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Comment by beat | Hacker News Reader

It's not like people plan on a torn ACL.

And for most major health care issues, the primary concern of the patient isn't price, but rather outcomes - quality of care. Do we choose the cheapest doctor, or the doctor with the best reputation?

My wife, who is a dancer, tore her ACL last year. Not getting it fixed, and fixed right, was the difference between being able to continue dancing, and having to give up the thing she loves the most. So when decisions like "Use transplant tissue, or cadaver tissue?" came up, there was zero thought given to "Which one costs the most?" It was all "Which one is most likely to get her back on her feet and allow her to continue dancing?"

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> Do we choose the cheapest doctor, or the doctor with the best reputation?

Most people in the US have never had a way of knowing who the 'cheapest' doctor is until after the bill comes.

My reasoning still applies, though. My spouse wasn't going to base her decision on who should fix her torn ACL based on cost, no matter what the price difference. If you have life-threatening cancer, do you go to the cheapest oncologist, or the one you think is mostly likely to save your life?

The real financial decision isn't on price comparison, but rather whether or not to get the treatment at all. I made a cost-based decision on treatment a while back. I was being treated for an eye problem where I was at risk of permanent blindness in my right eye. Treatment involved monthly injections of a quite inexpensive drug (about $27 iirc), that was inexpensive because it was developed for other, more common conditions and had been around for a long time. My doctor wanted to try a new, specialized drug, hoping for better results. It cost $8000 a dose. With 90% coverage, I would have been paying $800/mo out of pocket. I decided to stick with the cheap drug that seemed to be working.

But that's the sort of cost difference that matters, not the "This doctor is 5% cheaper!" dream of idealized free markets.

You clearly evaluate doctors and treatments based on multiple variables, depending on the situation.

Many people, perhaps not you, but many, would like price to be able to be one of those variables, as it is with nearly everything else in our society.

yes. "reputation" and "outcomes" are part of many other decision-making efforts we engage in.

I would like to point out that you have a very privileged position in life to be able to say that cost is no object to the quality of care you receive. Not every has that luxury. Also, there are some people in some situations that would be willing to sacrifice quality of care on price.

Don't belittle the point by calling it "privilege". I'm in the same situation as most Americans with employer-provided health insurance. The real cost decision, as I pointed out in another comment, is whether or not to get care at all, rather than to choose between Doctor A, or Doctor B who costs 5% less.

This is exacerbated by the fact that our insurance hides most of the cost variation from us anyway, and health care networks turn potentially cheaper care into probably much more expensive care. Writing this all off as "privilege" is a gross, lazy oversimplification.

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