[HarryHirsch]

This happens only now? In more civilized countries like Germany, prices for procedures have been set since time immorial. There is a provision for surcharges from the physician, but these aren't common, and the physician will have to have a good cause or the insurer will not pay it.

Same thing for new medications: they are not permitted in the clinic unless there is a genuine advantage for the patient.

All this is of course due to political circumstances: medicine is just too profitable.

[toomuchtodo]

All this is of course due to political circumstances: medicine is just too profitable.

No. Medicine in inelastic. There is no such thing as a rational demand side, as you don't get to choose if you need healthcare or not. When demand is inelastic, and supply is limited, prices will rise accordingly with no relief in sight.

The solution? Either set market prices (at the cost of stifling supply) or flood the market with supply (using technology to both drive down costs and replace what people do).

[msandford]

> No. Medicine in inelastic.

Fantastically incorrect! A good portion of medicine is elastic. If you have the sniffles you don't NEED to see a doctor but many people choose to because they can. If you tear your ACL you don't NEED surgery to continue to stay alive but you sure do WANT it.

Furthermore let's just suppose that the demand is fixed and won't change. Demonstrably false but let's just try. Okay. Publishing of prices can still shift that demand from one particular vendor to another depending on price. Just the same as the demand for TP is largely fixed but purchases can be shifted from Target to Wal-mart to Costco depending on price.

Very, very few illnesses are so outrageously life threatening that they have to be performed RIGHT NOW at WHATEVER hospital you're at. That's mostly limited to trauma type stuff from accidents of various kinds.

For everything else like seeing the doctor for the flu, broken bones, joint problems, diabetes, heart disease, etc etc etc you could certainly spend 15 minutes on the internet. And for many of those things you could afford to spend a whole weekend or three if you wanted. For example once you've got an insulin prescription for the next X days/weeks/months you've got tons of time to shop for a doctor that you would like, or who offers a better price, etc rather than the first doctor you can manage to get yourself to.

[Scaevolus]

Aggregate essentials (food, shelter) are generally inelastic. You don't choose if you need food or not. Being able to select what food you buy (based on price, etc) forces the prices to be competitive.

Not being able to select healthcare based on price means nothing checks rising prices. Regulations have made healthcare into a cartel where members won't compete to be affordable.

[abstractbill]

Aggregate essentials (food, shelter) are generally inelastic. You don't choose if you need food or not.

Right. And there were a lot of famines in the past. It's only by "flood[ing] the market with supply (using technology to both drive down costs and replace what people do)" that we've managed (in the West, at least) to ensure that most people no longer have to worry about food.

[jessaustin]

This is not a complete explanation. The most important factor is that Americans just have more resources than most humans in history. Transfer any but the absolute poorest Americans to anywhere on earth, at anytime in history, with their current income, and they'll be just as well-fed as they are here and now, even if the local farmers are driving oxen.

Another way of stating this, is that edible commodities are just as fungible as all other commodities. If Egyptians could afford to purchase enough wheat to feed themselves, they would.

[ry0ohki]

>There is no such thing as a rational demand side, as you don't get to choose if you need healthcare or not

That's not true in many cases. I bump my head or get a sore throat, I can choose to seek medical treatment or not. There are also lots of things like "yearly checkups", etc...

[saalweachter]

Is that anything more than noise?

Assuming you have a reasonable doctor and let yourself be guided by his recommendations, your bump-on-the-head visits are going to be an hour of you waiting in the waiting room, and five minutes of a nurse taking your blood pressure and the doctor asking you a couple of questions. Billing their time at $240 / hour, you've used up $20 of medical resources, plus a few bucks for the gloves and popsicle sticks they use during the exam.

If every man, woman, and child in the US went into the doctor every month for a bump or a cough, the total cost would be significant in absolute terms -- $72 billion -- but insignificant in the grand scheme of things; $72 billion is less than 3% of current US healthcare spending.

[toomuchtodo]

Fine. Sure, you bump your head or get a sore throat, you walk it off.

What happens when you try to "walk off" something you think is minor, and you're in the ER 24-72 hours later? Hello $20K-$50K bill.

My wife and I were in a car accident a year ago (someone turned in front of us while we were doing 40mph). My wife required an ambulance for transportation due to damage to her right foot. The ambulance didn't exactly let us compare prices and pick which hospital to go to.

[ahallock]

That's what insurance is for. Catastrophic situations. Or perhaps there's a way to pre-purchase emergency care at a discount. Or you set your emergency provider ahead of time based on price. I don't know. There must be creative ways to solve this problem rather than being all fatalist about it.

[ceol]

Most of those "creative solutions" are made by people who, to be frank, really have no idea what they're talking about.

If I get into a car accident, or if my intestine ruptures, do you think I want the person on the other end of 911 to have to deal with which ambulance provider I picked out or which ER I have on my list of approved locations? No. I want the closest ambulance to take me to the closest ER, and I want the first doctor available to take a look at me. Then, if need be, I want the first ER room open.

[toomuchtodo]

Counterpoint: At the time, we had insurance. Great insurance through Blue Cross Blue Shield. Also, had State Farm for auto. Our medical policy on our auto policy was exhausted solely from the hospital visit and ambulance ride, and the other at-fault party's coverage (also State Farm) barely covered the first few doctor visits for my wife.

I've now had to pay several thousand dollars out of pocket for my wife's physical therapy, MRIs, and prosthetics, and have been told I will need to sue State Farm to recoup my out of pocket expenses.

[ahallock]

I'm deeply sorry for what you had to endure, and I didn't mean to trivialize your situation.

[HarryHirsch]

How do you explain the fact that healthcare expenditures in the US are twice as high as in the rest of the Western world, and life expectancy is comparable?

[wisty]

Because while demand for healthcare is inelastic, more healthcare can actually be a bad thing. For example, old people (who are big customers) are often best if they are told to just go home, and look after themselves. Cutting up old people can be a waste of time (since they are unlikely to live a lot longer), and can actually reduce their life expectancy (since they don't always survive surgery).

Also, the money the US spends on healthcare could be better spent educating the people who will otherwise drop out of high school, which drastically reduces their life expectancy (since they can't read so good, have trouble getting jobs which don't involve selling meth, and otherwise have terrible lives).

[antitrust]

Someone's gotta sell the meth, work at McDonald's, mow the lawns (well, not mine... I mow it myself), make the firecrackers, clean the toilets, etc.

It's all about how we allocate this labor, I guess. Paying everyone the same salary leads to underperformance, so we encourage competition. I'm sure there's a better way, but it probably won't be a total reversal, only a modification, of what we have.

[chii]

> Someone's gotta sell the meth, work at McDonald's, mow the lawns (well, not mine... I mow it myself), make the firecrackers, clean the toilets, etc.

and someone does indeed do those things, but imagine if there isn't anyone to do it because everyone is so well educated that it's "beyond" them. Those jobs will "get done" initially at a higher price, but then because there's profit to be made, a smart individual will inevitably invent a machimne to the job, and thus, the total output of society increases (sure there's a turbulent period of transition, but that's acceptable in the grand scheme of things).

[toast0]

McDonald's is increasing automation. Seriously, go in and order a smoothie; once the order is finalized, the smoothie machine will dispense the ingredients, run the mixer, and put the result into a cup (that it also dispensed). Some of the locations have automated soda fountains for the drive through as well. I have heard stories about call centers for drive through ordering too (although I haven't seen that in practice)

[wisty]

I heard the employment rate for young black high-school dropouts is something like 5%. I doubt the employment rate for white high-school dropouts is fantastic, either. So it seems we don't need that many people to flip burgers, mow lawns, make firecrackers, clean toilets, etc. Or that a high-school dropout isn't even qualified to do those jobs.

And we don't need more crime.

[refurb]

Life expectancy is a terrible proxy for quality of healthcare delivered.

For example, if you eliminate traffic accidents (of which the US has many due to it's low density), US life expectancy is near the top globally.

[Scaevolus]

Either centrally controlled prices or a free market could work.

Government regulations about not advertising prices blind consumers to the costs of procedures, so hospitals have little reason to lower prices.

It's another case where a small dose of regulation is worse than strict regulation or no regulation.

[Vivtek]

Sure. "Give me all your money or you die" is a guaranteed profit.

[fnordfnordfnord]

"Give me all your money AND you die" is also a popular scheme.

I'm glad to see another chip in the the foundation of these business models.

[hysterix]

Really? You are really going to imply America is uncivilized when you compare it to a country that literally attempted to take over the world and exterminate an entire race of people? Within recent generational memory no less?

Europeans come in two flavors, smug, and really really smug. When will you all get off your high horses?

I think I should say it again because it bears repeating. The country that you just compared america to, implying we are not civilized and germany is, literally attempted to take over the world and exterminate an entire race of people. Civilized? Really?

At least our country was on the right side.

[beefman]

Are you really confusing setting prices with publishing them?

[tylee78]

the German welfare system (healthcare included) is taxing the living hell out of the working families. It's insane. I'm pretty sure that like anything else, there is a ton of beaurocracy in Germany that loves to "list" prices. Unfortunately, in the beaurocracy side of it, the US is in a worse state. Hopefully this is the beginning of free market competition in the healthcare sector.

[stephengillie]

If a person in Germany without insurance goes to a hospital emergency room for treatment, who pays for it?

[djcapelis]

The uninsured rate in Germany is so low (.2%) that it seems like most of the time that's not even a big deal. But it's generally billed to the patient from what I understand.

See:

* https://en.wikipedia.org/wiki/Healthcare_in_Germany

* http://www.npr.org/templates/story/story.php?storyId=9196396...

[Daishiman]

Health care in Germany is socialized. Some small items are left to the patient but for the most part nothing is paid out of pocket.

[cmarschner]

Not quite true, it is in some ways similar to the US, with public and private insurance. However the majority is part of the public insurance, and in general health insurance is mandatory. There are some awkward ways by which you can fall out of private insurance and can't get back into public insurance, but these cases are rare. In case of not having an insurance you'd be billed like any privately insured patient.