believe surgery can be made cheaper through scaling surgery operation. This will in turn increase the reliability of surgeons as they become more experienced in surgery.

In some case, cheaper actually means better surgeon. Obviously, this won't work as well for surgery procedure that are more exotic.

This is already true in heart surgery:

http://online.wsj.com/article/SB125875892887958111.html

[wpietri]

Interesting, but irrelevant. There are all sorts of good approaches to cost containment in medicine. The blog "The Incidental Economist" covers them regularly. None of them rely on seriously ill people pulling out the Sunday supplement and seeing who has the best deal this week on heart bypass surgery.

[kiba]

I have never met a person who suggests comparison shopping for health care who has actually been seriously ill.

I had required emergency care 3 times before the age of 21.

If you have had a major illness requiring serious care (e.g., heart disease, cancer, organ failure, stroke), please talk about exactly how you would have comparison shopped for the best bargain in hospitals.

If somebody isn't immediately dying and mentally unable, the relatives or caretaker can take care of comparison shopping or they can just buy the service from the nearest hospital.

Whatever they choose, will determine the price of the service that they pay for. If everyone is provided insurance, we will all pay an arm and a leg and the hospital get to make extravagant profit due to price insensitivity.

The healthcare system anywhere in the world can't save everybody or care for everybody. There will be some rationing of some kind. It could be long waiting line, denial of care for certain individuals, or based on ability to pay. This is the reality of all systems in the world. The only alternative is to be ruthless in improving efficiency, reliability and cost of a healthcare system so that those dilemma can't happen.

[wpietri]

Apparently reading comprehension is not one of your skills.

Have you had a major illness requiring serious care? Apparently not. But you still answered the question. You know why that's relevant? Because you quite literally have no idea what you're talking about. Because you didn't and can't talk about how you would have fit comparison shopping in the busy schedule that goes with not dying.

The notion that somebody is going to say, "Hey, I'm going to see if I can get a discount on dealing with my impending kidney failure" is so far from the reality of what's reasonable in a hospital setting that I don't know where to begin. Other than saying that I should have learned by now not to try to have rational conversations with fundamentalists, be they biblical, Freudian, Marxist, or free-market fundamentalists.

[mkramlich]

Don't let it get you upset. I'm on your side on this. I've found that on HN there's a large number of 20-something geeks who are book-smart but life-dumb, as well as a large percentage folks who are frankly very close to being sociopaths, if not outright sociopaths. So yeah, a lot of HN readers are going to be utter pinheads when it comes to debating about healthcare. The reality of people's health experiences is very messy, very random, extremely stressful and utterly terrifying and unfair at times. It's not about simply shopping for the lowest price on some commodity at a local store. It's about a loved one who is vomiting blood and you don't know why and it's 2am. It's about being told you need medical insurance then getting denied because you have a pre-existing health imperfection on some long list of terms -- no shit, sherlock, right? It's about the primary breadwinner of a family being diagnosed with cancer at age 30. It's about an expecting couple being told that based on tests of their fetus that the baby is very likely to have Down's syndrome.

So fuck shopping around. Fuck the market. Fuck economics. Fuck capitalism. Fuck the Republican and really the Libertarian outlook. Fuck everyone who thinks it's every man for himself, I got mine, everyone else can go fuck themselves. Until they wake up one day to find they've got some horrible problem and need help too.

You know when it makes sense for everyone to compete and not give a rat's ass about anyone else? Say you're running a 100-yard dash. Or playing a video game contest. Those are true competitions, may the best man wins. But when you're sick, your family, a neighbor, a fellow citizen, that is precisely the time when it is NOT okay and NOT humane or civilized to think like that.

[kiba]

Don't let it get you upset. I'm on your side on this. I've found that on HN there's a large number of 20-something geeks who are book-smart but life-dumb, as well as a large percentage folks who are frankly very close to being sociopaths, if not outright sociopaths. So yeah, a lot of HN readers are going to be utter pinheads when it comes to debating about healthcare. The reality of people's health experiences is very messy, very random, extremely stressful and utterly terrifying and unfair at times. It's not about simply shopping for the lowest price on some commodity at a local store. It's about a loved one who is vomiting blood and you don't know why and it's 2am. It's about being told you need medical insurance then getting denied because you have a pre-existing health imperfection on some long list of terms -- no shit, sherlock, right? It's about the primary breadwinner of a family being diagnosed with cancer at age 30. It's about an expecting couple being told that based on tests of their fetus that the baby is very likely to have Down's syndrome.

Guess what? Not too long ago, I had a random, extremely stressful, and utterly terrifying healthcare situation and it involves me, bleeding lot of blood and not knowing why. It just so that I have a different perspective.

So fuck shopping around. Fuck the market. Fuck economics. Fuck capitalism. Fuck the Republican and really the Libertarian outlook. Fuck everyone who thinks it's every man for himself, I got mine, everyone else can go fuck themselves. Until they wake up one day to find they've got some horrible problem and need help too.

You know when it makes sense for everyone to compete and not give a rat's ass about anyone else? Say you're running a 100-yard dash. Or playing a video game contest. Those are true competitions, may the best man wins. But when you're sick, your family, a neighbor, a fellow citizen, that is precisely the time when it is NOT okay and NOT humane or civilized to think like that.

I don't give a rat ass about capitalism, socialism, or any political ideology, just that the healthcare system works esave as many lives as possible and preferably without charging an arm and a leg for said medical care.

So either show why I am wrong or don't comment at all.

[wpietri]

In the words of Pauli, you aren't even wrong. If you work hard, you could get to the point of being wrong. But first you'd have to understand enough about health care economics to know what the actual problems are, and enough about health care consumption and delivery to frame a reasonable proposal.

Nobody's going to take the time to educate you on all that just to drag you up to the level so that you can understand why your proposal, once you got around to making it, would be wrong. That's your job.

[kiba]

Have you had a major illness requiring serious care? Apparently not. But you still answered the question. You know why that's relevant? Because you quite literally have no idea what you're talking about. Because you didn't and can't talk about how you would have fit comparison shopping in the busy schedule that goes with not dying.

Emergency care is serious care. I was rushed to the hospital. Is that's not "serious care"?

The notion that somebody is going to say, "Hey, I'm going to see if I can get a discount on dealing with my impending kidney failure" is so far from the reality of what's reasonable in a hospital setting that I don't know where to begin. Other than saying that I should have learned by now not to try to have rational conversations with fundamentalists, be they biblical, Freudian, Marxist, or free-market fundamentalists

Never mind. I guess you're right. In some circumstance, when you're healthy, you could comparison shop. When you're very ill, you can't comparison shop as well, due to mental state of mind. Still, I think my economic reasoning is not entirely without merit.

<strike>You obviously felt that your anecdote have more weight than my economic reasoning. Just because you don't comparison shop in your situation doesn't mean other people won't. Ever heard of medical tourism?</strike>

[krevis]

In some circumstance, when you're healthy, you could comparison shop.

Except: you can't. Try to find out how much a major medical procedure will cost you -- if you can find anyone who gives you any numbers at all, you'll be lucky if that's what you actually get charged. (And then try to find out how much your insurance, if you have any, will pay for! And then try to complain when the final bill is different!)

http://en.wikipedia.org/wiki/Health_care_prices