Hacker News Reader

Comment by tomkarlo | Hacker News Reader

Have you ever actually tried to "shop around" for a serious, non-elective procedure like chemo or surgery? It's very difficult to get quotes, you can't easily compare providers (there's no obviously corpus of "ratings" from other prior customers) and you're often limited to the 1-3 providers who are close enough to your home. That's not exactly a recipe for an effective market.

Re your medicare proposal, are you suggesting that people who are diagnosed with cancer should get a cash check for the estimated value of the treatment? The incentive for fraud and graft in that kind of system would be incredible - lots of diagnoses are relatively subjective, and you'd be rewarding people for reporting every possible ailment they might be eligible for. If you're saying just give them their dollar average benefits, that pretty much defeats the whole purpose of having a risk pool.

View on HN

The industry isn't built to support market based solutions which is why providers couldn't give you a price even if you asked. That's what parent poster is trying to say. There just isn't pricing transparency so you can't get pricing. Where it's been shown to work is with smaller doctors offices for routine procedures like a flu shot. If you ask for a price and offer cash, they can work with customers on that.

>It's very difficult to get quotes

It's very difficult to get quotes because no one is actually paying for it themselves. This would be solved immediately by empowering individual consumers.

>you can't easily compare providers (there's no obviously corpus of "ratings" from other prior customers)

This is because your insurance provider has chosen for you. Once again, this would be resolved by putting peoples' money back into their own hands.

>If you're saying just give them their dollar average benefits, that pretty much defeats the whole purpose of having a risk pool.

In my head I included still providing disaster coverage, but failed to type it. So that should alleviate your fears regarding things like getting cancer.

Can you point to an example where any of these three things have happened in the real world?

"Still providing disaster coverage"... is pretty much all of what health insurance does for people over 65. The annual spend on preventative care is dwarfed by a single common incident (fall, flu, cancer) at that age.

There's an urgent care place near me that I sometimes go to. They cater to a lot of people without insurance. The prices for all of their services are posted on a big menu board like you'd see at a fast food restaurant.

Here's a citation that shows emergency care is only 2% of all healthcare. Of course, that's the entire healthcare market, not just elderly care. I'd be interested in any citations you could provide that shows that system-wide preventative care is dwarfed by the system-wide costs of major incidents for the elderly.

http://www.politifact.com/truth-o-meter/statements/2013/oct/...

You're confusing emergency care with non-elective care. Just because something isn't an ER visit doesn't mean you don't need to get treated for it immediately. E.g. the flu.

> I'd be interested in any citations you could provide that shows that system-wide preventative care is dwarfed by the system-wide costs of major incidents for the elderly.

95% of healthcare spend is reactive, 5% is preventative[0] Medical spending in the last three years before death accounts for 13.4 percent of aggregate US medical spending.[1] And this ignores major treatments for people over 65 that occur more than 3 years before they die (and on average, people live 20+ years after they turn 65.)

[0] http://www.newsweek.com/health-prevention-worth-money-86075

[1] https://meps.ahrq.gov/data_files/publications/st429/stat429....

Well, when you're setting the standard of being unable to negotiate or shop around for prices, you're definitely not talking about stuff like flu treatment. Sure, that might not be "elective" care, but it's not the type of care that stops you from making a couple phone calls to different providers. But more likely you know which provider is the "wal-mart" provider vs which is the "Macy's" provider.

Let's consider the flu. Before you choose your provider you don't even know you have the flu in many cases. You might have a cold, or something much more serious. How is a consumer supposed to make an educated choice about what provider they should take when they don't even know their diagnosis? Simply saying "I'll take the cheaper one" is not an educated buying decision - it just incentivizes providers to provide the lowest quote up front, and maybe the worst service.

You would do the same thing you do today. There's a few options, you could go to your primary care physician who would have a known price for an office visit. You could go to an urgent care type facility. You could go to something like a CVS Minute Clinic which has flat rates for "minor illness" visits. All of whom may discover you have something more serious and refer you elsewhere.

You are acting as if paying out of pocket at a price not determined by an authoritarian central planner would suddenly mean nothing in healthcare would be regulated in any way and people would be getting healthcare from crackhead joe in the back alley.

Not everyone will pick the cheapest option all the time. Today there are free clinics in many places. Most people don't go to those. Some people will choose Wal-mart. Some people will choose Macy's. And there will be a myriad of options in between.

Reply on news.ycombinator.com