Comment by entee | Hacker News Reader

Comment by entee | Hacker News Reader

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Those who want the healthcare system to "work more like a market" would do well to understand this article. Healthcare is different, you don't get to price shop when you're passed out due to a car accident. Even when you do have the opportunity to price shop, how do you know the cheaper option is just as good? Is the surgeon down the street better or worse? Would you trust Yelp for that? Would you bet your life on it?

Health care is complicated, expensive, opaque and even when superficially transparent is affected by huge numbers of external factors.

Good article summarizing some of the issues:

http://www.slate.com/articles/business/the_bills/2017/01/why...

The JAMA study cited in the article:

http://jamanetwork.com/journals/jama/fullarticle/2518264

We have to think about these complexities because otherwise we'll keep hurting people. No solution will be perfect, but ideological ones will definitely be worse.

Demand for health care is inelastic which makes it mostly immune to market forces. With health care consumers really don't have a choice. Either they pay whatever price is set by providers or they die or become disabled by their condition. Whether the procedure costs $5 or $5000 is irrelevant. When it comes down to saving your life you will take on any expense.

More nefariously (and a point that many people often miss) recovering from a major illness is a full-time job. People who are very, very sick don't have the mental concentration or energy to even do a desk job. And if the job involves manual labor they're even more screwed. Strenuous physical activity during an illness can exacerbate the symptoms and kill the patient. Even having to stand for eight hours can greatly harm outcomes. So sick people have the worst of both worlds: accruing enormous expenses for incredibly pricey life-saving procedures and drugs, all while having their earnings drop to zero.

> Whether the procedure costs $5 or $5000 is irrelevant

To expand on this, it's impossible to compare prices between providers when the illness is known because the total cost is often not known until you receive a bill.

Also during an emergency situation you may be taken to an out-of-network hospital or be treated by an out-of-network doctor at a hospital, of which insurance may only cover 0%-50% of the bill. So you have no choice in provider, no choice in price, yet have 100% responsibility for paying.

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